In contrast to earlier reports, this prospective study up to 12 years after deep vein thrombosis demonstrates a low incidence of postthrombotic syndrome by administration of oral anticoagulants and regular compression therapy. However, the adverse clinical event rate (mortality 14%) and a recurrence rate of 24% show that the prognosis after deep vein thrombosis does not appear favorable even in low-risk patients.

The transparent oxygen electrode, recently developed by Huch and his co-workers, permits monitoring of transcutaneous oxygen tension (tcPo2) at defined sites on the capillaroscopic image obtained by videomicroscopy. This combined system has been applied to study the nutritional skin capillaries of patients with chronic venous incompetence (CVI). 806 simultaneous measurement of the oxygen tension of the skin (tcPo2) and examination of the nutritional skin capillaries at the monitoring site by videomicroscopy. This combined system was applied in the study of 17 patients with CVI and the results were compared with those obtained in a group of 24 healthy subjects. Materials and methodsPatients. The CVI group consisted of 17 patients (six women, 1 1 men) with a mean age of 56 years (range 22 to 76). Fortyfour measurements were obtained in this group. The method of selection of sites of measurement is described below.In 12 patients CVI was caused by deep venous thrombosis (obstruction and/or incompetence of deep veins, incompetent perforating veins) and in five CVI resulted from primary varicose veins with incompetent perforating veins.Nine patients had trophic skin changes without ulcers and eight had trophic skin changes with ulcers or healed ulcers. The diagnosis was based on patient history, clinical findings, and results of Doppler ultrasound examination. Venograms were obtained in seven patients.No patient had clinical evidence of peripheral arterial occlusive disease. Palpation of pulses, auscultation, and photoplethysmography at the big toe were normal in all cases.Control subjects.

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SUMMARY Microneedles, 0.2 mm o.d., were connected to a microsyringe and mounted on a micromanipulator. Under microscopic control, 0.01 ml of a 25% solution of FITC-labeled dextran-40 or dextran-150 were injected into the subepidermis at the big toe near the nailfold or in the medial ankle region. Fluorescence intravital microscopy revealed a network of lymphatic microvessels. The comparison with recent anatomic studies reveals that the reticular network visualized by FITC-dextran corresponds to the network in the stratum papillare. In 20 healthy subjects lymphatic capillaries were detected in a restricted area on the lateral aspect of the big toe. In 10 patients with primary lymphedema, the dye expanded to almost the entire dorsal skin surface of the big toe. In two cases, enlarged and tortuous microvessels of pathologic shape were observed.Fluorescence microlymphography is a simple and nearly atraumatic approach for depicting the intravital anatomy of human skin lymphatic capillaries.

The authors assessed the use of magnetic resonance imaging in differentiating lymphedema, phlebedema, and lipedema of the lower limb. They examined 14 patients: five with lipedema, five with lymphedema, and four with phlebedema. T1- and T2-weighted transaxial sequences were performed before administration of gadolinium tetraazacyclododecane-tetraacetic acid (DOTA) and T1-weighted spin-echo sequences were performed after administration of Gd-DOTA in each patient. Images of patients with lipedema showed homogeneously enlarged subcutaneous layers, with no increase in signal intensity at T2-weighted imaging or after Gd-DOTA administration. Patients with phlebedema had areas containing increased amounts of fluid within muscle and subcutaneous fat. In lymphedema, a honeycomb pattern above the fascia between muscle and subcutis was observed, with a marked increase in signal intensity at T2-weighted imaging. After Gd-DOTA administration, there was only a slight increase in signal intensity in the subcutis in lymphedema and phlebedema and a moderate increase in signal intensity in muscle in phlebedema.