Sample records for impending venous gangrene

  1. Endovascular Treatment of Phlegmasia Cerulea Dolens with Impending Venous Gangrene: Manual Aspiration Thrombectomy as the First-Line Thrombus Removal Method

    SciTech Connect

    Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur [Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Radiology (Turkey); Demirturk, Orhan S. [Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Thoracic and Cardiovascular Surgery (Turkey); Gur, Serkan [Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Radiology (Turkey)

    2011-12-15

    Purpose: Our purpose was to report the outcome of endovascular treatment with manual aspiration thrombectomy as the first-line thromboablative method for phlegmasia cerulea dolens. Methods: Between October 2006 and May 2010, seven consecutive patients (5 women, 2 men; age range, 31-80 years) with the diagnosis of phlegmasia cerulea dolens secondary to acute iliofemoral deep venous thrombosis had endovascular treatment with manual aspiration thrombectomy. Catheter-directed thrombolysis and stent placement were used as adjunctive procedures. Phlegmasia was left-sided in five and right-sided in two patients. Results: All patients had associated great saphenous vein thrombosis in addition to iliofemoral deep vein thrombosis (DVT). Aspiration thrombectomy completely removed the thrombus from the popliteal vein to the inferior vena cava (IVC) in all cases. Three patients with May-Thurner syndrome had stent placement in the left common iliac vein. Two patients had early recurrences. Repeated aspiration thrombectomy was unsuccessful in one patient. There were no complications related to the procedure. One patient who had been successfully treated died of sepsis and another patient who had unsuccessful repeated interventions had below-the-knee amputation. Overall, the clinical success and survival rates of patients in this study were 86%. On follow-up, three patients with successful treatment were asymptomatic with no deep venous insufficiency. One of these patients died during the 4-month follow-up period. Two patients had mild ankle swelling with deep venous insufficiency. Conclusions: Manual aspiration thrombectomy with adjunctive use of catheter-directed thrombolysis and stent placement is an effective endovascular treatment method with high clinical success and survival rates for phlegmasia cerulean dolens.

  2. Breast Gangrene

    PubMed Central

    2011-01-01

    Background Breast gangrene is rare in surgical practice. Gangrene of breast can be idiopathic or secondary to some causative factor. Antibiotics and debridement are used for management. Acute inflammatory infiltrate, severe necrosis of breast tissue, necrotizing arteritis, and venous thrombosis is observed on histopathology. The aim of was to study patients who had breast gangrene. Methods A prospective study of 10 patients who had breast gangrene over a period of 6 years were analyzed Results All the patients in the study group were female. Total of 10 patients were encountered who had breast gangrene. Six patients presented with breast gangrene on the right breast whereas four had on left breast. Out of 10 patients, three had breast abscess after teeth bite followed by gangrene, one had iatrogenic trauma by needle aspiration of erythematous area of breast under septic conditions. Four had history of application of belladonna on cutaneous breast abscess and had then gangrene. All were lactating female. Amongst the rest two were elderly, one of which was a diabetic who had gangrene of breast and had no application of belladonna. All except one had debridement under cover of broad spectrum antibiotics. Three patients had grafting to cover the raw area. Conclusion Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement. PMID:21854557

  3. 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 ...

  4. Fournier gangrene

    PubMed Central

    Parry, Nadiah

    2015-01-01

    Key Clinical Message Fournier gangrene is a rapidly progressive necrotizing infection of the perineal and genital fascia, often polymicrobial. Severity is increased in older patients, diabetics and the immunocompromised. As in this case, the disease can have an indolent onset. Early recognition and aggressive treatment is important.

  5. 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.

  6. 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.

  7. The Impending Crisis

    PubMed Central

    Kaplan, Raymond L.; Burgess, Thomas E.

    2010-01-01

    When you are ill and consult a physician for his or her expertise, many times laboratory testing is part of the clinical workup. This testing is critical to the physician’s ability to diagnose the patient’s condition. What if testing was not available … because there was no one to do the testing? Although seemingly far-fetched, this scenario could play itself out in the next ten years due to an impending manpower crisis in laboratory medicine. The profession of Medical Technology, also known as Clinical Laboratory Science, is experiencing a shortage of qualified individuals for a variety of reasons – not the least of which is the closure of almost 70% of the schools teaching this critical profession. Health care workers (HCW) rely on accurate and timely clinical laboratory results in order to make decisions for their patients. Because ? 70% of patient care decisions are based on clinical laboratory results, it is important to have a well-trained supply of laboratory professionals. This article will give an overview of the situation and the possible causes of this shortage, and pose challenges to our profession as to how this crisis can be averted. Visibility of this profession must be a prime focus of this effort in order for the population in general to be aware of the role Clinical Laboratory Scientists play in the health care consortium. This effort should begin early in the educational process, potentially as early as Middle School (junior high school), bringing awareness of the profession not only to students but to educators as well. PMID:23653714

  8. Fournier's Gangrene: Current Practices

    PubMed Central

    Mallikarjuna, M. N.; Vijayakumar, Abhishek; Patil, Vijayraj S.; Shivswamy, B. S.

    2012-01-01

    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

  9. Gas Gangrene in Orthopaedic Patients

    PubMed Central

    Ying, Zhimin; Zhang, Min; Yan, Shigui; Zhu, Zhong

    2013-01-01

    Clostridial myonecrosis is most often seen in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. Since 1953 cases of gas gangrene have been reported in orthopaedic patients including open fractures, closed fractures, and orthopaedic surgeries. We present a case of 55-year-old obese woman who developed rapidly progressive gas gangrene in her right leg accompanied by tibial plateau fracture without skin lacerations. She was diagnosed with clostridial myonecrosis and above-the-knee amputation was carried out. This patient made full recovery within three weeks of the initial episode. We identified a total of 50 cases of gas gangrene in orthopaedic patients. Several factors, if available, were analyzed for each case: age, cause of injury, fracture location, pathogen, and outcome. Based on our case report and the literature review, emergency clinicians should be aware of this severe and potentially fatal infectious disease and should not delay treatment or prompt orthopedic surgery consultation. PMID:24288638

  10. A case of Fournier's gangrene after hydrocelectomy

    PubMed Central

    Popper, Helmut; Pummer, Karl

    2012-01-01

    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

  11. Fournier's gangrene--current concepts.

    PubMed

    Wróblewska, Marta; Kuzaka, Boles?aw; Borkowski, Tomasz; Kuzaka, Piotr; Kawecki, Dariusz; Radziszewski, Piotr

    2014-01-01

    Fournier's gangrene (FG) is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital, or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin. It is believed that the occurrence of the disease in women is underreported and may be unrecognised by some clinicians. Fournier's gangrene is a life-threatening condition, constituting an urological emergency. Many patients with Fournier's gangrene have medical or surgical conditions, which are predisposing factors to this disease or its more severe or fatal course. These comprise diabetes mellitus, hypertension, alcoholism and advanced age. Recent reports in the literature point to changes in the epidemiology of FG, comprising an increasing age of patients. Several authors reported that the mean age of FG patients is at present 53-55 years. Prognosis in FG patients is based on FGSI (Fournier's gangrene severity index) score. Despite the progress in medical care for FG patients, the mortality rate reported in the literature remains high--most often 20-40%, but ranges from 4% to 80%. The most common isolates cultured from FG lesions are both Gram-positive and Gram-negative, as well as strictly anaerobic bacteria. Recently community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an etiological agent of FG with severe clinical course and even fulminant sepsis. Rarely FG may have a fungal etiology, being caused by yeast-like fungi Candida spp. or by moulds. Antibiotics should be administered parenterally and in doses high enough to reach an effective concentration in the infected tissues. PMID:25546936

  12. Gangrene

    MedlinePLUS

    ... or organs. Causes include Serious injuries Problems with blood circulation, such as atherosclerosis and peripheral arterial disease Diabetes Skin symptoms may include a blue or black color, pain, numbness, and sores that ...

  13. Pulmonary gangrene as a complication of mucormycosis

    SciTech Connect

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

    1985-06-01

    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.

  14. Venous insufficiency

    MedlinePLUS

    Chronic venous insufficiency; Chronic venous stasis; Chronic venous disease ... Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. Philadelphia, PA: Elsevier Saunders; ...

  15. Symmetrical Peripheral Gangrene Following Snake Bite

    PubMed Central

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

    2014-01-01

    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

  16. Peripheral gangrene in hypernatraemic dehydration of infancy.

    PubMed Central

    Comay, S C; Karabus, C D

    1975-01-01

    Gangrene of the extremities complicating diarrhoea and severe hypernatraemic dehydration occurred in 6 infants. This is a rare complication of gastroenteritis, and its association with hypernatraemia does not seem to have previously been emphasized. The increased blood viscosity resulting from serum hyperosmolarity may have been responsible for the gangrene, and studies in our patients suggested that disseminated intravascular coagulation was present. In addition to fluid and electrolyte replacement, the infants were treated with heparin with some recovery of the affected extremities. Images FIG. 1 FIG. 2 FIG. 3 PMID:1200677

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

    PubMed

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

    2014-12-01

    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

  18. Genital fournier's gangrene: experience with 38 patients

    Microsoft Academic Search

    Mohamed J. Hejase; Jose E. Simonin; Richard Bihrle; Christopher L. Coogan

    1996-01-01

    Objectives. Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum, or the abdominal wall. We report our experience with the management of this difficult infectious disease.Methods. Thirty-eight patients were admitted with the diagnosis of FG between May 1993 and May 1995. All patients were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and application of

  19. [Gas gangrene in childhood--a review].

    PubMed

    Roloff, D

    1991-01-01

    Although gas gangrene in childhood is not mentioned in the paediatric literature, paediatric surgery textbooks included, this toxic wound infection also occurs in children. Prognosis totally depends on the early detection of the disease. Having checked over 2000 relevant literature sources, in which 110 cases of gas gangrene are mentioned, of which 24 are described in detail, this paper points to constellations paving the way for developing or favouring the infection. In aetiologic respect accidents range first, but also in children postoperative clostridial myonecrosis and those resulting from intramuscular injections are possible, but rare. On the basis of case reports the initial symptoms are stressed. In the foreground local (heavy pains, odematous swelling, "dirty" exudate, dyschromia, foetor) and general (tachycardia, rapidly deteriorating condition, shock, icterus) signs are dealt with, which occur after a latent period ranging between some few and 72 (up to 96) hours. Only through quick diagnosis and sufficient immediate therapy it will be possible to improve the prognosis and, in particular, reduce letality. A later publication in this journal will explain that also in children gas gangrene does not belong to those diseases which seldom occur. PMID:2067869

  20. Upper limb ischemic gangrene as a complication of hemodialysis access.

    PubMed

    Cawich, Shamir O; Mohammed, Emil; Mencia, Marlon; Naraynsingh, Vijay

    2015-01-01

    Upper limb ischemia is a well-recognized complication of dialysis access creation but progression to gangrene is uncommon. We report a case of upper limb ischemic gangrene and discuss the lessons learned during the management of this case. Clinicians must be vigilant for this complication and they should be reminded that it requires urgent management to prevent tissue loss. PMID:25810944

  1. Upper Limb Ischemic Gangrene as a Complication of Hemodialysis Access

    PubMed Central

    Cawich, Shamir O.; Mohammed, Emil; Mencia, Marlon

    2015-01-01

    Upper limb ischemia is a well-recognized complication of dialysis access creation but progression to gangrene is uncommon. We report a case of upper limb ischemic gangrene and discuss the lessons learned during the management of this case. Clinicians must be vigilant for this complication and they should be reminded that it requires urgent management to prevent tissue loss.

  2. Fournier's gangrene in childhood: a report of 3 infant patients

    Microsoft Academic Search

    Gülsen Ekingen; Tonguç Isken; Hakan Agir; Selim Öncel; Ayla Günlemez

    2008-01-01

    Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy.Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively.Especially, prematurity and diaper rash are rare predisposing factors in the pediatric

  3. Fournier's gangrene following penile self-injection with cocaine.

    PubMed

    Mouraviev, V B; Pautler, S E; Hayman, W P

    2002-01-01

    To date, there have been no reports of Fournier's gangrene following penile self-injection of cocaine. We report a case of cocaine-induced Fournier's gangrene requiring parenteral antibiotics followed by primary surgical debridement and delayed reconstructive procedure of penile skin. PMID:12201928

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

    PubMed Central

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

    2014-01-01

    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

  5. A conservative approach to perineal Fournier's gangrene.

    PubMed

    Milanese, Giulio; Quaresima, Luigi; Dellabella, Marco; Scalise, Alessandro; Di Benedetto, Giovanni Maria; Muzzonigro, Giovanni; Minardi, Daniele

    2015-01-01

    Fournier's gangrene (FG) is a disease involving necrosis of perineum and external genitalia; in 95% of cases it is possible to diagnose the Fournier's gangrene just by physical examination. The clinical presentation of FG varies from an initial localized infection to large areas with necrotizing infection. The disease typically affect elderly men (6°-7° decade) with important systemic comorbidities; women are less frequently affected. Despite improvements in diagnosis and management, the mortality rate nowadays is between 20% and 43%. The severity and mortality of the disease is dependent upon the general condition of the patient at presentation and upon the rate of spread of the infection. Treatment involves a multidisciplinary approach: intensive systematic management, broad-spectrum antibiotic therapy, early surgical debridement (wide abscission of necrotic tissues and surgical drainage of peritoneum, scrotum, penis, and inguinal areas), hyperbaric oxygen therapy; surgery can eventually be repeated if necessary; reconstructive surgery has an important role in the final treatment of the disease. The technical difficulties frequently encountered and the inability to make a complete removal of the necrotizing tissues at the time of surgery in some cases has led to the application of combined techniques, in view of the enhancement effect of specific advanced medications, targeted antibiotic therapy and hyperbaric medicine. We have considered 6 patients affected by Fournier's gangrene treated at our institution; all the patients received treatment with the help of plastic surgeons of the same institution. After debridement, all the patients were treated with advanced specific dressings consisting of plates and strips made of calcium alginate, hydrogels and polyurethane and twodimensional cavity foams. Reconstructive surgery was necessary in one case. Hyperbaric oxygen therapy (HBO) has been performed in all cases. The multidisciplinary approach, the combined use of HBO therapy and the adoption of advanced specific dressings, have made possible the complete healing of the lesions in a shorter period, avoiding further surgery in 5 out of 6 patients. PMID:25847893

  6. Multiple Urethral Stones Causing Penile Gangrene

    PubMed Central

    Ramdass, Michael J.

    2014-01-01

    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

  7. Fournier's gangrene in childhood: a report of 3 infant patients.

    PubMed

    Ekingen, Gülsen; Isken, Tonguç; Agir, Hakan; Oncel, Selim; Günlemez, Ayla

    2008-12-01

    Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy. Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively. Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene. PMID:19040919

  8. [Gangrene as an initial manifestation of a catastrophic antiphospholipid syndrome].

    PubMed

    Vázquez Fuentes, Noelia; Tejero García, Sergio; Carnicero González, Fernando; Martínez Bagur, Irene; de Torres, Rafael Merino; Querol Gutiérrez, José Javier; Laza Laza, Enrique Manuel; Querol Gutiérrez, Juan Carlos

    2008-05-01

    Catastrophic antiphospholipid syndrome (CAPS) is an unusual form of presentation of antiphospholipid syndrome with a poor prognosis, so early diagnosis and treatment are necessary. We report a patient who had gangrene as the initial manifestation of CAPS. PMID:21794513

  9. 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...

  10. [Our experience in Fournier's gangrene with severe septic shock].

    PubMed

    Lukász, Péter; Ecsedy, Gábor; Lovay, Zoltán; Nagy, István; Kári, Dániel; Vörös, Attila; Ender, Ferenc

    2014-06-01

    Fournier's gangrene is a rare, rapidly progressing necrotizing fasciitis, which involves the genital area and perineum, progresses towards the thighs and abdominal wall through fascial plains. In our surgical department we treated seven patients with Fournier's gangrene between 2007 and 2011. Early diagnosis, immediate radical surgical debridement, necrosectomy, appropriate antibiotics and intensive care are all required and necessary for the successful treatment. Despite appropriate therapy, two patients were lost in septic shock. PMID:24873767

  11. Embolus entrapped in patent foramen ovale: impending paradoxical embolism.

    PubMed

    Podroužková, Helena; Horváth, Vladimír; Hlinomaz, Ota; Bedan, Jan; Bambuch, Miroslav; N?mec, Petr; Orban, Marek

    2014-12-01

    An impending paradoxical embolism is a rare finding, with fewer than 200 cases being documented so far. A 68-year-old woman, who presented with 3 weeks of increasing exertional dyspnea and exercise intolerance, underwent transesophageal echocardiography with a finding of an embolus in both right and left atria. At an emergent cardiac surgery, a worm-shaped, 5-cm-long thrombus was found in the right atrium, it was protruding to left atrium through the foramen ovale. The thrombus was removed intact, and the foramen ovale was closed. By our experience, an emergent cardiac surgery should always be considered as a treatment option for impending paradoxical embolism. PMID:25468129

  12. Digital Gangrene an Unusual Presentation of Takayasu's Arteritis

    PubMed Central

    Roy, Manoj Kumar; Datta, Joydip; Lahiri, Durjoy; Agarwal, Rakesh; Mukhopadhyay, Sumanto; Mukhopadhyay, Jotideb; Mondal, Anupam; Maity, Pranab

    2015-01-01

    Context: Takayasu arteritis (TA) is a chronic inflammatory disease involving large vessels like aorta and its major branches. It presents to clinician with features of arm claudication, stroke, asymmetrical pulse, or asymmetrical blood pressure in both limbs. Digital gangrene may be occurred secondary to various systemic diseases like diabetes, thrombophilic states, vascular embolism, and medium and small vessel vasculitis or infections. Through evaluation to diagnose the exact etiology and timely intervention is needed to prevent progression of the gangrene which at the time can be life-threatening. Digital gangrene as an initial presentation in TA is very rare. In medical literature, there are only few case reports have been reported. Case Report: We are reporting a case of a 26-year-old female patient presented with right little finger and index finger gangrene, ultimately diagnosed as TA and responded dramatically to treatment. Conclusion: Though rare, TA should be taken in the differential diagnosis for work up in a case of digital gangrene and it necessitates more studies in this field to uncover the exact pathophysiology for such presentation.

  13. Recognition of Risk Factors and Prognostic Indicators in Fournier's Gangrene.

    PubMed

    Kaufmann, Judith A; Ramponi, Denise

    2015-01-01

    Fournier's gangrene is a rare but rapidly progressive necrotizing infection that results from the synergistic action of multiple aerobic and anaerobic organisms colonized on the skin and in the anogenital area. This is a case report of a middle-aged man with late presentation of Fournier's gangrene that was treated aggressively by a team of infectious disease specialists, surgeons, intensivists, and intensive care unit specialty nurses over a 3-week period. Despite heroic efforts by the multidisciplinary team, the patient's condition deteriorated and he died of multisystem failure. The purpose of this article was to alert clinicians to the etiology, pathophysiology, risk factors for invasive necrosis, prognostic indicators, and current diagnostic and treatment recommendations. Fournier's gangrene represents a true medical and surgical emergency and requires early recognition and a team approach to management. PMID:25741955

  14. Venous Valves

    NSDL National Science Digital Library

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

    2009-11-20

    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.

  15. The care of a patient with Fournier's gangrene.

    PubMed

    Öz?aker, Esma; Yavuz, Meryem; Alt?nba?, Yasemin; ?ahin Köze, Burçak; Nurülke, Birgül

    2015-01-01

    Fournier's gangrene is a rare, necrotizing fasciitis of the genitals and perineum caused by a mixture of aerobic and anaerobic microorganisms. This infection leads to complications including multiple organ failure and death. Due to the aggressive nature of this condition, early diagnosis is crucial. Treatment involves extensive soft tissue debridement and broad-spectrum antibiotics. Despite appropriate therapy, mortality is high. This case report aimed to present nursing approaches towards an elderly male patient referred to the urology service with a diagnosis of Fournier's gangrene. PMID:25779717

  16. Clostridium septicum gas gangrene in the orbit: a case report.

    PubMed

    Fejes, I; Dégi, R; Végh, M

    2013-02-01

    Our report presents a case of Clostridium septicum gas gangrene in an unusual, orbital localization. The predisposing factors are typical: colon tumour and lymphatic malignancy. Most probably bacteria from the intestinal flora entered the bloodstream through the compromised intestinal wall and settled in the orbit resulting in the development of an abscess containing gas. At the site of the gas gangrene, an indolent B cell lymphoma was present. After surgery and antibiotic treatment, the patient healed from the C. septicum infection; but subsequently died as a consequence of the tumour. PMID:23203898

  17. Deep venous thrombosis and superficial venous reflux

    Microsoft Academic Search

    Mark H. Meissner; Michael T. Caps; Brenda K. Zierler; Robert O. Bergelin; Richard A. Manzo; D. Eugene Strandness

    2000-01-01

    Objective: Although superficial venous reflux is an important determinant of post-thrombotic skin changes, the origin of this reflux is unknown. The purpose of this study was to evaluate the frequency and etiologic mechanisms of superficial venous reflux after acute deep venous thrombosis (DVT). Methods: Patients with a documented acute lower extremity DVT were asked to return for serial venous duplex

  18. Venous Thromboembolism

    Microsoft Academic Search

    Esther S. H. Kim; John R. Bartholomew

    \\u000a Venous thromboembolism, a clinical entity which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common,\\u000a lethal disease that affects both hospitalized and non-hospitalized patients, recurs frequently, is often overlooked, and results\\u000a in long-term complications. The currently available antithrombin agents, including unfractionated heparin, low molecular weight\\u000a heparin, direct thrombin inhibitors, vitamin K antagonists, and factor Xa antagonists are

  19. Venous Thromboembolism

    Microsoft Academic Search

    Michele G. Beckman; W. Craig Hooper; Sara E. Critchley; Thomas L. Ortel

    2010-01-01

    Venous thromboembolism (VTE), defined as deep vein thrombosis, pulmonary embolism, or both, affects an estimated 300,000–600,000 individuals in the U.S. each year, causing considerable morbidity and mortality. It is a disorder that can occur in all races and ethnicities, all age groups, and both genders. With many of the known risk factors—advanced age, immobility, surgery, obesity—increasing in society, VTE is

  20. American Venous Forum

    MedlinePLUS

    ... venous and lymphatic health through education and disease awareness. Addressing your specific venous and lympatic disease questions ... veinforum.org © 2015 American Venous Forum. Contact Us | Legal/Terms of Use | Privacy Policy | Sitemap

  1. Venous thrombosis - series (image)

    MedlinePLUS

    Blood clot formation in the veins is called venous thrombosis. Venous thrombosis most commonly forms in the veins of the legs. Risk factors for venous thrombosis include prolonged bed rest or immobility, as can ...

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

    PubMed Central

    2009-01-01

    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

  3. Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings

    Microsoft Academic Search

    Cheng-Hsien Wu; Chien-Cheng Chen; Chao-Jan Wang; Yon-Cheong Wong; Li-Jen Wang; Chen-Chih Huang; Wan-Chak Lo; Huan-Wu Chen

    2011-01-01

    In acute cholecystitis, the presence of gangrene is associated with higher morbidity and mortality and necessitates open surgical\\u000a intervention rather than laparoscopic cholecystectomy. As Murphy’s sign may be absent, gangrene may not be detected ultrasonographically.\\u000a This retrospective study evaluated indications of acute gangrenous cholecystitis on computed tomography (CT) in 25 patients,\\u000a who were proven as having acute cholecysitis surgically and

  4. [Pheochromocytoma presenting as ischaemic gangrene of lower limbs].

    PubMed

    Galsgaard, Kristina; Hilberg, Ole; Hjorthaug, Karin

    2010-07-26

    We describe a 71-year-old woman who was admitted with pneumonia. She quickly developed severe pain and gangrene in all four extremities and had several fingers and crurae amputated. Pheochromocytoma was diagnosed by a 2 x 2 24-hour urine collection, computerized axial tomography and MIBG scintigraphy. The patient was suppressed with phenoxybenzamine hydrochloride and propanolol for three weeks and was subsequently laparoscopically adrenalectomized on her left side. PMID:20654282

  5. Leprosy & gangrene: A rare association; role of anti phospholipid antibodies

    PubMed Central

    Akerkar, Shashank M; Bichile, Lata S

    2005-01-01

    Background Leprosy still remains an important public health problem for many parts of the world. An association of gangrene with leprosy is a rare one & can have a number of causative mechanisms. We present a case with Leprosy & gangrene with positive anti phopholipid antibody titers. Case presentation A 50-year-old non-diabetic, non-hypertensive lady presented with 2 months history of progressive gangrene of bilateral toes. She was found to have madarosis & hypopigmented, hypoaesthetic macular lesions on the upper limb & thighs. Bilateral ulnar & popliteal nerves were thickened. A skin biopsy of the lesions revealed borderline tuberculoid leprosy, slit skin smears revealed a bacteriological index of 1+. She did not have any evidence of thromboembolic episode or atherosclerosis. ACLA was positive at presentation & also on another occasion 6 weeks later. ACLAs were of the IgM type on both occasions. Lupus Anticoagulant & ?2 GPI antibody were negative. DOPPLER of the lower limb arteries did not reveal any abnormality. Patient was successfully treated with multi-drug antileprotics & anticoagulants. Conclusion Infectious APLAs should be recognized as a cause of thrombosis in Leprosy. Appropriate anticoagulation can salvage limb function. PMID:16176580

  6. Ischemic Gangrene of the Glans following Penile Prosthesis Implantation.

    PubMed

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

    2013-01-01

    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

  7. Ischemic Gangrene of the Glans following Penile Prosthesis Implantation

    PubMed Central

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

    2013-01-01

    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

  8. Enterostomy can decrease the mortality of patients with Fournier gangrene

    PubMed Central

    Li, Yan-Dong; Zhu, Wei-Fang; Qiao, Jian-Jun; Lin, Jian-Jiang

    2014-01-01

    AIM: To determine the significance of enterostomy in the emergency management of Fournier gangrene. METHODS: The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed. RESULTS: The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P < 0.05) and average length of hospital stay (14.3 ± 7.8 d vs 20.1 ± 8.9 d, P < 0.05) were shorter in the enterostomy group. The case fatality rate was lower in the enterostomy group than that in the control group (3.6% vs 21.7%, P < 0.05). CONCLUSION: Enterostomy can decrease the case fatality rate of patients with Fournier gangrene. PMID:24976731

  9. Venous flaps.

    PubMed

    Thatte, M R; Thatte, R L

    1993-04-01

    One of the earliest postulates concerning the physiological basis of flap survival is attributed to Sushruta, who, in his inimitable style, very succinctly noted in Sanskrit verse the following words: "through continuity survives." Sanskrit being a very telegraphic language, what derives from these words is as follows: Through (the flap's) continuity (with its original location) (it) survives. The principle of continuity has survived through the ages, though continuity has come to imply vascular continuity based on the Harvesian model of circulation. No matter how we classify flaps, i.e., random or axial, the Harvesian model of circulation is the key to the mechanism of survival. Lately, however, a new category of flaps, that is, "venous flaps," have been reported by a number of investigators where the classical Harvesian model is not in evidence, at least apparently. The following effort is directed toward presenting the existing data on this subject for future guidance in research and clinical applications. PMID:8446733

  10. Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur

    SciTech Connect

    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

    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.

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

    E-print Network

    Christian, Eric

    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

  12. Cutaneous erosions: a herald for impending pancytopenia in methotrexate toxicity.

    PubMed

    Shiver, Mallory B; Hall, Lauren A; Conner, Kelly B; Brown, Grace E; Cheung, Wang L; Wirges, Marla L

    2014-07-01

    Psoriatic plaque erosion is a rare toxic side effect of low-dose methotrexate (LDMTX) that has been reported during the treatment of psoriasis and described as a herald for impending pancytopenia. Fatalities from this have rarely been reported. Even rarer is methotrexate (MTX)-induced erosions of clinically normal skin in patients without a history of psoriasis. We report 3 rare presentations of MTX-induced cutaneous erosions, 2 fatalities occurring with MTX-induced psoriatic plaque erosions, and the sixth reported case of MTX-induced erosions with no prior history of psoriasis. Each were elderly patients on proton pump inhibitors with a history of chronic non-steroidal anti-inflammatory drug (NSAID) use. They all presented with acute onset of erosions after a recent change in their MTX dose. Pancytopenia followed in each case. Physicians' awareness of the sequelae in MTX-induced cutaneous erosions is imperative so MTX can be discontinued and treatment instituted to prevent fatal bone marrow suppression. PMID:25046458

  13. Fournier's Gangrene of the Penis: A Rare Entity.

    PubMed

    Talwar, Ashutosh; Puri, Neerja; Singh, Majhail

    2010-01-01

    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

  14. Successful combined approach to a severe Fournier's gangrene

    PubMed Central

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

    2014-01-01

    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

  15. A case of gas gangrene in an immunosuppressed Crohn's patient.

    PubMed

    Kiel, Natalie; Ho, Vincent; Pascoe, Andrew

    2011-09-01

    Clostridium septicum (C. septicum) gas gangrene is well documented in the literature, typically in the setting of trauma or immunosuppression. In this paper, we report a unique case of spontaneous clostridial myonecrosis in a patient with Crohn's disease and sulfasalazine-induced neutropenia. The patient presented with left thigh pain, vomiting and diarrhea. Blood tests demonstrated a profound neutropenia, and magnetic resonance imaging of the thigh confirmed extensive myonecrosis. The patient underwent emergency hip disarticulation, followed by hemicolectomy. C. septicum was cultured from the blood. Following completion of antibiotic therapy, the patient developed myonecrosis of the right pectoral muscle necessitating further debridement, and remains on lifelong prophylactic antibiotic therapy. PMID:21987630

  16. Central venous catheters - ports

    MedlinePLUS

    Central venous catheter - subcutaneous; Port-a-Cath; InfusaPort; PasPort; Subclavian port; Medi - port; Central venous line - port ... A central venous catheter is a tube that goes into a vein in your chest and ends at your ...

  17. The bacteriology of gangrenous and perforated appendicitis--revisited.

    PubMed Central

    Bennion, R S; Baron, E J; Thompson, J E; Downes, J; Summanen, P; Talan, D A; Finegold, S M

    1990-01-01

    By using optimum sampling, transport, and culture techniques in patients with gangrenous or perforated appendicitis, we recovered than has previously been reported. Thirty patients older than 12 years with histologically documented gangrenous or perforated appendicitis had peritoneal fluid, appendiceal tissue, and abscess contents (if present) cultured. Appendiceal tissue was obtained so as to exclude the lumen. A total of 223 anaerobes and 82 aerobic or faculatative bacteria were recovered, an average of 10.2 different organisms per specimen. Twenty-one different genera and more than 40 species were encountered. Bacteroides fragilis group and Escherichia coli were isolated from almost all specimens. Within the B. fragilis group, eight species were represented. Other frequent isolates included Peptostreptococcus (80%), Pseudomonas (40% [P. aeruginosa, 23.3%, other Pseudomonas spp., 16.7%]), B. splanchnicus (40%), B. intermedius (36.7%), and Lactobacillus (36.7%). Interestingly a previously undescribed fastidious gram-negative anaerobic bacillus was isolated from nearly one half of all patients. This organism was found to have low DNA homology (by dot blot) with the known organisms most closely resembling it. PMID:2405791

  18. Fournier's Gangrene Associated with Local Cutaneous HPV Lesions in a Previously Healthy Girl.

    PubMed

    Tsinti, Maria; Tsekoura, Theophani; Blevrakis, Evangelos; Vlachakis, Ioannis; Tsilimigaki-Christaki, Amalia

    2013-01-01

    A case of an 11-year-old prepubertal girl with Fournier's gangrene is presented. The diagnosis was posed after the disease had progressed to the typical clinical picture of frank gangrene. A benign viral infection, common warts, possibly represents the initiating event of the development of this necrotizing soft tissue infection. The development of childhood Fournier's gangrene in association with viral infections has been reported in the past. An optimal outcome was achieved by aggressive antibiotic and surgical treatment despite the late diagnosis. In children, Fournier's gangrene develops in previously healthy individuals with benign diseases often representing the initiating events; thus, high index of suspicion is necessary for an early diagnosis that will lead to the optimal outcome. PMID:23710402

  19. Fournier's Gangrene Associated with Local Cutaneous HPV Lesions in a Previously Healthy Girl

    PubMed Central

    Tsekoura, Theophani; Blevrakis, Evangelos; Vlachakis, Ioannis; Tsilimigaki-Christaki, Amalia

    2013-01-01

    A case of an 11-year-old prepubertal girl with Fournier's gangrene is presented. The diagnosis was posed after the disease had progressed to the typical clinical picture of frank gangrene. A benign viral infection, common warts, possibly represents the initiating event of the development of this necrotizing soft tissue infection. The development of childhood Fournier's gangrene in association with viral infections has been reported in the past. An optimal outcome was achieved by aggressive antibiotic and surgical treatment despite the late diagnosis. In children, Fournier's gangrene develops in previously healthy individuals with benign diseases often representing the initiating events; thus, high index of suspicion is necessary for an early diagnosis that will lead to the optimal outcome. PMID:23710402

  20. Opioid analgesics stop the development of clostridial gas gangrene.

    PubMed

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

    2014-08-01

    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

  1. Fournier’s gangrene after adult male circumcision

    PubMed Central

    2014-01-01

    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

  2. Squamous cell carcinoma developing in the scar of Fournier's gangrene – Case report

    Microsoft Academic Search

    Chintamani; Manu Shankar; Vinay Singhal; JP Singh; Anju Bansal; Sunita Saxena

    2004-01-01

    BACKGROUND: Squamous cell carcinoma of the scrotum is rare and its development in the scar of Fournier's gangrene is still rarer. CASE PRESENTATION: A 65-year-old gentleman presented with a small non-healing ulcer developing on right hemi-scrotum two years after the treatment for Fournier's gangrene. On histological examination it was found to be squamous cell carcinoma. He was successfully managed by

  3. Treatment of venous ulcers

    Microsoft Academic Search

    Tami S. De Araujo; Camile Luiza Hexsel; Robert S. Kirsner

    2005-01-01

    Optional statement  Underlying the pathogenesis of venous ulceration is venous hypertension. Therefore, the use of multilayered compression therapy\\u000a is the gold standard in the treatment of a venous ulcer. As treatment progresses, an important determinant of response is\\u000a wound assessment, which should be performed on initial visit and subsequently thereafter. Among the methods to assess improvement\\u000a are digital photography and planimetry,

  4. Diabetic gangrene in multiple fingers and toes after a dog bite in an elderly patient with type 2 diabetes.

    PubMed

    Oya, Junko; Hanai, Ko; Miura, Junnosuke; Maruyama, Satoko; Ishii, Akiko; Syono, Kazu; Shinjo, Takamichi; Iwamoto, Yasuhiko

    2011-01-01

    A 78-year-old diabetic woman experienced multiple sites of gangrene not only in fingers that were directly bitten by a dog but also in fingers and toes that had not beenbitten. Her glycemic control was fair and microvascular complications were mild. There were no clinical findings related to angitis, collagenosis or severe infection. The fingers and toes with gangrene were amputated. The pathological diagnosis was diabetic gangrene. This report presents a case of multiple sites of gangrene of the fingers and toes after a dog bite in an elderly patient with type 2 diabetes. PMID:21673466

  5. Prophylaxis of venous thromboembolism

    Microsoft Academic Search

    Vijay V. Kakkar; Mark D. Stringer

    1990-01-01

    The objective of prophylaxis in venous thromboembolism is, first, to prevent fatal pulmonary embolism and, second, to reduce the morbidity associated with deep vein thrombosis (DVT) and the postphlebitic limb. This should now be standard practice for most patients over 40 years of age undergoing major surgery and for younger patients with a history of venous thromboembolism. Particularly high-risk groups

  6. Prophylaxis of Venous Thromboembolism

    Microsoft Academic Search

    Graham Pineo; Russell Hull

    There are now effective measures for the prevention of venous thromboembolism in most medical and surgical conditions. Based on information from level 1 clinical trials and systematic reviews, recommendations for the prevention of venous thromboembolism can be made for most circumstances encountered by the physician or surgeon. Where such information is not available, recommendations must be based on extrapolation from

  7. Mesenteric venous thrombosis

    MedlinePLUS

    Mesenteric venous thrombosis is a blood clot in one or more of the major veins that drain blood from the intestine. ... Mesenteric venous thrombosis is a clot that blocks blood flow in a mesenteric vein. There are two such veins through ...

  8. Fear of impending fractures: when to refer? A case-based review.

    PubMed

    Kronisch, Caroline; Balagué, Federico; Dudler, Jean

    2014-01-01

    Impending fractures and spinal cord compression are frequent complications of bone metastasis with debilitating consequences. The issue of impending fracture of the femurs and risk of spinal cord compression was raised in an 83-year-old woman with multiple myeloma. Some type of prophylactic treatment would appear suitable, usually surgical, for this condition. While criteria for prophylactic treatment exist in the orthopedic literature, most patients present to rheumatologists, oncologists, or internists. This article reviews the various scoring systems available to evaluate the risk of these very serious complications. We also discuss the current limitations of such tools and the need for a research agenda to address this common problem. PMID:24384823

  9. An outbreak of gangrenous dermatitis in commercial broiler chickens.

    PubMed

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

    2010-08-01

    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, and intestine. Immunofluorescence staining revealed Clostridium-like bacilli in the skin and the intestine. Both Clostridium perfringens and Clostridium septicum genomic sequences were identified by polymerase chain reaction in bacterial cultures isolated from the skin, muscle, and intestine, and in the frozen tissues from the GD-affected birds. Serological analysis demonstrated that both affected and clinically healthy birds from the same house had high serum antibody titres against C. perfringens, C. septicum, Eimeria, chick anaemia virus, and infectious bursal disease virus. These results are discussed in the context of the relationship between the different Clostridium spp. and the pathogenesis of GD. PMID:20706880

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

    PubMed Central

    El-Deeb, Wael M.

    2013-01-01

    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

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

    PubMed Central

    2009-01-01

    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

  12. The Impending Leadership Crisis in Historically Black College and University (HBCU) Libraries: A Mixed Methods Study

    ERIC Educational Resources Information Center

    Youmans, Tasha Lucas

    2009-01-01

    The purpose of this study was to disclose the claims of an impending shortage of librarians in academic libraries as it relates to Historically Black Colleges and Universities (HBCUs). The target population of this study was HBCU libraries that had a full-time equivalent enrollment of 3,000 students or more and that were accredited by the Southern…

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

    ERIC Educational Resources Information Center

    Corbett, Jane

    2012-01-01

    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…

  14. How a Faculty Made Sense of the Impending Succession of Its Principal. Revised.

    ERIC Educational Resources Information Center

    Fauske, Janice R.; Ogawa, Rodney T.

    This study sought to describe how an elementary school faculty made sense of the impending succession of its principal, and to extend Gephart's effort to develop a grounded theory of leader succession by examining an unforced succession in an organization whose members exerted little if any influence on the selection process. On the basis of…

  15. Detachment, Fear, and Expectation: A Faculty's Response to the Impending Succession of Its Principal.

    ERIC Educational Resources Information Center

    Fauske, Janice R.; Ogawa, Rodney T.

    1987-01-01

    Describes how an elementary school coped with its principal's impending departure and extends R. Gephart's grounded theory of leader succession--that faculty collectively degrade the departing principal's status. This study finds individual degradation attitudes prevalent among teachers lacking meaningful contact with the departing principal.…

  16. Treatment of chronic venous insufficiency

    Microsoft Academic Search

    Suman W. Rathbun; Angelia C. Kirkpatrick

    2007-01-01

    Opinion statement  Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux.\\u000a Treatment modalities are aimed at reducing venous valvular reflux, thereby inhibiting the ensuing pathologic inflammatory\\u000a process. Compression therapy using pumps, bandaging, and\\/or graded compression stockings is the mainstay of treatment for\\u000a CVI. Compression therapy has been shown to be effective in reducing venous

  17. [Functional venous explorations].

    PubMed

    Mollard, J M

    1994-02-10

    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

  18. Mesenteric Venous Thrombosis

    PubMed Central

    Hmoud, Bashar; Singal, Ashwani K.; Kamath, Patrick S.

    2014-01-01

    Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival. PMID:25755568

  19. Squamous cell carcinoma developing in the scar of Fournier's gangrene – Case report

    PubMed Central

    Chintamani; Shankar, Manu; Singhal, Vinay; Singh, JP; Bansal, Anju; Saxena, Sunita

    2004-01-01

    Background Squamous cell carcinoma of the scrotum is rare and its development in the scar of Fournier's gangrene is still rarer. Case presentation A 65-year-old gentleman presented with a small non-healing ulcer developing on right hemi-scrotum two years after the treatment for Fournier's gangrene. On histological examination it was found to be squamous cell carcinoma. He was successfully managed by surgery in the form of wide local excision and ilio-inguinal lymph node dissection followed by adjuvant radiotherapy and chemotherapy. Conclusions Squamous cell carcinoma can develop in the scar of Fournier's gangrene after a long delay, which differentiates it from other scar carcinomas or Marjolin's ulcer. PMID:15113443

  20. Peripheral Arterial Disease and Digital Gangrene: A Rare Presentation of Diabetic Hand Syndrome

    PubMed Central

    Singh, Santokh; Chand, Gian; Charan, Shiv; Arora, Sahil; Singh, Parampreet

    2013-01-01

    Digital gangrene in upper limbs may be due to systemic sclerosis, trauma, connective tissue disorders, vasculitic disorders and various myeloproliferative disorders or as a part of tropical diabetes hand syndrome which follows trauma. Peripheral arterial disease in diabetics commonly involves lower limbs. The present case, 45-year-old diabetic, presented with dry gangrene in fingertips of both hands for last two weeks without any history of trauma or lower limb gangrene. On examination and workup of the patient was found to have bilateral upper limb arterio-occlusive disease involving ulnar vessels as a macrovascular complication of diabetes mellitus. This presentation of diabetic hand syndrome is very, very rare, hence being reported. PMID:24298503

  1. Peripheral arterial disease and digital gangrene: a rare presentation of diabetic hand syndrome.

    PubMed

    Singh, Santokh; Chand, Gian; Charan, Shiv; Arora, Sahil; Singh, Parampreet

    2013-10-01

    Digital gangrene in upper limbs may be due to systemic sclerosis, trauma, connective tissue disorders, vasculitic disorders and various myeloproliferative disorders or as a part of tropical diabetes hand syndrome which follows trauma. Peripheral arterial disease in diabetics commonly involves lower limbs. The present case, 45-year-old diabetic, presented with dry gangrene in fingertips of both hands for last two weeks without any history of trauma or lower limb gangrene. On examination and workup of the patient was found to have bilateral upper limb arterio-occlusive disease involving ulnar vessels as a macrovascular complication of diabetes mellitus. This presentation of diabetic hand syndrome is very, very rare, hence being reported. PMID:24298503

  2. Venous thrombolysis: Current perspectives

    Microsoft Academic Search

    Jay Menon; Mahmoud M. Salman; George Hamilton

    2004-01-01

    Opinion statement  Venous thromboembolism is a common problem in hospital and community patients and is associated with longer hospital stays,\\u000a significant morbidity, and mortality. It is the third most common cardiovascular disease after ischemic coronary artery disease\\u000a and stroke. A quarter of patients with acute myocardial infarction and more than half of patients with acute ischemic stroke\\u000a may develop venous thromboembolism.

  3. [Gas gangrene: an extreme surgico-medical rather than medico-surgical emergency].

    PubMed

    Jancovici, R; Brinquin, L; Tripon, P; Naudan, P; Manaa, J; Bonsignour, J P; Pailler, J L

    1987-04-01

    A diabetic woman developed spontaneous gas gangrene of upper limb extending into trunk and due to clostridium septicum. Recovery was obtained after major surgery involving disarticulation of upper limb and excision of soft tissues of left hemithorax, and a difficult intensive care programme (hyperbaric oxygen therapy, assisted ventilation). The presence of this gas gangrene revealed a bipolar colon cancer treated in parallel. The conventional therapeutic hierarchy is discussed: surgery should be carried out as an extreme emergency and should not be delayed to allow transfer to a center equipped with a hyperbaric oxygen therapy apparatus. PMID:3584286

  4. Management of a young female patient with Fournier's gangrene and Lemierre's syndrome.

    PubMed

    Aslanidis, Theodoros; Myrou, Athena; Giannakou-Peftoulidou, Maria

    2014-01-01

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery. PMID:25489369

  5. Management of a young female patient with Fournier's gangrene and Lemierre's syndrome

    PubMed Central

    Aslanidis, Theodoros; Myrou, Athena; Giannakou-Peftoulidou, Maria

    2014-01-01

    Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery. PMID:25489369

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

    PubMed Central

    Bains, Satinder Pal Singh; Singh, Vikram; Jain, Amit; Arry, Vivek

    2014-01-01

    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

  7. Gangrene therapy and antisepsis before lister: the civil war contributions of Middleton Goldsmith of Louisville.

    PubMed

    Trombold, John M

    2011-09-01

    It is commonly accepted that Louis Pasteur is the father of microbiology and Joseph Lister is the father of antisepsis. Middleton Goldsmith, a surgeon in the Union Army during the American Civil War, meticulously studied hospital gangrene and developed a revolutionary treatment regimen. The cumulative Civil War hospital gangrene mortality was 45 per cent. Goldsmith's method, which he applied to over 330 cases, yielded a mortality under 3 per cent. His innovative work predated Pasteur and Lister, making his success truly remarkable and worthy of historical and surgical note. PMID:21944621

  8. Management of chronic gangrenous mastitis in a 3-year-old cow using partial (quarter) mastectomy.

    PubMed

    Phiri, A M; Muleya, W; Mwape, K E

    2010-08-01

    Bovine gangrenous mastitis is an acute or peracute condition involving one or more quarters of the cow's udder. It occurs infrequently, but when it occurs, mortality of the affected cows is high. A partial mastectomy of one quarter using a cranial epidural analgesia with 2% lignocaine is described to manage a gangrenous mastitis affecting only one quarter caused by Proteus mirabilis (a gram-negative bacteria) which was not amenable to medical treatment. Partial mastectomy can be a safe and effective procedure for ruminants with udder disease in genetically or otherwise valuable cattle. PMID:20213222

  9. Localised necrosis of scrotum (Fournier's gangrene) in a spinal cord injury patient – a case report

    Microsoft Academic Search

    Subramanian Vaidyanathan; Bakul M Soni; Peter L Hughes; Paul Mansour; Gurpreet Singh; James Darroch; Tun Oo

    2002-01-01

    BACKGROUND: Men with spinal cord injury (SCI) appear to have a greater incidence of bacterial colonisation of genital skin as compared to neurologically normal controls. We report a male patient with paraplegia who developed rapidly progressive infection of scrotal skin, which resulted in localised necrosis of scrotum (Fournier's gangrene). CASE PRESENTATION: This male patient developed paraplegia at T-8 level 21

  10. Preventive Measures to Control Clostridial Outbreaks of Gangrenous Dermatitis in Commercial Broiler Operations

    E-print Network

    Waneck, Casey R.

    2011-08-08

    bacteria from the high loads of bacteria in the litter (Ritter, 2008). The scratches allow for an entryway for the bacteria into the dermis to proliferate inside the bird, thus causing gangrenous-type lesions on the skin and disease (Willoughby et al...

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

    PubMed Central

    2013-01-01

    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

  12. Synchronous penile urethra onlay patch and scrotal reconstruction after Fournier's gangrene using medial thigh flaps

    Microsoft Academic Search

    G. G. Hallock

    1996-01-01

    Massive penoscrotal skin loss, frequently a sequela of Fournier's gangrene, can sometimes be successfully treated using skin grafts alone. If the urological debridement has been extensive with a concomitant disruption of the urethra, a regional vascularized flap must be introduced. A superiorly based fasciocutaneous flap can be constructed on the medial thigh to provide scrotal reconstruction. The underlying gracilis muscle

  13. Clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival.

    PubMed

    Pinzon-Guzman, Carolina; Bashir, Dalia; McSherry, George; Beck, Michael J; Rocourt, Dorothy V

    2013-04-01

    We present the only reported case of an immunocompetent pediatric patient in the literature to have fulminate gas gangrene of the lower extremity and concomitant gastrointestinal tract infection due to Clostridium septicum coinfected with Clostridium difficile colitis respectively. The patient survived with aggressive medical and surgical treatment. PMID:23583163

  14. 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...

  15. GENOME-WIDE DIFFERENTIAL GENE EXPRESSION PROFILES IN BROILER CHICKENS WITH GANGRENOUS DERMATITIS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Gangrenous dermatitis (GD) is a disease of poultry associated with the infection of Clostridium septicum (CS) and/or C. perfringens (CP) type A. While GD causes significant morbidity, mortality, and economic loss to the poultry industry, the fundamental mechanisms underlying this host-pathogen inte...

  16. Diagnosis of gas gangrene: does a discrepancy exist between the published data and practice.

    PubMed

    Brucato, Maryellen P; Patel, Krupa; Mgbako, Obinna

    2014-01-01

    The Infectious Disease Society of America has defined gas gangrene as an infection caused by Clostridium species. However, in many clinical settings, soft tissue infections that produce subcutaneous gas have been diagnosed as gas gangrene without identification of the presence of Clostridium species. Instead, the diagnosis was based on clinical and radiographic findings. A chart review was performed of 25 consecutive patients treated at the Atlantic Health System for infections of the lower extremity that were diagnosed as gas gangrene. Wound cultures from the 25 patients grew 31 different species of bacteria. The most prevalent organism was Staphylococcus aureus, which accounted for 17 of 31 (54.84%) different organisms identified and 19.77% of 86 separate aerobic or anaerobic cultures. The most prevalent genus was Streptococcus, which accounted for 20 (64.52%) of the organisms identified and 23.26% of the cultures. The most prevalent anaerobic genus was Peptostreptococcus, which accounted for 8 (25.81%) of the organisms identified and 9.3% of the cultures. None of the cultures grew Clostridium species. These findings showed that gas-forming soft tissue infections of the lower extremity, commonly diagnosed as gas gangrene, are rarely caused by Clostridium species. PMID:24345706

  17. Pathophysiology of venous thrombosis.

    PubMed

    Myers, Dd

    2015-03-01

    In this chapter, an overview of some of the prominent risk factors that contribute to the pathophysiology of venous thrombosis will be discussed. In 1856, Dr Rudolf Virchow developed the concept outlining the genesis of intravascular thrombosis. Dr Virchow hypothesized that circulatory stasis due to interrupted blood flow, changes in the blood leading to blood coagulation, and irritation or damage to the vascular endothelium would initiate acute venous thrombus generation. Presently, it is known that these above-mentioned risk factors are influenced by increasing age, gender, and obesity. The current chapter will focus on recent preclinical and clinical investigations that will give the reader insight into the prothrombotic mechanisms that lead to acute venous thrombosis. PMID:25729062

  18. Prophylaxis of venous thrombosis

    Microsoft Academic Search

    Samuel Z. Goldhaber

    2001-01-01

    Opinion statement  |\\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis\\u000a prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance\\u000a by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior\\u000a vena cava filters prevent pulmonary

  19. Central venous catheter use

    Microsoft Academic Search

    Kees H. Polderman; Armand R. J. Girbes

    2002-01-01

    Central venous catheters are being increasingly used in both intensive care units and general wards. Their use is associated with both mechanical and infectious complications. This review will focus on short- and medium-term mechanical complications of catheter placement; infectious complications will be discussed in a separate article. The most important risk factors are patient characteristics (morbidity, underlying disease and local

  20. Deep venous thrombosis

    MedlinePLUS

    Deep venous thrombosis is a blood clot that forms in a vein deep inside a part of the body. It mainly ... To prevent deep vein thrombosis: Wear the pressure stockings your doctor prescribed. Moving your legs often during long plane trips, car ...

  1. Mesenteric venous thrombosis.

    PubMed

    Singal, Ashwani K; Kamath, Patrick S; Tefferi, Ayalew

    2013-03-01

    The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis. PMID:23489453

  2. Venous insufficiency (image)

    MedlinePLUS

    The valves in the veins usually channel the flow of blood toward the heart. When these valves are damaged, blood leaks and pools in the legs and feet. Venous insufficiency is a condition in which the veins fail to return blood ...

  3. Impending Crisis.

    ERIC Educational Resources Information Center

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

    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…

  4. Arterial vs venous blood gas differences during hemorrhagic shock

    PubMed Central

    Williams, Kristopher Burton; Christmas, Ashley Britton; Heniford, Brant Todd; Sing, Ronald Fong; Messick, Joseph

    2014-01-01

    AIM: To characterize differences of arterial (ABG) and venous (VBG) blood gas analysis in a rabbit model of hemorrhagic shock. METHODS: Following baseline arterial and venous blood gas analysis, fifty anesthetized, ventilated New Zealand white rabbits were hemorrhaged to and maintained at a mean arterial pressure of 40 mmHg until a state of shock was obtained, as defined by arterial pH ? 7.2 and base deficit ? -15 mmol/L. Simultaneous ABG and VBG were obtained at 3 minute intervals. Comparisons of pH, base deficit, pCO2, and arteriovenous (a-v) differences were then made between ABG and VBG at baseline and shock states. Statistical analysis was applied where appropriate with a significance of P < 0.05. RESULTS: All 50 animals were hemorrhaged to shock status and euthanized; no unexpected loss occurred. Significant differences were noted between baseline and shock states in blood gases for the following parameters: pH was significantly decreased in both arterial (7.39 ± 0.12 to 7.14 ± 0.18) and venous blood gases (7.35 ± 0.15 to 6.98 ± 0.26, P < 0.05), base deficit was significantly increased for arterial (-0.9 ± 3.9 mEq/L vs -17.8 ± 2.2 mEq/L) and venous blood gasses (-0.8 ± 3.8 mEq/L vs -15.3 ± 4.1 mEq/L, P < 0.05). pCO2 trends (baseline to shock) demonstrated a decrease in arterial blood (40.0 ± 9.1 mmHg vs 28.9 ± 7.1 mmHg) but an increase in venous blood (46.0 ± 10.1 mmHg vs 62.8 ± 15.3 mmHg), although these trends were non-significant. For calculated arteriovenous differences between baseline and shock states, only the pCO2 difference was shown to be significant during shock. CONCLUSION: In this rabbit model, significant differences exist in blood gas measurements for arterial and venous blood after hemorrhagic shock. A widened pCO2 a-v difference during hemorrhage, reflective of poor tissue oxygenation, may be a better indicator of impending shock. PMID:24892020

  5. Plasmodium falciparum Cerebral Malaria Complicated by Disseminated Intravascular Coagulation and Symmetrical Peripheral Gangrene: Case Report and Review

    Microsoft Academic Search

    M. E. Liechti; V. Zumsteg; C. F. R. Hatz; T. Herren

    2003-01-01

    The case of a 56-year-old female tourist who survived cerebral Plasmodium falciparum malaria with disseminated intravascular coagulation and symmetrical peripheral gangrene, ultimately requiring amputation of her left-sided fingertips and toes, is reported. While symmetrical peripheral gangrene has been described rarely in Asian, African, and American patients with Plasmodium falciparum malaria and disseminated intravascular coagulation, no such case has been reported

  6. Penoscrotal reconstruction using groin and bilateral superomedial thigh flaps: a case of penile vaselinoma causing Fournier's gangrene.

    PubMed

    Lee, Sang Wook; Bang, Chi Young; Kim, Jeong Hyun

    2007-08-31

    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

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

    PubMed Central

    Dayan, Joseph H.; Clarke-Pearson, Emily M.; Dayan, Erez; Smith, Mark L.

    2014-01-01

    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

  8. Measurement of body venous tone.

    PubMed

    Pang, C C

    2000-01-01

    The venous system contains about 70% of the blood volume, and approximately 75% of the venous volume is in the small veins and venules. Veins play an active role in the control of cardiac output (CO) and blood pressure. Drugs that interfere with venous tone have profound effects on CO and blood pressure due to the large venous capacity. Information on body venous tone cannot be obtained from studies using isolated venous preparations and perfused venous beds, which lack modulating cardiovascular reflex mechanisms. In vivo methods used for the assessment of venous function in experimental animals and humans are as follows: the mean circulatory filling pressure (MCFP) method for the determination of body venous tone, constant CO reservoir technique for measuring vascular compliance and unstressed volume, plethysmography or blood-pool scintigraphy along with venous occlusion for measuring the volume and compliance of an organ, linear variable differential transformer (LVDT) technique for estimating the diameter of a human dorsal hand vein, intravascular ultrasound (IVUS) imaging technique to monitor the cross-sectional area of a large vein, and ultrasonic crystals to estimate the dimension of an organ. These methods are described and critically evaluated to disclose their validity, merits and limitations. PMID:11325578

  9. Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report

    PubMed Central

    Schulz, Dietmar; Mohor, Georgiana Simona; Solovan, Caius

    2015-01-01

    Fournier gangrene (FG) is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.

  10. Fournier’s gangrene caused by Listeria monocytogenes as the primary organism

    PubMed Central

    Asahata, Sayaka; Hirai, Yuji; Ainoda, Yusuke; Fujita, Takahiro; Okada, Yumiko; Kikuchi, Ken

    2015-01-01

    A 70-year-old man with a history of tongue cancer presented with Fournier’s gangrene caused by Listeria monocytogenes serotype 4b. Surgical debridement revealed undiagnosed rectal adenocarcinoma. The patient did not have an apparent dietary or travel history but reported daily consumption of sashimi (raw fish). Old age and immunodeficiency due to rectal adenocarcinoma may have supported the direct invasion of L monocytogenes from the tumour. The present article describes the first reported case of Fournier’s gangrene caused by L monocytogenes. The authors suggest that raw ready-to-eat seafood consumption be recognized as a risk factor for listeriosis, especially in cases of skin and soft tissue infection. PMID:25798155

  11. Lateral condensation in treatment of pulpitis and pulp gangrene: studies on dog canine teeth.

    PubMed

    Ratajczak, K; Gawor, J

    1998-04-01

    The clinical investigation, carried out in dogs, comprises selected cases of chronic pulpitis and pulpal gangrene of canine teeth resulting from injuries. A group of 20 teeth (group 1) underwent extirpation of pulp, as well as elaboration of a root canal and its filling with Endomethasone paste, under general anaesthesia during a one-stage procedure. The second group of 20 teeth differed from the first in an additional concentration of the paste, due to an introduction of gutta-percha points (lateral condensation). This sealing modification proved to diminish the risk of leaving empty spaces after pulp removal in the pulpitis state. However, in teeth where gangrenous pulp extirpation was performed, lateral condensation was endangered by pushing the paste through beyond the apex. Both anomalies were likely to predispose to the development of apical periodontitis. PMID:9673569

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

    PubMed

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

    2014-06-01

    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

  13. Fournier's gangrene in a female with spinal cord injury: a case report

    Microsoft Academic Search

    V Nigam; T A Halim; H S Chhabra

    2010-01-01

    Introduction:We report the case of a woman with spinal cord injury (SCI) who presented to us with Fournier's gangrene.Case report:A 60-year-old patient with SCI, ASIA A, neurological level D6, on clean intermittent catheterization presented with rapid necrosis of the perineal region, including the labia and anus, which developed after traumatic catheterizations for clean intermittent catheterization. She required repeated debridement and

  14. Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing

    Microsoft Academic Search

    Gerald S Treiman; Gustavo S. C Oderich; Amir Ashrafi; Peter A Schneider

    2000-01-01

    Objective: The objective of this study was to determine the effectiveness of treatment of nonhealing heel ulcers and gangrene and to define those variables that are associated with success.Methods: A multi-institutional review was undertaken at four university or university-affiliated hospitals of all patients with wounds of the heel and arterial insufficiency, which was defined as absent pedal pulses and a

  15. [Ischemic colitis: a report of 2 cases of ischemic gangrene of the colon].

    PubMed

    Mandarano, R; Ciccone, A; Venturini, N

    1996-03-01

    Two personal cases of ischaemic gangrene of the colon required emergency surgery. The two cases provide the basis for a discussion of the aetiopathogenetic, anatomo-pathological and clinical aspects of this pathology. Stress is laid on the fact that ischaemic colitis in its various anatomo-pathological signs is not easy to diagnose and needs early treatment of conservative or emergency surgery type depending on its anatomo-pathological expression. PMID:8684654

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

    PubMed Central

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

    2011-01-01

    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

  17. Impending rupture of a blunt trauma-induced left ventricular aneurysm: report of a case.

    PubMed

    Asai, Yasufumi; Kurimoto, Yoshihiko

    2007-01-01

    Most left ventricular true aneurysms that occur secondary to blunt trauma gradually become symptomatic as they enlarge, which validates conservative management as a reasonable initial course of action. We report a case of impending rupture of a left ventricular true aneurysm that showed rapid expansion within a few weeks. A 17-year-old youth was involved in a head-on collision into a car while riding a motorcycle. He underwent repair of a ruptured jejunum and internal fixation of a fractured femur; 28 days after the accident, he was transferred to another hospital for rehabilitation. His chest X-ray just before the transfer was normal. He was re-admitted to our hospital 58 days after the accident complaining of anterior chest pain and dyspnea. Echocardiography showed impending rupture of a left ventricular aneurysm. We performed emergency open repair of a left ventricular true aneurysm with a very thin wall. We report this case to show that even a true aneurysm of the left ventricle should be carefully monitored from the early stage, considering the possibility of rupture. PMID:17952528

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

    PubMed Central

    2014-01-01

    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

  19. Venous ulcers - self-care

    MedlinePLUS

    ... venous ulcers occur on the leg, above the ankle. This type of wound can be slow to heal. ... and legs every day: the tops and bottoms, ankles, and heels. Look ... prevent venous ulcers. If you have a wound, take these steps ...

  20. Cerebral sinus venous thrombosis

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Milena Castellar-Leones, Sandra; Alcala-Cerra, Gabriel; Rafael Moscote-Salazar, Luis

    2013-01-01

    Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment. PMID:24347950

  1. Design and fabrication of prototype system for early warning of impending bearing failure

    NASA Technical Reports Server (NTRS)

    Meacher, J.; Chen, H. M.

    1974-01-01

    A test program was conducted with the objective of developing a method and equipment for on-line monitoring of installed ball bearings to detect deterioration or impending failure of the bearings. The program was directed at the spin-axis bearings of a control moment gyro. The bearings were tested at speeds of 6000 and 8000 rpm, thrust loads from 50 to 1000 pounds, with a wide range of lubrication conditions, with and without a simulated fatigue spall implanted in the inner race ball track. It was concluded that a bearing monitor system based on detection and analysis of modulations of a fault indicating bearing resonance frequency can provide a low threshold of sensitivity.

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

    PubMed

    Phua, Kai-Lit; Hue, J W

    2013-01-01

    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

  3. Hyperhomocysteinaemia and chronic venous ulcers.

    PubMed

    de Franciscis, Stefano; De Sarro, Giovambattista; Longo, Paola; Buffone, Gianluca; Molinari, Vincenzo; Stillitano, Domenico M; Gallelli, Luca; Serra, Raffaele

    2015-02-01

    Chronic venous ulceration (CVU) is the major cause of chronic wounds of lower extremities, and is a part of the complex of chronic venous disease. Previous studies have hypothesised that several thrombophilic factors, such as hyperhomocysteinaemia (HHcy), may be associated with chronic venous ulcers. In this study, we evaluated the prevalence of HHcy in patients with venous leg ulcers and the effect of folic acid therapy on wound healing. Eighty-seven patients with venous leg ulcers were enrolled in this study to calculate the prevalence of HHcy in this population. All patients underwent basic treatment for venous ulcer (compression therapy ± surgical procedures). Patients with HHcy (group A) received basic treatment and administered folic acid (1·2 mg/day for 12 months) and patients without HHcy (group B) received only basic treatment. Healing was assessed by means of computerised planimetry analysis. The prevalence of HHcy among patients with chronic venous ulcer enrolled in this study was 62·06%. Healing rate was significantly higher (P < 0·05) in group A patients (78·75%) compared with group B patients (63·33%). This study suggests a close association, statistically significant, between HHcy and CVU. Homocysteine-lowering therapy with folic acid seems to expedite wound healing. Despite these aspects, the exact molecular mechanisms between homocysteine and CVU have not been clearly defined and further studies are needed. PMID:23418772

  4. Venous surgery for impotence.

    PubMed

    Lewis, R W

    1988-02-01

    Venous surgery for impotence is in a dynamic state. The drainage of the corpora cavernosa normally occurs through the crural veins or the cavernous veins and the deep dorsal penile vein. Patients with drainage seen on cavernosography only into a superficial system that persists after injection of intracavernous vasoactive agents are likely to have good results if this drainage is eliminated. This type of patient is not common. A surgical approach that attempts to eliminate the deep dorsal penile system or the crural veins is not as successful. Perhaps subtle arterial disease, concurrent presence of neurologic disease, and collateralization all add to the significant failure rate. Many failures of spontaneous erection will, however, respond to intracavernous injection of vasoactive agents postoperatively. Deep dorsal vein arterialization probably should be reserved for those patients who have an arterial component to their impotence as well as a venogenic cause. PMID:3344555

  5. Pycnogenol® in chronic venous insufficiency and related venous disorders.

    PubMed

    Gulati, Om P

    2014-03-01

    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

  6. Venous complications of pancreatitis: a review.

    PubMed

    Aswani, Yashant; Hira, Priya

    2015-01-01

    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

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

    PubMed Central

    Alamelu, V

    2011-01-01

    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

  8. Pathophysiology of chronic venous disease.

    PubMed

    Raffetto, J D; Mannello, F

    2014-06-01

    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

  9. Postoperative cerebral venous infarction

    PubMed Central

    Agrawal, Deepak; Naik, Vikas

    2015-01-01

    Background: Postoperative cerebral venous infarction (POCVI) is not an uncommon complication in cranial surgeries. However, literature is sparse on the epidemiology and management of postoperative venous infarcts. Aims and Objectives: The aim was to study the incidence and clinico-radiological course of POCVI in patients in a tertiary level neurosurgical unit and compare the outcome between pediatric and adult patients following POCVI. Materials and Methods: In this prospective study carried out over an 8 month period, consecutive patients undergoing elective major cranial surgeries were monitored neurologically and with serial computed tomography (CT) of the head for POCVI in the postoperative period. All patients had at least one CT head done within 24 hours of surgery. Diagnosis of hemorrhagic POCVI was based on the presence of subcortical, multifocal hyperdensities with irregular margins and or low density areas in the perioperative fields. Nonhemorrhagic POCVI was diagnosed if CT showed a localized hypodensity poorly demarcated in the subcortical white matter with/without mass effect, along with the presence of fresh neurological deficits. Observations and Results: A total of 376 patients were enrolled in the study period. Of these, 26 (7%) developed POCVI. The male: female ratio was 1.2:1 and age ranged from 6 to 68 years with 12 (46%) being under the age of 18 years. Sixteen (61%) patients developed hemorrhagic POCVI and 10 (39%) patients developed nonhemorrhagic POCVI. The mean time to POCVI detection was 72 hours (range 24–144 hours). Seventeen (66%) patients were managed conservatively, and nine (34%) patients underwent decompressive craniectomy as an additional procedure for management of POCVI. In five patients (all with hemorrhagic POCVI), the infarction was an incidental finding. Of the 21 patients with symptomatic POCVI, 13 (61.9%) patients improved neurologically and were discharged with residual deficits. Two (9.5%) showed no neurological improvement till discharge, and 6 (28.5%) died during the hospital stay following POCVI. Conclusions: Children constitute a significant population (46% in our study) of the patients who develop POCVI with poor outcome similar to that seen in adult patients.

  10. Gangrene of the lower limbs in diabetic patients: a malignant complication.

    PubMed

    Gutman, M; Kaplan, O; Skornick, Y; Klausner, J M; Lelcuk, S; Rozin, R R

    1987-09-01

    Diabetic foot lesions are a common medical problem with major socioeconomic impact. Gangrene is usually a late and sometimes fatal complication. A series of 118 diabetic patients who underwent amputation of the lower limb at our institution over a 10 year period has been presented. Forty-two patients underwent amputation of the toes or part of the foot, 48 underwent below-knee amputation, and 18 underwent above-knee amputation. In 24 (20.3 percent), the necrotic process advanced postoperatively and necessitated additional amputation. The average hospital stay was 33.6 days. Twenty-eight patients (23.7 percent) died during the postoperative period, and the main cause of death was sepsis. Patients who presented with extensive gangrene had a higher mortality rate. There was no correlation between mortality and the duration of conservative treatment, number of repeated operations, the treatment of diabetes before hospitalization, onset of symptoms, or status of the peripheral pulses. The solution to the problem is early and vigorous preventive treatment. This could be accomplished through highly specialized clinics within the community. PMID:3631409

  11. [Pyoderma gangrenosum of the penis presenting as Fournier's gangrene: a case report].

    PubMed

    Kohjimoto, Yasuo; Inagaki, Takeshi; Iba, Akinori; Kikkawa, Kazuro; Suzuki, Atsushi; Uekado, Yasunari; Shinka, Toshiaki

    2005-06-01

    We report a case of pyoderma gangrenosum of the penis presenting as Fournier's gangrene. A 77-year-old man who had undergone radiotherapy for localized prostate cancer 16 month earlier, presented with penile pain and fever. Symptoms began with erythema and induration on the dorsal surface of the penile shaft followed by spontaneous purulent drainage with severe pain. Magnetic resonance imaging was unremarkable except for swelling of the penile skin. Biopsy of the ulcerative penile lesion demonstrated a nonspecific inflammation without vasculitis or malignancy. Despite broad-spectrum antibiotics and debridement, the penile lesion extended and new satellite lesions developed as pustules on the glans. Since cultures were negative for aerobic and anaerobic bacteria, a course of intravenous prednisolone was then initiated at 100 mg/day. Within 24 hours the temperature normalized, progression of the penile lesions stopped and became convalescent. The steroid was then tapered and discontinued. The penile lesions healed slowly during the subsequent 1-month period. Based on the clinical course and histopathological findings as well as exclusion of other ulcerative conditions, a diagnosis of pyoderma gangrenosum was made. Penile involvement of this non-infectious ulcerating skin disease has rarely been reported. Pyoderma gangrenosum affecting the penile skin, such as that in present case, may show a similar presentation as Fournier's gangrene. Prompt differential diagnosis is mandatory since effective management for each processes is markedly different. PMID:16050483

  12. [Microbiological diagnosis of gas gangrene caused by Clostridium septicum (a clinical case)].

    PubMed

    Men'shikova, E D; Titova, G P; Kartavenko, V I; Sokolov, V A; Shabanov, A K; Men'shikov, D D

    2010-08-01

    Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C. bifermentans that were identified as C. septicum on cultural diagnosis. The pathogenic C. septicum strain spores were likely to be formed in the macroorganism upon exposure of the pathogen to a patient's defense factors and to a package of therapeutic measures. Microbiological data should be used only in combination with clinical and instrumental findings and the results of other laboratory studies when the optimal technology is chosen to treat gas infection. By keeping in mind that there may be clostridial gangrene in the patients and the experience of clinicians and bacteriologists may be insufficient in diagnosing this pathology, it is necessary to strengthen the training of physicians in the diagnosis of this pathology. PMID:20886724

  13. Mixed venous oximetry.

    PubMed

    Kupeli, I A; Satwicz, P R

    1989-01-01

    We now have the technology through reflectance spectrophotometry to evaluate and display continuously mixed venous oxygen saturation SvO2 through use of a modified pulmonary artery catheter. Adding this method of assessing the balance of oxygen supply and demand to our standard armamentarium of hemodynamic monitoring may improve our ability to diagnose and treat cardiovascular aberrations at an earlier stage than was previously possible. Through analysis of the Fick equation, it can be seen that SvO2 depends upon the cardiac output, the arterial oxygen saturation, the hemoglobin level, and the rate of oxygen consumption. These are, in turn, affected by a great number of factors (see Fig 8). As seen in the variety of patient care examples cited above, the usefulness of SvO2 monitoring continues to grow. It appears that there are no intrinsic risks associated with SvO2 monitoring beyond those of customary PA monitoring. This new technology provides us with online information not previously available, at an associated cost that needs to be further examined. PMID:2670771

  14. Cross-complementation of Clostridium perfringens PLC and Clostridium septicum ?-toxin mutants reveals PLC is sufficient to mediate gas gangrene

    Microsoft Academic Search

    Catherine L. Kennedy; Dena Lyras; Jackie K. Cheung; Thomas J. Hiscox; John J. Emmins; Julian I. Rood

    2009-01-01

    Clostridium perfringens and Clostridium septicum are the most common causes of clostridial myonecrosis or gas gangrene. Although they mediate a similar disease pathology, they elaborate functionally very different ?-toxins. We used a reciprocal complementation approach to assess the contribution of the primary toxin of each species to disease and found that C. perfringens ?-toxin (PLC) was able to mediate the

  15. Impact of neural noise on a sensory-motor pathway signaling impending collision

    PubMed Central

    Jones, Peter W.

    2012-01-01

    Noise is a major concern in circuits processing electrical signals, including neural circuits. There are many factors that influence how noise propagates through neural circuits, and there are few systems in which noise levels have been studied throughout a processing pathway. We recorded intracellularly from multiple stages of a sensory-motor pathway in the locust that detects approaching objects. We found that responses are more variable and that signal-to-noise ratios (SNRs) are lower further from the sensory periphery. SNRs remain low even with the use of stimuli for which the pathway is most selective and for which the neuron representing its final sensory level must integrate many synaptic inputs. Modeling of this neuron shows that variability in the strength of individual synaptic inputs within a large population has little effect on the variability of the spiking output. In contrast, jitter in the timing of individual inputs and spontaneous variability is important for shaping the responses to preferred stimuli. These results suggest that neural noise is inherent to the processing of visual stimuli signaling impending collision and contributes to shaping neural responses along this sensory-motor pathway. PMID:22114160

  16. Comprehensive study on laboratory biomarkers for prediction and diagnosis of deep venous thrombosis.

    PubMed

    Ghozlan, Manal F; Osman, Amani A; Mahmoud, Hanan M; Eissa, Doaa G

    2015-04-01

    Deep venous thrombosis (DVT) is based upon clinical suspicion in patients at risk and confirmatory duplex imaging of the deep venous system of the affected extremity. The aim of the present study was to determine different cutoff points of D-dimer, P-selectin and microparticles that could be used in early diagnosis and prediction of impending DVT in symptomatic patients with normal duplex ultrasound. Three groups of individuals were examined: 50 healthy volunteers (Group I); 75 patients with positive duplex ultrasound for DVT (Group II) and 75 symptomatic patients, but with negative duplex ultrasound for DVT (Group III). D-dimer was measured by immunoturbidimetric assay, P-selectin by flow cytometry and microparticles by ELISA. D-dimer, P-selectin and microparticles levels were significantly higher in Group II and III patients when compared with Group I individuals. Using receiver-operating characteristic curves, we determined that cutoff levels of 0.92?mg/l for D-dimer, 17.8% for P-selectin and 16.5?nmol/l for microparticles can accurately rule out DVT. New cutoff levels were estimated for the three studied biomarkers that differentiated the group of DVT-negative duplex patients without thrombosis from those patients of the same group who developed thrombosis being 2.81?mg/l for D-dimer, 30.2% for P-selectin and 26?nmol/l for microparticles. D-dimer, P-selectin and microparticles can be used to diagnose and detect impending DVT, thus identifying patients at high risk that could benefit from early anticoagulant therapy without the need for imaging studies. PMID:24991946

  17. Recanalisation of cerebral venous thrombosis

    PubMed Central

    Baumgartner, R; Studer, A; Arnold, M; Georgiadis, D

    2003-01-01

    Objective: To investigate recanalisation in the first 12 months after cerebral venous thrombosis. Methods: 33 consecutive patients presenting with cerebral venous thrombosis were enrolled in the study. Diagnosis was made by magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or catheter angiography. Patients were initially treated with intravenous heparin. Warfarin was given for at least four months. Cerebral MRI and MRV were done at four months and repeated after 12 months if venous thrombosis persisted. Outcome was evaluated by the Rankin scale at 12 months. Results: Outcome at 12 months was good, with a median modified Rankin scale score of 0 (range 0 to 2); 27 patients (82%) had no residual deficits. No patient suffered recurrent cerebral venous thrombosis, deep vein thrombosis, or pulmonary embolism during follow up. After four months, all deep cerebral veins and cavernous sinuses, 94% of superior sagittal sinuses, 80% of straight sinuses, 73% of jugular veins, 58% of transverse sinuses, and 41% of sigmoid sinuses had recanalised. No further recanalisation was observed thereafter. Conclusions: The results suggest that recanalisation only occurs within the first four months following cerebral venous thrombosis and not thereafter, irrespective of oral anticoagulation. PMID:12640063

  18. Intralesional radiofrequency in venous malformations.

    PubMed

    Garg, S; Kumar, S; Singh, Y B

    2015-03-01

    Venous malformations are usually asymptomatic and managed conservatively. Treatment, in the form of laser, sclerotherapy, or resection, is needed only if lesions present with symptoms or cosmetic deformity. The aim of this study was to find out how effective radiofrequency ablation was in patients with incomplete or unsatisfactory resolution of a venous malformation after an intralesional injection of bleomycin. During the 5 year period 2008-2012, we organised a prospective, clinical study at a tertiary care centre. Patients were selected from the outpatient department of the Lady Hardinge Medical College and associated hospitals, New Delhi, India. Five patients with venous malformations were treated by intralesional injection of bleomycin in a dose of 0.5U/kg body weight, which was repeated every 2 weeks for a total of 8 injections. They then had multiple intralesional radiofrequency ablation every 2 months until a satisfactory outcome was achieved. After the initial 8 doses the reduction in the size of the lesions was minimal (less than 50%). After 2-4 applications of radiofrequency ablation there was appreciable reduction in the size of the lesions (about 80%) with good functional and cosmetic outcomes. Radiofrequency ablation is an effective adjunct for patients with venous malformations of the head and neck that have not responded satisfactorily to intralesional injection of bleomycin. To our knowledge radiofrequency ablation after intralesional injection of bleomycin has not previously been described as a treatment for venous malformations. PMID:25554592

  19. Interpretation of peripheral venous duplex testing.

    PubMed

    Barleben, Andrew; Bandyk, Dennis F

    2013-01-01

    Venous duplex ultrasound and plethysmography are used to evaluate patients for suspected deep venous thrombosis (DVT) or venous insufficiency symptoms. Testing can provide clinicians with detailed information on location, extent, and severity of venous conditions before and after treatment. Duplex ultrasound can image the venous system from the vena cava to the peripheral veins, including veins of the calf musculature, and is the recommended technique to diagnose DVT. Accurate interpretation of venous testing requires an understanding of venous hemodynamics, including normal flow phasicity with cardiac and respiratory motion and the changes produced by acute DVT. Duplex scanning provides a roadmap of vein anatomy similar to contrast venography and essential hemodynamic information about the presence of proximal obstruction, vein valve function, and perforator vein reflux. Indications for testing include the diagnosis of acute/chronic DVT and evaluation of patients with venous insufficiency manifested as edema, varicose veins, or ambulatory venous hypertension. Venous plethysmography, an indirect physiologic test, can be used to estimate severity of obstructive or reflux venous pathophysiology and document improvement in venous hemodynamics after intervention. Using criteria based on ultrasound imaging and physiologic testing, venous conditions producing a swollen or painful limb can be accurately determined and aid in appropriate treatment selection. PMID:24636608

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

    PubMed Central

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

    2013-01-01

    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

  1. Fournier's gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring

    PubMed Central

    Sarmah, Piyush B.; Khan, Mashuk; Zilvetti, Miguel

    2015-01-01

    Fournier's gangrene (FG) requires prompt recognition and management. We report the case of a 68-year-old man who presented with extensive pain and purple discolouration from the right iliac fossa to perineum. Computed tomography demonstrated gas within the right hemiscrotum extending into the inguinal canal and right buttock, with a right pelvic fluid and air collection. At debridement necrotic fluid was arising from the superficial inguinal ring so laparotomy was performed, revealing a grossly inflamed appendix herniating into the inguinal canal; a right hemicolectomy was performed. Unfortunately, the patient went into cardiac arrest and passed away on the operating table. Histological analysis demonstrated acute-on-chronic inflammation involving the appendix. The condition where appendicitis is implicated in FG is usually due to retroperitoneal rupture and tracking into the perineal spaces. This is the first case reported of an inflamed appendix herniating into the inguinal canal and thus causing FG. PMID:25829533

  2. Diabetic Foot Gangrene Patient with Multi-drug Resistant Pseudomonas Putida Infection in Karawaci District, Indonesia

    PubMed Central

    Hardjo Lugito, Nata Pratama; Nawangsih, Cucu; Moksidy, Jevany Claudia; Kurniawan, Andree; Tjiang, Margaret Merlyn

    2015-01-01

    Pseudomonas putida is a rod-shaped, non fermenting Gram-negative organism frequently found in the environment that utilizes aerobic metabolism, previously thought to be of low pathogenicity. It had been reported as cause of skin and soft tissue infection, especially in immunocompromised patients. A female green grocer, 51 year-old came to internal medicine out-patient clinic with gangrene and osteomyelitis on her 1st, 2nd and 3rd digit and wound on the sole of the right foot since 1 month prior. The patient had history of uncontrolled diabetes since a year ago. She was given ceftriaxone 2 grams b.i.d, metronidazole 500 mg t.i.d empirically and then amikacin 250 mg b.i.d, followed by amputation of the digits and wound debridement. The microorganism's culture from pus revealed multi drug resistant Pseudomonas putida. She recovered well after antibiotics and surgery. PMID:25722620

  3. Atopobium deltae sp. nov., isolated from the blood of a patient with Fournier's gangrene.

    PubMed

    Cools, Piet; Oyaert, Matthijs; Vaneechoutte, Mario; De Laere, Emmanuel; Vervaeke, Steven

    2014-09-01

    A Gram-stain-positive, obligately anaerobic, short rod, designated strain HHRM1715(T), was isolated from the blood of a patient with Fournier's gangrene, complicated by sepsis. On the basis of 16S rRNA gene sequence analysis, strain HHRM1715(T) was shown to belong to the genus Atopobium and was most closely related to Atopobium minutum (95?% similarity). The results of 16S rRNA-gene-based phylogenetic analysis, cellular fatty acid analysis and differential biochemical tests, showed that strain HHRM1715(T) represented a novel species of the genus Atopobium. We therefore describe Atopobium deltae sp. nov. with HHRM1715(T) (?=?LMG 27987(T)?=?CCUG 65171(T)) as the type strain and propose an emended description of the genus Atopobium with regard to the DNA G+C content. PMID:24944340

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

    PubMed Central

    Chan, Cyrus C.; Shahrour, Khaled; Collier, Ronald D.; Welch, Marlene; Chang, Shiliang; Williams, Mallory

    2013-01-01

    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

  5. [Venous catheter-related infections].

    PubMed

    Padrón Ruiz, O M; Ojeda Betancor, N; Morales López, L; Rodríguez Pérez, A

    2013-04-01

    Central venous catheter-related infections can lead to a substantial increase in morbidity and mortality in patients. Nowadays, with the increase in multi-resistant bacteria, the recent appearance of new antibiotics, and the development of new treatment guidelines, means that this has to be constantly reviewed. The objective of this review is to briefly define the epidemiological and pathogenic concepts and to look in detail at the preventive and therapeutic measures of this type of infection. Practical aspects are presented of different clinical situations such as, antibiotic-lock of the central venous catheter, and the withdrawal or maintenance of the catheter. PMID:23141206

  6. Gas Gangrene

    MedlinePLUS

    ... Your Child Safe to Ride One? (Audio) Allergic Reactions Caused By Food Allergies AAP Policy: Learn About School Nursing Services School Requirements Increase Teen Vaccination Rates Nutrition: What Every Parent Needs to Know Pediatric ...

  7. Capillary versus venous bedside blood glucose estimations

    Microsoft Academic Search

    R Boyd; B Leigh; P Stuart

    2005-01-01

    Objectives: To determine the mean difference and correlation between capillary and venous bedside glucose estimation in comparison to laboratory blood glucose analysis in emergency department (ED) patients.Methods: Blood glucose levels were synchronously analysed using a bedside blood glucometer on capillary and venous derived samples from consenting ED patients aged >12 years. The venous sample was sent for comparative testing using

  8. Pathogenesis of venous thrombosis: a new insight

    Microsoft Academic Search

    T. W Wakefield; R. M Strieter; M. R Prince; L. J Downing; L. J Greenfield

    1997-01-01

    Venous thrombosis and thrombophlebitis have long been observed to result in painful inflammation around the affected veins. The full extent of the synergistic interaction between thrombosis and the inflammatory response and how this leads to the later sequelae of chronic venous insufficiency is only now beginning to be understood. Venous thrombosis is known directly to elicit an inflammatory response in

  9. Complications of Central Venous Catheterisation

    PubMed Central

    Tawfic, Qutaiba A.; Bhakta, Pradipta; Burad, Jyoti; Mishra, Pragyandipta; Kausalya, Rajini

    2011-01-01

    Central venous catheterisation (CVC) is a common bedside invasive procedure done in medical practice. Even though it is a safe procedure when done with ultrasound guidance, difficulties and complications do occur even in experienced hands. Here, we describe the difficulties encountered in the form of the breakage of the guidewire while inserting a CVC in a patient with sickle cell disease. PMID:22087404

  10. Automated grading of venous beading.

    PubMed

    Gregson, P H; Shen, Z; Scott, R C; Kozousek, V

    1995-08-01

    The degree of venous beading in ocular fundus images has been shown to be a more powerful predictor of conversion to proliferative diabetic retinopathy than any other type of retinal abnormality. Further, the degree of venous beading has been shown to be well correlated with disease progression. An algorithm for automated grading of venous beading in digitized ocular fundus images is described. Thresholding is used to extract a rough silhouette of the vein. Morphological closing is used to fill any holes in the silhouette arising from either the central light reflex or noise. The silhouette is then "thinned" to find vein centerlines. Each centerline is partitioned into fixed-length segments of 32 pixels. Vein diameters are measured as a function of distance along each segment with the aid of the local centerline orientations. The resulting diameter data are then interpolated and resampled to generate diameter data at constant sampling intervals. A fast Fourier transform is performed on the resulting data to determine the magnitude spectrum of vein segment diameter. A venous beading index is calculated from the distribution of vein diameter frequency components. Performance of the new algorithm is compared to the currently accepted clinical practice of manual grading in a pilot clinical study of 51 subjects. The algorithm is seen to perform well. PMID:8549121

  11. Air travel and venous thromboembolism.

    PubMed Central

    Mendis, Shanthi; Yach, Derek; Alwan, Ala

    2002-01-01

    There has recently been increased publicity on the risk of venous thrombosis after long-haul flights. This paper reviews the evidence base related to the association between air travel and venous thromboembolism. The evidence consists only of case reports, clinical case-control studies and observational studies involving the use of intermediate end-points, or expert opinion. Some studies have suggested that there is no clear association, whereas others have indicated a strong relationship. On the whole it appears that there is probably a link between air travel and venous thrombosis. However, the link is likely to be weak, mainly affecting passengers with additional risk factors for venous thromboembolism. The available evidence is not adequate to allow quantification of the risk. There are insufficient scientific data on which to base specific recommendations for prevention, other than that leg exercise should be taken during travel. Further studies are urgently needed in order to identify prospectively the incidence of the condition and those at risk. PMID:12077617

  12. Cerebral venous and sinus thrombosis

    Microsoft Academic Search

    F. Masuhr; S. Mehraein; K. Einhäupl

    2004-01-01

    Cerebral venous and sinus thrombosis (CVST) can present with a variety of clinical symptoms ranging from isolated headache to deep coma. Prognosis is better than previously thought and prospective studies have reported an independent survival of more than 80% of patients. Although it may be difficult to predict recovery in an individual patient, clinical presentation on hospital admission and the

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

    PubMed Central

    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

    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

  14. Xenogenic (porcine) acellular dermal matrix promotes growth of granulation tissues in the wound healing of Fournier gangrene.

    PubMed

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

    2015-01-01

    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

  15. Management strategy for facial venous malformations

    PubMed Central

    Kumar, Shailendra; Kumar, Vijay; Kumar, Sanjeev; Kumar, Surender

    2014-01-01

    Venous malformations (VMs) are slow-flow vascular malformations, caused by abnormalities in the development of the veins. Venous malformations vary in size and location within the body. When the skin or tissues just under the skin are affected, they appear as slightly blue-colored skin stains or swellings. These can vary in size from time to time because of swelling within the malformation. As these are vascular malformations, they are present at birth and grow proportionately with the child. Venous malformations can be very small to large in size, and sometimes, can involve a significant area within the body, When the venous malformation is well localized, this may cause localized swelling, however, when the venous malformation is more extensive, there may be more widespread swelling of the affected body part. Some patients with venous malformations have abnormal blood clotting within the malformation. Most venous malformations cause no life-threatening problems for patients. Some venous malformations cause repeated pain due to intermittent swelling and congestion of the malformation or due to the formation of blood clots within the malformation. Rarely, venous malformations may be part of a syndrome (an association of several clinically recognizable features) or be linked to an underlying genetic abnormality. We present 12 cases of venous malformations of the head and neck area, which have been managed at our hospital. PMID:25298729

  16. Review of Venous Vascular Ultrasound

    Microsoft Academic Search

    Gareth W. L. Phillips

    2000-01-01

    .   Duplex ultrasound (US) has become the new gold standard in the assessment of acute deep vein thrombosis. In view of the large\\u000a number of cases with persistent changes, all cases should be reassessed at 6 months to document the extent of residual disease.\\u000a The role of duplex US in chronic venous disease is less well established but it is

  17. Starling curves and central venous pressure.

    PubMed

    Berlin, David A; Bakker, Jan

    2015-12-01

    Recent studies challenge the utility of central venous pressure monitoring as a surrogate for cardiac preload. Starting with Starling's original studies on the regulation of cardiac output, this review traces the history of the experiments that elucidated the role of central venous pressure in circulatory physiology. Central venous pressure is an important physiologic parameter, but it is not an independent variable that determines cardiac output. PMID:25777871

  18. Drug treatment of chronic venous insufficiency and venous ulceration: a review.

    PubMed Central

    Cheatle, T R; Scurr, J H; Smith, P D

    1991-01-01

    Treatment of venous insufficiency and venous ulceration has for many years relied on established principles of compression and limb elevation. Drug treatment has been of little benefit. In recent years, a better understanding of the pathological mechanisms underlying skin damage in venous disease has allowed more rational pharmacotherapeutic approaches to be made. This review examines these, with special reference to current theories of the cause of venous ulceration. PMID:2061904

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

    PubMed

    Neumann, A P; Dunham, S M; Rehberger, T G; Siragusa, G R

    2010-08-01

    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

  20. Immunopathology and cytokine responses in commercial broiler chickens with gangrenous dermatitis.

    PubMed

    Li, Guangxing; Lillehoj, Hyun S; Lee, Kyung Woo; Lee, Sung Hyen; Park, Myeong Seon; Jang, Seung I; Bauchan, Gary R; Gay, Cyril G; Ritter, G Donald; Bautista, Daniel A; Siragusa, Gregory R

    2010-08-01

    Gangrenous dermatitis (GD) is an emerging disease of increasing economic importance in poultry resulting from infection by Clostridium septicum and Clostridium perfringens type A. Lack of a reproducible disease model has been a major obstacle in understanding the immunopathology of GD. To gain better understanding of host-pathogen interactions in GD infection, we evaluated various immune parameters in two groups of birds from a recent commercial outbreak of GD, the first showing typical disease signs and pathological lesions (GD-like birds) and the second lacking clinical signs (GD-free birds). Our results revealed that GD-like birds showed: reduced T-cell and B-cell mitogen-stimulated lymphoproliferation; higher levels of serum nitric oxide and alpha-1-acid glycoprotein; greater numbers of K55(+), K1(+), CD8(+), and MHC class II(+) intradermal lymphocytes, and increased K55(+), K1(+), CD8(+), TCR1(+), TCR2(+), Bu1(+), and MHC class II(+) intestinal intraepithelial lymphocytes; and increased levels of mRNAs encoding proinflammatory cytokines and chemokines in skin compared with GD-free chickens. These results provide the first evidence of altered systemic and local (skin and intestine) immune responses in GD pathogenesis in chickens. PMID:20706881

  1. Duplex ultrasound for chronic venous insufficiency.

    PubMed

    Zygmunt, Joseph A

    2014-11-01

    An advancing body of knowledge regarding chronic venous disorders and their diagnosis using duplex ultrasound has accumulated over the past two decades. Duplex ultrasound, primarily due to its low cost and reproducible nature, has impacted nomenclature and treatment technologies with its skillful application. Two distinct examination protocols have been developed and standardized, one for deep venous thrombosis and one for venous insufficiency (reflux). The duplex ultrasound protocol for chronic venous insufficiency and other insightful information regarding superficial reflux, anatomy, and concepts are presented. PMID:25364006

  2. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 2012-04-01 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...

  3. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...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...

  4. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...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...

  5. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...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...

  6. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...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...

  7. Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access

    SciTech Connect

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

    2011-12-15

    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.

  8. A popliteal venous aneurysm with deep venous thrombosis in the contralateral calf: report of a case.

    PubMed

    Ikeda, Akihiko; Kawamata, Takeshi; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki

    2014-10-01

    Although a popliteal venous aneurysm is a rare entity, it is an important cause of pulmonary embolism (PE), which is occasionally life-threatening. We herein report a case of a popliteal venous aneurysm with deep venous thrombosis (DVT) in the contralateral calf. A 65-year-old male, who presented with sudden onset palpitation and dyspnea, was transferred to our hospital. Enhanced computed tomography revealed PE and a venous aneurysm of the left popliteal vein. The popliteal venous aneurysm was saccular and had an intramural thrombus. Furthermore, duplex scanning detected DVT in the contralateral calf. The patient underwent a tangential aneurysmectomy with lateral venorraphy. The surgery and postoperative course were uneventful. The PE and calf DVT disappeared with perioperative anticoagulant therapy. It is recommended that, in the treatment of popliteal venous aneurysms, special attention should be given to the condition of the venous vessels of the contralateral leg, because this can influence the therapeutic strategy. PMID:23893160

  9. Venous Thromboembolism in Patients with Membranous Nephropathy

    PubMed Central

    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

    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

  10. Stent Placement on Fresh Venous Thrombosis

    SciTech Connect

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

    1997-09-15

    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.

  11. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M., E-mail: alexbarnacle@yahoo.co.uk; Kleidon, Tricia M. [Great Ormond Street Hospital for Children, Department of Radiology (United Kingdom)

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  12. Acroangiodermatitis secondary to chronic venous insufficiency.

    PubMed

    Palmer, Benjamin; Xia, Yang; Cho, Sunghun; Lewis, Felisa S; Lewis, Felicia S

    2010-11-01

    Acroangiodermatitis (AAD) is a benign uncommon vasoproliferative disorder that affects the lower extremities. It appears to be a reactive phenomenon related to severe chronic Venous insufficiency and stasis of the lower extremities. The clinical presentation of this condition often is similar to Kaposi sarcoma. We report a case of AAD in a patient with severe hypertension and chronic venous insufficiency. PMID:21214123

  13. Major venous resection during total laparoscopic pancreaticoduodenectomy

    PubMed Central

    Kendrick, Michael L; Sclabas, Guido M

    2011-01-01

    Background The feasibility of total laparoscopic pancreaticoduodenectomy (TLPD) has been established. Laparoscopic major venous resection during TLPD has not been reported. The aim of the present study was to describe the technique and outcomes of patients undergoing TLPD with major venous resection. Methods Retrospective review of all consecutive patients undergoing TLPD and major venous resection from July 2007 to December 2010 was performed. Patient demographics and peri-operative outcomes were retrieved. Data are presented as mean ± standard deviation (SD) or median with range. Results Out of 129 patients undergoing TLPD, major venous resection was performed in 11 patients with a mean age of 71 years. Median operative time and blood loss was 413 (301–666) min and 500 (75–2800) ml, respectively. Venous resection included tangential (n = 10) and segmental resection (n = 1). Venous reconstruction included patch (n = 4), suture (n = 4), stapled (n = 2) and a left renal vein interposition graft (n = 1). Median mesoportal clamp time was 35 (10–82) min. There was no 30-day or in-hospital mortality. Post-operative imaging was available in 10 patients with 100% patency at the venous reconstruction site. Conclusions Laparoscopic major venous resection during TLPD is feasible in selected patients. Extensive experience with complex laparoscopic pancreatic resection and reconstruction is advocated before attempting this procedure. PMID:21689228

  14. Is Duplex Venous Surveillance Worthwhile after Arthroplasty?

    Microsoft Academic Search

    Thomas E. Brothers; Charles E. Frank; Beth Frank; Jacob G. Robison; Bruce M. Elliott; H. Del Schutte; Keith D. Merrill; Richard J. Friedman

    1997-01-01

    Deep venous thrombosis (DVT) complicates 60% of knee and 80% of hip arthroplasties performed without prophylactic therapy. Routine postoperative duplex ultrasound surveillance has been proposed for the detection of venous thrombosis following arthroplasty. In order to determine whether surveillance represents an effective strategy to detect postoperative DVT when prophylaxis is used, surveillance duplex exams obtained after primary or revision hip

  15. The venous circulation: a piscine perspective.

    PubMed

    Sandblom, Erik; Axelsson, Michael

    2007-12-01

    Vascular capacitance describes the pressure-volume relationship of the circulatory system. The venous vasculature, which is the main capacitive region in the circulation, is actively controlled by various neurohumoral systems. In terrestrial animals, vascular capacitance control is crucial to prevent orthostatic blood pooling in dependent limbs, while in aquatic animals like fish, the effects of gravity are cancelled out by hydrostatic forces making orthostatic blood pooling an unlikely concern for these animals. Nevertheless, changes in venous capacitance have important implications on cardiovascular homeostasis in fish since it affects venous return and cardiac filling pressure (i.e. central venous blood pressure), which in turn may affect cardiac output. The mean circulatory filling pressure is used to estimate vascular capacitance. In unanaesthetized animals, it is measured as the central venous plateau pressure during a transient stoppage of cardiac output. So far, most studies of venous function in fish have addressed the situation in teleosts (notably the rainbow trout, Oncorhynchus mykiss), while any information on elasmobranchs, cyclostomes and air-breathing fishes is more limited. This review describes venous haemodynamic concepts and neurohumoral control systems in fish. Particular emphasis is placed on venous responses to natural cardiovascular challenges such as exercise, environmental hypoxia and temperature changes. PMID:17920321

  16. Lymphatic Leak Complicating Central Venous Catheter Insertion

    Microsoft Academic Search

    Alex M. Barnacle; Tricia M. Kleidon

    2005-01-01

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  17. Causes of venous ulceration: a new hypothesis

    Microsoft Academic Search

    P D Coleridge Smith; P Thomas; J H Scurr; J A Dormandy

    1988-01-01

    Previous hypotheses about the causes of venous ulceration are inconsistent with recently published data. In patients with chronic venous insufficiency the number of functioning capillary loops visible in the skin on microscopy fell after the legs had been dependent for 30 minutes. Another study had shown that leucocytes became trapped in the circulation in dependent legs. A new hypothesis linking

  18. Venous pressure in man during weightlessness

    NASA Technical Reports Server (NTRS)

    Kirsch, K. A.; Roecker, L.; Gauer, O. H.; Krause, R.; Wicke, H. J.; Leach, C.; Landry, R.

    1984-01-01

    To determine whether the body fluid shift from the lower limbs toward the head that occurs during spaceflight leads to lasting increases of venous pressure in the upper body, venous pressure and hematocrit measurements were made on four astronauts before flight and 1 and 12 hours after recovery and compared with measurements in space. During the mission the hematocrit was elevated and the venous pressure lowered by 1 to 8 centimeters of water as compared with the preflight data. One hour after landing the hematocrit decreased, indicating a hemodilution, venous pressures were unexpectedly high, and a body weight loss of 4 to 5 percent was observed. Twelve hours later the venous pressures were the lowest recorded during the study. The fluid shift apparently takes place during the first several hours of spaceflight. Thereafter, the pressure in the peripheral veins and the central circulation is lower than that measured before flight.

  19. Wartime major venous vessel injuries.

    PubMed

    Hudorovic, Narcis

    2008-02-01

    The aim of this study is to declare our experience and to identify the important factors that influence the mortality and morbidity in patients with combat-related penetrating wounds of the abdomen (CR-PWA) with major venous vessel injuries. Twenty-six wounded with combat-related injuries of major abdominal venous vessels, admitted in the University Clinic cardiovascular surgery department during the period from 1 August 1991 through 30 October 1995, were analyzed. Patients with concomitant injured arteries and extra-abdominal injuries (n=150; 85.2%) were excluded from this study. The Penetrating Abdominal Trauma Index (PATI) score for each patient was calculated. Fifteen patients (57.69%) sustained with PATI score greater than 25 died. The mean duration of hospitalization was 16 days (range 0-86). The average hospitalization time for those surviving their complications was 17 days with a PATI of 25 or less, and 43 days with a score more than 25. Three clinical assessments of the long-term outcome were performed after a median of about 3, 5 and 10 years, respectively. Surviving patients (42.31%) were symptom free and had normal Duplex scans as well as no other surgical related complications. Higher PATI scores, postoperative complications and reoperations exert an unfavorable effect on patient outcome. PMID:18006557

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

    PubMed Central

    Sarwar, Umran; Akhtar, Nadeem

    2012-01-01

    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

  1. Genome-wide differential gene expression profiles in broiler chickens with gangrenous dermatitis.

    PubMed

    Kim, Duk Kyung; Lillehoj, Hyun S; Lee, Kyung Woo; Jang, Seung Ik; Neumann, Anthony P; Siragusa, Gregory R; Lillehoj, Erik P; Hong, Yeong Ho

    2012-12-01

    Gangrenous dermatitis (GD) is a disease of poultry characterized by necrosis of the skin and severe cellulitis of the subcutaneous tissues caused by infection with Clostridium septicum (CS) and/or Clostridium perfringens (CP) type A. While GD causes significant morbidity, mortality, and economic loss to the poultry industry, the fundamental mechanisms underlying this host-pathogen interaction are relatively unknown. This study used comparative global gene expression microarray analysis of GD-affected and clinically healthy chickens from a recent GD outbreak to glean insights into the molecular and cellular changes associated with this disease process. Histopathologic and immunohistochemical analyses confirmed extensive muscle damage and prominent leukocyte infiltration in the skin of GD-affected birds but not in healthy controls. The levels of mRNAs in the skin and underlying muscle corresponding to 952 microarray elements were altered in GD-afflicted birds compared with healthy controls, with 468 being increased and 484 decreased. From these, a subset of 386 genes was identified and used for biologic function and pathway analyses. The biologic functions that were most significantly associated with the differentially expressed genes were "inflammatory response" and "cellular growth and proliferation" classified under the categories of "disease and disorders" and "molecular and cellular functions," respectively. The biologic pathway that was most significantly associated with the differentially expressed genes was the nuclear factor-erythroid 2-related factor 2 (NRF2)-mediated oxidative stress pathway. Finally, in vitro infection of chicken macrophages with CS or CP modified the levels of mRNAs encoding interferon (IFN)-alpha, IFN-gamma, interleukin (IL)-1beta, IL-6, IL-12p40, tumor necrosis factor superfamily 15 (downregulated), IL-8, and IL-10 (upregulated), thus confirming the suppressive effect of GD on the chicken immune system. PMID:23397837

  2. A temporary distal arteriovenous fistula improves venous hemodynamics in a model of venous occlusion.

    PubMed

    Sawchuk, A P; Dalsing, M C; Emerick, S C; Waller, B F; Reilly, M K; Broadie, T A

    1987-08-01

    The formation of a temporary distal arteriovenous fistula (dAVF) has been used clinically to palliate patients with symptomatic venous hypertension. This study tested the efficacy of a temporary dAVF for the treatment of venous hypertension in an experimental model. Twenty-four New Zealand white rabbits were divided into two experimental groups. Group I rabbits (n = 12) underwent standardized ligation of the iliac and femoral venous systems. Group II rabbits (n = 12) underwent standardized ligation of the iliac and femoral venous systems with the formation of a temporary dAVF. Venous obstruction was documented with venography, and venous hypertension was documented with femoral venous pressure measurements. Venous pressure, resistance, blood flow, vein circumference, vein cross-sectional area, vein wall thickness, and venography were compared between four rabbits from each group at 2, 4, and 8 weeks. The effect of differences in baseline venous pressures was eliminated by subtracting the venous pressure in the unobstructed rabbit limb from the pressure in the obstructed rabbit leg. Group II rabbits had a lower standardized venous pressure (4.4 +/- 2.2 versus 9.5 +/- 4.2 mm Hg, p less than 0.01) and venous outflow resistance (0.16 +/- 0.08 versus 0.36 +/- 0.18, p less than 0.05) than did group I rabbits. Group II rabbits also had a larger superficial femoral vein circumference (3.46 +/- 0.67 versus 2.57 +/- 0.08 mm, p less than 0.05) and cross-sectional area (0.66 +/- 0.31 versus 0.31 +/- 0.09 mm2, p less than 0.01) than did group I rabbits. The improvement persisted throughout the 6-week study, which suggested an improved venous outflow. PMID:2441482

  3. Biomarkers of deep venous thrombosis.

    PubMed

    Hou, Huacheng; Ge, Zhijuan; Ying, Pu; Dai, Jin; Shi, Dongquan; Xu, Zhihong; Chen, Dongyang; Jiang, Qing

    2012-10-01

    Deep venous thrombosis (DVT), which is associated with pulmonary embolism, is a fatal disease because of its high morbidity and mortality in outpatients and inpatients, especially in hospitalized patients. At the same time, lack of subjective clinical symptoms and objective clinical signs makes the diagnosis complicated. Historically, the primarily imaging modalities, including duplex ultrasound, helical CT scans, and venography, establish the diagnosis of DVT. Currently, both imaging modalities and serology are utilized. These plasma molecules are regarded as the biomarkers of DVT including D-dimer, P-selectin, Factor VIII, thrombin generation, inflammatory cytokines, microparticles, fibrin monomer, leukocyte count and so on. This brief review is used to analyze the contribution of the biomarkers to diagnosis and guidance of therapy for DVT. PMID:22528325

  4. Prevention of hemodialysis fistula thrombosis. Early detection of venous stenoses

    Microsoft Academic Search

    Steve J Schwab; John R Raymond; Moshin Saeed; Glenn E Newman; Patricia A Dennis; R Randal Bollinger

    1989-01-01

    Prevention of hemodialysis fistula thrombosis. Early detection of venous stenoses. Venous dialysis pressures were measured consecutively in 168 chronic hemodialysis patients for 265 patient-years of monitored dialysis. Venous dialysis pressure > 150 mm Hg measured by the protocol were considered elevated. Seventy-three patients had elevated venous dialysis pressures and 58 agreed to undergo elective venography (fistulogram). Fifty of 58 patients

  5. Multimodal Percutaneous Intervention for Critical Venous Occlusive Disease

    Microsoft Academic Search

    Rajeev Dayal; Joshua Bernheim; Daniel G. Clair; Albeir Y. Mousa; Scott Hollenbeck; Brain DeRubertis; James McKinsey; Nicholas J. Morrissey; K. Craig Kent; Peter L. Faries

    2005-01-01

    Critical deep venous thrombosis and occlusion constitutes a small percentage of patients with venous disease, who exhibit severe symptomatology. This study examined the results of multimodal percutaneous therapy for the treatment of complex critical venous thrombotic and occlusive disease. Twenty-five patients presented with critical venous thromboses or occlusions (11 with debilitating unilateral lower extremity edema causing ambulatory impairment, 2 with

  6. Current surgical approaches to venous hypertension and valvular reflux

    Microsoft Academic Search

    Vikrom S. Sottiurai

    1996-01-01

    Venous hypertension in the lower extremity with and without ankle ulceration can be attributed to venous outflow obstruction, venous valve incompetence with massive reflux. Compression stocking and pneumatic pump cannot provide a long-term cure of this advance stage of venous pathology and ulcer recurrence is to be expected. Definitive treatment requires the following sequential order: (1) correction of potential underlying

  7. Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.

    1996-01-01

    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.

  8. Measurement of venous compliance (8-IML-1)

    NASA Technical Reports Server (NTRS)

    Thirsk, R. B.

    1992-01-01

    The prime objective of this International Microgravity Laboratory (IML-1) investigation is to measure the bulk compliance (distensibility) of the veins in the lower leg before, during, and after spaceflight. It is of particular interest whether venous compliance over the range of both positive and negative transmural pressures (various states of venous distention and collapse) changes throughout the duration of spaceflight. Information concerning the occurrence and character of compliance changes could have implications for the design of improved antigravity suits and further the understanding of inflight and postflight venous hemodynamics.

  9. Relationships of glucose concentrations in capillary whole blood, venous whole blood and venous plasma

    Microsoft Academic Search

    Katsuhiko Kuwa; Toshimasa Nakayama; Tadao Hoshino; Makoto Tominaga

    2001-01-01

    We studied the difference in glucose levels between capillary and venous whole blood during 75-g oral glucose tolerance test (OGTT) in 75 healthy subjects. Capillary and venous whole blood glucose values were measured by HK–G6PD method after deproteinization. The post-loaded glucose levels in capillary blood were significantly higher than those in venous blood, and the mean values of capillary and

  10. Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation

    Microsoft Academic Search

    Simru Turnao?lu; Mehmet Tu?rul; Emre Çamci; Nahit Çakar; Özkan Akinci

    2001-01-01

    Objective: To examine the clinical applicability of substituting central venous oxygen saturation (ScvO2) for mixed venous oxygen saturation (SmvO2) in monitoring global tissue oxygenation. Design: Prospective clinical investigation. Setting: University hospital. Participants: Seventy-three adult patients. Interventions: Venous oxygen saturation was recorded, and oxygen saturation difference between SmvO2 and ScvO2 (?Smvcv) was calculated in 2 groups of patients (group I, sepsis

  11. Chronic Venous Disease (Beyond the Basics)

    MedlinePLUS

    ... from the surface of the legs to the deep veins and back to the heart; the valves ... is located in the superficial veins or the deep veins. (See "Diagnostic evaluation of chronic venous insufficiency" .) ...

  12. [Venous thromboembolic disease: presentation of a case].

    PubMed

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. PMID:23834985

  13. [Emphysematous gastritis with concomitant portal venous air].

    PubMed

    Jeong, Min Yeong; Kim, Jin Il; Kim, Jae Young; Kim, Hyun Ho; Jo, Ik Hyun; Seo, Jae Hyun; Kim, Il Kyu; Cheung, Dae Young

    2015-02-25

    Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review. PMID:25716715

  14. Hepatic Venous Pressure Gradient: Worth Another Look?

    Microsoft Academic Search

    Sameer Parikh

    2009-01-01

    Portal hypertension is one of the most important complications of chronic liver disease and accounts for significant morbidity\\u000a and mortality. Measurement of the hepatic venous pressure gradient (HVPG) is a simple, invasive, and reproducible method of\\u000a assessing portal venous pressure. Measurement of HVPG provides the clinician an estimate of the degree of intrahepatic portal\\u000a flow resistance, guides therapy for variceal

  15. Pathophysiology of spontaneous venous gas embolism

    NASA Technical Reports Server (NTRS)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  16. Noninvasive measurement of internal jugular venous oxygen saturation by photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Garcia-Uribe, Alejandro; Erpelding, Todd N.; Ke, Haixin; Reddy, Kavya; Sharma, Anshuman; Wang, Lihong V.

    2014-03-01

    The metabolic rate and oxygen consumption of the brain is reflected in jugular venous oxygen saturation. In many clinical conditions, such as head trauma, stroke, and low cardiac output states, the brain is at risk for hypoxic-ischemic injury. The current gold standard for monitoring brain oxygenation is invasive and requires jugular vein catheterization under fluoroscopic guidance; and therefore it is rarely used. Photo-acoustic tomography in combination with ultrasound can be used to estimate oxygen saturation of the internal jugular vein in real-time. This noninvasive method will enable earlier detection and prevention of impending hypoxic brain injury. A wavelength-tunable dye laser pumped by a Nd:YAG laser delivers light through an optical fiber bundle, and a modified commercial ultrasound imaging system (Philips iU22) detects both the pulse-echo ultrasound (US) and photoacoustic (PA) signals. A custom-built multichannel data acquisition system renders co-registered ultrasound and photoacoustic images at 5 frames per second. After the jugular vein was localized in healthy volunteers, dualwavelength PA images were used to calculate the blood hemoglobin oxygen saturation from the internal jugular vein in vivo. The preliminary results raise confidence that this emerging technology can be used clinically as an accurate, noninvasive indicator of cerebral oxygenation.

  17. Clinical applications of free arterialized venous flaps.

    PubMed

    Kayalar, Murat; Kucuk, Levent; Sugun, Tahir Sadik; Gurbuz, Yusuf; Savran, Ahmet; Kaplan, Ibrahim

    2014-11-01

    Venous flaps are flaps by which tissue perfusion is accessed through the venous network. Despite originally being questioned due to potential perfusion problems, as the dynamics of tissue perfusion have been more fully comprehended, venous flaps appear to have a far wider range of application than first thought. In our study, we analyzed the clinical results of the applications of free arterialized venous flaps along with the factors that can affect flap survival. Forty-one flaps were assessed retrospectively. Type of the trauma, traumatized area, the time duration between trauma and application of the flap, donor area, type and count of the anastomosis, encountered complications, and flap survival rates were analyzed. Regression and classification trees were used to study the relationship between flap surface area, anastomosis count, and flap survival. Circulatory abnormalities such as early congestion and edema were seen in 53.6% of the applied flaps. A total of four flaps (9.7%) developed necrosis which presented as full thickness in three flaps and partial thickness in one flap. It can be said that there was a weak but positive correlation between the size of the flap area and the number of anastomosis. Although the results of arterialized venous flaps are inconsistent in the literature, those flaps can be preferred as an alternative treatment option in single finger defects where tissue compatibility and cosmetic results are quite impressive. In the meantime, syndactylized venous flaps are the preferred method regarding multiple finger soft-tissue defects. PMID:24961162

  18. Call to action to prevent venous thromboembolism.

    PubMed

    Wakefield, Thomas W; McLafferty, Robert B; Lohr, Joann M; Caprini, Joseph A; Gillespie, David L; Passman, Marc A

    2009-06-01

    Deep venous thrombosis and pulmonary embolism, together called venous thromboembolism, remain a serious national health problem. Estimates suggest that over 900,000 cases occur in the United States per year, with 300,000 deaths per year. Because of the significant and serious nature of this problem, a workshop was held in May of 2006, which resulted in the Acting U.S. Public Health Service Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. On September 15, 2008, Acting Surgeon General, Rear Admiral Steven K. Galson, MD, MPH, and Elizabeth Nabel, MD, Director National Heart, Lung, and Blood Institute, announced the Call to Action. The Call to Action highlights public awareness about the risk factors, triggering events, and symptoms of venous thrombosis and pulmonary embolism, and encourages the development of evidence based practices for screening, prevention, diagnosis, and treatment of venous thrombosis and pulmonary embolism. It is designed to encourage new scientific investigation in an effort to obtain needed evidence to fill in the gaps of knowledge about venous thrombosis and pulmonary embolism. This knowledge should be quickly and easily disseminated to the public and put into practice by health professionals. The Surgeon General's Call to Action represents one of the most important advances in the field of venous thromboembolism and sets the stage for multidisciplinary efforts to combat this serious national health problem. PMID:19497526

  19. Informing parents about the actual or impending death of their infant in a newborn intensive care unit.

    PubMed

    Armentrout, Debra; Cates, Leigh Ann

    2011-01-01

    Modern perinatal and neonatal care practices have increased survival of infants that in previous care eras would have perished. The majority of infants admitted to a newborn intensive care unit following delivery currently do well and are discharged home. Unfortunately for others, the ultimate outcome may be death. The death of a newborn infant is clearly a devastating loss to parents. How parents are informed of their infant's actual or impending death can either add to a grief reaction, or help support parents through their loss. The literature supports that most healthcare professionals frequently feel inept while discussing the death of a newborn with the baby's family. This article will present parents' descriptions of what helped or did not help when they were informed of their infant's inevitable death. It will also demonstrate how simulation may be effective in improving communication of bad or sad news to families in a manner that sustains them in the immediate present, as well as adds to their future well-being. PMID:21825916

  20. Venous thromboembolism in neurologic disease.

    PubMed

    Schneck, Michael J

    2014-01-01

    Patients with neurologic disease are at high risk of venous thromboembolism (VTE) because of relative immobility. They are also at increased risk due to the presence of a hypercoagulable state. Patients with spinal cord injuries, brain tumors, and strokes are at particularly high risk and extra vigilance is needed in these patients. Because VTE is very common in hospitalized neurologic and neurosurgical patients, mechanical thromboprophylaxis is indicated in virtually all patients. Pharmacologic prophylaxis with either subcutaneous heparin or low molecular heparinoids should be given to all high-risk neurologic and neurosurgical patients provided there are no major contraindications. The major concern would be a risk of bleeding but in some patients alternate drugs must be considered given the risk of thrombosis (i.e., in the context of heparin-induced thrombocytopenia). The immediate or long-term treatment of full dose anticoagulation for VTE may not be appropriate in all patients as VTE therapy represents a balance between the risks of bleeding related to anticoagulant therapy versus the risk of recurrent events. An inferior vena cava (IVC) filter is another option in these patients but may not necessarily be the best choice for most neurologic patients. Given the high risk of VTE in patients with neurologic diseases, early recognition by clinicians of the signs and symptoms of VTE is essential. PMID:24365303

  1. Natural history of venous thromboembolism.

    PubMed

    Kearon, C

    2001-01-01

    Most deep vein thromboses (DVTs) start in the calf; however, thrombi that remain confined to the calf rarely cause leg symptoms or are associated with symptomatic pulmonary embolism (PE). The probability that calf DVT will extend to involve the proximal veins, and subsequently cause PE, increases with the severity of the initiating prothrombotic stimulus and if this stimulus persists. Although acute venous thromboembolism (VTE) usually presents with either leg or pulmonary symptoms, most patients have thrombosis at both sites at the time of diagnosis. Treated proximal DVTs resolve slowly, and half of patients still have detectable thrombi after a year. About 10% of patients with symptomatic DVT develop severe postthrombotic syndrome within 5 years. This is more likely to occur if there has been an ipsilateral recurrent DVT. About 10% of PEs are rapidly fatal. Of PEs that are diagnosed before death, about 50% are associated right ventricular dysfunction, a finding that is associated with a high short-term mortality. There is about 50% resolution of PE after 1 month of treatment, and perfusion eventually returns to normal in two thirds of patients. After a course of treatment, the risk of recurrent thrombosis is higher in patients without a reversible risk factor and in those with certain biochemical abnormalities, including antiphospholipid antibodies, hyperhomocysteinemia, and homozygous factor V Leiden. PMID:15199511

  2. HIV-Associated Venous Thromboembolism

    PubMed Central

    Bibas, Michele; Biava, Gianluigi; Antinori., Andrea

    2011-01-01

    HIV infection has been recognized as a prothrombotic condition and this association has now been proven by a large number of studies with a reported VTE frequency among HIV-infected patients ranging from 0.19% to 7,63 %/year. HIV infection is associated with a two to tenfold increased risk of venous thrombosis in comparison with a general population of the same age. Some risk factors demonstrated a strongest association with VTE such as, low CD4+ cell count especially in the presence of clinical AIDS, protein S deficiency, and protein C deficiency. Whereas other risk factors are still controversial like protease inhibitor therapy, presence of active opportunistic infections and presence of antiphospholipid antibodies, including anticardiolipin antibodies and lupus anticoagulant. Physicians caring for HIV positive patients should be able to recognize and treat not only the well-known opportunistic infections and malignancies associated with this chronic disease, but also be alert to the less well-known complications such as thromboses. Pulmonary embolism should be included in the differential diagnosis when patients with HIV/AIDS have unexplained dyspnea or hypoxemia. In younger individuals with VTE, especially men, without other identifiable risk factors for VTE, HIV should be considered. Because interactions between warfarin and antiretrovirals is possible, health care providers should also be alert to the potential of dangerously high or low INRs when they are giving anticoagulants to patients with HIV infection who are undergoing antiretroviral therapy. PMID:21869916

  3. Inelastic compression increases venous ejection fraction more than elastic bandages in patients with superficial venous reflux

    Microsoft Academic Search

    G Mosti; V Mattaliano; H Partsch

    2008-01-01

    Aim: To investigate the influence of compression bandages, manufactured using materials with different elastic properties, on the impaired venous pumping function in patients with venous insufficiency. Methods: Ejection volume (EV) and ejection fraction (EF) were measured using strain gauge plethysmography distal from the patella without and with elastic and inelastic compression bandages in a total of 30 patients with major

  4. Venous Malformation: update on etiopathogenesis, diagnosis & management

    PubMed Central

    Dompmartin, Anne; Vikkula, Miikka; Boon, Laurence M

    2011-01-01

    The aim of this review was to discuss the current knowledge on etiopathogenesis, diagnosis and therapeutic management of venous malformations. Venous malformations (VMs) are slow-flow vascular anomalies. They are simple, sporadic or familial (cutaneo-mucosal venous malformation or glomuvenous malformations), combined (e.g. capillaro-venous, capillaro-lymphaticovenous malformations) or syndromic (Klippel-Trenaunay, Blue Rubber Bleb Naevus and Maffucci). Genetic studies have identified causes of familial forms and of 40% of sporadic VMs. Another diagnostic advancement is the identification of elevated D-dimer level as the first biomarker of venous malformations within vascular anomalies. Those associated with pain are often responsive to Low Molecular Weight Heparin which should also be used to avoid disseminated intravascular coagulopathy secondary to intervention, especially if fibrinogen level is low. Finally, development of a modified sclerosing agent, ethylcellulose–ethanol, has improved therapy. It is efficient and safe, and widens indications for sclerotherapy to sensitive and dangerous areas such as hands, feet and periocular area. PMID:20870869

  5. Compression therapy for chronic venous insufficiency.

    PubMed

    Felty, Cindy L; Rooke, Thom W

    2005-03-01

    Compression therapy provides a means to treat venous stasis, venous hypertension, and venous edema. Different methods of compression therapy have been described periodically over the last 2,000 years. In addition to static compression, specialized compression pumps have been developed and a technique of massage called manual lymphatic drainage has emerged to treat primary and secondary lymphedema. Objectives of compression therapy are to reduce the swollen limb to minimum size, maintain that size, and allow the patient to participate in the care of his limb whenever possible. Reduction therapy is achieved by limb elevation, compression pumps as necessary, and compression wraps. Maintenance therapy largely consists of compression wraps or compression stockings. Nonelastic devices have found a place in treating severe lymphedema but it should be emphasized that periodic follow-up must be done during maintenance therapy so that adjunctive maintenance measures can be added as needed. PMID:15791552

  6. Noninvasive measurement of central venous pressure

    NASA Technical Reports Server (NTRS)

    Webster, J. G.; Mastenbrook, S. M., Jr.

    1972-01-01

    A technique for the noninvasive measurement of CVP in man was developed. The method involves monitoring venous velocity at a point in the periphery with a transcutaneous Doppler ultrasonic velocity meter while the patient performs a forced expiratory maneuver. The idea is the CVP is related to the value of pressure measured at the mouth which just stops the flow in the vein. Two improvements were made over the original procedure. First, the site of venous velocity measurement was shifted from a vein at the antecubital fossa (elbow) to the right external jugular vein in the neck. This allows for sensing more readily events occurring in the central veins. Secondly, and perhaps most significantly, a procedure for obtaining a curve of relative mean venous velocity vs mouth pressure was developed.

  7. Congenital venous valvular aplasia of the lower extremities.

    PubMed

    Friedman, E I; Taylor, L M; Porter, J M

    1988-01-01

    A 10-year-old girl had bilateral, symmetrical swelling of the lower extremities, which had been present since the age of 1 year. Noninvasive vascular laboratory measurements of the ambulatory venous pressure, venous recovery time, and maximum venous outflow revealed profound bilateral lower extremity venous valvular incompetence. Duplex imaging of the veins of the lower extremities demonstrated no evidence of thrombosis, and no venous valves could be imaged. On phlebography, the patient was found to have no venous valves in the superficial and deep systems of the leg. We conclude that congenital absence of the venous valves of the lower extremities is almost certainly underdiagnosed and that the vascular laboratory can accurately and easily differentiate between lymphedema and venous valvular imcompetence. Such differentiation may have therapeutic implications. PMID:3336868

  8. Impending Impeachment Vote

    NSDL National Science Digital Library

    Osmond, Andrew.

    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.

  9. The Impact of Lower Extremity Venous Ulcers due to Chronic Venous Insufficiency on Quality of Life

    PubMed Central

    Koupidis, Sotirios A; Paraskevas, Kosmas I; Stathopoulos, Vassilios; Mikhailidis, Dimitri P

    2008-01-01

    Lower extremity venous ulcers comprise a complex medical and social issue. The conservative and/or surgical management of venous ulcers is often inadequate. In addition, the psychosocial aspect of the disease is often overlooked and most often undertreated. Common symptoms such as pain, low self-esteem and patient isolation are usually not recognized and therefore not adequately managed. This mini-review summarizes the current data on the management of lower extremity venous ulcers and their impact on the quality of life of these patients. PMID:19430523

  10. Greater forearm venous compliance in resistance-trained men

    Microsoft Academic Search

    Hiroshi Kawano; Michiya Tanimoto; Kenta Yamamoto; Yuko Gando; Kiyoshi Sanada; Izumi Tabata; Mitsuru Higuchi; Motohiko Miyachi

    2010-01-01

    Greater venous compliance is associated with attenuation of the tolerance response to orthostatic stress and reduced incidence\\u000a of venous diseases. Resistance training induces tolerance to orthostatic challenge and the growth of capillaries, which may\\u000a lead to negative and positive effects on venous compliance, respectively. It has not been confirmed, however, whether habitual\\u000a resistance training positively or negatively affects venous compliance.

  11. Epidemiology and Risk Factors for Venous Thrombosis

    PubMed Central

    Cushman, Mary

    2007-01-01

    Venous thrombosis, including deep vein thrombosis and pulmonary embolism, occurs at an annual incidence of about 1 per 1000 adults. Rates increase sharply after around age 45 years, and are slightly higher in men than women in older age. Major risk factors for thrombosis, other than age, include exogenous factors such as surgery, hospitalization, immobility, trauma, pregnancy and the puerperium and hormone use, and endogenous factors such as cancer, obesity, and inherited and acquired disorders of hypercoagulation. This review focuses on epidemiology of venous thrombosis and the general implications of this in patient management. PMID:17433897

  12. Venous spread of renal cell carcinoma: MDCT

    Microsoft Academic Search

    Ranka Stern Padovan; Drazen Perkov; Ranko Smiljanic; Bozidar Oberman; Kristina Potocki

    2007-01-01

    Background  The purpose of our study was to present multidetector computed tomography (MDCT) findings in venous spread of renal cell carcinoma\\u000a (RCC), to determine the superior extent of tumor thrombus and to compare MDCT findings with surgical report.\\u000a \\u000a \\u000a \\u000a Methods  The prospective MDCT study was performed on 31 patients diagnosed with RCC with venous spread (19 males and 12 females; age\\u000a range 39–80 years;

  13. Patient ethnicity and use of venous thromboembolism prophylaxis

    Microsoft Academic Search

    REBECCA P. GELBER; TODD B. SETO

    2006-01-01

    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

  14. Future prospects in the treatment of venous disease

    Microsoft Academic Search

    Eugene F. Bernstein

    1986-01-01

    Our current knowledge of the natural history of venous disease suggests that congenital venous valve insufficiency and left iliac vein compression predispose to later deep vein thrombosis (DVT) and pulmonary embolism. Available longitudinal studies are, however, inadequate to justify prophylactic treatment of these conditions at the present time. Furthermore, our knowledge of the natural history of acute venous thrombosis, of

  15. Serendipitous detection of an errant central venous catheter

    SciTech Connect

    Orzel, J.A.; Romdall, K.; Griep, R.

    1985-09-01

    The inappropriate placement of a patient's central venous catheter in the pleural space by the serendipitous injection of Tc-99m labeled red blood cells through the catheter during a GI bleeding study was discovered. Position and patency of central venous lines can be incidentally evaluated by using existing central venous catheters for administration of radiopharmaceuticals during radionuclide imaging studies.

  16. A Review of Technological Approaches to Venous Ulceration

    Microsoft Academic Search

    M. Clarke-Moloney; G. M. Lyons; P. E. Burke; D. O'Keeff; P. A. Grace

    Leg ulceration is a chronic condition aff ecting about 1-2% of the adult population. Th e main causes of leg ulceration are venous hypertension, arterial insuffi ciency, diabetes, or a combination of these aetiologies (causes) or malignancy. Venous ulcers ac- count for approximately 80% of all leg ulcers and are a result of venous hypertension. Th e current mainstay of

  17. Negative pressure wound therapy applied before and after split-thickness skin graft helps healing of Fournier gangrene: a case report (CARE-Compliant).

    PubMed

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

    2015-02-01

    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

  18. Analysis of genetic similarities between Clostridium perfringens isolates isolated from patients with gas gangrene and from hospital environment conducted with the use of the PFGE method.

    PubMed

    Brzychczy-W?och, Monika; Bulanda, Ma?gorzata

    2014-03-01

    The objective of the study was to perform a comparative analysis of genetic similarity, with the use of pulsed field gel electrophoresis (PFGE), of Clostridium perfringens isolates originating from patients with gas gangrene and from the hospital environment. The study encompassed two patients with a clinical and microbiological diagnosis of gas gangrene, who were hospitalized in one of the hospitals of the Ma?opolska province in the time period between 31st March 2012 and 18th May 2012. Clostridium perfringens isolates genotyping indicated that the isolates originating from the two studied patients did not display genetic similarity and represented two different PFGE types, which corresponded to two different clones (clone A and B). Whereas the strains isolated from the hospital environment were genetically identical with the strain coming from the second patient and represented one PFGE type, which corresponded to one clone (clone A). As a result of the study, it is possible to conclude that both patients developed endogenous infection. Even so, the examination of the hospital environment indicates the possibility of the appearance of exogenous infections. It prompts recommending and following the exact regulations of sanitary regime in the ward and the operating theater if a patient is diagnosed with gas gangrene. PMID:24791817

  19. Malposition of central venous catheter in the jugular venous arch via external jugular vein -a case report-

    PubMed Central

    Ahn, SoWoon; Lee, Ju Ho; Park, Chunghyun; Hong, Yong-woo

    2015-01-01

    The central venous cannulation is commonly performed in the operating rooms and intensive care units for various purposes. Although the central venous catheter (CVC) is used in many ways, the malpositioning of the CVC is often associated with serious complications. We report a case of an unexpected malposition of a CVC in the jugular venous arch via external jugular vein.

  20. STUDIES OF OXYGEN IN THE VENOUS BLOOD

    PubMed Central

    Lundsgaard, Christen

    1919-01-01

    1. Determinations of the oxygen content and the oxygen unsaturation of the venous blood have been performed on patients with varying amounts of hemoglobin. 2. The oxygen unsaturation of the venous blood is independent of the oxygen capacity, unless the latter is reduced below the normal value for oxygen unsaturation (about 5 volumes per cent). In a polycythemic patient, for example, with 33.4 volumes per cent oxygen capacity (181 per cent hemoglobin), the venous oxygen content was. 28 volumes per cent, giving an unsaturation of 5.4 volumes per cent. Similarly, in an anemic patient with only 6.7 volumes per cent oxygen capacity (36 per cent hemoglobin), the venous oxygen was 1.5, giving an unsaturation of 5.2 volumes per cent. This means that the tissues extract from the blood all the oxygen they need with apparently equal readiness, regardless of whether the extraction leaves a great oxygen reserve in the blood as in polycythemia, or practically no reserve as in anemia. 3. The results seem to show that the resting organism does not increase its circulation until all the reserve oxygen is used. This means that the resting anemic organism does not need or use any compensation for its anemia until the hemoglobin has sunk below 30 per cent. Below that value the organism increases the blood flow in order to secure to the tissues the normal amount of oxygen. PMID:19868350

  1. Portal venous drainage for cadaveric renal transplantation.

    PubMed

    Rosenthal, J T; Loo, R K

    1990-10-01

    The iliac vessels are the standard site for vascular connections for kidney transplantation. Unusual circumstances may render the iliac vessels unusable. We report a case in which a cadaveric renal allograft was successfully transplanted despite an absence of normal venous anatomy, using the inferior mesenteric vein for revascularization. PMID:2398572

  2. Foudroyant Course of an Extensive Clostridium septicum Gas Gangrene in a Diabetic Patient with Occult Carcinoma of the Colon

    PubMed Central

    Kutup, Asad; Gehl, Axel; Zustin, Jozef; Grossterlinden, Lars G.; Rueger, Johannes M.; Lehmann, Wolfgang

    2013-01-01

    Background. Spontaneous gas gangrene is a rare disease in which Clostridium septicum frequently can be detected. After an incubation period of 5–48 hours, a very painful swelling is accompanied by a rapidly spreading toxic-infectious clinical picture ultimately leading to septic shock and multiple organ failure. We present a case of a completely documented rare infectious disease with triage findings including initial vital signs, initial medical findings, and the emergency lab., radiological, intraoperative, histopathological, microbiological, and postmortem results. After initial diagnosis of the underlying disease, the patient has been immediately transferred to the operating theatre. The laboratory findings reflect the devastating effect of toxin ? which is a toxin typically produced by C. septicum. The patient presented both an anaemia and a manifest coagulopathy as well as an onset of multiple organ failure. Despite the aggressive medical and surgical measures that have been taken, this patient could not be saved. Discussion. The case presented vividly emphasises the difficulty to identify these cases early enough to save a patient. This documentation may help health care providers to identify this life threatening disease as early as possible in future cases. PMID:23864974

  3. Foudroyant Course of an Extensive Clostridium septicum Gas Gangrene in a Diabetic Patient with Occult Carcinoma of the Colon.

    PubMed

    Hartel, Maximilian; Kutup, Asad; Gehl, Axel; Zustin, Jozef; Grossterlinden, Lars G; Rueger, Johannes M; Lehmann, Wolfgang

    2013-01-01

    Background. Spontaneous gas gangrene is a rare disease in which Clostridium septicum frequently can be detected. After an incubation period of 5-48 hours, a very painful swelling is accompanied by a rapidly spreading toxic-infectious clinical picture ultimately leading to septic shock and multiple organ failure. We present a case of a completely documented rare infectious disease with triage findings including initial vital signs, initial medical findings, and the emergency lab., radiological, intraoperative, histopathological, microbiological, and postmortem results. After initial diagnosis of the underlying disease, the patient has been immediately transferred to the operating theatre. The laboratory findings reflect the devastating effect of toxin ? which is a toxin typically produced by C. septicum. The patient presented both an anaemia and a manifest coagulopathy as well as an onset of multiple organ failure. Despite the aggressive medical and surgical measures that have been taken, this patient could not be saved. Discussion. The case presented vividly emphasises the difficulty to identify these cases early enough to save a patient. This documentation may help health care providers to identify this life threatening disease as early as possible in future cases. PMID:23864974

  4. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters.

    PubMed

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

    To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ?1 risk factor was 10.34% (12/116), in those with ?2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis. PMID:25664112

  5. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters

    PubMed Central

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

    To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ?1 risk factor was 10.34% (12/116), in those with ?2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis. PMID:25664112

  6. Rapid Parathyroid Hormone Analysis During Venous Localization

    PubMed Central

    Udelsman, Robert; Aruny, John E.; Donovan, Patricia I.; Sokoll, Lori J.; Santos, Florie; Donabedian, Richard; Venbrux, Anthony C.

    2003-01-01

    Objective To determine the usefulness of the rapid parathyroid hormone (PTH) assay during venous localization for primary hyperparathyroidism (1° HPTH). Summary Background Data Remedial exploration for persistent 1° HPTH poses a significant challenge when noninvasive preoperative localization studies are negative. Based on experience with the intraoperative rapid PTH assay, this technique was extrapolated to the interventional radiology suite and generated near real-time data for the interventional radiologist employing on-site hormone analysis, with a 12-minute turnaround time from blood sampling to assay result. Methods Between November 1997 and July 2002, 446 patients with 1° HPTH were referred for treatment. Of these, 56 (12.5%) represented remedial patients who had each undergone one or more previous cervical explorations. Noninvasive imaging studies were positive for or suggestive of localized disease in 49/56 (87.5%) of these patients, who therefore proceeded directly to surgical exploration. Seven patients with persistent 1° HPTH and negative noninvasive studies underwent selective venous sampling employing a rapid PTH assay in the interventional suite. Results Venous localization demonstrated an apparent PTH gradient in six of the seven patients. In three, a subtle gradient demonstrated in near real-time prompted additional sampling, which confirmed an unequivocal hormone gradient. In an additional case, the absence of a gradient on initial sampling prompted further sampling, which was positive. All of the patients were explored, and in five of the six patients with a positive PTH gradient, a parathyroid adenoma (mean weight 636 ± 196 mg) was resected from a location predicted by venous localization. In the sixth patient with a positive gradient, parathyroid tissue was not identified; however, there was a significant fall in the intraoperative PTH values, and immediate postoperative and follow-up laboratory data at 1 month are indicative of a cure. In the one patient with negative localization, abnormal parathyroid tissue could not be located during surgical exploration. Conclusions The rapid PTH assay is a major adjunct for obtaining informative venous localization in patients with persistent 1° HPTH. This information is extremely helpful to the surgeon in this challenging group of patients and resulted in a 100% cure rate when a venous gradient was demonstrated. The authors now employ this technique routinely in remedial patients with negative noninvasive imaging studies. PMID:12724638

  7. Partial anomalous pulmonary venous connections: surgical management.

    PubMed

    Fragata, José; Magalhães, Manuel; Baquero, Luis; Trigo, Conceição; Pinto, Fátima; Fragata, Isabel

    2013-01-01

    Partial anomalous pulmonary venous connections (PAPVCs) are a heterogeneous group of congenital heart lesions in which at least one pulmonary vein will drain into the systemic venous system. The consequences are a variable left-to-right hemodynamic shunt and more rarely pulmonary artery hypertension. Often, PAPVC occurs in association with other congenital cardiac malformations. Surgical correction is most often advisable and is generally straightforward and simple to achieve. Historically, some repairs have included incision across the junction of the superior vena cava with the right atrium, which can lead to late arrhythmias. The Warden technique avoids incision across the atriocaval junction. Neonates and infants with Scimitar syndrome represent the most challenging subset of patients with PAPVC. PMID:23799753

  8. New anticoagulants for venous thromboembolic disease.

    PubMed

    Chang, Patrick

    2004-01-01

    Venous thromboembolic disease, including deep vein thrombosis and pulmonary embolism, is a cause of significant mortality and morbidity. In the US, approximately 260000 cases are diagnosed annually. Current drugs for the prevention and treatment of venous thromboembolism (VTE) include heparin, low-molecular-weight heparins and warfarin. Since they possess several disadvantages, researchers are investigating improved anticoagulants. To understand how any promising anticoagulant would work, a review of the pathophysiology and regulation of the coagulation cascade is provided. The more prominent drugs reviewed include tissue factor pathway inhibitor protein, nematode anticoagulant protein, Factor IX inhibitors, anti-Factor Xa inhibitors (DX-9065a (Daiichi Seiyaku Co Ltd), YM-60828 (Yamanouchi Pharmaceutical Co Ltd), fondaparinux, idraparinux (Sanofi-Synthelabo/NV Organon)), selective thrombin inhibitors (oral heparin, ximelagatran (AstraZeneca plc)) and enhancers of natural anticoagulants (activated protein C, ART-123 (Asahi Kasei Pharma Corp)). PMID:14730467

  9. Primary Venous Obstruction of the Upper Extremity

    PubMed Central

    Rowen, Marshall; Dorsey, Thomas J.; Hepps, S. A.

    1973-01-01

    Three cases of primary axillary and subclavian venous obstruction presented herein demonstrated the classic findings of swelling, aching or pain, and discoloration following effort in an otherwise healthy person. The clinical diagnosis was confirmed by venography. Residual changes were frequent after treatment that included anticoagulation and thrombectomy. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7. PMID:4701707

  10. Cancer related venous thromboembolism - prophylaxis and therapy.

    PubMed

    Gary, Thomas

    2014-07-01

    Cancer is a highly thrombophilic entity leading to a high rate of symptomatic and even asymptomatic venous thromboembolic (VTE) events in patients suffering from malignant disease. As VTE events have impact on survival and can be reduced significantly by anticoagulant treatment, guidelines on prophylaxis of these events by means of anticoagulation exist from various societies. Purpose of this review is to give a concise overview of current possibilities for prophylaxis and also for the therapy of VTE events in cancer patients. PMID:25007902

  11. Venous thromboembolic prophylaxis for hip fractures

    Microsoft Academic Search

    D. Marsland; S. C. Mears; S. L. Kates

    2010-01-01

    Patients with hip fractures are at very high risk for the development of venous thromboembolism (VTE). To provide an overview\\u000a of cause, risk factors, current treatment strategies, and complications associated with VTE prophylaxis, we reviewed the most\\u000a current, best available evidence on VTE prophylaxis for patients with hip fractures. We comprehensively reviewed the literature\\u000a to assess the efficacy of VTE

  12. Antithrombotic Therapy for Venous Thromboembolic Disease

    Microsoft Academic Search

    Thomas M. Hyers; Giancarlo Agnelli; Russell D. Hull; Timothy A. Morris; Michel Samama; Victor Tapson; John G. Weg

    (CHEST 2001; 119:176S-193S) S tasis of blood, abnormalities of the vessel wall, and changes in the soluble and formed elements of the blood are the major contributors to thrombosis. All of these alterations can contribute to venous thrombosis, depending on the specific risk factors that are present in a given patient. Antithrombotic regimens modify one or more of these abnormalities.

  13. Venous air embolism during laparoscopic cholecystectomy.

    PubMed

    Abut, Yesim Cokay; Eryilmaz, Ramazan; Okan, Ismail; Erkalp, Kerem

    2009-01-01

    Vascular air embolism is a rare and potentially life-threatening event. In this study, a case of venous air embolism during laparoscopic cholecystectomy due to an injured inferior vena cava is presented. Anesthesiologists and surgeons must be aware of this dangerous complication. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications. PMID:19929300

  14. Venous Leg Ulcerations: A Treatment Update

    Microsoft Academic Search

    Ronda S. Farah; Mark D. P. Davis

    2010-01-01

    Opinion statement  Selecting the appropriate treatment for venous leg ulcerations is essential for optimal wound healing and patient quality\\u000a of life. Compression therapy remains the mainstay of treatment for these wounds. Compression methods should be carefully selected\\u000a and tailored for compatibility with patients’ daily life. Pain management should not be neglected. When response to compression\\u000a therapy is limited, adjuvant therapy such

  15. [Anatomic and functional features of venous valves].

    PubMed

    Griton, P; Vanet, P; Cloarec, M

    1997-05-01

    The comparison of the venous system in the human organism, and in particular the venous valves of the lower limbs, with studies conducted in animal models helped us to understand better the mechanisms involved in adapting to the upright position and walking. We examined work conducted in several species from the horse to the dog, especially in animals who often take on an upright position such as the chimpanzee and the kangouroo, in search for structures comparable to those in man. Different types of valves can be described in man: flotting valves (bicuspid, pigeon nest valves); reinforced valves (mid-thigh); reinforcing valves (periarticular zone in the knee); finally, "flat" valves which are highly resistant formations but with little anti-back flow action. We also describe valvular structures with muscle cells found in the plantar aspect of the foot and the veins of the quadriceps muscle, these valves may have an active hematopropulsive action (Bassi). These results allowed us to identify certain common points between the structures observed in the posterior legs of certain animals and to propose models for investigating venous diseases. PMID:9480339

  16. Unanswered questions, unmet needs in venous thromboprophylaxis.

    PubMed

    Cushner, Fred D; Nett, Michael P

    2009-12-01

    Although significant progress has been made over the past 25 years in preventing thromboembolic disease in patients undergoing total hip and total knee arthroplasty, important questions remain unanswered. Few would debate the need to seek a balance between maximal antithrombotic efficacy and minimal bleeding in choosing a thromboprophylactic strategy, but there is less agreement as to how efficacy should be defined, and whether efficacy and safety (however each is defined) are intrinsic to the thromboprophylactic agent chosen or depend as well on exogenous factors, ranging from the timing of drug administration to surgical technique. Differences between recent guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) illustrate these unanswered questions. The AAOS guidelines focus solely on preventing symptomatic pulmonary embolism and ignores the importance of other acute and chronic manifestations of venous thromboembolic disease. The ACCP, on the other hand, does consider these other manifestations of venous thromboembolic disease, and thus reaches very different conclusions about what constitutes effective thromboprophylaxis. Despite these questions and uncertainties, there are fundamental truths: (1) venous thromboembolism (VTE) is a known and serious complication of total joint arthroplasty, and (2) evidence-based thromboprophylaxis works. Gaps between guideline-recommended and actual orthopedic practice must be reduced. PMID:20201478

  17. Aurin tricarboxylic acid inhibits experimental venous thrombosis.

    PubMed

    Bernat, A; Lale, A; Herbert, J M

    1994-06-15

    In vitro, aurin tricarboxylic acid (ATA) inhibited ristocetin-induced human platelet agglutination in a dose-dependent manner. The IC50 value (dose which inhibits 50% of platelet agglutination) was 60 +/- 8.7 micrograms/ml. In vivo, the i.v. administration of ATA to rats reduced the thrombus formation in an arteriovenous shunt with an ED50 value of 9.0 +/- 1.6 mg/kg. In a venous thrombosis model, using a combination of a thrombogenic challenge and stasis, ATA displayed a significant, dose-dependent antithrombotic effect, the ED50 value being of 18.3 +/- 2.0 mg/kg. In an experimental model of disseminated intravascular coagulation, ATA protected mice from the lethal effect of thromboplastin-induced thromboembolism with a ED50 value of 1.1 +/- 0.15 mg/kg, being in that respect 12 times less potent than standard heparin (ED50 = 90 +/- 15 micrograms/kg). These observations therefore show that ATA is active in both arterial- or venous-type thrombosis models and suggest that von Willebrand Factor might be important not only in arterial but also in venous thrombosis. PMID:8091404

  18. Fibroblasts cultured from distal lower extremities in patients with venous reflux display cellular characteristics of senescence

    Microsoft Academic Search

    Manuel V. Mendez; Andrew Stanley; Tania Phillips; Melissa Murphy; James O. Menzoian; Hee-Young Park

    1998-01-01

    Purpose: Venous reflux precedes the development of venous ulcers. Our earlier work showed that the fibroblasts that are cultured from these wounds display more characteristics of senescence. We evaluated fibroblast senescence in patients with venous reflux but without ulcers to further investigate the role of venous reflux in the predisposition to venous ulcers. Methods: Fibroblasts that were isolated from skin

  19. Core content for training in venous and lymphatic medicine

    PubMed Central

    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

    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

  20. Factors related to venous ulceration: a cross-sectional study.

    PubMed

    Vlajinac, Hristina; Marinkovic, Jelena; Maksimovic, Milos; Radak, Djordje

    2014-10-01

    The aim of the study was to determine the factors related to venous ulceration. Patients with venous ulceration (278 patients) were compared with 1401 patients in other categories of clinical classification of venous disease (clinical, etiologic, anatomic, and pathophysiological [CEAP]). Demographic, anthropometric, and clinical data were collected. Univariate and multivariate logistic regression analyses were used. According to multivariate analyses, risk factors for venous ulceration were age, male sex, personal history of superficial and deep venous thrombosis, diabetes, high blood pressure, skeletal or joint disease in the legs and emphysema or chronic obstructive pulmonary disease, higher body mass index and physical inactivity, parental history of ankle ulcer as well as reflux in deep and perforator veins, deep obstruction, and combination of reflux and obstruction. It seems reasonable to pay special attention to patients in whom the postulated risk factors for venous ulceration are present. PMID:24165114

  1. Cerebral venous thrombosis in two patients with spontaneous intracranial hypotension.

    PubMed

    Garcia-Carreira, M C; Vergé, D Cánovas; Branera, J; Zauner, M; Herrero, J Estela; Tió, E; Perpinyà, G Ribera

    2014-01-01

    Although few patients with spontaneous intracranial hypotension develop cerebral venous thrombosis, the association between these two entities seems too common to be simply a coincidental finding. We describe two cases of spontaneous intracranial hypotension associated with cerebral venous thrombosis. In one case, extensive cerebral venous thrombosis involved the superior sagittal sinus and multiple cortical cerebral veins. In the other case, only a right frontoparietal cortical vein was involved. Several mechanisms could contribute to the development of cerebral venous thrombosis in spontaneous intracranial hypotension. When spontaneous intracranial hypotension and cerebral venous thrombosis occur together, it raises difficult practical questions about the treatment of these two conditions. In most reported cases, spontaneous intracranial hypotension was treated conservatively and cerebral venous thrombosis was treated with anticoagulation. However, we advocate aggressive treatment of the underlying cerebrospinal fluid leak. PMID:25525533

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

    PubMed Central

    2013-01-01

    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

  3. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients

    Microsoft Academic Search

    Manuela Bonizzoli; Stefano Batacchi; Giovanni Cianchi; Giovanni Zagli; Francesco Lapi; Valentina Tucci; Giacomo Martini; Simona Di Valvasone; Adriano Peris

    2011-01-01

    Background  Peripherally inserted central venous catheters (PICC) have been proposed as an alternative to central venous catheters (CVC).\\u000a The aim of this study was to determine the thrombosis rate in relation to PICC placement in patients discharged from the intensive\\u000a care unit (ICU).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Data of patients admitted to the ICU (Careggi Teaching Hospital, Florence, Italy; January–August 2008) and discharged with\\u000a a

  4. Another method to prevent venous thrombosis in microsurgery: an in situ venous catheter.

    PubMed

    Hudson, D A; Engelbrecht, G; Duminy, F J

    2000-03-01

    Free-flap failure is in the order of 4 to 10 percent. Heparin is more effective at preventing venous thrombosis than arterial thrombosis. This study was undertaken to investigate the efficacy of delivering heparin at a high dose locally but low dose systemically (heparin infusion via a catheter placed proximal to the venous anastomosis) to prevent venous thrombosis in microsurgery. A model of venous thrombosis was first established by a venous inversion graft in the rat femoral vein (this was performed in seven animals and resulted in 100 percent thrombosis). Saline and heparin were delivered proximal to the inverted vein graft to assess the effect of each in preventing venous thrombosis. Flow/patency distal to the inverted vein graft was assessed by observation under the microscope, the milk test, and rate of flow (flowmeter). Saline infused via a catheter proximal to the venous inversion graft resulted in 100 percent thrombosis in 10 animals. Heparin (100 U/ml at 2 to 3 ml/hour) infused through a catheter for 2 hours proximal to the anastomosis resulted in flow in all 10 animals during the infusion. Blood was also taken before beginning the procedure (control) and after the heparin infusion distal to the anastomosis (local partial thromboplastin time) as well as in the contralateral femoral vein (systemic). The control for all animals that received heparin was <3 minutes. The systemic partial thromboplastin time after heparin infusion was <3 minutes in seven animals, 3.3 minutes in two animals, and >7 minutes in one animal. The local partial thromboplastin time distal to the inverted vein graft was >10 minutes in nine animals and 3.7 minutes in one animal. The study also had a clinical component, in which a catheter was placed in a vein of the free flap, and heparin was infused over 5 days. This technique has been used in 83 consecutive free flaps. In three recent free flaps performed on the limbs, the local partial thromboplastin time (close to the anastomosis) was raised but the systemic time was normal. This technique offers a method in preventing venous thrombosis in microsurgery. It is simple to implement and is not associated with the systemic complications of heparin. PMID:10724260

  5. Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock

    Microsoft Academic Search

    Marjut Varpula; Sari Karlsson; Esko Ruokonen; Ville Pettilä

    2006-01-01

    Objective  Central venous oxygen saturation (ScvO2) in initial resuscitation is included in the Surviving Sepsis Campaign guidelines. ScvO2 monitoring has also been suggested to be comparable to mixed venous oxygen saturation (SvO2) for clinical purposes. The aim of our study was to assess the correlation and agreement of ScvO2 and SvO2 and compare ScvO2–SvO2 difference to lactate, oxygen-derived and hemodynamic parameters

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

    PubMed

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

    2014-09-01

    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

  7. Venous endothelial injury in central nervous system diseases

    PubMed Central

    2013-01-01

    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

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

    PubMed Central

    Chatterjee, Sasanka S.

    2012-01-01

    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

  9. Validation of cerebral venous oxygenation measured using near-infrared spectroscopy and partial jugular venous occlusion in the newborn lamb

    Microsoft Academic Search

    Flora Y Wong; Charles P Barfield; Louisa Campbell; Vojta A Brodecky; Adrian M Walker

    2008-01-01

    Near-infrared spectroscopy combined with partial jugular venous occlusion (JVO) offers promise for determining cerebral venous saturation (CSvO2) in sick preterm infants, but has not been validated in the newborn brain or under conditions of hypoxaemia. We assessed the accuracy of the CSvO2 estimate using cerebral venous oxygen saturation in superior sagittal sinus blood (SSSO2) as the ‘gold standard’. Comparisons were

  10. [Medial venous catheter or midline (MVC)].

    PubMed

    Carrero Caballero, Ma Carmen; Montealegre Sanz, María; Cubero Pérez, Ma Antonia

    2014-01-01

    Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters. Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Midlines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the necessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Midlines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In general, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings. Midlines have been associated with lower rates of phlebitis than short peripheral IVs, and less infections in contrast to central lines. There are different implantation techniques, which have evolved in terms of materials (silicone and polyurethane) and technological advances (ultrasound): Seldinger technique with micropuncture and Ultrasound-guided Seldinger technique. At present where scientific evidence, clinical needs, efficiency and costs are influential parameters, Midlines should be considered as an alternative peripheral venous access. Unlike PICC lines, Midline catheters offer peripheral, not central venous access. Midlines should be considered early in treatment instead of serial short peripheral IVs. These devices permit the infusion of most or all infusates that are appropriate for short peripheral IVs with the added advantage that Midlines can last much longer; at least six weeks and perhaps for months. PMID:24624619

  11. Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

    PubMed Central

    Hohl Moinat, Christine; Périard, Daniel; Hayoz, Daniel; André, Pascal; Kung, Marc; Betticher, Daniel C.

    2014-01-01

    Insertion of central venous port (CVP) catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE). However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE), or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3%) at 3 months, and 11.3% (IC95 9.4–13.2%) at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3%) at 3 months, and 15.3% (IC95 13.1–17.6%) at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis. PMID:24665264

  12. Response of fibrinolytic activity to venous occlusion.

    PubMed Central

    Shaper, A G; Marsh, N A; Patel, I; Kater, F

    1975-01-01

    Resting fibrinolytic activity and the response of the fibrinolytic system to venous occlusion were studied in a group of healthy middle-aged men. All subjects showed increased fibrinolytic activity but of varying degrees. There was a linear relationship between resting and occluded levels of fibrinolytic activity but many subjects with lower levels of fibrinolytic activity showed an anomalous response. Responses over the expected level were more common than unexpectedly low levels of response. Fibrinogen and plasminogen concentrations were inversely correlated with fibrinolytic activity. PMID:1174826

  13. Hypercoagulability and venous thromboembolism in burn patients.

    PubMed

    Meizoso, Jonathan P; Ray, Juliet J; Allen, Casey J; Van Haren, Robert M; Ruiz, Gabriel; Namias, Nicholas; Schulman, Carl I; Pizano, Louis R; Proctor, Kenneth G

    2015-02-01

    To our knowledge, this is the first comprehensive review on the subject of venous thromboembolism (VTE) and hypercoagulability in burn patients. Specific changes in coagulability are reviewed using data from thromboelastography and other techniques. Disseminated intravascular coagulation in burn patients is discussed. The incidence and risk factors associated with VTE in burn patients are then examined, followed by the use of low-molecular-weight heparin thromboprophylaxis and monitoring techniques using antifactor Xa levels. The need for large, prospective trials in burn patients is highlighted, especially in the areas of VTE incidence and safe, effective thromboprophylaxis. PMID:25590525

  14. Pleomorphic malignant fibrous histiocytoma/undifferentiated high-grade pleomorphic sarcoma of the scrotum in a patient presenting as fournier gangrene: a case report.

    PubMed

    Guo, Juan; Zhou, Shengmei; Rao, Nagesh P; Pez, Gholam H

    2010-10-01

    Pleomorphic malignant fibrous histiocytoma (MFH), also known as undifferentiated high-grade pleomorphic sarcoma according to the latest World Health Organization classification, is a diagnosis of exclusion and extremely rare in adult scrotal/paratesticular region. Clinical presentation of scrotal/paratesticular pleomorphic MFH is usually a painless and gradual scrotal swelling. We report a case of scrotal MFH in a 63-year-old man who presented as Fournier gangrene after 10-month painful scrotal swelling and multiple procedures. The specimen of emergent debridement was submitted for pathologic and bacteriologic examination. Microscopically, the lesion had marked architectural and cytologic pleomorphism. The neoplastic cells were positive for vimentin, but negative for all lineage-specific markers. Fluorescence in-situ hybridization showed an aneuploid karyotype and negative results for lipomatous tumor abnormalities. Bacterial cultures of the specimen showed extensive growth of virulent polymicrobes. The diagnosis of scrotal/paratesticular pleomorphic MFH with concurrent Fournier gangrene was made. Thoracic computed tomography scan showed bilateral multiple pulmonary nodules. The patient died 1 month later. PMID:20505510

  15. Diet as prophylaxis and treatment for venous thromboembolism?

    Microsoft Academic Search

    David K Cundiff; Paul S Agutter; P Colm Malone; John C Pezzullo

    2010-01-01

    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

  16. Ultrasonic locating devices for central venous cannulation: meta-analysis

    Microsoft Academic Search

    Daniel Hind; Neill Calvert; Richard McWilliams; Andrew Davidson; Suzy Paisley; Catherine Beverley; Steven Thomas

    2003-01-01

    Objectives To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. Data sources 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. Design Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. Intervention reviewed Guidance using real time two dimensional ultrasonography or Doppler needles and

  17. Is there a Link Between Atherothrombosis and Deep Venous Thrombosis?

    PubMed Central

    ANDREI, Maria-Cristina; ANDERCOU, Aurel

    2014-01-01

    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

  18. A volumetric index for the quantification of deep venous thrombosis

    Microsoft Academic Search

    Kenneth Ouriel; Roy K. Greenberg; Richard M. Green; James M. Massullo; Debra R. Goines

    1999-01-01

    Purpose: The evaluation of treatment strategies for deep venous thrombosis (DVT) is assessed through the use of a reliable method of quantifying the extent of the thrombotic process. Previous indices of thrombus burden have suffered from various limitations, including lack of clinical relevance, poor correlation with actual thrombus mass, and failure to include important venous segments in the methodology. The

  19. Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators

    Microsoft Academic Search

    Grzegorz Rozmus; James P. Daubert; David T. Huang; Spencer Rosero; Burr Hall; Charles Francis

    2005-01-01

    Venous complications of pacemaker\\/ implantable cardioverter defibrillator (ICD) system implantation rarely cause immediate clinical problems. The challenge starts when patients come for system revision or upgrade. Numerous reports of venous complications such as stenosis, occlusions, and superior vena cava syndrome have been published. We reviewed current knowledge of these complications, management, and their impact on upgrade\\/revision procedures. One study has

  20. Venous sampling: its role in localization of endocrine tumours.

    PubMed

    Chan, F L; Lam, K S

    1993-09-01

    Despite recent instrumentation advancement in morphologic imaging, venous sampling remains a sensitive physiological investigation for functional localization of hormonal hypersecretion. The test requires technical expertise and reliable laboratory support, and should be selectively applied to address individual clinical problems in coordination with other imaging modalities. Depending on the venous anatomy, sampling may achieve regional localization or lateralization of the endocrine tumour. Adrenal venous sampling serves to lateralize functioning tumour, and to differentiate it from hyperplasia. Inferior petrosal sinus sampling confirms pituitary Cushing's disease and lateralizes the adenoma. Systemic venous sampling identifies the site of ectopic hormonal secretion. In the localization of pancreatic islet cell tumours, the test is further enhanced by sampling after intraarterial injection of hormonal secretagogue. The experience of venous sampling in a regional referral hospital is discussed, including the patient selection, its technical details, pitfalls and effectiveness in achieving tumour localization for patient management. PMID:8267350

  1. Occult pulmonary embolism: a common occurrence in deep venous thrombosis

    SciTech Connect

    Dorfman, G.S.; Cronan, J.J.; Tupper, T.B.; Messersmith, R.N.; Denny, D.F.; Lee, C.H.

    1987-02-01

    Ventilation-perfusion scans were used in a prospective study to determine the prevalence of occult pulmonary embolus in proven deep venous thrombosis. Fifty-eight patients without symptoms of pulmonary embolism, but with venographically proven deep venous thrombosis, were subjected to chest radiographs, /sup 99m/Tc macroaggregated-albumin perfusion scans, and /sup 133/Xe ventilation scans. Of the 49 patients with deep venous thrombosis proximal to the calf veins, 17 (35%) had high-probability scans. Of all 58 patients, only 12 (21%) had normal scans. When the study population was compared with a group of 430 patients described in reports of pulmonary perfusion in asymptomatic persons, a significantly higher percentage of high-probability scans was found in the study population with deep venous thrombosis. Baseline ventilation-perfusion lung scanning is valuable for patients with proven above-knee deep venous thrombosis.

  2. Venous return curves obtained from graded series of valsalva maneuvers

    NASA Technical Reports Server (NTRS)

    Mastenbrook, S. M., Jr.

    1974-01-01

    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.

  3. Unilateral Loss of Spontaneous Venous Pulsations in an Astronaut

    NASA Technical Reports Server (NTRS)

    Mader, Thomas H.; Gibson, C. Robert; Lee, Andrew G.; Patel, Nimesh; Hart, Steven; Pettit, Donald R.

    2014-01-01

    Spontaneous venous pulsations seen on the optic nerve head (optic disc) are presumed to be caused by fluctuations in the pressure gradient between the intraocular and retrolaminar venous systems. The disappearance of previously documented spontaneous venous pulsations is a well-recognized clinical sign usually associated with a rise in intracranial pressure and a concomitant bilateral elevation of pressure in the subarachnoid space surrounding the optic nerves. In this correspondence we report the unilateral loss of spontaneous venous pulsations in an astronaut 5 months into a long duration space flight. We documented a normal lumbar puncture opening pressure 8 days post mission. The spontaneous venous pulsations were also documented to be absent 21 months following return to Earth.. We hypothesize that these changes may have resulted from a chronic unilateral rise in optic nerve sheath pressure caused by a microgravity-induced optic nerve sheath compartment syndrome.

  4. Managing unusual presentations of venous thromboembolism.

    PubMed

    Ageno, Walter

    2015-04-01

    Venous thromboembolism that occurs in unusual sites is challenging because of the potential severity of presentation, the presence of some major provoking risk factors, the high prevalence of potential contraindications to antithrombotic therapies, the lack of solid evidence to guide therapeutic decisions, and because of the severity of long-term consequences. For example, venous thrombosis in the splanchnic veins frequently occurs in patients with liver cirrhosis. Not uncommonly, these patients present with concomitant active gastrointestinal bleeding, and/or low platelet count or oesophageal varices. If inadequately treated, splanchnic vein thrombosis (SVT) may further worsen portal hypertension and, thus, increase the long-term risk of bleeding. Up to 40 % of patients with cerebral vein thrombosis (CVT) have signs of intracranial bleeding at the time of the diagnosis. This finding is associated with worst prognosis in terms of death or severe disability. Despite the apparent presence of a major contraindication to anticoagulation, only a timely administration of parenteral anticoagulant drugs may improve this unfavourable outcome. The available evidence on the management of these two challenging disorders, SVT and CVT, will be reviewed in this article. PMID:25682057

  5. [Comparative plethymography studies of arterial and venous hemodynamic parameters in the calf and foot in deep venous thrombosis].

    PubMed

    Franzeck, U K; Hagenbuch, R; Bollinger, A

    1983-03-01

    In 33 patients with acute deep venous thrombosis of the lower extremity, all verified by phlebography, and in 36 healthy subjects arterial inflow, venous volume and maximum venous outflow were measured by mercury-strain gauge plethysmography. The measurements were performed simultaneously in both legs at the calf and foot level with a cuff pressure of 60 mm Hg for 4 min. In contrast to thrombotic occlusions proximal to the knee and multi-level thromboses, which could be identified by a significantly (p less than 0.001) reduced venous volume and maximum venous outflow (measurement at the calf level), isolated calf vein thromboses could not be detected even by sensing from the foot level or only if all three deep veins of the calf were occluded. The best diagnostic criterion for proximal deep venous thrombosis was the correlation of maximum venous outflow and venous volume (83% right positive), if these parameters were determined from the calf. The results indicate that deep calf vein thrombosis can be detected, even if sensed from the foot, only in cases with cross sectional thrombotic occlusions. PMID:6843049

  6. Historical overview of venous valve prostheses for the treatment of deep venous valve insufficiency.

    PubMed

    Zervides, Constantinos; Giannoukas, Athanasios D

    2012-04-01

    Almost 3% of people in the Western world will suffer from a venous disease at some time in their lives, but as yet there are very few effective treatments for the venous system. When the valves become incompetent, they allow backflow and subsequent pooling of blood in the lower extremities. Current clinical therapies for the elimination of deep reflux are very invasive and provide short-lasting results. Thus, there is an urgent need for technological evolution of implantable valves and, if possible, with minimally invasive techniques. This review provides a basic history of the discovery of deep vein valves and various designs of prosthetic vein valves that have been evaluated in animal models and clinical studies. PMID:22545896

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

    PubMed

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

    2011-12-01

    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

  8. Regional hyperthermic fibrinolytic perfusion after unsuccessful venous thrombectomy of extensive deep venous thrombosis

    Microsoft Academic Search

    Achim Mumme; Wilfried Heinen; Bruno Geier; Winfried Maatz; Letterio Barbera; Gerhard Walterbusch

    2002-01-01

    Objective: Because of the dose-dependent increase in bleeding complications, the intraoperative administration of fibrinolytic agents is limited. This limitation impairs the efficacy of fibrinolytic therapy because low-dose fibrinolysis often fails in the treatment of complex deep venous thrombosis (DVT). The aim of this study was to investigate the efficacy and safety of intraoperative high-dose fibrinolytic therapy for extended DVT, which

  9. Venous Duplex Ultrasound of the Lower Extremity in the Diagnosis of Deep Venous Thrombosis

    Microsoft Academic Search

    Bruce L. Mintz; Clifford T. Araki; Athena Kritharis; Robert W. Hobson II

    Duplex ultrasonography has dominated the clinical landscape for the diagnosis of acute deep venous thrombosis (DVT) since\\u000a the early 1990s with utilization increasing in both the outpatient and inpatient milieu. Although this modality was initially\\u000a flawed by high cost, cumbersome size, and low resolution, advancing technology has eliminated many of the early objections\\u000a to the point where ultrasound has become

  10. Cardiovascular Pressures with Venous Gas Embolism and Decompression

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Robinson, R.; Sutton, T.; Kemper, G. B.

    1995-01-01

    Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.

  11. [Present and future in the management of venous vascular diseases].

    PubMed

    Gavorník, Peter; Dukát, Andrej; Gašpar, ?udovít; Gavorníková, Eva

    2015-01-01

    The prevalence and the incidence of chronic and acute venous vascular disease has been shown to be globally very high, in both industrialized and developing countries. Chronic venous diseases of lower extremities are being an integral part of the third millennium´s deadly angiopandemy, at the present time. The rate of the most severe cases with advanced stage of venous failure is approximately twice as high in the population (2.1 %) as has been assumed so far. Among venoactive drugs (VAD), micronized purified flavonoid fraction (MPFF) of diosmin hesperidin remains the agent with the highest degree of recommendation and it also indicated to pharmacotherapeutical support of leg ulcer healing, along with sulodexide and pentoxifylline. Compressive sclerotherapy, liquid or foam, is a safe and effective invasive method to treat telangiectasias, reticular varicose veins and subcutaneous varicose veins. Direct oral anticoagulants (DOAC) represent one of the therapeutic and preventive options of deep venous thrombosis (DVT) and of venous thromboembolism (VTE) with a limitation in patients with malignant conditions and in pregnancy. The most effective is triple simultaneous pharmaco-kinezio-mechano-phlebothromboemboloprophylaxis. Superficial vein thromboses longer than 5 cm are indicated to anticoagulant therapy too.Key words: angiology/vascular medicine - future - management - phlebology/venous medicine - present - vein - venous vascular disease. PMID:25813260

  12. Choroidal venous pulsations at an arterio-venous crossing in polypoidal choroidal vasculopathy.

    PubMed

    Okubo, Akiko; Sameshima, Munefumi; Sakamoto, Taiji

    2013-10-01

    It has been reported that pulsations in abnormal vessels are observed on indocyanine green (ICG) angiography in half of patients with polypoidal choroidal vasculopathy (PCV), although the mechanism of the pulsation is unknown. In this study, we report a case of PCV showing venous pulsations at an arterio-venous (A-V) crossing, and discuss a possible mechanism of polypoidal vessel formation and pulsations in PCV. A 66-year-old female presented with a reddish-orange elevated lesion and serous retinal detachment in the macula of her left eye, and was diagnosed as PCV. She was treated with photodynamic therapy (PDT), and followed-up through routine examinations, including ICG angiography. ICG angiography at presentation showed a branching vascular network and choroidal venules with dye leakage (polypoidal vessels) in the left eye. Pulsations, supposedly of venous origin, were observed at an A-V crossing in the abnormal vessels. Within 3 months after PDT, the polypoidal vessel ceased to leak and the pulsations vanished. The reddish-orange lesion gradually decreased in size with complete disappearance of retinal detachment. This study suggests that an unusual compression at an A-V crossing may make a venule polypoidal, and fluctuations of blood flow and pressure in the venule may cause pulsatile movements of the vessel wall. PMID:24082779

  13. Total Anomalous Pulmonary Venous Return in Siblings

    PubMed Central

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

    2014-01-01

    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

  14. Latest medical treatment strategies for venous thromboembolism.

    PubMed

    McRae, Simon J; Eikelboom, John W

    2007-06-01

    Anticoagulant therapy with unfractionated heparin (UFH) followed by warfarin prevents thrombus extension, reduces the risk of recurrent thrombosis and prevents death in patients with venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) has replaced UFH as the preferred initial anticoagulant therapy for VTE because it is as effective and safe as UFH, but does not require laboratory monitoring and is less likely to cause immune thrombocytopenia and osteoporosis. More recently, fondaparinux has been shown to be an effective and safe alternative to LMWH and several new parenteral anticoagulants are being evaluated. The most important unmet need in the anticoagulant management of VTE is a replacement for warfarin. New oral anticoagulants that selectively target individual steps in the coagulation cascade have been shown to be effective for the long-term treatment of VTE in Phase II and III trials and are likely to become available in the near future. PMID:17563258

  15. Prevention of venous thromboembolism in obesity

    PubMed Central

    Freeman, Andrew L; Pendleton, Robert C; Rondina, Matthew T

    2011-01-01

    Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized patients. Where appropriate, evidence-based methods of prophylaxis are implemented and the burden of VTE can be reduced substantially. Obesity, including morbid obesity, is associated with a high risk of VTE and, unfortunately, fixed doses of US FDA-approved anticoagulant regimens, including unfractionated heparins, low-molecular-weight heparins and factor Xa inhibitors, may not provide optimal VTE prophylaxis in these patients. Although the data are still limited, a rapidly growing body of literature and cumulative evidence suggests that anticoagulant dose adjustments in morbidly obese patients may optimize pharmacodynamic activity and reduce VTE risk. With the prevalence of morbid obesity continuing to rise, more high-quality clinical data are needed to better understand the pathobiology of VTE in obesity and provide effective, yet safe, prevention strategies. PMID:21108553

  16. Biliary Tract Anatomy and its Relationship with Venous Drainage

    PubMed Central

    Ramesh Babu, Chittapuram S.; Sharma, Malay

    2013-01-01

    Portal cavernoma develops as a bunch of hepatopetal collaterals in response to portomesenteric venous obstruction and induces morphological changes in the biliary ducts, referred to as portal cavernoma cholangiopathy. This article briefly reviews the available literature on the vascular supply of the biliary tract in the light of biliary changes induced by portal cavernoma. Literature pertaining to venous drainage of the biliary tract is scanty whereas more attention was focused on the arterial supply probably because of its significant surgical implications in liver transplantation and development of ischemic changes and strictures in the bile duct due to vasculobiliary injuries. Since the general pattern of arterial supply and venous drainage of the bile ducts is quite similar, the arterial supply of the biliary tract is also reviewed. Fine branches from the posterior superior pancreaticoduodenal, retroportal, gastroduodenal, hepatic and cystic arteries form two plexuses to supply the bile ducts. The paracholedochal plexus, as right and left marginal arteries, run along the margins of the bile duct and the reticular epicholedochal plexus lie on the surface. The retropancreatic, hilar and intrahepatic parts of biliary tract has copious supply, but the supraduodenal bile duct has the poorest vascularization and hence susceptible to ischemic changes. Two venous plexuses drain the biliary tract. A fine reticular epicholedochal venous plexus on the wall of the bile duct drains into the paracholedochal venous plexus (also called as marginal veins or parabiliary venous system) which in turn is connected to the posterior superior pancreaticoduodenal vein, gastrocolic trunk, right gastric vein, superior mesenteric vein inferiorly and intrahepatic portal vein branches superiorly. These pericholedochal venous plexuses constitute the porto-portal collaterals and dilate in portomesenteric venous obstruction forming the portal cavernoma. PMID:25755590

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

    E-print Network

    Duong, Timothy Q.

    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 is dependent only on venous blood, not arterial blood. Thus, relative venous and arterial blood volume (r

  18. Assessment of the risk factors for impending fractures following radiotherapy for long bone metastases using CT scan-based virtual simulation: a retrospective study.

    PubMed

    Tatar, Zuzana; Soubrier, Martin; Dillies, Anne; Verrelle, Pierre; Boisgard, Stéphane; Lapeyre, Michel

    2014-10-16

    BackgroundRadiotherapy for long bone metastases (RTLB) can be complicated by fractures, which considerably increase morbidity and mortality. The aim of this study was to analyze the risk factors for impending fractures following radiotherapy for long bone metastases (RTLB) using CT scan-based virtual simulation.MethodsForty-seven (47) patients were treated with RTLB (18 lung, 11 breast, 10 prostate and 8 other cancers) for a period of 18 months. Two doctors analyzed the CT images prior to radiation therapy. The impending fractures were then monitored and the correlation between bone scan parameters and fracture occurrence was analyzed.ResultsThe male gender ratio was 0.57 and the mean age 62.8 (33¿93) years. The average size of the metastatic lesions was 32 (8¿87) x 2 (6¿81) x 52 (7¿408) mm with cortical involvement (CI) in 66% of cases. The site was in the upper third of the bone in 92% of cases (28 femoral, 17 humeral and two tibial).Ten fractures occurred: two during RTLB, seven after one month and one after 6.6 months. The fractured lesions measured 48 (17¿87) x 34 (12¿66) x 76 (38¿408) mm. The predictive parameters for fracture were osteolytic (39% vs. 10%; p¿=¿0.02) and permeative lesions (42% vs. 0%; p¿<¿0.0005), a Mirels score ¿9 (42% vs. 0%; p¿<¿0.0005), circumferential CI ¿30% (71% vs. 0%, p¿<¿0.00001), CI ¿45 mm in height (67% vs. 0%, p¿<¿0.00001) and CI in thickness =100% (40% vs. 0%; p¿=¿0.0008). In the multivariate analysis, circumferential CI ¿30% was the only predictive parameter for fracture (p¿=¿0.00035; OR¿=¿62; CI 95%: 6.5-595). Overall survival was 91% and 40% at one month and twelve months respectively.ConclusionsProphylactic primary fixation surgery should always be considered when the circumferential CI ¿30%. PMID:25319635

  19. Venous thromboembolism in amyotrophic lateral sclerosis

    PubMed Central

    Gladman, Matthew; DeHaan, Melanie; Pinto, Hanika; Geerts, William

    2014-01-01

    Objective: To prospectively assess the incidence of both symptomatic and asymptomatic venous thromboembolism (VTE) in patients with amyotrophic lateral sclerosis (ALS) and to identify risk factors. Methods: Fifty outpatients with ALS were recruited consecutively and prospectively evaluated with bilateral venous duplex ultrasonography (VDU) of the proximal leg veins at enrollment and 6 and 12 months. The primary outcome measure was clinically important VTE, defined as asymptomatic proximal deep vein thrombosis (DVT) by screening VDU, symptomatically proven DVT or pulmonary embolism (PE), or fatal PE. For each patient, person-days of follow-up were recorded from enrollment until the date of VTE, death, loss to follow-up, or final 12-month visit. Results: During the 1-year follow-up period, VTE was detected in 4 patients (1 symptomatic DVT, 1 symptomatic PE, and 2 asymptomatic DVTs) over 13,011 person-days of follow-up, representing an 11.2% 1-year incidence. Subjects with leg-onset ALS or significant leg weakness had a 1-year VTE incidence rate of 35.8% and 35.5%, respectively. VTE risk was significantly increased for those patients with decreased lower extremity Revised ALS Functional Rating Scale subscore (p = 0.03), decreased Lower Extremity Activity Scale score (p = 0.02), and decreased average lower limb Medical Research Council scale strength score (p = 0.03). Conclusions: Our data suggest that clinically important VTE is common in patients with ALS, particularly those with leg weakness and reduced mobility. Given these results, the potential benefits of routine VTE screening and primary prophylaxis in high-risk patients with ALS with leg weakness should be explored in future studies. In the meantime, physicians should have a low threshold for considering VTE in patients with ALS with leg weakness. PMID:24727309

  20. [Purpura fulminans, venous thrombosis and constitutional thrombophilia in an infant].

    PubMed

    Fadil, F; Elfatoiki, F; Mortaji, K; Lasry, F; Itri, M; Khadir, K; Benchikhi, H; Sarbati, N; Nadifi, S

    2013-05-01

    The association of idiopathic purpura fulminans (PF) and venous thrombosis (VT) seldom reveals constitutional thrombophilia in an infant. We report a case of PF in an 18-month-old infant. Laboratory tests showed disseminated intravascular coagulation (DIVC) with normal rates of C and S proteins and antithrombin. The echo-Doppler examination conveyed venous thrombosis of the lower limbs, while the genetic study showed heterozygous mutation of Factor II (G 20210A). Precocious and multidisciplinary management included frozen fresh plasma supplementation and necrosectomy with skin grafts. The diagnosis and therapeutic problems posed by PF combined with deep venous thrombosis are discussed. PMID:23566584

  1. Acute mesenteric venous thrombosis with a vaginal contraceptive ring.

    PubMed

    Eilbert, Wesley; Hecht, Benjamin; Zuiderveld, Loren

    2014-07-01

    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

  2. [Capillary telangiectasia and developmental venous anomaly: a rare association].

    PubMed

    Arcalís Guaus, N; Medrano Martorell, S; Cuadrado Blázquez, M; García Figueredo, D

    2013-01-01

    We review the relevant literature for a case of capillary telangiectasia associated with a developmental venous anomaly in the pons discovered incidentally. The most common established associations among vascular malformations are capillary telangiectasias with cavernous malformations and developmental venous anomalies with cavernous malformations. The association of a capillary telangiectasia with a developmental venous anomaly is very rare and only two cases affecting the posterior fossa have been reported. An analysis of the associations among vascular malformations leads to a discussion of the role of obstructed flow in their pathogenesis and whether these malformations can be considered a spectrum of manifestations of a single disease. PMID:21529862

  3. Extensive portal venous gas: Unlikely etiology and outcome.

    PubMed

    Schatz, Tiffany P; Nassif, Mohammed O; Farma, Jeffrey M

    2015-01-01

    Portal venous gas or hepatic portal venous gas (HPVG) found on imaging portends grave outcomes for patients suffering from ischemic bowel disease or mesenteric ischemia. HPVG is more rarely seen with severe but treatable abdominal infection as well as multiple benign conditions, and therefore must be aggressively evaluated. We report a 70-year old female who developed extensive intra- and extra-hepatic portal venous gas, pneumatosis intestinalis and free air associated with a perforation of the jejunojejunostomy after a gastrectomy for gastric carcinoma. PMID:25681812

  4. Vertebral venous channels: CT appearance and differential considerations

    SciTech Connect

    Sartoris, D.J.; Resnick, D.; Guerra, J. Jr.

    1985-06-01

    A comprehensive study of the anatomy, radiologic images, and pathology of venous channels in the thoracic and lumbar vertebral bodies was performed using cadavers and patients. These structures may be mistaken for fractures, lytic lesions, or other abnormalities on high-resolution axial computed tomographic (CT) scans of the spine. A distinct osseous wall, absence of extension over multiple contiguous levels, lack of displacement, and predominant localization in the mid-axial plane of the vertebral body are characteristic features of venous channels. An understanding of the normal intraosseous venous anatomy should prevent misinterpretation of clinical CT studies in most instances.

  5. Update on the lower extremity venous ultrasonography examination.

    PubMed

    Needleman, Laurence

    2014-11-01

    Lower extremity venous ultrasonography is an accurate method to diagnose acute deep venous thrombosis (DVT). Recurrent DVT is often difficult diagnosis. The decision to order ultrasonography can be based on pretest risk assessment. If the ultrasonography study is negative, the report may recommend follow-up for patients whose clinical condition changes or for patients with specific risks. Lower extremity venous ultrasonography is the gold standard for diagnosis of DVT. It is accurate and objective, and because the clinical assessment of patients is limited and its potential complication, pulmonary embolism, is significant, the impact of a positive and negative test is high. PMID:25444111

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

    Microsoft Academic Search

    Jeshen H. G. Lau; William Drake; Matthew Matson

    2007-01-01

    Endocrine venous sampling plays a specific role in the diagnosis of endocrine disorders. In this article, we cover inferior\\u000a petrosal sinus sampling, selective parathyroid venous sampling, hepatic venous sampling with arterial stimulation, adrenal\\u000a venous sampling, and ovarian venous sampling. We review their indications and the scientific evidence justifying these indications\\u000a in the diagnosis and management of Cushing’s syndrome, hyperparathyroidism, pancreatic

  7. Upper extremity impedance plethysmography in patients with venous access devices.

    PubMed

    Horne, M K; Mayo, D J; Alexander, H R; Steinhaus, E P; Chang, R C; Whitman, E; Gralnick, H R

    1994-10-01

    Central venous access devices (VADs) are often associated with thrombotic obstruction of the axillary-subclavian venous system. To explore the accuracy of impedance plethysmography (IPG) in identifying this complication we performed IPG on 35 adult cancer patients before their VADs were placed and approximately 6 weeks later. At the time of the second IPG the patients also underwent contrast venography of the axillary-subclavian system. The venograms revealed partial venous obstruction in 12 patients (34%) and complete obstruction in two (5.7%). Although the IPG results from venographically normal and abnormal patients overlapped extensively, mean measurements of venous outflow were significantly lower in the patient population with abnormal venograms (P = 0.052 for Vo; P = 0.0036 for Vo/Vc). In our hands, therefore, upper extremity IPG cannot be used to make clinical decisions about individual patients with VADs, but it can distinguish venographically normal and abnormal populations. PMID:7878628

  8. ?R2 (*) gadolinium-diethylenetriaminepentacetic acid relaxivity in venous blood.

    PubMed

    Patil, Vishal; Johnson, Glyn

    2013-04-01

    The accuracy of perfusion measurements using dynamic, susceptibility-weighted, contrast-enhanced MRI depends on estimating contrast agent concentration in an artery, i.e., the arterial input function. One of the difficulties associated with obtaining an arterial input function are partial volume effects when both blood and brain parenchyma occupy the same pixel. Previous studies have attempted to correct arterial input functions which suffer from partial volume effects using contrast concentration in venous blood. However, the relationship between relaxation and concentration (C) in venous blood has not been determined in vivo. In this note, a previously employed fitting approach is used to determine venous relaxivity in vivo. In vivo relaxivity is compared with venous relaxivity measured in vitro in bulk blood. The results show that the fitting approach produces relaxivity calibration curves which give excellent agreement with arterial measurements. PMID:22576560

  9. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...

  10. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...

  11. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...

  12. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...

  13. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A...

  14. Deep venous thrombosis and postthrombotic syndrome: Invasive management.

    PubMed

    Comerota, Aj

    2015-03-01

    Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava. PMID:25729069

  15. Facts about Total Anomalous Pulmonary Venous Return or TAPVR

    MedlinePLUS

    ... Links to Other Websites Information For... Media Policy Makers Facts about Total Anomalous Pulmonary Venous Return or ... this image. Â Close Information For... Media Policy Makers Language: English Español (Spanish) File Formats Help: How ...

  16. Facts and fiction surrounding the discovery of the venous valves.

    PubMed

    Scultetus, A H; Villavicencio, J L; Rich, N M

    2001-02-01

    Venous valves are delicate structures, the integrity of which is crucial for the normal function of the venous system. Their abnormalities lead to widespread disorders, ranging from chronic venous insufficiency to life-threatening thromboembolic phenomena. The discovery of the venous valves, however, has been the subject of hot controversy. Even though Fabricius ab Aquapendente is credited with the discovery by most historians, we demonstrate in this paper that other anatomists described them many years before Fabricius ab Aquapendente publicly demonstrated them in Padua in 1579. A thorough review of the historical literature surrounding the discovery of the venous valves was carried out from 1545 to the present under the supervision of the Medical History Department of our institution. Research was performed at the History of Medicine Division of the National Library of Medicine and through MEDLINE access to the medical literature. The Parisian Charles Estienne first mentioned the venous valves in his 1545 publication when he described "apophyses membranarum" in the veins of the liver. Lusitanus and Canano publicly demonstrated them in the azygos vein during cadaver dissections performed in Ferrera, Italy. The Parisian Jacques Sylvius described valves in the veins of the extremities in 1555. The work of these anatomists, however, could not achieve full recognition, because Andreas Vesalius, the leading anatomist at that time, was unable to confirm their findings and strongly denied the existence of venous valves. Vesalius's influence was so powerful that research on the subject was idle until 1579, when Fabricius ab Aquapendente "discovered" the venous valves. About the same time, the German Salomon Alberti published the first drawings of a venous valve (in 1585). William Harvey, a disciple of Fabricius ab Aquapendente, finally postulated the function of the venous valves, providing anatomical support for one of the greatest discoveries in medicine: the blood circulation. Therefore, our investigations revealed that Estienne and Canano discovered the venous valves in the 1530s. Fabricius ab Aquapendente's achievement was their full recognition 64 years later. However, it was not until 1628 that their function was fully understood, with the discovery of the blood circulation by William Harvey. PMID:11174802

  17. Venous obstruction in permanent pacemaker patients: an isotopic study

    SciTech Connect

    Pauletti, M.; Di Ricco, G.; Solfanelli, S.; Marini, C.; Contini, C.; Giuntini, C.

    1981-01-01

    Isotope venography was used to study the venous circulation proximal to the superior vena cava in two groups of pacemaker patients, one with a single endocavitary electrode and the other with multiple pacing catheters. A control group of patients without pacemakers was also studied. Numerous abnormalities were found, especially in the group with multiple electrodes. These findings suggest that venous obstruction is a common complication of endocardial pacing.

  18. Serum Lipid Levels and the Risk of Venous Thrombosis

    Microsoft Academic Search

    Carine J. M. Doggen; Nicholas L. Smith; Rozenn N. Lemaitre; Susan R. Heckbert; Frits R. Rosendaal; Bruce M. Psaty

    2004-01-01

    Objective—: Lipids, through effects on the coagulation and fibrinolytic systems, may contribute to the development of venous thrombosis. This association has been investigated in a few studies, with conflicting results.\\u000a \\u000aMethods and Results—: We conducted a population-based, case-control study at a health maintenance organization in Washington State, to assess the association of serum lipid levels with the risk of venous

  19. Impact of Systemic Venous Congestion in Heart Failure

    Microsoft Academic Search

    Matthias Dupont; Wilfried Mullens; W. H. Wilson Tang

    Systemic venous congestion is one of the hallmarks of the syndrome of heart failure that results from activation of different\\u000a deleterious neurohormonal pathways. Apart from contributing to patients’ symptoms and hospital admissions, growing evidence\\u000a suggests that congestion itself drives further heart failure progression. In addition, systemic venous congestion exerts detrimental\\u000a effects on other organs (such as kidneys and liver) due

  20. Prospective study on central venous line associated bloodstream infections

    Microsoft Academic Search

    Mine Wagner; Jan Bonhoeffer; Thomas O Erb; René Glanzmann; Frank Martin Häcker; Michael Paulussen; Daniel Weibel; Ulrich Heininger

    2011-01-01

    ObjectiveTo prospectively assess the incidence rates and characteristics of central venous line associated bloodstream infections (CLABSI) in one institution.MethodsAll patients with indwelling central venous catheters (CVC) between 1 April 2008 and 31 March 2009 were enrolled. The medical records of patients were reviewed and information on relevant characteristics entered into a standardised questionnaire. Central laboratory records were regularly checked for

  1. Venous MR Angiography for Diagnosis and Follow-up

    Microsoft Academic Search

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

    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

  2. Impedance Phlebography for the Diagnosis of Venous Thrombosis

    NASA Astrophysics Data System (ADS)

    Urzic?, Denise; Dorohoi, Dana-Ortansa

    2007-04-01

    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.

  3. Sustained compression and healing of chronic venous ulcers

    Microsoft Academic Search

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

    1988-01-01

    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

  4. Oxpentifylline treatment of venous ulcers of the leg

    Microsoft Academic Search

    M P Colgan; J A Dormandy; P W Jones; I G Schraibman; D G Shanik; R A Young

    1990-01-01

    OBJECTIVE--To determine the effect of oxpentifylline on the healing of venous ulcers of the leg. DESIGN--Double blind, randomised, prospective, placebo controlled, parallel group study. SETTING--Four outpatient clinics treating leg ulcers in England and the Republic of Ireland. PATIENTS--80 Consecutive patients with clinical evidence of venous ulceration of the leg in whom appreciable arterial disease was excluded by the ratio of

  5. Venous pressures in the isolated upper limb during saline injection

    Microsoft Academic Search

    Barry A. Finegan; M. David Bukht

    1984-01-01

    Venous pressure changes were assessed in the antecubital vein of an isolated arm during saline injection via an intravenous\\u000a site on the dorsum of the hand. Although leak of contrast medium has been radiologically demonstrated in these circumstances,\\u000a the compliance of the venous system of the isolated and exsanguinated limb has not been investigated. In five male and five\\u000a female

  6. Investigation of the venous system in impotence of vascular origin

    Microsoft Academic Search

    C. Delcour; E. Wespes; C. C. Schulman; J. Struyven

    1984-01-01

    Vascular pathology is responsible for about 25% of cases of male impotence. Pudendal arteriography has been the object of\\u000a numerous publications. Venous conditions explain the majority of erectile dysfunctions in patients with normal arterial anatomy.\\u000a \\u000a We have performed cavernography in 30 patients, with monitoring of intracavernous pressure and flow measurement. Cavernograms\\u000a allowed study of the corpora cavernosa and the venous

  7. Novel Biomarkers of Arterial and Venous Ischemia in Microvascular Flaps

    PubMed Central

    Nguyen, Gerard K.; Monahan, John F. W.; Davis, Gabrielle B.; Lee, Yong Suk; Ragina, Neli P.; Wang, Charles; Zhou, Zhao Y.; Hong, Young Kwon; Spivak, Ryan M.; Wong, Alex K.

    2013-01-01

    The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and allow clinicians to both diagnose and successfully treat microvascular complications before irreversible tissue damage and flap loss occurs. PMID:23977093

  8. Venous air embolism: A complication during percutaneous nephrolithotomy

    PubMed Central

    Parikh, Geeta P.; Sonde, Sumedha R.; Kadam, Prachi

    2014-01-01

    Venous air embolism during percutaneous nephrolithotomy (PCNL) following air pyelogram or saline irrigation has been occasionally reported. We present a case of suspected venous air embolism during air pyelogram in a patient undergoing PCNL. The clinical diagnosis of air embolism was made by fall in end tidal carbon dioxide, blood pressure and Oxygen saturation and was conservatively managed. Early diagnosis with rapid resuscitation is the key to management of a patient with air embolism. PMID:25097326

  9. An Experimental Model of Intraoperative Venous Injury in the Rat

    PubMed Central

    Nakase, Hiroyuki; Nagata, Kiyoshi; Ohtsuka, Hiroyuki; Sakaki, Toshisuke; Kempski, Oliver

    1997-01-01

    Intraoperative obliteration of cerebral veins occasionally causes unexpected severe complications, especially in elderly patients. However, very title information is available on the pathophysiology of cerebral venous circulation disturbance. Occlusion of cortical veins in rats by a photochemical thrombotic technique is a less invasive, clinically relevant and reproducible model that is suitable for the study of venous circulation disturbance. In the present study, 54 male Wistar rats were used. We examined changes of the cerebral venous flow pattern by fluorescence anglography and brain damage histologically in a one- or two-(cortical) vein occlusion model using a photochemical thrombotic technique. Approximately 30% (9 of 27) of animals in the single-vein occlusion group and 90% (15 of 17) of those in the two-vein occlusion group had microcirculation perturbation, which results very soon in the formation of venous thrombus accompanied by severe venous infarction. In addition, infarction size in the two-vein occlusion group (9.7 ± 3.2%) was significantly larger than in the single-vein group (2.9 ± 1.3%) (unpaired T-test, P < 0.01). In conclusion, the photochemical dye technique of attaining cerebral venous occlusion is a worth while addition to the study of circulation perturbations of the brain. ImagesFigure 1Figure 2Figure 3 PMID:17171021

  10. Atrial natriuretic peptide increases resistance to venous return in rats

    SciTech Connect

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

    1987-05-01

    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.

  11. An unusual cause of venous hypertension after dialysis access creation.

    PubMed

    Hall, Helen Chang; Moudgill, Neil; Kahn, Mark; Burkhart, Richard; Eisenberg, Joshua; Rao, Atul; DiMuzio, Paul

    2011-10-01

    Venous hypertension after creation of arteriovenous fistula or arteriovenous shunt occurs in approximately 10-15% of patients (Kojecky et al., Biomed Papers, 2002;146:77-79; Criado et al., Ann Vasc Surg 1994;8:530-535). Its etiology is commonly stenosis and/or thrombosis of the central venous system secondary to previous catheterization with subsequent development of venous hypertension after the arteriovenous connection is made. Treatment strategies often involve venography to determine the site of venous stenosis and/or occlusion centrally and subsequent endovascular recanalization of the stenotic or occluded veins. In this article, we report a case of venous hypertension in a 76-year-old man who presented with a swollen arm after placement of an arteriovenous fistula. In this circumstance, venography revealed extrinsic compression of the subclavian vein at the level of the first rib, the anatomic abnormality seen in venous thoracic outlet syndrome. In this report, we describe surgical and endovascular management of this patient, and review the literature on the causes of central vein stenosis discovered after creation of dialysis access. PMID:21911188

  12. Coronary venous outflow persists after cessation of coronary arterial inflow.

    PubMed

    Chilian, W M; Marcus, M L

    1984-12-01

    During single long diastoles we simultaneously measured coronary arterial blood flow and coronary venous outflow. When vasomotor tone was intact, approximately 20% of the total volume of diastolic coronary venous outflow appeared after cessation of inflow. During maximal coronary dilation, approximately 40% of the total volume of diastolic coronary venous outflow appeared after cessation of inflow. Theoretically, coronary capacitance could enable persistence of diastolic coronary venous outflow during zero coronary artery inflow. Intramyocardial coronary capacitance calculated from these data was 0.10 ml X mmHg-1 X 100 g-1 with vasomotor tone intact and 0.21 during maximal coronary dilation. These results indicate that the diastolic coronary arterial stop-flow pressure cannot be equated with cessation of flow throughout the coronary vasculature due to the significant contribution of intramyocardial capacitance. We also found that the arterial pressure at which coronary outflow stopped (10-14 mmHg) was substantially less than that at which coronary artery inflow ceased (19-31 mmHg), yet slightly above right atrial pressure (5-9 mmHg). These studies indicate that coronary venous outflow stops at a lower pressure than arterial inflow. Furthermore, the cessation of venous blood flow in the coronary system during long diastoles occurs at pressures only a few mmHg above right atrial pressure. PMID:6507646

  13. Imaging method for changes in venous dynamics: a preliminary study.

    PubMed

    Lee, Yeong-Bae; Seo, Yeong-Bae; Park, Chan-A; Kang, Chang-Ki

    2015-04-15

    The present study proposes a novel functional magnetic resonance venography (fMRV) method to examine changes in venous dynamics that are difficult to detect with commonly used MRV methods such as susceptibility-weighted imaging (SWI). We used a fast gradient echo imaging sequence, known as a time-resolved angiography with interleaved stochastic trajectories, at 7T MRI; it achieves a high temporal resolution of 3?s, which enables detection of dynamic changes in blood oxygenation within the cerebral veins. Twelve healthy individuals participated in this functional imaging study. SWI was also performed using optimized parameters for comparison with fMRV. We measured the average signal change from representative veins in the visual cortex between resting and stimulation conditions. fMRV showed signal changes between the resting and the stimulation conditions in venous vessels more clearly than SWI. Dynamic changes in venous vessel oxygenation signals were observed in the 3?s measurement windows, and these changes showed an ?3?s delay at the onset and offset of stimulation. The average increase in the venous signal intensity was 6.86±0.82% (mean±SEM) during stimulation relative to the resting condition. This study shows that fMRV can directly visualize individual venous vessel blood oxygenation changes during visual stimulation, suggesting that it could be a useful method to investigate venous dynamics induced by visual stimulation. PMID:25714427

  14. Prophylaxis against venous thromboembolism in orthopedic surgery.

    PubMed

    Liu, Lin-tao; Ma, Bao-tong

    2006-08-01

    Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. Multiple-trauma patients are at increased risk for DVT but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Serial compression devices (SCDs) are an alternative for DVT prophylaxis. Compression devices provide adequate DVT prophylaxis with a low failure rate and no device-related complications. Immobilization is one of important reasons of VTE. The ambulant patient is far less likely to develop complications of inactivity, not only venous thrombosis, but also contractures, decubitus ulcers, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications. PMID:16849000

  15. Peripheral venous pressure as a reliable predictor for monitoring central venous pressure in patients with burns

    PubMed Central

    Sherif, Lulu; Joshi, Vikas S.; Ollapally, Anjali; Jain, Prithi; Shetty, Kishan; Ribeiro, Karl Sa

    2015-01-01

    Background: Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill patients with burns. Hemodynamic monitoring may be necessary to optimize resuscitation in serious burn patients with reasonable safety. Invasive central venous pressure (CVP) monitoring has become the corner stone of hemodynamic monitoring in patients with burns but is associated with inherent risks and technical difficulties. Previous studies on perioperative patients have shown that measurement of peripheral venous pressure (PVP) is a less invasive and cost-effective procedure and can reliably predict CVP. Objective: The aim of the present prospective clinical study was to determine whether a reliable association exists between changes in CVP and PVP over a long period in patients admitted to the Burns Intensive Care Unit (BICU). Subjects and Methods: The CVP and PVP were measured simultaneously hourly in 30 burns patients in the BICU up to 10 consecutive hours. The predictability of CVP by monitoring PVP was tested by applying the linear regression formula and also using the Bland–Altman plots of repeated measures to evaluate the agreement between CVP and PVP. Results: The regression formula revealed a reliable and significant association between CVP and PVP. The overall mean difference between CVP and PVP was 1.628 ± 0.84 mmHg (P < 0.001). The Bland–Altman diagram also showed a perfect agreement between the two pressures throughout the 10 h period. Conclusion: Peripheral venous pressure measured from a peripheral intravenous catheter in burns patients is a reliable estimation of CVP, and its changes have good concordance with CVP over a long period of time. PMID:25878426

  16. § Simultaneous Superficial Venous Surgery and On-Table Subintimal Angioplasty in the Treatment of Venous Leg Ulcers with Arterial Compromise

    Microsoft Academic Search

    Kent KC

    In this report, all patients were reviewed retrospectively for venous ulcers with arterial compromise and venous disease. The patients were identified as having arterial disease when ankle brachial index (ABI) was below 0.8, or arterial stenosis\\/occlusion was demonstrated on color Doppler ultrasonography, or both. Any reversed flow of more than 0.5 s in the great and small saphenous veins (GSV,

  17. Endovenous Ablation for the Treatment of Chronic Venous Insufficiency and Venous Ulcerations

    Microsoft Academic Search

    Christopher J. Marrocco; Marvin D. Atkins; W. Todd Bohannon; Thomas R. Warren; Clifford J. Buckley; Ruth L. Bush

    2010-01-01

    Objective  Conventional treatment of chronic venous disease with ulceration is layered compression dressings. Saphenous vein stripping\\u000a is reserved for recurrent or nonhealing ulcers. This study examines outcomes of aggressive endovenous therapy in promoting\\u000a ulcer healing and\\/or preventing ulcer recurrence. The role of additional perforator vein ablation also is analyzed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This retrospective chart review occurred during a 2.5-year time frame during which

  18. Venous Drainage Patterns in Carotid Cavernous Fistulas

    PubMed Central

    Aralasmak, Ayse; Karaali, Kamil; Senol, Utku; Ozdemir, Huseyin; Alkan, Alpay

    2014-01-01

    Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. PMID:24967298

  19. Prevention of venous thromboembolism in pregnancy.

    PubMed

    Greer, Ian A

    2004-03-30

    Venous thromboembolic complications (VTE) are a leading causes of maternal mortality in the developed World. To reduce the incidence VTE in pregnancy, and improve outcomes, a wider understanding of the risk factors involved and a better identification of women at risk of thrombosis coupled with effective thromboprophylaxis are required. The common risk factors for VTE in pregnancy are: age over 35 years; obesity; operative delivery (especially emergency Caesarean Section in labour); thrombophilia; and a family or personal history of thrombosis suggestive of an underlying thrombophilia. As warfarin is unsuitable for use in pregnancy because of problems with embryopathy and risk of fetal bleeding, optimal thromboprophylaxis in pregnancy centres on the use of low-molecular-weight heparin (LMWH). There is now extensive experience of the safety and efficacy of LMWH in pregnancy. LMWH's, such as enoxaparin and dalteparin, have clinical and practical advantages compared with unfractionated heparin in terms of improved safety (significantly lower incidence of osteoporosis and heparin induced thrombocytopenia), and patient convenience with once daily dosing for the majority of women. Thus LMWH is now the agent of choice in pharmacological thromboprophylaxis in pregnancy PMID:15096324

  20. Interventional treatment of venous thromboembolism: a review.

    PubMed

    Imberti, Davide; Ageno, Walter; Manfredini, Roberto; Fabbian, Fabio; Salmi, Raffaella; Duce, Rita; Gallerani, Massimo

    2012-04-01

    Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease after coronary artery disease and cerebrovascular disease and is responsible for significant morbidity and mortality in the general population. Full dose anticoagulation is the standard therapy for VTE, both for the acute and the long-term phase. The latest guidelines of the American College of Chest Physicians recommend treatment with a full-dose of unfractioned heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux, vitamin K antagonist (VKA) or thrombolysis for most patients with objectively confirmed VTE. Catheter-guided thrombolysis and trombosuction are interventional approaches that should be used only in selected populations; interruption of the inferior vena cava (IVC) with a filter can be performed to prevent life-threatening PE in patients with VTE and contraindications to anticoagulant treatment, bleeding complications during antithrombotic treatment, or VTE recurrences despite optimal anticoagulation. In this review we summarize the currently available literature regarding interventional approaches for VTE treatment (vena cava filters, catheter-guided thrombolysis, thrombosuction) and we discuss current evidences on their efficacy and safety. Moreover, the appropriate indications for their use in daily clinical practice are reviewed. PMID:22119500

  1. Venous thromboembolism in patients with prior stroke.

    PubMed

    Piazza, Gregory; Goldhaber, Samuel Z; Kroll, Aimee; Goldberg, Robert J; Emery, Catherine; Spencer, Frederick A

    2014-01-01

    Patients with prior stroke are susceptible to venous thromboembolism (VTE). We studied patients with stroke in the Worcester VTE study of 2488 consecutive patients hospitalized with VTE. In all, 288 (11.6%) had a clinical history of stroke and 2200 (88.4%) did not. Patients with stroke were more likely to die inhospital (9.2% vs 4%) and within 30 days of VTE diagnosis (16.7% vs 6.9%) compared with patients without stroke (all P < .001). Recent immobilization (adjusted odds ratio [OR] 2.15; 95% confidence interval [CI] 1.15-4.09) and inferior vena cava (IVC) filter insertion (adjusted OR 2.1; 95% CI 1.15-3.83) were associated with a doubling of inhospital death. Recent immobilization (adjusted OR 1.84; 95% CI 1.19-2.83) and IVC filter insertion (adjusted OR 1.94; 95% CI 1.2-3.14) were associated with an increased risk of death within 30 days of VTE. In conclusion, patients with VTE and prior stroke were more than twice as likely to die while hospitalized and within 30 days of VTE diagnosis. PMID:23637004

  2. Prognostic indicators in cerebral venous sinus thrombosis.

    PubMed

    Hameed, Bilal; Syed, Nadir Ali

    2006-11-01

    Cerebral venous sinus thrombosis (CVT) can affect all age groups, particularly women of childbearing age. Overall prognosis for survival and functional independence is better than it was believed. Mortality usually ranges from 6-15% and transtentorial herniation is the major cause of death. Approximately 80% of patients are functionally independent in the long term. Altered mental status and cerebral haemorrhage at presentation are the strongest predictors of death and disability. Patients with CVT related to pregnancy and puerperium generally do better than patients with other causes. Septic CVT carries a worse prognosis than aseptic CVT and of the latter, patients with syndrome of isolated intracranial hypertension have a better prognosis than those with focal deficits or encephalopathy. Anticoagulation is believed to improve outcome in CVT although robust data are lacking. Epilepsy, headaches, visual loss, pyramidal deficits and cognitive impairment are some of the long term sequelae. The risk of recurrence of CVT is low, particularly after the first 12 months of the first episode. PMID:17183990

  3. MECHANISMS UNDERLYING MATERNAL VENOUS ADAPTATION IN PREGNANCY

    PubMed Central

    Jones, Cresta Wedel; Mandala, Maurizio; Barron, Carolyn; Bernstein, Ira; Osol, George

    2009-01-01

    To define the effects of pregnancy on mechanical properties and reactivity, mesenteric veins from late pregnant (LP) and virgin control (NP) rats were pressurized to determine gestational changes in size and distensibility. Reactivity studies used an adrenergic constrictor (norepinephrine, NE) and an endothelium-mediated vasodilator (acetylcholine, ACh). The contribution of nitric oxide (NO) to endothelial function was evaluated with pharmacologic inhibition of NO synthase. Roles of NO and cGMP in smooth muscle vasodilation were determined by using an NO donor with and without cGMP inhibition using ODQ, a selective inhibitor of guanylyl cyclase. In pregnancy, endothelium-dependent vasodilation markedly increased (largely due to endogenous NO), smooth muscle response to NO decreased (primarily related to cGMP production), and NE sensitivity decreased considerably, with no changes in vessel size or distensibility. Our results identify a pro-vasodilatory state in the systemic venous system which would serve to facilitate the accommodation to plasma volume expansion requisite for normal pregnancy. PMID:19318688

  4. Venous drainage patterns in carotid cavernous fistulas.

    PubMed

    Aralasmak, Ayse; Karaali, Kamil; Cevikol, Can; Senol, Utku; Sindel, Timur; Toprak, Huseyin; Ozdemir, Huseyin; Alkan, Alpay

    2014-01-01

    Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. PMID:24967298

  5. Pulmonary hypertension caused by pulmonary venous hypertension

    PubMed Central

    2014-01-01

    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

  6. Physical activity and risk of venous thromboembolism. The Tromsø study

    PubMed Central

    Borch, Knut H.; Hansen-Krone, Ida; Braekkan, Sigrid K.; Mathiesen, Ellisiv B.; Njolstad, Inger; Wilsgaard, Tom; Hansen, John-Bjarne

    2010-01-01

    Background Previous studies have shown differences in the impact of regular physical exercise on the risk of venous thromboembolism. The inconsistent findings may have depended on differences in study design and specific population cohorts (men only, women only and elderly). We conducted a prospective, population-based cohort to investigate the impact of regular physical exercise on the risk of venous thromboembolism. Design and Methods Risk factors, including self-reported moderate intensity physical exercise during leisure time, were recorded for 26,490 people aged 25–97 years old, who participated in a population health survey, the Tromsø study, in 1994–95. Incident venous thromboembolic events were registered during the follow-up until September 1, 2007. Results There were 460 validated incident venous thromboembolic events (1.61 per 1000 person-years) during a median of 12.5 years of follow-up. Age, body mass index, the proportion of daily smokers, total cholesterol, and serum triglycerides decreased (P<0.001), whereas high density cholesterol increased (P<0.001) across categories of more physical exercise. Regular physical exercise of moderate to high intensity during leisure time did not significantly affect the risk of venous thromboembolism in the general population. However, compared to inactivity, high amounts of physical exercise (?3 hours/week) tended to increase the risk of provoked venous thromboembolism (multivariable hazard ratio, 1.30; 95% confidence interval, 0.84–2.0), and total venous thromboembolism in the elderly (multivariable hazard ratio, 1.33; 95% confidence interval, 0.80–2.21) and in the obese (multivariable hazard ratio, 1.49; 95% confidence interval, 0.63–3.50). Contrariwise, compared to inactivity, moderate physical activity (1.0–2.9 hours/week) was associated with a border-line significant decreased risk of venous thromboembolism among subjects under 60 years old (multivariable hazard ratio, 0.72; 95% confidence interval, 0.48–1.08) and subjects with a body mass index of less than 25 kg/m2 (multivariable hazard ratio, 0.59; 95% confidence interval, 0.35–1.01). Conclusions Our study showed that regular, moderate intensity physical exercise did not have a significant impact on the risk of venous thromboembolism in a general population. Future studies are required to assess the impact of regular physical exercise on venous thromboembolism risk in different population subgroups. PMID:20801904

  7. [Role of the large cerebral vein in active regulation of venous outflow].

    PubMed

    Gongal'ski?, V V; Prokopovich, E V

    2005-01-01

    Key part of venous basin of deep structures of the brain is the big vein of the brain (v. cerebri magna Galeni), which actively participates in redistribution of venous blood at heavy venous outflow from the skull cavity. Venous outflow parameters are proved to have tendency to stabilization of venous blood flow. It was tested by reflex influence on the tone of veins of the brain through proprioreceptors of cervical spine articular complexes and at pharmacological correction by venous tonic Flebodia 600. PMID:16025682

  8. Computer-assisted venous thrombosis volume quantification.

    PubMed

    Puentes, John; Dhibi, Mounir; Bressollette, Luc; Guias, Bruno; Solaiman, Basel

    2009-03-01

    Venous thrombosis (VT) volume assessment, by verifying its risk of progression when anticoagulant or thrombolytic therapies are prescribed, is often necessary to screen life-threatening complications. Commonly, VT volume estimation is done by manual delineation of few contours in the ultrasound (US) image sequence, assuming that the VT has a regular shape and constant radius, thus producing significant errors. This paper presents and evaluates a comprehensive functional approach based on the combination of robust anisotropic diffusion and deformable contours to calculate VT volume in a more accurate manner when applied to freehand 2-D US image sequences. Robust anisotropic filtering reduces image speckle noise without generating incoherent edge discontinuities. Prior knowledge of the VT shape allows initializing the deformable contour, which is then guided by the noise-filtering outcome. Segmented contours are subsequently used to calculate VT volume. The proposed approach is integrated into a system prototype compatible with existing clinical US machines that additionally tracks the acquired images 3-D position and provides a dense Delaunay triangulation required for volume calculation. A predefined robust anisotropic diffusion and deformable contour parameter set enhances the system usability. Experimental results pertinence is assessed by comparison with manual and tetrahedron-based volume computations, using images acquired by two medical experts of eight plastic phantoms and eight in vitro VTs, whose independently measured volume is the reference ground truth. Results show a mean difference between 16 and 35 mm(3) for volumes that vary from 655 to 2826 mm(3). Two in vivo VT volumes are also calculated to illustrate how this approach could be applied in clinical conditions when the real value is unknown. Comparative results for the two experts differ from 1.2% to 10.08% of the smallest estimated value when the image acquisition cadences are similar. PMID:19272860

  9. Elevated prothrombin promotes venous, but not arterial, thrombosis in mice

    PubMed Central

    Aleman, Maria M.; Walton, Bethany L.; Byrnes, James R.; Wang, Jian-Guo; Heisler, Matthew J.; Machlus, Kellie R.; Cooley, Brian C.; Wolberg, Alisa S.

    2013-01-01

    Objective Individuals with elevated prothrombin, including those with the prothrombin G20210A mutation, have increased risk of venous thrombosis. Although these individuals do not have increased circulating prothrombotic biomarkers, their plasma demonstrates increased tissue factor-dependent thrombin generation in vitro. The objectives of this study were to determine the pathologic role of elevated prothrombin in venous and arterial thrombosis in vivo, and distinguish thrombogenic mechanisms in these vessels. Approach and results Prothrombin was infused into mice to raise circulating levels. Venous thrombosis was induced by electrolytic stimulus to the femoral vein or inferior vena cava ligation. Arterial thrombosis was induced by electrolytic stimulus or ferric chloride application to the carotid artery. Mice infused with prothrombin demonstrated increased tissue factor-triggered thrombin generation measured ex vivo, but did not have increased circulating prothrombotic biomarkers in the absence of vessel injury. Following venous injury, elevated prothrombin increased thrombin generation and the fibrin accumulation rate and total amount of fibrin ~3-fold, producing extended thrombi with increased mass. However, elevated prothrombin did not accelerate platelet accumulation, increase the fibrin accumulation rate, or shorten the vessel occlusion time following arterial injury. Conclusions These findings reconcile previously discordant findings regarding thrombin generation in hyperprothrombinemic individuals measured ex vivo and in vitro, and show elevated prothrombin promotes venous, but not arterial, thrombosis in vivo. PMID:23723374

  10. Regaining venous access for implantation of a new lead

    PubMed Central

    Syska, Pawe?; Maci?g, Aleksander; Or?ziak, Artur; Ku?mierczyk, Mariusz; Przybylski, Andrzej

    2013-01-01

    Introduction Venous occlusion is a relatively common complication of endocardial lead implantation. It may cause a critical problem when implantation of a new lead is needed. Traditional methods result in leaving abandoned leads. The optimal approach seems to be the extraction of the damaged or abandoned lead, regaining venous access and implantation of a new lead. Aim To assess the efficacy and safety of new lead implantation by the method of lead extraction. Material and methods All transvenous lead extraction procedures (203 patients) between 1 August 2008 and 15 October 2012 were assessed. The analysis included cases with leads implanted for at least 6 months prior to extraction. Results Regaining venous access was the main indication for lead extraction in 5 patients (4.9%). The reason for new lead implantation was lead damage (n = 7) and system up-grade to cardiac resynchronization therapy (CRT) (n = 3). In total, 23 leads were extracted (9 defibrillation leads, 12 pacing leads and 2 left ventricular leads). The mean time from the implantation was 92.2 ±43.2 (48-152) months. In all cases Cook mechanical sheaths were applied. The use of the Evolution system was necessary to extract 3 leads. In all cases the new leads were successfully implanted as planned. No serious complications occurred. Conclusions Diagnosis of venous occlusion should not be a contraindication for ipsilateral implantation of the new lead, because the techniques of transvenous lead extraction enable successful regaining of venous access. PMID:24570688

  11. Venous collateral circulation of the extracranial cerebrospinal outflow routes.

    PubMed

    Zamboni, Paolo; Consorti, Giuseppe; Galeotti, Roberto; Gianesini, Sergio; Menegatti, Erica; Tacconi, Giovanna; Carinci, Francesco

    2009-08-01

    A new nosologic vascular pattern that is defined by chronic cerebrospinal venous insufficiency (CCSVI) has been strongly associated with multiple sclerosis. The picture is characterized by significant obstacles of the main extracranial cerebrospinal veins, the jugular and the azygous system, and by the opening of substitute circles. The significance of collateral circle is still neglected. To the contrary, substitute circles are alternative pathways or vicarious venous shunts, which permit the drainage and prevent intracranial hypertension. In accordance with the pattern of obstruction, even the intracranial and the intrarachidian veins can also become substitute circles; they permit redirection of the deviated flow, piping the blood toward available venous segments outside the central nervous system. We review the complex gross and radiological anatomy of collateral circulation found activated by the means of EchoColor-Doppler and selective venography in the event of CCSVI, focusing particularly on the suboccipital cavernous sinus (SCS), the condylar venous system, the pterygoid plexus, the thyroid veins, and the emiazygous-lumbar venous anastomosis with the left renal vein. PMID:19534716

  12. Squamous cell carcinoma developed on chronic venous leg ulcer.

    PubMed

    Sîrbi, Adelina Gabriela; Florea, Marius; P?tra?cu, Virgil; Rotaru, Maria; Mogo?, Dan Gabriel; Georgescu, Claudia Valentina; M?rg?ritescu, Nicolae Drago?

    2015-01-01

    Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC). Malignant transformation of a VLU is a rare finding and the relative risk of carcinomatous transformation is quite low (about 5.8). SCC arising in the context of a VLU has a particularly aggressive behavior. A 76-year-old male patient with no relevant medical familial history, with chronic venous insufficiency CEAP C6 for 10 years [recurrent leg ulcers with favorable outcome (healing) after specific local and systemic treatment], showing for about three years one ulcerated lesion located on the anterior upper third of the right calf non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology showed epidermal acanthosis, papillomatosis, intense parakeratosis, pseudoepitheliomatous hyperplasia, dysplasia and moderately differentiated squamous cell carcinoma with areas of acantholysis. Immunohistochemistry (Ki67, EMA, cytokeratin 34?E12 and p63) was performed and all types of immunostaining were moderately to intense positive. Above-knee leg amputation and specific oncologic treatment were proposed as possible curative solutions but the patient refused. Ten months after diagnosis and discharge form the Department of Dermatology, the patient died. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal. PMID:25826522

  13. Chronic cerebrospinal venous insufficiency in patients with Ménière's disease.

    PubMed

    Filipo, R; Ciciarello, F; Attanasio, G; Mancini, P; Covelli, E; Agati, L; Fedele, F; Viccaro, M

    2015-01-01

    To analyze the presence of chronic cerebrospinal venous insufficiency parameter and vascular abnormalities, in the internal jugular veins (IJVs) and/or vertebral veins in sitting and supine posture, in patients with Meniere's disease compared to healthy general population. A prospective study on 32 patients affected by definite Ménière was performed from February 2012 to January 2013. All subjects underwent an echo-color Doppler examination of the cerebrospinal venous flow. 21 of the 32 Menieric patients showed a statistically significant reflux in the intracranial veins versus healthy (65.6 vs 25%; P < 0.001). A high prevalence of IJVs stenosis with hemodynamic changes (increased velocity or absence of flow) was observed (66.7 vs 33.3%; P < 0.05). The other parameters considered did not show statistically significant differences among the two groups. The results obtained showed a vascular pattern of cerebrospinal venous system present in patients affected by definite Meniere. This vascular impairment significantly affects the vascular areas more directly involved in the venous drainage of the inner ear. Thus venous stasis may be considered a further pathogenetic mechanism for development of Meniere's disease. PMID:24318422

  14. Role of vascular system adrenoceptors in formation of venous return.

    PubMed

    Samoilenko, A V; Yurov, A Yu

    2006-01-01

    In experiments on cats electromagnetic flowmetry showed that contribution of the blood flow in the anterior and posterior cava venae to the formation of venous return during stimulation of adrenoceptors with catecholamines is determined by the dynamics of systemic pressor reactions. At the moment of maximum elevation of blood pressure, the major role is played by blood flow changes in the anterior vena cava, while the posterior vena cave plays the predominant role during the period of maximum venous return. Under the action of alpha- and beta-adrenoceptor blockers, venous return is predominantly formed by the blood flow in the posterior vena cava independently on the dynamics of systemic depressor reactions. Adrenoceptor blockade modulates the structure of venous return formation in response to catecholamines: alpha-adrenoceptor blockade reduced the role of anterior vena cava blood flow and increased that of posterior vena blood flow in the formation of venous return, while beta-adrenoceptor blockade induced opposite changes. It is concluded that alpha- and beta-adrenoceptors predominantly control changes in the blood flow in the anterior and posterior cava venae, respectively. PMID:16929949

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

    PubMed Central

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

    2006-01-01

    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

  16. Preparing for the "Impending Storm."

    ERIC Educational Resources Information Center

    Dodd, Julie

    1979-01-01

    Reports on an address by Richard Johns, director of Quill and Scroll, in which he suggests that the continuing existence of high school journalism programs is threatened by reduced funding and by the "back to the basics" movement. Johns offers some ideas for how to prepare for threatened cutbacks. (TJ)

  17. The treatment of venous ulcers of the lower extremities

    PubMed Central

    2007-01-01

    Venous hypertension from failure of proper venous valve function in the veins of thelower extremities causes changes over time in the microcirculation of the skin of the distal extremity. These changes set the stage for the development of a chronic nonhealing ulceration, which typically occurs at the ankle. The mainstay of treatment has been conservative, with compression dressings and elevation of the extremity. However, results have been less than satisfactory because of delay in healing and high recurrence rates after successful healing. Elimination of the venous hypertension should be the goal of therapy using more recent minimally invasive surgical techniques, including ablation of incompetent truncal veins with laser or radiofrequency energy and use of ultrasound-guided foam sclerosant injections to close incompetent perforator veins that are frequently found in or near the ulcer bed. This approach will shorten ulcer healing time and reduce recurrence rates as well as patient suffering and expense. PMID:17948110

  18. Central Venous Catheter–associated Nocardia Bacteremia in Cancer Patients

    PubMed Central

    Al Akhrass, Fadi; Hachem, Ray; Mohamed, Jamal A.; Tarrand, Jeffrey; Kontoyiannis, Dimitrios P.; Chandra, Jyotsna; Ghannoum, Mahmoud; Haydoura, Souha; Chaftari, Ann Marie

    2011-01-01

    Central venous catheters, often needed by cancer patients, can be the source of Nocardia bacteremia. We evaluated the clinical characteristics and outcomes of 17 cancer patients with Nocardia bacteremia. For 10 patients, the bacteremia was associated with the catheter; for the other 7, it was a disseminated infection. N. nova complex was the leading cause of bacteremia. Nocardia promoted heavy biofilm formation on the surface of central venous catheter segments tested in an in vitro biofilm model. Trimethoprim- and minocycline-based lock solutions had potent in vitro activity against biofilm growth. Patients with Nocardia central venous catheter–associated bloodstream infections responded well to catheter removal and antimicrobial drug therapy, whereas those with disseminated bacteremia had poor prognoses. PMID:21888790

  19. Bilateral anomalous pulmonary venous connection to bilateral superior caval veins.

    PubMed

    Sasikumar, Navaneetha; Ramanan, Sowmya; Chidambaram, Shanthi; Rema, Krishna Manohar Soman; Cherian, Kootturathu Mammen

    2014-01-01

    A four-year-old girl presented with superior vena cava (SVC) type of sinus venosus defect, right upper pulmonary vein draining into right SVC-right atrium junction, left upper lobe pulmonary veins draining into the lower part of persistent left SVC (LSVC), and a patent ductus arteriosus. The anomalous pulmonary venous drainage to LSVC was overlooked in the preoperative evaluation and was found intraoperatively. Warden procedure was performed for right-sided veins. Lower LSVC draining the anomalous pulmonary veins was anastomosed to the left atrial appendage. The short stump of LSVC was diverted to left pulmonary artery. Anomalous pulmonary venous connections to LSVC are rare. Embryology of venous development is analyzed with respect to this rare anomaly, and options for surgical correction are discussed. PMID:24403371

  20. [Venous Aneurysms of the Lower Extremities - Clinical Significance and Therapy.

    PubMed

    Weiske, N; Gebauer, T; Bürger, T

    2014-11-13

    Isolated venous aneurysms are very rare. In clinical practice it is predominantly seen in the course of a random diagnosis to find the cause of pulmonary embolism or venous thrombosis. Due to an increased use of duplex scans there is also an increase in the number of diagnoses of venous aneurysms even if patients are still asymptomatic. The precise prevalence is yet unknown. The choice of therapeutic procedure is dependent on each individual clinic as well as the size and morphology (fusiform or saccular) of the aneurysm. At present, the available data are still insufficient. We discuss our own surgical treatment of 7 patients with primary aneurysms involving the vena cava, iliac vein, great saphenous vein junction and popliteal vein in consideration of the latest literature. PMID:25393736

  1. New insights into the mechanisms of venous thrombosis

    PubMed Central

    Mackman, Nigel

    2012-01-01

    Venous thrombosis is a leading cause of morbidity and mortality in industrialized countries, especially in the elderly. Many risk factors have been identified for venous thrombosis that alter blood flow, activate the endothelium, and increase blood coagulation. However, the precise mechanisms that trigger clotting in large veins have not been fully elucidated. The most common site for initiation of the thrombus appears to be the valve pocket sinus, due to its tendency to become hypoxic. Activation of endothelial cells by hypoxia or possibly inflammatory stimuli would lead to surface expression of adhesion receptors that facilitate the binding of circulating leukocytes and microvesicles. Subsequent activation of the leukocytes induces expression of the potent procoagulant protein tissue factor that triggers thrombosis. Understanding the mechanisms of venous thrombosis may lead to the development of new treatments. PMID:22751108

  2. Cortical venous thrombosis following exogenous androgen use for bodybuilding

    PubMed Central

    Sveinsson, Olafur; Herrman, Lars

    2013-01-01

    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

  3. Cortical venous thrombosis following exogenous androgen use for bodybuilding.

    PubMed

    Sveinsson, Olafur; Herrman, Lars

    2013-01-01

    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

  4. Complicated cerebral venous sinus thrombosis with intracranial hemorrhage and mastoiditis.

    PubMed

    Skeik, Nedaa; Stark, Madeline M; Tubman, David E

    2012-10-01

    Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke, occurring when a blood clot forms in any of the brain venous sinuses. Symptoms include neurological deficits, headache, seizures, and coma. There are many predisposing factors for CVST including prothrombotic conditions, oral contraceptives, pregnancy/puerperium, malignancy, infection, and head injury. Cerebral venous sinus thrombosis has no identifiable underlying etiology in about 12.5% to 33% of the cases. Diagnosis has become easier with newer imaging techniques, such as magnetic resonance venography. The treatment options for CVST include symptomatic treatment, anticoagulation (AC), thrombolysis, and thrombectomy. Controversy exists over the efficacy and safety of AC in patients with CVST with concurrent intracranial hemorrhage (ICH). We present a complex case of CVST with ICH and mastoiditis as well as provide a literature review about CVST. PMID:22918938

  5. Venous embolization after deflation of lower extremity tourniquets.

    PubMed

    McGrath, B J; Hsia, J; Boyd, A; Shay, P; Graeter, J; Conry, K; Campbell, D; Naulty, J S

    1994-02-01

    Massive pulmonary embolism has been reported to occur with the use of lower extremity tourniquets. We used transesophageal echocardiography to determine the incidence of venous embolism during lower extremity orthopedic surgery performed with a pneumatic tourniquet. The hemodynamic and respiratory consequences of all embolic events were assessed. Venous emboli were detected after tourniquet deflation in 8 of 30 procedures. The incidence of embolism was unrelated to the type of surgical procedure performed or the duration of tourniquet inflation. There were no significant differences in preoperative characteristics or postdeflation hemodynamic and respiratory responses between patients with and without emboli. Venous embolization is a relatively common event after tourniquet deflation. The clinical significance of these events remains to be determined. PMID:8311289

  6. Sarcoidosis mimicking a venous ulcer: a case report.

    PubMed

    Joshi, Smita S; Romanelli, Paolo; Kirsner, Robert S

    2009-11-01

    Sarcoidosis--a chronic, multisystem disease of unknown etiology characterized by noncaseating granulomas--may cause ulcerative lesions, particularly in African American women. A case of ulcerative sarcoidosis mimicking a venous ulcer is presented. The patient is a 44-year-old African American hypertensive, obese woman with a nonhealing medially based lower leg ulcer of 3 years' duration clinically consistent with a venous ulcer. The ulcer did not heal with compression therapy and pentoxifylline. Subsequent biopsies showed granulomatous inflammation consistent with sarcoidosis. When intralesional triamcinolone was added to compression therapy, the ulcer resolved after 3 months. Given its propensity toward formation on the lower extremities and ulcerative and atrophic appearance, ulcerative sarcoidosis should be considered in the differential diagnosis of a venous ulcer refractory to standard therapy, especially in African American women. PMID:19934463

  7. Varicose Veins: Role of Mechanotransduction of Venous Hypertension

    PubMed Central

    Atta, Hussein M.

    2012-01-01

    Varicose veins affect approximately one-third of the adult population and result in significant psychological, physical, and financial burden. Nevertheless, the molecular pathogenesis of varicose vein formation remains unidentified. Venous hypertension exerted on veins of the lower extremity is considered the principal factor in varicose vein formation. The role of mechanotransduction of the high venous pressure in the pathogenesis of varicose vein formation has not been adequately investigated despite a good progress in understanding the mechanomolecular mechanisms involved in transduction of high blood pressure in the arterial wall. Understanding the nature of the mechanical forces, the mechanosensors and mechanotransducers in the vein wall, and the downstream signaling pathways will provide new molecular targets for the prevention and treatment of varicose veins. This paper summarized the current understanding of mechano-molecular pathways involved in transduction of hemodynamic forces induced by blood pressure and tries to relate this information to setting of venous hypertension in varicose veins. PMID:22489273

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

    SciTech Connect

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

    1983-08-01

    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.

  9. Internal jugular/subclavian venous access in electrophysiology study and ablation.

    PubMed

    Bohora, Shomu; Tharakan, Jaganmohan

    2009-01-01

    Multiple venous accesses are required for catheter placement during electrophysiology study and ablation. Internal jugular/subclavian venous access, though restricted nowadays, can be important in difficult situations. PMID:19652728

  10. Internal Jugular/Subclavian Venous Access In Electrophysiology Study And Ablation

    PubMed Central

    Bohora, Shomu; Tharakan, Jaganmohan

    2009-01-01

    Multiple venous accesses are required for catheter placement during electrophysiology study and ablation. Internal jugular/subclavian venous access, though restricted nowadays, can be important in difficult situations. PMID:19652728

  11. The nomenclature of venous flow-through flaps: updated classification and review of the literature.

    PubMed

    Goldschlager, Romi; Rozen, Warren M; Ting, Jeannette W C; Leong, James

    2012-09-01

    Venous flow-through flaps (venous flaps) are useful reconstructive options, particularly in the repair of defects with segmental vessel loss. They are relatively easy to harvest and confer several benefits at the donor site. However, given that they are based on a single central vein, their survival is notoriously unreliable and they are susceptible to ischemia and venous congestion. Various designs have been suggested to improve the circulatory physiology, and hence survival, of venous flap. More recent designs involve adaptations to the arrangement and number of efferent veins draining arterialized venous flaps. The most commonly used classification system for venous flaps, proposed by Chen, Tang, and Noordhoff, does not afford adequate description of these alternate designs. This article offers a classification system that can incorporate all reported modifications to venous flaps. This simple adaptation to the classification system proposed by Chen et al. restores its usefulness in describing modern variations to venous flap design. PMID:22434451

  12. Mapping hV4 and ventral occipital cortex: The venous eclipse

    E-print Network

    Wandell, Brian A.

    Mapping hV4 and ventral occipital cortex: The venous eclipse Department of Psychology, Stanford: The venous eclipse. Journal of Vision, 10(5):1, 1­22, http://journalofvision.org/content/10/5/1, doi:10

  13. Paterns of Cranial Venous System from the Comparative Anatomy in Vertebrates

    PubMed Central

    Aurboonywat, T.; Suthiponchai, S.; Pereira, V.; Ozanne, A.; Lasjaunis, P.

    2007-01-01

    Summary Many classifications of the cerebral venous system are found in the literature but they are seldom based on phylogenic study. Among vertebrates, venous drainage of the brain vesicles differs depending on the species. Due to the variability, poorly descriptive articles, and many different names used for the veins, the comparative study of the cranial venous system can hardly be performed in detail. The cranial venous system in vertebrates can be divided into three systems based on the evolution of the meninges and structures of the brain vesicles: the dorsal, lateral-ventral and ventricular systems. This study proposes a new classification of the venous drainage of brain vesicles using knowledge from a comparative study of vertebrates and focusing on the dorsal venous system. We found that the venous drainage of the neopallium and neocerebellum is involved with this system which may be a recent acquisition of cranial venous evolution. PMID:20566102

  14. Venous haemodynamics of the upper extremity after subclavian vein thrombosis.

    PubMed

    Lindblad, B; Bornmyr, S; Kullendorff, B; Bergqvist, D

    1990-01-01

    Late post-thrombotic complaints after subclavian vein thrombosis are reported with highly varying frequencies (8-80% severe disability). The therapeutic approach depends partly on this frequency. With the aim to evaluate late sequelae a questionnaire was answered by 26 patients with arm-shoulder symptoms leading to arm phlebography, but where the examination did not reveal any thrombi. 65% had remaining symptoms 2-9 years after the examination. 3 had to change profession. 36 patients with phlebographically shown subclavian vein thrombosis answered the same questionnaire. Only 9 (25%) had remaining symptoms and in 4 it was classified as mild, in 4 as moderate and only in 1 patient as severe leading to change of profession. Venous haemodynamics in the upper extremity were also studied in 3 groups of patients; I) healthy volunteers (n = 16 arms), II) patients with arm-shoulder disabilities with negative arm phlebography (n = 7 disabled arms, n = 7 non-disabled arms), III) patients with phlebographically verified subclavian vein thrombi (n = 10 arms with DVT, n = 8 arms without DVT). Strain gauge plethysmography was used measuring venous capacity and maximal venous outflow. Venous pressure measurements were made both with the arms in a resting position and in a military position with and without work-load. Repeat phlebography of arms with symptoms were made. Maximal venous outflow was significantly lower in arms with previous subclavian vein thrombi (p less than 0.05) and venous pressure measurements with the arm in military position was significantly higher in those arms. However, no correlation between these measurements and the degree of arm disability was noted.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2238816

  15. The maternal venous system: the ugly duckling of obstetrics

    PubMed Central

    Tomsin, K.

    2013-01-01

    In pregnancy, both maternal vascular tone and cardiac function are considered key players to reach a normal outcome for both mother and child. This complex story of maternal hemodynamics is intensely discussed in current scientific literature, however the role of the maternal veins has been strongly underestimated. We developed and evaluated a set of measurable objective parameters which give an indication of venous function, i.e. the venous impedance index and the venous pulse transit time. These parameters turned out to be subject to changes throughout normal pregnancy and in preeclampsia enabling their use in gestational hemodynamic studies. From our studies, we concluded that the venous system is a crucial determinant of cardiac output, which can be estimated by impedance cardiography. The introduction of these non-invasive techniques in obstetrics enables profiling the maternal cardiovascular system, integrating both arteries and veins, as well as maternal cardiac function. Studying the cascade of cardiovascular changes throughout pregnancy using such non-invasive, easily applicable, and highly accessible methods opens perspectives to introduce this maternal cardiovascular profile in several clinical settings. The early discrimination between low and high risk patients, together with the classification of different pregnancy disorders may help guiding the clinical work-up of the pregnant population regarding both prevention and treatment, as well as follow-up. We illustrate that the venous system, being an “ugly duckling” at first neglected by the medical world, transforms and matures into a beautiful swan, accepted by the obstetric world. We are confident that this is the beginning of many other studies regarding the maternal venous system, an important piece of the gestational physiology puzzle. PMID:24753937

  16. Microcirculation is similar in ischemic and venous ulcers.

    PubMed

    Gschwandtner, M E; Ambrózy, E; Mari?, S; Willfort, A; Schneider, B; Böhler, K; Gaggl, U; Ehringer, H

    2001-11-01

    Microcirculation of 15 ischemic and 15 venous ulcers, their scars, and intact surrounding skin were examined in order to demonstrate their similarities in the development and healing process. Subpapillary and nutritive perfusion of four areas were investigated by a laser Doppler perfusion imager (arbitrary units) and capillary microscopy (capillaries/mm2): one ulcer area without granulation tissue (no wound healing) and one with granulation tissue (ulcer healing); one skin area adjacent to the ulcer (1-8 mm) (scar developed from ulcer areas) and one distant (12-25 mm; intact skin). Areas without granulation tissue in ischemic and venous ulcers were similar, demonstrating a lack of capillaries (0.13 +/- 0.52; 0.93 +/- 2.09) and low laser Doppler flux (0.81 +/- 0.69; 1.47 +/- 1.17; P > 0.05 for each). In granulation tissue of both ulcers there was a tendency to a higher capillary density (0.67 +/- 1.40; 5.60 +/- 2.32; P < 0.0001 for venous ulcers) and a higher laser Doppler flux (1.15 +/- 0.67; 4.04 +/- 1.62; P < 0.0001 for venous ulcers) than in areas without granulation tissue. In scars of ischemic and venous ulcers capillary density (8.18 +/- 8.84; 13.60 +/- 5.45) and laser Doppler flux (1.72 +/- 1.00; 1.94 +/- 1.45) were similar (P > 0.05). In skin distant from ischemic ulcers very high capillary density (24.63 +/- 1.89) was associated with low laser Doppler flux (0.99 +/- 0.59); distant from venous ulcer capillary density was moderate (10.47 +/- 3.42) while laser Doppler flux was high (3.77 +/- 1.62; P < 0.0001 between both groups). The development and healing process of ischemic and venous ulcers is similar. Nutritive and subpapillary perfusion are involved in ulcer healing. In intact skin surrounding ischemic and venous ulcers, microcirculation is different due to the underlying pathophysiology. PMID:11678625

  17. Traffic light system for healed venous leg ulcer monitoring.

    PubMed

    Hindley, Jenny

    2012-09-01

    The purpose of this paper is to introduce the conceptualisation and evolution of a trialed Doppler traffic light system for healed venous leg ulceration. This tool aims to facilitate clinical decision-making and provides a systematic approach to the ongoing assessment of arterial disease in patients with healed venous leg ulcers when used in conjunction with other purposely-designed assessment documentation to ensure the novice registered and unregistered nurse contributes safely and effectively to the care of patients. The validation and trial of this clinical decision tool is discussed in terms of the use of a recognised methodology determining its fitness for purpose and robustness. PMID:23638479

  18. Cerebral venous sinus stenting for pseudotumor cerebri: A review

    PubMed Central

    Kanagalingam, Sivashakthi; Subramanian, Prem S.

    2014-01-01

    Pseudotumor cerebri is characterized by headaches, visual field changes, papilledema and an elevated cerebrospinal fluid opening pressure without evidence of an intracranial mass. In the setting of failed medical therapy, surgical options such as ventriculoperitoneal shunts and optic nerve sheath fenestrations are considered. Recently, venous sinus stenting has emerged as a new treatment option for patients with pseudotumor cerebri. We review the role of cerebral venous sinus stenting in the management of patients with medically refractory pseudotumor cerebri. Although long- term studies are needed in this field, the current reports indicate a favorable outcome for preventing vision loss and symptom control.

  19. Venous thromboembolic events in minimally invasive gynecologic surgery

    PubMed Central

    Ramirez, Pedro T.; Nick, Alpa M.; Frumovitz, Michael; Schmeler, Kathleen M.

    2015-01-01

    The rate of venous thromboembolic events (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) among women undergoing gynecologic surgery is high, particularly for women with a gynecologic malignancy. Current guidelines recommend VTE thrombopropylaxis in the immediate postoperative period for patients undergoing open surgery. However, the VTE prophylaxis recommendations for women undergoing minimally invasive gynecologic surgery are not as well established. The risk of VTE in patients undergoing minimally invasive surgery appears to be low based on retrospective analyses. To date, there are no established guidelines that specifically provide a standard of care for patients undergoing minimally invasive gynecologic surgery for benign or malignant disease. PMID:23850360

  20. Central Venous Disease in Hemodialysis Patients: An Update

    SciTech Connect

    Modabber, Milad, E-mail: mmodabber@gmail.com [McMaster University, Michael G. DeGroote School of Medicine (Canada); Kundu, Sanjoy [Scarborough Hospital and Scarborough Vascular Ultrasound, The Vein Institute of Toronto (Canada)

    2013-08-01

    Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.

  1. The Diagnosis of Deep Venous Thrombosis Using Laser Doppler Skin Perfusion Measurements

    Microsoft Academic Search

    Jurgen C. de Graaff; Dirk Th. Ubbink; Harry R. Büller; Michael J. H. M. Jacobs

    2001-01-01

    Compression ultrasonography (CUS) falls short in the diagnosis of deep venous thrombosis in asymptomatic patients and thrombi limited to the calf veins. Alternatively, laser Doppler fluxmetry (LDF) may be useful for this purpose, as it can measure the peripheral vasoconstriction response upon an increase in venous pressure, which is hypothetically preactivated upon venous damming by a thrombus. We investigated the

  2. Technetium 99m diphosphonate uptake and intraosseous hemodynamics during venous congestion in bone

    Microsoft Academic Search

    Ebbe Stender Hansen; Vibeke E. Hjortdal; Dorthe Kjølseth; Shu-Zeng He; Kristian Høy; Kjeld Søballe; Cody Bringer

    1991-01-01

    Venous congestion in bone is a common early feature of inflammatory and degenerative joint diseases. An experimental study was performed of the relationship between the scintigraphic appearance of joints and the intraosseous hemodynamics during venous congestion caused by obstruction of the osseous venous drainage by increased intra-articular pressure. Intra-articular pressure was raised to 75% of mean arterial pressure in one

  3. Evaluation of the Time Course of Vascular Responses to Venous Congestion in the Human Lower Limb

    Microsoft Academic Search

    Mark A. Oldfield; Margaret D. Brown

    2006-01-01

    This study examined the time course of changes in blood flow to the lower leg in response to venous distension – the veni-arteriolar vasoconstrictor response – in 31 healthy males. During a 5-min period of venous distension (thigh cuff pressure 50 mm Hg), calf blood flow (venous occlusion plethysmography) decreased more rapidly (within 30 s) compared to skin perfusion (after

  4. [Venous flow reversal and the pedicled radial island flap (anatomic study)].

    PubMed

    Piza-Katzer, H; Weinstabl, R

    1987-07-01

    In the distally pedicled radial island flap a reverse venous flow was observed. In 20 cadaver extremities the veins of the forearms were perfused, dissected and also island flaps elevated. The three venous systems are described as to number, localization and shape of the flaps with an explanation of the venous flow. PMID:3623267

  5. Use of single-cannula venous-venous extracorporeal life support in the management of life-threatening airway obstruction.

    PubMed

    Ko, Michael; Dos Santos, Pedro R; Machuca, Tiago N; Marseu, Katherine; Waddell, Thomas K; Keshavjee, Shaf; Cypel, Marcelo

    2015-03-01

    The use of venous-venous extracorporeal life support (VV ECLS) for the endoscopic management of airway obstruction has been rarely reported. In most instances, ECLS has been used in the setting of cardiopulmonary resuscitation in which venoarterial ECLS was initiated as part of resuscitation. We report a patient with a bulky primary tumor of the tracheal carina presenting with airway obstruction who was managed with intraoperative single-cannula VV ECLS to facilitate endoscopic interventions leading to more definitive airway security. PMID:25742860

  6. Evaluation of Suspected Deep Venous Thrombosis in Oncologic Patients

    Microsoft Academic Search

    Deborah L. Keefe; Nancy Roistacher; Mary Kathryn Pierri

    1994-01-01

    Impedance plethysmography (IPG) and duplex scanning with color flow Doppler were performed in 100 consecutive high-risk patients with clinically suspected deep venous thrombosis. Risk factors included recent surgery (

  7. Prevention of Venous Thromboembolism After Hip or Knee Arthroplasty

    Microsoft Academic Search

    Frederick A. Anderson; Wei Huang; Richard J. Friedman; Louis M. Kwong; Jay R. Lieberman; Vincent D. Pellegrini

    A survey was mailed to a representative sample of US orthopedic surgeons to assess protocols for the prevention of venous thromboembolism after lower extremity total joint arthroplasty. Practices were examined by type of operation, annual surgical volume, and opinions of consensus guidelines issued by the American Academy of Orthopaedic Surgeons and the American College of Chest Physicians. Although there was

  8. Coronary arteries form by developmental reprogramming of venous cells

    E-print Network

    Krasnow, Mark A.

    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

  9. Occult malignant neoplasm in patients with deep venous thrombosis

    Microsoft Academic Search

    Robert J. Goldberg; Michael Seneff; Joel M. Gore; Frederick A. Anderson; H. L. Greene; H. Brownell Wheeler; James E. Dalen

    1987-01-01

    An association between venous thrombosis and cancer was first suggested by Armand Trousseau and subsequently confirmed by multiple postmortem studies. In a previous study, patients with pulmonary embolism, as assessed by pulmonary angiography, were at significantly increased risk of occult cancer with a comparison group of patients without pulmonary embolism. This nonconcurrent prospective epidemiologic study extends these findings by demonstrating

  10. Physiologic variations in lower extremity venous valvular function

    Microsoft Academic Search

    Enrique Criado; Patty F. Daniel; William Marston; Deborah I. Mansfield; Blair A. Keagy

    1995-01-01

    We conducted this study to investigate the physiologic variations in venous valvular function and calf muscle pump function that occur in normal limbs after prolonged stationary standing. Twenty-two limbs from 11 healthy volunteers were studied after a brief period of activity and after 4 to 6 hours of stationary standing. Vein diameter, peak reflux flow velocity (PRFV), and valve closure

  11. Treatment and secondary prevention of venous thromboembolism in cancer

    Microsoft Academic Search

    R Coleman; P MacCallum

    2010-01-01

    Patients with cancer who develop venous thromboembolism (VTE) are at elevated risk for recurrent thrombotic events, even during anticoagulant therapy. The clinical picture is further complicated because these patients are also at increased risk of bleeding while on anticoagulants. In general, there are four key goals of treatment for VTE: preventing fatal pulmonary embolism (PE); reducing short-term morbidities associated with

  12. Anomalous venous blood flow and iron deposition in multiple sclerosis

    Microsoft Academic Search

    Ajay Vikram Singh; Paolo Zamboni

    2009-01-01

    Multiple sclerosis (MS) is primarily an autoimmune disorder of unknown origin. This review focuses iron overload and oxidative stress as surrounding cause that leads to immunomodulation in chronic MS. Iron overload has been demonstrated in MS lesions, as a feature common with other neurodegenerative disorders. However, the recent description of chronic cerebrospinal venous insufficiency (CCSVI) associated to MS, with significant

  13. The Future of Medical Therapy for Venous Thromboemboli

    Microsoft Academic Search

    Joseph A. Caprini

    2008-01-01

    The field of medicine has a >30-year experience of prophylactic anticoagulation treatment in surgical patients, especially those with joint replacement and hip fracture. Extensive research to find anticoagulation alternatives beyond the use of unfractionated heparin has resulted in the development of low-molecular-weight heparin and vitamin K antagonist for prophylaxis of venous thromboembolism (VTE). In this article, drug administration regimens, pharmacologic

  14. Triplex ultrasound: elasticity imaging to age deep venous thrombosis

    Microsoft Academic Search

    S. Y Emelianov; X Chen; M O’Donnell; B Knipp; D Myers; T. W Wakefield; J. M Rubin

    2002-01-01

    Deep venous thrombosis (DVT), and its sequela, pulmonary embolism (PE), is the leading cause of preventable in-hospital mortality in the USA and other developed countries. After it is detected, acute clots must be differentiated from chronic DVT for appropriate treatment. However, there are no reliable thrombus staging methods presently available in clinical practice. In this study, we tested the hypothesis

  15. Thermal Imaging in the Investigation of Deep Venous Thrombosis

    Microsoft Academic Search

    J. Richard

    Preliminary assessment of clinically suspected deep venous thrombosis (DVT) of the lower limb by thermography avoids the need for over one third of venograms or duplex Doppler ultrasound scans. Clinical diagnosis of DVT is notoriously unreliable - hence the need for an accurate means of clini- cal investigation. Untreated DVT is dangerous as it can progress to pulmonary embolism (PE)

  16. Acute on Chronic Venous Thromboembolism on Therapeutic Anticoagulation

    PubMed Central

    Bassi, Byron; Nickels, L. Connor; Flach, F. Eike; DePortu, Guiliano; Ganti, Latha

    2013-01-01

    A case of proximal venous thromboembolism in a patient who presented to the ED with lower extremity pain is presented. Making this diagnosis is very important as fifty percent of patients with symptomatic proximal DVTs will go on to develop PE without treatment. This report underscores the utility of bedside ultrasonography in the emergency department. PMID:24223315

  17. Deep venous thrombosis after percutaneous insertion of vena caval filters

    Microsoft Academic Search

    John Blebea; Ryan Wilson; Peter Waybill; Marsha M. Neumyer; Judy S. Blebea; Karla M. Anderson; Robert G. Atnip

    1999-01-01

    Purpose: A large multicenter study has recently questioned the overall clinical efficacy of vena caval filters, especially when inserted prophylactically, because of the subsequent development of deep venous thrombosis (DVT) at the insertion site. We examined the incidence of this complication with newer, smaller diameter percutaneous devices. Methods: We reviewed our vascular surgery and interventional radiology clinical registries to identify

  18. Calf deep venous thrombosis should be treated with anticoagulation

    Microsoft Academic Search

    Steven R Deitcher; Joseph A Caprini

    2003-01-01

    A 50-YEAR-OLD MAN with hypertension presents with a 2-day history of right calf swelling and pain. Venous duplex ultrasound reveals a right soleal vein thrombosis. He denies history of bleeding, renal disease, and symptoms suggestive of pulmonary embolism (PE). Physical examination is unrevealing except for calf tenderness, redness, warmth, and swelling. He is ambulatory. A decision is made to treat

  19. Thermal imaging in the investigation of deep venous thrombosis

    Microsoft Academic Search

    J. Richard Harding; Glan Hafren

    1995-01-01

    Preliminary assessment of clinically suspected deep venous thrombosis (DVT) of the lower limb by thermography avoids the need for over one third of venograms or duplex Doppler ultrasound scans. Clinical diagnosis of DVT is notoriously unreliable-hence the need for an accurate means of clinical investigation. Untreated DVT is dangerous as it can progress to pulmonary embolism (PE) which is frequently

  20. Model-based reconstructive elasticity imaging of deep venous thrombosis

    Microsoft Academic Search

    Salavat Aglyamov; Andrei R. Skovoroda; Jonathan M. Rubin; Matthew O'Donnell; Stanislav Y. Emelianov

    2004-01-01

    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

  1. Venous Graft-Derived Cells Participate in Peripheral Nerve Regeneration

    PubMed Central

    Lavasani, Mitra; Gehrmann, Sebastian; Gharaibeh, Burhan; Clark, Katherine A.; Kaufmann, Robert A.; Péault, Bruno; Goitz, Robert J.; Huard, Johnny

    2011-01-01

    Background Based on growing evidence that some adult multipotent cells necessary for tissue regeneration reside in the walls of blood vessels and the clinical success of vein wrapping for functional repair of nerve damage, we hypothesized that the repair of nerves via vein wrapping is mediated by cells migrating from the implanted venous grafts into the nerve bundle. Methodology/Principal Findings To test the hypothesis, severed femoral nerves of rats were grafted with venous grafts from animals of the opposite sex. Nerve regeneration was impaired when decellularized or irradiated venous grafts were used in comparison to untreated grafts, supporting the involvement of venous graft-derived cells in peripheral nerve repair. Donor cells bearing Y chromosomes integrated into the area of the host injured nerve and participated in remyelination and nerve regeneration. The regenerated nerve exhibited proper axonal myelination, and expressed neuronal and glial cell markers. Conclusions/Significance These novel findings identify the mechanism by which vein wrapping promotes nerve regeneration. PMID:21966370

  2. Hepatic Venous Pressure in Practice How, When, and Why

    Microsoft Academic Search

    Julio D. Vorobioff

    Hepatic venous pressure gradient (HVPG) measure- ment has evolved into an extremely useful procedure for the assessment of portal hypertensive patients and in the prediction and management of portal hypertension-related events. Although invasive and not widely available, its safety and reproducibility can be warranted when performed in referral centers and following accepted guidelines. Well-established manometric HVPG cut off are reliable

  3. Development of Needle Insertion Manipulator for Central Venous Catheterization

    NASA Astrophysics Data System (ADS)

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

    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.

  4. Pneumothorax as a complication of central venous catheter insertion.

    PubMed

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion. PMID:25815301

  5. Migration of Indwelling Central Venous Catheter and Fatal Hydrothorax

    PubMed Central

    Jabeen, Shagufta; Murtaza, Ghulam; Hanif, Muhammad Zubair; Morabito, Antonino; Khalil, Basem

    2013-01-01

    Central venous catheter complications can be related to insertion, indwelling, or extraction. Most of the times, immediate complications are anticipated and managed; whereas, delayed complications can go unnoticed. In the case discussed here, migration and dislodgement of catheter tip resulted in delayed hydrothorax and sudden death of a 9-month-old female infant. PMID:25755966

  6. Venous thromboembolism in patients with essential thrombocythemia and polycythemia vera

    Microsoft Academic Search

    H Reikvam; R V Tiu

    2012-01-01

    Polycythemia vera (PV) and essential thrombocythemia (ET) are myeloproliferative neoplasms (MPNs), which generally follow a benign and indolent clinical course. However, venous thromboses are common and constitute the main cause of morbidity and mortality. The discovery of the JAK2V617F mutation and other biomarkers has advanced our understanding of these diseases. There is a strong association between the presence of the

  7. Critical appraisal of surgical venous access in children

    Microsoft Academic Search

    M. A. Hollyoak; T. H. Ong; J. F. Leditschke

    1997-01-01

    Central venous catheters (CVC) have become an important adjunct to the overall management of paediatric patients, but their use is associated with frequent complications resulting in premature removal. This report evaluates the insertion techniques and complications of 295 consecutive surgically inserted CVC from 1987 to 1991 in a paediatric hospital. Fully implanted catheters had significantly less incidence of catheter-related problems

  8. Hypodense bubbles in acute extradural haematomas following venous sinus tear

    Microsoft Academic Search

    C. P. Chee; Z. A. Habib

    1991-01-01

    Between January 1982 and December 1989, 12 patients with 13 acute extradural haematomas as a result of injury involving the venous sinuses were treated by the first author. The CT scan appearances in 6 cases were remarkable in that there were large bubbles of low density in the hyperdense haematomas and liquid blood was found during the operation. The possible

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

    Microsoft Academic Search

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

    2009-01-01

    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

  10. Incidental venous thromboembolism in ambulatory cancer patients receiving chemotherapy

    Microsoft Academic Search

    M. Di Nisio; N. Ferrante; M. De Tursi; S. Iacobelli; F. Cuccurullo; H. R. Büller; B. Feragalli; E. Porreca

    2010-01-01

    While the association between cancer and symptomatic venous thromboembolism (VTE) is well established, the incidence and risk factors for incidental VIE in cancer patients remain unclear The medical records of 1,921 consecutive cancer patients starting chemotherapy from January 2003 up to March 2009 were identified Patients with a positive history of VTE were excluded Pre existing signs of VIE, kind

  11. Pneumothorax as a complication of central venous catheter insertion

    PubMed Central

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos

    2015-01-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the “central venous oxygen saturation”), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

  12. A familial venous malformation locus is on chromosome 9p

    SciTech Connect

    Boon, L.M.; Mulliken, J.B. [Children`s Hospital, Boston, MA (United States); Vikkula, M. [Harvard Medical School, Boston, MA (United States)] [and others

    1994-09-01

    Venous malformation is the most common vascular malformation affecting 0.2% of the population. Depending upon size and location, these slow-flow lesions may cause pain, anatomic distortion and threaten life. Most venous malformations occur sporadically and present as solitary lesions. For this reason, determining their pathogenic bases has proven elusive. However, venous malformations also occur in several rare syndromes, some of which demonstrate Mendelian inheritance. As a first step towards identifying the pathogenic bases for these lesions, we have mapped a locus for an autosomal dominant disorder in a three generation family that manifests as multiple cutaneous and mucosal venous malformations. This locus lies within a 24.5 cM interval on chromosome 9p, defined by the markers D9S157 and D9S163. A maximum LOD score of 4.11 at {theta} = 0.05 is obtained with several markers within the interval. The interferon gene cluster, which has previously been implicated in angiogenesis, and the multiple tumor suppressor gene, responsible for several types of malignant tumors, also lie within this interval and are potential candidates.

  13. Volume Calculation of Venous Thrombosis Using 2D Ultrasound Images.

    PubMed

    Dhibi, M; Puentes, J; Bressollette, L; Guias, B; Solaiman, B

    2005-01-01

    Venous thrombosis screening exams use 2D ultrasound images, from which medical experts obtain a rough idea of the thrombosis aspect and infer an approximate volume. Such estimation is essential to follow up the thrombosis evolution. This paper proposes a method to calculate venous thrombosis volume from non-parallel 2D ultrasound images, taking advantage of a priori knowledge about the thrombosis shape. An interactive ellipse fitting contour segmentation extracts the 2D thrombosis contours. Then, a Delaunay triangulation is applied to the set of 2D segmented contours positioned in 3D, and the area that each contour defines, to obtain a global thrombosis 3D surface reconstruction, with a dense triangulation inside the contours. Volume is calculated from the obtained surface and contours triangulation, using a maximum unit normal component approach. Preliminary results obtained on 3 plastic phantoms and 3 in vitro venous thromboses, as well as one in vivo case are presented and discussed. An error rate of volume estimation inferior to 4,5% for the plastic phantoms, and 3,5% for the in vitro venous thromboses was obtained. PMID:17281109

  14. Histamine and H1-histamine receptors faster venous circulation

    PubMed Central

    Galajda, Zoltan; Balla, Jozsef; Szentmiklosi, A Jozsef; Biro, Tamas; Czifra, Gabriella; Dobrosi, Nora; Cseppento, Agnes; Patonay, Lajos; Roszer, Tamas; Balla, Gyorgy; Popescu, Laurenciu M; Lekli, Istvan; Tosaki, Arpad

    2011-01-01

    Abstract The study has analysed the action of histamine in the rabbit venous system and evaluated its potential role in contraction during increased venous pressure. We have found that a great variety exists in histamine sensitivity and H1-histamine receptor expression in various types of rabbit veins. Veins of the extremities (saphenous vein, femoral vein, axillary vein) and abdomen (common iliac vein, inferior vena cava) responded to histamine by a prominent, concentration-dependent force generation, whereas great thoracic veins (subclavian vein, superior vena cavas, intrathoracic part of inferior vena cava) and a pelvic vein (external iliac vein) exhibited slight sensitivity to exogenous histamine. The lack of reactivity to histamine was not due to increased activity of nitric oxide synthase (NOS) or heme oxygenase-1. H1-histamine receptor expression of veins correlated well with the histamine-induced contractions. Voltage-dependent calcium channels mediated mainly the histamine-induced force generation of saphenous vein, whereas it did not act in the inferior vena cava. In contrast, the receptor-operated channels were not involved in this response in either vein. Tyrosine phosphorylation occurred markedly in response to histamine in the saphenous vein, but not in the inferior vena cava. Histamine induced a prominent ? kinase activation in both vessels. Protein kinase C and mitogen-activated protein kinase (MAPK) were not implicated in the histamine-induced intracellular calcium sensitization. Importantly, transient clamping of the femoral vein in animals caused a short-term constriction, which was inhibited by H1-histamine receptor antagonist in vivo. Furthermore, a significantly greater histamine immunopositivity was detected in veins after stretching compared to the resting state. We conclude that histamine receptor density adapts to the actual requirements of the circulation, and histamine liberated by the venous wall during increased venous pressure contributes to the contraction of vessels, providing a force for the venous return. PMID:21199332

  15. [Clinical characteristics of pain in chronic venous insufficiency].

    PubMed

    Coget, J M; Millien, J P

    1992-01-01

    Since the report of the 1st International Conference of Phlebology at Chambéry, devoted to venous pain, the subject has scarcely attracted attention apart from the meeting of the Benelux Society of Phlebology devoted to "pain in the legs". Pain due to superficial venous insufficiency has scarcely changed in nature for 30 years and remains one of the major presenting symptoms in phlebology. Acute or chronic, punctate or diffuse, modifications in this functional symptomatology have been accentuated, or have varied in their aspects under the influence of certain fashions or certain habits of modern life, i.e.: sedentary behaviour, underfloor heating, the use of oral contraceptives or of menopausal hormone replacement therapy. However, the distribution of the various aspects of venous pain remains in the same proportions as those described by the authors cited previously. While the etiological diagnosis must essentially eliminate all other causes: arterial, neurological, muscular, articular, it is essential not to neglect deep venous insufficiency of the gemellar veins, often responsible for a wide range of symptomatology and still all too often neglected. The pathogenesis of this pain not only involves the concept of pain receptors but also the appearance of algogenic metabolites at the site of the microcirculatory unit, to which endothelial cells are particularly sensitive during stasis. In fact, pain is the expression of disorders concerning local exchanges, whether thermal, pressure, metabolic or hemorheological. It is the alarm bell of venous insufficiency and merits the attention of the phebologist who must thus undertake active treatment before problems become irreversible. PMID:1496035

  16. Understanding venous leg ulcer pain: results of a longitudinal study.

    PubMed

    Nemeth, Kathleen A; Harrison, Margaret B; Graham, Ian D; Burke, Sharon

    2004-01-01

    Venous leg ulcer pain experienced during compression bandaging is poorly understood. A prospective, pilot cohort study was initiated to determine the feasibility of conducting a large-scale, repeated measures cohort study of venous leg ulcer pain and to document and describe the venous leg ulcer pain experience during the first 5 weeks of treatment with compression bandages. Eligible individuals admitted to a nurse-led community leg ulcer service in one Canadian community were recruited for the 5-week study. Pain assessment tools (ie, numerical rating scale and short form McGill Pain Questionnaire) were evaluated by 20 venous ulcer patients (mean age = 73.7 years) and their nurses for ease of use during one baseline and five weekly follow-up visits. Health-related quality of life (HRQL) information was obtained. Nurses reported on ease of integrating pain data collection into regular clinical care. Each pain assessment tool was audited for completion. Most participants found the pain assessment tools easy to use, but nurses reported lengthened visit times with some participants as a result of tool administration difficulties, particularly the visual analogue scale (VAS). Overall completeness of pain assessment tools ranged from 85.0% (visual analogue scale) to 96.3% (present pain intensity and word descriptor list). The vast majority of patients (18) reported ulcer pain at baseline. Total mean scores for all pain assessment tools used decreased over time, but most patients reported pain throughout the study. The most common pain descriptors used were "aching," "stabbing," "sharp," "tender," and "tiring." Health-related quality of life was low and did not change during the 5-week study. The results of this study suggest that the vast majority of venous ulcer patients experience pain and that it is feasible to examine this pain in individuals receiving care in the community over time. PMID:14712004

  17. Radionuclide analysis of the forearm venous pressure-volume relationship: response to nitroglycerin

    SciTech Connect

    Dittrich, H.C.; Slutsky, R.A.

    1984-04-01

    By means of equilibrium radionuclide forearm venous occlusion plethysmography, we studied 12 adult men without heart failure. By using stepwise increases in venous occlusion pressure (0, 10, 20, and 30 mm Hg), we found that the relationship between venous cuff pressure and forearm radionuclide volume was consistently linear (r greater than 0.985). When sublingual nitroglycerin (NTG) was administered (0.8 mg), the venous pressure-volume relationship was consistently shifted rightward (reducing the slope and increasing the intercept). This resulted in large increases in venous capacitance, as shown by other workers using alternative techniques. Increased venous distensibility due to NTG was caused by an entire shift of the venous pressure-volume relationship rather than increased capacitance at one occlusion pressure. Equilibrium radionuclide venous occlusion plethysmography is a sensitive way to characterize venous pressure-volume relations. In addition, by using radionuclide blood pool component imaging to evaluate venous compliance, concern over fluid transudation seen with standard strain gauge venous plethysmographic techniques can be ignored, particularly at higher occlusion pressures.

  18. Circulating Endothelial Cells in Venous Blood as a Marker of Endothelial Damage in Chronic Venous Insufficiency: Improvement with Venoruton

    Microsoft Academic Search

    Maria Rosaria Cesarone; Gianni Belcaro; Luciano Pellegrini; Andrea Ledda; Giulia Vinciguerra; Andrea Ricci; Giuseppe Gizzi; Edmondo Ippolito; Filiberto Fano; Mark Dugall; Giovanni Acerbi; Marisa Cacchio; Morio Hosoi; Stefano Stuard; Marcello Corsi

    Damage to endothelial cells is common in vascular disorders and in reactions associated with transplantation. An elevated number of circulating endothelial cells indicates the extent of endothelial damage in a variety of disorders. In chronic venous insufficiency (CVI), the num- ber of endothelial cells is abnormally increased, and this can be considered an important indi- cation of endothelial damage. A

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

    PubMed Central

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

    2013-01-01

    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

  20. Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study

    PubMed Central

    Kenet, Gili; Kirkham, Fenella; Niederstadt, Thomas; Heinecke, Achim; Saunders, Dawn; Stoll, Monika; Brenner, Benjamin; Bidlingmaier, Christoph; Heller, Christine; Knöfler, Ralf; Schobess, Rosemarie; Zieger, Barbara; Sébire, Guillaume; Nowak-Göttl, Ulrike

    2007-01-01

    Summary Background The relative importance of previous diagnosis and hereditary prothrombotic risk factors for cerebral venous thrombosis (CVT) in children in determining risk of a second cerebral or systemic venous thrombosis (VT), compared with other clinical, neuroimaging, and treatment variables, is unknown. Methods We followed up the survivors of 396 consecutively enrolled patients with CVT, aged newborn to 18 years (median 5·2 years) for a median of 36 months (maximum 85 months). In accordance with international treatment guidelines, 250 children (65%) received acute anticoagulation with unfractionated heparin or low-molecular weight heparin, followed by secondary anticoagulation prophylaxis with low-molecular weight heparin or warfarin in 165 (43%). Results Of 396 children enrolled, 12 died immediately and 22 (6%) had recurrent VT (13 cerebral; 3%) at a median of 6 months (range 0·1–85). Repeat venous imaging was available in 266 children. Recurrent VT only occurred in children whose first CVT was diagnosed after age 2 years; the underlying medical condition had no effect. In Cox regression analyses, non-administration of anticoagulant before relapse (hazard ratio [HR] 11·2 95% CI 3·4–37·0; p<0·0001), persistent occlusion on repeat venous imaging (4·1, 1·1–14·8; p=0·032), and heterozygosity for the G20210A mutation in factor II (4·3, 1·1–16·2; p=0·034) were independently associated with recurrent VT. Among patients who had recurrent VT, 70% (15) occurred within the 6 months after onset. Conclusion Age at CVT onset, non-administration of anticoagulation, persistent venous occlusion, and presence of G20210A mutation in factor II predict recurrent VT in children. Secondary prophylactic anticoagulation should be given on a patient-to-patient basis in children with newly identified CVT and at high risk of recurrent VT. Factors that affect recanalisation need further research. PMID:17560171

  1. The early fate of venous repair after civilian vascular trauma. A clinical, hemodynamic, and venographic assessment.

    PubMed

    Meyer, J; Walsh, J; Schuler, J; Barrett, J; Durham, J; Eldrup-Jorgensen, J; Schwarcz, T; Flanigan, D P

    1987-10-01

    Repair of major venous injuries of the extremities has been advocated to improve limb salvage rates and to prevent the early and late sequelae of venous interruption. The contribution of venous repair to the surgical outcome remains controversial, however, in part because the fate of venous reconstruction has previously not been well defined. The current study was done to determine the early patency rate of venous repair, to compare the accuracy of various methods used to assess venous patency, and to analyze the relationship between early venous patency and surgical outcome. During a recent 27-month period, 36 patients with major extremity venous injuries were treated by venous reconstruction; 34 patients (94%) had an associated major arterial injury that also required repair. Venous repair was performed in the upper extremity (22%) as well as the lower extremity (78%) using various reconstructive methods, including lateral repair (17%), end-to-end anastomosis (11%), autogenous vein patching (25%), interposition autogenous vein grafting (42%), and panelled autogenous vein grafting (6%). After operation, venous repair patency was evaluated by clinical examination, impedence plethysmography, and Doppler ultrasonography, and contrast venography. There were no perioperative deaths in these 36 patients. The limb salvage rate was 100% and all 34 major arterial repairs were patent at the time of hospital discharge. Venography performed on the seventh postoperative day demonstrated that 14 venous repairs had thrombosed (39%) and that 22 had remained patent (61%). Local venous repair had a significantly lower thrombosis rate (21%) than those requiring interposition vein grafting (59%) (p less than 0.03). Compared with venography, the clinical evaluation was 67% accurate in the assessment of venous repair patency, and the noninvasive examination was 53% accurate. In conclusion, a substantial percentage of venous repairs will thrombose in the postoperative period, especially if interposition vein grafting is used. However, in this series limb salvage was not adversely influenced by an unexpectedly high rate of venous repair thrombosis. In addition, clinical evaluation and noninvasive testing did not provide an accurate assessment of venous patency after venous repair. PMID:2959215

  2. Infraclavicular brachial plexus block for the management of inadvertent intraarterial drug administration after arterial insertion of a venous cannula during ultrasound-guided venous cannulation.

    PubMed

    Leo, Anne-Marie; Mislovic, Branislav

    2014-09-15

    This case report documents the inadvertent placement of an arterial cannula despite using realtime ultrasound to insert a peripheral venous cannula in a child with difficult venous access. The resultant limb ischemia was treated with an infraclavicular ultrasound-guided brachial plexus block as sympatholytic treatment. PMID:25611526

  3. Caring for Your Venous Access Device: PortaCath A portacath is an implanted venous access device that is surgically placed under the skin on your chest

    E-print Network

    Kim, Duck O.

    Caring for Your Venous Access Device: PortaCath A portacath is an implanted venous access will be put into your port by a nurse. This is called "accessing" the port. This is a sterile procedure that is outside of your skin will lay flat against your skin. A sterile bandage will be put over the needle

  4. Potential involvement of the extracranial venous system in central nervous system disorders and aging

    PubMed Central

    2013-01-01

    Background The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. Discussion A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. Summary Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials. Please see related editorial: http://www.biomedcentral.com/1741-7015/11/259. PMID:24344742

  5. Genes regulating lymphangiogenesis control venous valve formation and maintenance in mice.

    PubMed

    Bazigou, Eleni; Lyons, Oliver T A; Smith, Alberto; Venn, Graham E; Cope, Celia; Brown, Nigel A; Makinen, Taija

    2011-08-01

    Chronic venous disease and venous hypertension are common consequences of valve insufficiency, yet the molecular mechanisms regulating the formation and maintenance of venous valves have not been studied. Here, we provide what we believe to be the first description of venous valve morphogenesis and identify signaling pathways required for the process. The initial stages of valve development were found to involve induction of ephrin-B2, a key marker of arterial identity, by venous endothelial cells. Intriguingly, developing and mature venous valves also expressed a repertoire of proteins, including prospero-related homeobox 1 (Prox1), Vegfr3, and integrin-?9, previously characterized as specific and critical regulators of lymphangiogenesis. Using global and venous valve-selective knockout mice, we further demonstrate the requirement of ephrin-B2 and integrin-?9 signaling for the development and maintenance of venous valves. Our findings therefore identified molecular regulators of venous valve development and maintenance and highlighted the involvement of common morphogenetic processes and signaling pathways in controlling valve formation in veins and lymphatic vessels. Unexpectedly, we found that venous valve endothelial cells closely resemble lymphatic (valve) endothelia at the molecular level, suggesting plasticity in the ability of a terminally differentiated endothelial cell to take on a different phenotypic identity. PMID:21765212

  6. Acute Cytomegalovirus Infection as a Cause of Venous Thromboembolism

    PubMed Central

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

    2014-01-01

    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

  7. Radiotherapy for intraarticular venous malformations of the knee.

    PubMed

    Fujita, Takeshi; Okimoto, Tomoaki; Ito, Katsuyoshi; Tanabe, Masahiro; Matsunaga, Naofumi

    2014-11-01

    Intraarticular venous malformation (IAVM) of the knee is a rare vascular disease that manifests with pain, swelling, and hemarthrosis. A young man with left knee pain and swelling was admitted to our institution for the treatment of the IAVM of the left knee which was diagnosed by a local orthopedic doctor via arthroscopy. A total dose of 40 Gy of radiotherapy was delivered with a daily dose of 2.0 Gy using 6 MV X-ray beams and a linear accelerator through anteroposterior portals. Fifteen months after radiotherapy, follow-up examination using radiologic imaging showed distinct shrinkage of the venous malformations. Swelling and pain of the left knee had decreased, and range of motion of the left knee was maintained. This report describes a case involving a 38-year-old man with IAVM of the left knee in whom favorable outcomes were obtained in response to radiotherapy. PMID:25017778

  8. Sinus venous stenosis, intracranial hypertension and progression of primary headaches.

    PubMed

    De Simone, Roberto; Ranieri, Angelo; Montella, Silvana; Marchese, Mario; Persico, Pasquale; Bonavita, Vincenzo

    2012-05-01

    The recently advanced hypothesis that idiopathic intracranial hypertension without papilledema (IIHWOP) is a powerful risk factor for the progression of pain in individuals prone to episodic primary headache implies that IIHWOP is much more prevalent than it is believed to be in the general population and that it can run almost asymptomatic in most of the affected individuals. In this review, we discuss the evidence available supporting that: (a) sinus venous stenosis-associated IIHWOP is much more prevalent than believed in the general population and can run without symptoms or signs of raised intracranial pressure in most of individuals affected, (b) sinus venous stenosis is a very sensitive and specific predictor of intermittent or continuous idiopathic intracranial hypertension with or without papilledema, even in asymptomatic individuals, (c) in primary headache prone individuals, a comorbidity with a hidden stenosis-associated IIHWOP represents a very common, although largely underestimated, modifiable risk factor for the progression and refractoriness of headache. PMID:22644164

  9. Congenital umbilical arterio-venous malformation: a word of caution.

    PubMed

    Gozar, Horea; Gozar, Liliana; Badiu, Catalin Constantin; Suciu, Horatiu

    2014-05-01

    We report on an 18-month old girl who presented in good clinical shape with a pulsatile tumour in the umbilical area which had a shape and localization similar to that of an umbilical bowel hernia. The Doppler ultrasound of the umbilical tumour revealed a large arterio-venous vascular malformation with a haemodynamically significant blood shunting. Furthermore, the inferior caval vein and the hepatic veins were dilated. Computed tomography angiography revealed permeable umbilical veins and arteries communicating within a large dilated arterio-venous fistula. The growing tumour was excised without any perioperative complications. Further postoperative recovery was uneventful and the baby was discharged 10 days after surgery. We advocate careful antenatal ultrasound evaluation of these vascular malformations. Early surgical removal in newborns is vital in order to avoid severe complications. PMID:24550232

  10. Unusual Infra-Clavicular Venous Circle – A Case Report

    PubMed Central

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

    2014-01-01

    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

  11. Venous endothelin guides sympathetic innervation of the developing mouse heart

    PubMed Central

    Manousiouthakis, Eleana; Mendez, Monica; Garner, Madeline C.; Exertier, Prisca; Makita, Takako

    2014-01-01

    The mechanisms responsible for establishing correct target innervation during organ development are largely unknown. Sympathetic nerves traverse or follow blood vessels to reach their end-organs, suggesting the existence of vascular guidance cues that direct axonal extension. The sinoatrial node and the ventricle of the heart receive sympathetic innervation from the stellate ganglia (STG). Here we show that STG axons follow veins, specifically the superior vena cavae and sinus venosus, to reach these targets. We find that the election of these routes is determined by venous endothelium-derived endothelin-1, acting through its specific receptor Ednra expressed within a subpopulation of STG neurons. Furthermore, we demonstrate that Edn1-Ednra signaling is essential for functional regulation of the heart by sympathetic nerves. Our findings present venous Edn1 as a sympathetic guidance cue, and show how axon guidance mechanisms are coordinated with end-organ morphogenesis. PMID:24875861

  12. Historical aspects in the development of venous autografts.

    PubMed Central

    Harrison, L H

    1976-01-01

    During the past 75 years much progress has occurred in the field of vascular surgery. During this period, contributions from clinical surgeons have stimulated new scientific discoveries which have led to further clinical applications in a mutually perpetuating cycle of surgical advancement. One of the major achievements has been the use of the venous autograft employed as an arterial substitute. First used by Goyanes in 1906 to replace a popliteal aneurysm, a venous autograft was first successfully employed in the United States by Bernheim in 1915. The stepwise development of this aspect of modern vascular surgery is presented, and the role of other related contributions in making its use feasible is reviewed. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:1108815

  13. Superior mesenteric venous thrombosis in malrotation with chronic volvulus.

    PubMed

    Walsh, D S; Crombleholme, T M

    2000-05-01

    Malrotation can be difficult to diagnose after the newborn period because of intermittent symptoms and vague clinical findings, but malrotation with midgut volvulus is usually quite striking in its presentation. Early diagnosis and surgical treatment are essential to prevent acute ischemic infarction of the bowel, although chronic complications are rare. The authors present an unusual case of mesenteric venous thrombosis secondary to chronic midgut volvulus. A 13-year-old girl presented with an 11-year history of recurrent bouts of abdominal pain evaluated at 3 other institutions without a diagnosis. At the referring hospital, an episode of bilious emesis associated with abdominal pain prompted a computerized tomography scan of the abdomen. This showed a calcified thrombus within the superior mesenteric vein (SMV). At laparotomy, malrotation with chronic 270 degree volvulus was found with evidence of mesenteric venous hypertension. Segmental occlusion was documented on magnetic resonance angiography. SMV thrombosis is an unusual complication of malrotation with chronic midgut volvulus. PMID:10813342

  14. Central Venous Saturation: A Prognostic Tool in Cardiac Surgery patients

    Microsoft Academic Search

    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

    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%

  15. Venous thromboembolism prophylaxis in medical patients: Future perspectives

    Microsoft Academic Search

    Davide Imberti; Domenico Prisco

    2005-01-01

    Venous thromboembolism is a common potentially life-threatening complication in acutely ill medical patients. Actually, over 70% fatal episodes of pulmonary embolism during hospitalization occur in non-surgical patients. In the absence of thromboprophylaxis, the incidence of venographically detected deep vein thrombosis is about 15% in medical patients and several trials and meta-analyses have clearly demonstrated the prophylactic role of unfractioned heparin

  16. Spontaneous migration of central venous catheter tip following extubation

    PubMed Central

    Prabaharan, Balaji; Thomas, Sara

    2014-01-01

    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

  17. Venous Thromboembolic Disease Reduction With a Portable Pneumatic Compression Device

    Microsoft Academic Search

    Mark I. Froimson; Trevor G. Murray; Alice F. Fazekas

    2009-01-01

    This study compares a miniaturized, portable, sequential, pneumatic compression device (ActiveCare continuous enhanced circulation therapy [CECT] system) (Medical Compression Systems Ltd, Or Aqiva, Israel), with a nonmobile, nonsequential device on the ability to prevent postoperative deep venous thrombosis (DVT) after joint arthroplasty. All patients were treated with low-molecular-weight heparin, application of 1 of the 2 devices perioperatively, and routine duplex

  18. Cancer in males and risk of venous thromboembolism.

    PubMed

    Beyer-Westendorf, Jan; Werth, Sebastian; Halbritter, Kai; Weiss, Norbert

    2010-04-01

    Venous thromboembolism (VTE) is a common complication associated with increased mortality in cancer patients. Adequate treatment of thrombotic complications increases survival in these patients although additional complications such as thrombus progression with pulmonary embolism and bleeding events are common. The incidence of types of cancer as well as malignancy-associated VTE varies between genders. This article focuses on cancers more common in male patients and reviews the risk of VTE with special regard to types of cancer and anticancer therapy. PMID:20433997

  19. Embryologicalic collateral venous channel on radionuclide liver/spleen study

    SciTech Connect

    Wilkinson, R.H. Jr.; Johnson, D.G.

    1983-07-01

    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.

  20. The role of factor Xa inhibitors in venous thromboembolism treatment

    PubMed Central

    Cabral, Katherine P; Ansell, Jack E

    2015-01-01

    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. PMID:25673997

  1. Unanticipated complication of a malpositioned central venous catheter

    Microsoft Academic Search

    Pankaj Kundra; Bathala V. Sai Chandran; Kasturi S. V. K. Subbarao

    2009-01-01

    We report an unusual complication that occurred late in the postoperative period, due to a damaged and malpositioned peripherally\\u000a inserted central catheter (PICC) used for central venous pressure monitoring during esophagocoloplasty and for postoperative\\u000a parenteral nutrition. On the seventh postoperative day, the development of a leak from the neck wound coincided with the administration\\u000a of intravenous fluids via the PICC.

  2. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.

    PubMed

    Knuttinen, M-Gracia; Xie, Karen; Jani, Aarti; Palumbo, Alison; Carrillo, Tami; Mar, Winnie

    2015-02-01

    OBJECTIVE. The purposes of this article are to review the causes of pelvic congestion syndrome and the imaging used to make the diagnosis and to summarize the treatment options. CONCLUSION. Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is thought to arise from ovarian and pelvic venous incompetence. Findings from various noninvasive imaging studies, such as Doppler ultrasound and MRI, in association with the clinical symptoms are critical in establishing the diagnosis. PMID:25615769

  3. Venous Anatomy of the Sphenoparietal Sinus: Evaluation by MR Imaging

    PubMed Central

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

    2007-01-01

    Summary The termination of the superficial middle cerebral vein (SMCV) has been described as entering or being partially equivalent to the venous sinus coursing under the lesser sphenoid wing, which has classically been called the sphenoparietal sinus. However, the recent literature reports that the SMCV is not connected to the sphenoparietal sinus. In this study, the venous anatomy was evaluated to clarify the anatomy of the sphenoparietal sinus and the termination of the SMCV. Magnetic resonance imaging (MRI) was performed on 1.5-T superconductive units using a three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) sequence with fat suppression in a total of 48 sides of 24 patients. Coronal source images and reconstructed axial images were displayed on the Advantage Window Console, and connections to the cavernous sinus were then evaluated for the venous sinus coursing under the lesser sphenoid wing (hereafter called the sinus of the lesser sphenoid wing), the middle meningeal vein, and the SMCV. The following findings were observed bilaterally in all patients. The sinus of the lesser sphenoid wing was connected medially with the cavernous sinus and laterally with the anterior branch of the middle meningeal vein near the pterion. The anterior branch of the middle meningeal vein entered the bony canal laterally above the junction with the sinus of the lesser sphenoid wing and coursed along the inner table of the skull or emerged into the diploic vein, indicating its parietal portion. Although the termination of the SMCV had several patterns, the SMCV was not connected with the sinus of the lesser sphenoid wing in any of the patients. The sphenoparietal sinus is considered to consist of the sinus of the lesser sphenoid wing and the parietal portion of the anterior branch of the middle meningeal vein; these were identified as venous structures distinct to the SMCV. PMID:20566082

  4. Compression Therapy for Treatment of Venous Disease and Limb Swelling

    Microsoft Academic Search

    Raghu Kolluri

    2011-01-01

    Opinion statement  Although compression therapy was initially described over 2,000 years ago (Felty and Rooke Semin Vasc Surg Mar 18:36-40, 1), several patients with edema do not receive appropriate compression therapy. Instead, most patients with edema are treated\\u000a primarily with diuretics. Compression therapy is the cornerstone of treatment of venous edema and lymphatic disorders. Compression\\u000a therapy decreases the foot and leg volume

  5. Adrenal venous sampling: where is the aldosterone disappearing to?

    PubMed

    Solar, Miroslav; Ceral, Jiri; Krajina, Antonin; Ballon, Marek; Malirova, Eva; Brodak, Milos; Cap, Jan

    2010-08-01

    Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity. PMID:19795165

  6. Hemosiderotic fibrohistiocytic lipomatous lesion: clinical correlation with venous stasis.

    PubMed

    Kazakov, Dmitry V; Sima, Radek; Michal, Michal

    2005-07-01

    Hemosiderotic fibrohistiocytic lipomatous lesion (HFLL) is a recently proposed lipomatous entity. HFLL was originally suggested to be a benign reactive lesion arising due to an antecedent trauma. We report two patients with HFLL who also suffered from chronic vein insufficiency due to varicose involving deep veins of the low limbs. Both patients were middle-aged women with solitary, poorly circumscribed subcutaneous lesions on the lower extremities. Histopathological examination revealed typical features of HFLL. We think that the consistent clinical features such as advanced age, female sex predilection, and specific location along with distinctive histopathological features allow the suggestion that impaired blood circulation, to wit, venous stasis is involved in the pathogenesis of HFLL. We hypothesize that the proliferation of spindled fibroblastic and myofibroblastic cells and capillaries, erythrocyte extravasation, and hemosiderin deposition with lipomatous tissue of HFLL may simply represent an exaggerated tissue response to venous stasis in which elevated venous and capillary pressures, oxygen saturation, and edema stimulate the proliferation of the above mentioned elements and lead to erythrocyte extravasation. A similar histopathological pattern is seen in acroangiodermatitis of Mali and vascular transformation of lymph node sinuses, and these conditions are also associated with impaired blood circulation. PMID:15947948

  7. Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?

    SciTech Connect

    Solar, Miroslav; Ceral, Jiri, E-mail: ceral.jiri@fnhk.c [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Internal Medicine (Czech Republic); Krajina, Antonin [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Radiology (Czech Republic); Ballon, Marek [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Internal Medicine (Czech Republic); Malirova, Eva [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Nuclear Medicine (Czech Republic); Brodak, Milos [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Urology (Czech Republic); Cap, Jan [Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Department of Internal Medicine (Czech Republic)

    2010-08-15

    Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.

  8. Potential Risk Factors for Varicose Veins with Superficial Venous Reflux

    PubMed Central

    Uzun Kulao?lu, Tülin; Fen, Turgay; Kap?s?z, Hasan Fahri

    2014-01-01

    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

  9. Endometrial venous aneurysms in three New Zealand white rabbits.

    PubMed

    Bray, M V; Weir, E C; Brownstein, D G; Delano, M L

    1992-08-01

    Hematuria in rabbits has been associated with uterine adenocarcinoma, uterine polyps, renal infarction, urolithiasis, cystitis, bladder polyps, and pyelonephritis. Three adult female New Zealand White rabbits (Oryctolagus cuniculus) developed apparent hematuria, as suggested by blood in their excreta pans. They had been immunized with antigen-adjuvant emulsions, but had uneventful clinical histories. Physical examination disclosed no abnormalities, and laboratory tests, including hematology, serum chemistries, urinalyses, urine cultures, ultrasonography, and intravenous pyelography disclosed mild anemia, hematuria, and proteinuria in two of the rabbits. Antibiotic therapy failed to alleviate clinical signs. Two rabbits were euthanized because of persistent urogenital bleeding and the third rabbit underwent exploratory laparotomy and ovariohysterectomy. Multiple endometrial venous aneurysms were present in the uteri of all rabbits and urogenital bleeding was attributed to episodic bleeding from these lesions. Varices and aneurysms of uterine subserosal and myometrial venous plexuses, but not of endometrial vessels in women have been reported. To our knowledge, endometrial venous aneurysms have not been reported in animals previously. Our findings indicate that the differential diagnoses for sporadic apparent hematuria in female rabbits should include endometrial aneurysms. PMID:1434495

  10. Detecting Baker's cyst: venous duplex scanning in ambulatory setting.

    PubMed

    Matejci?, Aljosa; Vidovi?, Dinko; Ivica, Mihovil; Tomljenovi?, Mladen; Kuna, Tomislav; Mesi?, Marko; Jurisi?, Darko; Teufel, Nenad; Car, Boris

    2010-03-01

    Popliteal cyst, also called Baker's cyst, is a popliteal fossa enlargement filled with synovial fluid. Baker's cysts can be symptomatic and cause considerable pathologies such as thrombophlebitis, compartment syndrome and even nerve entrapment. It is the most common nonvascular pathology seen in the popliteal fossa but clinically indistinguishable from deep vein thrombosis. The aim of the present study was to evaluate venous duplex scanning in detecting and distinguishing complicated Baker's cyst and deep vein thrombosis in outpatient setting. Medical records of all patients undergoing venous duplex scanning during 2008 and 2009 to rule out deep vein thrombosis were reviewed. Ten patients having undergone ultrasonography examination were found to have complicated Baker's cyst. Baker's cysts are a rather common condition. When presenting with swollen and painful calf, it is impossible to differentiate it from deep vein thrombosis by simple clinical examination. Venous duplex scanning of lower extremity was found to be a useful imaging modality for detection of Baker's cysts, deep vein thrombosis and associated pathology. PMID:20635584

  11. Doxycycline speeds up healing of chronic venous ulcers.

    PubMed

    Serra, Raffaele; Gallelli, Luca; Buffone, Gianluca; Molinari, Vincenzo; Stillitano, Domenico M; Palmieri, Camillo; de Franciscis, Stefano

    2015-04-01

    Venous ulcers are common, with an overall prevalence of up to 2% in the general population of western countries, and have significant socioeconomic impact. Matrix metalloproteinases (MMPs) are involved in the alteration of extracellular matrix that could lead to venous ulceration. Sixty-four patients with venous ulcers were recruited in a 22-month period. All patients were subjected to the most appropriate treatment considering also the patient's wishes (compression therapy followed or not by vein surgery). Patients were randomised into two groups of 32 persons in each (groups A and B). Patients of group A in addition to the basic treatment, described above, received the administration of oral low doses of doxycycline 20?mg b.i.d. for 3?months, whereas patients of group B received basic treatment only. Healing was assessed by means of direct ulcer tracing with computerised planimetry. Group A showed a higher healing rate compared with group B. In group B, the lower healing rate was related to higher levels of MMP-9; neutrophil gelatinase-associated lipocalin and vascular endothelial growth factor, documented in plasma; wound fluid and biopsies executed and compared between both groups. Pharmacological treatments, as doxycycline administration, which by means of its immunomodulatory and anti-inflammatory actions, through the inhibition of MMP, could improve extracellular matrix functioning and represent a possible solution to support wound healing. PMID:23557025

  12. The Malposition of Central Venous Catheters in Children

    PubMed Central

    Dzierzega, Maria; Ossowska, Magdalena; Chmiel, Dariusz; Wieczorek, Aleksandra; Balwierz, Walentyna

    2014-01-01

    Summary Background Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. Material/Methods A total number of 309 CVCs were implanted at Children’s University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. Results CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. Conclusions In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them. PMID:25177409

  13. Guidelines for the treatment of head and neck venous malformations

    PubMed Central

    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

    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

  14. Transesophageal Echocardiographic Study of Decompression-Induced Venous Gas Emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Morris, W. P.

    1995-01-01

    Transesophageal echo-cardiography was used to evaluate venous bubbles produced in nine anesthetized dogs following decompression from 2.84 bar after 120 min at pressure. In five dogs a pulsed Doppler cuff probe was placed around the inferior vena cava for bubble grade determination. The transesophageal echo images demonstrated several novel or less defined events. In each case where the pulmonary artery was clearly visualized, the venous bubbles were seen to oscillate back and forth several times, bringing into question the effect of coincidental counting in routine bubble grade analysis using precordial Doppler. A second finding was that in all cases, extensive bubbling occurred in the portal veins with complete extraction by the liver sinusoids, with one exception where a portal-to-hepatic venous anastomosis was observed. Compression of the bowel released copious numbers of bubbles into the portal veins, sometimes more than were released into the inferior vena cava. Finally, large masses of foam were routinely observed in the non-dependent regions of the inferior vena cava that not only delayed the appearance of bubbles in the pulmonary artery but also allowed additional opportunity for further reaction with blood products and for coalescence to occur before reaching the pulmonary microcirculation. These novel observations are discussed in relation to the decompression process.

  15. Loss of hepatic venous responsiveness after endotoxin in anesthetized cats.

    PubMed

    Seaman, K L; Greenway, C V

    1984-05-01

    Endotoxin (from Salmonella enteriditis ) was administered either as an intravenous bolus injection after administration of indomethacin to prevent the acute anaphylactoid response or as a slow intravenous infusion to cats anesthetized with pentobarbital. Within 30 min, hepatic blood volume measured by plethysmography increased by 30%. However, unlike the outflow block seen in dogs after endotoxin, this increase in blood volume was associated with a fall in portal and hepatic lobar venous pressures. Responses to hepatic nerve stimulation (1-8 Hz), to intravenous infusions of norepinephrine (0.2-1.0 microgram X kg-1 X min-1), and to infusions into the hepatic artery of norepinephrine (0.1-0.5 microgram X kg-1 X min-1) and angiotensin II (0.1-0.5 microgram X kg-1 X min-1) were compared before and 150 min after endotoxin administration. Both portal pressure and hepatic blood volume responses to these stimuli were markedly depressed by 150 min after endotoxin. We conclude that in cats endotoxin causes a markedly depressed responsiveness of hepatic venous smooth muscle to agonists and a modest pooling of blood in the liver probably due to impairment of preexisting sympathetic tone. Although these hepatic venous effects were observed at a time when cardiac output was not markedly depressed, it is suggested that they may play a significant role in the later development of reduced cardiac output and shock. PMID:6372524

  16. Presentation of Epilepsy in a Patient with Wilson’s Disease and Developmental Venous Anomaly (Venous Angioma) in the Brain

    PubMed Central

    Alobaidy, Ammar; Alazri, Faisal; Jacob, P.C.; Al-Kalbani, Jamila H.

    2012-01-01

    Intracranial developmental venous anomalies (DVAs), also called venous angiomas, and Wilson’s disease are both considered rare disorders with varying degrees of neurologic and systemic manifestations; yet the coexistence of the two disorders is considered extremely rare, bearing in mind the low prevalence of each disorder. Epilepsy is a recognised presentation in these disorders and will be the focus of discussion in our report of a 21-year-old male patient who, based on a clinical examination and laboratory and neuroimaging results, was diagnosed with both Wilson’s disease and DVA. He presented initially at Sultan Qaboos University Hospital, Oman with tremors and writing difficulties in the right hand followed by the development of epilepsy, and was treated medically by de-coppering and antiepileptic medications. We also present a brief literature review of both disorders, their association with epilepsy, and treatment options. Family screening for patients with Wilson’s disease is pivotal in preventing unfavourable outcomes. PMID:23275849

  17. The effect of bed rest and an exercise countermeasure on leg venous function.

    PubMed

    van Duijnhoven, Noortje T L; Bleeker, Michiel W P; de Groot, Patricia C E; Thijssen, Dick H J; Felsenberg, Dieter; Rittweger, Jörn; Hopman, Maria T E

    2008-12-01

    This study was performed to assess the effect of resistive vibration exercise during bed rest deconditioning on venous vascular dimension and function, as measured with ultrasound in the popliteal vein. Sixteen men were assigned to bed rest (BR-Ctrl) or bed rest with resistive vibration exercise (BR-RVE). Before and at 25 and 52 days of bed rest, popliteal vein diameter was measured at increasing cuff pressures. Venous capacitance and compliance were calculated from the pressure-volume curve. After 52 days of bed rest, BR-Ctrl showed no change in baseline popliteal vein diameter or compliance, while venous capacitance decreased. Resistive vibration exercise had no effect on the response in venous diameter, capacitance or compliance to 52 days of bed rest. The decline in venous capacitance due to long-term bed rest is not effectively counteracted by resistive vibration exercise, indicating that an alternative factor during bed rest deconditioning is responsible for venous changes. PMID:18719936

  18. The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment

    PubMed Central

    Kurpiewski, Waldemar; Kowalczyk, Marek; Szynkarczuk, Rafa?; ?uba, Magdalena; ?urada, Anna; Grabysa, Rados?aw

    2011-01-01

    In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatment of advanced chronic venous insufficiency at the 5th and 6th degree of CEAP classification is still a great clinical challenge. In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternative therapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery (SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrent venous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascial endoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency. PMID:23255980

  19. [Effect of compression therapy in the management of venous ulcer - practical experience].

    PubMed

    Vranjkovi?, Ivana; Strok, Nevenka; Topolovec, Zeljka; Huljev, Dubravko

    2013-10-01

    Venous insufficiency is one of the most common causes of chronic wounds. Venous ulcers account for about 75% of all leg ulcers, and 50% of venous leg ulcers require long-term treatment lasting for more than 1 year. The most common location of venous ulcers is the lower third of the leg, as it is the site of strongest venous pressure; less often there are multiple venous ulcers that tend to be localized on both lower legs. In addition to the negative impact on the quality of life, such as immobility, pain and social isolation, which significantly affect the course and length of treatment, we cannot ignore the high costs of long-term and often uncertain treatment, which poses a major health, social and economic problem in the world and in our country. PMID:24371985

  20. Non-contact imaging of venous compliance in humans using an RGB camera

    NASA Astrophysics Data System (ADS)

    Nakano, Kazuya; Satoh, Ryota; Hoshi, Akira; Matsuda, Ryohei; Suzuki, Hiroyuki; Nishidate, Izumi

    2015-03-01

    We propose a technique for non-contact imaging of venous compliance that uses the red, green, and blue (RGB) camera. Any change in blood concentration is estimated from an RGB image of the skin, and a regression formula is calculated from that change. Venous compliance is obtained from a differential form of the regression formula. In vivo experiments with human subjects confirmed that the proposed method does differentiate the venous compliances among individuals. In addition, the image of venous compliance is obtained by performing the above procedures for each pixel. Thus, we can measure venous compliance without physical contact with sensors and, from the resulting images, observe the spatial distribution of venous compliance, which correlates with the distribution of veins.

  1. Venous Sac Embolization of Pulmonary Arteriovenous Malformation: Preliminary Experience Using Interlocking Detachable Coils

    SciTech Connect

    Takahashi, Koji [Department of Radiology, Asahikawa Medical College, 4-5-3-11 Nishikagura, Asahikawa, 078-8510 (Japan); Tanimura, Keiichi; Honda, Masanori [Department of Radiology, Saiseikai Utunomiya Hospital, 911-1 Takebayashi, Tochigi, 321 (Japan); Kikuno, Motoyuki [Department of Radiology, Takagi Hospital, 141-11 Sakami, Ohkawa, 831-0016 (Japan); Toei, Hisao; Hyodoh, Hideki; Furuse, Makoto [Department of Radiology, Jichi Medical School and Hospital, 3311-1 Yakushiji, Minamikawachi, Tochigi, 329-0498 (Japan); Yamada, Tomonori; Aburano, Tamio [Department of Radiology, Asahikawa Medical College, 4-5-3-11 Nishikagura, Asahikawa, 078-8510 (Japan)

    1999-05-15

    Purpose: To evaluate the indication and advantages of venous sac embolization of pulmonary arteriovenous malformations (PAVMs) using interlocking detachable coils (IDCs). Methods: We performed percutaneous embolization in 12 PAVMs in four patients using IDCs, initially placed in the venous sac or at the feeding artery to prevent systemic migration of additional coils. We placed the IDCs in the venous sac in PAVMs with the following vascular architecture: the draining vein was larger than the feeding arteries and both vessels were interposed with the venous sac or there were short feeding arteries. Results: Complete occlusion was achieved in all 12 PAVMs without significant complications. We deployed IDCs in the venous sac in eight PAVMs and in the feeding artery in four. Conclusion: Venous sac embolization may be beneficial in PAVMs with large out-flow vessels or short feeding arteries. IDCs are suitable for this procedure.

  2. Patterns of the Cranial Venous System from the Comparative Anatomy in Vertebrates

    PubMed Central

    Aurboonyawat, T.; Pereira, V.; Krings, T.; Toulgoat, F.; Chiewvit, P.; Lasjaunias, P.

    2008-01-01

    Summary Ontogenetically, the ventricular venous system may develop in order to drain the gray matter (cells of the mantle layer of the neural tube) which migrates dorsally. On primitive brain vesicles of submammals especially fish, amphibian and reptile, the ventricular venous system is the major venous collector located on the mid-dorsal surface, in between the meningeal layers comparable to the subarachnoid space in mammals. The ventricular venous system functions as a major drainage system for the brain vesicles in these submammals but its role decreases when the other two venous systems develop. Concerning the route of venous exit from the brain vesicles, we found that it resembles the spinal cord but could not be found all the way along the brain vesicles. PMID:20557753

  3. Surgical Correction of Isolated Superficial Venous Reflux Reduces Long-term Recurrence Rate in Chronic Venous Leg Ulcers

    Microsoft Academic Search

    JR Barwell; M Taylor; J Deacon; ASK Ghauri; C Wakely; LK Phillips; Whyman; KR Poskitt

    2000-01-01

    Objectives: surgical correction of isolated superficial venous reflux in ulcerated legs may reduce short term recurrence rates but the longer term benefits are unknown. Design: prospective non-randomised cohort study. Methods: consecutive patients with chronic leg ulcers were prospectively assessed at a one-stop clinic over a 4-year period from July 1995 to July 1999. All patients with ankle brachial pressure indices

  4. How to prevent venous cannula orifice obstruction during extracorporeal circulation.

    PubMed

    Abdel-Sayed, S; Favre, J; von Segesser, L K

    2015-04-01

    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

  5. Combining autologous peripheral blood mononuclear cells with fibroblast growth factor therapy along with stringent infection control leading to successful limb salvage in diabetic patient with chronic renal failure and severe toe gangrene.

    PubMed

    Osawa, Hiroshi; Orii, Kouan; Terunuma, Hiroshi; Abraham, Samuel Jk

    2014-11-01

    Peripheral arterial disease (PAD) is a common complication of Diabetes Mellitus (DM) and often culminates in amputation of the affected foot. Pseudomonas aeruginosa infections associated with PAD are difficult to treat due to their multi-drug resistance. Herein we report a 38 year old male who reported with DM, chronic kidney disease (CKD) and rest pain of the right second toe in October 2011. He underwent percutaneous transluminal angioplasty (PTA) which was unsuccessful. The gangrene of the toes worsened and amputation of the right second toe was done. Bacteriological examination showed presence of P. aeruginosa which during the course of antibiotic therapy became multi-drug resistant. Gangrene and abscess of the foot worsened and amputation of the right third toe was performed. Then autologous peripheral blood mononuclear cell (PBMNC) therapy was performed but as infection control could not still be achieved, the fourth toe was amputated. A protocol of foot bath using carbonic water, local usage of antibiotics (Polymyxin-B), and basic fibroblast growth factor (b-FGF) spray was then employed after which the infection could be controlled and improvement in vascularity of the right foot could be observed in angiography. This combined approach after proper validation could be considered for similar cases. PMID:25473454

  6. Growing Dural Sinus Malformation with Associated Developmental Venous Anomaly, Multiple Cavernomas and Facial Venous Malformation in an Infant

    PubMed Central

    Mohamed, Z.; Batista, LL.; Sachet, M.; Mahadevan, J.; Alvarez, H.; Lasjaunias, P.

    2002-01-01

    Summary This is an unusual case report of an infant, who initially presented with a facial haemangioma and was later diagnosed to have a dural sinus malformation (DSM) involving the torcula. The DSM increased in size lateralising to the right transverse sinus at three months of age. Postnatal enlargement of the dural sinus has not been described before suggesting a delay in the maturation of the dural sinus which normally would occur antenatally. There was a further association with a complex developmental venous anomaly (DVA) draining the right cerebral hemisphere into the deep cerebral vein and multiple cavernous malformations. The DVA was not clearly demonstrated at age one month but was more obvious at age three months. This would be the first reported case of DSM associated with a DVA. Increasing venous hypertension probably contributed to the poor opacification of the DVA on follow-up angiography at age six months and to the haemorrhagic changes within the cavernomas on magnetic resonance imaging (MRI). The therapeutic goal was to correct venous hypertension by partially embolising the dural shunts to remodel the cerebral vasculature and preserve the patent sinus. The treatment strategy and possible link between the complex disease entities presented in this infant are discussed. Despite these attemps, the lesion continued to grow compressing the posterior fossa structures. The infant died at nine months of age. PMID:20594504

  7. Old and new risk factors for upper extremity deep venous thrombosis

    Microsoft Academic Search

    J. W. Blom; C. J. M. Doggen; S. Osanto; F. R. Rosendaal

    2005-01-01

    Background: Well known risk factors for upper extremity deep venous thrombosis are the presence of a central venous catheter (CVC) and malignancy, but other potential risk factors, such as surgery, injury and hormone replacement therapy (HRT), have not yet been explored. Methods: We performed a population-based case-control study including 179 consecutive patients, aged 18–70 years with upper extremity deep venous

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

    PubMed Central

    Larimer, P.; McDermott, M.W.; Scott, B.J.; Shih, T.T.; Poisson, S.N.

    2014-01-01

    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

  9. Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism

    Microsoft Academic Search

    Jawed Fareed; Cafer Adiguzel; Indermohan Thethi

    2011-01-01

    Background  The prevention of venous thromboembolism has been identified as a leading priority in hospital safety. Recommended parenteral\\u000a anticoagulant agents with different indications for the prevention and treatment of venous thromboembolism include unfractionated\\u000a heparin, low-molecular-weight heparins and fondaparinux. Prescribing decisions in venous thromboembolism management may seem\\u000a complex due to the large range of clinical indications and patient types, and the range

  10. Advancement in idiopathic intracranial hypertension pathogenesis: focus on sinus venous stenosis

    Microsoft Academic Search

    Roberto De Simone; Angelo Ranieri; Vincenzo Bonavita

    2010-01-01

    Idiopathic intracranial hypertension is consistently associated with venous outflow disturbances. Sinus venous stenosis are\\u000a found at magnetic resonance venography in the large majority of IIH patients and may have various conformations, ranging from\\u000a functional smooth narrowings of sinus segments associated or not with definite flow gaps, to segmental hypoplasia or aplasia\\u000a of one or more central venous collectors. Stenosis are

  11. Total Anomalous Systemic Venous Drainage with Heterotaxia Syndrome: A Rare Case

    PubMed Central

    Kosger, Pelin; Ozdemir, Gokmen; Ucar, Birsen; Kilic, Zubeyir

    2014-01-01

    Total anomalous systemic venous return is a very rare anomaly, where vena cava inferior, vena cava superior, and coronary sinus drain into left atrium. Two-day-old male baby was admitted with cyanosis and tachypnea after the birth. Left atrial isomerism with anomalous systemic venous drainage was found on echocardiographic examination. We present an unusual case of total anomalous systemic venous drainage in to the left atrium. PMID:25197579

  12. Systematic review of emergency department central venous and arterial catheter infection

    Microsoft Academic Search

    Christopher H. LeMaster; Ashish T. Agrawal; Peter Hou; Jeremiah D. Schuur

    2010-01-01

    Background  There is an extensive critical care literature for central venous catheter and arterial line infection, duration of catheterization,\\u000a and compliance with infection control procedures. The emergency medicine literature, however, contains very little data on\\u000a central venous catheters and arterial lines. As emergency medicine practice continues to incorporate greater numbers of critical\\u000a care procedures such as central venous catheter placement, infection

  13. Reduction of erosion risk in adult patients with implanted venous access ports.

    PubMed

    Burris, Jennifer; Weis, Mary

    2014-08-01

    One of the most common venous access devices used in patients with cancer is the implanted venous access port. Although incidences of infection and thrombosis are the most commonly reported complications, erosion rates of venous access ports are estimated at almost 1%. This article describes how evidence-based interdisciplinary interventions decreased port erosions for a regional health center from 3.2% to less than 1%. PMID:25095292

  14. A new approach to non-invasive oxygenated mixed venous PCO(sub)2

    NASA Technical Reports Server (NTRS)

    Fisher, Joseph A.; Ansel, Clifford A.

    1986-01-01

    A clinically practical technique was developed to calculate mixed venous CO2 partial pressure for the calculation of cardiac output by the Fick technique. The Fick principle states that the cardiac output is equal to the CO2 production divided by the arterio-venous CO2 content difference of the pulmonary vessels. A review of the principles involved in the various techniques used to estimate venous CO2 partial pressure is presented.

  15. Venous insufficiency of the lower limb and stasis ulceration. Changing concepts and management.

    PubMed Central

    Raju, S

    1983-01-01

    In a group of patients studied for venous insufficiency, the incidence of deep venous insufficiency was much higher than previously suspected. Insufficiency of the superficial system, when present, was associated invariably with deep venous insufficiency, suggesting a leading role for the latter condition. Evidence is presented to show that in many instances, such reflux is probably non-thrombotic. The results of various types of direct venous valve surgery in a group of patients are presented. Images Fig. 1. Figs. 4a,b. Fig. 6. Fig. 7. PMID:6859978

  16. A rational approach to surgery of the chronic venous statis syndrome.

    PubMed Central

    Schanzer, H; Peirce, E C

    1982-01-01

    Ambulatory venous pressure (AVP) and ascending and retro-grade phlebography have been used to elucidate the precise pathogenetic factors in cases of venous stasis. On the bases of this information, procedures aimed at the correction of the particular pathophysiological alterations were carried out. Fifty-two lower extremities in 49 patients suffering from chronic venous statis were studied. The AVP was performed by having the patient walk in place for 15 seconds without tourniquet and with one or two tourniquets at different levels of the extremity. The per cent drop of pressure in a foot vein during exercise and the time to return to standing pressure were used to determine a venous sufficiency index. Four distinct factors or groupings could be distinguished: incompetent perforators (31), deep vein incompetence (14), incompetence of the saphenous vein (3), and obstruction of deep veins (4). Six types of surgical procedures were done: ligation of perforators (25), superficial femoral valvuloplasty (3), segmental venous transposition (1), ligation of the superficial femoral vein (1), cross femoral venous bypass (1) and high ligation and stripping of the long saphenous vein (3). Three patients had skin sloughing after perforator ligation, and one patient developed a hematoma requiring evacuation following segmental venous transfer. Post-operative AVP evaluation in 11 patients after perforator ligation, two patients following superficial femoral valvuloplasty, one patient after segmental venous transfer, and one patient after cross femoral venous bypass showed significant improvement. Early follow-up results are very satisfactory. PMID:7055380

  17. Role of Interventional Radiologists in the Management of Lower Extremity Venous Insufficiency

    PubMed Central

    Hardman, Rulon L.; Rochon, Paul J.

    2013-01-01

    Lower extremity venous insufficiency affects over half of all women. Interventional radiologists should be aware of the clinical evaluation of women with venous insufficiency and classification of disease. Endovascular therapies available for treatment of lower extremity venous insufficiency include: endovenous laser ablation, radiofrequency endovascular ablation, and sclerotherapy. The interventional radiologist should be versed on which therapy to select in each clinical presentation and the procedural techniques. The authors review the role of the interventional radiologist in managing this lower extremity venous disorder. PMID:24436566

  18. Venous gas embolism caused by fibrin sealant application to the prostate during greenlight laser photoselective vaporization.

    PubMed

    Lee, Alexander; Vazquez, Rafael

    2015-04-15

    Venous gas embolism is a complication of fibrin sealant application and is a well-described event during various modes of prostate resection. We describe the case of a nitrogen venous gas embolism during Greenlight laser photovaporization of the prostate during the application of fibrin sealant to the operative site for hemostasis. Fibrin sealant application by a compressed gas applicator is a cause of venous air embolism, and this case highlights the need to keep venous gas embolism in mind when compressed gas applicators are used. PMID:25867193

  19. Role of the venous system in baroreceptor-mediated reflexes in man

    PubMed Central

    Epstein, Stephen E.; Beiser, G. David; Stampfer, Morris; Braunwald, Eugene

    1968-01-01

    Although baroreceptor stimulation produced by marked alterations in arterial pressure has been shown to produce reflex changes in venous tone in animals, the effects on venous tone in man of altering arterial pressure within the physiologic range have not been clear. In six subjects, venous tone did not change when mean arterial pressure was raised by 25-40 mm Hg, although heart rate fell reflexly by 40%. Venous tone remained constant in 10 subjects when arterial pressure was lowered. This contrasted to the sustained rise in forearm vascular resistance and the persistent tachycardia that occurred. However, 12 subjects continued to respond to these interventions by transient venoconstriction. To eliminate possible emotional influences on venous tone due to the experimental intervention, venous responses were studied before and during general anesthesia in five of these subjects. In contrast to the response before anesthesia, an equivalent fall in arterial pressure during anesthesia no longer evoked a venoconstrictor response. Venous reactivity and the baroreceptor reflex arc remained intact during anesthesia, since venous tone always rose after a deep inspiration, and tachycardia always accompanied the fall in arterial pressure. It is concluded that changes in arterial pressure in the physiologic range in man do not induce measurable reflex alterations in venous tone, and that the increases sometimes seen with decreases in arterial pressure appear to be due to extraneous psychic factors. Images PMID:16695936

  20. Concomitant Deep Venous Thrombosis, Femoral Artery Thrombosis, and Pulmonary Embolism after Air Travel

    PubMed Central

    Clyde, Marshall; Brenes, Robert A.; Tripodi, Giuseppe

    2014-01-01

    The association between air travel and deep venous thrombosis and/or pulmonary embolism “economy-class syndrome” is well described. However, this syndrome does not describe any association between long duration travel and arterial thrombosis or coexistence of venous and arterial thrombosis. We present a case of concomitant deep venous thrombosis, acute femoral artery thrombosis, and bilateral pulmonary embolisms in a patient following commercial air travel. Echocardiogram did not reveal an intracardiac shunt that may have contributed to the acute arterial occlusion from a paradoxical embolus. To our knowledge, this is the first report in the literature that associates air traveling with both arterial and venous thrombosis. PMID:25221684

  1. Percutaneous atrial septal defect closure by using jugular venous access in a case with interrupted inferior vena cava

    PubMed Central

    Narin, Nazmi; Baykan, Ali; Argun, Mustafa; Ozyurt, Abdullah; Uzum, Kazim

    2014-01-01

    Femoral venous approach is the classical route of percutaneous atrial septal defect (ASD) closure. But in certain circumstances alternative routes are used. In this report percutaneous ASD closure in a case with interrupted vena cava by jugular venous approach is discussed. Percutaneous closure through femoral venous route was planned in a 6-year-old girl with ASD. Because of interrupted vena cava the jugular venous route was used. Having knowledge of this anatomical variation is important for interventionalists before performing femoral venous approach. Percutaneous transjugular venous access is a feasible alternative route in paediatric population for ASD closure. PMID:25489321

  2. Controversies of Treatment Modalities for Cerebral Venous Thrombosis

    PubMed Central

    Khan, Maria; Kamal, Ayeesha Kamran; Wasay, Mohammad

    2010-01-01

    Cerebral vein thrombosis has been well recognized for nearly two centuries. However, therapeutic options for the condition are limited due to lack of large randomized trials. The various modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, and mechanical thrombectomy. Of these, antiplatelets are the least studied, and there are only anecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modality with favorable outcomes documented in two randomized controlled trials. Various fibrinolytic agents have also been tried. Local infusions have shown more promise compared to systemic agents. Similarly, mechanical thrombectomy has been used to augment the effects of chemical thrombolysis. However, in the absence of randomized controlled trials; there is no concrete evidence of the safety and efficacy of either of these modalities. Limited study series disclosed that decompression surgery in malignant CVT can be life saving and provides good neurological outcome in some cases. Conclusion. Overall therapeutics for CVT need larger randomized controlled trials. Anticoagulaion with heparin is the only modality with a reasonable evidence to support its use in CVT. Endovascular thrombolysis and mechanical thrombectomy are reserved for selected cases who fail anticoagulation and decompression surgery for malignant CVT with impending herniation. PMID:21197452

  3. The special case of venous thromboembolism in pregnancy.

    PubMed

    Greer, I A

    1998-01-01

    Pulmonary thromboembolism remains a major cause of maternal death in the Western world. The frequency of antepartum deaths, including deaths in the first and second trimester, which can be associated with early pregnancy problems such as hyperemesis, is similar in number to the deaths occurring following delivery. Risk factors for deep vein thrombosis have been identified and include age > 35 years, operative delivery (particularly emergency Caesarean section), obesity and a personal or family history of thrombosis or thrombophilia. These risk factors should be used to guide administration of thromboprophylaxis during both pregnancy and the post-partum period, particularly after Caesarean section. Specific consideration towards thromboprophylactic agents is required. Warfarin crosses the placenta, is a known teratogen when used in early pregnancy and can also be associated with bleeding problems in the foetus, particularly at the time of delivery. Thus, warfarin has a limited use in the antenatal period and is usually only employed in patients such as those with artificial heart valves who require long-term anticoagulation. However, as warfarin does not cross the breast in any significant amount, it is suitable during breast feeding. In contrast, heparin does not cross the placenta or the breast therefore foetal problems are not associated with this treatment. However, heparin can be associated with problems such as heparin-induced osteoporosis, allergy and heparin-induced thrombocytopenia. The risk of some of these complications can be reduced by the use of low-molecular-weight heparins. When venous thromboembolism is suspected in pregnancy, it is critically important to obtain an objective diagnosis. This will include real-time or duplex ultrasound scan of the legs to elaborate the venous system, ventilation perfusion lung scan and, occasionally, venography. Treatment of established venous thromboembolism is similar to that in the non-pregnant patient and it is likely that low-molecular-weight heparins will play a major role in thromboprophylaxis in the future. PMID:10069759

  4. Maternal venous hemodynamics in gestational hypertension and preeclampsia

    PubMed Central

    2014-01-01

    Background To evaluate characteristics of venous hemodynamics, together with cardiac and arterial function, in uncomplicated pregnancies (UP), non-proteinuric gestational hypertension (GH) and preeclampsia (PE). Methods In this observational cross-sectional study, venous hemodynamics was assessed using a standardised protocol for combined electrocardiogram (ECG)-Doppler ultrasonography, together with a non-invasive standardised cardiovascular assessment using impedance cardiography (ICG) in 13 women with UP, 21 with GH, 34 with late onset PE ? 34 w (LPE) and 22 with early onset PE?venous pulse transit times (VPTT), as well as resistive and pulsatility index, and arterial pulse transit time (APTT) at the level of uterine arcuate arteries. ICG parameters were aortic flow velocity index (VI), acceleration index (ACI) and thoracic fluid content. Mann Whitney U-test, Kruskall-Wallis test and linear regression analysis with heteroskedastic variance was used for statistical analysis. Results RIVI in both kidneys was >15% higher (P???.010) in LPE and EPE, as compared to GH and UP. Next to this, >30% lower values for VI and ACI (P???.029), and?>?15% lower values for APTT (P???.012) were found in GH, LPE and EPE, as compared to GH. Conclusion In comparison to UP, similar abnormalities of central arterial function and APTT were found in GH, EPE and LPE. Proteinuria of LPE and EPE was associated with increased RIVI, this was not observed in GH. PMID:24957330

  5. Selective venous sampling for androgen producing ovarian pathology

    PubMed Central

    Levens, Eric D.; Whitcomb, Brian W.; Csokmay, John M.; Nieman, Lynnette K.

    2008-01-01

    Structured Summary Objective Multiple diagnostic modalities may be needed to establish the source of excessive androgen production in women. The role of selective venous catheterization in this process has not been established fully. Design A study of hyperandrogenemic subjects and literature review. Patients Four hyperandrogenemic women and an additional 132 previously reported cases with available testing data and a pathologic diagnosis were evaluated. Measurements Serum androgens, diagnostic imaging, and ovarian venous effluent sampling. Criteria to distinguish ovarian tumours from other ovarian conditions and to localize the lesion(s) were evaluated. Results Basal peripheral testosterone levels ?4.51 nmol/L (?130 ng/dL) discriminated ovarian tumours from benign causes of hyperandrogenism (sensitivity: 93.8%, 95%CI: 85.0–98.2%; specificity: 77.8%, 95%CI: 66.4–86.7%). Single lesions produced higher ipsilateral testosterone concentrations (612.6±162.0 nmol/L; 17,653±4,670 ng/dL) compared to contralateral values (testosterone: 26.4±5.2 nmol/L; 761±150 ng/dL). In women with peripheral testosterone ?4.51 nmol/L, a right-to-left (R:L) ovarian testosterone ratio ?1.44 correctly identified all 18 women with right-sided tumours and misclassified 2 with bilateral lesions; 12 of 14 women with left-sided or bilateral lesions had a lower R:L value. When this criterion was combined with a left-to- right (L:R) ovarian testosterone effluent ratio of > 15 to identify left sided tumours, overall 66% of women were correctly categorized. Conclusions Peripheral testosterone concentrations identified ovarian androgen-producing tumours, and venous sampling could correctly localize 66% of these, suggesting a role for sampling when imaging studies are not revealing. PMID:18721192

  6. Sinus venous thrombosis: a differential diagnosis of postpartum headache.

    PubMed

    Wittmann, Maria; Dewald, Daniela; Urbach, Horst; Gast, Anne-Sybil; Linnebank, Michael; Baumgarten, Georg; Knuefermann, Pascal; Hering, Rudolf

    2012-01-01

    In this report, we describe a patient who developed severe headache following epidural analgesia for labor and delivery. Although the epidural puncture had been reported to be uneventful, headache was initially suspected to result from an accidental dural puncture. After the headache worsened, a sinus venous thrombosis was suspected and subsequently confirmed by magnetic resonance imaging. This case highlights the difficulty of differential diagnosis of headache in the postnatal period in patients after EDA and stresses the necessity of considering alternative pathologies. PMID:21773786

  7. [Severe thrombocytopenia after diagnosis of deep venous thrombosis].

    PubMed

    Frøslev-Friis, Christina; Kliment, Herbert; Andersen, Johnny Dohn Holmgren

    2013-08-12

    A patient presented with erysipelas and developed deep venous thrombosis (DVT) and later idiopatic thrombocytopenic purpura (ITP). In the literature we find no reports of ITP following DVT. It is well known that patients can develop HIT after DVT or DVT after ITP, both caused by the medicine used for treatment. Patients have developed ITP after heparin-induced thrombocytopenia (HIT). Cases are also described in which heparin antibodies are found, but in which the final diagnosis was ITP. The diagnosis of the patient in our case story could be ITP based on DVT, but with no history of HIT. Alternatively, he could have developed two complications to an infection. PMID:23937877

  8. Retrievable inferior vena cava filters for venous thromboembolism.

    PubMed

    Ni, Han; Win, Lei Lei

    2013-01-01

    Inferior vena cava (IVC) filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism (PE) in venous thromboembolic disorders. Retrievable IVC filters have become an increasingly attractive option due to the long-term risks of permanent filter placement. These devices are shown to be technically feasible in insertion and retrieval percutaneously while providing protection from PE. Nevertheless, there are complications and failed retrievals with these retrievable filters. The aim of the paper is to review the retrievable filters and their efficacy, safety, and retrievability. PMID:24967292

  9. Prevention and treatment of venous thromboembolism during HRT: current perspectives

    PubMed Central

    Rott, Hannelore

    2014-01-01

    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

  10. Central Venous Line and Acute Neurological Deficit: A Case Series

    PubMed Central

    Ahmadi, Seyed Hossein; Shirzad, Mahmood; Zeraatian, Sam; Salehiomran, Abbas; Abbasi, Seyed Hesameddin; Ghiasi, Atefeh

    2014-01-01

    Abstract Central venous catheter (CVC) insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation, unconsciousness, disorientation to time and place and hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage.

  11. Radial osteomyelitis as a complication of venous cannulation

    PubMed Central

    Straussberg, R; Harel, L; Bar-Sever, Z; Amir, J

    2001-01-01

    Venepuncture of the superficial veins in the forearm is considered a relatively safe procedure. We report two patients who presented with osteomyelitis of the proximal radius following venous cannulation of the median cubital vein, and one patient who developed osteomyelitis of the distal radius after cannulation of the cephalic vein. Osteomyelitis developing in proximity to a venepuncture site should raise the suspicion that a pathogen causing superficial thrombophlebitis has spread through the deep veins of the arm into the adjacent bone, thus causing osteomyelitis.?? PMID:11668105

  12. Perioperative venous thromboembolism and antibiotic prophylaxis in obstetrics and gynecology.

    PubMed

    Dalton, Vanessa

    2010-09-01

    Venous thromboembolism (VTE) and surgical site infection are common and potentially preventable postoperative complications. National patient safety and healthcare quality initiatives target perioperative VTE and infection as opportunities to improve patient care and reduce healthcare costs. Women undergoing gynecologic surgery and cesarean delivery are at risk for these complications. There is sufficient evidence to recommend that VTE and antibiotic prophylaxis be given to women undergoing certain major gynecologic surgery or cesarean delivery. Because there are always emerging issues as new studies become available, physicians should anticipate periodic changes to the guidelines. Adherence to the available practice guidelines and awareness of relevant performance measures will further efforts to reduce postoperative complications. PMID:20661037

  13. Case study: psychosocial aspects of chronic bilateral venous leg ulcers.

    PubMed

    Mapplebeck, Lynda

    2008-03-01

    This case study gives an concise report on how venous leg ulceration can cause deep psychological problems for those suffering with this condition. As with all disease, you cannot separate the physical from the psychological. Suffering with clinical depression and not seeing a future, Emily's life has been turned around by the evidence-based application of a 2-layer bandaging system. Emily's ulcers are now almost healed showing that good clinical skills and collaboration with patients are the key to effective clinical outcomes in hard-to-heal wounds. PMID:18557572

  14. Venous leg ulcer management: single use negative pressure wound therapy.

    PubMed

    Dowsett, Caroline; Grothier, Lorraine; Henderson, Valerie; Leak, Kathy; Milne, Jeanette; Davis, Lynn; Bielby, Alistair; Timmons, John

    2013-06-01

    A number of leg ulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous leg ulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use. PMID:24156166

  15. Intracranial Venous Thrombosis After Placement of a Lumbar Drain

    Microsoft Academic Search

    Mitchell G. Miglis; David N. Levine

    2010-01-01

    Background  Lumbar drains are frequently used in clinical neuroscience and are often managed in the neurointensive care unit. Complications\\u000a are generally rare, and intracranial venous thrombosis (IVT) and infarction has not been reported.\\u000a \\u000a \\u000a \\u000a Methods  We report the case of a 45-year-old woman who developed a cerebrospinal fluid (CSF) leak after spinal surgery. Fifteen hours\\u000a after placement of a lumbar drain she developed

  16. The Causes of Skin Damage and Leg Ulceration in Chronic Venous Disease

    Microsoft Academic Search

    Philip Coleridge Smith

    2006-01-01

    Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in

  17. Early image acquisition after administration of indium-111 platelets in clinically suspected deep venous thrombosis

    Microsoft Academic Search

    David C. Farlow; Michael D. Ezekowitz; Sunder Ram Rao; Cielo Martinez; Don F. Denny; Steven S. Morse; Janice S. Decho; Frans Wackers; Edward Strauss

    1989-01-01

    Indium-111 platelet scintigraphy accurately detects acute deep venous thrombosis in asymptomatic high-risk patients and may be used as a surveillance test. However, its value in symptomatic patients and its accuracy early after platelet injection are not satisfactorily established. The latter is important for timely institution of therapy. Accordingly, 65 patients (67 limbs) with suspected deep venous thrombosis (symptom duration 8

  18. Progestogen-only contraception in women at high risk of venous thromboembolism

    Microsoft Academic Search

    Jacqueline Conard; Geneviève Plu-Bureau; Narges Bahi; Marie-Hélène Horellou; Clara Pelissier; Jean-Christophe Thalabard

    2004-01-01

    The objective of the study was to evaluate the venous impact of a progestogen-only contraception on women at high risk of venous thromboembolism (VTE). In this retrospective cohort study, 204 consecutive women at high risk of VTE were recruited between January 1992 and June 1997 and were prospectively followed. Women using chlormadinone acetate (CMA) at antigonadotropic doses (n=102) were matched

  19. Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery

    Microsoft Academic Search

    A. C. W. Ting; S. W. K. Cheng; P. Ho; L. L. H. Wu; G. C. Y. Cheung

    2003-01-01

    Background: We evaluated the clinical results of subfascial endoscopic perforating vein surgery (SEPS) in patients with severe chronic venous insufficiency (CVI) (clinical class 4–6) and assessed the hemodynamic changes associated with SEPS using air plethysmography (APG). Methods: Forty-five patients with severe CVI who had undergone SEPS were evaluated. Clinical score and venous hemodynamics, as measured by APG before operation and

  20. Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

    Microsoft Academic Search

    Juan Cabrera; Pedro Redondo; Antonio Becerra; Celia Garrido; Maria Antonia Garcia-Olmedo; Alejandro Sierra; Pedro Lloret; Miguel A. Martinez-Gonzalez

    Background: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating sur- gery) is only possible in a subset of patients with leg ul- cers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments. Objective: To

  1. Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

    Microsoft Academic Search

    Juan Cabrera; Pedro Redondo; Antonio Becerra; Celia Garrido; Maria Antonia Garcia-Olmedo; Alejandro Sierra; Pedro Lloret; Miguel A. Martinez-Gonzalez; Iltefat Hamzavi; Hem Jain; David McLean; Jerry Shapiro; Haishan Zeng; Harvey Lui; Julie A. Byrd; Mark D. P. Davis; Roy S. Rogers III; Alice N. Lee; Victoria P. Werth; Michael E. Ming; Ross M. Levy; Ole J. Hoffstad; Jennifer Filip; Phyllis A. Gimotty; David J. Margolis

    2004-01-01

    Background: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating sur- gery) is only possible in a subset of patients with leg ul- cers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments. Objective: To

  2. Sickle cell trait and the risk of venous thromboembolism among blacks

    Microsoft Academic Search

    Harland Austin; Nigel S. Key; Jane M. Benson; Cathy Lally; Nicole F. Dowling; Carolyn Whitsett; W. Craig Hooper

    2007-01-01

    People with sickle cell disease have a chronically activated coagulation system and display hemostatic perturbations, but it is unknown whether they experience an increased risk of venous thromboembo- lism. We conducted a case-control study of venous thromboembolism that in- cluded 515 hospitalized black patients and 555 black controls obtained from medical clinics. All subjects were as- sayed for hemoglobin S

  3. Multimodal prophylaxis for venous thromboembolic disease after total hip and knee arthroplasty: current perspectives

    Microsoft Academic Search

    Ning LU; Eduardo A. Salvati

    2010-01-01

    Life-threatening in the short term and leading to a high level of morbidity in the long term, venous thromboembolism (VTE) is the most fearful complication following lower limb arthroplasty. With advances in surgical procedure, anesthetic management and postoperative convalescence have altered the risks of venous thromboembolism after total joint arthroplasty in the lower extremity. The pathogenesis of VTE is multifactorial

  4. Recent Portal or Mesenteric Venous Thrombosis: Increased Recognition and Frequent Recanalization on Anticoagulant Therapy

    Microsoft Academic Search

    Bertrand Condat; Fabienne Pessione; Marie Helene Denninger; Sophie Hillaire; Dominique Valla

    2000-01-01

    Characteristics and outcomes of recent portal or mesenteric venous thrombosis are ill-known. We intended to compare these features with those of patients with portal cavernoma, and also to assess the incidence of recanalization of recent thrombosis on anticoagulation therapy. All patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or mesenteric venous thrombosis or

  5. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis

    PubMed Central

    2013-01-01

    Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular. CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation. Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius. CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917

  6. Accidental Subclavian Artery Catheterization During Attempted Internal Jugular Central Venous Catheter Placement: A Case Report

    PubMed Central

    Kamal, Manoj; Purohit, Anamika; Rana, Kirti; Chouhan, Dilip Singh

    2015-01-01

    Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation. PMID:25738064

  7. DIAGNOSTIC VALUE OF D-DIMER MEASUREMENT IN PATIENTS SUSPECTED TO HAVE CEREBRAL VENOUS THROMBOSIS

    Microsoft Academic Search

    M. Ghaffarpour; N. Mohsenzadeh; H. Poormahmoodian; M. H. Harrirchian; A. Fallah

    Among the causes of headache, cerebral venous and\\/or dural sinus thrombosis (CVT) is an important challenge because of its variable clinical presentation, having negative brain CT in up to 30% of cases and unavailability of MRI in some situations. On the other hand as D-Dimer (DD) test has been reported to be a sensitive test for the exclusion of venous

  8. Treatment of infected tunneled venous access hemodialysis catheters with guidewire exchange

    Microsoft Academic Search

    Derrick Robinson; Paul Suhocki; Steve J. Schwab

    1998-01-01

    Treatment of infected tunneled venous access hemodialysis catheters with guidewire exchange. Cuffed venous access catheters have become commonplace for hemodialysis access. The major complications of these catheters are catheter thrombosis, catheter fibrin sheathing and infection. When catheter associated bacteremia occurs treatment with antimicrobial therapy alone has been unsuccessful in providing acceptable cure rates. Failed antimicrobial therapy exposes the patient to

  9. The role of air plethysmography in the diagnosis of chronic venous insufficiency

    Microsoft Academic Search

    Enrique Criado; Mark A. Farber; William A. Marston; Patty F. Daniel; Cynthia B. Burnham; Blair A. Keagy

    1998-01-01

    Purpose: The role of air plethysmography (APG) in the diagnosis of venous disease is not well defined. We conducted this study to investigate the value of APG in the diagnosis of chronic venous insufficiency and to determine its correlation with the clinical severity of disease and the anatomic distribution of reflux. Methods: We studied 186 lower extremities with duplex scanning

  10. Understanding the Clinical Relevance of the Various Components of the Lower Extremity Venous Examination

    Microsoft Academic Search

    Richard Pennell

    Venous duplex imaging of the lower extremities provides information that affects clinical decision making in many ways. As technology advances, the treatment of acute deep venous thrombosis (DVT) is evolving. Not so long ago, the diagnostic dilemma of DVT centered on whether or not anticoagulant thera- py was necessary. With the advent of minimally inva- sive techniques, treatment algorithms include

  11. A national survey of practice patterns in the noninvasive diagnosis of deep venous thrombosis

    Microsoft Academic Search

    John Blebea; Todd K. Kihara; Marsha M. Neumyer; Judy S. Blebea; Karla M. Anderson; Robert G. Atnip

    1999-01-01

    Purpose: Recent studies have recommended unilateral venous duplex scanning for the diagnosis of deep venous thrombosis (DVT) in patients who are unilaterally symptomatic. Vascular laboratory accreditation standards, however, imply that bilateral leg scanning should be performed. We examined whether actual practice patterns have evolved toward limited unilateral scanning in such patients. Methods: A questionnaire was mailed to all 808 vascular

  12. Impedance plethysmography as a screening procedure for asymptomatic deep venous thrombosis in a rehabilitation hospital

    Microsoft Academic Search

    Richard T. Katz; Mary Michael McCulla

    1995-01-01

    Objective: Patients admitted for an inpatient rehabilitation treatment program almost uniformly have an elevated risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). We assessed the value of impedance plethysmography (IPG) as a screening procedure for asymptomatic deep venous thrombosis in a series of patients admitted to our institution. Design: Using a prospective observational study design, consecutive admissions to

  13. The prevalence of thrombophilia in patients with chronic venous leg ulceration

    Microsoft Academic Search

    Rhoda K. MacKenzie; Christopher A. Ludlam; C. Vaughan Ruckley; Paul L. Allan; Paul Burns; Andrew W. Bradbury

    2002-01-01

    Background: Thrombophilia is increasingly recognized as a risk factor for deep venous thrombosis (DVT), which in turn is a major risk factor for chronic venous ulceration (CVU). However, the relationship between thrombophilia and CVU remains unknown. The aim of this study was to define the prevalence of thrombophilia in patients with CVU and to determine whether this is associated with

  14. Prevention and diagnosis of venous thromboembolism in critically ill patients: a Canadian survey

    Microsoft Academic Search

    Deborah Cook; Joseph McMullin; Richard Hodder; Mark Heule; Jaime Pinilla; Peter Dodek; Thomas Stewart

    2001-01-01

    BACKGROUND: Venous thromboembolism (VTE) confers considerable morbidity and mortality in hospitalized patients, although few studies have focused on the critically ill population. The objective of this study was to understand current approaches to the prevention and diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) among patients in the intensive care unit (ICU). DESIGN: Mailed self-administered survey of ICU

  15. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis.

    PubMed

    Beggs, Clive B

    2013-01-01

    Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular.CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation.Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius.CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917

  16. Multidetector CT angiography in living donor renal transplantation: accuracy and discrepancies in right venous anatomy.

    PubMed

    Kulkarni, S; Emre, S; Arvelakis, A; Asch, W; Bia, M; Formica, R; Israel, G

    2011-01-01

    Multidetector computed tomography (MDCT) angiography is a reliable technique for assessing pre-operative renal anatomy in living kidney donors. The method has largely evolved into protocols that eliminate dedicated venous phase and instead utilize a combined arterial/venous phase to delineate arterial and venous anatomy simultaneously. Despite adoption of this protocol, there has been no study to assess its accuracy. To assess whether or not MDCT angiography compares favorably to intra-operative findings, 102 donors underwent MDCT angiography without a dedicated venous phase with surgical interpretation of renal anatomy. Anatomical variants included multiple arteries (12%), multiple veins (7%), early arterial bifurcation (13%), late venous confluence (5%), circumaortic renal veins (5%), retroaortic vein (1%), and ureteral duplication (2%). The sensitivity and specificity of multiple arterial anomalies were 100% and 97%, respectively. The sensitivity and specificity of multiple venous anomalies were 92% and 98%, respectively. The most common discrepancy was noted exclusively in the interpretation of right venous anatomy as it pertained to the renal vein/vena cava confluence (3%). MDCT angiography using a combined arterial/venous contrast-enhanced phase provides suitable depiction of renal donor anatomy. Careful consideration should be given when planning a right donor nephrectomy whether the radiographic interpretation is suggestive of a late confluence. PMID:20070320

  17. Venous oxygenation in the diabetic neuropathic foot: Evidence of arteriovenous shunting?

    Microsoft Academic Search

    A. J. M. Boulton; J. H. B. Scarpello; J. D. Ward

    1982-01-01

    Summary  Venous PO2 was measured in the feet and hands of four subject groups: 14 diabetics with neuropathy and foot ulceration; 12 diabetics with neuropathy but no ulceration; 11 diabetics with no evidence of microvascular complications; and 10 nondiabetic controls. Neither patients nor controls had clinical evidence of peripheral vascular disease. The mean venous PO2 in the feet of subjects with

  18. Risk Factors Associated With the Failure of a Venous Leg Ulcer to Heal

    Microsoft Academic Search

    David J. Margolis; Jesse A. Berlin; Brian L. Strom

    1999-01-01

    Background: Venous leg ulcers afflict a significant por- tion of the population. The most popular form of therapy for venous leg ulcers is a compression bandage (eg, Unna boot), a therapy that is frequently unsuccessful. Objective: To describe risk factors associated with the failure of a wound to heal when treated with a limb- compression bandage for 24 weeks. Design:

  19. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency

    Microsoft Academic Search

    William A. Marston; Robert E. Carlin; Marc A. Passman; Mark A. Farber; Blair A. Keagy

    1999-01-01

    Objective: Although newer techniques to promote the healing of leg ulcers associated with chronic venous insufficiency are promising, improved healing rates and cost effectiveness are unproven. We prospectively followed a series of patients who underwent treatment with outpatient compression for venous stasis ulcers without adjuvant techniques to determine healing rates and costs of treatment. Methods: Two hundred fifty-two patients with

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

    Microsoft Academic Search

    Karen R. Lorimer; Margaret B. Harrison; Ian D. Graham; Elaine Friedberg; Barbara Davies

    2003-01-01

    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