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1

Manual Aspiration Thrombectomy with Stent Placement: Rapid and Effective Treatment for Phlegmasia Cerulea Dolens with Impending Venous Gangrene  

SciTech Connect

Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene.

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Tercan, Fahri; Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology (Turkey)

2008-01-15

2

Safety of salvaging impending flap congestion in breast reconstruction by venous supercharging of the cephalic vein.  

PubMed

Autologous flap breast reconstruction is an established technique that carries a risk of vascular failure. We evaluated the safety of salvaging impending venous congestion by using the cephalic vein for supercharging autologous abdominal flaps. Our main outcome measures were flap survival, triggering or impairing lymphedema as measured by the physician or reported by the patient, and scar severity as measured by the Vancouver scar scale. We were able to save 100% of the flaps, but could not find any statistical association with or without increased lymphedema before and after the procedure. One patient reported that lymphedema worsened. The patients accepted the scars (mean Vancouver scar scale score, 5.7). In sum, using the cephalic vein to improve venous drainage of autologous breast reconstruction was safe and did not trigger or impair lymphedema, but scarring in the upper arm was unavoidable. PMID:23759974

Landin, Luis; Bolado, Pedro; Casado-Sanchez, Cesar; Bonastre, Jorge; Garcia-Redondo, Marta; Zharbakhsh, Shirin; Diez, Jesus; Leyva, Francisco; Casado-Perez, Cesar

2015-01-01

3

Gas Gangrene  

MedlinePLUS

... Issues > Conditions > Skin > Gas Gangrene Health Issues Listen Gas Gangrene Article Body Gangrene describes the death of ... this is the case, the disease is called gas gangrene or clostridial myonecrosis (myo refers to muscle, ...

4

Gas gangrene  

MedlinePLUS

Tissue infection - Clostridial; Gangrene - gas; Myonecrosis; Clostridial infection of tissues ... Gas gangrene is most often caused by a bacterium called Clostridium perfringens. It also can be caused ...

5

[Fournier's gangrene].  

PubMed

Fournier's gangrene, although bearing the eponymous name of J.A. Fournier, was first reported by Baurienne in 1764 and 1883. His description was characterized by an abrupt onset of a rapidly progressive gangrene of the scrotum in otherwise healthy young males with an absence of a specific causative agent. Today, the frontiers of Fournier's gangrene have expanded to include all cases of necrotizing fasciitis of the perineum and external genitalia males and females from all age groups. All the patients were treated with antibiotics, surgical debridement and frequent wound dressings with hypertonis saline, hydrogen peroxide, colostomy and epicystostomy. PMID:11727714

Masek, M; Zak, J

2001-01-01

6

[Fournier gangrene].  

PubMed

Since first described in 1883 by Fournier only 420 cases of Fournier's gangrene have been published worldwide during the last 100 years. The anatomic association between the fascies of penis, scrotum, perineum, groin and gluteal favors the fast spread of tissue necrosis. We report two cases in which the penis, scrotum and a great part of the trunk and extremities were affected. Extensive débridement, including removal of the scrotum, and antibiotic treatment permitted us to get rid of the symptoms. Reconstruction of the skin defects was done in a second step by applying mesh grafts. The histological findings correspond to those found in cases of necrotizing fasciitis. The basic difference between these two illnesses is their localization. While Fournier's gangrene, as a special form, is localized primarily in the anogenital area, fasciitis may arise in all locations. For successful treatment of Fournier's gangrene speedy radical débridement and local application of antibiotics to cover the entire area are required. PMID:7934580

Prokop, A; Gawenda, M; Witt, J; Schmitz-Rixen, T

1994-01-01

7

[Fournier gangrene].  

PubMed

Fournier's gangrene is a relatively rare, mixed aerobic and anaerobic soft tissue infection in the perineoscrotal area. Although it is convenient to give it a separate name, it is really either necrotizing fasciitis or nonclostridial myonecrosis of the scrotal and perineal areas. The condition frequently develops from perineal diseases, including perianal abscess, and fistulas, inflamed haemorrhoids and indwelling urethral catheter. In patients with Fournier's gangrene morbidity is extreme and mortality high. This article is based on a retrospective study of 15 cases of Fournier's gangrene, 13 in male and 2 in female patients. A combination of surgery and antibiotics was used to treat 9 patients. The last 6 cases were treated with a combination of surgery, antibiotics and hyperbaric oxygen. In 13 cases, the diagnosis was made on the basis of the fulminating progression of the infection to a scrotal gangrene, identification of multiple underlying pathogenic organisms and toxaemia. In the 2 female patients, a similar infection developed in the labia majora and perineum and extended to the buttocks and the anterior abdominal wall. PMID:7791483

Ersan, Y; Ozgültekin, R; Cetinkale, O; Celik, V; Ayan, F; Cerçel, A

1995-01-01

8

Gas gangrene (image)  

MedlinePLUS

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.

9

Gas gangrene (image)  

MedlinePLUS

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.

10

Lower limb gangrene postcardiac surgery  

PubMed Central

A 67-year-old gentleman presented with a 1-day history of left foot pain. He had recently been discharged following a coronary artery bypass graft; during the admission, he had received an intravenous heparin infusion. Examination revealed black–purple discolouration of the first and second digits of the left foot with pitting oedema to the level of the knee. The posterior tibial and dorsalis pedis pulses were both shown to be patent. A new thrombocytopenia was noted. Ultrasound imaging revealed multiple deep vein thrombosis. The history of recent heparin exposure coupled with venous gangrene secondary to deep vein thrombosis was consistent with heparin-induced thrombocytopenia. He was treated acutely with intravenous danaparoid and later with warfarin. There was complete resolution of the venous gangrene at 1?month follow-up. PMID:23417943

Rozati, Hamoun; Shah, Sonya Pratik; Peng, Ying Ying

2013-01-01

11

[Fournier's gangrene].  

PubMed

Today Fournier's gangrene ranks among necrotizing fasciitis. Most of the cases reveal the origin of the disease (proctogenic, urologic, gynecologic). Untreated, the polybacterial synergistic infection will overwhelmingly spread along anatomically defined fascias of the pelvic floor. Thus the lethality rate is high, especially in patients with risk factors i.e. diabetes, alcoholism, arterial occlusive disease, chronic consumptive disorders and obesity. Only by instant and radical surgical excision of the total gangrenous tissue the spreading of the disease and the developing of sepsis can be stopped together with calculated antibiotic therapy and intensive care. Mutilating operations (i.e. penectomy, orchiectomy) are seldom necessary; thus plastic reconstructions will show good results both in function and cosmetic. Based on the experience with 6 patients, a pathogenic concept, concerning both diagnosis and therapy, is presented: after radical emergency surgery in the first risky stage, an elective approach can safely be performed in a second stage for the repair of functional lesions. PMID:8436051

Ecker, K W; Derouet, H; Omlor, G; Mast, G J

1993-01-01

12

Fournier's gangrene. Case report.  

PubMed

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

2014-09-01

13

Neonatal Fournier's gangrene.  

PubMed

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any ages but it is rare in neonates and infants. Here, we report a case of Fournier's gangrene in a 21 day old male neonate 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 gives good results and probably in our setting, to some extent, it is a preventable condition. PMID:20597572

Dey, Subhajeet; Bhutia, Kincho L; Baruah, Anil K; Kharga, Bikram; Mohanta, Pradip K; Singh, Varun K

2010-07-01

14

Fournier's gangrene current approaches.  

PubMed

Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18?days, while it was 20?days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients. PMID:25145578

Ozkan, Omer F; Koksal, Neset; Altinli, Ediz; Celik, Atilla; Uzun, Mehmet A; C?kman, Oztekin; Akbas, Alpaslan; Ergun, Ersin; Kiraz, Hasan A; Karaayvaz, Muammer

2014-08-22

15

Fournier's Gangrene: Current Practices  

PubMed Central

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.

2012-01-01

16

Actinobaculum schaalii Causing Fournier's Gangrene?  

PubMed Central

Actinobaculum schaalii, which belongs to the group of Gram-positive rods, is difficult to culture. Using molecular genetics, Actinobaculum schaalii could be identified as a causing microorganism in a case of Fournier's gangrene. PMID:21508151

Vanden Bempt, Isabelle; Van Trappen, Stefanie; Cleenwerck, Ilse; De Vos, Paul; Camps, Kim; Celens, Annemie; Van De Vyvere, Martine

2011-01-01

17

[Fournier's gangrene: a case report].  

PubMed

Since necrotizing fasciitis of the genitalia was first described by Fournier in 1883, approximately 400 cases have been reported. It has been seldom reported in Japan. Because its mortality rate is still high, the importance of early diagnosis and the subsequent vigorous treatment has been emphasized. A 73-year-old man who had poor controlled diabetes mellitus was admitted to our hospital with painful swelling of scrotum. Chemotherapy using broad spectrum antibiotics and debridement of scrotal skin was performed combined with insulin therapy. As culture of pus and excised tissue from the gangrenous patches yielded the growth of candida, we used 8 g/day of 5-fluorocytosine. Because the gangrene was not healed, we performed bilateral orchiectomy. After the operation, the gangrene was healed and the wound was closed. Diabetes mellitus was controlled well and his general condition was improved. PMID:3425526

Takaba, H; Okamura, K; Tanaka, J; Kato, K; Shimoji, T

1987-08-01

18

Fournier's gangrene: a urologic emergency.  

PubMed

Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and penis, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of three mechanisms: local trauma, extension from a perianal, periurethral or ischiorectal infection. Fournier's gangrene is a urologic emergency that requires prompt recognition and aggressive hemodynamic stabilization, treatment with parenteral broad-spectrum antibiotics and surgical debridement. This disease is associated with a high mortality rate; a high index of suspicion is essential for early recognition whenever a patient presents with scrotal discomfort and swelling. PMID:7484692

Anzai, A K

1995-11-01

19

A case of Fournier's gangrene after hydrocelectomy  

PubMed Central

An uncommon case of Fournier's gangrene following hydrocelectomy is described. A 78-year-old male with no remarkable previous history, who underwent hydrocelectomy in another hospital, developed Fournier's gangrene 15 days later. The patient required wide aggressive surgical debridement, hyperbaric oxygen chamber and broad-spectrum antibiotic coverage. Afterwards the patient was referred for plastic surgery. Fournier's gangrene is a polymicrobial infection of perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Fournier's gangrene following hydrocelectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management. PMID:24578938

Popper, Helmut; Pummer, Karl

2012-01-01

20

Rectal diversion without colostomy in Fournier's gangrene.  

PubMed

Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy. PMID:19484342

Estrada, O; Martinez, I; Del Bas, M; Salvans, S; Hidalgo, L A

2009-06-01

21

Gas Gangrene at Tertiary Care Centre  

Microsoft Academic Search

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

22

Data Mining to Characterize Signatures of Impending System Events  

E-print Network

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

23

[A case of Fournier's gangrene].  

PubMed

A 59-year-old man was admitted to our hospital complaining of perineal pain and scrotal redness. He was diagnosed with diabetes mellitus 12-years ago but had not received treatment. The scrotum soon showed necrosis and pus discharge. A culture study revealed Clostridium, Bacteroides and many other bacteria. Antibiotics chemotherapy (CMZ, AMK, MINO) was done but because necrotizing fasciitis progressed, we performed surgical treatment of necrosis. The skin defect was closed naturally with wound irrigation. The patient is doing well and his diabetes is under control. We found 13 other cases of Fournier's gangrene in the Japanese literature and their age, culture study and complications are discussed. PMID:3072876

Yonezu, M; Okishio, N

1988-10-01

24

Group C streptococcal sepsis complicating Fournier gangrene.  

PubMed

Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical debridement and broad-spectrum antibiotic therapy. We describe a case of Fournier gangrene in a young diabetic man that was associated with group C streptococcal bacteremia, an association previously unreported in the literature to our knowledge. PMID:16217985

Marinella, Mark A

2005-09-01

25

Pulmonary gangrene as a complication of mucormycosis  

SciTech Connect

Pulmonary gangrene, a rare complication of pneumonia occurs when vascular thrombosis leads to necrosis of a large portion of lung. The devitalized lung is then sloughed into a cavity, resulting in a characteristic radiographic appearance. The previously reported cases of pulmonary gangrene have been associated with either bacterial or tuberculous pneumonia; the authors describe a case resulting from mucormycosis. In addition to the plain-film findings, the computed tomographic (CT) appearance is described.

Zagoria, R.J.; Choplin, R.H.; Karstaedt, N.

1985-06-01

26

Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene.  

PubMed

We present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8-11?days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration. PMID:25315802

Tattersall, Timothy Lee; Thangasamy, Isaac A; Reynolds, Jamie

2014-01-01

27

Fournier's gangrene: still highly lethal.  

PubMed

Five patients with necrotizing soft tissue infections of the perineum and scrotum are presented. There were one female and four male patients, aged from 35 to 70 years. Portals of entry were perirectal abscesses in four cases and a scrotal abscess in one case. All patients required extensive surgical debridement and intravenous broad-spectrum antibiotics. Operative debridement involved the scrotum, the perineal and inguinal area, the upper thighs and the anterior abdominal wall. One patient required transverse loop colostomy and one loop sigmoidostomy. One patient was reoperated on after inadequate drainage of a perirectal abscess. Three patients were referred to our unit after some delay, while one patient did not seek medical care until after being febrile for 2 weeks. Despite aggressive debridement, this last patient died of fulminant sepsis. Fournier's gangrene, which is not so rare as in generally considered, is still associated with a high mortality, which can be reduced only by improving medical awareness and early treatment both of the primary cause and of necrotizing fasciitis. PMID:9049954

Papachristodoulou, A J; Zografos, G N; Papastratis, G; Papavassiliou, V; Markopoulos, C J; Mandrekas, D; Gogas, J G

1997-01-01

28

Symmetrical peripheral gangrene following snake bite.  

PubMed

SPG (Symmetrical peripheral gangrene) is defined as symmetrical distal ischemic damage at two or more sites in the absence of large vessels obstruction. It has been ascribed to a number of infectious and non infectious conditions including connective tissue, cardiovascular, neoplastic and iatrogenic causes. We report a unique case of SPG in a 35-year-old Indian female who developed spontaneous gangrene of the distal phalanges of the right and left index, middle, ring and little fingers and the distal phalanges of all toes of the right and left foot following a snake bite. There have been very few cases of peripheral gangrene and acute renal failure associated with snake bite in literature. PMID:25386476

Shastri, Minal; Parikh, Mital; Patel, Dwijal; Chudasma, Ketan; Patell, Rushad

2014-09-01

29

Symmetrical Peripheral Gangrene Following Snake Bite  

PubMed Central

SPG (Symmetrical peripheral gangrene) is defined as symmetrical distal ischemic damage at two or more sites in the absence of large vessels obstruction. It has been ascribed to a number of infectious and non infectious conditions including connective tissue, cardiovascular, neoplastic and iatrogenic causes. We report a unique case of SPG in a 35-year-old Indian female who developed spontaneous gangrene of the distal phalanges of the right and left index, middle, ring and little fingers and the distal phalanges of all toes of the right and left foot following a snake bite. There have been very few cases of peripheral gangrene and acute renal failure associated with snake bite in literature. PMID:25386476

Shastri, Minal; Parikh, Mital; Patel, Dwijal; Chudasma, Ketan

2014-01-01

30

The features and aetiology of Fournier's gangrene.  

PubMed

This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier's gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum. PMID:7937450

Efem, S E

1994-08-01

31

Fournier's Gangrene: Report of 2 Cases  

PubMed Central

Fournier's gangrene is a very serious surgical emergency seen all over the world. With the newer advancement of surgical techniques and critical care medicine, the mortality and morbidity of this disease has come down significantly over a period of time. An early diagnosis including evaluation of predisposing and etiological factors, metabolic and physiological parameters with prompt resuscitation, aggressive surgical debridement, broad-spectrum antibiotic coverage, and continuous monitoring of all the parameters is essential for a good outcome, therefore reducing the high mortality and morbidity of this condition. In this study, we report 2 different cases of Fournier gangrene. Our first case was a young, nondiabetic, and without any multiorgan failure, who was managed successfully with good outcome. The second case was a 67-year-old man with diabetes and multiorgan dysfunction with extensive gangrene at presentation, who recovered well, but with a stormy postoperative period. PMID:23326734

Hota, Prasan Kumar

2012-01-01

32

Fournier's gangrene: review of fifteen cases.  

PubMed

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women. The process was believed to be idiopathic in initial descriptions. Fifteen patients were treated for Fournier's gangrene between 1990 and 1995 in the Departments of General Surgery and Urology, School of Medicine, Atatürk University, Erzurum, Turkey. The most common causes were perianal sepsis and urogenital diseases. Escherichia coli and Staphylococcus aureus were identified most commonly in cultures of necrotic tissue. The mortality rate was 20 per cent despite aggressive surgical debridement and broad-spectrum antibiotics. PMID:9358795

Ba?o?lu, M; Gül, O; Yildirgan, I; Balik, A A; Ozbey, I; Oren, D

1997-11-01

33

[Fournier's gangrene: description of a case].  

PubMed

Fournier's gangrene, named after the french dermatologist who was the first to described it in 1883, is a necrotizing fasciitis which affects men's external genitalia and more rarely women's. In most cases the clinical onset is sudden, characterized by fever and local tumefaction rapidly evolving into gangrene. The most credited aetiology is infective and one or more aerobic and/or anaerobic micro-organisms are supposed to be the cause. The pathogenesis involves an endarteritic obliterative process affecting the small vessels of the superficial branch of the internal pudendal artery. PMID:9005398

Negri, S; Petraglia, B; Azzolini, D

1996-08-01

34

[Fournier's gangrene: report of 4 cases].  

PubMed

Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal region. We treated four cases of Fournier's gangrene from July 2002 to April 2003. All patients were male, ranging in age from 73-92 years old (80.5 +/- 6.5). They were admitted to our hospital complaining of perineal pain, scrotal swelling and high fever. Immediately, we started systemic chemotherapy with broad-spectrum antibiotics, and performed surgical debridements for all patients. Three patients made a full recovery, but one patient died of sepsis. These cases are presented with some notes on the relevant literature. PMID:15237489

Kobori, Yoshitomo; Matsushita, Tomohiko; Amano, Toshiyasu; Takemae, Katsuro

2004-05-01

35

Sudden unexpected death due to Fournier's gangrene.  

PubMed

A 43-year-old Japanese male vagrant collapsed suddenly in a police station. The man was resuscitated in hospital but died about 13 h later. An autopsy revealed necrotizing fasciitis in the genitalia and lower abdominal wall. The man was considered to have died from endotoxic shock following on Fournier's gangrene. PMID:9168331

Bunai, Y; Nagai, A; Nakamura, I; Ohya

1997-01-01

36

Vitamin K deficiency bleeding presenting as impending brain herniation.  

PubMed

It is presently a universal practice to administer vitamin K at birth. Hence, the serious bleeding manifestations from vitamin K deficiency are nowadays very rare. We describe a case of late vitamin K deficiency bleeding presenting as intracranial hemorrhage with impending coning and the related review of literature. Such severe bleeding episodes due to vitamin K deficiency are associated with multiple cranial involvement and impending brain herniation is probably rare. PMID:21042512

Gopakumar, H; Sivji, R; Rajiv, P K

2010-01-01

37

Vitamin K deficiency bleeding presenting as impending brain herniation  

PubMed Central

It is presently a universal practice to administer vitamin K at birth. Hence, the serious bleeding manifestations from vitamin K deficiency are nowadays very rare. We describe a case of late vitamin K deficiency bleeding presenting as intracranial hemorrhage with impending coning and the related review of literature. Such severe bleeding episodes due to vitamin K deficiency are associated with multiple cranial involvement and impending brain herniation is probably rare. PMID:21042512

Gopakumar, H.; Sivji, R.; Rajiv, P. K.

2010-01-01

38

A clinical case of Fournier's gangrene: imaging ultrasound.  

PubMed

Fournier's gangrene is a rapidly progressing necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency with a potentially high mortality rate. Although the diagnosis of Fournier's gangrene is often made clinically, emergency ultrasonography and computed tomography lead to an early diagnosis with accurate assessment of disease extent. The Authors report their experience in ultrasound diagnosis of one case of Fournier's gangrene of testis illustrating the main sonographic signs and imaging diagnostic protocol. PMID:25368689

Di Serafino, Marco; Gullotto, Chiara; Gregorini, Chiara; Nocentini, Claudia

2014-12-01

39

[Antony's fire (gangrenous ergotism) and medieval iconography].  

PubMed

Ergotism was known as Holy Fire or St Antony's Fire in the Middle Ages, because of the burning sensations and limb gangrene it entailed. It was a frequent disorder, caused by eating rye flour contaminated by the fungus Claviceps purpurea. The Hospitable Order of St Antony was founded near Vienne in France, and counted 400 establishments in Europe by 1777. Ergotism is the subject of an abundant iconography, including statues and paintings. Woodcuts show the temptations of St Antony, with strange and diabolic scenes, and individuals with gangrenous limbs. Germanic woodcuts of the XVth century show various stages of ergotism and hands and feet. The tryptics of Bosch and Grunewald bear witness to the frequency and gravity of this disorder, at the beginning of the XVIth century. PMID:20669555

Battin, Jacques

2009-11-01

40

[Fournier's gangrene secondary to anorectal trauma].  

PubMed

Fournier's Gangrene (FG) is a rapidly progressive necrotizing fasciitis affecting the male scrotum and perineum, highly uncommon in paediatric patients. Initially considered as an idiopathic disease, it is frequently found associated to debilitating diseases or in immunocompromised patients. Prognosis is more favourable in children than in adults and is dependent of an early diagnosis and a rapid institution of the appropriate medical and surgical therapy. PMID:7976718

Antón-Pacheco Sánchez, J; Angulo Gómez, S; Cano Novillo, I; Gómez Fraile, A

1994-04-01

41

Gas gangrene after intramuscular injection of adrenaline.  

PubMed

A 13-year-old girl incurred gas gangrene after intramuscular injection of adrenaline to the buttock. Clinical evidence of very severe pain at the site of injection with septicemia and collapse within 24 to 48 hours should arouse the suspicion of clostridial myositis rather than pyogenic infection. Early diagnosis and treatment by adequate excision of necrotic muscle (with a wide margin of normal-appearing muscle) can prevent loss of life or limb in these patients. PMID:6831805

Teo, W S; Balasubramaniam, P

1983-04-01

42

Fournier's Gangrene as a Postoperative Complication of Inguinal Hernia Repair.  

PubMed

Fournier's gangrene is the necrotizing fasciitis of perianal, genitourinary, and perineal regions. Herein, we present a case of scrotal Fournier's gangrene as a postoperative complication of inguinal hernia repair. A 51-year-old male with giant indirect hernia is presented. Patient underwent inguinal hernia repair, and after an unproblematic recovery period, he was discharged. He applied to our outpatient clinic on the fifth day with swollen and painful scrotum and it turned out to be Fournier's gangrene. Polypropylene mesh was not infected. Patient recovered and was discharged after repeated debridements. Basic principles in treatment of Fournier's gangrene are comprised of initial resuscitation, broad-spectrum antibiotics therapy, and early aggressive debridement. In the management of presented case, aggressive debridement was made right after diagnosis and broad-spectrum antibiotics were given to the hemodynamically stable patient. In these circumstances, the important question is whether we could prevent occurrence of Fournier's gangrene. PMID:25506030

Dinc, Tolga; Kayilioglu, Selami Ilgaz; Sozen, Isa; Yildiz, Baris Dogu; Coskun, Faruk

2014-01-01

43

Bilateral upper limb digital gangrene in a patient on maintenance hemodialysis.  

PubMed

Upper limb gangrene is uncommon compared to lower limb gangrene. But digital gangrene is seen occasionally in patients on maintenance hemodialysis. Of the various causes described, atherosclerosis, diabetic vascular disease, following AV fistula surgery were few of the causes. Herein, we report a case of development of early digital gangrene following AV fistula in a patient on maintenance hemodialysis. PMID:24956933

Bathini, Gangadhar; Yadla, Manjusha; Burri, Srikanth; Bottu, Malleshwar; Kamalapuram, Bhanuprasad; Chada, Ramesh; Deshpande, Pradeep

2014-09-01

44

Remote Triggering Not Evident Near Epicenters of Impending Great Earthquakes  

E-print Network

Remote Triggering Not Evident Near Epicenters of Impending Great Earthquakes by Nicholas J. van der-year seismological history. Each great earthquake presents an opportunity to study a major fault earthquake. This study also carefully addresses the possibility that large earthquakes interact in a cas

Brodsky, Emily

45

Fournier's gangrene: report of 20 patients.  

PubMed

Synergistic necrotizing fasciitis of the penis and scrotum was described first by Fournier and remains a rare but life-threatening disease. In Fournier's initial description the process was believed to be idiopathic. During the last 10 years we have treated 20 patients with Fournier's gangrene and a definite urologic or colorectal cause could be identified as the source of the infection in 19 (95 per cent). Despite the use of broad-spectrum antibiotics and aggressive surgical débridement the mortality rate was 45 per cent. PMID:6699959

Spirnak, J P; Resnick, M I; Hampel, N; Persky, L

1984-02-01

46

[Fournier gangrene (manifestation of anogenital necrotizing fasciitis)].  

PubMed

In connection with a typical case, clinical features of genitaly extended Fournier gangrene--its pathogenic factors and the standpoints of treatment--are demonstrated. This infection of foudroyant nature, going on with significant mortality is held to be a characteristic form of necrotizing fasciitis, constituting main manifestation of toxic shock-like syndrome. Attention is drawn to the fact, that in case of internal diseases, predisposing factors respectively-even by adequate therapy-outcome of the infection may be lethal nowadays as well. PMID:8992439

Török, L; Ficsor, E

1996-10-27

47

[Extensive Fournier gangrene. A dermatologic emergency].  

PubMed

Fournier gangrene is a necrotizing fasciitis of the perineal and genital region, which almost exclusively affects men. The cause is a polymicrobial infection associated with superficial trauma, urological diseases and operations, as well as colorectal diseases. Diabetes mellitus, alcoholism, immunosuppression and other severe illnesses are frequent co-factors. Immediate administration of systemic broad-spectrum antibiotic therapy with coverage of both gram-positive and gram-negative bacteria combined with surgical debridement and intensive medical care can lower the high mortality rate of this condition. PMID:16477468

Aschoff, R; Baldauf, A; Leike, S; Wirth, M P; Meurer, M

2006-03-01

48

Multiple Urethral Stones Causing Penile Gangrene  

PubMed Central

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.

2014-01-01

49

Management of perineal necrotizing fasciitis (Fournier's gangrene).  

PubMed

Eleven cases of perineal necrotizing fasciitis were treated in the Department of Surgery, University of Turku, Finland. In 10 cases the diagnosis was made on the basis of the fulminating progression of the infection to scrotal gangrene, identification of multiple underlying pathogenic organisms and toxaemia. In one female patient a corresponding infection developed in the labia majora. Each patient suffered nonspecific symptoms before the gangrene became evident. The management included surgical debridement of the necrotic tissue with incisions and drainage of the involved areas, antibiotic therapy and hyperbaric oxygen (HBO) treatment. The infection originated from the anorectal area in 5 patients, 1 patient had sustained scrotal trauma and in 5 cases the underlying condition was unknown. Colostomy was performed in 6 patients. One patient died 2 days after the admission. All the infections proved to be multimicrobial. Hyperbaric oxygenation was employed as a therapeutic adjunct in the present series, but it should neither replace nor delay surgical intervention. The key points in the management include early diagnosis with prompt surgical debridement and antibiotic therapy. After healthy granulation has appeared, the healing time can be shortened with reconstructive surgical procedures. PMID:2624399

Hirn, M; Niinikoski, J

1989-01-01

50

[Fournier's gangrene in non-resectable colorectal carcinoma].  

PubMed

Fournier's gangrene is a necrotizing fasciitis of the genitalia and perineum. Primary inflammatory focus is usually located in the genitourinary tract, skin or anorectum. The gangrene is caused by a mixed bacterial flora. The management is based on surgical debridement, drainage and antibiotics. Despite of adequate treatment mortality is approximately 20%. We present a case of 65 year-old male with a non-resectable rectal carcinoma who developed Fournier's gangrene after a palliative operation because of intestinal obstruction. Several excisions of the necrotic tissues were performed resulting in significant local improvement. The patient died of disseminated carcinoma a few weeks after the last debridement procedure. PMID:15559615

Wro?ski, Marek; Ma?yszka, Katarzyna; Paw?owski, Waldemar

2004-07-01

51

Venous Valves  

NSDL National Science Digital Library

This simple FlashTM animation depicts the function of a venous valve. It is shown in the context of a transverse section. During systole corpuscles are shown flowing through the open valve. As the pressure reverses during diastole, the valve closes and back flow is blocked.

PhD Jack D Thatcher (West Virginia School of Osteopathic Medicine Structural Biology)

2009-11-20

52

An outbreak of gangrenous dermatitis in commerical broiler chickens  

Technology Transfer Automated Retrieval System (TEKTRAN)

Gangrenous dermatitis (GD) is an emerging disease with increasing economic importance. This experiment was undertaken to describe symptoms, patholgocial changes and diagnosis of GD and to study their immunopathology and cytokine expression alterations. In addition to description of symptoms, pathol...

53

[Venous ecology].  

PubMed

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

1977-01-01

54

Fournier's gangrene associated with sparganosis in the scrotum.  

PubMed

Fournier's gangrene is a necrotizing fasciitis of the scrotum or perineum that may extend by way of the fascial planes to the penis and the anterior abdominal wall up to the clavicles, buttocks, or lower extremities. It is a life-threatening progressive disease that requires aggressive antibiotic therapy and early radical debridement. Sparganosis is a parasitic infection that occurs principally in cats and dogs, but human infestations have been reported, albeit rarely. Recently, we experienced a case of Fournier's gangrene associated with sparganosis in the scrotum, which was treated with antibiotics and extensive debridement including removal of a white, flat, shiny sparganum worm. PMID:14751384

Jeong, Hee Jong

2004-01-01

55

Fournier's gangrene complicating aggressive therapy for hematologic malignancy.  

PubMed

The authors describe two cases of Fournier's gangrene complicating aggressive therapy for hematologic malignancies. Fournier's gangrene is a fulminant necrotizing fasciitis of the scrotum and penis, often with an infectious etiology. Only one prior case has been reported in a patient receiving aggressive chemotherapy for a hematologic malignancy. Unique to these three cases was profound granulocytopenia and the culturing of Pseudomonas aeruginosa in both the blood and necrotic perineal-scrotal tissue. Maintaining a high index of suspicion with early recognition and aggressive therapy may decrease the morbidity and mortality of this devastating and life-threatening infection in the compromised host. PMID:3697930

Berg, A; Armitage, J O; Burns, C P

1986-06-15

56

CQ3. Volcanoes Do volcanoes signal impending eruptions through changes in the  

E-print Network

CQ3. Volcanoes Do volcanoes signal impending eruptions through changes in the temperature and extent of vegetation cover? #12;CQ3: Do volcanoes signal impending eruptions through changes changes in eruptive behavior at already active volcanoes. Rising magma ultimately results in a flux

Christian, Eric

57

Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur  

SciTech Connect

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: frederic.deschamps@igr.fr; Farouil, Geoffroy, E-mail: g.farouil@gmail.com; Hakime, Antoine, E-mail: thakime@yahoo.com; Teriitehau, Christophe, E-mail: cteriitehau@me.com; Barah, Ali, E-mail: ali.barah@gmail.com; Baere, Thierry de, E-mail: debaere@igr.fr [Institut Gustave Roussy, Interventional Radiology Department (France)

2012-12-15

58

Gangrenous stomatitis (cancrum oris): clinical features, etiologic factors, and complications.  

PubMed

Gangrenous stomatitis (cancrum oris) is a lesion involving the orofacial structures that is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene. The general clinical features, associated etiologic factors, and ensuing complications in eight consecutive cases diagnosed between 1991 and 1995 are presented and discussed. PMID:10332380

Chindia, M L; Guthua, S W; Kimaro, S S; Moshy, J

1997-04-01

59

Fournier's gangrene in a patient after third-degree burns: a case report  

PubMed Central

Introduction Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis. Case presentation We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed. Conclusion Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections. PMID:19830156

2009-01-01

60

Fournier's gangrene after unrelated cord blood stem cell transplantation.  

PubMed

A 16-year-old boy with refractory acute myelogenous leukemia developed Fournier's gangrene as an early complication after two-antigen HLA-mismatched unrelated cord blood stem cell transplantation. On day 25 after the transplantation, he noted abrupt onset of penile swelling with miction pain. The penile inflammation rapidly extended posteriorly to involve the scrotum and perianal tissues, inferiorly to involve the thighs, and superiorly up the lower abdominal region within the next 36 h, and he died from sepsis on day 27. Fournier's gangrene presenting as a genitoperineal necrotizing fasciitis should be considered as a potential complication in umbilical-cord blood recipients in the cytopenic post-transplant phase. PMID:12373358

Yoshida, C; Kojima, K; Shinagawa, K; Hashimoto, D; Asakura, S; Takata, S; Tanimoto, M

2002-09-01

61

Tectonic Deep Anterior Lamellar Keratoplasty in Impending Corneal Perforation Using Cryopreserved Cornea  

PubMed Central

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS® solution at -70? for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis. PMID:21461227

Jang, Ji Hye

2011-01-01

62

An outbreak of gangrenous dermatitis in commercial broiler chickens  

Microsoft Academic Search

The present report describes an outbreak of gangrenous dermatitis (GD) infection in a commercial poultry farm in Delaware involving 34-day-old broiler chickens. In addition to obvious clinical signs, some GD-affected broilers also showed severe fibrino-necrotic enteritis and large numbers of Gram-positive rods in the necrotic tissue. Histopathological findings included haemorrhage, degeneration and necrosis of parenchymatous cells, especially of skin, muscle,

Guangxing Li; Hyun S. Lillehoj; Kyung Woo Lee; Seung I. Jang; Pagčs Marc; Cyril G. Gay; G. Donald Ritter; Daniel A. Bautista; Kathy Phillips; Anthony P. Neumann; Thomas G. Rehberger; Gregory R. Siragusa

2010-01-01

63

Ischemic Gangrene of the Glans following Penile Prosthesis Implantation.  

PubMed

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

García Gómez, Borja; Romero Otero, Javier; Díez Sicilia, Laura; Jiménez Alcaide, Estibaliz; García-Cruz, Eduardo; Rodríguez Antolín, Alfredo

2013-01-01

64

Ischemic Gangrene of the Glans following Penile Prosthesis Implantation  

PubMed Central

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

García Gómez, Borja; Romero Otero, Javier; Díez Sicilia, Laura; Jiménez Alcaide, Estibaliz; García-Cruz, Eduardo; Rodríguez Antolín, Alfredo

2013-01-01

65

Fournier's Gangrene due to Masturbation in an Otherwise Healthy Male.  

PubMed

Fournier's gangrene is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic, or otherwise immune-compromised individuals. Here, we report an unusual case of Fournier's gangrene due to excessive masturbation in an otherwise healthy 29-year-old male who presented to the emergency department complaining of two days of fever, vomiting, and diffuse myalgias. Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant resulting in recurrent penile erythema and minor skin abrasions. Examination of the patient's perineum was consistent with Fournier's gangrene and included significant erythema, edema, and calor of the penis and scrotum with a large malodorous eschar. He was given intravenous antibiotics and immunoglobulin and promptly underwent three surgical debridements of the scrotum and penis with split-thickness skin grafting. Complications from excessive masturbation are exceedingly rare, but as this case illustrates, they can be life threatening. PMID:23326701

Heiner, Jason D; Eng, Katisha D; Bialowas, Todd A; Devita, Diane

2012-01-01

66

Fournier's Gangrene due to Masturbation in an Otherwise Healthy Male  

PubMed Central

Fournier's gangrene is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic, or otherwise immune-compromised individuals. Here, we report an unusual case of Fournier's gangrene due to excessive masturbation in an otherwise healthy 29-year-old male who presented to the emergency department complaining of two days of fever, vomiting, and diffuse myalgias. Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant resulting in recurrent penile erythema and minor skin abrasions. Examination of the patient's perineum was consistent with Fournier's gangrene and included significant erythema, edema, and calor of the penis and scrotum with a large malodorous eschar. He was given intravenous antibiotics and immunoglobulin and promptly underwent three surgical debridements of the scrotum and penis with split-thickness skin grafting. Complications from excessive masturbation are exceedingly rare, but as this case illustrates, they can be life threatening. PMID:23326701

Heiner, Jason D.; Eng, Katisha D.; Bialowas, Todd A.; Devita, Diane

2012-01-01

67

Fournier's Gangrene as Seen in University of Maiduguri Teaching Hospital  

PubMed Central

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.

2013-01-01

68

Cerebral venous angiomas  

SciTech Connect

Several unusual cases of cerebral venous angiomas as well as some characteristic cases are reported. The characteristic angiographic feature is that of a collection of dilated medullary veins draining into a single large draining vein, which appears first in the early venous phase and persists into the late venous phase of the arteriogram. Computed tomography (CT) was abnormal in 12/13 cases. The draining vein was the most common abnormality identified on CT. Coronal and sagittal reconstruction may be helpful in demonstrating the draining vein. A case of large twin venous angiomas, a case of hemorrhage from a venous angioma, and a case of a venous angioma with an incidentally associated glioblastoma are presented.

Olson, E.; Gilmor, R.L.; Richmond, B.

1984-04-01

69

Epidemiology of venous thromboembolism.  

PubMed Central

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

1977-01-01

70

Fournier's gangrene: the need for early recognition and radical surgical débridement.  

PubMed

Fournier's gangrene, a specific form of necrotizing fasciitis, predominantly affects the male genitals, perineum and perianal region. Most frequently Fournier's gangrene is caused by the synergistic action of aerobic and anaerobic microorganisms and leads to early septicaemia with a high mortality. The case histories of three patients with Fournier's gangrene are presented to illustrate the importance of early recognition and radical surgical débridement as essential objectives for therapeutic success. In the first patient, who died of Fournier's gangrene after a vasectomy, appropriate therapy was significantly delayed due to late recognition of the condition. The second patient presented with a rapidly progressive fasciitis secondary to a perianal abscess; immediate excision of all necrotic tissue was successfully performed. The third patient developed gangrene from an urogenital infectious focus, which was primarily treated by insufficient incisional and drainage therapy. Only after radical débridement his general condition rapidly improved. PMID:1787906

de Roos, W K; van Lanschot, J J; Bruining, H A

1991-10-01

71

Successful combined approach to a severe Fournier's gangrene  

PubMed Central

We present a case of a successful reconstruction of a severe Fournier's gangrene (FG) involving the scrotum, the perineum, the right ischial area and extended to the lower abdomen. There are many different surgical techniques to repair and reconstruct the defect following debridement in FG. The authors treated this complex wound using negative pressure wound therapy (NPWT), dermal regeneration template and a split-thickness skin graft. Complete recovery was achieved and no major complications were observed. The patient showed a satisfying functional and aesthetic result. PMID:24987219

Agostini, Tommaso; Mori, Francesco; Perello, Raffaella; Dini, Mario; Russo, Giulia Lo

2014-01-01

72

Fournier's Gangrene of the Penis: A Rare Entity  

PubMed Central

Fournier's gangrene is a rare, fulminant, but and usually a localized disease of the scrotum and penis, with an occasional extension up to the abdominal wall. The usual organism is an anaerobic streptococcus synergistic with other organisms. A 45-year-old male presented with fever and pain and a brownish-black discolouration of the penis, of four days. Our case was unusual in that the penis was involved, which is very rare. Early therapy is the key, including hospitalization, debridement of the entire shaft of the penis distal to the devastated area, without excising the normal skin, parenteral broad-spectrum antibiotics, and skin grafting. PMID:20606995

Talwar, Ashutosh; Puri, Neerja; Singh, Majhail

2010-01-01

73

Successful combined approach to a severe Fournier's gangrene.  

PubMed

We present a case of a successful reconstruction of a severe Fournier's gangrene (FG) involving the scrotum, the perineum, the right ischial area and extended to the lower abdomen. There are many different surgical techniques to repair and reconstruct the defect following debridement in FG. The authors treated this complex wound using negative pressure wound therapy (NPWT), dermal regeneration template and a split-thickness skin graft. Complete recovery was achieved and no major complications were observed. The patient showed a satisfying functional and aesthetic result. PMID:24987219

Agostini, Tommaso; Mori, Francesco; Perello, Raffaella; Dini, Mario; Russo, Giulia Lo

2014-01-01

74

Imparting the knowledge of impending death to the intensive care patient who is unable to respond.  

PubMed

Silence during death is a communication deficit in the care of dying patients. In the ICU, patients are often unable to communicate, but may still be able to hear. Giving information of impending death to such patients is, therefore, done without their consent. Such information could be beneficial in enabling them to face death. Alternatively, it could cause emotional turmoil. Telling patients they are dying may help relatives to begin the grieving process. Guidelines are proposed to help nurses wishing to impart knowledge of impending death to their patients. PMID:9594128

Horton, S

1996-01-01

75

Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution  

PubMed Central

Purpose. Fournier's gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier's gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, n = 6) or dressings with dakin's solution (sodium hypochloride) (group II, n = 8). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II (P < 0.05). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin's solution for the dressings in the treatment of FG. Also, dressings with dakin's solution seems to have favorable effects on morbidity and mortality. Consequently dakin's solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality. PMID:22567424

Altunoluk, Bülent; Resim, Sefa; Efe, Erkan; Eren, Mustafa; Benlioglu, Can; Kankilic, Nazim; Baykan, Halit

2012-01-01

76

[Saint Anthony's Fire or gangrenous ergotism and its medieval iconography].  

PubMed

The frequent epidemics of ergotism were called Holy Fire or st-Antony's Fire in the Middle Ages, because of the burning sensations resulting in gangrene of limbs. It was caused by eating rye bread contaminated with the fungus Claviceps purpurea. The hospitable Order of st-Antony was founded near Vienne in France with 300 establishements in Europe until 1777. In coptic and byzantine art st-Antony is the father of the monks, whereas in Occident he is the the master of fire, thaumaturgic, resulting a very important iconography in statuary and painworks in all regions, especially in Lorraine, the catholic and tridentin Lotharingia and in Corsica thanks to the franciscan pastoral. Woodcuts show not only the temptations of st-Antony, with strange and diabolic scenes, patients with gangrenous limbs. Germanic woodcuts of the 15th century show patients with different stages of ergotism and hands and feet like ex-voto. Triptycs of H. Bosch and M. Gunewald are witnesses of the frequency and seriousness of this disease still at the beginning of the 16th century. PMID:21598563

Battin, Jacques

2010-01-01

77

Lymphangioma-Like Kaposi's Sarcoma Presenting as Gangrene  

PubMed Central

Kaposi's sarcoma (KS) is a multicentric vascular neoplasm associated with the Kaposi's sarcoma-associated herpes virus (KSHV). KS can occur in immunocompromised patients as well as certain populations in Africa or in the Mediterranean. Less than 5% of KS cases can present with lymphangioma-like kaposi sarcoma (LLKS), which can occur in all KS variants. KS presents with characteristic skin lesions that appear as brown, red, blue, or purple plaques and nodules. The lesions are initially flat and if untreated will become raised. LLKS presents similarly to KS but is associated with severe lymphedema and soft tissue swelling as well as bulla-like vascular lesions. We present the case of an 85-year-old Lebanese, HIV negative, man who presented with a swollen and painful right lower extremity accompanied by necrotic lesions. Wound cultures were positive, and we began the work-up for secondarily infected gangrene. However, skin biopsy results revealed that he in fact had lymphangioma-like Kaposi sarcoma, which allowed us to shift our management. Advanced Kaposi's sarcoma can present similar to gangrene. It is important to recognize the typical skin lesions of KS and not to overlook Kaposi's sarcoma or LLKS within the differential. PMID:23781364

Friedman, Eitan R.; Farquharson, Lesley; Milikowski, Clara

2013-01-01

78

[Chronic venous insufficiency (CVI)].  

PubMed

Chronic venous insufficiency (CVI) is an important and frequent disease for dermatologists, phlebologists and general practitioners. There are various hypotheses for the ethiopathology in CVI, e. g. hormone receptors and impairments concerning the venous contraction or relaxation of the vessel wall and the venous valves might play an important role. At the moment, colour doppler-duplex sonography seems to be the diagnostic method of choice. Modern therapeutic options include compression systems alone or in combination with topical or systemic treatment including minimal invasive methods like endovenous laser or radiofrequency obliteration or foam sclerotherapy. PMID:19826982

Renner, R; Simon, J

2009-10-01

79

[Abdominal compartimental syndrome as a complica-tion of Fournier's gangrene].  

PubMed

Analyzing a complex case and referring to the literature, the authors describe abdominal compartmental syndrome as a complication of Fournier's gangrene, stressing out the importance of an early diagnosis to perform prompt and effective treatment. The characteristic of this case is not represented only by the Fournier's gangrene rarity, but also by the appearance of an abdominal compartmental syndrome due to the gangrene extension from the scrotum to the abdominal wall and cavity through the spermatic funiculus. The treatment of the abdominal compartmental syndrome was the surgical toilette of the necrotic regions (scrotum, abdominal wall and cavity) together with an orchiectomy. PMID:19419615

Cattorini, L; Cirocchi, R; Spizzirri, A; Morelli, U; De Sol, A; Napolitano, V; La Mura, F; Locci, E; Coccetta, M; Mecarelli, V; Giustozzi, G; Sciannameo, F

2009-04-01

80

Limb salvage after gas gangrene: a case report and review of the literature  

PubMed Central

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

2011-01-01

81

[Functional venous explorations].  

PubMed

The methods for exploring venous function globally are presented first. These methods include venous pressure and plethysmography for which the methods using a garrot are separated from those using air volumetry which give reliable physiological and reproducible results. The Nachev method, the thermometry, the thermography and isotope clearances are also reviewed since they have been important in the development of exploration of venous function. The methods giving morphological or segmentary data are then presented in historical order: phlebography (completed by tomodensitography and nuclear magnetic resonance), then ultrasonography with Doppler, echography and duplex and colour techniques. Finally promising methods for the future including oxygen partial pressures, laser-Doppler, capillaroscopy and venous endoscopy are discussed. For each method, there is a description of the technique, a presentation of the measured parameters and their reliability, the signification of the measurement and its clinical use. Finally, each method is discussed in the context of concrete clinical situations with a schema for management of diagnosis. PMID:8177873

Mollard, J M

1994-02-10

82

Management of venous thromboembolism.  

PubMed

This article describes the risk factors, diagnostic tools, and therapeutic approaches for venous thromboembolism (VTE), which includes primarily deep vein thrombosis and pulmonary embolism, as well as VTE occurring at other sites. Outpatient management strategies are emphasized. PMID:23402462

Burnett, Bruce

2013-03-01

83

Diagnosing Deep Venous Thrombosis  

PubMed Central

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

1992-01-01

84

A Study of Community College Leadership Practices in Response to the Impending Leadership Crisis  

ERIC Educational Resources Information Center

The literature attests to a leadership crisis that is predicted to impact leadership pipelines in just about every industry imaginable, including community colleges. This impending crisis is thought to be a result of baby boomer retirements plus the lack of next generation workers equipped with the skills to replace them. Community colleges are…

Corbett, Jane

2012-01-01

85

Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever.  

PubMed

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

2014-01-01

86

Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever  

PubMed Central

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.

2014-01-01

87

A case of Fournier's gangrene: an insidious and dangerous pathology.  

PubMed

Fournier's Gangrene is a rare form of necrotizing fasciitis due to microbial infection of perineum and scrotum. It's a sever infectious disease with an high mortality rate: an early and aggressive debridement is a significant prognostic factor in the management of this pathology. We present a clinical case of a 52-years old male patient that suffered from this disease after a long car journey that may have favoured the maceration of skin with the following penetration and proliferation of microbes into the scrotal skin. Subsequently he developed fever, not adequately considered, and this leads to development of sepsis that required hospitalization in Resuscitation and Intensive Care Unit, then in Infectious Disease Ward, and finally he was placed under our care so that he could undergo procedures of reconstruction of scrotum and reparation of the cutaneous defect. PMID:23762998

Zermani, Rita; Bocchi, Francesca

2012-12-01

88

Fournier's gangrene syndrome in a chimpanzee (Pan troglodytes).  

PubMed

A 37-yr-old male chimpanzee (Pan troglodytes) was evaluated for intermittent diarrhea, scrotal swelling, and lethargy of 2 days duration. Physical examination revealed marked swelling of the scrotum and perineal tissues with mild pitting edema and crepitus. Computed tomography revealed a mixed gas and soft-tissue density extending from the caudal ventral subcutaneous tissues caudally to the scrotum and perineal tissues. Surgical exploration and castration were performed to establish drainage, and culture revealed a polymicrobial infection. A diagnosis of scrotal and fascial plane abscessation consistent with Fournier's gangrene was made. Although castration with open drainage was performed, the animal died 36 hr after surgery. Postmortem examination and histopathology revealed necrotizing fasciitis of the penis, vaginal tunic, and subcutaneous perineal and perianal tissues. PMID:20722275

Okeson, Danelle M; Marrow, Judilee; Carpenter, James W; Armbrust, Laura J; Ragsdale, John M; Klocke, Emily

2010-03-01

89

Digital gangrene associated with anticentromere antibodies: a case report  

PubMed Central

Introduction Anticentromere antibodies have been associated with peripheral vascular occlusive disease, most frequently accompanied by sclerodactyly in the context of a connective tissue disorder. We report a case of digital gangrene with no other clinical associations except positive anticentromere antibodies. Case presentation Our patient, a 53-year-old Caucasian woman, non-smoker, presented with progressive pain and blackening of the distal right third finger over the preceding five weeks. No sclerodactyly was evident. She was anticentromere antibody positive at greater than 100 U/mL. Angiography revealed diffuse distal vasculopathy in both upper extremities. Other investigations were unremarkable. Conclusions It is rare for anticentromere antibody-associated digital necrosis to develop without concomitant sclerodactyly. However, this patient's case illustrates the need to consider an autoimmune contribution to the pathogenesis of digital ischemia even in the absence of a recognizable connective tissue disease. PMID:20569489

2010-01-01

90

Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease.  

PubMed

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; Freitas, Thaís Helena Proença de; Simone, Karine

2014-01-01

91

Opioid analgesics stop the development of clostridial gas gangrene.  

PubMed

Gas gangrene is a potentially fatal disease that is primarily caused by the ubiquitous, anaerobic bacteria Clostridium perfringens and Clostridium septicum. Treatment is limited to antibiotic therapy, debridement of the infected tissue, and, in severe cases, amputation. The need for new treatment approaches is compelling. Opioid-based analgesics such as buprenorphine and morphine also have immunomodulatory properties, usually leading to faster disease progression. However, here we show that mice pretreated with buprenorphine and morphine do not die from clostridial myonecrosis. Treatment with buprenorphine after the onset of infection also arrested disease development. Protection against myonecrotic disease was specific to C. perfringens-mediated myonecrosis; buprenorphine did not protect against disease caused by C. septicum infection even though infections due to both species are very similar. These data provide the first evidence of a protective role for opioids during infection and suggest that new therapeutic strategies may be possible for the treatment of C. perfringens-mediated myonecrosis. PMID:24550443

Chakravorty, Anjana; Awad, Milena M; Hiscox, Thomas J; Cheung, Jackie K; Choo, Jocelyn M; Lyras, Dena; Rood, Julian I

2014-08-01

92

Fournier’s gangrene after adult male circumcision  

PubMed Central

Background In the advent of mass voluntary medical male circumcision (VMMC) for the partial prevention of HIV, previously rare adverse events associated with adult male circumcision are likely to be encountered with higher frequency. Fournier’s gangrene, defined as a polymicrobial necrotizing fasciitis of the perineal, perianal or genital areas, is one such rare and life-threatening adverse event. In this report, we present two cases that were identified in the context of a VMMC programme over a 3-year period during which approximately 100,000 adult circumcisions were performed. Case presentations Case 1: A 19-year-old male who had VMMC performed using the dorsal slit technique developed pain and blisters on the scrotal skin on the sixth postoperative day. He had no co-morbidities, and serology for HIV was negative. On examination, locally he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. Repeated aggressive debridement was done while he stayed in a hospital for 3 weeks; at which point, he had healthy granulation tissue and was free of infection. The wound had closed spontaneously and completely by the fifth month. Case 2: A 52-year-old male who had VMMC performed with the sleeve resection method developed pain and swelling of the penis and scrotum on the fourth postoperative day. He had a low-grade fever of 37.6°C. He was not diabetic or immunosuppressed and had a negative HIV serology. He was admitted and was given IV antibiotics, and repeated aggressive debridement was performed. On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft. At 4 months, the scrotal defect had completely closed. Conclusion Fournier’s gangrene is a rare occurrence after adult male circumcision with associated high morbidity. These are the first descriptions in the VMMC era. PMID:25635197

2014-01-01

93

Histopathology of tissue removed during vitrectomy for impending idiopathic macular holes.  

PubMed

Vitrectomy may prevent the progression of an impending macular hole by removing the layer of cortical vitreous from the posterior retina. To determine the nature of the cortical vitreous tissue, we identified and removed from the surface of the posterior retina a thin sheet of what appeared to be posterior cortical vitreous in 29 patients undergoing vitrectomy for an impending macular hole. In seven patients, the tissue was isolated for transmission electron microscopic study. Millipore filter specimens of the vitreous aspirates from all of the patients were studied by light microscopy. Vitreous condensates were present in all 29 specimens, fibrocellular membrane fragments were present in three, and fragments of internal limiting membrane were present in four. A collagen matrix was present in each of the seven specimens studied by electron microscopy, and in every specimen, the collagen's diameter was consistent with indigenous vitreous collagen. These findings confirm the presence of an acellular tissue layer on the posterior retina in eyes with an impending macular hole and indicate that it is usually indigenous vitreous collagen. PMID:2801855

Smiddy, W E; Michels, R G; de Bustros, S; de la Cruz, Z; Green, W R

1989-10-15

94

Venous oxygen saturation.  

PubMed

Early detection and rapid treatment of tissue hypoxia are important goals. Venous oxygen saturation is an indirect index of global oxygen supply-to-demand ratio. Central venous oxygen saturation (ScvO2) measurement has become a surrogate for mixed venous oxygen saturation (SvO2). ScvO2 is measured by a catheter placed in the superior vena cava. After results from a single-center study suggested that maintaining ScvO2 values >70% might improve survival rates in septic patients, international practice guidelines included this target in a bundle strategy to treat early sepsis. However, a recent multicenter study with >1500 patients found that the use of central hemodynamic and ScvO2 monitoring did not improve long-term survival when compared to the clinical assessment of the adequacy of circulation. It seems that if sepsis is recognized early, a rapid initiation of antibiotics and adequate fluid resuscitation are more important than measuring venous oxygen saturation. PMID:25480771

Hartog, Christiane; Bloos, Frank

2014-12-01

95

[Venous surgery for impotence].  

PubMed

The treatment of cavernovenous leak consists of the ligation resection of the deep dorsal vein and the cavernous veins when the arterial inflow is normal. When the penile arterial inflow is reduced, deep dorsal vein arterialization can improve the venous leakage. PMID:2064362

Wespes, E

1991-01-01

96

Central Venous Catheter Access  

Microsoft Academic Search

Central venous access for the purpose of supplying parenteral nutrition to the pediatric age group requires a careful definition of the patient’s caloric need, estimated duration of therapy, and an assessment of available sites. Peripheral vein parenteral nutrition is limited by caloric density of the nutrient fluids, while peripherally inserted central catheters (PICC) offers a new technology for accessing central

Dai H Chung; Moritz M Ziegler

1998-01-01

97

Prospective evaluation of risk factors for mortality in patients of Fournier's gangrene: A single center experience  

PubMed Central

Introduction: Fournier's gangrene is an aggressive disease with high morbidity and mortality. The aim of this study was to assess risk factors associated with mortality among patients of Fournier's gangrene. Materials and Methods: Between May 2011 and September 2012, all patients of Fournier's gangrene treated at our center were included in the study. All patients underwent emergency surgical debridement and received broad spectrum intravenous antibiotics. Their baseline characteristics, treatment, and follow-up data were recorded and analyzed. Results: A total of 30 patients were included in the study. Of these, six patients (20%) died during the treatment. Age <55 years, total leukocyte count <15000 cumm, extent of the area involved, septic shock at admission, visual analog scale (VAS) <7 at admission, and Fournier gangrene severity index (FGSI) score <8 at admission were significantly associated with increased mortality. Conclusion: In patients of Fournier's gangrene, increased age, total leukocyte count, extent of the area involved, septic shock at admission, VAS score, and FGSI score at admission have a significant association with mortality. PMID:24082432

Vyas, Hari Gopal; Kumar, Anup; Bhandari, Vimal; Kumar, Niraj; Jain, Abhinav; Kumar, Rohit

2013-01-01

98

Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report  

PubMed Central

Introduction Fournier gangrene is a rare necrotising fascitis of the perineum and genitals caused by a mixture of aerobic and anaerobic microorganisms. The first case was described by Baurienne in 1764 but the condition was named by Fournier in 1883 who reported the cases of five men with the condition with no apparent etiology. Infection most commonly arises from the skin, urethra, or rectal regions. Despite appropriate therapy, mortality in this disease is still high. We report a case of a low rectal malignancy presenting as Fournier gangrene. This case report serves to highlight an extremely unusual presentation of rectal cancer, a common surgical pathology. Case presentation The patient is a 48 years old Afghanian male that admitted with Fournier gangrene. In the course of medical and surgical treatment the presence of extensive rectal adenocarcinoma was discovered. After partial recovery, standard loop colostomy was inserted. Skin grafting of necrotic areas was performed and systemic rectal cancer chemotherapy initiated after full stabilization. Conclusion Fournier gangrene is an uncommon but life threatening condition with high associated mortality and morbidity. Usually there is an underlying cause for the development of Fournier gangrene, that if addressed correctly, can lead to a good outcome. Early diagnosis and treatment decrease the morbidity and mortality of this life threatening condition. Good management is based on aggressive debridement, broad spectrum antibiotics and intensive supportive care. PMID:20062653

2009-01-01

99

Clinicobiochemical investigations of gangrenous mastitis in does: immunological responses and oxidative stress biomarkers*  

PubMed Central

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.

2013-01-01

100

An observational study addressing the anatomic basis of mesosigmoidopexy as a rational treatment of non-gangrenous sigmoid volvulus.  

PubMed

Sigmoid volvulus is a common cause of bowel obstruction. We describe mesosigmoidopexy, an accepted surgical technique for the management of non-gangrenous sigmoid volvulus, and provide anatomic correlations supporting the therapy. Mesosigmoidopexy should be considered as a rational alternative to resection and anastomosis when operating on non-gangrenous sigmoid volvulus. PMID:22184737

Samuel, Jonathan C; Msiska, Nelson; Muyco, Arturo P; Cairns, Bruce A; Charles, Anthony G

2012-01-01

101

Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report  

PubMed Central

Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately. PMID:22151925

2011-01-01

102

Oro-facial gangrene (noma/cancrum oris): pathogenetic mechanisms.  

PubMed

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 1 to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of micro-organisms, with Fusobacterium necrophorum (Fn) and Prevotella intermedia (Pi) as the suspected key players. Additional to production of a growth-stimulating factor for Pi, Fn displays a classic endotoxin, a dermonecrotic toxin, a cytoplasmic toxin, and a hemolysin. Without appropriate treatment, the mortality rate from noma is 70-90%. Survivors suffer the two-fold afflictions of oro-facial mutilation and functional impairment, which require a time-consuming, financially prohibitive surgical reconstruction. PMID:12002813

Enwonwu, C O; Falkler, W A; Idigbe, E O

2000-01-01

103

Fournier Gangrene as a Manifestation of Undiagnosed Metastatic Perforated Colorectal Cancer  

PubMed Central

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

2013-01-01

104

Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene.  

PubMed

Epididymo-orchitis is a relatively common diagnosis in elderly men, often related to prostatic outflow obstruction. A 70-year-old man presented with a 4-day history of swelling and pain in the scrotum, fevers, dysuria and frequency. He had severe symptoms of prostatic hypertrophy. Physical examination and urine microscopy confirmed the diagnosis of left epididymo-orchitis and antimicrobial therapy was commenced. Subsequently, however, he developed severe necrotizing fasciitis (Fournier's gangrene) of the scrotum requiring surgical debridement, and at laparotomy, a perforated carcinoma of the sigmoid colon was found at the level of the left deep inguinal ring. Despite further radical surgery the gangrene extended, his condition deteriorated and he died. There has been no other similar case reported in the literature, and thus, although rare, intra-peritoneal causes of infection should be considered in patients with Fournier's gangrene. PMID:9315070

Gould, S W; Banwell, P; Glazer, G

1997-08-01

105

Impending Crisis.  

ERIC Educational Resources Information Center

Filled with evidence and advice for corporate leaders in for-profit, not-for-profit, governmental, and education organizations, this book addresses how to evaluate one's organization's vulnerability and take action. An introduction is followed by a section on the new roles of the chief executive officer, chief operating officer, chief financial…

Herman, Roger E.; Olivo, Thomas G.; Gioia, Joyce L.

106

Fournier gangrene: a review of 41 patients and strategies for reconstruction.  

PubMed

Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was diabetes mellitus in 21 patients (51.2%), followed by cirrhosis of the liver, uremia, alcoholism, and underlying malignancy. The most common symptoms were fever (87.8%) and pain or swelling over the genital region (85.4%). The initial treatment included extensive debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life. PMID:20407363

Chen, Shih-Yi; Fu, Ju-Peng; Wang, Chih-Hsin; Lee, Tzu-Peng; Chen, Shyi-Gen

2010-06-01

107

Elective gangrene of the corpus spongiosum of idiopathic origin: A case report.  

PubMed

Penile gangrene is rare and associated with significant morbidity and mortality. It can be dry or wet. Treatment for dry gangrene is based on surgery, watchful waiting allowing spontaneous amputation of necrotic tissue or revascularization. It often depends on the general condition of the patient. We report a case of a 54-year-old patient with no significant medical history who presented with necrosis of the glans penis. Upon surgical exploration, we found an elective necrosis of the entire corpus spongiosum for which partial penectomy was performed. No etiology was found. To our knowledge, this is the first such case to be reported in the literature. PMID:25553173

Kharbach, Youssef; Tenkorang, Somuah; Bouchikhi, Amine; Mellas, Soufiane; Ammari, Jalaleddine El; Tazi, Mohammed Fadl; Khallouk, Abdelhak; Fassi, Mohammed Jamal El; Farih, Moulay Hassan

2014-11-01

108

Elective gangrene of the corpus spongiosum of idiopathic origin: A case report  

PubMed Central

Penile gangrene is rare and associated with significant morbidity and mortality. It can be dry or wet. Treatment for dry gangrene is based on surgery, watchful waiting allowing spontaneous amputation of necrotic tissue or revascularization. It often depends on the general condition of the patient. We report a case of a 54-year-old patient with no significant medical history who presented with necrosis of the glans penis. Upon surgical exploration, we found an elective necrosis of the entire corpus spongiosum for which partial penectomy was performed. No etiology was found. To our knowledge, this is the first such case to be reported in the literature. PMID:25553173

Kharbach, Youssef; Tenkorang, Somuah; Bouchikhi, Amine; Mellas, Soufiane; Ammari, Jalaleddine El; Tazi, Mohammed Fadl; Khallouk, Abdelhak; Fassi, Mohammed Jamal El; Farih, Moulay Hassan

2014-01-01

109

Fournier’s Gangrene in a Two Year Old Child: A Case Report  

PubMed Central

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

2014-01-01

110

Fournier's Gangrene in a Heterosexual Man: A Complication of Neisseria meningitidis Urethritis  

PubMed Central

A 55-year-old heterosexual male presented to the emergency department with a symptomatology consistent with urethritis and Fournier's gangrene. Urethral swab and operative tissue cultures were positive for coagulase-negative Staphylococcus and an intracellular Gram-negative diplococcus. The latter was initially thought to be Neisseria gonorrhea; however, DNA sequencing technique confirmed it to be Neisseria meningitidis. The patient required three separate surgical debridements to control widespread necrotizing infection. Following documentation of sterile wound healing with appropriate antibiotics, four reconstructive surgeries were necessary to manage the resultant wound defects. To our knowledge, Neisseria meningitidis as a causative organism in Fournier's gangrene has not been reported in the literature. PMID:23304623

Porshinsky, Brian S.; Patel, Abhishek P.; McClung, Christopher D.

2012-01-01

111

Fournier's Gangrene in a Two Year Old Child: A Case Report.  

PubMed

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

2014-08-01

112

Management of unusual genital lymphedema complication after Fournier’s gangrene: a case report  

PubMed Central

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

2012-01-01

113

Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality  

PubMed Central

Introduction Fournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality. Methods The medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Results Ten males and five females were enrolled in the study. The mean age was 54?years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality. Conclusions Fournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices. PMID:23547796

2013-01-01

114

Clostridium tertium isolated from gas gangrene wound; misidentified as Lactobacillus spp initially due to aerotolerant feature  

Microsoft Academic Search

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

2007-01-01

115

Quantitative real-time PCR assay for Clostridium septicum in poultry gangrenous dermatitis associated samples  

Microsoft Academic Search

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

2010-01-01

116

Digital gangrene after accidental intra-arterial injection of phenytoin (epanutin).  

PubMed

A case is described in which inadvertent intra-arterial injection of phenytoin led to digital gangrene, with arteriography showing occlusion of the digital arteries, necessitating amputation of fingers. The high alkalinity of phenytoin is strongly irritant to vessel walls. Intravenous injection of phenytoin should be given only with great care and in emergencies, preferably avoiding the cubital fossa. PMID:1354499

Sintenie, J B; Tuinebreijer, W E; Kreis, R W; Breederveld, R S

1992-05-01

117

Gallbladder Stones Following Ileal Resection for Gangrenous Intussusceptions: A Follow-up Study  

PubMed Central

Background: Intussusceptions are the most common causes of bowel obstruction in infancy and childhood in this environment they present late, resulting in gangrene of the intussusception consequently resection of the affected bowel and a limited or extended right hemicolectomy (RH) to establish bowel continuity. Aim: The aim of the following study is to follow-up these children that had a limited ileal resection for gangrenous intussusceptions and document the formation of stones in their gallbladders. Materials and Methods: A total of 14 patients who had limited ileal resection during infancy for gangrenous intussusceptions were matched with sixteen patients who had manual reduction for viable intussusceptions during infancy. Both groups had ultrasound scans of their gallbladders to document the formation of stones in their gallbladders. Results: No gallbladder stones were found in both groups, however, one male child that had a resection and a RH for a gangrenous intussusception at the age of 4 months and was seen at an interval of 72 months had a thickened gallbladder on ultrasonography, another child, a female child operated on at the age of 6 months and seen at an interval of 57 months also had a thickened gallbladder on ultrasonography. Conclusion: Although no stones were seen, we suggest a prolonged follow-up of these patients with either periodic ultrasonography of the their gallbladders or with the periodic estimation of their serum bile acids. PMID:24665197

Osuoji, Roland Iheanyichukwu; Balogun, Babajide Olawale; Olofinlade, Olatunbosun Olabode

2014-01-01

118

Immunopathology and Cytokine Responses in Commercial Broiler Chickens with Gangrenous Dermatitis  

Technology Transfer Automated Retrieval System (TEKTRAN)

Gangrene dermatitis (GD) is an emerging disease of increasing economic importance in poultry that results from infection by Clostridium septicum and C. perfringens (CP) type A. Lack of a reproducible disease model has been a major obstacle in understanding the immunopathology of GD. To gain better u...

119

Venous thromboembolism in adolescents.  

PubMed

The incidence of venous thromboembolism (VTE) during childhood is low with two peaks - neonatal and adolescent age. This retrospective study is focused on clinical characteristics ofVTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed--16 girls (88.9%), 2 boys (11.1%). In 9 patients (50%) thrombosis of the lower limb deep veins was diagnosed, six patients (33.3%) suffered from symptomatic pulmonary embolism (PE) and 3 patients (16.7%) from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%). The most frequent acquired risk factor was oral contraception (OC) in 12 out of 16 girls (75%). All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6%) patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50%) in patients with distal lower limb thrombosis, but very high (100%) in patients with PE. PMID:23101270

Samková, Aneta; Lejhancová, Katerina; Hak, Jirí; Lukes, Antonín

2012-01-01

120

The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.  

PubMed

Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed. PMID:6968314

Harris, P L; Woollard, K; Bartoli, A; Makey, A R

1980-01-01

121

Death talk: gender differences in talking about one’s own impending death  

PubMed Central

Background According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient’s family without that patient’s consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient’s impending death, patient’s significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients. Methods This is a retrospective analysis of detailed prospective “field notes” from chaplain interviews of all patients aged 30–75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication. Results During the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p?=?0.001). By the end of the second interview gender difference was less, but still statistically significant (p?=?0.001). Conclusions Gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training. Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men. PMID:24618410

2014-01-01

122

Aesthetic scrotal reconstruction following extensive Fournier’s gangrene using bilateral island pedicled sensate anterolateral thigh flaps: A case report  

PubMed Central

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.

2014-01-01

123

Penoscrotal Reconstruction Using Groin and Bilateral Superomedial Thigh Flaps: A Case of Penile Vaselinoma Causing Fournier's Gangrene  

PubMed Central

Penile augmentation by the injection of mineral oil provokes many serious, undesirable effects. Although there are reports of complications such as deformity, ulceration, necrosis, and erectile dysfunction, Fournier's gangrene resulting from the injection of petroleum jelly into the penis has not been reported. Here, we present a 42-year-old man with penile vaselinoma causing Fournier's gangrene which was treated successfully with aggressive surgical debridement, followed by penoscrotal reconstruction using groin and bilateral superomedial thigh flaps. PMID:17722250

Lee, Sang Wook; Bang, Chi Young

2007-01-01

124

Ethical dilemmas related to predictions and warnings of impending natural disaster.  

PubMed

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

2013-01-01

125

Balloon cinch deformity during angioplasty procedures: an indication for impending rupture.  

PubMed

Percutaneous transluminal balloon angioplasty (PTA) is a commonly performed procedure for hemodialysis vascular access dysfunction including thrombosis. While PTA is generally safe, balloon rupture during the procedure is a potential complication. Because such a rupture can cause damage to the blood vessel, indication of an imminent balloon rupture might help avoid such a complication. This analysis reports on six PTA procedures that were complicated by balloon rupture. All cases demonstrated terminal (caudal/cranial) cinch deformation. There was a loss of sharp terminal tapering and its replacement with banana silhouette before the balloon rupture. Importantly, the contour deformation and balloon rupture occurred at a pressure that was lower than the rated burst pressure. The cinch deformity can be used as an indication for impending balloon rupture. We suggest deflation of balloons that demonstrate shape deformations to avoid vascular injury. PMID:24118583

Salman, Loay; Castro, Hector; Vazquez-Padron, Roberto I; Monrroy, Mauricio; Abdelwahed, Yehia; Rizvi, Abid; Duque, Juan; Akmal, Muhammad Usman Talha; Merrill, Donna; Nayer, Ali; Asif, Arif

2014-03-01

126

Pycnogenol® in chronic venous insufficiency and related venous disorders.  

PubMed

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

2014-03-01

127

Venous complications of pancreatitis: a review.  

PubMed

Pancreatitis is notorious to cause vascular complications. While arterial complications include pseudoaneurysm formation with a propensity to bleed, venous complications can be quite myriad. Venous involvement in pancreatitis often presents with thrombosis. From time to time case reports and series of unusual venous complications associated with pancreatitis have, however, been described. In this article, we review multitudinous venous complications in the setting of pancreatitis and propose a system to classify pancreatitis associated venous complications. PMID:25640778

Aswani, Yashant; Hira, Priya

2015-01-01

128

Venous ulcers - self-care  

MedlinePLUS

... When these valves become weak, blood can flow backward and pool in your legs. This is called ... are at risk for venous ulcers, take these steps to help prevent problems. Raise your feet above ...

129

Central Venous Access for Chemotherapy  

Microsoft Academic Search

\\u000a Systemic chemotherapy is the cornerstone of modern day cancer treatment. Chemotherapeutic agents are often caustic solutions\\u000a that require large high flow venous channels for safe delivery; hence the need for central venous access. Chemotherapeutic\\u000a protocols vary greatly with respect to frequency, intensity, and duration. The concept of dose intensity is being scrutinized\\u000a with current trends favoring more frequent administration of

M. Andreas Mauro

130

Pathophysiology of chronic venous disease.  

PubMed

Chronic venous disease (CVD) is a debilitating condition with a prevalence between 60-70%. The disease pathophysiology is complex and involves genetic susceptibility and environmental factors, with individuals developing visible telengiectasias, reticular veins, and varicose veins. Patient with significant lower extremity symptoms have pain, dermal irritation, swelling, skin changes, and are at risk of developing debilitating venous ulceration. The signature of CVD is an increase in venous pressure referred to as venous hypertension. The various symptoms presenting in CVD and the clinical signs that are observed indicate that there is inflammation, secondary to venous hypertension, and it leads to a number of inflammatory pathways that become activated. The endothelium and glycocalyx via specialized receptors are critical at sensing changes in shear stress, and expression of adhesion molecules allows the activation of leukocytes leading to endothelial attachment, diapedisis, and transmigration into the venous wall/valves resulting in venous wall injury and inflammatory cells in the interstitial tissues. There is a complex of cytokines, chemokines, growth factors, proteases and proteinases, produced by activated leukocytes, that are expressed and unbalanced resulting in an environment of persistent inflammation with the clinical changes that are commonly seen, consisting of varicose veins to more advanced presentations of skin changes and venous ulceration. The structural integrity of protein and the extracellular matrix is altered, enhancing the progressive events of CVD. Work focusing on metabolic changes, miRNA regulation, inflammatory modulation and the glycocalyx will further our knowledge in the pathophysiology of CVD, and provide answers critical to treatment and prevention. PMID:24755829

Raffetto, J D; Mannello, F

2014-06-01

131

Fatal spontaneous Clostridium septicum gas gangrene: a possible association with iatrogenic gastric acid suppression.  

PubMed

The long-term use of proton pump inhibitors has been linked to an increased risk for the development of gastric polyps, hip fractures, pneumonia, and Clostridium difficile colitis. There is evidence that chronic acid suppression from long-term use of proton pump inhibitors poses some risk for the development of C difficile-associated diarrhea by decreasing the elimination of pathogenic microbes before reaching the lower gastrointestinal tract. Here we present a case of a 51-year-old woman with a recent history of abdominal pain and fever who presented to the emergency department with rapidly progressive spontaneous necrotizing fasciitis and gas gangrene and died within hours of presentation. Postmortem examination confirmed spreading tissue gas gangrene and myonecrosis. In addition, multiple intestinal ulcers containing Clostridium septicum were present at autopsy. This case illustrates a possible association between proton pump inhibitor therapy and fatal C septicum infection. PMID:24878026

Wu, Yiru E; Baras, Alexander; Cornish, Toby; Riedel, Stefan; Burton, Elizabeth C

2014-06-01

132

Fournier's gangrene in a patient with obesity and B-lymphoma.  

PubMed

We present a case of Fournier's gangrene disease in a young obese patient with coexistent B-lymphoma. It remains controversial if obesity constitutes a predisposing factor for an individual to develop necrotizing fasciitis. On the other hand, only few cases of patients with coexistence of B-lymphoma and Fournier's gangrene disease have been reported. A 30-years-old obese man was admitted to emergency department with fever (38.7 °C), pain, erythema and swelling extended from the left scrotum to the left lower abdominal quadrant. He was confused, with low urinary excretion and septic shock's signs. The clinical findings were characteristics of Fournier's gangrene disease. Furthermore during physical examination a massive, painless and motionless mass in the left breast was revealed. The patient required urgent surgical debridement of the affected area and pus drainage. Biopsies of the breast mass were received by excision. Pus and blood cultures yielded Staphylococci coagulase(-), Klebsiella and Proteus sp. Intravenous antibiotic treatment with Meropeneme and Clindamycine started immediately. Repeated debridement was often performed. Pathology examination of the massive tissue revealed a diffuse B-lymphoma of large cells (Germinal center B-cell like- GCB). The patient was discharged from the hospital 35 days later. Afterwards, he was treated with chemotherapeutic agents for malignant lymphoma at the oncological department. The aim of this case's presentation is to mention that young obese patients with Fournier's gangrene disease should be particularly investigated due to the possible occurrence of another not obvious predisposing factor, such as a malignant disease. PMID:24093820

Komninos, C; Karavitakis, M; Koritsiadis, S

2013-01-01

133

[Thromboprophylaxis of venous thromboembolism].  

PubMed

Recently in Japan, venous thromboembolism (VTE) [deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE)] has increased with the Westernization of eating habits and the aging of society. In the West, prophylactic guidelines have been discussed for many years, and, unfortunately, Japan falls far behind the West in this area. We developed Japanese Guidelines for VTE prophylaxis based on the 6th ACCP guidelines in 2004. The incidence of perioperative PTE in Japan has been investigated by the Japanese Society of Anesthesiologists since 2002. The rate of perioperative PTE was estimated to be 4.76 per 10,000 operations in 2003. As we expected, it significantly decreased after the guidelines for thromboprophylaxis were issued and the management fee for PTE prophylaxis was covered by health insurance in April 2004. However, mechanical prophylaxis is not sufficient to prevent mortality rates, and advanced prophylaxis by anticoagulants, such as low-molecular-weight heparin/Xa inhibitors along with unfractionated heparin/vitamin K antagonists will be essential. As a result of use of anticoagulants, mortality rates have been significantly decreased recently. PMID:25163326

Kobayashi, Takao

2014-07-01

134

Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess  

PubMed Central

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy. PMID:21317986

Papaconstantinou, Ioannis; Yiallourou, Anneza I.; Dafnios, Nicolaos; Grapsa, Irini; Polymeneas, George; Voros, Dionysios

2011-01-01

135

Is chronic venous ulcer curable? A sample survey of a plastic surgeon  

PubMed Central

Introduction: Venous ulcers of lower limbs are often chronic and non-healing, many a time neglected by patients and their treating physicians as these ulcers mostly do not lead to amputation as in gangrenous arterial ulcer and also cost much to complete the course of treatment and prevention of recurrence. Materials and Methods: One hundred and twenty two lower limb venous ulcers came up for treatment between May 2006 and April 2009. Only twenty nine cases completed the treatment. The main tool of investigation was the non invasive Duplex scan venography. Biopsy of the ulcer was done for staging the disease. Patients? choice of treatment was always conservative and as out-patient instead of hospitalisation and surgery, which required a lot of motivation by the treating unit. Results: Out of twenty nine cases, ten cases were treated conservatively and seven (24.13%) healed well. Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful. Only seven cases (24.13%) failed to heal. Compression stockings were advised to control oedema, varices and pain. Foot care, regular exercises and follow-up were stressed effectively. PMID:21713194

Alamelu, V

2011-01-01

136

Evaluation of the Utility of the Fournier's Gangrene Severity Index in the Management of Fournier's Gangrene in North India: A Multicentre Retrospective Study  

PubMed Central

Objective: To study the utility of Fournier's Gangrene Severity Index (FGSI) with mortality predictive value in our tertiary institutes in North India. Materials and Methods: A retrospective study of 95 cases of Fournier's Gangrene (FG), admitted from 2009 to 2011, was carried out. We analysed clinical and laboratory findings, various prognostic factors, surgical treatments and their outcomes in FG patients. FGSI was used as individual variable to estimate the severity of FG; the effects of these factors on mortality were also evaluated. Results: The overall mean age was 46.5 ± 15.6 (range 24-82) years. Anorectal and urological regions were the main sites of the infection. The most common site of infection origin was scrotum in 81.3% in group A and 41.2% in group B. One or more predisposing factors such as diabetes mellitus (DM; 55%) malignancies (4.6%), chronic renal failure (4.5%) and previous surgery (9.2%) were detected. We observed mortality in 26.5% cases (17/65). The FGSI calculated averaged 5.95 ± 365 in group A and 9.44 ± 2.56 in group B, at the time of admission (P > 0.05). Conclusion: In FG, an early diagnosis and early surgical debridement are essential. The FGSI seems to be an excellent tool for the outcome prediction. PMID:23378710

Verma, Satyajeet; Sayana, Ashutosh; Kala, Sanjay; Rai, Sujeet

2012-01-01

137

Prophylactic bilateral intramedullary femoral nails for bisphosphonate-associated signs of impending subtrochanteric hip fracture.  

PubMed

In the short and midterm, bisphosphonates have proven highly efficacious in the prevention of low-energy fractures, but long-term results and adverse effects have yet to be definitively identified. Of particular concern are emerging reports of long-term bisphosphonate users presenting with unusual low-energy subtrochanteric femur fractures. Perhaps associated with hyperactive bone remodeling leading to an eventually weakened bony architecture, the efficacy of longer-term bisphosphonate use has come into question, especially in those with >5 years of therapy.This article describes a case of a 65-year-old woman with a 10-year history of bisphosphonate use who presented with prodromal thigh pain and characteristic radiographic findings indicative of potential impending subtrochanteric insufficiency fracture. Supported by reports in the literature, unique characteristics of a certain clinical picture warn of potential bisphosphonate-associated subtrochanteric hip fracture; to our knowledge, we present the first reported prophylactic bilateral femoral intramedullary nailing to prevent fragility fracture. A deeper look into the biochemistry behind associated bony weakness caused by long-term incorporation of bisphosphonates is needed, especially if an endpoint to the therapy is to be determined. However, with mounting clinical evidence supporting the risk of bisphosphonate-associated fragility fracture, a characteristic radiographic appearance and clinical presentation cannot be ignored. In the interim, elective surgery may be an efficacious alternative in the treatment of an expected, readily preventable fracture. PMID:20415309

Yoon, Richard S; Beebe, Kathleen S; Benevenia, Joseph

2010-04-01

138

Dutch Venous Ulcer guideline update.  

PubMed

The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. PMID:24843102

Maessen-Visch, M Birgitte; de Roos, Kees-Peter

2014-05-19

139

Neutrophil Functions and Cytokines Expression Profile in Buffaloes with Impending Postpartum Reproductive Disorders  

PubMed Central

The study was conducted to correlate the periparturient immune status in terms of neutrophil functions and cytokine expression in peripheral blood mononuclear cell culture with impending postpartum reproductive disorders in buffaloes. Forty pregnant buffaloes were observed for occurrence of postpartum reproductive disorders (PRD), i.e., metritis, endometritis and delayed uterine involution etc., during one week prepartum to four weeks postpartum period. A representative number (n = 6) of buffaloes that did not develop any PRD were included in group I (healthy, control), while the animals which experienced PRD were assigned into group II (PRD, n = 8). The blood samples were collected at weekly interval from one week prepartum to four weeks postpartum period considering the day of calving as ‘d 0’. Differential leucocytes counts, superoxide and hydrogen peroxide production activity in isolated neutrophils and the mRNA expression profile of cytokines i.e., IL-2, IL-4 and IFN-? in PBMC culture were studied in all the samples. A higher total leucocytes, neutrophil and band cells count along with impaired neutrophil functions i.e., lowered level of production of superoxide and hydrogen peroxide before parturition and during early postpartum period were observed in buffaloes developing PRD. Further, a lower expression of IL-2, IFN-? and IL-4 mRNA in PBMC culture was observed at calving in buffaloes that subsequently developed PRD at later postpartum. Thus, suppression in neutrophil function and cytokine expression at prepartum to early postpartum period predisposes the buffaloes to develop postpartum reproductive disorders. Hence, monitoring of neutrophils function and cytokine expression profile would be effective to predict certain reproductive disorders at late pregnancy or immediately after parturition in buffaloes. In future, this may be a novel approach for determining suitable management and therapeutic decisions for prevention of commonly occurring reproductive disorders in farm animals. PMID:25049724

Patra, Manas Kumar; Kumar, Harendra; Nandi, Sukdeb

2013-01-01

140

Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review.  

PubMed

Metastatic disease commonly occurs in the spine and incidence is likely to increase secondary to improved survival rates in many cancer patients. Despite published research on instability in patients with metastatic disease of the thoracolumbar spine, controversy exists regarding risk factors for instability and indications for surgical stabilization. The objective of this systematic review was to determine what defines instability and impending instability in patients with metastatic disease of the thoracic and lumbar spine. We systematically reviewed the medical literature in order to identify all the relevant studies concerning patients with metastatic involvement of T1-L5, in the domains of biomechanics, epidemiology, clinical issues, and radiographic parameters. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all the identified studies. We were then able to define the criteria to identify instability of the spine with metastases. A literature search and review identified 14 relevant, good quality studies for inclusion. The predictors of instability included increased tumor size, a larger cross-sectional area of bone defect, increased force of spinal loading, decreased bone density, posterior location of the tumor within the vertebrae, destruction of the costovertebral joint, pedicle destruction in the thoracolumbar spine, increased axial rigidity, and sagittal spinal deformity. Definitive conclusions cannot be reached due to lack of evidence. However, variables such as tumor size, magnitude of spinal loading, bone density, tumor location within the vertebrae and spine, and tumor type are risk factors for instability in spinal metastases. Improved clinical research methodology for this patient population is required. PMID:21109920

Weber, Michael H; Burch, Shane; Buckley, Jenny; Schmidt, Meic H; Fehlings, Michael G; Vrionis, Frank D; Fisher, Charles G

2011-01-01

141

A keratoacanthoma with venous invasion  

PubMed Central

Keratoacanthomas are variously regarded as a self-limiting variant of squamous cell carcinoma or as a distinct benign lesion and they very seldom show attributes normally associated with malignant behaviour, such as perineural invasion. Herein we report the case of a keratoacanthoma with venous invasion proven by immunoperoxidase and elastic tissue stains. PMID:23785617

Tschandl, Philipp; Rosendahl, Cliff; Williamson, Richard; Weedon, David

2012-01-01

142

Anomalies of pulmonary venous return  

Microsoft Academic Search

Total anomalous pulmonary venous return is a rare but life-threatening congenital heart lesion. We present our experience with 48 consecutive infants operated on from 1977 to 1983. Improved results are due to earlier diagnosis, improved surgical technique, and meticulous postoperative care. Since 1980 some patients with this lesion were submitted to surgery on the basis of two-dimensional echocardiography, thus avoiding

Jaroslav Stark

1985-01-01

143

Hyperbaric Oxygen in Therapy of Gas Gangrene—Report of a Case Following Induced Abortion  

PubMed Central

The treatment of gas gangrene has been revolutionized by oxygen drenching of tissues infected with Clostridia. This was used in a massive infection of the abdominal wall following a traumatic abortion attempt. The clostridial infection was controlled, but the patient almost succumbed to a secondary infection of gram-negative organisms. This responded to drainage, antibiotics and general supportive measures. In the course of treatment, the value of a team approach to complicated special problems was documented. ImagesFigure 1.Figure 2. PMID:5949926

Schaupp, Karl L.; Pinto, Douglas; Valentine, Rodney J.

1966-01-01

144

Use of a Vacuum-Assisted Device for Fournier's Gangrene: A New Paradigm.  

PubMed

Fournier's gangrene is a necrotizing infection of the scrotum or perineum that requires aggressive surgical debridement. Radical debridement of perineal necrotizing fasciitis can leave extensive tissue defects that are difficult to close and often require multiple surgical interventions. Vacuum-assisted closure (VAC) devices have been shown to assist in a more rapid closure of these wounds, but placement of such devices in the perineum can pose significant challenges. We have had success with use of VAC devices and report our techniques for their placement. PMID:18470279

Silberstein, Jonathan; Grabowski, Julia; Parsons, J Kellog

2008-01-01

145

Fatal Fournier's gangrene in a young adult with acute lymphoblastic leukemia.  

PubMed

Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the external genitalia. Few reports of FG exist in patients with hematologic malignancies. We describe a case of fatal FG in a 21-year-old man with acute lymphoblastic leukemia who was receiving remission-induction chemotherapy. Despite early local surgery, administration of appropriate antibiotics, resurgery for wider debridement and aggressive ICU support he succumbed while pancytopenic to septic shock, 26 days after initiation of chemotherapy. Multi-drug resistant Pseudomonas aeruginosa was isolated from blood and scrotal cultures obtained at initial surgery. FG is a fulminant infection, especially in the face of profound cytopenias. PMID:16425246

Mantadakis, Elpis; Pontikoglou, Charalampos; Papadaki, Helen A; Aggelidakis, George; Samonis, George

2007-11-01

146

Fournier's gangrene during induction treatment of acute promyelocytic leukemia, a case report.  

PubMed

Fournier's gangrene is described as a fulminant necrotizing fasciitis of the scrotum and penis. Few cases have been reported in the context of acute leukemia. We describe a case, complicating the induction treatment of an acute promyelocytic leukemia with all-trans-retinoic acid and chemotherapy. The evolution was favorable, following surgical excision and broad-spectrum antibiotic therapy. The respective roles of all-trans-retinoic acid and granulocytopenia are discussed. This devastating and life-threatening infection must be kept in mind for early clinical, bacteriological, and radiological diagnosis and surgical management. PMID:9540765

Lévy, V; Jaffarbey, J; Aouad, K; Zittoun, R

1998-02-01

147

Fournier’s Gangrene Complicating Hematologic Malignancies: a Case Report and Review of Licterature  

PubMed Central

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

2013-01-01

148

Use of a Vacuum-Assisted Device for Fournier’s Gangrene: A New Paradigm  

PubMed Central

Fournier’s gangrene is a necrotizing infection of the scrotum or perineum that requires aggressive surgical debridement. Radical debridement of perineal necrotizing fasciitis can leave extensive tissue defects that are difficult to close and often require multiple surgical interventions. Vacuum-assisted closure (VAC) devices have been shown to assist in a more rapid closure of these wounds, but placement of such devices in the perineum can pose significant challenges. We have had success with use of VAC devices and report our techniques for their placement. PMID:18470279

Silberstein, Jonathan; Grabowski, Julia; Parsons, J. Kellog

2008-01-01

149

Fournier's gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation.  

PubMed

Three patients with ANLL developed Fournier's gangrene as an early complication after allo-BMT (two cases) and auto-BMT (one case); two patients were in first CR, the third had resistant disease. Patients developed fever, perineal pain, swelling and blistering of the genital area. Pseudomonas aeruginosa was isolated from the lesions and patients received systemic antibiotic therapy, surgical debridement and medication with potassium permanganate solution. Two patients made a complete recovery although one died of sepsis. The third had progressive involvement of the abdominal wall and later died of leukemia. Early diagnosis of this disorder and prompt initiation of appropriate therapy can prevent progression of this acute necrotizing infection. PMID:9849702

Martinelli, G; Alessandrino, E P; Bernasconi, P; Caldera, D; Colombo, A; Malcovati, L; Gaviglio, M R; Vignoli, G P; Borroni, G; Bernasconi, C

1998-11-01

150

[Gangrene of the penis due to strangulation by a rubber band: a case report].  

PubMed

We report a case of strangulation of the penis by a rubber band. A 79-year-old man placed a rubber band tightly around the corona of his glans penis in order to prevent urinary incontinence. After five days, he was taken to our hospital in an ambulance for high temperature and general malaise. We found the rubber band and removed it immediately. Gangrene of the penis continued and he did not recover from sepsis, so we performed partial penectomy. After the operation, he completely recovered. Penile strangulation using a soft constricting object such as a rubber band might result in severe complications and we should be careful. PMID:24759505

Sasaki, Yutaro; Oda, Shinpei; Fujikata, Shiro; Tanimoto, Shuji; Kan, Masaharu

2014-03-01

151

Necrotic gangrenous intrathoracic appendix in a marfanoid adult patient: a case report  

PubMed Central

Background A diaphragmatic hernia is defined as a defect in part of the diaphragm through which abdominal contents can protrude into the thorax. It may be congenital or acquired. In this case report, we aim to demonstrate a congenital diaphragmatic hernia in an adult marfanoid patient which required emergency treatment Case presentation A 43 year old woman was admitted with classical appendicitis requiring surgery. She incidentally had Marfan's clinical features with a positive family history for the syndrome. At operation she had grossly abnormal abdominal anatomy. Radiological investigations demonstrated a large right congenital diaphragmatic hernia with an intrathoracic hernial sac containing a perforated gangrenous appendix. The hernial sac was opened surgically and the appendix excised. The patient made a full recovery. Conclusion Diaphragmatic hernias are usually congenital in nature often requiring early corrective surgery for future survival. We have demonstrated the presence of an unusually large diaphragmatic defect, almost a hemidiaphragmatic defect, of unknown direct etiology, but of some possible association with Marfan's syndrome in an adult patient presenting with an acute perforated gangrenous appendix requiring emergency life-saving surgery. PMID:15762981

Barakat, Mohannad J; Vickers, Jon H

2005-01-01

152

Management of Fournier's gangrene--report of 7 cases and review of the literature.  

PubMed

Fournier's gangrene is a rare infection characterized with fast-progressing myonecrosis, that affect regions of perineum, genitalia and perianal area. This retrospective study presents authors' experiences and their principles in early diagnosis and treatment of Fournier's gangrene. The goal of this paper is to point out numerous diagnostically and therapeutic difficulties that lead to a high mortality if not recognized in time. We here describe seven male patients with myonecrosis and necrotising fasciitis in scrotal, perianal and perineal regions. Average age was 61 years (form 57 to 66 years of age), and average length of treatment was 25.8 days (from 14 to 36 days), with lethality of 14% (one case). We have recognised diabetes mellitus as risk factor, together with urethrostenosis, and other diseases of the perianal region (hemorrhoids, anal fissure, abscesses). Our hypothesis is that the key of the successful treatment is to treat as soon as symptoms onset, early and aggressive necrectomy under broad antibiotic protection. We also emphasize the possibility of recurrence of this disease even several years after treatment. PMID:17509961

Fajdic, J; Bukovic, D; Hrgovic, Z; Habek, M; Gugic, D; Jonas, D; Fassbender, Walter J

2007-04-26

153

Management of necrotizing pneumonia and pulmonary gangrene: A case series and review of the literature  

PubMed Central

BACKGROUND: Necrotizing pneumonia is an uncommon but severe complication of bacterial pneumonia, associated with high morbidity and mortality. The availability of current data regarding the management of necrotizing pneumonia is limited to case reports and small retrospective observational cohort studies. Consequently, appropriate management for these patients remains unclear. OBJECTIVE: To describe five cases and review the available literature to help guide management of necrotizing pneumonia. METHODS: Cases involving five adults with respiratory failure due to necrotizing pneumonia admitted to a tertiary care centre and infected with Streptococcus pneumoniae (n=3), Klebsiella pneumoniae (n=1) and methicillin-resistant Staphylococcus aureus (n=1) were reviewed. All available literature was reviewed and encompassed case reports and retrospective reviews dating from 1975 to the present. RESULTS: All five patients received aggressive medical management and consultation by thoracic surgery. Three patients underwent surgical procedures to debride necrotic lung parenchyma. Two of the five patients died in hospital. CONCLUSIONS: Necrotizing pneumonia often leads to pulmonary gangrene. Computed tomography of the thorax with contrast is recommended to evaluate the pulmonary vascular supply. Further study is necessary to determine whether surgical intervention, in the absence of pulmonary gangrene, results in better outcomes. PMID:24791253

Chatha, Neela; Fortin, Dalilah; Bosma, Karen J

2014-01-01

154

[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases].  

PubMed

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

2013-08-01

155

Imaging of cerebral venous thrombosis.  

PubMed

Cerebral venous thrombosis (CVT) is a potentially life-threatening emergency. The wide ranging of clinical symptoms makes the use of imaging in "slices" even more important for diagnosis. Both CT and MRI are used to diagnose the occlusion of a venous sinus, but MRI is superior to CT for detecting a clot in the cortical or deep veins. CT can show the hyperintense clot spontaneously and CT angiography the intraluminal defect. MRI also detects this thrombus, whose signal varies over time: in the acute phase, it is hypointense in T2*, whilst T1 and T2 can appear falsely reassuring; in the subacute phase, it is hyperintense on all sequences (T1, T2, FLAIR, T2*, diffusion). MRI easily shows the ischemic damage, even hemorrhagic, in the cerebral parenchyma in cases of CVT. Finally, imaging may reveal pathology at the origin of the CVT, such as a fracture of the skull, infection, tumor, dural fistula, or intracranial hypotension. PMID:25465119

Bonneville, F

2014-12-01

156

Inherited thrombophilia and venous thromboembolism.  

PubMed

Pulmonary thromboembolism (PTE) is the major cause of maternal death in the UK. Underlying PTE is the problem of deep venous thrombosis (DVT). Inherited thrombophilia will be found in about 50% of women with a personal history of venous thromboembolism (VTE), and screening for thrombophilia should be considered in women with a personal or family history of VTE. There is currently no place for universal screening for thrombophilia in pregnancy. There are particular considerations with regard to the management of thrombophilia in pregnancy. Low-molecular-weight heparins are now the heparin of choice in pregnancy because of a better side-effect profile (substantially reduced risk of heparin-induced osteoporosis and heparin-induced thrombocytopaenia) compared to unfractionated heparin, good safety record for mother and fetus and convenient once-daily dosing for prophylaxis. PMID:12787535

Greer, Ian A

2003-06-01

157

Abdominal angina and intestinal gangrene—A catastrophic presentation of arterial fibromuscular dysplasia: Case report and review of the literature  

Microsoft Academic Search

A 5-year-old boy presented with episodic, postprandial abdominal pain and hypertension. A few days after the onset of symptoms, the pain became more severe, and progressed into a picture of acute abdomen and intestinal obstruction. Urgent laparotomy findings showed the presence of small bowel gangrene. Pathology findings of the superior mesenteric artery (SMA), which was found to be occluded, showed

Radi M. A Hamed; Khalil Ghandour

1997-01-01

158

Where does venous reflux start?  

Microsoft Academic Search

Purpose: This study was designed to identify the origin of lower limb primary venous reflux in asymptomatic young individuals and to compare patterns of reflux with age-matched subjects with prominent or clinically apparent varicose veins.Methods: Forty age- and sex-matched subjects with no symptoms (age, 15 to 35 years; 80 limbs; group A), 20 subjects (age, 19 to 32 years; 40

Nicos Labropoulos; Athanasios D. Giannoukas; Kostas Delis; M. Ashraf Mansour; Steven S. Kang; Andrew N. Nicolaides; John Lumley; William H. Baker

1997-01-01

159

Macroglossia due to venous malformation  

Microsoft Academic Search

Massive vascular malformation involving tongue can cause significant functional impairment. In this report we describe a rare\\u000a case of extensive venous malformation involving tongue leading to obstructive sleep apnoea, inability to speak, eat, severe\\u000a discomfort due to exposure induced dryness and ulceration. Multimodality treatment approach comprising of sclerotherapy, electrocautery\\u000a and radiation therapy was used in this case.

T. S Anand; Ritu Mittal; T. B. Shashidhar; R. K. Sharma

2006-01-01

160

Experience with penile venous surgery.  

PubMed

Venogenic impotence was detected in 37 out of 141 patients who attended our clinic with a complaint of erectile dysfunction. Eighteen patients presented with primary impotence and the rest had progressive secondary impotence. All 37 patients have shown partial or poor response to 60 mg of intracavernosal papaverine. The corporovenous leak (CVL) was diagnosed on the careful workup of dynamic pharmacocavernosometry and cavernosography. Concomitant arterial cause was noted in 10% cases on the basis of penile duplex Doppler ultrasound study. 24 patients in the age group of 23-60 years underwent the penile venous surgery. The CVL was noted in the deep dorsal vein (23 cases), cavernous vein (16) and in the crural vein (2). The operation consisted of deep dorsal vein (DDV) ligation and excision with all tributaries (8 cases) or DDV ligation and excision+cavernous vein ligation (13 cases), through an infrapubic curvilinear incision. One patient had crural vein ligation and corporoplasty through a perineal incision, one had direct corporeal revascularization for associated arteriogenic impotence with venous leak and another had distal spongiolysis and closure of a corporospongiosal shunt. The results were excellent in 11 cases, improved in 6 and 7 had failures. Surgical intervention is effective in CVL in selected cases but limiting factors in the form of increasing age, concomitant arteriogenic cause, significant crural leak, missing tributaries, recurrent venous leak and unknown factors may also be present to prevent total cure. PMID:8333094

Motiwala, H G; Patel, D D; Joshi, S P; Baxi, H M; Desai, K D; Shah, K N

1993-01-01

161

21 CFR 870.1140 - Venous blood pressure manometer.  

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 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...

2011-04-01

162

21 CFR 870.1140 - Venous blood pressure manometer.  

Code of Federal Regulations, 2014 CFR

...2014-04-01 2014-04-01 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...

2014-04-01

163

21 CFR 870.1140 - Venous blood pressure manometer.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 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...

2013-04-01

164

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...

2010-04-01

165

Septic shock due to Fournier’s gangrene of the scrotum  

PubMed Central

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

2011-01-01

166

Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene  

PubMed Central

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

2013-01-01

167

[A case of Fournier's gangrene requiring extensive debridement including bilateral orchiectomy and amputation of the penis].  

PubMed

With the evolution of antibiotic agents, necrotizing fasciitis of the male genitalia first described by Fournier has become rare. However, its mortality rate is still high. We present a severe case of this disease. An 80-year-old man who had poor controlled diabetes mellitus was admitted to our hospital with painful swelling of penoscrotal region. Chemotherapy using broad-spectrum antibiotics and drainage of penis, scrotum and lower abdominal wall was performed combined with insulin therapy. Despite the drainage and aggressive chemotherapy with insulin therapy, the gangrene enlarged rapidly and the patient's general condition was getting very poor. Then, we performed extensive debridement including bilateral orchiectomy and amputation of the penis. After the operation, the patient became afebrile and his general condition was improved. PMID:4061207

Oki, M; Yui, Y; Akimoto, M

1985-06-01

168

Fournier's gangrene - Not a stigma for surgery with newer surgical reconstruction of scrotum.  

PubMed

A 34-year-old man with complaining of high fever and painful swelling and edema of the scrotum was admitted to our hospital. As per clinical and radiological findings, he diagnosed as a case of Fournier's gangrene. We started treatment with antibiotics, and extensive soft tissue debridement of scrotum done. After the debridement, infection was controlled by wound irrigation, higher antibiotic, regular dressing. Patient improved drastically and mature granulation covered both the testes completely within 14 days. After all this treatment, the neoscrotum was made successfully by mobilizing bilateral fascio-cutaneous flaps from adjacent supero-medial sites of the thighs. The patient was discharged on 26th day and patient is doing well in follow up. PMID:23133291

Tomar, Suryapratap Singh

2010-07-01

169

Solitary Candida albicans Infection Causing Fournier Gangrene and Review of Fungal Etiologies  

PubMed Central

Polymicrobial bacterial infections are commonly found in cases of Fournier gangrene (FG), although fungal growth may occur occasionally. Solitary fungal organisms causing FG have rarely been reported. The authors describe a case of an elderly man with a history of diabetes who presented with a necrotizing scrotal and perineal soft tissue infection. He underwent emergent surgical debridement with findings of diffuse urethral stricture disease and urinary extravasation requiring suprapubic tube placement. Candida albicans was found to be the single causative organism on culture, and the patient recovered well following antifungal treatment. Fungal infections should be considered as rare causes of necrotizing fasciitis and antifungal treatment considered in at-risk immunodeficient individuals. PMID:25009452

Perkins, Tiffany A; Bieniek, Jared M; Sumfest, Joel M

2014-01-01

170

Partial penectomy after debridement of a Fournier's gangrene progressing with an isolated penile necrosis.  

PubMed

Fournier's gangrene (FG) is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic and immune compromised patients. Here, we report an unusual case of FG with isolated glans penis necrosis in a diabetic 77-year-old male patient presented to the emergency department complaining 5 days of pain and darkening of the glans penis. Examination of the patient's glans penis was consistent with FG and included significant erythema and infectious discharge. He was given intravenous antibiotics and emergency debridement was done. On following days, the necrotic area spread to distal parts of both cavernosal areas. Partial penectomy was performed. Isolated penile involvement in FG is very rare. Performing partial penectomy in appropriate cases can save penile length, stop the progression of disease, and increase the quality of life. PMID:25541853

Akbulut, Fatih; Kucuktopcu, Onur; Sonmezay, Erkan; Simsek, Abdulmuttalip; Ozgor, Faruk; Gurbuz, Zafer Gokhan

2014-09-01

171

Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access  

SciTech Connect

Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.

Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio, E-mail: sergio.sierre@usa.net [Hospital Aleman, Department of Interventional Radiology (Argentina)

2011-12-15

172

Stent Placement on Fresh Venous Thrombosis  

SciTech Connect

Purpose: To report on the efficacy of fixing fresh venous thrombus to the venous wall by stent placement. Methods: Seven patients underwent stenting to treat acute venous thrombosis. In two patients, the hemodialysis fistula was thrombosed with the thrombus extending into the brachial veins. In three patients, the hemodialysis fistula was patent but massive swelling of the ipsilateral arm was caused by proximal venous thrombosis. Two patients presented with iliac venous thrombosis within stented pelvic veins. Stent placement was preceded by other mechanical thrombectomy methods in all cases. Results: Attachment of thrombus to the venous wall was successful in all cases treated. Acute rethrombosis did not occur. Follow-up patency in dialysis patients was 7.2 {+-} 2.1 months. One patient had rethrombosis of the dialysis graft 3 months after primary treatment. Three patients developed restenosis within a mean period of 7.7 months. One shunt remained patent for 10 months with no event of reobstruction during follow-up. In both patients with iliac stent placement, the vein remained patent over a follow-up period of 8 and 12 months respectively. Conclusion: Stenting fresh venous thrombus can achieve immediate venous patency. It may be used as an alternative approach when all other percutaneous methods fail. Frequent restenosis within stented veins limits its use to very selected cases.

Vorwerk, Dierk; Guenther, Rolf W.; Schuermann, Karl [Department of Diagnostic Radiology, Technical University of Aachen, Pauwelstrasse, D-52057 Aachen (Germany)

1997-09-15

173

Venous Anatomy of the Right Colon  

Microsoft Academic Search

PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and

Shigeki Yamaguchi; Hiroya Kuroyanagi; Jeffrey W. Milsom; Richard Sim; Hiroshi Shimada

2002-01-01

174

Total anomalous systemic and pulmonary venous connection.  

PubMed

Total anomalous systemic and pulmonary venous connection is an extremely rare congenital cardiac anomaly. We present our unique experience of managing this complex partially diagnosed cardiac anomaly in a 16-month-old boy. The systemic venous anomaly was not detected during the initial preoperative evaluation. He was doing well on follow-up, with normal pulmonary artery pressure. PMID:24887855

Mishra, Amit; Sharma, Pranav; Shah, Ritesh; Oswal, Nilesh; Rana, Yashpal

2015-01-01

175

Venous Thromboembolism in Patients with Membranous Nephropathy  

PubMed Central

Summary Background and objectives The aims of this study were to determine the frequency of venous thromboembolic events in a large cohort of patients with idiopathic membranous nephropathy and to identify predisposing risk factors. Design, setting, participants, & measurements We studied patients with biopsy-proven membranous nephropathy from the Glomerular Disease Collaborative Network (n=412) and the Toronto Glomerulonephritis Registry (n=486) inception cohorts. The cohorts were pooled after establishing similar baseline characteristics (total n=898). Clinically apparent and radiologically confirmed venous thromboembolic events were identified. Potential risk factors were evaluated using multivariable logistic regression models. Results Sixty-five (7.2%) subjects had at least one venous thromboembolic event, and this rate did not differ significantly between registries. Most venous thromboembolic events occurred within 2 years of first clinical assessment (median time to VTE = 3.8 months). After adjusting for age, sex, proteinuria, and immunosuppressive therapy, hypoalbuminemia at diagnosis was the only independent predictor of a venous thromboembolic event. Each 1.0 g/dl reduction in serum albumin was associated with a 2.13-fold increased risk of VTE. An albumin level <2.8 g/dl was the threshold below which risk for a venous thromboembolic event was greatest. Conclusions We conclude that clinically apparent venous thromboembolic events occur in about 7% of patients with membranous nephropathy. Hypoalbuminemia, particularly <2.8 g/dl, is the most significant independent predictor of venous thrombotic risk. PMID:22076873

Lionaki, Sophia; Derebail, Vimal K.; Hogan, Susan L.; Barbour, Sean; Lee, Taewoo; Hladunewich, Michelle; Greenwald, Allen; Hu, Yichun; Jennette, Caroline E.; Jennette, J. Charles; Falk, Ronald J.; Cattran, Daniel C.; Nachman, Patrick H.; Reich, Heather N.

2012-01-01

176

Intracranial venous drainage through spinal veins.  

PubMed

There is extensive collateral networking at the craniocervical junction with a substantial anatomical and functional continuity between the veins, venous sinuses, and venous plexuses of the brain and spine. The predominant pathway for intracranial blood outflow may depend on the level and degree of obstruction. We are presenting an unusual case of predominant egress of intracranial blood through enlarged spinal canal venous collaterals due to thrombosis of the intracranial venous sinuses. Awareness of this unique pattern of venous drainage of the cranium is important and should be considered in the differential diagnosis of spinal arteriovenous malformation (AVM) or arteriovenous fistula (AVF). Magnetic Resonance Venography (MRV) of the brain should be considered to exclude intracranial thrombosis in these cases. PMID:25141475

Choudhary, Arabinda Kumar; Dias, Mark S; Iantosca, Mark

2014-06-01

177

Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy  

PubMed Central

Fournier's gangrene is a rare process which affects soft tissue in the genital and perirectal area. It can also progress to all different stages of sepsis, and abdominal compartment syndrome can be one of its complications. Two patients in septic shock due to Fournier gangrene were admitted to the Intensive Care Unit of Emergency Department. In both cases, infection started from the scrotum and the necrosis quickly involved genitals, perineal, and inguinal regions. Patients were treated with surgical debridement, protective colostomy, hyperbaric oxygen therapy, and broad-spectrum antibacterial chemotherapy. Vacuum-assisted closure (VAC) therapy was applied to the wound with the aim to clean, decontaminate, and avoid abdominal compartmental syndrome development. Both patients survived and were discharged from Intensive Care Unit after hyperbaric oxygen therapy cycles and abdominal closure. PMID:22606389

Zagli, Giovanni; Cianchi, Giovanni; Degl'Innocenti, Sara; Parodo, Jessyca; Bonetti, Lorenzo; Prosperi, Paolo; Peris, Adriano

2011-01-01

178

Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria  

PubMed Central

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

2013-01-01

179

Xenogenic (porcine) Acellular Dermal Matrix Promotes Growth of Granulation Tissues in the Wound Healing of Fournier Gangrene.  

PubMed

This article investigates the application values of Xenogenic (porcine) acellular dermal matrix (XADM) in preparation of a Fournier gangrene wound bed. Thirty-six consecutive cases of patients with Fournier gangrene between 2002 and 2012 were enrolled in our department of our hospital. The patients were divided into two groups according to different methods of wound bed preparation after surgical débridement, including the experimental group (17 cases) and the control group (19 cases). The wounds in the experimental group were covered with XADM after surgical wound débridement, whereas the wounds were cleaned with hydrogen peroxide and sodium hypochlorite solution (one time/day) in the control group. The wound bed preparation time and hospital stay were then compared in the two groups. The wound preparation time was 13.64 ± 1.46 days and hospitalization period was 26.06 ± 0.83 days in the experimental XADM group. In the control group, the wound bed preparation time and hospitalization period were 22.37 ± 1.38 and 38.11 ± 5.60 days, respectively. The results showed statistical differences between these two groups. When used in wound débridement after Fournier gangrene, XADM protects interecological organizations, promotes the growth of granulation tissues, and maximally retains function and morphology of the perineum and penis. PMID:25569072

Zhang, Zhaoxin; Lv, Lei; Mamat, Masut; Chen, Zhao; Zhou, Zhitao; Liu, Lihua; Wang, Zhizhong

2015-01-01

180

Early scrotal approximation after hemiscrotectomy in patients with Fournier’s gangrene prevents scrotal reconstruction with skin graft  

PubMed Central

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.

2013-01-01

181

Venous thromboembolism in Thai children.  

PubMed

This is a retrospective study of 24 pediatric venous thromboembolism (VTE) patients with or without pulmonary embolism, conducted in Bangkok, Thailand, between 1981 and 2005. The incidence rate of VTE in Thai children was 3.9/10,000 hospital admissions per year. The median age was 11.7 years. Seventy-five percent of the patients had at least one associated medical condition accounting for the VTE; the two most common conditions, however, were infection and malignancy. Pulmonary embolism occurred in 29% of patients. Observed outcomes of VTE in this series included death (13%), postphlebitic syndrome (13%), and recurrence (26%). Genetic risk factors were explored in 19 patients, and no factor V Leiden or prothrombin 20210 mutations were detected. Protein C deficiency was found in 4 patients. PMID:17613867

Sirachainan, Nongnuch; Chuansumrit, Ampaiwan; Angchaisuksiri, Pantep; Pakakasama, Samart; Hongeng, Suradej; Kadegasem, Praguywan

2007-06-01

182

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.

1996-01-01

183

[Venous angioma with associated cerebellar haemorrhage].  

PubMed

Venous angiomas are a developmental anomaly in which embryonic venous drainage is still present into adulthood. They are usually asymptomatic and benign course but they can cause seizures and less commonly bleeding, usually associated to cavernous malformation. Normally, treatment is not necessary although bleeding, severe clinical and lesions in which it is possible a favourable approach, we can consider treatment. We show a case of a 11 years old boy with acute decrease level of consciousness. We observed hematoma in the right cerebellar hemisphere with radial tubular structures consistent with developmental venous anomaly. The hematoma was evacuated without a demonstrable other reason justifying the bleeding. PMID:23218501

Sánchez Medina, Yanire; Pérez del Rosario, Pedro Antonio; Domínguez, Jaime; Millán, Ana

2013-01-01

184

Venous Ulcers: New Options in Treatment: Minimally Invasive Vein Surgery  

PubMed Central

Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the underlying venous pathology either due to venous valvular dysfunction or venous obstruction leading to venous hypertension. Recently, significant advances in endogenous methods have evolved. The development of a new concept, minimally invasive vein surgery (MIVS), has improved upon traditional, open, invasive treatments of venous disease. MIVS techniques are performed percutaneously, with minimal anesthesia, no incisions and rarely require hospital admission. This article summarizes the concept of MIVS, describes each method of MIVS and its complementary role in the management of venous leg ulcers patients. PMID:24527103

Poblete, Honesto; Elias, Steven

2009-01-01

185

Anatomy of the foot venous pump: physiology and influence on chronic venous disease.  

PubMed

The aim of this paper is to demonstrate the location of the venous foot pump using an anatomical study. Four hundred cadaveric feet were injected with green neoprene latex followed by a dissection. A coloured segmentation of the venous system was achieved. The Lejars' concept of the venous sole of the foot is incorrect: the true blood venous reservoir of the foot is located deeply in the plantar veins, between the plantar muscles. The medial and mostly lateral plantar veins converge into the plexus shaped calcaneal crossroad, where the blood is ejected upwards into the two posterior tibial veins. In addition, the several medial perforators of the foot directly connect the deep system (medial plantar veins) to the superficial venous system (medial marginal vein). This forms a true 'medial functional unit' which is unique in the limb given its directional flow is from deep to superficial. In conclusion, the plantar veins play an important role in the physiology of the venous return since a venous reservoir of 25 mL of blood is mobilized upwards with each step during walking. Therefore, the impairment of the foot pump by a static foot disorder should be considered as an important risk factor for chronic venous disease, and should be evaluated and corrected in any patient with venous insufficiency. PMID:22847928

Uhl, J-F; Gillot, C

2012-08-01

186

Debate: whether venous perforator surgery reduces recurrences.  

PubMed

Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive procedures. Despite this, there remains much discussion (as well as overt disagreement) about whether perforator vein surgery is actually appropriate and beneficial in the first place. Surgeons have no level I evidence from randomized controlled studies to determine whether perforator vein surgery does or does not reduce the chances of recurrence of superficial venous varicosities, so we must rely on the evidence as it currently is. Perhaps not surprisingly, our two experts have assembled divergent opinions on the role of perforator venous surgery in contemporary practice. PMID:25154966

Whiteley, Mark S; O'Donnell, Thomas F

2014-09-01

187

[Deep venous insufficiency of the lower extremities].  

PubMed

Lower limbs chronic venous insufficiency (CVI) is a widespread pathologic condition. Prevalence of venous ulcer in Europe ranges between 0.5% and 1.0%. Venous ulceration can be due to insufficiency of the superficial system, although deep venous insufficiency is responsible for 75% of the cases. Morbidity and socio-economic costs are exceedingly high especially because of frequent recurrences. CVI recognises mainly two causes: 1) increased influx, due to arteriovenous fistulas; 2) difficult outflow usually secondary to postphlebitic or primitive valvular incompetence. The prevalence of CVI and venous ulceration is difficult to assess. Surgical treatment tends to cure the underlying hemodynamic problem. Homans in 1916 first introduced surgical treatment of CVI and venous ulceration: excision of the cutaneous lesion and ligature suprafascial of the communicating veins. Since then different various techniques have been introduced in the clinical practice: Linton in 1938 supported subfascial interruption of the perforating veins but still reported a recurrence rate of 47%. Stripping of internal saphenous vein associated with division of perforating veins is still controversial, because lacks evidence of its real effectiveness in preventing recurrences. Felder's surgical technique is preferred by some authors to Linton's technique, because of the possibility to divide and section incompetent perforating veins without a cutaneous incision in the severely diseased postphlebitic tissues. In personal experience (56 patients) treated by Felder's techniques, we reached a cutaneous ulceration healing rate of 36% has been obtained. Subfascial interruption of perforating veins under endoscopic vision associated to the stripping of the internal saphenous vein could be a valuable option in the treatment of CVI because of the shorter duration of the operation and hospital stay and lesser postoperative complications. Repair and/or replacement of deep venous valves, originally described by Kistner in 1968, could be curative of venous hypertension due to primitive valvular insufficiency (primitive or postphlebitic): the same author in 1975 reported positive results (80% at 5 years). Major advantages of indirect valvuloplastic surgical technique are: 1) venotomy is not necessary; 2) it does not introduce extraneous material in the vasal lumen; 3) clamping of the vein is avoided; 4) heparine or other antithrombotic measures are usually not necessary. Although preliminary encouraging results, subsequent clinical experiences have demonstrated that correction of the reflux of the main axial venous system alone is not curative and durable resolution of venous symptoms also depends on the concomitant correction of all incompetent perforating veins. Venous valves transplantation is theoretically good to correct the deep long reflux and to improve calf pump function, although clinical results are still limited and follow-up not prolonged enough in terms of symptoms resolution and complete ulcer healing. PMID:10207291

Sica, G S; Forlini, A; Sileri, P; Russo, F; Rulli, F; Gaspari, A L

1998-11-01

188

The chronic cerebrospinal venous insufficiency syndrome.  

PubMed

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials. PMID:21106999

Zamboni, P; Galeotti, R

2010-12-01

189

Quantitative real-time PCR assay for Clostridium septicum in poultry gangrenous dermatitis associated samples.  

PubMed

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

2010-08-01

190

Clostridium tertium isolated from gas gangrene wound; misidentified as Lactobacillus spp initially due to aerotolerant feature.  

PubMed

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

2007-01-01

191

Venous thromboembolism in multiple myeloma.  

PubMed

As for other malignancies, multiple myeloma is associated with an increased risk of venous thromboembolism (VTE). The incidence of VTE is estimated as 8 to 22 per 1,000 person-years; risk factors can be patient related (advanced age, other risk factors shared with the general population), disease related, and treatment related. Disease-related risk factors can derive from the monoclonal component (rarely hyperviscosity or inhibition of natural anticoagulants) or hypercoagulability sustained by inflammatory cytokines (increased von Willebrand factor, factor VIII, fibrinogen levels, decreased protein S levels, acquired activated protein C resistance). The 1 to 2% baseline of incident VTE associated with conventional therapies as melphalan and prednisone is at least doubled by the use of doxorubicin or other chemotherapeutic agents. The VTE rate associated with thalidomide or lenalidomide as monotherapy is similar, whereas combination with high-dose dexamethasone or multiple chemotherapeutic agents induces a multiplicative effect on the VTE rate up to 25%. Low-molecular-weight heparin (LMWH), fixed low-dose warfarin, and aspirin are acceptable strategies for antithrombotic prophylaxis, reducing VTE to 5 to 8% in thalidomide-treated patients and 1 to 3% in lenalidomide-treated patients. LMWH shows an advantage in efficacy not statistically significant. Prophylaxis should be tailored considering individual risk factors for VTE, the stage of disease, the possible occurrence of thrombocytopenia, or renal insufficiency. PMID:24599441

De Stefano, Valerio; Za, Tommaso; Rossi, Elena

2014-04-01

192

Impact of expected changes in national papanicolaou test volume on the cytotechnology labor market: an impending crisis.  

PubMed

With the new screening and treatment guidelines and the prospect of human papillomavirus vaccination for adolescents, the current total volume of Papanicolaou (Pap) tests will be significantly reduced. We used available data to assess the current supply and demand in the cytotechnology labor market and how an expected change in Pap test volume impacts this market. Cytotechnologists' data were obtained from the American Society for Clinical Pathology (ASCP) Board of Registry and the Center for Medicare and Medicaid Services. Data for wages and vacancies were obtained from American Society for Cytotechnologists and ASCP Surveys. Cytotechnology training program data were obtained from annual reports of the Cytotechnology Programs Review Committee of American Society for Cytopathology. In the current market, the demand for cytotechnologists increases by 3.6% and the supply by 4.0% each year. At any given time, there is a vacancy rate of 3%. In the coming years, the demand will decrease remarkably with a projected total demand for cytotechnologists of 5,623 instead of 8,033 by the year 2010 and of 8,538 instead of 14,146 by the year 2026. The cytotechnology market faces an impending crisis. There is a high need for prospectively collected accurate data on demand for and supply of cytotechnologists. PMID:17875520

Eltoum, Isam A; Roberson, Janie

2007-10-01

193

Surgical treatment for venous malformation.  

PubMed

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

2013-12-01

194

Signs and Symptoms of Impending Death in End-of-life Elderly Dementia Sufferers: Point of View of Formal Caregivers in Rural Areas  

PubMed Central

Objective: The aim of the present study was to clarify the signs and symptoms of impending death in end-of-life senile dementia from the point of view of formal caregivers in rural areas. Patient/Materials and Methods: We used qualitative data based on retrospective analyses. The data was gathered following a workshop on end-of-life care of the elderly with dementia attended by formal caregivers that was held in Iga City, Mie Prefecture, Japan, in September 2011. There was a total of 29 workshop participants. The workshop products were created in the first session of the workshop entitled “Signs of death.” During the session, we used the brainstorming method, and participants took turns stating at least two signs, symptoms or premonitions of death. In the end, there were 93 cards in total displaying signs of impending death observed in the end stage of dementia. These 93 entries were then classified into clear categories. Results: The categories defined were breathing disorder, consciousness decline, vital power decline, reduced oral intake, feces disorder, calm and peaceful character, blood pressure decline, change in skin color, patient odor, edema, preagonal vital power, body temperature decline, bedsore/wound deterioration, body weight reduction, cyanosis, and oliguria. The most frequently cited symptoms fell in the breathing disorder category (12 cards), followed by consciousness decline (9 cards), vital power decline (9 cards), reduced oral intake (6 cards), and feces disorder (6 cards). Also frequently mentioned were symptoms falling in the calm and peaceful character, patient odor and preagonal vital power categories. Conclusion: The results show that formal caregivers in rural areas identified breathing disorder as a top indicator of impending death in end-of-life senile dementia cases. The results also highlight some other characteristic signs of impending death, such as preagonal vital power and calm and peaceful character. This research could help develop formal caregivers’ observational skills in the end-of-life care settings.

Hirakawa, Yoshihisa; Uemura, Kazumasa

2012-01-01

195

Venous stasis and routine hematologic testing.  

PubMed

Prolonged venous stasis, as generated by a long tourniquet placement, produces spurious variations in several measurable analytes. To verify to what extent venous stasis influences routine hematologic testing, we assessed routine hematologic parameters, including hemoglobin, hematocrit, red blood cell count (RBC), main cell hemoglobin (MHC), main cell volume (MCV), platelet count (PLT), main platelet volume (MPV), white blood cell count (WBC) and WBC differential on the Advia 120 automated hematology analyzer in 30 healthy volunteers, either without venous stasis (no stasis) or after application of a 60 mmHg standardized external pressure by a sphygmomanometer, for 1 (1-min stasis) and 3 min (3-min stasis). Although the overall correlation between measures was globally acceptable, the mean values for paired samples were significantly different in all parameters tested, except MCV, MHC, PLT, MPV, eosinophils, basophils and large unstained cells after 1-min stasis and all parameters except MCV, MHC, MPV and basophils after 3-min venous stasis. As expected RBC, hemoglobin and hematocrit displayed a significant trend towards increase, whereas WBC and the WBC subpopulations were decreased. Difference between measurements by Bland and Altman plots exceeded the current analytical quality specifications for desirable bias for WBC, RBC, hemoglobin, hematocrit, lymphocytes and monocytes in samples collected after either 1- and 3-min stasis. These results provide clear evidence that venous stasis during venipuncture might produce spurious and clinically meaningful biases in the measurement of several hematologic parameters, prompting further considerations on the usefulness of adopting appropriate preventive measures for minimizing such influences. PMID:16999725

Lippi, G; Salvagno, G L; Montagnana, M; Franchini, M; Guidi, G C

2006-10-01

196

Fournier's gangrene developing secondary to infected hydrocele: A unique clinical scenario  

PubMed Central

We report the first case of Fournier's gangrene (FG) developing secondary to an infected hydrocele worldwide. We present a case report with a brief overview of the literature relating to FG and its aetiology, diagnosis and management. A 70 year-old male was referred by his General Practitioner with a 2 week history of worsening symptoms of scrotal discomfort and swelling. Following clinical examination, an initial diagnosis of an infected right-sided hydrocele was made and treatment, consisting of antibiotics, was initiated. Despite showing good clinical improvement, several days later, necrotic areas were observed over the right hemiscrotum with spreading cellulitis. A diagnosis of FG was made. The patient was started on triple–therapy antibiotics and taken to the operating room for urgent surgical debridement. Necrotic skin and subcutaneous tissue extending over the perineum and lower anterior abdomen was debrided down to healthy tissue. A further debridement took place 2 days later. The patient continued to improve and was eventually discharged under the care of Plastic Surgeons for reconstruction of the soft tissue defect. FG is a type of necrotising fasciitis predominantly affecting the male perineal, perianal, genital and anterior abdominal wall regions. It has a significant mortality rate, and the key to survival is early detection and treatment consisting of antibiotics and surgical debridement of the affected area. To the best of our knowledge, this is the first reported case of FG developing secondary to an existing hydrocele without any prior urological intervention. The case highlights the important clinical diagnostic and therapeutic interventions required to prevent complications associated with this, potentially fatal, condition. PMID:22629017

Sarwar, Umran; Akhtar, Nadeem

2012-01-01

197

Prevalence of detectable venous pressure drops expected with venous needle dislodgement.  

PubMed

Venous needle dislodgement (VND) is a potentially fatal complication during hemodialysis (HD) treatment and the venous pressure monitor is the most widely used device for its detection. VND can only be detected by the venous sensor if the resulting pressure drop exceeds the difference between the actual venous pressure and the lower alarm limit. In clinical practice, the lower alarm limit is usually set 30-40 mmHg below the actual venous pressure to avoid a disproportionate high number of nuisance alarms. The aim of this study was to quantify the number of fistulas and grafts in a group of HD patients where venous pressure monitoring can be expected to detect VND. We determined intra-access pressures in 99 chronic HD patients. Sixty-five (65.7%) had a fistula and 34 (34.3%) had a prosthetic graft as a vascular access. Mean intra-access pressure (Pa ) in fistulas was 32.6 ± 23.5 mmHg, whereas in grafts mean Pa was 60.9 ± 19.5 mmHg. Nineteen (29.2%) of the fistulas and 32 (94.1%) of the grafts exhibited an intra-access pressure above 40 mmHg. Therefore, in our study nearly all grafts but only 29% of fistulas would fulfill the requirement for venous pressure monitoring to detect VND. PMID:24341865

Ribitsch, Werner; Schilcher, Gernot; Hafner-Giessauf, Hildegard; Krisper, Peter; Horina, Jörg H; Rosenkranz, Alexander R; Schneditz, Daniel

2014-01-01

198

Thrombolytic therapy for central venous catheter occlusion  

PubMed Central

Background Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and Methods This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms “central venous catheter”, “central venous access device” OR “central venous line” associated with the terms “obstruction”, “occlusion” OR “thrombolytic” was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. Results Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67–74% within 30–40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16–68% in the control group to 4–23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. Conclusions Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction. PMID:22180420

Baskin, Jacquelyn L.; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Pui, Ching-Hon; Howard, Scott C.

2012-01-01

199

Percutaneous transpenile and retrograde venous occlusion for the treatment of venous leak impotence.  

PubMed

In 17 patients percutaneous transpenile venous occlusion was performed for the treatment of so-called venous leak impotence. Because of primary failure, the procedure was repeated in 5 patients. On four occasions, it was combined with a retrograde venous occlusion via the internal iliac vein. Within a rather short follow-up period of 23 months maximum, the overall success rate is 65%. Six patients are able to have intercourse and 5 others need additional intracavernous injections. Complications of the procedure were not observed. PMID:2022211

Müller, S C; Schild, H; Fritz, T; Witzsch, U

1991-01-01

200

Endovascular Retrograde Cortical Venous Approach to Disconnect Retrograde Leptomeningeal Venous Reflux in a Patient with Dural AVF  

PubMed Central

Summary We report a case of dural arteriovenous fistual (DAVF) with cortical venous reflux in whom disconnection of the refluxing cortical vein was achieved by using a retrograde transcortical venous approach through the cortical vein itself. PMID:20670511

Goyal, M.; TerBrugge, K.; Farb, R.

1999-01-01

201

Patient ethnicity and use of venous thromboembolism prophylaxis  

Microsoft Academic Search

Objective. Patients at highest risk for developing venous thromboembolism include those undergoing major orthopedic sur- gery. However, physicians vary in their strategies to prevent venous thromboembolism. We evaluated whether the use of venous thromboembolism prophylaxis after orthopedic surgery is related to patient ethnicity. Design. Retrospective cohort study, 1998-2002. Setting. Tertiary care, university-affiliated hospital in Hawaii. Study participants. 1811 adults (1085

REBECCA P. GELBER; TODD B. SETO

2006-01-01

202

Clostridium Perfringens a-Toxin and NetB Toxin Antibodies and their possible role in protection against Necrotic Enteritis and Gangrenous Dermatitis in broiler chickens  

Technology Transfer Automated Retrieval System (TEKTRAN)

Necrotic enteritis (NE) and gangrenous dermatitis (GD) are important infectious diseases of poultry. Although NE and GD share a common pathogen, Clostridium perfringens, they differ in other important aspects, such as clinical signs, pathologic symptoms, and age of onset. The primary virulence facto...

203

Arterial and venous blood gas analyses.  

PubMed

Arterial and venous blood gases provide useful information regarding pulmonary function as well as acid-base balance. The goal of this article is to discuss the collection of blood gases, common errors in analysis, and what information can be gleaned from a blood gas analysis. PMID:24182995

Rieser, Teresa M

2013-08-01

204

[Portal pulmonary venous anastomosis and portal hypertension].  

PubMed

The authors report two cases of portopulmonary anastomosis to show the value of multidetector CT with MPR MIP reformations in the diagnosis of portopulmonary venous anastomosis. This diagnosis has consequences in the treatement of hypoxemia in patients with chronic liver disease and embolization of bleeding esophageal varices in these patients. PMID:12469015

Masi, L; André, A; Rémy-Jardin, M; Rémy, J

2002-11-01

205

Venous congestive myelopathy: a mimic of neoplasia  

Microsoft Academic Search

Venous congestive myelopathy is a progressive disorder frequently associated with arteriovenous fistulas, usually dural. By causing diffuse spinal cord enlargement and enhancement on imaging, it may simulate a neoplasm and prompt a biopsy. We evaluated the biopsy findings in seven such patients (M=5, F=2, mean age 59±11 years) who presented variably with progressive lower extremity weakness (86%), bowel and bladder

Fausto J Rodriguez; Brian A Crum; William E Krauss; Bernd W Scheithauer; Caterina Giannini

2005-01-01

206

Impending Impeachment Vote  

NSDL National Science Digital Library

This week's In the News focuses on the forthcoming debate and vote in the US House of Representatives. The seven resources discussed provide background information, primary materials, recent news, political commentary, and legal analysis. On Friday and Saturday, December 11-12, 1998, the House Judiciary Committee, after weeks of partisan debate, drafted and approved four articles of impeachment against President William Clinton. The first article alleges that Clinton, during his appearance before a grand jury last August, "provided perjurious, false, and misleading testimony" concerning his lawsuit with Paula Jones and his relationship with Monica Lewinsky. The second article also alleges that Clinton committed perjury, citing two instances of misleading testimony given in Paula Jones case: the first occurring in December 1997 during Clinton's responses to written questions, the second occurring during his January deposition. The third article of impeachment alleges that Clinton, in relation to the Jones case, committed acts that "prevented, obstructed, and impeded the administration of justice" in seven instances between December 7, 1997 and January 26, 1998. The fourth and final article alleges that Clinton abused his presidential power by proffering false statements to Congress in his answers to the 81 questions that were asked of him last month during the Judiciary Committee's impeachment inquiry. On Thursday, the four articles of impeachment will be introduced, debated, and voted on by the 435 members of the House. If a majority of representatives endorses one or more of the articles, then Clinton will be tried in the Senate, wherein a two-thirds majority vote is required to remove the president from office. Political pundits believe that the imminent vote for impeachment is contingent upon the decisions of about two dozen moderate Republicans who are publicly undecided about the vote.

Osmond, Andrew.

207

Partial aortic occlusion and cerebral venous steal: venous effects of arterial manipulation in acute stroke.  

PubMed

Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and "luxury perfusion" in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifested by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution analogous to positive end-expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs. PMID:21441149

Pranevicius, Osvaldas; Pranevicius, Mindaugas; Liebeskind, David S

2011-05-01

208

Gangrene of the Digits of the Right Lower Limb in a Patient with Homozygous Sickle Cell Disease and Ulcerative Colitis  

PubMed Central

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.

2014-01-01

209

Lower extremity arterial and venous ulcers.  

PubMed

The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found. PMID:15924901

Sieggreen, Mary

2005-06-01

210

Venous thromboembolism in chronic liver disease.  

PubMed

The liver plays a central role in the maintenance of a normal hemostatic balance by synthesizing several factors belonging to the pathways of coagulation, anticoagulation, and fibrinolysis. It is thereby unsurprising that patients with chronic liver disease (CLD) or cirrhosis may experience a kaleidoscope of hemostatic disorders. A bleeding tendency represents the most frequent and clinically severe hemostatic complication of CLD or cirrhosis. Perhaps less anticipated, growing evidence now suggests that a procoagulant state may be also associated with CLD, so that patients with CLD or cirrhosis, irrespective of its etiology, rather than be "naturally anticoagulated" might also experience a large spectrum of spontaneous or unprovoked venous thrombotic complications. The clinical significance of an increased risk of venous thromboembolism in CLD is an important topic for future research, and the initiation of new randomized studies of potential treatments for this complication is needed. PMID:21305802

Lippi, Giuseppe; Targher, Giovanni; Favaloro, Emmanuel J; Franchini, Massimo

2011-02-01

211

Cerebral venous thrombosis after myelography with iopamidol.  

PubMed

A young man developed intracranial hypertension immediately after myelography with non-ionic water-soluble contrast medium (iopamidol). Cerebral angiography showed extensive cerebral venous thrombosis. The common causes of thrombophlebitis were excluded. A relationship to the contrast medium was strongly suspected, since a similar case has been reported. The rheological properties and haemo-concentration induced by iopamidol could explain this complication. PMID:8880713

Brugeilles, H; Pénisson-Besnier, I; Pasco, A; Oillic, P; Lejeune, P; Mercier, P

1996-08-01

212

Duration of Anticoagulant Therapy After Venous Thromboembolism  

Microsoft Academic Search

\\u000a Long-term treatment of venous thromboembolism (VTE) primarily focuses on the duration of anticoagulant therapy, usually with\\u000a vitamin K antagonists (VKA). The duration of therapy should be individualized based on the risk of recurrent VTE if treatment\\u000a is stopped and the risk of bleeding if treatment is continued. The risk of recurrence is low if thrombosis was provoked by\\u000a a reversible

Clive Kearon

213

Clinical significance of intracranial developmental venous anomalies  

PubMed Central

OBJECTIVES—Venous angiomas, or developmental venous anomalies (DVAs), represent the most often occurring cerebral vascular malformation. The clinical significance of a DVA is, however, at present unclear.?METHODS—A retrospective analysis was carried out on two series of consecutive cranial MRIs performed between January 1990 and August 1996 in a university department of neuroradiology and in a large radiological private practice. The medical records of all patients in whom a DVA was diagnosed were screened to identify the specific complaint which necessitated the imaging procedure.?RESULTS—A total of 67 patients with DVA could be identified. In 12 patients an associated cavernoma was found. The main reason for performing the MRI was the evaluation of seizures or of headaches. In all patients with DVA in whom an intracerebral haemorrhage was diagnosed an associated cavernoma was present at the site of the haemorrhage. None of the 67 patients showed an association between the complaints that led to the MRI and the location of the DVA.?CONCLUSIONS—DVAs do not seem to be associated with a specific clinical presentation. In a significant percentage of cases, however, coexisting cavernomas are found which have a defined bleeding potential and should be treated independently of the DVA. This study supports the hypothesis that DVAs are a congenital abnormality of venous drainage without clinical significance.?? PMID:10407000

Topper, R.; Jurgens, E.; Reul, J.; Thron, A.

1999-01-01

214

Chronic cerebrospinal venous insufficiency and multiple sclerosis.  

PubMed

A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular balloon angioplasty or venous stent placement has been proposed as well as conducted in small patient series. In some cases, it may have resulted in serious injury. In this Point of View, we discuss the recent investigations that led to the description of CCSVI as well as the conceptual and technical shortcomings that challenge the potential relationship of this phenomenon to MS. The need for conducting carefully designed and rigorously controlled studies to investigate CCVSI has been recognized by the scientific bodies engaged in MS research. Several scientific endeavors examining the presence of CCSVI in MS are being undertaken. At present, invasive and potentially dangerous endovascular procedures as therapy for patients with MS should be discouraged until such studies have been completed, analyzed, and debated in the scientific arena. PMID:20373339

Khan, Omar; Filippi, Massimo; Freedman, Mark S; Barkhof, Frederik; Dore-Duffy, Paula; Lassmann, Hans; Trapp, Bruce; Bar-Or, Amit; Zak, Imad; Siegel, Marilyn J; Lisak, Robert

2010-03-01

215

Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting  

PubMed Central

Background: The high pressures documented in the intracranial venous sinuses in idiopathic intracranial hypertension (IIH) could be the result of focal stenotic lesions in the lateral sinuses obstructing cranial venous outflow. Objective: To explore the relation between venous sinus disease and IIH. Methods: 12 patients with refractory IIH had dilatation and stenting of the venous sinuses after venography and manometry had shown intracranial venous hypertension proximal to stenoses in the lateral sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome. Results: Intrasinus pressures were variably reduced by stenting. Five patients were rendered asymptomatic, two were improved, and five were unchanged. Conclusions: The importance of venous sinus disease in the aetiology of IIH is probably underestimated. Lateral sinus stenting shows promise as an alternative treatment to neurosurgical intervention in intractable cases. PMID:14638886

Higgins, J; Cousins, C; Owler, B; Sarkies, N; Pickard, J

2003-01-01

216

Microparticles: new light shed on the understanding of venous thromboembolism  

PubMed Central

Microparticles are small membrane fragments shed primarily from blood and endothelial cells during either activation or apoptosis. There is mounting evidence suggesting that microparticles perform a large array of biological functions and contribute to various diseases. Of these disease processes, a significant link has been established between microparticles and venous thromboembolism. Advances in research on the role of microparticles in thrombosis have yielded crucial insights into possible mechanisms, diagnoses and therapeutic targets of venous thromboembolism. In this review, we discuss the definition and properties of microparticles and venous thromboembolism, provide a synopsis of the evidence detailing the contributions of microparticles to venous thromboembolism, and propose potential mechanisms, by which venous thromboembolism occurs. Moreover, we illustrate a possible role of microparticles in cancer-related venous thromboembolism. PMID:25152025

Zhou, Lin; Qi, Xiao-long; Xu, Ming-xin; Mao, Yu; Liu, Ming-lin; Song, Hao-ming

2014-01-01

217

Core content for training in venous and lymphatic medicine  

PubMed Central

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

2014-01-01

218

A Fatal Spontaneous Gas Gangrene due to Clostridium perfringens during Neutropenia of Allogeneic Stem Cell Transplantation: Case Report and Literature Review  

PubMed Central

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

2014-01-01

219

Venous endothelial injury in central nervous system diseases  

PubMed Central

The role of the venous system in the pathogenesis of inflammatory neurological/neurodegenerative diseases remains largely unknown and underinvestigated. Aside from cerebral venous infarcts, thromboembolic events, and cerebrovascular bleeding, several inflammatory central nervous system (CNS) diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and optic neuritis, appear to be associated with venous vascular dysfunction, and the neuropathologic hallmark of these diseases is a perivenous, rather than arterial, lesion. Such findings raise fundamental questions about the nature of these diseases, such as the reasons why their pathognomonic lesions do not develop around the arteries and what exactly are the roles of cerebral venous inflammation in their pathogenesis. Apart from this inflammatory-based view, a new hypothesis with more focus on the hemodynamic features of the cerebral and extracerebral venous system suggests that MS pathophysiology might be associated with the venous system that drains the CNS. Such a hypothesis, if proven correct, opens new therapeutic windows in MS and other neuroinflammatory diseases. Here, we present a comprehensive review of the pathophysiology of MS, ADEM, pseudotumor cerebri, and optic neuritis, with an emphasis on the roles of venous vascular system programming and dysfunction in their pathogenesis. We consider the fundamental differences between arterial and venous endothelium, their dissimilar responses to inflammation, and the potential theoretical contributions of venous insufficiency in the pathogenesis of neurovascular diseases. PMID:24228622

2013-01-01

220

Venous ulcers of the lower limb: Where do we stand?  

PubMed

Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

Chatterjee, Sasanka S

2012-05-01

221

Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene: A Case Report (CARE-Compliant).  

PubMed

Fournier gangrene is a rare but highly infectious disease characterized by fulminant necrotizing fasciitis involving the genital and perineal regions. Negative pressure wound therapy (NPWT; KCI USA Inc, San Antonio, TX) is a widely adopted technique in many clinical settings. Nevertheless, its application and effect in the treatment of Fournier gangrene are unclear.A 47-year-old male patient was admitted with an anal abscess followed by a spread of the infection to the scrotum, which was caused by Pseudomonas aeruginosa. NPWT was applied on the surface of the scrotal area and continued for 10 days. A split-thickness skin graft from the scalp was then grafted to the wound, after which, NPWT utilizing gauze sealed with an occlusive dressing and connected to a wall suction was employed for 7 days to secure the skin graft.At discharge, the percentage of the grafted skin alive on the scrotum was 98%. The wound beside the anus had decreased to 4?×?0.5?cm with a depth of 1?cm. Follow-up at the clinic 1 month later showed that both wounds had healed. The patient did not complain of any pain or bleeding, and was satisfied with the outcome.NPWT before and after split-thickness skin grafts is safe, well tolerated, and efficacious in the treatment of Fournier gangrene. PMID:25654376

Ye, Junna; Xie, Ting; Wu, Minjie; Ni, Pengwen; Lu, Shuliang

2015-02-01

222

Duplex ultrasonography scanning for chronic venous disease: Patterns of venous reflux  

Microsoft Academic Search

Purpose: Patterns of flow in superficial and deep veins and outward flow in medial calf perforators were studied by duplex ultrasonography scanning in 1653 lower limbs in 1114 consecutive patients. This study compares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosis or past venous ulceration.Methods: Duplex scanning determined whether

Kenneth A. Myers; Robert W. Ziegenbein; Ge Hua Zeng; P. Geoffrey Matthews

1995-01-01

223

Management of venous thromboembolism in pregnancy.  

PubMed

Pulmonary thromboembolism (PTE) is the major cause of maternal death in the UK, with recent trends showing an increase in the numbers of deaths. Underlying PTE is the problem of deep venous thrombosis (DVT). An appreciation of risk factors, particularly, thrombophilia, and signs or symptoms suggestive of thromboembolism, coupled with objective diagnosis and treatment should reduce mortality and morbidity. There are particular considerations with regard to the management of thrombosis in pregnancy, especially the use of anticoagulants. Low-molecular-weight heparins are now replacing unfractionated heparin for the treatment of DVT and PTE in pregnancy. PMID:11478817

Greer, I A; Thomson, A J

2001-08-01

224

Is there a Link Between Atherothrombosis and Deep Venous Thrombosis?  

PubMed Central

ABSTRACT Venous and arterial thromboses have traditionnally been regarded as separate diseases with different causes. Clinical experience shows, that the arterial atherothrombotic disease can be associated with venous thrombotic disease, but there is insufficient evidence to prove and explain the nature of this association. This review focuses on the risk factors associated with both arterial and venous thrombotic events, and recent epidemiological studies have documented an association between these vascular complications. According to the results of recent studies, atherosclerosis and venous thrombosis share common risk factors, including age, obesity, cigarette smoking, and metabolic syndrome. Several studies have demonstrated that subjects with idiopathic venous thrombosis have an increased risk of cardiovascular events compared with subjects with secondary thrombosis or control group. On the other hand, atherosclerosis has the potential to promote the development of thrombotic disorders in the venous system. Based on the results of population studies carried out in the United States, atherosclerosis is unlikely to constitute a risk factor for venous thrombosis. In conclusion, the separate nature of arterial and venous disorders has been challenged. Future studies are needed to clarify the nature of this association, and to evaluate its implications for clinical practice. PMID:25553135

ANDREI, Maria-Cristina; ANDERCOU, Aurel

2014-01-01

225

Surgical treatment of venous malformations in Klippel-Trénaunay syndrome  

Microsoft Academic Search

Purpose: Klippel-Trénaunay syndrome (KTS) is a complex congenital anomaly, characterized by varicosities and venous malformations (VMs) of one or more limbs, port-wine stains, and soft tissue and bone hypertrophy. Venous drainage is frequently abnormal because of embryonic veins, agenesis, hypoplasia, valvular incompetence, or aneurysms of deep veins. We previously reported on the surgical management of KTS. In this article, we

Audra A Noel; Peter Gloviczki; Kenneth J Cherry; Thom W Rooke; Anthony W Stanson; David J Driscoll

2000-01-01

226

Congestive heart failure and outpatient risk of venous thromboembolism  

Microsoft Academic Search

Although CHF has been considered a risk factor for venous thromboembolism, this has not been directly studied. We hypothesized that congestive heart failure would increase the risk of venous thromboembolism in an outpatient population, and that this risk would increase as patients' ventricular function worsened. We conducted a case-control study to examine whether CHF due to left ventricular dysfunction was

M. D. Howell; J. M. Geraci; A. A. Knowlton

2001-01-01

227

Is hyperhomocysteinaemia a risk factor for recurrent venous thrombosis?  

Microsoft Academic Search

Several studies have shown a relation between hyperhomocysteinaemia and arterial vascular disease. We looked at the association between hyperhomocysteinaemia and venous thrombosis which could be clinically important as hyperhomocysteinaemia is easily corrected by vitamin supplementation. We studied 185 patients with a history of recurrent venous thrombosis and 220 controls from the general population. Homocysteine concentrations were measured before and 6

M. den Heijer; W. B. J. Gerrits; H. L. Haak; P. W. Wijermans; G. M. J. Bos; H. J. Blom; F. R. Rosendaal

1995-01-01

228

Anatomy of the presacral venous plexus: implications for rectal surgery  

Microsoft Academic Search

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

2004-01-01

229

Congenital intrahepatic portohepatic venous shunt: treatment with coil embolisation.  

PubMed

Congenital abnormalities of the portal venous system are rare. There are few radiological descriptions of intrahepatic portosystemic venous shunt detected in the perinatal period. We report a congenital portosystemic shunt that was detected by US and treated with coil embolisation in the neonatal period. PMID:10836599

Kim, I O; Cheon, J E; Kim, W S; Chung, J W; Yeon, K M; Yoo, S J; Seo, J K; Choi, J H

2000-05-01

230

[Prevention of perioperative venous thromboembolism in children].  

PubMed

Venous thromboembolic events (VTE) occur in children at the time of surgery. Few guidelines about how to assess the risk and provide prophylaxis have been developed and published so far. It is uncertain if any of these guidelines have been adopted into clinical practice. The article discusses the specific differences of the haemostatic system throughout childhood, risk assessment, choice and dosing of antithrombotic agents, difficulties in drug monitoring and side effects of treatment including HIT. Current available recommendations and guidelines are summarized. Current evidence on which to base risk stratification and prevention of VTE for children undergoing surgery consists mainly of cohort studies, case series, case reports and expert opinion. Many suggestions are merely extrapolated from results from clinical trials in adults. Primary healthy children who undergo minor surgery including circumcision, herniotomy and appendectomy do not need antithrombotic prophylaxis. Children with multiple risk factors for VTE including severe underlying conditions and long-term immobilization, children with central venous lines and children with a history of VTE should be considered to receive VTE prophylaxis. Older children (Tanner II+) should be treated following adult guidelines. Standard unfractionated heparin and low molecular heparin are the most frequently recommended antithrombotic drugs. Decision for VTE prophylaxis must widely be based on individual risk assessment by experienced physicians. Newly developed scores and guidelines may provide assistance. Well designed clinical studies in children that provide proper evidence on risk assessment for VTE at the time of surgery and investigate safety and efficacy of antithrombotic prophylaxis/treatment are urgently needed. PMID:19898787

Streif, Werner

2009-10-01

231

Interventional Treatment of Mesenteric Venous Occlusion  

PubMed Central

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

2014-01-01

232

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.

1974-01-01

233

Improvements of venous tone with pycnogenol in chronic venous insufficiency: an ex vivo study on venous segments.  

PubMed

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?

Belcaro, Gianni; Dugall, Mark; Luzzi, Roberta; Hosoi, M; Corsi, Marcello

2014-03-01

234

Fournier's Gangrene after Open Hemorrhoidectomy without a Predisposing Factor: Report of a Case and Review of the Literature.  

PubMed

Fournier's gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and vulva in women. An unpredictable case of FG two weeks after open hemorrhoidectomy in a previously healthy 55-year-old male is described. Full-thickness patchy skin necrosis of the perianal, perineal and scrotal region associated with rectal perforation was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Because of rectal involvement, diverting sigmoid colostomy was fashioned. The patient survived after two additional local debridements. Nevertheless, loss of sphincter function due to massive muscle destruction led to permanent colostomy. Our case together with others reported in the literature illustrates that, although rare, FG after open hemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. The development of fever and urinary retention should draw the attention of the surgeon, even if the presentation is delayed. The current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than anticipated. This disastrous complication without predisposing factor is discussed along with a literature review. PMID:21103267

Karadeniz Cakmak, Guldeniz; Irkorucu, Oktay; Ucan, Bulent H; Karakaya, Kemal

2009-01-01

235

Fournier's Gangrene after Open Hemorrhoidectomy without a Predisposing Factor: Report of a Case and Review of the Literature  

PubMed Central

Fournier's gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and vulva in women. An unpredictable case of FG two weeks after open hemorrhoidectomy in a previously healthy 55-year-old male is described. Full-thickness patchy skin necrosis of the perianal, perineal and scrotal region associated with rectal perforation was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Because of rectal involvement, diverting sigmoid colostomy was fashioned. The patient survived after two additional local debridements. Nevertheless, loss of sphincter function due to massive muscle destruction led to permanent colostomy. Our case together with others reported in the literature illustrates that, although rare, FG after open hemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. The development of fever and urinary retention should draw the attention of the surgeon, even if the presentation is delayed. The current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than anticipated. This disastrous complication without predisposing factor is discussed along with a literature review. PMID:21103267

Karadeniz Cakmak, Guldeniz; Irkorucu, Oktay; Ucan, Bulent H.; Karakaya, Kemal

2009-01-01

236

Evaluation of prosthetic venous valves, fabricated by electrospinning, for percutaneous treatment of chronic venous insufficiency.  

PubMed

Chronic venous insufficiency (CVI) remains a major health problem worldwide. Direct venous valve surgical repair and venous segment transplantation are clinical options; however, they are highly invasive procedures. The objectives of this study were to fabricate prosthetic venous valves (PVVs) by electrospinning, for percutaneous treatment of CVI, and evaluate their hydrodynamic characteristics in vitro at the same locations and under the same flow conditions. The PVVs consisted of polyurethane fiber scaffolds attached to a cobalt-chromium stent. PVVs with two different valve-leaflet configurations were compared: biomimetic PVV (bPVV) and open PVV (oPVV). A balloon catheter was used to implant the devices in a poly(vinyl chloride) tube and the column outlet was set at a height of 100 cm above the test valve to simulate the elevation of the heart above a distal vein valve while standing; 50 wt% glycerin solution was used as the test fluid. The devices were evaluated for antegrade flow, effect of ankle flexion, and stagnation zones around the valve leaflets. During sudden hydrostatic backpressure, little leakage and constant peripheral pressure were observed for the devices; under forward pulsatile pressure of 0-4 mmHg, to simulate the effect of breathing, the oPVV had a higher flow rate than the bPVV. With regard to the effect of ankle flexion, the oPVV was functionless. Moreover, the stagnation zone around the oPVV valve leaflets was larger than that around the bPVV valve leaflets. These results suggest that the bPVV would be clinically suitable for percutaneous treatment of CVI. PMID:21789716

Moriyama, Masaki; Kubota, Shinichiro; Tashiro, Hideo; Tonami, Hiroyuki

2011-12-01

237

Comparison of four objective methods of monitoring digital venous congestion.  

PubMed

This study sought to determine which of the four most commonly used objective monitoring modalities--pulse oximetry, laser Doppler flowmetry, skin surface temperature measurement, and skin surface fluorescence--is best able to detect early digital venous congestion. Digital venous congestion was induced in 12 hands by inflating a digital cuff to 5 mm Hg above the resting diastolic pressure. The cuff remained inflated for 1 hour while monitoring was done at 10-minute intervals. The baseline and experimental laser Doppler indices differed by at least 30% in each subject, and the laser Doppler index was always less than 40% during venous congestion. Skin surface fluorescence gave falsely normal results in three of eight hands, while pulse oximetry failed to detect venous congestion in any hand. The difference in temperature between the control and experimental fingers almost always exceeded the threshold of 2.5 degrees C. The results indicate that both laser Doppler flowmetry and skin surface temperature measurement are highly accurate methods of monitoring early digital venous congestion that are noninvasive and easy to use. Skin surface temperature measurement has further advantages in that thermometers are less expensive and easier to transport than laser Doppler devices. In contrast, skin surface fluorescence is invasive and cumbersome in addition to being less sensitive to experimentally induced early digital venous congestion than either laser Doppler flowmetry or skin surface temperature measurement. Pulse oximetry is unreliable in detecting early digital venous congestion. PMID:1748752

Levinsohn, D G; Gordon, L; Sessler, D I

1991-11-01

238

Preoperative evaluation of collateral venous anastomoses in meningioma involving cerebral venous sinus by susceptibility weighted imaging.  

PubMed

Precise preoperative identification of the collateral venous anastomoses is critical for proper surgical management of patients with meningioma involving sinus. This study was to assess the feasibility of susceptibility weighted imaging (SWI) to delineate the collateral venous anastomoses before surgery.Twenty-five patients with meningiomas that were involved in sinuses underwent surgery and the collateral anastomoses were evaluated with SWI and phase-contrast magnetic resonance venography (MRV) before surgery. The results obtained with SWI were compared with those obtained with MRV. Intraoperative findings were used as the gold standard.By surgery, a total of 98 collateral anastomotic veins were identified in the 25 patients. SWI depicted 85 collateral anastomotic veins close to the meningioma with a sensitivity of 87%, whereas MRV showed 57 collateral anastomotic veins with a sensitivity of 58%. The detectability of collateral anastomotic veins in SWI images was superior to MRV.The results suggest that SWI is superior to MRV and could provide more reliable information on the collateral venous anastomoses in patients with meningioma. PMID:25501068

Wang, Qing; He, Jingzhen; Ma, Xiangxing

2014-12-01

239

Total Anomalous Pulmonary Venous Return in Siblings  

PubMed Central

Total anomalous pulmonary venous return (TAPVR) is a rare and critical congenital vascular anomaly that requires an early operation. However, initial symptoms of TAPVR may be non-specific, and cardiovascular findings may be minimal. The heart may not be enlarged and there is often no cardiac murmur. Without cardiac murmur, these symptoms are similar to those of respiratory distress syndrome in newborns. Therefore, a high degree of suspicion and an early diagnosis of TAPVR are important. This condition generally occurs without a family history and has a low recurrence rate, but several familial cases, including siblings, have been reported worldwide. Additionally, several chromosomal or gene abnormalities associated with TAPVR have been reported. In the case presented here, two brothers with a 6-year age gap were diagnosed with TAPVR. Surgery was performed without cardiac or neurological complications. This is the first report on TAPVR in siblings in Korea. PMID:25580197

Kim, Ho-Sung; Jeong, Kumi; Cho, Hwa-Jin; Choi, Woo-Yeon; Choi, Young Earl; Ma, Jae Sook

2014-01-01

240

Venous surgery in resection for abdominal malignancy.  

PubMed

Vascular surgical techniques were applied to the radical resection of carcinoma of the liver, biliary tract and pancreas. Distal and proximal portal vein reconstruction, respectively, was carried out in 16 patients with carcinoma of the pancreas and 16 with cancer of the liver and biliary tract. Hepatic vein trunks with tumour involvement were resected and reconstructed by various techniques in six patients. A suprarenal segment of the inferior vena cava was completely replaced by a prosthetic graft in three patients with retroperitoneal malignancy. Venous surgery increased the resectability of malignant tumours and preserved circulation in the organ remnant, although the long-term effect on survival is not yet clear. Vascular surgical techniques should be applied more widely in the field of general abdominal surgery. PMID:8076012

Sakaguchi, S; Nakamura, S

1993-04-01

241

Internal jugular venous abnormalities in transient monocular blindness  

PubMed Central

Background The etiology of transient monocular blindness (TMB) in patients without carotid stenosis has been linked to ocular venous hypertension, for their increased retrobulbar vascular resistance, sustained retinal venule dilatation and higher frequency of jugular venous reflux (JVR). This study aimed to elucidate whether there are anatomical abnormalities at internal jugular vein (IJV) in TMB patients that would contribute to impaired cerebral venous drainage and consequent ocular venous hypertension. Methods Contrast-enhanced axial T1-weighted magnetic resonance imaging (MRI) was performed in 23 TMB patients who had no carotid stenosis and 23 age- and sex-matched controls. The veins were assessed at the upper IJV (at C1–3 level) and the middle IJV (at C3–5 level). Grading of IJV compression/stenosis was determined bilaterally as follows: 0 = normal round or ovoid appearance; 1 = mild flattening; 2 = moderate flattening; and 3 = severe flattening or not visualized. Results There was significantly more moderate or severe IJV compression/stenosis in the TMB patients at the left upper IJV level and the bilateral middle IJV level. Defining venous compression/stenosis scores ? 2 as a significant cerebral venous outflow impairment, TMB patients were found to have higher frequency of significant venous outflow impairment at the upper IJV level (56.5% vs. 8.7%, p = 0.0005) and the middle IJV level (69.6% vs. 21.7%, p=0.0011). Conclusions TMB Patients with the absence of carotid stenosis had higher frequency and greater severity of IJV compression/stenosis which could impair cerebral venous outflow. Our results provide evidence supporting that the cerebral venous outflow abnormality is one of the etiologies of TMB. PMID:23876171

2013-01-01

242

Absence of venous valves in mice lacking Connexin37.  

PubMed

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

2013-01-15

243

Validation of the new venous severity scoring system in varicose vein surgery  

Microsoft Academic Search

ObjectivesWe performed this observational study to validate the three components of a new venous severity scoring (VSS) system, ie, venous clinical severity score (VCSS), venous segmental disease score (VSDS), and venous disability score (VDS), and to evaluate VCSS, VDS, and CEAP clinical class and score in quantifying outcome of varicose vein surgery.

Stavros K Kakkos; Marco A Rivera; Miltiadis I Matsagas; Miltos K Lazarides; Peter Robless; Gianni Belcaro; George Geroulakos

2003-01-01

244

Acute mesenteric venous thrombosis with a vaginal contraceptive ring.  

PubMed

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

2014-07-01

245

Acute Mesenteric Venous Thrombosis with a Vaginal Contraceptive Ring  

PubMed Central

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

2014-01-01

246

Venous disease and chronic oedema: treatment and patient concordance.  

PubMed

Compression therapy is the mainstay in the management of chronic venous disease, venous leg ulceration (VLU) and chronic oedema. The management of VLU alone is thought to cost a staggering Ł400 million per year and accounts for 13% of all district nursing visits. The predicted increase in elderly, obese and chronically ill patients will pose a further strain on already stretched resources. The impact of chronic venous and lymphovenous disease is also costly in terms of physical and psychological terms for patients. Adopting a preventive approach would reduce the financial, workload and symptomatic aspects of this condition. PMID:24820810

Todd, Marie

247

Predictive genetic variants for venous thrombosis: what's new?  

PubMed

Various pathways lead to the development of venous thrombosis. Risk factors are common and can be genetic or acquired. Since the identification of factor V Leiden and prothrombin 20210 G-->A, the field of genetic epidemiology has developed rapidly and many new genetic variants have been described in the past decade. However, the association with venous thrombosis is often unclear and conflicting results have been reported in various studies. The aim of this review is to describe these candidate predictors of venous thrombosis and to put these in perspective. PMID:17433900

Bezemer, Irene D; Rosendaal, Frits R

2007-04-01

248

Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency.  

PubMed

Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units. PMID:21803799

Thapar, A; Lane, T R A; Pandey, V; Shalhoub, J; Malik, O; Ellis, M; Franklin, I J; Nicholas, R; Davies, A H

2011-09-01

249

["Chronic cerebrospinal venous insufficiency" in multiple sclerosis - is multiple sclerosis a disease of the cerebrospinal venous outflow system?].  

PubMed

Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients. PMID:21487978

Wattjes, M P; Doepp, F; Bendszus, M; Fiehler, J

2011-06-01

250

Fournier’s gangrene of the penis caused by Streptococcus dysgalactiae subspecies equisimilis: case report and incidence study in a tertiary-care hospital  

PubMed Central

Background Fournier’s gangrene is a rare necrotizing soft tissue infection of the scrotum and penis. We report, to our knowledge, the first case of Fournier’s gangrene caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE), a strain of pyogenic ?-hemolytic streptococci that is increasingly being recognized as an important human pathogen. Case presentation We describe a healthy 59 year-old Caucasian male who presented to the emergency department with Fournier’s gangrene of the penis and scrotum, with extension to the anterior abdominal wall. He underwent urgent surgical debridement of his scrotum, penis, and anterior abdomen. Swabs from the scrotum grew Gram-positive cocci, which were initially identified as Streptococcus anginosus group by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). However, polymerase chain reaction (PCR) amplification and sequencing of the 16S rRNA gene identified the isolate as Streptococcus dysgalatiae subspecies equisimilis (SDSE). The incidences of invasive S. anginosus group and SDSE infections at the London Health Sciences Centre, a tertiary-care institution in southwestern Ontario, were determined between August 1, 2011 and August 31, 2012, revealing a slightly lower rate of SDSE (3.2 cases per 100,000 population) than other studies. Conclusions This case highlights a unique disease manifestation of the emerging human pathogen Streptococcus dysgalatiae subspecies equisimilis that has not been previously reported. This case also underscores the limitations of MALDI-TOF MS in differentiating between closely-related streptococcal species which may have different pathogenic profiles. PMID:23957431

2013-01-01

251

Development of Clostridium septicum gas gangrene as an adverse effect of clindamycin-induced Clostridium difficile infection in a pediatric patient.  

PubMed

Clostridium myonecrosis or gas gangrene is a life-threatening infection characterized by either traumatic or atraumatic etiology. It has been widely described in patients with traumatic open wounds and in immunocompromised patients, including malignancy. A third source can result from natural flora in the gastrointestinal tract after bowel ischemia. This is a rare occurrence and is even less commonly described in the pediatric population. We present a pediatric patient who developed Clostridium septicum myonecrosis as an iatrogenic complication from clindamycin-induced Clostridium difficile ischemic colitis. PMID:24590337

Kiser, Casey J; Urish, Kenneth L; Boateng, Henry A

2014-09-01

252

Management of venous bullet embolus in a child.  

PubMed

Bullet embolus is a rare complication of penetrating missile injury in children with only a handful of case reports. We describe a seven year old with a venous bullet embolus to the right ventricle. PMID:25197862

Doud, Andrea N; Hines, Michael H; Pranikoff, Thomas

2014-09-01

253

An improved technique for venous drainage and right heart decompression.  

PubMed

Venous return for cardiopulmonary bypass is successfully achieved using of two stage cavoatrial cannula. Right heart decompression is facilitated and drainage optimized by the use of a caval occluding clamp which stabilizes the cannula. This technique is described. PMID:2808503

McNicholas, K W; Spagna, P M; Karmilowicz, N P; Serra, A J; Lemole, G M

1989-01-01

254

Mechanisms of viability in rabbit flank venous flaps.  

PubMed

Venous flaps may become more versatile in reconstruction and offer different opportunities to reconstructive surgeons if the mechanisms of their viability is clarified. In this study, axial pattern flank flaps in rabbits were converted into venous flaps by dividing the cutaneous pedicles and ligating the artery. Fluorescein and radioactive tracer studies were performed to elucidate the mechanisms of possible circulation. It is hypothesized that the venous flaps do not have a capillary circulation, but veins transport the fluid out, which is drawn into the capillaries from the interstitium, and that the nutrients and oxygen for flap viability diffuse from the wound bed. Venous drainage plays an important role by draining the metabolites away until revascularization offers a more direct supply. PMID:8333688

Gençosmano?lu, R; Ulgen, O; Yaman, C; Songür, E; Akin, Y; Ca?das, A

1993-01-01

255

Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructed sigmoid colon cancer: a case report.  

PubMed

Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently. PMID:16521237

Huang, Wen-Shih; Liu, Kuang-Wen; Lin, Paul Y; Hsieh, Ching-Chuan; Wang, Jeng-Yi

2006-02-14

256

Multiple medullary venous malformations decreasing cerebral blood flow: Case report  

SciTech Connect

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))

1991-02-01

257

Preventing and recognizing venous thromboembolism after obstetric and gynecologic surgery.  

PubMed

Venous thromboembolism (VTE) is a hypercoagulable disorder that is associated with two potential significant complications-deep venous thrombosis (DVT) and pulmonary embolus (PE). During pregnancy and the postpartum period, the risk for VTE is increased. Prevention is optimal, but early detection and treatment of VTE in women after obstetric and gynecologic surgery is imperative, as DVT is often asymptomatic and, in many patients, clinical presentation only occurs after a fatal PE occurs. PMID:23957798

Harrington, Deedra

2013-01-01

258

Venous MR Angiography for Diagnosis and Follow-up  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to determine the value of venous MR angiognaphy as the sole procedure for the diagnosis and follow-up of dural sinus thrombosis. MATERIALS AND METHODS. Forty-two patients with clinical findings suggestive of dural sinus thrombosis were examined with venous MR angiography and spin-echo MR imaging. Maximum-intensity-projection reconstructions and individual sections of the MR angiograms

Thomas J. yogI; Clifford Bergman; Arno Villringer; Karl Einh; Joseph Lissner; Roland Felix

259

Venous drainage of the penis of the equine  

E-print Network

by the processus dorsalis glandis into the dorsal venous system of the penis. The CSP sends lateral branches that join the dorsal venous system of the penis. Vascular connection between the CSP and CSG is present. The tunica albuginea surrounding the CSP... cavernosogram ? distal extremity (mature pony stallion). The towel clamp is placed over the processus dorsalis glandis. The needle is placed 2 cm proximal to the towel clamp directly into the CCP 32 Corpus cavernosogram ? shaft of the penis (mature pony...

De Barros, Christine Ann Heise

2012-06-07

260

Central venous access: techniques and indications in oncology  

Microsoft Academic Search

Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial\\u000a caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been\\u000a placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters\\u000a are cancer patients undergoing long-term chemotherapy. The most important issues, in

Pierre-Yves Marcy; Antoine Lacassagne Anticancer

2008-01-01

261

Large plaque-like glomuvenous malformation (glomangioma) simulating venous malformation.  

PubMed

Glomuvenous malformations and venous malformations are vascular lesions that can be distinguished on the basis of clinical and pathological features. A vascular lesion of the skin and superficial and deep soft tissues of a lower limb in a 5-year-old child is described. The clinical and radiological features, including skeletal muscle involvement, were typical of venous malformation, whereas the histopathological features were those of a glomuvenous malformation. The clinical and histopathological features are briefly discussed. PMID:16716158

Vercellino, N; Nozza, P; Oddone, M; Bava, G L

2006-07-01

262

Impedance Phlebography for the Diagnosis of Venous Thrombosis  

NASA Astrophysics Data System (ADS)

We used a noninvasive diagnostic technique, occlusive cuff impedance phlebography (IPG) for the diagnosis of deep venous thrombosis. Eleven patients were examined by IPG with overall diagnostic accuracy of 95% sensitivity, 81% - specificity. Nine patients had symptoms suggestive of deep venous thrombosis but this diagnosis was confirmed in only 25%. The use of impedance phleobography to screen high-risk patients prospectively and evaluate patients with pulmonary emboli is discussed.

Urzic?, Denise; Dorohoi, Dana-Ortansa

2007-04-01

263

A three–year review of the management of Fournier's gangrene presented in a single Saudi Arabian institute  

PubMed Central

Introduction Fournier‘s gangrene (FG), is a rare life threatening urologic emergency that requires immediate admission of metabolic stabilization and surgical debridement. The mortality rate ranges from 16% to 40%. This study was conducted to investigate the reasons behind the excellent survival rate in our center. Materials and method A retrospective analysis of the medical records of 20 FG cases from January 2010 to January 2013 was conducted. Data was collected on patients’ comorbidity, survivals, Fournier‘s severity index (FSI) at presentation, length of hospital stay (LOS), the number of intensive care unit (ICU) and operating room (OR) entries, the total phalli and testes removed, colostomies created, and cystostomies performed. Results All 20 cases (100%) collected for the study survived. All patients were male. The median age of the patients was 55.95 years (39–78 year). Only one patient (5%) was admitted to ICU post–operatively. Penile amputation was carried out in three of the 20 cases (15%). The total number of OR entries was 34 (average of 1.7). A majority of 12 patients (60%) were diabetic. A total of six testes were extirpated from the study group. None of the patients required colostomy creation. Only one patient (5%) required a cystostomy tube insertion. FSI was 5.65 ranging from 0 to 14. The average length of hospital stay was 22.3 days. Conclusion In contrast to what is published in the literature, FG is not rare in our center. Perfect survival rate owes to the moderate severity of the cases treated, but mostly to the urgent surgical intervention with extensive debridement. PMID:24707378

Al–Adawi, Mohammad; Dakkak, Bassem; Bakhsh, Amani

2013-01-01

264

Venous Doppler in the Evaluation of Fetal Hydrops  

PubMed Central

Objective. To examine venous blood flow velocity in different types of fetal hydrops and its value in the prediction of outcome of pregnancies. Methods. Venous Doppler sonography was performed in 100 hydropic fetuses from 15 to 37 weeks of gestation. Blood velocity was recorded in the right hepatic vein (HV), the ductus venosus (DV) and in the intra-abdominal part of the umbilical vein (UV). Blood velocity indices were calculated and pulsations in the umbilical vein noted and grouped into a single, double or triple flow pattern. Blood velocity was related to cause of hydrops. Results. Mortality was noted in 51 cases of which 19 were by termination of pregnancy. Mortality in the 30 with normal venous blood velocity was 35%, but 58% in cases of abnormal Doppler. Abnormal HV and DV blood velocities were recorded in 39 and 34 cases, respectively and were strongly related to mortality (P < .04 and P < .003, resp.). UV pulsations were noted in 49 fetuses and were significantly related to mortality (P < .04). Mortality and abnormal venous velocities were most frequent in the low-output hydrops group (79% and 75%, resp.). Conclusions. Abnormal venous blood velocity is related to mortality in pregnancies complicated by fetal hydrops. Venous Doppler sonography should be a part of the routine work-up of pregnancies complicated by fetal hydrops. PMID:20454533

Hofstaetter, C.; Gudmundsson, S.

2010-01-01

265

Atrial natriuretic peptide increases resistance to venous return in rats  

SciTech Connect

To examine mechanisms by which administration of atrial natriuretic peptide (ANP) decreases venous return, the authors compared the hemodynamic effects of ANP furosemide (FU), and hexamethonium (HEX) with those of vehicle (VE) in anesthetized rats. Compared with VE, ANP reduced mean arterial pressure, central venous pressure, and cardiac index and increased calculated resistance to venous return. /sup 141/Ce-labeled microspheres were used to determine cardiac output. Mean circulatory filling pressure, distribution of blood flow between splanchnic organs and skeletal muscles, and total peripheral resistance remained unchanged. FU increased urine output similar to that of ANP, yet produced no hemodynamic changes, dissociating diuresis, and decreased cardiac output. HEX lowered arterial pressure through a reduction in total peripheral resistance without altering cardiac output or resistance to venous return. The results confirm previous findings that ANP decreases cardiac output through a reduction in venous return and suggest that this results partly from increased resistance to venous return and not from venodilation or distribution of blood flow.

Chien, Y.W.; Frohlich, E.D.; Trippodo, N.C.

1987-05-01

266

Visualization of coronary venous anatomy by cardiovascular magnetic resonance  

PubMed Central

Background Coronary venous imaging with whole-heart cardiovascular magnetic resonance (CMR) angiography has recently been described using developmental pulse sequences and intravascular contrast agents. However, the practical utility of coronary venous imaging will be for patients with heart failure in whom cardiac resynchronisation therapy (CRT) is being considered. As such complementary information on ventricular function and myocardial viability will be required. The aim of this study was to determine if the coronary venous anatomy could be depicted as part of a comprehensive CMR protocol and using a standard extracellular contrast agent. Methods and Results Thirty-one 3D whole heart CMR studies, performed after intravenous administration of 0.05 mmol/kg gadolinium DTPA, were reviewed. The cardiac venous system was visualized in all patients. The lateral vein of the left ventricle was present in 74%, the anterior interventricular vein in 65%, and the posterior interventricular vein in 74% of patients. The mean maximum distance of demonstrable cardiac vein on the 3D images was 81.5 mm and was dependent on the quality of the 3D data set. Five patients showed evidence of myocardial infarction on late gadolinium enhancement (LGE) images. Conclusion Coronary venous anatomy can be reliably demonstrated using a comprehensive CMR protocol and a standard extracellular contrast agent. The combination of coronary venous imaging, assessment of ventricular function and LGE may be useful in the management of patients with LV dysfunction being considered for CRT. PMID:19671132

Younger, John F; Plein, Sven; Crean, Andrew; Ball, Stephen G; Greenwood, John P

2009-01-01

267

[The "rete venosum plantare" (the plantar venous network or Lejars' venous sole of the foot)].  

PubMed

Looking at the bibliography of the venous sole of the foot (Lejars), the authors point out the opposite convictions concerning this structure. For some ones, it doesn't exist, but fort the others, it is a very important network of tiny veins, such as it was described by Lejars himself. However, all this studies, are made upon cadavers, injected or not, and must be compared with results from living people by the mean of angiography, non invasive Vascular Assessment, or RMN, which take in account vasomotricity. PMID:8362000

Bastide, G; Lefebvre, D

1993-01-01

268

Review of venous anatomy for venographic interpretation in chronic cerebrospinal venous insufficiency.  

PubMed

Chronic cerebrospinal venous insufficiency (CCSVI) represents a recently described condition that may potentially contribute to the symptoms experienced by patients with multiple sclerosis. The evaluation of a prospective patient for CCSVI often involves an invasive evaluation with venography of the internal jugular and azygos veins. The purpose of this article is to review the normal anatomy of the internal jugular, vertebral, and azygos veins, as an understanding of these veins is necessary for appropriate interpretation of the venograms obtained to evaluate patients for CCSVI. PMID:21975259

Werner, John D; Siskin, Gary P; Mandato, Kenneth; Englander, Meridith; Herr, Allen

2011-12-01

269

Contraception, venous thrombosis and biological plausability.  

PubMed

Exogenous use of hormones leads to different impact on coagulation. Usually estrogen leads to an activation of coagulation, while use of progestogens alone do not. Combined oral contraceptives (COC) differs significantly regarding VTE risk depending on amount of estrogen and type of progestagen: COC containing desogestrol, gestoden or drospirenone in combination with ethinyl-estradiol (EE) (so called 3rd or 4th generation COC) are associated with a higher VTE risk than COC with EE and levonorgestrel or norethisterone (so called 2nd generation COC). The VTE risk for transdermal COC like vaginal ring (NuvaRing) or patch (Evra) is as high than than for COC of 3rd or 4th generation. 2nd generation COC should therefore be the first choice when prescribing hormonal contraception. Most PROGESTAGEN-only contraceptive methods do not increase VTE risk significantly. In patients with a history of venous thromboembolism (VTE) and /or a known thrombophilic defect COC are contraindicated, but progestagen-only contraceptives can be safely used in this patient group. New kinds of COC without EE but with Estradiolvalerat or Estradiol showed a much lower degree of coagulation activation than "classical" COC containing EE. If newer COC with Estradiolvalerat or Estradiol have a lower VTE risk, remains to be elucidated. PMID:23514992

Rott, H

2013-04-01

270

Contraception-related venous thromboembolism in adolescents.  

PubMed

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

2014-02-01

271

Depression in patients with chronic venous ulceration.  

PubMed

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of "caseness". A total of 52 (27%) people scored as depressed while 50 (26%) scored as anxious. The two symptoms which appeared to be associated with anxiety and depression were pain and odour, while there was no association found between living alone, mobility and exudate. These findings suggest that the focus of care needs to be redirected for many patients for whom cure is not an option, but who are left to live with a chronic wound. Furthermore, psychological factors, including depression, should be a focus in assessment and ongoing review of patients with leg ulceration. PMID:16835511

Jones, June; Barr, Wally; Robinson, Jude; Carlisle, Caroline

272

Pulmonary hypertension caused by pulmonary venous hypertension  

PubMed Central

Abstract The effect of pulmonary venous hypertension (PVH) on the pulmonary circulation is extraordinarily variable, ranging from no impact on pulmonary vascular resistance (PVR) to a marked increase. The reasons for this are unknown. Both acutely reversible pulmonary vasoconstriction and pathological remodeling (especially medial hypertrophy and intimal hyperplasia) account for increased PVR when present. The mechanisms involved in vasoconstriction and remodeling are not clearly defined, but increased wall stress, especially in small pulmonary arteries, presumably plays an important role. Myogenic contraction may account for increased vascular tone and also indirectly stimulate remodeling of the vessel wall. Increased wall stress may also directly cause smooth muscle growth, migration, and intimal hyperplasia. Even long-standing and severe pulmonary hypertension (PH) usually abates with elimination of PVH, but PVH-PH is an important clinical problem, especially because PVH due to left ventricular noncompliance lacks definitive therapy. The role of targeted PH therapy in patients with PVH-PH is unclear at this time. Most prospective studies indicate that these medications are not helpful or worse, but there is ample reason to think that a subset of patients with PVH-PH may benefit from phosphodiesterase inhibitors or other agents. A different approach to evaluating possible pharmacologic therapy for PVH-PH may be required to better define its possible utility. PMID:25610595

2014-01-01

273

Epidemiology of cancer-related venous thromboembolism  

PubMed Central

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.

2009-01-01

274

Fatal cerebral malaria: a venous efflux problem  

PubMed Central

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. PMID:25414834

Frevert, Ute; Nacer, Adéla

2014-01-01

275

Penile reconstruction with dermal template and vacuum therapy in severe skin and soft tissue defects caused by Fournier's gangrene and hidradenitis suppurativa.  

PubMed

The aim of this article is to improve the treatment of patients with complete skin loss of the penile shaft after Fournier's gangrene or hidradenitis suppurativa using modern biomatrices and topical negative pressure therapy. From January 2010 to December 2011, three patients with Fournier's gangrene or hidradenitis suppurativa were treated. After initial radical debridements, topical negative pressure therapy was applied for wound stabilisation. After that dermal templates (acellular dermal matrix) were used to achieve early healing and topical negative pressure-dressing in a special setting or a special foam compression bandage was used together with a urinary catheter. After integration of the dermal template, a split-thickness skin graft is used for coverage and again secured with a circular total negative pressure-dressing. In all cases, the split-thickness skin grafts healed very well applying this therapy concept. The patients were very satisfied with the functional as well as with the aesthetic outcome. We suggest a new method of staged reconstruction to successfully preserve the functionality of the penis after complete loss of the skin and soft tissue of the penile shaft using modern biomatrices and topical negative pressure therapy. PMID:24618357

Ludolph, Ingo; Titel, Torsten; Beier, Justus P; Dragu, Adrian; Schmitz, Marweh; Wullich, Bernd; Horch, Raymund E

2014-02-21

276

The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients  

PubMed Central

Background Cirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation. Our aim was to determine the incidence and predictors of venous thromboembolism (VTE) and examine the practice of deep venous thrombosis (DVT) prophylaxis among hospitalized cirrhotic patients. Methods A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE. Results Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7%) developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51%) underlying cause of liver cirrhosis, followed by hepatitis B (22%); 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis. Conclusion Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal. PMID:21244669

2011-01-01

277

The Current Role of Venous Sampling in the Localization of Endocrine Disease  

SciTech Connect

Endocrine venous sampling plays a specific role in the diagnosis of endocrine disorders. In this article, we cover inferior petrosal sinus sampling, selective parathyroid venous sampling, hepatic venous sampling with arterial stimulation, adrenal venous sampling, and ovarian venous sampling. We review their indications and the scientific evidence justifying these indications in the diagnosis and management of Cushing's syndrome, hyperparathyroidism, pancreatic endocrine tumors, Conn's syndrome, primary hyperaldosteronism, pheochromocytomas, and androgen-secreting ovarian tumors. For each sampling technique, we compare its diagnostic accuracy with that of other imaging techniques and, where possible, look at how it impacts patient management. Finally, we incorporate venous sampling into diagnostic algorithms used at our institution.

Lau, Jeshen H. G., E-mail: jeshlau@doctors.org.uk; Drake, William [St Bartholomew's Hospital, Department of Endocrinology (United Kingdom); Matson, Matthew [St Bartholomew's Hospital, Department of Radiology (United Kingdom)

2007-07-15

278

Preliminary clinical investigations of a new noninvasive venous pulse oximeter  

NASA Astrophysics Data System (ADS)

For decades, the monitoring of mixed venous oxygen saturation, SvO2 has been performed invasively using fibre-optic catheters. This procedure is not without risk as complications may arise from catheterisation. The group has devised a new non-invasive venous oximetry method which involves inducing regular modulations of the venous blood volume and associated measurement of those modulations using optical means. A clinical investigation was conducted in Glenfield Hospital, UK to evaluate the sensitivity of the new technique to haemodynamic changes such as Cardiac Output (CO) in intraoperative and postoperative cardiac patients. Preliminary trials on patients recovering from cardiac surgery yielded an average correlation of r = 0.72 between CO at different Intra Aortic Balloon Pump (IABP) augmentation levels and SvO2 measured by the new venous oximeter. In intraoperative patients undergoing off-pump cardiac surgery, SvO2 recorded by the new technique responded to unplanned events such as a cardiac arrest. CONCLUSION: The new venous oximetry technique is a promising technique which responds to haemodynamic changes such as CO and with further development might offer an alternative means of monitoring SvO2 non-invasively.

Chan, Daniel; Smith, Peter R.; Caine, Michael P.; Spyt, Tomasz; Boehm, Maria; Machin, David

2003-10-01

279

Bortezomib protects from varicose-like venous remodeling.  

PubMed

Despite the high prevalence of venous diseases that are associated with and based on the structural reorganization of the venous vessel wall, not much is known about their mechanistic causes. In this context, we demonstrated that the quantity of myocardin, a transcriptional regulator of the contractile and quiescent smooth muscle cell phenotype, was diminished in proliferating synthetic venous smooth muscle cells (VSMCs) of human and mouse varicose veins by 51 and 60%, respectively. On the basis of the relevance of proteasomal activity for such phenotypic changes, we hypothesized that the observed VSMC activation is attenuated by the proteasome inhibitor bortezomib. This drug fully abolished VSMC proliferation and loss of myocardin in perfused mouse veins and blocked VSMC invasion in collagen gels by almost 80%. In line with this, topical transdermal treatment with bortezomib diminished VSMC proliferation by 80%, rescued 90% of VSMC myocardin abundance, and inhibited varicose-like venous remodeling by 67 to 72% in a mouse model. Collectively, our data indicate that the proteasome plays a pivotal role in VSMC phenotype changes during venous remodeling processes. Its inhibition protects from varicose-like vein remodeling in mice and may thus serve as a putative therapeutic strategy to treat human varicose veins. PMID:24769668

Pfisterer, Larissa; Meyer, Ralph; Feldner, Anja; Drews, Oliver; Hecker, Markus; Korff, Thomas

2014-08-01

280

Chronic cerebrospinal venous insufficiency: Masked multimodal imaging assessment  

PubMed Central

Background Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of MS. Objective We evaluated neurosonography (NS), magnetic resonance venography (MRV) and transluminal venography (TLV) in subsets of MS patients drawn from a single center, prospective case-control study of 206 MS and 70 non-MS volunteers. Methods As previously reported, findings on high resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vrs. 7.14%; p=0.266). Ninety-nine MS participants consented to intravascular contrast enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins. Results NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties. Conclusions Our findings lend no support for altered venous outflow dynamics as common among MS patients, or likely contribute to the disease process. PMID:23828872

Brod, Staley A.; Kramer, Larry A.; Cohen, Alan M.; Barreto, Andrew D.; Bui, Thanh-Tung; Jemelka, James R.; Ton, Kelly; Lindsey, John W.; Nelson, Flavia; Narayana, Ponnada A.; Wolinsky, Jerry S.

2013-01-01

281

The clinical anatomy of congenital portosystemic venous shunts.  

PubMed

Congenital portosystemic venous shunts are rare. Their gross anatomy has not been well defined. Four different varieties of congenital portosystemic venous shunts are described in six children seen during a 10-year period, focusing on the anatomy of the shunt as determined by imaging studies and surgery. A detailed review of the literature indicates that congenital portosystemic venous shunts are best classified as: extrahepatic or intrahepatic. Extrahepatic shunts may be further subdivided into portocaval shunts (type 1 end-to-side and type 2 side-to-side) and others. Intrahepatic shunts are due to an abnormal intrahepatic connection between the portal vein and hepatic vein/inferior vena cava or a persistent patent ductus venosus. Additional congenital anomalies, particularly cardiac malformations, may be associated with any type. Some congenital intrahepatic portosystemic venous shunts close spontaneously in infancy; all other congenital portosystemic venous shunts tend to remain patent. To a variable extent, depending largely on the volume and duration of the shunt, affected individuals are at risk of developing hepatic encephalopathy and/or an intrahepatic tumor. The key to understanding the pathogenesis of these shunts lies in the normal developmental mechanisms underlying the formation of the portal vein and inferior vena cava in the embryo. PMID:18161055

Stringer, Mark D

2008-03-01

282

Carotid-Cavernous Fistula Associated with an Intracranial Lesion Caused by Cortical Venous Reflux  

PubMed Central

Summary Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) findings in 20 patients with carotid-cavernous fistula (CCF; 3 direct CCFs and 17 indirect CCFs) were retrospectively reviewed to evaluate venous drainage patterns that may cause intracerebral haemorrhage or venous congestion of the brain parenchyma. We evaluated the relationship between cortical venous reflux and abnormal signal intensity of the brain parenchyma on MRI. Cortical venous reflux was identified on DSA in 12 of 20 patients (60.0%) into the superficial middle cerebral vein (SMCV; n=4), the uncal vein (n=2), the petrosal vein (n=2), the lateral mesencephalic vein (LMCV; n=1), the anterior pontomesencephalic vein (APMV; n=1), both the APMV and the petrosal vein (n=1) and both the uncal vein and the SMCV (n=1). Features of venous congestion, such as tortuous and engorged veins, focal staining and delayed appearance of the veins, were demonstrated along the region of cortical venous reflux in the venous phase of internal carotid or vertebral arteriography in six of 20 patients (30.0%). These findings were not observed in the eight CCF patients who did not demonstrate cortical venous reflux. MRI revealed abnormal signal intensity of the brain parenchyma along the region with cortical venous reflux in four of 20 indirect CCF patients (20%). Of these four patients, one presented with putaminal haemorrhage, while the other three presented with hyperintensity of the pons, the middle cerebellar peduncle or both on T2-weighted images, reflecting venous congestion. The venous drainage routes were obliterated except for cortical venous reflux in these four patients and the patients without abnormal signal intensity on MRI had other patent venous outlets in addition to cortical venous reflux. CCF is commonly associated with cortical venous reflux. The obliteration or stenosis of venous drainage routes causes a converging venous outflow that develops into cortical venous reflux and results in venous congestion of the brain parenchyma or intracerebral haemorrhage. Hyperintensity of brain parenchyma along the region of cortical venous reflux on T2-weighted images reflects venous congestion and is the crucial finding that indicates concentration of venous drainage into cortical venous reflux. PMID:20569625

Takahashi, S.; Sakuma, I.; Otani, T.; Yasuda, K.; Tomura, N.; Watarai, J.; Kinouchi, H.; Yanagisawa, T.; Mizoi, K.

2006-01-01

283

Evaluation of asymptomatic venous disease by venous Doppler ultrasonography in patients with Behcet's disease without overt thrombosis.  

PubMed

One of the major causes of mortality and morbidity in Behcet's disease (BD) is vascular involvement. Limited data suggest a high prevalence of venous insufficiency (VI) and some cases of asymptomatic thrombosis in BD. In this study, we aimed to investigate asymptomatic venous disease by venous Doppler ultrasonography (US) prospectively in patients with BD, without known vascular disease. The study included 93 patients with BD (M/F, 45/48; age, 36.4?±?10 years), 97 patients with ankylosing spondylitis (AS) (M/F, 50/47; age, 37.5?±?9.5 years), and 43 healthy controls (HC) (M/F, 25/18; age, 34.7?±?4.5 years). All patients were examined for the clinical findings of venous thrombosis. Vessels of both upper and lower extremities were examined, while the subjects were in supine position by venous Doppler US. Clinical signs ("C"), the various etiologies ("E"), anatomical sites ("A"), and pathophysiological disorder ("P") (CEAP) severity score was used to evaluate the severity of the VI. We did not detect any "silent thrombosis" in any group. VI findings in lower extremity were detected in 32.2 % (n?=?30) in the BD group, 28.8 % (n?=?28) in AS group, and 9.3 % (n?=?4) in the HC group. Both BD and AS patients had significantly higher VI rates than controls (p?=?0.007 and 0.015). Similarly, CEAP severity score in BD (0.34 (0-3)) was significantly higher than controls (0, p?=?0.008) but similar to AS (0.18 (0-39), p?=?0.18). No correlations were present between C-reactive protein elevation (>5 mg/L) and VI in both BD (p?=?0.546) and AS (p?=?0.754). A high prevalence of VI was present in both BD and AS patients without symptomatic thrombosis. Presence of VI also in AS, a disease without a major tendency to venous thrombosis, might suggest that chronic inflammation might cause a mild insufficiency detected only by Power US in venous vessels. Long-term consequences of this finding require further follow-up studies to show whether asymptomatic venous disease is a predictor of future venous thrombotic events in patients with BD. PMID:24013509

Alibaz-Oner, Fatma; Karatay, Emrah; Akpinar, Ihsan Nuri; Ergun, Tulin; Direskeneli, Haner

2014-02-01

284

Primary hyperaldosteronism: comparison of CT, adrenal venography, and venous sampling  

SciTech Connect

Twenty-nine patients with primary hyperaldosteronism were evaluated with computed tomography (CT), adrenal venous sampling, and adrenal venography. Twenty-three patients had aldosteronomas and six had bilateral adrenocortical hyperplasia. Sixteen (70%) of the adenomas were accurately located by CT. All nodules of 1.5 cm or larger diameter and 50% of nodules 1.0 to 1.4 cm in diameter were demonstrated. Nodules of less than 1.0 cm in diameter generally were not detected. High-resolution CT appeared more sensitive than standard CT (75% vs 58%). Adrenal venous sampling for aldosterone assay was the most sensitive of the three methods, localizing 22 (96%) of the 23 adenomas. Eighteen (78%) of the adenomas were identified by adrenal venography, although two patients with bilateral cortical hyperplasia were mistakenly diagnosed as having a small adenoma. No such false-positive studies were encountered with CT or adrenal venous sampling.

Geisinger, M.A.; Zelch, M.G.; Bravo, E.L.; Risius, B.F.; O'Donovan, P.B.; Borkowski, G.P.

1983-08-01

285

Instantaneous venous oxygenation estimation using the Photoplethysmograph (PPG) waveform  

NASA Astrophysics Data System (ADS)

In this study oesophageal photoplethysmograph data from eight patients under positive pressure ventilation were analysed in order to test the hypothesis that the modulations created by the ventilation in the AC Photoplethysmograph (PPG) signal could be used to estimate venous oxygen saturation. In order to estimate the instantaneous arterial and venous oxygen saturation Smoothed-pseudo Wigner-Ville Distribution (SPWVD) was utilised. The result from this study showed that there was no significant different in the conventional (time domain) arterial saturation and the instantaneous arterial saturation. However, the instantaneous venous oxygen saturation estimated with the ventilator modulation were significantly lower then the conventional arterial saturation (P = 0.008) and also from the instantaneous arterial saturation (P = 0.008).

Shafqat, K.; Kyriacou, P. A.; Pal, S. K.; Langford, R. M.

2011-08-01

286

Cortical venous thrombosis following exogenous androgen use for bodybuilding  

PubMed Central

There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic–clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20?mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11?days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4?months later showed resolution of the thrombosis. He recovered fully. PMID:23389726

Sveinsson, Olafur; Herrman, Lars

2013-01-01

287

Venous symptoms in C0 and C1 patients: UIP consensus document.  

PubMed

This UIP document provides an update on venous symptoms in CO and C1 patients. The correlation between venous symptoms and the presence of telangiectases and/or reticular veins is one of the most controversial topics in chronic venous disorders. As symptoms may be non-specific of chronic venous disease, it is important to differentiate venous symptoms from symptoms of other causes. Some data from the Bonn Vein Study suggest that the risk to develop venous symptoms is increased in women, advanced age and obesity. Treatment is based on physical advice, elastic compression, venoactive drugs, sclerotherapy, correction of foot static disorders and reduction of body weight. Future research should be promoted on venous symptoms in epidemiological and follow-up studies, about the relationship between female hormone levels and symptomatic telangiectasias, and between venous pain and foot static disorders in C0s C1s patients. PMID:23711678

Benigni, J P; Bihari, I; Rabe, E; Uhl, J F; Partsch, H; Cornu-Thenard, A; Jawien, A

2013-06-01

288

Brothers and Sisters: Molecular insights into arterial-venous heterogeneity  

PubMed Central

The molecular differences between arteries and veins are genetically predetermined and are evident even before the first embryonic heart beat. Although ephrinB2 and EphB4 are expressed in cells that will ultimately differentiate into arteries and veins respectively, many other genes have been shown to play a significant role in cell fate determination. The expression patterns of ephrinB2 and EphB4 are restricted to arterial-venous boundaries, and Eph/ephrin signaling provides repulsive cues at arterial-venous boundaries that are thought to prevent intermixing of arterial- and venous-fated cells. However, the maintenance of arterial-venous fate is susceptible to some degree of plasticity. Thus, in response to signals from the ambient microenvironment and shear stress, there is flow-mediated intercalation of the arteries and veins that ultimately leads to the formation of a functional, closed-loop circulation. In addition, cells in the blood vessels of each organ undergo epigenetic, morphologic and functional adaptive changes that are specific to the proximate function of their cognate organ(s). These adaptive changes result in an inter-organ and intra-organ vessel heterogeneity that manifest clinically in a disparate response of different organs to identical risk factors and injury in the same animal. In this review, we will focus on the molecular and physiologic factors influencing arterial-venous heterogeneity between and within different organ(s). We will explore arterial-venous differences in selected organs as well as their respective endothelial cell architectural organization that results in their inter- and intra-organ heterogeneity. PMID:18948631

Aitsebaomo, Julius; Portbury, Andrea L; Schisler, Jonathan C; Patterson, Cam

2009-01-01

289

[Treatment of patients with venous diseases of the lower extremities].  

PubMed

Results of treatment of 355 patients with chronic venous insufficiency of the lower limbs were analyzed. In 169 patients with postthrombophlebitic disease, in 38 patients with postthrombophlebitic trophic ulcers and in 43 patients with varicose trophic ulcers the lymphotropic therapy was used (the study group). Control group consisted of 105 patients treated with traditional methods. Limphotropic therapy improved microcirculatory and metabolic processes in tissues that promotes faster cure of inflammation and edema and epithelization of trophic ulcers in patients with chronic venous insufficiency. PMID:12077830

Azizov, G A; Dzhumabaev, E S

2002-01-01

290

Endovascular Therapy for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis  

PubMed Central

Recent reports have emerged suggesting that multiple sclerosis (MS) may be due to abnormal venous outflow from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI). These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment. PMID:21808631

Lazzaro, Marc A.; Zaidat, Osama O.; Mueller-Kronast, Nils; Taqi, Muhammad A.; Woo, Douglas

2011-01-01

291

Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis.  

PubMed

Recent reports have emerged suggesting that multiple sclerosis (MS) may be due to abnormal venous outflow from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI). These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment. PMID:21808631

Lazzaro, Marc A; Zaidat, Osama O; Mueller-Kronast, Nils; Taqi, Muhammad A; Woo, Douglas

2011-01-01

292

Intracranial dural arterio-venous fistula presenting with progressive myelopathy.  

PubMed

Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF. PMID:22675039

Ogbonnaya, Ebere Sunny; Yousaf, Irfan; Sattar, Taufiq Mohammed

2011-01-01

293

Ultrasound-Guided Central Venous Cannulation in Bariatric Patients  

Microsoft Academic Search

Background  Central venous catheterization may be difficult in morbidly obese patients because anatomic landmarks are often obscured.\\u000a \\u000a \\u000a \\u000a Methods  We evaluated the efficacy and safety of ultrasound-guided central venous cannulation in 55 patients undergoing bariatric surgery.\\u000a The usefulness of ultrasonic examination combined with intraatrial electrocardiogram as a diagnostic tool for catheter misplacement\\u000a was studied.\\u000a \\u000a \\u000a \\u000a Results  Preliminary ultrasound examination of the neck vessels demonstrated anatomical

Claudia Brusasco; Francesco Corradi; Pier Luigi Zattoni; Claudio Launo; Yigal Leykin; Salvatore Palermo

2009-01-01

294

Critical Review of Mouse Models of Venous Thrombosis  

PubMed Central

Deep vein thrombosis and pulmonary embolism are a significant health care concern, representing a major source of mortality and morbidity. In order to understand the pathophysiology of thrombogenesis and thrombus resolution, animal models are necessary. Mouse models of venous thrombosis contribute to our understanding of the initiation, propagation, and resolution of venous thrombus, as well as allow for the evaluation of new pharmaceutical approaches to prophylaxis and treatment of deep vein thrombosis. In this work we review the ferric chloride model, the inferior vena cava ligation model, the inferior vena cava stenosis models, and the electrolytic inferior vena cava model and compare their advantages and disadvantages. PMID:22345593

Diaz, Jose Antionio; Obi, Andrea T.; Myers, Daniel D.; Wrobleski, Shirley K.; Henke, Peter K.; Mackman, Nigel; Wakefield, Thomas W.

2012-01-01

295

Vacuum-assisted venous drainage, angel or demon: PRO?  

PubMed

Vacuum-assisted venous drainage (VAVD) was proposed to optimize venous drainage during bypass through femoral venous cannulation. It is currently used in both adult and pediatric surgery when siphon gravity venous drainage is suboptimal. In pediatric surgery, the major advantages of VAVD are a significant decrease in cardiopulmonary bypass prime volume and an improved drainage with all collateral benefits. To limit gravity drainage, we use a two-level heart-lung machine dedicated to pediatric perfusion. The top level of the cardiotomy reservoir is positioned at the patient atrial level, making it possible to downsize the length and diameter of venous and arterial lines. Since 2008, a negative pressure of approximately -30 mmHg has been used for all patients. Initiation of bypass is performed in a classical way with a cardiotomy reservoir open; vacuum is added as soon as the maximal gravity drainage is reached. During bypass, when the blood level in the reservoir decreases to the safety limit level, a small increase in negative pressure is used to improve venous drainage. For weaning from bypass, the negative pressure is gradually decreased to zero, then the reservoir is opened and the venous line progressively closed. Prime volumes were significantly reduced to 100 mL for small neonates, 125 mL for infants, and 175 mL for older children with flow up to 1.5 L/min(-1). A low prime volume is expected to improve blood conservation and decrease donor exposure, prevent drawbacks of transfusion (immunomodulation, infection), increase the incidence of blood-free surgery in smaller babies, and decrease whole body systemic inflammation by decreasing surface of foreign material in contact with blood and inflammation associated with blood transfusion. The main drawbacks described have been retrograde flow in the venous line with cerebral air embolus and an increased incidence of gaseous microemboli. These drawbacks are avoidable through appropriate training of perfusionists. When negative pressure is "reasonable," complications are more theoretical than significant in clinical practice. A technique with a benefit/drawback ratio of 1:0 is utopian, but the advantages of VAVD far outweigh any potential drawbacks when applied properly. PMID:23930382

Durandy, Yves

2013-06-01

296

Relative Changes of Cerebral Arterial and Venous Blood Volumes During Increased Cerebral Blood Flow  

E-print Network

Relative Changes of Cerebral Arterial and Venous Blood Volumes During Increased Cerebral Blood Flow-Gi Kim1* Measurement of cerebral arterial and venous blood volumes during increased cerebral blood flow, and neuronally active conditions. In particular, the change in venous blood volume induced by neural activity

Duong, Timothy Q.

297

Effect of Postthrombotic Syndrome on Health-Related Quality of Life After Deep Venous Thrombosis  

Microsoft Academic Search

Background: Postthrombotic syndrome (PTS) is a fre- quent chronic complication of deep venous thrombosis, yet its impact on health-related quality of life has not been well characterized. We compared generic and venous dis- ease-specific quality of life in patients with and without PTS, and assessed whether quality of life correlated with severity of PTS. Methods: Subjects with previous deep venous

Susan R. Kahn; Andrew Hirsch; Ian Shrier

2002-01-01

298

Gene expression changes in venous segment of overflow arteriovenous fistula.  

PubMed

Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV) fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44?K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas. PMID:23710358

Hashimoto, Yasuhiro; Okamoto, Akiko; Saitoh, Hisao; Hatakeyama, Shingo; Yoneyama, Takahiro; Koie, Takuya; Ohyama, Chikara

2013-01-01

299

Neonatal venous cerebral hemorrhage. Report of two cases.  

PubMed

Intracranial pathological changes can occur as a result of impaired craniocervical venous return. Thrombosis of central venous access catheters was demonstrated in two neonates born at 38 and 27 weeks' gestation. Neither infant developed hemorrhage of prematurity as confirmed on cranial ultrasonography. Clinical evidence of vena cava thrombosis and associated spontaneous intraventricular hemorrhage developed on Day 24 and 36, respectively, and these findings were confirmed on imaging studies. In one infant the hemorrhage was accompanied by communicating hydrocephalus. The cause of the intracranial disease was attributable to the retrograde cerebral venous congestion. This, together with the primitive venous bed developing in the periventricular region, was associated with the spontaneous hemorrhage in the region of the foramen of Monro. To the authors' knowledge, this is the first report in the English-language literature of spontaneous neonatal intracerebral hemorrhage, due to thrombosis of the superior or inferior vena cava. The natural history of this condition is resolution without sequelae after appropriate therapeutic intervention for the vena cava thrombosis. PMID:15344898

Misra, Sanjay N; Misra, Ashish K

2003-10-15

300

[The focal brain ischemia with disturbance of venous drainage].  

PubMed

The focal brain ischemia with disturbance of cerebral venous drainage often lead to brain edema and hemorrhagic infarction and make mortality and morbidity worse. So we tried to make sure of this fact using a middle cerebral artery (MCA) occlusion model in adult cat. The MCA was exposed by the transorbital approach and temporally obstructed by Zen's clip. We divided the animals into two groups of eight cats. One group is only MCA occlusion group (sham group) and the other in MCA occlusion with disturbance of venous drainage (VRD group). We ligated bilateral external jugular vein (EJV) and internal jugular vein (IJV) and injected embolic sources from the left EJV to obstruct the venous system of cat brain. The pressure of superior sagittal sinus was increased up to 18.7 +/- 5.3 mmHg by this method. A cranial window was made above the ectosylvian gyrus, which has poor anastomosis. The reactivity of pial arteriole and regional cerebral blood flow (rCBF) were observed through the window. And histological brain examination was also performed. The result was that the reactivity of pial arterioles was severely disturbed in VRD group. The area of cerebral infarction and edema were also significantly expanded in VRD group. Considering from these facts, when the venous drainage was disturbed, cerebral perfusion pressure relatively decrease. Because of the decrease in cerebral perfusion pressure, cerebral infarction and edema probably expand to the area so called penumbra. PMID:1419337

Miyamoto, K; Tsujimoto, S; Tominaga, M; Takeshima, T; Morimoto, T; Tsunoda, S; Sakaki, T

1992-07-01

301

What went wrong? The flawed concept of cerebrospinal venous insufficiency  

PubMed Central

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, José M; Doepp, Florian; Schreiber, Stephan J; van Oosten, Bob W; Schmierer, Klaus; Paul, Friedemann; Wattjes, Mike P

2013-01-01

302

Mastoiditis, meningitis and venous sinus thrombosis caused by Fusobacterium necrophorum  

Microsoft Academic Search

The authors report a case of septic venous sinus thrombosis (VST) and meningitis occurring as an early complication of mastoiditis caused byFusobacterium necrophorum. CT scan was normal, and cerebral angiography was required to diagnose the VST. The evolution was favourable with appropriate antimicrobial therapy and steroids.

Brigitte Bader-Meunier; Graziella Pinto; Marc Tardieu; Daniele Pariente; Serge Bobin; Jean-Paul Dommergues

1994-01-01

303

Travel as a Risk Factor for Venous Thromboembolic Disease  

Microsoft Academic Search

Background: The link between travel and the risk of venous thromboembolic disease (VTED) has been widely suspected. However, only cases or series of cases have been reported in the literature. Study objectives: By means of a case-control study, we sought to confirm this relationship and to determine the main features, if any, of these posttravel VTEDs. Design: The history, in

Emile Ferrari; Thierry Chevallier; Alexis Chapelier; Marcel Baudouy

304

Chronic cerebrospinal venous insufficiency in multiple sclerosis: a historical perspective  

PubMed Central

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

305

What went wrong? The flawed concept of cerebrospinal venous insufficiency.  

PubMed

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, José M; Doepp, Florian; Schreiber, Stephan J; van Oosten, Bob W; Schmierer, Klaus; Paul, Friedemann; Wattjes, Mike P

2013-05-01

306

Recombinant tissue plasminogen activator for central venous access device occlusion  

Microsoft Academic Search

Maintaining and restoring the function of central venous access devices (CVAD) is an important component of pediatric oncology nursing care. Until 1999, Abbokinase Open Cath (urokinase; Abbott, Abbott Park, IL), a thrombolytic agent was the product primarily used to resolve thrombotic occlusions in intravascular devices. Changes in the manufacturing process mandated by the FDA have resulted in a lack of

Casey Hooke

2000-01-01

307

Model-based reconstructive elasticity imaging of deep venous thrombosis  

Microsoft Academic Search

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

2004-01-01

308

Macromolecular Transport across Arterial and Venous Endothelium in Rats  

E-print Network

Macromolecular Transport across Arterial and Venous Endothelium in Rats Studies with Evans Blue- cence microscopic examination of en face preparation of the aorta stained with hematoxylln allowed to the "blue areas" for EBA or "brown areas" for HRP. Compared wtth arteries, veins had fewer mltotlc cells

Chuang, Pao-Tien

309

Surgical treatment for venous ulcers: is it worthwhile?  

PubMed Central

We have reviewed the results of treatment of 159 consecutive limbs presenting with a clinical diagnosis of venous ulcer in 140 patients (70 male, aged 28-90 years, median 66 years). Of the patients, 61% were referred because of severe pain and 53% of the ulcers had been present > 2 years. Patients were evaluated clinically and by Doppler, with selective use of venography, photoplethysmography, arteriography and latterly duplex scanning. Seventy-one limbs had surgery to the superficial veins, 18 limbs had arterial reconstruction, and 10 limbs had skin grafting alone. There was one operative death after arterial reconstruction but none after venous surgery. Patients were followed up for 1-5 years (median 3 years). Of those who had been treated surgically, healing was achieved in 88%, and ulcers healed in 52% of those treated non-operatively. In all, 18% of the ulcers recurred in each group. These results show a favourable association between appropriate venous and arterial surgery and the healing of venous ulcers, with relief of pain. They support a policy of thorough evaluation and appropriate surgical treatment in these patients. PMID:8540660

Dunn, J. M.; Cosford, E. J.; Kernick, V. F.; Campbell, W. B.

1995-01-01

310

Intrahepatic portosystemic venous shunt associated with biliary atresia: case report.  

PubMed

We describe an infant with intrahepatic portosystemic venous shunt (IPSVS), which was detected by MR angiography. IPSVS is rare and its cause is disputed. However, with improvements in imaging the number of reports of IPSVS identified incidentally in patients without definite symptoms is increasing. The present case is the first associated with congenital biliary atresia and the youngest reported in the literature. PMID:10929369

Yamagami, T; Nakamura, T; Tokiwa, K; Ohno, K; Itoh, H; Maeda, T

2000-07-01

311

Hepatic portal venous gas: Physiopathology, etiology, prognosis and treatment  

Microsoft Academic Search

Hepatic portal venous gas (HPVG), an ominous ra- diologic sign, is associated in some cases with a se- vere underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiogra- phy, sonography, color Doppler flow imaging

Bassam Abboud; Jad El Hachem; Thierry Yazbeck; Corinne Doumit

2009-01-01

312

Development of Needle Insertion Manipulator for Central Venous Catheterization  

NASA Astrophysics Data System (ADS)

Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

313

Prophylaxis of venous thromboembolism in abdominal wall surgery  

Microsoft Academic Search

Summary Venous thromboembolic disease (VTD) is a major cause of morbidity and mortality in hospitalized patients, mainly in those undergoing surgery. In this setting, the development of convenient and safe prophylactic measures has become a need. The main role in fulfilling this need is currently played by the so-called low molecular weight heparins (LMWH), among which one of the latest

M. Hidalgo; J. M. Figueroa

2000-01-01

314

The role of venous valves in pressure shielding  

Microsoft Academic Search

BACKGROUND: It is widely accepted that venous valves play an important role in reducing the pressure applied to the veins under dynamic load conditions, such as the act of standing up. This understanding is, however, qualitative and not quantitative. The purpose of this paper is to quantify the pressure shielding effect and its variation with a number of system parameters.

Constantinos Zervides; Andrew J Narracott; Patricia V Lawford; David R Hose

2008-01-01

315

Venous thromboembolism in medical critically ill patients: prevalence and incidence.  

PubMed

The objective of this study was to determine the prevalence and incidence of venous thromboembolism among critically ill medical surgical patients. In this cross sectional and retrospective study, we observed 243 patients who were first admitted at the intensive care unit. Patients who were diagnosed with deep venous thrombosis or embolism either by clinical or paraclinical methods were enrolled. Among 243 patients of ICU ward 12 cases of them were confirmed to have thromboembolism (prevalence of 9.4%).But the incidence of venous thromboembolism after 48 hour of ICU admission was 5.2%(6 cases). Among 6 VTE cases 3 of them didn't receive any anticoagulant prophylaxis, 2 patients received LDUH 5000 unit twice a day and one patient received LMWH 60 mg daily but all developed VTE although receiving prophylaxis. We found that the prevalence of proximal lower limb DVT among medical-surgical critically ill patients remaining in the ICU for ?3 days is about 9.4% and the incidence of that is about 5.2%. Further studies should be performed in order to assess the benefits and risks of venous thromboprophylaxis in Iranian patients. PMID:23605601

Adimi Naghan, Parisa; Malekmohammad, Majid; Jamaati, Hamidreza; Sharifkashani, Babak; Najafi, Arvin; Hashemian, Seyed Mohammadreza

2013-01-01

316

Coronary arteries form by developmental reprogramming of venous cells  

E-print Network

ARTICLES Coronary arteries form by developmental reprogramming of venous cells Kristy Red-Horse1 , Hiroo Ueno2 , Irving L. Weissman2 & Mark A. Krasnow1 Coronary artery disease is the leading cause of death worldwide. Determining the coronary artery developmental program could aid understanding

Krasnow, Mark A.

317

Ethanol Sclerotherapy of Superficial Venous Malformation: A New Procedure  

Microsoft Academic Search

Background: Superficial venous malformations (SVM) are the most frequent vascular malformations. Outpatient percutaneous treatment with ethanol injection has rarely been described. Objective: To analyze the results from treating SVM patients with ethanol sclerotherapy. Methods: 81 patients were followed up prospectively over a median period of 18 months. 47 were female and 34 were male with a median age of 21

José Luiz Orlando; Jose Guilherme Mendes Pereira Caldas; Heloisa Galvăo do Amaral Campos; Kenji Nishinari; Nelson Wolosker

2010-01-01

318

Feline gangrenous mastitis  

PubMed Central

A 3.7-kg, 3-year-old intact female domestic shorthaired cat was presented with the chief complaint of anorexia and lethargy of 3 days duration with a noticeable decrease in body condition and a large open wound on her ventral caudal abdomen. A diagnosis of acute mastitis with gland abscessation was made. The patient was successfully treated with oral antibiotics and open wound management using surgical debridement and lavage followed by wound dressings using honey. PMID:23997269

Wilson, Courtney R.

2013-01-01

319

Sustained compression and healing of chronic venous ulcers.  

PubMed Central

STUDY OBJECTIVE--Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN--Part of larger randomised trial of five different dressings. SETTING--Outpatient venous ulcer clinic in university hospital. PATIENTS--(a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer bandage was assessed in 148 legs in 126 consecutive patients (mean age 71 (SE 2); range 30-96) with chronic venous ulcers that had resisted treatment with traditional bandaging for a mean of 27.2 (SE 8) months. INTERVENTIONS--(a) Four layer bandage system or traditional adhesive plaster bandaging for pressure studies; (b) four layer bandaging applied weekly for studies of healing. END POINTS--(a) Comparison of pressures achieved at the ankle for up to one week; (b) complete healing within 12 weeks. MEASUREMENTS AND MAIN RESULTS--(a) Four layer bandage produced higher initial pressures at the ankle of 42.5 (SE 1) mm Hg compared with 29.8 (1.8) for the adhesive plaster (p less than 0.001; 95% confidence interval 18.5 to 6.9). Pressure was maintained for one week with the four layer bandage but fell to 10.4 (3.5) mm Hg at 24 hours with adhesive plaster bandaging. (b) After weekly bandaging with the four layer bandage 110 of 48 venous ulcers had healed completely within 12 (mean 6.3 (0.4)) weeks. CONCLUSION--Sustained compression of over 40 mm Hg achieved with a multilayer bandage results in rapid healing of chronic venous ulcers that have failed to heal in many months of compression at lower pressures with more conventional bandages. PMID:3144330

Blair, S. D.; Wright, D. D.; Backhouse, C. M.; Riddle, E.; McCollum, C. N.

1988-01-01

320

Chronic venous obstruction: diagnostic considerations and therapeutic role of percutaneous iliac stenting.  

PubMed

Iliac venous outflow obstruction has an important role in the expression of symptomatic chronic venous insufficiency. This anatomic obstruction is frequently overlooked, owing in part to diagnostic difficulty. The combination of venous obstruction and reflux leads to more severe clinical disease. Current diagnostic modalities do not allow an definitive assessment of hemodynamically critical venous obstruction. No single invasive or noninvasive study can accurately detect borderline obstruction of potential hemodynamic significance. A high index of suspicion is critical in the initial recognition of chronic venous obstruction. The diagnosis relies on clinical signs and symptoms and radiologic assessment of morphologic venous outflow obstruction. Treatment strategy should be based on the results of morphologic investigations such as transfemoral phlebography or, preferably, intravascular ultrasonography. Percutaneous iliac venous stenting offers a safe and efficient method to correct pelvic venous obstruction. Percutaneous iliac stenting does not preclude subsequent venous bypass or corrective superficial and deep reflux surgery. This article reviews the etiologic factors and diagnostic modalities of iliac venous obstruction. The therapeutic role of percutaneous iliac stenting in the management of venous obstruction is also discussed. PMID:17976327

Neglén, Peter

2007-01-01

321

Elevated Levels of Coagulation Factor VIII in Patients With Venous Leg Ulcers.  

PubMed

Chronic venous disease affects millions of people around the world. Venous valvular incompetencies and venous reflux, often a result of outflow obstruction are important contributors to venous disease. The prevalence of thrombophilia is increased in patients with chronic venous insufficiency (CVI). The recognition of underlying thrombophilia particularly in young patients opens new avenues in the management and prevention plan. We emphasize on the consideration of workup for coagulopathy, especially factor VIII deficiency in young patients with venous disease. We report 3 patients with chronic leg ulcers and high levels of FVIII:C activity in plasma and other associated thrombophilic factors. We highlight the need to get a workup done for thrombophilia in young patients with recurrent and chronic leg ulcers related to venous insufficiency or livedoid vasculopathy. Further studies with larger sample sizes are required to define the definite indications for the thrombophilia workups. PMID:24861090

Criado, Paulo Ricardo; Alavi, Afsaneh; Kirsner, Robert S

2014-05-25

322

Arterial and Venous Progenitors of the Major Axial Vessels Originate at Distinct Locations  

PubMed Central

Summary Currently, it remains controversial how vascular endothelial progenitor cells (angioblasts) establish their arterial or venous fates. We show using zebrafish that the arterial progenitors of the major axial vessels originate earlier and closer to the midline than the venous progenitors. Both medial and lateral progenitor populations migrate to distinct arterial and venous positions and not into a common precursor vessel as previously suggested. Overexpression of VEGF or Hedgehog (Hh) homologs results in the partially randomized distribution of arterial and venous progenitors within the axial vessels. We further demonstrate that the function of the Etv2 transcription factor is required at earlier stages for arterial development than for venous. Our results argue that the medial angioblasts undergo arterial differentiation because they receive higher concentration of Vegf and Hh morphogens than the lateral angioblasts. We propose a revised model of arterial-venous differentiation that explains how angioblasts choose between an arterial and venous fate. PMID:23639444

Kohli, Vikram; Schumacher, Jennifer A.; Desai, Sharina Palencia; Rehn, Kira; Sumanas, Saulius

2013-01-01

323

Predicting the risk of recurrent venous thromboembolism. The Austrian study on recurrent venous thromboembolism (AUREC).  

PubMed

Venous thromboembolism (VTE) is a disease, which often recurs. The recurrence risk is highest in patients with unprovoked proximal deep-vein thrombosis (VT) or pulmonary embolism. Men have a higher risk than women. The risk is low in patients with VTE related to a temporary risk factor such as surgery or estrogen use. Other risk factors include overweight, post-thrombotic syndrome, history of VTE, residual VT or a vena cava filter. Both factor V Leiden and the prothrombin mutation confer a negligible increase in recurrence risk. High clotting factor levels, deficiency of a natural coagulation inhibitor, or hyperhomocysteinaemia are also associated with an increased risk. Reasons why routine laboratory thrombophilia screening however is no longer warranted are addressed in this article. Prediction rules combining clinical characteristics and coagulation assays have recently been developed. One such model, the Vienna Prediction Model, allows predicting recurrent VTE on the basis of VTE location, sex and D-dimer. This article describes strategies to distinguish between patients with high risk of recurrent VTE from those with a lower risk, who might not benefit from long-term antithrombotic therapy. PMID:23712242

Kyrle, P A; Eischer, L

2013-08-01

324

A multistep approach to manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report  

PubMed Central

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

2013-01-01

325

Fatal venous air embolism in a cat undergoing dental extractions.  

PubMed

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

2008-11-01

326

[Upper gastrointestinal haemorrhage after venous bypass in cirrhotics (author's transl)].  

PubMed

In a series of 76 patients who had undergone venous bypass for upper gastrointestinal haemorrhage, the authors noted 13 recurrences of bleeding, six resulting in death directly or secondary to hepatic failure. Repeated rupture of esophageal varices after thrombosis of an anastomosis is well known but in one out of two cases a second bypass involving another part of the portal territory resulted in cure. The important problem remains that of the precise aetiological diagnosis of the haemorrhage, there often being a doubt between esophageal varices and haemorrhagic gastritis. In certain cases there is no good indication for a bypass, as indicated by the absence of further bleeding after certain anastomotic thromboses. Ulcers due to venous bypass are rare. Secondary medical or surgical treatment in patients with a patent anastomosis should be undertaken with caution, in particular in the case of splenectomy for residual hypersplenism. PMID:303354

Lataste, J; Carlier, M

1977-10-01

327

Cerebral Sinus Venous Thrombosis due to Asparaginase Therapy  

PubMed Central

We report a 9-year-old boy with acute lymphoblastic leukemia (ALL) in high-risk group who suffered from left sided focal seizures and ipsilateral hemiparesis during his induction with Asparaginase chemotherapy. Superior sagittal sinus thrombosis and right frontal hemorrhage were demonstrated on brain magnetic resonance imaging (MRI) scans . Anticoagulation was initiated with unfractionated heparin and switched to low molecular weight heparin after 3?weeks and continued for 6?months. At one-year followup, he had complete response to chemotherapy for ALL, with residual mild left hemiparesis, and his MRI scans revealed recanalized venous sinuses. The case highlights the importance of considering cerebral venous thrombosis as a complication of Asparaginase therapy. PMID:23781355

Alsaid, Youssef; Gulab, Shamshad; Bayoumi, Mohammed

2013-01-01

328

Unusual Infra-Clavicular Venous Circle – A Case Report  

PubMed Central

Currently, numerous invasive procedures are preferred in cephalic vein (CV) and axillary vein (AV) than other veins in the neck. Anatomical variations of these veins in the axilla and delto-pectoral region may result in failure and postoperative complications of the procedures. A thorough knowledge of possible variations of AV and CV may immensely contribute to the success of any such procedures where the veins are involved. We report the variations of the CV, tributaries of AV and median cubital vein. We observed a venous circle formed by the tributaries of AV in the infra-clavicular region, deep to the pectoral muscles. Cephalic vein joined proximal end of venous circle just before ending into AV. Further, duplication of the median cubital vein was observed. PMID:25584205

Sirasanagandla, Srinivasa Rao; Aithal P, Ashwini; Guru, Anitha; S, Sudarshan

2014-01-01

329

Recurrent cerebral venous thrombosis revealing paraneoplastic angiitis in Hodgkin's lymphoma.  

PubMed

Recurrent cerebral venous thrombosis (CVT), as a manifestation of paraneoplastic angiitis and revealing of nodular lymphocyte predominant Hodgkin's disease (NLPHD), is an extremely rare condition. We herein report a 55-year-old man who developed recurrent CVT despite efficacious anticoagulant therapy and subsequent stenting of the superior longitudinal sinus. Progressive neurological deterioration ensued and a body scan revealed axillary lymph nodes. Pathological analysis led to a diagnosis of NLPHD. Conventional angiography showed CVT and multiple arterial narrowings. A paraneoplastic primary cerebral angiitis with prominent venous structure involvement was suspected. Immunotherapy using rituximab and steroids provided a dramatic recovery. This case of CVT due to paraneoplastic cerebral angiitis is a rare condition and represents a new, very rare manifestation of nodular lymphocyte predominant Hodgkin's disease. PMID:18461283

Roggerone, Stephanie; Traverse-Glehen, Alexandra; Derex, Laurent; Honnorat, Jerome; Berger, Francoise; Salles, Gilles; Rousset, Hugues; Trouillas, Paul; Nighoghossian, Norbert

2008-09-01

330

Cryotherapy and ankle motion in chronic venous disorders  

PubMed Central

This study compared ankle range of motion (AROM) including dorsiflexion, plantar flexion, inversion and eversion, and venous refill time (VRT) in leg skin inflamed by venous disorders, before and after a new cryotherapy ulcer prevention treatment. Fifty-seven-individuals participated in the randomized clinical trial; 28 in the experimental group and 29 received usual care only. Results revealed no statistically significant differences between the experimental and usual care groups although AROM measures in the experimental group showed a consistent, non-clinically relevant decrease compared to the usual care group except for dorsiflexion. Within treatment group comparisons of VRT results showed a statistically significant increase in both dorsiflexion and plantar flexion for patients with severe VRT in the experimental group (6.9 ± 6.8; p = 0.002 and 5.8 ± 12.6; p = 0.02, respectively). Cryotherapy did not further restrict already compromised AROM, and in some cases, there were minor improvements. PMID:23516043

Kelechi, Teresa J.; Mueller, Martina; Zapka, Jane G.; King, Dana E.

2013-01-01

331

Acute Cytomegalovirus Infection as a Cause of Venous Thromboembolism  

PubMed Central

Acute Human Cytomegalovirus (HCMV) infection is an unusual cause of venous thromboembolism, a potentially life-threatening condition. Thrombus formation can occur at the onset of the disease or later during the recovery and may also occur in the absence of acute HCMV hepatitis. It is likely due to both vascular endothelium damage caused by HCMV and impairment of the clotting balance caused by the virus itself. Here we report on two immunocompetent women with splanchnic thrombosis that occurred during the course of acute HCMV infection. Although the prevalence of venous thrombosis in patients with acute HCMV infection is unknown, physicians should be aware of its occurrence, particularly in immunocompetent patients presenting with fever and unexplained abdominal pain. PMID:24959338

Rinaldi, Francesca; Lissandrin, Raffaella; Mojoli, Francesco; Baldanti, Fausto; Brunetti, Enrico; Pascarella, Michela; Giordani, Maria Teresa

2014-01-01

332

Cerebral Venous Thrombosis in the Mediterranean Area in Children  

PubMed Central

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.

2011-01-01

333

Embryologicalic collateral venous channel on radionuclide liver/spleen study  

SciTech Connect

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.

1983-07-01

334

The role of factor Xa inhibitors in venous thromboembolism treatment  

PubMed Central

Three factor Xa inhibitors have been studied in the treatment of venous thromboembolism, both for acute therapy and as extended therapy to prevent recurrent events. Rivaroxaban, apixaban, and edoxaban have all proven to be effective in Phase III clinical trials for this indication when compared to current standard of therapy with similar or less bleeding. Nevertheless, the agents all offer different pharmacological profiles, which have an impact on patient selection and potential advantages in clinical practice.

Cabral, Katherine P; Ansell, Jack E

2015-01-01

335

Multiple sclerosis and chronic cerebrospinal venous insufficiency: a critical review  

PubMed Central

Chronic cerebrospinal venous insufficiency (CCSVI) was recently proposed as a contributing factor in the pathology of multiple sclerosis. This concept has gained remarkable attention, partly because endovascular neurointervention has been suggested as a treatment strategy. This review summarizes available evidence and provides a critical analysis of the published data. Currently, there is inconclusive evidence to support CCSVI as an etiological factor in patients with multiple sclerosis. Endovascular procedures should not be undertaken outside of controlled clinical trials. PMID:21765873

Awad, Amer M.; Marder, Ellen; Milo, Ron; Stüve, Olaf

2011-01-01

336

Spontaneous migration of central venous catheter tip following extubation  

PubMed Central

Migration of the tip of central venous catheters is not an uncommon event and the mechanism for this is not clear. Increased intrathoracic pressure due to coughing, sneezing or weight lifting, changing the body position or physical movements such as abduction or adduction of the arms is thought to be the cause of such migration. We present here a case of a patient with a port catheter tip that migrated from the left subclavian to the superior vene cava following extubation. PMID:24665255

Prabaharan, Balaji; Thomas, Sara

2014-01-01

337

Preventing central venous catheter-related bloodstream infection.  

PubMed

Nurses should be able to apply evidence-based practice in a way that is appropriate for the individual patient. This article discusses one area, the incidence of central venous catheter-related bloodstream infection in acute care, to examine the available evidence and identify ways in which this evidence can be applied to practice. Research indicates that implementing best practice at the time of insertion is a principal determinant in minimising the risk of catheter-related bloodstream infection. PMID:25563126

Wilson, Charlotte

2015-01-01

338

Central Venous Saturation: A Prognostic Tool in Cardiac Surgery patients  

Microsoft Academic Search

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

2010-01-01

339

Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile?  

Microsoft Academic Search

Background: Whether or not superior mesentericoportal venous resection (SM-PVR) associated with pancreaticoduodenectomy (PD) is safe and worthwhile has not been fully confirmed. The aim of the present study was to investigate results of this surgical procedure performed for pancreatic head and periampullary neoplasms.Methods: As a first analysis, postoperative morbidity and mortality after PD with (n = 31) or without SM-PVR

Philippe Bachellier; Hiroshi Nakano; Jean-Christophe Weber; Karim Boudjema; Daniel Jaeck

2001-01-01

340

Stent implantation for post-Mustard systemic venous obstruction  

Microsoft Academic Search

In this paper, we report on the use of stents in the treatment of late-onset post-Mustard systemic venous obstruction in three patients with clinical signs of obstructive caval syndrome. After unsuccessful balloon dilation, Palmaz-Schatz stents were implanted at the veno-atrial junction. Further dilation has been achieved using high-pressure balloons. Vessel diameter increased from 4.4±1.8 to 13±1.7 mm (P<0.05) and the

Giuseppe Santoro; Luigi Ballerini; Jacek Bialkowski; Ramon Bermůdez-Canete

1998-01-01

341

Guidelines for the treatment of head and neck venous malformations  

PubMed Central

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

2013-01-01

342

[Deep venous thromboses--established treatment procedures and new trends].  

PubMed

Thrombolysis in deep venous thrombosis is indicated in documented thrombosis of the legs, because, in most cases, it is due to no or minimal collateral flow with bad prognosis. Thrombolysis should not be used regularly in isolated thrombosis of the veins of the lower legs and in subclavian vein thrombosis. The aims in therapy of deep venous thrombosis are reduction of possible complications such as fatal pulmonary embolism, avoidance of progression and recurrence, respectively, and avoidance of a postthrombotic syndrome. In contrast to heparinization, thrombolysis has the advantage of high recanalization rates, but the disadvantage of higher incidence of hemorrhage. With clinically proven dosage regimens of streptokinase and urokinase in our experience, complete recanalization rates are in the range of 30% of primary occluded vessels. According to pivotal and dose-finding studies, the results with tissue plasminogen activator (t-PA) are within the same range. In a different approach, the thrombolytic substances are delivered in a loco-regional type via a vein of the foot. There is some evidence from pivotal clinical trials that the same recanalization rates are obtainable as with streptokinase in ultrahigh dosage. Considering the individual importance and also the epidemiologic and economic value of deep venous thrombosis, there is a need for prospective, randomized trials. Results of clinical studies currently under way will hopefully show the benefit of such new therapeutic strategies. PMID:8328209

Seifried, E

1993-01-01

343

Chronic Venous Insufficiency: prevalence and effect of compression stockings  

PubMed Central

Introduction Chronic venous insufficiency (CVI) is a common disease affecting mainly lower limbs and significantly influencing the quality of life. This study aims to estimate the prevalence of CVI in the Qassim Region and test the effectiveness of compression stockings as an intervention option. Methods A cross sectional study was conducted to assess the prevalence of CVI among patients visiting primary health care (PHC) centers in the Qassim Region. CVI patients were diagnosed and classified using the clinical, etiologic, anatomical, and pathophysiological (CEAP) scale. They were randomly divided into two groups, one using compression stockings and the other standard medical therapy. A clinical follow up was done using multiple scale system including CEAP scale. Data analysis was performed using SPSS. Results Among the 226 screened patients, 138 (61.1%) were diagnosed as having CVI (69% female and 45% male, p<0.001). Compared to the baseline, both the clinical and venous scores for CVI at the follow-up were significantly lower among patients using compression stockings, p=0.002 and p=0.003, respectively. Regression analysis suggested that, after controlling for age, sex and body mass index, compliance was the main factor responsible for a significant reduction in the clinical score among CVI patients. Conclusions Chronic venous insufficiency is very common in the Qassim Region. Compression stockings are highly effective in improving clinical symptoms and signs of CVI. Trial registration This study is registered at www.clinicaltrials.gov(NCT02050061). PMID:25505858

Al Shammeri, Owayed; AlHamdan, Nourah; Al-hothaly, Bushra; Midhet, Farid; Hussain, Mahboob; Al-Mohaimeed, Abdulrahman

2014-01-01

344

Catheter venography and endovascular treatment of chronic cerebrospinal venous insufficiency.  

PubMed

Multiple sclerosis (MS) is a disorder characterized by damage to the myelin sheath insulation of nerve cells of the brain and spinal cord affecting nerve impulses which can lead to numerous physical and cognitive disabilities. The disease, which affects over 500,000 people in the United States alone, is widely believed to be an autoimmune condition potentially triggered by an antecedant event such as a viral infection, environmental factors, a genetic defect or a combination of each. Chronic cerebrospinal venous insufficiency (CCSVI) is a condition characterized by abnormal venous drainage from the central nervous system that has been theorized to have a possible role in the pathogenesis and symptomatology of MS (1). A significant amount of attention has been given to this theory as a possible explanation for the etiology of symptoms related to MS patients suffering from this disease. The work of Dr. Zamboni, et al, who reported that treating the venous stenoses causing CCSVI with angioplasty resulting in significant improvement in the symptoms and quality of life of patients with MS (2) has led to further interest in this theory and potential treatment. The article presented describes endovascular techniques employed to diagnose and treat patients with MS and CCSVI. PMID:22640501

Mandato, Kenneth; Englander, Meridith; Keating, Lawrence; Vachon, Jason; Siskin, Gary P

2012-06-01

345

Electrolytic Inferior Vena Cava Model (EIM) of Venous Thrombosis  

PubMed Central

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.

2011-01-01

346

Variability in the cardiac venous system of wistar rats.  

PubMed

Rats are often used as animal models in experimental cardiology for studying myocardial infarctions and various cardiologic procedures. Currently the cardiac venous system is a target for the delivery of drugs, gene vectors, angiogenetic growth factors, stem cells, and cardioprotective reagents. The purpose of this study was to describe the anatomic configuration and variability of the cardiac venous system in Wistar rats, by using the corrosion cast method and perfusion of colored latex. The distribution of veins in the rat heart disagrees with prior descriptions for other mammals, except mice, which have a similar pattern. Coronary venous drainage in the 36 rats examined consistently involved the left cardiac, left conal, major caudal, right cardiac, and right conal veins. Other veins involved inconsistently included the cranial cardiac vein (58.3% of cases), minor caudal veins (16.7%), conoanastomotic vein (66.7%), and left atrial vein (75%). In 4 cases (11.1%), the collateral veins were located between the left conal and left cardiac veins. In this study, high morphologic variability between cases was manifested by differences in the arrangement, size, mode of opening, and formation of the common root and affected all regions of the heart but primarily the right ventricle. PMID:25651085

Krešáková, Lenka; Purzyc, Halina; Schusterová, Ingrid; Fulton, Benjamin; Maloveská, Marcela; Vdoviaková, Katarina; Kravcová, Zuzanna; BoldiŽár, Martin

2015-01-01

347

Potential Risk Factors for Varicose Veins with Superficial Venous Reflux  

PubMed Central

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

2014-01-01

348

Venous thromboembolism at uncommon sites in neonates and children.  

PubMed

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

2014-11-01

349

How to prevent venous cannula orifice obstruction during extracorporeal circulation.  

PubMed

Venous cannula orifice obstruction is an underestimated problem during augmented cardiopulmonary bypass (CPB), which can potentially be reduced with redesigned, virtually wall-less cannula designs versus traditional percutaneous control venous cannulas. A bench model, allowing for simulation of the vena cava with various affluent orifices, venous collapse and a worst case scenario with regard to cannula position, was developed. Flow (Q) was measured sequentially for right atrial + hepatic + renal + iliac drainage scenarios, using a centrifugal pump and an experimental bench set-up (afterload 60 mmHg). At 1500, 2000 and 2500 RPM and atrial position, the Q values were 3.4, 6.03 and 8.01 versus 0.77*, 0.43* and 0.58* l/min: p<0.05* for wall-less and the Biomedicus(®) cannula, respectively. The corresponding pressure values were -15.18, -31.62 and -74.53 versus -46.0*, -119.94* and -228.13* mmHg. At the hepatic position, the Q values were 3.34, 6.67 and 9.26 versus 2.3*, 0.42* and 0.18* l/min; and the pressure values were -10.32, -20.25 and -42.83 versus -23.35*, -119.09* and -239.38* mmHg. At the renal position, the Q values were 3.43, 6.56 and 8.64 versus 2.48*, 0.41* and 0.22* l/min and the pressure values were -9.64, -20.98 and -63.41 versus -20.87 -127.68* and -239* mmHg, respectively. At the iliac position, the Q values were 3.43, 6.01 and 9.25 versus 1.62*, 0.55* and 0.58* l/min; the pressure values were -9.36, -33.57 and -44.18 versus -30.6*, -120.27* and -228* mmHg, respectivly. Our experimental evaluation demonstrates that the redesigned, virtually wall-less cannulas, allowing for direct venous drainage at practically all intra-venous orifices, outperform the commercially available control cannula, with superior flow at reduced suction levels for all scenarios tested. PMID:25416743

Abdel-Sayed, S; Favre, J; von Segesser, Lk

2014-11-21

350

A review of the current management and treatment options for superficial venous insufficiency.  

PubMed

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

2014-10-01

351

Elevated plasma gas6 levels are associated with venous thromboembolic disease  

Microsoft Academic Search

Growth arrest-specific 6 (gas6), a novel vitamin K-dependent protein, has been demonstrated to have a role in thrombus stabilization\\u000a as gas6 null mice are resistant to lethal venous and arterial thrombosis. However, the association between gas6 and venous\\u000a thromboembolism has not been elucidated in humans. The present study aims to assess the role of gas6 in human venous thromboembolic\\u000a (VTE)

Mark D. Blostein; Isabelle Rajotte; Deepa P. Rao; Christina A. Holcroft; Susan R. Kahn

352

Recurrent Syncope Due to Refractory Cerebral Venous Sinus Thrombosis and Transient Elevations of Intracranial Pressure  

PubMed Central

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.

2014-01-01

353

Primary intra osseous venous malformation of nasal bone: A rare case report  

PubMed Central

Primary intra osseous venous malformation with involvement of nasal bone is a rare phenomenon. Nasal bone intraosseous venous malformation on a back ground of port wine stain of face has not been reported in the available literature. We report the very rare case of intraosseous venous malformation of left nasal bone developing on a background of port wine stain of face, its diagnosis, pathology, management and review of literature.

Pati, Ajit Kumar; Nayak, Bibhuti Bhusan; Choudhury, Arun Kumar; Rout, Debesh Kumar

2014-01-01

354

Hepatic portal venous gas following colonoscopy in a patient with Crohn's disease.  

PubMed

Hepatic portal venous gas is a rare condition that occurs when intraluminal gas or gas produced by intestinal bacteria enters the portal venous circulation. It has recently been recognized as a rare complication of colon procedures by endoscopy or barium enema. Given the frequency of these procedures in patients with inflammatory bowel disease, hepatic portal venous gas may occur more frequently in these patients than previously reported. Here, we report a woman with Crohn's disease who developed hepatic portal venous gas following colonoscopy who was treated with conservative therapy. PMID:24640184

Ujihara, Masaki; Ando, Takafumi; Ishiguro, Kazuhiro; Maeda, Osamu; Watanabe, Osamu; Hirayama, Yutaka; Maeda, Keiko; Morise, Kazuhiro; Matsushita, Masanobu; Funasaka, Kohei; Nakamura, Masanao; Miyahara, Ryoji; Ohmiya, Naoki; Goto, Hidemi

2013-08-01

355

Cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy.  

PubMed

Cerebral venous sinus thrombosis (CVST) rarely induces cerebral hemorrhage, and CVST with cerebral hemorrhage during early pregnancy is extremely rare. Upon literature review, we are able to find only one case of CVST with cerebral hemorrhage in early pregnancy. In this paper, we report another case of a 27-year-old patient who developed CVST with cerebral hemorrhage in her fifth week of pregnancy. Although the optimal treatment for this infrequent condition remains controversial, we adopted anticoagulation as the first choice of treatment and obtained favorable results. PMID:25630781

Nie, Quanmin; Guo, Pin; Ge, Jianwei; Qiu, Yongming

2015-01-01

356

Cerebral sinus venous thrombosis in a child with nephrotic syndrome.  

PubMed

Cerebral venous thrombosis (CVT) as a complication in children with nephrotic syndrome is rarely reported. Although clinical characteristics are increasingly recognized, therapeutic management and clinical outcomes are not well documented. This case report presents a 10-year-old female who presented with dehydration associated with headache and decreased level of consciousness, which required intubation. Brain imaging revealed CVT. Thrombolytic therapy was started, and she showed a good clinical, as well as radiological recovery. The literature was reviewed to highlight the benefit of such therapy in cases with life threatening complications. PMID:24739410

Al-Rumayyan, Ahmed R

2014-04-01

357

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: A Case Report.  

PubMed

Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present a man with CVT of right transverse sinus who presented a SAH in right parietal sinus. In the study we found a hyperhomocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance to identify possible causes that could be reversed with an appropriate treatment and the controversy about the moment of starting anticoagulant therapy in such cases. PMID:25380613

Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana

2014-11-01

358

Prevention and treatment of venous thromboembolism during HRT: current perspectives  

PubMed Central

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

2014-01-01

359

MRI and venographic aspects of pelvic venous insufficiency.  

PubMed

Pelvic venous insufficiency is a frequent pathology in multiparous women. Diagnosis can be made by chance or suspected in the case of symptoms suggesting pelvic congestion syndrome or atypical lower limb varicosity fed by pelvic leaks. After ultrasound confirmation, dynamic venography is the reference pretherapeutic imaging technique, searching for pelvic varicosity and possible leaks to the lower limbs. MRI is less invasive and allows a three-dimensional study of the varicosity and, with dynamic angiography, it can assess ovarian reflux. It also helps to plan or even sometimes avoid diagnostic venography. PMID:24630150

Leiber, L M; Thouveny, F; Bouvier, A; Labriffe, M; Berthier, E; Aubé, C; Willoteaux, S

2014-11-01

360

Portal venous aneurysms--report of 4 cases.  

PubMed

Portal venous aneurysms are rare and are usually discovered as incidental findings on abdominal imaging studies. Although most are asymptomatic, they may occasionally cause symptoms of compression of an adjacent structure, thrombosis, or bleeding. Treatment is usually not necessary and conservative follow-up is suggested. We present four patients with portal system aneurysms. One patient had a 10.5 cm thrombosed aneurysm, one had a right 3.5 cm intrahepatic portal aneurysm, one patient had a symptomatic 4 cm splenic artery aneurysm, which was repaired, and one patient had a 4 cm aneurysm at the confluence of the splenic and portal veins. PMID:20471219

Oleske, Alexandra; Hines, George L

2010-07-01

361

Incidence of varicose veins, chronic venous insufficiency and venous reflux in the general population and associated risk factors: the Edinburgh Vein Study follow up   

E-print Network

Chronic venous disease (CVD) is a common problem in the western world, causes considerable morbidity and has a substantial impact on the health care system in terms of cost of treatment. Most epidemiological research has ...

Robertson, Lindsay Anne

2013-07-06

362

Increased expressions of integrin subunit ?1, ?2 and ?3 in patients with venous thromboembolism: new markers for venous thromboembolism  

PubMed Central

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

2014-01-01

363

Validity of the diagnostic criteria for chronic cerebrospinal venous insufficiency and association with multiple sclerosis  

PubMed Central

Background: The chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis. Methods: We compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants. Results: We enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography. Interpretation: We detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity. PMID:24890104

Costello, Fiona; Modi, Jayesh; Lautner, David; Bhayana, Deepak; Scott, James N.; Davenport, W. Jeptha; Trufyn, Jessie; Frayne, Richard; Ciura, Viesha A.; Goyal, Mayank; Mah, Jean; Hill, Michael D.

2014-01-01

364

Venous malformations in blue rubber bleb nevus syndrome: variable onset of presentation  

Microsoft Academic Search

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by discrete venous malformations of varying size and appearance that are present on the skin and within the gastrointestinal tract. The characteristic cutaneous lesions consist of deep-blue, soft, rubbery blebs, which are easily compressible. A serious complication is gastrointestinal bleeding. Because venous malformations were described historically as cavernous hemangiomas,

Walter K Nahm; Sharon Moise; Lawrence F Eichenfield; Amy S Paller; Laura Nathanson; Denise M Malicki; Sheila Fallon Friedlander

2004-01-01

365

Radiographic and Intravascular (IVUS) Evaluation of Venous Morphology During CCSVI Treatment  

ClinicalTrials.gov

To Determine the Safety and Validity of Venous Angioplasty and; Valvuloplasty in the Treatment of CCSVI. In Addition, it Will; Allow Researchers to Sub-classify Valve Morphology in Relation; to Treatment Success. This Will be Evidenced by Venous Patency; Forty-eight Hours by Doppler Ultrasound as Well as Clinical; Symptom Improvement.

2012-05-06

366

Genetic polymorphisms of vein wall remodeling in chronic venous disease: a narrative and systematic review.  

PubMed

Chronic venous disease encompasses a spectrum of disorders caused by an abnormal venous system. They include chronic venous insufficiency, varicose veins, lipodermatosclerosis, postthrombotic syndrome, and venous ulceration. Some evidence suggests a genetic predisposition to chronic venous disease from gene polymorphisms associated mainly with vein wall remodeling. The literature exploring these polymorphisms has not been reviewed and compiled thus far. In this narrative and systematic review, we present the current evidence available on the role of polymorphisms in genes involved in vein wall remodeling and other pathways as contributors to chronic venous disease. We searched the EMBASE, Medline, and PubMed databases from inception to 2013 for basic science or clinical studies relating to genetic associations in chronic venous disease and obtained 38 relevant studies for this review. Important candidate genes/proteins include the matrix metalloproteinases (extracellular matrix degradation), vascular endothelial growth factors (angiogenesis and vessel wall integrity), FOXC2 (vascular development), hemochromatosis (involved in venous ulceration and iron absorption), and various types of collagen (contributors to vein wall strength). The data on associations between these genes/proteins and the postthrombotic syndrome are limited and additional studies are required. These associations might have future prognostic and therapeutic implications. PMID:25006132

Bharath, Vighnesh; Kahn, Susan R; Lazo-Langner, Alejandro

2014-08-21

367

Oral Contraceptives and Cerebral Venous Thrombosis: case report and a brief review of literature  

Microsoft Academic Search

Cerebral venous thrombosis remains an important and sometimes an elusive cause of strokes. Oral contracep- tives seem to have a strong causative association with this entity. We describe a case that highlights the importance of asking specific questions about oral contraceptive use in patients with strokes due to cerebral venous sinus thrombo- sis, especially, where the cause remains cryptic.

Mughis Sheerani; Mian Zainul; Sajadeen Urfy

368

Venous leg ulcer care: How evidence-based is nursing practice?  

Microsoft Academic Search

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

2003-01-01

369

The surgical anatomy of coronary venous return in hearts with isomeric atrial appendages  

Microsoft Academic Search

Although absence of the coronary sinus is widely recognized in hearts with isomerism of the right atrial appendages, little attention has been paid to the fashion of the venous return from the heart itself. In this study, the arrangement of coronary venous return was investigated in 99 specimens with isomeric right and 49 with isomeric left appendages. In the normal

Hideki Uemura; Siew Yen Ho; Robert H. Anderson; William A. Devine; Audrey Smith; Tokuko Shinohara; Toshikatsu Yagihara; Yasunaru Kawashima

1995-01-01

370

Principles of chronic venous access: recommendations based on the Roswell Park experience  

Microsoft Academic Search

At Roswell Park Cancer Institute, we have seen a dramatic increase in the need for long-term venous access. Chronic venous catheters are an indispensible part of the treatment provided to oncology patients. Cancer patients are often at higher risk for complications secondary to their underlying disease and treatment. These risks may be minimized by paying close attention to several important

Michael S. Sabel; Judy L. Smith

1997-01-01

371

Risk Assessment and Prophylaxis of Venous Thromboembolism in Acutely and\\/or Critically Ill Patients  

Microsoft Academic Search

Both undetected and clinically evident venous thrombosis and venous thromboembolism (VTE) can seriously impact the prognosis of acutely and\\/or critically ill patients. Pulmonary embolism (PE) is harder to diagnose in the acutely and\\/or critically ill, many of whom also have developed respiratory failure for other reasons. Deep vein thrombosis (DVT) of the upper and lower extremities can subsequently complicate insertion

Bruce L. Davidson

2000-01-01

372

Hepato-venous reconstruction in orthotopic liver transplantation with preservation of the recipients' inferior vena cava and veno-venous bypass  

Microsoft Academic Search

Background and aims: The potential advantages of vena cava-preserving recipient hepatectomy in orthotopic liver transplantation are reduced hemorrhage, improved cardiovascular stability and preserved renal perfusion without the requirement of veno-venous bypass as compared with recipient hepatectomy including the vena cava. No detailed information is available on the use of veno-venous bypass during complicated vena cava preserving recipient hepatectomy and liver

U. J. Hesse; F. Berrevoet; R. Troisi; P. Pattyn; E. Mortier; J. Decruyenaere; B. de Hemptinne

2000-01-01

373

Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation.  

PubMed

A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery. PMID:19299276

Casian, D; Gutsu, E; Culiuc, V

2009-04-01

374

Sharp Central Venous Recanalization by Means of a TIPS Needle  

SciTech Connect

The purpose of this study was to perform an alternative technique for recanalization of a chronic occlusion of the left brachiocephalic vein that could not be traversed with a guidewire. Restoration of a completely thrombosed left brachiocephalic vein was attempted in a 76-year-old male hemodialysis patient with massive upper inflow obstruction, massive edema of the face, neck, shoulder, and arm, and occlusion of the stented right brachiocephalic vein/superior vena cava. Vessel negotiation with several guidewires and multipurpose catheters proved unsuccessful. The procedure was also non-viable using a long, 21G puncture needle. Puncture of the superior vena cava (SVC) at the distal circumference of the stent in the right brachiocephalic vein/superior vena cava, however, was feasible with a transjugular intrahepatic portosystemic shunt (TIPS) set under biplanar fluoroscopy using the distal end of the right brachiocephalic vein as a target, followed by balloon dilatation and partial extraction of thrombotic material of the left brachiocephalic vein with a wire basket. Finally, two overlapping stents were deployed to avoid early re-occlusion. Venography demonstrated complete vessel patency with free contrast media flow via the stents into the SVC, which was reconfirmed in follow-up examinations. Immediate clinical improvement was observed. Venous vascular recanalization of chronic venous occlusion by means of a TIPS needle is feasible as a last resort under certain precautions.

Honnef, Dagmar, E-mail: honnef@rad.rwth-aachen.de; Wingen, Markus; Guenther, Rolf W.; Haage, Patrick [University Hospital, Department of Diagnostic Radiology (Germany)

2005-06-15

375

Extrahepatic aneurysm of the portal venous system and portal hypertension  

PubMed Central

Portal venous aneurysm (PVA) is a rare condition characterized by dilatation of the portal venous system. PVA manifestation of symptoms is varied and depends on the aneurysm size, location and related-complications, such as thrombosis. While the majority of reported cases of PVA are attributed to portal hypertension, very little is known about the condition’s pathophysiology and clinical management remains a challenge. Here, we describe a 67-year-old woman who presented with complaint of dyspepsia and without a significant medical history, for whom PVA was incidentally diagnosed. The initial upper abdominal ultrasound revealed marked dilatation of the main portal vein, and subsequent contrast-enhanced computed tomography with angiography revealed a large aneurysm arising from the extrahepatic troncus portion of the portal vein, as well as gastroesophageal varices. A conservative approach using beta-blocker therapy was chosen. The patient was followed-up for 60 mo, during which time the asymptomatic status was unaltered and the PVA remained stable. PMID:23556049

Debernardi-Venon, Wilma; Stradella, Davide; Ferruzzi, Greta; Marchisio, Filippo; Elia, Chiara; Rizzetto, Mario

2013-01-01

376

Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment  

PubMed Central

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.; Kózka, M.; Urbanek, T.

2013-01-01

377

Common peroneal nerve compression by a popliteal venous aneurysm.  

PubMed

A 58-yr-old man with a right foot drop and a sensory change in the right calf and foot, which developed after a bladder operation, was referred to our clinic for an electrodiagnostic evaluation. Neurologic examination showed grade 1 weakness of the right ankle in dorsiflexion, great toe in dorsiflexion, and ankle in eversion. In addition, the patient complained of pain and a tingling sensation in the right calf and foot. Electrodiagnostic findings were consistent with right common peroneal nerve palsy at the level of the fibula head. In addition, duplex ultrasonography, computed tomography angiography, and magnetic resonance imaging revealed a right popliteal venous aneurysm and impingement of the right common peroneal nerve between the aneurysm and the belly of the biceps femoris muscle. After resection of the aneurysm, his sensory symptoms and motor strength of the right foot and calf gradually improved. This case suggests that compression by the venous system should be considered when there is clinical evidence of focal neuropathy but no abnormal findings at common entrapment sites. PMID:19661772

Jang, Seong Ho; Lee, Honggi; Han, Seung Hoon

2009-11-01

378

Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion  

SciTech Connect

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: ulf.teichgraeber@charite.de; Streitparth, Florian, E-mail: florian.streitparth@charite.d [Charite Universitaetsmedizin Berlin, Institut fuer Diagnostische und Interventionelle Radiologie (Germany); Gebauer, Bernhard, E-mail: bernhard.gebauer@charite.d [Charite Universitaetsmedizin Berlin, Klinik fuer Strahlenheilkunde (Germany); Benter, Thomas, E-mail: Thomas.Benter@klinikum-rg.d [Elblandkliniken Riesa-Grossenhain gGmbH, Klinik fuer Innere Medizin II Haematologie/Onkologie und Gastroenterologie (Germany)

2010-04-15

379

Deep Posterior Compartment Pressure in the Evaluation of Venous Insufficiency of the Lower Extremity — A Preliminary Report  

Microsoft Academic Search

A new method of assessing the extent of venous insufficiency in the lower extremity at the tissue level was tested on thirteen limbs with various degrees of venous insufficiency as evidenced by clinical signs and descending venography. Deep posterior compartment pressures in standing patients correlated well with standing venous pressures in these same limbs. Eighty-three percent of those limbs with

Syde A. Taheri; Gerald N. Yacobucci; James Williams; Steven Elias

1984-01-01

380

Ex-situ liver surgery without veno-venous bypass  

PubMed Central

AIM: To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass. METHODS: In 3 patients with liver tumor, the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation. It was impossible to resect the tumors by the routine hepatectomy, so the patients underwent ex-situ liver surgery, vein cava replacement and hepatic autotransplantation without veno-venous bypass. All surgical procedures were carried out or supervised by a senior surgeon. A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery, vein cava replacement and hepatic autotransplantation without veno-venous bypass. We also compared our data with the 9 cases of Pichlmayr’s group. RESULTS: Three patients with liver tumor were analysed. The first case was a 60-year-old female with a huge haemangioma located in S1, S4, S5, S6, S7 and S8 of liver; the second was a 64-year-old man with cholangiocarcinoma in S1, S2, S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1, S5, S7 and S8. The operation time for the three patients were 6.6, 6.4 and 7.3 h, respectively. The anhepatic phases were 3.8, 2.8 and 4.0 h. The volume of blood loss during operation were 1200, 3100, 2000 mL in the three patients, respectively. The survival periods without recurrence were 22 and 17 mo in the first two cases. As for the third case complicated with postoperative hepatic vein outflow obstruction, emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day, and finally died of liver and renal failure on the third day. Operation time (6.7 ± 0.47 h vs 13.7 ± 2.6 h) and anhepatic phase (3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr’s group and our series (P = 0.78). CONCLUSION: Ex-situ liver resection and liver autotransplantation has shown a potential for treatment of complicated hepatic neoplasms that are unresectable by traditional procedures. PMID:23326135

Zhang, Ke-Ming; Hu, Xiong-Wei; Dong, Jia-Hong; Hong, Zhi-Xian; Wang, Zhao-Hai; Li, Gao-Hua; Qi, Rui-Zhao; Duan, Wei-Dong; Zhang, Shao-Geng

2012-01-01

381

Factor XI Antisense Oligonucleotide for Prevention of Venous Thrombosis.  

PubMed

Background Experimental data indicate that reducing factor XI levels attenuates thrombosis without causing bleeding, but the role of factor XI in the prevention of postoperative venous thrombosis in humans is unknown. FXI-ASO (ISIS 416858) is a second-generation antisense oligonucleotide that specifically reduces factor XI levels. We compared the efficacy and safety of FXI-ASO with those of enoxaparin in patients undergoing total knee arthroplasty. Methods In this open-label, parallel-group study, we randomly assigned 300 patients who were undergoing elective primary unilateral total knee arthroplasty to receive one of two doses of FXI-ASO (200 mg or 300 mg) or 40 mg of enoxaparin once daily. The primary efficacy outcome was the incidence of venous thromboembolism (assessed by mandatory bilateral venography or report of symptomatic events). The principal safety outcome was major or clinically relevant nonmajor bleeding. Results Around the time of surgery, the mean (±SE) factor XI levels were 0.38±0.01 units per milliliter in the 200-mg FXI-ASO group, 0.20±0.01 units per milliliter in the 300-mg FXI-ASO group, and 0.93±0.02 units per milliliter in the enoxaparin group. The primary efficacy outcome occurred in 36 of 134 patients (27%) who received the 200-mg dose of FXI-ASO and in 3 of 71 patients (4%) who received the 300-mg dose of FXI-ASO, as compared with 21 of 69 patients (30%) who received enoxaparin. The 200-mg regimen was noninferior, and the 300-mg regimen was superior, to enoxaparin (P<0.001). Bleeding occurred in 3%, 3%, and 8% of the patients in the three study groups, respectively. Conclusions This study showed that factor XI contributes to postoperative venous thromboembolism; reducing factor XI levels in patients undergoing elective primary unilateral total knee arthroplasty was an effective method for its prevention and appeared to be safe with respect to the risk of bleeding. (Funded by Isis Pharmaceuticals; FXI-ASO TKA ClinicalTrials.gov number, NCT01713361 .). PMID:25482425

Büller, Harry R; Bethune, Claudette; Bhanot, Sanjay; Gailani, David; Monia, Brett P; Raskob, Gary E; Segers, Annelise; Verhamme, Peter; Weitz, Jeffrey I

2014-12-01

382

Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study.  

PubMed

Venous anatomy of the testis was reexamined by retrograde spermatic venography during surgery in 17 men with and in 11 without a varicocele. The route of venous drainage of the testis was the internal spermatic vein and the external pudendal vein. The cremasteric and vasal veins were smaller collaterals. There was no cross communication between the right and left spermatic venous systems in the scrotal, retropubic or pelvic areas. In men with a varicocele the spermatic venous plexus was formed of numerous venous sinuses and large dilated veins. PMID:1569670

Wishahi, M M

1992-05-01

383

Decreased brain venous vasculature visibility on susceptibility-weighted imaging venography in patients with multiple sclerosis is related to chronic cerebrospinal venous insufficiency  

PubMed Central

Background The potential pathogenesis between the presence and severity of chronic cerebrospinal venous insufficiency (CCSVI) and its relation to clinical and imaging outcomes in brain parenchyma of multiple sclerosis (MS) patients has not yet been elucidated. The aim of the study was to investigate the relationship between CCSVI, and altered brain parenchyma venous vasculature visibility (VVV) on susceptibility-weighted imaging (SWI) in patients with MS and in sex- and age-matched healthy controls (HC). Methods 59 MS patients, 41 relapsing-remitting and 18 secondary-progressive, and 33 HC were imaged on a 3T GE scanner using pre- and post-contrast SWI venography. The presence and severity of CCSVI was determined using extra-cranial and trans-cranial Doppler criteria. Apparent total venous volume (ATVV), venous intracranial fraction (VIF) and average distance-from-vein (DFV) were calculated for various vein mean diameter categories: < .3 mm, .3-.6 mm, .6-.9 mm and > .9 mm. Results CCSVI criteria were fulfilled in 79.7% of MS patients and 18.2% of HC (p < .0001). Patients with MS showed decreased overall ATVV, ATVV of veins with a diameter < .3 mm, and increased DFV compared to HC (all p < .0001). Subjects diagnosed with CCSVI had significantly increased DFV (p < .0001), decreased overall ATVV and ATVV of veins with a diameter < .3 mm (p < .003) compared to subjects without CCSVI. The severity of CCSVI was significantly related to decreased VVV in MS (p < .0001) on pre- and post-contrast SWI, but not in HC. Conclusions MS patients with higher number of venous stenoses, indicative of CCSVI severity, showed significantly decreased venous vasculature in the brain parenchyma. The pathogenesis of these findings has to be further investigated, but they suggest that reduced metabolism and morphological changes of venous vasculature may be taking place in patients with MS. PMID:22011402

2011-01-01

384

Cerebrospinal Venous Outflow in Multiple Sclerosis Patients versus Fatigue and/or Depression  

PubMed Central

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.

2014-01-01

385

The Ovine Cerebral Venous System: Comparative Anatomy, Visualization, and Implications for Translational Research  

PubMed Central

Cerebrovascular diseases are significant causes of death and disability in humans. Improvements in diagnostic and therapeutic approaches strongly rely on adequate gyrencephalic, large animal models being demanded for translational research. Ovine stroke models may represent a promising approach but are currently limited by insufficient knowledge regarding the venous system of the cerebral angioarchitecture. The present study was intended to provide a comprehensive anatomical analysis of the intracranial venous system in sheep as a reliable basis for the interpretation of experimental results in such ovine models. We used corrosion casts as well as contrast-enhanced magnetic resonance venography to scrutinize blood drainage from the brain. This combined approach yielded detailed and, to some extent, novel findings. In particular, we provide evidence for chordae Willisii and lateral venous lacunae, and report on connections between the dorsal and ventral sinuses in this species. For the first time, we also describe venous confluences in the deep cerebral venous system and an ‘anterior condylar confluent’ as seen in humans. This report provides a detailed reference for the interpretation of venous diagnostic imaging findings in sheep, including an assessment of structure detectability by in vivo (imaging) versus ex vivo (corrosion cast) visualization methods. Moreover, it features a comprehensive interspecies-comparison of the venous cerebral angioarchitecture in man, rodents, canines and sheep as a relevant large animal model species, and describes possible implications for translational cerebrovascular research. PMID:24736654

Nitzsche, Björn; Lobsien, Donald; Seeger, Johannes; Schneider, Holm; Boltze, Johannes

2014-01-01

386

Chronic venous ulceration of leg associated with peripheral arterial disease: an underappreciated entity in developing country.  

PubMed

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

2014-10-01

387

Hemoglobin diffusion across a venous wall: an experimental study.  

PubMed

The aim of this study was to investigate the permeation behavior of a large molecule through a venous wall; hemoglobin was chosen as a model substance. In vitro experiments were performed using a Chien-Valia diffusion chamber. Postmortem, hemolyzed, and fresh nonhemolyzed blood samples were investigated as permeants. Vein patches from vena cava inferior and vena jugularis interna were used as diffusion barriers. Applying this technique, extravasation of hemoglobin was detectable. The portion of hemoglobin molecules passing through the vascular wall depended on time, vein type, and graduation of hemolysis. The passage of hemoglobin across the wall of a large vein suggests intravascular changes in drug concentrations from postmortem blood samples not to be restricted on the unbound portion of the particular drug. PMID:9885934

Skopp, G; Pötsch, L; Lutz, R; Ganssmann, B; Mattern, R

1998-12-01

388

Contrast echocardiography in detection of portopulmonary venous anastomosis.  

PubMed

Portopulmonary venous anastomosis is a potential channel for systemic arterial embolization during embolization procedures for bleeding esophageal varices. To document the presence of such anastomoses, 15 patients with esophageal varices were studied by real-time contrast echocardiography combined with transhepatic cineportography. Cinefluorographic technique, which was applied for this purpose, occasionally failed to demonstrate the dynamic events in the left atrium because of rapid dilution of contrast medium. Echocardiography after the injection of dextrose solution into the gastric coronary vein allowed two-dimensional real-time images of contrast echoes in the left cardiac chambers. By combining these two methods, more reliable diagnostic information was obtained in five of the 15 patients studied. PMID:6606947

Sano, A; Nishizawa, S; Sasai, K; Imanaka, K; Tanaka, K; Hashimura, T; Iida, A; Ban, N; Moriyasu, F; Takahashi, Y

1984-01-01

389

Cerebral venous thrombosis-A primer for the haematologist.  

PubMed

Cerebral venous thrombosis (CVT) is a condition that can affect all age groups and can often be difficult to diagnose and treat. The difficulties in diagnosis are mainly due to the non-specific presenting features of CVT, which can range from isolated headache and visual or auditory problems, to serious symptoms such as hemiparesis and coma. Therefore, it can present to various specialists including general physicians, obstetricians and neurologists. In recent years, more widespread use of cerebral imaging has led to the diagnosis being made more often. Since thrombosis is the key component, haematologists are consulted in the management of these patients including for identification of a causative factor for CVT. In this regard, the pivotal International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) has shed more light on its epidemiology and management options. This review aims to provide guidance to haematologists when faced with a patient with CVT, based on the currently available evidence. PMID:25282690

Thorell, Sofia E; Parry-Jones, Adrian R; Punter, Martin; Hurford, Robert; Thachil, Jecko

2015-01-01

390

Healing refractory venous ulcers: new treatments offer hope.  

PubMed

Non-healing wounds are associated with an inflammatory and proteolytic wound environment, and recent therapeutic strategies have been focused on reversing these changes. Connexins, as members of gap junctions, are important in intercellular signaling and wound repair. Connexin 43 (Cx43) downregulation is associated with normal wound healing, and it has been found to be upregulated in non-healing venous leg ulcers (VLUs). Ghatnekar et al. (2014) report findings of a small phase II trial performed in Indian patients with chronic VLUs, reporting that ACT1, a mimetic peptide of Cx43, accelerates healing in the treatment group. Despite standard care with compression therapy and adjuvant therapy for refractory wounds, at present in clinical practice a significant number of patients remain unhealed. The potential for ACT1 exists to help heal refractory VLUs, but it faces additional regulatory hurdles. PMID:25501380

Kirsner, Robert S; Baquerizo Nole, Katherine L; Fox, Joshua D; Liu, Sophia N

2015-01-01

391

Posterior mediastinal venous masses in patients with portal hypertension.  

PubMed Central

Of 304 consecutive splenic venograms performed for suspected portal hypertension, oesophageal collateral veins were filled in 145. In seven patients massively dilated paraoesophageal collaterals were visible on the plain chest radiograph as a retrocardiac posterior mediastinal mass. Erect and supine radiographs have been compared in four patients, and the Valsalva and Mueller manoeuvres performed in one patient. The size of the masses was unchanged by these procedures, which were therefore of no value in differential diagnosis. The mass was still present immediately after portocaval anastomosis in one patient, but in another is no longer seen on radiographs taken seven years postoperatively. All seven patients also had submucosal oesophageal varices and therefore the barium swallow remains the most useful study to clarify the nature of a retrocardiac mass. Correct identification of pseudotumoural venous collaterals may avoid unnecessary further investigation. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 PMID:1140628

Moult, P J; Waite, D W; Dick, R

1975-01-01

392

Dielectric coagulometry: a new approach to estimate venous thrombosis risk.  

PubMed

We present dielectric coagulometry as a new technique to estimate the risk of venous thrombosis by measuring the permittivity change associated with the blood coagulation process. The method was first tested for a simple system of animal erythrocytes suspended in fibrinogen solution, where the coagulation rate was controlled by changing the amount of thrombin added to the suspension. Second, the method was applied to a more realistic system of human whole blood, and the inherent coagulation process was monitored without artificial acceleration by a coagulation initiator. The time dependence of the permittivity at a frequency around 1 MHz showed a distinct peak at a time that corresponds to the clotting time. Our theoretical modeling revealed that the evolution of heterogeneity and the sedimentation in the system cause the peak of the permittivity. PMID:21033672

Hayashi, Yoshihito; Katsumoto, Yoichi; Omori, Shinji; Yasuda, Akio; Asami, Koji; Kaibara, Makoto; Uchimura, Isao

2010-12-01

393

Current Status of the Korean Venous Thromboembolism Registry  

PubMed Central

The Korean venous thromboembolism (VTE) registry, which was initiated by the Working Parties of Korean Society on Thrombosis and Hemostasis, and the Korean Society of Hematology, is a web-based multicenter registry (http://kdvt.chamc.co.kr) for recruiting consecutive VTE patients. The aim of the registry is to prospectively collect data on the epidemiology and clinical outcomes of VTE from a large, unselected cohort of patients, and to provide data on the true incidence and management of VTE in the real-world. By the end of 2007, the starting year of the registry, 840 patients were registered. By the end of 2008, 1,121 were registered, with 1,289 by the end of 2009, and 1,463 by April 2010 from 11 hospitals. The first report on the epidemiologic characteristics of 596 consecutive VTE patients was released in October 2007. PMID:21623595

2011-01-01

394

Strategies for Diagnosis and Prevention of Venous Thromboembolism during Pregnancy  

PubMed Central

Pregnancy and the postpartum period have an increased incidence of venous thromboembolism (VTE). The condition is unique during this period for several reasons. Primarily, because there is complexity in diagnosing this condition in view of altered physiology and preexisting edema in pregnancy and also because there are restrictions on the use of certain drugs and a need for vigilant monitoring of anticoagulant activities of drugs during the period. The problem is compounded and assumes the highest order of significance since two lives are involved and all the investigations and management done should also take into account the potential adverse effects on the foetus. In order to prevent the development of VTE during pregnancy, sound clinical evaluation for risk factors, risk stratification, and optimal use of resource both mechanical and pharmacological is necessary. This paper details strategies in preventing development of deep vein thrombosis and treatment of VTEs. PMID:21869932

Bagaria, Shalini Jain; Bagaria, V. B.

2011-01-01

395

Neonatal central venous catheter thrombosis: diagnosis, management and outcome.  

PubMed

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?

Park, Christina K; Paes, Bosco A; Nagel, Kim; Chan, Anthony K; Murthy, Prashanth

2014-03-01

396

Cerebral venous sinus thrombosis: update on diagnosis and management.  

PubMed

Cerebral venous thrombosis (CVT) is less frequent than ischemic stroke or intracerebral haemorrhage. Its incidence is comparable to that of acute bacterial meningitis in adults. Because of the increased use of magnetic resonance imaging (MR) for investigating patients with acute and subacute headaches and new onset seizures, CVT are now being diagnosed with increasing frequency. CVT have a more varied clinical presentation than other stroke types as they rarely present as a stroke syndrome. Their most frequent presentations are isolated headache, intracranial hypertension syndrome, seizures, a focal lobar syndrome and encephalopathy. The confirmation of the diagnosis of CVT relies on the demonstration of thrombi in the cerebral veins and/or sinuses by MR/MR venography or veno CT. The more frequent risk factors for CVT are prothrombotic conditions, either genetic or acquired, oral contraceptives, puerperium and pregnancy, infection and malignancy. The prognosis of CVT is in general favourable, as only around 15% of the patients remain dependent or die. The main intervention in the acute is anticoagulation with either low molecular weight or unfractionated heparin. In patients in severe condition on admission or who deteriorate despite anticoagulation, local thrombolysis or thrombectomy is an option. Decompressive surgery is life-saving in patients with large venous infarcts or haemorrhage. After the acute phase patients remain anticoagulated for a variable period of time, depending on their inherent thrombotic risk. CVT patients may experience recurrent seizures. Prophylaxis with antiepileptics is recommended after the first seizures, in particular in those with hemispheric lesions. There are several ongoing multicentre registries sand trials which will improve evidence-based management of CVT in the near future. PMID:25073867

Ferro, José M; Canhăo, Patrícia

2014-09-01

397

Queckenstedt's Test Affects More than Jugular Venous Congestion in Rat  

PubMed Central

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

2013-01-01

398

The hepatic-arterial/portal-venous scintiangiogram in alcoholic hepatitis  

SciTech Connect

This study was designed to identify abnormalities in the hepatic-arterial/portal-venous scintiangiogram (SA) in alcoholic hepatitis (AH). SA's were performed in 35 patients with acute alcoholic hepatitis (AAH), 8; acute alcoholic hepatitis superimposed on cirrhosis (A/C), 14; and cirrhosis (C), 13. Posterior flows were done with a bolus of 10 mCi Tc-99m sulfur colloid with computer time-activity curves over the liver and left kidney. Curves were analyzed for per cent of hepatic arterial (HA) and portal venous contribution using the slope ratio method. Hepatic arterialization was estimated from the angle of the HA component of the curve. Reversal of the relative contribution of the hepatic and portal components of total flow were seen in all groups. Although quite severe in AH, the degree of reversal could not be used to differentiate among the groups. The average HA angle in AAH was 48.3 +- 8.1, in A/C 41.5 +- 10.6, and in C 30.4 +- 12.1. In reviewing the data of only those in the acute clinical phase of AH and not the recovery phase (1 AAH, 3 A/C) and those without other causes of alteration in hepatic arterialization (1 hepatoma, 1 portalcaval shunt, 6 renal failure), the average HA angle in AAH was 50.1 +- 6.6, 45.4 +- 8.2 in A/C, and 23.2 +- 4.2 in C. In 6 with renal failure (2 C, 2AAH, 2 A/C) the HA angle ws 52.7 +- 5.7. In all cases cirrhosis could be differentiated from both A/C (P=.05) and AAH (P<.01) using the HA angle. In absence of renal failure, portal shunt, or hepatoma, P was <.01 in both comparisons.

Stewart, C.; Sakimura, I.; Siegel, M.E.; Harley, H.; Lee, K.

1984-01-01

399

Management of venous thrombo-embolism: an update.  

PubMed

Venous thrombo-embolism is the third most frequent acute cardiovascular syndrome after myocardial infarction and stroke. Recently published landmark trials paved the way for significant progress in the management of the disease and provided the evidence for the ESC Pulmonary Embolism (PE) Guidelines 2014 update. Risk stratification strategies for non-high-risk PE continue to evolve, with an increasing emphasis on clinical prediction rules and right ventricular (RV) assessment on computed tomographic pulmonary angiography. In the field of anticoagulation treatment, pharmacogenetic testing for vitamin K antagonists on top of clinical parameters was not found to offer a significant benefit during the initiation phase; on the other hand, dosing based on the patient's clinical data seems superior to fixed loading regimens. The phase 3 trial programme of new oral anticoagulants in the treatment of venous thrombo-embolism has been completed, and the results indicate that these agents are at least as effective and probably cause less major bleeding than currently standard treatment. A multicentre prospective phase 4 trial will determine whether early discharge and out-of-hospital treatment of low-risk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. For intermediate-risk PE defined on the basis of imaging tests and laboratory biomarkers, the bleeding risks of full-dose thrombolytic treatment appear too high to justify its use, unless clinical signs of haemodynamic decompensation appear. Patients in whom PE has resulted in chronic thrombo-embolic pulmonary hypertension and who are not suitable for pulmonary endarterectomy, may be expected to benefit from emerging pharmaceutical and interventional treatment options. PMID:25179762

Konstantinides, Stavros; Torbicki, Adam

2014-11-01

400

Subcutaneous Venous Port Implantation in Patients with Bilateral Breast Surgery  

SciTech Connect

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: borapeynir@gmail.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)

2007-06-15

401

Autoimmune diseases and venous thromboembolism: a review of the literature  

PubMed Central

Venous thromboembolism (VTE) is major health problem and is sometimes complicated by lethal pulmonary embolism (PE). Disturbances of the coagulation and anticoagulation systems are important risk factors for VTE. Comparative studies suggest that coagulation and innate immunity have a shared evolutionary origin. It is therefore unsurprising that the immune and coagulation systems are linked, with many molecular components being important for both systems. Systemic inflammation modulates thrombotic responses by suppressing fibrinolysis, upregulating procoagulant, and downregulating anticoagulants, and autoimmune disorders such as systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), and Behçet’s syndrome have been linked to an increased risk of VTE. Recent reports have further shown that a majority of autoimmune and immune-mediated disorders are linked to an increased risk of venous thrombosis, PE, or VTE. For instance, a Swedish nationwide study found that the risk of PE was increased in the first year after hospitalization for 33 different autoimmune disorders. Especially high risks were noted for several autoimmune diseases such as immune thrombocytopenic purpura, polyarteritis nodosa, polymyositis/dermatomyositis, ulcerative colitis, and SLE. Another study from England, also based on hospitalization data, found that immune-mediated disorders were associated with an increased risk of VTE compared with other medical causes of hospitalization. Multiple mechanisms may operate and disease-specific factors, such as cardiolipin antibodies, have been identified. However, inflammation by itself appears to change the hemostatic balance in a thrombogenic direction. Recent epidemiological studies, together with previous experimental and clinical studies, indicate that autoimmune disorders should not only be viewed as inflammatory disorders, but also hypercoagulable disorders. Research to identify thrombotic risk factors, elucidate the mechanisms involved, and investigate prophylactic regiments is needed. The present review describes the epidemiological, clinical, and experimental evidence for the connection between VTE and autoimmune and immune-mediated disorders. PMID:22937487

Zöller, Bengt; Li, Xinjun; Sundquist, Jan; Sundquist, Kristina

2012-01-01

402

Lack of correlation between arterial and venous beta-adrenergic receptor sensitivity.  

PubMed

The regulation of vascular beta-adrenoceptor responses in humans has been studied in vivo in both arteries and veins. Because venous responses can be studied less invasively than arterial responses, they are an attractive substitute for the measurement of arterial responses, provided that venous responses are representative of responses in resistance arteries. However, although venous, particularly hand vein response, has been extensively studied, arterial and venous beta-adrenergic sensitivities, in the same individuals, have not been compared. Measures of venous and arterial beta-adrenergic sensitivities were compared in 10 healthy normotensive subjects. Forearm blood flow, after administration of increasing doses of isoproterenol into the brachial artery, was measured by strain-gauge plethysmography and was used for determination of arterial beta-adrenoceptor sensitivity, expressed as the IP500 (the dose of isoproterenol resulting in a fivefold [500%] increase in baseline forearm blood flow). Venous sensitivity to isoproterenol, expressed as the IP15 (the dose of isoproterenol resulting in 15% venodilation), was measured in a dorsal hand vein using the linear variable differential transformer. Administration of isoproterenol into the hand vein and brachial artery resulted in venodilation and increased forearm blood flow, respectively. However, there was no correlation between the measures of venous (log IP15) and arterial (log IP500) measures of vascular beta-adrenergic sensitivity (r = -.12, P = .74). We conclude that since arterial and venous sensitivities to isoproterenol in healthy white men did not correlate, venous and arterial beta-adrenergic responses are regulated differently and that studies examining vascular beta-adrenoceptor sensitivity would most appropriately be performed in a vessel representative of the vascular bed of interest. PMID:9180628

Stein, C M; Deegan, R; Wood, A J

1997-06-01

403

Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome.  

PubMed

Venous invasion, or "large vessel" invasion, is a known independent prognostic indicator of distant recurrence and survival in colorectal cancer. Accurate assessment of venous invasion is of particular importance in stage II disease because it may influence the decision to administer adjuvant therapy. Venous invasion is widely believed to be an underreported finding with significant variability in its reported incidence. In the most recent College of American Pathologists' cancer reporting protocol, venous invasion is not recorded separately from lymphovascular, or "small vessel" invasion, which may not be appropriate because these features confer differing prognostic information. The presence of extramural venous invasion is strongly predictive of adverse outcome, although the prognostic significance of intramural venous invasion remains unknown. There are no formal guidelines regarding the pathologic assessment of venous invasion or the application of specific reporting criteria. The routine use of an elastic stain results in an almost 3-fold increase in the venous invasion detection rate when compared with a standard hematoxylin and eosin stain and may be a cost-effective means of increasing the diagnostic yield of venous invasion. The development of high-resolution magnetic resonance imaging, where extramural venous invasion can be detected preoperatively, may also influence the manner in which pathologists process specimens. This review focuses on recent developments in the assessment of venous invasion and highlights their potential impact on future practice. PMID:22406362

Messenger, David E; Driman, David K; Kirsch, Richard

2012-07-01

404

Spontaneous Recanalization of Occluded Dural Venous Sinuses after Successful Trans Arterial Embolisation of a Dural Arteriovenous Shunt  

PubMed Central

Summary Dural arteriovenous shunts (DAVS) occur within the walls of dural venous sinuses or their tributaries. They may be related to previous episodes of sinus thrombosis. The presence of impediments to venous outflow results in venous congestion, predisposing to haemorrhage and cerebral parenchymal damage. Cerebral venous congestion is an indication for treatment. This case is unusual in some respects; firstly, the patient was relatively well despite worrisome features on imaging and secondly the occluded dural venous sinuses appeared to spontaneously recanalize after treatment of the DAVS. Anticoagulation may have had a role in avoiding thrombosis of the patient's precarious venous drainage after embolisation and in encouraging recanalization of the thrombosed dural venous sinuses. PMID:20594510

Brew, S.; Taylor, W.; Lasjaunias, P.

2002-01-01

405

Cerebral Venous Congestion as Indication for Thrombolytic Treatment  

SciTech Connect

Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. Eight of these were diagnosed with dural sinus thrombosis only, and had a stable hospital course without worsening of symptoms. These patients also did not have imaging evidence of cerebral venous congestion. The remaining 2 patients had cerebral edema on the CT scan. One had only a small amount of edema in the right cerebellum, but the other had severe edema in the bilateral basal ganglia and thalamic areas. Nine of these patients had a stable hospitalization course and experienced a symptom-free recovery, but 1 died with severe cerebral edema and hemorrhage. Seven of the remaining 15 patients were initially treated with anticoagulation therapy for periods ranging from 2 days to 2 months (average 11 days). These 7 patients were considered to have failed anticoagulation therapy since they had worsening symptoms, and 5 of these had developed hemorrhage on subsequent CT or MR imaging scans. Five of the 7 then underwent thrombectomy with the administration of tPA. Of the remaining 2, 1 underwent thrombectomy alone without the administration of tPA, and the other was given 1 million units of urokinase instead of tPA. Three of these patients had a symptom-free recovery, but 2 had residual left-sided weakness, 1 patient had a minimal gait disturbance, and another patient developed a transverse sinus arteriovenous fistula 7 months after thrombolytic therapy. The remaining 8 patients did not receive anticoagulation therapy, and went straight to treatment with thrombectomy and administration of tPA. All of these presented with worsening clinical symptoms. Six had hemorrhage on their imaging studies, 1 had new edema on a subsequent CT scan, and 1 had edema along with the dural sinus thrombosis, but experienced worsening clinical symptoms consisting of headache and atypical dystonia. Five of these 8 patients experienced a symptom-free recovery, and 3 patients had mild residual weakness. Conclusion. In patients with acute dural sinus thrombosis, an indication for thrombectomy or thrombolytic therapy may be the development of cerebral venous conge

Tsai, Fong Y., E-mail: ftsai@uci.edu; Kostanian, Varoujan; Rivera, Monica [UCI Medical Center, Department of Radiological Sciences (United States); Lee, Kwo-Whie [Changhua Christian Hospital, Department of Radiology (China); Chen, Clayton C. [Taichung Veterans General Hospital, Department of Radiology (China); Nguyen, Thong H. [UCI Medical Center, Department of Radiological Sciences (United States)

2007-07-15

406

HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy.  

PubMed

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; I?ik, Yuksel; Simsek, Yavuz; Tulmac, Ozlem Banu; Demiray, Demet

2014-01-01

407

HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy  

PubMed Central

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; I?ik, Yuksel; Simsek, Yavuz; Tulmac, Ozlem Banu; Demiray, Demet

2014-01-01

408

Novel Wound Healing Powder Formulation for the Treatment of Venous Leg Ulcers  

PubMed Central

Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were successfully treated with the powder, demonstrating the potential of herbal remedies in the clinical treatment of venous leg ulcers. PMID:24527167

Ghatnekar, Angela V.; Elstrom, Tuan; Ghatnekar, Gautam S.; Kelechi, Teresa

2011-01-01

409

[Surgical treatment of venous-induced erectile impotence in the male].  

PubMed

In 14 out of 94 patients with erectile dysfunction a venous insufficiency was suspected. Localization and securing of the venous leak were done by dynamic cavernosography. An insufficient penile blood supply could excluded by Doppler ultrasonography and measurement of the penile-brachial artery-pressure index. In 7 out of 13 patients treated by ligation of penile veins the erectile function was normalized after operation, in 4 cases an additional intracavernous injection therapy was necessary and in 2 patients the operation was unsuccessful. If impotence occurs once more due to venous collaterals the implantation of a penile prosthesis should considered. PMID:2652944

Török, A; Lenk, S; Székely, J; Götz, F

1989-01-01

410

Recanalization of Aged Venous Thrombotic Occlusions with the Aid of a Rheolytic System: An Experimental Study  

SciTech Connect

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)

1996-04-15

411

Cerebral Venous Thrombosis and Livedo Reticularis in a Case with MTHFR 677TT Homozygote  

PubMed Central

Hyperhomocysteinemia associated with methylene terahydrofolate reductase (MTHFR) mutation can be a risk factor for idiopathic cerebral venous thrombosis. We describe the first case of MTHFR 677TT homozygote with cerebral venous thrombosis and livedo reticularis. A 45-year-old man presented with seizures and mottled-like skin lesions, that were aggravated by cold temperature. Hemorrhagic infarct in the right frontoparietal area with superior sagittal sinus thrombosis was observed. He had hyperhomocysteinemia, low plasma folate level, and MTHFR 677TT homozygote genotype, which might be associated with livedo reticularis and increase the risk for cerebral venous thrombosis. PMID:20396498

Lee, Jee-Young

2006-01-01

412

Surveillance and medical therapy following endovascular treatment of chronic cerebrospinal venous insufficiency.  

PubMed

The debate regarding the possible link between chronic cerebrospinal venous insufficiency and multiple sclerosis (MS) is continuously becoming more and more contentious due to the current lack of level 1 evidence from randomized trials. Regardless of this continued uncertainty surrounding the safety and efficacy of this therapy, MS patients from Canada, and other jurisdictions, are traveling abroad to receive central venous angioplasty and, unfortunately, some also receive venous stents. They often return home with few instructions regarding follow-up or medical therapy. In response we propose some interim, practical recommendations for post-procedural surveillance and medical therapy, until further information is available. PMID:22577160

Forbes, Thomas L; Harris, Jeremy R; Kribs, Stewart W

2012-06-01

413

Abnormalities in embryological development in total anomalous pulmonary venous connection. A case report.  

PubMed

Pulmonary venous system development starts early in embryonic life. Abnormalities in the development of pulmonary venous system occur either by the absence of common pulmonary vein communication to the splanchnic plexus or by the absence of its incorporation into the dorsal wall of the left atrium. We present the case of a 10-day-old male newborn, diagnosed with TAPVC, operated, with long recovery and, who died by pneumonia, heart failure, and obstructive pulmonary disease (one pulmonary vein obstructed and another one with severe stenosis). Total anomalous pulmonary venous connection (TAPVC) reflects one of the most severe forms of congenital heart disease, with important clinical consequences. PMID:24068416

B?lgr?dean, Mihaela; Cintez?, Eliza; Cîrstoveanu, C; Enculescu, Augustina; Ple?ca, Doina

2013-01-01

414

[Evaluation of preoperative cavernosometry and cavernosography in erectile dysfunction of presumed venous origin].  

PubMed

During the period November 1988 to September 1992, 42 patients with erectile dysfunction underwent preoperative dynamic cavernosometry and cavernosography. Radiologically visible venous leakage was demonstrated in all cases but one. At a maintenance flow of more than 20 ml/min, venous leakage was always demonstrable and the types of veins opacified were stereotype. Therefore, clinically relevant leakage can be documented on the basis of cavernosometry. A surgical approach to penile venous leakage with resection of the deep dorsal vein and ligation of all superficial anastomoses including the superficial dorsal vein will eliminate the most common types of radiologically visible veins. PMID:8066878

Jensen, P R; Jensen, K M

1994-06-13

415

Association of varicosities and concomitant deep venous thrombosis in patients with superficial venous thrombosis, a systematic review.  

PubMed

Background: In patients with superficial venous thrombosis (SVT) co-existence of deep venous thrombosis (DVT) can be present. Varicosities are considered as a risk factor for both SVT and DVT separately. However, current evidence is contradictory whether varicosities are associated with an increased or reduced prevalence of concomitant DVT in patients with SVT. Objectives: To determine the diagnostic value of both presence and absence of varicosities in the detection of concomitant DVT in non-hospitalized patients with SVT. Methods: In MEDLINE and EMBASE, a systematic search was performed to collect all published studies on this topic. The selected papers were critically appraised. By diagnostic 2 × 2 tables prior probabilities and predictive values were computed. Results: Six relevant articles were identified. The prior probability of concomitant DVT in patients referred from primary care to the outpatient clinic varied between 13 and 34%. In five studies, absence of varicosities was related to a higher probability of concomitant DVT (33-44%) compared to a presence of varicosities (3-23%). The sixth study showed an inversed, non-significant association: DVT was present in 21% of patients with SVT on non-varicose veins versus in 35% of patients with SVT on varicose veins. Conclusion: In five out of six studies on patients with SVT in outpatient settings, absence of varicosities was related to a higher probability of concomitant DVT. Further research is needed to determine whether an assessment of varicosities in general practice could result in an improved selection of patients who require additional imaging to detect or exclude DVT. PMID:24909345

Baggen, Vivan J M; Chung, Kaman; Koole, Koos; Sarneel, Michelle H J; Rutten, Frans H; Hajer, Gideon R

2014-06-01

416

Influence of central venous pressure upon sinus node responses to arterial baroreflex stimulation in man  

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.

1978-01-01

417

Venous shunting as a complication to penile revascularization--a case report.  

PubMed

As a serious complication to arterial penile revascularisation arterio-venous shunting was observed in a 60 years old male. The patient suffered bilateral obstruction of his pudendal arteries. Following revascularization using the left inferior epigastric artery he obtained good pulsation in the penis but no return of sexual function. Instead his general condition deteriorated. A follow-up angiogram revealed shunting of the contrast from the epigastric artery, via the penis, to the venous system. Venous ligation was carried out. The patient's general condition returned to normal status and he can now obtain rigid erections. Reconstructive arterial surgery for erectile dysfunction should never be carried out unless venous leak has been ruled out as a complicating factor. PMID:7939445

Ekman, P; Takolander, R; Kalin, B

1994-01-01

418

Cerebral tubercular thrombophlebitis presenting as venous infarct: Magnetic resonance imaging and pathologic correlation  

PubMed Central

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

2014-01-01

419

Total anomalous pulmonary venous return and Mayer–Rokitansky–Kuster–Hauser syndrome  

Microsoft Academic Search

We present an adult woman with total anomalous pulmonary venous return (TAPVR) and Mayer–Rokitansky–Kuster–Hauser syndrome that was diagnosed intraoperatively during a planned atrial secundum defect closure. Surgical repair of TAPVR was performed with good outcome.

Julio C. Vasquez; Jacob DeLaRosa; Efrain Montesinos; Edmundo Rosales; Roy Duenas; Aida Rotta; Juan J. Leon

2008-01-01

420

Association between venous leg ulcers and sex chromosome anomalies in men.  

PubMed

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

2010-11-01

421

A case of cerebral venous sinus thrombosis associated with Crohn's disease: dilemma in management.  

PubMed

Inflammatory bowel disease (IBD) is known to increase the risk of venous thromboembolism. Cerebral venous sinus thrombosis (CVST) is a rare but important complication of IBD. Timely diagnosis, particularly in younger patients, requires a high level of suspicion in order to prevent potentially devastating complications such as hemorrhage or venous infarction. The paper presents a 44-year-old Caucasian woman with a previous history of Crohn's disease and deep venous thrombosis. Magnetic resonance imaging confirmed the diagnosis of CVST. Achieving therapeutic anticoagulation with warfarin was difficult, due to presumed pharmacological interaction between warfarin and 6-mercaptopurine. Clinicians should have a high index of suspicion for CVST when a patient with Crohn's disease presents with acute headache, and be aware of challenges related to medical management. PMID:25389155

Kwon, Younghoon; Koene, Ryan J; Cho, Yeilim

2014-11-10

422

Results of a pancreatectomy with a limited venous resection for pancreatic cancer  

Microsoft Academic Search

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

2008-01-01

423

Hormone replacement therapy and risk of venous thromboembolism: population based case-control study  

Microsoft Academic Search

AbstractObjective: To evaluate the association between use of hormone replacement therapy and the risk of idiopathic venous thromboembolism.Design: Population based case-control study.Setting: Population enrolled in the General Practice Research Database, United Kingdom.Subjects: A cohort of 347 253 women aged 50 to 79 without major risk factors for venous thromboembolism was identified. Cases were 292 women admitted to hospital for a

Susanne Pérez Gutthann; Luis A Garcia Rodriguez; Jordi Castellsague; Alberto Duque Oliart

1997-01-01

424

Lower extremity venous thrombosis in patients younger than 50 years of age  

PubMed Central

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

2012-01-01

425

Percutaneous embolization of congenital portosystemic venous fistula in an infant with down syndrome.  

PubMed

Congenital intrahepatic portosystemic venous shunts are rare vascular malformations often associated with severe complications. We describe a term male infant with Down syndrome with high output heart failure secondary to a congenital arterial to portal venous fistula that was diagnosed by Doppler ultrasound. Percutaneous embolizations of the left hepatic vein, portal vein, and communicating fistulas were performed without complications, resulting in clinical improvement. A subsequent hepatic ultrasound demonstrated resolution of the pathologic fistulous communication and shunting effects. PMID:24171135

Tanya Chun, Pattaraporn; Chun, Terrence; Files, Matthew; Vo, Nghia; McAdams, Ryan M

2013-01-01

426

The carina as a landmark for central venous catheter placement in small children  

Microsoft Academic Search

Central venous devices are frequently used in children to monitor haemodynamic status, to administer fluids, medication, parenteral\\u000a nutrition and for blood sampling. Life-threatening complications that may occur on insertion if the central venous catheter\\u000a (CVC) is misplaced, are cardiac tamponade or a hydro-\\/haemopericardium. There is still controversy over the optimum catheter\\u000a tip position in paediatric patients, whether to place the

Knut Albrecht; Dirk Breitmeier; Bernhard Panning; Hans Dieter Tröger; Heike Nave

2006-01-01

427

Percutaneous Embolization of Congenital Portosystemic Venous Fistula in an Infant with Down Syndrome  

PubMed Central

Congenital intrahepatic portosystemic venous shunts are rare vascular malformations often associated with severe complications. We describe a term male infant with Down syndrome with high output heart failure secondary to a congenital arterial to portal venous fistula that was diagnosed by Doppler ultrasound. Percutaneous embolizations of the left hepatic vein, portal vein, and communicating fistulas were performed without complications, resulting in clinical improvement. A subsequent hepatic ultrasound demonstrated resolution of the pathologic fistulous communication and shunting effects. PMID:24171135

Tanya Chun, Pattaraporn; Files, Matthew; Vo, Nghia; McAdams, Ryan M.

2013-01-01

428

Prediction of Liver Function by Using Magnetic Resonance-based Portal Venous Perfusion Imaging  

SciTech Connect

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: yuecao@umich.edu [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)

2013-01-01

429

Hemodynamics of the hepatic venous three-vessel confluences using particle image velocimetry.  

PubMed

Despite rapid advancements in the patient-specific hemodynamic analysis of systemic arterial anatomies, limited attention has been given to the characterization of major venous flow components, such as the hepatic venous confluence. A detailed investigation of hepatic flow structures is essential to better understand the origin of characteristic abnormal venous flow patterns observed in patients with cardiovascular venous disease. The present study incorporates transparent rapid-prototype replicas of two pediatric hepatic venous confluence anatomies and two-component particle image velocimetry to investigate the primary flow structures influencing the inferior vena cava outflow. Novel jet flow regimes are reported at physiologically relevant mean venous conditions. The sensitivity of fluid unsteadiness and hydraulic resistance to multiple-inlet flow regimes is documented. Pressure drop measurements, jet flow characterization, and blood damage assessments are also performed. Results indicate that the orientation of the inlets significantly influences the major unsteady flow structures and power loss characteristics of this complex venous flow junction. Compared to out-of-plane arranged inlet vessel configuration, the internal flow field observed in planar inlet configurations was less sensitive to the venous inlet flow split. Under pathological flow conditions, the effective pressure drop increased as much as 77% compared to the healthy flow state. Experimental flow field results presented here can serve as a benchmark case for the surgical optimization of complex anatomical confluences including visceral hemodynamics as well as for the experimental validation of high-resolution computational fluid dynamics solvers applied to anatomical confluences with multiple inlets and outlets. PMID:21607758

Lara, Mikhail; Chen, Chia-Yuan; Mannor, Philip; Dur, Onur; Menon, Prahlad G; Yoganathan, Ajit P; Pekkan, Kerem

2011-09-01

430

Treatment of venous thromboembolism in patients with cancer: subgroup analysis of the Matisse clinical trials  

Microsoft Academic Search

In the initial treatment of venous thromboembolism (VTE) fondaparinux, a pentasaccharide, is a good alternative to heparin. Whether this is also true for cancer patients is unknown. We performed two post-hoc analyses of two randomized studies to compare efficacy, safety and overall survival of fondaparinux to standard initial (low-molecular-weight) heparin (LMWH) treatment in cancer patients with venous thromboembolism. Two hundred

Frederiek F. van Doormaal; Gary E. Raskob; Bruce L. Davidson; Hervé Decousus; Alexander Gallus; Anthie W. A. Lensing; Franco Piovella; Martin H. Prins; Harry R. Büller

2009-01-01

431

Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization  

PubMed Central

Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs. PMID:23378884

Chang, Michael C.; Shim, John J.

2012-01-01

432

Venous intravasation: a potential pitfall of confirmatory hysterosalpingogram following essure hysteroscopic sterilization.  

PubMed

Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs. PMID:23378884

Chang, Michael C; Shim, John J

2012-09-01

433

Percutaneous treatment of dual pulmonary venous drainage and coarctation of the aorta in a single patient  

PubMed Central

Following routine medical screening, a 26-year-old man was found to have aortic coarctation and a partial anomalous pulmonary venous connection. Historically, multiple cardiac pathologies, such as in the present case, required a surgical approach; however, percutaneous treatment of the coarctation with a covered stent and occlusion of the partial anomalous pulmonary venous connection with an Amplatzer device (AGA Medical Corporation, USA) without complications is described. PMID:20664774

Mamas, Mamas A; Clarke, Bernard; Mahadevan, Vaikom S

2010-01-01

434

Resistance and Venous Oxygen Dynamics during Sinusoidal Exercise of Dog Skeletal Muscle  

Microsoft Academic Search

We observed the response of vascular resistance and venous oxygen (O2) satu- ration to sinusoidally modulated continuous exercise of the isolated dog calf. Stimulus frequency was varied sinusoidally between 0.5 Hz and 1 Hz with modulation fre- quencies ranging from 0.005 Hz to 0.05 Hz. Venous O2 responses were corrected for dispersion due to vascular and catheter transit. As modulation

David E. Mohrman; Harvey V. Sparks

435

Measurement of T1 of human arterial and venous blood at 7T  

PubMed Central

Techniques for measuring cerebral perfusion require accurate longitudinal relaxation (T1) of blood, a MRI parameter that is field dependent. T1 of arterial and venous human blood was measured at 7T using three different sources – pathology laboratory, blood bank and in vivo. The T1 of venous blood was measured from sealed samples from a pathology lab and in vivo. Samples from a blood bank were oxygenated and mixed to obtain different physiological concentrations of hematocrit and oxygenation. T1 relaxation times were estimated using a three-point fit to a simple inversion recovery equation. At 37° C, the T1 of blood at arterial pO2was 2.29 ± 0.1 s and 2.07 ± 0.12 at venous pO2. The in vivo T1 of venous blood, in three subjects, was slightly longer at 2.45 ± 0.11s. T1 of arterial and venous blood at 7T was measured and found to be significantly different. The T1 values were longer in vivo than in vitro. While the exact cause for the discrepancy is unknown, the additives in the blood samples, degradation during experiment, oxygenation differences, and the non-stagnant nature of blood in vivo could be potential contributors to the lower values of T1 in the venous samples. PMID:23102945

Rane, S.; Gore, J.C.

2012-01-01

436

Improving the reliability of venous Doppler flow measurements: relevance of combined ECG, training and repeated measures.  

PubMed

The nature of venous Doppler waves is highly variable. An additional electrocardiogram (ECG) improves the interpretation of venous Doppler wave characteristics and allows measurement of venous pulse transit time. The purpose of this study was to assess the reproducibility of ECG-guided repeated measurements of venous Doppler flow characteristics before and after sonographer training and the inter- and intra-observer variability. In four groups of 25 healthy women, venous Doppler flow measurements were performed at the level of the kidneys and liver according to a standardized protocol. Intra-observer Pearson correlation coefficients of the renal interlobar vein Doppler indices were ? 0.80 with the addition of the ECG, which are higher than the results of a former study. The inter-observer correlation between an experienced ultrasonographer and an inexperienced ultrasonographer improved from ? 0.71 to ? 0.91 after training. The correlation range of all parameters between two independent observers improved when values were based on repeated measures. The addition of an ECG to the Doppler image, training and repeated measurements are helpful in improving venous Doppler wave interpretation. PMID:24631376

Staelens, Anneleen S E; Tomsin, Kathleen; Oben, Jolien; Mesens, Tinne; Grieten, Lars; Gyselaers, Wilfried

2014-07-01

437

The posterior intercostal vein: a thermoregulatory gateway to the internal vertebral venous plexus.  

PubMed

The internal vertebral venous plexus (IVVP) plays a putative role in thermoregulation of the spinal cord. Cold cutaneous venous blood may cool, while warm venous blood from muscles and brown fat areas may warm the spinal cord. The regulating mechanisms for both cooling and warming are still unknown. Warm venous blood mainly enters the IVVP via the intervertebral veins. In the thoracic area these veins are connected to the posterior intercostal veins. In this study, anatomical structures were investigated that might support the mechanisms by which warmed venous blood from the intercostal muscles and the recently described paravertebral patches of brown adipose tissue are able to drain into the vertebral venous plexus. Therefore, tissue samples from human cadavers (n?=?21) containing the posterior intercostal vein and its connections to the IVVP and the azygos veins were removed and processed for histology. Serial sections revealed that the proximal parts of the posterior intercostal veins contained abundant smooth muscle fibers at their opening into the azygos vein. Furthermore, the walls of the proximal parts of the posterior intercostal veins contain plicae that allow the vessel to dilate, thereby allowing it to serve as a pressure chamber. It is suggested that a cold induced closure of the intercostal/azygos opening can result in retrograde blood flow from the proximal posterior intercostal vein towards the IVVP. This blood flow would be composed of warm blood from the paravertebral brown adipose tissue and blood containing metabolic heat from the muscles draining into the intercostal veins. PMID:23813753

Hoogland, P V; Wessels, Q; Vorster, W; Groen, R J M; Wettstein, R; Greyling, L M; Kotzé, S H

2013-09-01

438

Diet as prophylaxis and treatment for venous thromboembolism?  

PubMed Central

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

2010-01-01

439

Hepatic venous pressure gradient: clinical use in chronic liver disease  

PubMed Central

Portal hypertension is a severe consequence of chronic liver diseases and is responsible for the main clinical complications of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension. Patients who had a reduction in HVPG of ?20% or to ?12 mmHg in response to drug therapy are defined as responders. Responders have a markedly decreased risk of bleeding/rebleeding, ascites, and spontaneous bacterial peritonitis, which results in improved survival. This review provides clinical use of HVPG measurement in the field of liver disease. PMID:24757653

2014-01-01

440

Venous ulcer care: which dressings are cost effective?  

PubMed

Healed or open venous ulcers may be present in up to 1% of Western populations and consume a large amount of healthcare resources. These ulcers are characterized by a chronic inflammatory environment with impaired healing and often require months for closure. The average monthly cost of care for an open ulcer has been estimated to be $4095. The fundamental tenets of ulcer care include adequate compression and maintaining a moist wound environment with an appropriate primary dressing. A number of specialized products including semi-occlusive/occlusive, antimicrobial, and advanced wound matrix dressings are now available. However, there is little data from appropriate clinical studies to suggest significantly improved outcomes with any of these dressings. Data regarding their cost-effectiveness is also limited, often conflicting, and subject to bias. At present, there is little solid evidence to guide the choice of primary dressings and a patient-centered approach focusing on characteristics of both the patient and their ulcer, while paying attention to costs, may be most appropriate. PMID:24843106

Meissner, Mark H

2014-05-19

441

Implications of cytogenetics for venous thromboembolism in acute myeloid leukaemia.  

PubMed

Due to the high risk of thrombocytopenia and haemorrhage, thrombotic complications have received little attention in patients with acute myeloid leukemia (AML). Furthermore, the predictive role of cytogenetics on venous thromboembolism (VTE) has largely been ignored. This study aimed to evaluate the incidence, risk factors, and prognostic aspects of VTE in AML. A total of 811 consecutive patients with AML were enrolled and analysed retrospectively. Cox time-dependent covariate regression analysis was used to identify the significant predictors of VTE development. To minimise potential confounding factors, we used propensity-score matching to compare overall survival between patients with and without VTE. The six-month and one-year cumulative incidences of VTE were 3.1?% (95?% confidence interval [CI], 2.0-4.7) and 3.9?% (95?% CI, 2.6-5.7), respectively. Of the 26 cases of VTE, 22 (85?%) developed within 6 months of leukemia diagnosis and 13 (50?%) were catheter-related. In multivariate analysis, advanced age (??65 years) (hazard ratio [HR], 2.70; p = 0.03) and increasing cytogenetic risk (common HR, 1.84; p = 0.05) were independent predictors of VTE. There was no significant association between VTE development and decreased survival (p = 0.32 for matched analysis). Advanced age and increasing cytogenetic risk, well-known predictors for clinical outcome in AML, were also independent risk factors of VTE development. Our results suggest that VTE does not hold prognostic implications for AML. PMID:25339605

Lee, Y-G; Kim, I; Kwon, J-H; Yoon, S S; Park, S; Song, L; Yoon, J-H; Shin, S-H; Min, W-S; Kim, H-J

2015-01-01

442

Arterial-venous perfusion without anticoagulation: the impeller centrifugal pump.  

PubMed

A study was designed to test the effects of the absence of anticoagulation in the extracorporeal circuit. Five swine were subjected to this experiment utilizing the impeller centrifugal pump during which neither heparin nor any other anticoagulant was used. The extracorporeal circuit consisted of polyvinylchloride tubing, a Centri-Med pump and an external stainless steel heat exchanger that was primed with albuminized Ringer's solution. An arterial-venous circuit was employed with oxygenation supplied from the subject's lungs. A series of blood aliquots were analyzed for coagulation at various times throughout the procedure. Following total body cooling using topically applied ice water, the subjects were rewarmed utilizing bypass. Within 10 minutes after the initiation of bypass, the circuits became clotted, rendering perfusion and subsequent warming ineffective. The lab values indicated that intrinsically activated coagulation occurred upon exposure to the extracorporeal apparatus. Flow visualization studies revealed a source of stagnant blood flow in the area around the hub of the pump head. Blood clot was similarly located in this area, with clot extension throughout the return circuit being realized. It is imperative that areas of stagnation be eliminated from extracorporeal circuits, since they may be potential sites for clot formation. PMID:10149016

Vertrees, R A; Yu, Y; Wacker, C; Cernaianu, A C; DelRossi, A J

1991-01-01

443

[Procedure adverse events: nursing care in central venous catheter fracture].  

PubMed

In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels. PMID:24439203

Pérez-Juan, Eva; Maqueda-Palau, Mňnica; Romero-Grilo, Cristina; Muńoz-Moles, Yolanda

2014-01-01

444

Pharmacological prevention of venous thromboembolism in orthopaedic surgery  

PubMed Central

Summary The prophylaxis of venous thromboembolism (VTE) with anticoagulant drugs is a long-established practice in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, while there are few data regarding the prevention of VTE in other fields of orthopaedic surgery and traumatology. In order to provide practical recommendations for daily management of VTE prophylaxis in orthopaedic patients, recently the Italian Societies of Thrombosis and Haemostasis, Orthopaedics and Traumatology and Anaesthesia have drawn up a first Intersociety Consensus on antithrombotic prophylaxis in total hip and knee replacement surgery, and in the treatment of femoral neck fracture, then updated in 2013, and a subsequent Intersocietary Consensus, in cooperation also with the Society of general practitioners, concerning antithrombotic prophylaxis in other types of orthopaedic surgery and traumatology. Before starting any prophylactic treatment it is of crucial importance the assessment of both thrombotic and bleeding risk of patients undergoing surgery. Thromboembolic prophylaxis is recommended with low molecular weight heparins (LMWH), fondaparinux (FON) or with the new oral anticoagulants (NOA) in patients undergoing hip and knee replacement surgery while patients undergoing treatment of femoral neck fracture should be treated with LMWH or FON. Regarding the non-prosthetic orthopaedic surgery and traumatology, it is recommended prophylaxis with LMWH or FON in situations of high thromboembolic risk or in the case of interventions or trauma involving pelvis, acetabulum or knee. PMID:25568652

Prisco, Domenico; Cenci, Caterina; Silvestri, Elena; Emmi, Giacomo; Ciucciarelli, Lucia

2014-01-01

445

Prophylaxis of venous thromboembolism in elderly patients with multimorbidity.  

PubMed

Pharmacological thromboprophylaxis (TP) is known to reduce venous thromboembolism (VTE) in medical inpatients, but the criteria for risk-driven prescription, safety and impact on mortality are still debated. We analyze data on elderly patients with multimorbidities admitted in the year 2010 to the Italian internal medicine wards participating in the REPOSI registry to investigate the rate of TP during the hospital stay, and analyze the factors that are related to its prescription. Multivariate logistic regression, area under the ROC curve and CART analysis were performed to look for independent predictors of TP prescription. Association between TP and VTE, bleeding and death in hospital and during the 3-month post-discharge follow-up were explored by logistic regression and propensity score analysis. Among the 1,380 patients enrolled, 171 (15.2 %) were on TP during the hospital stay (162 on low molecular weight heparins, 9 on fondaparinux). The disability Barthel index was the main independent predictor of TP prescription. Rate of fatal and non-fatal VTE and bleeding during and after hospitalization did not differ between TP and non-TP patients. In-hospital and post-discharge mortality was significantly higher in patients on TP, that however was not an independent predictor of mortality. Among elderly medical patients there was a relatively low rate of TP, that was more frequently prescribed to patients with a higher degree of disability and who had an overall higher mortality. PMID:23653407

Marcucci, Maura; Iorio, Alfonso; Nobili, Alessandro; Tettamanti, Mauro; Pasina, Luca; Djade, Codjo Djignefa; Marengoni, Alessandra; Salerno, Francesco; Corrao, Salvatore; Mannucci, Pier Mannuccio

2013-09-01

446

Using a superabsorbent dressing and antimicrobial for a venous ulcer.  

PubMed

In chronic wounds, exudate is believed to prolong the inflammatory phase and is detrimental to healing (Trengove et al, 1999; Vowden and Vowden, 2004). Poor exudate management can have important management cost implications, and may result in increased patient morbidity (White and Cutting, 2006). Accurate assessment of wound exudate is a key component of wound healing and management is achieved through different methods depending on the cause of the excessive exudate production. Superabsorbent dressings have been designed to treat highly exuding wounds; they have a greater fluid-handling capacity than traditional dressings and require changing less frequently (Tadej, 2009). This case study reports on the combined use of a superabsorbent dressing with an antibacterial dressing in a 102-year-old patient who presented with a painful infected venous ulcer complicated by some arterial disease. The combination of the superabsorbent KerraMax® (Crawford Healthcare) with the antibacterial honey Algivon® (Advancis Medical) created the ideal dressing for the treatment of this infected mixed aetiology ulcer, as manuka honey has a strong antibacterial effect (Molan, 1992), and the dressing absorbs the excessive exudate. The dressings worked together to reduce the bacterial load on the wound bed surface, with the honey selectively destroying the bacteria (Molan, 1992), and KerraMax absorbed and locked away the bacteria-containing exudate, which helped to reduce further exudate production, prevent maceration and reduce the potential for a wound to become malodorous (Hampton, 2011). PMID:21841650

Hampton, Sylvie; Coulborn, Anna; Tadej, Martin; Bree-Aslan, Cathie

447

The long-term prognosis of congenital portosystemic venous shunt.  

PubMed

Congenital portosystemic venous shunt (PSVS), considered to be a rare disease, can lead to hepatic encephalopathy (HE). With improvements in diagnostic imaging techniques, the number of infants and children with documented PSVS has increased. The natural course of the disease and indications for surgical closure of the shunt vessel have not been well defined. We review