4 Matching Annotations
  1. Last 7 days
    1. Treatment of superficial vein reflux (see Varicose Veins, above) has been shown to decrease the recurrence rate of venous ulcers. Where there is substantial obstruction of the femoral or popliteal deep venous system, superficial varicosities supply the venous return and should not be removed.

      Failure of venous insufficiency ulcerations to heal is most often due to inconsistent use of first-line treatment methods. Ongoing control of edema is essential to prevent recurrent ulceration; the use of compression stockings following ulcer healing is critical, with recurrence rates 2–20 times higher if compression stockings are not used

      Duplex ultrasound evaluation should assess blood flow direction, venous reflux, and venous obstruction, and include examination of the deep venous system, great saphenous vein (GSV), small saphenous vein (SSV) and its thigh extension (Giacomini vein), accessory saphenous veins, and perforating veins. Venography is recommended primarily in patients with post-thrombotic disease, especially when intervention is planned, as it provides greater anatomic detail than duplex ultrasonograph The examination also identifies patterns of disease that have treatment implications. Axial reflux is defined as uninterrupted retrograde flow from groin to calf and can occur in either superficial or deep systems. [4] Junctional reflux is limited to the saphenofemoral or saphenopopliteal junction, while segmental reflux occurs in a portion of a truncal vein. [4] Understanding whether reflux originates from superficial junctions versus deep venous incompetence fundamentally changes treatment planning, as superficial disease is amenable to ablation while deep disease typically requires conservative management Management of secondary varicose veins from post-thrombotic syndrome (PTS) is fundamentally different and more challenging. Compression therapy, lifestyle modifications, and symptom management form the cornerstone of PTS treatment. [4-8] Elastic compression stockings (20-30 mm Hg), leg elevation, weight loss, and exercise constitute the primary therapeutic approach Endovascular interventions for PTS—including percutaneous transluminal venoplasty and stenting—are reserved for select patients with significant iliofemoral obstruction who have failed conservative management. [7] These procedures require careful patient selection and standardized criteria. The role of superficial venous ablation in PTS patients with concomitant superficial reflux remains controversial and should be approached cautiously, as the underlying deep venous pathology may limit benefit

    Tags

    Annotators

    URL

  2. Nov 2023
    1. hat that's going to mean is that a lot of the things um that again that this wealthy say onethird of our society has normalized will have to change the size of our houses 00:12:01 we shouldn't be building really huge houses anymore I would also go further and say if we are really serious about climate change we need to think about the very large properties that we have which there are many of in our society 00:12:12 that need to be divided to make good quality and reasonable sized houses for say three or four families rather than just one family no more second homes and where second homes are in areas where other 00:12:25 people need to live they are no longer allowed to exist so no more second homes
  3. May 2022
    1. ocio-cultural and lifestyle changes can accelerate climate change mitigation (medium26confidence). Among 60 identified actions that could change individual consumption, individual27mobility choices have the largest potential to reduce carbon footprints. Prioritizing car-free mobility by28walking and cycling and adoption of electric mobility could save 2 tCO2eq cap-1 yr-1. Other options with29high mitigation potential include reducing air travel, cooling setpoint adjustments, reduced appliance30use, shifts to public transit, and shifting consumption towards plant-based diets

      The highest potential for demand side reduction among lifestyle change are: mobility, cooling setpoint adjustments, appliance usage, and diet.

  4. Jul 2019
    1. It is not really a trifling effort, as those will discover who have yet to essay it. To “clear” even seven hours and a half from the jungle is passably difficult. For some sacrifice has to be made. One may have spent one’s time badly, but one did spend it; one did do something with it, however ill-advised that something may have been. To do something else means a change of habits. And habits are the very dickens to change! Further, any change, even a change for the better, is always accompanied by drawbacks and discomforts. If you imagine that you will be able to devote seven hours and a half a week to serious, continuous effort, and still live your old life, you are mistaken. I repeat that some sacrifice, and an immense deal of volition, will be necessary. And it is because I know the difficulty, it is because I know the almost disastrous effect of failure in such an enterprise, that I earnestly advise a very humble beginning. You must safeguard your self-respect. Self-respect is at the root of all purposefulness, and a failure in an enterprise deliberately planned deals a desperate wound at one’s self-respect. Hence I iterate and reiterate: Start quietly, unostentatiously.