In addition to the well reported beneficial effects of horse chestnut (Aesculus hippocastanum) extracts on venous insufficiency and associated conditions, such preparations also have many potential positive pharmacological effects on the skin. Extracts from this species, and in particular, those based on horse chestnut seeds, contain saponins, known collectively as 'aescin', which have a gentle soapy feel, and are potent anti-inflammatory compounds. Saponins, such as escin, also reduce capillary fragility, and therefore help to prevent leakage of fluids into surrounding tissues, which can cause swelling. An extract of horse chestnut has recently been shown to have one of the highest 'active-oxygen' scavenging abilities of 65 different plant extracts tested. Such extracts are more powerful anti-oxidants than vitamin E, and also exhibit potent cell-protective effects, which are linked to the well-known anti-ageing properties of anti-oxidants. The extract is also rich in a number of flavonoids, such as derivatives of quercetin and kaempferol. Flavonoids also have protective effects on blood vessels, and are well-known, powerful anti-oxidants.

Type II endoleaks are the most common endovascular complications of endovascular abdominal aortic aneurysm repair (EVAR); however, there has been a divided opinion regarding their significance in EVAR. Some advocate a conservative approach unless there is clear evidence of sac expansion, while others maintain early intervention is best to prevent adverse late outcomes such as rupture. There is a lack of level-one evidence in this challenging group of patients, and due to a low event rate of complications, large numbers of patients would be required in well-designed trials to fully understand the natural history of type II endoleak. This review will discuss the imaging, management, and outcome of patients with isolated type II endoleaks following infra-renal EVAR.

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The bioactivity of feverfew (Tanacetum parthenium) leaf extracts has been analysed, by use of a human polymorphonuclear leukocyte (PMNL) bioassay, to assess the relative contributions of solvent extraction and parthenolide content to the biological potency of the extract. Extracts prepared in acetone-ethanol (system 1) contained significantly more parthenolide (mean +/- s.d. 1.3 +/- 0.2% dry leaf weight) than extracts in chloroform-PBS (phosphate-buffered saline; system 2; 0.1 +/- 0.04% dry leaf weight) or PBS alone (system 3; 0.5 +/- 0.1% dry leaf weight). Extract bioactivity, measured as inhibition of phorbol 12-myristate 13-acetate-induced, 5-amino-2,3-dihydro-1,4-phthalazinedione (luminol)-enhanced PMNL, chemiluminescence, followed a similar trend. Extracts inhibited phorbol 12-myristate 13-acetate-induced oxidative burst by amounts which, if solely attributable to parthenolide, indicated parthenolide concentrations for the respective solvent systems of 2.2 +/- 0.6%, 0.2 +/- 0.1% and 0.9 +/- 0.1% dry leaf weight. The mean ratio of parthenolide concentration to the parthenolide equivalent/PMNL-bioactivity value, for acetone-ethanol and PBS extracts were both 1:1.7. Parthenolide, although a key determinant of biological activity for T. parthenium leaf extracts based on the PMNL-bioassay, seems not to be the sole pharmacologically-active constituent. The identical and elevated bioactivity-parthenolide ratios for both organic and aqueons-phase leaf extracts suggest that a proportion of the other bioactive compounds have solubilities similar to that of parthenolide.

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