Objectives Short saphenous vein (SSV) surgery carries a high risk of failure to identify the saphenopopliteal junction (SPJ). We assessed the impact of surgical expertise on anatomical outcome from SSV surgery and the role of preoperative duplex SPJ marking in improving outcome for vascular and non-vascular specialists. Methods A retrospective analysis identified patients (30 limbs) who had undergone SSV surgery. These were recalled for duplex scanning of the SPJ. In a prospective study, 187 limbs had preoperative duplex marking of SPJ and postoperative duplex to assess outcome. Grade of operating surgeon was recorded in both retrospective and prospective analysis. Results In both retrospective and prospective analysis, vascular specialists were significantly more likely than non-vascular specialists to correctly identify the SPJ ( P < 0.0001). Preoperative SPJ marking did not improve outcome for the vascular specialist or the non-vascular specialist. Conclusion Preoperative SPJ marking is no substitute for surgical expertise. Competence in SSV surgery should be assessed prior to surgeons proceeding to independent practice.

Objectives. Adipose tissue is able to secrete a variety of active mediators into the circulation. One of these is Interleukin 6 (IL6). IL6 may play a causal role in the development of atherosclerosis. It has therefore been suggested that IL6 may form part of the link between obesity and vascular disease. The aim of this study was to quantify the relative IL6 expression in adipose tissue compared to other tissues.Methods. Tissue (vein, fat, muscle, blood) was collected from 32 patients undergoing varicose vein surgery. RNA was extracted and mRNA measured using RT-PCR relative quantification. The mean relative IL6 mRNA levels were compared between tissues using the Mann Whitney U test and the independent t-test. Tissue levels were compared for individuals using the Wilcoxon signed rank test.Results. Mean relative IL6 mRNA levels (mean SEM) were significantly greater in adipose tissue 44.8 +/- 16.1 than in other tissues (leukocytes 1.1 +/- 0.3, vein 2.0 +/- 0.8, muscle 0.06 +/- 0.03: p < 0.001). mRNA expression levels were also significantly higher in fat than in all other tissue types in individuals (p < 0.001).Conclusions. IL6 mRNA expression is significantly higher in adipose than in many other tissues known to express IL6. (C) 2007 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Objectives:This study assesses the anatomical outcome of subfascial endoscopic perforator vein surgery (SEPS) in cases where no perioperative marking of incompetent perforators was used. Methods:Patients who had undergone SEPS and who had been investigated with a preoperative duplex ultrasound scan were identified from hospital records. These patients were recalled for a follow-up duplex ultrasound scan, which was compared with the preoperative investigation. Results:In total, 15 patients (17 limbs) were studied. Four legs (23.5%) had no incompetent perforators at follow-up scan. The remaining 11 limbs (76.8%) all had at least one incompetent perforator. Six limbs (35.2%) showed incompetent perforators in the same position as the incompetent perforators identified at the preoperative duplex scan. A total of 10 incompetent perforators persisted at follow-up (35.7% of preoperatively identified incompetent perforating veins). Nine legs (52.9%) had developed at least one new incompetent perforator since undergoing SEPS. Conclusion:In our study, a large proportion of incompetent perforators persisted at post-operative follow-up duplex scan. These probably represent perforators missed during surgery. Endoscopy of the subfascial space alone is not a reliable method for incompetent perforator identification. Alternative methods of localization should be employed perioperatively.

BACKGROUND: G-CSF given as split dose increased the harvested number of CD34+ cells in comparison to a once daily schedule, but the mechanism is poorly understood.STUDY DESIGN AND METHODS: To investigate the schedule dependency of G-CSF in healthy volunteers with respect to CD34+ cell mobilization, the same dose of G-CSF was applied in four healthy volunteers in two different schedules (once daily vs. split doses twice daily) in a crossover design after a washout period of 3 months. CD34+ cell kinetics in serum were determined as well as G-CSF serum kinetics on Days 1 and 4 after stimulation.RESULTS: In all volunteers, the twice daily schedule led to a higher CD34+ cell count after 4 days of G-CSF stimulation (median, 94.5 vs. 47/muL; p = 0.05). On Days I and 4, there was a higher peak serum concentration of G-CSF serum level after the once daily application (15,175 vs. 6,859 pg/mL and 7440 vs. 2388 pg/mL, respectively) than after the twice daily schedule. In contrast, after the once daily application the minimum serum level of G-CSF serum level was lower than after the twice daily schedule (663 vs. 1361 pg/mL and 246 vs. 441 pg/ mL, respectively). No difference of area under the curve for G-CSF was observed on Days 1 and 4 after G-CSF stimulation.CONCLUSION: It is suggested that application of G-CSF twice daily leads to a higher CD34+ cell mobilization owing to a higher minimum serum level and therefore to a more continuous serum baseline level resulting in a more efficient CD34+ cell mobilization.

To evaluate the efficacy and toxicity of two different etoposide dosages (30 or 45 mg/kg) in combination with busulfan/cyclophosphamide as conditioning regimen followed by stem cell transplantation in patients with acute myeloid leukemia (AML).

We compared two doses of recombinant human granulocyte-stimulating factor (G-CSF) for stem cell mobilisation in 90 healthy donors for allogeneic stem cell transplantation in a retrospective analysis. Group I (n = 46) received 10 μg/kg G-CSF (filgrastim) given as 5 μg/kg twice daily, and group II (n = 44) received 16 μg/kg, given as 8 μg/kg twice daily with a 12-h interval. The groups were well-balanced for age and body-weight. G-CSF application was performed on an out-patient basis, and leukapheresis was started in all donors on day 5. The most frequent side-effects of G-CSF were grade I/II, bone pain, headache and fatigue in both groups, whereas grade III of bone pain, headache and fatigue occurred in the 2 × 8 μg/kg group only. One serious non-fatal event with non-traumatic spleen rupture occurred in the 2 × 5 μg/kg group. The CD34+cell count in the first apheresis of all donors was 5.1 × 106/kg donor weight (range, 1.5–19.3). The CD34+ cell harvest was higher in the 2 × 8 μg/kg group than in the 2 × 5 μg/kg group (7.1 × 106/kg vs 4.9 × 106/kg; P = 0.09). The target of collecting >5.0 × 106 CD34+ cells/kg donor weight with one apheresis procedure was achieved in 45% of group I and in 61% of group II, respectively. Administering G-CSF at a dosage of 8 μg/kg twice daily leads to a higher CD34+ cell yield than a dosage of 2 × 5 μg/kg, but is associated with increased toxicity and higher cost.

One-hundred and two patients with good risk myeloid leukemia (CML first chronic phase or AML first CR) were transplanted from HLA-related donors after conditioning with (n = 45) or without anti-thymocyte globulin (ATG) (n = 57). One graft failure was observed in the non-ATG and none in the ATG group. The median time to leukocyte engraftment (>1 × 109/l) was 16 (range 12–33) in the ATG group and 17 days (range 11–29) in the non-ATG group (NS) and for platelet engraftment (>20 × 109/l) 24 and 19 days (P = 0.002), respectively. Acute GVHD grade II–IV was observed in 47% of the non-ATG and in 20% of the ATG group (P = 0.004). Grade III/IV GVHD occurred in 7% of the ATG and in 32% of the non-ATG group (P = 0.002). Chronic GVHD was seen in 36% and 67% (P = 0.005), respectively. After a median follow-up of 48 months (range 2–128), the 5-year estimated OS is 66% (95% KI: 51–81%) for the ATG group and 59% (95% KI: 46–72%) for the non-ATG group (NS). The 5-year estimated DFS is 64% (95% KI: 50–78%) for ATG and 55% (95% KI: 43–67%) for the non-ATG regimen (NS). The 5-year probability of relapse was 5% in the ATG and 15% in the non-ATG group (NS). ATG as part of the conditioning regimen leads to a significant reduction in GVHD without increase of relapse in patients with myeloid leukemia after stem cell transplantation from HLA-related donors.

We investigated the efficacy and toxicity of the combination of busulfan, cyclophosphamide, and etoposide (Bu/Cy/VP-16) as a preparative regimen prior to autologous hematopoietic stem cell transplantation (ASCT) in patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL). Fifty-three patients with recurrent (n=30), refractory (n=20), or high-risk (n=3) lymphoma were enrolled. The 10 patients with HD and 43 with NHL (median age: 46 years, range: 18–64) received busulfan (16 mg/kg), cyclophosphamide (120 mg/kg), and etoposide (30 or 45 mg/kg) followed by ASCT. A total of 50 patients (94%) were consolidated in complete (n=25) or partial (n=25) remission, whereas 3 patients had chemoresistant disease before Bu/Cy/VP-16. Thirty-five patients (66%) had received prior radiotherapy (RT) excluding total body irradiation (TBI) as part of the conditioning regimen. The main nonhematological toxicities (grade II-IV according to the Bearman score) in 52 evaluable patients were mucositis (79%) and hepatic toxicity (15%). Severe veno-occlusive disease (VOD) occurred in three patients (5.8%) including one treatment-related death caused by VOD. Overall, treatment-related mortality was 3.8%. After a median follow-up for surviving patients of 21 months (range: 6–118), 20 patients (38%) are in continuous complete remission, 8 patients (15%) are alive in relapse, and 25 patients (47%) died. Probabilities of relapse, event-free survival, and overall survival at 3 years were 63% [95% confidence interval (CI): 48–79%], 31% (95% CI: 17–46%), and 43% (95% CI: 27–59%), respectively. In conclusion, Bu/Cy/VP-16 is an effective and well-tolerated conditioning regimen in patients with HD and NHL. Both toxicity and outcome were not significantly different in patients treated with 30 mg/kg and 45 mg/kg etoposide, respectively. The observed long-term results are even comparable to those published for other established high-dose protocols, including TBI-based regimens. However, further investigations are necessary to evaluate the value of Bu/Cy/VP-16 as a high-dose protocol for malignant lymphoma, especially in patients who have already received extensive RT.

To evaluate the efficacy and toxicity of two different etoposide (VP-16) dosages (30 or 45 mg/kg) in combination with busulfan/cyclophosphamide as conditioning therapy followed by stem cell transplantation in acute myeloid leukemia (AML), 90 patients with AML received either 30 mg/kg ( n = 60) or 45 mg/kg ( n = 30) etoposide in combination with busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg). The stem cell source was allogeneic related bone marrow (BM) ( n = 53), allogeneic unrelated BM ( n = 5), allogeneic unrelated peripheral blood (PBSC) ( n = 2), syngeneic BM ( n = 2), autologous BM purged ( n = 9) or unpurged ( n = 9), autologous PBSC ( n = 10). fifty-six patients (62%) were in first cr, 26 (29%) were > first CR, and eight (9%) were transplanted in relapse. Principal toxicities in both groups were mucositis and hepatotoxicity. Forty-five mg/kg etoposide resulted in greater hepatic toxicity ( P = 0.03), and a higher incidence of VOD (23 vs 12%, P = 0.04) and acute GVHD grade III/IV (13 vs 5%, NS). The treatment-related mortality was 17% in the 30 mg/kg group and 33% in the 45 mg/kg group, mainly due to infections, intestinal pneumonia and GVHD. Hematological recovery of leukocytes 1/nl was comparable in both groups (17 vs 16 days). After a median follow-up of 16 months 19% in the 30 mg/kg group and 23% in the 45 mg/kg group relapsed. In patients who had undergone allogeneic related bone marrow transplantation in first CR no relapses occurred after a median follow-up of 3 years. For all patients the 3-year estimated disease-free survival was 62% in the 30 mg/kg group and 40% in the 45 mg/kg group ( P = 0.03). For patients in first CR who underwent allogeneic related stem cell transplantation the 3 year disease-free survivals were 80% and 66%, respectively ( P = 0.4). We conclude that etoposide 30 mg/kg or 45 mg/kg in combination with busulfan/cyclophosphamide is a highly active regimen for bone marrow transplantation of patients with AML with a low relapse rate. However, conditioning with 30 mg/kg rather than 45 mg/kg etoposide resulted in less toxicity and a better overall survival due to a lower transplant-related mortality. Bone Marrow Transplantation (2000) 26, 711–716.