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Purpose: Our purpose was to report the outcome of endovascular treatment with manual aspiration thrombectomy as the first-line thromboablative method for phlegmasia cerulea dolens. Methods: Between October 2006 and May 2010, seven consecutive patients (5 women, 2 men; age range, 31-80 years) with the diagnosis of phlegmasia cerulea dolens secondary to acute iliofemoral deep venous thrombosis had endovascular treatment with manual aspiration thrombectomy. Catheter-directed thrombolysis and stent placement were used as adjunctive procedures. Phlegmasia was left-sided in five and right-sided in two patients. Results: All patients had associated great saphenous vein thrombosis in addition to iliofemoral deep vein thrombosis (DVT). Aspiration thrombectomy completely removed the thrombus from the popliteal vein to the inferior vena cava (IVC) in all cases. Three patients with May-Thurner syndrome had stent placement in the left common iliac vein. Two patients had early recurrences. Repeated aspiration thrombectomy was unsuccessful in one patient. There were no complications related to the procedure. One patient who had been successfully treated died of sepsis and another patient who had unsuccessful repeated interventions had below-the-knee amputation. Overall, the clinical success and survival rates of patients in this study were 86%. On follow-up, three patients with successful treatment were asymptomatic with no deep venous insufficiency. One of these patients died during the 4-month follow-up period. Two patients had mild ankle swelling with deep venous insufficiency. Conclusions: Manual aspiration thrombectomy with adjunctive use of catheter-directed thrombolysis and stent placement is an effective endovascular treatment method with high clinical success and survival rates for phlegmasia cerulean dolens.
Oguzkurt, Levent, E-mail: email@example.com; Ozkan, Ugur [Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Radiology (Turkey); Demirturk, Orhan S. [Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Thoracic and Cardiovascular Surgery (Turkey); Gur, Serkan [Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Radiology (Turkey)
Gas gangrene is a severe form of gangrene (tissue death) caused by the bacterium Clostridium perfringens. Patients ... vascular diseases are more prone to spontaneously develop gas gangrene, which is rapidly progressive and often fatal.
Gas gangrene is a severe form of gangrene (tissue death) caused by the bacterium Clostridium perfringens. It ... causing painful swelling and destruction of involved tissue. Gas gangrene is rapidly progressive and often fatal.
Fournier's gangrene. Case report.
Fournier's gangrene is a condition marked by fulminant polymicrobial necrotizing fasciitis of the urogenital and perineal areas. We present a patient with Fournier's gangrene and describe the physical examination and bedside sonographic findings. These findings can assist in the evaluation of patients with concerning symptoms so there can be timely administration of antibiotics and specialist consultation when necessary. PMID:25110769
Matilsky, Danielle; Lewiss, Resa E; Whalen, Michael; Saul, Turandot
Fournier's gangrene following vasectomy.
Routine vasectomy was performed on a 29-year old man for whom rheumatoid arthritis had been diagnosed 4 years previously and treated with nonsteroidal anti-inflammatory drugs. The man experienced a flare-up of arthralgia in the wrists 2 weeks prior to the vasectomy. He was treated with a single course of parenteral methyl prednisolone and was in remission at the time of the surgery. On the day following the vasectomy, the patient noticed some erythema around the wound and felt unwell but did not seek medical advice until 4 days later. He was clinically toxic when he presented and experiencing painful gangrene of the scrotum. Treatment was begun immediately with parenteral benzyl penicillin, tobramycin and metronidazole plus aggressive debridement; 30 ml of pus drained and beta hemolytic streptococci Group A, sensitive to penicillin, were cultured. Within a few hours, further spread of gangrene along the penile shaft was noted. He was given hyperbaric oxygen treatment for 3 days followed by secondary debridement. No further spread of the gangrene occurred. 1 week later there was a good tranulating bed over the anterior scrotum. Meshed split skin graft was applied with tie-over dressings. An almost 100% take was achieved 4 weeks later. If hyperbaric oxygen had been employed immediately after surgery, spread of the gangrene might have been avoided. The use of hyperbaric oxygen should be considered as a firstline treatment. PMID:3401669
Chantarasak, N D; Basu, P K
When you are ill and consult a physician for his or her expertise, many times laboratory testing is part of the clinical workup. This testing is critical to the physician's ability to diagnose the patient's condition. What if testing was not available … because there was no one to do the testing? Although seemingly far-fetched, this scenario could play itself out in the next ten years due to an impending manpower crisis in laboratory medicine. The profession of Medical Technology, also known as Clinical Laboratory Science, is experiencing a shortage of qualified individuals for a variety of reasons – not the least of which is the closure of almost 70% of the schools teaching this critical profession. Health care workers (HCW) rely on accurate and timely clinical laboratory results in order to make decisions for their patients. Because ? 70% of patient care decisions are based on clinical laboratory results, it is important to have a well-trained supply of laboratory professionals. This article will give an overview of the situation and the possible causes of this shortage, and pose challenges to our profession as to how this crisis can be averted. Visibility of this profession must be a prime focus of this effort in order for the population in general to be aware of the role Clinical Laboratory Scientists play in the health care consortium. This effort should begin early in the educational process, potentially as early as Middle School (junior high school), bringing awareness of the profession not only to students but to educators as well. PMID:23653714
Kaplan, Raymond L.; Burgess, Thomas E.
Fournier's Gangrene: Current Practices
Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes. PMID:23251819
Mallikarjuna, M. N.; Vijayakumar, Abhishek; Patil, Vijayraj S.; Shivswamy, B. S.
Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux, as well as venous obstruction. The most severe clinical manifestation of CVI is venous leg ulceration that can result in significant morbidity, including venous gangrene and amputation, albeit rare. Treatment modalities are aimed at reducing venous hypertension. Diuretic therapy, although widely used, only provides short-term improvement of the edema but provides no long-term benefit. Compression therapy is the cornerstone in the management of CVI. Compression can be achieved using compression bandaging, compression pumps, or graduated compression stockings. Topical steroid creams may reduce inflammation, venous eczema, and pain in the short term, but they can be detrimental in the long run. Apligraf (a living, bilayered, cell-based product) in conjunction with compression therapy was noted to be more effective in healing venous leg ulcerations, when compared with treatment with compression therapy and zinc paste. Endovascular and surgical techniques that minimize valvular reflux and relieve venous obstruction improve venous hemodynamics, promoting wound healing. PMID:24840970
Kolluri, Raghu
Fournier gangrene and unexpected death.
Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70-year-old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case. PMID:22471925
Bury, Danielle; Byard, Roger W
Experience in management of Fournier's gangrene
. We report our experience and results in the management of Fournier's gangrene. Fournier's gangrene is a synergistic infective\\u000a necrotizing fasciitis, which involves perianal, perineal and genital regions, originated mostly from colorectal and genitourinary\\u000a sources. Charts and records from 28 patients with Fournier's gangrene diagnosed between 1993 and 1997 were reviewed. The mean\\u000a patients age was 57.8 years (range, 22–82
E. Villanueva-Sáenz; P. Martínez Hernández-Magro; M. Valdés Ovalle; J. Montes Vega
Gas Gangrene at Tertiary Care Centre
Objectives : To study gas gangrene isolates at tertiary care centre. Methods : Analysis of a series of 206 cases of gas gangrene was done over a period of 2 yr (Dec. 2004 - Dec. 2006). Results : Clostridium perfringens was cultured in 58 (90.6%) of the cases, Clostridium tertium were isolated in 5 (7.8%) and clostridium tetani in 1
A Sonavane; M Mathur
Acute gangrenous cholecystitis: radionuclide diagnosis
Radionuclide hepatobiliary imaging with Tc-99m IDA is a useful procedure for the diagnosis of acute cholecystitis. Visualization of the gallbladder essentially rules out acute cholecystitis. Nonvisualization suggest acute cholecystitis but may also be associated with chronic gallbladder disease or other conditions. The authors recently observed five patients in whom a rim of increased parenchymal liver activity was seen adjacent to the gallbladder fossa. All five patients had acute gangrenous cholecystitis. The rim of increased activity appears to be a useful secondary sign of acute cholecystitis.
Brachman, M.B.; Tanasescu, D.E.; Ramanna, L.; Waxman, A.D.
Data Mining to Characterize Signatures of Impending System Events
Data Mining to Characterize Signatures of Impending System Events or Performance from PMU the Future Electric Energy System #12;#12;Data Mining to Characterize Signatures of Impending System Events Mining to Characterize Signatures of Impending System Events or Performance from PMU Measurements
Fournier's Gangrene: Population Based Epidemiology and Outcomes
Purpose Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene. Materials and Methods We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated. Results We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean ± SD 0.6 ± 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively. Conclusions Patients with Fournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers. PMID:19286224
Sorensen, Mathew D.; Krieger, John N.; Rivara, Frederick P.; Broghammer, Joshua A.; Klein, Matthew B.; Mack, Christopher D.; Wessells, Hunter
Gangrenous sigmoid volvulus in a pregnant woman.
A rare case of gangrenous sigmoid volvulus in a pregnant woman causing intestinal obstruction is reported. The patient had intrauterine foetal death. Laparatomy for resection of sigmoid colon and hysterotomy for removal of dead foetus was carried out. Terminal iliac colostomy with closure of rectal stump was done in the first surgery. The patient underwent colorectal anastomosis 2 months after the first operation and recovered uneventfully. PMID:10695426
Joshi, M A; Balsarkar, D; Avasare, N; Pradhan, C; Pereira, G; Subramanyan, P; Shirahatti, R G; Changlani, T T
Diversity components of impending primate extinctions
Many extant species are at risk to go extinct. This impending loss of species is likely to cause changes in future ecosystem functions. Ecological components of diversity, such as dietary or habitat specializations, can be used to estimate the impact of extinctions on ecosystem functions. As an approach to estimate the impact of future extinctions, we tested interdependency between ecological and taxonomic change based on current predictions of extinction rates in primates. We analyzed the ecological characteristics of extant primate faunas having species in various categories of endangerment of extinction and forecasted the future primate faunas as if they were paleontological faunas. Predicting future faunas combines the wealth of ecological information on living primates with large, fossil record-like changes in diversity. Predicted extinction patterns of living primates in Africa, Asia, Madagascar, and South America show that changes in ecology differ among the regions in ways that are not reducible to taxonomic measures. The ecological effects of primate extinctions are initially least severe in South America and larger in Asia and Africa. Disproportionately larger ecological changes are projected for Madagascar. The use of taxonomy as a proxy for ecology can mislead when estimating competence of future primate ecosystems. PMID:9736727
Jernvall, Jukka; Wright, Patricia C.
We report the case of a 71-year-old man who had interval gangrene of his calf with subsequent vein graft blowout 3 months after undergoing a femoral–to–dorsalis pedis saphenous vein bypass grafting procedure. To provide wound coverage, restore vascular continuity, and preserve functional ambulation, a flow-through radial forearm fasciocutaneous free flap was interposed between cut ends of the bypass graft. Venous
Michael A. Gooden; Andrew T. Gentile; Christopher P. Demas; Scott S. Berman; Joseph L. Mills
Multiple Urethral Stones Causing Penile Gangrene
Penile urethral stones are a rare occurrence resulting from a number of causes including migration of stones within the urinary tract, urethral strictures, meatal stenosis, and obstructing tumours such as adenomatous metaplasia of the uroepithelium, hypospadias, urethral diverticulum, and very rarely primary fossa navicularis calculi. We report the case of a 54-year-old male presenting with penile gangrene and sepsis resulting from impaction of multiple stones within the penile urethra. This paper summarises the topic and discusses the pathophysiology of this unusual condition. PMID:24963438
Ramdass, Michael J.
Sources of Gas Gangrene in Hospital
Of four cases of postoperative gas gangrene in three hospitals three followed amputation of legs with gangrenous lesions, and one followed gastrectomy. Clostridium welchii was isolated from the wounds and the faeces of each patient; small numbers of Cl. welchii were found on the floors of the theatres where the operations had been performed. Two infections occurred in one hospital on successive days. Typing of strains of Cl. welchii from these patients showed that they were serologically distinct. Further studies suggested that in each of the four cases infection was probably acquired from the patients' intestinal flora, probably through faecal contamination of skin. In 76 patients sampling of the skin with surface contact plates showed occasional heavy contamination of the thighs, groins, and buttocks with Cl. welchii, most of which were present as spores or sporing bacilli; Cl. welchii was more commonly found in patients with incontinence of faeces. Compresses of povidone-iodine applied for 30 minutes were found greatly to reduce the numbers of Cl. welchii, and swabbing with 70% alcohol was effective in some cases; washing with soap and water had no effect on the numbers of Cl. welchii on the skin. ImagesFig. 1Fig. 2Fig. 3 PMID:4305849
Ayliffe, G. A. J.; Lowbury, E. J. L.
Halo sign on indium-111 leukocyte scan in gangrenous cholecystitis
A 56-year-old man with a long history of Crohn's disease was evaluated by In-111 labeled leukocyte scanning. A halo of leukocyte activity was seen around the gallbladder fossa. A gangrenous gallbladder was removed at surgery.
Bauman, J.M.; Boykin, M.; Hartshorne, M.F.; Cawthon, M.A.; Landry, A.J.
Impending paradoxical embolism: have we lost the clot?
Impending paradoxical embolism is a rare diagnosis that requires urgent treatment. We present a case where surgical thromboembolectomy was undertaken. The thrombus vanished from view on transesophageal ultrasound and was presumed to have undergone embolisation while bypass was established. Unexpectedly, it was found tangled in the superior vena cava cannula apertures. PMID:24330672
Ghent, Finn; Bassin, Levi; Keller, Michael; Cranney, Gregory; McKenzie, David; Grant, Peter W
Fournier's Gangrene: a clinical and bacteriological study.
Bacteriological studies were conducted in patients presenting with Fournier's Gangrene (FG) in our Department during a period of 11 years. These studies showed high numbers of anaerobes (96%) and the ratio of aerobes to anaerobes was reported to be 1.4: 3.2. Among the anaerobes,Peptostreptococci, Bacteroides and Prevotella were more frequently isolated. The predominant facultative aerobic microorganisms were Streptococci and Escherichia coli. Clinical investigation showed necrotic cellulitis and fasciitis of the scrotum due to mixed aerobic-anaerobic infection. Patients with complicated paraproctitis and periurethral abscesses and urinary phlegmones who also presented with symptoms of FG were treated during this same period. Microbiological studies gave similar results and clinical studies showed that the process had spread to the scrotum. The question was then raised whether FG should be diagnosed as an independent nosological entity in cases where the underlying cause of the disease was obscure or if FG should be the result of different pathological processes which occurred within the scrotal surfaces. In other cases, FG is secondary and occurred after reaching the scrotum per continuitatem. PMID:16887589
Fichev, G; Kostov, V; Marina, M; Tzankova, M
Fatherhood, Impending or Newly Established, Precipitating Delusional Disorders
Psychopathological reactions to fatherhood are probably not so infrequent as they would seem from psychiatric literature. In a material of paranoid psychoses, impending or newly established fatherhood was considered the main precipitating factor in 4 patients (i.e. 2.4%), compared with 7% of the female psychoses precipitated by pregnancy, childbirth or nursing. Two of the men were batchelors, insecure and inhibited,
Nils Retterstřl; Stein Opjordsmoen
Limb Salvage for Streptococcal Gangrene of the Extremity
Background: Extremity soft tissue infections from group A, ?-hemolytic streptococcus frequently culminate in amputation. This study compares our protocol for limb salvage with expected results.Methods: Patients with extremity streptococcal gangrene treated from 1989 to 1995 were reviewed. The management protocol mandated immediate, radical excision of involved skin and subcutaneous tissue, with preservation of fascia. Patients were managed in the burn
Michael Schurr; Sandra Engelhardt; Richard Helgerson
Phlebotomy as a Source of Clostridium septicum Gas Gangrene
ISSUE: Phlebotomy is often performed by personnel without nursing or infection prevention education. Infection Control (IC) was notified regarding a potential Clostridium septicum gas gangrene inoculation in an outpatient phlebotomy setting. A 70-year-old patient expired 52 hours after receiving phlebotomy. The patient presented to an outside facility with pain and swelling of the right antecubital space. After the diagnosis of
K. Mackie; S. Mayoryk; S. E. Cosgrove; T. Perl
Symmetric Peripheral Gangrene Associated with H1N1 Infection
More and more cases of H1N1 influenza are being detected in India and so also the variety of complications this virus can cause. Here, we report a case of symmetric peripheral gangrene following H1N1 infection. PMID:24319562
Kaulgud, Ram S.; Kamath, Vasantha; Patil, Vijayalaxmi; Desai, Sagar
... venous disorders Find a vein doctor American Venous Forum 555 East Wells Street, Suite 1100 Milwaukee, WI ... 3349 E: email@example.com © 2014 American Venous Forum. Contact Us | Legal/Terms of Use | Privacy Policy | ...
One of the earliest postulates concerning the physiological basis of flap survival is attributed to Sushruta, who, in his inimitable style, very succinctly noted in Sanskrit verse the following words: "through continuity survives." Sanskrit being a very telegraphic language, what derives from these words is as follows: Through (the flap's) continuity (with its original location) (it) survives. The principle of continuity has survived through the ages, though continuity has come to imply vascular continuity based on the Harvesian model of circulation. No matter how we classify flaps, i.e., random or axial, the Harvesian model of circulation is the key to the mechanism of survival. Lately, however, a new category of flaps, that is, "venous flaps," have been reported by a number of investigators where the classical Harvesian model is not in evidence, at least apparently. The following effort is directed toward presenting the existing data on this subject for future guidance in research and clinical applications. PMID:8446733
Thatte, M R; Thatte, R L
The purpose of venous ecology is to study the effect of the environment on the peripheral vessels. It is very extensive but still little explored subject in need of multidisciplinary study. The author reviews some of the major problems of ecophlebology: --pollution and harmful effects of urban life (atmospheric pollution, stress and influence of noise on the vessels); --the influence of habitat (furniture, ergonomics, urbanism, sociological studies and under-floor heating); --the cites new research on terrestrial electro-magnettism, meteoropathology, biological clocks and the influence of the mass media. In conclusion he hopes that ecophlebology will be the object of research which will permit a better understanding, and hence better control, of the pathological mechanisms resulting from the environment. PMID:928510
Reinharez, D
Gas gangrene of the arm due to Enterobacter cloacae in a neutropenic patient.
Gas gangrene is a life-threatening emergency. Most cases are caused by clostridial infections, but nonclostridial causes are being increasingly recognized. Nonclostridial gas gangrene is most often due to polymicrobial organisms. Early diagnosis and therapy are required, since the disease may rapidly progress to fatal toxemia. We report a case of gangrenous, atraumatic, nonclostridial myonecrosis of the arm due to Enterobacter cloacae in a nondiabetic patient with neutropenia. PMID:8903295
Fata, F; Chittivelu, S; Tessler, S; Kupfer, Y
Acral gangrene as a presentation of non-uremic calciphylaxis
We are describing a case of 55-year-old obese female with significant history of uncontrolled rheumatoid arthritis, who recently had decreased her immune-suppression medications. She presented with extensive acral gangrene involving multiple fingers and toes. Clinical picture and laboratory findings were suggestive of vasculitis; however, skin biopsy established diagnosis of calciphylaxis, in settings of normal kidney function. Patient was treated with sodium thiosulfate with gradual improvement in her skin lesions. PMID:24327971
Hammadah, Muhammad; Chaturvedi, Shruti; Jue, Jennifer; Buletko, Andrew Blake; Qintar, Mohammed; Madmani, Mohammed Eid; Sharma, Prashant
Arterial cannulation can hasten the onset of symmetrical peripheral gangrene
Symmetrical peripheral gangrene (SPG) is a devastating complication seen in critical care settings due to several contributory factors like low perfusion, high dose of vasopressors, disseminated intravascular coagulation, etc. Arterial cannulation is commonly done in critical patients for monitoring. We report a case of patient who developed early features of SPG which recovered in one hand, although it progressed in the hand which had the arterial cannula.
Srinivasan, Nataraj M.; Chaudhuri, Souvik
Oro-Facial Gangrene (Noma\\/Cancrum Oris): Pathogenetic Mechanisms
Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from I to 7 cases per 1000 population. The risk factors are poverty, malnutrition,
C. O. Enwonwu; W. A. Falkler; E. O. Idigbe
Ischemic Gangrene of the Glans following Penile Prosthesis Implantation
The development of ischemic gangrene of the penis following implantation of prosthesis is unusual, and very few cases are available in the literature. As a result, no established treatment protocol is available. We report our experience within a case of gangrene of the glans following implantation of a three-component prosthesis. We present a 53-year-old male, smoker with diabetes and hypercholesterolemia, who underwent surgery for the insertion of a penile prosthesis with 3 components to correct his erectile dysfunction and severe Peyronie's disease. The procedure was carried out without incidents. During the postoperative period, the patient began to complain from penile and perineal pain. He developed avascular necrosis of the glans. The necrosed area was excised. Four weeks later, he developed fever and perineal pain arriving to the emergency room with the prosthesis extruding through the glans. He had emergency surgery to remove the prosthesis plus surgical lavage and was prescribed broad-spectrum antibiotic therapy. Four weeks later, the penis was completely revascularized and reepithelialized. Ischemic gangrene following penile prosthesis implantation takes place in patients with poor peripheral vascularisation. Diabetes mellitus has been the common denominator to all of the reported cases. PMID:23956919
Garcia Gomez, Borja; Romero Otero, Javier; Diez Sicilia, Laura; Jimenez Alcaide, Estibaliz; Garcia-Cruz, Eduardo; Rodriguez Antolin, Alfredo
Enterostomy can decrease the mortality of patients with Fournier gangrene
AIM: To determine the significance of enterostomy in the emergency management of Fournier gangrene. METHODS: The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed. RESULTS: The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P < 0.05) and average length of hospital stay (14.3 ± 7.8 d vs 20.1 ± 8.9 d, P < 0.05) were shorter in the enterostomy group. The case fatality rate was lower in the enterostomy group than that in the control group (3.6% vs 21.7%, P < 0.05). CONCLUSION: Enterostomy can decrease the case fatality rate of patients with Fournier gangrene. PMID:24976731
Li, Yan-Dong; Zhu, Wei-Fang; Qiao, Jian-Jun; Lin, Jian-Jiang
Fournier's Gangrene as Seen in University of Maiduguri Teaching Hospital
Background. Fournier's gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier's gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier's gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome. PMID:23997966
Aliyu, S.; Ibrahim, A. G.; Ali, N.; Waziri, A. M.
Fournier's Gangrene as Seen in University of Maiduguri Teaching Hospital.
Background. Fournier's gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier's gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30-39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier's gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome. PMID:23997966
Aliyu, S; Ibrahim, A G; Ali, N; Waziri, A M
Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur
Objective: Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. Methods: We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score {>=}8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. Results: The mean Mirels' score was 9.8 {+-} 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 {+-} 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 {+-} 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. Conclusions: POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.
Deschamps, Frederic, E-mail: firstname.lastname@example.com; Farouil, Geoffroy, E-mail: email@example.com; Hakime, Antoine, E-mail: firstname.lastname@example.com; Teriitehau, Christophe, E-mail: email@example.com; Barah, Ali, E-mail: firstname.lastname@example.com; Baere, Thierry de, E-mail: firstname.lastname@example.com [Institut Gustave Roussy, Interventional Radiology Department (France)
Priapism and penile gangrene due to thrombotic thrombocytopenic purpura.
A 51-year-old man presented with 4 days of idiopathic ischemic priapism. Partial detumescence was achieved with aspiration and injection with intracorporeal adrenaline. On further evaluation, the patient was diagnosed with thrombotic thrombocytopenic purpura. This was treated with plasma exchange and steroids. The penis was initially observed for 3 weeks, which subsequently became necrotic and infected, requiring debridement. After debridement of penile shaft skin, it became apparent that the entire penis was necrotic, necessitating total penectomy. The wound was closed secondarily 2 weeks later. Gangrene of the penis after priapism is very rare. Priapism associated with thrombotic thrombocytopenic purpura has not been reported previously in published data. PMID:19896177
Kwok, Benjamin; Varol, Celi
Limb salvage after gas gangrene: a case report and review of the literature
Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection. Herein we present a case of gas gangrene of the arm in an intravenous drug user with a history of intramuscular injections with normal saline in the shoulder used to provoke pain for recovery after drug induced coma. The patient was early treated with surgery and antibiotics rendering possible the preservation of the limb and some of its function. Additionally, a review of the literature regarding case reports of limb salvage after gas gangrene is presented. PMID:21846405
Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease*
Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity. PMID:25387503
Komatsu, Yumi Cristina; Capareli, Gabriela Cunha; Boin, Maria Fernanda Feitosa de Camargo; Lellis, Rute; de Freitas, Thais Helena Proenca; Simone, Karine
[Fournier's gangrene: from urological emergency to plastic surgery].
Fournier's gangrene (FG) is a rare and potentially fatal infectious disease characterised by necrotic fasciitis of the perineum and abdominal wall in addition to the scrotum and penis in men and the vulva in women. Skin loss can be very damaging and difficult to repair. This condition must be treated aggressively. Several techniques are used to reconstruct lost tissue: skin grafts, transposition of the testicles and spermatic cords to a subcutaneous pocket in the upper thigh, scrotal musculocutaneous flaps, fasciocutaneous flaps and several other types of pediculated myocutaneous flaps are all employed. The supero-medial thigh skin flap is a likely arterial flap and has been shown to be an effective method for reconstructing large scrotal defects. PMID:19900390
Horta, Ricardo; Cerqueira, Manuel; Marques, Marisa; Ferreira, Pedro; Reis, Jorge; Amarante, José
Septic shock due to Fournier's gangrene of the scrotum.
A 57-year-old morbidly obese (160 kg) man presented with a 12 h history of severe bilateral scrotal pain and swelling. His scrotum was erythematous, with cellulitis advancing superiorly along the anterior abdominal wall. He was in septic shock. Following resuscitation with intravenous fluids, commencement of vasopressor infusion and broad-spectrum antimicrobials, he underwent surgical exploration and debridement. This revealed a devitalised gangrenous scrotum with abscess formation noted in the ischio-rectal spaces. This was debrided posteriorly to the wall of the rectum. The penis was de-gloved. Both testicles were spared. A colostomy was performed on day 3 to maintain a clean environment for healing. Subsequent scrotal reconstruction and grafting was performed with a pedicled gracilis flap and split skin grafting. The colostomy was reversed at 5 months. PMID:22675057
Callaghan, Michael Andrew; Baggott, Richard; D'Arcy, Frank T
Septic shock due to Fournier's gangrene of the scrotum
A 57-year-old morbidly obese (160 kg) man presented with a 12 h history of severe bilateral scrotal pain and swelling. His scrotum was erythematous, with cellulitis advancing superiorly along the anterior abdominal wall. He was in septic shock. Following resuscitation with intravenous fluids, commencement of vasopressor infusion and broad-spectrum antimicrobials, he underwent surgical exploration and debridement. This revealed a devitalised gangrenous scrotum with abscess formation noted in the ischio-rectal spaces. This was debrided posteriorly to the wall of the rectum. The penis was de-gloved. Both testicles were spared. A colostomy was performed on day 3 to maintain a clean environment for healing. Subsequent scrotal reconstruction and grafting was performed with a pedicled gracilis flap and split skin grafting. The colostomy was reversed at 5 months. PMID:22675057
Callaghan, Michael Andrew; Baggott, Richard; D'Arcy, Frank T
Epidemiology of venous thromboembolism.
This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease. PMID:329779
Coon, W W
Vacuum-assisted closure (V.A.C.) was used in two paraplegic patients with Fournier's gangrene in a context of ischial pressure ulcer This type of dressing facilitated preparation of reconstruction. PMID:17969807
Stainier, Annabelle; Tombal, Bertrand; Di Gregorio, Marcelo; Van Cauwenberghe, Gilles; Querton, Michaël; Fosseprez, Philippe; Lorge, Francis
Gallbladder torsion is a rare cause of acute gangrenous cholecystitis; its occurrence within an abdominal hernia has not been previously reported. We present such a case occurring within a parastomal hernia and imaged with unenhanced CT. PMID:24421934
Rosenblum, Jessica K.; Dym, R. Joshua; Sas, Norman; Rozenblit, Alla M.
Penile gangrene is a rare but unfortunate complication of surgical intervention and priapism shunts. The literature regarding penile gangrene following surgical correction of priapism is sparse, the majority of which dates back to thirty to forty years. Here, we present the case of a 60-year-old man who presented with priapism that required operative management with a modified Al-Ghorab shunt and eventually suffered from complete necrosis of the penis with abscess formation in both corpora cavernosa.
Ford-Glanton, Beneranda S.; Siddiqui, Sameer
Surgical treatment of Fournier's gangrene: use of cultured allogeneic keratinocytes
We discuss the value of the use of skin culturing as an addition to the classic treatment of Fournier's gangrene. A 32-year-old\\u000a morbidly obese man was admitted with signs of a severe septic shock syndrome due to Fournier's gangrene. He recovered completely\\u000a after an aggressive surgical débridement, combined with the use of broad spectrum antibiotics and invasive ventilator support\\u000a for
B. Oelbrandt; A. Krasznai; T. Bruyns; L. Duinslaeger; P. Reper; A. Vanderkelen; P. J. Guelinckx
Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively. PMID:25037301
Pandove, Paras K.; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K.
, gangrenous dermatomyositis, avian malignant edema, gas edema disease, wing rot, and blue wing disease in turkeys (Flicken and Wages, 1997). In chickens, blue wing disease is caused by chicken infectious anemia virus (Engstrom and Luthman, 1984... such as infectious bursal disease virus, chicken anemia virus, avian adenovirus infections, Marek?s disease, reovirus, and mycotoxins (Rosenberger et al., 1975; Hagood et al., 2000; Ritter, 2008). Gangrenous dermatitis often occurs secondary to skin hemorrhages...
Waneck, Casey R.
Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively. PMID:25037301
Pandove, Paras K; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K
Summary Objective: Evalution of low-intensity laser irradiation on the healing of bone affections and gangrene in patients suffering from diabetic microangiopathy. Design: Case-report study. Patients: Two consecutive diabetic male patients with gangrene, osteomyelitis, and bone fractures. Intervention: Helium-neon laser irradiation (36 J\\/cm2 ) 50 min\\/day. Main Outcome Parameter: Healing of gangrene and corticalis lesion as well as remineralisation of bone
M. Schindl; A. Schindl; D. Pölzleitner; L. Schindl
Developmental venous anomalies (DVA): The so-called venous angioma
Summary Following a review of the literature it is possible to demonstrate the "normality" of the so called venous angiomas. They should be named Developmental Venous Anomaly (DVA). They illustrate in their two extreme types (superfical and deep) the hemodynamic equilibrium of the transcortical venous drainage in the periependymal zones. Venous ectasias and varices which can be encountered, associated with
Pierre Lasjaunias; Patricia Burrows; Chantal Planet
We repaired four eyes in four patients with impending perforation using a vascular periosteal-temporalis fascia pedicle flap continuous to the periorbita of the orbital wall. Two eyes with extruding keratoprostheses, one eye with severe ocular surface dysfunction and a perforated, infected keratoplasty, and one eye with scleral ectasia were successfully reconstructed. Excellent visual acuity (20/25) was attained in one eye and functional visual acuity (20/100) was maintained in another. Structural integrity was maintained in all eyes. A vascularized flap was an excellent source of tissue for reconstructing eyes with impending perforation and scleral melting. PMID:2596551
Spoor, T C; Ramocki, J M; Cowden, J W
The etiology of venous ulceration
Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall
N. L. Browse
A total of 50 does were used to determine selected hematological and biochemical parameters with special references to oxidative stress markers, acute phase protein profiles, and proinflammatory cytokines in healthy and gangrenous mastitis affected does. Animals were divided into two equal groups represented as clinically healthy (control) and diseased groups, respectively. The bacteriological examination of milk samples from diseased does revealed many types of bacterial infection. The isolated bacteria were Staphylococcus aureus (N=23/25), Escherichia coli (N=11/25), and Clostridium perfringens (N=4/25). There was a significant increase in the levels of ?-hydroxybutyrate, non-esterified free fatty acids, triglyceride, low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase, and alanine aminotransferase and a significant reduction in the levels of glucose, cholesterol, and high density lipoprotein cholesterol (HDL-C) in does with gangrenous mastitis compared to healthy does. Moreover, there was a significant increase in the levels of malondialdehyde and uric acid with a significant decrease in the levels of reduced glutathione, super oxide dismutase, and catalase in does with gangrenous mastitis compared to healthy does. In addition, there was a significant increase in the haptoglobin, serum amyloid A, fibrinogen, interleukin 6 (IL-6), IL-1?, and tumor necrosis factor-? (TNF-?) in does with gangrenous mastitis compared to healthy ones. Conclusively, oxidative stress biomarkers, acute phase proteins, and proinflammatory cytokines play an essential task as biomarkers for gangrenous mastitis in does. Mastitis may be considered as one of the ketotic stressors in does after parturition. PMID:23303629
El-Deeb, Wael M.
Diagnosing Deep Venous Thrombosis
Patients often present with unexplained lower limb pain and swelling. It is important to exclude deep venous thrombosis in the diagnosis because of the threat of sudden death. Simple clinical diagnosis is unacceptable, and noninvasive tests should be used initially. Serial testing detects proximal extension of isolated calf thrombi. Multiple diagnostic modalities are employed to diagnose a new deep venous thrombosis in patients with postphlebitic syndrome. PMID:21221369
Doyle, D. Lynn
ERIC Educational Resources Information Center
The purpose of this study was to disclose the claims of an impending shortage of librarians in academic libraries as it relates to Historically Black Colleges and Universities (HBCUs). The target population of this study was HBCU libraries that had a full-time equivalent enrollment of 3,000 students or more and that were accredited by the Southern…
Youmans, Tasha Lucas
Honey in the treatment of Fournier's gangrene as an adjuvant: a cross sectional study.
Fournier's gangrene is a progressive polymicrobial necrotising infection. The purpose of this study was to assess the outcome of Fournier's gangrene infection in patients who received topical honey with their therapeutic regimens. The cross-sectional study included 17 patients with Fournier's gangrene. Under spinal anaesthesia, the necrotic areas were debrided. In the first week, every day, the wounds were cleansed with Betadine, normal saline, and 2% oxygenated water, then 30-50cc of honey was used after the wounds were dried. The wounds were then dressed. This method of dressing was taught to the patients' attendants. The granulation tissues, generally bright pink, were observed on the 10th day. Four (23.5%) patients underwent colostomy and 1 (5.9%) died. All the patients were discharged two weeks after the initial debridement. Compared with other studies, honey reduced the healing and hospitalisation time as well as additional costs. PMID:25272547
Haidari, Mohammad; Nazer, Mohammad Reza; Ahmadinejad, Mojtaba; Almasi, Vahid; Khorramabadi, Manouchehr Shams; Pournia, Yadollah
Peripheral Arterial Disease and Digital Gangrene: A Rare Presentation of Diabetic Hand Syndrome
Digital gangrene in upper limbs may be due to systemic sclerosis, trauma, connective tissue disorders, vasculitic disorders and various myeloproliferative disorders or as a part of tropical diabetes hand syndrome which follows trauma. Peripheral arterial disease in diabetics commonly involves lower limbs. The present case, 45-year-old diabetic, presented with dry gangrene in fingertips of both hands for last two weeks without any history of trauma or lower limb gangrene. On examination and workup of the patient was found to have bilateral upper limb arterio-occlusive disease involving ulnar vessels as a macrovascular complication of diabetes mellitus. This presentation of diabetic hand syndrome is very, very rare, hence being reported. PMID:24298503
Singh, Santokh; Chand, Gian; Charan, Shiv; Arora, Sahil; Singh, Parampreet
Fournier Gangrene as a Manifestation of Undiagnosed Metastatic Perforated Colorectal Cancer
Fournier gangrene is a necrotizing soft tissue infection involving the perineum. We present a case of Fournier gangrene as the clinical presentation of perforated metastatic rectal cancer. The patient is a 78-year-old man in a nursing home who presented to our institution with necrosis and ischemia of the scrotum. After wide debridement of necrotic tissue and bilateral orchiectomy, computed tomography was carried out to investigate abnormal findings seen on his chest X-ray, which revealed multiple pulmonary metastases as well as a mass highly suspicious for a perforated rectal mass. Once stable, a diverting colostomy and biopsies of the rectal mass were performed, confirming the presence of a metastatic, poorly differentiated rectal adenocarcinoma. Albeit an unusual etiology of Fournier gangrene, this case highlights the rare but important causes of this deadly condition and teaches us to be cognizant of the variations in the presentation of colorectal cancer. PMID:23438275
Chan, Cyrus C.; Williams, Mallory
We describe a 2-month-old girl with atypical Kawasaki disease (KD) complicated by peripheral gangrene and myocardial infarction. Peripheral ischaemia leading to gangrene is a rare but serious complication of KD in infants younger than 7 months of age. Treatment has been targeted at reducing arterial inflammation, arteriospasm and thrombosis. We report the first patient with incomplete KD and peripheral ischaemia in whom therapy with prostaglandin E1 (PGE1) as vasodilating and antithrombotic agent appeared successful, restoring hand and foot perfusion without significant long-term sequelae. However, PGE1 could have supported development of myocardial infarction by shunting blood away from ischaemic areas distal to a giant coronary artery aneurysm with beginning thrombosis. CONCLUSION. Atypical KD with peripheral gangrene appears to react favourably to treatment with PGE1, but needs careful monitoring to detect early signs of cardiac ischaemia. PMID:8529683
von Planta, M; Fasnacht, M; Holm, C; Fanconi, S; Seger, R A
Gangrene of the penis, scrotum, and perineum, occurred after radiotherapy of rectal cancer
We present a case of a 58-year-old man hospitalized because of gangrene of the penis and scrotum, after radiochemotherapy for rectal cancer. At the time of the admission the patient presented with extensive gangrene with necrosis affecting the scrotum and the penis. During the first day of hospitalization the patient was operated. Due to the progress of the disease he had to be operated again. The status of the patient, which initially was very bad, was gradually improving. He was discharged from the hospital after 59 days in a good general state with good wound healing. PMID:24707380
Zyczkowski, Marcin; Bryniarski, Piotr; Nowakowski, Krzysztof; Muskala, Bartosz; Paradysz, Andrzej
Fournier's Gangrene in a Two Year Old Child: A Case Report
Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any age but it is relatively uncommon in children. Here, we report a case of Fournier's gangrene in a two year old male child who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gave good results. PMID:25302233
Bains, Satinder Pal Singh; Singh, Vikram; Jain, Amit; Arry, Vivek
Fournier's Gangrene in a Two Year Old Child: A Case Report.
Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any age but it is relatively uncommon in children. Here, we report a case of Fournier's gangrene in a two year old male child who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gave good results. PMID:25302233
Bains, Satinder Pal Singh; Singh, Vikram; Gill, Manmeet Kaur; Jain, Amit; Arry, Vivek
The Role of X-Rays in the Treatment of Gas Gangrene: A Historical Assessment
While the use of x-rays to treat patients with gas gangrene ended in the early 1940's with the advent of antibiotics, x-ray had been widely accepted as a useful and highly effective treatment for this condition. The present paper re-assesses the historical foundations of this belief, the quality of the data, use of confirmatory animal models, and underlying mechanisms that might account for the therapeutic role of x-rays in the treatment of gas gangrene. PMID:23304109
Calabrese, Edward J.; Dhawan, Gaurav
Venous aneurysms are rare: only 311 cases of venous aneurysms and 56 cases of aneurysms in vein transplants have been reported since 1939 to date. 62% of the patients suffering from venous aneurysms were less than 40 years of age. The most frequently involved vessels were the internal jugular vein (n = 56), the portal vein (n = 28), the v. saphena magna (n = 30) the popliteal vein (n = 23), the azygos vein (n = 22) and the vena cava superior (n = 20). The diameters of the aneurysms were between 1 and 16 cm. Symptoms, if at all noticeable, depend on the localisation of the aneurysm, but they are unspecific in the majority of cases. The most frequent finding was the space- occupying growth seen in 190 patients (52%). Pulmonary embolisms originating from venous aneurysms were seen in 19/311 (6.1%), a rupture of an aneurysm in 4/311 (1.2%) of the venous aneurysms and 5/56 (8.9%) of the aneurysms in transplant veins, respectively. and were fatal in 1 (0.3%) and 2 (3.6%) of the cases, respectively. Of the 205 patients who were operated on, 3 (1.5%) died from intraoperative complications. PMID:1571374
Schild, H; Berg, S; Weber, W; Schmied, W; Steegmüller, K W
Venous Thromboembolism Prophylaxis
Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile. PMID:24436666
Laryea, Jonathan; Champagne, Bradley
Intrahepatic venous collaterals
. \\u000a \\u000a Background: The aim of this study was to reevaluate the causes and sites of intrahepatic venous collaterals and to determine the role\\u000a of color Doppler sonography in the diagnosis of this relatively rare vascular abnormality.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Real-time color Doppler sonography was used to study 21 patients with intrahepatic venous collaterals. The cause, distribution,\\u000a and clinical manifestations of collaterals were
H. Naganuma; H. Ishida; K. Konno; T. Komatsuda; Y. Hamashima; J. Ishida; O. Masamune
Clostridium tertium has been increasingly reported as a human pathogen. This organism is an aerotolerant Gram-positive rod that is often mistaken for other organisms, such as Lactobacillus or Bacillus species. We describe a case of a patient with a history of intravenous drug use presenting to UCLA-Olive View Medical Center with gas gangrene of both upper extremities. The organism was
Shigeki Fujitani; Chengxu X. Liu; Sydney M. Finegold; Yuli L. Song; Glenn E. Mathisen
Clostridium septicum is a spore-forming anaerobe frequently implicated in cases of gangrenous dermatitis (GD) and other spontaneously occurring myonecrotic infections of poultry. Although C. septicum is readily cultured from diseased tissues it can be difficult to enumerate due to its tendency to swarm over the surface of agar plates. In this study a quantitative real-time PCR assay was developed in
A. P. Neumann; S. M. Dunham; T. G. Rehberger; G. R. Siragusa
Sepsis with an Atopobium-Like Species in a Patient with Fournier's Gangrene
Atopobium species are Gram-positive, anaerobic, catalase-negative, fastidious bacteria belonging to the family Coriobacteriaceae. We report the isolation of an Atopobium-like species in a patient with Fournier's gangrene and highlight the role of 16S rRNA gene sequencing in the identification of fastidious organisms in the clinical laboratory. PMID:24153131
Oyaert, Matthijs; Cools, Piet; Breyne, Joke; Heyvaert, Gert; Vandewiele, Anne; Vaneechoutte, Mario; Vervaeke, Steven
Management of unusual genital lymphedema complication after Fournier's gangrene: a case report
Background Fournier's gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier's gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient. Case presentation Following perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier's gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a "penile lift" allowed a satisfactory esthetical and functional result. Conclusion Fournier's gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by "penile lift". PMID:23259537
Protected Iliofemoral Venous Thrombectomy
Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. Pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity. The cause was determined to be a severe protein S deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy. When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant. (Tex Heart Inst J 2002;29:130–2) PMID:12075871
Neri, Eugenio; Civeli, Letizia; Benvenuti, Antonio; Toscano, Thomas; Miraldi, Fabio; Capannini, Gianni; Muzzi, Luigi; Sassi, Carlo
Achieving an aesthetic appearance of the scrotum after extensive Fournier's gangrene is a reconstructive challenge. Testicular coverage is often prioritized over scrotal cosmesis due to the comorbidities typically seen in this patient population. We describe our treatment of a young, healthy male with extensive Fournier's gangrene, with loss of the scrotum. Bilateral neurotized anterolateral thigh flaps were used to achieve a sensate and aesthetically acceptable result. PMID:24554975
Dayan, Joseph H.; Clarke-Pearson, Emily M.; Dayan, Erez; Smith, Mark L.
Mechanical perturbations applied during impending movement evoke startle-like responses
Stretch reflexes have been considered one of the simplest circuits in the human nervous system. Yet, their role is controversial given that they assist or resist an imposed perturbation depending on the task instruction. Evidence shows that a loud acoustic stimulus applied prior to an impending movement elicits a movement-direction dependent muscle activity. In our study, we found that a perturbation can also trigger this early onset of movement, if applied during movement preparation. These responses were also perturbation direction dependent. This suggests an interaction of between the limb-stabilizing stretch reflexes and the voluntary activity. PMID:19963543
Ravichandran, Vengateswaran J.; Shemmell, Jonathan B.; Perreault, Eric J.
Intrauterine Extremity Gangrene and Cerebral Infarction at Term: A Case Report
Intrauterine extremity gangrene in combination with cerebral infarction is a serious and rare event. We present a case with a healthy mother who gave birth to a child with this condition. At term, the mother presented at the antenatal clinic with decreased fetal movements. Cardiotocography (CTG) showed signs of fetal distress and a caesarean section was performed. The left arm of the newborn was found gangrenous. Amputation of the arm was necessary and the child was subsequently treated with anticoagulant therapy due to thrombosis and cerebral infarction in the left hemisphere found by magnetic resonance imaging (MRI). At one year of age the boy was doing well and had prosthesis as a left arm. He had no signs of further complications. Despite thorough examination of the parents and the child, the reason for the thrombosis is still unknown. PMID:22606511
Tanvig, M.; J?rgensen, J. S.; Nybo, M.; Zachariassen, G.
Objective: The objective of this study was to determine the effectiveness of treatment of nonhealing heel ulcers and gangrene and to define those variables that are associated with success.Methods: A multi-institutional review was undertaken at four university or university-affiliated hospitals of all patients with wounds of the heel and arterial insufficiency, which was defined as absent pedal pulses and a
Gerald S Treiman; Gustavo S. C Oderich; Amir Ashrafi; Peter A Schneider
Objective: We report the outcomes of an early loose closure of the scrotum with a modified U-stitch to minimize use of split thickens skin graft for patients with hemiscrotal tissue loss after surgical debridement. Methods: From January 2006 to August 2011, 28 male patients presented with Fournier's gangrene, requiring major urological surgical care and scrotal debridement at Denver Health Medical Center. Surgical outcomes were compared between patients receiving a novel U-Stitch approximation and those treated by traditional management. Results: The mean age of the patients was 47.1 ± 10.2 years. In total 8 patients (2.2%) developed bacteremia and 3 (0.1%) had methicillin-resistant staphylococcus aureus (MRSA) infection. There was conversion from the U-Stitch approximation patients to traditional management. U-stitch patients required less hospitalization than patients requiring split-thickness skin graft (STSG) due to loss of >50% of the total scrotal tissue (11 vs. 35 days, p = 0.081). The U-stitch demonstrated non-inferiority to traditional treatment. Conclusion: Immediate loose scrotal wound approximation with efficient surgical debridement for Fournier's gangrene may prevent testis exposure facilitating local wound treatment, decreasing the length of hospital stay in patients with Fournier's gangrene involving the scrotum. Future randomized trials may validate these findings. PMID:23914264
Akilov, Oleg; Pompeo, Alexandre; Sehrt, David; Bowlin, Paul; Molina, Wilson R.; Kim, Fernando J.
Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy. PMID:23837143
Oh, Myung Jin
Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, self-help (advice to elevate leg, advice to keep leg active, advice to modify diet, advice to stop smoking, advice to reduce weight), and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative-pressure recombinant keratinocyte growth factor, platelet-derived growth factor). PMID:19445798
Ethical dilemmas related to predictions and warnings of impending natural disaster.
Scientists and policy makers issuing predictions and warnings of impending natural disaster are faced with two major challenges, that is, failure to warn and issuing a false alarm. The consequences of failure to warn can be serious for society overall, for example, significant economic losses, heavy infrastructure and environmental damage, large number of human casualties, and social disruption. Failure to warn can also have serious for specific individuals, for example, legal proceedings against disaster research scientists, as in the L'Aquila earthquake affair. The consequences of false alarms may be less serious. Nevertheless, false alarms may violate the principle of nonmaleficence (do no harm), affect individual autonomy (eg, mandatory evacuations), and may result in the "cry wolf" effect. Other ethical issues associated with natural disasters include the promotion of global justice through international predisaster technical assistance and postdisaster aid. Social justice within a particular country is promoted through greater postdisaster aid allocation to the less privileged. PMID:24481888
Phua, Kai-Lit; Hue, J W
The purpose of this study was to evaluate the frequency and characteristics of epilepsy associated with cerebral venous angiomas (VA). We examined epileptic patients in which magnetic resonance imaging (MRI) showed VA. The characteristics of epilepsy and its relationships to VA were studied. Out of 1020 epileptic patients submitted to MRI in a 10-year period, 4 presented with VA. All had partial seizures, most frequently complex partial, with secondary generalizations in 3. Drug resistance was observed in 2. One patient had a small area of cortical dysplasia near the VA; another had a cutaneous angioma. In 2 patients, there was no topographic concordance between the VA and the focus on electroencephalography. Our study reveals that VA are rarely found in epileptic patients, differently from other vascular malformations, in particular cavernomas. Topographic and/or etiological relationships between VA and epilepsy are still undefined. PMID:11076003
Striano, S; Nocerino, C; Striano, P; Boccella, P; Meo, R; Bilo, L; Cirillo, S
Venous thrombosis: the history of knowledge
Venous thrombosis is a frequent disease. It is surpris- ing, therefore, that no case truly compatible with a diag- nosis of venous thrombosis was apparently reported in the antiquity. There is no case that could be reasonably attributed to a venous thrombus in the writings of Hippocrates, Galenus, Celius Aurelianus, Ibn an-Nafiz, Avicenna and others. Venous thrombosis is not among
P. M. Mannucci
Leg ulceration in venous disease.
We have given a brief summary of the scale of the problem caused by venous ulceration in the UK, and have then reviewed the various theories of causation, including a historical survey, and presented the evidence for and against the two main current theories of fibrin cuffs and white cell trapping. We also outline previous hypotheses of the aetiology of venous ulceration, including arteriovenous microanastomoses, stasis and oedema. The contribution of superficial venous incompetence in the pathogenesis of ulceration is also examined. PMID:1461849
Shami, S. K.; Shields, D. A.; Scurr, J. H.; Smith, P. D.
Pycnogenol® in chronic venous insufficiency and related venous disorders.
The present review provides an update of the biological profile of Pycnogenol in the light of its use in the treatment of chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids. Pycnogenol is a French maritime pine bark extract produced from the outer bark of Pinus pinaster Ait. subsp. atlantica. Its strong antioxidant, anti-inflammatory and vasodilator activities, antithrombotic effects and collagen stabilizing properties make it uniquely able to target the multi facet pathophysiology of CVI and related venous disorders. Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration. This review highlights clinical research findings on the safety, compliance and efficacy of Pycnogenol, including its use in combination products. PMID:23775628
Gulati, Om P
Staphylococcus aureus mastitis in dairy sheep ranges from subclinical mastitis to lethal gangrenous mastitis. Neither the S. aureus virulence factors nor the host-factors or the epidemiological events contributing to the different outcomes are known. In a field study in a dairy sheep farm over 21 months, 16 natural isolates of S. aureus were collected from six subclinical mastitis cases, one lethal gangrenous mastitis case, nasal carriage from eight ewes and one isolate from ambient air in the milking room. A genomic comparison of two strains, one responsible for subclinical mastitis and one for lethal gangrenous mastitis, was performed using multi-strain DNA microarrays. Multiple typing techniques (pulsed-field-gel-electrophoresis, multiple-locus variable-number, single-nucleotide polymorphisms, randomly amplified polymorphic DNA, spa typing and sas typing) were used to characterise the remaining isolates and to follow the persistence of the gangrenous isolate in ewes' nares. Our results showed that the two strains were genetically closely related and they shared 3 615 identical predicted open reading frames. However, the gangrenous mastitis isolate carried variant versions of several genes (sdrD, clfA-B, sasA, sasB, sasD, sasI and splE) and was missing fibrinogen binding protein B (fnbB) and a prophage. The typing results showed that this gangrenous strain emerged after the initial subclinical mastitis screening, but then persisted in the flock in the nares of four ewes. Although we cannot dismiss the role of host susceptibility in the clinical events in this flock, our data support the hypothesis that S. aureus populations had evolved in the sheep flock and that S. aureus genetic variations could have contributed to enhanced virulence. PMID:19576164
Vautor, Eric; Cockfield, Joshua; Le Marechal, Caroline; Le Loir, Yves; Chevalier, Marlčne; Robinson, D Ashley; Thiery, Richard; Lindsay, Jodi
Fournier's Gangrene Complicating Hematologic Malignancies: a Case Report and Review of Licterature
Fournier's gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease. A review of the scientific literature focusing on the topic of FG complicating hematologic disorders is reported PMID:24363882
D'Arena, Giovanni; Pietrantuono, Giuseppe; Buccino, Emilio; Pacifico, Giancarlo; Musto, Pellegrino
Varicose veins and venous insufficiency
Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 65. Goldman MP, ...
... treat a venous ulcer, you want to improve blood flow to your legs. Wear compression stockings or bandages ... or exercise every day. Being active helps improve blood flow. Take medications as directed to help with healing. ...
Venous Thromboembolism and Marathon Athletes
... Sign In Cardiology Patient Page Venous Thromboembolism and Marathon Athletes Claire M. Hull , PhD ; Julia A. Harris , ... general adult population are indisputable. However, for the marathon athlete who trains intensively and for long periods ...
Heritability of chronic venous disease
Varicose veins without skin changes have a prevalence of approximately 20% in Northern and Western Europe whereas advanced\\u000a chronic venous insufficiency affects about 3% of the population. Genetic risk factors are thought to play an important role\\u000a in the aetiology of both these chronic venous diseases (CVD). We evaluated the relative genetic and environmental impact upon\\u000a CVD risk by estimating
Andreas Fiebig; Petra Krusche; Andreas Wolf; Michael Krawczak; Birgitt Timm; Susanna Nikolaus; Norbert Frings; Stefan Schreiber
[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases].
Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases. PMID:21450384
Ettalbi, S; Benchamkha, Y; Boukind, S; Droussi, H; Ouahbi, S; Soussou, M; Elatiqi, K; Lakmichi, M A; Dahami, Z; Moudouni, S M; Sarf, I; Rabbani, K; Louzi, A; Benelkhaiat, R; Finech, B
[Duplexsonography investigation in patients with venous ulcer].
Venous hypertension due to venous insufficiency causes venous ulcers. Duplexsonography is a widely accepted non invasive method to assess venous insufficiency with venous reflux measurements. Retrograde venous flow is defined as venous reflux. The testing of venous reflux is reliable if transvalvular pressure is sufficiently high and transvalvular flow velocity exceeds 30 cm/s. Reflux testing in the proximal leg veins (V. femoralis communis, V. femoralis, V. saphena magna) is done using a standardised Valsalva Manoeuvre (exspiration into a tube up to a pressure of 30 mmHg, pressure established within 0.5 seconds, pressure hold for 3 seconds). Distal leg vein testing (V. poplitea, V. tibialis posterior, V. saphena parva) is recommended with a two handed - compression distally to the tested veins. The most important parameter is venous reflux time, a cut off of > 2 seconds is recommended. PMID:21360458
Jeanneret-Gris, Christina
Using a rodent model of ischemic stroke [permanent middle cerebral artery occlusion (pMCAO)], our laboratory has previously demonstrated that sensory-evoked cortical activation via mechanical single whisker stimulation treatment delivered under an anesthetized condition within 2 h of ischemic onset confers complete protection from impending infarct. There is a limited time window for this protection; rats that received the identical treatment at 3 h following ischemic onset lost neuronal function and sustained a substantial infarct. Rats in these studies, however, were anesthetized with sodium pentobarbital or isoflurane, whereas most human stroke patients are typically awake. To optimize our animal model, the present study examined, using functional imaging, histological, and behavioral analysis, whether self-induced sensorimotor stimulation is also protective in unrestrained, behaving rats that actively explore an enriched environment. Rats were revived from anesthesia either immediately or at 3 h after pMCAO, at which point they were allowed to freely explore an enriched environment. Rats that explored immediately after ischemic onset maintained normal cortical function and did not sustain infarct, even when their whiskers were clipped. Rats that were revived at 3 h post-pMCAO exhibited eliminated cortical function and sustained cortical infarct. Further, the data suggested that the level of individual active exploration could influence the outcome. Thus, early activation of the ischemic cortical area via unrestrained exploration resulted in protection from ischemic infarct, whereas late activation resulted in infarct, irrespective of the level of arousal or whisker-specific stimulation. PMID:25216240
Lay, Christopher C; Frostig, Ron D
Systemic venous drainage: can we help Newton?
In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton. PMID:17336540
Corno, Antonio F
... PedFACTs) Teaching Package Infant CPR Anytime® Dark Skin (English/Spanish) Allergies and Asthma Nutrition: What Every Parent Needs to Know Infant CPR Anytime® (English/Spanish) Health Issues Conditions Abdominal ADHD Allergies & Asthma ...
Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025
Chan, Cyrus C.; Shahrour, Khaled; Collier, Ronald D.; Welch, Marlene; Chang, Shiliang; Williams, Mallory
Venous aneurysm was diagnosed in a 3-year-old horse, using contrast radiography and acid-base analysis of blood samples taken simultaneously from the right jugular vein and a swelling in the right mandibular angle. Attempted surgical correction was followed by rupture of the right maxillary vein. Hemorrhagic shock developed, and the horse died. PMID:1158779
Hilbert, B J; Rendano, V T
Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria
Background: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. Results: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. Conclusion: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene. PMID:24497752
Bakari, Abubakar A; Ali, Nuhu; Gadam, Ibrahim A; Gali, Bata M; Tahir, Chubado; Yawe, KDT; Dahiru, Adamu B; Mohammed, Baba S; Wadinga, Dauda
A 62-year-old-man presented to our hospital with complaints of coldness, numbness, pain, weakness and cyanosis on the fingers and toes in March 2010. Laboratory findings revealed marked eosinophilia (46.6%; WBC 20600/?l), an elevation of serum creatine kinase, proteinuria and hematuria. He was diagnosed as hypereosinophilic syndrome (HES) without evidence to support a diagnosis of underlying diseases causing eosinophilia. After the initiation of corticosteroid therapy, peripheral eosinophil count was dramatically decreased, and both serum CK value and urinary findings became normalized. However, his symptoms persisted and digital necrotic changes developed. Angiography of the bilateral upper and lower extremities showed multiple arterial occlusions with poor collaterals. The digital gangrenes were unresponsive to peripheral circulation ameliorators and gradually progressed. In July 2010, autologous transplantation of bone marrow mononuclear cells was performed for achievement of therapeutic angiogenesis. His digital skin color was ameliorated by the angiogenic therapy in two weeks, and digital gangrenes did not progress after that. After amputation of his fingers and toe, cut surfaces healed with favorable epithelization, and the symptoms were subsequently eliminated. Moreover, during three years after the therapy, as well as the effect on the skin lesion, the significant improvement in peripheral circulation was observed. Therefore, we proposed that therapeutic angiogenesis by autologous bone marrow mononuclear cells transplantation was a novel and effective treatment for intractable digital gangrene associated with HES. PMID:24835138
Azuma, Naoto; Matoba, Satoaki; Nishioka, Aki; Muramoto, Mutsuko; Ueda, Eiichiro; Hatakeda, Noriko; Manabe, Ran; Kou, Masahiro; Iwamura, Yumi; Nozaki, Yuko; Matsui, Kiyoshi; Sano, Hajime
Management strategy for facial venous malformations
Venous malformations (VMs) are slow-flow vascular malformations, caused by abnormalities in the development of the veins. Venous malformations vary in size and location within the body. When the skin or tissues just under the skin are affected, they appear as slightly blue-colored skin stains or swellings. These can vary in size from time to time because of swelling within the malformation. As these are vascular malformations, they are present at birth and grow proportionately with the child. Venous malformations can be very small to large in size, and sometimes, can involve a significant area within the body, When the venous malformation is well localized, this may cause localized swelling, however, when the venous malformation is more extensive, there may be more widespread swelling of the affected body part. Some patients with venous malformations have abnormal blood clotting within the malformation. Most venous malformations cause no life-threatening problems for patients. Some venous malformations cause repeated pain due to intermittent swelling and congestion of the malformation or due to the formation of blood clots within the malformation. Rarely, venous malformations may be part of a syndrome (an association of several clinically recognizable features) or be linked to an underlying genetic abnormality. We present 12 cases of venous malformations of the head and neck area, which have been managed at our hospital.
Kumar, Shailendra; Kumar, Vijay; Kumar, Sanjeev; Kumar, Surender
The venous system of the lower limbs.
The venous system anatomy of the lower limbs and especially its functionality still presents half-lighted areas, fact easily qualified as incredible for the third millennium. Our dissections on fresh amputation segments, methylene blue injected in superficial veins or in deeper veins pointed out that venous circulation is much more complex than it seemed, that there are subdermal collectors connected to the saphene trunks which permit bidirectional transfer of blood mass to saphene venous roots or to derm. The dermal plexus has also a complex connection with the deep venous system by Delater perforators, by perforators, which drain saphene systems after having previously received dermal affluents, and by Delater equivalences (submillimetric perforators) that provide blood mass transfer from deep to surface under the conditions of a moderate and temporary venous hypertension. High- and long-term venous hypertension determines the valvular device deterioration of classical perforators making possible a pathological bi-directional flow. PMID:18060185
Calot?, F; Mogoant?, S; Intorcaciu, M; Pa?alega, M; Popescu, Carmen Florina; Vasile, I; Me?in?, C
Ruptured venous aneurysm of cervicomedullary junction
Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual. Case Description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein. Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion. PMID:24575317
Aggarwal, Ashish; Salunke, Pravin; Futane, Sameer; Mathuriya, S. N.; Kumar, Ajay; Mukherjee, K. K.; Radotra, B. D.
Clostridium septicum is a spore-forming anaerobe frequently implicated in cases of gangrenous dermatitis (GD) and other spontaneously occurring myonecrotic infections of poultry. Although C. septicum is readily cultured from diseased tissues it can be difficult to enumerate due to its tendency to swarm over the surface of agar plates. In this study a quantitative real-time PCR assay was developed in order to more accurately measure the levels of C. septicum in healthy as well as GD associated poultry samples. The assay was specifically designed to target the C. septicum alpha toxin gene, csa, which is, to our knowledge, carried by all strains of C. septicum and has been shown to be essential for virulence. Genomic DNAs from a diverse collection of bacterial species, including closely related Clostridium chauvoei, Clostridium carnis, Clostridium tertium as well as several strains of Clostridium perfringens, all failed to produce a positive reaction. An approximate reproducible limit of detection in spiked extracts of at least 10(3) cfu/g of C. septicum was observed for a variety of different sample types. C. septicum levels in broiler chicken field samples estimated from the results of qPCR were statistically correlated to culture based enumerations obtained from those same tissues. PMID:20399850
Neumann, A P; Dunham, S M; Rehberger, T G; Siragusa, G R
Clostridium tertium has been increasingly reported as a human pathogen. This organism is an aerotolerant Gram-positive rod that is often mistaken for other organisms, such as Lactobacillus or Bacillus species. We describe a case of a patient with a history of intravenous drug use presenting to UCLA-Olive View Medical Center with gas gangrene of both upper extremities. The organism was initially misidentified as a Lactobacillus species on aerobic culture plates. However, terminal spore formation was detected in this isolate on a sub-cultured anaerobic culture plate and this isolate was confirmed as C. tertium biochemically and genetically by 16S rDNA sequencing. Additional DNA cloning libraries made from the formalin-fixed specimen revealed Peptoniphilus species and an uncultured Clostridium clone, but not C. tertium. C. tertium might be a causative organism of gas-producing myonecrosis but such an association has never been described. Clinicians should be aware of the phenomenon of aerotolerance of some anaerobes and need to clarify the identification of organisms if the clinical picture does not fit the isolated organism. PMID:17446094
Fujitani, Shigeki; Liu, Chengxu X; Finegold, Sydney M; Song, Yuli L; Mathisen, Glenn E
Fournier's gangrene is still a major cause for the development of soft tissue defects of the perineum and is associated with a mortality of 40-67% of all patients. Along with the initial life-preserving treatment such as broad-spectrum antibiotics and multifold agressive surgical debridement, reconstruction of the body contour is of the utmost importance for these patients. An individual adjustment of treatment in every single case is required due to the wide variety of the resulting complex soft tissue defects and differing patient profiles. Most publications describe the use of musculo- or fasciocutaneous flaps for scrotal reconstruction. In this paper, we present two cases of successfully performed plastic reconstructions of the scrotum using a solely muscular gracilis flap to cover the exposed testicles, followed by a split-skin graft to cover the muscle. The plasticity of the muscle and the variability of flap design resulted along with the transplanted mesh-graft in an excellent outcome for the patient with respect to function, form and quality of life. PMID:19421949
Noack, Niklas; Spierer, R
21 CFR 870.1140 - Venous blood pressure manometer.
Code of Federal Regulations, 2010 CFR
...2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section...Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device...
Cerebral Venous Sinuses: Anatomical Variants or Thrombosis?
Anatomical variations of the posterosuperior dural venous sinuses and, in particular, the absence or hypoplasia of one of them has been described in several studies. However, no recent detailed analysis on the subject exists. Cerebral venous thrombosis is quite often evoked, although rarely confirmed, when the physician is faced with patients having various neurological problems. In fact, for a number
A. Zouaoui; G. Hidden
Lymphatic Leak Complicating Central Venous Catheter Insertion
Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.
Barnacle, Alex M., E-mail: firstname.lastname@example.com; Kleidon, Tricia M. [Great Ormond Street Hospital for Children, Department of Radiology (United Kingdom)
Arterial and venous compromise by an osteochondroma
A 9.5-year-old girl had popliteal arterial and venous compression by a distal femoral osteochondroma. Magnetic resonance imaging demonstrated the relation of the vessels to the osteochondroma and a three-phase bone scintigram showed asymmetry of arterial perfusion and evidence of venous stasis.
R. M. Shore; A. K. Poznanski; E. C. Anandappa; L. S. Dias
Causes of venous ulceration: a new hypothesis
Previous hypotheses about the causes of venous ulceration are inconsistent with recently published data. In patients with chronic venous insufficiency the number of functioning capillary loops visible in the skin on microscopy fell after the legs had been dependent for 30 minutes. Another study had shown that leucocytes became trapped in the circulation in dependent legs. A new hypothesis linking
P D Coleridge Smith; P Thomas; J H Scurr; J A Dormandy
Thrombophilia in children with venous thromboembolic disease
Venous thromboembolic events (VTEs) in children are usually associated with underlying clinical conditions such as central venous line, cancer and cardiac diseases. The objective of this review is to present the importance of thrombophilia to the occurrence of childhood VTE. The reported prevalence of thrombophilia in children with VTE varies extremely between 10% and 78% in different registries. The variation
Shoshana Revel-Vilk; Gili Kenet
Heritability of chronic venous disease
Varicose veins without skin changes have a prevalence of approximately 20% in Northern and Western Europe whereas advanced chronic venous insufficiency affects about 3% of the population. Genetic risk factors are thought to play an important role in the aetiology of both these chronic venous diseases (CVD). We evaluated the relative genetic and environmental impact upon CVD risk by estimating the heritability of the disease in 4,033 nuclear families, comprising 16,434 individuals from all over Germany. Upon clinical examination, patients were classified according to the CEAP guidelines as either C2 (simple varicose veins), C3 (oedema), C4 (skin changes without ulceration), C5 (healed ulceration), or C6 (active ulcers). The narrow-sense heritability (h2) of CVD equals 17.3% (standard error 2.5%, likelihood ratio test P = 1.4 × 10?13). The proportion of disease risk attributable to age (at ascertainment) and sex, the two main risk factors for CVD, was estimated as 10.7% (Kullback–Leibler deviance R2). The heritability of CVD is high, thereby suggesting a notable genetic component in the aetiology of the disease. Systematic population-based searches for CVD susceptibility genes are therefore warranted. PMID:20354728
Krusche, Petra; Wolf, Andreas; Krawczak, Michael; Timm, Birgitt; Nikolaus, Susanna; Frings, Norbert; Schreiber, Stefan
Travel, venous thromboembolism, and thrombophilia.
Current evidence indicates that prolonged air travel predisposes to venous thrombosis and pulmonary embolism. An effect is seen once travel duration exceeds 6 to 9 hours and becomes obvious in long-haul passengers traveling for 12 or more hours. A recent records linkage study found that increase in thrombosis rate among arriving passengers peaked during the first week and was no longer apparent after 2 weeks. Medium- to long-distance travelers have a 2- to 4-fold increase in relative thrombosis risk compared with nontravelers, but the averaged absolute risk is small (approximately one symptomatic event per 2 million arrivals, with a case-fatality rate of approximately 2%) and there is no evidence that thrombosis is more likely in economy class than in business- or first-class passengers. It remains uncertain whether and to what extent thrombosis risk is increased by short-distance air travel or prolonged travel by motorcar, train, or other means. Most travelers who develop venous thrombosis or pulmonary embolism also have one or more other predisposing risk factors that may include older age, obesity, recent injury or surgery, previous thrombosis, venous insufficiency, malignancy, hormonal therapies, or pregnancy. Limited (though theoretically plausible) evidence suggests that factor V Leiden and the prothrombin gene mutation predispose to thrombosis in otherwise healthy travelers. Given that very many passengers with such predispositions do not develop thrombosis, and a lack of prospective studies to link predisposition with disease, it is not now possible to allocate absolute thrombosis risk among intending passengers or to estimate benefit-to-risk ratios or benefit-to-cost ratios for prophylaxis. Randomized comparisons using ultrasound imaging indicate a measurable incidence of subclinical leg vein thrombosis after prolonged air travel, which appears to increase with travel duration and is reduced by graded pressure elastic support stockings. Whether this surrogate outcome measure translates into clinical benefit remains unknown, but support stockings are likely to be more effective and have less adverse effects than the use of aspirin. PMID:15706480
Gallus, Alexander S
[Venous thromboembolism in the elderly].
Venous thromboembolism (VTE) is a common disease and has a high impact on morbidity, mortality, and costs of care. The majority of patients with VTE are aged > or = 65 years, making VTE essentially a disease of the elderly. Despite its high prevalence and the fact that VTE has a less favourable outcome in elderly patients (e.g., higher rate of mortality, major bleeding, and post-thrombotic syndrome), older patients are underrepresented in prospective studies of VTE. Moreover, little is known about patient factors that determine medical outcomes, quality of life, and costs of care in elderly patients with VTE. The goal of this article is to review the existing evidence regarding VTE in the elderly. A prospective multicenter Swiss cohort study will examine medical outcomes, quality of life, and medical resource utilization in elderly patients with VTE. PMID:19968026
Méan, M; Aujesky, D
Venous thromboembolism in malignant gliomas
Summary Malignant gliomas are associated with a very high risk of venous thromboembolism (VTE). While many clinical risk factors have previously been described in brain tumor patients, the risk of VTE associated with newer anti-angiogenic therapies such as bevacizumab in these patients remains unclear. When VTE occurs in this patient population, concern regarding the potential for intracranial hemorrhage complicates management decisions regarding anticoagulation, and these patients have a worse prognosis than their VTE-free counterparts. Risk stratification models identifying patients at high risk of developing VTE along with predictive plasma biomarkers may guide the selection of eligible patients for primary prevention with pharmacologic thromboprophylaxis. Recent studies exploring disordered coagulation, such as increased expression of tissue factor (TF), and tumorigenic molecular signaling may help to explain the increased risk of VTE in patients with malignant gliomas. PMID:19912518
Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans
NASA Technical Reports Server (NTRS)
Human venous compliance hypothetically decreases from upper to lower body as a mechanism for maintenance of the hydrostatic indifference level 'headward' in the body, near the heart. This maintains cardiac filling pressure, and thus cardiac output and cerebral perfusion, during orthostasis. This project entailed four steps. First, acute whole-body tilting was employed to alter human calf and neck venous volumes. Subjects were tilted on a tilt table equipped with a footplate as follows: 90 deg, 53 deg, 30 deg, 12 deg, O deg, -6 deg, -12 deg, -6 deg, O deg, 12 deg, 30 deg, 53 deg, and 90 deg. Tilt angles were held for 30 sec each, with 10 sec transitions between angles. Neck volume increased and calf volume decreased during head-down tilting, and the opposite occurred during head-up tilt. Second, I sought to cross-validate Katkov and Chestukhin's (1980) measurements of human leg and neck venous pressures during whole-body tilting, so that those data could be used with volume data from the present study to calculate calf and neck venous compliance (compliance = (Delta)volume/(Delta)pressure). Direct measurements of venous pressures during postural chances and whole-body tilting confirmed that the local changes in venous pressures seen by Katkov and Chestukhin (1980) are valid. The present data also confirmed that gravitational changes in calf venous pressure substantially exceed those changes in upper body venous pressure. Third, the volume and pressure data above were used to find that human neck venous compliance exceeds calf venous compliance by a factor of 6, thereby upholding the primary hypothesis. Also, calf and neck venous compliance correlated significantly with each other (r(exp 2) = 0.56). Fourth, I wished to determine whether human calf muscle activation during head-up tilt reduces calf venous compliance. Findings from tilting and from supine assessments of relaxed calf venous compliance were similar, indicating that tilt-induced muscle activation is relatively unimportant. Low calf venous compliance probably results from stiffer venous, skeletal muscle, and connective tissues, and better-developed local and central neural controls of venous distensibility. This research establishes that upper-to-lower body reduction of venous compliance can explain headward positioning of the hydrostatic indifference level in humans.
Watenpaugh, Donald E.
[Central venous catheter with a poor flow].
Insertion of a central venous catheter is a quite common procedure; for instance in USA it is done for approx. five million patients per year. At the operating department of Meilahti hospital, central venous catheters have been placed as a main or side procedure for approx. 2000 patients per year. In addition, central venous catheters are placed in emergency departments and in some operational units, such as dialysis catheters in dialysis units. Although the application of ultrasound imaging has now resulted in improved patient safety, complications continue to occur. To exclude complications, a chest X-ray is often taken after the procedure. The control image may reveal even unexpected issues. PMID:25272788
Niemi-Murola, Leila; Jousela, Irma
Measurement of venous compliance (8-IML-1)
NASA Technical Reports Server (NTRS)
The prime objective of this International Microgravity Laboratory (IML-1) investigation is to measure the bulk compliance (distensibility) of the veins in the lower leg before, during, and after spaceflight. It is of particular interest whether venous compliance over the range of both positive and negative transmural pressures (various states of venous distention and collapse) changes throughout the duration of spaceflight. Information concerning the occurrence and character of compliance changes could have implications for the design of improved antigravity suits and further the understanding of inflight and postflight venous hemodynamics.
Thirsk, R. B.
Strain gauge plethysmography (SGP) is a non-invasive method used in the detection of deep venous thrombosis (DVT). The technique\\u000a is based on the measurement of calf volume changes in response to venous occlusion by a thigh cuff, the volume changes reflecting\\u000a the rates of arterial inflow and venous outflow. A numerical model of the blood circulation within the limb and
I. C. Turner; M. A. McNally; B. M. O'Connell; E. A. Cooke; W. G. Kernohan; R. A. B. Mollan
Asian venous thromboembolism guidelines: prevention of venous thromboembolism.
Venous thromboembolism (VTE) prophylaxis is under-utilized in Asia because of the misconception that its incidence is lower in Asians as compared to the Caucasians. The available data on VTE in Asia is limited due to the lack of well-designed multicenter randomized controlled trials as well as non-standardized research designs, making data comparison difficult. Emerging data indicates that the VTE incidence is not low in Asia, and is comparable to that reported in the Western literature in some instances. There is also a trend towards increasing incidence of VTE, as demonstrated by a number of hospital-based studies in Asia. This could be attributed to lifestyle changes, ageing population, increasing awareness of VTE and wider availability of Duplex ultrasound. The risk of VTE in hospitalized patients remain the same in Asians and Caucasians, even though there may be factors that are inherent to patients in Asia that influence the slight variation in incidence. The utilization rate of VTE prophylaxis remains suboptimal in Asia. The Asian Venous Thrombosis Forum (AVTF) comprises participants from various countries such as China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand and experts from Australia and Europe. The forum evaluated the available data on VTE from the Asian region and formulated guidelines tailored to meet the needs of the region. We recommend that serious considerations are given to VTE prophylaxis especially in the at-risk group and a formal hospital policy be established to facilitate the implementation. On admission to the hospital, we recommend assessing the patients for both VTE and bleeding risk. We recommend mechanical prophylaxis for patients at increased risk of bleeding and utilizing it as an adjunctive measure in combination with pharmacological prophylaxis in patients with high risk of VTE. For patients undergoing general or gynecological surgery and with moderate risk for VTE, we recommend prophylaxis with one of the following: low dose unfractionated heparin (LDUH), low molecular weight heparin (LMWH), fondaparinux or intermittent pneumatic compression (IPC). For the same group of patients at high risk of VTE, we recommend pharmacological or combination of pharmacological and mechanical prophylaxis. For patients undergoing major orthopedic surgeries like total hip replacement, total knee replacement and proximal hip fracture surgery, we recommend using one of the following: LMWH, fondaparinux, rivaroxaban, apixaban, edoxaban, dabigatran, warfarin or aspirin with IPC. For patients admitted to the hospital with acute medical illness and has moderate risk of VTE, we recommend prophylaxis with LDUH, LMWH or Fondaparinux. For the same group at high risk of VTE, we recommend combination of pharmacological and mechanical prophylaxis. PMID:23222928
Liew, N C; Chang, Y H; Choi, G; Chu, P H; Gao, X; Gibbs, H; Ho, C O; Ibrahim, H; Kim, T K; Kritpracha, B; Lee, L H; Lee, L; Lee, W Y; Li, Y J; Nicolaides, A N; Oh, D; Pratama, D; Ramakrishnan, N; Robless, P A; Villarama-Alemany, G; Wong, R
Trends in the incidence of venous stasis syndrome and venous ulcer: A 25-year population-based study
Background: The incidence rates of venous stasis syndrome and venous ulcer are uncertain, and trends in incidence are unknown. Methods: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of venous stasis syndrome and venous ulcer during the 25-year period, 1966 to 1990, and to
John A. Heit; Thom W. Rooke; Marc D. Silverstein; David N. Mohr; Christine M. Lohse; Tanya M. Petterson; W. Michael O'Fallon; L. Joseph Melton
Developmental venous anomaly (DVA), formally known as venous angioma, is a congenital anatomic variant of the venous drainage of the brain. Although they typically have a benign clinical course and a low symptomatic rate, thrombosis of a drainage vein may occur, leading to potentially debilitating complications. We report a unique case of spontaneous thrombosis of a posterior fossa developmental venous anomaly with cerebellar infarct in a 61-year-old man who presented with acute onset cerebellar ataxia. DVA thrombosis was well-depicted on CT and MR studies. Patient was put on anticoagulant therapy and complete recanalization was seen on follow-up imaging. PMID:24676737
Agarwal, Amit; Kanekar, Sangam; Kalapos, Paul; Vijay, Kanupriya
Chronic Venous Disease (Beyond the Basics)
... problems, and preventing and treating ulcers. (See "Medical management of lower extremity chronic venous disease" .) Leg elevation — Simply elevating the legs above heart level for 30 minutes three or four times per ...
Pathophysiology of spontaneous venous gas embolism
NASA Technical Reports Server (NTRS)
The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.
Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.
Dabigatran etexilate in venous thromboembolism.
Dabigatran etexilate (Pradaxa) is the orally available prodrug of dabigatran, a potent compound belonging to the new class of nonpeptide direct thrombin inhibitors (DTIs). Following oral administration, dabigatran etexilate reached peak plasma concentrations within 2 hours, showed linear pharmacokinetics across a wide dose range, a linear relationship between ecarin clotting time (ECT) and international normalized ratio (INR), and no significant food or drug interactions. Dabigatran etexilate at once-daily doses of 150 mg and 220 mg has demonstrated non-inferiority to once-daily enoxaparin 40 mg for the prevention of venous thromboembolism (VTE) in patients undergoing total hip or knee replacement surgery in two large, randomized, double-blind clinical trials. The safety profile of dabigatran etexilate was similar to that of enoxaparin with comparable rates of major bleeding, liver enzyme elevation and acute coronary events. Oral availability of dabigatran etexilate, together with a rapid onset and offset of action and predictable anticoagulation response, makes this compound an attractive alternative to traditional anticoagulant therapies for the prevention of VTE. PMID:20069135
Ferrer, Elisa
HIV-Associated Venous Thromboembolism
HIV infection has been recognized as a prothrombotic condition and this association has now been proven by a large number of studies with a reported VTE frequency among HIV-infected patients ranging from 0.19% to 7,63 %/year. HIV infection is associated with a two to tenfold increased risk of venous thrombosis in comparison with a general population of the same age. Some risk factors demonstrated a strongest association with VTE such as, low CD4+ cell count especially in the presence of clinical AIDS, protein S deficiency, and protein C deficiency. Whereas other risk factors are still controversial like protease inhibitor therapy, presence of active opportunistic infections and presence of antiphospholipid antibodies, including anticardiolipin antibodies and lupus anticoagulant. Physicians caring for HIV positive patients should be able to recognize and treat not only the well-known opportunistic infections and malignancies associated with this chronic disease, but also be alert to the less well-known complications such as thromboses. Pulmonary embolism should be included in the differential diagnosis when patients with HIV/AIDS have unexplained dyspnea or hypoxemia. In younger individuals with VTE, especially men, without other identifiable risk factors for VTE, HIV should be considered. Because interactions between warfarin and antiretrovirals is possible, health care providers should also be alert to the potential of dangerously high or low INRs when they are giving anticoagulants to patients with HIV infection who are undergoing antiretroviral therapy. PMID:21869916
Bibas, Michele; Biava, Gianluigi; Antinori., Andrea
A 72 year-old woman was admitted with a one-week history of weakness, right limb pain and progressive breathlessness. Her blood pressure was 60/40 mmHg, ECG showed inverted T waves in the precordial leads and incomplete right bundle branch block (RBBB). Transthoracic echocardiography revealed a large serpentine mobile mass across the atrial septum and mitrale valve extending into the left ventricular cavity. The right ventricle was dilated and peak systolic tricuspid annular velocity (RV-Sm) was 6.5 cm/sn, indicate right ventricular systolic function was severely depressed. Transoesophageal echocardiography showed a large, mobile thrombus in the foramen ovale, extending into the left atrium and ventricle. As the patient was in a haemodynamically compromised condition, high dose rapid infusion of streptokinase was administered. However, the thrombus did not fully resolve with this intervention. Therefore, low dose continuous streptokinase infusion was administered for an additional 72 h resulting in full resolution of the lesion by the third day of therapy. The optimal management of impending paradoxical embolism remains unclear. Prolonged continuous thrombolytic infusion may be a option for patients who do not experience full resolution of high risk thrombi with conventional thrombolytic therapy. PMID:22079089
Turfan, Murat; Vatankulu, Mehmet Akif; Murat, Sani Namik; Oksuz, Fatih; Duran, Mustafa; Ornek, Ender
Noninvasive measurement of internal jugular venous oxygen saturation by photoacoustic imaging
NASA Astrophysics Data System (ADS)
The metabolic rate and oxygen consumption of the brain is reflected in jugular venous oxygen saturation. In many clinical conditions, such as head trauma, stroke, and low cardiac output states, the brain is at risk for hypoxic-ischemic injury. The current gold standard for monitoring brain oxygenation is invasive and requires jugular vein catheterization under fluoroscopic guidance; and therefore it is rarely used. Photo-acoustic tomography in combination with ultrasound can be used to estimate oxygen saturation of the internal jugular vein in real-time. This noninvasive method will enable earlier detection and prevention of impending hypoxic brain injury. A wavelength-tunable dye laser pumped by a Nd:YAG laser delivers light through an optical fiber bundle, and a modified commercial ultrasound imaging system (Philips iU22) detects both the pulse-echo ultrasound (US) and photoacoustic (PA) signals. A custom-built multichannel data acquisition system renders co-registered ultrasound and photoacoustic images at 5 frames per second. After the jugular vein was localized in healthy volunteers, dualwavelength PA images were used to calculate the blood hemoglobin oxygen saturation from the internal jugular vein in vivo. The preliminary results raise confidence that this emerging technology can be used clinically as an accurate, noninvasive indicator of cerebral oxygenation.
Garcia-Uribe, Alejandro; Erpelding, Todd N.; Ke, Haixin; Reddy, Kavya; Sharma, Anshuman; Wang, Lihong V.
Infantile neuroaxonal dystrophy (IND) is a well-established autosomal recessive neurodegenerative disease. Clinical signs generally begin toward the end of the first or during the second year of life. We are aware of at least 4 cases of pre- or perinatal onset of this condition, and report here on 2 brothers who were affected at birth and had an unusual clinical course with onset of peripheral gangrene that progressed to autoamputation of digits. Both boys died in infancy with pathological changes compatible with IND. The somewhat different clinical course in these brothers leaves open the possibility that this is a variant of neuroaxonal dystrophy due to an X-linked recessive mutation. PMID:3314508
Hunter, A G; Jimenez, C L; Carpenter, B F; MacDonald, I
Thrombosis may play an important role in the pathophysiology of certain complications of sickle cell disease (SCD). While the association between SCD and ulcerative colitis (UC) is still debatable, inflammatory bowel disease is known to be associated with an increased incidence of thromboembolic disease. We report a case of a 16-year old girl known to have homozygous SCD and also diagnosed with UC who presented with digital ischemia of her right lower limb. This led to gangrene and subsequent amputation of the first, second and third digits of that limb. This case highlights that patients with both UC and SCD may have an increased risk of thromboembolism and raises the question as to whether patients with UC and SCD should be screened for thrombophilia. PMID:24847432
Rankine-Mullings, Angela E.; Knight-Madden, Jennifer M.; Reid, Marvin; Ferguson, Trevor S.
Venous waterfalls in coronary circulation.
Several studies of flow through collapsible tubing deformed by external pressures have led to a concept known as the "vascular waterfall". One hallmark of this state is a positive zero-flow pressure intercept (Pe) in flow-pressure curves. This intercept is commonly observed in the coronary circulation, but in blood-perfused beating hearts a vascular waterfall is not the only putative cause. To restrict the possibilities, we have measured flow-pressure curves in excised non-beating rabbit hearts in which the coronary arteries were perfused in a non-pulsatile way with a newtonian fluid (Ringers solution) containing potent vasodilator drugs. Under these circumstances, vascular waterfalls are believed to be the only tenable explanation for Pe. In physical terms the waterfall is a region where the vessel is in a state of partial collapse with a stabilized intraluminal fluid pressure (Pw). It is argued that the most probable site of this collapse was the intramural veins just before they reached the epicardial surface. In accord with the waterfall hypothesis, Pe increased as the heart became more edematous, but flow-pressure curves also became flatter, implying multiple waterfalls with differing Pws, leading to complete collapse of some of the venous channels. The principal compressive force is believed to have been the interstitial fluid pressure as registered through a needle (Pn) implanted in the left ventricular wall, but a small additional force (Ps) was probably due to swelling of interstitial gels. A method is presented for estimating Ps and Pw. Unlike rubber tubing, blood vessels are both collapsible and porous. Apparently because of increased capillary filtration, Pn was found to increase linearly with the perfusion pressure. Thus, Pw was not the same at all points on the flow-pressure curve. This finding has interesting implications with respect to the concept of coronary resistance. PMID:2062096
Gosselin, R E; Kaplow, S M
Surgical treatment for venous malformation.
Sclerotherapy is generally the preferred treatment for venous malformation (VM) with surgery usually playing an adjunctive role. This study presents our experience with surgical treatment of VMs. Consecutive patients were identified from our vascular anomalies database 1996-2011 and patient demographics, location of the lesion, type of tissue(s) affected and symptoms were analysed. The patients completed a questionnaire to assess the impact of surgery on the severity of symptoms, appearance, function and overall quality of life (QoL), using a visual analogue scale of 0 (no symptom) to 10 (maximal symptom). They also rated their overall satisfaction of treatment using a scale of 0 (complete dissatisfaction) to 10 (complete satisfaction). Fifty patients with VM underwent a total of 58 procedures. Complication occurred in six patients (9.7% of operations), including transient sensory loss (n=3) and permanent frontal branch palsy (n=1), haematoma formation (n=1) and minor wound dehiscence (n=1). At least 50% improvement in symptoms of background pain, acute episodic pain, contour deformity and skin discolouration occurred in 88.9%, 92.3%, 83.3% and 75.0% of patients, respectively. At least 50% improvement in the appearance, function and overall QoL occurred in 54.3%, 71.4% and 70.4% of patients, respectively. The mean overall patient satisfaction with the treatment was 8.9 (range, 1-10). Surgery remains an important treatment modality for selected patients with VM having low complication rates and high patient satisfaction. It improves the appearance, function and overall QoL for the majority of the patients by reducing the severity of pain, contour deformity and skin discolouration. PMID:24012651
Steiner, Frederica; FitzJohn, Trevor; Tan, Swee T
Spontaneous retinal venous pulsation: aetiology and significance
Spontaneous retinal venous pulsation is seen as a subtle variation in the calibre of the retinal vein(s) as they cross the optic disc. The physical principles behind the venous pulsations has been the point of much debate. Initial theories suggested that the pulsation occurred because of the rise in intraocular pressure in the eye with the pulse pressure. This article presents an argument that this is not the case. The pulsations are in fact caused by variation in the pressure gradient along the retinal vein as it traverses the lamina cribrosa. The pressure gradient varies because of the difference in the pulse pressure between the intraocular space and the cerebrospinal fluid. The importance of this is that as the intracranial pressure rises the intracranial pulse pressure rises to equal the intraocular pulse pressure and the spontaneous venous pulsations cease. Thus it is shown that cessation of the spontaneous venous pulsation is a sensitive marker of raised intracranial pressure. The article discusses the specificity of the absence of spontaneous venous pulsation and describes how the patient should be examined to best elicit this important sign. PMID:12486256
Jacks, A; Miller, N
Scent communication plays a central role in the mating behavior of many nonhuman mammals but has often been overlooked in the study of human mating. However, a growing body of evidence suggests that men may perceive women's high-fertility body scents (collected near ovulation) as more attractive than their low-fertility body scents. The present study provides a methodologically rigorous replication of this finding, while also examining several novel questions. Women collected samples of their natural body scent twice--once on a low-fertility day and once on a high-fertility day of the ovulatory cycle. Tests of luteinizing hormone confirmed that women experienced ovulation within two days of their high-fertility session. Men smelled each woman's high- and low-fertility scent samples and completed discrimination and preference tasks. At above-chance levels, men accurately discriminated between women's high- and low-fertility scent samples (61%) and chose women's high-fertility scent samples as more attractive than their low-fertility scent samples (56%). Men also rated each scent sample on sexiness, pleasantness, and intensity, and estimated the physical attractiveness of the woman who had provided the sample. Multilevel modeling revealed that, when high- and low-fertility scent samples were easier to discriminate from each other, high-fertility scent samples received even more favorable ratings compared with low-fertility scent samples. This study builds on a growing body of evidence indicating that men are attracted to cues of impending ovulation in women and raises the intriguing question of whether women's cycling hormones influence men's attraction and sexual approach behavior. PMID:22137971
Gildersleeve, Kelly A; Haselton, Martie G; Larson, Christina M; Pillsworth, Elizabeth G
Complex central venous catheter insertion for hemodialysis.
Despite the introduction of payment by results in the UK, there has been no decrease in central venous catheter (CVC) use. In part, this may relate to a requirement to dialyse through a CVC while autogenous access matures. Mortality data have improved in parallel and patients on hemodialysis live longer, which may lead to an increased exposure to CVCs.Exposure to CVCs carries a significant risk of infection and occlusion requiring their repositioning or exchange. The mid to long-term sequelae of CVC use is central venous occlusion leaving clinical teams with an ever increasing challenge to find adequate venous access.In this article, we will discuss the challenges faced by operators inserting CVCs into the hemodialysis-dependent patient who has exhausted more tradition insertion sites. These include translumbar caval catheters, transocclusion and transcollateral catheters, transjugular Inferior Vena Cava catheter positioning, and transhepatic catheters. We will demonstrate the techniques employed, complications, and anticipated longevity of function. PMID:24817471
Powell, Steven; Belfield, Jane
Venous leg ulcer pain and its characteristics.
This study investigated the prevalence, severity and characteristics of pain associated with venous leg ulceration. Sixty-five patients suffering with venous leg ulceration were randomised to one of three treatment groups over a 12-week treatment period. All patients received short-stretch compression bandaging. Data were collected by use of a visual analogue scale and the McGill Pain Questionnaire. Seventy per cent of patients reported pain on entry to the study and within 2 weeks of effective treatment initial pain was dramatically reduced. Patients typically described their pain as throbbing, sharp, itchy, sore and tender. The affective nature of pain was often described as tiring and patients evaluated their pain as being annoying and nagging. This study highlights the importance of pain associated with venous leg ulceration. PMID:12476504
Charles, Hildegard
[Surgical treatment of chronic venous insufficiency].
Results of surgical treatment of 700 patients with chronic venous insufficiency of the lower extremities are presented. Subfascial endoscopic ligature of perforating veins and catheteric truncal sclerotherapy of v. saphena magna was applied by the authors side by side with traditional operations--venectomy and ligature of perforating veins. In the patients, treated using miniinvasive methods, the lowest frequency of purulent postoperative complications, the veins varicosis and the trophic ulcers recurrence was registered. Good immediate and late follow-up results achieved are due to meticulous selection of patients depending on the venous insufficiency stage and the deep venous system passability. It is necessary to proceed with further investigation of possibilities of the perforating veins endoscopic subfascial ligature and of catheteric truncal sclerotherapy performance in other stages of the disease. PMID:15074208
Rusyn, V I; Levchak, Iu A; Rusyn, A V
Topical issues in venous thromboembolism.
Despite clear guidelines and the availability of effective treatments, venous thromboembolism (VTE) remains relatively common, particularly in the hospital setting. This paper reviews topical issues in VTE, in terms of treatments, data and guidelines. Existing anticoagulants have several limitations. Bleeding risk is a concern with all anticoagulants. Vitamin K antagonists are the mainstay of oral anticoagulant therapy, but they are limited by the need for frequent monitoring. Unfractionated heparin (UFH) is limited by an inconvenient route of administration (continuous intravenous infusion) and a higher risk of heparin-induced thrombocytopenia and bleeding compared with low molecular weight heparins (LMWH). LMWH have a more predictable pharmacokinetic profile and greater bioavailability than UFH, which permits weight-adjusted LMWH dosing without the need for monitoring in most patients. LMWH also have a more convenient dosing strategy than UFH (once-daily subcutaneous injection). Fondaparinux is a selective inhibitor of factor Xa and, like LMWH, does not require monitoring. The efficacy of fondaparinux in long-term VTE treatment remains to be established. The optimal time to initiate thromboprophylaxis in patients undergoing orthopaedic surgery remains controversial. Initiating thromboprophylaxis just before or soon after surgery (the 'just-in-time' strategy) achieves better thromboprophylaxis but could increase the risk of bleeding complications. Balancing the need for extended thromboprophylaxis after major surgery with the need to minimize bleeding remains an important consideration. Despite clear guidelines, thromboprophylaxis is widely underused, particularly in medical patients, in whom rates as low as 28% have been reported. Electronic alert systems may be of value for increasing the use of adequate thromboprophylaxis. The use of different definitions of VTE and bleeding in clinical trials, together with missing venography data, conflicting guidelines in patients undergoing total hip or knee arthroplasty, and the limited amount of data in children, also make VTE prevention and management more difficult. Administering thromboprophylaxis to a wider group of patients, employing the 'just-in-time' protocols, ensuring adequate duration of thromboprophylaxis, combining different methods of thromboprophylaxis and developing new anticoagulants should help to improve thromboprophylaxis. PMID:21162605
Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Páramo Fernández, José Antonio
Anatomic considerations for central venous cannulation
Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225
Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela
Venous thrombosis: the history of knowledge.
Venous thrombosis is a frequent disease. It is surprising, therefore, that no case truly compatible with a diagnosis of venous thrombosis was apparently reported in the antiquity. There is no case that could be reasonably attributed to a venous thrombus in the writings of Hippocrates, Galenus, Celius Aurelianus, Ibn an-Nafiz, Avicenna and others. Venous thrombosis is not among the many diseases mentioned in the Bible. The term "leucophlegmasia", first used by Hippocrates and then by Celius Aurelianus, refers to cases of bilateral leg edema, most likely due to conditions such as heart failure, liver cirrhosis and renal insufficiency. Nothing compatible with a diagnosis of venous thrombosis can be found in pieces of art from ancient Egypt, Greece, Rome, Persia and South America. While in these sources there are sometimes representations of varicose veins and ulcers, unilateral leg edema or other pictures compatible with venous thrombosis are not featured. The first well documented case of venous thrombosis is depicted in a beautifully illustrated manuscript written in the 13th century and currently preserved in Paris at the Bibliothčque Nationale (MS Fr 2829, Folio 87). The manuscript describes the case of a young man from Normandy named Raoul who at the age of twenty developed unilateral edema in the right ankle that subsequently extended up to the thigh, with no obvious symptoms in the contralateral leg. Raoul was advised to visit the tomb of Saint Louis who was buried in the church of Saint Denis, where the patient spent several days confessing his sins and praying the saint. Afterwards he chose to collect the dust accumulating below the stone that covered the tomb and to apply it on the fistulae and ulcers of his foot. The openings stopped running and were filled with flesh. He was first obliged to use crutches but subsequently he could walk with a cane, to be eventually able to dispose of all devices, even though his foot throbbed a little. Raoul was cured as described above in the year 1271 and was still alive and well in 1282. Not only this is the first case of venous thrombosis, the young age of the patients leads us to suspect that Raoul had a thrombophilic condition. PMID:13679643
Mannucci, P M
The anterior jugular venous system: variability and clinical impact.
The anterior jugular venous system, with its interconnections to the subclavian and deep jugular veins, provides a collateral venous network across the midline of the neck area, which is especially important in unilateral occlusion of an innominate vein. We illustrate the variability of this system and its clinical impact on catheterization by three cases of landmark-guided central venous cannulation. Case 1: Cannulation of the left internal jugular vein with a central venous catheter and of the left innominate vein (LIV) with a pulmonary artery catheter resulted in correctly positioned catheter tips. However, these catheters were actually not placed in the innominate vein but coursed through the jugular venous arch. Case 2: Cannulation of the left subclavian vein was complicated by resistance of guidewire advancement at 13 cm. Occlusion of the LIV and enlargement of the jugular venous arch were present. Case 3: Insertion of a pulmonary artery catheter and a central venous catheter through the LIV. The pulmonary artery catheter was correctly placed. The tip of the central venous catheter was mistakenly positioned in the left anterior jugular vein. We describe the normal anatomy of the anterior jugular venous system and its role as a major collateral. Correct placement of central venous catheters may be possible via the anterior jugular venous system. Conversely, central venous catheters malpositioned in the anterior jugular vein can increase the risk for complications and should be removed. PMID:15562044
Schummer, Wolfram; Schummer, Claudia; Bredle, Don; Fröber, Rosemarie
Most cases of gas gangrene caused by Clostridium species begin with trauma-related injuries but in rare cases, spontaneous gas gangrene (SGG) can occur when patients have conditions such as advanced malignancy, diabetes, or immunosuppression. Clostridium perfringens, a rare cause of SGG, exists as normal flora of skin and intestines of human. Adequate antibiotics with surgical debridement of infected tissue is the only curative therapeutic management. Mortality rate among adults is reported range of 67-100% and majority of deaths are occurred within 24 hours of onset. We experienced a case of SGG on the trunk, buttock and thigh in a neutropenic patient with acute lymphoblastic leukemia. His clinical course was rapid and fatal during pre-engraftment neutropenic period of allogeneic stem cell transplantation. PMID:25298910
Lee, Hae-Lim; Cho, Sung-Yeon; Ko, Yumi; Hyun, Ji In; Kim, Bo Kyoung; Seo, Jae Hyun; Lee, Jung Woo; Lee, Seok
Introduction Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions and has a high mortality rate. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms and predisposing factors, including diabetes mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a case of Fournier's gangrene in a patient with unknown type II diabetes submitted to 24-hour catheterization 15 days before gangrene onset. Case presentation The patient, a 60-year-old Caucasian man, presented with a swollen, edematous, emphysematous scrotum with a crepitant skin and a small circle of necrosis. A lack of resistance along the dartos fascia of the scrotum and Scarpa's lower abdominal wall fascia combined with the presence of gas and pus during the first surgical debridement also supported the diagnosis of Fournier's gangrene. On the basis of the microbiological culture, the patient was given multiple antibiotic therapy, combined hypoglycemic treatment, hyperbaric oxygen therapy, and several surgical debridements. After five days the infection was not completely controlled and a vacuum-assisted closure device therapy was started. Conclusions This report describes the successful multistep approach of an immediate surgical debridement combined with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted closure is a well-known method used to treat complex wounds. In this case study, vacuum-assisted closure treatment was effective and the patient did not require reconstructive surgery. Our report shows that bladder catheterization, a minimally invasive maneuver, may also cause severe infective consequences in high-risk patients, such as patients with diabetes. PMID:23286211
National Technical Information Service (NTIS)
Pheripheral venous tone, central venous and oesophageal pressures were recorded while the upright sitting subjects were immersed to the neck in a thermoneutral water bath. The central venous pressure rose from 3.4 to 15.2 mm Hg. The transmural pressure, w...
M. Echt, L. Lange, O. H. Gauer
Venous thromboembolism in pediatric nephrotic syndrome.
Childhood nephrotic syndrome (NS) is one of the most common pediatric kidney diseases, with an incidence of 2-7 per 100,000. Venous thromboembolism (VTE) is associated with significant morbidity and mortality, and occurs in ?3 % of children with NS, though incidence approaches 25 % in high-risk groups. VTE etiology is multifactorial, with disease-associated coagulopathy thought to be a significant contributor. Other risks include age, disease severity, and treatment-related hazards, such as the presence of central venous catheters. Non-pharmacologic preventive measures such as ambulation and compression stockings are recommended for patients with identified VTE risks. Central venous catheters should be avoided whenever possible. Symptoms of VTE include venous catheter dysfunction, unilateral extremity symptoms, respiratory compromise, flank pain, and gross hematuria. When VTE is suspected, confirmatory imaging studies should be obtained, followed by appropriate laboratory evaluation and treatment. Therapeutic goals include limiting thrombus growth, extension, and embolization by early institution of anticoagulant therapy. Anticoagulation is recommended for a minimum of 3 months, but should be continued until NS remission is achieved. Further studies are necessary to identify VTE-risk biomarkers and optimal therapeutic regimens. Observational cohort studies are needed to identify VTE-risk groups who may benefit from thromboprophylaxis and to define disease-specific treatment algorithms. PMID:23812352
Kerlin, Bryce A; Haworth, Kellie; Smoyer, William E
Quality of life in chronic venous insufficiency
Aim. Chronic venous insufficiency (CVI) is a chronic dis- ease, whose disability has not been appreciated clearly, and several treatment costs are not covered by Public Health Service, probably because its any social impact is not well known. The aim of the study was to assess the impact of CVI on quality of life (QoL), and to compare the sensitivity
According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration. PMID:19648868
Malone, P Colm; Agutter, P S
Limb blood flow is widely used as an indicator of the human vascular properties. There are only few non-invasive methods for its measurement such as venous occlusion plethysmography. However, several authors have questioned its validity. The problems appear to be related to the process of venous occlusion. We developed two methods to measure forearm blood flow by plethysmography without venous occlusion in combination with Doppler velocimetry (without imaging). Method 1: the gradient of a tangent drawn on the latter part of the down stroke of the plethysmographic volume pulse is an approximation of venous blood flow in the absence of diastolic blood flow. At equilibrium, it equals the average arterial flow in a cardiac cycle. The Doppler velocity waveform recorded simultaneously allows improvement of this approximation when there is diastolic blood flow. Method 2: the volume pulse detected by a plethysmograph calibrated in absolute volume is used to calibrate the velocity waveform recorded simultaneously to produce an approximation of arterial volumetric flow waveform. Bland-Altman analysis shows both methods have good correlation and agreement with venous occlusion plethysmography at rest. Method 1: mean difference (blood flow measured by venous occlusion minus calculated flow) = 0.10 ml/pulse (+/-0.18), limits of agreement = -0.41 and 0.61 ml/pulse. Method 2: mean difference = -0.041 ml/pulse (+/-0.15), limits of agreement = -0.45 and 0.37 ml/pulse. During hyperaemia, venous occlusion plethysmography grossly underestimated relative to the new methods. The new methods are not dependent on venous occlusion and produce consistent results with or without hyperaemia. PMID:15383087
Chuah, Seong S; Woolfson, Peter I; Pullan, Brian R; Lewis, Philip S
Background Laparoscopic hepatectomy (LH) is increasingly used. However, the safety and outcomes of LH have yet to be elucidated. The\\u000a risk of venous gas embolism is increased during liver parenchymal transection. This risk may be increased with positive pressure\\u000a carbon dioxide (CO2) pneumoperitoneum (PP). This may be exacerbated further when low central venous pressure (CVP) anesthesia is used to minimize\\u000a hemorrhage
S. Jayaraman; A. Khakhar; H. Yang; D. Bainbridge; D. Quan
Controlled studies of Daflon 500 mg in chronic venous insufficiency.
Although great advances have been made in the operative treatment of vascular disorders, the management of most venous problems is still nonsurgical. Daflon 500 mg* is a micronized flavonoid mixture of 90% diosmin and 10% hesperidin that has phlebotonic properties. The efficacy of Daflon 500 mg has been investigated in three double-blind, randomized trials using strain gauge plethysmography to provide quantitative information on venous hemodynamics in patients with chronic venous insufficiency. In total, 183 patients were treated with Daflon 500 mg versus a control group of equal number of patients. Daflon 500 mg produced a significant decrease in venous capacitance, venous distensibility, and venous emptying time (P < 0.001). In addition, these changes were accompanied by improvement in clinical symptoms and a decrease in the supramalleolar circumference. Clinical side effects were rare and led to treatment withdrawal in only 3 patients. It is concluded that Daflon 500 mg is of benefit to patients with chronic venous insufficiency. PMID:8203786
Geroulakos, G; Nicolaides, A N
[Venous aneurysm of V. saphena accessoria--a case report].
A 43-year-old male was admitted for subcutaneous mass of rt. inguinal lesion. Saccular dilatation of vein is a rare phenomenon and usually termed "venous aneurysm". Venous aneurysm has been reported in the following vein: face, neck, extremities, superior vena cava region, portal vein region and by-pass grafting vein. This is the 1st report of a venous aneurysm found in V. saphena accessories in Japan. The true etiology is unknown, but underlying causes which produce damage to the venous wall (trauma, inflammation, congenital weakness, and localized degenerative change) have been mentioned as possible causes. Rarely, thrombosed venous aneurysm may cause pulmonary emboli. Definitive diagnosis is established by venography. Venous aneurysm often increases or reduces in size according to the change of venous pressure by proximal vein compression postural change and Valsalva maneuver. In general, surgical resection of the aneurysm is the treatment of choice. PMID:2263249
Kanamaru, H; Asahina, K
A new top-loading venous bag provides vacuum-assisted venous drainage.
A new venous bag has been developed, prototyped, and tested. The new bag has its inlet, outlet purge, and infusion tubes extending upward from the top of the bag, and are threaded through, bonded to, and sealed within a flat rigid top plate. This design allows the bag to be hung from its top plate by its tubes. It also allows the bag to be: 1) dropped into or removed from its holder, as is done with existing hard-shell reservoirs so that its weight pulls it into the holder without the need for eyelets and hooks and 2) placed closer to the floor so that gravity drainage is facilitated. The V-Bag (VB) is easily sealed within an accompanying rigid housing. Once sealed, vacuum applied to the housing is transmitted across the flexible walls of the bag to the venous blood. Thus, vacuum-assisted venous drainage (VAVD) is obtained as it is with a hard-shell reservoir, but without any contact of air with the blood. Bench tests, using a circuit that simulated the venous side of the cardiopulmonary bypass (CPB) circuit, showed that applying suction to the housing increased venous flow, and the fractional increase in flow was not a function of the venous cannula, but of the level of vacuum applied. In the gravity drainage mode, the bubble counts at the outlet of the V-Bag compared to two other bags were lower at any pumping condition. When used in the VAVD mode, bubble counts were two orders of magnitude lower than when using kinetically assisted venous drainage (KAVD) with a centrifugal pump. Results obtained with the VB suggest its clinical usefulness. PMID:12243444
Tamari, Y; Lee-Sensiba, K; Beck, J; Chan, R; Salogub, M; Hall, M; Lee, T; Ganju, R; Mongero, L
Patterns of anomalous pulmonary venous drainage.
All of our cases of abnormal pulmonary venous connections collected to the middle of 1965 and verified at surgery or autopsy have been reviewed by means of diagrams and tabulations, using a specially devised code to facilitate the survey. The material consisted of 52 autopsy cases (half of them obtained after surgery) and the cases of 72 patients who survived operation. The postmortem group was much younger than the surgical group and differed also from the latter by showing male preponderance as well as relatively many instances of total abnormal pulmonary venous connection and frequently associated cardiac anomalies. Partial anomalous connection of right pulmonary veins was 10 times more frequent than that of the left pulmonary veins. This was caused by (1) the frequent drainage of some of the right pulmonary veins into the junctional area between right atrium and superior vena cava in the presence of normal left pulmonary veins, and (2) the complete absence of isolated left pulmonary venous connection to the right atrium. Abnormal connection of solitary pulmonary veins was always effected to the most proximal venous structure among the four possible ones which are derived from the main embryonic channels (superior vena cava and inferior vena cava on the right side, and left superior vena cava and coronary sinus on the left side). Common pulmonary veins from one lung also drained in accordance with this proximity rule, if this may be taken to apply also to the drainage of right pulmonary veins into the right atrium. The one exception in our material was the drainage of all right pulmonary veins into the portal venous system. Total abnormal pulmonary venous connection may be found with all structures mentioned, but most frequently with the left superior vena cava, or coronary sinus, or both, usually by way of a common pulmonary vein. In a few cases however, drainage into different sites, all of them abnormal, did occur. Then again the proximity rule seemed to apply. A tentative embryological explanation is given for the patterns described. PMID:11712292
Snellen, H A; van Ingen, H C; Hoefsmit, E C
Sulodexide in the treatment of chronic venous disease.
Chronic venous disease encompasses a range of venous disorders, including those involving the lower limbs resulting from venous hypertension. The spectrum of chronic venous disease signs and symptoms shows variable severity, ranging from mild (aching, pain, and varicose veins) to severe (venous ulcers). The pathophysiology of chronic venous disease is characterized by venous hypertension, which triggers endothelial dysfunction and inflammation leading to microcirculatory and tissue damage, and eventually to varicose veins and venous ulcers. Sulodexide is an orally active mixture of glycosaminoglycan (GAG) polysaccharides with established antithrombotic and profibrinolytic activity. The agent is used in the treatment of a number of vascular disorders with increased risk of thrombosis, including intermittent claudication, peripheral arterial occlusive disease and post-myocardial infarction. Sulodexide differs from heparin because it is orally bioavailable and has a longer half-life and a smaller effect on systemic clotting and bleeding. An increasing body of preclinical evidence shows that sulodexide also exerts anti-inflammatory, endothelial-protective, and pleiotropic effects, supporting its potential efficacy in the treatment of chronic venous disease. Clinical studies of sulodexide have shown that the agent is associated with significant improvements in the clinical signs and symptoms of venous ulcers, and is therefore a recommended therapy in combination with local wound care and bandages for patients with persistent venous leg ulcers. Preliminary evidence supports the use of sulodexide in the prevention of recurrent deep venous thrombosis. Sulodexide was generally safe and well tolerated in clinical trials, without hemorrhagic complications. Sulodexide therefore appears to be a favorable option for the treatment of all stages of chronic venous disease and for the prevention of disease progression. PMID:22329592
Andreozzi, Giuseppe Maria
Venous thromboembolism and cancer: a systematic review
Venous thromboembolism (VTE) is a serious and potentially fatal disorder, which is often associated with a significant impact\\u000a on the quality of life and on the clinical outcome of cancer patients. The pathophysiology of the association between thrombosis\\u000a and cancer is complex: malignancy is associated with a baseline hypercoagulable state due to many factors including release\\u000a of inflammatory cytokines, activation
Celso Arrais Rodrigues; Renata Ferrarotto; Roberto Kalil Filho; Yana A. S. Novis; Paulo M. G. Hoff
[Variability of the deep femoral venous system].
Deep venous system is known for its extreme variability but in anatomy it receives only marginal interest. Although a few previous anatomical studies have already pointed out the fact of a significant discrepancy between the autopsy findings and the literary description, it has not had any particular output so far. Our findings confirmed the deep femoral vein to be an alternative collateral vein connecting the popliteal with the femoral vein. PMID:21751509
Eberlová, Lada; Tolar, Jakub; Mikulás, Jan; Valenta, Jirí; Kocová, Jitka; Hirmerová, Jana; Fiala, Pavel
Echocardiographic Evaluation of Umbilical Venous Catheter Placement
OBJECTIVE: To compare techniques for guiding and confirming placement of umbilical venous catheters (UVCs) using two-dimensional echocardiography.STUDY DESIGN: Fifty-three newborns admitted to our neonatal intensive care unit who required an UVC or who were transferred within 24 hours of UVC placement at a referring hospital were studied. UVC position was assessed by antero-posterior (AP) chest radiography (CXR), lateral CXR, and
Anne Ades; Craig Sable; Susan Cummings; Russell Cross; Bruce Markle; Gerard Martin
Unanswered questions, unmet needs in venous thromboprophylaxis.
Although significant progress has been made over the past 25 years in preventing thromboembolic disease in patients undergoing total hip and total knee arthroplasty, important questions remain unanswered. Few would debate the need to seek a balance between maximal antithrombotic efficacy and minimal bleeding in choosing a thromboprophylactic strategy, but there is less agreement as to how efficacy should be defined, and whether efficacy and safety (however each is defined) are intrinsic to the thromboprophylactic agent chosen or depend as well on exogenous factors, ranging from the timing of drug administration to surgical technique. Differences between recent guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) illustrate these unanswered questions. The AAOS guidelines focus solely on preventing symptomatic pulmonary embolism and ignores the importance of other acute and chronic manifestations of venous thromboembolic disease. The ACCP, on the other hand, does consider these other manifestations of venous thromboembolic disease, and thus reaches very different conclusions about what constitutes effective thromboprophylaxis. Despite these questions and uncertainties, there are fundamental truths: (1) venous thromboembolism (VTE) is a known and serious complication of total joint arthroplasty, and (2) evidence-based thromboprophylaxis works. Gaps between guideline-recommended and actual orthopedic practice must be reduced. PMID:20201478
Cushner, Fred D; Nett, Michael P
[Anatomic and functional features of venous valves].
The comparison of the venous system in the human organism, and in particular the venous valves of the lower limbs, with studies conducted in animal models helped us to understand better the mechanisms involved in adapting to the upright position and walking. We examined work conducted in several species from the horse to the dog, especially in animals who often take on an upright position such as the chimpanzee and the kangouroo, in search for structures comparable to those in man. Different types of valves can be described in man: flotting valves (bicuspid, pigeon nest valves); reinforced valves (mid-thigh); reinforcing valves (periarticular zone in the knee); finally, "flat" valves which are highly resistant formations but with little anti-back flow action. We also describe valvular structures with muscle cells found in the plantar aspect of the foot and the veins of the quadriceps muscle, these valves may have an active hematopropulsive action (Bassi). These results allowed us to identify certain common points between the structures observed in the posterior legs of certain animals and to propose models for investigating venous diseases. PMID:9480339
Griton, P; Vanet, P; Cloarec, M
Metastases in the proximal femur and in the femoral diaphysis are usually treated with either cephalomedullary or intramedullary nailing. The benefit of curettage and augmentation of the nail with methyl methacrylate remains controversial. The authors retrospectively studied the outcomes with cephalomedullary and intramedullary nailing without curettage and methyl-methacrylate augmentation for lytic metastases of the proximal/diaphyseal femur. Twenty-one complete (11) or impending (10) pathological fractures in 19 consecutive patients were treated between January 2006 and August 2013. There were 11 women and 8 men. Their mean age was 62 years (range, 38 to 87). All patients received adjuvant chemotherapy or radiotherapy.The average postsurgical survival was 9.7 months (range 1-36 months). A single deep infection was debrided. Seventeen out of 19 patients were ambulatory, with or without a walking aid. No implant failure was noted. In other words, patients succumbed to the disease prior to hardware failure. Femoral nail insertion without curettage and cement augmentation provided satisfactory stabilization of proximal and diaphyseal femur fractures, impending or complete, even when there was massive bone destruction. PMID:24873100
Shemesh, Shai; Kosashvili, Yona; Sidon, Eliezer; Yaari, Lee; Cohen, Nir; Velkes, Steven
Core content for training in venous and lymphatic medicine.
The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. PMID:25059735
Zimmet, Steven E; Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F
Core content for training in venous and lymphatic medicine
The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. PMID:25059735
Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F
Systemic venous atrium stimulation in transvenous pacing after mustard procedure.
We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case presented demonstrates that, when the systemic venous atrium is separate from the left atrial appendage, the lead can be easily and safely placed in the systemic venous left atrium gaining satisfactory sensing and pacing thresholds despite consisting partially of pericardial tissue. PMID:25276305
Puntrello, Calogero; Lucŕ, Fabiana; Rubino, Gaspare; Rao, Carmelo Massimiliano; Gelsomino, Sandro
Systemic venous atrium stimulation in transvenous pacing after mustard procedure
We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case presented demonstrates that, when the systemic venous atrium is separate from the left atrial appendage, the lead can be easily and safely placed in the systemic venous left atrium gaining satisfactory sensing and pacing thresholds despite consisting partially of pericardial tissue. PMID:25276305
Puntrello, Calogero; Luca, Fabiana; Rubino, Gaspare; Rao, Carmelo Massimiliano; Gelsomino, Sandro
77 FR 24718 - Scientific Information Request on Chronic Venous Ulcers Treatments
Federal Register 2010, 2011, 2012, 2013
...Information Request on Chronic Venous Ulcers Treatments AGENCY: Agency for Healthcare...submissions from manufacturers of chronic venous ulcer treatment medical devices. Scientific...solicited to inform our Chronic Venous Ulcers: A Comparative Effectiveness Review...
Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis
Background: The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. Methods: Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined transcranial and extracranial colour-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. Results: CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29 to 65, p<0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; this provides a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated with CCSVI patterns significantly different from those of primary progressive (p<0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. Conclusion: CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease. PMID:19060024
Zamboni, P; Galeotti, R; Menegatti, E; Malagoni, A M; Tacconi, G; Dall'Ara, S; Bartolomei, I; Salvi, F
Role of Tissue Factor in Venous Thrombosis
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide. However, the mechanisms by which clots are formed in the deep veins have not been determined. Tissue factor (TF) is the primary initiator of the coagulation cascade and is essential for hemostasis. Under pathological conditions, TF is released into the circulation on small-membrane vesicles termed microparticles (MPs). Recent studies suggest that elevated levels of MPTF may trigger thrombosis. This review provides an overview of the role of TF in VTE. PMID:20690821
Manly, David A.; Boles, Jeremiah; Mackman, Nigel
[Prophylaxis of venous thromboembolism in orthopedic surgery].
The patients undergoing major orthopedic surgery, which includes total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS), represent a group that has a particularly high risk for venous thromboembolism (VTE), and routine thromboprophylaxis has been standard of care for >20 years. The following article summarizes data derived from numerous randomized clinical trials of thromboprophylaxis following THR, TKR, and HFS; areas of orthopedic surgery for which there are much less data, including knee arthroscopy and isolated lower extremity injuries, are also reviewed. PMID:20228720
Giuseppini, M U; Guiducci, S; Bardelli, M
Venous thromboembolic prophylaxis: the use of aspirin.
Venous thromboembolism (VTE) is a term used collectively for deep vein thrombosis (DVT) and pulmonary embolism. Without prophylaxis, the incidence of documented DVT in the orthopaedic surgery patient is reported in the range of 50%-60%. A multimodal approach to DVT prophylaxis is the standard of care for all patients undergoing total hip arthroplasty and total knee arthroplasty. At our local hospital, low-risk patients are being sent home with aspirin as the medication for VTE prophylaxis. This article will provide an overview of the pathophysiology of VTE and the current prevention guidelines including the use of aspirin. PMID:18677248
Snyder, Brenda K
Venous Thromboembolism Following Major Orthopedic Surgery
ABSTRACT Venous thromboembolism (VTE) is an important complication of major orthopedic surgery (total hip arthroplasty-THA, total knee arthroplasty-TKA, hip fracture surgery-FHS) and is associated with significant morbidity and mortality. Despite this, not all patients receive an appropriate prophylaxis, often due to a disproportionate fear of bleeding complications. A challenge in the management of VTE prophylaxis is to balance the benefits of the treatment with the risk of bleeding. In this article, we review the latest guidelines recommendations regarding prevention of postoperative VTE in patients undergoing orthopedic surgery. PMID:24371484
CIONAC FLORESCU, Simona; ANASTASE, Denisa-Madalina; MUNTEANU, Ana-Maria; STOICA, Ioan Cristian; ANTONESCU, Dinu
Somatosensory evoked potentials (SSEPs) are widely utilized for the intraoperative detection and prevention of nerve conduction injuries. Their use in identifying position-related injuries to the brachial plexus in patients undergoing supine craniotomies for the treatment of supratentorial pathology is not well documented. This case series describes three instances of unilateral upper extremity SSEP changes in patients positioned for supine craniotomies. In all three cases SSEP responses improved after repositioning. None of the patients exhibited new neurological deficits post-operatively. This case series highlights the importance of vigilant monitoring in the period after final positioning and demonstrates the usefulness of SSEPs as a tool to aid in the early detection and prevention of impending position-related nerve injury. PMID:25351034
La Neve, Joseph E; Zitney, Gregory P
Anatomy of the presacral venous plexus: implications for rectal surgery
The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to
P. Baqué; B. Karimdjee; A. Iannelli; E. Benizri; A. Rahili; D. Benchimol; J.-L. Bernard; E. Sejor; S. Bailleux; F. de Peretti; A. Bourgeon
Intervention targeted at nurses to improve venous thromboprophylaxis
Objective. To assess the effectiveness of an intervention targeting both physicians and nurses vs. physicians only in impro- ving venous thromboprophylaxis for older patients. Design. Cluster randomized trial. Setting. Fifty hospital-based post-acute care departments in France. Participants. Patients aged 65 years or older. Intervention. A multifaceted intervention to implement a clinical practice guideline addressing venous thromboprophylaxis. Main outcome measures. The
Doppler Study on Pulmonary Venous Flow in the Human Fetus
Objectives: The fetal pulmonary circulation is different from the postnatal circulation: the flow is small. The arterial pressure is almost systemic, and the vascular resistance is high. Moreover, lungs are collapsed in the fetus. However, the pulmonary venous flow in the fetus has not been studied. The aims of this study were to look at flow patterns of pulmonary venous
Y. Hong; J. Choi
Septic Mesenteric Venous Thrombophlebitis: A Rare Complication of Acute Appendicitis
Mesenteric venous thrombophlebitis represents a very rare complication of acute appendicitis. Based on the findings of a 45-year-old patient with mesenteric venous thrombophlebitis due to acute appendicitis, we herein describe the diagnostic difficulties and therapeutic options in this uncommon disease. The treatment in our case consisted of simple appendectomy and perioperative anticoagulation therapy. PMID:22162705
Kykalos, Stylianos; Sotiropoulos, Georgios C.; Vernadakis, Spiridon
Prenatal Diagnosis of Total Anomalous Pulmonary Venous Connection with Asplenia
The prenatal diagnosis of 2 fetuses with total anomalous pulmonary venous connection was made by color Doppler echocardiography at 31 and 38 weeks of gestation, respectively. Both had asplenic hearts and their diagnoses were confirmed by postnatal echocardiography, magnetic resonance imaging, and angiography. The antenatal diagnosis of total anomalous pulmonary venous connection in right isomerism could provide an optimal postnatal
Satoshi Yasukochi; Gengi Satomi; Yasushi Iwasaki
Prevention of venous thromboembolism in patients with hemorrhagic stroke.
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are part of the spectrum of venous thromboembolism (VTE). It is one of the most frequent medical complications in stroke patients. The risk of VTE is even higher after hemorrhagic stroke. This article reviews various screening methods, diagnostic techniques, and pharmacologic as well as nonpharmacologic means of preventing VTE after hemorrhagic stroke. PMID:23611851
Chaudhry, Farrukh S; Schneck, Michael J; Morales-Vidal, Sarkis; Javaid, Furqan; Ruland, Sean
Hormone replacement therapy and venous thromboembolism.
Hormone replacement therapy (HRT) for post-menopausal women is known to promote venous thromboembolism (VTE), i.e., deep venous thrombosis and pulmonary embolism, though the absolute risk for a given patient is very small. The risk of VTE appears to be greatest soon after the initiation of HRT and returns to the baseline level of risk of non-HRT users after discontinuation. There is inconsistent data about whether estrogen-only or combined estrogen-progestin HRT are associated with similar VTE risk. Retrospective analyses suggest that transdermal HRT is not as prothrombotic as oral HRT, though this has not been evaluated in randomized clinical trials. Increasing age and weight further promote HRT's VTE risk. Some studies have investigated whether prothrombotic combinations may increase HRT's VTE risk and there is evidence that Factor V Leiden may do this. However, no benefit to screening prospective HRT users has been described, yet. Advanced proteomic and genomic studies may hold promise in the future for better elucidating which HRT users are at highest risk for VTE. Presently, physicians and prospective HRT users should discuss the potential risks and benefits for the individual patient, acknowledging there is no way to fully mitigate the risk of VTE. This article is part of a Special Issue entitled 'Menopause'. PMID:24007716
Eisenberger, Andrew; Westhoff, Carolyn
Interventional Treatment of Mesenteric Venous Occlusion
Summary Background Mesenteric venous thrombus may be an incidental finding during imaging studies and asymptomatic patients are treated conservatively or with anticoagulant therapy only. Patients with symptomatic acute thrombosis causing bowel ischemia require urgent treatment, which frequently includes extensive surgery. Interventional treatment may be an alternative. Purpose: To present results of interventional treatment in patients with symptomatic occlusion of the mesenteric veins. Material/Methods Eight patients, four men and four women aged 24–74 years (mean 53 years) were treated due to symptomatic portomesenteric venous occlusion of thrombotic origin. Transhepatic (n=5), trans-splenic (n=2), and transjugular (n=4) accesses were used. Patients were treated with mechanical thrombus fragmentation (n=4), pharmacological thrombolysis (n=3) and stent placement (n=8). Additional transjugular intrahepatic portosystemic shunt (TIPS) was created to facilitate the outflow from the treated veins (n=4). Results The majority of the patients required combination of different treatment methods. Resolution of symptoms with initial clinical success was achieved in seven of the eight patients, and one patient died the day after the procedure due to sepsis. Two other patients had procedure-related complications; one of them required embolization. Two patients had documented long-term clinical success with patent stents and no symptoms at one year following intervention. Conclusions Endovascular treatment of portomesenteric occlusion in patients with acute symptomatology showed good short-term clinical success rate. PMID:25089163
Wichman, Heather J.; Cwikiel, Wojciech; Keussen, Inger
Papilloedema associated with dural venous sinus thrombosis.
Papilloedema is a diagnostic term used exclusively to describe optic disc oedema associated with increased intracranial pressure. Septic cerebral venous sinus thrombosis has become an increasingly rare cause of papilloedema because of the widespread availability of antimicrobial agents; however, it is imperative for optometrists to maintain vigilance for this pathologic process. Presented is a case of a 77-year-old Caucasian male with a complaint of blurred vision and non-specific, diffuse headache. He had a right sixth cranial nerve palsy and bilateral disc oedema. Raised intracranial pressure was confirmed by lumbar puncture. Neuroimaging, including magnetic resonance imaging and magnetic resonance venography in conjunction with cytological assessment of the cerebral spinal fluid led to a probable diagnosis of mastoiditis causing multiple dural venous sinus thrombi of the superior sagittal and right transverse sinuses. Sequential evaluation of this complex case is displayed along with pertinent differential diagnoses for optic disc oedema and a review of current standards for diagnosis and management of papilloedema from dural sinus thrombosis. PMID:23865959
O'Rourke, Tara Leigh; Slagle, W Scott; Elkins, Meghan; Eckermann, Daniel; Musick, Angela
Venous return curves obtained from graded series of valsalva maneuvers
NASA Technical Reports Server (NTRS)
The effects were studied of a graded series of valsalva-like maneuvers on the venous return, which was measured transcutaneously in the jugular vein of an anesthetized dog, with the animal serving as its own control. At each of five different levels of central venous pressure, the airway pressure which just stopped venous return during each series of maneuvers was determined. It was found that this end-point airway pressure is not a good estimator of the animal's resting central venous pressure prior to the simulated valsalva maneuver. It was further found that the measured change in right atrial pressure during a valsalva maneuver is less than the change in airway pressure during the same maneuver, instead of being equal, as had been expected. Relative venous return curves were constructed from the data obtained during the graded series of valsalva maneuvers.
Mastenbrook, S. M., Jr.
Economic burden of venous thromboembolism in hospitalized patients.
Venous thromboembolism, a condition that includes deep vein thrombosis and pulmonary embolism, is a significant medical problem that affects more than 1 million patients each year. In addition to the immense impact of venous thromboembolism on morbidity and mortality, the economic burden of the disease is considerable, costing the health care system in the United States more than $1.5 billion/year. The cost of managing an initial episode of deep vein thrombosis is estimated at $7712-10,804, and for an initial pulmonary embolism event $9566-16,644. Management of acute venous thromboembolism in patients with cancer costs more than $20,000. Although much of the costs of venous thromboembolism are associated with managing the acute event, there are also significant costs associated with its long-term complications such as recurrent venous thromboembolism, postthrombotic syndrome, and pulmonary hypertension. Data from numerous robust clinical trials have demonstrated that with appropriate prophylaxis, many of these venous thromboembolism events can be prevented in both surgical and medical patients. Even though the strong evidence supporting venous thromboembolism prophylaxis spans several decades, a number of large American and global registries have documented very poor use of appropriate venous thromboprophylaxis. Because of increasing regulatory requirements, hospitals nationwide are developing necessary documentation of appropriate venous thromboembolism prophylaxis programs for both surgical and medical patients. Hospitals and clinicians must have a firm understanding of not only the clinical impact but also the economic impact of failing to use appropriate prophylaxis and of the cost-effectiveness of different venous thromboprophylaxis methods. PMID:19637948
Dobesh, Paul P
This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects that had not used the supplement) were compared with normal, unused vein segments harvested for bypass grafting. The segments were suspended and a weight was attached to the distal part of the veins for 3 minutes and dilated with pressurized water. Digital images were recorded; the veins were measured before and after stretching to evaluate elongation. The manipulation of the vein segment was minimal. Tests were completed within 20 minutes after harvesting the veins. All segments were 4 cm long. The stretching test indicated a significantly higher level of passive elongation in control, varicose segments (2.29; 0.65 mm) in comparison with 1.39; 0.2?mm in vein segments from Pycnogenol-using patients. The dilation test showed an average higher dilation (2.19; 0.3 mm) in control varicose veins in comparison with varicose veins from Pycnogenol-using patients (1.32; 0.7 mm) (p?0.05). Stretching and dilatation were lower in veins from Pycnogenol-using subjects (p?0.05). The measurement of destretching and the recovery after dilatation indicated a better tone and recovery of the original size/shape in varicose segments from patients using Pycnogenol. Varicose segments had a more significant persistent dilatation and elongation in comparison with normal vein segments. Pycnogenol seems to decrease passive dilatation and stretching and gives vein walls a greater tonic recovery and elasticity that allows the vein to recover its original shape after dynamic stresses. PMID:24627617
Belcaro, Gianni; Dugall, Mark; Luzzi, Roberta; Hosoi, M; Corsi, Marcello
Cerebral Venous Sinus Thrombosis and Venous Hemorrhagic Infarction in a Young Woman
Cerebral venous sinus thrombosis (CVST) is an uncommon cause of cerebral infarction, compared to arterial diseases. It is often unrecognized at initial presentation due to the diversity of causes and clinical manifestations. A 29-year-old female patient complained of severe headache and presented at the emergency room with altered consciousness. Brain computed tomography and brain magnetic resonance image revealed the left sigmoid sinus thrombosis with venous hemorrhagic infarction (VHI) in the left temporal lobe. The patient had no past medical and family history of bleeding diathesis. The laboratory finding at the admission showed severe iron-deficiency anemia (IDA), and protein C and S activities were decreased. After the neurosurgery, iron replacement, and neurorehabilitation, the patient had a good recovery. There has been no known recurrence. We report our therapeutic intervention on a very rare case of CVST and VHI, with IDA as a probable cause of cerebral thrombosis. PMID:25379501
Choe, Yuri; Lee, Jun-Beom; Kim, Young-Jin
Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis
The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis.
Inada, K.; Shirai, N.; Hayashi, M.; Matsumoto, K.; Hirose, M.
Cardiovascular Pressures with Venous Gas Embolism and Decompression
NASA Technical Reports Server (NTRS)
Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.
Butler, B. D.; Robinson, R.; Sutton, T.; Kemper, G. B.
Hormones and venous thromboembolism among postmenopausal women.
Abstract Venous thromboembolism (VTE) is a common and potentially fatal disease in postmenopausal women. VTE has emerged as the most prevalent adverse effect of oral estrogens in 50-60-year-old women. Obesity and VTE history can be easily used to identify women at high risk but genetic screening is not cost-effective. Based on consistent biological and epidemiological findings, transdermal estrogen is the safest option with respect to VTE, especially in women at high risk. There is strong evidence that VTE risk is greater in women using medroxyprogesterone acetate compared with those receiving other progestins. Based on observational data, progesterone appears safe with respect to VTE. More research and action are needed to avert the hepatic first-pass effect of oral estrogens and to increase awareness of hormone-related VTE. Improving individual risk stratification and a personalized approach to hormone therapy are major challenges for future work. PMID:25223916
Scarabin, P-Y
Hepatic venous outflow obstruction: Three similar syndromes
Our goal is to provide a detailed review of veno-occlusive disease (VOD), Budd-Chiari syndrome (BCS), and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed, enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS, and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions. However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction. Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure. PMID:17461490
Bayraktar, Ulas Darda; Seren, Soley; Bayraktar, Yusuf
Legging orthosis for venous and lymphatic insufficiency.
Presented are the description and advantages of a unique compression device in the form of a legging for the treatment of venous and lymphatic insufficiency. It consists of a number of pliable, unyielding, adjustable compression bands, from the knee to the instep. The bands are easily closed, tightened, and opened, which is particularly useful for the physically handicapped patient for whom the commonly prescribed elastic stocking is inappropriate because of the difficulty in putting it on and removing it. The effectiveness of the legging is enhanced by its nonelasticity, as has been long proven by the Unna boot, and its ability to maintain an unreduced compression level throughout its lifetime, regardless of edema changes. PMID:3606372
Vernick, S H; Shapiro, D; Shaw, F D
Bilateral Pneumothoraces Following Central Venous Cannulation
We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital "Buffalo chests" explaining bilateral pneumothoraces and a secondary tension pneumothorax. PMID:19901997
Pazos, F.; Masterson, K.; Inan, C.; Robert, J.; Walder, B.
Setting a standard for venous thromboembolism prophylaxis.
Trials of the new antithrombotic agent fondaparinux sodium in patients undergoing orthopedic surgery are discussed. Phase II studies conducted in more than 900 hip-replacement and 400 knee-replacement patients demonstrated significant dose-dependent reductions in the frequency of venous thromboembolism. Phase III trials evaluated the efficacy and safety of fondaparinux sodium 2.5 mg s.c. once daily starting six hours after surgery compared with enoxaparin for prevention of venous thromboembolism (VTE). Four multicenter, randomized, comparative, double-blind Phase III trials were conducted: two in total hip replacement patients (Ephesus and Pentathlon 2000), one in knee surgery patients (PentaMaks), and one in hip fracture surgery patients (Penthifra). All four studies followed the same design template, and the comparator was one of two regimens of enoxaparin approved for this indication. Enoxaparin sodium 30 mg s.c. every 12 hours starting postoperatively was used in Pentathlon 2000 and PentaMaks, and enoxaparin sodium 40 mg s.c. once daily starting preoperatively was used in Ephesus and Penthifra. The primary efficacy endpoint was the occurrence of VTE up to day 11, as determined by venography or confirmation of symptoms. The main safety outcome was occurrence of major bleeding. In total, 7344 patients were randomized and efficacy was evaluated in 5385 (73.3%). Risk of VTE was reduced by 50% in patients receiving fondaparinux compared with those receiving enoxaparin. Safety profiles for clinically relevant bleeding were similar between the two drugs. Fondaparinux sodium, a novel antithrombotic agent, is effective for the prevention of VTE, with a favorable safety profile, in patients undergoing major orthopedic surgery. PMID:11715835
Turpie, A G
Absence of venous valves in mice lacking Connexin37
Venous valves play a crucial role in blood circulation, promoting the one-way movement of blood from superficial and deep veins towards the heart. By preventing retrograde flow, venous valves spare capillaries and venules from being subjected to damaging elevations in pressure, especially during skeletal muscle contraction. Pathologically, valvular incompetence or absence of valves are common features of venous disorders such as chronic venous insufficiency and varicose veins. The underlying causes of these conditions are not well understood, but congenital venous valve aplasia or agenesis may play a role in some cases. Despite progress in the study of cardiac and lymphatic valve morphogenesis, the molecular mechanisms controlling the development and maintenance of venous valves remain poorly understood. Here, we show that in valved veins of the mouse, three gap junction proteins (Connexins, Cxs), Cx37, Cx43, and Cx47, are expressed exclusively in the valves in a highly polarized fashion, with Cx43 on the upstream side of the valve leaflet and Cx37 on the downstream side. Surprisingly, Cx43 expression is strongly induced in the non-valve venous endothelium in superficial veins following wounding of the overlying skin. Moreover, we show that in Cx37-deficient mice, venous valves are entirely absent. Thus, Cx37, a protein involved in cell-cell communication, is one of only a few proteins identified so far as critical for the development or maintenance of venous valves. Because Cxs are necessary for the development of valves in lymphatic vessels as well, our results support the notion of common molecular pathways controlling valve development in veins and lymphatic vessels. PMID:23142761
Munger, Stephanie J.; Kanady, John D.; Simon, Alexander M.
Compliance and reactivity of the peripheral venous system in chronic intermittent hemodialysis
Compliance and reactivity of the peripheral venous system in chronic intermittent hemodialysis. A reduced venous compliance and\\/or inadequate venoconstriction could impair hemodynamics during hemodialysis. Therefore, compliance and reactivity of the peripheral venous system were assessed in hemodialysis patients and controls using strain gauge plethysmography. Reactivity of the venous system towards an efferent sympathetic stimulus was assessed using a cold pressor
Jeroen P Kooman; Jef A G Wijnen; Petra Draaijer; Luc M A B van Bortel; Ulrich Gladziwa; Henricus G Peltenburg; Harry A J Struyker-Boudier; Johannes P van Hooff; Karel M L Leunissen
Total Anomalous Pulmonary Venous Connection to the Portal Vein
Anomalous pulmonary venous return represents a rare congenital anomaly with wide anatomic and physiologic variability. We report a case of a newborn with a rare form of total infracardiac anomalous pulmonary venous connection (TAPVC). The pulmonary veins draining both lungs formed two vertical veins, which joined to a common pulmonary trunk below the diaphragm. This venous channel connected to the portal vein through the esophageal hiatus. The diagnosis was suggested by color Doppler sonography and confirmed by intravenous digital subtraction angiography, which allowed definition of the anatomy.
Wyttenbach, Marina [Department of Diagnostic Radiology, Division of Children's Radiology, University Hospital, Inselspital, CH-3010 Bern (Switzerland); Carrel, Thierry; Schuepbach, Peter [Department of Thoracic and Cardiovascular Surgery, University Hospital, Inselspital, CH-3010 Bern (Switzerland); Tschaeppeler, Heinz; Triller, Juergen [Department of Diagnostic Radiology, Division of Children's Radiology, University Hospital, Inselspital, CH-3010 Bern (Switzerland)
[Current status of the management of venous thromboembolism in Japan].
In the past, unfractionated heparin and warfarin have been used as anticoagulants for treatment of venous thromboembolism in Japan. Although it has been effective anticoagulants, these uses are accompanied by several pitfalls, which have led to research and the discovery of new additional groups of anticoagulants: parenteral factor Xa inhibitors, such as fondaparinux, and oral direct factor Xa inhibitors, such as rivaroxaban, apixaban and edoxaban. These new anticoagulants are fast-acting, noninferior to heparin and warfarin in preventing recurrence of venous thromboembolism, and do not require monitoring. These new anticoagulants show promise for improvement of long-term outcome for venous thromboembolism. PMID:25163325
Nakamura, Mashio
Acute mesenteric venous thrombosis with a vaginal contraceptive ring.
Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring. PMID:25035742
Eilbert, Wesley; Hecht, Benjamin; Zuiderveld, Loren
Staphylococcus epidermidis and retention of neonatal percutaneous central venous catheters.
The percutaneous insertion of central venous catheters has become an established practice on many neonatal units. We describe four low birthweight babies, whose catheters became tethered in the vein, and discuss the management of this unusual complication. PMID:2317075
Gladman, G; Sinha, S; Sims, D G; Chiswick, M L
Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Clinician Research Summary.
National Technical Information Service (NTIS)
A systematic review of 179 articles published between January 1980 and May 2011 sought to determine the comparative effectiveness, benefits, and adverse effects of venous thromboembolism (VTE) prophylaxis for patients undergoing orthopedic surgery. The re...
21 CFR 876.5955 - Peritoneo-venous shunt.
Code of Federal Regulations, 2011 CFR
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...
21 CFR 876.5955 - Peritoneo-venous shunt.
Code of Federal Regulations, 2012 CFR
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...
21 CFR 876.5955 - Peritoneo-venous shunt.
Code of Federal Regulations, 2013 CFR
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...
21 CFR 876.5955 - Peritoneo-venous shunt.
Code of Federal Regulations, 2010 CFR
...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...
Cardiac arrhythmias associated with umbilical venous catheterisation in neonates
Umbilical venous catheters (UVCs) are commonly used in the management of severely ill neonates. Several life-threatening complications have been described, including catheter-related infections, myocardial perforation, pericardial effusion and cardiac arrhythmias. This report describe two neonates with cardiac arrhythmias due to umbilical venous catheterisation. One neonate had a supraventricular tachycardia requiring treatment with intravenous adenosine administration. Another neonate had an atrial flutter and was managed successfully with synchronised cardioversion. The primary cause of cardiac arrhythmias after umbilical venous catheterisation is inappropriate position of the UVC within the heart and the first step to treat them should be to pull back or even remove the catheter. Cardiac arrhythmia is a rare but potentially severe complication of umbilical venous catheterisation in neonates. PMID:21691401
Verheij, Gerdina; Smits-Wintjens, Vivianne; Rozendaal, Lieke; Blom, Nico; Walther, Frans; Lopriore, Enrico
Incidence of Venous Thromboembolic Events Among Nursing Home Residents
Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic events among nursing home residents. A retrospective cohort study was derived from data compiled in the State of Kansas Minimum Data Set (MDS) for nursing home residents from July 1, 1997 to July 1, 1998. A total of 18,661 residents (median age, 85 years, 74% female, 95% white) satisfied the study criteria. The outcome measures of the primary endpoint—development of a venous thromboembolic event (VTE)—were obtained from the MDS quarterly health assessments and the Medicare ICD-9 codes. We determined the incidence of VTE among nursing home residents as 1.30 events per 100 person-years of observation. PMID:14687280
Gomes, Josephine P; Shaheen, Wassim H; Truong, Son V; Brown, Edward F; Beasley, Brent W; Gajewski, Byron J
Orbital venous congestion: rare manifestation of an intracranial arteriovenous malformation.
Intracranial arteriovenous malformations (AVM) are uncommon vascular lesions which typically present with hemorrhage or, in the case of unruptured lesions, with seizure, headache, or focal neurological deficit. The importance of the venous drainage pattern in AVM natural history and treatment outcomes is well documented. It is exceptionally rare for an AVM to drain into the orbital venous system. We present a 42-year-old man with a large, complex AVM of the midbrain, basal ganglia, and thalamus which partially drained into the superior ophthalmic vein. The patient was referred for treatment with radiosurgery. The resolution of orbital venous congestion symptoms accompanied AVM obliteration. An attempt to relieve orbital venous congestion by endovascular obliteration or surgical ligation without successful and complete cure of the AVM will most likely destabilize the nidus and predispose it to rupture. Serial ophthalmologic monitoring by an experienced neuro-ophthalmologist is crucial to monitoring the ophthalmologic effects of AVM progression and treatment. PMID:24128772
Ding, Dale; Liu, Kenneth C
Venous thoracic outlet syndrome caused by a congenital rib malformation
Summary Venous thoracic outlet syndrome (VTOS) represents a rare disorder. Hypertrophy of the anterior scalene musculature is the cause of the compression syndrome in most cases. To our knowledge, we describe the first reported case worldwide of a venous compression syndrome caused by a congenital malformation of the 1st and 2nd ribs. Treatment by transaxillary partial rib resection was necessary and a very good postoperative result was achieved. PMID:22544354
Kirschbaum, Andreas; Palade, Emanuel; Csatari, Zoltan; Passlick, Bernward
An unusual case of central venous catheter-related bacteremia.
Some hemodialysed patients need definitive central venous catheterization. One of the main complications is catheter infection, and each infection must be treated. We report a case of an unusual cause of central venous catheter (CVC) infection: physical examination and catheter opacification demonstrated two pin-holes in the catheter. It was possible to salvage the catheter following a treatment regimen combining systemic antibiotics, antibiotic locks, fibrinolytics, and removal of a catheter segment. PMID:21948129
Badin, Julie; François, Maud; Birmelé, Béatrice; Turmel-Rodrigues, Luc; Nivet, Hubert; Pengloan, Josette
Novel Biomarkers of Arterial and Venous Ischemia in Microvascular Flaps
The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and allow clinicians to both diagnose and successfully treat microvascular complications before irreversible tissue damage and flap loss occurs. PMID:23977093
Nguyen, Gerard K.; Monahan, John F. W.; Davis, Gabrielle B.; Lee, Yong Suk; Ragina, Neli P.; Wang, Charles; Zhou, Zhao Y.; Hong, Young Kwon; Spivak, Ryan M.; Wong, Alex K.
Multiple medullary venous malformations decreasing cerebral blood flow: Case report
A rare case of multiple medullary venous malformations in the right cerebral hemisphere is reported. The literature review yielded only one case of multiple medullary venous malformations. Computed tomography scan showed multiple calcified lesions with linear contrast enhancement representing abnormal dilated vessels and mild atrophic change of the right cerebral hemisphere. Single-photon emission computed tomography using N-isopropyl-p-({sup 123}I) iodoamphetamine demonstrated decreased cerebral blood flow in the right cerebral hemisphere.
Tomura, N.; Inugami, A.; Uemura, K.; Hadeishi, H.; Yasui, N. (Research Institute for Brain and Blood Vessels, Akita (Japan))
Cerebral venous sinus thrombosis: unusual imaging appearance. A case report.
Cerebral venous sinus thrombosis (CVST) has widely varied clinical and radiological manifestations ranging from asymptomatic minimal brain oedema to severe haemorrhagic infarcts associated with focal deficits, coma and even death. Cerebral venous sinus thrombosis presenting with lobar or subdural hematomas are rare and the cause may easily be overlooked. We present a case of CVST with an atypical radiological picture of intra-arenchymal, subdural and subarachnoid haemorrhage. PMID:24207147
Muttikkal, T J E; Shaikh, R; Ben Nakhi, A; Gupta, R; Sheikh, M
Venous air embolism: A complication during percutaneous nephrolithotomy
Venous air embolism during percutaneous nephrolithotomy (PCNL) following air pyelogram or saline irrigation has been occasionally reported. We present a case of suspected venous air embolism during air pyelogram in a patient undergoing PCNL. The clinical diagnosis of air embolism was made by fall in end tidal carbon dioxide, blood pressure and Oxygen saturation and was conservatively managed. Early diagnosis with rapid resuscitation is the key to management of a patient with air embolism. PMID:25097326
Parikh, Geeta P.; Sonde, Sumedha R.; Kadam, Prachi
Physiological Changes in Venous Hemodynamics Associated with Elective Fasciotomy
It has been postulated that lower extremity fasciotomy may disrupt the calf musculovenous pump and predisposes to development\\u000a of chronic venous insufficiency (CVI). However, studies based on trauma patients who undergo emergent fasciotomy are confounded\\u000a by the possibility of concomitant vascular and soft tissue injury and use historical controls. This is a prospective study\\u000a that evaluates venous hemodynamics in young
Niten Singh; Anton N. Sidawy; Craig R. Bottoni; Elena Antedomenico; Teddie S. Gawley; Denise Harada; David L. Gillespie; Catherine F. T. Uyehara; Paul R. Cordts
Venous drainage of the penis of the equine
(Member ) Charles L. Bo (Head of Department) December 1983 111 ABSTRACT Venous Drainage of the Penis of the Equine. (December 1983 ) Christine Ann Heise de Barros, D. M. V. , Universidade Federal Fluminense, Brazil Chairman of Advisory Committee... (Member ) Charles L. Bo (Head of Department) December 1983 111 ABSTRACT Venous Drainage of the Penis of the Equine. (December 1983 ) Christine Ann Heise de Barros, D. M. V. , Universidade Federal Fluminense, Brazil Chairman of Advisory Committee...
De Barros, Christine Ann Heise
Prospective study on central venous line associated bloodstream infections
ObjectiveTo prospectively assess the incidence rates and characteristics of central venous line associated bloodstream infections (CLABSI) in one institution.MethodsAll patients with indwelling central venous catheters (CVC) between 1 April 2008 and 31 March 2009 were enrolled. The medical records of patients were reviewed and information on relevant characteristics entered into a standardised questionnaire. Central laboratory records were regularly checked for
Mine Wagner; Jan Bonhoeffer; Thomas O Erb; René Glanzmann; Frank Martin Häcker; Michael Paulussen; Daniel Weibel; Ulrich Heininger
Multimodal percutaneous intervention for critical venous occlusive disease.
Critical deep venous thrombosis and occlusion constitutes a small percentage of patients with venous disease, who exhibit severe symptomatology. This study examined the results of multimodal percutaneous therapy for the treatment of complex critical venous thrombotic and occlusive disease. Twenty-five patients presented with critical venous thromboses or occlusions (11 with debilitating unilateral lower extremity edema causing ambulatory impairment, 2 with debilitating bilateral lower extremity edema, 3 with phlegmasia cerulea dolens, 2 with venous claudication, 2 with superior vena cava (SVS) syndrome with respiratory compromise, 4 with debilitating upper extremity edema, and 1 with renal insufficiency). Therapeutic modalities including thrombolysis, mechanical thrombectomy, percutaneous venoplasty and stent placement, temporary inferior vena cava filtration, and ultrasound guidance were used in all cases in conjunction with long-term systemic anticoagulation. The venous access site was determined by the anatomic location of the lesion and included popliteal, femoral, brachial, and lesser saphenous. Patients were followed with clinical exam and duplex surveillance. Resolution of symptoms was achieved in 18 of 25 patients (72%) and partial resolution occurred in 4 of 25 (16%). Failure of treatment identified as both lack of clinical response and evidence of continued venous thrombosis occurred 3 of 25 patients (12%). Restoration of arterial pulses and limb salvage was achieved in the three patients with phlegmasia cerulea dolens and acute limb-threatening ischemia. Both patients with SVC syndrome experienced resolution of respiratory compromise and facial edema. The mean length of follow-up was 11 +/- 2.7 months. Complications included transfusion requirement (2), hematuria (2), retroperitoneal hematoma (1), and cellulitis (1). Acute critical venous thrombotic and occlusive disease is responsive to multimodal percutaneous treatment. The relief of pain and resolution of acutely life and limb-threatening conditions in this most severely symptomatic subset of patients represents the immediate goal of treatment. PMID:15770366
Dayal, Rajeev; Bernheim, Joshua; Clair, Daniel G; Mousa, Albeir Y; Hollenbeck, Scott; DeRubertis, Brain; McKinsey, James; Morrissey, Nicholas J; Kent, K Craig; Faries, Peter L
Chronic venous leg ulcer treatment: future research needs.
The prevalence and costs of chronic venous ulcer care in the US are increasing. The Johns Hopkins University Evidence-Based Practice Center recently completed a systematic review of the comparative effectiveness of advanced wound dressings, antibiotics, and surgical management of chronic venous ulcers. Of 10,066 citations identified in the literature search, only 66 (0.06%) met our liberal inclusion criteria for providing evidence on the effectiveness of interventions for chronic venous ulcers. Based on review of those studies, members of our team and a panel of informed stakeholders identified important research gaps and methodological deficiencies and prioritized specific future research needs. Based on that review, we provide the results of our assessment of future research needs for chronic venous ulcer care. Advanced wound dressings were considered to have the highest priority for future research, followed by venous surgery and antibiotics. An imperative from our assessment is that future research evaluating interventions for chronic venous ulcers meet quality standards. In a time of increasing cost pressure, the wound care community needs to develop high-quality evidence to justify the use of present and future therapeutic modalities. PMID:24134795
Lazarus, Gerald; Valle, M Fran; Malas, Mahmoud; Qazi, Umair; Maruthur, Nisa M; Doggett, David; Fawole, Oluwakemi A; Bass, Eric B; Zenilman, Jonathan
Glycosaminoglycan sulodexide modulates inflammatory pathways in chronic venous disease.
Inflammation represents an important epiphenomenon in the etiopathogenesis of chronic venous disease, a worldwide debilitating condition affecting millions of subjects. The pathophysiology of chronic venous disease (CVD) is based on the hemodynamic abnormalities in conjunction to alterations in cellular and extracellular matrix biocompounds. The endothelial dysfunction results from early perturbation in the endothelium linked to glycocalyx injury and promoted by inflammatory cells and mediators (such as matrix metalloproteinases and interleukins), which lead to progressive dilation of the vein resulting in chronic venous insufficiency. Activated leukocytes during the inflammatory process release enzymes, free radicals, chemokines and inflammatory cytokines in the vessel microenvironment, which are responsible for the changes of the venous wall and venous valve, reflux and venous hypertension, and the development/progression of tissue destruction and skin changes. Sulodexide, a highly purified mixture of glycosaminoglycans composed by 80% fast moving heparin and 20% of dermatan sulphate, exhibits anti-thrombotic and profibrinolytic properties, restoring also the essential endothelial glycocalyx. Glycosaminoglycan sulodexide has been also characterized to reduce the release of inflammatory cytokines/chemokines and to inhibit the matrix metalloproteinases-related proteolytic cascades, counteracting endothelial dysfunctions. The pleiotropic effects of sulodexide set the basis for a very promising agent in treating the spectrum of CVD. PMID:24936532
Mannello, F; Ligi, D; Raffetto, J D
Ever since its earliest reports, portal venous gas (PVG) has been associated with numerous intraabdominal catastrophes and has served as an indication for urgent surgical exploration. It is traditionally regarded to be an ominous finding of impending death, with highest mortality reported in patients with underlying bowel ischemia. Today, computed tomography has demonstrated a wider range of clinical conditions associated with PVG, some of which are "benign" and do not necessarily require surgery, unless when there are signs of intraabdominal catastrophe or systemic toxicity. One of these "benign" conditions is Crohn's disease. The present report describes a 19-year-old Chinese boy with Crohn's pancolitis who presented with septic shock associated with PVG and portal vein thrombosis, and was successfully managed surgically. To our knowledge, this is the first report of PVG and portal vein thrombosis associated with Crohn's disease in a Chinese patient. In addition, we have also reviewed the reports of another 18 Crohn's patients with PVG previously described in the English literature. Specific predisposing factors for PVG were identified in 8 patients, including barium enema, colonoscopy, blunt abdominal trauma, and enterovenous fistula. The patients who developed PVG following barium enema and blunt trauma were all asymptomatic and no specific treatment was necessary. Eleven patients (58%) who presented with signs of intraabdominal catastrophe or systemic toxicity required either immediate or eventual surgery. The overall mortality rate among the 19 patients was only 11%. The present literature review has shown that the finding of PVG associated with Crohn's disease does not always mandate surgical intervention. It is the clinical features and the related complications that ultimately determine the treatment approaches. The overall outcome of PVG associated with Crohn's disease has been favourable. PMID:17007007
Ng, Simon Siu-Man; Yiu, Raymond Ying-Chang; Lee, Janet Fung-Yee; Li, Jimmy Chak-Man; Leung, Ka-Lau
Purpose: We have previously shown that fibroblasts cultured from venous ulcers display characteristics of senescence and have reduced growth rates. Susceptibility of young fibroblasts to the microcirculatory changes associated with venous ulcers, such as macrophage trapping and activation, could explain the prevalence of senescent fibroblasts in these wounds. Methods: We tested the in vitro effect of venous ulcer wound fluid
Manuel V. Mendez; Joseph D. Raffetto; Tania Phillips; James O. Menzoian; Hee-Young Park
Fatal cerebral malaria: a venous efflux problem
Most Plasmodium falciparum-infected children with cerebral malaria (CM) die from respiratory arrest, but the underlying pathology is unclear. Here we present a model in which the ultimate cause of death from CM is severe intracranial hypertension. Dynamic imaging of mice infected with P. berghei ANKA, an accepted model for experimental CM, revealed that leukocyte adhesion impairs the venous blood flow by reducing the functional lumen of postcapillary venules (PCV). The resulting increase in intracranial pressure (ICP) exacerbates cerebral edema formation, a hallmark of both murine and pediatric CM. We propose that two entirely different pathogenetic mechanisms—cytoadherence of P. falciparum-infected erythrocytes in pediatric CM and leukocyte arrest in murine CM—result in the same pathological outcome: a severe increase in ICP leading to brainstem herniation and death from respiratory arrest. The intracranial hypertension (IH) model unifies previous hypotheses, applies to human and experimental CM alike, eliminates the need to explain any selective recognition mechanism Plasmodium might use to target multiple sensitive sites in the brain, and explains how an intravascular parasite can cause so much neuronal dysfunction.
Frevert, Ute; Nacer, Adéla
Venous thromboembolism after traumatic brain injury.
No standard exists for venous thromboembolism (VTE) prophylaxis after traumatic brain injury (TBI). Caregivers agree that there is an early time point after injury in which the chances of spontaneous injury progression are high and the risks of prophylactic anticoagulation are excessive, and that these injuries eventually stabilize to the point that anticoagulation may be safely started. Translating this consensus into an application that can inform bedside decision making has not occurred. National groups have promulgated guidelines in the United States suggesting that anticoagulants be used when the risk of renewed intracranial hemorrhage has ceased with no guidance beyond this vague recommendation. This is largely due to the relative paucity of literature about pharmacologic prophylaxis, which has in turn been due to fears of propagation of intracranial hemorrhage. Although interest in this field has increased of late, many studies are limited by the simple dichotomization of TBI patients as having the presence or absence of intracranial blood. Although methodologically easier, this approach does not account for the heterogeneity of TBI and, consequently, the spectrum of time to stabilization. To address this, our group has created an algorithm which stratifies patients by risk for spontaneous progression and tailors a unique VTE prophylaxis regimen to each arm. PMID:23629824
Phelan, Herb A
Contraception-related venous thromboembolism in adolescents.
Venous thromboembolism (VTE) is a rare but serious complication of combined hormonal contraception. While the absolute risk of VTE is low in adolescents, thrombotic events in contraception users younger than the age of 20 years account for 5 to 10% of total contraception-related VTE events in population studies, because of the high frequency of contraception use in adolescents. An increased risk of VTE exists not only with oral contraceptives, but also the contraceptive patch and vaginal ring. Most adolescents who experience contraception-related VTE have additional transient or inherited thrombotic risk factors at the time of VTE. Although the presence of inherited thrombophilia impacts the risk of contraception-related VTE, thrombophilia screening before contraception prescribing should be targeted only to high-risk populations. Pediatric institutions, caregivers, and young women need to be aware of the risk of VTE with estrogen-containing contraception, and maintain a high index of suspicion for this complication in women using these agents. PMID:24356931
O'Brien, Sarah H
Venous thromboembolism in patients with prior stroke.
Patients with prior stroke are susceptible to venous thromboembolism (VTE). We studied patients with stroke in the Worcester VTE study of 2488 consecutive patients hospitalized with VTE. In all, 288 (11.6%) had a clinical history of stroke and 2200 (88.4%) did not. Patients with stroke were more likely to die inhospital (9.2% vs 4%) and within 30 days of VTE diagnosis (16.7% vs 6.9%) compared with patients without stroke (all P < .001). Recent immobilization (adjusted odds ratio [OR] 2.15; 95% confidence interval [CI] 1.15-4.09) and inferior vena cava (IVC) filter insertion (adjusted OR 2.1; 95% CI 1.15-3.83) were associated with a doubling of inhospital death. Recent immobilization (adjusted OR 1.84; 95% CI 1.19-2.83) and IVC filter insertion (adjusted OR 1.94; 95% CI 1.2-3.14) were associated with an increased risk of death within 30 days of VTE. In conclusion, patients with VTE and prior stroke were more than twice as likely to die while hospitalized and within 30 days of VTE diagnosis. PMID:23637004
Piazza, Gregory; Goldhaber, Samuel Z; Kroll, Aimee; Goldberg, Robert J; Emery, Catherine; Spencer, Frederick A
Dialysis central venous catheter types and performance.
The choice of both short-term (nontunneled) and long-term (tunneled) central venous catheters (CVCs) for hemodialysis is a difficult one, due to the large number of available catheters, with very different characteristics and cost.CVC-related complications (in particular infections, thrombosis and inefficient dialysis) can determine ominous consequences and death, with extremely elevated costs due to prolonged hospitalization and expensive procedures. Thus, the correct balance between cost and quality of CVC is required when deciding which kind of CVC should be adopted.In this regard, the design of CVCs has become a very active area of industrial and clinical research, with the ultimate goal of improving the long-term function of the catheter and of reducing complication rates, because even small improvements in the complication or reintervention rates have a positive impact on individual patient care and cost to society. In this article we review the general features of CVCs, including differences between tunneled and nontunneled CVCs, materials and their compatibility with lock solutions, the implications of straight versus precurved design in nontunneled CVCs, lumen and tip features with their clinical implications, catheter coatings and their effect on infection and thrombosis. PMID:24817472
Gallieni, Maurizio; Brenna, Irene; Brunini, Francesca; Mezzina, Nicoletta; Pasho, Sabina; Giordano, Antonino
Epidemiology of cancer-related venous thromboembolism
Recent studies have better defined the epidemiology of venous thromboembolism (VTE) in cancer patients. The incidence is highest in patients who have metastatic disease at the time of presentation and who have fast growing, biologically aggressive cancers associated with a poor prognosis. The incidence is also high in patients with haematological cancers. Other specific risk factors that affect the incidence of VTE include undergoing invasive neurosurgery, the number of underlying chronic co-morbid conditions, and being of Asian/Pacific Islander decent (lower incidence). The incidence is highest in the first few months after diagnosis, which may reflect the biology of the cancer or medical interventions such as major surgery or start of chemotherapy. The development of VTE is clearly associated with decreased survival, and this effect is greater among patients initially diagnosed with local- or regional-stage cancer compared with patients with metastatic cancer, probably because VTE reflects the presence of a biologically aggressive cancer. Finally, a small percentage of patients with idiopathic VTE and no clinical or laboratory evidence of cancer may harbour an aggressive but 'occult' malignancy likely causally linked to the development of VTE. PMID:19285269
Wun, Ted; White, Richard H.
Primary smooth muscle tumors of venous origin.
Vein tumors are rare, difficult to diagnose, and usually malignant. We have encountered three: a leiomyoma of the jugular vein and leiomyosarcomas of the saphenous vein and inferior vena cava (IVC). The leiomyoma was lost to follow-up, the saphenous vein leiomyosarcoma survived nine years, and the leiomyosarcoma of the IVC is six months without recurrence. Half of venous leiomyosarcomas arise in the IVC, predominately in women over 50 years of age. Surgical excision is the treatment of choice since malignant or benign status cannot be determined operatively. Resection should include a segment of the original vessel. This poses problems in the IVC when the renal veins require sacrifice. Right renal vein interruption mandates nephrectomy. Edema following IVC resection is evaluated. The incidence is lower than anticipated when resection is for tumor if there is no history of phlebitis. The IVC was reconstructed with a composite autograft but this is not now recommended. Despite significant local recurrences or distal metastases, cure or long-term palliation can often be achieved. Radiation and chemotherapy do not improve survival or prevent recurrence. Images Fig. 1. Fig. 2. Figs. 3a and b. PMID:7149825
Fischer, M G; Gelb, A M; Nussbaum, M; Haveson, S; Ghali, V
Venous Drainage Patterns in Carotid Cavernous Fistulas
Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. PMID:24967298
Aralasmak, Ayse; Karaali, Kamil; Senol, Utku; Ozdemir, Huseyin; Alkan, Alpay
Oral Clonidine Pretreatment Prior to Venous Cannulation
Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability. PMID:16863391
Hall, David L; Rezvan, Ehsan; Tatakis, Dimitris N; Walters, John D
Physical activity and risk of venous thromboembolism. The Troms? study
Background Previous studies have shown differences in the impact of regular physical exercise on the risk of venous thromboembolism. The inconsistent findings may have depended on differences in study design and specific population cohorts (men only, women only and elderly). We conducted a prospective, population-based cohort to investigate the impact of regular physical exercise on the risk of venous thromboembolism. Design and Methods Risk factors, including self-reported moderate intensity physical exercise during leisure time, were recorded for 26,490 people aged 25–97 years old, who participated in a population health survey, the Tromsř study, in 1994–95. Incident venous thromboembolic events were registered during the follow-up until September 1, 2007. Results There were 460 validated incident venous thromboembolic events (1.61 per 1000 person-years) during a median of 12.5 years of follow-up. Age, body mass index, the proportion of daily smokers, total cholesterol, and serum triglycerides decreased (P<0.001), whereas high density cholesterol increased (P<0.001) across categories of more physical exercise. Regular physical exercise of moderate to high intensity during leisure time did not significantly affect the risk of venous thromboembolism in the general population. However, compared to inactivity, high amounts of physical exercise (?3 hours/week) tended to increase the risk of provoked venous thromboembolism (multivariable hazard ratio, 1.30; 95% confidence interval, 0.84–2.0), and total venous thromboembolism in the elderly (multivariable hazard ratio, 1.33; 95% confidence interval, 0.80–2.21) and in the obese (multivariable hazard ratio, 1.49; 95% confidence interval, 0.63–3.50). Contrariwise, compared to inactivity, moderate physical activity (1.0–2.9 hours/week) was associated with a border-line significant decreased risk of venous thromboembolism among subjects under 60 years old (multivariable hazard ratio, 0.72; 95% confidence interval, 0.48–1.08) and subjects with a body mass index of less than 25 kg/m2 (multivariable hazard ratio, 0.59; 95% confidence interval, 0.35–1.01). Conclusions Our study showed that regular, moderate intensity physical exercise did not have a significant impact on the risk of venous thromboembolism in a general population. Future studies are required to assess the impact of regular physical exercise on venous thromboembolism risk in different population subgroups. PMID:20801904
Borch, Knut H.; Hansen-Krone, Ida; Braekkan, Sigrid K.; Mathiesen, Ellisiv B.; Njolstad, Inger; Wilsgaard, Tom; Hansen, John-Bjarne
Which venous system to choose for anastomosis in head and neck reconstructions?
It has been postulated that venous thrombosis in free flap surgery necessitates the use of 2 venous anastomoses into different venous systems. We retrospectively analyzed a single surgeon's 10-year experience (August 1993 to August 2003) in primary free flap reconstruction for malignant tumors of the head and neck. Of 492 primary reconstructions that did not need a vein graft, vein loop, or cephalic turnover procedure, 251 used the internal jugular venous system as venous outflow, 140 used the subclavian system as outflow, and 101 used both. Two hundred thirty-eight of 251 (95%) of flaps utilizing the internal jugular venous system for outflow were successful compared with 129 of 140 (92%) of flaps utilizing the subclavian system. Where both venous systems were used the success rate was 101 of 101 (100%) (P < 0.05). Where possible, a second venous anastomosis should be performed utilizing both venous drainage systems. PMID:18812709
Ross, Gary L; Ang, Erik S W; Golger, Alex; Lannon, Declan; Addison, Patrick; Snell, Laura; Novak, Christine B; Lipa, Joan E; Gullane, Patrick J; Neligan, Peter C
A systematic review of compression treatment for venous leg ulcers.
OBJECTIVE: To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers. METHODS: Systematic review of research. Search of 19 electronic databases including Medline, CINAHL, and Embase. Relevant journals and conference proceedings were hand searched and experts were consulted. MAIN OUTCOME MEASURES: Rate of healing and proportion of ulcers healed within a time period. STUDY SELECTION: Randomised controlled trials, published or unpublished, with no restriction on date or language, that evaluated compression as a treatment for venous leg ulcers. RESULTS: 24 randomised controlled trials were included in the review. The research evidence was quite weak: many trials had inadequate sample size and generally poor methodology. Compression seems to increase healing rates. Various high compression regimens are more effective than low compression. Few trials have compared the effectiveness of different high compression systems. CONCLUSIONS: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers. Insufficient reliable evidence exists to indicate which system is the most effective. More good quality randomised controlled trials in association with economic evaluations are needed, to ascertain the most cost effective system for treating venous leg ulcers. PMID:9302954
Fletcher, A.; Cullum, N.; Sheldon, T. A.
Venous collateral circulation of the extracranial cerebrospinal outflow routes.
A new nosologic vascular pattern that is defined by chronic cerebrospinal venous insufficiency (CCSVI) has been strongly associated with multiple sclerosis. The picture is characterized by significant obstacles of the main extracranial cerebrospinal veins, the jugular and the azygous system, and by the opening of substitute circles. The significance of collateral circle is still neglected. To the contrary, substitute circles are alternative pathways or vicarious venous shunts, which permit the drainage and prevent intracranial hypertension. In accordance with the pattern of obstruction, even the intracranial and the intrarachidian veins can also become substitute circles; they permit redirection of the deviated flow, piping the blood toward available venous segments outside the central nervous system. We review the complex gross and radiological anatomy of collateral circulation found activated by the means of EchoColor-Doppler and selective venography in the event of CCSVI, focusing particularly on the suboccipital cavernous sinus (SCS), the condylar venous system, the pterygoid plexus, the thyroid veins, and the emiazygous-lumbar venous anastomosis with the left renal vein. PMID:19534716
Zamboni, Paolo; Consorti, Giuseppe; Galeotti, Roberto; Gianesini, Sergio; Menegatti, Erica; Tacconi, Giovanna; Carinci, Francesco
Cerebral Venous Thrombosis - A New Diagnosis in Travel Medicine?
Cerebral venous thrombosis is a syndrome seen in association with a large number of disease processes. The commonest reported causes in adults are oral contraception,1 pregnancy and complications associated with the postpartum period,2 systemic malignancy,3 and infection.4 In approximately 20% of adult cases reported during the past 20 years no etiology was established.5 Cerebral venous thrombosis can be caused by similar mechanisms, such as venous thrombosis, occurring elsewhere in the body, e.g., blood vessel wall alterations attributable to inflammation, infection, or invasion of malignant cells, as well as from changes in blood flow due to dehydration and changes in the coagulability of the blood (e.g., from use of oral contraception). PC Gates and HJM Barnett list 38 causes of cerebral venous thrombosis that were proven by angiography or autopsy. One item on their list was dehydration/ hyperpyrexia.5 Recently thrombosis of the venae saphena or femoralis/iliaca has been reported to occur in long distance air travelers.6 We would like to report on five patients (out of 15) in whom cerebral venous thrombosis was causatively linked with either long distance air travel alone, air travel and diarrhea, or air travel and exposure to tropical heat. PMID:9815446
Pfausler; Vollert; Bösch; Schmutzhard
[Case of cerebral venous thrombosis causing refractory intracerebral hemorrhage].
Cerebral venous thrombosis is an uncommon disease characterized by expansive cerebral edema, venous infarction and massive intracerebral hemorrhage. Magnetic resonance imaging and angiography are useful for diagnosis of cerebral venous thrombosis. A 54-year-old man was admitted with headache, vomiting and right hemiparesis. Computed tomography (CT) revealed subcortical hematoma in the left parietal lobe. Digital subtraction angiography (DSA) demonstrated occlusion of the left Labbé vein with dilation of cortical veins and deep cerebral veins. He also suffered from pulmonary embolization and deep vein thrombosis in the lower extremities. Anticoagulant and thrombolytic agents were administered, then respiratory condition and hemiparesis were improved. However, his condition deteriolated 7 months after the initial attack. CT revealed huge subcortical hematoma in the same site. He underwent craniotomy and intracerebral hematoma was evacuated during treatment with vitamin K. His symptom gradually improved and he was discharged with moderate disability 2 months after operation. Dicision of surgical treatment is difficult because there is a risk of rebleeding due to thrombolytic therapy and progressive venous congestion. Since anticoagulant and thrombolytic therapy are inevitable, surgical indication for refractory intracerebral hemorrhage associated with cerebral venous thrombosis should be considered carefully. PMID:19175034
Kato, Naoki; Mori, Ryousuke; Seki, Koujirou; Noda, Yasuto; Morooka, Satoru; Morita, Masayo; Tanaka, Toshihide; Abe, Toshiaki
Digital subtraction angiography of the portal venous system
Venous-phase arteriography after celiac or superior mesenteric artery injection is the most common technique used to demonstrate portal venous anatomy, flow direction, and portal systemic shunts. Large-volume contrast material injections and intraarterial vasodilators or balloon occlusion technique are required for optimal examinations using film-screen recording. A technique for performing venous-phase arteriography with digital subtraction imaging after celiac and superior mesenteric artery injection is described. The major advantage of intraarterial digital subtraction technique in comparison to film-screen recording is sensitivity to intravascular iodine with a consequent reduction in contrast material load and examination time. Technical success is limited only by motion artifact and should approximate the 80%-90% figure achieved for intravenous digital subtraction angiography of the aortorenal vessels.
Foley, W.D.; Stewart E.T.; Milbrath, J.R.; SanDretto, M.; Milde, M.
Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion.
Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting.First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access.In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is preferred because it is noninvasive, does not require contrast agent, carries no exposure to ionizing radiation, and is highly accurate and reproducible. Apart from catheter-directed thrombolysis, mechanical thrombectomy has proven to be a quick and safe treatment modality by enabling the recanalization of thrombotic occlusions in conjunction with minimal invasiveness and a low bleeding risk. Mechanical thrombectomy devices should only be used in conjunction with a temporary cava filter.Contrast-enhanced CT is at present considered the examination of choice for acute mesenteric vein occlusion which has mortality rates as high as 80%. Patients with proven acute mesenteric venous occlusion and contraindications to surgical therapy and no identified bleeding disposition without looming bowel ischemia or infarction are possible contenders to the less invasive percutaneous approach either by (in)direct thrombolysis or mechanical means. Ultrasonography is the primary imaging modality for the diagnosis of upper extremity thrombosis. Computed tomography and MRI are in addition helpful in diagnosing central chest vein occlusions. The interventionalist is rarely involved in the treatment of this entity. Catheter-directed thrombolysis is known to improve lysis rates. Together with balloon angioplasty good results have been obtained. If stenosis or thrombus remains after thrombolysis and angioplasty, stent placement should follow. Within the first two weeks, thrombosed dural sinus and cerebral venous vessels are typically hyperdense on CT compared with brain parenchyma; after the course of 2 weeks, the thrombus will become isodense. In MRI an axial fluid-attenuated inversion recovery sequence, an axial diffusion-weighted MRI, coronal T1-weighted spin-echo and T2-weighted turbo-spin-echo sequences, a coronal gradient-echo and a 3D phase-contrast venous angiogram should be performed. Local thrombolysis is needed only when patients have an exacerbation of clinical symptoms or imaging signs of worsening disease despite sufficient anticoagulation therapy. Acute occlusions of dia
Haage, Patrick; Krings, Timo; Schmitz-Rode, Thomas
[Implantations of venous ports--the latest advances].
A continuously growing spectrum of cytostatic preparations used to treat oncological patients, as well as a growing spectrum of indications to treat patients with disseminated or locally advanced findings even in the elderly patients, brings on a subject of long-term venous portae problems to solve. The venous port is a smart solution of this problem. The method minimalizes risks resulting from long-term canylations of the central venous system and, primarily, substantially improves comfort of patients. This argument takes in consideration not only periods between chemotherapy applications, but also administration of the cytostatic preparation itself. The following article summarizes long-term experience with port implantations in the MOU. It points out increasing rates of patients with implanted ports and highlights frequency rates of observed complications connected with both the port implantation and the port use. PMID:15938379
Ondrák, M; Kaplan, Z; Fait, V; Sýkorová, Z
Venous malformations: Sclerotherapy with a mixture of ethanol and lipiodol
Purpose. To evaluate the usefulness of a mixture of absolute ethanol and lipiodol in the management of venous malformations. Methods. Percutaneous sclerotherapy was performed with a mixture of absolute ethanol and lipiodol (9:1) in 17 patients with venous malformations, once in 12 patients, twice in 5. The therapeutic efficacy was evaluated by pain reduction. Conventional radiographs (n=15) and posttreatment magnetic resonance imaging (n=5) were obtained for the follow-up evaluation. Results. Sclerotherapy was successful in all but two patients. The therapeutic effect was excellent in two patients, good in seven, fair in five, and poor in one. Radiopacity of lipiodol was beneficial for monitoring the procedure rather than for follow-up evaluations. Areas with low signal-intensity strands were increased on T2-weighted images obtained after the sclerotherapy. Conclusion. Sclerotherapy with a mixture of ethanol and lipiodol is effective in treating venous malformations.
Suh, Jin-Suck [Yonsei University, College of Medicine, Department of Diagnostic Radiology (Korea, Republic of); Shin, Kyoo-Ho [Yonsei University, College of Medicine, Department of Orthopedic Surgery (Korea, Republic of); Na, Jae-Bum [Kyungsang University, College of Medicine, Department of Diagnostic Radiology (Korea, Republic of); Won, Jong-Yun [Yonsei University, College of Medicine, Department of Diagnostic Radiology (Korea, Republic of); Hahn, Soo-Bong [Yonsei University, College of Medicine, Department of Orthopedic Surgery (Korea, Republic of)
Venous Thromboembolism in the Cancer Population: Pathology, Risk, and Prevention
Patients with cancer have an increased risk of developing venous thromboembolism (VTE) and the incidence of these events has been increasing over the past decade. Venous thromboembolic events include both deep venous thrombosis and pulmonary embolism. These events contribute to higher morbidity and mortality rates. Understanding the complex pathogenesis of and risk factors for cancer-associated VTE will help guide advanced practitioners to improve outcomes with prophylaxis. The American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Society of Medical Oncology have utilized this information and developed evidence-based guidelines for prophylactic management for those who are at highest risk of developing cancer-associated VTE. This review will discuss the impact of cancer-associated VTE as well as its underlying pathogenesis, risk factors, and current recommendations for prophylaxis. PMID:25031924
Hawbaker, Susan
Original research article Risk of venous thromboembolism from oral contraceptives containing
Original research article Risk of venous thromboembolism from oral contraceptives containing, USA Abstract Controversy exists regarding whether oral contraceptives (OCs) containing desogestrel for a given woman. © 2001 Elsevier Science Inc. All rights reserved. Keywords: Oral contraceptives; Venous
Hennessy, Sean
Predictive Factors of Late Venous Aortocoronary Graft Failure: Ultrastructural Studies
Background Venous aortocoronary graft arterialization may precede a preterm occlusion in some coronary artery bypass grafting (CABG) patients. The aim of the present study was to identify ultrastructural variations in the saphenous vein wall that may have an impact on the development of venous graft disease in CABG patients. Methods The study involved 365 consecutive patients with a mean age of 62.9±9.4 years who underwent isolated CABG. The thickness and area of the whole venous wall, the tunica intima, the tunica media and the adventitia and the number and shape (length, thickness and length/thickness ratio) of the nuclei in the medial smooth muscle cells nuclei in the distal saphenous vein segments were evaluated by ultrastructural studies. Patients were followed up for 41 to 50 months (mean 45.1±5.1). Saphenous vein graft patency was assessed by follow-up coronary angiography. Logistic regression models were used to identify independent risk factors for late graft failure. Results In 71 patients significant lesions in the saphenous vein grafts were observed. The whole venous wall thickness (437.5 µm vs. 405.5 µm), tunica media thickness (257.2 µm vs. 211.5 µm), whole venous wall area (2.23 mm2 vs. 2.02 mm2) and tunica media area (1.09 mm2 vs. 0.93 mm2) were significantly larger for this group of patients than for those without graft disease. In the latter group more elongated smooth muscle cell nuclei (higher length/thickness ratio) were found in the tunica media of the saphenous vein segments. Thickening of the saphenous vein tunica media and chunky smooth muscle cell nuclei were identified as independent risk factors for graft disease development. Conclusions Saphenous vein tunica media hypertrophy (resulting in wall thickening) and chunky smooth muscle cell nuclei might predict the development of venous graft disease. PMID:23940610
Perek, Bartlomiej; Malinska, Agnieszka; Stefaniak, Sebastian; Ostalska-Nowicka, Danuta; Misterski, Marcin; Zabel, Maciej; Suri, Anuj; Nowicki, Michal
Reversible brainstem dysfunction from spinal arterio-venous fistula.
A 45-year-old man presented with subacute onset of ataxia, diplopia, urinary retention and paraparesis. MR scan of brain showed abnormal T2 hyperintense signal within the cervical cord, medulla and lower pons and vascular appearances suggesting an arterio-venous fistula. The fistula was surgically explored and successfully disconnected with good clinical outcome. Brainstem or cervical dural arterio-venous fistulae more typically present as a myelopathy; only a handful of cases have presented with brainstem dysfunction. This is a rare but reversible cause of subacute brainstem dysfunction. PMID:24969585
Willis, M D; Amato-Watkins, T; Zaben, M; Baig, A; Corkill, R; Joshi, Y
New Anticoagulants for the Prevention and Treatment of Venous Thromboembolism
Anticoagulant therapy is effective at preventing the development of venous thromboembolism in high-risk patients, and reduces morbidity and mortality in individuals with established thromboembolic disease. Vitamin K antagonists and heparins are currently the most commonly used anticoagulant drugs, but they have practical limitations. Therefore, new antithrombotic agents with predictable dose-responses (thereby decreasing the need for monitoring without compromising efficacy or safety), ideally available in an oral formulation and with a rapidly reversible anticoagulant effect, are needed. New drugs fulfilling some of the above criteria have been developed and have proven to be effective agents for the treatment and prevention of venous thromboembolism. PMID:17319097
McRae, Simon J; Ginsberg, Jeffrey S
Erythrocyte volume in acidified venous blood from exercising limbs.
NASA Technical Reports Server (NTRS)
Five male volunteers performed arm exercises in the sitting position by cranking the pedals of a bicycle ergometer at 50 revolutions per min. The initial mechanical work load of 0 kgm/min was increased every minute by 75 kgm/min until exhaustion occurred. The data obtained show a significant acidification of the venous blood from the working arms and a substantial increase in venous pCO2 during this type of muscular activity. However, the erythrocyte volume remained unaltered during the exercise.
Van Beaumont, W.; Rochelle, R. H.
[Differential diagnosis of venous aneurysm of femoral hernia].
Eight hundred and twelve patients with varicose disease were examined, 18 (2.2%) of them had aneurysms in the region of sapheno-femoral anastomosis. Venous aneurysm was diagnosed before surgery in all 18 patients. All of them underwent surgery with positive result. Diagnosis of aneurysm of great saphena vein in inguinal region is not difficult in most cases. Difficulties usually occur in patients with overweight. In 5 patients with obesity aneurysm was initially diagnosed as femoral hernia. Duplex scanning is the best non-invasive method of diagnosis of venous aneurysm in obese patients. PMID:15602456
Serazhitdinov, A Sh; Fokin, A A; Vladimirski?, V V; Orekhova, L A; Makarov, A V
Chemoprophylaxis for Venous Thromboembolism Prevention: Concerns Regarding Efficacy and Ethics
Summary: Chemoprophylaxis has been recommended for plastic surgery patients judged to be at increased risk for venous thromboembolism. Several investigators have encountered this complication in patients despite anticoagulation therapy. An increased rate of complications related to postoperative bleeding has been reported. This article examines the efficacy and safety of this intervention, along with ethical considerations, in an attempt to determine whether any benefits of chemoprophylaxis justify the additional risks. The statistical methods and conclusion of the Venous Thromboembolism Prevention Study are challenged. Other preventative measures that do not cause negative side effects are discussed as safer alternatives.
The authors paid attention to revealing as precisely as possible anatomical and haemodynamic conditions in venous vascular bed in the course of ultrasonographic examination of 309 lower extremities with clinical manifestations of chronic venous insufficiency (CVI). A combined reflux in the superficial and deep venous system (53.7%) or isolated reflux in superficial veins (25.9%) proved to be the most frequent pathogenic bases of CVI. Pathophysiology of varices was mostly based on the venous reflux and the primary idiopathic CVI was mostly present (98.1%). The post-thrombotic partial obstruction of the deep venous system (post-thrombotic venous changes on the walls) was demonstrated exceptionally (1.9%). A high coincidence of reflux in the deep and superficial venous system points out to s.c. secondary reflux in the deep veins originating on the basis of primary reflux in the large or small saphena. An attempt was made to clarify, whether the development and frequency of incompetent perforators is directly connected with the presence and seriousness of reflux in the large and small saphena. The presence and severity of large saphena insufficiency does not univocally indicate the presence of dilated or insufficient perforators on the medical side of the crus, where these anastomoses are present most frequently. The large saphena is a long vein typically suffering from segmental insufficiency, i.e. reflux affecting a certain portion, whereas other parts of the vein may be fully competent. Anatomical venous variability and abnormalities on lower extremities were demonstrated in every fifth extremity (62 extremities, 20.1%). Most of them concerned large saphena (39 extremities, 62.8%), small saphena being second (15 extremities, 25.2%). Other anatomical deviations occurred sporadically as solitary findings. In the large saphena, duplication was present most frequently (54.8%). Insufficient variable superficial veins and anatomical venous anomalies were mostly not the only pathogenic basis of CVI, but were predominantly associated with insufficiently in the area of deep veins and perforators (84%). In our cohort there were altogether 55 extremities (17.8%) after the operation on superficial venous system, where relapses of varices were found. The causes of post-operation relapse of varices may be divided into three groups: 1. insufficiency of the large saphena, 2. insufficiency of the small saphena and 3. insufficiency of the deep veins. A combined simultaneous insufficiency in several venous systems was found most frequently (27 extremities, 49.1%). Even though the reflux in the deep veins was demonstrated in 50.9% of these extremities, a combination with the reflux in superficial veins and perforators (49.1%) was present with the exception of one case of isolated insufficiency. The insufficiency of the large and small saphena was clearly the leading single causes (15 extremities, 27.3%) of varix relapses. The patients should never be operated on the venous system of lower extremities without previous detailed ultrasonographic examination. It is the only way to increase probability of the operation success and to decrease the risk of relapses of CVI manifestations. PMID:14518084
Musil, D; Herman, J
Purpose: Central venous obstruction is a common problem in patients with chronic renal failure who undergo maintenance hemodialysis. We studied the use of right atrial bypass grafting in nine cases of central venous obstruction associated with upper extremity venous hypertension. To better understand the options for managing this condition, we discuss the roles of surgery and percutaneous transluminal angioplasty with
Rafik A. El-Sabrout; J. Michael Duncan
The ability of practitioners to assess the adequacy of global oxygen delivery is dependent on an accurate measurement of central venous saturation. Traditional techniques require the placement of invasive central venous access devices. This study aimed to compare two non-invasive technologies for the estimation of regional venous saturation (reflectance plethysmography and near infrared spectroscopy [NIRS]), using venous blood gas analysis as gold standard. Forty patients undergoing cardiac surgery were recruited in two groups. In the first group a reflectance pulse oximeter probe was placed on the skin overlying the internal jugular vein. In the second group, a Somanetics INVOS oximeter patch was placed on the skin overlying the internal jugular vein and overlying the ipsilateral cerebral hemisphere. Central venous catheters were placed in all patients. Oxygen saturation estimates from both groups were compared with measured saturation from venous blood. Twenty patients participated in each group.Data were analyzed by the limits of agreement technique suggested by Bland and Altman and by linear regression analysis. In the reflectance plethysmography group, the mean bias was 4.27% and the limits of agreement were 58.3 to -49.8% (r(2) = 0.00, p = 0.98). In the NIRS group the mean biases were 10.8% and 2.0% for the sensors attached over the cerebral hemisphere and over the internal jugular vein, respectively, and the limits of agreement were 33.1 to -11.4 and 19.5 to -15.5% (r(2) = 0.22, 0.28;p = 0.04, 0.03) for the cerebral hemisphere and internal jugular sites, respectively. While transcutaneous regional oximetry and NIRS have both been used to estimate venous and tissue oxygen saturation non-invasively, the correlation between estimates of ScvO(2) and SxvO(2) were statistically significant for near infrared spectroscopy, but not for transcutaneous regional oximetry. Placement of cerebral oximetry patches directly over the internal jugular vein (as opposed to on the forehead) appeared to approximate internal jugular venous saturation better (lower mean bias and tighter limits of agreement), which suggests this modality may with refinement offer the practitioner additional clinically useful information regarding global cerebral oxygen supply and demand matching. PMID:22290065
Colquhoun, Douglas A; Tucker-Schwartz, Jason M; Durieux, Marcel E; Thiele, Robert H
A rare variety of mixed total anomalous pulmonary venous connection.
We describe a rare case of mixed supra- and infracardiac total anomalous pulmonary venous connection in a 2-month-old boy weighing 2.3 kg who was admitted with central cyanosis. Although the surgical repair was successful, the child died due to pulmonary hypertensive crisis. PMID:24887821
Mishra, Amit; Sharma, Pranav; Patel, Ramesh; Panchal, Jigar; Solanki, Atul
Frailty and Risk of Venous Thromboembolism in Older Adults
Background. Frailty is a common risk factor for morbidity and mortality in elderly persons. Recent evidence links frailty to activation of coagulation and inflammatory pathways. We aimed to determine whether frailty in community- dwelling older adults is a risk factor for venous thromboembolism (VTE). Methods. We conducted a prospective cohort study in four U.S. communities involving 4859 participants 65 years
Aaron R. Folsom; Lori L. Boland; Mary Cushman; Susan R. Heckbert; Wayne D. Rosamond; Jeremy D. Walston
Coronary arteries form by developmental reprogramming of venous cells
proepicardial cells that undergo an epithelial-to-mesenchymal transition, and then differentiate into isolatedARTICLES Coronary arteries form by developmental reprogramming of venous cells Kristy Red-Horse1, that coronary vessels arise from angiogenic sprouts of the sinus venosus--the vein that returns blood
Krasnow, Mark A.
Endovascular correction of an infantile intracranial venous outflow obstruction.
The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization. PMID:24138142
Soltanolkotabi, Maryam; Rahimi, Shahram; Hurley, Michael C; Bowman, Robin M; Russell, Eric J; Ansari, Sameer A; Shaibani, Ali
Cerebral venous sinus thrombosis after gender reassignment surgery
Background: Many factors have been implicated in the etiology of cerebral venous sinus thrombosis (CVT). These include head injury, cancer, infections (sepsis, sinusitis, and mastoiditis), coagulopathies, pregnancy, systemic lupus erythematosus, and dehydration.Case summary: We present the case of a patient who received long-term estrogen therapy for ~15 years after feminizing genitoplasty. The patient experienced a CVT with an excellent clinical
Joel M. Oster; Priya Shastri; Carl Geyer
Plantaris Rupture: A Mimic of Deep Venous Thrombosis
Background: The differential diagnosis of non-traumatic lower extremity pain and swelling runs the gamut from simple musculoskeletal injury to a possibly life-threatening deep venous thrombosis (DVT). Although evaluation and management are often guided by physical examination and history, a diagnostic study is often required. Institutional factors surrounding diagnostic imaging often lead physicians to empirically treat these patients for DVT with
Gregory J. Lopez; Robert S. Hoffman; Moira Davenport
Use of the PUSH tool to measure venous ulcer healing.
Currently, no instrument is available to provide an accurate and simple method of monitoring venous ulcer healing in clinical practice. The Pressure Ulcer Scale for Healing (PUSH) tool was developed and validated to monitor the healing of pressure ulcers. During a 2-month study involving 27 venous ulcer patients visiting a chronic wound clinic of a major university, the feasibility of using the PUSH tool to monitor healing was evaluated. The patients were assessed by two Wound Ostomy Continence Nurses using the PUSH tool, where 0 = healed and 17 = worst possible score. The mean score at the initial clinic visit was 12. One month and 2 months later, the mean scores were 9 and 8, respectively. Of the 27 participating patients, 23 had a decrease in their PUSH score over the 2-month period of the study; four of the 23 patients had PUSH scores of zero after 2 months because their venous ulcers had healed. One ulcer did not change and three ulcers worsened and their PUSH scores increased. Based on this study, the PUSH tool appears to be an effective way to monitor healing trends in venous ulcers as well as pressure ulcers. PMID:16014985
Ratliff, Catherine R; Rodeheaver, George T
Automated identification of adverse events related to central venous catheters
Methods for surveillance of adverse events (AEs) in clinical settings are limited by cost, technology, and appropriate data availability. In this study, two methods for semi-automated review of text records within the Veterans Administration database are utilized to identify AEs related to the placement of central venous catheters (CVCs): a Natural Language Processing program and a phrase-matching algorithm. A sample
Janet F. E. Penz; Adam B. Wilcox; John F. Hurdle
Cerebral venous sinus thrombosis associated with bulimia nervosa
Central venous sinus thrombosis (CVST) is a rare cause of headache and stroke but has a wide clinical spectrum of presentations, including headache, seizures, focal neurological signs and alteration in consciousness, which can present in isolation or in various combinations. CVST is a difficult diagnosis to make in clinical practice but advances in neuroimaging allows for faster and more precise
Christopher McAloon; Saad A M Saeed
Venous Thromboembolism in Young Patients From Western India: A Study
The goal of this article is to study the association of known markers of thrombophilia with venous thrombosis in young patients (< 45 years) from the Western part of India. A prospective study of 432 patients (252 males and 180 females, age 1-45 years) was conducted between 1994 and 2000 (6 years). The diagnosis was confirmed in all the patients
K. Ghosh; S. Shetty; M. Madkaikar; A. Pawar; S. Nair; A. Khare; A. Pathare; F. Jijina; D. Mohanty
Free arterialised venous forearm flaps for intraoral reconstruction
In 29 patients, the intraoral defect after excision of an oral squamous cell carcinoma was repaired with an arterialised venous forearm flap. In all cases, a flap of skin and fat with a superficial vein passing through it was raised from the flexor surface of the right forearm. After the flap had been sutured into the intraoral defect, the original
C. Klein; A. Kovacs; T. Stuckensen
High incidence of local venous reactions to esorubicin
A retrospective analysis was performed on the medical charts of 160 cancer patients who received esorubicin (ESO or 4? deoxydoxorubicin) in a Phase I clinical trial. The purpose of the review was to characterize the incidence of local venous reactions to this investigational doxorubicin (DOX) analog. The impact of prophy lactic pretreatments or post-treatment using antihistamines and glucocorticosteroids was also
Kai Ming Lee; Robert T. Dorr; Aurelia Robertone
Diagnostic Test Comparisons in Patients with Deep Venous Thrombosis
New diagnostic modalities are often judged relative to accepted standard procedures. These comparisons are influenced by the accuracy of the standard test and the prevalence of disease in the study population. We evaluated the importance of these factors in the assessment of antifibrin scintigraphy when used to detect deep venous thrombosis. Methods: Scintigraphy is compared to contrast venography in two
Bruce R. Line; Teresa L. Peters; James Keenan
Central venous stenosis--endovascular and surgical treatments.
Central venous stenosis remains a difficult disease to diagnose and treat. The etiology of the lesion and the condition of the patient dictates the treatment strategy. Both endovascular and surgical approaches are successful and are best accomplished by the endovascular cardiovascular surgeon. PMID:20143593
Reardon, Michael J; Davies, Mark G
Coiling of a vulvar arterio-venous malformation
The authors report the case of a 13-year-old girl with a painful vulvar swelling and abnormal vaginal bleeding, increasing in size after trauma. With MRI (GE Signa HDx 1.5 Tesla), it is diagnosed as an arterio-venous malformation arising from the left superior femoral artery. It is treated by embolisation using a coil. PMID:22674935
Van der Woude, Daisy Adriana Annejan; Stegeman, Marjan; Seelen, Jan L
Chronic cerebrospinal venous insufficiency in multiple sclerosis: a historical perspective
Summary Chronic cerebrospinal venous insufficiency (CCSVI) is a term used to describe impaired venous drainage from the central nervous system (CNS) caused by abnormalities in anatomy and flow affecting the extracranial veins. Recently, it has been proposed that CCSVI may contribute to the pathogenesis of multiple sclerosis (MS). It is hypothesized that venous obstruction results in abnormal flow that promotes inflammation at the blood-brain barrier and that this triggers a process marked by a disturbance of homeostasis within the CNS that leads to demyelination and neurodegeneration. The venous abnormalities of CCSVI are often diagnosed by ultrasound or magnetic resonance venography, however the prevalence of CCSVI detailed in groups of MS patients and patients without MS varies widely in published reports. Increased standardization of diagnostic studies to evaluate both anatomical and physiological findings associated with CCSVI is needed. The purpose of this article is to provide a background to understand the development of the theory of CCSVI and to frame the relevant issues regarding its diagnosis and relationship to the pathogenesis of MS. PMID:22364939
Dake, Michael D.; Zivadinov, Robert; Haacke, E. Mark
Nonlinear modeling of venous leg ulcer healing rates
BACKGROUND: The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. METHODS: We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. RESULTS: A majority (72%) of VLUs exhibited surface
Matthew Cardinal; Tania Phillips; David E Eisenbud; Keith Harding; Jonathan Mansbridge; David G Armstrong
Prevention of Venous Thromboembolism in Hospitalized Patients With Cancer
This is a literature review of the frequency of venous thromboembolism in hospitalized patients with cancer and of the available evidence supporting the use of thromboprophylaxis. Patients with cancer are at particularly high risk of venous thromboembolism and account for almost 20% of patients in the population. Hospitalization is an important risk factor in patients with cancer, with rates reported between 0.6% and 7.8%. The incidence has been increasing over the past decade. Three randomized controlled trials and meta-analyses indicate that prophylaxis with low molecular weight heparin, heparin, or fondaparinux significantly reduces the rate of venous thromboembolism in hospitalized medical patients who are at high risk. Patients with cancer were included in these studies, but prospective trials specifically focused on patients with cancer are not available. Evidence indicates that appropriate thromboprophylaxis is provided to a minority of hospitalized patients with cancer and that targeted educational efforts and computerized prompt systems can increase appropriate use. Guidelines developed by both oncology and thrombosis organizations support the use of thromboprophylaxis in hospitalized patients with cancer. In conclusion, most patients hospitalized with cancer are at high risk of venous thromboembolism, and thromboprophylaxis should be provided in the absence of active bleeding or a high bleeding risk. PMID:19704060
Francis, Charles W.
Use of central venous oxygen saturation to guide therapy.
The use of pulmonary artery catheters has diminished, so that other technologies are emerging. Central venous oxygen saturation measurement (ScvO?) as a surrogate for mixed venous oxygen saturation measurement (SvO?) is simple and clinically accessible. To maximize the clinical utility of ScvO? (or SvO?) measurement, it is useful to review what the measurement means in a physiologic context,how the measurement is made, important limitations, and how this measurement may be helpful in common clinical scenarios. Compared with cardiac output measurement, SvO? is more directly related to tissue oxygenation. Furthermore,when tissue oxygenation is a clinical concern, SvO? is less prone to error compared with cardiac output, where small measurement errors may lead to larger errors in interpreting adequacy of oxygen delivery. ScvO? should be measured from the tip of a central venous catheter placed close to, or within, the right atrium to reduce measurement error. Correct clinical interpretation of SvO?, or its properly measured ScvO? surrogate, can be used to (1) estimate cardiac output using the Fick equation, (2) better understand whether a patient's oxygen delivery is adequate to meet their oxygen demands, (3) help guide clinical practice, particularly when resuscitating patients using validated early goal directed therapy treatment protocols, (4) understand and treat arterial hypoxemia, and (5) rapidly estimate shunt fraction (venous admixture). PMID:21177882
Walley, Keith R
Model-based reconstructive elasticity imaging of deep venous thrombosis
Deep venous thrombosis (DVT) and its sequela, pulmonary embolism, is a significant clinical problem. Once detected, DVT treatment is based on the age of the clot. There are no good noninvasive methods, however, to determine clot age. Previously, we demonstrated that imaging internal mechanical strains call identify and possibly age thrombus in a deep vein. In this study the deformation
Salavat Aglyamov; Andrei R. Skovoroda; Jonathan M. Rubin; Matthew O'Donnell; Stanislav Y. Emelianov
Effect of Blood Flow on Thermal Equilibration and Venous Rewarming
In this study we have explored the feasibility of using an isolated rat limb as an animal model for studying countercurrent arterial thermal equilibration and venous rewarming in muscle tissue. Unlike in vivo experiments in which animal models have been used for studying thermoregulation or temperature response in tissue under various physiological conditions, isolated organ or tissue provides for better
Qinghong He; Liang Zhu; Sheldon Weinbaum
[The quality assessment of the management of venous catheters].
A study was conducted in 2009 at Nantes University Hospital (44) to assess nurses' knowledge and practices with regard to dressing rehabilitation and the changing of central venous catheter IV lines in conventional hospital departments, excluding intensive care units. A self-assessment questionnaire was used along with direct observations in the wards, involving health care professionals. PMID:23697053
Boidé, Maryline; Bourigault, Céline; des Buttes, Anne-Claire Guille; Lepelletier, Didier
Anomalous venous blood flow and iron deposition in multiple sclerosis
Multiple sclerosis (MS) is primarily an autoimmune disorder of unknown origin. This review focuses iron overload and oxidative stress as surrounding cause that leads to immunomodulation in chronic MS. Iron overload has been demonstrated in MS lesions, as a feature common with other neurodegenerative disorders. However, the recent description of chronic cerebrospinal venous insufficiency (CCSVI) associated to MS, with significant
Ajay Vikram Singh; Paolo Zamboni
What went wrong? The flawed concept of cerebrospinal venous insufficiency
In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research. PMID:23443168
Valdueza, Jose M; Doepp, Florian; Schreiber, Stephan J; van Oosten, Bob W; Schmierer, Klaus; Paul, Friedemann; Wattjes, Mike P
Venous Port Salvage Utilizing Low Dose tPA
This study was performed to evaluate the efficacy of low dose tPA for catheter salvage in cases of fibrin sheath formation in patients with venous access ports. Prospective evaluation was accomplished in patients who had venous ports with catheter malfunction. There were a total of 50 patients and 56 occlusive events.Each patient had a catheter injection documenting a fibrin sheath.Patient population included 45 for chemotherapy and 5 for antibiotics.A low dose tPA regimen was instilled into the port and upon successful return of function, a completion venogram was accomplished. Fifty patients were enrolled in the study with the average time between placement and dysfunction of 99 days. Five patients had a second occlusive event (38.5 days) and one had a third event (27 days). All patients had a venogram confirming a fibrin sheath as the cause of catheter malfunction. The average dose of tPA was 2.29 mg (range 1 mg-4 mg). Success was achieved in 52 of the 56 occlusive events(92.9%). There were no bleeding complications. Catheter occlusion is a common complication of long-term venous access ports. Aggressive therapy with low-dose tPA can salvage function. It provides safe and effective therapy for venous port malfunction secondary to fibrin sheath.
Whigham, Cliff J.; Lindsey, Jason I.; Goodman, Chad J.; Fisher, Richard G. [Baylor College of Medicine, Department ofRadiology, One Baylor Plaza-MS 360, Houston, Texas77030-3487 (United States)
Evaluation of venous distension device: potential aid for intravenous cannulation.
A device designed to augment venous filling by applying a vacuum to the upper extremity during tourniquet application was evaluated. Ten healthy adult male volunteers with clinical normovolemia were studied for changes in forearm volume and dorsal hand vein turgor during use of an elastic tubing tourniquet, a blood pressure cuff tourniquet, and a vacuum-assisted cuff tourniquet. Use of the device for 30 seconds was not associated with petechia formation and resulted in a significant increase in venous turgor, as measured by an ophthalmologic tonometer, in comparison to the other tourniquet techniques (P less than .005). Use for 60 seconds was associated with mild to moderate subjective discomfort in all volunteers and petechiae in all nine white volunteers. All petechiae resolved in three days. Venous engorgement as reflected by volume displacement was significantly greater for the vacuum device and blood pressure cuff tourniquet combination than other techniques at 30 and 60 seconds of tourniquet application (P less than .005). Brief application of a vacuum to the arm during tourniquet use increases venous turgor and engorgement in normovolemic volunteers. PMID:3963533
Hedges, J R; Weinshenker, E; Dirksing, R
Portal venous stenosis is relatively a rare complication after liver transplantation in children and it sometimes leads to\\u000a life threatening event due to gastrointestinal bleeding or graft failure. Recently, balloon dilatation has been widely accepted\\u000a as a treatment of choice for the management of portal venous stenosis. The purpose of this study was to evaluate the feasibility\\u000a of transileocolic venous
Ryo Hotta; Ken Hoshino; Seishi Nakatsuka; Shioko Nakao; Jun Okamura; Yohei Yamada; Koji Komori; Yasushi Fuchimoto; Hideaki Obara; Shigeyuki Kawachi; Minoru Tanabe; Yasuhide Morikawa; Subaru Hashimoto; Masaki Kitajima
A prototype paediatric venous cannula with shape change in situ.
During cardiopulmonary bypass (CPB), venous drainage may be impeded due to small vessel and cannula size or chattering, thus, blood return to the heart-lung machine is reduced. We designed a self-expandable prototype cannula, which is able to maintain the vein open and overcome this problem and analysed its performance capability. This prototype and several other cannulae were tested using an access vessel diameter of 7 mm. An in vitro circuit was set up with a 10 mm penrose latex tube simulating the patient's vein placed between the patient preload reservoir and the cannula, encasing the cannula's inlet(s). Maximum flow rate was determined for passive venous drainage (PVD) at preloads (P) of 2 and 4 mmHg. We compared these results to three classic single-stage venous cannulae: basket tip, thoracic drain and percutaneous tip. By comparing the other cannulae to the prototype, under PVD conditions and a central venous pressure (CVP) of 2 mmHg, the prototype cannula's flow rate (1.32 +/- 0.04 L/min) outperformed the basket type (the best performing comparator) (1.02 +/- 0.08 L/min) by 23% (p < 0.005). When the preload was increased to 4 mmHg under PVD conditions, the same trend was noted with the prototype cannula (1.65 +/- 0.05 L/min), outperforming the basket cannula's value (1.26 +/- 0.05 L/min) by 24% (p < 0.001). This new cannula design provides superior flow characteristics, under all test conditions, compared to the classic single-stage venous cannulae used for paediatric CPB surgery. PMID:12705652
Jegger, David; Corno, Antonio F; Mucciolo, Antonio; Mucciolo, Giuseppe; Boone, Yves; Horisberger, Judith; Seigneul, Isabelle; Jachertz, Mirka; von Segesser, Ludwig K
Physiological changes in venous hemodynamics associated with elective fasciotomy.
It has been postulated that lower extremity fasciotomy may disrupt the calf musculovenous pump and predisposes to development of chronic venous insufficiency (CVI). However, studies based on trauma patients who undergo emergent fasciotomy are confounded by the possibility of concomitant vascular and soft tissue injury and use historical controls. This is a prospective study that evaluates venous hemodynamics in young patients undergoing elective fasciotomy for chronic exertional compartment syndrome (CECS), eliminating the problems associated with retrospective study of trauma patients. CECS was diagnosed by history and, when indicated, measurement of compartment pressures. Prior to elective two- or four-compartment fasciotomy, each patient underwent lower extremity air plethysmography (APG) and colorflow duplex ultrasonography. These studies were repeated a minimum of 6 weeks postoperatively. Fifteen patients who had fasciotomies for CECS were studied; two of these patients had bilateral fasciotomies for a total of 17 limbs. There were 13 male and two female patients (average age 31.2 years). APG and colorflow duplex were performed an average of 12 weeks after fasciotomy. Outflow fraction, venous volume, and ejection volume showed no significant changes postoperatively. However, the venous filling index (VFI) increased (0.9 +/- 0.1 vs. 1.1 +/- 0.1 mL/sec; p < 0.05, paired t-test), the ejection fraction tended to decrease (59 +/- 4% vs. 52 +/- 2%; p < 0.08, paired t-test), and the residual volume fraction (RVF) increased (26 +/- 3% vs. 36 +/- 5%; p < 0.05, paired t-test). There were no patients with evidence of deep venous reflux. Two extremities with preoperative greater saphenous vein (GSV) reflux did not worsen, and three extremities developed new GSV reflux following fasciotomy, although VFI remained normal in each extremity. Elective fasciotomy for CECS does not lead to significant venous reflux but likely does diminish calf muscle pump function and increases RVF moderately in young adult patients. With longer follow-up this diminished calf muscle pump function may increase the risk of CVI. PMID:16612581
Singh, Niten; Sidawy, Anton N; Bottoni, Craig R; Antedomenico, Elena; Gawley, Teddie S; Harada, Denise; Gillespie, David L; Uyehara, Catherine F T; Cordts, Paul R
Central venous catheterisation in very low birthweight infants.
Forty two premature babies (mean birth weight 980 g, mean gestation 27.6 weeks) had central venous lines inserted at a mean age of 10 days through the internal jugular vein because of poor peripheral venous access and for purposes of parenteral feeding and minimal handling. Eight babies died from complications of prematurity and four from septicaemia with a central line in situ, but the other 30 babies had lines in place for a mean of 20 days. A mean weight gain of 17.5 g/kg/day was recorded. Eight babies showed signs of infection at a mean of 22 days after insertion of the line. The other complications were thrombosis related to the catheter (three cases), embolisation (two), and hydrocephalus related to superior vena caval thrombosis (one). The policy of management is outlined, and the risks and benefits of the technique are analysed. PMID:3087297
Mactier, H; Alroomi, L G; Young, D G; Raine, P A
Central venous catheterisation in very low birthweight infants.
Forty two premature babies (mean birth weight 980 g, mean gestation 27.6 weeks) had central venous lines inserted at a mean age of 10 days through the internal jugular vein because of poor peripheral venous access and for purposes of parenteral feeding and minimal handling. Eight babies died from complications of prematurity and four from septicaemia with a central line in situ, but the other 30 babies had lines in place for a mean of 20 days. A mean weight gain of 17.5 g/kg/day was recorded. Eight babies showed signs of infection at a mean of 22 days after insertion of the line. The other complications were thrombosis related to the catheter (three cases), embolisation (two), and hydrocephalus related to superior vena caval thrombosis (one). The policy of management is outlined, and the risks and benefits of the technique are analysed. PMID:3087297
Mactier, H; Alroomi, L G; Young, D G; Raine, P A
[Facial venous malformation presented with an unusual course].
Venous malformations are constitutionally-dependent vascular anomalies. In contrast to haemangiomas, they show no spontaneous regression. We describe here the case of a 21-year-old woman with a very severe facial disfigurement caused by a large venous malformation. After intensive consultation, advice and planning, the patient decided to undergo therapy and was admitted to hospital for treatment by an interdisciplinary team, consisting of a radiologist and a plastic surgeon. Under general anaesthesia, percutaneous sclerosis was performed twice. This enabled thrombosing and subsequent extensive resection of the monstrously large tumour. The well-planned and efficiently performed surgery helped the patient to gain a significant improvement in her quality of life. PMID:19085823
Piza-Katzer, H; Waldenberger, P
Minimizing venous thromboembolic complications in the orthopaedic patient.
Venous thromboembolic events (VTE), which include deep venous thrombosis (DVT) and pulmonary embolus (PE), are the most common life-threatening complications associated with orthopaedic surgical procedures. DVT is particularly prevalent in patients undergoing total knee and hip arthroplasty, occurring at a rate of 50 to 60%. In addition, up to 2% of orthopaedic patients receiving pharmacologic prophylaxis still develop PE. Because the majority of candidates for these procedures are older adults with a multitude of comorbid conditions, standard prophylactic practices may not always result in optimal clinical outcomes. Thus, it is important for nurses to have a general understanding of appropriate thromboprophylaxis. This article will provide an overview of the current recommended guidelines and explore the risks and benefits of both pharmacologic agents and adjunctive treatment modalities. PMID:12025799
Rice, K L; Walsh, M E
Historical aspects in the development of venous autografts.
During the past 75 years much progress has occurred in the field of vascular surgery. During this period, contributions from clinical surgeons have stimulated new scientific discoveries which have led to further clinical applications in a mutually perpetuating cycle of surgical advancement. One of the major achievements has been the use of the venous autograft employed as an arterial substitute. First used by Goyanes in 1906 to replace a popliteal aneurysm, a venous autograft was first successfully employed in the United States by Bernheim in 1915. The stepwise development of this aspect of modern vascular surgery is presented, and the role of other related contributions in making its use feasible is reviewed. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:1108815
Harrison, L H
Fatal venous air embolism in a cat undergoing dental extractions.
A five-year-old domestic shorthair cat underwent general anaesthesia and tooth extractions. Immediately after use of a high-speed, air-driven, water-cooled dental drill, the cat suffered cardiac arrest and attempted resuscitation was unsuccessful. Post-mortem radiographs showed air in the vena cava, right atrium, right auricle and right ventricle, hepatic and renal veins. These findings were confirmed at post-mortem examination. The cause of death was massive air embolism. There are reports of fatal venous air embolism in the human literature from the use of high-speed, air-driven, water-cooled dental drills. In this case, we believe that the air jet from the cooling system provided an enormous pressure gradient allowing air entry through an alveolar bone fracture or the inflamed gingival tissues. This is the first report of fatal venous air embolism associated with the use of a high-speed dental drill in the veterinary literature. PMID:19006491
Gunew, M; Marshall, R; Lui, M; Astley, C
Splenic and portal venous obstruction in chronic pancreatitis
The aim of this study was a prospective search for splenoportal venous obstruction (SPVO) in a medical-surgical series of 266 patients with chronic pancreatitis who were followed up a mean time of 8.2 years. SPVO was systematically searched for using ultrasonography and then confirmed by angiography or computed tomography. SPVO was found in 35 patients (13.2%) but was symptomatic in
Pierre Bernades; André Baetz; Philippe Lévy; Jacques Belghiti; Yves Menu; François Fékété
Embryologicalic collateral venous channel on radionuclide liver/spleen study
Obstruction of normal venous portal blood flow generally results in collateral circulation. The obstruction may be intrinsic t the vasculature (e.g., hepatic vein thrombosis, vascular anomalies) or it may be extravascular (e.g., cirrhosis, hepatic masses) and may effect blood flow by deforming and compressing the intrahepatic or splenoportal axis vessels. A technetium-99m sulfur colloid liver/spleen study demonstrates what is thought to be a functional paraumbilical or umbilical vein in a cirrhotic patient with portal hypertension.
Wilkinson, R.H. Jr.; Johnson, D.G.
Selective Venous Catheterization for the Localization of Phosphaturic Mesenchymal Tumors
Tumor-induced osteomalacia (TIO) is characterized by renal phosphate wasting, hypophosphatemia, and aberrant vitamin D3 metabolism and is caused by fibroblast growth factor 23 (FGF-23)–producing mesenchymal tumors, which are often difficult to locate. We investigated the utility of selective venous sampling in tumor localization. The primary endpoint was identification of the FGF-23 concentration ratio between the venous drainage of the tumor bed and the general circulation that was diagnostic of the location of an FGF-23-secreting tumor. Fourteen subjects underwent 15 sampling procedures after functional and anatomic imaging studies. Subjects fit into three imaging categories: no suspicious site, multiple sites, and single site (positive controls). FGF-23 levels were measured by ELISA. Suspicious tumors were resected for diagnosis, confirmation, and cure. In subjects with a positive venous sampling study and subsequent cure, a minimum ratio of 1.6 was diagnostic. In 7 of 14 subjects there was suggestive imaging, a diagnostic ratio, and an associated TIO tumor (true positive). Four of these required complicated resection procedures. In 4 of 14 subjects with no suspicious site on imaging studies, an FGF-23 diagnostic ratio was not detected (true negative). Biopsy or resection of a single lesion in 2 of 14 subjects with a diagnostic ratio failed to identify a TIO tumor (false positive). A diagnostic FGF-23 ratio was absent in 1 of 14 subjects whose tumor was a single highly suspicious lesion on imaging studies (false negative). These data yield a sensitivity of 0.87 [95% confidence interval (CI) 0.47–0.99] and a specificity of 0.71 (95% CI 0.29–0.96). Selective venous sampling for FGF-23 was particularly useful in subjects with multiple suspicious sites or an anatomically challenging planned resection but not in the absence of a suspicious lesion on imaging studies. © 2011 American Society for Bone and Mineral Research. PMID:21611969
Andreopoulou, Panagiota; Dumitrescu, Claudia E; Kelly, Marilyn H; Brillante, Beth A; Cutler Peck, Carolee M; Wodajo, Felasfa M; Chang, Richard; Collins, Michael T
Selective venous catheterization for the localization of phosphaturic mesenchymal tumors.
Tumor-induced osteomalacia (TIO) is characterized by renal phosphate wasting, hypophosphatemia, and aberrant vitamin D(3) metabolism and is caused by fibroblast growth factor 23 (FGF-23)-producing mesenchymal tumors, which are often difficult to locate. We investigated the utility of selective venous sampling in tumor localization. The primary endpoint was identification of the FGF-23 concentration ratio between the venous drainage of the tumor bed and the general circulation that was diagnostic of the location of an FGF-23-secreting tumor. Fourteen subjects underwent 15 sampling procedures after functional and anatomic imaging studies. Subjects fit into three imaging categories: no suspicious site, multiple sites, and single site (positive controls). FGF-23 levels were measured by ELISA. Suspicious tumors were resected for diagnosis, confirmation, and cure. In subjects with a positive venous sampling study and subsequent cure, a minimum ratio of 1.6 was diagnostic. In 7 of 14 subjects there was suggestive imaging, a diagnostic ratio, and an associated TIO tumor (true positive). Four of these required complicated resection procedures. In 4 of 14 subjects with no suspicious site on imaging studies, an FGF-23 diagnostic ratio was not detected (true negative). Biopsy or resection of a single lesion in 2 of 14 subjects with a diagnostic ratio failed to identify a TIO tumor (false positive). A diagnostic FGF-23 ratio was absent in 1 of 14 subjects whose tumor was a single highly suspicious lesion on imaging studies (false negative). These data yield a sensitivity of 0.87 [95% confidence interval (CI) 0.47-0.99] and a specificity of 0.71 (95% CI 0.29-0.96). Selective venous sampling for FGF-23 was particularly useful in subjects with multiple suspicious sites or an anatomically challenging planned resection but not in the absence of a suspicious lesion on imaging studies. PMID:21611969
Andreopoulou, Panagiota; Dumitrescu, Claudia E; Kelly, Marilyn H; Brillante, Beth A; Cutler Peck, Carolee M; Wodajo, Felasfa M; Chang, Richard; Collins, Michael T
A history of pulmonary embolism and deep venous thrombosis.
Although enormous progress has been made in understanding the physiology of pulmonary embolism, developing new diagnostic modalities and strategies, and constant refinement in the use of heparin therapy and thrombolytic therapy, venous thromboembolism remains a common and lethal process. As the history of this disease illustrates, advances continue to be made and it is anticipated that with newer diagnostic studies and anticoagulants under development, diagnosis and treatment of pulmonary embolism will continue to improve. PMID:19268798
Wood, Kenneth E
Healing process of venous ulcers: the role of microcirculation.
In order to describe adequately the process of healing in the intermediate degrees, we investigated microcirculatory changes in the venous ulcers at well-defined stages of wound repair. We investigated dynamic changes in microcirculation during the healing process of venous ulcers. Ten venous ulcers were investigated in three consecutive clinical stages of wound healing: non granulation tissue (NGTA), GTA and scar. Subpapillary microcirculation was measured by laser Doppler perfusion (LDP) imaging and expressed using LDP values in arbitrary units. Nutritive perfusion by capillary microscopy and expressed as capillary density (CD) - the number of capillaries per square millimetre. Before the development of GTA the LDP was low (median 1·35; lower-upper quartiles 0·71-1·83) accompanied with zero CD in all but one patient who had a density of 1. With the first appearance of GTA in the same area, the LDP was improved (2·22; 1·12-2·33; P = 0·0024) when compared with NGTA, in combination with a significant increase in CD (1·75; 0-3; P = 0·0054). In scar, the LDP was similar to that in the NGTA (1·03; 0·77-1·83; P = 0·278), combined with the highest CD (5·75; 4·5-8) in comparison with the previous stages of the area (for both pairs, P < 0·0001). Venous ulcers are caused by poor nutritive and subpapillary perfusion. Subpapillary perfusion plays a major role in the formation of GTA. In a scar, the increased nutritive perfusion is sufficient to cover the blood supply and keep skin viable while subpapillary perfusion is low. PMID:22313523
Ambrózy, Ewald; Waczulíková, Iveta; Willfort, Andrea; Böhler, Kornelia; Cauza, Karla; Ehringer, Herbert; Heinz, Gottfried; Koppensteiner, Renate; Mari?, Snezana; Gschwandtner, Michael E
Central Venous Saturation: A Prognostic Tool in Cardiac Surgery patients
Background: Central venous oxygen saturation (ScvO2) is a valuable prognostic marker in sepsis. However, its value in cardiac surgery has not been assessed yet. This study aimed at evaluating ScvO2 as a tool for predicting short-term organ dysfunction (OD) after cardiac surgery. Methods: A prospective cohort including cardiac surgery patients submitted to a goal-oriented therapy to maintain ScvO2 above 70%
Pedro M. Nogueira; Hugo T. Mendonça-Filho; Luiz Antonio Campos; Renato V. Gomes; Alexandre R. Felipe; Marco A. Fernandes; Cristiane A. Villela-Nogueira; José R. Rocco
Argon laser vascular fusion: venous and arterial bursting pressures.
This study was designed to determine the optimal laser power (watts) for maximal strength of argon laser vascular fusions by measuring bursting pressures of repairs. Longitudinal incisions (n = 105) measuring either 2.5 or 5 mm in length were performed in canine femoral, carotid, and jugular veins and arteries and were fused with the argon laser at 0.3, 0.5, 0.7, or 0.9 W power. Total exposure time for each repair (50 to 80 sec/0.5 cm) was adjusted to yield identical energy fluences of 1,100 J/cm2. Bursting pressure of the fusions was determined by monitored infusion of anticoagulated blood into an isolated segment of the vessel that contained the fusion. Mean bursting pressures for venous and arterial repairs were significantly higher in the 2.5 mm incisions compared with the 5 mm incisions (P less than 0.05). Venous and arterial repairs of equal length performed at each power resulted in equivalent bursting strengths, except that 5 mm venous segments fused with 0.9 W withstood lower pressures than all other venous repairs (P less than 0.05), and 5 mm arterial segments were in turn significantly weaker at 0.3 W (P less than 0.02). We conclude that argon laser fusion is equally suitable for repair of medium-sized veins and arteries and that immediate strength decreases with increasing length of repair. To maximize strength of longer repairs, venotomies should be welded at power settings between 0.3 and 0.7 W while arteriotomies should be fused at power settings between 0.5 and 0.9 W. The differences in optimal power may be explained by variable wall composition and thickness between veins and arteries. PMID:2811570
Vlasak, J W; Kopchok, G E; Fujitani, R M; White, R A
Cerebral Venous Thrombosis in the Mediterranean Area in Children
Cerebral Venous Sinus (sinovenous) Thrombosis (CSVT) is a serious and rare disorder, increasingly recognized and diagnosed in pediatric patients. The etiology and pathophisiology has not yet been completely clarified, and unlike adults with CSVT, management in children and neonates remains controversial. However, morbidity and mortality are significant, highlighting the continued need for high-quality studies within this field. The following review will highlight aspects of CSVT in the mediteranian area in children. PMID:21869915
Menascu, S.; Lotan, A.; Ben Zeev, B.; Nowak-Gottl, U:; Kenet, G.
[Comprehensive treatment of venous ulcer of the leg].
A comprehensive approach to the treatment of venous leg ulcer is described. Its main characteristics are: 1. Maximum debridement of wound area of the ulcer and suppressing of its microbial contamination 2. Wound conditioning and its preparation for autografting and especially 3. Simultaneous operation of varicose veins (stripping of vena saphena and ligature of venae perforates Cocketti) and application of dermoepidermal autograft to the ulcer. The procedure is presented as a case report. PMID:8948161
Brychta, P; Cerbák, P
Automated noninvasive determination of mixed venous pCO2.
The determination of mixed venous pCO2 is desirable for assessing the metabolic and respiratory status of a patient. A totally automated, laboratory computer-controlled noninvasive system has been developed to determine mixed venous pCO2 by an equilibrium rebreathing method or by an exponential compartmental analysis for cases in which equilibrium is not achieved. A gas mixture is charged to a 2-liter anesthesia bag contained in a thermostatically controlled chamber used to maintain the temperature at 37 degrees C. This feature improves upon past rebreathing methods and eliminates water vapor as a variable in gas composition measurement. This bag is connected to a rebreathing circuit controlled by a minicomputer. The subject breathes from a mouthpiece attached to a two-way valve and rebreathes the gas mixture for a period of 30 seconds. Inspirate and expirate hoses are placed in the rebreathing bag to ensure a more uniform gas distribution than is generally found in rebreathing systems. Exchange of CO2 takes place between lungs and rebreathing bag, and the concentration of CO2 is continuously monitored by a mass spectrometer. After a period of time, the concentration of CO2 in the rebreathing bag, the alveoli, and the mixed venous blood come into equilibrium, demonstrated by a plateau on the record of CO2 concentration vs. time. Compartmental analysis predicts the mixed venous pCO2 even if an equilibrium is not established. This feature is a significant benefit of this new method, eliminating problems associated with establishing an equilibrium, such as gas mixture volume adjustment, recirculation, and poor ventilation. The predicted value agrees with the equilibrium valve for cases in which equilibrium is reached.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3097463
Leavell, K; Finkelstein, S M; Warwick, W J; Budd, J R
Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography.
Hepatic portal venous air embolism is the rarest complication of gastrointestinal endoscopy, resulting from penetration of gas into the portal veins, and may occur during endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy. The likely mechanism is intramural dissection of insufflated air into the portal venous system through duodenal vein radicles transected during the procedure. Hepatic portal air embolism may be fatal. Cerebral air embolism may also occur. So far 13 cases of air embolism after endoscopic retrograde cholangiopancreatography have been reported, with 4 cases of systemic spread that proved fatal. Death was due to pulmonary air embolism in 2 cases, and cerebral air embolism in another 2. We report on an additional such fatal case, concerning a 78-year-old male patient, who several years previously had undergone surgical gastroduodenal resection with cholecystectomy and papillotomy, and was admitted for recurrent ascending cholangitis secondary to bile duct stones. During the third endoscopic cholangioscopic procedure for removal of bile duct stones, sudden cardiopulmonary arrest occurred. Death was due to massive pulmonary air embolism. Cerebral air embolism was also found. Autopsy was performed. A spontaneous duodenobiliary fistula was found. On the basis of bench radiologic investigation (retrograde suprahepatic venography and anterograde portography), it was demonstrated that the air insufflated during duodenal endoscopy, which entered through the spontaneous duodeno-biliary fistula, penetrated into intrahepatic vein radicles injured secondarily to prolonged impaction of biliary sand and stones and infection, resulting in portal and hepatic venous gas and systemic air embolism. PMID:19546613
Bisceglia, Michele; Simeone, Anna; Forlano, Rosario; Andriulli, Angelo; Pilotto, Alberto
Microvascular changes in chronic venous insufficiency--a review.
Chronic venous insufficiency is the result of an impairment of the main venous conduits, causing microvascular changes. The driving force responsible for the alterations in the microcirculation is probably the intermittently raised pressure propagated from the deep system into the capillaries. The capillaries are dilated, elongated and tortuous and their endothelium is injured (irregular luminal surface, increased cytopempsis, dilated interendothelial spaces). Through the latter an increased extravasation can be observed, leading to an enlarged pericapillary space, oedema in the interstitial tissue and to the clinical finding of swelling. Haemoglobin from extravasated erythrocytes and erythrocyte fragments in the pericapillary space is degraded to haemosiderin which is responsible for hyperpigmentation. Microthrombosis in the capillaries causes microinfarction and micronecrosis. Skin areas with severe microangiopathy have reduced numbers of perfused nutritional capillaries and are characterized by a low transcutaneous (tc) PO2. The increased blood flow in the deeper skin layers does not contribute to nutrition of the superficial skin layers. The microvascular ischaemia is patchy and appears to be the main factor determining trophic changes and venous ulceration. The process of microinfarction and micronecrosis is followed by the formation of a granulation tissue, proliferation of capillaries and fibroblasts and finally wound healing by formation of scar tissue destroying the microlymphatic network. Clinically this process leads to lipodermatosclerosis, atrophy and in its most extreme form to ulceration where the compensating mechanisms are no longer able to repair the damage. PMID:7655836
Leu, A J; Leu, H J; Franzeck, U K; Bollinger, A
Guidelines for the treatment of head and neck venous malformations
Venous malformation is one of the most common benign vascular lesions, with approximately 40% of cases appearing in the head and neck. They can affect a patient's appearance and functionality and even cause life-threatening bleeding or respiratory tract obstruction. The current methods of treatment include surgery, laser therapy, sclerotherapy, or a combined. The treatment of small and superficial venous malformations is relatively simple and effective; however, the treatment of deep and extensive lesions involving multiple anatomical sites remains a challenge for the physicians. For complex cases, the outcomes achieved with one single treatment approach are poor; therefore, individualized treatment modalities must be formulated based on the patient's condition and the techniques available. Comprehensive multidisciplinary treatments have been adapted to achieve the most effective results. In this paper, based on the national and international literature, we formulated the treatment guidelines for head and neck venous malformations to standardize clinical practice. The guideline will be renewed and updated in a timely manner to reflect cutting-edge knowledge and to provide the best treatment modalities for patients. PMID:23724158
Zheng, Jia Wei; Mai, Hua Ming; Zhang, Ling; Wang, Yan An; Fan, Xin Dong; Su, Li Xin; Qin, Zhong Ping; Yang, Yao Wu; Jiang, Yin Hua; Zhao, Yi Fang; Suen, James Y
Electrolytic Inferior Vena Cava Model (EIM) of Venous Thrombosis
Animal models serve a vital role in deep venous thrombosis (DVT) research in order to study thrombus formation, thrombus resolution and to test potential therapeutic compounds (1). New compounds to be utilized in the treatment and prevention of DVT are currently being developed. The delivery of potential therapeutic antagonist compounds to an affected thrombosed vein has been problematic. In the context of therapeutic applications, a model that uses partial stasis and consistently generates thrombi within a major vein has been recently established. The Electrolytic Inferior vena cava Model (EIM) is mouse model of DVT that permits thrombus formation in the presence of continuous blood flow. This model allows therapeutic agents to be in contact with the thrombus in a dynamic fashion, and is more sensitive than other models of DVT (1). In addition, this thrombosis model closely simulates clinical situations of thrombus formation and is ideal to study venous endothelial cell activation, leukocyte migration, venous thrombogenesis, and to test therapeutic applications (1). The EIM model is technically simple, easily reproducible, creates consistent thrombi sizes and allows for a large sample (i.e. thrombus and vein wall) which is required for analytical purposes. PMID:21775963
Diaz, Jose A.; Wrobleski, Shirley K.; Hawley, Angela E.; Lucchesi, Benedict R.; Wakefield, Thomas W.; Myers, Jr., Daniel D.
Venous thromboembolism at uncommon sites in neonates and children.
We retrospectively analyzed the data of 24 children (whereof 11 neonates), with non-central venous line-related and nonmalignancy-related venous thromboembolism (VTE) at uncommon sites, referred to our Unit from January 1999 to January 2012. Thirty patients who also suffered deep vein thrombosis, but in upper/low extremities, were not included in the analysis. The location of rare site VTE was: portal (n=7), mesenteric (n=2) and left facial vein (n=1), spleen (n=3), lung (n=3), whereas 10 neonates developed renal venous thrombosis. The majority of patients (91.7%) had at least 1 risk factor for thrombosis. Identified thrombophilic factors were: antiphospholipid antibodies (n=2), FV Leiden heterozygosity (n=6), MTHFR C677T homozygosity (n=4), protein S deficiency (n=2), whereas all neonates had age-related low levels of protein C and protein S. All but 6 patients received low-molecular-weight heparin, followed by warfarin in 55% of cases, for 3 to 6 months. Prolonged anticoagulation was applied in selected cases. During a median follow-up period of 6 years, the clinical outcome was: full recovery in 15 patients, evolution to both chronic portal hypertension and esophageal varices in 2 children, and progression to renal failure in 7 of 10 neonates. Neonates are greatly vulnerable to complications after VTE at uncommon sites, particularly renal. Future multicentre long-term studies on neonatal and pediatric VTE at unusual sites are considered worthwhile. PMID:24517966
Pergantou, Helen; Avgeri, Maria; Komitopoulou, Anna; Xafaki, Panagiota; Kapsimali, Zoey; Mazarakis, Michail; Adamtziki, Eftychia; Platokouki, Helen
Potential Risk Factors for Varicose Veins with Superficial Venous Reflux
The objective of the study is to evaluate a range of potential risk factors in the etiology of varicose veins with superficial venous reflux. Forty-nine patients attending a cardiovascular surgery clinic for the management of varicose disease between 2009 and 2010 were enrolled for the study. The age range of the patient group was 44,04 ± 15,05 years and female/male (F/M) ratio was 30/19. Twenty-six normal, healthy volunteers with the age of 40,94 ± 13,60 years and with the female/male ratio of 15/11 acted as control subjects. We investigated several parameters including body mass index, age, birth number > 1, standing for a long time (standing for 8 or more hours without taking a break), systemic diseases, family history, venous Doppler f?ndings, the levels of homocysteine, ferritin, vitamin B12, and hemoglobin, sedimentation rate, mean corpuscular volume, low density lipoprotein, and rheumatoid factor of the patient group and the control group. We also determined the contribution of the methylene tetrahydrofolate reductase 677 C>T and 1298 A>C gene polymorphisms and FV Leiden in both groups. In this small study, there appears to be no association between varicose veins and body mass index, smoking, type 2 DM, hypertension, family history, and birth number. A history of increased standing duration period (>8 hours) and rheumatoid factor positivity have association with varicose veins with superficial venous reflux. PMID:25302121
Uzun Kulao?lu, Tülin; Fen, Turgay; Kap?s?z, Hasan Fahri
Enhanced global mathematical model for studying cerebral venous blood flow.
Here we extend the global, closed-loop, mathematical model for the cardiovascular system in Müller and Toro (2014) to account for fundamental mechanisms affecting cerebral venous haemodynamics: the interaction between intracranial pressure and cerebral vasculature and the Starling-resistor like behaviour of intracranial veins. Computational results are compared with flow measurements obtained from Magnetic Resonance Imaging (MRI), showing overall satisfactory agreement. The role played by each model component in shaping cerebral venous flow waveforms is investigated. Our results are discussed in light of current physiological concepts and model-driven considerations, indicating that the Starling-resistor like behaviour of intracranial veins at the point where they join dural sinuses is the leading mechanism. Moreover, we present preliminary results on the impact of neck vein strictures on cerebral venous hemodynamics. These results show that such anomalies cause a pressure increment in intracranial cerebral veins, even if the shielding effect of the Starling-resistor like behaviour of cerebral veins is taken into account. PMID:25169660
Müller, Lucas O; Toro, Eleuterio F
[Venous Doppler velocimetry: ten years of development of a method].
Doppler velocimetry enables three haemodynamic parameters that are extremely useful for the study of venous diseases to be evaluated: blood flow direction, the morphology of the velocity wave and venous pressure. These three parameters are used in association depending on the particular requirements of the diagnostic problem. In the case of suspected deep venous thrombosis, study of the morphology of the velocity wave and clinostatism pressure give good diagnostic possibilities for the iliaco-femoral axis but poor for the leg trunks. In post-thrombotic syndrome, Doppler velocimetry is not so useful because the patient has to remain immobile during the examination while this specific pathology features insufficiency of the muscular pump during walking. In varicose disease, the investigation offers a very high diagnostic capability by evidencing the site and extent of valvular incontinence in the saphena and perforating vessels. The only limitation is the presence of numerous incontinent perforating vessels, but this is infrequent. In this pathology, Doppler v. has almost completely supplanted phlebography because it responds to the needs of modern medicine to replace invasive diagnostic investigations with non-invasive techniques that are equally effective. Finally, two other fields of application are very important for this investigation: the study of a patient with varices prior to saphenic stripping and prior to sclerotherapy. Definition of the origin and course of the reflux ways makes an optimal result possible, even allowing for the evolution of varicosity. PMID:2192304
Annoni, F; Lovaria, A; Pezzoni, F; Saccheri, S; Ceva, M
Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?
Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.
Solar, Miroslav; Ceral, Jiri, E-mail: firstname.lastname@example.com [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Internal Medicine (Czech Republic); Krajina, Antonin [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Radiology (Czech Republic); Ballon, Marek [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Internal Medicine (Czech Republic); Malirova, Eva [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Nuclear Medicine (Czech Republic); Brodak, Milos [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Urology (Czech Republic); Cap, Jan [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Internal Medicine (Czech Republic)
The Malposition of Central Venous Catheters in Children
Summary Background Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. Material/Methods A total number of 309 CVCs were implanted at Children's University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. Results CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. Conclusions In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them. PMID:25177409
Dzierzega, Maria; Ossowska, Magdalena; Chmiel, Dariusz; Wieczorek, Aleksandra; Balwierz, Walentyna
Transesophageal Echocardiographic Study of Decompression-Induced Venous Gas Emboli
NASA Technical Reports Server (NTRS)
Transesophageal echo-cardiography was used to evaluate venous bubbles produced in nine anesthetized dogs following decompression from 2.84 bar after 120 min at pressure. In five dogs a pulsed Doppler cuff probe was placed around the inferior vena cava for bubble grade determination. The transesophageal echo images demonstrated several novel or less defined events. In each case where the pulmonary artery was clearly visualized, the venous bubbles were seen to oscillate back and forth several times, bringing into question the effect of coincidental counting in routine bubble grade analysis using precordial Doppler. A second finding was that in all cases, extensive bubbling occurred in the portal veins with complete extraction by the liver sinusoids, with one exception where a portal-to-hepatic venous anastomosis was observed. Compression of the bowel released copious numbers of bubbles into the portal veins, sometimes more than were released into the inferior vena cava. Finally, large masses of foam were routinely observed in the non-dependent regions of the inferior vena cava that not only delayed the appearance of bubbles in the pulmonary artery but also allowed additional opportunity for further reaction with blood products and for coalescence to occur before reaching the pulmonary microcirculation. These novel observations are discussed in relation to the decompression process.
Butler, B. D.; Morris, W. P.
In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatment of advanced chronic venous insufficiency at the 5th and 6th degree of CEAP classification is still a great clinical challenge. In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternative therapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery (SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrent venous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascial endoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency. PMID:23255980
Kurpiewski, Waldemar; Kowalczyk, Marek; Szynkarczuk, Rafal; Luba, Magdalena; Zurada, Anna; Grabysa, Radoslaw
A review of the current management and treatment options for superficial venous insufficiency.
The recognition of lower extremity venous disease as a significant cause of morbidity and lower quality of life, afflicting up to 25 % of Western populations, has led to rapid and drastic improvements in treatment options as well as an increasing awareness of the disease. Superficial venous disease, a frequent medical problem encountered in clinical practices, is now a common reason for referral to providers offering a spectrum of interventions. Venous guidelines have been set forth by the American Venous Forum and Society for Vascular Surgery covering simple spider veins to chronic venous ulcerations. (Gloviczki et al. J Vas Surg 53:2S-48S, 2011) This review provides an overview of the modern management of varicose veins and venous insufficiency. PMID:24803347
Zhan, Henry T; Bush, Ruth L
Central venous injuries of the subclavian-jugular and innominate-caval confluences.
Injuries to the central venous system can result from penetrating trauma or iatrogenic causes. Injuries to major venous confluences can be particularly problematic, because the clavicle and sternum seriously limit exposure of the injury site. We report our institution's experience with central venous injuries of the subclavian-jugular and innominate-caval venous confluences. Significant injuries of the subclavian-jugular venous confluence frequently result from penetrating trauma, while injuries to the innominate-caval confluence are usually catheter-related. Median sternotomy provides adequate exposure of the innominate-caval confluence, while exposure of the subclavian-jugular venous confluence requires extension of the median sternotomy incision into the neck and resection of the clavicle. The literature is reviewed. PMID:10524738
Baumgartner, F J; Rayhanabad, J; Bongard, F S; Milliken, J C; Donayre, C; Klein, S R
Problems with Attempted Chorioretinal Venous Anastomosis by Laser for Nonischemic CRVO and BRVO
Purpose: To report the complications and long-term results of laser-induced chorioretinal venous anastomosis in vein occlusions. Patients and Methods: Eight consecutive eyes, 3 with central retinal vein (CRVO) and 5 with branch retinal vein occlusion (BRVO), were observed for up to 5 years after attempted laser-induced chorioretinal venous anastomosis. Results: Successful chorioretinal venous anastomoses were created in 2 (25%) eyes.
Tayfun Bavbek; Ozlem Yenice; Okan Toygar
Chronic paroxysmal intracranial hypertension leading to syncope is a phenomenon not reported previously in patients with refractory cerebral venous sinus thrombosis. We report a case of paroxysmal intracranial hypertension leading to syncopal episodes in a patient with idiopathic autoimmune hemolytic anemia and venous sinus thrombosis. This case demonstrates that intermittent elevations in intracranial pressure can lead to syncope in patients with venous sinus thrombosis and emphasizes the importance of considering this potentially treatable etiology of syncopal episodes. PMID:24381706
Larimer, P.; McDermott, M.W.; Scott, B.J.; Shih, T.T.; Poisson, S.N.
Effect of Ovariectomy on Blood Pressure and Venous Tone in Female Spontaneously Hypertensive Rats
BackgroundVenous capacitance plays an important role in circulatory homeostasis. A number of reports have suggested an effect of estrogen on venous function. This study tested the hypothesis that ovariectomy would increase venous tone in the female spontaneously hypertensive rat (SHR) via autonomic mechanisms.MethodsFive-week-old female SHR were subjected to sham operation (Sham) or ovariectomy (OVX). At 10 weeks of age, the
Douglas S. Martin; Rebecca Redetzke; Erin Vogel; Connie Mark; Kathleen M. Eyster
Pharmacological agents in the treatment of venous disease: an update of the available evidence.
Varicose veins and the complications of venous disease are thought to affect over a quarter of the adult population and the management of these conditions are a major cause of health service expense. Advances in the understanding of venous pathophysiology have highlighted numerous potential targets for pharmacotherapy. This review considers the evidence for pharmacological agents used for the treatment of chronic venous disease. A literature search using Pubmed, Embase and Cinahl databases was performed. The initial search terms 'varicose vein', 'venous ulcer' and 'venous disease' were used with appropriate search limits to identify prospective studies of pharmacotherapy in venous disease. A wide range of venoactive and non-venoactive drugs have been studied in patients with venous disease. The use of micronized purified flavonoid fraction (Daflon) can reduce symptoms of pain, heaviness and oedema in patients with venous reflux and a recent meta-analysis concluded that Daflon improves healing in patients with venous ulceration treated with compression. Pentoxifylline may be a useful adjunct to compression therapy for patients with venous ulceration. Oxerutins and calcium dobesilate may be of benefit in reducing oedema and rutosides may help to relieve the symptoms of varicose veins in pregnancy. The clinical benefits of other medications remain unproven. Although numerous pharmacological agents have been proposed and studied, Daflon has demonstrated the greatest clinical benefits in patients with venous disease. Further research is needed to define the role of venoactive drugs in clinical care and improve our understanding of the pathophysiology of venous disease to help identify new therapeutic avenues. PMID:19601855
Gohel, Manjit S; Davies, Alun H
A new approach to non-invasive oxygenated mixed venous PCO(sub)2
NASA Technical Reports Server (NTRS)
A clinically practical technique was developed to calculate mixed venous CO2 partial pressure for the calculation of cardiac output by the Fick technique. The Fick principle states that the cardiac output is equal to the CO2 production divided by the arterio-venous CO2 content difference of the pulmonary vessels. A review of the principles involved in the various techniques used to estimate venous CO2 partial pressure is presented.
Fisher, Joseph A.; Ansel, Clifford A.
Systematic review of emergency department central venous and arterial catheter infection
Background There is an extensive critical care literature for central venous catheter and arterial line infection, duration of catheterization,\\u000a and compliance with infection control procedures. The emergency medicine literature, however, contains very little data on\\u000a central venous catheters and arterial lines. As emergency medicine practice continues to incorporate greater numbers of critical\\u000a care procedures such as central venous catheter placement, infection
Christopher H. LeMaster; Ashish T. Agrawal; Peter Hou; Jeremiah D. Schuur
Eph-B4 prevents venous adaptive remodeling in the adult arterial environment
Eph-B4 determines mammalian venous differentiation in the embryo but is thought to be a quiescent marker of adult veins. We have previously shown that surgical transposition of a vein into the arterial environment is characterized by loss of venous identity, as indicated by the loss of Eph-B4, and intimal thickening. We used a mouse model of vein graft implantation to test the hypothesis that Eph-B4 is a critical determinant of venous wall thickness during postsurgical adaptation to the arterial environment. We show that stimulation of Eph-B4 signaling, either via ligand stimulation or expression of a constitutively active Eph-B4, inhibits venous wall thickening and preserves venous identity; conversely, reduction of Eph-B4 signaling is associated with increased venous wall thickness. Stimulated Eph-B4 associates with caveolin-1 (Cav-1); loss of Cav-1 or Eph-B4 kinase function abolishes inhibition of vein graft thickening. These results show that Eph-B4 is active in adult veins and regulates venous remodeling. Eph-B4–Cav-1–mediated vessel remodeling may be a venous-specific adaptive mechanism. Controlled stimulation of embryonic signaling pathways such as Eph-B4 may be a novel strategy to manipulate venous wall remodeling in adults. PMID:21339325
Muto, Akihito; Yi, Tai; Harrison, Kenneth D.; Davalos, Alberto; Fancher, Tiffany T.; Ziegler, Kenneth R.; Feigel, Amanda; Kondo, Yuka; Nishibe, Toshiya; Sessa, William C.
The association between air travel and deep venous thrombosis and/or pulmonary embolism "economy-class syndrome" is well described. However, this syndrome does not describe any association between long duration travel and arterial thrombosis or coexistence of venous and arterial thrombosis. We present a case of concomitant deep venous thrombosis, acute femoral artery thrombosis, and bilateral pulmonary embolisms in a patient following commercial air travel. Echocardiogram did not reveal an intracardiac shunt that may have contributed to the acute arterial occlusion from a paradoxical embolus. To our knowledge, this is the first report in the literature that associates air traveling with both arterial and venous thrombosis. PMID:25221684
Abunnaja, Salim; Clyde, Marshall; Cuviello, Andrea; Brenes, Robert A; Tripodi, Giuseppe
Noninvasive Optical Quantification of Cerebral Venous Oxygen Saturation in Humans
Rationale and Objectives Cerebral oxygen extraction, defined as the difference between arterial and venous oxygen saturations (SaO2 and SvO2), is a critical parameter for managing intensive care patients at risk for neurological collapse. Although quantification of SaO2 is easily performed with pulse oximetry or moderately invasive arterial blood draws in peripheral vessels, cerebral SvO2 is frequently not monitored because of the invasiveness and risk associated with obtaining jugular bulb or super vena cava (SVC) blood samples. Materials and Methods In this study, near-infrared spectroscopy (NIRS) was used to noninvasively measure cerebral SvO2 in anesthetized and mechanically ventilated pediatric patients (n = 10). To quantify SvO2, the NIRS signal component that fluctuates at the respiration frequency is isolated. This respiratory component is dominated by the venous portion of the interrogated vasculature. The NIRS measurements of SvO2 were validated against the clinical gold standard: invasively measured oxygen saturations from SVC blood samples. This technique was also applied in healthy volunteers (n = 5) without mechanical ventilation to illustrate its potential for use in healthy populations with natural airways. Results Ten pediatric patients with pulmonary hypertension were studied. In these patients, SvO2 in the SVC exhibited good agreement with NIRS-measured SvO2 (R2 = 0.80, P = .001, slope = 1.16 ± 0.48). Furthermore, in the healthy adult volunteers, mean (standard deviation) NIRS-measured SvO2 was 79.4 (6.8)%. This value is in good agreement with the expected average central venous saturation reported in literature. Conclusion Respiration frequency-selected NIRS can noninvasively quantify cerebral SvO2. This bedside technique can be used to help assess brain health in neurologically unstable patients. PMID:24439329
Lynch, Jennifer M.; Buckley, Erin M.; Schwab, Peter J.; Busch, David R.; Hanna, Brian D.; Putt, Mary E.; Licht, Daniel J.; Yodh, Arjun G.
Pathogenesis of venous thromboembolism: when the cup runneth over.
A comprehensive understanding of the pathogenesis of venous thrombosis is essential for identifying patients at increased risk and who may therefore benefit from more aggressive preventive and therapeutic measures. As for other pathologies, the pathogenesis of venous thromboembolism is multifactorial. All risk factors, either congenital or acquired, are relatively "innocent" when considered alone. However, when an individual is unlucky enough to inherit one or more abnormality, compounded in many cases by environmental hazards, that person may be propelled over a threshold that precipitates the development of thrombosis. An appropriate analogy is that where "the last drop makes the cup run over." A reinterpretation of the traditional Virchow's triad (abnormal vessel wall, abnormal blood flow, and abnormal blood constituents) was provided by Eberhard Mammen throughout his research, and this has contributed greatly to the understanding of the pathogenesis of this serious disorder. Mammen postulated immobility as the leading event, because it reduced blood flow as a result of decreased muscle contraction. The subsequent "stasis of flow" led to accumulation of blood within the intramuscular sinuses, especially of the calf, triggering hypercoagulability due to local accumulation of activated clotting factors and coagulation activation products and the simultaneous consumption of blood coagulation inhibitors. On Mammen's "hit list" nearly 20 years ago were included (among inherited abnormalities) decreased protein C, protein S, antithrombin III, plasminogen, and tissue plasminogen activator, and increased plasminogen activator inhibitor-1, whereas (among acquired predisposing conditions) surgery, trauma, previous thromboembolism, prolonged immobility and paralysis, malignancy, congestive heart failure, obesity, advanced age, pregnancy and puerperium, varicose veins, and oral contraceptives were also identified. Some two decades later, the situation has perhaps not changed so much, although studies continue to expand our knowledge of this topic, clarifying the relative contribution of each single risk factor in the pathogenesis of venous thrombosis. PMID:19214913
Lippi, Giuseppe; Franchini, Massimo
Maternal venous hemodynamics in gestational hypertension and preeclampsia
Background To evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE). Methods In this observational cross-sectional study, venous hemodynamics was assessed using a standardised protocol for combined electrocardiogram (ECG)-Doppler ultrasonography, together with a non-invasive standardised cardiovascular assessment using impedance cardiography (ICG) in 13 women with UP, 21 with GH, 34 with late onset PE ? 34 w (LPE) and 22 with early onset PE?34 w (EPE). ECG-Doppler parameters were impedance index at the level of hepatic veins (HVI) and renal interlobar veins (RIVI) together with venous pulse transit times (VPTT), as well as resistive and pulsatility index, and arterial pulse transit time (APTT) at the level of uterine arcuate arteries. ICG parameters were aortic flow velocity index (VI), acceleration index (ACI) and thoracic fluid content. Mann Whitney U-test, Kruskall-Wallis test and linear regression analysis with heteroskedastic variance was used for statistical analysis. Results RIVI in both kidneys was >15% higher (P???.010) in LPE and EPE, as compared to GH and UP. Next to this, >30% lower values for VI and ACI (P???.029), and?>?15% lower values for APTT (P???.012) were found in GH, LPE and EPE, as compared to GH. Conclusion In comparison to UP, similar abnormalities of central arterial function and APTT were found in GH, EPE and LPE. Proteinuria of LPE and EPE was associated with increased RIVI, this was not observed in GH. PMID:24957330
Segmentation and separation of venous vasculatures in liver CT images
NASA Astrophysics Data System (ADS)
Computer-aided analysis of venous vasculatures including hepatic veins and portal veins is important in liver surgery planning. The analysis normally consists of two important pre-processing tasks: segmenting both vasculatures and separating them from each other by assigning different labels. During the acquisition of multi-phase CT images, both of the venous vessels are enhanced by injected contrast agent and acquired either in a common phase or in two individual phases. The enhanced signals established by contrast agent are often not stably acquired due to non-optimal acquisition time. Inadequate contrast and the presence of large lesions in oncological patients, make the segmentation task quite challenging. To overcome these diffculties, we propose a framework with minimal user interactions to analyze venous vasculatures in multi-phase CT images. Firstly, presented vasculatures are automatically segmented adopting an efficient multi-scale Hessian-based vesselness filter. The initially segmented vessel trees are then converted to a graph representation, on which a series of graph filters are applied in post-processing steps to rule out irrelevant structures. Eventually, we develop a semi-automatic workow to refine the segmentation in the areas of inferior vena cava and entrance of portal veins, and to simultaneously separate hepatic veins from portal veins. Segmentation quality was evaluated with intensive tests enclosing 60 CT images from both healthy liver donors and oncological patients. To quantitatively measure the similarities between segmented and reference vessel trees, we propose three additional metrics: skeleton distance, branch coverage, and boundary surface distance, which are dedicated to quantifying the misalignment induced by both branching patterns and radii of two vessel trees.
Wang, Lei; Hansen, Christian; Zidowitz, Stephan; Hahn, Horst K.
Hepatocellular carcinoma with venous invasion: sonographic-angiographic correlation
Ultrasound was correlated with angiography for assessment of tumor extension to the intrahepatic inferior vena cava, hepatic veins, and portal vein branches in 15 cases of hepatocellular metastases. Sonography revealed intraluminal tumor thrombus in 5 cases of HCC (33%), which were confirmed by angiography (sensitivity and specificity = 100%), and in 1 case of hepatic metastases (1%). Sonography was superior in depicting veins obscured on nonopacified on angiography, which in turn demonstrated arteriovenous shunting not appreciated on sonography. Used as the initial procedure for evaluation of venous extension of HCC, ultrasound can suggest the histology (though this must be confirmed by biopsy) and determine the feasibility of resection.
Subramanyam, B.R.; Balthazar, E.J.; Hilton, S.; Lefleur, R.S.; Horii, S.C.; Raghavendra, B.N.
Effect of peritoneo-venous shunt on portal pressure.
The cause of variceal bleed after a peritoneo-venous shunt is not known. Portal haemodynamic consequences of a peritoneo-venous shunt are poorly understood. The most critical period after a peritoneo-venous shunt is the early postoperative period when rapid mobilisation of peritoneal fluid occurs. Serial changes in the portal pressure during the early postoperative period have not been recorded. In the present study preoperative wedge hepatic vein (WHV), right atrial (RA) and pulmonary capillary wedged (PCW) pressures, cardiac index (CI), and plasma volume (PV) were measured in five alcoholic cirrhotic patients with tense ascites for up to 20 hours postoperatively. The longterm effect was assessed by repeating the intrahepatic and/or wedged hepatic vein pressures in three of the surviving patients after 10 to 20 months. A significant increase in the circulatory dynamics and portal pressure was seen within two hours after shunt placement. Wedged hepatic vein pressure increased from 27.6 (8.2) mmHg to 37.2 (9.2) mmHg (p less than 0.01), RA pressure increased from 6.8 (1.5) mmHg to 14.0 (4.3) mmHg (p less than 0.05), PCW increased from 7.2 (3.5) mmHg to 19.3 (5.7) mmHg (p less than 0.01), CI increased from 3.4 (0.27) lit/m2/min to 4.3 (0.85) lit/m2/min (p less than 0.05). This was accompanied by a 34% increase in the plasma volume from 1838.5 (142.1) to 2471.4 (210) ml/m2. These derangements were maintained up to 20 hours postoperatively. After 10 to 20 months, repeat measurements revealed a return to preoperative measurements. It is concluded that there is an acute increase portal pressure after a peritoneo-venous shunt attributed to increased circulation plasma volume, resulting from rapid mobilisation of ascitic fluid after the shunt. A sudden increase in portal pressure might be an important provoking factor for variceal bleeding after peritoneo-venus shunt. PMID:2920931
Samanta, A K; Leevy, C M
Thyrocervical artery - jugular fistula following internal jugular venous catheterization
Arteriovenous fistula (AVF) is an anomalous communication between an artery and a vein, caused by an iatrogenic or traumatic etiology. Surgically created upper limb AVF remains the preferred vascular access for patients on maintenance hemodialysis. Nonetheless central vein cannulation for hemodialysis is a common procedure done in patients who need hemodialysis. We incidentally detected a thyrocervical artery - jugular fistula in a patient on maintenance hemodialysis. He underwent a successful intra arterial coil embolization of the feeding vessel. Review of literature has shown that, a thyrocervical artery - internal jugular vein arteriovenous fistula following a central venous catheterization has not been reported so far. PMID:25120297
Zachariah, P. P.; Unni, V. N.; Kurian, G.; Nair, R. R.; Mathew, A.
Prophylaxis of venous thromboembolism: analysis of cost effectiveness.
The rapidly expanding literature regarding prevention of venous thromboembolism is confusing and contradictory, but, when analysed in the aggregate, the collective experience permits a judgment about the relative efficacy of different prophylactic regimens in specific patient populations, who vary in the risk factors predisposing them to thromboembolism. The dollar cost of the several approaches to prevention and their consequences should also be a matter of concern. Efficacy and dollar cost together determine cost effectiveness, which provides a practical guide to selection of the prophylactic approach appropriate to an individual patient. PMID:6767449
Salzman, E W; Davies, G C
Prevention and treatment of venous thromboembolism during HRT: current perspectives
Many large trials in the past 15 years have proven an increased risk of vascular complications in women using oral, mostly non-bioidentical, hormone therapy. The risk of vascular complications depends on the route of administration (oral versus transdermal), age, duration of administration, and type of hormones (bioidentical versus non-bioidentical). Acquired and/or hereditary thrombophilias (eg, factor V Leiden, prothrombin mutation G20210A, and others) lead to a further increase of risk for venous thromboembolism, stroke, or myocardial infarction. Therefore, bioidentical hormone therapy via the transdermal route seems to be the safest opportunity for hormone replacement therapy, although large trials for bioidentical hormone therapy are needed. PMID:25210472
Rott, Hannelore
Interventional radiology with venous port (chemotherapy and infusional support).
A completely portable permanent central venous access, consisting of a steel capsule sealed with a silicone membrane and connected to a silicone catheter (Port-a-Cath), was implanted in the subcutaneous tissue of 36 patients, most of whom no longer had accessible peripheral veins and needed to continue chemotherapy or undergo total parenteral nutrition. The access vessel was mostly the subclavian vein and the capsule was sutured to the pectoral fascia. Total subcutaneous implantation seems to afford optimum safety from infection and freedom for personal hygiene, produced no noteworthy complications and proved relatively simple to maintain. PMID:3095116
Damascelli, B; Bonalumi, M G; Terno, G; Pupa, A; Preda, F; Spreafico, C; Tagliabue, L
Advances and controversies in the management of cerebral venous thrombosis.
Cerebral venous thrombosis (CVT) is a rare form of stroke found most often in young women of reproductive age, often associated with oral contraceptive use, genetic or acquired thrombophilia, pregnancy, dehydration, or infection. CVT should be considered in any young patient who presents with an unexplained headache in combination with known hypercoagulable state, focal neurologic deficits, seizure, lobar hemorrhage, or bilateral thalamic or basal ganglionic edema. Acute treatment is with unfractionated heparin or low-molecular-weight heparin. It is important to provide supportive treatment. Outcomes are good compared with other types of stroke. Pediatric patients, excluding neonates, have similar presentation, treatment, and outcomes as adults. PMID:23896504
Star, Michael; Flaster, Murray
[Hepatic portal venous gas: surgery or not surgery?].
Finding hepatic portal venous gas with pneumatosis intestinalis on computed tomography (CT) represents diagnostic and therapeutic challenge. The intestinal necrosis, particularly associated with acute mesenteric ischemia, is the very first hypothesis to assess, with the underlying question of an urgent surgery. However, knowing the non-surgical causes that have been identified in the last decade seems necessary to better assess the risk-benefit ratio of emergency surgery. Among these causes, we report the case of the acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, whose first line treatment is medical. PMID:24161290
Kearns, K; Tran Van, D; Alberti, N; Fontaine, B; Fritsch, N
Objective: To investigate the core proteins (integrin subunits ?1, ?2 and ?3) in the acute venous thrombi and validate the specificity and sensitivity of increased expression of integrin subunits ?1, ?2 and ?3 in patients with venous thromboembolism. Methods: A total of 120 patients (73 females) with clinically proven acute VTE and aged between 24-90 years, and 120 non-VTE patients and healthy controls receiving physical examination matched in the sex and age were recruited. Flow cytometry was done to measure the expressions of blood integrin ?1, ?2 and ?3. The receiver-operator characteristic (ROC) curve analysis was conducted to evaluate the diagnostic accuracy of integrin ?1, ?2 and ?3. Results: The median levels of integrin ?1, ?2 and ?3 were significantly higher in VTE patients than in non-VTE patients (P=0.000, 0.000 and 0.000, respectively) and healthy controls (P=0.000, 0.000 and 0.000, respectively). The ROC curves showed that integrin ?1, ?2 and ?3 were specific diagnostic predictors of VTE with an area under the curve (AUC) of 0.870, 0.821, and 0.731, respectively. When three integrins were combined for diagnosis, the AUC of ROC curve was 0.916, and the sensitivity, specificity, positive and negative predictive values were 84.6%, 90.8%, 81.7% and 92.0%, respectively. Conclusion: The increased integrin ?1, ?2 and ?3, as the core protein of venous thrombosis, have relatively high specificity and sensitivity for VTE and thus may serve as useful new biomarkers for the diagnoses of VTE. PMID:25356112
Song, Yanli; Yang, Fan; Wang, Lemin; Duan, Qianglin; Jin, Yun; Gong, Zhu
Measurement of oxygen saturation in venous blood by dynamic near IR spectroscopy
A method for the measurement of oxygen saturation in the venous blood, SvO2, based on optical measurements of light absorption in the infrared region is presented. The method consists of applying relatively low external pressure of 25 mm Hg on the forearm, thereby increasing the venous blood volume in the tissue, and comparing the light absorption before and after the
Meir Nitzan; Anatoly Babchenko; Boris Khanokh; Haim Taitelbaum
[New results in the research of the biomechanics of the venous system].
The upright posture of man had been a major evolutional challenge. The mechanisms responsible for orthostatic tolerance mostly affect the venous system. In this paper, we discuss new results regarding the biomechanics of the venous system highlighting a rather neglected field, the biomechanical properties of the vein wall. These properties change according to localization of veins, age, gender and body mass. The anti-gravitational adaptation of veins is a complex process involving all three layers of the venous wall. Local myogenic and humoral mechanisms as well as systemic hormonal and nervous influences control the adaptive processes in the veins. Long term adaptation involves structural and functional remodeling of the venous wall. Disorders of the veins mostly cause pathological remodeling. Hemodynamic factors (pressure and flow) together with inflammatory processes may lead to pathological alterations, changing the biomechanical properties of the vein wall, which further contribute to the reservation and progression of venous dysfunction. Appropriate testing of venous function can reveal biomechanical disorders even in clinically asymptomatic patients. Thus, biomechanical investigation of veins not only helps to understand the underlying pathomechanism but it also can contribute to early diagnosis and follow-up of venous disorders. When recognized in time, pathological remodeling can be prevented or treated. In this way, the incidence of venous disorder could be cut back reducing both human suffering and material loss. PMID:18805766
Molnár, Andrea Agnes; Apor, Asztrid; Kiss, Róbert Gábor; Préda, István; Monos, Emil; Bérczi, Viktor; Nádasy, György László
Cerebral venous sinus thrombosis in HIV-infected patients: report of 2 cases
Infection with the human immunodeficiency virus (HIV) is associated with increased risk of cerebrovascular disease; however Cerebral Venous Sinus Thrombosis (CVST) is rarely associated with HIV-related cerebrovascular events. We describe two cases of HIV-positive patients who, at the same time, presented to our hospital with deep cerebral venous thrombosis and stroke. PMID:24570775
Mwita, Julius Chacha; Baliki, Kgomotso; Tema, Ludo
Hemodynamics of the Hepatic Venous Three-Vessel Confluences Using Particle Image Velocimetry
Hemodynamics of the Hepatic Venous Three-Vessel Confluences Using Particle Image Velocimetry-prototype replicas of two pediatric hepatic venous confluence anatomies and two-component particle image velocimetry confluences with multiple inlets and outlets. Keywords--Particle image velocimetry, Patient-specific surgical
Pekkan, Kerem
Venous leg ulcer care: How evidence-based is nursing practice?
Objectives: The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. Design: The practice variation study group was an audit of nursing agency client records to determine the provision
Karen R. Lorimer; Margaret B. Harrison; Ian D. Graham; Elaine Friedberg; Barbara Davies
Histologic changes mimicking biliary disease in liver biopsies with venous outflow impairment
Impairment of venous outflow from the liver manifests as zone 3 sinusoidal dilatation and congestion (SDC) in liver biopsy. The spectrum of histologic changes in portal tracts has not been described. We studied liver biopsies from 34 patients with a confirmed diagnosis of venous outflow impairment (VOI). Liver transplant recipients and biopsies with cirrhosis and hepatic neoplasms were excluded. Clinical
Sanjay Kakar; Kenneth P Batts; John J Poterucha; Lawrence J Burgart
Clinical Decisionmaking Based on Venous Versus Capillary Blood Gas Values in the Well-Perfused Child
Study objective: In children aged 1 month to 18 years, we sought to examine the correlation between venous and arterialized capillary blood gas values, and to determine whether the source of blood sample influenced the interpretation of the acid-base status and clinical management. Methods: In a cross-sectional study, venous and capillary blood gas values were simultaneously obtained in acutely ill
David McGillivray; Francine M Ducharme; Yves Charron; Claire Mattimoe; Steve Treherne
It has been proposed that all ultrasonic vocalizations (USVs) in young rats are by-products of a cardiovascular response to decreased venous return, the abdominal compression reaction. To test the hypothesis, venous return was decreased in infant rats while USV and cardiovascular measures were monitored. Neither injection of the vasodilator sodium nitroprusside nor blood withdrawal from the superior vena cava or
Harry N. Shair; Anna Jasper
Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings
Gas within the portal circulation has been known to be associated with a number of conditions most commonly mesenteric ischemia and necrosis. Systemic venous gas is described with few conditions and is mostly iatrogenic in nature. We describe a case of combined portal and systemic venous gas detected by computed tomography in a patient with perforated duodenal ulcer.
Fam, Maged Nassef Abdalla; Attia, Khaled Mostafa Elgharib; Khalil, Safaa Maged Fathelbab
Emerging Concepts in the Diagnosis and Management of Venous Thromboembolism During Pregnancy
Multiple changes in the coagulation system occur during pregnancy and account for the hypercoagulable state of pregnancy. Consequently, pregnant women are five times more likely to experience venous thromboembolism than non-pregnant women. Although the estimated rates of such events are low, venous thromboembolic disease is a leading cause of maternal death. The administration of intravenous or subcutaneous unfractionated heparin is
Maureen M. Burns
Is External Jugular Venous Pressure a Good Predictor of Volume Status in Kidney Graft Recipients?
To ensure appropriate function of the transplanted organ, it is necessary to adequately maintain vascular volume during the kidney transplantation procedure. For this purpose, central venous pressure (CVP) is monitored through a catheter inserted into the superior vena cava (SVC). Central venous cannulation is associated with a risk of serious complications. An objective of this study was to investigate whether
J. Trzebicki; E. Flakiewicz; P. Nowakowski; M. Kosieradzki; W. Lisik; A. Chmura
The patient with complex congenital heart disease, severe pulmonary outflow obstruction, and visceral heterotaxia, may have 'silent' obstruction of the pulmonary venous return. Severe reduction of pulmonary blood flow secondary to pulmonary stenosis or atresia in such patients may prevent the usual radiographic appearance of pulmonary oedema. If such obstructed anomalous pulmonary venous connections are not diagnosed before operation, construction
R M Freedom; P M Olley; F Coceani; R D Rowe
Venous oxygen measurements in the inferior vena cava in neonates with respiratory failure
BACKGROUND: The present study was undertaken to examine the feasibility of venous oxygen measurements in the inferior vena cava (IVC) via a catheter through the umbilical vein. This may serve as a proxy for mixed venous oxygenation and the complications of right atrial cannulation can be avoided at the same time. It has the added advantage of not being affected
Frans B Plötz; Richard A van Lingen; Albert P Bos
Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis.
Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular.CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation.Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius.CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917
Beggs, Clive B
[Venous tone of the limbs. Methods and comparison of 2 areas].
The limb venous tone, index of local venous compliance, was studied with mercury strain gauge plethysmography on 28 male normal subjects (40 +/- 17 years, +/- SD) simultaneously on upper and lower limbs. Measurements were done after 20 mn rest in supine position. Venous tone (VT) equals the slope of the pressure-volume curve established by simultaneous recording of the forearm and calf relative volumes for successive steps of pressure lower than or equal to 30 mmHg. Limb venous capacitance was expressed by means of the maximal limb relative volume (V30) reached for a pressure of 30 mmHg applied through cuffs in standardized conditions. The upper limb venous tone was greater than the lower limb venous tone: 24.3 +/- 8.2 mmHg/ml/100 vs 17.5 +/- 7.9 mmHg/ml/100, p = 0.001. V30 was greater in lower limb than in upper limb: 1.5 +/- 0.5 ml/100 vs 1.1 +/- 0.4 ml/100, p = 0.001. In conclusion, it appears that upper and lower limbs venous distensibility and capacitance are different. They are greater in the lower limb in baseline conditions. Thus simultaneous studies of both these limb venous systems seems important for physiological experiments because of their baseline differences. PMID:2510642
Journo, H; London, G; Pannier, B; Safar, M
A nation-wide initiative against venous thromboembolism.
There is a gap between knowledge and recommendations regarding venous thromboembolism (VTE) on the one hand and daily practice on the other. This fact has prompted a Swiss multidisciplinary group consisting of angiologists, haematologists, internists, and emergency medicine and pharmaceutical medicine specialists interested in VTE, the SAMEX group, to set up a series of surveys and studies that give useful insight into the situation in our country. Their projects encompassed prophylactic and therapeutic aspects of VTE, and enrolled over 7000 patients from five academic and 45 non-academic acute care hospitals and fifty-three private practices in Switzerland. This comprehensive Swiss Clinical Study Programme forms the largest database surveying current clinical patterns of VTE management in a representative sample of the Swiss patient population. Overall the programme shows a lack of thromboprophylaxis use in hospitalised at-risk medical patients, particularly in those with cancer, acute heart or respiratory failure and the elderly, as well as under-prescription of extended prophylaxis beyond hospital discharge in patients undergoing major cancer surgery. In regard to VTE treatment, planning of anticoagulation duration, administration of LMWH for cancer-associated thrombosis, and the use of compression therapy for prevention of post-thrombotic syndrome in patients with symptomatic proximal DVT require improvement. In conclusion, this programme highlights insufficient awareness of venous thromboembolic disease in Switzerland, underestimation of its burden and inconsistent application of international consensus statement guidelines regarding prophylaxis and treatment adopted by the Swiss Expert Group. PMID:21720971
Bounameaux, H; Spirk, D; Kucher, N
Effect of age on oral contraceptive-induced venous thrombosis.
This study was undertaken to investigate the effect of age on oral contraceptive-induced venous thrombosis. All women seen in the University of Padua Department of Medical and Surgical Science who had had two courses of oral contraceptive therapy at different ages were included. A total of 28 subjects met these criteria. Fifteen patients had a congenital or acquired prothrombotic condition, whereas 13 women were normal subjects. The mean age at which thrombosis occurred was 33.3 and 36.3 years for women with or without a prothrombotic condition, respectively. The ages during which the women remained asymptomatic were 23.1 and 23.3 years for women with or without a predisposing defect, respectively. Thrombosis occurred, during the second course of oral contraceptive therapy, after the mean duration of 6.5 cycles or 18.4 cycles in women with or without prothrombotic defects, respectively. During the asymptomatic course, approximately the same number of women took old progestins or third-generation compounds. On the contrary, during the second period, 21 of 28 women took progestins with third-generation compounds. Age seems to plays an important role in oral contraceptive-induced venous thrombosis. In normal women, thrombosis occurred after a greater number of oral contraceptive cycles as compared with the women with prothrombotic defects. Because the majority of women took preparations that contained third-generation progestins during the second course of therapy, concomitant contributing effects of these compounds cannot be excluded. PMID:15247983
Girolami, A; Spiezia, L; Girolami, B; Zocca, N; Luzzatto, G
Should patients with venous thromboembolism be screened for thrombophilia?
In the mid-19th century, Virchow identified hypercoagulability as part of the triad leading to venous thrombosis, but the specific causes of hypercoagulability remained a mystery for another century. The first specific cause to be identified was antithrombin III deficiency. Many other causes of thrombophilia, both genetic and acquired, have been discovered since then. The 2 most common genetic causes of thrombophilia are the Leiden mutation of factor V and the G20210A mutation of prothrombin. The most common acquired cause is antiphospholipid syndrome. These factors increase the relative risk of an initial episode of venous thromboembolism (VTE) by a factor of 2 to 10, but the actual risk remains relatively modest. Therefore, thrombophilia screening to prevent initial episodes of VTE is not indicated, except possibly in women with a family history of idiopathic VTE who are considering oral contraceptive therapy. Some physicians screen for thrombophilia to aid decision making concerning the duration of anticoagulant therapy. However, several studies have demonstrated that, with the exception of antiphospholipid syndrome, thrombophilia does not significantly increase the risk of recurrent VTE. On the other hand, idiopathic VTE significantly increases the risk of recurrence in patients with or without thrombophilia. PMID:18501222
Dalen, James E
Syndactylizing arterialized venous flaps for multiple finger injuries.
Multiple soft tissue finger defects in different shapes and locations are usually difficult to manage. Such defects commonly involve tendons and bones. Palmar soft tissue defects may also lead to vascular compromise. In this retrospective report, we report the results of seven patients with multiple soft tissue finger defects that were covered by syndactylizing arterialized venous flaps. Six of the patients suffered hot-pressing machine and crushing injuries, one patient had a rolling belt injury. All patients presented with soft tissue defects on palmar or dorsal sides involving at least two digits. The palmar forearm was donor site for all patients. At least one afferent artery and two efferent veins were selected for the anastomosis. Lengths of afferent and efferent veins were long enough to perform healthy anastomosis outside the injury zone. The afferent vessels were anastamosed to the digital arteries with the largest possible diameter or to the common digital arteries to maximize flow. The efferent veins were anastamosed to dorsal veins. Separations of the digits were performed after three weeks by longitudinal incisions. The mean follow-up period was 12 months. None of our patients suffered a flap loss. Syndactylizing arterialized venous flaps may be used for composite or single tissue reconstruction for multiple finger defects with satisfactory cosmetic and functional outcomes. © 2014 Wiley Periodicals, Inc. Microsurgery 34:527-534, 2014. PMID:24782226
Kayalar, Murat; Levent, Kucuk; Sugun, Tahir Sadik; Gurbuz, Yusuf; Savran, Ahmet; Kaplan, Ibrahim
Clinician's perspectives on the treatment of venous leg ulceration.
Treatment of venous leg ulcers (VLU) represents a considerable challenge to the health care professional and to the patient alike. Much of the current literature regarding VLU focuses on either wound pathophysiology and treatment of chronic venous insufficiency or the patients' experience of the condition. We present two studies that examine more closely the clinicians' experience of treating VLU and reflect upon how that understanding may further enhance better outcomes for patients in the future. The first of these studies is a qualitative investigation of 49 clinicians treating VLU in the UK and USA. The second is a quantitative, online survey of 304 clinicians' beliefs, attitudes and practices in the UK, Germany and USA. Findings show that the clinicians' experience of treating VLU is often accompanied by frustration and dissatisfaction with treatment challenges and uncertain outcomes. Practices and treatment choices were found to vary widely and differ by countries. We conclude that a key aspect in improving VLU treatment is in listening to the frustrations of the clinician when considering new approaches to therapy. PMID:19912394
Cullen, George H; Phillips, Tania J
Venous compliance and fluid shift measurements on Spacelab IML-1
NASA Technical Reports Server (NTRS)
During the first few hours of a human spaceflight mission, a headward fluid shift out of the abdomen, pelvis, and legs initiates a number of adaptive cardiovascular responses, including a loss of intravascular and extravascular fluid volume. On return to earth, these cardiovascular changes may lead to debilitating symptoms of orthostatic intolerance in an unprotected astronaut. To test the hypothesis that an inflight increase in compliance of the leg veins may contribute to this condition, measurements of lower leg fluid shift and bulk venous compliance were collected from crew members during the eight-day First International Microgravity Laboratory shuttle mission. An ultrasonic limb plethysmograph, in conjunction with two compression cuffs encircling the calf and thigh, was used to determine bulk compliance of the underlying veins over a range of negative and positive transmural pressures. The data from inflight experiment sessions were compared to preflight and postflight sessions. The preliminary results indicate that the volume of the lower leg decreased by over 10 percent by the sixth day of flight, but there was no apparent change in venous compliance.
Leiski, D.; Thirsk, R. B.; Charles, J. B.; Bennett, B.
Delay of the reverse pedicled venous island flap: clinical applications.
In patients with hand or foot injuries, the delay procedure of the reverse pedicled venous flap was applied, including the loose areolar tissue around the pedicle vein. As preliminary clinical observations, five patients were treated with delay and the results compared with those of four patients without delay. The delay procedures were two types: type 1 was circumferential incision with ligature of the proximal vein, and type 2 was a bipedicled flap without ligature of the pedicle vein. Two weeks later, the flap was transferred to the defect. In the patients treated without delay, the maximum limit of the perfectly survived flap sizes was 4.0 × 2.0 cm. However, in the patients treated with delay, the perfectly survived sizes were 5.0 × 3.0 cm and 10 × 4.0 cm in type 1 delay and 12 × 5.0 cm in type 2 delay. The delay procedure appeared to stabilise the reverse pedicled venous flap and to expand its clinical applications. PMID:23710795
Ueda, Koichi; Nuri, Takashi; Akamatsu, Jun; Sugita, Naoya; Otani, Kazuhiro; Yamada, Akira
Antiplatelet therapy in prevention of cardio- and venous thromboembolic events.
The contribution of platelets in the pathophysiology of low-shear thrombosis-specifically, in atrial fibrillation (AF) and venous thromboembolic events (VTE)-remains less clear than for arterial thrombosis. AF itself appears to lead to platelet activation, offering a potential target for aspirin and other antiplatelet agents. Randomized trial results suggest a small benefit of aspirin over placebo, and of dual antiplatelet therapy (aspirin plus clopidogrel) over aspirin alone, for prevention of cardioembolic events in AF. Antiplatelet therapy thus can represent an option for patients with AF who are unsuitable for therapy with warfarin or novel oral anticoagulant agents. For VTE, the rationale for antiplatelet therapy reflects the venous response to disrupted blood flow-interactions among monocytes, neutrophil extracellular traps, and platelets. Early randomized trials generally showed poorer performance of aspirin relative to heparins and danaparoid sodium in prevention of VTE. However, results from large placebo- and dalteparin-controlled randomized trials have spurred changes in the most recent practice guidelines-aspirin is now recommended after major orthopedic surgery for patients who cannot receive other antithrombotic therapies. PMID:24221804
Steinhubl, Steven R; Eikelboom, John W; Hylek, Elaine M; Dauerman, Harold L; Smyth, Susan S; Becker, Richard C
Management of venous edema: insights from an international task force.
An International Task Force made up of a panel of 16 experts has reviewed and objectively evaluated all aspects of chronic venous disease of the leg (CVDL). All available publications on CVDL from 1983 to 1997 were identified through computerized search in Medline and by a manual search. Next, three different screenings were performed in order to select only relevant papers providing a level of scientific evidence that was considered moderate to strong. Final conclusions and further therapeutic recommendations were made based on these publications. Medication, compression, local therapy, sclerotherapy, and surgery are the accepted available therapeutic options for CVDL. For edema, the following recommendations can be made: edema is an early sign of CVDL, but before starting any treatment, nonvenous causes of edema should be excluded. Medication and compression are the therapeutic options for edema that are accepted by the Task Force. Evaluation of their efficacy is based on objective measures of edema. Several well-conducted, placebo-controlled trials have shown efficacy of drugs such as micronized purified flavonoid fraction, rutosides, calcium dobesilate, and coumarin rutin. Graduated compression stockings have been shown to be effective; compression needs to be exerted at least at 35 mm Hg. Bandages, if properly applied, both fixed and stretched, can produce favorable results. Sclerotherapy or surgery is not indicated unless there is saphenofemoral or saphenopopliteal reflux. In the absence of such reflux or following deep venous thrombosis, there is no evidence to support sclerotherapy or surgery. PMID:10667638
Clement, D L
CDC Grand Rounds: preventing hospital-associated venous thromboembolism.
Deep venous thrombosis (DVT) is a blood clot in a large vein, usually in the leg or pelvis. Sometimes a DVT detaches from the site of formation and becomes mobile in the blood stream. If the circulating clot moves through the heart to the lungs it can block an artery supplying blood to the lungs. This condition is called pulmonary embolism. The disease process that includes DVT and/or pulmonary embolism is called venous thromboembolism (VTE). Each year in the United States, an estimated 350,000-900,000 persons develop incident VTE, of whom approximately 100,000 die, mostly as sudden deaths, the cause of which often goes unrecognized. In addition, 30%-50% of persons with lower-extremity DVT develop postthrombotic syndrome (a long-term complication that causes swelling, pain, discoloration, and, in severe cases, ulcers in the affected limb). Finally, 10%-30% of persons who survive the first occurrence of VTE develop another VTE within 5 years. PMID:24598595
Streiff, Michael B; Brady, Jeffrey P; Grant, Althea M; Grosse, Scott D; Wong, Betty; Popovic, Tanja
Cilostazol minimizes venous ischemic injury in diabetic and normal rats
We evaluated the effects of cilostazol on venous infarction produced by a photothrombotic two-vein occlusion (2VO) model in diabetic and control rats. The cerebral blood flow (CBF) between the occluded veins was measured by laser Doppler flowmetry for 4?hours after 2VO. Infarct size and immunohistochemistry were evaluated 24, 48, 96, and 168?hours after 2VO. Cilostazol was administered 1?hour after 2VO, and thereafter at a continuous oral dose of 60?mg/kg per day. Cilostazol reduced the infarct size, and the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)-positive apoptotic and B-cell lymphoma 2-associated X protein (Bax)-positive cells, and improved the CBF in control rats. In diabetic rats, cilostazol reduced the infarct size, and the number of TUNEL-positive apoptotic and Bax-positive cells, 96 and 168?hours after 2VO, but did not improve the CBF 4?hours after 2VO. Cilostazol increased the number of B-cell lymphoma 2 (Bcl-2)-positive cells in both strains 48, 96, and 168?hours after 2VO, but did not improve vessel wall thickness or collagen deposits. Cilostazol appeared to limit venous infarcts by improving the penumbral CBF in nondiabetic rats, and inhibited pro-apoptotic changes through Bcl-2 overexpression, without improving the CBF in diabetic rats. PMID:21505475
Wajima, Daisuke; Nakamura, Mitsutoshi; Horiuchi, Kaoru; Takeshima, Yasuhiro; Nishimura, Fumihiko; Nakase, Hiroyuki
Venous patch grafts and carotid endarterectomy. A critical appraisal.
Seventy-eight patients underwent 83 carotid endarterectomies (CEAs) with vein patch grafts from 1980 to 1985. A technically satisfactory endarterectomy was confirmed by completion arteriogram in all instances. Indications for venous patch graft included a diameter of the internal carotid artery of less than 3.0 mm (49 patients); an internal carotid artery diameter of less than 3.5 mm, with contralateral internal carotid artery occlusion (nine patients); unexpected stenosis detected by completion arteriogram (six patients); a reexploration for neurologic deficit following conventional CEA (three patients); and irregular surface or edges of the endarterectomy site or high extension of a plaque (16 patients). Late follow-up arteriograms (66 studies) after a mean two-year interval revealed three instances (4.5%) of recurrent asymptomatic stenosis. Four patients (6%) developed late occlusions; three were asymptomatic and one was associated with major stroke 2 1/2 years later. One patient (1.5%) developed a false aneurysm. One patient experienced a postoperative transient ischemic attack. There was no operative mortality. Six patients died in the late follow-up period. The venous patch graft ensured immediate patency of the internal carotid artery but failed to prevent recurrent stenosis or occlusion in internal carotid arteries less than 3.0 mm in diameter. PMID:3662791
Hans, S S; Girishkumar, H; Hans, B
Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System
Purpose. The purpose of this study was to retrospectively evaluate interventional radiological management of patients with symptomatic portal hypertension secondary to obstruction of splanchnic veins. Material and Methods. Twenty-four patients, 15 males and 9 females, 0.75 to 79 years old (mean, 36.4 years), with symptomatic portal hypertension, secondary to splanchnic venous obstruction, were treated by percutaneous methods. Causes and extent of splanchnic venous obstruction and methods are summarized following a retrospective evaluation. Results. Obstructions were localized to the main portal vein (n = 22), intrahepatic portal veins (n = 8), splenic vein (n = 4), and/or mesenteric veins (n = 4). Interventional treatment of 22 (92%) patients included recanalization (n = 19), pharmacological thrombolysis (n = 1), and mechanical thrombectomy (n = 5). Partial embolization of the spleen was done in five patients, in two of them as the only possible treatment. TIPS placement was necessary in 10 patients, while an existing occluded TIPS was revised in two patients. Transhepatic embolization of varices was performed in one patient, and transfemoral embolization of splenorenal shunt was performed in another. Thirty-day mortality was 13.6% (n=3). During the follow-up, ranging between 2 days and 58 months, revision was necessary in five patients. An immediate improvement of presenting symptoms was achieved in 20 patients (83%). Conclusion. We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction.
Semiz-Oysu, Aslihan [Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Department of Radiology (Turkey)], E-mail: email@example.com; Keussen, Inger [Malmoe University Hospital, Department of Radiology (Sweden); Cwikiel, Wojciech [University of Michigan Hospital, Department of Radiology (United States)
Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment
An investigation of effectiveness of topical treatment of nonhealing chronic venous leg ulcers with propolis ointment was conducted. 56 patients were included in the study and randomized into two groups. In group 1, there were 28 patients (ulceration area: 6.9–9.78?cm2) treated by means of topical propolis ointment application and short stretch bandage compression. In group 2, there were 29 patients (ulceration area: 7.2–9.4?cm2) treated by means of Unna boot leg compression without topical propolis treatment. In the study, the efficacy of both treatment methods in patients with resistive venous leg ulcers was compared. The ulceration of patients from group 1 healed completely after 6 weeks of therapy in all cases. In all patients from group 2, the process of healing was longer but successfully completed after 16 weeks of the therapy. We found that an adjunctive propolis ointment treatment increases the efficacy of the short stretch bandage compression stocking, and this combined treatment is more effective than Unna's boot compression alone. PMID:23662121
Kucharzewski, M.; Kozka, M.; Urbanek, T.
Topical treatment of nonhealing venous leg ulcer with propolis ointment.
An investigation of effectiveness of topical treatment of nonhealing chronic venous leg ulcers with propolis ointment was conducted. 56 patients were included in the study and randomized into two groups. In group 1, there were 28 patients (ulceration area: 6.9-9.78?cm(2)) treated by means of topical propolis ointment application and short stretch bandage compression. In group 2, there were 29 patients (ulceration area: 7.2-9.4?cm(2)) treated by means of Unna boot leg compression without topical propolis treatment. In the study, the efficacy of both treatment methods in patients with resistive venous leg ulcers was compared. The ulceration of patients from group 1 healed completely after 6 weeks of therapy in all cases. In all patients from group 2, the process of healing was longer but successfully completed after 16 weeks of the therapy. We found that an adjunctive propolis ointment treatment increases the efficacy of the short stretch bandage compression stocking, and this combined treatment is more effective than Unna's boot compression alone. PMID:23662121
Kucharzewski, M; Kózka, M; Urbanek, T
Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion
Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.
Teichgraeber, Ulf Karl-Martin, E-mail: firstname.lastname@example.com; Streitparth, Florian, E-mail: firstname.lastname@example.com [Charite Universitaetsmedizin Berlin, Institut fuer Diagnostische und Interventionelle Radiologie (Germany); Gebauer, Bernhard, E-mail: email@example.com [Charite Universitaetsmedizin Berlin, Klinik fuer Strahlenheilkunde (Germany); Benter, Thomas, E-mail: email@example.com [Elblandkliniken Riesa-Grossenhain gGmbH, Klinik fuer Innere Medizin II Haematologie/Onkologie und Gastroenterologie (Germany)
Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients. The most common cause of this vascular access dysfunction is venous stenosis as a result of venous neointimal hyperplasia within the peri-anastomotic region (AV fistula) or at the graft-vein anastomosis (PTFE grafts). There have been few effective treatments to-date for venous neointimal hyperplasia in part because of the poor understanding of the pathogenesis of venous neointimal hyperplasia. Therefore, this article will (1) describe the pathology of hemodialysis access stenosis in AV fistulas and grafts, (2) review and describe both current and novel concepts in the pathogenesis of neointimal hyperplasia formation, (3) discuss current and future novel therapies for treating venous neointimal hyperplasia, and (4) suggest future research areas in the field of hemodialysis vascular access dysfunction. PMID:19695501
Lee, Timmy; Roy-Chaudhury, Prabir
Functional adaptation of bovine mesenteric lymphatic vessels to mesenteric venous hypertension.
Lymph flow is the primary mechanism for returning interstitial fluid to the blood circulation. Currently, the adaptive response of lymphatic vessels to mesenteric venous hypertension is not known. This study sought to determine the functional responses of postnodal mesenteric lymphatic vessels. We surgically occluded bovine mesenteric veins to create mesenteric venous hypertension to elevate mesenteric lymph flow. Three days after surgery, postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 7) and sham surgery (Sham; n = 6) group animals were evaluated and compared. Contraction frequency (MVH: 2.98 ± 0.75 min(-1); Sham: 5.42 ± 0.81 min(-1)) and fractional pump flow (MVH: 1.14 ± 0.30 min(-1); Sham: 2.39 ± 0.32 min(-1)) were significantly lower in the venous occlusion group. These results indicate that postnodal mesenteric lymphatic vessels adapt to mesenteric venous hypertension by reducing intrinsic contractile activity. PMID:24671245
Quick, Christopher M; Criscione, John C; Kotiya, Akhilesh; Dongaonkar, Ranjeet M; Hardy, Joanne; Wilson, Emily; Gashev, Anatoliy A; Laine, Glen A; Stewart, Randolph H
Radionuclide plethysmography (RPG) is a new technique that uses Tc-99m labelled red blood cells to ascertain changes in venous volumes by detecting the change in counts in response to the inflation and deflation of proximal thigh cuffs. Diagnosis of ileofemoral venous occlusion is possible using this technique, which also provides kinetic data of venous outflow. A range of normal values
I. Singer; H. D. Royal; R. F. Uren; R. C. Waugh; A. F. McLaughlin; G. J. Bautovich; I. A. Dyer; R. R. Fulton; J. G. Morris
Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study
Wang-Huei Sheng; Wen-Je Ko; Jann-Tay Wang; Shan-Chwen Chang; Po-Ren Hsueh; Kwen-Tay Luh
Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle-Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non-invasive outpatient department (OPD)-based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries. PMID:23170845
Nag, Falguni; De, Abhishek; Hazra, Avijit; Chatterjee, Gobinda; Ghosh, Arghyaprasun; Surana, Trupti V
Cerebrospinal Venous Outflow in Multiple Sclerosis Patients versus Fatigue and/or Depression
Background Endovascular treatment of impaired cerebrospinal venous outflow has been suggested to improve the overall quality of life in multiple sclerosis (MS) patients. Fatigue and depression are key factors in measuring the quality of life in MS patients. Objective In the present study, we investigated the correlation between anomalous venous outflow and the seriousness of fatigue and depression in MS patients and healthy controls. Methods Five cerebrospinal venous outflow parameters were measured in 20 MS patients and age- and sex-matched controls using extra- and transcranial Colour Doppler sonography. All patients and volunteers filled out the Fatigue Severity Scale (FSS) and Hospital Anxiety Depression Subscale (HADS). Results Nine abnormal parameters were found in 8 MS patients, whereas five abnormal parameters were found in 3 healthy controls (no significant difference). Only 1 MS patient met the criteria for chronic cerebrospinal venous insufficiency compared to 2 healthy controls. No significant differences were found in the FSS and HADS scores between patients with and without abnormal cerebrospinal venous outflow parameters. Conclusions We found no significantly impaired cerebrospinal venous outflow in patients with MS versus sex- and age-matched controls. Furthermore, we did not find any correlation between anxiety or depression and impaired venous outflow in MS patients. PMID:25337088
Hagens, Marloes H.J.; Hoogervorst, Erwin L.J.; Frequin, Stephan T.F.M.; Tromp, Selma C.
Venous disease treatment and compliance: the nursing role.
This article explores the numerous factors that influence compliance in the management of venous disease. The nurse's/health practitioner's role is highlighted as being pivotal in promoting compliance or non-compliance. The literature suggests there are many components that influence compliance, varying from impersonal relationships, treatment regimes and psychosocial influences. This implies that compliance is a shared responsibility between the healthcare practitioner/nurse and the patient. Holistic assessment incorporating negotiated care plans will provide the foundation of a partnership in care. Nurses have a responsibility to empower the patients with the necessary knowledge and skills to enable them to be an active participant in their own treatment/life regimes. Nurse education is key to effective, tolerable treatments that are acceptable to patients. PMID:12146178
Furlong, W
Rivaroxaban for the prevention and treatment of venous thromboembolism.
Venous thromboembolism (VTE) is a common and often life-threatening cardiovascular disorder. Patients undergoing total hip replacement or total knee replacement surgery are at increased risk of VTE. In this setting, clinical practice guidelines recommend the use of low molecular weight heparins, vitamin K antagonists or fondaparinux for the prevention of VTE. However, the use of these anticoagulants is beset by practical difficulties that reduce compliance to therapy and adherence to recommended guidelines. New oral anticoagulants (OACs) that are administered in fixed doses without the need for monitoring are now being introduced to clinical practice. Rivaroxaban, dabigatran and apixaban are either approved or in advanced stages of clinical development for the prevention and/or treatment of VTE. This article provides an overview of the phase III clinical development programmes for these novel OACs, with special focus on rivaroxaban. With encouraging data already emerging, the promise of a simplified single-drug approach for VTE treatment is on the horizon. PMID:21851388
Turpie, Alexander G G
Paradoxical embolism following intralesional sclerotherapy for cervical venous malformation.
We present a rare case of a 47-year-old woman admitted to our maxillofacial surgery department for a large cervicofacial venous malformation. The patient underwent fluoroscopy-guided intralesional foam sclerotherapy with sodium tetradecyl sulfate and air under general anaesthesia. On awakening, after 48?h of endotracheal intubation, she displayed dysarthria and dysmetria. Her brain CT scan showed no haemorrhagic lesions. A chest CT scan ruled out a potential pulmonary embolism. Suspicion for a paradoxical embolism was high and echocardiography confirmed a patent foramen ovale, which acted as a passageway for the embolus. Transcranial ultrasound showed mild right-to-left heart shunting. The dysarthria and dysmetria disappeared gradually over 48?h, thus confirming a reversible ischaemic neurological deficit. A brain MRI performed 1?week later showed no ischaemic or haemorrhagic lesions. The patient recovered completely. She was advised cardiosurgical follow-up and discharged. PMID:25422340
Allevi, Fabiana; Rabbiosi, Dimitri; Mandalŕ, Marco; Colletti, Giacomo
Clinical guide SEOM on venous thromboembolism in cancer patients.
Venous thromboembolism (VTE) is a common event in cancer patients and one of the major causes of cancer-associated mortality and a leading cause of morbidity. In recent years, the incidence rates of VTE have notably increased; however, VTE is still commonly underestimated by oncologists. VTE is considered an adverse prognostic factor in cancer patients in all settings. In 2011 the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of prophylaxis and treatment of VTE in cancer patients. In an effort to incorporate evidence obtained since the original publication, SEOM presents an update of the guideline for thrombosis and cancer in order to improve the prevention and management of VTE. PMID:25366189
Muńoz Martín, A J; Font Puig, C; Navarro Martín, L M; Borrega García, P; Martín Jiménez, M
The Spectrum of Cavernous Sinus and Orbital Venous Thrombosis
Orbital venous pathologies encompass a broad range of entities including tumors, shunts, congenital anomalies, aneurysms, and obstructive lesions. Patients may present with a variety of clinical findings which may include a combination of tumefaction, vascular engorgement, orbital pulsation, and exophthalmos, depending on the relationship between the lesion and the vascular system. Clinical findings may be unreliable in excluding serious underlying disorders, and so an extensive clinical and radiologic evaluation is necessary. This article presents a rare case of spontaneous aseptic cavernous sinus-superior ophthalmic vein thrombosis in a woman on hormone replacement therapy, and illustrates the multidisciplinary approach in diagnosis and management. The literature on issues surrounding this case is reviewed. PMID:17170953
Lai, Paul F.S.; Cusimano, Michael D.
Infectious complications of percutaneous central venous catheterization in pediatric patients
Objective Analysis of infectious complications and risk factors in percutaneous central venous catheters.\\u000a \\u000a \\u000a \\u000a Design One-year observational, prospective, multicenter study (1998–1999).\\u000a \\u000a \\u000a \\u000a Setting Twenty Spanish pediatric intensive care units.\\u000a \\u000a \\u000a \\u000a Patients Eight hundred thirty-two children aged 0–14 years.\\u000a \\u000a \\u000a \\u000a Intervention None.\\u000a \\u000a \\u000a \\u000a Measurements and main results One thousand ninety-two catheters were analyzed. Seventy-four (6.81%) catheter-related bloodstream infections (CRBSI) were\\u000a found. The CRBSI rate was 6.4 per 1,000 CVC days (95% CI 5.0–8.0).
M. Ángeles García-Teresa; Juan Casado-Flores; M. Ángel Delgado Domínguez; Jorge Roqueta-Mas; Francisco Cambra-Lasaosa; Andrés Concha-Torre; Cristina Fernández-Pérez
Influence of arterio-venous haemofiltration on teicoplanin elimination.
The pharmacokinetics of teicoplanin infused for 30 min at a dose of 6 mg kg-1 was studied in 11 infected patients under continuous arterio-venous haemofiltration (CAVH). Serum teicoplanin levels were assayed by h.p.l.c. over 24 h. After 0.5 h, i.e. at the end of the infusion, the mean plasma concentration was 49.6 +/- 15.1 mg l-1. At the last sampling time (24 h), the mean concentration was 2.6 +/- 1.0 mg l-1. The concentration of teicoplanin was determined in the haemofiltrates. The percentage of the administered dose recovered in the haemofiltrate was low: less than 1% for seven patients, between 1.8 and 3.7% for three patients and 7% for one patient. CAVH patients should be given teicoplanin using the same dosage regimens as previously described for patients with renal impairment. PMID:8527277
Hillaire-Buys, D; Peyriere, H; Lobjoie, E; Bres, J; Ossart, M; Despaux, E
Venous thrombosis and splenic rupture in paroxysmal nocturnal hemoglobinuria.
A patient with an 11 year history of paroxysmal nocturnal hemoglobinuria presented with severe abdominal pain. On admission, the hematocrit value was 30 per cent and unchanged from repeated measurements during the previous three years. Abdominal angiography identified extensive thromboses of the splenic and portal venous systems. After initial improvement on heparin therapy, the patient experienced additional abdominal crises. A ruptured and multifragmented spleen was removed at the time of exploratory laparotomy. Postoperatively, after a several days' interval of improvement, the patient experienced additional thrombotic episodes of the abdomen, upper extremities and cerebral cortex. The latter was associated with disabling nerve paralysis. With continuous intravenous heparin plus steroid therapy, the patient's condition improved progressively. Despite the numerous thrombotic episodes during the prolonged hospital course, no hemolytic episodes were observed. This is the first report of documented splenic rupture in a patient with paroxysmal nocturnal hemoglobinuria. PMID:7355897
Zimmerman, D; Bell, W R
Automated grading of venous beading: an algorithm and parallel implementation
NASA Astrophysics Data System (ADS)
A consistent, reliable method of quantifying diabetic retinopathy is required, both for patient assessment and eventually for use in screening tests for diabetes. To this end, an algorithm for determining the degree of venous beading in digitized ocular fundus images has been developed. A parallel implementation of the algorithm has also been investigated. The algorithm thresholds the fundus image to extract vein silhouettes. Morphological closing is used to fill any anomolous holes. Thinning is used to determine vein centerlines. Vein diameters are measured normal to the centerlines. A frequency analysis of vein diameter with distance along the centerline is then performed to permit estimation of veinous beading. For the parallel implementation, the binary vein silhouette and the vein centerline are rotated so that vein diameter may be estimated in one direction only. The time complexity of the parallel algorithm is O(N). Algorithm performance is demonstrated with real fundus images. A simulation of the parallel algorithm is used with actual fundus images.
Shen, Zhijiang; Gregson, Peter H.; Cheng, Heng-Da; Kozousek, V.
Iatrogenic vertebral artery pseudoaneurysm due to central venous catheterization
Central venous lines have become an integral part of patient care, but they are not without complications. Vertebral artery pseudoaneurysm formation is one of the rarer complications of central line placement. Presented is a rare case of two pseudoaneurysms of the vertebral and subclavian artery after an attempted internal jugular vein catheterization. These were successfully treated with open surgical repair and bypass. Open surgical repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudoaneurysms has been described with promising outcomes, but long-term results are lacking. Ultimately, the best treatment of these iatrogenic injuries should start with prevention. Well-documented techniques to minimize mechanical complications, including inadvertent arterial puncture, should be practiced and taught in training programs to avoid the potentially devastating consequences. PMID:21566753
Vasquez, Jay
Mechanical complications during central venous cannulations in pediatric patients
Objective Identification of early mechanical complications (EMC) of central venous catheterizations (CVC) in pediatric patients and\\u000a determination of EMC risk factors.\\u000a \\u000a \\u000a \\u000a Design Prospective observational study.\\u000a \\u000a \\u000a \\u000a Setting Pediatric intensive-care unit in a university hospital.\\u000a \\u000a \\u000a \\u000a Patients and measurements Eight-hundred and twenty-five CVC were performed in 546 patients. Age, weight, gender, mechanical ventilation, analgesia,\\u000a resident CVC failure, CVC indication, admission diagnosis, emergency or scheduled procedure, type of
Corsino Rey; Francisco Álvarez; Victoria De La Rua; Alberto Medina; Andrés Concha; Juan José Díaz; Sergio Menéndez; Marta Los Arcos; Juan Mayordomo-Colunga
[Color-coded Doppler sonography of chronic venous insufficiency].
20 patients (i.e. 40 lower extremities) with chronic venous insufficiency were examined by means of colour-coded Doppler sonography (CCDS). This method enables the simultaneous visualisation of the anatomy and haemodynamics of the examined vessels. All cases of varicosis of the stem of the vena saphena magna (VSM) (n = 21) and of the vena saphena parva (VSP) (n = 13) were correctly diagnosed by CCDS. However, an incomplete varicosis of the stem was identified in only 3 of 5 cases. Insufficiency of the V. perforantes was identified by CCDS with a high rate of accuracy in diagnosing the insufficiency of the cross of the VSM and VSP. Although assessment of the V. perforantes and diagnosis of incomplete stem varicoses or varicoses of lateral branches is possible, as a rule, it does take up much time and requires a great deal of experience on the part of the investigator. PMID:1751558
von Itter, C; Harder, T; Rabe, E
[Adequate venous autoplasty in severe superior vena cava syndrome].
Eleven patients underwent plastic operations on the superior vena cava (SVC) in its severe occlusion. The SVC syndrome was caused by malignant tumors of the right lung and mediastinum in 9 patients, lymphogranulomatosis in one patient, and by chronic fibrous mediastinitis in another patient. The SVC and its main branches were replaced by a multisegmental graft (lineal or bifurcation) of autogenous vein formed by parallel stitching together of 3-5 longitudinally cut segments of the vena saphena magna. Venous drainage was adequate and the graft remained unobstructed for a long time due to the anatomical conformity of the graft to the SVC and the equal diameters of the joined vessels. The immediate and late-term (3 to 26 months) results of plastics with a multisegmental graft or autogenous vein were good. PMID:2687134
Babliak, D E; Averchuk, V G
Popliteal venous aneurysm as a cause of recurrent pulmonary embolism.
We report 2 cases of recurrent pulmonary embolism (PE) in popliteal venous aneurysm (PVA). Patients were 78-year-old and 72-year-old women. Both were initially seen for acute PE. Saccular and fusiform PVAs were diagnosed in each patient based on duplex ultrasound. However, despite anticoagulation therapy, both patients had PE. At the time of the event, 1 patient was receiving inadequate dose of low-molecular-weight heparin. The other patient was treated with warfarin and had adequate international normalized ratio at the time of re-embolism, and thus, an inferior vena cava filter was inserted. Both patients underwent successful aneurysm resection without any additional thromboembolic events. PMID:23315197
Tomko, Tomás; Malý, Radovan; Jiska, Stanislav; Chovanec, Vendelín
Hydration status substantially affects chronic cerebrospinal venous insufficiency assessments
Summary We sought to determine the effect of hydration on the criteria for chronic cerebrospinal venous insufficiency (CCSVI), a proposed hypothesis for the etiology of multiple sclerosis (MS). Sixteen subjects (11 MS and 5 controls) were asked to fast overnight. The following morning, 2 CCSVI ultrasound examinations were performed: 1 in the mildly dehydrated state, and another 30–45 minutes after rehydrating with 1.5 L of Gatorade. Seven subjects fulfilled CCSVI criteria in the dehydrated state. Of these, 5 (71%) no longer fulfilled CCSVI criteria after rehydration. One additional subject met CCSVI criteria only after rehydration. Hydration status has a substantial effect on CCSVI criteria, suggesting that the sonographic findings of CCSVI may represent a physiologic rather than pathologic state. PMID:24175155
Diaconu, Claudiu I.; Fox, Robert J.; Grattan, Alia; Rae-Grant, Alexander; Lu, Mei; Gornik, Heather L.
Portal venous gas: is it a premorbid indicator?
A 72-year-old Caucasian man presented with subtle and insidious symptoms of pain in the left iliac fossa and vomiting. The first clinical impression was of diverticulitis but he did not improve with conservative management. An initial contrast tomography (CT) scan demonstrated no diagnostic features. Four days later, a repeat CT scan demonstrated intramural gas in the ascending colon and in the intrahepatic portal venous radicles. There was a thrombus in the superior mesenteric artery with infarction of the caecum and ascending colon. An urgent right hemicolectomy was carried out. Although there was resolution of the thrombus and air in the portal system, the patient died 8 days later from intestinal haemorrhage. PMID:22696738
Kailani, O; Farid, M; Tewari, N; Khawaja, H T
Aims/hypothesis Secondary type 1 diabetes prevention trials require selection of participants with impending diabetes. HLA-A and -B alleles have been reported to promote disease progression. We investigated whether typing for HLA-B*18 and -B*39 may complement screening for HLA-DQ8, -DQ2 and -A*24 and autoantibodies (Abs) against islet antigen-2 (IA-2) and zinc transporter 8 (ZnT8) for predicting rapid progression to hyperglycaemia. Methods A registry-based group of 288 persistently autoantibody-positive (Ab+) offspring/siblings (aged 0–39 years) of known patients (Ab+ against insulin, GAD, IA-2 and/or ZnT8) were typed for HLA-DQ, -A and -B and monitored from the first Ab+ sample for development of diabetes within 5 years. Results Unlike HLA-B*39, HLA-B*18 was associated with accelerated disease progression, but only in HLA-DQ2 carriers (p < 0.006). In contrast, HLA-A*24 promoted progression preferentially in the presence of HLA-DQ8 (p < 0.002). In HLA-DQ2- and/or HLA-DQ8-positive relatives (n = 246), HLA-B*18 predicted impending diabetes (p = 0.015) in addition to HLA-A*24, HLA-DQ2/DQ8 and positivity for IA-2A or ZnT8A (p ? 0.004). HLA-B*18 interacted significantly with HLA-DQ2/DQ8 and HLA-A*24 in the presence of IA-2 and/or ZnT8 autoantibodies (p ? 0.009). Additional testing for HLA-B*18 and -A*24 significantly improved screening sensitivity for rapid progressors, from 38% to 53%, among relatives at high Ab-inferred risk carrying at least one genetic risk factor. Screening for HLA-B*18 increased sensitivity for progressors, from 17% to 28%, among individuals carrying ?3 risk markers conferring >85% 5 year risk. Conclusions/interpretation These results reinforce the importance of HLA class I alleles in disease progression and quantify their added value for preparing prevention trials. PMID:23712485
Mbunwe, E.; Van der Auwera, B. J.; Weets, I.; Van Crombrugge, P.; Crenier, L.; Coeckelberghs, M.; Seret, N.; Decochez, K.; Vandemeulebroucke, E.; Gillard, P.; Keymeulen, B.; van Schravendijk, C.; Wenzlau, J. M.; Hutton, J. C.; Pipeleers, D. G.; Gorus, F. K.; Registry, The Belgian Diabetes
Venous Thromboembolism in Urologic Surgery: Prophylaxis, Diagnosis, and Treatment
Venous thromboembolism (VTE) represents one of the most common and potentially devastating complications of urologic surgery. With VTE's rapid onset of symptoms, association with a precipitous clinical course, and high mortality rate, all urologists should be well versed in appropriate prophylaxis, prompt diagnosis, and expeditious treatment. A MEDLINE® search was performed for articles that examined the incidence, diagnosis, and treatment of VTE in urologic surgery. Additional articles were reviewed based on cited references. There is a paucity of prospective studies on VTE in the urologic literature with most recommendations for urologic surgery patients being extrapolated from other surgical disciplines. Retrospective studies place VTE incidence rates in major urologic surgeries among the highest reported-highlighting the importance of thromboprophylaxis. Conversely, VTE was rarely reported in association with endoscopic and laparoscopic procedures making mechanical thromboprophylaxis sufficient. Recent literature reveals delayed VTE occurring after hospital discharge to be a persistent threat despite inpatient preoperative prophylaxis. Computed tomographic angiography has emerged as the test of choice for diagnosing pulmonary embolism, whereas lower extremity duplex sonography is recommended for diagnosing deep venous thrombosis. Traditional angiography is rarely used. Treatment of VTE involves therapeutic anticoagulation for various lengths of time based on presence and reversibility of patient risk factors as well as number of events. Perioperative thromboprophylaxis should be considered in all major urologic surgeries. Urologists should be familiar with incidence rates, recommended prophylaxis, appropriate diagnosis, and treatment recommendations for VTE to minimize morbidity and mortality. The limited number of prospective, randomized, controlled trials evaluating the use of thromboprophylaxis in urologic surgery demonstrates the need for further research. PMID:20811548
Rice, Kevin R; Brassell, Stephen A; McLeod, David G
Subcutaneous Venous Port Implantation in Patients with Bilateral Breast Surgery
The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up.
Peynircioglu, Bora, E-mail: firstname.lastname@example.com; Arslan, E. Bengi; Cil, Barbaros E.; Geyik, Serdar; Hazirolan, Tuncay [Hacettepe University, School of Medicine, Department of Radiology (Turkey); Konan, Ali [Hacettepe University, School of Medicine, Department of General Surgery (Turkey); Balkanci, Ferhun [Hacettepe University, School of Medicine, Department of Radiology (Turkey)
Neonatal central venous catheter thrombosis: diagnosis, management and outcome.
Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. There is no guideline that systematically addresses the diagnosis, management, and prevention of this complication. The objective of this review is to establish evidence-based guidance for the management of CVC-related thrombosis. A comprehensive search of the scientific literature was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged below 28 days, CVC insertion, and English language - were included for analysis. The incidence of thrombosis was 9.2% (308/3332). Singly inserted umbilical venous catheters (UVCs) and peripherally inserted central catheters accounted for over 80% of all CVCs. Frequently reported thrombotic sites were the hepatic vein, right atrium, and inferior vena cava. Symptoms included distal swelling of affected areas and thrombocytopenia. Increased length of catheter stay, infusion of blood products and malpositioned UVCs were identified as risk factors. The commonest diagnostic investigations to confirm thrombosis were echocardiography and ultrasonography. Spontaneous resolution may occur in UVC-related thrombosis, but this warrants close monitoring. Thrombolysis with urokinase alone or combined with low-molecular-weight heparin might be effective and well tolerated as treatment strategies. Prophylactic heparin increases the duration of catheter usability (P?0.005, 95% confidence interval 0.35-0.81), decreases catheter occlusion, but may not uniformly prevent thrombosis. CVL-related thrombosis is an underreported complication because events in the majority occur silently. Currently, solid evidence-based recommendations for diagnosis and treatment are not possible. Well designed prospective studies are urgently required to establish a concrete investigational approach to CVC-related thrombosis and to institute safe therapeutic modalities. PMID:24477225
Park, Christina K; Paes, Bosco A; Nagel, Kim; Chan, Anthony K; Murthy, Prashanth
Queckenstedt's Test Affects More than Jugular Venous Congestion in Rat
Jugular venous compression by the Queckenstedt's test (Q-test) increases the intracranial pressure, but the effects of isolated jugular venous congestion are not well known. Intraventricular pressure (IVP) was compared during direct obstruction of the common jugular veins (bilateral CJV clipping) and during external compression of bilateral CJV flows (Q-test) in a rat model. Intracerebroventricular catheters were inserted into the right lateral ventricle of nine male Sprague-Dawley rats (371.1±44.8 g, 82.2±12.0 days old). The initial mean IVP, arterial pressure (MAP), and pulse rate were 2.8±1.3 mmHg, 88.8±12.7 mmHg, and 348.3±69.1 beats/min, respectively. The mean IVP increment and MAP decrement were 6.5±2.5 and 13.5±5.7 mmHg, respectively, during the Q-test, compared to 2.3±1.5 and 7.3±3.8 mmHg, respectively, during bilateral CJV clipping (all p?=?0.008). The IVP increment and MAP decrement were greater during the Q-test than during bilateral CJV clipping (p?=?0.008 and p?=?0.038). Although the Q-test and bilateral CJV clipping showed similar effects, the response with the Q-test was greater. Thus, the Q-test appears to obstruct other collateral cerebral veins in addition to bilateral CJV flows. Since this model revealed significant differences between the manual Q-test and bilateral CJV clipping, the finding should be taken into account in future studies on the Q-test in SD rats. PMID:23516633
Chou, Chi-Hsiang; Doong, Ming-Luen; Fuh, Jong-Ling; Wu, Jaw-Ching; Wang, Shuu-Jiun
Venous Thromboembolism After Removal of Retrievable Inferior Vena Cava Filters
The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism (VTE) after retrieval of inferior vena cava (IVC) filters and risk factors associated with such recurrence. Between March 2001 and September 2008, at our institution, implanted retrievable vena cava filters were retrieved in 76 patients. The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval. In 5 (6.6%) of the 76 patients, redevelopment or worsening of VTE was seen after retrieval of the filter. Three patients (4.0%) had recurrent deep venous thrombosis (DVT) in the lower extremities and 2 (2.6%) had development of pulmonary embolism, resulting in death. Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated, a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required (40% in patients with recurrent VTE vs. 23% in those without VTE; p = 0.5866 according to Fisher's exact probability test) and in patients in whom DVT remained at the time of filter retrieval (60% in patients with recurrent VTE vs. 37% in those without VTE; p = 0.3637). In conclusion, new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval. We must point out that the fatality rate from PE after filter removal was high (2.6%).
Yamagami, Takuji, E-mail: email@example.com; Tanaka, Osamu; Yoshimatsu, Rika; Miura, Hiroshi; Nishimura, Tsunehiko [Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Department of Radiology (Japan)
A study of factors associated with cerebral venous thrombosis.
Cerebral venous thrombosis (CVT) is an uncommon but important cause of stroke. Since there are few number of studies about the factors associated with CVT, we aimed to perform a study on Iranian patients, during a 12-year period (1997-2010) and assessed the risk factors, mortality rate, symptoms and signs, imaging and seasonal distribution. This study was a retrospective cross sectional study conducted in Rasul-e-Akram Hospital of Tehran University of Medical Sciences. The hospital is a referral neurology center for west, south and east parts of the capital city. The patients' data were extracted from the documents and entered to a self-designed checklist including probable risk factors, sequels, involved venous and also demographic characteristics. From 62 patients, 85.5% of the patients were female. Most of the patients were between 25 and 35 years old. Superior sagittal sinus was involved in 35 patients. Generalized seizure in the expired group (7 patients) was significantly more than the alive group (P = 0.017). There was a significant relationship between intracranial hemorrhage and mortality rate and between the site of thrombosis and level of consciousness. There was also a significant relationship between fasting and pregnancy with seizure in these patients. Although most of the patients presented in spring and autumn, majority of the expired cases were reported in autumn. This study can help defining risk factors, symptoms, and predicting risk factors of seizure in patients with CVT. We suggest future studies based on gathering data for meta-analysis. PMID:22395946
Jalili, Mehdi; Ghourchian, Shadi; Shahidi, Gholam Ali; Rohani, Mohammad; Rezvani, Mohammad; Zamani, Babak
Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study
Objective: To evaluate the patterns of pulmonary venous drainage into the left atrium and to determine the frequency of each variant of pulmonary venous anatomy. Materials and methods: After institutional review board approval (No. 09JUL011148), 300 studies of thoracic multidetector computed tomography were retrospectively reviewed for the anatomical features of the pulmonary vein and its drainage pattern into the left atrium. The percentage of each pattern was calculated. Results: The anatomy of pulmonary venous drainage in 300 patients (150 male and 150 female, mean age 60.16 years) showed some variation. In the right pulmonary vein, the most common drainage pattern was two ostia (90.33%), followed by three to five ostia (6.33%) and a single ostium (3.33%). There were one or two separate middle lobe vein ostia in groups of more than two openings. On the left side, there were two patterns; a single venous ostium (59%) was much more common than two ostia (41%). In both right and left pulmonary veins, there were five cases (2 male, 3 female) that had a single pulmonary venous ostium, bilaterally. However, there were only 17 cases (5.67%), out of 300 enrolled in this study, that had bilateral pulmonary venous ostial variations. Conclusion: A classification system to succinctly describe pulmonary venous drainage patterns was developed. In left-sided drainage, a single left pulmonary ostium was the most common variation. The right-sided venous drainage varied more in both number and pattern than those of the left side; nevertheless, bilateral pulmonary venous ostial variation was not frequently found. PMID:22970060
Wannasopha, Y; Oilmungmool, N; Euathrongchit, J
Cephalic Vein Transposition versus Vein Grafts for Venous Outflow in Free-flap Breast Reconstruction
Introduction: When recipient veins for free-flap breast reconstruction are unavailable or inadequate, vein grafts or cephalic vein transposition (CVT) an option to provide alternate venous outflow. There are no comparative data to elucidate the indications and outcomes for each. We hypothesize that the CVT is as reliable as vein grafts when indicated. Methods: All consecutive cases where a CVT or venous vein grafts were used for free-flap breast reconstruction between 2000 and 2012 were reviewed. Patient demographics, operative notes, indications, and flap survival were compared between the 2 groups. Results: Ten patients underwent a CVT and 38 patients received a vein graft for insufficient venous outflow. There were no differences in average age, body mass index, or comorbid conditions between the groups. Similarly, there was no difference in previous radiotherapy, timing of reconstruction, or side of reconstruction. A CVT was used for salvage following venous thrombosis in 7 patients (70.0%) and for primary venous outflow in the remaining patients due to inability to use the internal mammary vein. Vein grafts were performed primarily in 31 patients, 22 for augmenting venous drainage (supercharge), 9 for the dominant venous outflow, and 7 for salvage of a thrombosis. One patient in each group suffered a complete loss of the free flap (cephalic: 10.0% vs vein graft: 14.3%, P = 0.36). Conclusions: The CVT is a reliable alternate venous outflow that can be used as a primary recipient vein or as a salvage option following venous thrombosis. Surgeons should consider a CVT when primary recipient veins are compromised or unavailable. PMID:25289334
Chang, Edward I.; Fearmonti, Regina M.; Chang, David W.
The aim of this study was to prospectively investigate the clinical efficacy of Daflon therapy in patients with mild to moderate chronic venous insufficiency (CVI) (clinical class 1-4) and to assess the changes in venous hemodynamics by using air plethysmography (APG). Fifty-six limbs in 28 patients were studied. They all had primary venous insufficiency with no venous obstruction, and mixed deep and superficial venous incompetence was found in 64% of the limbs. There was a significant decrease in symptom score for swelling and heaviness after 6 months of Daflon therapy. The symptom score for cramps also showed improvement though it did not reach statistical significance. Pain was significantly reduced with a mean pain score of 21.8 +/- 19.3% before comparing to 10.4 +/- 20.2% after 6 months of Daflon therapy (p < 0.01). This was also associated with a decrease in mean calf circumference from 37.0 +/- 4.3 to 36.4 +/- 4.3 cm (p < 0.001). There was no significant change in the venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) before and after 6 months of Daflon therapy (VFI: 3.7 +/- 3.5 vs 3.4 +/- 2.5 mL/s, EF: 54.5 +/- 15.9% vs 57.7 +/- 19.7%, RVF: 41.4 +/- 19.2% vs 39.4 +/- 24.2%). The clinical improvement without associated changes in venous hemodynamics as measured by APG suggests that Daflon mainly works by modifying the microcirculatory environment not detected by APG and this microcirculatory change is associated with clinical improvement. In this regard, Daflon would be especially useful for symptomatic relief in patients with functional venous insufficiency who do not have clinical evidence of varicose veins but suffer from symptoms of venous insufficiency. PMID:16222383
Ting, A C; Cheng, S W; Wu, L L; Cheung, G C
Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy. PMID:25317347
Dag, Zeynep Ozcan; Isik, Yuksel; Simsek, Yavuz; Tulmac, Ozlem Banu; Demiray, Demet
Hepatic laceration as a life-threatening complication of umbilical venous catheterization.
Umbilical venous catheterization is an intravenous infusion route for maintenance fluids, medications, blood products, and parenteral nutrition in preterm neonates. However, this procedure may be associated with several complications, such as infection, thrombosis, vessel perforation, and cardiac and hepatic injuries. Hepatic laceration is a rare but life-threatening complication of umbilical venous catheterization that is a result of direct injury through the liver parenchyma. Here, we present a preterm newborn with hepatic laceration as a rare and serious complication of umbilical venous catheterization. PMID:21980821
Gülcan, Hande; Hanta, Deniz; Törer, Birgin; Temiz, Adbülkerim; Demir, Senay
Purpose: The suitability of a rheolytic system for recanalization of aged venous thrombotic occlusions was tested in an animal experiment. Methods: The system consists of a flush-suction catheter and a high-pressure liquid pump. Thrombosis was experimentally induced in 13 venous segments of 10 adult goats. Results: After a mean period of 12 days, a complete thrombectomy using the flush-suction system was achieved in 12 cases. No complications such as perforation or dissection were observed. Conclusion: This system seems to be an appropriate device for percutaneous transluminal venous thrombectomy, even in older occlusions.
Vicol, Calin; Dalichau, Harald [Clinic for Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, D-37075 Goettingen (Germany)
[Clinical case of the month. Portal venous gas due to a hydrogen peroxide colic enema].
Portal venous gas is a worrying radiological sign that was described for the first time in 1955 among newborn children suffering from necrotizing enterocolitis. It was often related to mesenteric ischemia which mortality remains very high. Now, as radiological explorations increase, portal venous gas is more and more described in less pejorative contexts, such as hydrogen peroxide intoxication. It is what happened to our patient who underwent a hydrogen peroxide colic enema followed by a major and transient portal venous gas onset. This solved quickly and spontaneously. PMID:21638834
El, Hachemi M; Couvreur, T; Meunier, P
HMG CoA reductase inhibitors and the risk of venous thrombosis among postmenopausal women
medications, including bile-acid sequestrants, fibrates and niacins. Current use was defined as the receipt the diagnosis of venous thrombosis was clinically made. Deep vein thrombosis (DVT) in the leg occurred in 348
Twente, Universiteit
Central nervous system involvement by tuberculosis to produce basal meningitis, hydrocephalus, arteritis and infarcts is well-known, the brunt of the pathology being borne by the arterial vasculature to produce neurological sequelae. However, tuberculous thrombophlebitis causing venous infarction is exceedingly rare. We present imaging and pathological features of two autopsy proven cases of tuberculous thrombophlebitis with venous infarcts involving superficial venous system in one and deep venous system in the other. This is the first study presenting radiopathologic correlation of this rare complication. Tuberculous thrombophlebitis should be suspected if basal exudates and multiple white matter T2 hyperintensities are seen on neuroimaging and the imaging protocol should include both magnetic resonance arteriogram and venogram. PMID:24753682
Mangalore, Sandhya; Desai, Sunali; Mahadevan, Anita; Kovoor, Jerry M. E.; Vasudev, Late M. K.; Tally, Arun Bhagwandas; Shankar, Susarla Krishna
Association between venous leg ulcers and sex chromosome anomalies in men.
We report here two cases of men, aged 46 and 23 years, with refractory chronic venous leg ulcers in association with sex chromosome aberrations: one with a 47,XXY/48,XXXY karyotype (Klinefelter syndrome) and the other with a 47,XYY karyotype (Jacob syndrome). In both patients, the occurrence of leg ulcers was the reason for seeking medical care; their medical history was other-wise unremarkable. Chromosomal analyses were performed due to the unusually young age for development of venous leg ulcers. The pathophysiology behind the occurrence of venous leg ulcers in patients with numerical aberrations of the sex chromosomes is incompletely understood. Involvement of elevated plasminogen activator inhibitor-1 levels in the pathogenesis of venous leg ulcers has been reported in patients with Klinefelter syndrome. Notably, our patient with 47,XXY/48,XXXY presented with androgen deficiency but normal plasminogen activator inhibitor-1 activity. PMID:21057745
Gattringer, Cornelia; Scheurecker, Christine; Höpfl, Reinhard; Müller, Hansgeorg
Early Venous Occlusion Detection in a Free Flap Using Real-time Laser Doppler Imaging
Summary: Early detection of venous occlusion in free flaps is particularly difficult to identify, and its duration is known to be directly proportional to flap mortality. Here, we report a case of deep inferior epigastric perforator based breast reconstruction in which the intraoperative use of a perfusion camera enabled identifying a venous occlusion based on microcirculatory pulsation dynamics in real time. The sensitivity of our proposed method suggests that in certain cases in which the onset of venous occlusion begins in the operating room we can detect and treat occlusion before sending the patient to recovery. Further development of this technique will allow for earlier and more objective decision making with regard to venous occlusion detection in free tissue transfer.
Alkhashnam, Heba; Sarfati, Benjamin; Kolb, Frederic
Anomalously draining right pulmonary veins are expected with scimitar syndrome, but systemic venous abnormalities are rare. We present an unusual case of a female patient with scimitar and an interrupted inferior vena cava. PMID:23987117
Elder, Robert W; Kogon, Brian E; Sahu, Anurag
Venous Oxygenation Mapping using Velocity-Selective Excitation and Arterial Nulling (VSEAN)
A new MRI technique to map the oxygenation of venous blood is presented. The method uses velocity-selective excitation and arterial nulling pulses, combined with phase sensitive signal detection to isolate the venous blood signal. The T2 of this signal along with a T2-Y calibration curve yields estimates of venous oxygenation in situ. Results from phantoms and healthy human subjects under normoxic and hypoxic conditions are shown, and venous saturation levels estimated from both sagittal sinus and grey matter based ROIs are compared to the related techniques TRUST and QUIXOTIC. In addition, combined with an additional scan without arterial nulling pulses, the oxygen saturation level on arterial side can also be estimated. PMID:22294414
Guo, Jia; Wong, Eric C.
Induced venous pooling and cardiorespiratory responses to exercise after bed rest
NASA Technical Reports Server (NTRS)
Venous pooling induced by a specially constructed garment is investigated as a possible means for reversing the reduction in maximal oxygen uptake regularly observed following bed rest. Experiments involved a 15-day period of bed rest during which four healthy male subjects, while remaining recumbent in bed, received daily 210-min venous pooling treatments from a reverse gradient garment supplying counterpressure to the torso. Results of exercise testing indicate that while maximal oxygen uptake endurance time and plasma volume were reduced and maximal heart rate increased after bed rest in the control group, those parameters remained essentially unchanged for the group undergoing venous pooling treatment. Results demonstrate the importance of fluid shifts and venous pooling within the cardiovascular system in addition to physical activity to the maintenance of cardiovascular conditioning.
Convertino, V. A.; Sandler, H.; Webb, P.; Annis, J. F.
Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)
Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James [SDI Radiology, Department of Radiology, Saint Joseph's Hospital, 3001 Dr. Martin Luther King Blvd., Tampa, FL 33607 (United States)
Central venous catheter infection with Bacillus pumilus in an immunocompetent child: a case report
Background Bacillus organisms are common laboratory contaminants. The majority of Bacillus bacteraemias are transient and not clinically significant. Clinically significant infection due to Bacillus species is rare and mostly due to Bacillus cereus infections in immuno-compromised hosts. Case presentation We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition (PN). There were three episodes of central venous catheter infection with Bacillus pumilus in three months. Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear resulting in the need for removal of the catheter for complete cure. Conclusion Bacillus species can cause clinically significant central venous catheter infection, even in an immunocompetent host. Despite adequate antibiotic treatment, the central venous catheter may need removal for complete cure. PMID:17967173
Bentur, HN; Dalzell, AM; Riordan, FAI
NASA Technical Reports Server (NTRS)
Measurements were made of sinus node responses to arterial baroreceptor stimulation with phenylephrine injection or neck suction, before and during changes of central venous pressure provoked by lower body negative pressure or leg and lower truck elevation. Variations of central venous pressure between 1.1 and 9.0 mm Hg did not influence arterial baroreflex mediated bradycardia. Baroreflex sinus node responses were augmented by intravenous propranolol, but the level of responses after propranolol was comparable during the control state, lower body negative pressure, and leg and trunk elevation. Sinus node responses to very brief baroreceptor stimuli applied during the transitions of central venous pressure also were comparable in the three states. The authors conclude that physiological variations of central venous pressure do not influence sinus node responses to arterial baroreceptor stimulation in man.
Mark, A. L.; Takeshita, A.; Eckberg, D. L.; Abboud, F. M.
Results of a pancreatectomy with a limited venous resection for pancreatic cancer
Purpose The indications for a pancreatectomy with a partial resection of the portal or superior mesenteric vein for pancreatic cancer,\\u000a when the vein is involved by the tumor, remain controversial. It can be assumed that when such involvement is not extensive,\\u000a resection of the tumor and the involved venous segment, followed by venous reconstruction will extend the potential benefits\\u000a of this
Giulio Illuminati; Fabio Carboni; Riccardo Lorusso; Antonio D'Urso; Gianluca Ceccanei; Vassilios Papaspyropoulos; Maria Antonietta Pacile; Eugenio Santoro
Matrix Metalloproteinases as Potential Targets in the Venous Dilation Associated with Varicose Veins
Varicose veins (VVs) are a common venous disease of the lower extremity characterized by incompetent valves, venous reflux, and dilated and tortuous veins. If untreated, VVs could lead to venous thrombosis, thrombophlebitis and chronic venous leg ulcers. Various genetic, hormonal and environmental factors may lead to structural changes in the vein valves and make them incompetent, leading to venous reflux, increased venous pressure and vein wall dilation. Prolonged increases in venous pressure and vein wall tension are thought to increase the expression/activity of matrix metalloproteinases (MMPs). Members of the MMPs family include collagenases, gelatinases, stromelysins, matrilysins, membrane-type MMPs and others. MMPs are known to degrade various components of the extracellular matrix (ECM). MMPs may also affect the endothelium and vascular smooth muscle, causing changes in the vein relaxation and contraction mechanisms. ECs injury also triggers leukocyte infiltration, activation and inflammation, which lead to further vein wall damage. The vein wall dilation and valve dysfunction, and the MMP activation and superimposed inflammation and fibrosis would lead to progressive venous dilation and VVs formation. Surgical ablation is an effective treatment for VVs, but may be associated with high recurrence rate, and other less invasive approaches that target the cause of the disease are needed. MMP inhibitors including endogenous tissue inhibitors (TIMPs) and pharmacological inhibitors such as zinc chelators, doxycycline, batimastat and marimastat, have been used as diagnostic and therapeutic tools in cancer, autoimmune and cardiovascular disease. However, MMP inhibitors may have side effects especially on the musculoskeletal system. With the advent of new genetic and pharmacological tools, specific MMP inhibitors with fewer undesirable effects could be useful to retard the progression and prevent the recurrence of VVs. PMID:23316963
Kucukguven, Arda; Khalil, Raouf A.
Lower extremity venous thrombosis in patients younger than 50 years of age
Aim Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients. Methods From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females) younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years). The control group included 217 patients (86 males and 131 females) older than 50 years (range: 50–96 years; mean 72.9 years). Results The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001), pregnancy (18.2% compared with 0.5%; P < 0.001), treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001), and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084). Conclusion Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia represent a frequent cause of venous thrombosis among young female patients. Inferior vena cava abnormalities should be excluded in young patients with spontaneous proximal venous thrombosis especially when recurrent venous thrombosis or resistance to anticoagulation are observed. PMID:22454560
Kreidy, Raghid; Salameh, Pascale; Waked, Mirna
Right Renal Vein Aplasia Associated With Diverted Renal Venous Drainage Through Lower Pole
We report a unique anomalous renal venous drainage on a 25-year-old man who had congenital absence of the right renal vein and an aberrant venous drainage through the lower pole of the kidney into the inferior vena cava. To our knowledge, this anomaly has not been previously reported in the peer-reviewed literature. State-of-the-art imaging findings are presented.
Bozlar, Ugur, E-mail: email@example.com [Gulhane Military Medical School, Assistant Professor, Department of Radiology (Turkey); Ugurel, Mehmet Sahin [Gulhane Military Medical School, Associate Professor, Department of Radiology (Turkey); Bedir, Selahattin [Gulhane Military Medical School, Assistant Professor, Department of Urology (Turkey); Ors, Fatih [Gulhane Military Medical School, Assistant Professor, Department of Radiology (Turkey); Coskun, Unsal [Gulhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Division of Radiology (Turkey); Aydur, Emin [Gulhane Military Medical School, Assistant Professor, Department of Urology (Turkey)
Treatment of vascular malformations of the urinary bladder can be challenging. We report a case of bladder venous malformation treated with sodium tetradecyl sulphate (STS 3%) sclerotherapy, using a combined cystoscopic and percutaneous transperitoneal laparoscopy guided approach. When cystoscopic views are poor, the laparoscopic approach is a useful adjunct to aid sclerotherapy of bladder venous malformation. This technique has not been previously described. PMID:22841403
Sinha, C K; Barnacle, A; Mushtaq, I; Cherian, A
Cost Effectiveness of Dalteparin for Preventing Venous Thromboembolism in Abdominal Surgery
Introduction: Patients undergoing abdominal surgeries face substantial risk of experiencing venous thromboembolic events in the perioperative period. The low-molecular-weight heparin dalteparin sodium is clinically effective in reducing the incidence of venous thromboembolism (VTE) in these patients. Dalteparin may be used in low (2500 units [U]) and high (5000U) once-daily doses for this indication. However, the cost effectiveness of dalteparin 5000U
Adrienne Heerey; Sanjeev Suri
X-Ray of One-Sided "White Lung" after Central Venous Catheterization
Complications during insertion of a subclavian central venous line are rare but potentially serious. This case report describes the radiological abnormality of a one-sided pleural effusion during a routine control directly after a difficult central venous catheterization. We illustrate the findings, the initial emergency management, and our procedure to rule out an iatrogenic hemothorax. Possible differential diagnoses and strategies for management of a suspected complication are discussed. PMID:24563796
Ummenhofer, Wolfgang
SummaryA multinational hospital-based case-control study of the risk of venous thromboembolic disease associated with combined oral contraceptives (OCs) done in 1989-93 prompted a separate inquiry comparing the risk of venous thromboembolism (VTE) associated with low oestrogen (137 cases and 203 controls were current users of levonorgestrel (odds ratio [OR with 95% confidence interval] 3·5 [2·6-4·7]), with non-users as the reference;
Ethanol sclerotherapy of rectal venous abnormalities in Klippel–Trenaunay syndrome
Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder characterized by the triad of capillary malformations, atypical venous malformations and varicosities and bony and/or soft tissue hypertrophy. We present the case of an 18-year-old man with KTS affected by haematochezia secondary to rectal venous malformations that was managed with endoscopic sclerotherapy. In this case, we compared the use of ethanol to phenol as a sclerosant. PMID:25141856
Agostinho, Nelson; Ge, Ludi; Solomon, Michael J.
Prediction of Liver Function by Using Magnetic Resonance-based Portal Venous Perfusion Imaging
Purpose: To evaluate whether liver function can be assessed globally and spatially by using volumetric dynamic contrast-enhanced magnetic resonance imaging MRI (DCE-MRI) to potentially aid in adaptive treatment planning. Methods and Materials: Seventeen patients with intrahepatic cancer undergoing focal radiation therapy (RT) were enrolled in institution review board-approved prospective studies to obtain DCE-MRI (to measure regional perfusion) and indocyanine green (ICG) clearance rates (to measure overall liver function) prior to, during, and at 1 and 2 months after treatment. The volumetric distribution of portal venous perfusion in the whole liver was estimated for each scan. We assessed the correlation between mean portal venous perfusion in the nontumor volume of the liver and overall liver function measured by ICG before, during, and after RT. The dose response for regional portal venous perfusion to RT was determined using a linear mixed effects model. Results: There was a significant correlation between the ICG clearance rate and mean portal venous perfusion in the functioning liver parenchyma, suggesting that portal venous perfusion could be used as a surrogate for function. Reduction in regional venous perfusion 1 month after RT was predicted by the locally accumulated biologically corrected dose at the end of RT (P<.0007). Regional portal venous perfusion measured during RT was a significant predictor for regional venous perfusion assessed 1 month after RT (P<.00001). Global hypovenous perfusion pre-RT was observed in 4 patients (3 patients with hepatocellular carcinoma and cirrhosis), 3 of whom had recovered from hypoperfusion, except in the highest dose regions, post-RT. In addition, 3 patients who had normal perfusion pre-RT had marked hypervenous perfusion or reperfusion in low-dose regions post-RT. Conclusions: This study suggests that MR-based volumetric hepatic perfusion imaging may be a biomarker for spatial distribution of liver function, which could aid in individualizing therapy, particularly for patients at risk for liver injury after RT.
Cao Yue, E-mail: firstname.lastname@example.com [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Wang Hesheng [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Johnson, Timothy D. [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States)] [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Pan, Charlie [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Hussain, Hero [Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States)] [Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Balter, James M.; Normolle, Daniel; Ben-Josef, Edgar; Ten Haken, Randall K.; Lawrence, Theodore S.; Feng, Mary [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)] [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)
Persistent valve of systemic venous sinus: a cause of neonatal cyanosis.
Incomplete involution of valve of systemic venous sinus can present across a spectrum of anatomical lesions ranging from eustachian valve to division of right atrium (cor triatriatum dexter) with overlapping features. We present the case of a neonate presenting with cyanosis, having persistent valve of systemic venous sinus with anatomical details of the redundant tissue in right atrium suggesting an intermediate form between Chiari network and division of right atrium. PMID:24016801
Qureshi, Ahmad U; Latiff, Haifa A; Sivalingam, Sivakumar
Palmar arch reconstruction using dorsal venous arch of foot for revascularisation of multiple digits
A case of trauma causing total loss of superficial and deep palmar arches of hand with ischemia of all the digits was managed using dorsal venous arch of the foot to reconstruct the palmar arch. The ends of the venous arch were anastomosed to radial and ulnar arteries and the tributaries to the arch were coapted to the cut ends of the common digital vessels and princeps pollicis. The surgery yielded gratifying results, successfully revascularising all the digits. PMID:24987216
Krishnakumar, K. S.; Petkar, Kiran; Lateef, Sameer; Rasalkar, Jyoti; Arun, T. J.; Suresh, V.
Anomalous venous drainage in a case of non-syndromic craniosynostosis
The authors describe the clinical and radiological findings in a case of non-syndromic craniosynostosis affecting multiple\\u000a sutures, in which the intracranial venous drainage was grossly anomalous. Investigation by magnetic resonance imaging and\\u000a angiography revealed that almost all of the intracranial venous blood was draining from the dural sinuses transosseoussly\\u000a via enlarged emissary veins to the external jugular veins and the
P. J. Anderson; William J. Harkness; Wendy Taylor; Barry M. Jones; Richard D. Hayward
Little data are available in late-presenting children with unobstructed totally anomalous pulmonary venous connection. Eleven patients underwent repair at a median age of 6.5 months using a modified transseptal approach to improve access and avoid circulatory arrest. There were no early or late deaths, and none of the patients presented pulmonary venous stenosis at a median follow-up of 8.7 years. PMID:24403372
Kalangos, Afksendiyos; Cherian, Sanjay; Tissot, Cécile; Myers, Patrick O
New peripheral venous cannulae have recently been proposed for minimally invasive open cardiac surgery. We present a femoral venous cannula designed to simultaneously drain both superior and inferior vena cavae. Used in adult patients for atrial septal defect repair, the cannula allowed passive blood drainage of 70.6% +/- 11.7% of theoretical cardiac output. Drainage was augmented to 93.4% +/- 8.6% of theoretical cardiac output by means of a centrifugal pump. PMID:11722098
Tevaearai, H T; Mueller, X M; Jegger, D; Ruchat, P; von Segesser, L K
Background Despite improving outcomes, venous problems in the harvest of deep inferior epigastric artery perforator (DIEP) flaps remain the more common vascular complications. However, it is apparent that the venous anatomy of the anterior abdominal wall has not been described to the same extent as the arterial anatomy. Cadaveric dissection studies of venous anatomy frequently lack the detail of their arterial counterparts. Venous valves complicate retrograde injection, resulting in poor quality studies with limited anatomical information. Methods The current manuscript comprises a review of the literature, highlighting key features of the anatomy of the venous drainage of the abdominal wall integument, with particular pertinence to DIEP flaps. Both cadaveric and clinical studies are included in this review. Our own cadaveric and in-vivo studies were undertaken and included in detail in this manuscript, with the cadaveric component utilizing direct catheter venography and the in-vivo studies were undertaken using preoperative computed tomographic angiography (CTA), mapping in-vivo venous flow. Results Several key features of the venous anatomy of the abdominal wall render it different to other regions, and are of particular importance to DIEP flap transfer. Conclusions The cause of venous compromise is multi-factorial, with perforator diameter, midline crossover, and deep-superficial venous communications all important. Venous cadaveric studies as well as clinical CTA preoperatively can identify these anomalies. PMID:25083432
Ashton, Mark W
Diet as prophylaxis and treatment for venous thromboembolism?
Background Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT) and pulmonary emboli (PE)) with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs) showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE) without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%). However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%). Additionally, an FPE rate of about 0.012% (35/28,400) in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored. Methods and Findings The literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment. Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with the rationale of using anticoagulants as VTE prophylaxis. For both prophylaxis and treatment of VTE, we propose RCTs comparing standard anticoagulation with low VTE risk diets, and we discuss the statistical considerations for an example of such a trial. Conclusions Because of (a) the risks of biochemical anticoagulation as anti-VTE prophylaxis or treatment, (b) the lack of placebo-controlled efficacy data supporting anticoagulant treatment of VTE, (c) dramatically reduced hospital-acquired FPE incidence in surgical patients without anticoagulant prophylaxis from 1980 - 2010 relative to the 1960s and 1970s, and (d) evidence that VTE incidence and outcomes may be influenced by diet, randomized controlled non-inferiority clinical trials are proposed to compare standard anticoagulant treatment with potentially low VTE risk diets. We call upon the U. S. National Institutes of Health and the U.K. National Institute for Health and Clinical Excellence to design and fund those trials. PMID:20701748
Prevention and treatment of venous thromboembolism in patients with cancer
Background: Many patients who experience a venous thromboembolic event have cancer, and thrombosis is much more prevalent in patients with cancer than in those without it. Thrombosis is the second most common cause of death in cancer patients and cancer is associated with a high rate of recurrence of venous thromboembolism (VTE), bleeding, requirement for long-term anticoagulation and poorer quality of life. Methods: A literature review was conducted to identify guidelines and evidence pertaining to anticoagulation prophylaxis and treatment for patients with cancer, with the goal of identifying opportunities for pharmacists to advocate for and become more involved in the care of this population. Results: Many clinical trials and several guidelines providing guidance to clinicians in the treatment and prevention of VTE in patients with cancer were identified. Current clinical evidence and guidelines suggest that cancer patients receiving care in hospital with no contraindications should receive VTE prophylaxis with unfractionated heparin (UFH), a low-molecular-weight heparin (LMWH) or fondaparinux. Patients who require surgery for their cancer should receive prophylaxis with UFH, LMWH or fondaparinux. Cancer patients who have experienced a VTE event should receive prolonged anticoagulant therapy with LMWH (at least 3 months to 6 months). No routine prophylaxis is required for the majority of ambulatory patients with cancer who have not experienced a VTE event. Most publicly funded drug plans in Canada have developed criteria for funding of LMWH therapy for patients with cancer. Conclusions: Evidence suggests that LMWH for 3 to 6 months is the preferred strategy for most cancer patients who have experienced a thromboembolic event and for hospital inpatients, but this is often not implemented in practice. Concerns about adherence with injectable therapy should not prevent use of these agents. Pharmacists should assess cancer patients for their risk of VTE and should advocate for optimal VTE pharmacotherapy as appropriate. If LMWH is the preferred agent, on the basis of the evidence, the pharmacist should educate the patients appropriately and work with the prescriber to ensure best care. PMID:23509484
Semchuk, William M.; Sperlich, Catherine
Pathogenesis of venous ulceration in relation to the calf muscle pump function.
Air plethysmography has been used to quantitate venous reflux by measuring the average filling rate of the veins (venous filling index; in milliliters per second) on standing from the supine position, the ejection fraction of the calf muscle pump as a result of one tip-toe movement, and the residual volume fraction after 10 tip-toe movements. Thirty normal limbs, 110 limbs with primary varicose veins, 34 limbs with reflux in the deep veins but without occlusion, and 31 limbs with deep venous occlusion, with or without reflux, have been studied. An increase in the incidence of ulceration occurred with increasing values of reflux and decreasing values of the calf muscle pump ejection fraction. A poor ejection fraction was the primary cause of venous ulceration in limbs with minimal reflux. A good ejection fraction, however, significantly reduced the incidence of ulceration in limbs with marked reflux (p less than 0.05). The residual volume fraction, which expresses the combined effect of venous reflux and ejection fraction with rhythmic exercise, showed a good correlation with the incidence of ulceration and the measurements of ambulatory venous pressure (r = 0.81). The air-plethysmographic measurements completely assess the calf muscle pump function and provide an accurate method to identify the predominant hemodynamic factor (ejection fraction, reflux, or both) responsible for the clinical picture of the patient. PMID:2814817
Christopoulos, D; Nicolaides, A N; Cook, A; Irvine, A; Galloway, J M; Wilkinson, A
The Angiotensin Infusion Test and Peripheral Venous Renin Activity
Forty hypertensive patients were studied to examine the assumption that the angiotensin pressor dose reflects endogenous renin activity. Peripheral renin activity was assayed by the method of Boucher et al.4 Sensitivity to the infusion of synthetic angiotensin II was determined as suggested by Kaplan and Silah.1 Sixteen patients with essential hypertension with normal renal angiography required 3.8 ng. angiotensin/kg./min. to raise the diastolic pressure 20 mm. Hg. All but one were sensitive to angiotensin infusion of less than 5 ng./kg./min. Renin activity was normal in all except in one sensitive subject. Angiotensin infusion response and mean renin activity in 13 patients with essential hypertension with abnormal renal angiography were similar to that of the first group. The pressor dose in 11 renovascular hypertensives was 9.8 ng./kg./min. All but three had elevated plasma renin activity. Our results suggest that: (1) the angiotensin infusion test is suitable for differentiating patients with true renovascular hypertension from those with essential hypertension with or without associated renal artery disease; (2) the angiotensin pressor dose correlates with the level of peripheral venous renin activity (p < 0.01). PMID:4290836
Silah, J. G.; Strong, C. G.; Nowaczynski, W.; Genest, J.
The angiotensin infusion test and peripheral venous renin activity.
Forty hypertensive patients were studied to examine the assumption that the angiotensin pressor dose reflects endogenous renin activity. Peripheral renin activity was assayed by the method of Boucher et al.(4) Sensitivity to the infusion of synthetic angiotensin II was determined as suggested by Kaplan and Silah.(1)Sixteen patients with essential hypertension with normal renal angiography required 3.8 ng. angiotensin/kg./min. to raise the diastolic pressure 20 mm. Hg. All but one were sensitive to angiotensin infusion of less than 5 ng./kg./min. Renin activity was normal in all except in one sensitive subject. Angiotensin infusion response and mean renin activity in 13 patients with essential hypertension with abnormal renal angiography were similar to that of the first group. The pressor dose in 11 renovascular hypertensives was 9.8 ng./kg./min. All but three had elevated plasma renin activity.OUR RESULTS SUGGEST THAT: (1) the angiotensin infusion test is suitable for differentiating patients with true renovascular hypertension from those with essential hypertension with or without associated renal artery disease; (2) the angiotensin pressor dose correlates with the level of peripheral venous renin activity (p < 0.01). PMID:4290836
Silah, J G; Strong, C G; Nowaczynski, W; Genest, J
Aspirin increases the risk of venous thromboembolism in surgical patients.
The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE. PMID:25264630
Barmparas, Galinos; Jain, Monica; Mehrzadi, Devorah; Melo, Nicolas; Chung, Rex; Bloom, Matthew; Ley, Eric J; Margulies, Daniel R
Is there resetting of central venous pressure in microgravity?
NASA Technical Reports Server (NTRS)
In the early phase of the Space Shuttle program, NASA flight surgeons implemented a fluid-loading countermeasure in which astronauts were instructed to ingest eight 1-g salt tablets with 960 ml of water approximately 2 hours prior to reentry from space. This fluid loading regimen was intended to enhance orthostatic tolerance by replacing circulating plasma volume reduced during the space mission. Unfortunately, fluid loading failed to replace plasma volume in groundbased experiments and has proven minimally effective as a countermeasure against post-spaceflight orthostatic intolerance. In addition to the reduction of plasma volume, central venous pressure (CVP) is reduced during exposure to actual and groundbased analogs of microgravity. In the present study, we hypothesized that the reduction in CVP due to exposure to microgravity represents a resetting of the CVP operating point to a lower threshold. A lower CVP 'setpoint' might explain the failure of fluid loading to restore plasma volume. In order to test this hypothesis, we conducted an investigation in which we administered an acute volume load (stimulus) and measured responses in CVP, plasma volume and renal functions. If our hypothesis is true, we would expect the elevation in CVP induced by saline infusion to return to its pre-infusion levels in both HDT and upright control conditions despite lower vascular volume during HDT. In contrast to previous experiments, our approach is novel in that it provides information on alterations in CVP and vascular volume during HDT that are necessary for interpretation of the proposed CVP operating point resetting hypothesis.
Convertino, V. A.; Ludwig, D. A.; Elliott, J. J.; Wade, C. E.
Does Venous Thromboembolism Affect Rehabilitation after Hip Fracture Surgery?
Purpose Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a serious and life-threatening complication in elderly (older than 65 years) patients undergoing hip fracture surgery (HFS). However, few have reported on the influences of VTE on postoperative rehabilitation in these patients. This study was performed to determine whether VTE affects clinical outcomes in patients who underwent HFS. Materials and Methods We retrospectively evaluated 330 HFSs in 325 consecutive patients, which were performed from January 2009 to June 2010. From chart review, we identified 15 patients with symptomatic VTE. We compared Geriatric depression scale, Modified Barthel index and Berg balance scale scores as well as 10 meter gait speed at discharge and hospital stay between a symptomatic VTE group and a non-VTE group. Results No significant difference in clinical outcomes at discharge between the two groups was found, although hospital stay was longer in patients with symptomatic VTE (p=0.012). Conclusion East Asian patients have a low incidence of symptomatic VTE after HFS, and the clinical outcomes of patients with symptomatic VTE were similar to patients without VTE, although there was a longer rehabilitation period. PMID:23709439
Lee, Young-Kyun; Choi, Yoon-Hee; Ha, Yong-Chan; Koo, Kyung-Hoi
Unprotected anal Intercourse among Iranian Intra-Venous Drug Users
Purpose: To assess the prevalence and associated factors of unprotected anal intercourse among Iranian male heterosexual Intra-Venous Drug Users (IDUs). Methods: In a cross-sectional study 360 male heterosexual IDUs were sampled from streets of eight different geographical parts of Iran. Variables such as socio-demographics, HIV knowledge (10 items), and HIV attitude (16 items) were entered to a logistic regression to determine the predictors of unprotected anal intercourse during the past month. Results: From all, 20.8% reported unprotected anal intercourse during the past month. HIV knowledge was not significantly different among IDUs with and without unprotected anal intercourse. High age [odds ratio (OR)?=?0.954, 95% confidence intervals (CI)?=?0.916–0.992] was associated with a lower likelihood of unprotected anal intercourse, while being not married (OR?=?2.301, 95% CI?=?1.151–4.601), and high perceived HIV risk (OR?=?1.776, 95% CI?=?1.376–2.290) were associated with a higher likelihood of unprotected anal intercourse. Conclusion: Although the results might not be generalizable to all Iranian IDUs, this study findings may still be helpful for design and implementation of public health programs in Iran to prevent sexual transmission of HIV through IDUs. PMID:24350203
Mirabi, Parvaneh; Yarmohmmadi Vasel, Mosaieb; Moazen, Babak; Sehat, Mahmoud; Rezazadeh, Majid; Ahmadi, Khodabakhsh
Cerebral venous thrombosis: a Moroccan retrospective study of 30 cases
Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better than arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnosis. We studied 30 cases of CVT diagnosed in the department of neurology at the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%), consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behçet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes were observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.
Souirti, Zouhayr; Messouak, Ouafae; Belahsen, Faouzi
Three cases of stroke following peripheral venous interventions.
We report three cases of stroke in association with peripheral venous interventions that each included foam ultrasound-guided sclerotherapy (UGS). All three female patients experienced a right middle cerebral artery (MCA) stroke causing dysphasia and left hemiparesis. A patent foramen ovale was found in each patient. The first incident occurred two days after foam UGS to treat small tributaries of a great saphenous vein (GSV). Paradoxical clot embolism was presumed in this case where concurrent deep vein thrombosis with non-occlusive thrombus in a medial gastrocnemius vein extending to the popliteal vein was detected on ultrasound. The second case occurred immediately at the completion of foam UGS and ambulatory phlebectomy to treat GSV tributaries. Paradoxical gas embolism was demonstrated in this patient confirmed by visualization of bubbles in the right MCA on CT angiography. The third case occurred one day after endovenous laser ablation (1470 nm) and foam UGS to treat both great and small saphenous veins. No specific cause could be confirmed in this patient. Sodium tetradecyl sulphate foam was used in all three cases (3%, 16 mL; 1.5%, 4 mL and 3%, 25 mL, respectively). All three patients recovered completely within a few days. PMID:21422195
Ma, R W L; Pilotelle, A; Paraskevas, P; Parsi, K
Current and future management of pediatric venous thromboembolism
Venous thromboembolism (VTE) is an increasingly common complication encountered in tertiary care pediatric settings. The purpose of this review is to summarize the epidemiology, current and emerging pharmacotherapeutic options, and management of this disease. Over 70% of VTE occur in children with chronic diseases. Although they are seen in children of all ages, adolescents are at greatest risk. Pediatric VTE is associated with an increased risk of in-hospital mortality; recurrent VTE and post-thrombotic syndrome are commonly seen in survivors. In recent years, anticoagulation with low molecular weight heparin has emerged as the mainstay of therapy, but compliance is limited by its onerous subcutaneous administration route. New anticoagulants either already approved for use in adults or in the pipeline offer the possibility of improved dose stability and oral routes of administration. Current recommended anticoagulation course durations are derived from very limited case series and cohort data, or extrapolations from adult literature. However, the pathophysiologic underpinnings of pediatric VTE are dissimilar from those seen in adults and are often variable within groups of pediatric patients. Clinical studies and trials in pediatric VTE are underway which will hopefully improve the quality of evidence from which therapeutic guidelines are derived. PMID:22367975
Kerlin, Bryce A.
Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?*,**
OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ? 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (? 65 years of age). PMID:23857692
Akpinar, Evrim Eylem; Hosgun, Derya; Akan, Burak; Ates, Can; Gulhan, Meral
Venous pulse transit time in normal pregnancy and preeclampsia.
Uncomplicated pregnancies (n = 16) were evaluated longitudinally and compared to early- (n = 12) and late-onset (n = 14) preeclampsia patients, assessed once at diagnosis. Pulse transit time (PTT), equivalent to pulse wave velocity, was measured as the time interval between corresponding characteristics of electrocardiography and Doppler waves, corrected for heart rate, at the level of renal interlobar veins, hepatic veins, and arcuate branches of uterine arteries. Impedance cardiography was used to measure PTT at the level of the thoracic aorta. In normal pregnancy, all PTT increased gradually (P ? .01). Pulse transit time was shorter in late-onset preeclampsia (P < .05) and also in early-onset preeclampsia, with exception for hepatic veins and thoracic aorta (P > .05). Our results indicate that PTT is an easy and highly accessible measure for vascular reactivity at both arterial and venous sites of the circulation. Our observations correlate well with known gestational cardiovascular adaptation mechanisms. This suggests that PTT could be used as a new parameter in the evaluation and prediction of preeclampsia. PMID:22378859
Tomsin, Kathleen; Mesens, Tinne; Molenberghs, Geert; Gyselaers, Wilfried
Nonlinear modeling of venous leg ulcer healing rates
Background The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. Methods We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. Results A majority (72%) of VLUs exhibited surface area reduction via an exponential decay model, particularly during the early stages of healing. These results were consistent with the mechanics of wound contraction and epithelial cell proliferation, supported by the higher frequency at which exponential surface area reduction associated with full wound closure (35% of wounds that fit the exponential model healed vs. 21% of wounds that did not fit the exponential model completely healed during the study period, p = 0.018). Goodness-of-fit statistics suggested that much of the individual variation in healing could be described as nonlinear variation from the exponential model. Conclusion We believe that parameter estimates from a mathematical model may provide a more accurate quantification of wound healing rates, and that similar models may someday reach routine use in comparing the efficacy of various treatments in routine practice and in product registration trials. PMID:19335882
Cardinal, Matthew; Phillips, Tania; Eisenbud, David E; Harding, Keith; Mansbridge, Jonathan; Armstrong, David G
Assessing Risk of Venous Thromboembolism in the Patient With Cancer
Purpose Patients with cancer are increasingly at risk for venous thromboembolism (VTE). Rates of VTE, however, vary markedly among patients with cancer. Design This review focuses on recent data derived from population-based, hospital-based, and outpatient cohort studies of patients with cancer that have identified multiple clinical risk factors as well as candidate laboratory biomarkers predictive of VTE. Results Clinical risk factors for cancer-associated VTE include primary tumor site, stage, initial period after diagnosis, presence and number of comorbidities, and treatment modalities including systemic chemotherapy, antiangiogenic therapy, and hospitalization. Candidate predictive biomarkers include elevated platelet or leukocyte counts, tissue factor, soluble P-selectin, and D-dimer. A recently validated risk model, incorporating some of these factors, can help differentiate patients at high or low risk for developing VTE while receiving chemotherapy. Conclusion Identifying patients with cancer who are most at risk for VTE is essential to better target thromboprophylaxis, with the eventual goal of reducing the burden as well as the consequences of VTE for patients with cancer. PMID:19720906
Khorana, Alok A.; Connolly, Gregory C.
Tinzaparin prophylaxis against venous thromboembolic complications in brain tumor patients
The purpose of this study was to determine the safety of tinzaparin for deep vein thrombosis prophylaxis in newly diagnosed grade III–IV malignant glioma patients. Patients were initiated on daily tinzaparin at a fixed dose of 4,500 IU subcutaneously bet