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Neutrophil oxygen radical production was studied in 18 limbs with class 2 or 3 venous disease and compared with that of nine normal limbs. Neutrophils were isolated from arm and leg venous samples. Free radical production was determined using chemiluminescence after stimulation with the chemotactic peptide formyl-methionyl-leucyl-phenylalanine (FMLP) or the ester phorbol myristate acetate (PMA). The ratio of leg to arm luminescence was greater after FMLP stimulation in patients with venous disease (median 1.52 (95 per cent confidence interval (c.i.) 1.27-2.60)) than in controls (median 0.97 (95 per cent c.i. 0.70-1.12); P < 0.01). These changes were not observed with PMA (venous disease 1.16 (95 per cent c.i. 1.05-1.40); controls 0.95 (95 per cent c.i. 0.78-1.24)). There were fewer FMLP receptors on activated leg neutrophils (median 20.19 (95 per cent c.i. 3.58-51.42) fluorescence units) than arm neutrophils (median 36.03 (95 per cent c.i. 13.00-65.28) fluorescence units; P < 0.05), indicating an amplification of signal transduction. Intracellular calcium imaging demonstrated a larger release of calcium after stimulation of leg neutrophils (median 25.0 per cent (95 per cent c.i. 15.7-43.9 per cent)) compared with neutrophils from the arm (median 8.0 per cent (95 per cent c.i. 5.6-16.1 per cent); P = 0.04), demonstrating calcium-dependent activation. Neutrophils in patients with chronic venous disease inappropriately produce more oxygen free radical as a result of amplification of a calcium-dependent signal pathway.

One hundred two patients with symptomatic hemorrhoids were randomized to receive treatment with either infrared photocoagulation (IRPC) or a bipolar diathermy probe (BD). There was no significant difference in complications, number of treatments required (IRPC 1.7 [0.9], BD 1.6 [0.8]). Third-degree hemorrhoids required more treatments than smaller piles. BD has some practical advantages over IRPC but results are similar.

Objective: To investigate neutrophil free radical production in patients with venous hypertension. Patients: Thirteen legs in patients with venous ulceration were compared with seven legs in patients suffering from lipodermatosclerosis (LDS) only and nine normal controls. Design: Leg and arm venous blood samples were obtained from each patient after a period of 30 min of leg dependency followed by elevation to the horizontal for a further 5 min. Neutrophils were isolated and free radical production assessed by luminol-dependen t chemiluminescence following stimulation with the chemotactic peptide FMLP. Results: The ratio of leg to arm luminescence was significantly higher in patients with venous ulceration (median 1.61; 95% confidence interval (CI) 1.20–3.05; p=0.0002) and those with LDS (median 1.36; 95% CI 1.05–2.01; p=0.0036) when compared with the controls (median 0.97; 95% CI 0.70–1.12). Conclusions: Neutrophil free radical production is increased in the legs of patients with venous hypertension and may be implicated in the underlying pathogenesis of this disease.

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