Subfascial endoscopic perforator surgery (SEPS) in chronic venous insufficiency. A 14 years experience

Introduction. Subfascial Endoscopic Perforator Surgery (SEPS) enables the direct visualization and section of perforating veins. Morbidity and duration of hospitalization are both less than with conventional open surgery (Linton���s or Felder���s techniques). Patients and methods. A total of 322 legs from 285 patients with a mean age of 56 years (range 23-90) were treated at our Department from May 1996 to January 2010. In 309 cases, an endoscope (ETM Endoskopische Technik GmbH, Berlin, Germany) was introduced through a transverse incision approximately 1.5 cm in length and 10 cm from the tibial tuberosity, as with Linton���s technique. A spacemaker balloon dissector for SEPS, involving a second incision 6 cm from the first, was used in only 13 cases. Results. The procedure used in each case was decided on the basis of preoperative evaluation. SEPS and stripping were performed in 238 limbs (73.91%), SEPS and short stripping in 7 limbs (2.17%), SEPS and crossectomy in 51 limbs (15.84%), and SEPS alone in 26 limbs (8.07%). 103 patients presented a total of 158 trophic ulcers; the healing time was between 1 and 3 months, with a healing rate of 82.91% after 1 month and 98.73% after 3 months. Conclusion. Subfascial ligature of perforating veins is superior to sclerotherapy and minimally invasive suprafascial treatment for the treatment of CVI. It is easy to execute, minimally invasive and has few complications.

Surface thermal analysis of North Brabant cities and neighbourhoods during heat waves

The urban heat island effect is often associated with large metropolises. However, in the Netherlands even small cities will be affected by the phenomenon in the future (Hove et al., 2011), due to the dispersed or mosaic urbanisation patterns in particularly the southern part of the country: the province of North Brabant. This study analyses the average night time land surface temperature (LST) of 21 North-Brabant urban areas through 22 satellite images retrieved by Modis 11A1 during the 2006 heat wave and uses Landsat 5 Thematic Mapper to map albedo and normalized difference temperature index (NDVI) values. Albedo, NDVI and imperviousness are found to play the most relevant role in the increase of nighttime LST. The surface cover cluster analysis of these three parameters reveals that the 12 ���urban living environment��� categories used in the region of North Brabant can actually be reduced to 7 categories, which simplifies the design guidelines to improve the surface thermal behaviour of the different neighbourhoods thus reducing the Urban Heat Island (UHI) effect in existing medium size cities and future developments adjacent to those cities.