Between 1964 and 1994, at least 52 patients with cutaneous adverse effects of vitamin K have been described in the European and North American literature. A review of the details of these patients is given and 2 new cases reported. Adverse effects are seen not only in patients with liver-function disturbances but also in patients without liver diseases, and occur mostly after intramuscular or subcutaneous administration of vitamin K1, independent of the total dose. Patch and intracutaneous tests often give positive reactions. The mechanism of action is probably in many patients a delayed-type hypersensitivity reaction.

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Objective: To investigate the reproducibility of an adapted optical leg volume meter and to determine intraindividual volume changes of the lower legs on separate days and in the course of a working day in healthy volunteers. Design: Adaptation of a standard optical leg volume meter, ‘volometer’, and calibration on an artificial leg and on volunteers. Study of the behaviour of lower leg volume in volunteers. Setting: Free University Hospital, Amsterdam. Participants: Thirty-six healthy volunteers, workers in the hospital. Intervention: The lower leg volume was measured on five or six different days at the beginning and end of a full working day. Main outcome measures: Reproducibility of the adapted volometer, and volume changes of the lower legs at different times. Results: Adaptation of the volometer resulted in a reproducibility of 0.07% in an artificial leg and of 0.46% in volunteers. A significant increase ( p<0.0001) in the volume of the lower legs in the course of the day was observed. Conclusion: Adaptation of the optical leg volume meter resulted in reproducible recordings of the volume of lower legs. In the course of the day an increase in volume occurs.

Objective: To study the value of light reflection rheography (LRR) as a diagnostic tool in subjects with varicose veins and venous insufficiency. Design: A prospective study comparing patients and workers with an occupation necessitating standing. Setting: Departments of Dermatology and Vascular Surgery, University Hospital VU, Amsterdam, The Netherlands and several manufacturing plants throughout the country. Subjects: Group I: 123 patients (168 legs) with a history of primary varicose veins attending the outpatient clinic; Group II: 374 male workers (748 legs) with an occupation necessitating standing. Methods: A questionnaire on venous disorders was administered, followed by clinical investigation, continuous-wave (c/w) Doppler ultrasound and LRR examination. LRR measurements were performed above the medial malleolus. A refilling time of at least 25 s after 10 dorsiflexions at the ankle was considered normal. In the case of shorter refilling times the procedure was repeated with a tourniquet above the probe. Normalization of the refilling time indicates an incompetent superficial venous system and a normal deep system. If there was no change we concluded deep venous insufficiency was present. Furthermore, in group I, duplex investigation of the venous system was performed. Main outcome measures: The diagnostic conclusions of the LRR measurements were compared with the diagnosis based on duplex investigation (group I) and clinical examination combined with c/w Doppler investigation (group II). Results: Group I: duplex investigation showed 156 cases of superficial venous insufficiency; LRR, 33. Sensitivity of LRR: 20%. Group II: Clinical and c/w Doppler examination showed 189 cases of superficial venous reflux; LRR, 29. Sensitivity of LRR: 7%. Conclusion: LRR has no apparent additive value in diagnosing superficial varicose veins in patients with a history of primary varicosities nor in screening a population for the presence of venous insufficiency.