Phlebolymphology N°69 – Editorial
This issue of Phlebolymphology presents an interesting mixture of topics demonstrating the broad variety inherent to our discipline. Clinical physiology is a fascinating field in which Scandinavian medical schools have traditionally played an outstanding role.
Einar Stranden from Oslo, one of the leading specialists in the pathophysiology of the peripheral circulation, gives a clear and clinically orientated review of the transcapillary fluid balance in venous edema and the complex mechanism of the venous pump, supplemented by highly educational illustrations and drawings. Reading the methodological details of measuring transcapillary pressure gradients governing Starling’s equilibrium, one can understand that there is still uncertainty and dispute regarding how much fluid will be reabsorbed by the venules and how much by the initial lymphatics, especially in the dynamic situation of the lower leg.
A very moving report by André Cornu-Thénard, Paris, on the spectacular improvements achieved using compression therapy in African patients with severe lymphedema caused by filariasis. It is amazing what he and his colleagues accomplished in a short time during their charity mission. The impressive pictures clearly show that even self-treatment using sub-optimally applied bandages can produce dramatic improvements and save patients from leg amputations.
A review article on recent guidelines in the management of chronic venous disease and the place of venoactive drugs raises some key questions that need to be answered in order to improve protocols for good clinical trials and to draw up future guidelines on these agents. Regrettably, the terms “chronic venous disease” and “chronic venous disorder” are mixed up. Correct definitions can be found in the Veinterm article, reported by Michel Perrin in Phlebolymphology 2009;16:299-305.
Cristobal Papendieck, Buenos Aires, a world authority in pediatric surgery specialized in vascular malformations, gives us an excellent overview of the difficult problem of lymphatic dysplasia in children, which is illustrated by several very instructive pictures.
In his article on the treatment of vulvar and perineal varicose veins, Jean-Francois van Cleef, Paris, reports on favorable results with sclerotherapy using low concentrations of liquid sclerosant, even in patients with pelvic congestion syndrome. The recommended “class 2” compression stockings refer to the French classification system corresponding to a pressure between 15 and 20 mm Hg, which is lower than in other countries.
Two reports by Michel Perrin, Lyon, conclude this issue of Phlebolymphology, one on the book on CHIVA by Franceschi and Zamboni and one on the last Meeting of the European Venous Forum held in Antwerp, Belgium, on June 2010.
Enjoy your reading!