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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 Ozkan, Ugur; Demirturk, Orhan S.; Gur, Serkan

    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. Gangrene

    MedlinePlus

    Gangrene requires urgent evaluation and treatment. In general, dead tissue should be removed to allow healing of ... gangrene An emergency operation to find and remove dead tissue An operation to improve blood supply to ...

  3. Gangrene

    MedlinePlus

    ... needed. Images Gangrene References Kumar V, Abbas AK, Aster JC. Cellular responses to stress and toxic insults. In: Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease . ...

  4. Warfarin-induced venous limb ischemia/gangrene complicating cancer: a novel and clinically distinct syndrome.

    PubMed

    Warkentin, Theodore E; Cook, Richard J; Sarode, Ravi; Sloane, Debi A; Crowther, Mark A

    2015-07-23

    Venous limb gangrene (VLG) can occur in cancer patients, but the clinical picture and pathogenesis remain uncertain. We identified 10 patients with metastatic cancer (7 pathologically proven) who developed severe venous limb ischemia (phlegmasia/VLG) after initiating treatment of deep-vein thrombosis (DVT); in 8 patients, cancer was not known or suspected at presentation. The patients exhibited a novel, clinically distinct syndrome: warfarin-associated supratherapeutic international normalized ratio (INR; median, 6.5) at onset of limb ischemia, rising platelet count during heparin anticoagulation, and platelet fall after stopping heparin. Despite supratherapeutic INRs, patient plasma contained markedly elevated thrombin-antithrombin (TAT) complex levels (indicating uncontrolled thrombin generation) and protein C (PC) depletion; this profile resembles the greatly elevated TAT/PC activity ratios reported in patients with warfarin-associated VLG complicating heparin-induced thrombocytopenia. Analyses of vitamin K-dependent factors in 6 cancer patients with available serial plasma samples showed that variations in the INR corresponded most closely with changes in factor VII, with a highly collinear relationship between VII and PC. We conclude that venous limb ischemia/gangrene is explained in some cancer patients by profoundly disturbed procoagulant-anticoagulant balance, whereby warfarin fails to block cancer-associated hypercoagulability while nonetheless contributing to severe PC depletion, manifest as a characteristic supratherapeutic INR caused by parallel severe factor VII depletion. PMID:25979950

  5. Gas gangrene

    MedlinePlus

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

  6. 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.

  7. 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.

  8. Management of scrotal gangrene.

    PubMed

    Badejo, O A

    1985-12-01

    Sixteen cases of scrotal gangrene are presented. The aetiology, environmental factors and pattern of clinical presentation are described. A total reconstruction of the scrotal sac in all cases as practised in Ife is described. It is advocated that surgeons in the tropics should, in spite of various constraints, try to salvage any infected testis before considering orchidectomy. Infective gangrene of the scrotum is considered a more suitable diagnostic label than Fournier's gangrene. PMID:4095772

  9. Peripheral gangrene in a case of severe dengue.

    PubMed

    Nair, B T; Sanjeev, R K; Tarikjot, S B

    2016-01-01

    We report the case of a 10-year-old male who developed gangrene of his fingers and toes following severe dengue fever complicated by disseminated intravascular coagulation (DIC). Child developed bilateral dry gangrene of fingers and toes. All the peripheral pulses of the affected limbs were palpable. The child had no history of taking B-blockers, ergot alkaloids or other related medications. Color Doppler of peripheral arterial and venous systems of all limbs indicated normal flow. Blood was positive for D-dimers and fibrin degradation products. The patient was managed with broad spectrum antibiotics, fluid resuscitation, low molecular weight heparin, blood transfusions, fresh frozen plasma and other supportive measures. Peripheral gangrene seen in DIC associated with dengue is very rare and carries a higher mortality. PMID:26755235

  10. 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

  11. 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

  12. 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

  13. Clinical analysis of leg ulcers and gangrene in rheumatoid arthritis.

    PubMed

    Hasegawa, Michiko; Nagai, Yayoi; Sogabe, Yoko; Hattori, Tomoyasu; Inoue, Chizuru; Okada, Etsuko; Tago, Osamu; Ishikawa, Osamu

    2013-12-01

    Leg ulcers are often complicated in patients with rheumatoid arthritis (RA), however, the etiology is multifactorial. We examined the cases of leg ulceration or gangrene in seven RA patients who were hospitalized over the past 3 years. One patient was diagnosed as having pyoderma gangrenosum. Although vasculitis was suspected in three patients, no histological evidence was obtained from the skin specimens. In these patients, angiography revealed the stenosis or occlusion of digital arteries. In the remaining three patients, leg ulcers were considered to be due to venous insufficiency. Treatment should be chosen depending on the causes of leg ulcers. PMID:24304368

  14. [Gas gangrene: a military disease?].

    PubMed

    Pailler, J L; Labeeu, F

    1986-01-01

    Gas gangrene is a general toxi-infection, which is mostly the result of a contamination of the muscles from traumatic or post-operative origin. Muscular necrosis expands very quickly, causes mutilations, hits several organs and leads to shock. The spontaneous evolution is mostly mortal within a couple of hours. For a long time it was considered to be a typical military disease: during World War I some 100,000 German soldiers lost their lives as a direct result. It represented then 10 to 12% of all deads of wounds. This mortality rate decreased between 0.3 and 1.5% during World War II and to 0.016% during the Vietnam WAr. Although gas gangrene is no longer a typical military disease, the holy principles of war surgery must be respected. All war wounds, and in particular those caused by high velocity missiles are contaminated, a.o. by clostridium spores. An immediate suture of those wounds, through which necrotized tissue is covered (an ideal anaerobic environment), furthers the development of gas gangrene. The only prevention consists of debriding those wounds, leaving them opened, followed by a delayed primary suture between the 4th and 7th day after the debridement. Not properly treated will gas gangrene always be mortal. In some instances, an emergency amputation will be the only way to save the patient's life. Antibiotherapy, hyperbaric oxygenotherapy and most of all surgery from the medical triade which is imperative to treat this disease. Thanks to these measures, the mortality rate decreased from 70% before 1960 to 41%. Nonetheless the most important act remains the early, complete, rational and rigorous debridement of the wounds. Far from being an obsolete attitude, this is one of humility, wisdom ... and with future prospects. PMID:3716723

  15. [Mixed-aetiology extensive ulcers of the crus: postthrombotic disease and gangrenous pyoderma].

    PubMed

    Andreev, D Iu

    2011-01-01

    Gangrenous pyoderma (GP) is a rare infectious disease typically manifesting itself by utterly painful crural ulcers. Currently, the disease is considered to be most likely of an autoimmune origin. The author presents herein a case report describing key diagnostic and treatment decisions regarding a 30-year-old woman suffering from extensive crural ulcers. Of special interest was the finding that this patient's ultrasonographic duplex scanning showed the signs corresponding to postthrombotic disease. However, conventional treatment of venous trophic ulcers turned out inefficient. The woman was diagnosed as having GP. Topical therapy with corticosteroid drugs (combined with autodermoplasty and compression therapy) made it possible to achieve complete epithelisation of ulcers. Thus, should conventional treatment of venous trophic ulcers result in the patient's failure to respond properly, it is necessary to take into consideration the probability of gangrenous pyoderma. PMID:22616234

  16. Fournier's gangrene complicating ulcerative pancolitis.

    PubMed

    Katsanos, Konstantinos H; Ignatiadou, Eleftheria; Sarandi, Maria; Godevenos, Dimitrios; Asproudis, Ioannis; Fatouros, Michael; Tsianos, Epameinondas V

    2010-06-01

    Fournier gangrene is a very rare and a rapidly progressing, polymicrobial necrotizing faciitis or myonecrosis of the perineal, perianal and genital regions, with a high mortality rate. Infection is associated with superficial traum, urological and colorectal diseases and operations. The most commonly found bacteria are Escherichia coli followed by Bacteroides and streptococcal species. Diabetes mellitus, alcoholism, and immunosuppression are perpetuating co-factors. Fournier's gangrene complicating inflammatory bowel disease has been reported in three patients so far, two with Crohn's disease. A 78-year-old man diagnosed with ulcerative pancolitis was referred for fever, and painful perianal and scrotal swelling after perianal surgery for a horseshoe-type perianal abscess. Since bowel disease diagnosis, patient was on mesalazine and achieved long-term remission. Perianal abscess occurred suddenly one week before perianal surgery without any evidence of pre-existing fistula or other abnormalities. Physical examination showed extensive edema and crepitus of perineum and genitalia and patient had symptoms of significant toxicity. The diagnosis of Fournier's gangrene was made and patient underwent emergency surgery with extensive surgical debridement of the scrotal and perianal area and Hartman procedure with a diverting colostomy. In addition, patient started on therapy with mesalazine 3gr, methylprednisolone 16 mg, parenteral nutrition and broad spectrum of antibiotics. Two days after the first operation the patient needed a second operation for perianal debridement. On the fourth day, blood cultures showed E. coli. Patient had an uneventful recovery and was discharged after 34 days of hospitalization. On follow up, disease review is scheduled and colostomy closure is planned. PMID:21122507

  17. Acute gangrenous cholecystitis: radionuclide diagnosis

    SciTech Connect

    Brachman, M.B.; Tanasescu, D.E.; Ramanna, L.; Waxman, A.D.

    1984-04-01

    Radionuclide hepatobiliary imaging with Tc-99m IDA is a useful procedure for the diagnosis of acute cholecystitis. Visualization of the gallbladder essentially rules out acute cholecystitis. Nonvisualization suggest acute cholecystitis but may also be associated with chronic gallbladder disease or other conditions. The authors recently observed five patients in whom a rim of increased parenchymal liver activity was seen adjacent to the gallbladder fossa. All five patients had acute gangrenous cholecystitis. The rim of increased activity appears to be a useful secondary sign of acute cholecystitis.

  18. Fungal Fourniers Gangrene in an Immunocompromised Patient

    PubMed Central

    Crowell, Winston; Roberts, Robyn; Tarry, Susan

    2015-01-01

    Fournier's Gangrene is a rapidly progressive necrotizing fasciitis of the groin, perianal and perineal region that is often polymicrobial in nature, often averaging 3 species of bacteria per patient. The typical infection can be due to a host of microbes, including gram positive, gram negative and anaerobic species including. Many of the causative organisms are found in the normal microbial flora of the perineum. Therefore, Fourniers is an opportunistic infection most commonly affecting the immunosuppressed. The majority of Fournier's gangrene are bacterial; however there have been cases of fungal Fournier's gangrene reported in the literature. PMID:26793562

  19. 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 ...

  20. A rare case of Fournier's Gangrene.

    PubMed

    Sheehy, Sally-Ann; Kelly, Michael E; Francis, Eamon C; Sweeney, Karl J; Hussey, Alan

    2016-01-01

    We report a rare case that highlights acute pancreatitis as the protagonist of Fournier's Gangrene. This patient was treated with a radical debridement of his perineum at presentation and subsequently reconstructed with split thickness skin grafting. This is an unusual aetiology of necrotizing fasciitis with only one other case reported in the literature. This serves to emphasize to physicians that acute pancreatitis is a potential source when investigating and treating patients with Fournier's Gangrene. PMID:27150281

  1. 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.

  2. Isolated Fournier's gangrene of the penis.

    PubMed

    Obi, A O

    2016-01-01

    To share experience on the presentation and management of 4 cases of isolated penile Fournier's gangrene. Clinical and demographic data of four patients with isolated penile Fournier's gangrene seen over an 8-year period (January 2006-December 2013) were reviewed. All patients had intravenous fluid resuscitation, emergency surgical debridement, and broad-spectrum intravenous antibiotics. Fournier's gangrene of the penis was, respectively, due to long segment anterior urethral stricture, penile edema from poorly controlled congestive cardiac failure, penile abrasion from oral sex and idiopathic. The mean age of the patients was 34.3 ± 5.6 years. One patient with urethral stricture had urinary tract infection. The patients presented with a prodromal period of genital pain and fever followed by genital swelling, gangrene, and ulceration. The most common wound swab isolates were Staphylococcus aureus and Escherichia coli. Only the skin and dartos fascia were affected with sparing of the corporal cylinders. Mean hospital stay was 17.3 ± 3.0 days and mean Fournier's gangrene severity index (FGSI) was 4.0 ± 0.8. Wound closure was achieved by split skin grafting in 2 patients, delayed primary closure in the third and healing by secondary intention in the fourth patient. Subjectively assessed erectile function was preserved in all four patients. Isolated Fournier's gangrene of the penis is very rare. It is associated with low FGSI and sparing of the three corporal cylinders. It may rarely follow oral sexual practice. PMID:27022814

  3. Fournier gangrene: rare complication of rectal cancer

    PubMed Central

    Ossibi, Pierlesky Elion; Souiki, Tarik; Majdoub, Karim Ibn; Toughrai, Imane; Laalim, Said Ait; Mazaz, Khalid; Tenkorang, Somuah; Farih, My Hassan

    2015-01-01

    Fournier's Gangrene is a rare complication of rectal cancer. Its discovery is often delayed. It's incidence is about 0.3/100 000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis. PMID:26161211

  4. Symmetrical peripheral gangrene caused by septic shock

    PubMed Central

    Shimbo, Keisuke; Yokota, Kazunori; Miyamoto, Junpei; Okuhara, Yukako; Ochi, Mitsuo

    2015-01-01

    We report three cases of symmetrical peripheral gangrene (SPG) caused by septic shock. Most of sepsis survivors with SPG require amputation of the affected extremities. To preserve the length of the thumb and fingers, we performed surgical amputation and used flaps to cover the amputated peripheral extremities.

  5. Fournier's gangrene and its emergency management

    PubMed Central

    Thwaini, A; Khan, A; Malik, A; Cherian, J; Barua, J; Shergill, I; Mammen, K

    2006-01-01

    Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non‐obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high. PMID:16891442

  6. Delayed stoma formation in Fournier's gangrene.

    PubMed

    Bronder, C S; Cowey, A; Hill, J

    2004-11-01

    Fournier's gangrene is traditionally treated with prompt surgical debridement and in many cases a diverting colostomy is also fashioned during the same procedure. We present four cases where stoma formation was delayed until the second look procedure. The physiological states at the time of either procedure were compared using POSSUM. The results showed an improvement in the physiological condition in all patients at the time of the second operation, suggesting that a delay can potentially improve prognosis in such cases. PMID:15521946

  7. Skin Bioprinting: Impending Reality or Fantasy?

    PubMed

    Ng, Wei Long; Wang, Shuai; Yeong, Wai Yee; Naing, May Win

    2016-09-01

    Bioprinting provides a fully automated and advanced platform that facilitates the simultaneous and highly specific deposition of multiple types of skin cells and biomaterials, a process that is lacking in conventional skin tissue-engineering approaches. Here, we provide a realistic, current overview of skin bioprinting, distinguishing facts from myths. We present an in-depth analysis of both current skin bioprinting works and the cellular and matrix components of native human skin. We also highlight current limitations and achievements, followed by design considerations and a future outlook for skin bioprinting. The potential of bioprinting with converging opportunities in biology, material, and computational design will eventually facilitate the fabrication of improved tissue-engineered (TE) skin constructs, making bioprinting skin an impending reality. PMID:27167724

  8. Suprasternal approach for impending tracheo-innominate artery fistula.

    PubMed

    Fujimoto, Yoshifumi; Hirose, Keiichi; Ota, Noritaka; Murata, Masaya; Ide, Yujiro; Tosaka, Yuko; Tachi, Maiko; Sakamoto, Kisaburo

    2010-09-01

    We report preventive innominate artery division or ligation through a suprasternal approach for impending tracheo-innominate artery fistula (TIF) with recurrent airway oozing in patients with severe neuromuscular disease. Our approach is less invasive and a favorable procedure as preventive surgery for impending TIF. PMID:20859729

  9. Isolated Ileal Pancreatic Heterotopia Causing Intussusception with Gangrene.

    PubMed

    Sundaram, Jegadeesh; Menon, Prema; Kumar, Vinod; Rao, Katragadda Lakshmi Narasimha; Vaiphei, Kim; Kakkar, Nandita

    2015-01-01

    Isolated ileal heterotopic pancreatic tissue as a lead point of intussusception in children is extremely rare. We report a 6-month-old female with ileoileal intussusception and a 4-year-old female with ileocolic intussusception both associated with gangrene. A review of literature suggests a higher prevalence of gangrene probably secondary to the pancreatic exocrine tissue. PMID:26107550

  10. 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

  11. [Necrotizing cutaneous infections and Fournier's gangrene].

    PubMed

    Lasocki, S; Geffroy, A; Montravers, P

    2006-09-01

    Fournier's gangrene is a necrotizing infection of skin and soft tissue of the perineum. Several sources of contamination have been described: cutaneous, urological or anorectal. Anatomy of the perineum helps in the prediction of the extension of the infection. The bacterial flora (usually mixed aero-anaerobic flora) depends on the source of infection: gram-positive cocci (skin source) combined with gram-negative bacilli and anaerobes (urological or anorectal source). CT scan and echography are useful tools for the diagnosis without delaying surgery. In the diagnostic procedure and the management, proctological examination, retrograde uretrography, bowel and urine derivation should be discussed. PMID:16675183

  12. [Venous ulcer].

    PubMed

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms. PMID:27405863

  13. Gas gangrene in traumatic hand injuries. Report of three cases.

    PubMed

    Boisdenghien, A; Zorman, D

    1984-01-01

    Gaseous gangrene is an infection with anaerobies germs characterized by gaseous infiltration of soft tissues with quick and serious damage to the general state. Known in war time, it rages also in civilian practice. Two etiologies are dominating: post-trauma gaseous gangrenes, post-surgery gaseous gangrenes. Among post-trauma gaseous gangrenes, the ones on departure of inferior members are the most frequent arising from fractures or from luxations open or closed. Localisation on superior limbs is scarce, specially after soft parts' trauma. We report three cases of superior limbs' gaseous gangrene after seemingly benign trauma. Diagnosis has been set by the clinical surgery, and the presence of gas bubbles at soft tissues' radiography. It didn't exist any favorising agent such as diabetes, arterial insufficiency, intercurrent disease treated with corticoïdes or with immuno-depressors. Bacteriological levyings have not put the causal germ in evidence, this is due to levying conditions. Evolution of gaseous gangrene depends on quickness of diagnosis and treatment. This one includes surgical flattening, discharge's incisions and excisions of devitalized tissues, as well as antibiotherapy with 20 000 to 60 000 U penicilline by parenteral way. We didn't need appeal to hyperbare oxygenotherapy. Simple procedures of secondary repair surgery were sufficient to restoration of a normal function. Gaseous gangrene is a real surgical urgency, even without bacteriological proof. PMID:6529302

  14. Iatrogenic non-clostridial gas gangrene - a case report.

    PubMed

    Sh, Jayanth; Yp, Girish Chandra; J, Ramkumar

    2016-03-01

    Skin and soft tissue infections of the lower limbs are quite common and can at times progress rapidly to become both limb and life-threatening infections. Muscular infections usually occur in areas of the body that have been compromised or injured by a foreign body, trauma, ischaemia, injection of illicit drugs, malignancy or surgery. Gas gangrene is one such limb-threatening infection. The gas-forming infection can be clostridial or non-clostridial. Clostridia are the main causative organism of the gas gangrene. Non-clostridial gas gangrene is a rare condition and is known to be associated with high mortality. Here, we report one such rare case where a middle-aged man succumbed to non-clostridial gas gangrene after he was administered an intramuscular injection. The case was registered as a suspicious death by the police and the body was subjected to medico legal autopsy. PMID:26672772

  15. 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...

  16. Halo sign on indium-111 leukocyte scan in gangrenous cholecystitis

    SciTech Connect

    Bauman, J.M.; Boykin, M.; Hartshorne, M.F.; Cawthon, M.A.; Landry, A.J.

    1986-02-01

    A 56-year-old man with a long history of Crohn's disease was evaluated by In-111 labeled leukocyte scanning. A halo of leukocyte activity was seen around the gallbladder fossa. A gangrenous gallbladder was removed at surgery.

  17. Takayasu's arteritis presenting as digital gangrene of right hand.

    PubMed

    Verma, Sudhir; Saraf, Sameer; Himanshu, D; Singh, Shailesh

    2013-01-01

    Takayasu's arteritis (TA) is a chronic inflammatory disease of medium and large vessels, mainly involving the aorta and its major branches. TA may have diverse clinical presentation including claudication, stroke, asymmetric pulse or blood pressure. However, the association of TA with digital gangrene is a rare entity. Here, we report a case of a 40-year-old woman who presented with digital gangrene of the right hand, which on workup was diagnosed as a case of TA. PMID:23314451

  18. A rare case of Fournier’s Gangrene

    PubMed Central

    Sheehy, Sally-Ann; Kelly, Michael E.; Francis, Eamon C.; Sweeney, Karl J.; Hussey, Alan

    2016-01-01

    We report a rare case that highlights acute pancreatitis as the protagonist of Fournier’s Gangrene. This patient was treated with a radical debridement of his perineum at presentation and subsequently reconstructed with split thickness skin grafting. This is an unusual aetiology of necrotizing fasciitis with only one other case reported in the literature. This serves to emphasize to physicians that acute pancreatitis is a potential source when investigating and treating patients with Fournier’s Gangrene. PMID:27150281

  19. Venous insufficiency

    MedlinePlus

    ... and ankles Skin color changes around the ankles Varicose veins on the surface (superficial) Thickening and hardening of ... skin on the legs and ankles (lipodermatosclerosis) Surgery ( varicose vein stripping ) to treat chronic venous insufficiency has been ...

  20. Venous Ulcers

    PubMed Central

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  1. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis

    PubMed Central

    Nikfarjam, Mehrdad; Niumsawatt, Vachara; Sethu, Arun; Fink, Michael A; Muralidharan, Vijayaragavan; Starkey, Graham; Jones, Robert M; Christophi, Christopher

    2011-01-01

    Background: Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies. Methods: Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database. Data were reviewed retrospectively and patients with GC were compared with those with NGAC. Results: A total of 184 patients with NGAC and 106 with GC were identified. The risk factors associated with GC included older age (69 years vs. 57 years; P = 0.001), diabetes (19% vs. 10%; P = 0.049), temperature of >38 °C (36% vs. 16%; P < 0.001), tachycardia (31% vs. 15%; P = 0.002), detection of muscle rigidity on examination (27% vs. 12%; P = 0.01) and greater elevations in white cell count (WCC) (13.4 × 109/l vs. 10.7 × 109/l; P < 0.001), C-reactive protein (CRP) (94 mg/l vs. 17 mg/l; P = 0.001), bilirubin (19 µmol/l vs. 17 µmol/l; P = 0.029), urea (5.3 mmol/l vs. 4.7 mmol/l; P = 0.016) and creatinine (82 µmol/l vs. 74 µmol/l; P = 0.001). The time from admission to operation in days was greater in the GC group (median = 1 day, range: 0–14 days vs. median = 1 day, range: 0–10 days; P = 0.029). There was no overall difference in complication rates between the GC and NGAC groups (22% vs. 14%; P = 0.102). There was a lower incidence of common bile duct stones in the GC group (5% vs. 13%; P = 0.017). Gangrenous cholecystitis was associated with increased mortality (4% vs. 0%; P = 0.017), but this was not an independent risk factor on multivariate analysis. Conclusions: Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help to differentiate it from NGAC. It is not associated with an overall increase in

  2. Symmetrical peripheral gangrene due to Plasmodium falciparum malaria

    PubMed Central

    Abdali, Nasar; Malik, Azharuddin Mohammed; Kamal, Athar; Ahmad, Mehtab

    2014-01-01

    A 45-year-old man presented with a 4-day history of high-grade fever with rigours and a 2-day history of painful bluish black discolouration of extremities (acrocyanosis). He was haemodynamically stable and all peripheral pulses palpable, but the extremities were cold with gangrene involving bilateral fingers and toes. Mild splenomegaly was present on abdominal examination but rest of the physical examinations were normal. On investigating he was found to have anaemia, thrombocytopaenia with gametocytes of Plasmodium falciparum on peripheral blood smear. His blood was uncoagulable during performance of prothrombin time with a raised D-dimer. Oxygen saturation was normal and the arterial Doppler test showed reduced blood flow to the extremities. A diagnosis of complicated P. falciparum malaria with disseminated intravascular coagulation (DIC) leading to symmetrical peripheral gangrene was performed. Artemisinin combination therapy was started and heparin was given for DIC. A final line of demarcation of gangrene started forming by 12th day. PMID:24862424

  3. Contemporary diagnosis and management of Fournier’s gangrene

    PubMed Central

    Khourdaji, Iyad; Burks, Frank; Killinger, Kim A.

    2015-01-01

    Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing fasciitis of the external genitalia. Mainly associated with men and those over the age of 50, Fournier’s gangrene has been shown to have a predilection for patients with diabetes as well as people who are long-term alcohol misusers. The nidus for the synergistic polymicrobial infection is usually located in the genitourinary tract, lower gastointestinal tract or skin. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. The diagnosis is often made clinically, although radiography can be helpful when the diagnosis or the extent of the disease is difficult to discern. The Laboratory Risk Indicator for Necrotizing Fasciitis score can be used to stratify patients into low, moderate or high risk and the Fournier’s Gangrene Severity Index (FGSI) can also be used to determine the severity and prognosis of Fournier’s gangrene. Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. In cases of severe perineal involvement, colostomy has been used for fecal diversion or alternatively, the Flexi-Seal Fecal Management System can be utilized to prevent fecal contamination of the wound. After extensive debridement, many patients sustain significant defects of the skin and soft tissue, creating a need for reconstructive surgery for satisfactory functional and cosmetic results. PMID:26445600

  4. Peripheral venous hypertension after the creation of arteriovenous fistula for haemodialysis.

    PubMed

    Bachleda, Petr; Kojecký, Zdenek; Utíkal, Petr; Drác, Petr; Herman, Jirí; Zadrazil, Josef

    2004-07-01

    The function of an arteriovenous (av) fistula for haemodialysis may be complicated by manifestation of peripheral venous hypertension, which results from the arterial blood flow through the venous system into the periphery of the upper extremity. Its development is most typically caused by a proximal forearm av-fistula, as, in addition to the desirable arterialisation of the subcutaneous venous system of the arm, arterialisation of the venous system of the forearm and the hand may occur and possibly promote the development of venous hypertension, which may in the extreme result in gangrene of the fingers. Awareness of these problems as well as of the necessity of their surgical solution is essential for doctors dealing with haemodialysis. PMID:15523553

  5. [Forefoot gangrene and infra-crural bypass: simultaneous amputation].

    PubMed

    Jacobs, M J

    1996-01-01

    Patients presented for amputation mostly have chronic limb ischaemia caused by atherosclerosis, with signs of severe arterial insufficiency including rest pain, non-healing skin lesions, ulceration or gangrene. Foot infections, especially in diabetic patients, are often multimicrobial, deeply invasive and frequently require aggressive measures, like debridement and drainage or partial open forefoot amputation in addition to broad-spectrum antibiotics, in patients with critical limb ischaemia and limited necrosis and forefoot gangrene, distal bypass surgery is the treatment of choice. The main question is whether amputation should be performed simultaneously or in a secondary stage. Our own experience deals with 342 femorocrural and femoropedal bypass grafts for the treatment of critical limb ischaemia. The results showed no significant difference in graft patency between crural and pedal grafts. Clinical factors like diabetes mellitus, poor distal run-off and site of the distal anastomosis had no adverse effect on the functioning and patency of the graft. In this series we found that in diabetic patients significantly more amputations were required because of persistent foot infection. Since in these patients amputation was performed in a secondary stage, we changed our policy to simultaneous amputation. After completion of the bypass, closure and coverage of all the wounds, the gangrenous part is amputated. In case of deep, wet or infectious gangrene of the forefoot, an open transmetatarsal amputation is performed. Using this approach we have further increased limb-salvage and especially the number of usuable limbs. PMID:8713389

  6. Combined Arterial and Venous Thrombosis in Ulcerative Colitis- A Rare Vascular Manifestation

    PubMed Central

    Singh, Harpreet; Dewan, Richa; Anuradha, S; Singla, Sumeet

    2016-01-01

    Combined arterial and venous thrombosis in patients with ulcerative colitis is a rare extra vascular manifestation, which motivated the current report. Increased coagulability is a recognised feature of ulcerative colitis with frequency increasing during flares. We report the case of a 42-year-old lady who was a diagnosed case of ulcerative colitis, currently in remission. She presented with swelling followed by discolouration of left lower limb which later was diagnosed as deep venous thrombosis combined with femoral and popliteal artery thrombosis. This led to wet gangrene of the limb, sepsis, septic shock and death despite aggressive management with heparin infusion, ionotropes, and parenteral antibiotics therapy. PMID:27190869

  7. Venous thrombosis.

    PubMed

    Wolberg, Alisa S; Rosendaal, Frits R; Weitz, Jeffrey I; Jaffer, Iqbal H; Agnelli, Giancarlo; Baglin, Trevor; Mackman, Nigel

    2015-01-01

    Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism. VTE is the leading cause of lost disability-adjusted life years and the third leading cause of cardiovascular death in the world. DVT leads to post-thrombotic syndrome, whereas pulmonary embolism can cause chronic pulmonary hypertension, both of which reduce quality of life. Genetic and acquired risk factors for thrombosis include non-O blood groups, factor V Leiden mutation, oral contraceptive use, hormone replacement therapy, advanced age, surgery, hospitalization and long-haul travel. A combination of blood stasis, plasma hypercoagulability and endothelial dysfunction is thought to trigger thrombosis, which starts most often in the valve pockets of large veins. Animal studies have revealed pathogenic roles for leukocytes, platelets, tissue factor-positive microvesicles, neutrophil extracellular traps and factors XI and XII. Diagnosis of VTE requires testing and exclusion of other pathologies, and typically involves laboratory measures (such as D-dimer) and diagnostic imaging. VTE is treated with anticoagulants and occasionally with thrombolytics to prevent thrombus extension and to reduce thrombus size. Anticoagulants are also used to reduce recurrence. New therapies with improved safety profiles are needed to prevent and treat venous thrombosis. For an illustrated summary of this Primer, visit: http://go.nature.com/8ZyCuY. PMID:27189130

  8. Impending rupture in an aortic arch aneurysm by Candida infection.

    PubMed

    Minami, H; Wakita, N; Kawanishi, Y; Kitano, I; Sakata, M

    2001-03-01

    A 68-year-old man was hospitalized with the complaints of left back pain and fever. He had a history of using steroids to treat uveitis for about thirty years. Computed tomography on the chest demonstrated an impending rupture in an aortic arch aneurysm, which was consequently surgically excised. Candida albicans was identified in the wall of the aneurysm, so fluconazole and itraconazole were administered. The patient was discharged at 120 days after surgery without recrudescence of the candida. To our knowledge, this is the fifteenth case of a successfully treated aneurysm caused by candida infection. PMID:11305059

  9. Arterial cannulation can hasten the onset of symmetrical peripheral gangrene

    PubMed Central

    Srinivasan, Nataraj M.; Chaudhuri, Souvik

    2011-01-01

    Symmetrical peripheral gangrene (SPG) is a devastating complication seen in critical care settings due to several contributory factors like low perfusion, high dose of vasopressors, disseminated intravascular coagulation, etc. Arterial cannulation is commonly done in critical patients for monitoring. We report a case of patient who developed early features of SPG which recovered in one hand, although it progressed in the hand which had the arterial cannula. PMID:25885311

  10. 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

  11. Gangrenous Appendicitis in a Boy with Mobile Caecum.

    PubMed

    Keskin, Suat; Keskin, Zeynep; Gunduz, Metin; Sekmenli, Taner; Kivrak, Hatice Yazar

    2015-04-01

    A mobile caecum and ascending colon is an uncommon congenital disorder, and it is even rarer as the cause of an acute abdomen during childhood. This report presents the case of a 6-year-old boy with acute gangrenous appendicitis with a mobile caecum and ascending colon. Data from the surgical course, as well as laboratory and imaging studies, were acquired and carefully examined. Emergency ultrasound (US) was performed and revealed no signs of appendicitis in the right lower quadrant. Serial imaging study, including non-enhanced computed tomography (CT), was performed. An imaging study identified epigastric appendicitis with mobile caecum. Surgery was executed under general anesthesia with a median incision extending from the epigastrium to the suprapubic region. The caecum was mobile and placed in the right epigastric area, next to the left lobe of the liver and gallbladder. The gangrenous appendix was discovered posterior to the caecum and transverse colon, enlarging to the left upper quadrant. Appendectomy was executed, the gangrenous appendix was confirmed pathologically, and the patient was released 4 days later. In the US, if there are unusual clinical findings or no findings in patients with abdominal pain, CT is beneficial in determining the location of the caecum and appendix and preventing misdiagnosis in children. PMID:26060548

  12. 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

  13. [Fournier's gangrene: Cervical and facial extension. A very rare case].

    PubMed

    Carloni, R; Pechevy, L; Isola, N; Vidal, L; Goga, D; Watier, E; Bertheuil, N

    2016-02-01

    Fournier's gangrene is a fearsome disease with a bad prognosis and a mortality rate ranging between 10 and 80% according to the literature. It is extensive in 13 to 54% of cases. Up to date, cervico-facial extension has never been reported. We describe the case of a 51-year-old overweighed woman with a history of type 2 diabetes and a narrow lumbar canal who was referred to our institution for significant fatigue and increasingly painful legs. A diagnosis of Fournier's gangrene was made after correlating the physical findings with the results of a full body scan. Diffuse subcutaneous emphysema involving the face, neck, mediastinum, abdominal wall, right buttock, perineum and the right thigh was identified. Treatment included multiple surgical debridements, admission to intensive care unit, and an efficient antibiotic therapy that enabled preservation of the patient's life. To our knowledge, this is the first case of cervical and mediastinal extension of Fournier's gangrene to be reported. No clear guidelines exit on the management of this complication (cervico-facial and mediastinal drainage). We share our experience of this unusual case. PMID:25766003

  14. Deep venous reconstructive surgery.

    PubMed

    Maleti, Oscar; Lugli, Marzia; Tripathi, Ramesh K

    2015-03-01

    Surgical correction of deep venous reflux is a valuable adjunct in treatment of selected patient with lower limb venous ulcer. Deep venous obstruction and superficial reflux is must be corrected first. Sustained venous ulcer healing and reduced ambulatory venous hypertension can be achieved in patients with both primary and secondary deep venous insufficiency. When direct valve repair is possible, valvuloplasty is the best option, but when this is not feasible, other techniques can be used, including femoral vein transposition into the great saphenous vein, vein valve transplant, neovalve construction, or nonautologous artificial venous valve. PMID:26358308

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

    SciTech Connect

    Deschamps, Frederic Farouil, Geoffroy Hakime, Antoine Teriitehau, Christophe Barah, Ali Baere, Thierry de

    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.

  16. 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

  17. Central venous catheters - ports

    MedlinePlus

    Central venous catheter - subcutaneous; Port-a-Cath; InfusaPort; PasPort; Subclavian port; Medi - port; Central venous line - port ... catheter is attached to a device called a port that will be under your skin. The port ...

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

    PubMed

    Battin, Jacques

    2010-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  20. Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

    PubMed

    Nwankwo, Okechukwu Emmanuel

    2008-04-01

    Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004. PMID:18453489

  1. Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis

    PubMed Central

    Agarwal, Mayank Mohan; Singh, Shrawan K.; Mandal, Arup K.

    2007-01-01

    Penile gangrene associated with chronic renal failure is very uncommon. A 52-year-old man with diabetes mellitus, diffuse atherosclerosis, ischemic cardiomyopathy and end-stage renal disease presented with blackening of distal penis for 10 days. His general condition was poor and gangrene of prepuce and glans was noted. Doppler and magnetic-resonance angiography revealed bilateral internal iliac artery obstruction. He underwent trocar suprapubic cystostomy and was planned for partial penectomy. But he died of severe diabetic complications in the interim period. Penile gangrene is a manifestation of widespread vascular calcifications associated with end-stage renal disease and is a marker of poor prognosis. PMID:19675807

  2. Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease*

    PubMed Central

    Komatsu, Yumi Cristina; Capareli, Gabriela Cunha; Boin, Maria Fernanda Feitosa de Camargo; Lellis, Rute; de Freitas, Thaís Helena Proença; Simone, Karine

    2014-01-01

    Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity. PMID:25387503

  3. Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease.

    PubMed

    Komatsu, Yumi Cristina; Capareli, Gabriela Cunha; Boin, Maria Fernanda Feitosa de Camargo; Lellis, Rute; Freitas, Thaís Helena Proença de; Simone, Karine

    2014-01-01

    Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity. PMID:25387503

  4. Don’t underestimate fournier’s gangrene: report of 8 cases in 10 month survey

    PubMed Central

    Danesh, Hosein Ali; Saboury, Mahdy; Sabzi, Ameneh; Saboury, Moosa; Jafary, Maryamsadat; Saboury, Shahriar

    2015-01-01

    Background: Fourniers gangrene caused by synergic aerobic and anaerobic organism is a life threatening disorder. Methods: The medical records of 8 among 839 patients admitted to imam ali general hospital Zahedan university of Medical Sciences with fourniers gangrene during the 10 months period between 2012 and 2013 were reviewed. Results: The most common etiology and presentation were abscess and perianal pain respectively. Mixed bacterial flora was common finding in patient. Single debridement was carried out in 2 patients and repeated procedure was needed in 6. Conclusion: This disease is characterized with high mortality of up to 75% but in our study the rate was 37.5%. In other studies diabetes mellitus was found to be the common condition related to fourniers gangrene but in our study the common etiology was perianal abscess. Fourniers gangrene should be rule out in any patient with perianal pain and flulike, swelling skin. PMID:26034725

  5. Juvenile gangrenous vasculitis of the scrotum: Is it a variant of pyoderma gangrenosum?

    PubMed

    Caputo, Ruggero; Marzano, Angelo V; Di Benedetto, Alessandra; Ramoni, Stefano; Cambiaghi, Stefano

    2006-08-01

    Juvenile gangrenous vasculitis of the scrotum was described by Piñol et al in 1974 as a unique variant of scrotal gangrene of unknown origin, occurring exclusively in young individuals. It was characterized by an acute onset of skin ulcers undergoing complete resolution after appropriate therapy, with no relapses. We present a typical case of this extremely rare disease affecting a 16-year-old boy in whom the scrotal ulcerations were preceded by an episode of pharyngitis with fever. The condition promptly regressed after administration of intramuscular betamethasone in combination with oral ciprofloxacin. According to Piñol et al, juvenile gangrenous vasculitis of the scrotum, although poorly known to dermatologists, should be regarded as a distinctive entity within the wide group of scrotal gangrenes. On the other hand, the hypothesis that this condition may well represent a variant of pyoderma gangrenosum is discussed. PMID:16843125

  6. Cerebral venous angiomas

    SciTech Connect

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

    1984-04-01

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

  7. Epidemiology of venous thromboembolism.

    PubMed Central

    Coon, W W

    1977-01-01

    This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease. PMID:329779

  8. Venous ulcers -- self-care

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000744.htm Venous ulcers - self-care To use the sharing features on this ... slow to heal. Alternative names Venous leg ulcers - self-care; Venous insufficiency ulcers - self-care; Stasis leg ...

  9. Compression and venous ulcers.

    PubMed

    Stücker, M; Link, K; Reich-Schupke, S; Altmeyer, P; Doerler, M

    2013-03-01

    Compression therapy is considered to be the most important conservative treatment of venous leg ulcers. Until a few years ago, compression bandages were regarded as first-line therapy of venous leg ulcers. However, to date medical compression stockings are the first choice of treatment. With respect to compression therapy of venous leg ulcers the following statements are widely accepted: 1. Compression improves the healing of ulcers when compared with no compression; 2. Multicomponent compression systems are more effective than single-component compression systems; 3. High compression is more effective than lower compression; 4. Medical compression stockings are more effective than compression with short stretch bandages. Healed venous leg ulcers show a high relapse rate without ongoing treatment. The use of medical stockings significantly reduces the amount of recurrent ulcers. Furthermore, the relapse rate of venous leg ulcers can be significantly reduced by a combination of compression therapy and surgery of varicose veins compared with compression therapy alone. PMID:23482538

  10. Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

    PubMed Central

    Oguz, Abdullah; Gümüş, Metehan; Turkoglu, Ahmet; Bozdağ, Zübeyir; Ülger, Burak Veli; Agaçayak, Elif; Böyük, Abdullah

    2015-01-01

    We aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary. PMID:25859652

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

    PubMed

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

    2000-01-01

    Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from 1 to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of micro-organisms, with Fusobacterium necrophorum (Fn) and Prevotella intermedia (Pi) as the suspected key players. Additional to production of a growth-stimulating factor for Pi, Fn displays a classic endotoxin, a dermonecrotic toxin, a cytoplasmic toxin, and a hemolysin. Without appropriate treatment, the mortality rate from noma is 70-90%. Survivors suffer the two-fold afflictions of oro-facial mutilation and functional impairment, which require a time-consuming, financially prohibitive surgical reconstruction. PMID:12002813

  12. 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

  13. Early warning signs of impending hypoglycaemia masked by post-extraction labial paraesthesia.

    PubMed

    Jowett, N I; Cabot, L B

    1998-07-25

    Temporary lingual and labial paraesthesia are not uncommon following the removal of mandibular third molar teeth. In patients with insulin-treated diabetes circum-oral paraesthesia is a common and important sign of impending hypoglycaemia. This report highlights the case of a 17-year-old girl with Type 1 (insulin-dependent) diabetes who, following the extraction of her four wisdom teeth, experienced minor circum-oral sensory disturbances. These effectively masked her early warning signs of impending hypoglycaemia which had hitherto allowed her to have very good glycaemic control. Trembling, sweating and loss of concentration became the new presenting symptom complex, which she found both disabling and worrying. Fortunately, within six months the paraesthesia had subsided and the patient was once again able to appreciate her usual warning symptom of impending hypoglycaemia. PMID:9718802

  14. [Chronic venous insufficiency (CVI)].

    PubMed

    Renner, R; Simon, J

    2009-10-01

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

  15. 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

  16. Fournier gangrene as a manifestation of undiagnosed metastatic perforated colorectal cancer.

    PubMed

    Chan, Cyrus C; Williams, Mallory

    2013-01-01

    Abstract Fournier gangrene is a necrotizing soft tissue infection involving the perineum. We present a case of Fournier gangrene as the clinical presentation of perforated metastatic rectal cancer. The patient is a 78-year-old man in a nursing home who presented to our institution with necrosis and ischemia of the scrotum. After wide debridement of necrotic tissue and bilateral orchiectomy, computed tomography was carried out to investigate abnormal findings seen on his chest X-ray, which revealed multiple pulmonary metastases as well as a mass highly suspicious for a perforated rectal mass. Once stable, a diverting colostomy and biopsies of the rectal mass were performed, confirming the presence of a metastatic, poorly differentiated rectal adenocarcinoma. Albeit an unusual etiology of Fournier gangrene, this case highlights the rare but important causes of this deadly condition and teaches us to be cognizant of the variations in the presentation of colorectal cancer. PMID:23438275

  17. Reconstruction of Defects After Fournier Gangrene: A Systematic Review

    PubMed Central

    Karian, Laurel S.; Lee, Edward S.

    2015-01-01

    Background: Reconstruction of scrotal defects after Fournier gangrene is often achieved with skin grafts or flaps, but there is no general consensus on the best method of reconstruction or how to approach the exposed testicle. We systematically reviewed the literature addressing methods of reconstruction of Fournier defects after debridement. Methods: PubMed and Cochrane databases were searched from 1950 to 2013. Inclusion criteria were reconstruction for Fournier defects, patients 18 to 90 years old, and reconstructive complication rates reported as whole numbers or percentages. Exclusion criteria were studies focused on methods of debridement or other phases of care rather than reconstruction, studies with fewer than 5 male patients with Fournier defects, literature reviews, and articles not in English. Results: The initial search yielded 982 studies, which was refined to 16 studies with a total pool of 425 patients. There were 25 (5.9%) patients with defects that healed by secondary intention, 44 (10.4%) with delayed primary closure, 36 (8.5%) with implantation of the testicle in a medial thigh pocket, 6 (1.4%) with loose wound approximation, 96 (22.6%) with skin grafts, 68 (16.0%) with scrotal advancement flaps, 128 (30.1%) with flaps, and 22 (5.2%) with flaps or skin grafts in combination with tissue adhesives. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Conclusions: Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. There is no conclusive evidence to support flap coverage of exposed testes rather than skin graft. A reconstructive algorithm is proposed. Skin grafting or flap reconstruction is recommended for defects larger than 50% of the scrotum or extending beyond the scrotum, whereas scrotal advancement flap reconstruction or healing by secondary intention is best for defects confined to less than 50

  18. Mesenteric venous thrombosis

    MedlinePlus

    Intestinal ischemia is a serious complication of mesenteric venous thrombosis. Some or all of the intestine dies because of ... Brandt LJ, Feuerstadt P. Instestinal ischemia. In: Feldman M, ... Pathophysiology/Diagnosis/Management. 9th ed. Philadelphia, ...

  19. Venous thrombosis: an overview

    SciTech Connect

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  20. Chronic Venous Insufficiency

    MedlinePlus

    ... What is Chronic V enous I nsufficiency (CVI)? Varicose veins are hereditary most of the time and generally ... members of the same family. Much less commonly, varicose veins develop after Chronic venous insufficiency (CVI) is a ...

  1. Deep venous thrombosis

    MedlinePlus

    Deep venous thrombosis is a condition that occurs when a blood clot forms in a vein deep inside a part ... M, et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis. 9th ed. American College of Chest ...

  2. Mesenteric venous thrombosis

    MedlinePlus

    ... of the tissues surrounding the veins, and include: Appendicitis Cancer Diverticulitis Liver disease with cirrhosis Pancreatitis Patients ... Mesenteric venous thrombosis. Mayo Clin Proc Read More Appendicitis Blood clots Cirrhosis Diverticulitis Small intestinal ischemia and ...

  3. 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

  4. 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

  5. An Unusual Case of HCV Negative Cryoglobulinemia Presenting as Symmetrical Peripheral Gangrene

    PubMed Central

    Meher, Lalit Kumar; Behera, Samir Kumar; Nayak, Sachidananda; Tripathy, Sujit Kumar

    2016-01-01

    Cryoglobulins are monoclonal or polyclonal immunoglobulins that undergo reversible precipitation at low temperatures. Cryoglobulinemia is associated with HCV infection in more than 90% cases, the remaining 10% being called as Essential Cryoglobulinemia which is generally associated with a severe course and suboptimal response to conventional therapies. As the digital vessels are more prone to colder temperatures, hyperviscosity in those vessels can initiate local thrombosis and may manifest as ischemic ulceration and gangrene. We report here a very unusual case of HCV negative cryoglobulinemic vasculitis presenting as symmetrical peripheral gangrene of fingers and toes. PMID:27190872

  6. Gangrene of the penis, scrotum, and perineum, occurred after radiotherapy of rectal cancer

    PubMed Central

    Życzkowski, Marcin; Bryniarski, Piotr; Nowakowski, Krzysztof; Muskała, Bartosz; Paradysz, Andrzej

    2013-01-01

    We present a case of a 58-year-old man hospitalized because of gangrene of the penis and scrotum, after radiochemotherapy for rectal cancer. At the time of the admission the patient presented with extensive gangrene with necrosis affecting the scrotum and the penis. During the first day of hospitalization the patient was operated. Due to the progress of the disease he had to be operated again. The status of the patient, which initially was very bad, was gradually improving. He was discharged from the hospital after 59 days in a good general state with good wound healing. PMID:24707380

  7. 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…

  8. 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…

  9. 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…

  10. Cerebral venous sinus thrombosis

    PubMed Central

    Allroggen, H.; Abbott, R.

    2000-01-01

    Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. It is very often unrecognised at initial presentation. All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Extensive collateral circulation within the cerebral venous system allows for a significant degree of compensation in the early stages of thrombus formation. Systemic inflammatory diseases and inherited as well as acquired coagulation disorders are frequent causes, although in up to 30% of cases no underlying cause can be identified. The oral contraceptive pill appears to be an important additional risk factor. The spectrum of clinical presentations ranges from headache with papilloedema to focal deficit, seizures and coma. Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. It has now been conclusively shown that intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis because of its efficacy, safety and feasability. Local thrombolysis may be indicated in cases of deterioration, despite adequate heparinisation. This should be followed by oral anticoagulation for 3-6 months. The prognosis of cerebral venous sinus thrombosis is generally favourable. A high index of clinical suspicion is needed to diagnose this uncommon condition so that appropriate treatment can be initiated.


Keywords: cerebral venous sinus thrombosis PMID:10622773

  11. A case of Fournier gangrene complicating idiopathic nephrotic syndrome of childhood.

    PubMed

    Wright, A J; Lall, A; Gransden, W R; Joyce, M R; Rowsell, A; Clark, G

    1999-11-01

    A 10-year-old boy presenting with steroid resistant nephrotic syndrome developed Fournier gangrene of the scrotum. Antimicrobial drug therapy, intravenous albumin, excision of necrotic scrotum and left orchidectomy followed by skin grafting 3 weeks later led to an excellent cosmetic and medical result. Six months later he remains nephrotic on diuretic and angiotensin converting enzyme inhibitor medication. PMID:10603132

  12. 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...

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

    PubMed Central

    2012-01-01

    Background Fournier’s gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier’s gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient. Case presentation Following perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier’s gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a “penile lift” allowed a satisfactory esthetical and functional result. Conclusion Fournier’s gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by “penile lift”. PMID:23259537

  14. 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

  15. Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report

    PubMed Central

    Yang, Bo Kyu; Yi, Seung Rim; Lee, Ye Hyun; Kim, Hyun See; Nam, Seok Woo; Ahn, Young Joon; Kim, Seong Wan; Yang, Sung Wook

    2014-01-01

    As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.

  16. 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...

  17. Pathophysiology of venous thrombosis.

    PubMed

    Myers, D D

    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. Investigation of venous ulcers.

    PubMed

    Kokkosis, Angela A; Labropoulos, Nicos; Gasparis, Antonios P

    2015-03-01

    The evaluation of patients with venous ulceration primarily includes noninvasive methods to elucidate the distribution and extent of pathology. Duplex ultrasound is the first line of investigation, as it provides assessment of both reflux and obstruction conditions. In patients with iliofemoral pathology, axial imaging with computed tomography scan or magnetic resonance imaging should be performed. If the treatment of iliofemoral vein obstruction is warranted, then invasive assessment using venography and/or intravascular ultrasound should be used to guide the interventional procedure. Venous valve reflux can be identified and accurately characterized by duplex ultrasound, whereas the ultrasound assessment of functional abnormality associated with obstruction is less reliable. In patients with ulceration, the evaluation for and treatment of proximal venous obstruction has resulted in improved ulcer healing. PMID:26358305

  19. 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 β-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-1β, and tumor necrosis factor-α (TNF-α) 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

  20. Intraoral venous malformation with phleboliths

    PubMed Central

    Mohan, Ravi Prakash S.; Dhillon, Manu; Gill, Navneet

    2011-01-01

    The most common type of vascular malformation is the venous malformation and these are occasionally associated with phleboliths. We report a case of a 45 year old woman with intraoral venous malformation with phleboliths. PMID:24151422

  1. Venous occlusive diseases in women.

    PubMed

    Ozsvath, Kathleen J; Moore, Colleen J

    2013-04-01

    Women have a high incidence of chronic venous disease. Venous occlusive disease can lead to significant morbidity and even death. Factors such as genetics, medications, and diseases can play a role in the development of venous thrombosis. In women, pregnancy can lead to a hypercoagulable state and a greater risk of venous complication. Awareness and education will be very important in the future to help identify those patients at risk. PMID:23522718

  2. Compression and venous surgery for venous leg ulcers.

    PubMed

    Mosti, Giovanni

    2012-07-01

    This article reviews published data on the effects of surgery and compression in the treatment of venous ulcers and the best options for compression therapy. Randomized controlled studies reveal that surgery and compression have similar effectiveness in healing ulcers but surgery is more effective in preventing recurrence. Most leg ulcers have a venous pathophysiology and occur because of venous ambulatory hypertension caused by venous reflux and impairment of the venous pumping function. Proposed surgical interventions range from crossectomy and stripping to perforator vein interruption and endovascular procedures (laser, radiofrequency). More conservative procedures (foam sclerotherapy, conservative hemodynamic treatment) have also been proposed. PMID:22732375

  3. Venous interventions in children.

    PubMed

    Kukreja, Kamlesh; Vaidya, Sandeep

    2011-03-01

    Advanced medical treatment options have improved pediatric survival but often require invasive vascular procedures or venous access. These procedures increase the risk for thromboembolism in children, and there has been a corresponding increase in the reported incidence of deep venous thrombosis and postthrombotic syndrome in the pediatric population. Percutaneous venous interventions using catheter-directed therapy (CDT), like mechanical thrombectomy and infusion thrombolysis, have been used much less frequently in children, even though they have shown good results in adults. A multidisciplinary team including pediatric hematology, interventional radiology, and intensive care unit is suggested for management of venous thrombosis in children. Indications and contraindications for CDT in children are similar to adults. Mechanical thrombectomy and infusion thrombolysis are some of the more commonly performed treatments. CDT in children requires adapting to patient size and locally available equipment. Ultrasound guidance for access, "cork" technique, appropriate dosing of tissue plasminogen activator for infusion/pharmacomechanical thrombolysis, and simultaneous administration of heparin, plasminogen (fresh frozen plasma), and deficient coagulation factors are some of the important variations of CDT technique in children. Postprocedure monitoring is very important for successful thrombolysis. Retrievable inferior vena cava filters are increasingly being used in children as well, for prophylaxis against pulmonary embolism (PE) if there is a significant risk of PE with/without contraindications to anticoagulation. PMID:21335289

  4. Short-impending Anomaly of GPS Observation and its Implications in Yunnan Earthquake Predication

    NASA Astrophysics Data System (ADS)

    Hong, M.; Shao, D.; Zhang, S.; Wu, T.; Wang, F.; Zhang, Y.; Wang, L.; Qian, X.

    2015-12-01

    This study proposals a new method, short-impending anomaly of GPS (SIA-GPS), to predict the coming earthquake. Based on long-term GNSS observations, we observed the abnormal deformations occurred around the active faults in Yunnan area before the earthquakes of magnitude MW³5.0. We constructed the regional strain fields with networks filtering, and extracted the abnormal deformations of each grid before each strong coming earthquake. Such special deformations of the GNSS observation are able to serve for short-impending earthquake prediction. The SIA-GPS method includes three steps. Firstly, Yunnan region is divided into multiple grids using interpolation calculation and the uniform displacement field is created. The area velocity field is obtained based on the continuous GNSS observations using GAMIT/GLOBK software. Next, the earthquake response capacity of each grid is evaluated in time-series analysis focusing on strains, and the short-term anomalies are easily extracted. Lastly, all the abnormal signals are carefully diagnosed in the considerations of tectonic movements. As examples, we predicated 19 earthquakes using the (SIA-GPS) method. 14 earthquakes of them are successful within the tolerable special and time misfits, and 5 of them do not occurred. The code of predication for short-impending earthquake requires that all the coming earthquakes of Mw³5 must be predicated, the maximum time error for coming event is three months, and the corresponding spatial misfit allows 5 grids. Following this role, 14 earthquakes of Mw³5 are predicted using SIA-GPS indicators with success rate 73.6%. For such experiences, SIA-GPS method has been utilized as a benefit tool to predicate the potential coming earthquakes in Earthquake Administration of Yunnan Province. Keywords:Short-impending anomaly of GPS, SIA-GPS, time series of analysis, GNSS observation, earthquake prediction, surface deformation, strain, Yunnan area.

  5. Coping strategies in the presence of one's own impending death from cancer.

    PubMed

    Sand, Lisa; Olsson, Mariann; Strang, Peter

    2009-01-01

    An incurable cancer is a threat to life itself. This study focused on how native-born Swedes, who define themselves as nonreligious, actually reflect and act when they try to create helpful strategies in the presence of their own impending deaths and how the strategies serve their purposes. Twenty patients were interviewed in depth. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed and analyzed with a qualitative, hermeneutic interpretative method. The informants' efforts to develop useful strategies to restrain death could be symbolized as a cognitive and emotional pendulum, swinging between the extremes of life and death. During the swings of the pendulum, the informants used every means available: their own resources, other people, animals, nature, a transcendent power, hope, imagination and magical thinking. They strove to find factors that fitted their conceptual system and supported their inner balance and structure, all to keep death at a discreet distance and preserve their links to life. These links were togetherness, involvement, hope and continuance, and they served as a shield against hurtful feelings connected to their impending death. The new knowledge about how strategies in the presence of one's own impending death can develop and be used is perhaps the most novel and clinically relevant contribution of this study. PMID:18676119

  6. Predicted burden of venous disease.

    PubMed

    Onida, Sarah; Davies, Alun Huw

    2016-03-01

    Chronic venous disease is a common condition with clinical signs and symptoms ranging from spider veins, to varicose veins, to active venous ulceration. Both superficial and deep venous dysfunction may be implicated in the development of this disease. Socio-economic factors are shaping our population, with increasing age and body mass index resulting in significant pressure on healthcare systems worldwide. These risk factors also lead to an increased risk of developing superficial and/or deep venous insufficiency, increasing disease prevalence and morbidity. In this chapter, the authors review the current and future burden of chronic venous disease from an epidemiological, quality of life and economic perspective. PMID:26916773

  7. 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…

  8. 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

  9. Gangrene in Takayasu's arteritis: a report of two cases and review of literature.

    PubMed

    Misra, Durga Prasanna; Chowdhury, Abhra Chandra; Lal, Hira; Mohindra, Namita; Agarwal, Vikas

    2016-03-01

    Takayasu's arteritis (TA) is a granulomatous large vessel vasculitis more commonly seen in India. The vascular inflammation in TA results in stenoses of affected vessels. Usually this is a slow process with good collateral circulation; only rarely does critical limb ischemia result. We present two patients of TA who presented with gangrene of extremities, and review eight prior such patients reported in the literature. With appropriate diagnosis and treatment with oral corticosteroids and low-dose aspirin, none of our patients had recurrence at a mean follow-up of 3.8 ± 2.8 years. Although rare, TA can present with gangrene and rheumatologists need to be aware of this unusual but limb-threatening manifestation of TA to institute appropriate therapy in a timely manner. PMID:26563339

  10. Gangrenous Appendicitis: A Rare Presentation of Pericecal Hernia; Case Report and Review of the Literature

    PubMed Central

    Kumar, Shailesh; Dikshit, Priyadarshi; Bhaduri, Shubhendu; Sattavan, Swati

    2015-01-01

    Intra-abdominal Hernias are rare conditions usually secondary to congenital defects, with pericecal hernias accounting for a minority of them. They can be difficult to diagnose due to non-specific presentations but may lead to strangulation and thus require early management. We herein report a rare case of pericecal hernia with gangrenous appendicitis in an 88 year-old lady presenting with features of acute intestinal obstruction and right iliac fossa lump, which on exploration was found to be a pericecal hernia with knotting, strangulation, and gangrenous changes of appendix. This case highlights the need of a high index of suspicion for internal hernias and that of prompt operative intervention to avoid enterectomies and to improve outcome. PMID:27162920

  11. 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. PMID:25878494

  12. Streptococcal cellulitis of the scrotum and penis with secondary skin gangrene.

    PubMed

    Haury, B; Rodeheaver, G; Stevenson, T; Bacchetta, C; Edgerton, M T; Edlich, R F

    1975-07-01

    Cellulitis of the scrotum and penis is caused, in the majority of instances, by a beta hemolytic streptococci without a discernible portal of entry. Clostridium, occasionally, will result in this disease as a manifestation of a perirectal abscess. In either instance, fluid accumulates rapidly in the closed space between Colles' and Buck's fascia, producing intense swelling of the scrotum. If this compartment is not immediately decompressed by linear incisions, devascularization of the scrotal and penile skin will often occur, resulting in gangrene. Immediate treatment of the bacterial infection with penicillin also is essential. If gangrene does develop, radical debridement of the necrotic tissue as well as a wide margin of adjacent inflamed skin must be undertaken. Continual monitoring of the microflora of the debrided would is essential for the selection of the appropriate antibiotic against any secondary intruders. Coverage of the granulating would is accomplished when the would bacterial count is below 10-5 per gram of tissue. PMID:1098183

  13. Staphylococcus aureus proteins differentially produced in ewe gangrenous mastitis or ewe milk.

    PubMed

    Le Maréchal, Caroline; Jardin, Julien; Briard-Bion, Valérie; Rault, Lucie; Berkova, Nadia; Vautor, Eric; Thiéry, Richard; Even, Sergine; Le Loir, Yves

    2013-05-31

    Despite being one of the main pathogens involved in ruminant mastitis, little is known about what proteins Staphylococcus aureus does express, in vivo, during the infection. Here, two S. aureus strains were isolated from curds formed within the udder of two ewes suffering from gangrenous mastitis. Protein samples were prepared from cell fractions and were analyzed using 1D-LC MS/MS. Results were compared to 1D-LC MS/MS analysis of the same S. aureus strains grown in ewe milk. A total of 365 proteins were identified. Most of them were related to cellular metabolism, cellular division and stress response. Half of the proteins were found in both conditions but a substantial number were specifically found in in vivo conditions and gave indications about the active metabolic status and the stresses encountered by S. aureus within the cistern during a gangrenous mastitis. PMID:23415898

  14. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

    Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing. PMID:26076949

  15. Venous Leg Ulcers.

    PubMed

    Vivas, Alejandra; Lev-Tov, Hadar; Kirsner, Robert S

    2016-08-01

    This issue provides a clinical overview of venous leg ulcers, focusing on prevention, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers. PMID:27479227

  16. Doppler ultrasound study and venous mapping in chronic venous insufficiency.

    PubMed

    García Carriazo, M; Gómez de las Heras, C; Mármol Vázquez, P; Ramos Solís, M F

    2016-01-01

    Chronic venous insufficiency of the lower limbs is very prevalent. In recent decades, Doppler ultrasound has become the method of choice to study this condition, and it is considered essential when surgery is indicated. This article aims to establish a method for the examination, including venous mapping and preoperative marking. To this end, we review the venous anatomy of the lower limbs and the pathophysiology of chronic venous insufficiency and explain the basic hemodynamic concepts and the terminology required to elaborate a radiological report that will enable appropriate treatment planning and communication with other specialists. We briefly explain the CHIVA (the acronym for the French term "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire"=conservative hemodynamic treatment for chronic venous insufficiency) strategy, a minimally invasive surgical strategy that aims to restore correct venous hemodynamics without resecting the saphenous vein. PMID:26655801

  17. [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

  18. Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

    PubMed Central

    Tarchouli, Mohamed; Bounaim, Ahmed; Essarghini, Mohamed; Ratbi, Moulay Brahim; Belhamidi, Mohamed Said; Bensal, Abdelhak; Zemmouri, Adil; Ali, Abdelmounaim Ait; Sair, Khalid

    2015-01-01

    Introduction: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality. Methods: We carried out a retrospective study of 72 patients treated for Fournier’s gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and non-survivors and potential prognostic factors were analyzed. Results: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier’s Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002). Conclusion: Fournier’s gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival. PMID:26600888

  19. Perforated Gastric Gangrene without Pneumothorax in an Adult Bochdalek Hernia due to Volvulus

    PubMed Central

    Sebastian, George Mathew; Ambady, Venugopal; Hariharan, Ramesh

    2016-01-01

    Bochdalek hernia is the most frequent congenital diaphragmatic hernia which occurs due to a defect in the posterior attachment of the diaphragm when there is a failure of closure of the pleuroperitoneal membrane in utero. It rarely presents for the first time in adults. We report one such case of a 23-year-old male patient who presented with an acute abdomen. Chest X-ray showed air under diaphragm and he was taken up for an emergency laparotomy. Intraoperatively an organoaxial volvulus of the stomach was found in a bochdaleks hernia with a focal gangrene of the stomach fundus with perforation and peritonitis. However, there was no breach of pleural cavity. A sleeve resection of the gangrenous portion of the stomach was performed and the diaphragmatic defect was repaired. Patient made an uneventful postoperative recovery. Gastric gangrene with perforation as a manifestation of the adult bochdalek hernia is indeed rare. A concomitant pneumothorax occurs along with this condition which requires an intercostal drainage tube prior to the laparotomy. We report this case for its unique presentation without pneumothorax. PMID:27190884

  20. Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion.

    PubMed

    Eray, Ismail Cem; Alabaz, Omer; Akcam, Atilgan Tolga; Ulku, Abdullah; Parsak, Cem Kaan; Sakman, Gurhan; Seydaoglu, Gulsah

    2015-12-01

    In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters. PMID:26730041

  1. Acute ischemic gangrene of the rectum: Report of 3 cases and review of literature☆

    PubMed Central

    Azimuddin, Khawaja; Raphaeli, Tal

    2013-01-01

    INTRODUCTION Acute ischemia of the rectum resulting in full thickness necrosis is extremely uncommon because of its excellent blood supply. PRESENTATION OF CASE We present 3 cases with spontaneous ischemic gangrene of the rectum. All three patients were elderly with atherosclerotic arterial disease and presented with hypotensive shock but in none of these patients we encountered a precipitating factor such as preceding vascular surgery or shock state. DISCUSSION A high index of suspicion should be maintained in elderly patients with atherosclerotic disease who present with lower GI symptoms with hypotensive shock and an inflamed rectum on CT scan. Immediate beside proctoscopy should be offered to these patients and if the diagnosis is confirmed these patients should be taken to the operating room immediately. If the entire rectum is found to be gangrenous then an emergency APR should be performed and the perineal wound left open. If the rectum is partially gangrenous then a low anterior resection with Hartman's procedure for diversion is appropriate. CONCLUSION Prompt diagnosis and resuscitation followed by immediate surgical intervention is necessary to save these elderly patients. PMID:24240084

  2. [Gas gangrene and hyperbaric oxygenation--a lesson forgotten or never learned?].

    PubMed

    Petri, Nadan M; Andrić, Dejan; Kovacević, Hasan; Vranjković-Petri, Lena; Racić, Goran; Mulić, Rosanda; Ropac, Darko

    2002-05-01

    Gas gangrene develops in devitalized hypoxic tissue. It spreads rapidly under strong influence of enzymes produced by the causing bacteria and often results in fatal outcome. It is of utmost importance to stop toxin production as soon as possible, which is most effectively achieved by early application of hyperbaric oxygenation (HBO2), as the first measure in a "trident" (HBO2, antibiotics, surgical measures). The paper reviews the most important data from microbiology, pathophysiology and epidemiology of gas gangrene, current clinical practice, scientific basis for application of HBO2 in the treatment of this disease, and data from the archives of the Naval Medical Institute of the Croatian Navy in Split (NMI). At the NMI, in the period from 1982 to 2000, HBO2 was administered in the treatment of 21 patients with gas gangrene, of average age 41.6 +/- 16.3 years. The average treatment consisted of 6.8 +/- 3.8 sessions. 13 (76%) patients were cured. PMID:12152414

  3. Old man gallbladder syndrome: Gangrenous cholecystitis in the unsuspected patient population

    PubMed Central

    Dhir, Teena; Schiowitz, Robert

    2015-01-01

    Introduction Acute cholecystitis is a common surgical condition, but not many are aware of the serious complication of gangrenous cholecystitis (GC). Presence of GC increases patients’ postoperative complications, morbidity and mortality. Predictive factors for GC include age >45, male gender, white blood cell count >13,000/mm3 and ultrasound findings of a negative Murphy’s sign. Case presentation (1) GW, 83 male with dull right upper quadrant pain and a negative Murphy’s sign with further imaging showing a thickened septated gallbladder suggestive of GC. Patient’s surgery was difficult and he received a cholecystostomy tube for drainage. (2) PH, 75 male with minimal right upper quadrant pain, equivocal ultrasound with a negative Murphy’s sign and computer tomography (CT) showing acute cholecystitis. Patient was taken to the operating room for cholecystectomy, with pathology consistent with gangrenous cholecystitis. Discussion Multiple laboratory findings and imaging patterns have been found to be highly predictive of GC. Along with age and WBC, thickened gallbladder wall and lack of mucosal enhancement have been predictive of GC. On physical examination, lack of Murphy’s sign secondary to denervation from gangrenous changes also increases the index of suspicion for GC. Conclusion GC is a serious complication of acute cholecystitis with increased morbidity and mortality. There should be a high index of suspicion for GC if the above unique physical and laboratory findings are present. PMID:25917175

  4. Fournier’s Gangrene in a Neonate With Acute Myeloid Leukemia: A Case Report

    PubMed Central

    Mosayebi, Ziba; Omidian, Ali; Movahedian, Amir Hossein; Kompani, Farzad; Hosseininodeh, Seyyed Saeed

    2016-01-01

    Introduction: Fournier’s gangrene is an infective necrotizing fasciitis of external genital and perineal region. Hematologic malignancies and immunocompromised status are predisposing factors. Simultaneous occurrence of Fournier’s gangrene and congenital leukemia in neonates is extremely rare. Case Presentation: We present a case of Fournier’s gangrene in a 4-day-old female infant with a necrotic lesion in perineum and no history of trauma or other predisposing condition. Focusing on high blast percentage in blood cell count she was affected by acute myeloid leukemia (M4 type). Pseudomonas aeruginosa was isolated from the blood and wound culture. She was treated with broad spectrum antibiotics and supportive care. The parents refused chemotherapy and the patient was discharged from hospital. Bleeding and DIC was the cause of death in a local hospital few days later. Conclusions: High index of suspicion is essential for diagnosis and appropriate treatment. Congenital leukemia should be considered in the differential diagnosis of a newborn with clinical features of sepsis and necrotizing fasciitis.

  5. Fournier’s gangrene: Causes, presentation and survival of sixty-five patients

    PubMed Central

    Taken, Kerem; Oncu, Mehmet Resit; Ergun, Muslum; Eryilmaz, Recep; Demir, Canser Yilmaz; Demir, Murat; Gunes, Mustafa

    2016-01-01

    Objective: To report our experience with Fournier’s Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality. Methods: Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed. Results: Our cases included 8 women and 57 men. The average age of men was 51±13.9 (range 19-75) and the average age of women was 63±10.5 (range 52-76). Average hospitalization time was 9.2±6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement. Conclusions: Fournier’s gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity. PMID:27375726

  6. [Studies of oral microbiogenesis. II. Significance of staphylocci present in periodontal lesions, pulp gangrene and in the alveolus after tooth extraction].

    PubMed

    Sefer, M; Boanchiş, A; Greceanu, V; Costache, D; Crăifăleanu, G

    1979-01-01

    A study was carried out on the properties and significance of staphylococci isolated from the alveoli after dental extraction (12 strains), from parodontal pus (19 strains) and pulpar gangrene (15 strains). By their frequency, staphylococci of the Staphylococcus aureus have an etiologic significance in pulpar gangrene. Of particular importance for the diagnosis and epidemiology was the predominance of lysotype 80 among the staphylococci isolated from pulpar gangrene and lysotype 77 in healthy carriers. In 2 of 11 patients the coexistence of the same lysotype was found in the pulpar gangrene and nasal secretion. PMID:379963

  7. Venous leg ulcers

    PubMed Central

    2011-01-01

    Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids

  8. Evaluation of factors affecting mortality in Fournier’s Gangrene: Retrospective clinical study of sixteen cases

    PubMed Central

    Oymacı, Erkan; Coşkun, Ali; Yakan, Savaş; Erkan, Nazif; Uçar, Ahmet Deniz; Yıldırım, Mehmet

    2014-01-01

    Objective: Fournier’s gangrene is a progressive, necrotizing fasciitis due to synergistic infection of the perineum and external genitalia that is associated with high mortality and morbidity. The purpose of this study is to review the diagnostic and treatment methods that effect mortality in Fournier’s gangrene. Material and Methods: Sixteen patients who were diagnosed and treated at our clinic between 2011 and 2013 due to Fournier’s gangrene were retrospectively analyzed. The surviving and non-surviving patient groups were compared in terms of age, sex, onset time of symptoms, isolated microorganisms, concomitant diseases, Fournier’s gangrene severity index (FGSI), and length of hospital stay. Results: Ten of our cases (62.5%) were male and six (37.5%) were female, with a mean age of 61.2±12.3 (42–73) years. The mortality rate was 18.8% (3 cases). The mean duration of symptoms before admission was 4.31±1.81 (2–8) days. This period was 6.67±1.52 days in patients who succumbed to death, and 3.77±1.42 days in patients who survived (p=0.007). Ten cases (62.5%) had concomitant diabetes mellitus. The most common organism isolated in wound cultures was Escherichia coli (68.7%), and Acinetobacter baumannii, Proteus mirabilis, methicillin-resistant Staphylococcus aureus and Enterococcus spp. in the remaining patients. The mean FGSI of surviving patients was 3.84±1.77, and 7.66±0.57 in fatal cases (p=0.003). The mean length of hospital stay was 25.5 days (2–57) and duration of hospitalization was significantly longer in survivors (p<0.05). Conclusion: The delay in diagnosis and higher FGSI may be responsible for worsening of prognosis and mortality in Fournier’s gangrene. Early diagnosis and determination of the severity of the disease, aggressive surgical debridement and appropriate antimicrobial therapy may improve prognosis. PMID:25931901

  9. Medical management of venous ulcers.

    PubMed

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. PMID:26358306

  10. Current management of venous ulceration.

    PubMed

    Patel, Nima P; Labropoulos, Nicos; Pappas, Peter J

    2006-06-01

    It has been estimated that chronic venous insufficiency affects 10 to 35 percent of the entire U.S. population and that 4 percent of people older than 65 have active venous ulcers. The high prevalence of the disease results in an annual expenditure of more than 1 billion dollars a year to the U.S. health care system. To have a rational approach toward patients with venous ulcers, it is important to understand the pathophysiology and clinical characteristics of the disease process, in order to initiate appropriate treatment and prevent venous ulcer recurrence. PMID:16799394

  11. Treatment of chronic venous insufficiency.

    PubMed

    Rathbun, Suman W; Kirkpatrick, Angelia C

    2007-04-01

    Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux. Treatment modalities are aimed at reducing venous valvular reflux, thereby inhibiting the ensuing pathologic inflammatory process. Compression therapy using pumps, bandaging, and/or graded compression stockings is the mainstay of treatment for CVI. Compression therapy has been shown to be effective in reducing venous hypertension retarding the development of inflammation and pathologic skin changes. Pharmacologic agents such as diuretics and topical steroid creams reduce swelling and pain short term but offer no long-term treatment advantage. Herbal supplements may reduce the inflammatory response to venous hypertension, but are not licensed by the US Food and Drug Administration, and vary in their efficacy, quality, and safety. However, several randomized controlled trials using the herbal horse chestnut seed extract containing aescin have shown short-term improvement in signs and symptoms of CVI. Endovascular and surgical techniques aimed at treatment of primary and secondary venous valvular reflux have been shown to improve venous hemodynamics promoting healing of venous ulcers and improving quality of life. The newer endovascular treatments of varicose veins using laser, radiofrequency ablation, and chemical foam sclerotherapy show some promise. PMID:17484814

  12. Travel and venous thrombosis.

    PubMed

    Gallus, Alexander S; Goghlan, Douglas C

    2002-09-01

    Debate continues about whether and to what extent travel predisposes to venous thrombosis and pulmonary embolism (PE). Almost certainly, the strength of any association was greatly exaggerated in recent press reports. Conclusions from case-control studies vary, with some finding no excess of recent travel among patients with venous thromboembolism and others reporting a two-four fold excess. The strongest evidence that prolonged air travel predisposes to thrombosis comes from the travel history of people who present with PE immediately after landing. Two independent analyses suggest that the risk of early embolism increases exponentially with travel times beyond 6 hours and may reach 1:200,000 passengers traveling for more than 12 hours. The most likely explanation is venous stasis in the legs from prolonged sitting, and there is evidence (preliminary and controversial) that elastic support stockings may prevent deep vein thrombosis in people who travel long-distances. There is an urgent need for more and better studies to define the absolute hazard from travel-related thrombosis and the personal risk factors that may contribute. Without these, it is difficult to give a balanced account to people who intend to travel or to consider definitive prevention trials. Case reports suggest that in most cases, travel-related thrombosis has affected people who were also at risk because of previous thrombosis, recent injury, or other predispositions. This makes it sensible to target such "at risk" people with advice about hazards and precautions, at least until formal study validates some other approach. PMID:12172438

  13. Frosted branch angiitis in one eye and impending CRVO in the other: a diagnostic dilemma.

    PubMed

    Kumar, Abiraj; Yangzes, Sonam; Singh, Ramandeep

    2015-01-01

    We present a unique case of frosted branch angiitis in one eye and impending central retinal vein occlusion in other eye of a pregnant woman, which could be an initial manifestation of Behçet's disease. A 28-year-old, 33 weeks pregnant woman presented with sudden diminution of vision in her right eye. Her best-corrected visual acuity was light perception in the right eye and 20/20 in her left eye. The fundus examination revealed frosted branch angiitis in the right eye and impending central retinal vein occlusion in the left eye. After a thorough initial examination, she was administered intravenous methyl prednisolone 1 g once a day for 3 days followed by oral steroids. All extensive work up to find the cause of frosted branch angiitis was negative except for positive human leukocyte antigen B51. Systemic work up was normal. On last follow-up at 6 months, the patient had visual acuity of 20/60 in the right eye and 20/20 in the left eye. Her systemic work up was normal up to follow-up. She still remains a diagnostic dilemma, with Behçet's disease as the closest diagnosis. PMID:26055592

  14. 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

  15. Turning back from the brink: Detecting an impending regime shift in time to avert it

    PubMed Central

    Biggs, Reinette; Carpenter, Stephen R.; Brock, William A.

    2009-01-01

    Ecological regime shifts are large, abrupt, long-lasting changes in ecosystems that often have considerable impacts on human economies and societies. Avoiding unintentional regime shifts is widely regarded as desirable, but prediction of ecological regime shifts is notoriously difficult. Recent research indicates that changes in ecological time series (e.g., increased variability and autocorrelation) could potentially serve as early warning indicators of impending shifts. A critical question, however, is whether such indicators provide sufficient warning to adapt management to avert regime shifts. We examine this question using a fisheries model, with regime shifts driven by angling (amenable to rapid reduction) or shoreline development (only gradual restoration is possible). The model represents key features of a broad class of ecological regime shifts. We find that if drivers can only be manipulated gradually management action is needed substantially before a regime shift to avert it; if drivers can be rapidly altered aversive action may be delayed until a shift is underway. Large increases in the indicators only occur once a regime shift is initiated, often too late for management to avert a shift. To improve usefulness in averting regime shifts, we suggest that research focus on defining critical indicator levels rather than detecting change in the indicators. Ideally, critical indicator levels should be related to switches in ecosystem attractors; we present a new spectral density ratio indicator to this end. Averting ecological regime shifts is also dependent on developing policy processes that enable society to respond more rapidly to information about impending regime shifts. PMID:19124774

  16. The relationship between oxygen extraction and venous pH in sepsis.

    PubMed

    Giovannini, I; Chiarla, C; Boldrini, G

    1997-11-01

    This study was performed to quantify the impact of Haldane effect (HE) on the relationship between O2 extraction (O2Ex; mL O2/dL blood) and venous pH in 247 measurements performed in 91 septic patients (73 patients with intra-abdominal sepsis, 11 with retroperitoneal abscesses, 6 with severe cholangitis, and 1 with gangrenous fasclitis). The severity of sepsis varied from relatively compensated to extremely diseased conditions. This allowed a detailed assessment of the impact of HE over a wide range of cardiorespiratory and metabolic abnormalities. A recently developed model was used to quantify blood CO2 exchange and Haldane relationships and, in particular, the buffering of venous pH allowed by O2Ex (O2-linked H+ binding) on the basis of arterial and mixed venous blood gas measurements. Arterio-venous pH difference (a-vDpH) was .033 +/- .024 (mean +/- SD). It increased with venoarterial CO2 concentration difference (v-aDCO2; mL CO2/dL blood), but the increase was moderated by a simultaneous increase in O2Ex, as the likely consequence of HE: a-vDpH = .006 + .017 (v-aDCO2) - .009 (O2Ex) [r2 = .96, p < < .001]. To confirm this, the moderation of a-vDpH allowed by the HE (DpH) was calculated. A first component, due to O2-linked H+ binding, had a value of .016 +/- .012, and a second component, due to the Haldane-mediated reduction in venous CO2 tension and plasma carbonic acid concentration, had a value of .019 +/- .006. Their sum (total DpH) was .033 +/- .017 and was related directly and strongly to O2Ex: DpH = -.002 + .009 (O2Ex) [r2 = .85, p < < .001], thus confirming the quantitative impact of HE in moderating the decrease in venous pH relative to arterial pH. The loss of this effect was responsible for the larger decreases in venous pH observed in hypodynamic patients developing impaired O2Ex. These results allow an easy quantification of the Haldane component, separated from the other components affecting pH, and are also useful for assessing the protective role

  17. 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

  18. Cerebral sinus venous thrombosis.

    PubMed

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

    2013-10-01

    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

  19. Traumatic Dural Venous Sinus Injury

    PubMed Central

    Kim, You-Sub; Jung, Seung-Hoon; Lim, Dong-Ho; Kim, Tae-Sun; Kim, Jae-Hyoo

    2015-01-01

    Objective The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. Methods We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. Results Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. Conclusion When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma. PMID:27169076

  20. Management of Symptomatic Venous Aneurysm

    PubMed Central

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  1. Management of symptomatic venous aneurysm.

    PubMed

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  2. [A Case of Pyoderma Gangrenosum of the Penis Difficult to Distinguish from Fournier Gangrene].

    PubMed

    Taguchi, Makoto; Inoue, Takaaki; Nishida, Teruhisa; Kawabata, Takashi; Kawakita, Shigenari; Muguruma, Kouei; Murota, Takashi; Kinoshita, Hidefumi; Matsuda, Tadashi

    2015-11-01

    Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes and treated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited our department following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/μl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated but proved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made. PMID:26699892

  3. 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

  4. Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

    PubMed

    Hu, Ning; Wu, Xing-Huo; Liu, Rong; Yang, Shu-Hua; Huang, Wei; Jiang, Dian-Ming; Wu, Qiang; Xia, Tian; Shao, Zeng-Wu; Ye, Zhe-Wei

    2015-08-01

    Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection. PMID:26223928

  5. Portomesenteric Vein Thrombosis, Bowel Gangrene, and Bilateral Pulmonary Artery Embolism Two Weeks after Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Darcy, David G.; Charafeddine, Ali H.; Choi, Jenny; Camacho, Diego

    2015-01-01

    Sleeve gastrectomy and gastric bypass surgery are popular and effective options for weight loss surgery. Portomesenteric vein thrombosis (PMVT) is a documented but rare complication of bariatric surgery. Proper surgical technique, careful postoperative prophylaxis, and early mobilization are essential to prevent this event. The diagnosis of PMVT in the postoperative period requires a high index of suspicion and early directed intervention to prevent a possibly fatal outcome. We present a case of PMVT complicated by small bowel ischemia resulting in gangrene that necessitated resection. PMID:26576312

  6. Laparoscopic management of an axially torsed gangrenous Meckel's diverticulum in a child.

    PubMed

    Ahmed, Kotti; Hayet, Zitouni; Hamdi, Louati; Mahdi, Ben Dhaou; Mohamed, Jallouli; Riadh, Mhiri

    2016-01-01

    Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Most often is asymptomatic but it may give a number of complications including gastrointestinal bleeding, obstruction and inflammation. Axial torsion and gangrene of MD are exceptional. The correct diagnosis of MD could only be made during surgery. Early surgery is important to reduce morbidity, especially perforation. Laparoscopy aided in the diagnosis and adequate treatment. We herein describe the case of a 4-year-old boy with axial torsion of MD. Clinical and radiographic finding suggest a segmental volvulus. Laparoscopy contributes to diagnosis and treatment of torted MD. PMID:27502885

  7. Scrotal reconstruction using a superficial circumflex iliac artery perforator flap following Fournier's gangrene.

    PubMed

    Han, Hyun H; Lee, Jung H; Kim, Sue M; Jun, Young J; Kim, Young J

    2014-08-01

    Fournier's gangrene is a type of necrotising fasciitis around the scrotum and perineum. Because of its aggressive nature, patients should be treated with broad-spectrum antibiotics and emergency, radical debridement during the acute phase. After recovering from the acute phase, reconstruction of the scrotal and perineal soft tissue defects is needed and is often challenging. Traditionally, various reconstruction methods have been used, including skin grafts, fasciocutaneous flaps and musculocutaneous flaps, each with its pros and cons. We successfully covered a wide scrotal defect using a superficial circumflex iliac artery perforator flap, which has not been previously reported for this indication. The design and operative technique are introduced in this study. PMID:25091799

  8. [Group a streptococcal necrotizing fasciitis of the genital area (Fournier's gangrene): a case report].

    PubMed

    Ochi, Atsuhiko; Naoi, Makito; Enatsu, Noritoshi; Fujisaki, Akira; Funada, Satoshi; Suzuki, Koichiro; Shiga, Naoki; Ota, Tomonori; Kuji, Hiroshi; Hosokawa, Naoto; Iwata, Kentaro

    2011-07-01

    A necrotizing fasciitis especially caused by group A streptococcal infection is a life-threatening disease. This infection cause death due to septic shock and multiple organ failure in a short time without the immediate and adequate treatment. Currently a rapid test kit for streptococcal pharyngitis (strep A) is useful for prediction of group A streptococcal infection. We here demonstrate a 61 years old man's case of life-saved necrotizing fasciitis in genital area (Fournier's gangrene) by group A streptococcus infection, and usefulness of this kit for rapid diagnosis, aggressive debridement, and selection of adequate antibiotics. PMID:21961278

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

    PubMed

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

    1980-01-01

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

  10. 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

  11. Case Report: Frontalis sign for early bedside consideration of impending uncal herniation

    PubMed Central

    Munakomi, Sunil; Mohan Kumar, Bijoy

    2016-01-01

    It is prudent to have early diagnosis and timely management of uncal herniation for better management of neurosurgical patients. There are several clinical and radiological armamentariums that aid in early recognition of the condition. Through this case report, we try to highlight a simple bedside clinical sign that can be a valuable adjunct in early recognition of the impending uncal herniation especially in scenarios wherein it is difficult to assess the pupillary size and reactivity correctly. The improvement in the sign also confirms the resolution of the mass effect in the postoperative period. This is especially helpful for doctors working in the periphery or in resource restrained areas, for a timely referral of the patient to tertiary centre.

  12. 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.

  13. Identifying the occurrence time of an impending mainshock: a very recent case

    NASA Astrophysics Data System (ADS)

    Varotsos, Panayiotis A.; Sarlis, Nicholas V.; Skordas, Efthimios S.; Christopoulos, Stavros-Richard G.; Lazaridou-Varotsos, Mary S.

    2015-06-01

    The procedure by means of which the occurrence time of an impending mainshock can be identified by analyzing in natural time the seismicity in the candidate area subsequent to the recording of a precursory seismic electric signals (SES) activity is reviewed. Here, we report the application of this procedure to an M W 5.4 mainshock that occurred in Greece on 17 November 2014. This mainshock (which is pretty rare since it is the strongest in that area for more than half a century) was preceded by an SES activity recorded on 27 July 2014, and the results of the natural time analysis reveal that the system approached the critical point (mainshock occurrence) early in the morning on 15 November 2014.

  14. Primary omental gangrene mimicking appendicular perforation peritonitis—A case report

    PubMed Central

    Kumar, A.; Shah, J.; Vaidya, P.

    2016-01-01

    Introduction Primary omental torsion is a rare cause of acute abdomen in adults and presents with variable signs and symptoms. Establishing a preoperative diagnosis may be difficult in the emergency setting. It is rarely diagnosed preoperatively as it mimics common surgical emergencies such as acute appendicitis, appendicular perforation, acute cholecystitis and perforated peptic ulcers and can lead to the clinical deterioration of patient if missed Presentation of case A 47 years old male was taken to the operating room with a diagnosis of appendicular perforation peritonitis and during surgery was found to have a primary omental gangrene with pyoperitoneum, for which omentectomy and peritoneal lavage was performed. Discussion Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Omental torsion can be primary (idiopathic) or secondary, depending on an underlying cause. Primary omental torsion was first described by Eitel in 1899. However, very few cases have been reported. Our case was a rare case presenting with omental gangrene with pyoperitoneum mimicking appendicular perforation peritonitis. Conclusion Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion. PMID:26945486

  15. Spontaneous Occurrence of Gangrene Due to Clostridium septicum in a Patient With Advanced Endometrial Carcinoma

    PubMed Central

    Ghosh, Kris; Sutton, Gregory P.

    1994-01-01

    Background: We report the first known case of spontaneous, atraumatic Clostridium septicum gangrene occurring in a patient with recurrent endometrial adenocarcinoma. Case: A 63-year-old white female undergoing chemotherapy for recurrent endometrial adenocarcinoma presented with right “arthritis-like” shoulder pain. She denied fever, chills, or shoulder trauma. The patient was afebrile and her blood pressure was 100/50. Her right shoulder and upper extremity were remarkable for an area of dark blue discoloration with crepitus. The white blood cell (WBC) count was 8,200/μl with left shift. Serum creatinine, platelet count, and coagulation studies were normal. Computed tomography revealed gas in the right shoulder tissues. A Gram stain of fluid aspirated from the shoulder demonstrated gram-positive spore-forming rods. She declined surgical intervention and expired within hours of admission. Cultures of the right shoulder eventually grew Clostridium septicum. Conclusion: It is imperative to consider clostridial gangrene in the differential diagnosis for any patient with cancer and a fever of unknown origin. PMID:18475364

  16. Fournier's gangrene: A retrospective analysis of 26 cases in a Canadian hospital and literature review.

    PubMed

    McCormack, Michael; Valiquette, Anne Sophie; Ismail, Salima

    2015-01-01

    We performed a systematic review of all cases of Fournier's Gangrene (FG) at our hospital over a 12-year period. A total of 26 cases were assessed. Our goal was to determine the mortality rate and to identify risk factors associated with FG. We also wanted to examine three potential prognostic factors in relation to patient survival, including the time delay from emergency room admission to surgery, the initial extent of the disease, and the impact of more than one debridement procedure under general anesthesia. The time between emergency room admission and the beginning of surgical debridement was not statistically different between survivors and non-survivors. The extent of surgical debridement was close to the margin of statistical significance (p = 0.07) and can be considered an index of the extent of the disease. FG extending to the thighs or to the abdominal wall carries a worse prognosis. The number of surgical debridement procedures done under anesthesia was statistically different between survivors and non-survivors. Patients were 4.8 times more at risk of dying if they are required to have more than one surgical debridement under general anesthesia. This presumably reflects persistent gangrene following initial surgical debridement, fluid resuscitation, and wide spectrum antibiotic treatment. PMID:26225189

  17. [A Case of Rectal Carcinoma with Recurrence around the Drainage Site Complicated by Fournier's Gangrene].

    PubMed

    Abe, Kaoru; Kameyama, Hitoshi; Shimada, Yoshifumi; Yamada, Saki; Soma, Daiki; Yagi, Ryoma; Miura, Kohei; Tatsuda, Kumiko; Tajima, Yosuke; Okamura, Takuma; Nakano, Mae; Nakano, Masato; Kobayashi, Takashi; Kosugi, Shin-ichi; Wakai, Toshifumi

    2015-11-01

    A 71-year-old woman diagnosed with Fournier's gangrene caused by penetration of a rectal carcinoma was referred to our hospital. Emergency drainage and sigmoid colostomy were performed. Pathological examination of a biopsy sample showed moderately differentiated tubular adenocarcinoma. Abdominoperineal resection with bilateral salpingo-oophorectomy and hysterectomy was performed with curative intent after 4 courses of chemotherapy with S-1 and oxaliplatin. The postoperative pathological diagnosis was StageⅡ (pT4bN0M0). The patient received tegafur/uracil and Leucovorin as adjuvant chemotherapy. Seven months after the curative operation, partial pneumonectomy was performed for the recurrence of the rectal carcinoma in the right lung. Eight months after pneumonectomy, recurrent tumors were observed in the right lung and subcutaneous fat layer of the right buttock along the drainage site. The tumor in the right buttock was excised along with part of the gluteus maximus, and partial pneumonectomy was then performed. Three years and 6 months after the emergency drainage, the patient is alive with no evidence of recurrence. After drainage for rectal carcinoma complicated by Fournier's gangrene, the possibility of recurrence around the drainage site should be considered. PMID:26805341

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

    PubMed

    Ettalbi, S; Benchamkha, Y; Boukind, S; Droussi, H; Ouahbi, S; Soussou, M; Elatiqi, K; Lakmichi, M A; Dahami, Z; Moudouni, S M; Sarf, I; Rabbani, K; Louzi, A; Benelkhaiat, R; Finech, B

    2013-08-01

    Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases. PMID:21450384

  19. [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

  20. Venous Thromboembolism and Marathon Athletes

    MedlinePlus

    ... Heart Association Cardiology Patient Page Venous Thromboembolism and Marathon Athletes Claire M. Hull and Julia A. Harris ... general adult population are indisputable. However, for the marathon athlete who trains intensively and for long periods ...

  1. Varicose veins and venous insufficiency

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/001109.htm Varicose veins and venous insufficiency To use the sharing features on this page, please enable JavaScript. Varicose veins are swollen, twisted, and enlarged veins that you ...

  2. A case of Fournier’s gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis

    PubMed Central

    Wanis, Michael; Nafie, Shady; Mellon, John Kilian

    2016-01-01

    We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier’s gangrene. PMID:27106611

  3. A case of Fournier's gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis.

    PubMed

    Wanis, Michael; Nafie, Shady; Mellon, John Kilian

    2016-01-01

    We discuss the case of a 28-year-old male patient presenting to our department with an atypical history of acute scrotal swelling on a background of abdominal pain. He was diagnosed with a perforated appendicitis and Fournier's gangrene. PMID:27106611

  4. [Thromboprophylaxis of venous thromboembolism].

    PubMed

    Kobayashi, Takao

    2014-07-01

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

  5. Management of Venous Thromboembolism

    PubMed Central

    Finks, Shannon W.; Trujillo, Toby C.; Dobesh, Paul P.

    2016-01-01

    Objective: To review clinical data on direct oral anticoagulants (DOACs) used in the acute treatment of venous thromboembolism (VTE) as well as practical considerations when using these products. Data Sources: Searches of PubMed and Google Scholar for VTE, deep vein thrombosis, pulmonary embolism, and relevant drug international nonproprietary names were conducted. Additional online searches were conducted for prescribing information. Study Selection and Data Extraction: Relevant articles on dabigatran, rivaroxaban, apixaban, and edoxaban for the management of VTE compared with oral vitamin K antagonists (VKAs; published between 1966 and December 2015) were reviewed and summarized, together with information on dosing, pharmacokinetics/pharmacodynamics, and drug-drug interactions. Data Synthesis: The DOACs have the potential to circumvent many of the disadvantages of VKAs. At a minimum, they greatly increase the available therapeutic options, thus providing a greater opportunity for clinicians to select a management option that best fits the needs of individual patients. Despite the significant advance that DOACs represent, they are not without risk and require careful consideration of a number of clinical issues to optimize safety and efficacy. Conclusions: The emergence of DOACs for the management of thromboembolic disorders represents a paradigm shift from oral VKAs. The DOACs provide similar efficacy and improved safety in selected patients as compared with VKAs. Clinicians treating VTE need to be familiar with the intricacies involved in using these agents, including the appropriate dose selection for the relevant indication, avoidance of drug-drug and drug-disease interactions, and consideration of dose adjustments in specific clinical situations, such as organ dysfunction. PMID:26917821

  6. Gas Gangrene

    MedlinePlus

    ... Health Issues Conditions Abdominal ADHD Allergies & Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial Developmental Disabilities Ear Nose & Throat Emotional Problems Eyes Fever From Insects or Animals Genitals and Urinary Tract Glands & Growth ...

  7. Gas gangrene

    MedlinePlus

    ... of shock. Tests that may be done include: Tissue and fluid cultures to test for bacteria including clostridial species Blood culture to determine the bacteria causing the infection Gram ... X-ray , CT scan, or MRI of the area may show gas in the tissues.

  8. 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

  9. Denial of impending death: a discourse analysis of the palliative care literature.

    PubMed

    Zimmermann, Camilla

    2004-10-01

    Terminally ill patients and their families are often referred to as being "in denial" of impending death. This study uses the qualitative method of discourse analysis to investigate the usage of the term "denial" in the contemporary hospice and palliative care literature. A Medline search (1970-2001) was performed combining the text words "deny" and "denial" with the subject headings "terminal care", "palliative care" and "hospice care," and restricted to English articles discussing death denial in adults. The 30 articles were analysed using a constant comparison technique and emerging themes regarding the meaning and usage of the words "deny" and "denial" identified. This paper focusses on the theme of denial as an individual psychological process. Three dominant subthemes were distinguished: denial as an unconscious "defence mechanism", denial as "healthy" and denial as temporary. The analysis focusses on the intertextuality of these themes with each other and with previous texts on the denial of death. Elements of the psychoanalytic definition of denial as an unconscious defence mechanism are retained in the literature but are interwoven with new themes on patient choice. The result is an overall discourse that is conflictual and at times self-contradictory but overall consistent with the biomedical model of illness. I suggest that the representation of death denial elaborated in these articles may be related to a larger discourse on dying in contemporary Western society, which both invites patients to participate in the planning of their death and labels those who do not comply. PMID:15279932

  10. [A Case of Fournier's Gangrene Caused by Small Intestinal Perforation during Bevacizumab Combination Chemotherapy].

    PubMed

    Ishida, Takashi; Shinozaki, Hiroharu; Ozawa, Hiroki; Kobayashi, Toshimichi; Kato, Subaru; Wakabayashi, Taiga; Matsumoto, Kenji; Sasakura, Yuuichi; Shimizu, Tetsuichiro; Terauchi, Toshiaki; Kimata, Masaru; Furukawa, Junji; Kobayashi, Kenji; Ogata, Yoshiro

    2016-07-01

    A 51-year-old man underwent abdominoperineal resection for advanced rectal cancer at a hospital. He attended our outpatient clinic 58 months later with pain in the external genitalia, and was diagnosed with local pelvic recurrence and metastasis to the para-aortic lymph node and both adrenal glands. He received a total of 30 Gy of radiation for analgesia; subsequently, chemotherapy(mFOLFOX6 plus bevacizumab)was initiated. However, extreme left buttock and left femoral pain developed after the 6 courses of chemotherapy. Abdominal CT revealed Fournier's gangrene caused by small intestinal perforation. Emergency drainage under spinal anesthesia was immediately performed. Two additional drainage procedures were required thereafter and an ileostomy was constructed. The patient was discharged 100 days after the initial drainage. This is an extremely rare example of a bevacizumab-related small intestinal perforation that developed into Fournier's gan- grene. PMID:27431640

  11. The development of Fournier's gangrene following rubber band ligation of haemorrhoids

    PubMed Central

    Subramaniam, Daryl; Hureibi, Khalid; Zia, Khawaja; Uheba, Mokthar

    2013-01-01

    The development of Fournier's gangrene in an 80-year-old male patient with diabetes after a routine outpatient haemorrhoid banding procedure is described. Four days following the procedure, the patient noticed an increasing amount of pain and swelling of the perianal region. When the patient presented to the emergency department 18 days later, immediate radical debridement of ischiorectal necrotic tissue was performed. A defunctioning loop sigmoid colostomy was also formed. Subsequent operations required excision of the scrotum and abdominoperineal excision of the rectum. Histology studies later confirmed the presence of necrotising fasciitis. The case acts as a reminder that clinicians should maintain a high index of suspicion for high-risk patients still suffering from problems following the procedure. PMID:24287481

  12. The development of Fournier's gangrene following rubber band ligation of haemorrhoids.

    PubMed

    Subramaniam, Daryl; Hureibi, Khalid; Zia, Khawaja; Uheba, Mokthar

    2013-01-01

    The development of Fournier's gangrene in an 80-year-old male patient with diabetes after a routine outpatient haemorrhoid banding procedure is described. Four days following the procedure, the patient noticed an increasing amount of pain and swelling of the perianal region. When the patient presented to the emergency department 18 days later, immediate radical debridement of ischiorectal necrotic tissue was performed. A defunctioning loop sigmoid colostomy was also formed. Subsequent operations required excision of the scrotum and abdominoperineal excision of the rectum. Histology studies later confirmed the presence of necrotising fasciitis. The case acts as a reminder that clinicians should maintain a high index of suspicion for high-risk patients still suffering from problems following the procedure. PMID:24287481

  13. 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

  14. Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report.

    PubMed

    Snow, Alec F; Vannahme, Milena; Kettley, Laura; Pullyblank, Anne

    2016-01-01

    Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity. PMID:27173883

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

    PubMed Central

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

    2014-01-01

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

  16. 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

  17. Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report

    PubMed Central

    Snow, Alec F.; Vannahme, Milena; Kettley, Laura; Pullyblank, Anne

    2016-01-01

    Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity. PMID:27173883

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

    PubMed

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

    2014-01-01

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

  19. Overview of different scoring systems in Fournier’s Gangrene and assessment of prognostic factors

    PubMed Central

    Doluoğlu, Ömer Gökhan; Karagöz, Mehmet Ali; Kılınç, Muhammet Fatih; Karakan, Tolga; Yücetürk, Cem Nedim; Sarıcı, Haşmet; Özgür, Berat Cem; Eroğlu, Muzaffer

    2016-01-01

    Objective In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier’s gangrene (FG), and overview different validated scoring systems for outcome prediction. Material and methods We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier’s Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis. Results Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0–9) for the survivors and 6 (2–14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0–10) and 6.5 (5–11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. Conclusion High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

  20. Dutch Venous Ulcer guideline update.

    PubMed

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

    2014-05-19

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

  1. Epidural Venous Plexus Engorgement: What Lies Beneath?

    PubMed Central

    Donmez, Fuldem Yildirim

    2015-01-01

    Epidural venous plexus engorgement may occur due to several conditions that prevent the normal venous circulation. Inferior vena cava agenesis is a very rare cause of epidural venous enlargement. We present a case with a very thin inferior vena cava and left iliac vein agenesis who presented with back pain due to epidural vein engorgement and lacked other venous problems such as deep vein thrombosis. PMID:25722912

  2. Distal tibial interosseous osteochondroma with impending fracture of fibula – a case report and review of literature

    PubMed Central

    2009-01-01

    Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. We present a 16 year old young boy with an impending fracture, erosion and weakness of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma avoided the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications. PMID:19187551

  3. Central venous catheters: incidence and predictive factors of venous thrombosis

    PubMed Central

    Hammes, Mary; Desai, Amishi; Pasupneti, Shravani; Kress, John; Funaki, Brian; Watson, Sydeaka; Herlitz, Jean; Hines, Jane

    2015-01-01

    Aims: Central venous catheter access in an acute setting can be a challenge given underlying disease and risk for venous thrombosis. Peripherally inserted central venous catheters (PICCs) are commonly placed but limit sites for fistula creation in patients with chronic renal failure (CKD). The aim of this study is to determine the incidence of venous thrombosis from small bore internal jugular (SBIJ) and PICC line placement. This investigation identifies populations of patients who may not be ideal candidates for a PICC and highlights the importance of peripheral vein preservation in patients with renal failure. Materials and methods: A venous Doppler ultrasound was performed at the time of SBIJ insertion and removal to evaluate for thrombosis in the internal jugular vein. Data was collected pre- and post-intervention to ascertain if increased vein preservation knowledge amongst the healthcare team led to less use of PICCs. Demographic factors were collected in the SBIJ and PICC groups and risk factor analysis was completed. Results: 1,122 subjects had PICC placement and 23 had SBIJ placement. The incidence of thrombosis in the PICC group was 10%. One patient with an SBIJ had evidence of central vein thrombosis when the catheter was removed. Univariate and multivariate analysis demonstrated a history of transplant, and the indication of total parenteral nutrition was associated with thrombosis (p < 0.001). The decrease in PICCs placed in patients with CKD 6 months before and after intervention was significant (p < 0.05). Conclusions: There are subsets of patients with high risk for thrombosis who may not be ideal candidates for a PICC. PMID:25997503

  4. [Current treatment of venous thrombembolism].

    PubMed

    Munteanu, Ionuţ

    2013-01-01

    Deep vein thrombosis and pulmonary embolism, considered to be different manifestations of the same disease - venous thromboembolism, have few differences regarding the anticoagulant treatment. However, there are some issues which will be discussed. The therapy objectives in patients with venous thromboembolism include: prevention of death by pulmonary embolism, relieving symptoms in the affected leg, preventing morbidity and prevention of recurrent thromboembolism or postthrombotic syndrome, or minimize symptoms of post-thrombotic syndrome. For most patients, treatment goals are achieved using appropriate anticoagulant therapy, reducing the risk of recurrence in the first three months after diagnosis from over 25% to under 4%. Using of compression socks, providing a gradient of 30-40 mmHg at the ankle for 2 years after the diagnosis, reduce the risk of postthrombotic syndrome. Thrombolysis, applied either systemic or directly by catheter, is indicated in selected cases to prevent onset of postthrombotic syndrome or remove quickly the symptoms due to high venous obstruction. Thrombolytic therapy should be continued with anticoagulant therapy to prevent recurrence of venous thromboembolism. The use of an inferior vena cava filter is indicated for prevention of death by pulmonary embolism in patients who have contraindications to anticoagulant therapy, or anticoagulant treatment that was properly administered remains inefficient. Surgical treatment is recommended in case of chronic pulmonary hypertension, due to thromboembolic disease. PMID:23781572

  5. 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

  6. Venous ulceration, fibrinogen and fibrinolysis.

    PubMed Central

    Leach, R. D.

    1984-01-01

    The effect of long and short-term venous hypertension upon lymph fibrinogen concentrations was studied in an attempt to explain the peri-capillary deposition of fibrin reported in patients with post-phlebitic syndromes. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of rats and human volunteers was also studied. Both long- and short-term venous hypertension were found to increase fibrinogen transport across the interstitial space by more than 600%. Not only was there evidence of fibrinolytic activity in the lymph but after long-term venous hypertension alpha 2 antiplasmin activity was also detectable. Skin biopsies from the venous hypertensive ankles showed deposition of interstitial fibrin. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of the rat was found to be delayed if the rats were given epsilon amino caproic acid but it could not be increased with stanozolol. In human subjects it was found that patients with lipodermatosclerosis had delayed clot clearance and retarded blood fibrinolytic activity when compared with normal volunteers and patients with uncomplicated varicose veins. The principle cause why tall men are more subject to ulcers than short men, Dr Young conceived to be then length of the column of blood in their veins; which by its pressure, renders the legs less able to recover when hurt by any violence. Images Fig. 1 Fig. 2 Fig. 5 PMID:6742738

  7. Venous lakes of the hands

    SciTech Connect

    Levy, J.M.; Hessel, S.J.; Joseph, R.B.; Bodell, L.S.

    1985-09-01

    Following pharmacologic vasodilation, multiple vascular lakes were observed on angiograms of the hand in 55 patients. Most had no history of vascular anomalies or disease. The authors believe that these lakes are venous structures and that their filling is a physiologic phenomenon.

  8. Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report.

    PubMed

    Bhutia, Kincho Lhasong; Dey, Subhajeet; Singh, Varun; Gupta, Amlan

    2011-01-01

    Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene. PMID:21698086

  9. The wound/burn guidelines - 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene.

    PubMed

    Isei, Taiki; Abe, Masatoshi; Nakanishi, Takeshi; Matsuo, Koma; Yamasaki, Osamu; Asano, Yoshihide; Ishii, Takayuki; Ito, Takaaki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Takeshi; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakamura, Yasuhiro; Hashimoto, Akira; Hasegawa, Minoru; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Madokoro, Naoki; Yoshino, Yuichiro; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

    2016-06-01

    We aimed to prepare guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. They serve as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of the care for diabetic ulcer in Japan by systematically presenting evidence-based recommendations for clinical judgments by incorporating various viewpoints. PMID:26972937

  10. Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report

    PubMed Central

    Bhutia, Kincho Lhasong; Dey, Subhajeet; Singh, Varun; Gupta, Amlan

    2011-01-01

    Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene. PMID:21698086

  11. Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene

    PubMed Central

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

    2015-01-01

    Abstract 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

  12. Venous ulcers: pathophysiology and treatment options.

    PubMed

    Trent, Jennifer T; Falabella, Anna; Eaglstein, William H; Kirsner, Robert S

    2005-05-01

    Venous ulcers affect approximately 1% of the world's population, increasing healthcare expenditures and decreasing quality of life. Several hypotheses may help explain their origin. Incompetent veins or valves or impaired muscle function may lead to abnormal calf muscle pump function that can elevate ambulatory venous pressure (venous hypertension). This hypertension subsequently results in local venous dilatation and pooling, concomitantly trapping leukocytes that may release proteolytic enzymes that destroy tissues. Venous pooling also induces interendothelial pore widening and deposition of fibrin and other macromolecules that "trap" growth factors within them, rendering them unavailable for wound repair. Compression therapy, the mainstay treatment, reduces edema, reverses venous hypertension, and improves calf muscle pump function. Several treatment options can be employed as adjuvants to compression--eg, systemic therapy with pentoxifylline or aspirin, autologous grafts, tissue-engineered skin, growth factor therapy, and/or vein surgery. The epidemiology, pathophysiology, diagnosis, and management options regarding venous ulcers are reviewed. PMID:16014984

  13. Prognostic Factors for Fournier’s Gangrene; A 10-year Experience in Southeastern Iran

    PubMed Central

    Sabzi Sarvestani, Amene; Zamiri, Mehdi; Sabouri, Mehdi

    2013-01-01

    Objectives: To describe the characteristics and prognostic factors of 28 patients with Fournier’s Gangrene (FG) referred to our medical center at Southeastern Iran. Methods: This was a cross-sectional study including 28 cases of FG that were operated in Surgery department of Zahedan University of Medical Sciences during a 10-year period from April 2002 to March 2012. The study analyzed 9 parameters including the body temperature, heart rate, respiratory rate, hematocrit, white blood count (WBC), and serum levels of sodium, potassium, creatininee (twice for 2 for acute renal failure), and bicarbonate for Fournier Gangrene Severity Index (FGSI) score. The aspects taken into account were age, gender, predisposing factors, duration of symptoms, hospitalization period, and number of debridements, disease outcome and the FGSI. Results: All patients were males, aged from 26 to 68 years, with mean age 44.6 ±8.49 years. Statistically significant differences in age (p<0.001), duration of symptoms (p=0.001), number of debridements (p=0.006), hospitalization duration (p<0.001) and FGSI (p<0.001) were found between surviving and dead patients. The mortality rate was 35.7%, and the most common presentation was perianal/scrotal pain (78.6%). Perianal and primary scrotal abscesses were most common causes of FG and were found in 57.14% and 21.42% of patients respectively. The most prevalent predisposing factor was diabetes mellitus in 12 (42.85%) patients. With respect to laboratory findings, statistically significant differences in WBC (p=0.002), creatinine (p<0.001), albumin (p<0.001), calcium (p<0.001) and serum sodium (p=0.035) were found between the surviving and dead patients. Conclusion: Serious outcome of FG was associated with old age, delayed diagnosis and treatment, inadequate surgical debridement, shorter hospitalization and higher FGSI scores. In addition higher WBC, higher creatininee and serum sodium and lower albumin and calcium levels implicated worse prognosis

  14. Sepsis, venous return, and teleology.

    PubMed

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  15. Imaging of cerebral venous thrombosis.

    PubMed

    Bonneville, F

    2014-12-01

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

  16. Treatment of High-risk Venous Thrombosis Patients Using Low-dose Intraclot Injections of Recombinant Tissue Plasminogen Activator and Regional Anticoagulation

    PubMed Central

    Chang, Richard; Butman, John A.; Lonser, Russell R.; Sherry, Richard M.; Pandalai, Prakash K.; Horne, McDonald K.; Lozier, Jay N.

    2013-01-01

    Seven patients with venous thrombosis and contraindications to traditional thrombolytic therapy, consisting of recent intracranial surgery, recent pineal or retroperitoneal hemorrhage, active genitourinary or gastrointestinal bleeding, epidural procedures, and impending surgery, were successfully treated with a modified thrombolytic regimen. To improve safety, prolonged continuous infusions of tissue plasminogen activator (tPA) was eliminated in favor of once-daily low-dose intraclot injections of tPA to minimize the amount and duration of tPA in the systemic circulation, and low-therapeutic or regional anticoagulation was used to reduce anticoagulant risks. These modifications may allow thrombolytic treatment for selected patients with severe venous thrombosis who are deemed to be at high risk. PMID:23273695

  17. Pycnogenol in chronic venous insufficiency.

    PubMed

    Arcangeli, P

    2000-06-01

    Forty patients with chronic venous insufficiency (CVI) and varices of the legs were selected and double-blindly randomly assigned to a treatment with Pycnogenol (French maritime pine bark extract), 100 mg x 3/day or a placebo for 2 months, according to a double-blind experimental design. The effects of the treatment were evaluated by scoring the symptomatology with a semi-quantitative scale, and the venous blood flow by means of a hand-held Doppler ultrasound. The tolerability was evaluated by recording the adverse effects and by means of hematology and blood chemistry parameters, before and at the end of the treatment. Pycnogenol treatment induced a significant reduction in subcutaneous edema as well as heaviness and pain in the legs, on both after 30 and 60 days, the evaluation time periods. Approximately 60% of patients treated with Pycnogenol(R) experienced a complete disappearance of edema (the most rapidly disappearing symptom) and pain at the end of the treatment, while almost all the patients reported a reduction in leg heaviness which disappeared in approximately 33% of patients. These changes were statistically significant. No effect was observed in the placebo-treated subjects. No effect on the venous blood flow was observed in either of the experimental groups. PMID:10844161

  18. Uterine Perforation with Intra-Abdominal Clostridium perfringens Gas Gangrene: A Rare and Fatal Infection

    PubMed Central

    Kashan, David; Muthu, Nagarajan; Davalos, Fidencio; Bernstein, Michael; Chendrasekhar, Akella

    2016-01-01

    Abstract Background: Clostridium perfringens gas gangrene is an extremely rare and fatal infection. Necrosis of the myometrium is rarely seen and has only been recorded in 18 cases to date. Of these 18 reported cases, only 5 have occurred in nonpregnant women. This article presents the 6th case of myometrium necrosis from C. perfringens. Case: A 72-year-old woman, gravida 2, para 2, presented with abdominal pain and vaginal bleeding. After examinations, laboratory testing, and several surgical interventions, she was found to have C. perfringens infection and advanced high-grade serous adenocarcinoma of the endometrium with >50% invasion into the myometrium. Results: Despite the surgical interventions and use of several antibiotics, this patient did not improve. She was weaned from treatment per her advance directive and died after weaning. Conclusions: Awareness of the many etiologies for peritonitis is of great importance when a fatal infection may be the cause of the condition. Correct diagnosis and proper treatment is essential for the survival of patients infected with C. perfringens. (J GYNECOL SURG 32:182) PMID:27274183

  19. Is hemoglobin A1c level effective in predicting the prognosis of Fournier gangrene?

    PubMed Central

    Sen, Haluk; Bayrak, Omer; Erturhan, Sakip; Borazan, Ersin; Koc, Mustafa Nihat

    2016-01-01

    Objectives: To evaluate the effect of immune failure and/or diabetes mellitus (DM) association on the mortality and morbidity of the Fournier's Gangrene (FG), and interrelatedly, the usability of HbA1c level in the prediction of prognosis. Materials and Methods: The data of 38 patients with the diagnosis of FG were investigated retrospectively. The patients were divided into two groups as patients with DM (Group 1, n = 18) and non-diabetics (Group 2, n = 20). The patients in group 1 were also divided into two subgroups as patients with HbA1c value ≥7 (Group 1a) and HbA1c value <7 (Group 1b). Results: The mean age of all 38 male patients was 66.3 ± 6.4 years. The initial symptoms were scrotal rash and swelling (n = 20, 52.6%), high fever (>38°C) (n = 22, 57.8%), purulent discharge from genital or perineal areas (n = 13, 34.2%), skin bruises (n = 11, 28.9%) and general state disorder in five patients that were admitted from day care center (13.1%). DM, as the most often comorbid disease, was detected in 18 patients (47.3%). Six patients (15.7%) were deceased during the follow-up period. Conclusion: In the present study, the researchers determined that diabetic patients with HbA1c level of 7 or higher had worse prognosis, and increased mortality. PMID:27453658

  20. Clostridium septicum Gas Gangrene in Colon Cancer: Importance of Early Diagnosis

    PubMed Central

    Nanjappa, Sowmya; Shah, Sweta; Pabbathi, Smitha

    2015-01-01

    The Clostridia species are responsible for some of the deadliest diseases including gas gangrene, tetanus, and botulism. Clostridium septicum is a rare subgroup known to cause atraumatic myonecrosis and is associated with colonic malignancy or immunosuppression. It is a Gram-positive, anaerobic, spore-forming bacillus found in the gastrointestinal tract and can lead to direct, spontaneous infections of the bowel and peritoneal cavity. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring germination of clostridial spores. Tumor-induced mucosal ulceration allows for translocation of sporulated bacteria from the bowel into the bloodstream, leading to fulminant sepsis. C. septicum bacteremia can have a variable presentation and is associated with greater than 60% mortality rate. The majority of deaths occur within the first 24 hours if diagnosis and appropriate treatment measures are not promptly started. We report a case of abdominal myonecrosis in a patient with newly diagnosed colon cancer. The aim of this study is to stress the importance of maintaining a high suspicion of C. septicum infection in patients with underlying colonic malignancy. PMID:26793397

  1. [Original vacuum dressing for the treatment of open femur fracture with gangrene immobilized by external fixation].

    PubMed

    Debarge, R; Pinaroli, A; Caillot, J-L; Voiglio, E-J

    2008-02-01

    We report a case of gangrene, which developed following an open fracture of the femur immobilized with an external fixator in a 45-year-old patient. A conventional vacuum dressing (VAC Therapy) could not be applied with the external fixator in place. An original vacuum dressing was thus fashioned after surgical debridement. Scabs were covered with calcium alginate. The lower limb was enveloped in sterile dressings and vacuum was achieved by suction with gastric tubes under adhesive films. The dressing was redone every 48 h in a surgical setting. Antibiotic prophylaxis enabled cure of the infection. Budding appeared within two weeks enabling skin grafting. Centro-medullary nailing was undertaken on day 30 to accelerate bone healing. At three months from the trauma, the initial loss of sensitivity in the leg and foot noted at the first weight bearing required programmed disarticulation of the knee after femur and wound healing. At six months, the patient had resumed his occupational activities and was pain free. This type of dressing could be useful for tissue loss over a fracture immobilized with an external fixator. This type of assembly can easily be installed in the operating room. PMID:18342034

  2. Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

    PubMed Central

    Bruketa, Tomislav; Majerovic, Matea; Augustin, Goran

    2015-01-01

    Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects. PMID:26290629

  3. Effects of impending ovarian failure induced by 4-vinylcyclohexene diepoxide on fertility in C57BL/6 female mice.

    PubMed

    Haas, Jamie R; Christian, Patricia J; Hoyer, Patricia B

    2007-10-01

    Repeated daily dosing of mice with 4-vinylcyclohexene diepoxide (VCD) causes a gradual onset of ovarian failure, providing a model for perimenopause. Because increasing numbers of women are delaying starting a family, infertility in aging women is of concern. This study was designed to determine the effects of impending ovarian failure on fertility in VCD-treated mice. Female C57BL/6J mice were dosed daily (17 d) with vehicle control or VCD (160 mg/kg, intraperitoneally) to deplete primordial follicles and then were divided into 2 groups. Group 1 was mated soon after dosing; group 2 was mated on day 20 after dosing, during impending ovarian failure. Fertility was evaluated on gestational day 16. In group 1, cycle length, pregnancy rate, and number of live fetuses did not differ between VCD-treated animals and controls, but VCD-treated mice required more matings to become pregnant and had more resorptions. In group 2, VCD-treated mice demonstrated proestrus and copulatory plugs, but only 1 animal became pregnant, and she had no viable fetuses. Ovaries from pregnant and nonpregnant controls contained similar numbers of follicles and corpora lutea. Ovaries from VCD-treated animals contained no follicles, and corpora lutea were seen only in pregnant animals. In VCD-treated mice mated soon after dosing, conception was more difficult and more resorbed fetuses were seen, whereas in those mated closer to impending ovarian failure, no successful pregnancies were achieved. These results demonstrate that VCD-treated mice can be used to model infertility in perimenopausal women. PMID:17974126

  4. Intestinal venous congestion as a complication of elective silo placement for gastroschisis.

    PubMed

    Ryckman, Jon; Aspirot, Ann; Laberge, Jean-Martin; Shaw, Kenneth

    2009-05-01

    Use of a spring-loaded silastic silo has been advocated as a means of gentle reduction of the herniated bowel, while avoiding the possible complications of primary closure of gastroschisis. We recently encountered intestinal venous congestion during elective silo reduction of gastroschisis. Two babies with gastroschisis were treated postdelivery with a spring-loaded silo placed under the fascial defect and the eviscerated bowel suspended within the silo. Patient #1 had no bowel matting. On day of life 2, the bowel within the silo was noted to be dusky. The silo was removed, and the bowel was indeed congested, but viable. Complete reduction with a modified Bianchi closure was performed at the bedside. Patient #2 had severe matting of the bowel and did not require intubation for silo placement. As daily reductions progressed, the bowel was noted to be congested on day 2. On day 3, removal of the silo revealed frank bowel necrosis with impending perforation. Two-thirds of the small bowel required resection, leaving the child with short bowel. Venous congestion within a silo should be given prompt attention, including removal of the silo, as bowel infarction may result. PMID:19349001

  5. Diagnosis and management of venous ulcers.

    PubMed

    Carr, Sandra C

    2008-03-01

    Venous ulceration of the lower extremities is a common and often disabling condition. Venous ulcers are the result of a chronic inflammatory condition caused by persistent venous hypertension. Therapy is directed at counteracting the chronic inflammation in the tissues and at decreasing ambulatory venous hypertension in the area. Compression therapy helps decrease the venous hypertension and aids healing. Topical agents may be used to help decrease the bacterial load in the wound, provide a moist healing environment for dry wounds, or absorb the exudate in wounds with a lot of drainage. Pharmacological adjuncts, such as pentoxifylline or flavanoids, may help counteract the chronic inflammation in the ulcerated area. Interventions to decrease the ambulatory venous hypertension can help patients with either active or healed ulcers. Ablation of incompetent superficial truncal veins and/or perforating veins using radiofrequency ablation, endovenous laser ablation, or foam sclerotherapy can speed ulcer healing and prevent recurrence. PMID:18388013

  6. Optimizing venous drainage using an ultrasonic flow probe on the venous line.

    PubMed

    Walker, Joshua L; Young, Haven A; Lawson, D Scott; Husain, S Adil; Calhoon, John H

    2011-09-01

    The use of smaller cannulae for minimally invasive surgery techniques and/or aggressive miniaturization of the cardiopulmonary bypass (CPB) circuitry has necessitated the need to augment venous drainage to achieve adequate flow rates. Vacuum assisted venous drainage (VAVD) has become the dominant method to augment venous drainage. VAVD, however, has been associated with a number of known side effects including increased transmission of gaseous microemboli to the patient, venous line chatter, and increased arterial to venous shunts in the circuit. Historically, our practice has been to monitor the arterial output flow rate and to monitor VAVD by observing venous line chatter and changes in the venous reservoir level. In 2008 our pediatric cardiothoracic service began monitoring venous line flow rates by using a second ultrasonic flow probe placed on the venous line. After 12 months, our staff perfusionists reviewed the impact of monitoring venous line flow rates on VAVD and its known side effects on daily clinical practice. When monitoring venous line flow rates, empiric observation revealed that less overall vacuum pressure was needed for our CPB cases. This novel approach to monitoring venous drainage has aided us in providing optimal vacuum levels and therefore, may reduce some of the known side effects experienced with excessive VAVD. PMID:22164455

  7. The precursory fault width formation and critical stress state of impending large earthquakes: The observation and deterministic forecasting

    NASA Astrophysics Data System (ADS)

    Takeda, F.

    2009-12-01

    Dividing Japan into meshes of about 5 degrees, we collect earthquakes (EQs) for each mesh-area from an on-line JMA focus catalog of Japan with a regionally dependent magnitude window of M ≥ 3-3.5. The time history of each mesh-collection is a string of EQ events, which draw a zigzagged trajectory in a physical space. The space coordinates are the EQ epicenter, focal depth (DEP), inter-EQ time interval (INT), and magnitude (MAG). Thus, each coordinate component of the trajectory is the time series of the corresponding EQ source parameter where time is the chronological event index. The zigzagged motion appears random like Brownian motion; however, it is a deterministic chaos. The evidence is that the largest Lyapunov exponents of each trajectory are all positive, statistically distinct from those surrogated by randomly shuffling only the event index. Thus, the deterministic chaos suggests that any impending large EQ does not rupture randomly and that some deterministic seismogenesis controls the rupture process. Namely, some short-term deterministic forecasting is theoretically possible. Therefore, we first take a moving-average of 15-25 events on each series to reduce the zigzagged motion. We further take its second order difference at the interval of 20-35 events to find its acceleration (seismogenic force) acting on each averaged series. We then find only two unique different triple phase couplings of the acceleration on source parameter DEP, INT, and MAG precursory to every impending large EQs (M > about 6) throughout Japan [Takeda, 2003; Takeda and Takeo, 2004]. Each triple phase coupling begins the MAG with medium MAG of about 4.1 at either small (shallow) DEP and large INT or large (deep) DEP and small INT, then change it to small MAG of about 3.8 at either deep DEP and small INT or shallow DEP and large INT. The transition of the EQ state creates a large linear DEP variation (W) on its series, which is found comparable to the fault width of large EQs

  8. Severe gangrene at the glans penis requiring penectomy as the first major complication of Buerger’s disease

    PubMed Central

    Pham, Khanh N; Sokoloff, Mitchell H; Steiger, Charles A

    2016-01-01

    We report an interesting case of Buerger’s disease that manifested at the glans penis in a 56 year-old former smoker. Penile involvement in Buerger’s disease is rare. Our patient had no prior extremity or digit amputations in his 4-year history of Buerger’s disease. However, our patient did suffer from recurrent penile ulcers over an 8-week timeframe that ultimately progressed to a gangrenous, unsalvageable glans penis. He underwent a partial penectomy and urethral reconstruction with excellent post-operative results. PMID:27069957

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

    SciTech Connect

    Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio

    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.

  10. 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

  11. Coronary venous oximetry using MRI.

    PubMed

    Foltz, W D; Merchant, N; Downar, E; Stainsby, J A; Wright, G A

    1999-11-01

    Based on the Fick law, coronary venous blood oxygen measurements have value for assessing functional parameters such as the coronary flow reserve. At present, the application of this measure is restricted by its invasive nature. This report describes the design and testing of a noninvasive coronary venous blood oxygen measurement using MRI, with a preliminary focus on the coronary sinus. After design optimization including a four-coil phased array and an optimal set of data acquisition parameters, quality tests indicate measurement precision on the order of the gold standard optical measurement (3%O(2)). Comparative studies using catheter sampling suggest reasonable accuracy (3 subjects), with variability dominated by sampling location uncertainty ( approximately 7%O(2)). Intravenous dipyridamole (5 subjects) induces significant changes in sinus blood oxygenation (22 +/- 9% O(2)), corresponding to flow reserves of 1.8 +/- 0.4, suggesting the potential for clinical utility. Underestimation of flow reserve is dominated by right atrial mixing and the systemic effects of dipyridamole. Magn Reson Med 42:837-848, 1999. PMID:10542342

  12. Heritability of chronic venous disease

    PubMed Central

    Krusche, Petra; Wolf, Andreas; Krawczak, Michael; Timm, Birgitt; Nikolaus, Susanna; Frings, Norbert; Schreiber, Stefan

    2010-01-01

    Varicose veins without skin changes have a prevalence of approximately 20% in Northern and Western Europe whereas advanced chronic venous insufficiency affects about 3% of the population. Genetic risk factors are thought to play an important role in the aetiology of both these chronic venous diseases (CVD). We evaluated the relative genetic and environmental impact upon CVD risk by estimating the heritability of the disease in 4,033 nuclear families, comprising 16,434 individuals from all over Germany. Upon clinical examination, patients were classified according to the CEAP guidelines as either C2 (simple varicose veins), C3 (oedema), C4 (skin changes without ulceration), C5 (healed ulceration), or C6 (active ulcers). The narrow-sense heritability (h2) of CVD equals 17.3% (standard error 2.5%, likelihood ratio test P = 1.4 × 10−13). The proportion of disease risk attributable to age (at ascertainment) and sex, the two main risk factors for CVD, was estimated as 10.7% (Kullback–Leibler deviance R2). The heritability of CVD is high, thereby suggesting a notable genetic component in the aetiology of the disease. Systematic population-based searches for CVD susceptibility genes are therefore warranted. PMID:20354728

  13. Septic cerebral venous sinus thrombosis.

    PubMed

    Khatri, Ismail A; Wasay, Mohammad

    2016-03-15

    Septic cerebral venous sinus thrombosis, once a common and deadly disease, has fortunately become rare now. Not only that the incidence has fallen significantly after the antibiotic era, the morbidity and mortality has also decreased substantially. Cavernous sinus thrombosis is by far the commonest form of septic cerebral venous sinus thrombosis. Due to its rare occurrence, a lot of current generation clinicians have not encountered the entity in person. Despite all the advances in diagnostic modalities, a high index of clinical suspicion remains the mainstay in prompt diagnosis and management of this potentially lethal condition. Keeping this in view, the authors have reviewed the subject including the old literature and have summarized the current approach to diagnosis and management. Septic cavernous thrombosis is a fulminant disease with dramatic presentation in most cases comprised of fever, periorbital pain and swelling, associated with systemic symptoms and signs. The preceding infection is usually in the central face or paranasal sinuses. The disease rapidly spreads to contralateral side and if remains undiagnosed and untreated can result in severe complications or even death. Prompt diagnosis using radiological imaging in suspected patient, early use of broad spectrum antibiotics, and judicial use of anticoagulation may save the life and prevent disability. Surgery is used only to treat the nidus of infection. PMID:26944152

  14. 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

  15. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    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.

  16. Subacute myelopathy caused by spinal venous infarction.

    PubMed Central

    Clarke, C. E.; Cumming, W. J.

    1987-01-01

    A 44 year old female presented with a subacute myelopathy in association with pelvic venous thrombosis. It is inferred from the temporal relationship of these events that the patient suffered a subacute spinal venous infarction. This is discussed along with the aetiology, anatomical distribution and management of the condition. Images Figure 1 PMID:3422870

  17. Stent Placement on Fresh Venous Thrombosis

    SciTech Connect

    Vorwerk, Dierk; Guenther, Rolf W.; Schuermann, Karl

    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.

  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. [A rare case of an acute abdomen patient with gangrene of the colon as a complication of systemic lupus erythematosus].

    PubMed

    Dolák, S; Prochotský, A; Mifkovič, A; Škultéty, J; Ježovít, M; Koudelka, P; Bluska, P

    2015-02-01

    The authors present a case report of a 39-year-old woman with acute abdomen - a comorbid patient with systemic lupus erythematosus, chronic renal insufficiency as a complication of lupus nephritis, included in a haemodialysis programme. The patient had also undergone transplantation of the left kidney in the past. She was initially admitted to the Department of Traumatology for a total endoprosthesis procedure due to bionecrosis of the head of the thigh bone. Postoperatively, the patients condition was complicated by gangrene of the colon confirmed by CT scan and during the operation. The patient was operated on - subtotal colectomy, terminal ileostomy and left-sided ovariectomy was performed. The postoperative course was complicated by perforation of the jejunum which was sutured. The patient was admitted to ICU and, after recovery, to our surgical department. Because of the metabolic disturbance she was treated in the internal medicine department. After 60 days she was discharged in a good condition, walking and with full per os realimentation.Key words: lupus erythematosus gangrene of the colon acute abdomen. PMID:25659257

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  1. 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

  2. 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.

  3. Direct puncture angiography in congenital venous malformations

    SciTech Connect

    Boxt, L.M.; Levin, D.C.; Fellows, K.E.

    1983-01-01

    Angiodysplasia of the extremities is a broad group of vascular lesions of arterial, capillary, and venous origin. They are generally detected initially during late childhood or early adulthood. Although they may cause swelling and pain, they are often asymptomatic and are discovered incidentally on physical examination performed for other reasons. One of the most troublesome diagnostic aspects of these lesions is the fact that while they consist of enlarged venous channels, standard venographic techniques may fail to demonstrate them. Three cases are described in which the diagnosis of venous angioma was made by direct needle puncture and contrast material injection, after arteriographic and/or venographic examination was either negative or nondiagnostic.

  4. Venous disease: the missing link in cardiovascular medicine.

    PubMed

    Madyoon, Hooman; Lepor, Norman E

    2013-01-01

    Until recently, medical literature and the practice of vascular medicine focused on the cosmetic aspects of venous disease and the advanced stages of venous insufficiency such as painful varicose veins and venous ulcers. The systemic effects of venous insufficiency resulting from a reduction of venous return and increased transit time of blood from the lower extremities that can mimic heart failure are only recently being recognized. This article reviews the diagnosis and treatment options for the patients with venous insufficiency, and increases awareness about the systemic effects of venous disease and its role in the practice of cardiovascular medicine. PMID:23651983

  5. The possibility for use of venous flaps in plastic surgery

    NASA Astrophysics Data System (ADS)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  6. The possibility for use of venous flaps in plastic surgery

    SciTech Connect

    Baytinger, V. F. Kurochkina, O. S. Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  7. Intraneural Venous Malformations of the Median Nerve

    PubMed Central

    González Rodríguez, Alba; Midón Míguez, José

    2016-01-01

    Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation. PMID:27462571

  8. Case 3: chronic venous leg ulcer.

    PubMed

    Hämmerle, Gilbert

    2016-03-01

    A non-healing, sloughy venous leg ulcer quickly responded to topical treatment including octenilin Wound Gel and octenilin Wound Irrigation Solution. Full healing occurred within 6 weeks. PMID:26949848

  9. 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.

  10. Subfascial endoscopic perforator surgery for venous ulcers.

    PubMed

    Lee, D W H; Lam, Y H; Chan, A C W; Chung, S C S

    2003-08-01

    We report the treatment and outcomes of 12 patients who underwent subfascial endoscopic perforator surgery for severe chronic venous insufficiency and venous ulceration. All patients had received prior superficial venous ablative surgery and presented with incompetent perforating veins in the calf and persistent venous ulceration (lasting >10 years). Outcome measures included ulcer healing time, recurrence, clinical symptom, and disability scores. There was one wound complication after subfascial endoscopic perforator surgery. The cumulative ulcer healing rate was 25% at 3 months, 42% at 6 months, and 92% at 1 year. One patient developed ulcer recurrence at 12 months after surgery. The mean clinical score and disability score decreased from 13.00 (standard deviation, 2.26) to 4.83 (1.47) and 1.75 (0.45) to 0.50 (0.52), respectively (P<0.001) after a median follow-up of 15.0 months (interquartile range, 12.0-21.5 months). Subfascial endoscopic perforator surgery was safe and effective in the treatment of patients with severe chronic venous insufficiency and venous ulceration caused by incompetent perforating veins in the calf. PMID:12904616

  11. On bone adaptation due to venous stasis

    PubMed Central

    Wang, Liyun; Fritton, Susannah P.; Weinbaum, Sheldon; Cowin, Stephen C.

    2014-01-01

    This paper addresses the question of whether or not interstitial fluid flow due to the blood circulation accounts for the observed periosteal bone formation associated with comprised venous return (venous stasis). Increased interstitial fluid flow induced by increased intramedullary pressure has been proposed to account for the periosteal response in venous stasis. To investigate the shear stresses acting on bone cell processes due to the blood circulation-driven interstitial fluid flow, a poroelastic model is extended to the situation in which the interstitial fluid flow in an osteon is driven by the pulsatile extravascular pressure in the osteonal canal as well as by the applied cyclic mechanical loading. Our results show that under normal conditions, the pulsatile extravascular pressure in the osteonal canal due to cardiac contraction (10mm Hg at 2 Hz) and skeletal muscle contraction (30mm Hg at 1 Hz) induce peak shear stresses on the osteocyte cell processes that are two orders of magnitude lower than those induced by physiological mechanical loading (100 microstrain at 1 Hz). In venous stasis the induced peak shear stress is reduced further compared to the normal conditions because, although the mean intramedullary pressure is increased, the amplitude of its pulsatile component is decreased. These results suggest that the interstitial fluid flow is unlikely to cause the periosteal bone formation in venous stasis. However, the mean interstitial fluid pressure is found to increase in venous stasis, which may pressurize the periosteum and thus play a role in periosteal bone formation. PMID:14499293

  12. Venous catheterization with ultrasound navigation

    NASA Astrophysics Data System (ADS)

    Kasatkin, A. A.; Urakov, A. L.; Nigmatullina, A. R.

    2015-11-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient's exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  13. Investigational treatments of venous thromboembolism.

    PubMed

    Spyropoulos, Alex C

    2007-04-01

    The antithrombotic management of venous thromboembolism (VTE) has gone through major developments. Indirect inhibitors such as low molecular weight heparin and the pentasaccharide fondaparinux represent improvements over traditional drugs such as unfractionated heparin for acute treatment of VTE with more targeted approaches, predictable pharmacokinetic profiles and lack of need for monitoring. Vitamin K antagonists, with inherent limitations of multiple food and drug interactions and frequent need for monitoring, remain the only oral anticoagulants approved for long-term secondary thromboprophylaxis in VTE with the removal of the oral direct thrombin inhibitor ximelagatran from the world market due to safety concerns. Newer anticoagulant drugs such as parenteral pentasaccharides (idraparinux and SSR-126517-E), oral direct thrombin inhibitors (dabigatran), oral direct Factor Xa inhibitors (rivaroxaban, apixaban, YM-150 and DU-176b) and tissue factor-Factor VIIa complex inhibitors (NAPc2) are tailor-made to target specific procoagulant complexes and have the potential to greatly expand our antithrombotic armamentarium for both acute and long-term treatment of VTE, especially as non-monitored parenteral and oral anticoagulants with a wide therapeutic window and a predictable anticoagulant response. PMID:17371192

  14. Venous catheterization with ultrasound navigation

    SciTech Connect

    Kasatkin, A. A. Nigmatullina, A. R.; Urakov, A. L.

    2015-11-17

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  15. Xanthogranulomatous Pyelonephritis with Staghorn Calculus, Acute Gangrenous Appendicitis and Enterocolitis: A Multidisciplinary Challenge of Kidney-Preserving Conservative Therapy.

    PubMed

    Friedl, Alexander; Tuerk, Christian; Schima, Wolfgang; Broessner, Clemens

    2015-09-01

    Xanthogranulomatous pyelonephritis (XP) is a rare form of pyelonephritis and without treatment destructive to the kidney. We describe a 74-year-old Caucasian immunocompetent female patient with XP and multiple abscesses on the upper pole of the right kidney and several impacted obstructing renal calculi in the middle calyx that developed severe colitis and gangrenous appendicitis during therapy. Proteus mirabilis was detected as the major pathogen in the urine culture. Kidney preserving therapy was carried out by intensive parenteral bacterial eradication, CT-guided abscess drainage and stone destruction by 3 sessions of extracorporeal shock wave lithotripsy under ureteral stenting. Large tumor masses in XP are often daunting and may lead to a nephrectomy. However, kidney-preserving therapy is possible and should be considered in non-septic patients or in case of a solitary kidney. PMID:26889137

  16. Xanthogranulomatous Pyelonephritis with Staghorn Calculus, Acute Gangrenous Appendicitis and Enterocolitis: A Multidisciplinary Challenge of Kidney-Preserving Conservative Therapy

    PubMed Central

    Friedl, Alexander; Tuerk, Christian; Schima, Wolfgang; Broessner, Clemens

    2015-01-01

    Xanthogranulomatous pyelonephritis (XP) is a rare form of pyelonephritis and without treatment destructive to the kidney. We describe a 74-year-old Caucasian immunocompetent female patient with XP and multiple abscesses on the upper pole of the right kidney and several impacted obstructing renal calculi in the middle calyx that developed severe colitis and gangrenous appendicitis during therapy. Proteus mirabilis was detected as the major pathogen in the urine culture. Kidney preserving therapy was carried out by intensive parenteral bacterial eradication, CT-guided abscess drainage and stone destruction by 3 sessions of extracorporeal shock wave lithotripsy under ureteral stenting. Large tumor masses in XP are often daunting and may lead to a nephrectomy. However, kidney-preserving therapy is possible and should be considered in non-septic patients or in case of a solitary kidney. PMID:26889137

  17. Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies.

    PubMed

    Mills, Joseph L

    2016-01-01

    The confluence of several chronic conditions--in particular ageing, peripheral artery disease, diabetes, and chronic kidney disease--has created a global wave of lower limbs at risk for major amputation. While frequently asymptomatic or not lifestyle limiting, at least 1% of the population has peripheral artery disease of sufficient severity to be limb threatening. To avoid the critical error of failing to diagnose ischaemia, all patients with diabetic foot ulcers and gangrene should routinely undergo physiologic evaluation of foot perfusion. Ankle brachial index is useful when measurable, but may be falsely elevated or not obtainable in as many as 30% of patients with diabetic foot ulcers primarily because of medial calcinosis. Toe pressures and skin perfusion pressures are applicable to such patients. PMID:26455728

  18. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases

    PubMed Central

    Sharma, Naveen; Singh, Varun; Agrawal, Ashish; Bhargava, Rakesh

    2015-01-01

    Background: Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good. Materials and Methods: Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system. Results: At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed. Conclusions: Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate. PMID:26538755

  19. Venous waterfalls in coronary circulation.

    PubMed

    Gosselin, R E; Kaplow, S M

    1991-03-21

    Several studies of flow through collapsible tubing deformed by external pressures have led to a concept known as the "vascular waterfall". One hallmark of this state is a positive zero-flow pressure intercept (Pe) in flow-pressure curves. This intercept is commonly observed in the coronary circulation, but in blood-perfused beating hearts a vascular waterfall is not the only putative cause. To restrict the possibilities, we have measured flow-pressure curves in excised non-beating rabbit hearts in which the coronary arteries were perfused in a non-pulsatile way with a newtonian fluid (Ringers solution) containing potent vasodilator drugs. Under these circumstances, vascular waterfalls are believed to be the only tenable explanation for Pe. In physical terms the waterfall is a region where the vessel is in a state of partial collapse with a stabilized intraluminal fluid pressure (Pw). It is argued that the most probable site of this collapse was the intramural veins just before they reached the epicardial surface. In accord with the waterfall hypothesis, Pe increased as the heart became more edematous, but flow-pressure curves also became flatter, implying multiple waterfalls with differing Pws, leading to complete collapse of some of the venous channels. The principal compressive force is believed to have been the interstitial fluid pressure as registered through a needle (Pn) implanted in the left ventricular wall, but a small additional force (Ps) was probably due to swelling of interstitial gels. A method is presented for estimating Ps and Pw. Unlike rubber tubing, blood vessels are both collapsible and porous. Apparently because of increased capillary filtration, Pn was found to increase linearly with the perfusion pressure. Thus, Pw was not the same at all points on the flow-pressure curve. This finding has interesting implications with respect to the concept of coronary resistance. PMID:2062096

  20. Wound care in venous ulcers.

    PubMed

    Mosti, G

    2013-03-01

    -to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing. PMID:23482540

  1. 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.

  2. 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

  3. [Central venous lines in children: new trends].

    PubMed

    Desruennes, E

    2006-04-01

    Central venous catheterisation under two-dimensional ultrasound (US) guidance has been proved to be quicker and safer than the classical landmark method in both adults and children. In the literature US guidance with sterile dressing of the probe is the 'gold-standard'. Another way to use US is simple preoperative US location followed either by blind puncture, either by US guided puncture when difficulties are expected: small infants (<15 kg), small diameter or collapses of the vein, multiple unsuccessful attempts during blind technique. Ideal location of the tip of central venous catheters is no more controversial but can depend on age and weight. In 2002 a French agency (Afssaps) study showed that the risk of perforation and tamponade was especially high in small weight prematures with 27 gauge polyurethane catheters when tip was located in the cardiac cavities. In children and adults venous thrombosis and catheter malfunction are closely related to short catheters whose tip is above T3-T4. Excepted polyurethane catheters in small weight prematures, the best location of long-term central venous catheters tip is the superior vena cava-right auricle junction. At this time routine antithrombotic prophylaxis is not recommended for children with long-term central venous catheters. PMID:16414237

  4. [Cerebral venous thrombosis during tuberculous meningoencephalitis].

    PubMed

    Guenifi, W; Boukhrissa, H; Gasmi, A; Rais, M; Ouyahia, A; Hachani, A; Diab, N; Mechakra, S; Lacheheb, A

    2016-05-01

    Cerebral venous thrombosis is a rare disease characterized by its clinical polymorphism and multiplicity of risk factors. Infections represent less than 10% of etiologies. Tuberculosis is not a common etiology, only a few observations are published in the literature. Between January 2005 and March 2015, 61 patients were hospitalized for neuro-meningeal tuberculosis. Among them, three young women had presented one or more cerebral venous sinus thromboses. No clinical feature was observed in these patients; vascular localizations were varied: sagittal sinus (2 cases), lateral sinus (2 cases) and transverse sinus (1 case). With anticoagulant and antituberculosis drugs, the outcome was favorable in all cases. During neuro-meningeal tuberculosis, the existence of consciousness disorders or neurological focal signs is not always the translation of encephalitis, hydrocephalus, tuberculoma or ischemic stroke; cerebral venous sinus thrombosis may be the cause and therefore should be sought. PMID:27090100

  5. 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.

  6. The Role of Platelets in Venous Thromboembolism.

    PubMed

    Montoro-García, Silvia; Schindewolf, Marc; Stanford, Sophia; Larsen, Ole Halfdan; Thiele, Thomas

    2016-04-01

    Multiple factors contribute to the risk of venous thromboembolism (VTE). Platelets have attracted much interest in arterial cardiovascular disease, whereas their role in VTE has received much less attention. Recent evidence suggests that platelets may play a more important role in VTE than previously anticipated. This review discusses the mechanisms that link platelets with venous thrombotic disease and their potential applications as novel risk factors for VTE. In addition, animal studies and randomized clinical trials that highlight the potential effect of antiplatelet therapy in venous thrombosis are evaluated to assess the role of platelets in VTE. The clinical significance of platelets for VTE risk assessment in specific patient cohorts and their role as a suitable therapeutic target for VTE prevention is acknowledged. The role of platelets in VTE is a promising field for future research. PMID:26926584

  7. Topical issues in venous thromboembolism.

    PubMed

    Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Páramo Fernández, José Antonio

    2010-12-14

    Despite clear guidelines and the availability of effective treatments, venous thromboembolism (VTE) remains relatively common, particularly in the hospital setting. This paper reviews topical issues in VTE, in terms of treatments, data and guidelines. Existing anticoagulants have several limitations. Bleeding risk is a concern with all anticoagulants. Vitamin K antagonists are the mainstay of oral anticoagulant therapy, but they are limited by the need for frequent monitoring. Unfractionated heparin (UFH) is limited by an inconvenient route of administration (continuous intravenous infusion) and a higher risk of heparin-induced thrombocytopenia and bleeding compared with low molecular weight heparins (LMWH). LMWH have a more predictable pharmacokinetic profile and greater bioavailability than UFH, which permits weight-adjusted LMWH dosing without the need for monitoring in most patients. LMWH also have a more convenient dosing strategy than UFH (once-daily subcutaneous injection). Fondaparinux is a selective inhibitor of factor Xa and, like LMWH, does not require monitoring. The efficacy of fondaparinux in long-term VTE treatment remains to be established. The optimal time to initiate thromboprophylaxis in patients undergoing orthopaedic surgery remains controversial. Initiating thromboprophylaxis just before or soon after surgery (the 'just-in-time' strategy) achieves better thromboprophylaxis but could increase the risk of bleeding complications. Balancing the need for extended thromboprophylaxis after major surgery with the need to minimize bleeding remains an important consideration. Despite clear guidelines, thromboprophylaxis is widely underused, particularly in medical patients, in whom rates as low as 28% have been reported. Electronic alert systems may be of value for increasing the use of adequate thromboprophylaxis. The use of different definitions of VTE and bleeding in clinical trials, together with missing venography data, conflicting guidelines in

  8. Use of negative pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration

    PubMed Central

    CHEN, YU; XU, SONG-FENG; XU, MING; YU, XIU-CHUN

    2016-01-01

    Major wound complications of the extremities, following wide tumor resection and reconstruction for soft-tissue sarcomas (STSs), remain a challenge for limb-sparing surgery. Furthermore, STSs with ulceration or impending ulceration predispose patients to an increased risk of post-operative infection. The present study was conducted to assess the efficacy of negative pressure wound therapy (NPWT) in preventing wound complications associated with surgical treatment of STSs with ulceration or impending ulceration, in patients treated between February 2012 and January 2013. A total of 5 patients, with a mean age of 48 years (range, 24–68 years), were enrolled in the present study. The diagnoses consisted of undifferentiated pleomorphic sarcoma (n=2), leiomyosarcoma (n=1), synovial sarcoma (n=1) and epithelioid sarcoma (n=1). According to American Joint Committee on Cancer criteria, 3 cases were stage III tumors, and the remaining 2 cases were of stages IIA and IIB, respectively. A total of 3 patients exhibited ulceration at diagnosis, and the remaining patients demonstrated impending ulceration. The mean wound area following wide resection of the tumor was 73 cm2 (range, 45–110 cm2). A continuous suction mode, with pressures measuring −200 to −300 mmHg, was used for 7–10 days on the soft-tissue defects as preparation for wound closure. Soft-tissue reconstruction included muscle flaps (n=2) and skin grafts (n=5). No major wound complications occurred. Post-operative functional and cosmetic outcomes were acceptable. A single patient demonstrated local recurrence 12 months after surgery and re-excision of the tumor was performed. All patients remained alive at the conclusion of follow-up, with a mean follow-up time of 26 months (range, 12–36 months). The present study demonstrated that NPWT is effective and safe when used as an adjunct to wound closure following resection of extremity STS with ulceration/impending ulceration. PMID:27347212

  9. Venous sinus occlusive disease: MR findings

    SciTech Connect

    Yuh, W.T.C.; Simonson, T.M.; Tali, E.T.; Fisher, D.J. ); Wang, A.M. ); Koci, T.M. ); Simon, J.H. ); Jinkins, J.R. ); Tsai, Fong )

    1994-02-01

    To study MR patterns of venous sinus occlusive disease and to relate them to the underlying pathophysiology by comparing the appearance and pathophysiologic features of venous sinus occlusive disease with those of arterial ischemic disease. The clinical data and MR examinations of 26 patients with venous sinus occlusive disease were retrospectively reviewed with special attention to mass effect, hemorrhage, and T2-weighted image abnormalities as well as to abnormal parenchymal, venous, or arterial enhancement after intravenous gadopentetate dimeglumine administration. Follow-up studies when available were evaluated for atrophy, infraction, chronic mass effect, and hemorrhage. Mass effect was present in 25 of 26 patients. Eleven of the 26 had mass effect without abnormal signal on T2-weighted images. Fifteen patients had abnormal signal on T2-weighted images, but this was much less extensive than the degree of brain swelling in all cases. No patient showed abnormal parenchymal or arterial enhancement. Abnormal venous enhancement was seen in 10 of 13 patients who had contrast-enhanced studies. Intraparenchymal hemorrhage was seen in nine patients with high signal on T2-weighted images predominantly peripheral to the hematoma in eight. Three overall MR patterns were observed in acute sinus thrombosis: (1) mass effect without associated abnormal signal on T2-weighted images, (2) mass effect with associated abnormal signal on T2-weighted images and/or ventricular dilatation that may be reversible, and (3) intraparenchymal hematoma with surrounding edema. MR findings of venus sinus occlusive disease are different from those of arterial ischemia and may reflect different underlying pathophysiology. In venous sinus occlusive disease, the breakdown of the blood-brain barrier (vasogenic edema and abnormal parenchymal enhancement) does not always occur, and brain swelling can persist up to 2 years with or without abnormal signal on T2-weighted images. 34 refs., 5 figs.

  10. Impending ionospheric anomaly preceding the Iquique Mw8.2 earthquake in Chile on 2014 April 1

    NASA Astrophysics Data System (ADS)

    Guo, Jinyun; Li, Wang; Yu, Hongjuan; Liu, Zhimin; Zhao, Chunmei; Kong, Qiaoli

    2015-12-01

    To investigate the coupling relationship between great earthquake and ionosphere, the GPS-derived total electron contents (TECs) by the Center for Orbit Determination in Europe and the foF2 data from the Space Weather Prediction Center were used to analyse the impending ionospheric anomalies before the Iquique Mw8.2 earthquake in Chile on 2014 April 1. Eliminating effects of the solar and geomagnetic activities on ionosphere by the sliding interquartile range with the 27-day window, the TEC analysis results represent that there were negative anomalies occurred on 15th day prior to the earthquake, and positive anomalies appeared in 5th day before the earthquake. The foF2 analysis results of ionosonde stations Jicamarca, Concepcion and Ramey show that the foF2 increased by 40, 50 and 45 per cent, respectively, on 5th day before the earthquake. The TEC anomalous distribution indicates that there was a widely TEC decrement over the epicentre with the duration of 6 hr on 15th day before the earthquake. On 5th day before the earthquake, the TEC over the epicentre increased with the amplitude of 15 TECu, and the duration exceeded 6 hr. The anomalies occurred on the side away from the equator. All TEC anomalies in these days were within the bounds of equatorial anomaly zone where should be the focal area to monitor ionospheric anomaly before strong earthquakes. The relationship between ionospheric anomalies and geomagnetic activity was detected by the cross wavelet analysis, which implied that the foF2 was not affected by the magnetic activities on 15th day and 5th day prior to the earthquake, but the TECs were partially affected by anomalous magnetic activity during some periods of 5th day prior to the earthquake.

  11. Anatomic considerations for central venous cannulation

    PubMed Central

    Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela

    2011-01-01

    Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225

  12. Venous angiomata: treatment with sclerosant foam.

    PubMed

    Pascarella, Luigi; Bergan, John J; Yamada, Clayton; Mekenas, Lisa

    2005-07-01

    Venous angiomata, or venous malformations, are often present at birth, although they may not be evident until later. They consist of a spongy tangle of veins, and these lesions usually vary in size. Treatment of venous angiomata is often requested for cosmetic reasons, but painful ulcerations, nerve compression, functional disability can command care. This presentation describes management using sclerosant foam as the treating agent. During a 30-month period ending March 2004, 1,321 patients were investigated for venous disorders at the Vein Institute of La Jolla. Fourteen (incidence 1%) were found to have venous angiomata (: nine women). The age range was 15-76 years (mean 30.8 +/- 18.6). Lesions were classified by the Hamburg system and were primarily venous, extratruncular in 12 patients and combined extratruncular and truncular in two patients. Eight patients, three males, had manifestations of lower extremity Klippel-Trenaunay (syndrome; six had only venous angiomas. Only 10 of the 14 patients were treated. All patients were studied by Doppler duplex examination. Selected lesions were chosen for helical computed tomographic studies. Magnetic resonance venography was also used to image the lesions, define the deep circulation, note connections with normal circulation, identify vessels for therapeutic access, and determine infiltration of the lesion into adjacent soft tissue. Foam was produced by the Tessari two syringes one three-way stopcock teclinique, with the air to Polidocanol ratio being 4 or 5 to 1. This was used at 1% or 2% concentration, specific for each patient. The SonoSite 190 plus Duplex Doppler was used for ultrasound guidance, whenever deep access was required and to monitor progress and effects of treatment. A goal was set for each patient before treatment was begun. Ten patients were treated, and four await treatment. The mean number of treatments was 3.6 +/- 2.8 (range 1-10). A primary goal of pain-free healing was set in patients with

  13. Cerebral venous thrombosis in ulcerative colitis

    PubMed Central

    Menon, Bindu; Goyal, Rajeev; Nihal, Lalit; Reddy, Rajasekhar

    2013-01-01

    Ulcerative colitis has been reported to show hyper coagulation leading to peripheral and rarely central thrombosis. A 35-year-old female was admitted with chief complaints of increased frequency of bloody diarrhea, abdominal pain, and weight loss for 2 months. The patient was diagnosed to have ulcerative colitis after sigmoidoscopy and biopsy and she was started on treatment. Two days later, the patient developed headache and seizures. Magnetic resonance imaging of brain showed cerebral venous thrombosis with venous infarcts. A high index of clinical suspicion is needed to diagnose this uncommon condition so that appropriate treatment can be initiated. PMID:23546367

  14. ASSESSMENT OF VENOUS THROMBOSIS IN ANIMAL MODELS

    PubMed Central

    SP, Grover; CE, Evans; AS, Patel; B, Modarai; P, Saha; A, Smith

    2016-01-01

    Deep vein thrombosis and common complications, including pulmonary embolism and post thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro computed tomography and high frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition. PMID:26681755

  15. Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes

    MedlinePlus

    ... Membership Directory (SIR login) Interventional Radiology Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes People with ... without surgery by an interventional radiologist. Central Venous Access Catheters (CVAC) A CVAC is a tube that ...

  16. Current Status of the Application of Intracranial Venous Sinus Stenting

    PubMed Central

    Xu, Kan; Yu, Tiecheng; Yuan, Yongjie; Yu, Jinlu

    2015-01-01

    The intracranial venous sinus is an important component of vascular disease. Many diseases involve the venous sinus and are accompanied by venous sinus stenosis (VSS), which leads to increased venous pressure and high intracranial pressure. Recent research has focused on stenting as a treatment for VSS related to these diseases. However, a systematic understanding of venous sinus stenting (VS-Stenting) is lacking. Herein, the literature on idiopathic intracranial hypertension (IIH), venous pulsatile tinnitus, sinus thrombosis, high draining venous pressure in dural arteriovenous fistula (AVF) and arteriovenous malformation (AVM), and tumor-caused VSS was reviewed and analyzed to summarize experiences with VS-Stenting as a treatment. The literature review showed that satisfactory therapeutic effects can be achieved through stent angioplasty. Thus, the present study suggests that selective stent release in the venous sinus can effectively treat these diseases and provide new possibilities for treating intracranial vascular disease. PMID:26516306

  17. Innovative technique: Distal venous cannulation for salvaging free flap venous thrombosis by heparinised saline irrigation

    PubMed Central

    Kalra, G. D. S.; Mohanty, Devidutta; Jain, Ritesh

    2015-01-01

    Introduction: Successful free tissue transfer depends on a multitude of factors, and adequate drainage of venous blood is one of the most critical part of successful free tissue transfers. Material and Methods: We report 6 cases of microvascular free flaps used for covering various defects, which developed venous congestion, that were salvaged with heparinised saline irrigation through the distal end of the congested vein by the help of an intravenous cannula. The irrigation was continued for 5 days. Results: All the flaps were successfully salvaged. Conclusion: This method has potential applications in situations for successful salvage of free tissue transfer particularly due to venous thrombosis. PMID:25991887

  18. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a...

  19. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  20. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  1. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  2. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  3. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  4. Estimating venous admixture using a physiological simulator.

    PubMed

    Hardman, J G; Bedforth, N M

    1999-03-01

    Estimation of venous admixture in patients with impaired gas exchange allows monitoring of disease progression, efficacy of interventions and assessment of the optimal inspired oxygen fraction. A pulmonary artery catheter allows accurate measurement, although the associated risks preclude its use solely for estimation of venous admixture. Non-invasive methods require assumed values for physiological variables. Many of the required data (e.g. haemoglobin concentration (Hb), base excess, inspired oxygen fraction, arterial oxygen (PaO2) and carbon dioxide (PaCO2) tensions, temperature) are available routinely in the intensive therapy unit. We have compared a typical iso-shunt-style estimation of venous admixture (assuming Hb, base excess, PaCO2 and temperature), and estimation using the Nottingham physiology simulator (NPS), with measured data. When the arteriovenous oxygen content difference (CaO2-CvO2) was assumed to be 50 ml litre-1, the 95% limits of agreement (LA95%) for venous admixture using the NPS were -3.9 +/- 8.5% and using an iso-shunt-style calculation, -6.4 +/- 10.6%. CaO2-CvO2 was 41.1 ml litre-1 in the patients studied, consistent with previous studies in the critically ill. When CaO2-CvO2 was assumed to be 40 ml litre-1, LA95% values were 0.5 +/- 8.2% and -2.1 +/- 10.1%, respectively. PMID:10434813

  5. Venous air embolism during a craniofacial procedure.

    PubMed

    Phillips, R J; Mulliken, J B

    1988-07-01

    The possibility of venous air embolism exists whenever the craniofacial operative field is above the level of the heart. Craniotomy with the high-torque craniotome is hypothesized to have produced venous air embolism in the patient described in this report. The diagnosis of venous air embolism is determined by transesophageal Doppler probe, transesophageal echocardiogram or external echocardiogram, and end-tidal N2 and CO2 determinations. Treatment includes control of the air entry sites, aspiration of air from the right atrium via a catheter placed prior to operation, and discontinuing nitrous oxide. If these measures are unsuccessful, the operative field should be transposed below heart level and the procedure terminated. In the event of significant hemodynamic compromise, closed cardiac massage should be tried; if that fails, open cardiac massage and direct aspiration are necessary. The true incidence of venous air embolism in craniofacial operations may be much higher than previously suspected. We therefore recommend placement of appropriate monitoring equipment to detect intracardiac air in those major craniofacial procedures in which there is a potential for intravascular air ingress. PMID:3289061

  6. Thrombotic Venous Diseases of the Liver

    PubMed Central

    Sabol, Timothy P.; Molina, Marco; Wu, George Y.

    2015-01-01

    Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges. The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems. PMID:26623265

  7. Nonclinical aspects of venous thrombosis in pregnancy.

    PubMed

    Struble, Evi; Harrouk, Wafa; DeFelice, Albert; Tesfamariam, Belay

    2015-09-01

    Pregnancy is a hypercoagulable state which carries an excess risk of maternal venous thrombosis. Endothelial injury, alterations in blood flow and activation of the coagulation pathway are proposed to contribute to the hypercoagulability. The risk for thrombosis may be accentuated by certain drugs and device implants that directly or indirectly affect the coagulation pathway. To help ensure that these interventions do not result in adverse maternal or fetal outcomes during pregnancy, gravid experimental animals can be exposed to such treatments at various stages of gestation and over a dosage range that would identify hazards and inform risk assessment. Circulating soluble biomarkers can also be evaluated for enhancing the assessment of any increased risk of venous thrombosis during pregnancy. In addition to traditional in vivo animal testing, efforts are under way to incorporate reliable non-animal methods in the assessment of embryofetal toxicity and thrombogenic effects. This review summarizes hemostatic balance during pregnancy in animal species, embryofetal development, biomarkers of venous thrombosis, and alterations caused by drug-induced venous thrombosis. PMID:26404176

  8. PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ORTHOPAEDIC SURGERY

    PubMed Central

    Leme, Luiz Eugênio Garcez; Sguizzatto, Guilherme Turolla

    2015-01-01

    The relevance of prophylaxis of venous thromboembolism and its complications in orthopedic surgery is increasingly significant. This review discusses the pathophysiology of thrombus formation in general and orthopedic surgery, its incidence, predisposing factors and complications. It also presents an updated presentation and critique of prophylaxis currently available in our environment. PMID:27047885

  9. [Arterial and venous microanastomoses in the rat].

    PubMed

    Gianaroli, L; Bufferli, M; Livani, M F

    1980-11-15

    Arterial and venous microvascular surgery for diameters smaller than 2 mm are shown with particular care. Some technical devices are put in evidence. Besides their statistical data the Authors present immediate and long term post-operative controls which are usually applied. The most frequent causes of failure are discussed. PMID:7213480

  10. Arterialized Venous Bone Flaps: An Experimental Investigation

    PubMed Central

    Borumandi, Farzad; Higgins, James P.; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander

    2016-01-01

    In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705

  11. Arterialized Venous Bone Flaps: An Experimental Investigation.

    PubMed

    Borumandi, Farzad; Higgins, James P; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander

    2016-01-01

    In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705

  12. Plethysmography without venous occlusion for measuring forearm blood flow: comparison with venous occlusive method.

    PubMed

    Chuah, Seong S; Woolfson, Peter I; Pullan, Brian R; Lewis, Philip S

    2004-09-01

    Limb blood flow is widely used as an indicator of the human vascular properties. There are only few non-invasive methods for its measurement such as venous occlusion plethysmography. However, several authors have questioned its validity. The problems appear to be related to the process of venous occlusion. We developed two methods to measure forearm blood flow by plethysmography without venous occlusion in combination with Doppler velocimetry (without imaging). Method 1: the gradient of a tangent drawn on the latter part of the down stroke of the plethysmographic volume pulse is an approximation of venous blood flow in the absence of diastolic blood flow. At equilibrium, it equals the average arterial flow in a cardiac cycle. The Doppler velocity waveform recorded simultaneously allows improvement of this approximation when there is diastolic blood flow. Method 2: the volume pulse detected by a plethysmograph calibrated in absolute volume is used to calibrate the velocity waveform recorded simultaneously to produce an approximation of arterial volumetric flow waveform. Bland-Altman analysis shows both methods have good correlation and agreement with venous occlusion plethysmography at rest. Method 1: mean difference (blood flow measured by venous occlusion minus calculated flow) = 0.10 ml/pulse (+/-0.18), limits of agreement = -0.41 and 0.61 ml/pulse. Method 2: mean difference = -0.041 ml/pulse (+/-0.15), limits of agreement = -0.45 and 0.37 ml/pulse. During hyperaemia, venous occlusion plethysmography grossly underestimated relative to the new methods. The new methods are not dependent on venous occlusion and produce consistent results with or without hyperaemia. PMID:15383087

  13. To what extent might deep venous thrombosis and chronic venous insufficiency share a common etiology?

    PubMed

    Malone, P Colm; Agutter, P S

    2009-08-01

    According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration. PMID:19648868

  14. Venous Thrombosis in Handsewn vs. Coupled Venous Anastomoses in 857 Consecutive Breast Free Flaps

    PubMed Central

    Kulkarni, Anita R; Mehrara, Babak J; Pusic, Andrea L; Cordeiro, Peter G; Matros, Evan; McCarthy, Colleen M; Disa, Joseph J

    2016-01-01

    Background The Anastomotic Coupling Device has demonstrated safety and efficacy; however, the coupler has never been compared directly to handsewn venous anastomoses exclusively in breast reconstruction. We hypothesized that rates of venous thrombosis would be lower using the coupler versus handsewn anastomoses in free flap breast reconstruction. Methods We performed a retrospective review utilizing clinic records, hospital records, and operative reports for 857 consecutive breast free flaps at a single institution from 1997-2012. Data was collected on reconstruction type, recipient vessels, timing, laterality, preoperative radiation, chemotherapy, venous thrombosis, and flap outcome. We compared rates of venous thrombosis between handsewn and coupled anastomoses for breast free flaps. Chi square test was used to calculate statistical significance. Results A total of 857 consecutive free flaps were performed for breast reconstruction in 647 patients over 16 years. The venous anastomosis was handsewn in 303 flaps, and the anastomotic coupler was used in 554 flaps. The rate of venous thrombosis requiring anastomotic revision in the handsewn group was 0.04% (12/303), compared to 0.01% in the coupled group (8/554; p=0.02). Conclusion The anastomotic coupler was more effective in preventing venous thrombosis than handsewn anastomoses in our series. While our study demonstrates improved patency rates using the venous coupler in breast reconstruction, we were unable to definitively separate this finding from potential confounding variables due to the low rates of thrombosis in both groups. Our data is consistent with current literature, which suggests that the coupler is a safe and effective alternative to hand sutured anastomoses. PMID:26372685

  15. 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. PMID:25844137

  16. 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

  17. Partial Aortic Occlusion and Cerebral Venous Steal: Venous Effects of Arterial Manipulation in Acute Stroke

    PubMed Central

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

    2011-01-01

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

  18. Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement

    PubMed Central

    Eades, Shannan; Turiy, Yuliya

    2015-01-01

    OBJECTIVES: With the apparent increase in venous thromboembolism noted in the pediatric population, it is important to define which children are at risk for clots and to determine optimal preventative therapy. The purpose of this study was to determine the risk factors for venous thromboembolism in pediatric patients with central venous line placement. METHODS: This was an observational, retrospective, case-control study. Control subjects were patients aged 0 to 18 years who had a central venous line placed. Case subjects had a central line and a radiographically confirmed diagnosis of venous thromboembolism. RESULTS: A total of 150 patients were included in the study. Presence of multiple comorbidities, particularly the presence of a congenital heart defect (34.7% case vs. 14.7% control; p < 0.005), was found to put pediatric patients at increased risk for thrombosis. Additionally, the administration of parenteral nutrition through the central line (34.7% case vs. 18.7% control; p = 0.03) and location of the line increased the risk for clot formation. CONCLUSIONS: With increased awareness of central venous line–related thromboembolism, measures should be taken to reduce the number and duration of central line placements, and further studies addressing the need for thromboprophylaxis should be conducted. PMID:26472949

  19. Intestinal Infarction Caused by Thrombophlebitis of the Portomesenteric Veins as a Complication of Acute Gangrenous Appendicitis After Appendectomy

    PubMed Central

    Tang, Rui; Tian, Xiaodong; Xie, Xuehai; Yang, Yinmo

    2015-01-01

    Abstract The clinical symptoms of pylephlebitis caused by acute appendicitis are varied and atypical, which leads to delayed diagnosis and poor outcomes. Here, we report a case of intestinal necrosis caused by thrombophlebitis of the portomesenteric veins as a complication of acute appendicitis after appendectomy. The patient had acute abdominal pain with tenderness and melena on the 3rd day after appendectomy for the treatment of gangrenous appendicitis. He was diagnosed with intestinal infarction caused by thrombophlebitis of the portomesenteric veins based on enhanced CT and diagnostic abdominal paracentesis. The patient was treated by bowel excision anastomosis and thrombectomy. After postoperative antibiotic and anticoagulation treatments, the patient recovered well and was discharged 22 days after the 2nd operation. A follow-up CT scan showed no recurrence of portomesenteric veins thrombosis 3 months later. Thrombophlebitis of the portomesenteric veins is a rare but fatal complication of acute appendicitis. For all the cases with acute abdominal pain, the possibility of thrombophlebitis should be considered as a differential diagnosis. Once pylephlebitis is suspected, enhanced CT scan is helpful for early diagnosis, and sufficient control of inflammation as well as anticoagulant therapy should be performed. PMID:26091450

  20. A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

    PubMed Central

    Merali, N.; Almeida, R.A.R.; Hussain, A.

    2015-01-01

    Introduction We present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia. Presentation of case Our patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required. High dose intravenous broad-spectrum antibiotic treatment and Negative Pressure Wound Therapy (NPWT) was administrated in combination with adopting a multidisciplinary approach was key to our success. Discussion Stoppa Re et al. complied a series of 360 ventral hernia mesh repairs reporting an infection rate of 12% that were managed conservatively. However, our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with CLL. Recent modifications in mesh morphology, such as lower density, wide pores, and lighter weight has led to considerable improvements regarding infection avoidance. Conclusion This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair. PMID:26322822

  1. Investigation of the antibiotic resistance and biofilm formation of Staphylococcus aureus strains isolated from gangrenous mastitis of ewes.

    PubMed

    Tel, Osman Yaşar; Aslantaş, Ozkan; Keskin, Oktay; Yilmaz, Ebru Sebnem; Demir, Cemil

    2012-06-01

    In this study, Staphylococcus aureus strains (n = 110) isolated from seven ewe flocks in Sanliurfa, Turkey were screened for antibiotic resistance and biofilmforming ability as well as for genes associated with antibiotic resistance and biofilm-forming ability. All isolates were found to be susceptible to oxacillin, gentamicin, clindamycin, cefoxitin, tetracycline, vancomycin, amoxicillin-clavulanic acid, ciprofloxacin and sulphamethoxazole-trimethoprim. The percent proportions of strains resistant to penicillin G, ampicillin and erythromycin were 27.2% (n = 30), 25.4% (n = 28) and 6.3% (n = 7), respectively. Regarding the antibiotic resistance genes, 32 (29%) isolates carried the blaZ and 8 (7.2%) the ermC gene. Other resistance genes were not detected in the isolates. All isolates showed biofilm-forming ability on Congo red agar (CRA), while 108 (98.18%) and 101 (91.81%) of them were identified as biofilm producers by the use of standard tube (ST) and microplate (MP) methods, respectively. All isolates carried the icaA and icaD genes but none of them harboured the bap gene. The results demonstrated that S. aureus isolates from gangrenous mastitis were mainly resistant to penicillins (which are susceptible to the staphylococcal beta-lactamase enzyme), and less frequently to erythromycin. Furthermore, all of the S. aureus isolates produced biofilm which was considered a potential virulence factor in the pathogenesis of staphylococcal mastitis. PMID:22609990

  2. Greater forearm venous compliance in resistance-trained men.

    PubMed

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

    2010-11-01

    Greater venous compliance is associated with attenuation of the tolerance response to orthostatic stress and reduced incidence of venous diseases. Resistance training induces tolerance to orthostatic challenge and the growth of capillaries, which may lead to negative and positive effects on venous compliance, respectively. It has not been confirmed, however, whether habitual resistance training positively or negatively affects venous compliance. We compared the forearm venous compliance in resistance-trained men with age-matched controls. Eleven resistance-trained middle-aged men (37.7 ± 1.5 years) and 12 age-matched sedentary controls (36.7 ± 1.6 years) were studied. Forearm venous compliance was measured in subjects in the supine position by inflating a venous collecting cuff placed around the upper arm to 60 mmHg for 8 min and then decreasing cuff pressure to 0 mmHg at a rate of 1 mmHg/s. Forearm venous compliance was determined using the first derivative of the pressure-volume relation during cuff pressure reduction (compliance = β(1) + 2β(2) × cuff pressure). Forearm venous compliance at 20 mmHg cuff pressure was 16% greater in the resistance-trained group than in the age-matched sedentary controls (0.097 ± 0.005 vs. 0.083 ± 0.004 ml/dl/mmHg, P < 0.05). Forearm venous compliance was positively related to forearm venous volume (r = 0.643, P = 0.0009), but not forearm muscle mass (r = 0.391, P = 0.0648). In conclusion, the present study suggests that (1) the resistance-trained men have greater forearm venous compliance than age-matched controls, and (2) the higher forearm venous compliance in the resistance-trained men may be explained by greater forearm venous capacitance. PMID:20596725

  3. The influence of intramedullary nailing upon the development of metastases in the treatment of an impending pathological fracture: an experimental study.

    PubMed

    Bouma, W H; Mulder, J H; Hop, W C

    1983-01-01

    An experimental model has been developed in which the effects of a pathological fracture and intramedullary nailing on metastatic spread have been investigated. The endpoint used was the production of lung metastases in rats inoculated intracortically with a rhabdomyosarcoma. We have found that a pathological fracture markedly increases the incidence of lung metastases and that intramedullary nailing, by decreasing the incidence of fractures, decreases the incidence of lung metastases. The surgical procedure itself does not increase the incidence significantly. It is concluded that in metastatic disease prophylactic nailing of an impending pathological fracture is the treatment of choice. PMID:6546199

  4. Deep venous thrombophlebitis following aortoiliac reconstructive surgery

    SciTech Connect

    Reilly, M.K.; McCabe, C.J.; Abbott, W.M.; Brewster, D.C.; Moncure, A.C.; Reidy, N.C.; Darling, R.C.

    1982-09-01

    One hundred patients undergoing elective aortic surgery were scanned prospectively for development of deep venous thrombosis (DVT). The incidence of DVT in this population was 13%. Eleven patients showed only calf vein thrombosis on venography, whereas two had occlusive iliofemoral thrombus. The correlation between venous Doppler ultrasound and venography was 80%. More importantly, Doppler examination correctly identified both patients with occlusive thrombus. Fibrinogen scanning was associated with a false-positive rate of 31%. Only one patient suffered a nonfatal pulmonary embolus. Fibrinogen scanning has an unacceptably high false-positive rate; however, Doppler ultrasound will identify significant occlusive thrombus without a high false-positive rate. The low incidence of pulmonary emboli does not warrant such definitive measures as prophylactic vena caval interruption.

  5. Navigating venous access: a guide for hospitalists.

    PubMed

    Simonov, Michael; Pittiruti, Mauro; Rickard, Claire M; Chopra, Vineet

    2015-07-01

    Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. However, such knowledge is difficult to come by and usually only gleaned through years of clinical experience. To bridge this gap, we provide an in-depth summary of the relevant anatomical considerations, physical characteristics, advantages, and disadvantages of VADs commonly used in the hospital setting. In doing so, we seek to improve the safety and share the science of vascular access with frontline clinicians. To aid decision-making, we conclude by operationalizing the available data through algorithms that outline appropriate vascular access for the hospitalized patient. PMID:25755150

  6. Intracranial venous thrombosis complicating oral contraception

    PubMed Central

    Dindar, F.; Platts, M. E.

    1974-01-01

    Four days after the onset of a severe headache a 22-year-old woman who had been taking oral contraceptives for less than three weeks had a convulsion, followed by right hemiparesis. Other focal neurologic signs and evidence of raised intracranial pressure appeared, and she became comatose on the seventh day. A left craniotomy revealed extensive cerebral venous thrombosis. She died the next day. On postmortem examination extensive thrombosis of the superior sagittal sinus and draining cerebral veins, and multiple areas of cerebral hemorrhage and hemorrhagic infarction were seen. Some of the superficial cerebral veins showed focal necrosis of their walls, and the lateral lacunae of the superior sagittal sinus contained proliferating endothelial cells. The adrenal veins were also thrombosed. The significance of these findings is discussed. The literature on cerebrovascular complications of oral contraception, particularly cerebral venous thrombosis, is reviewed. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6 PMID:4413961

  7. What's new: Management of venous leg ulcers: Approach to venous leg ulcers.

    PubMed

    Alavi, Afsaneh; Sibbald, R Gary; Phillips, Tania J; Miller, O Fred; Margolis, David J; Marston, William; Woo, Kevin; Romanelli, Marco; Kirsner, Robert S

    2016-04-01

    Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing. PMID:26979354

  8. [Implantable venous access ports, nursing practices].

    PubMed

    Ourliac, Maryse; Dijols-Lécuyer, Isabelle

    2016-05-01

    Following the publication of national recommendations regarding the handling of implantable venous access ports, an observation audit was carried out in a hospital in 2013. This enabled an assessment of the existing system to be performed, current practices to be compared with the hospital's protocol and adapted corrective measures to be put in place. A further audit carried out in 2015 was particularly encouraging. PMID:27157553

  9. Venous air embolus during scalp incision.

    PubMed

    Spence, Nicole Z; Faloba, Kathryn; Sonabend, Adam M; Bruce, Jeffrey N; Anastasian, Zirka H

    2016-06-01

    Venous air embolism (VAE) is a known complication of sitting craniotomy. Clinical consequences of VAE can range from tachypnea to cardiovascular collapse. The entrainment of air typically occurs during bone work, but we describe a case in which a VAE was recognized while working on the scalp. Monitoring techniques are critical for early treatment of VAE to avoid more serious complications, and our case illustrates the need to implement monitors early and remain vigilant throughout the procedure. PMID:26765767

  10. Fluid dynamics of venous valve closure.

    PubMed

    Qui, Y; Quijano, R C; Wang, S K; Hwang, N H

    1995-01-01

    In vitro experiment was performed on a stented bovine jugular vein valve (VV, 14 mm I.D. x 2 cm long) and a stentless bovine jugular vein valve conduit (10 mm I.D. x 6 cm long) in a hydraulic flow loop with a downstream oscillatory pressure source to mimic respiratory changes. Simultaneous measurements were made on the valve opening area, conduit and sinus diameter changes using a specially designed laser optic system. Visualization of flow fields both proximal and distal to the venous valve, and the valve opening area were simultaneously recorded by using two video cameras. Laser Doppler anemometer surveys were made at three cross sections: the valve inlet, the valve exist, and 2 cm downstream of the venous valve to quantity flow reflux at valve closure. The experiment confirmed that the VV is a pressure-operated rather than a flow-driven device and that little or no reflux is needed to close the valve completely. The experiment further demonstrated that the VV sinus expands rapidly against back pressure, a critical character to consider in venous prosthesis design. PMID:8572425

  11. [Retinal venous obliteration and general pathology].

    PubMed

    Aconiu, M; Mihălaş, G; Nemoianu, C

    1992-01-01

    The study of 148 retinal venous obliterations have shown 81 occlusions of central vein and 67 of I and II venous branch. A number of 90 was for the feminine gender (sex) and 59 for the masculine sex. The average age for the appearance of the venous occlusions was 62 years old, having extreme limits between 36-84 years old. Bilaterality has been for 3 cases. Concerning the associated medical affections, hypertension was for 67 patients, myocardiosclerosis have been mentioned for 67 patients, atherosclerosis for 21 patients, pulmonary scleroemphisis for 12 patients. Arterial hypertension with its aspersion that is arteriosclerosis are the main factors that have generated retinal circulation modifyings and have led to a degree of arterial insufficiency. Comparing the ophthalmological aspect to the pressure in the ophthalmic artery, most of the patients had a concordance of TACR and the retinal and choroidal angiosclerosis. The oscillometric examination to the inferior members has been effectuated for 21 patients and it has shown diminished values only for 3 cases. The forecast of the disease is still reserved. Following a group of 40 patients having OVR between 5 and 15 years old it has been established an average survival of 6.2 years. It is mentioned that 26% between these have dyed during the first six years. PMID:1520668

  12. [Management of venous thromboembolism: A 2015 update].

    PubMed

    Galanaud, J-P; Messas, E; Blanchet-Deverly, A; Quéré, I; Wahl, D; Pernod, G

    2015-11-01

    Deep venous thrombosis (DVT) and pulmonary embolism (PE) constitute venous thromboembolic disease (VTE). Venous thromboembolic disease is a common, serious, and multifactorial disease, the incidence of which increases with age. Risk factors, whether transient (surgery, plaster immobilization, bed rest/hospitalization) or chronic/persistent (age, cancer, clinical or biological thrombophilia, etc.), modulate the duration of treatment. In the absence of pathognomonic clinical sign or symptom, diagnostic management relies in the evaluation of the clinical pre-test probability followed by a laboratory or an imaging testing. So far, compression ultrasound and multidetector computed tomography angiography are the best diagnostic tests to make a positive diagnosis of DVT or PE, respectively. Anticoagulants at therapeutic dose for at least 3months constitute the cornerstone of VTE management. Availability of new direct oral anticoagulants, which have recently been shown to be as effective and as safe as vitamin K antagonist in clinical trials, should facilitate ambulatory management of VTE and favour extended treatments for individuals with unprovoked VTE or VTE provoked by a chronic/persistent risk factor. PMID:26235049

  13. [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

  14. The venous drainage of the human myocardium.

    PubMed

    von Lüdinghausen, M

    2003-01-01

    New cardiological techniques such as coronary sinus catheterization and selective catheterization of the cardiac veins permit the opening of new experimental and clinical fields, for instance in venous angiography and the reverse nourishment of myocardium which is endangered by ischemia,and also in the electrophysiological study of the components of the conduction system. New approaches in heart surgery, such as the removal of accessory pathways of the conduction system (as in WPW syndrome), necessitate the realization of the topographical relationships of the vessels in the various sections of the coronary sulci in a different way. The objective of this work is, therefore, to present comprehensive and almost new macro- and microanatomical data about the venous drainage of the myocardium via the coronary sinus and its related and unrelated (non-coronary) cardiac veins. Examination of meticulously dissected heart specimens (of individuals who had achieved old or extreme old age at the time of their death in Germany: n=250) as well as corrosion casts of adult cardiac vessels (of individuals of all ages, n=25) formed the basis for the exact description and documentation of the occurrence, frequency, origin, and courses of both the normal and anomalously developed human coronary sinus and cardiac veins. A wide range of morphological and experimental references was consulted in order to enable thorough discussion of the anatomical findings in the light of modern cardiological diagnostics and treatment. The anatomical and clinical nomenclature is presented and there is a brief comment on modern diagnostic techniques and their applications where the cardiac veins are concerned. The two principal and one compound cardiac venous system are defined and discussed with reference to the existence of both the normal and anomalous coronary sinus and cardiac vein. 1. The greater (major) cardiac venous system (2) The smaller (minor) cardiac venous system (3)The compound cardiac

  15. 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 β-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

  16. Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access

    PubMed Central

    Siddiqui, Adeel M; Harris, Gregory S; Movahed, Assad; Chiang, Karl S; Chelu, Mihail G; Nekkanti, Rajasekhar

    2015-01-01

    The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker. PMID:26380831

  17. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence.

    PubMed

    Lee, Byung B; Nicolaides, Andrew N; Myers, Kenneth; Meissner, Mark; Kalodiki, Evi; Allegra, Claudio; Antignani, Pier L; Bækgaard, Niels; Beach, Kirk; Belcaro, Giovanni; Black, Stephen; Blomgren, Lena; Bouskela, Eliete; Cappelli, Massimo; Caprini, Joseph; Carpentier, Patrick; Cavezzi, Attilio; Chastanet, Sylvain; Christenson, Jan T; Christopoulos, Demetris; Clarke, Heather; Davies, Alun; Demaeseneer, Marianne; Eklöf, Bo; Ermini, Stefano; Fernández, Fidel; Franceschi, Claude; Gasparis, Antonios; Geroulakos, George; Sergio, Gianesini; Giannoukas, Athanasios; Gloviczki, Peter; Huang, Ying; Ibegbuna, Veronica; Kakkos, Stavros K; Kistner, Robert; Kölbel, Tilo; Kurstjens, Ralph L; Labropoulos, Nicos; Laredo, James; Lattimer, Christopher R; Lugli, Marzia; Lurie, Fedor; Maleti, Oscar; Markovic, Jovan; Mendoza, Erika; Monedero, Javier L; Moneta, Gregory; Moore, Hayley; Morrison, Nick; Mosti, Giovanni; Nelzén, Olle; Obermayer, Alfred; Ogawa, Tomohiro; Parsi, Kurosh; Partsch, Hugo; Passariello, Fausto; Perrin, Michel L; Pittaluga, Paul; Raju, Seshadri; Ricci, Stefano; Rosales, Antonio; Scuderi, Angelo; Slagsvold, Carl E; Thurin, Anders; Urbanek, Tomasz; M VAN Rij, Andre; Vasquez, Michael; Wittens, Cees H; Zamboni, Paolo; Zimmet, Steven; Ezpeleta, Santiago Z

    2016-06-01

    There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein

  18. Secular trends in occurrence of acute venous thromboembolism: the Worcester venous thromboembolism study (1985 to 2009)

    PubMed Central

    Huang, Wei; Goldberg, Robert J.; Anderson, Frederick A.; Kiefe, Catarina I; Spencer, Frederick A.

    2014-01-01

    BACKGROUND The clinical epidemiology of venous thromboembolism has changed recently due to advances in identification, prophylaxis, and treatment. We sought to describe secular trends in occurrence of venous thromboembolism among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA). METHODS Population-based methods were used to monitor trends in event rates of first-time or recurrent venous thromboembolism in 5025 WMSA residents diagnosed with acute pulmonary embolism and/or lower-extremity deep vein thrombosis during 9 annual periods between 1985 and 2009. Medical records were reviewed by abstractors and validated by clinicians. RESULTS Age- and sex-adjusted annual event rates for first-time venous thromboembolism increased from 73 (95% CI 64–82) per 100,000 in 1985/1986 to 133 (122–143) in 2009, due mostly to an increase in pulmonary embolism. The rate of recurrent venous thromboembolism decreased from 39 (32–45) in 1985/1986 to 19 (15–23) in 2003, and then increased to 35 (29–40) in 2009. There was an increasing trend in using non-invasive diagnostic testing, with about half of tests being invasive in 1985/1986 and almost all non-invasive by 2009. CONCLUSIONS Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the annual event rate of venous thromboembolism has increased and remains high. While these increases may be partially due to increased sensitivity of diagnostic methods, especially for pulmonary embolism, it may also imply that current prevention and treatment strategies are less than optimal. PMID:24813864

  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. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    ERIC Educational Resources Information Center

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  1. [Venous thrombosis associated with central venous catheter use in patients with cancer].

    PubMed

    Iglesias Rey, Leticia; Fernández Pérez, Isaura; Barbagelata López, Cristina; Rivera Gallego, Alberto

    2015-01-01

    The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment. PMID:25771092

  2. What's new: Management of venous leg ulcers: Treating venous leg ulcers.

    PubMed

    Alavi, Afsaneh; Sibbald, R Gary; Phillips, Tania J; Miller, O Fred; Margolis, David J; Marston, William; Woo, Kevin; Romanelli, Marco; Kirsner, Robert S

    2016-04-01

    Venous leg ulcers account for approximately 70% of all leg ulcers and affect 2.2 million Americans annually. After a comprehensive patient and wound assessment, compression therapy remains the cornerstone of standard care. Adjuvant care with topical or systemic agents is used for wounds that do not heal within 4 weeks. Once healed, long-term compression therapy with stockings or surgical intervention will reduce the incidence of recurrence. This continuing medical education article aims to outline optimal management for patients with venous leg ulcers, highlighting the role of a multidisciplinary team in delivering high quality care. PMID:26979355

  3. Magnetic resonance angiography in the diagnosis of thoracic venous obstruction.

    PubMed

    Chang, Y C; Su, C T; Yang, P C; Wang, T C; Chiu, L C; Hsu, J C

    1998-01-01

    The aims of this study were to evaluate the diagnostic value of orthogonal magnetic resonance angiography (MRA) and to compare the results of MRA with those of digital subtraction venography (DSV) in thoracic venous diseases. Ten normal volunteers were evaluated using two-dimensional time-of-flight MRA in three orthogonal planes to determine the image quality of each venous segment. Twelve consecutive patients suspected of having thoracic venous disease were studied with both MRA and DSV. In the normal subjects, the plane perpendicular to the target vein provided the most consistent visualization. Using three orthogonal MRA images, a diagnostic-quality image was obtained in 175 (83%) of 210 venous segments in normal volunteers. In patients with thoracic venous obstructive disease, MRA was more effective than DSV in detecting total (84 vs 54), patent (56 vs 36), stenotic (13 vs 10), and obstructive (15 vs 8) venous segments, poststenotic or postobstructive veins (15 vs 10), thrombosis of the internal jugular vein (7 vs 2), intraluminal thrombus (5 vs 3), and azygos veins (12 vs 2). Using venous segments visible on DVS (n = 54) as the standard, the sensitivity and specificity of MRA were 94% and 100%, respectively, in detecting venous patency, and 100% and 98% in detecting complete venous obstruction. In the shoulder region, the sensitivity and specificity of MRA were 93% and 100%, respectively, in detecting venous patency, and 100% and 97% in detecting venous obstruction. We conclude that MRA with three orthogonal planes can provide relatively complete and reliable venous mapping, without the need for contrast medium. PMID:9481063

  4. Venous Leg Ulcer in a Sarcoidosis Patient: A Case Report

    PubMed Central

    Ohn, Jungyoon; Byun, Sang Young; Kim, In Su

    2015-01-01

    Venous leg ulcers, the most common form of leg ulcers, are relevant to the pathogenicity of pericapillary fibrin cuff. Sarcoidosis, a multiorgan granulomatous disease, causes fibrin deposition in tissues. We report a case of a 50-year-old man with venous leg ulcers coexisting with sarcoidosis. On the basis of the histologic findings, we propose the hypothesis that sarcoidosis patients are prone to the development of venous leg ulcers. PMID:26719645

  5. Unusual venous drainage of face: a case report.

    PubMed

    Maskey, Dhiraj; Baral, Prakash; Kuwar, Ram Bahadur; Rai, Dilip; Dhungel, Shaligram; Jha, Chandra Bhusan; Bhattacharya, Sounmya

    2006-12-01

    Facial region has enormous blood supply. The maxillary vein, facial vein and superficial temporal vein are chief venous draining channels. There are numerous reports of unusual venous system of face, in the present case, retromandibular vein divides into anterior and posterior division soon after its formation, external carotid artery lying lateral to retromandibular vein, formation of common venous channel between internal jugular vein and anterior jugular vein where facial, lingual and submental vein drain. PMID:17357652

  6. Cerebral Venous Air Embolism Secondary to Mesenteric Infarction

    PubMed Central

    Tamura, Aileen; Matsuda, Brent; Leo, Qi Jie Nicholas; Sung, Hiro

    2016-01-01

    Cerebral air embolism is a rare, yet potentially fatal condition. We present a case of retrograde cerebral venous air emboli arising from the hepatic portal venous system, secondary to a mesenteric infarction. A 69-year-old man with a history of gastrointestinal amyloidosis presented with fever and lethargy. Computed tomography of the brain detected multiple foci of air in the right frontal, fronto-parietal, and left lateral frontal sulci consistent with cerebral venous air emboli. Computed tomography of the abdomen and pelvis revealed moderate thickening and dilatation of the small bowel with diffuse scattered intestinal pneumatosis suggestive of mesenteric infarction with resultant extensive intrahepatic portal venous air. The patient was deemed a poor candidate for surgical intervention and died as a result of septic shock. We believe the cerebral venous air emboli was a result of retrograde flow of air arising from the hepatic venous air ascending via the inferior and superior vena cava to the cerebral venous system. To our knowledge, there have been no reported cases of retrograde cerebral venous air embolism arising from hepatic portal venous system secondary to mesenteric infarction. The clinical significance and prognosis in this setting requires further investigation. PMID:27239392

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

    PubMed

    Chatterjee, Sasanka S

    2012-05-01

    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

  8. 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

  9. Impact of Jugular Vein Valve Function on Cerebral Venous Haemodynamics.

    PubMed

    Toro, Eleuterio F; Muller, Lucas O; Cristini, Mariapaola; Menegatti, Erica; Zamboni, Paolo

    2015-01-01

    We quantify the effect of internal-jugular vein function on intracranial venous haemodynamics, with particular attention paid to venous reflux and intracranial venous hypertension. Haemodynamics in the head and neck is quantified by computing the velocity, flow and pressure fields, and vessel cross-sectional area in all major arteries and veins. For the computations we use a global, closed-loop multi-scale mathematical model for the entire human circulation, recently developed by the first two authors. Validation of the model against in vitro and in vivo Magnetic Resonance Imaging (MRI) measurements have been reported elsewhere. Here, the circulation model is equipped with a sub-model for venous valves. For the study, in addition to a healthy control, we identify two venous-valve related conditions, namely valve incompetence and valve obstruction. A parametric study for subjects in the supine position is carried out for nine cases. It is found that valve function has a visible effect on intracranial venous haemodynamics, including dural sinuses and deep cerebral veins. In particular, valve obstruction causes venous reflux, redirection of flow and intracranial venous hypertension. The clinical implications of the findings are unknown, though they may relate to recent hypotheses linking some neurological conditions to extra-cranial venous anomalies. PMID:26256005

  10. Direct oral anticoagulants and venous thromboembolism.

    PubMed

    Franchini, Massimo; Mannucci, Pier Mannuccio

    2016-09-01

    Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g. dabigatran etexilate). This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE. PMID:27581829

  11. Role of Tissue Factor in Venous Thrombosis

    PubMed Central

    Manly, David A.; Boles, Jeremiah; Mackman, Nigel

    2011-01-01

    Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide. However, the mechanisms by which clots are formed in the deep veins have not been determined. Tissue factor (TF) is the primary initiator of the coagulation cascade and is essential for hemostasis. Under pathological conditions, TF is released into the circulation on small-membrane vesicles termed microparticles (MPs). Recent studies suggest that elevated levels of MPTF may trigger thrombosis. This review provides an overview of the role of TF in VTE. PMID:20690821

  12. Cerebral venous thrombosis revealing an ulcerative colitis

    PubMed Central

    Taous, Abdellah; Berri, Maha Aït; Lamsiah, Taoufik; Zainoun, Brahim; Ziadi, Tarik; Rouimi, Abdelhadi

    2016-01-01

    Cerebral venous thrombosis (CVT) has been reported as an uncommon and devastating complication of ulcerative colitis (UC), with an annual incidence varying between 0,5 to 6,7%. It is suspected to be a consequence of the hypercoagulable state occurring during disease relapse. We report a case of 22-year-old female patient presenting with CVT revealing an UC. Our case raises the awareness among health professionals about the inflammatory bowel diseases (IBD) as a rare etiology of CVT, and signifies the importance of considering antithrombotic prophylaxis in all hospitalised IBD patients, especially those with active disease. PMID:27279947

  13. [Phlebitogenicity of venous catheters of Vialon].

    PubMed

    Fassolt, A

    1985-12-01

    During three days 132 surgical patients with postoperative infusion treatment were checked on the frequency of venous reactions in the arms when catheters/cannulas of 4 different materials were used and the outcome compared. A significant result was obtained in connection with the I-cath catheter made of vialon (a polyurethanelike resin polymer) and the L-cath of polyurethane. Phlebitis was decreased to 27.3% resp. 24.2% - approximately half of its usual frequency - when I-cath of polyvinyl-chloride and FEP-teflon vasofix cannulas were applied (both 51.5%). The different predisposing factors of infusion phlebitis are under discussion. PMID:4093198

  14. Cerebral Venous Thrombosis in Paroxysmal Nocturnal Hemoglobinuria

    PubMed Central

    Meppiel, Elodie; Crassard, Isabelle; de Latour, Régis Peffault; de Guibert, Sophie; Terriou, Louis; Chabriat, Hugues; Socié, Gérard; Bousser, Marie-Germaine

    2015-01-01

    Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder of hematopoietic stem cells characterized by hemolytic anemia, marrow failure, and a high incidence of life-threatening venous thrombosis. Cerebral venous system is the second most frequent location of thrombosis after hepatic veins. However, data about PNH-related cerebral venous thrombosis (CVT) are very scarce because of the rarity of both the disorders. We report a French study about PNH patients with CVT. Patients were recruited retrospectively, from the Société Française d’Hématologie (SFH) registry of 465 patients with PNH; the Lariboisière registry of 399 patients with CVT; and a direct contact with 26 French Hematology Units. We review cases reported since 1938 in the English and French language literature. We then compared patients of our series with cases from the literature, with non-PNH-related CVT cases from Lariboisière registry, and with PNH patients without CVT from SFH registry. Fifteen patients were included between 1990 and 2012. Most patients were women (12/15) and half of them presented associated hormonal venous thrombosis risk factors. Three patients had concomitant hepatic vein thrombosis. CVT was the first manifestation of PNH in 4 patients. No major difference in CVT characteristics was found compared with non-PNH-related CVT cases, except for a younger age at diagnosis in PNH patients (P < 0.001). All patients were treated with anticoagulation therapy. One death occurred in acute stage. All surviving patients were independent 1 year after. Median survival time was 9 years. Recurrent thrombosis rate was 50% at 6 years, occurring in patients that did not have bone marrow transplantation or eculizumab therapy. Cases of death were mainly related to hepatic vein thrombosis. Prognosis of CVT was good in our series. However, these patients have a poor long-term prognosis due to PNH disease by itself. PNH treatment should be proposed as soon as possible to

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

    PubMed

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

    2016-02-01

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

  16. Menopausal hormone therapy and venous thromboembolism

    PubMed Central

    2014-01-01

    Menopausal hormone therapy (MHT) is the most effective method of treating vasomotor symptoms and other climacteric symptoms related to estrogen deficiency in peri- and postmenopausal period. In addition to estrogen replacement, women with preserved uterus require the addition of progestagen in order to ensure endometrial safety. One of rare but severe complications of MHT is venous thromboembolism (VTE). The incidence of VTE rises in parallel to women's age and body weight. The condition is also linked to hereditary and acquired risk factors. Oral estrogens increase the risk of venous thromboembolic complications to varying extents, probably depending on their type and dose used. Observational studies have not found an association between an increased risk of VTE and transdermal estrogen treatment regardless of women's age and body mass index (BMI). Micronized progesterone and pregnanes, including dydrogesterone, have no effect on the risk of VTE, whereas norpregnane progestagens cause an additional increase in risk. Among hormonal preparations which are commercially available in Poland, the combination of transdermal estradiol with oral dydrogesterone appears to be the optimum choice, as it does not elevate the risk of VTE (compared to patients not using MHT), and dydrogesterone seems to be the progestagen of choice. PMID:26327865

  17. [Biology of primary hyperparathyroidism: selective venous sampling].

    PubMed

    Fulla, Y; Bonnichon, P; Tissier, F; Delbot, T; Richard, B; Bertagna, X; Legmann, P

    2009-03-01

    The diagnosis of primary hyperparathyroidism (PHP) is chemical: high level of Parathormone (PTH) in conjunction with hypercalcaemia. In borderline cases with sub-normal plasma PTH and calcium, an oral calcium load test could allow a differential diagnosis from other causes of high PTH. Imaging is required only for PHP. Selective venous sampling can help in localizing a parathyroid adenoma in difficult cases by PTH cartography in the following situations: imaging in favour of an ectopic mediastinal gland or a deep cervical adenoma, persistent or recurrent PHP after first failed surgery with negative neck exploration or unsatisfactory in case of another hypersecreting gland, PHP well diagnosed with indeterminate imaging, symptomatic PHP with normal PTH and negative imaging. Venous blood sampling performed in a vascular radiological department with a quick PTH assay can reveal an area of maximum secretion potentially linked to a nodule localized by previous ultrasound coupled to scintigraphy, giving thus a "biological imaging" study. The association of imaging and biology is an efficient procedure enabling localization of an area of abnormal PTH secretion and characterization of the level of PTH secretion. The area with the highest gradient of PTH concentration can help to protocol CT and MR examination. PMID:19421132

  18. The cerebral venous system and hypoxia.

    PubMed

    Wilson, Mark H; Imray, Christopher H E

    2016-01-15

    Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static "Monro-Kellie" doctrine, which forms the basis of the "Tight-Fit" hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure. PMID:26294747

  19. Immunological aspects of chronic venous disease pathogenesis

    PubMed Central

    Grudzińska, Ewa

    2014-01-01

    Chronic venous disease (CVD) is a very common health problem concerning up to 1/3 of the society. Although venous hypertension and valvular incompetence have been long known to be crucial for development of the illness, its exact aetiology remains unclear. Recent findings indicate that inflammatory processes may be crucial for development of incompetent valves and vein wall remodelling. One of the most interesting theories describes “leucocyte trapping” as the mechanism responsible for elevated vein wall permeability and oxidative stress in the veins. At the same time, the cytokine profile of the blood in incompetent veins has not been thoroughly examined. Popular anti-inflammatory drugs relieve some symptoms but do not have much proved effects in prevention and treatment. We intend to summarize the existing knowledge of the immunological aspects of CVD in order to emphasize its importance for understanding the aetiology of this illness. We also wish to indicate some aspects that remain to be studied in more detail. PMID:26155174

  20. Venous disease: investigation and treatment, fact or fiction?

    PubMed Central

    Scott, H. J.; McMullin, G. M.; Coleridge Smith, P. D.; Scurr, J. H.

    1990-01-01

    This review looks at some clinical and experimental methods and treatments used in venous disease, and attempts to dispel some myths which have been associated with it. Over the last century numerous techniques have been introduced to aid the understanding of the physiology of normal legs and the pathophysiology of those with venous disease. Tourniquet testing along with clinical examination remains the only method of venous assessment in most hospitals. Venous ulceration in the past has been associated with deep vein incompetence, but the newer, non-invasive techniques of Doppler ultrasound and duplex examination are now identifying patients with leg ulceration who have superficial venous insufficiency and therefore a surgically correctable condition. Perforating veins and their possible role in the aetiology of venous ulceration along with invasive and non-invasive methods for their detection is reviewed. Some of the conservative compression treatments and dressings available for the treatment of venous ulceration are discussed. It is concluded that adherence to sound surgical principles remains the mainstay of the successful management of patients with venous disease. PMID:2192676

  1. Comparative study of different venous reflux duplex quantitation parameters.

    PubMed

    Valentín, L I; Valentín, W H

    1999-09-01

    The objective of this study was to compare different quantitation parameters of venous reflux by duplex scan in different venous disease manifestations. Duplex scan is a new modality to quantify venous reflux. Several studies propose different parameters. In addition, there is controversy about the importance of deep and superficial involvement in different disease manifestations. It is not clear whether there is an increased venous reflux associated with varied clinical stages. Venous conditions were classified in seven stages and their differences for several quantitation variables studied. Most quantitation variables, such as average and peak velocity, average and peak flow, and reflux volume disclosed significantly increased reflux from normal, pain only, and edema group to varicose vein, with or without edema, to lipodermatosclerosis and ulcer groups at every location in the lower extremity. Reflux time was not as consistent as other variables. Totalization of the results of every parameter for the whole extremity points to an increased reflux from pain only to edema and from lipodermatosclerosis to ulcer group. Chronic edema is not usually associated with increased venous reflux. The greater saphenous vein (superficial system) seems to be the main contributor to reflux in all stages of disease. Different quantitation methods of venous reflux are equivalent. Increased deep and superficial reflux and its totalization are associated with a more advanced disease stage. Reflux time may be the least useful variable. Chronic edema is frequently not associated with venous reflux. Greater saphenectomy may be the most useful intervention, even in the presence of deep vein reflux. PMID:10496498

  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. Functional total anomalous pulmonary venous connection via levoatriocardinal vein.

    PubMed

    Hayashi, Taiyu; Ozawa, Katsusuke; Sugibayashi, Rika; Wada, Seiji; Ono, Hiroshi

    2016-07-01

    We report a fetal case of double outlet right ventricle, mitral atresia, and intact atrial septum. Although the pulmonary veins were connected to the left atrium, pulmonary venous blood drained into the right superior vena cava via the stenotic levoatriocardinal vein (LACV), which resulted in a circulation resembling total anomalous pulmonary venous connection (TAPVC) with pulmonary venous obstruction. Since the pulmonary veins were connected to both the stenotic LACV and the "dead-end" left atrium, the pulmonary venous flow had a to-and-fro pattern along with atrial relaxation and contraction. Postnatal echocardiography and computed tomography confirmed the diagnosis of normally connected but anomalously draining pulmonary veins via the LACV. Surgical creation of an atrial septal defect on the day of birth successfully relieved pulmonary venous obstruction. Normally connected but anomalously draining pulmonary veins via the LACV should be considered for TAPVC differential diagnosis in fetuses with a left-side heart obstruction. PMID:27460400

  4. 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.

  5. Pericardial patch venoplasty heals via attraction of venous progenitor cells.

    PubMed

    Bai, Hualong; Wang, Mo; Foster, Trenton R; Hu, Haidi; He, Hao; Hashimoto, Takuya; Hanisch, Jesse J; Santana, Jeans M; Xing, Ying; Dardik, Alan

    2016-06-01

    Pericardial patches are commonly used during cardiovascular surgery to close blood vessels. In arteries, patches accumulate arterial progenitor cells; we hypothesized that venous patches would accumulate venous progenitor cells, in the absence of arterial pressure. We developed a novel rat inferior vena cava (IVC) venotomy model and repaired it with a pericardial patch. Cells infiltrated the patch to form a thick neointima by day 7; some cells were CD34(+)/VEGFR2(+) and CD31(+)/Eph-B4(+) consistent with development of venous identity in the healing patch. Compared to arterial patches, the venous patches had increased neointimal thickness at day 7 without any pseudoaneurysms. Addition of an arteriovenous fistula (AVF) to increase blood flow on the patch resulted in reduced patch neointimal thickness and proliferation, but neointimal thickness was not reversible with AVF ligation. These results show that rat patch venoplasty is a novel model of aggressive venous neointimal hyperplasia. PMID:27354544

  6. Microparticles as biomarkers of venous thromboembolic events.

    PubMed

    Campello, Elena; Spiezia, Luca; Radu, Claudia M; Simioni, Paolo

    2016-07-01

    Microparticles (MPs) are small (0.1-1.0 μm) membrane vesicles constitutively released from the surface of cells after activation and apoptosis. The clinical research on MPs is hampered by the limitations of the currently available detection methods. A correlation between MPs and venous thromboembolism (VTE) has been observed. The effects of MPs on thrombogenesis involve the exposure of phosphatidylserine, the vehiculation of tissue factor, and MP-induced intercellular cross-talk between inflammation and coagulation. This review will focus on the potential role of plasma MPs as biomarkers in detecting acute unprovoked VTE, predicting VTE occurrence in high-risk situations (mainly cancer), and ultimately, we will discuss currently available studies on the prognostic role of MPs to guide primary and secondary VTE prevention protocols. PMID:27338783

  7. Endovascular Treatment of Venous Occlusive Disease

    PubMed Central

    2008-01-01

    Endovascular treatment of acute and chronic iliac vein occlusions has proven to be safe and effective. Recanalization of chronic occlusions with balloon angioplasty and stenting can re-establish normal venous flow in the iliac veins and the IVC and relieve symptoms in the majority of treated patients. CDT with recanalization and stenting of underlying chronically obstructed iliofemoral segments is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as anticoagulation and compression therapy alone are not satisfactory in preventing PTS. The new treatment modalities offer stimulating options for a patient group that is not adequately treated, neither by medical nor open surgical therapy. The substantial effort and additional costs of endovascular treatment appear to be justified by the encouraging mid-term results both for patients with acute and chronic occlusive iliofemoral disease. However, multi-center randomized prospective studies are required to further validate the role of these techniques. PMID:23555345

  8. Percutaneous foam sclerotherapy for venous leg ulcers.

    PubMed

    Bush, R; Bush, P

    2013-10-01

    The technique of foam sclerotherapy directed at the distal most vessels, draining the ulcer bed was first described in 2010, with excellent penetration into the underlying venous network possible with this technique. Thirty-five patients have now been treated with this technique as the initial treatment at Midwest Vein Laser, USA. There have been no complications with this technique and rapid healing occurred within 4-8 weeks after the initial treatment in 90% of the patients, and all ulcers were healed at 4 months. Here we present the representative case of a 67-year-old man treated with a modified technique that used a percutaneous approach via reticular or spider veins at the margin of the ulcer bed. PMID:24142137

  9. Controversies in the diagnosis of venous thromboembolism.

    PubMed

    Le Gal, G; Righini, M

    2015-06-01

    Over the last decades, important advances have been made in the diagnosis of venous thromboembolism (VTE). Current diagnostic strategies rely on the sequential use of non-invasive diagnostic tests, based on the pretest clinical probability of disease. Diagnostic tests include D-dimer measurement, leg vein compression ultrasonography, chest computed tomography pulmonary angiography, or ventilation perfusion (V/Q) lung scan. The safety and cost-effectiveness of these strategies have been extensively validated. They have been widely implemented in clinical practice and have replaced the historical gold standard diagnostic tests (venography and pulmonary angiography). However, new challenges arise, including a lower clinical suspicion threshold and concerns on potential over-diagnosis of VTE. Moreover, the diagnostic management remains suboptimal in many subgroups of patients with suspected VTE: patients with prior VTE, pregnant women, or elderly patients. PMID:26149033

  10. In the Clinic. Deep venous thrombosis.

    PubMed

    Spandorfer, John; Galanis, Taki

    2015-05-01

    This issue provides a clinical overview of deep venous thrombosis, focusing on prevention, diagnosis, treatment, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic. PMID:25939012

  11. Hepatic venous outflow obstruction: Three similar syndromes

    PubMed Central

    Bayraktar, Ulas Darda; Seren, Soley; Bayraktar, Yusuf

    2007-01-01

    Our goal is to provide a detailed review of veno-occlusive disease (VOD), Budd-Chiari syndrome (BCS), and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed, enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS, and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions. However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction. Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure. PMID:17461490

  12. [The diagnostic scores for deep venous thrombosis].

    PubMed

    Junod, A

    2015-08-26

    Seven diagnostic scores for the deep venous thrombosis (DVT) of lower limbs are analyzed and compared. Two features make this exer- cise difficult: the problem of distal DVT and of their proximal extension and the status of patients, whether out- or in-patients. The most popular score is the Wells score (1997), modi- fied in 2003. It includes one subjective ele- ment based on clinical judgment. The Primary Care score 12005), less known, has similar pro- perties, but uses only objective data. The pre- sent trend is to associate clinical scores with the dosage of D-Dimers to rule out with a good sensitivity the probability of TVP. For the upper limb DVT, the Constans score (2008) is available, which can also be coupled with D-Dimers testing (Kleinjan). PMID:26502582

  13. [Diagnosis and treatment of venous thrombosis].

    PubMed

    Hach-Wunderle, V

    2005-11-01

    In the diagnosis of deep vein thrombosis in ambulatory patients, the recommended initial steps are assessment of clinical probability (CP) and a sensitive D-dimer test. With a low CP and negative D-dimer, thrombosis can be ruled out. All other constellations require further investigation with imaging techniques. Compression ultrasonography is the first-line investigation. Low-molecular weight heparin is the treatment of choice for uncomplicated venous thrombosis. Secondary prophylaxis with a vitamin K antagonist is introduced in parallel as quickly as possible. The duration of treatment depends on the exposure and predisposing factors, weighing carefully the risk of recurrence on the one hand against the risk of bleeding on the other. If there are contraindications to anticoagulation with heparins or coumarins, various other anticoagulant drugs are available. PMID:16395485

  14. [Ambulatory treatment of deep venous thrombosis].

    PubMed

    Metz, D; Hezard, N; Brasselet, C

    2001-11-01

    Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation. PMID:11794978

  15. Provisional Matrix Deposition in Hemostasis and Venous Insufficiency: Tissue Preconditioning for Nonhealing Venous Ulcers

    PubMed Central

    Parker, Tony J.; Broadbent, James A.; McGovern, Jacqui A.; Broszczak, Daniel A.; Parker, Christina N.; Upton, Zee

    2015-01-01

    Significance: Chronic wounds represent a major burden on global healthcare systems and reduce the quality of life of those affected. Significant advances have been made in our understanding of the biochemistry of wound healing progression. However, knowledge regarding the specific molecular processes influencing chronic wound formation and persistence remains limited. Recent Advances: Generally, healing of acute wounds begins with hemostasis and the deposition of a plasma-derived provisional matrix into the wound. The deposition of plasma matrix proteins is known to occur around the microvasculature of the lower limb as a result of venous insufficiency. This appears to alter limb cutaneous tissue physiology and consequently drives the tissue into a ‘preconditioned’ state that negatively influences the response to wounding. Critical Issues: Processes, such as oxygen and nutrient suppression, edema, inflammatory cell trapping/extravasation, diffuse inflammation, and tissue necrosis are thought to contribute to the advent of a chronic wound. Healing of the wound then becomes difficult in the context of an internally injured limb. Thus, interventions and therapies for promoting healing of the limb is a growing area of interest. For venous ulcers, treatment using compression bandaging encourages venous return and improves healing processes within the limb, critically however, once treatment concludes ulcers often reoccur. Future Directions: Improved understanding of the composition and role of pericapillary matrix deposits in facilitating internal limb injury and subsequent development of chronic wounds will be critical for informing and enhancing current best practice therapies and preventative action in the wound care field. PMID:25785239

  16. Feline gangrenous mastitis

    PubMed Central

    Wilson, Courtney R.

    2013-01-01

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

  17. Retinal venous pressure: the role of endothelin.

    PubMed

    Flammer, Josef; Konieczka, Katarzyna

    2015-01-01

    The retinal venous pressure (RVP) can be measured non-invasively. While RVP is equal to or slightly above intraocular pressure (IOP) in healthy people, it is often markedly increased in patients with eye or systemic diseases. Beside a mechanical obstruction, the main cause of such an elevation is a local dysregulation of a retinal vein, particularly a constriction induced by endothelin-1 (ET-1). A local increase of ET-1 can result from a high plasma level, as ET-1 can diffuse from the fenestrated capillaries of the choroid into the optic nerve head (ONH), bypassing the blood retinal barrier. A local increase can also result from increased local production either by a sick neighboring artery or retinal tissue. Generally, the main factors increasing ET-1 are inflammations and hypoxia, either locally or in a remote organ. RVP is known to be increased in patients with glaucoma, retinal vein occlusion (RVO), diabetic retinopathy, high mountain disease, and primary vascular dysregulation (PVD). PVD is the major vascular component of Flammer syndrome (FS). An increase of RVP decreases perfusion pressure, which heightens the risk for hypoxia. An increase of RVP also elevates transmural pressure, which in turn heightens the risk for retinal edema. In patients with RVO, a high level of RVP may not only be a consequence but also a potential cause of the occlusion; therefore, it risks causing a vicious circle. Narrow retinal arteries and particularly dilated retinal veins are known risk indicators for future cardiovascular events. As the major cause for such a retinal venous dilatation is an increased RVP, RVP may likely turn out to be an even stronger predictor. PMID:26504500

  18. Cardiac veins: collateral venous drainage pathways in chronic hemodialysis patients.

    PubMed

    Ozmen, Evrim; Algin, Oktay

    2016-01-01

    Venous anomalies are diagnostic and therapeutic challenges. Subclavian or superior vena cava stenosis can be developed and venous return can be achieved via cardiac veins and coronary sinus in patients with central venous catheter for long-term hemodialysis. These types of abnormalities are not extremely rare especially in patients with a history of central venous catheter placement. Detection of these anomalies and subclavian vein stenosis before the surgical creation of hemodialysis fistulae or tunneled central venous catheter placement may prevent unnecessary interventions in those patients. Multidetector computed tomography (MDCT) technique can give further information when compared with fluoroscopy or digital subtraction angiography in the management of these patients. This case report describes interesting aspects of central vein complications in hemodialysis patients. As a conclusion, there are limited data about thoracic venous return, and further prospective studies with large patient number are required. MDCT with 3D reconstruction is particularly useful for the accurate evaluation of venous patency, variations, and collateral circulation. Also it is an excellent tool for choosing and planning treatment. PMID:27056032

  19. Statins and prevention of venous thromboembolism: Myth or reality?

    PubMed

    Gaertner, Sébastien; Cordeanu, Eléna-Mihaela; Nouri, Salah; Mirea, Corina; Stephan, Dominique

    2016-03-01

    The pleiotropic effects of statins, beyond their cholesterol-lowering properties, are much debated. In primary prevention, several observational cohort and case-control studies appear to show that statins reduce the incidence of venous thromboembolism by about 30%. In a single randomized placebo-controlled clinical trial (JUPITER), which included 17,000 patients, rosuvastatin 20mg/day reduced the risk of venous thromboembolism by 43%. However, these patients were at low risk of venous thromboembolism, and the frequency of the event was, in principle, low. In secondary prevention, several observational studies and post-hoc analyses of randomized clinical trials have suggested that statins may prevent recurrence of venous thromboembolism. However, none of these studies had enough scientific weight to form the basis of a recommendation to use statins for secondary prevention. The putative preventive effect of statins appears to be independent of plasma cholesterol concentration and could be a pharmacological property of the statin class, although a dose-effect relationship has not been demonstrated. The mechanism through which statins might prevent venous thrombosis is thought to involve their anti-inflammatory and antioxidant effects or perhaps a more specific action, by blocking the degradation of antithrombotic proteins. A mechanism involving the action of statins on interactions between risk factors for atherosclerosis and venous thromboembolism is supported by some studies, but not all. In the absence of firm evidence, statins cannot currently be recommended for primary or secondary prevention of venous thromboembolism. PMID:26778087

  20. Venous emptying mediates a transient vasodilation in the human forearm.

    PubMed

    Tschakovsky, M E; Hughson, R L

    2000-09-01

    We tested the hypothesis that venous emptying serves as a stimulus for vasodilation in the human forearm. We compared the forearm blood flow (FBF; pulsed Doppler mean blood velocity and echo Doppler brachial artery diameter) response to temporary elevation of a resting forearm from below to above heart level when venous volume was allowed to drain versus when venous drainage was prevented by inflation of an upper arm cuff to approximately 30 mmHg. Arm elevation resulted in a rapid reduction in venous volume and pressure. Cuff inflation just before elevation effectively prevented these changes. FBF was briefly reduced by approximately 16% following arm elevation. A transient (86%) increase in blood flow began by approximately 5 s of arm elevation and peaked by 8 s, indicating a vasodilation. This response was completely abolished by preventing venous emptying. Arterial inflow below heart level was markedly elevated by 343% following brief (4 s) forearm elevation. This hyperemia was minor when venous emptying during forearm elevation had been prevented. We conclude that venous emptying serves as a stimulus for a transient (within 10 s) vasodilation in vivo. This vasodilation can substantially elevate arterial inflow. PMID:10993762

  1. 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.

  2. 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

  3. Venous compression syndromes: clinical features, imaging findings and management

    PubMed Central

    Liu, R; Oliveira, G R; Ganguli, S; Kalva, S

    2013-01-01

    Extrinsic venous compression is caused by compression of the veins in tight anatomic spaces by adjacent structures, and is seen in a number of locations. Venous compression syndromes, including Paget–Schroetter syndrome, Nutcracker syndrome, May–Thurner syndrome and popliteal venous compression will be discussed. These syndromes are usually seen in young, otherwise healthy individuals, and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, CT, or MR conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method. PMID:23908347

  4. Venous ulcer: late complication of a traumatic arteriovenous fistula.

    PubMed

    Young, Calvin J; Dardik, Alan; Sumpio, Bauer; Indes, Jeff; Muhs, Bart; Ochoa Chaar, Cassius I

    2015-01-01

    Arteriovenous fistula (AVF) formation after penetrating trauma is a well-described phenomenon. However, diagnosis of traumatic AVF is frequently delayed as patients often do not have hard signs of vascular injury at the initial presentation. Late complications of traumatic AVF include arterial and venous dilatation, distal ischemia, venous congestion, and congestive heart failure. This case report describes a traumatic femoral AVF causing distal venous ulceration 3 years after the injury. The AVF was treated with open repair. In the operating room, the Nicoladoni-Branham sign was elicited. The ulcer healed at 1 month and has not recurred at 1-year follow-up. PMID:25725283

  5. Venous gas embolism - Time course of residual pulmonary intravascular bubbles

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Luehr, S.; Katz, J.

    1989-01-01

    A study was carried out to determine the time course of residual pulmonary intravascular bubbles after embolization with known amounts of venous air, using an N2O challenge technique. Attention was also given to the length of time that the venous gas emboli remained as discrete bubbles in the lungs with 100 percent oxygen ventilation. The data indicate that venous gas emboli can remain in the pulmonary vasculature as discrete bubbles for periods lasting up to 43 + or - 10.8 min in dogs ventilated with oxygen and nitrogen. With 100 percent oxygen ventilation, these values are reduced significantly to 19 + or - 2.5 min.

  6. Percutaneous transhepatic thrombectomy and pharmacologic thrombolysis of mesenteric venous thrombosis.

    PubMed

    Zhou, Wei; Choi, Lorraine; Lin, Peter H; Dardik, Alan; Eraso, Andrea; Lumsden, Alan B

    2007-01-01

    Mesenteric venous occlusion is a rare yet highly morbid condition that is traditionally treated with anticoagulation while surgery serves as the last resort. Percutaneous intervention provides an effective option with relatively low mortality and morbidity. We herein describe use of transhepatic percutaneous thrombectomy and pharmacologic thrombolysis in treating two cases of symptomatic mesenteric venous thrombosis. These cases underscore the fact that transhepatic thrombectomy and thrombolysis are a highly effective strategy for treating acute symptomatic mesenteric venous thrombosis. Several percutaneous techniques are also reviewed. PMID:17382054

  7. Subarachnoid hemorrhage as the initial presentation of cerebral venous thrombosis.

    PubMed

    Kato, Yuji; Takeda, Hidetaka; Furuya, Daisuke; Nagoya, Harumitsu; Deguchi, Ichiro; Fukuoka, Takuya; Tanahashi, Norio

    2010-01-01

    Cerebral venous thrombosis presenting as subarachnoid hemorrhage (SAH) is very rare. We present a woman with thrombosis of the superior sagittal, straight, transverse and sigmoid sinuses who presented with SAH in the right temporal sulcus and bilateral cerebellar sulci. Brain perfusion CT demonstrated a delay of the mean transit time and high cerebral blood volume around the right posterior temporal lobe and cerebellum. These findings were compatible with venous congestion and they suggest the possibility that extension of the dural sinus thrombosis into the superficial veins caused localized venous hypertension with dilatation of the thin, fragile-walled cortical veins which eventually ruptured into the subarachnoid space. PMID:20190485

  8. Venous thromboembolism in cancer patients: risk assessment, prevention and management.

    PubMed

    Tukaye, Deepali N; Brink, Heidi; Baliga, Ragavendra

    2016-03-01

    Thrombosis and thromboembolic events contribute to significant morbidity in cancer patients. Venous thrombosis embolism (which includes deep vein thrombosis and pulmonary embolism) accounts for a large percentage of thromboembolic events. Appropriate identification of cancer patients at high risk for venous thromboembolism and management of thromboembolic event is crucial in improving the quality of care for cancer patients. However, thromboembolism in cancer patients is a complex problem and the management has to be tailored to each individual. The focus of this review is to understand the complex pathology, physiology and risk factors that drive the process of venous thrombosis and embolism in cancer patients and the current guidelines in management. PMID:26919091

  9. Total Anomalous Pulmonary Venous Connection to the Portal Vein

    SciTech Connect

    Wyttenbach, Marina; Carrel, Thierry; Schuepbach, Peter; Tschaeppeler, Heinz; Triller, Juergen

    1996-03-15

    Anomalous pulmonary venous return represents a rare congenital anomaly with wide anatomic and physiologic variability. We report a case of a newborn with a rare form of total infracardiac anomalous pulmonary venous connection (TAPVC). The pulmonary veins draining both lungs formed two vertical veins, which joined to a common pulmonary trunk below the diaphragm. This venous channel connected to the portal vein through the esophageal hiatus. The diagnosis was suggested by color Doppler sonography and confirmed by intravenous digital subtraction angiography, which allowed definition of the anatomy.

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

    PubMed

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

    2014-03-01

    This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects that had not used the supplement) were compared with normal, unused vein segments harvested for bypass grafting. The segments were suspended and a weight was attached to the distal part of the veins for 3 minutes and dilated with pressurized water. Digital images were recorded; the veins were measured before and after stretching to evaluate elongation. The manipulation of the vein segment was minimal. Tests were completed within 20 minutes after harvesting the veins. All segments were 4 cm long. The stretching test indicated a significantly higher level of passive elongation in control, varicose segments (2.29; 0.65 mm) in comparison with 1.39; 0.2 mm in vein segments from Pycnogenol-using patients. The dilation test showed an average higher dilation (2.19; 0.3 mm) in control varicose veins in comparison with varicose veins from Pycnogenol-using patients (1.32; 0.7 mm) (p < 0.05). Stretching and dilatation were lower in veins from Pycnogenol-using subjects (p < 0.05). The measurement of destretching and the recovery after dilatation indicated a better tone and recovery of the original size/shape in varicose segments from patients using Pycnogenol. Varicose segments had a more significant persistent dilatation and elongation in comparison with normal vein segments. Pycnogenol seems to decrease passive dilatation and stretching and gives vein walls a greater tonic recovery and elasticity that allows the vein to recover its original shape after dynamic stresses. PMID

  11. Improvements of Venous Tone with Pycnogenol in Chronic Venous Insufficiency: An Ex Vivo Study on Venous Segments

    PubMed Central

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

    2014-01-01

    This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects that had not used the supplement) were compared with normal, unused vein segments harvested for bypass grafting. The segments were suspended and a weight was attached to the distal part of the veins for 3 minutes and dilated with pressurized water. Digital images were recorded; the veins were measured before and after stretching to evaluate elongation. The manipulation of the vein segment was minimal. Tests were completed within 20 minutes after harvesting the veins. All segments were 4 cm long. The stretching test indicated a significantly higher level of passive elongation in control, varicose segments (2.29; 0.65 mm) in comparison with 1.39; 0.2 mm in vein segments from Pycnogenol-using patients. The dilation test showed an average higher dilation (2.19; 0.3 mm) in control varicose veins in comparison with varicose veins from Pycnogenol-using patients (1.32; 0.7 mm) (p < 0.05). Stretching and dilatation were lower in veins from Pycnogenol-using subjects (p < 0.05). The measurement of destretching and the recovery after dilatation indicated a better tone and recovery of the original size/shape in varicose segments from patients using Pycnogenol. Varicose segments had a more significant persistent dilatation and elongation in comparison with normal vein segments. Pycnogenol seems to decrease passive dilatation and stretching and gives vein walls a greater tonic recovery and elasticity that allows the vein to recover its original shape after dynamic stresses. PMID

  12. Seizure in Pregnancy Following Cerebral Venous Sinus Thrombosis

    PubMed Central

    Farzi, Farnoush; Abdollahzadeh, Mehrsima; Faraji, Roya; Chavoushi, Tahereh

    2015-01-01

    Introduction: Seizure involves less than 1% of pregnancies; however it is associated with increased maternal and fetal complications. Cerebral venous sinus thrombosis is a rare, but potentially life-threatening cause of seizure during pregnancy, presenting primarily as seizure in 12% - 31.9% of cases. Pregnancy and puerperium are known as the risk factors of cerebral venous sinus thrombosis. Case Presentation: Here is presented a case of seizure after delivery by cesarean section in an otherwise healthy woman. The final diagnosis was cerebral venous sinus thrombosis probably due to hypercoagulable state in pregnancy. Conclusions: If seizure occurs during the peripartum period, along with providing complete cardiovascular and respiratory support, advanced diagnostic measures are needed and cerebral venous sinus thrombosis should be considered as a possible diagnosis. PMID:26161329

  13. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in...

  14. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in...

  15. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in...

  16. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a pressure activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in...

  17. Cerebral venous infarction during a high altitude expedition.

    PubMed

    Cheng, S; Chng, S M; Singh, R

    2009-08-01

    Bilateral venous infarction of the brain due to thrombosis of the deep cerebral venous system is relatively rare, accounting for approximately 3-8 percent of all cases of cerebral venous thrombosis (CVT). Known risk factors include the use of oral contraceptives, pregnancy, puerperium, malignancy and thrombophilic states. CVT, in the setting of acute mountain sickness (AMS), has rarely been reported. We present an unusual occurrence of bilateral deep subcortical venous infarction in a previously-well, 39-year-old woman, who developed AMS during a high altitude expedition in Nepal. The possible mechanisms responsible for this unfortunate event include dehydration with resultant relative polycythaemia and raised intracranial pressure at high altitudes. CVT should be considered in mountain climbers presenting with progressive neurological deterioration that is not solely attributable to AMS. PMID:19710966

  18. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms

    PubMed Central

    Wattanakit, Keattiyoat; Cushman, Mary

    2010-01-01

    Purpose of review An estimated 13% of Americans have kidney disease. We sought to describe the association of kidney disease with risk of venous thromboembolism and discuss possible mechanisms explaining this association. Recent findings All severities of kidney disease appear to increase the risk of venous thromboembolism. In the general population the risk associated with mild to moderate kidney disease is 1.3–2-fold increased, and present even for microalbuminuria, although stage 1 chronic kidney disease itself has not been studied. End-stage renal disease is also associated with a 2.3-fold increased risk, compared to the general population. Although data are limited, risk increases after kidney transplant and with nephrotic syndrome as well. Summary Rates of kidney disease are increasing rapidly in the population and kidney disease is a risk factor for venous thromboembolism. An improved understanding of mechanisms linking kidney disease with venous thromboembolism will allow further study of best prevention efforts. PMID:19561505

  19. [Surgical options in the treatment of chronic venous ulcers].

    PubMed

    Stellmes, Arno; Derungs, Urs; Schmidli, Jürg; Widmer, Matthias K

    2011-03-01

    Surgery offers several options in prevention of chronic venous insufficiency and its sequelae. Both the operation on veins with valve dysfunction to reduce reflux and the elimination of obstruction in thrombosed veins aim for the reduction of venous hypertension. Elevated venous pressure, impairment of cutaneous capillaries and a chronic inflammatory process result in sclerosis of skin and subcutaneous tissue and might proceed to the fascia resulting in a chronic compartment syndrome. Non- healing chronic venous ulcers under conservative therapy for more than three months may be treated by vein-surgery, local wound care therapy like shaving and negative pressure treatment and if necessary by lowering of elevated intracompartimental pressure by fasciotomy or even fasciectomy. PMID:21360463

  20. Genetics Home Reference: multiple cutaneous and mucosal venous malformations

    MedlinePlus

    ... These abnormal blood vessels show a deficiency of smooth muscle cells while endothelial cells are maintained. Venous malformations cause lesions below the surface of the skin or mucous membranes, which are ...

  1. Advances in our understanding of mechanisms of venous thrombus resolution.

    PubMed

    Altmann, Johanna; Sharma, Smriti; Lang, Irene M

    2016-01-01

    Traditionally, venous thrombosis has been seen as the consequence of a regulated cascade of proteolytic steps leading to the polymerization of fibrinogen and fibrin crosslinking that is facilitated by platelets. A new view of thrombosis is providing a more integrated concept, with components of the vascular wall contributing to the vascular remodeling of thrombosis. Angiogenesis and inflammation are two key mechanisms that safeguard venous thrombus resolution and restitution of vascular patency after thrombosis. Disturbance of these processes leads to thrombus persistence and has potentially severe consequences for affected patients. Examples for clinical conditions associated with recurrent or persisting venous thrombosis are post-thrombotic syndrome or chronic thromboembolic pulmonary hypertension. Recently, studies using animal models of venous thrombosis have contributed to a better understanding of thrombus non-resolution that will eventually lead to modification of current treatment concepts. For example, recent data suggest that innate immunity is involved in the modification of thrombosis. PMID:26629617

  2. [Persistent left superior vena cava. Implications in central venous catheterisation].

    PubMed

    Lacuey Lecumberri, G; Ureña, M; Martínez Basterra, J; Basterra, N

    2009-01-01

    The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC). The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient. PMID:19430517

  3. 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

  4. Simple handling of venous air embolism during abdominal myomectomy.

    PubMed

    Basaran, Betül; Basaran, Ahmet; Kozanhan, Betül; Özmen, Sadık; Basaran, Mustafa

    2016-01-01

    We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment. PMID:27591473

  5. Multiple medullary venous malformations decreasing cerebral blood flow: Case report

    SciTech Connect

    Tomura, N.; Inugami, A.; Uemura, K.; Hadeishi, H.; Yasui, N. )

    1991-02-01

    A rare case of multiple medullary venous malformations in the right cerebral hemisphere is reported. The literature review yielded only one case of multiple medullary venous malformations. Computed tomography scan showed multiple calcified lesions with linear contrast enhancement representing abnormal dilated vessels and mild atrophic change of the right cerebral hemisphere. Single-photon emission computed tomography using N-isopropyl-p-({sup 123}I) iodoamphetamine demonstrated decreased cerebral blood flow in the right cerebral hemisphere.

  6. Venous air embolism following insufflation of the urethra.

    PubMed

    Vanlinthout, L; Boghaert, A; Thienpont, L

    1986-01-01

    Venous air embolism following urethral inflation only scarcely documented: an extensive search of the literature yielded four papers relating to this subject. We report a new case of venous air embolism due to this uncommon etiology. Careful study revealed some common pathogenetic features with previously reported cases. Some important precautions can diminish the likelihood of gas embolism and reduce its fatal outcome in situations, similar to the kind mentioned. PMID:3564882

  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

  8. Long-term parenteral nutrition: problems with venous access.

    PubMed Central

    McIntyre, A S; Gertner, D J; Wood, S; Phillips, R K; Lennard-Jones, J E

    1990-01-01

    Long-term parenteral nutrition requires central venous access, often difficult in patients who have had several central venous catheterizations. Therapy may be complicated by thrombosis and sepsis which may further compromise central access. We report five cases illustrating such difficulties and suggest that these patients be referred early to specialist centres where experienced catheter insertion and management results in a greatly reduced incidence of complications. PMID:2116522

  9. Preventing and recognizing venous thromboembolism after obstetric and gynecologic surgery.

    PubMed

    Harrington, Deedra

    2013-01-01

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

  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. Fish Intake and Venous Thromboembolism: A Systematic Literature Review.

    PubMed

    Mattiuzzi, Camilla; Cervellin, Gianfranco; Franchini, Massimo; Lippi, Giuseppe

    2016-05-01

    Diet plays an important role in modulating the risk of arterial and venous thrombosis. Several lines of evidence attest that consumption of fish and its compounds, especially omega-3 fatty acids, may be effective to decrease the cardiovascular risk. Since the pathogenesis of arterial and venous thrombosis share some common aspects, we performed a systematic review of published clinical studies that investigated the association between fish intake and venous thrombosis. An electronic search was carried out in Medline, Scopus, and ISI Web of Science using the key words "fish" OR "seafood" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism", with no language or date restriction. Overall, 6 studies (5 prospective and 1 case-control) were finally identified. In only 1 small case-control study, a larger intake of total fish was found to be negatively associated with the risk of venous thromboembolism. No association was found in 4 large prospective studies, whereas a positive association was observed in the remaining. No substantial difference was also noticed between intake of fatty or lean fish. Taken together, the current epidemiological evidence does not support the existence of a significant effect of total fish consumption on the risk of venous thromboembolism. PMID:25962392

  12. Beta-receptor-mediated increase in venous return in humans.

    PubMed

    Leenen, F H; Reeves, R A

    1987-08-01

    To assess the involvement of beta 1- and beta 2-receptors in the regulation of venous return in humans, changes in left ventricular end-diastolic (LVED) dimension were determined during beta-receptor stimulation either by exogenous catecholamines or by increased endogenous sympathetic activity after hydralazine, after placebo and during nonselective versus beta 1-selective blockade. Taking changes in heart rate and LV emptying into account, the three beta-agonists (isoproterenol, terbutaline, and epinephrine) as well as hydralazine increased venous return as inferred from LVED dimension. After hydralazine, nonselective and beta 1-selective blockade were equally effective in blunting the increases in venous return, in heart rate, and in positive inotropic response. Beta 1-Selective blockade did not affect the increase in heart rate caused by epinephrine and partially inhibited the positive inotropic effect and the increase in venous return. Nonselective blockade not only blocked the increase in venous return owing to epinephrine but actually led to a decrease, as evidenced by a decrease in LVED dimension despite the marked bradycardia and high afterload with this combination. The present findings in healthy humans indicate that stimulation of both beta 1- and beta 2-receptors increases venous return, heart rate, and myocardial contractility. Beta 1-Receptors appear to predominate in the response to neuronal sympathetic activity. PMID:2825941

  13. Visualization of coronary venous anatomy by cardiovascular magnetic resonance

    PubMed Central

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

    2009-01-01

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

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

    PubMed

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

    2011-12-01

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

  15. New anticoagulants for treatment of venous thromboembolism.

    PubMed

    Gross, Peter L; Weitz, Jeffrey I

    2008-03-01

    Anticoagulant therapy is the cornerstone of treatment of venous thromboembolism (VTE). Such treatment is divided into 2 stages: Rapid initial anticoagulation is given to minimize the risk of thrombus extension and fatal pulmonary embolism, whereas extended anticoagulation is aimed at preventing recurrent VTE, thereby reducing the risk of postphlebitic syndrome. With currently available drugs, immediate anticoagulation can only be achieved with parenteral agents, such as heparin, low-molecular-weight heparin, or fondaparinux. Extended treatment usually involves the administration of vitamin K antagonists, such as warfarin. Emerging anticoagulants have the potential to streamline VTE treatment. These agents include idraparinux, a long-acting synthetic pentasaccharide that is given subcutaneously on a once-weekly basis, and new oral anticoagulants that target thrombin or factor Xa. This article (1) reviews the pharmacology of these agents, (2) outlines their potential strengths and weaknesses, (3) describes the results of clinical trials with these new drugs, and (4) identifies the evolving role of new anticoagulants in the management of VTE. PMID:18296593

  16. New anticoagulants: focus on venous thromboembolism.

    PubMed

    Gómez-Outes, Antonio; Lecumberri, Ramón; Pozo, Carmen; Rocha, Eduardo

    2009-07-01

    Anticoagulation is recommended for prophylaxis and treatment of venous thromboembolism (VTE) (deep vein thrombosis and pulmonary embolism) and/or arterial thromboembolism. The therapeutic arsenal of anticoagulants available to clinicians is mainly composed by unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux and oral vitamin K antagonists (VKA) (i.e. warfarin and acenocumarol). These anticoagulants are effective, but they require parenteral administration (UFH, LMWH, fondaparinux) and/or frequent anticoagulant monitoring (intravenous UFH, oral VKA). Novel anticoagulants in clinical testing include orally active direct factor II inhibitors [dabigatran etexilate (BIBR 1048), AZD0837)], parenteral direct factor II inhibitors (flovagatran sodium), orally active direct factor X inhibitors [rivaroxaban (BAY 59-7939), apixaban, betrixaban, YM150, DU-176b, LY-517717, GW813893, TAK-442, PD 0348292] and new parenteral FXa inhibitors [idraparinux, idrabiotaparinux (biotinilated idraparinux; SSR 126517), ultra-low-molecular-weight heparins (ULMWH: AVE5026, RO-14)]. These new compounds have the potential to complement heparins and fondaparinux for short-term anticoagulation and/or to replace VKA for long-term anticoagulation in most patients. Dabigatran and rivaroxaban have been the firsts of the new oral anticoagulants to be licensed for the prevention of VTE after hip and knee replacement surgery. In the present review, we discuss the pharmacology of new anticoagulants, the key points necessary for interpreting the results of studies on VTE prophylaxis and treatment, the results of clinical trials testing these new compounds and their potential advantages and drawbacks over existing therapies. PMID:19601856

  17. Intracerebral hemorrhage due to developmental venous anomalies.

    PubMed

    Li, Xiaodi; Wang, Yuzhou; Chen, Wenming; Wang, Wensheng; Chen, Kaizhe; Liao, Huayin; Lu, Jianjun; Li, Zhigang

    2016-04-01

    Developmental venous anomalies (DVA) and cavernous malformations (CM) are a common form of mixed vascular malformation. The relationship between DVA, CM and hemorrhage is complicated. It is important to differentiate hemorrhagic CM and hemorrhagic DVA. A retrospective review of all patients with acute spontaneous intracerebral hemorrhages (ICH) between 1 May 2008 and 1 May 2013 was performed. ICH due to DVA or CM were identified and compared for demographic features, clinical symptoms, neurological deficits, and radiological findings. A total of 1706 patients with acute spontaneous ICH were admitted to our hospital during the study period. Among these, 10 (0.59%) were caused by DVA and 42 (2.47%) were caused by CM. No significant differences were found in age (p=0.252) or sex ratio (p=1.000) between the two groups. Compared with CM-induced ICH, DVA-induced ICH were characterized by cerebellar predominance (p=0.000) and less severe neurological deficits (p=0.008). Infratentorial hemorrhagic DVA are characterized by cerebellar predominance and benign clinical course. Infratentorial hemorrhagic CM are mainly located in the brainstem. DVA should be given suspected rather than CM when considering the etiology of a cerebellar hemorrhage, especially in young adults. PMID:26803466

  18. Imaging Diagnosis of Splanchnic Venous Thrombosis

    PubMed Central

    Rajesh, S.; Mukund, Amar; Arora, Ankur

    2015-01-01

    Splanchnic vein thrombosis (SVT) is a broad term that includes Budd-Chiari syndrome and occlusion of veins that constitute the portal venous system. Due to the common risk factors involved in the pathogenesis of these clinically distinct disorders, concurrent involvement of two different regions is quite common. In acute and subacute SVT, the symptoms may overlap with a variety of other abdominal emergencies while in chronic SVT, the extent of portal hypertension and its attendant complications determine the clinical course. As a result, clinical diagnosis is often difficult and is frequently reliant on imaging. Tremendous improvements in vascular imaging in recent years have ensured that this once rare entity is being increasingly detected. Treatment of acute SVT requires immediate anticoagulation. Transcatheter thrombolysis or transjugular intrahepatic portosystemic shunt is used in the event of clinical deterioration. In cases with peritonitis, immediate laparotomy and bowel resection may be required for irreversible bowel ischemia. In chronic SVT, the underlying cause should be identified and treated. The imaging manifestations of the clinical syndromes resulting from SVT are comprehensively discussed here along with a brief review of the relevant clinical features and therapeutic approach. PMID:26600801

  19. 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

  20. Severe Acute Respiratory Failure due to Inhalation of Baby Powder and Successfully Treated with Venous-Venous Extracorporeal Membrane Oxygenation.

    PubMed

    Panarello, Giovanna; Occhipinti, Giovanna; Piazza, Marcello; Capitanio, Guido; Vitulo, Patrizio; Gridelli, Bruno; Pilato, Michele; Arcadipane, Antonio

    2015-12-15

    Accidental inhalation of powder is a potential problem for infants. The clinical effects of inhaling powder depend on the powder contents, degree of aspiration, and the child's underlying systemic response. We present a case of accidental inhalation of rice starch powder in a 17-month-old girl, which led to severe acute respiratory distress syndrome responsive to conventional treatment, ultimately requiring venous-venous extracorporeal membrane oxygenation. PMID:26657704

  1. Cannulation Selection of Portal Venous and Splenic Venous Catheterization in Venovenous Bypass of Swine Orthotopic Liver Transplantation.

    PubMed

    Wang, Meng-Yuan; Wang, Meng-Hao; Peng, Yong; You, Hai-Bo; Chen, Xian-Feng; Zhao, Lei; Gan, Lin; Li, Min; Li, Jin-Zheng; Gong, Jian-Ping; Li, Xu-Hong

    2016-01-01

    BACKGROUND The aim of this study was to compare the hemodynamic changes in 2 different cannulations in portal system (portal venous catheterization and splenic venous catheterization) during venovenous bypass (VVB) of swine orthotopic liver transplantation (OLT) MATERIAL AND METHODS Thirty pairs (a total of 60) of healthy Duroc pigs were selected for OLT. According to the difference of cannulation in portal venous system during VVB, these pigs were divided into 2 groups: the PVC group (pigs with portal venous catheterization, n=15) and the SVC group (pigs with splenic venous catheterization, n=15). Intraoperative hemodynamic parameters were monitored continuously. RESULTS Two recipients in the PVC group died: 1 died of unsmooth bypass during the operation and 1 died of disseminated intravascular coagulation (DIC). There was only 1 death in the SVC group, due to hemorrhagic shock. The duration of anhepatic phase (AP) in the SVC group was significantly shorter than in the PVC group (P<0.05). Moreover, hemodynamic parameters in phase III (5 min after start of portal vein suturing) and phase IV (5 min after graft reperfusion) were remarkably different between the SVC group and the PVC group (P<0.05). CONCLUSIONS Our results show that VVB via splenic venous catheterization in swine OLT: 1) shortens the AP time; 2) keeps the hemodynamics stable; and 3) reduces the occurrence of postoperative complications. Thus, SVC appears to be superior to PVC. PMID:27251849

  2. Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations

    PubMed Central

    MITSUHASHI, Yutaka; HAYASAKI, Koji; KAWAKAMI, Taichiro; NAGATA, Takashi; KANESHIRO, Yuta; UMABA, Ryoko; OHATA, Kenji

    2016-01-01

    The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage. PMID:27063146

  3. Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations.

    PubMed

    Mitsuhashi, Yutaka; Hayasaki, Koji; Kawakami, Taichiro; Nagata, Takashi; Kaneshiro, Yuta; Umaba, Ryoko; Ohata, Kenji

    2016-06-15

    The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery "medial venous axis" carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves "lateral venous axis" are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves "intermediate venous axis" contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage. PMID:27063146

  4. Living-Engineered Valves for Transcatheter Venous Valve Repair

    PubMed Central

    Weber, Benedikt; Robert, Jérôme; Ksiazek, Agnieszka; Wyss, Yves; Frese, Laura; Slamecka, Jaroslav; Kehl, Debora; Modregger, Peter; Peter, Silvia; Stampanoni, Marco; Proulx, Steven; Falk, Volkmar

    2014-01-01

    Background: Chronic venous insufficiency (CVI) represents a major global health problem with increasing prevalence and morbidity. CVI is due to an incompetence of the venous valves, which causes venous reflux and distal venous hypertension. Several studies have focused on the replacement of diseased venous valves using xeno- and allogenic transplants, so far with moderate success due to immunologic and thromboembolic complications. Autologous cell-derived tissue-engineered venous valves (TEVVs) based on fully biodegradable scaffolds could overcome these limitations by providing non-immunogenic, non-thrombogenic constructs with remodeling and growth potential. Methods: Tri- and bicuspid venous valves (n=27) based on polyglycolic acid–poly-4-hydroxybutyrate composite scaffolds, integrated into self-expandable nitinol stents, were engineered from autologous ovine bone-marrow-derived mesenchymal stem cells (BM-MSCs) and endothelialized. After in vitro conditioning in a (flow) pulse duplicator system, the TEVVs were crimped (n=18) and experimentally delivered (n=7). The effects of crimping on the tissue-engineered constructs were investigated using histology, immunohistochemistry, scanning electron microscopy, grating interferometry (GI), and planar fluorescence reflectance imaging. Results: The generated TEVVs showed layered tissue formation with increasing collagen and glycosaminoglycan levels dependent on the duration of in vitro conditioning. After crimping no effects were found on the MSC level in scanning electron microscopy analysis, GI, histology, and extracellular matrix analysis. However, substantial endothelial cell loss was detected after the crimping procedure, which could be reduced by increasing the static conditioning phase. Conclusions: Autologous living small-diameter TEVVs can be successfully fabricated from ovine BM-MSCs using a (flow) pulse duplicator conditioning approach. These constructs hold the potential to overcome the limitations of

  5. Review of the cost of venous thromboembolism

    PubMed Central

    Fernandez, Maria M; Hogue, Susan; Preblick, Ronald; Kwong, Winghan Jacqueline

    2015-01-01

    Background Venous thromboembolism (VTE) is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion Costs for VTE treatment are considerable and increasing faster than general inflation for medical care services, with hospitalization costs being the primary cost driver. Readmissions for VTE are generally more costly than the initial VTE admission. Further studies evaluating the economic impact of new

  6. [Prevention of venous thromboembolism: generally accepted guidelines].

    PubMed

    Gumulec, J; Penka, M; Bezdĕk, R; Wróbel, M; Kessler, P; Brejcha, M; Klodová, D; Sumná, E; Králová, S

    2006-03-01

    This article summarizes the published data on the prevention of venous thromboembolism. Routine thromboprophylaxis is the best way to lower the risk. It is recommended to sort patients according the thrombosis risk and to make use of the standard prophylactic modes. In low risk patients, no specific thromboprophylaxis is needed. Patients with moderate risk levels are candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression. At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people after major orthopaedic surgeries and with a history of heparin induced thrombocytopenia over the past three months. An alternative to the administration of LMWH even after the end of the hospitalization can be warfarin in certain situations. The sole use of acetylsalicylic acid or Rheodextran is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis. PMID:16637444

  7. Iliocaval Confluence Stenting for Chronic Venous Obstructions

    SciTech Connect

    Graaf, Rick de; Wolf, Mark de; Sailer, Anna M.; Laanen, Jorinde van Wittens, Cees; Jalaie, Houman

    2015-10-15

    PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.

  8. SP-05VENOUS THROMBOEMBOLISM AND GLIOBLASTOMA

    PubMed Central

    Yust-Katz, Shlomit; Mandel, Jacob; Ying, Yuan; Wu, Jimin; Courtney, C.; Ladha, Harshad; Pawar, Tushar; Gilbert, Mark; Armstrong, Terri

    2014-01-01

    The risk of venous thromboembolism (VTE) is very high for patients with brain tumors; Glioblastoma (GB) specifically is one of the most at risk cancers. The aim of this study is to estimate the frequency and identify potential risk factors of GB patients developing VTE during adjuvant chemotherapy and to test if the Khorana scale accurately predicts the risk of VTE among this patient population. We retrospectively reviewed patients with GB treated at MD Anderson during the years 2005-2011. The target population of our study was patients who developed VTE after starting adjuvant chemotherapy. Patients were excluded if they did not start treatment with the established standard of care, had less than 6 months follow up or if they developed VTE before starting adjuvant treatment. The study sample included 440 patients. 64 (14.5%) of them developed VTE. The median time to develop VTE was 6.5 months. On multivariate analysis male sex, BMI≥ 35, KPS ≤80, history of VTE and steroid therapy were significantly associated with the development of VTE. We also found that in this patient sample, the Khorana scale was not a valid predictive model in GB patients due to very poor specificity. Of the 64 patients who developed a VTE, 36 were treated with anticoagulation, 2 with an IVC filter, and 21 with both. Complications secondary to anticoagulation were reported in 16% (n = 10) of patients. The complications included intracranial hemorrhage, bleeding to other organs and thrombocytopenia. VTE is very common in patients with GB. Currently, we are lacking a scale that accurately predicts the risk of VTE among GB patients. Predictive scales used for other cancers do not seem valid for GB due to the unique nature of the disease. Future studies are needed to create an accurate predictive model for VTE in GB patients.

  9. Management of venous thromboembolism during pregnancy.

    PubMed

    Ginsberg, J S; Bates, S M

    2003-07-01

    The incidence of venous thromboembolism (VTE) probably increases 2-4-fold in pregnancy and is higher after a caesarean section than after vaginal delivery. Management of VTE in pregnancy is challenging. Many diagnostic tests are less accurate in pregnant than in non-pregnant patients and some radiologic procedures expose the fetus to ionizing radiation, although this can be reduced by taking appropriate precautions. Compression ultrasonography (CUS) is the test of choice for deep vein thrombosis (DVT), whereas for PE, V/Q lung scan is the first-line test, followed by CUS if the results are non-diagnostic. Anticoagulants that have been evaluated for the prevention and treatment of VTE in pregnancy include heparin and heparin compounds, and coumarin derivatives. When determining the optimal treatment regimens, it is important to consider: (i) the safety of the drug for the fetus and mother; (ii) the efficacy of the regimen; and (iii) the dose regimens for acute and secondary treatment, and during delivery and postpartum. Heparins are safer than coumarins for the fetus, as they do not cross the placental barrier. Heparins, particularly unfractionated heparin (UFH) and low molecular weight heparin (LMWH) tend also to be safer for the mother than other compounds. Of the two, LMWHs, although more expensive, are associated with lower rates of bleeding complications, and heparin-induced thrombocytopenia and osteoporosis, than UFH, and should therefore be the treatment of choice in VTE during pregnancy. Patients with prior VTE or a hypercoagulable state have an increased risk of VTE during pregnancy. Depending on the presence of one or both of these factors, clinical surveillance, with anticoagulant treatment where necessary, is recommended. PMID:12871278

  10. 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

  11. Imaging features of left ovarian and renal venous aneurysms: two case reports and literature review.

    PubMed

    Yoo, Jeongin; Park, Sung Bin; Shin, Mack; Lee, Eun Sun; Park, Hyun Jeong; Lee, Jong Beum; Choi, Byung Ihn

    2016-01-01

    Venous aneurysms rarely occur in the visceral veins. We report two extremely rare cases of venous aneurysms, one of the ovarian vein and the other one of the renal vein. The aneurysms were depicted on grayscale and color Doppler ultrasonography as anechoic saccular structures with compressibility and blood flow. Pulsed Doppler ultrasonography showed venous flow. Contrast-enhanced computed tomography showed aneurysmal venous dilatation. We diagnosed left ovarian and renal venous aneurysms. We also review the clinical presentation and implications of visceral venous aneurysms. PMID:27317200

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

    SciTech Connect

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

    2007-07-15

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

  13. Air pollution and venous thrombosis: a meta-analysis

    PubMed Central

    Tang, Liang; Wang, Qing-Yun; Cheng, Zhi-Peng; Hu, Bei; Liu, Jing-Di; Hu, Yu

    2016-01-01

    Exposure to air pollution has been linked to cardiovascular and respiratory disorders. However, the effect of air pollution on venous thrombotic disorders is uncertain. We performed a meta-analysis to assess the association between air pollution and venous thrombosis. PubMed, Embase, EBM Reviews, Healthstar, Global Health, Nursing Database, and Web of Science were searched for citations on air pollutants (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and particulate matters) and venous thrombosis. Using a random-effects model, overall risk estimates were derived for each increment of 10 μg/m3 of pollutant concentration. Of the 485 in-depth reviewed studies, 8 citations, involving approximately 700,000 events, fulfilled the inclusion criteria. All the main air pollutants analyzed were not associated with an increased risk of venous thrombosis (OR = 1.005, 95% CI = 0.998–1.012 for PM2.5; OR = 0.995, 95% CI = 0.984–1.007 for PM10; OR = 1.006, 95% CI = 0.994–1.019 for NO2). Based on exposure period and thrombosis location, additional subgroup analyses provided results comparable with those of the overall analyses. There was no evidence of publication bias. Therefore, this meta analysis does not suggest the possible role of air pollution as risk factor for venous thrombosis in general population. PMID:27600652

  14. Venous velocity increase with a pneumatic foot compression garment.

    PubMed

    Ilgenfritz, F M; Meier, J R

    1994-11-01

    Intermittent compression garments have been widely accepted for prophylaxis of deep venous thrombosis. They have broad applicability in both elective and emergent situations. Development of a new type of garment that acts to compress the plantar plexus of the foot provides a potential method of prophylaxis for patients with contraindications to the traditional calf- or thigh-high garments. Evaluation of the ability of the foot compression garment demonstrates a statistically significant increase in peak femoral venous velocity (40.6 cm/sec) as compared with the resting state (25.9 cm/sec). This increase in femoral venous velocity is comparable to that seen with single-cell compression socks. The authors conclude that the recently introduced foot garment produces increases in peak femoral venous velocity similar to those produced by existing garments and that use of the foot compression garment may provide deep venous thrombosis prophylaxis in patients who previously have not been candidates for a compression garment. PMID:7978509

  15. Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis.

    PubMed

    Bever, Katherine M; Masha, Luke I; Sun, Fangui; Stern, Lauren; Havasi, Andrea; Berk, John L; Sanchorawala, Vaishali; Seldin, David C; Sloan, J Mark

    2016-01-01

    Patients with immunoglobulin light chain amyloidosis are at risk for both thrombotic and bleeding complications. While the hemostatic defects have been extensively studied, less is known about thrombotic complications in this disease. This retrospective study examined the frequency of venous thromboembolism in 929 patients with immunoglobulin light chain amyloidosis presenting to a single referral center, correlated risk of venous thromboembolism with clinical and laboratory factors, and examined complications of anticoagulation in this population. Sixty-five patients (7%) were documented as having at least one venous thromboembolic event. Eighty percent of these patients had events within one year prior to or following diagnosis. Lower serum albumin was associated with increased risk of VTE, with a hazard ratio of 4.30 (CI 1.60-11.55; P=0.0038) for serum albumin less than 3 g/dL compared to serum albumin greater than 4 g/dL. Severe bleeding complications were observed in 5 out of 57 patients with venous thromboembolism undergoing treatment with anticoagulation. Prospective investigation should be undertaken to better risk stratify these patients and to determine the optimal strategies for prophylaxis against and management of venous thromboembolism. PMID:26452981

  16. Chronic cerebrospinal venous insufficiency: Masked multimodal imaging assessment

    PubMed Central

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

    2013-01-01

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

  17. Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

    PubMed Central

    Bever, Katherine M.; Masha, Luke I.; Sun, Fangui; Stern, Lauren; Havasi, Andrea; Berk, John L.; Sanchorawala, Vaishali; Seldin, David C.; Sloan, J. Mark

    2016-01-01

    Patients with immunoglobulin light chain amyloidosis are at risk for both thrombotic and bleeding complications. While the hemostatic defects have been extensively studied, less is known about thrombotic complications in this disease. This retrospective study examined the frequency of venous thromboembolism in 929 patients with immunoglobulin light chain amyloidosis presenting to a single referral center, correlated risk of venous thromboembolism with clinical and laboratory factors, and examined complications of anticoagulation in this population. Sixty-five patients (7%) were documented as having at least one venous thromboembolic event. Eighty percent of these patients had events within one year prior to or following diagnosis. Lower serum albumin was associated with increased risk of VTE, with a hazard ratio of 4.30 (CI 1.60–11.55; P=0.0038) for serum albumin less than 3 g/dL compared to serum albumin greater than 4 g/dL. Severe bleeding complications were observed in 5 out of 57 patients with venous thromboembolism undergoing treatment with anticoagulation. Prospective investigation should be undertaken to better risk stratify these patients and to determine the optimal strategies for prophylaxis against and management of venous thromboembolism. PMID:26452981

  18. Calf pump activity influencing venous hemodynamics in the lower extremity.

    PubMed

    Recek, Cestmir

    2013-03-01

    Calf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of the previous pathological situation; this chain of events has been called hemodynamic paradox. PMID:24436580

  19. A systematic review of compression treatment for venous leg ulcers.

    PubMed Central

    Fletcher, A.; Cullum, N.; Sheldon, T. A.

    1997-01-01

    OBJECTIVE: To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers. METHODS: Systematic review of research. Search of 19 electronic databases including Medline, CINAHL, and Embase. Relevant journals and conference proceedings were hand searched and experts were consulted. MAIN OUTCOME MEASURES: Rate of healing and proportion of ulcers healed within a time period. STUDY SELECTION: Randomised controlled trials, published or unpublished, with no restriction on date or language, that evaluated compression as a treatment for venous leg ulcers. RESULTS: 24 randomised controlled trials were included in the review. The research evidence was quite weak: many trials had inadequate sample size and generally poor methodology. Compression seems to increase healing rates. Various high compression regimens are more effective than low compression. Few trials have compared the effectiveness of different high compression systems. CONCLUSIONS: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers. Insufficient reliable evidence exists to indicate which system is the most effective. More good quality randomised controlled trials in association with economic evaluations are needed, to ascertain the most cost effective system for treating venous leg ulcers. PMID:9302954

  20. Air pollution and venous thrombosis: a meta-analysis.

    PubMed

    Tang, Liang; Wang, Qing-Yun; Cheng, Zhi-Peng; Hu, Bei; Liu, Jing-Di; Hu, Yu

    2016-01-01

    Exposure to air pollution has been linked to cardiovascular and respiratory disorders. However, the effect of air pollution on venous thrombotic disorders is uncertain. We performed a meta-analysis to assess the association between air pollution and venous thrombosis. PubMed, Embase, EBM Reviews, Healthstar, Global Health, Nursing Database, and Web of Science were searched for citations on air pollutants (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and particulate matters) and venous thrombosis. Using a random-effects model, overall risk estimates were derived for each increment of 10 μg/m(3) of pollutant concentration. Of the 485 in-depth reviewed studies, 8 citations, involving approximately 700,000 events, fulfilled the inclusion criteria. All the main air pollutants analyzed were not associated with an increased risk of venous thrombosis (OR = 1.005, 95% CI = 0.998-1.012 for PM2.5; OR = 0.995, 95% CI = 0.984-1.007 for PM10; OR = 1.006, 95% CI = 0.994-1.019 for NO2). Based on exposure period and thrombosis location, additional subgroup analyses provided results comparable with those of the overall analyses. There was no evidence of publication bias. Therefore, this meta analysis does not suggest the possible role of air pollution as risk factor for venous thrombosis in general population. PMID:27600652

  1. Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers*

    PubMed Central

    Januário, Virginia; de Ávila, Dione Augusto; Penetra, Maria Alice; Sampaio, Ana Luisa Bittencourt; Noronha Neta, Maria Isabel; Cassia, Flavia de Freire; Carneiro, Sueli

    2016-01-01

    BACKGROUND: Among the chronic leg ulcers, venous ulcers are the most common and constitute a major burden to public health. Despite all technology available, some patients do not respond to established treatments. In our study, carboxymethylcellulose was tested in the treatment of refractory chronic venous ulcers. OBJECTIVE: To evaluate the efficacy of carboxymethylcellulose 20% on the healing of chronic venous ulcers refractory to conventional treatments. METHODS: This is an analytical, pre-experimental study. Thirty patients were included with refractory venous ulcers, and applied dressings with carboxymethylcellulose 20% for 20 weeks. The analysis was based on measurement of the area of ulcers, performed at the first visit and after the end of the treatment. RESULTS: There was a reduction of 3.9 cm2 of lesion area (p=0.0001), corresponding to 38.8% (p=0.0001). There was no interruption of treatment and no increase in lesion area in any patient. CONCLUSIONS: Carboxymethylcellulose 20% represents a low cost and effective therapeutic alternative for the treatment of refractory chronic venous ulcers. However, controlled studies are necessary to prove its efficacy. PMID:26982773

  2. Regaining venous access for implantation of a new lead

    PubMed Central

    Syska, Paweł; Maciąg, Aleksander; Oręziak, Artur; Kuśmierczyk, 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

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

    PubMed

    Gavorník, Peter; Dukát, Andrej; Gašpar, Ľudovít; Gavorníková, Eva

    2015-02-01

    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. PMID:25813260

  4. Uncontrolled seizures resulting from cerebral venous sinus thrombosis complicating neurobrucellosis

    PubMed Central

    Faraji, Fardin; Didgar, Farshid; Talaie-Zanjani, Afsoon; Mohammadbeigi, Abolfazl

    2013-01-01

    Cerebral venous sinus thrombosis is a rare form of stroke caused by thrombosis in venous sinuses of the brain. In this study, we reported on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure despite being treated with anti-epileptic drugs at high doses. The case was a 33-year-old woman with a history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month. She was febrile and a brain CT scan indicated hemorrhagic focus in the left posterior parietal and the temporal lobe. Magnetic resonance imaging and magnetic resonance venography also proved venous sinus thrombosis in the left transverse sinus. Besides [In addition], a laboratory assessment confirmed brucellosis. Following the treatment with anti-coagulant, anti-brucellosis, and anti-epileptic agents, the patient was discharged in good condition with medical orders. Clinical suspicion and accurate evaluation of a patient's history is the most important clue in diagnosis and treatment of brucellosis and cerebral venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control. PMID:24250168

  5. Impending United States energy crisis.

    PubMed

    Hirsch, R L

    1987-03-20

    The U.S. oil and gas industry has been dramatically weakened by the recent oil price collapse. Domestic drilling activity reached a new post-World War II low during the summer of 1986. Given a weak, unstable oil price outlook, U.S. capability will continue to deteriorate. In the last year U.S. imports of foreign oil have risen significantly, and if market forces alone dominate, U.S. dependence is expected to rise from 32% in 1983 to the 50 to 70% level in the not-too-distant future. The 1973 oil embargo and the subsequent attempts to improve U.S. energy security vividly demonstrated the huge costs and long periods of time required to change our energy system. These facts, coupled with the nation's generally short-term orientation, suggest a strong likelihood of a new U.S. energy crisis in the early to middle 1990s. PMID:17775008

  6. The Impending Oral Health Crisis.

    PubMed

    Tegtmeier, Carl H; Miller, David J; Shub, Judith L

    2016-04-01

    Last May, the New York State Dental Association and the New York State Dental Foundation convened the first "Oral Health Stakeholders' Summit on the Future of Special Needs Dentistry, Hospital Dentistry and Dental Education." The summit was chaired by David J. Miller, then NYSDA President Elect, and Carl H. Tegtmeier, then chair of the NYSDA Council on Dental Health Planning and Hospital Dentistry. It brought together experts, called to frame the issues and provide information necessary for a reasoned response. And it sought input from attendees to develop recommendations to ensure that patients with intellectual and developmental disabilities, as well as an aging population with Alzheimer's disease and dementia, have access to appropriate oral health care in the years ahead. Over 100 participants, representing dentistry, hospital training programs, third-party payers, state government offices and related patient support associations, attended the two-day event in Albany. They focused on the impact of reductions in funding, the transition of Medicaid services into a managed care model, a loss of service providers and the need for expanded training programs. They heard from speakers epresenting a broad spectrum of those involved in he oral health care of patients with intellectual and evelopmental disabilities, the Alzheimer's Association, dental educators and researchers, hospital dentistry and the benefits industry, whose presentations focused on a looming oral health crisis threatening access to dental care for patients with disabilities. PMID:27348951

  7. Arterio-venous shunts or low oxygen utilization?

    PubMed

    Rozin, Alexander P

    2010-02-01

    An idea of arteriovenous shunts (AVS) was proposed for explanation of dynamic regulation of oxygenation and venous hyperoxia. A formula enabling calculation of AVS and real CO2 production has recently been derived by comparing data of arterial and venous blood gases. Regarding venous hyperoxia, there is a need to differentiate capillary to tissue transport defect (low oxygen utilisation-LOU) from AVS, which may exist simultaneously. The AVS may be associated with normal or relatively high oxygen utilization from the capillary vessels and increased CO2 production. AVS is proposed to carry protective and 'stealing' properties including renal, cardiac, and pulmonary hemodynamic. Calculations of the AVS may be important for dynamic assessment of vascular and metabolic status and in emergency medicine. PMID:20026514

  8. Digital subtraction angiography of the portal venous system

    SciTech Connect

    Foley, W.D.; Stewart E.T.; Milbrath, J.R.; SanDretto, M.; Milde, M.

    1983-03-01

    Venous-phase arteriography after celiac or superior mesenteric artery injection is the most common technique used to demonstrate portal venous anatomy, flow direction, and portal systemic shunts. Large-volume contrast material injections and intraarterial vasodilators or balloon occlusion technique are required for optimal examinations using film-screen recording. A technique for performing venous-phase arteriography with digital subtraction imaging after celiac and superior mesenteric artery injection is described. The major advantage of intraarterial digital subtraction technique in comparison to film-screen recording is sensitivity to intravascular iodine with a consequent reduction in contrast material load and examination time. Technical success is limited only by motion artifact and should approximate the 80%-90% figure achieved for intravenous digital subtraction angiography of the aortorenal vessels.

  9. Cerebral venous thrombosis after ventriculoperitoneal shunting: a case report.

    PubMed

    Matsubara, Teppei; Ayuzawa, Satoshi; Aoki, Tsukasa; Ikeda, Go; Shiigai, Masanari; Matsumura, Akira

    2014-01-01

    Ventriculoperitoneal shunting (VPS) is a simple procedure, but there are several potential complications. We describe the first reported case of cerebral venous thrombosis (CVT) after VPS. A 69-year-old man suffering from normal pressure hydrocephalus underwent left VPS. Two months later he developed CVT and cerebral venous hemorrhage in the left frontal lobe. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the thrombus formation just adjacent to the shunt tube. One possible cause is compression of the cortical vein after brain shift and/or tension of the cortical vein due to intracranial hypotension. A protein C deficiency was also detected. Surgeons should be aware that cerebral venous thrombosis can occur after VPS. PMID:24257484

  10. 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.

  11. Bilateral Emphysematous Pyelonephritis with Hepatic Portal Venous Gas: Case Report.

    PubMed

    Cheng, Mao Li; Nording, Hasnizal; Lim, Chen Hong

    2015-01-01

    Emphysematous pyelonephritis is a rare life-threatening condition caused by a severe acute necrotising infection of the renal parenchyma and its perinephric tissues, and it is commonly seen in diabetic patients. There is a rare association between emphysematous pyelonephritis and hepatic portal venous gas. Hepatic portal venous gas is an uncommon radiological finding, which implies a significant underlying abdominal disease. The management of emphysematous pyelonephritis has evolved from prompt nephrectomy to medical therapy. In the present report, we present a case of a diabetic woman diagnosed with bilateral emphysematous pyelonephritis with hepatic portal venous gas that was successfully managed medically despite the presence of poor prognostic factors, such as acute renal failure and thrombocytopenia. PMID:26715900

  12. Cerebral Venous Thrombosis after Ventriculoperitoneal Shunting: A Case Report

    PubMed Central

    MATSUBARA, Teppei; AYUZAWA, Satoshi; AOKI, Tsukasa; IKEDA, Go; SHIIGAI, Masanari; MATSUMURA, Akira

    2014-01-01

    Ventriculoperitoneal shunting (VPS) is a simple procedure, but there are several potential complications. We describe the first reported case of cerebral venous thrombosis (CVT) after VPS. A 69-year-old man suffering from normal pressure hydrocephalus underwent left VPS. Two months later he developed CVT and cerebral venous hemorrhage in the left frontal lobe. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the thrombus formation just adjacent to the shunt tube. One possible cause is compression of the cortical vein after brain shift and/or tension of the cortical vein due to intracranial hypotension (IH). A protein C deficiency was also detected. Surgeons should be aware that cerebral venous thrombosis can occur after VPS. PMID:24257484

  13. Right internal jugular venous cannulation complicated by tension hydrothorax.

    PubMed

    Maroun, Rabih; Chalhoub, Michel; Harris, Kassem

    2013-01-01

    Central Venous Catheter (CVC) is a common procedure performed in patients' management, especially the critically ill ones. CVC has been used as main access in patients requiring large amount of fluid resuscitation, total parenteral nutrition or measuring the central venous pressure. Although most complications associated with central venous cannulation are minimal, local and easy to control, others may be critical and rapidly fatal if not recognized and treated immediately. One of the most serious incidents that can occur post CVC placement is delayed hydrothorax. It usually results from migration and perforation of the catheter through the SVC wall. In this report, we describe a case of tension hydrothorax that occurred a few hours after placement of CVC in the right internal jugular vein. In acutely ill patients that are already unstable, making the diagnosis of tension hydrothorax secondary to CVC placement requires high level of suspicion. Prompt pleural effusion drainage like in our case is crucial for favorable outcome. PMID:23871236

  14. Cerebral venous hemodynamic abnormalities in episodic and chronic migraine

    PubMed Central

    Petolicchio, Barbara; Viganò, Alessandro; di Biase, Lazzaro; Tatulli, Doriana; Toscano, Massimiliano; Vicenzini, Edoardo; Passarelli, Francesco; Di Piero, Vittorio

    2016-01-01

    Summary Alterations of cerebral venous drainage have been demonstrated in chronic migraine (CM), suggesting that cerebral venous hemodynamic abnormalities (CVHAs) play a role in this condition. The aim of the present study was to look for a correlation between CM and CVHAs. We recruited 33 subjects suffering from CM with or without analgesic overuse, 29 episodic migraine (EM) patients with or without aura, and 21 healthy subjects as controls (HCs). CVHAs were evaluated by transcranial and extracranial echo-color Doppler evaluation of five venous hemodynamic parameters. CVHAs were significantly more frequent in the CM and EM patients than in the HCs. In the migraine patients, CVHAs were not correlated with clinical features. The significantly greater frequency of CVHAs observed in the migraineurs may reflect a possible relationship between migraine and these abnormalities. Prospective longitudinal studies are needed to investigate whether CVHAs have a role in the processes of migraine chronification. PMID:27358220

  15. A review of the treatment for venous leg ulcers.

    PubMed

    Palfreyman, Simon; King, Brenda; Walsh, Bridget

    Venous ulcers, sometimes termed varicose or stasis ulcers, are a consequence of damage to the valves in the veins of the legs, leading to raised venous pressure. They are characterized by a cyclical pattern of healing and recurrence. There is a need to have a thorough assessment of patients with leg ulcers by an appropriately experienced clinician to maximize the chance of healing the ulcer. The main treatment is the application of compression, either in the form of compression bandages or hosiery. Dressings are applied beneath the compression with a view to controlling exudate, comfort and to aid healing. There are a large number of dressing products and types available but the evidence to justify their use is poor. The main treatment for venous ulcers should therefore be the application of compression therapy with a simple, low adherent dressing. PMID:17851372

  16. Venous malformations: Sclerotherapy with a mixture of ethanol and lipiodol

    SciTech Connect

    Suh, Jin-Suck; Shin, Kyoo-Ho; Na, Jae-Bum; Won, Jong-Yun; Hahn, Soo-Bong

    1997-07-15

    Purpose. To evaluate the usefulness of a mixture of absolute ethanol and lipiodol in the management of venous malformations. Methods. Percutaneous sclerotherapy was performed with a mixture of absolute ethanol and lipiodol (9:1) in 17 patients with venous malformations, once in 12 patients, twice in 5. The therapeutic efficacy was evaluated by pain reduction. Conventional radiographs (n=15) and posttreatment magnetic resonance imaging (n=5) were obtained for the follow-up evaluation. Results. Sclerotherapy was successful in all but two patients. The therapeutic effect was excellent in two patients, good in seven, fair in five, and poor in one. Radiopacity of lipiodol was beneficial for monitoring the procedure rather than for follow-up evaluations. Areas with low signal-intensity strands were increased on T2-weighted images obtained after the sclerotherapy. Conclusion. Sclerotherapy with a mixture of ethanol and lipiodol is effective in treating venous malformations.

  17. 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

  18. 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

  19. Chemotherapy-induced persistent serpentine supra-venous hyperpigmented eruption and persistent supra-venous erythematous eruption: case report.

    PubMed

    Marongiu, P; Lissia, A; Cottoni, F

    2009-02-01

    This paper presents the case of an 85-year-old male affected by classic Kaposi's sarcoma (CKS) since 1994. The disease was widespread over much of the skin surface. Since 1995 the patient had undergone several chemotherapy treatments with good, but not lasting results. Due to a worsening in the pathology, in October 2005 the patient was prescribed a further cycle of vinorelbine. Twenty-four hours after the first infusion, followed by isotonic sodium chloride solution vein wash, a supra-venous serpentine erythematous lesion appeared directly above infusion site. The lesion extended centripetally from the injection point and involved the whole supra-venous area. Over the following days, a gradual variation in lesion colour, from erythematous to hyperpigmented, was observed. Given this clinical and histological picture, the diagnosis of persistent serpentine supra-venous hyperpigmented eruption (PSSHE) was made. Draft of a rare secondary effect whose pathogenesis still remain to explain. The literature holds reports of another skin manifestation with similar supra-venous characteristics: persistent supra-venous erythematous eruption (PSSE), clinical entity that enters in differential diagnosis with the PSSHE. Many of the drugs used in chemotherapy have been indicated as responsible for these peculiar side-effects. To the authors' knowledge, the literature reports only one PHSSE case induced by i.v. vinorelbine infusion. PMID:19218916

  20. Obstruction of Venous Drainage Linked to Transient Global Amnesia

    PubMed Central

    Han, Ke; Chao, A-Ching; Chang, Feng-Chi; Chung, Chih-Ping; Hsu, Hung-Yi; Sheng, Wen-Yung; Wu, Jiang; Hu, Han-Hwa

    2015-01-01

    Abnormal extracranial venous drainage modality has been considered an etiology of transient global amnesia (TGA). Evidence suggests that the transmission of the intrathoracic/intraabdominal pressure during a Valsalva maneuver (VM) is mainly through the vertebral venous system, and patency of internal jugular vein (IJV) is essential for venous drainage and pressure releasing. We hypothesize that obstruction of IJV venous drainage is a contributing factor in TGA pathogenesis. A magnetic resonance (MR) imaging protocol was used in 45 TGA patients and 45 age- and sex-matched controls to assess the morphologies of IJV, brachiocephalic vein (BCV) and asymmetry of transverse sinus (TS). The IJV was divided into the upper- and middle-IJV segments. Compared to the controls, TGA patients had significantly higher rates of moderate and severe compression/stenosis at the bilateral upper-IJV segment (left: 37.8% vs. 17.8%, P = 0.0393; right: 57.8% vs.15.6%, P<0.0012), in left BCV (60% vs. 8.9%, P<0.0004), and in TS hypoplasia (53.3%% vs. 31.1%, P = 0.0405). The prevalence of at least one site of venous compression/stenosis in IJV or BCV was significantly higher in patients than in controls (91.1% vs. 33.3%, P<0.0004). The diameter of the left TS in MRV, but not in T1 contrast imaging, was significantly smaller in TGA patients than in controls (0.31±0.21 vs. 0.41±0.19, P = 0.0290), which was compatible with downstream venous stenosis/obstruction. TGA patients have a higher prevalence of compression/stenosis of the bilateral IJV and the left BCV and TS hypoplasia, which is new evidence that supports the role of extracranial veins in TGA pathogenesis. PMID:26173146

  1. Brothers and Sisters: Molecular insights into arterial-venous heterogeneity

    PubMed Central

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

    2009-01-01

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

  2. Sulodexide for the Prevention of Recurrent Venous Thromboembolism

    PubMed Central

    Bignamini, Angelo A.; Davì, Giovanni; Palareti, Gualtiero; Matuška, Jiří; Holý, Martin; Pawlaczyk-Gabriel, Katarzyna; Džupina, Andrej; Sokurenko, German Y.; Didenko, Yury P.; Andrei, Laurentia D.; Lessiani, Gianfranco; Visonà, Adriana

    2015-01-01

    Background— Patients with a first episode of unprovoked venous thromboembolism have a high risk of recurrence after discontinuation of anticoagulant therapy. Extending anticoagulation reduces the risk of recurrence but is associated with increased bleeding. Sulodexide, a glycosaminoglycan, exerts antithrombotic and profibrinolytic actions with a low bleeding risk when administered orally, but its benefit for preventing recurrent venous thromboembolism is not well known. Methods and Results— In this multicenter, double-blind study, 615 patients with first-ever unprovoked venous thromboembolism who had completed 3 to 12 months of oral anticoagulant treatment were randomly assigned to sulodexide 500 lipasemic units twice daily or placebo for 2 years, in addition to elastic stockings. The primary efficacy outcome was recurrence of venous thromboembolism. Major or clinically relevant bleeding was the primary safety outcome. Venous thromboembolism recurred in 15 of the 307 patients who received sulodexide and in 30 of the 308 patients who received placebo (hazard ratio, 0.49; 95% confidence interval [CI], 0.27–0.92; P=0.02). The analysis in which lost to follow-up was assigned to failure yielded a risk ratio among treated versus control subjects of 0.54 (95% confidence interval, 0.35–0.85; P=0.009). No major bleeding episodes occurred; 2 patients in each treatment group had a clinically relevant bleeding episode. Adverse events were similar in the 2 groups. Conclusion— Sulodexide given after discontinuation of anticoagulant treatment reduced the risk of recurrence in patients with unprovoked venous thromboembolism, with no apparent increase of bleeding risk. Clinical Trial Registration— URL: https://www.clinicaltrialsregister.eu/. Identifier: EudraCT number 2009-016923-77. PMID:26408273

  3. Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: a case of Fournier's gangrene caused by fish bone.

    PubMed

    Shimizu, Takae; Harada, Kazutoshi; Akazawa, Satoshi; Yamaguchi, Miyuki; Inozume, Takashi; Kawamura, Tatsuyoshi; Shibagaki, Naotaka; Momosawa, Akira; Shimada, Shinji

    2014-06-01

    Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74-year-old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed. Intraoperative findings showed dirty necrosis of soft tissue, and a splinter-shaped foreign body was found in the perirectal region. The foreign body was thought to be the cause of the condition, and it was analyzed using Fourier transform infrared spectroscopy. We found that the foreign body was a mixture of calcium phosphate and protein, suggesting that the splinter was a bone. Moreover, during the medical interview, the patient mentioned about intake of fish around the time of onset of symptoms. Therefore, to confirm the results of the analysis, DNA was extracted from the foreign body, and genomic PCR with subsequent sequence analysis was performed. The DNA sequence was identical to that of Oncorhynchus kisutch, a salmon that is a very popular food in Japan. On the basis of these findings, we concluded that FG in this case was caused by the penetration into the rectum of an accidentally ingested fish bone. Although some cases of intra-abdominal abscess due to accidental ingestion of fish bone have been reported, FG caused by fish bone is extremely rare. PMID:24909217

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

    PubMed

    Durandy, Yves

    2013-06-01

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

  5. 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

  6. Management of catheter-associated upper extremity deep venous thrombosis.

    PubMed

    Crawford, Jeffrey D; Liem, Timothy K; Moneta, Gregory L

    2016-07-01

    Central venous catheters or peripherally inserted central catheters are major risk factors for upper extremity deep venous thrombosis (UEDVT). The body and quality of literature evaluating catheter-associated (CA) UEDVT have increased, yet strong evidence on screening, diagnosis, prevention, and optimal treatment is limited. We herein review the current evidence of CA UEDVT that can be applied clinically. Principally, we review the anatomy and definition of CA UEDVT, identification of risk factors, utility of duplex ultrasound as the preferred diagnostic modality, preventive strategies, and an algorithm for management of CA UEDVT. PMID:27318061

  7. Central Venous Disease in Hemodialysis Patients: An Update

    SciTech Connect

    Modabber, Milad; Kundu, Sanjoy

    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.

  8. Adrenal venous sampling in a patient with adrenal Cushing syndrome

    PubMed Central

    Villa-Franco, Carlos Andrés; Román-Gonzalez, Alejandro; Velez-Hoyos, Alejandro; Echeverri-Isaza, Santiago

    2015-01-01

    The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia. PMID:26309345

  9. Central Venous Catheter-related Fungemia Caused by Rhodotorula glutinis.

    PubMed

    Miglietta, Fabio; Letizia Faneschi, Maria; Braione, Adele; Palumbo, Claudio; Rizzo, Adriana; Lobreglio, Giambattista; Pizzolante, Maria

    2015-01-01

    Bloodstream infection due to Rhodotorula glutinis is extremely rare and mostly associated with underlying immunosuppression or cancer. Vascular access devices provide the necessary surfaces for biofilm formation and are currently responsible for a significant percentage of human infections. In this work, we describe a rare case of central venous catheter-related Rhodotorula glutinis fungemia in a female patient with acute myelogenous leukemia in remission. The timely removal of central venous catheter was an essential element for overcoming this CVC-related Rhodotorula fungemia. PMID:26329371

  10. Subclavian Vein Stent Fracture and Venous Motion.

    PubMed

    Mallios, Alexandros; Taubman, Kevin; Claiborne, Paul; Blebea, John

    2015-10-01

    Primary subclavian vein stents are not recommended for venous thoracic outlet syndrome before surgical decompression by first rib resection due to a high risk of fracture because they are compressed between the clavicle and first rib. After rib removal, however, stent insertion has been advocated for venous restenosis, and it is felt that stent fracture is unlikely to occur. We present a case suggesting that repetitive differential vein movement during respiration may be one of the causative factors for stent fractures occurring in this anatomic region. PMID:26122410

  11. Venous Air Embolism during Surgery, Especially Cesarean Delivery

    PubMed Central

    Kim, Chang Seok; Liu, Jia; Kwon, Ja-Young; Shin, Seo Kyung

    2008-01-01

    Venous air embolism (VAE) is the entrapment of air or medical gases into the venous system causing symptoms and signs of pulmonary vessel obstruction. The incidence of VAE during cesarean delivery ranges from 10 to 97% depending on surgical position or diagnostic tools, with a potential for life-threatening events. We reviewed extensive literatures regarding VAE in detail and herein described VAE during surgery including cesarean delivery from background and history to treatment and prevention. It is intended that present work will improve the understanding of VAE during surgery. PMID:18955777

  12. Deep venous thrombosis and atypical antipsychotics: three cases report

    PubMed Central

    2012-01-01

    Background Deep venous Thrombosis is a serious, possible life threatening event which is often ignored in psychiatric Settings. Purpose In this paper three cases of deep venous Thrombosis (DVT) following the use of olanzapine and risperidone are presented. Methods The data of Three patients was collected from hospital records. Results The patients were in good general physical health and had no personal or familial history of DVT. The patients were not overweight (BMI < 25) but they suffered from DVT after initiating risperidone and olanzapine. Conclusion Risk of DVT exists in patients under treatment with atypical antipsychotics in spite of no pre existing risk factor. PMID:23351722

  13. Pathophysiology of venous leg ulceration--an update.

    PubMed

    Dormandy, J A

    1997-01-01

    The microcirculatory component of the pathophysiology of venous ulceration is now attracting considerable research interests, but is still far from fully elucidated. Currently, the central role is filled by the inappropriately activated white cell and its interaction with the endothelium. Interstitial oedema, pericapillary fibrin cuff and capillary microthromboses could all fit in with this hypothesis. However, there are other demonstrated changes, for instance in lymphatic drainage, intrinsic fibrinolysis and hemorheological changes which also need to be taken into account. The interaction between the microcirculatory changes is an obvious target for the systemic pharmacotherapy of venous ulceration. PMID:8995347

  14. Erythrocyte volume in acidified venous blood from exercising limbs.

    NASA Technical Reports Server (NTRS)

    Van Beaumont, W.; Rochelle, R. H.

    1973-01-01

    Five male volunteers performed arm exercises in the sitting position by cranking the pedals of a bicycle ergometer at 50 revolutions per min. The initial mechanical work load of 0 kgm/min was increased every minute by 75 kgm/min until exhaustion occurred. The data obtained show a significant acidification of the venous blood from the working arms and a substantial increase in venous pCO2 during this type of muscular activity. However, the erythrocyte volume remained unaltered during the exercise.

  15. Pharmacologic treatment to improve venous leg ulcer healing.

    PubMed

    Raffetto, Joseph D; Eberhardt, Robert T; Dean, Steven M; Ligi, Daniela; Mannello, Ferdinando

    2016-07-01

    Pharmacologic treatment for venous leg ulcers (VLUs) is an adjuvant treatment to compression therapy. It encompasses a variety of plant-derived and synthetic compounds with properties that alter venous microcirculation, endothelial function, and leukocyte activity to promote VLU healing. These compounds are often referred to as venotonics or venoactive drugs but have also been referred to as edema-protective agents, phlebotonics, vasoprotectors, phlebotropics, and venotropics. The exact mechanism of their ability to heal VLUs is not known; however, clinical trials support their efficacy. This evidence-based review assesses randomized clinical trials and meta-analyses with the objective of determining the effectiveness of venotonics to promote VLU healing. PMID:27318060

  16. Chemoprophylaxis for Venous Thromboembolism Prevention: Concerns Regarding Efficacy and Ethics

    PubMed Central

    2013-01-01

    Summary: Chemoprophylaxis has been recommended for plastic surgery patients judged to be at increased risk for venous thromboembolism. Several investigators have encountered this complication in patients despite anticoagulation therapy. An increased rate of complications related to postoperative bleeding has been reported. This article examines the efficacy and safety of this intervention, along with ethical considerations, in an attempt to determine whether any benefits of chemoprophylaxis justify the additional risks. The statistical methods and conclusion of the Venous Thromboembolism Prevention Study are challenged. Other preventative measures that do not cause negative side effects are discussed as safer alternatives. PMID:25289217

  17. Effect of beta-aescin extract from Chinese buckeye seed on chronic venous insufficiency.

    PubMed

    Yu, Zhihong; Su, Ping

    2013-06-01

    The aim of this study was to explore the mechanism of domestic beta-aescin treating chronic venous insufficiency through observing its actions on the isolated canine saphenous venous tension, venous pressure, venous return and lymphatic return. The isolated canine spiral saphenous venous tension test was performed to detect the activity of the beta-aescin. Furthermore, in the condition of constant canine femoral artery perfusion kept in the extracorporeal circulation, we measured the changes of the canine femoral artery pressure, femoral artery flow and the lymphatic return flow after intravenous injection of the agent. The results showed that when beta-aescin was administrated at the dose between 5.0 x 10(-5)-5.25 x 10(-4) mol/L, it increased obviously the contractile tension of the venous to norepinephrine in a dose-dependent manner. With canine femoral artery perfusion kept constant, beta-aescin, whose doses were 50 mg and 100 mg, reinforced intently the canine femoral venous tension accelerated the rise of the venous pressure. These finding suggested that domestic betabeta-aescin extracted from Chinese Buckeye Seed had an effect on chronic venous insufficiency by strengthening the venous tension, increasing the venous pressure and promoting venous return and lymphatic return. PMID:23875249

  18. Chronic venous insufficiency and the therapeutic effects of Daflon 500 mg.

    PubMed

    Bergan, John J

    2005-01-01

    Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade. PMID:16193222

  19. Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding.

    PubMed

    Plotnik, Adam N; Hebroni, Frank; McWilliams, Justin

    2016-02-01

    Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding. PMID:25871943

  20. Diploic venous anatomy studied in-vivo by MRI.

    PubMed

    Jivraj, Khalil; Bhargava, Ravi; Aronyk, Keith; Quateen, Ahmed; Walji, Anil

    2009-04-01

    Calvarial diploic venous anatomy has been studied post-mortem, but few studies have addressed these venous structures in-vivo. Previous work in our laboratory has shown that intraosseous infusion through the skull diploic space near the diploic veins in animals and humans does access the superior sagittal sinus and the systemic venous system. We developed a volumetric method of imaging the diploic veins in-vivo using MRI, intravenous gadolinium, and digital subtraction to provide for three-dimensional depiction and exact localization of these veins. We hypothesized that this technique would allow for an assessment of the probability of existence, distribution, and concentration of diploic veins in the skull. We scanned 31 neurosurgical patients, and were able to create 3D diploic venous maps in 74% of them. These maps were processed using Adobe Photoshop CS2. Mathworks MatLab 6.5, once customized, counted the number of pixels occupied by the diploic veins in the processed image. The probability of veins was highest in the occipital regions (100%). The inferior occipital (4.1%) and posterior parietal (4.1%) regions had the highest concentrations of diploic veins. Digital subtraction venography using a volumetric MRI sequence can demonstrate the diploic veins in-vivo. The inferior occipital region may be the best area for an intraosseous infusion device because it has the greatest likelihood of containing a vein and also has the highest concentration of veins. PMID:19173254

  1. Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience

    PubMed Central

    Mokin, Maxim; Lopes, Demetrius K; Binning, Mandy J; Veznedaroglu, Erol; Liebman, Kenneth M; Arthur, Adam S; Doss, Vinodh T; Levy, Elad I

    2015-01-01

    Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0–2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder. PMID:26055685

  2. Optoacoustic monitoring of cerebral venous blood oxygenation through extracerebral blood

    PubMed Central

    Petrov, I. Y.; Petrov, Y.; Prough, D. S.; Deyo, D. J.; Cicenaite, I.; Esenaliev, R. O.

    2011-01-01

    There is strong clinical evidence that controlling cerebral venous oxygenation (oxyhemoglobin saturation) is critically important for patients with severe traumatic brain injury as well as for patients undergoing cardiac surgery. However, the only available method for cerebral venous blood oxygenation monitoring is invasive and requires catheterization of the internal jugular vein. We designed and built a novel optoacoustic monitor of cerebral venous oxygenation as measured in the superior sagittal sinus (SSS), the large midline cerebral vein. To the best of our knowledge, optical monitoring of cerebral venous blood oxygenation through overlying extracerebral blood is reported for the first time in this paper. The system was capable of detecting SSS signals in vivo at 700, 800, and 1064 nm through the thick (5–6 mm) sheep skull containing the circulating blood. The high (submillimeter) in-depth resolution of the system provided identification of the SSS peaks in the optoacoustic signals. The SSS peak amplitude closely followed the actual SSS blood oxygenation measured invasively using catheterization, blood sampling, and “gold standard” CO-Oximetry. Our data indicate the system may provide accurate measurement of the SSS blood oxygenation in patients with extracerebral blood over the SSS. PMID:22254173

  3. The treatment of ambulatory venous ulcer patients with warming therapy.

    PubMed

    Cherry, G W; Wilson, J

    1999-09-01

    The standard treatment for ambulatory patients with venous ulcers is compression therapy. The aim of the present study was to develop a warming regimen to treat venous ulcers, which could be easily used by patients in their home or work environment. Five patients with a mean age of 66 years (51-80) who had venous ulcers for an average of 8 months (3-13) were treated with zip-up compression stockings (gradient compression 40 mmHg at the ankle) and a warming dressing. The latter was controlled by the patient to warm the ulcer to 38 degrees C for 1 hour three times daily. Warming therapy was carried out for 2 weeks and patients' ulcers were monitored for healing for 12 weeks. In all but one of the patients following warming therapy, there was marked increase in granulation tissue as well as a decrease in pain. Four of the five patients completely healed during the 12-week period. In conclusion, this study has demonstrated that warming therapy can be used by ambulatory patients with venous ulcers in conjunction with compression therapy. A randomized prospective study is in progress. PMID:10655876

  4. 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. PMID:25815301

  5. 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

  6. Evaluation of venous distension device: potential aid for intravenous cannulation.

    PubMed

    Hedges, J R; Weinshenker, E; Dirksing, R

    1986-05-01

    A device designed to augment venous filling by applying a vacuum to the upper extremity during tourniquet application was evaluated. Ten healthy adult male volunteers with clinical normovolemia were studied for changes in forearm volume and dorsal hand vein turgor during use of an elastic tubing tourniquet, a blood pressure cuff tourniquet, and a vacuum-assisted cuff tourniquet. Use of the device for 30 seconds was not associated with petechia formation and resulted in a significant increase in venous turgor, as measured by an ophthalmologic tonometer, in comparison to the other tourniquet techniques (P less than .005). Use for 60 seconds was associated with mild to moderate subjective discomfort in all volunteers and petechiae in all nine white volunteers. All petechiae resolved in three days. Venous engorgement as reflected by volume displacement was significantly greater for the vacuum device and blood pressure cuff tourniquet combination than other techniques at 30 and 60 seconds of tourniquet application (P less than .005). Brief application of a vacuum to the arm during tourniquet use increases venous turgor and engorgement in normovolemic volunteers. PMID:3963533

  7. [Proceedings maintenance of the devices of venous access].

    PubMed

    Castro, Carmen Noya; Casamayor, Conchita Martínez; Trillo, Inmaculada Serrano

    2007-10-01

    An extended version of the winning Poster Prize 3M Tegaderm 2007. It shows the proceedings maintenance of the devices of venous access settle down, based on the best scientific evidence available and consensus with the professionals of infirmary of the work centre. PMID:18274391

  8. [Cell technologies in complex treatment of venous trophic ulcers].

    PubMed

    Gavrilenko, A V; Pavlova, O V; Ivanov, A A; Vakhrat'ian, P E; Dashinimaev, É B; Li, R A

    2011-01-01

    Live skin equivalent and fibroblasts in gel were used in complex treatment of venous trophic ulcers to evaluate efficacy of cell transplants. Their efficacy depended on extent of trophic ulcer and time of their existence. Cell culture method is minimally traumatic, can be used in elder patients and seniors and gives positive results in 85% of cases. PMID:21350400

  9. Prevention of Venous Thromboembolism in Hospitalized Patients With Cancer

    PubMed Central

    Francis, Charles W.

    2009-01-01

    This is a literature review of the frequency of venous thromboembolism in hospitalized patients with cancer and of the available evidence supporting the use of thromboprophylaxis. Patients with cancer are at particularly high risk of venous thromboembolism and account for almost 20% of patients in the population. Hospitalization is an important risk factor in patients with cancer, with rates reported between 0.6% and 7.8%. The incidence has been increasing over the past decade. Three randomized controlled trials and meta-analyses indicate that prophylaxis with low molecular weight heparin, heparin, or fondaparinux significantly reduces the rate of venous thromboembolism in hospitalized medical patients who are at high risk. Patients with cancer were included in these studies, but prospective trials specifically focused on patients with cancer are not available. Evidence indicates that appropriate thromboprophylaxis is provided to a minority of hospitalized patients with cancer and that targeted educational efforts and computerized prompt systems can increase appropriate use. Guidelines developed by both oncology and thrombosis organizations support the use of thromboprophylaxis in hospitalized patients with cancer. In conclusion, most patients hospitalized with cancer are at high risk of venous thromboembolism, and thromboprophylaxis should be provided in the absence of active bleeding or a high bleeding risk. PMID:19704060

  10. 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.

  11. Infant death due to air embolism from peripheral venous infusion.

    PubMed

    Sowell, Matthew W; Lovelady, Cari L; Brogdon, B G; Wecht, Cyril H

    2007-01-01

    An otherwise healthy male infant was brought to the hospital because the mother suspected superficial infection at the operative site 5 days after an inguinal hernia repair. He was admitted to the pediatric unit overnight to be evaluated by his surgeon the next morning. When a venous infusion of maintenance fluids was started, the patient immediately went into cardio-respiratory arrest and was pronounced dead after resuscitation efforts failed. Subsequently, air collections were found in both venous and arterial circulations, including the splenoportal system. Detailed review of the clinical presentation and course, laboratory results, radiological, and pathological findings, along with a review of pertinent literature provides an explanation for the death by air embolism. Apparent inconsistent findings both radiographically and at autopsy are resolved. The mechanism of distribution of air to both systemic and splenoportal circulation is discussed. We believe this to be only the eighth case reported in English-language literature of infantile death from peripheral venous infusion. In all age groups, we find only six other cases in the English-language literature of gas found concomitantly in both the systemic and portal venous systems. PMID:17209934

  12. Scintigraphic demonstration of lower extremity periostitis secondary to venous insufficiency

    SciTech Connect

    Gensburg, R.S.; Kawashima, A.; Sandler, C.M.

    1988-07-01

    The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of (/sup 67/Ga)citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

  13. Central venous catheter-related Corynebacterium minutissimum bacteremia.

    PubMed

    Rupp, M E; Stiles, K G; Tarantolo, S; Goering, R V

    1998-10-01

    Although Corynebacterium minutissimum is well-known as the cause of erythrasma, it is noted as the etiologic agent of nondermatologic disease only rarely. We document this organism as a cause of central venous catheter-associated bacteremia and report the use of pulsed-field gel electrophoresis to characterize its molecular epidemiology. PMID:9801290

  14. Gene expression changes in venous segment of overflow arteriovenous fistula.

    PubMed

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

    2013-01-01

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

  15. Sporadic Multifocal Venous Malformations of the Head and Neck

    PubMed Central

    Amato, Michael V.; Patel, Neha A.; Hu, Shirley; Pantelides, Harry

    2015-01-01

    Objective. To report a case of unusually widespread sporadic venous malformations of the head and neck associated with normal D-dimer levels and, due to the protean clinical manifestations and increased risk of coagulopathy of these lesions, to review their diagnosis and clinical management. Case Report. A 25-year-old man presented with a one-year history of intermittent right-sided neck swelling and tongue swelling. Physical exam revealed additional lesions present throughout the head and neck. There was no family history suggestive of heritable vascular malformations. Radiographic imaging demonstrated 15 lesions located in various tissue layers consistent with venous malformations. A coagulation screen showed a normal prothrombin time, activated partial thromboplastin time, international normalized ratio, D-dimer level, and fibrinogen level. It was determined that the patient was not at increased risk for intraoperative coagulopathy and preoperative heparin administration would not be necessary. The patient's buccal and tongue lesions were subsequently excised with no complications. The patient also underwent sclerotherapy evaluation for his neck mass. Conclusion. This case describes a unique presentation of sporadic multifocal venous malformations. It also emphasizes the importance of prompt diagnosis and workup when multiple venous malformations are present to prevent morbidity during surgical excision secondary to intravascular coagulopathy. PMID:26483982

  16. Reduced venous compliance: an important determinant for orthostatic intolerance in women with vasovagal syncope.

    PubMed

    Skoog, Johan; Lindenberger, Marcus; Ekman, Mikael; Holmberg, Bengt; Zachrisson, Helene; Länne, Toste

    2016-02-01

    The influence of lower limb venous compliance on orthostatic vasovagal syncope (VVS) is uncertain. The most widespread technique to calculate venous compliance uses a nonphysiological quadratic regression equation. Our aim was therefore to construct a physiologically derived venous wall model (VWM) for calculation of calf venous compliance and to determine the effect of venous compliance on tolerance to maximal lower body negative pressure (LBNP). Venous occlusion plethysmography was used to study calf volume changes in 15 women with VVS (25.5 ± 1.3 yr of age) and 15 controls (22.8 ± 0.8 yr of age). The fit of the VWM and the regression equation to the experimentally induced pressure-volume curve was examined. Venous compliance was calculated as the derivative of the modeled pressure-volume relationship. Graded LBNP to presyncope was used to determine the LBNP tolerance index (LTI). The VWM displayed a better fit to the experimentally induced pressure-volume curve (P < 0.0001). Calf blood pooling was similar in the groups and was not correlated to the LTI (r = 0.204, P = 0.30). Venous compliance was significantly reduced at low venous pressures in women with VVS (P = 0.042) and correlated to the LTI (r = 0.459, P = 0.014) in the low pressure range. No correlation was found between venous compliance at high venous pressures and the LTI. In conclusion, the new VWM accurately adopted the curvilinear pressure-volume curve, providing a valid characterization of venous compliance. Reduced venous compliance at low venous pressures may adversely affect mobilization of peripheral venous blood to the central circulation during hypovolemic circulatory stress in women with VVS. PMID:26561647

  17. Impact of venous thromboembolism, venous stasis syndrome, venous outflow obstruction and venous valvular incompetence on quality of life and activities of daily living: a nested case-control study.

    PubMed

    Ashrani, Aneel A; Silverstein, Marc D; Rooke, Thom W; Lahr, Brian D; Petterson, Tanya M; Bailey, Kent R; Melton, L Joseph; Heit, John A

    2010-10-01

    The role of venous stasis syndrome (VSS) mechanisms (i.e. venous outflow obstruction [VOO] and venous valvular incompetence [VVI]) on quality of life (QoL) and activities of daily living (ADL) is unknown. The objective of this study was to test the hypotheses that venous thromboembolism (VTE),VSS,VOO and VVI are associated with reduced QoL and ADL. This study is a follow-up of an incident VTE case-control study nested within a population-based inception cohort of residents from Olmsted County, MN, USA, between 1966 and 1990. The study comprised 232 Olmsted County residents with a first lifetime VTE and 133 residents without VTE. Methods included a questionnaire and physical examination for VSS; vascular laboratory testing for VOO and VVI; assessment of QoL by SF36 and of ADL by pertinent sections from the Older Americans Resources and Services (OARS) and Arthritis Impact Measurement Scales (AIMS2) questionnaires. Of the 365 study participants, 232 (64%), 161 (44%), 43 (12%) and 136 (37%) had VTE, VSS, VOO and VVI, respectively. Prior VTE was associated with reduced ADL and increased pain, VSS with reduced physical QoL and increased pain, and VOO with reduced physical QoL and ADL.VVI was not associated with QoL or ADL. In conclusion,VSS and VOO are associated with worse physical QoL and increased pain. VOO and VTE are associated with impaired ADL. We hypothesize that rapid clearance of venous outflow obstruction in individuals with acute VTE will improve their QoL and ADL. PMID:20926498

  18. Communication between lymphatic and venous systems in mice.

    PubMed

    Shao, Lenan; Takeda, Kazu; Kato, Shigeki; Mori, Shiro; Kodama, Tetsuya

    2015-09-01

    The lymphatic system in mice consists of lymphatic vessels and 22 types of lymph nodes. Metastatic tumor cells in the lymphatic system spread to distant organs through the venous system. However, the communication routes between the lymphatic and venous systems have not been fully elucidated. Here, we identify the communication routes between the lymphatic and venous systems in the axillary and subiliac regions of MXH10/Mo-lpr/lpr inbred mice, which develop systemic swelling of lymph nodes up to 10mm in diameter, allowing investigation of the topography of the lymph nodes and lymphatic vessels. Using a gross anatomy dissection approach, the efferent lymphatic vessels of the proper axillary lymph node were shown to communicate with the subclavian vein. Furthermore, we found that the thoracoepigastric vein, which connects the subclavian vein and inferior vena cava, runs adjacent to the subiliac and proper axillary lymph nodes, and receives venous blood from these lymph nodes routed through small branches. The direction of blood flow in the thoracoepigastric vein occurred in two directions in the intermediate region between the proper axillary lymph node and subiliac lymph node; one to the subclavian vein, the other to the inferior vena cava. This paper reveals the anatomy of the communication between the lymphatic and venous systems in the axillary and subiliac regions of the mouse, and provides new insights relevant to the investigation of the mechanisms of lymph node metastasis and cancer immunology, and the development of diagnostic and treatment methods for lymph node metastasis, including drug delivery systems. PMID:26009246

  19. Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion.

    PubMed

    Comerota, Anthony J; Grewal, Nina K; Thakur, Subhash; Assi, Zacaria

    2010-07-01

    Chronic postthrombotic occlusion of the iliofemoral venous segments produces severe morbidity, which can be alleviated if venous drainage is restored. The common femoral vein (CFV) cannot always be fully recanalized with percutaneous endovenous techniques alone. We report the technique combining operative endovenectomy and patch venoplasty of the CFV with intraoperative iliac vein venoplasty and stenting to restore unobstructed venous drainage from the infrainguinal venous system to the vena cava. This procedure led to reduced pain, edema, and healing of a long-standing venous ulcer, with a marked reduction in postthrombotic morbidity. PMID:20620770

  20. Emulsifiers' composition modulates venous irritation of the nanoemulsions as a lipophilic and venous irritant drug delivery system.

    PubMed

    Mao, Chengwen; Wan, Jiangling; Chen, Huabing; Xu, Huibi; Yang, Xiangliang

    2009-01-01

    In this study, a nanoemulsion (NE) system was investigated for intravenous delivery of lipophilic and venous irritant drugs. NEs were prepared to deliver diallyl trisulfide (DT) for systemic therapy of bacterial and fungal infection, egg phospholipid was chosen as the main emulsifier, and two co-emulsifiers were also incorporated, including Poloxamer 188 (P188) and Solutol HS 15 (S15). Soybean oil was used as the dispersed phases, forming stable DT NEs with small particle sizes. The venous irritation of DT NEs was evaluated by in vitro human umbilical cord endothelial cells (CRL 1730) compatibility model with the intracellular adenosine triphosphate (ATP) and guanosine triphosphate (GTP) concentrations as the indices. The intracellular ATP and GTP reduction changed with the incorporation of a variety of co-emulsifiers, which varied in a free DT concentration-dependent manner. It was deduced that the free DT concentrations of NEs containing co-emulsifiers were determined by the partition coefficient of DT between oil and surfactant buffer solution. In conclusion, NE was an appropriate delivery system for lipophilic and venous irritant drug, and optimization of the composition of emulsifiers was an effective method to alleviate the venous irritation of DT NEs. PMID:19669895

  1. Superior caval venous syndrome after atrial switch procedure: relief of complete venous obstruction by gradual angioplasty and placement of stents.

    PubMed

    Michel-Behnke, I; Hagel, K J; Bauer, J; Schranz, D

    1998-10-01

    Superior caval venous syndrome is one of the late problems known to occur after Mustard repair of complete transposition. Reoperation may leave residual stenosis, and carries substantial risk for the patient. It is now feasible to use intravascular stents to overcome systemic venous baffle obstructions, and such an approach is probably more effective. The purpose of our study therefore, was to assess immediate and medium term results of inserting stents subsequent to gradual balloon enlargement of acquired atresia of the intraatrial baffle in patients who had undergone an atrial switch operation. We investigated five patients with complete obstruction of the superior caval venous pathway at perforation of the atretic segment was achieved using a guide wire technique. The procedure was successful in all patients. Gradual angioplasty was performed and intravascular stents were implanted. The pressure in the superior caval vein dropped to normal values, symptoms improved, and the patency of the newly created venoatrial communication was proven at mid-term follow-up. Thus critical obstructions at the superior caval venous pathway after the Mustard procedure can be reopened by interventional catheterization. Implantation of balloon-expandable intravascular stents is safe and effective in the acute relief of the obstructions, but careful long-term follow-up is mandatory. PMID:9855097

  2. 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.

  3. Impact of altered venous hemodynamic conditions on the formation of platelet layers in thromboemboli.

    PubMed

    Bajd, Franci; Vidmar, Jernej; Fabjan, Andrej; Blinc, Aleš; Kralj, Eduard; Bizjak, Nina; Serša, Igor

    2012-02-01

    Although it is generally believed that the structure of venous thromboemboli is a homogeneous red blood cell-fibrin clot, their structure may be heterogeneous, with non-uniformly distributed platelet layers, known as the lines of Zahn. We tested (a) whether venous thromboemboli ex vivo contained platelet layers, i.e. the lines of Zahn, and (b) whether, according to mathematical modeling, eddies can arise in the venous system, possibly contributing to platelet aggregation. The structure of venous thromboemboli ex vivo was determined by high-resolution magnetic resonance imaging (MRI) and by immunohistochemistry (IHC). High-resolution ultrasound (US) imaging was employed to determine the popliteal vein geometry and hemodynamics in healthy subjects and in subjects with previous venous thrombosis. The US data were then used as input for numerical simulations of venous hemodynamics. MRI and IHC confirmed that 42 of 49 ex vivo venous thromboemboli were structurally heterogeneous with platelet layers. The peak venous flow velocity was higher in patients with partly recanalized deep vein thrombosis than in healthy subjects in the prone position (46±4cm/s vs. 16±3cm/s). Our numerical simulation showed that partial venous obstruction with stenosis or malfunctioning venous valves creates the conditions for eddy blood flow. Our experimental results and computer simulation confirmed that the heterogeneous structure of venous thromboemboli with twisted platelet layers may be associated with eddy flow at the sites of their formation. PMID:21962985

  4. Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients

    SciTech Connect

    Bodner, Leonard J.; Nosher, John L.; Patel, Kaushik M.; Siegel, Randall L.; Biswal, Rajiv; Gribbin, Christopher E.; Tokarz, Robert

    2000-03-15

    Purpose: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data.Methods: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data.Results: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant

  5. 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

  6. Intraventricular hemorrhage caused by intracranial venous sinus thrombosis

    PubMed Central

    Zhang, Hongbo; Song, Shuijiang; Ouyang, Zhiyuan

    2016-01-01

    Abstract Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. The underlying risk factors include hypertension and aneurysms, among others. However, not all the exact etiologies are known. In this study, a case of a 24-year-old man who suffered from a headache and a decline in memory has been reported. A brain computed tomography scan suggested the diagnosis of spontaneous intraventricular hemorrhage. However, brain magnetic resonance imaging, magnetic resonance venography, and other tests eventually confirmed cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis may be one of the causes of intraventricular hemorrhage and should be considered for unexplained intraventricular hemorrhage. PMID:27428184

  7. 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

  8. Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review.

    PubMed

    Hernandez, Sergio; Valdes, Jorge; Salama, Moises

    2016-06-01

    Venous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fear of bleeding or hematoma complications postoperatively. Venous thromboembolism creates an economic burden on both the patient and the healthcare system. The intent of this literature review is to determine existing VTE risk using assessment models available to aid in the implementation of protocols for VTE prevention, specifically for high-risk cosmetic surgical patients in office-based settings. PMID:27501651

  9. Low flow veno-venous ECMO: an experimental study.

    PubMed

    Calderón, M; Verdín, R; Galván, J; Gonzalez, M; Cárdenas, H; Campos, R; Vidrio, H; Amezcua, J

    1994-01-01

    Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered. PMID:10147372

  10. Managing venous leg ulcers using compression therapy and dressings.

    PubMed

    Powell, Gail; Wicks, Gill; Will, Katrin

    Patient comfort and satisfaction with both compression therapy and wound care are critical to the success of venous leg ulcer treatment. This study observed 22 patients with venous leg ulcers treated over 12 weeks with two-layer compression hosiery and a range of wound dressings. The mean duration of the ulcers was 10.5 months and 48% had a history of recurrent ulcers. Half the ulcers healed within 12 weeks; there was an increase in the proportion of patients reporting 'no impairment' to their mobility, but it was not significant. The ease of donning the two-layer hosiery was rated as excellent or good at 86% of control visits and the ease of doffing at 78%. In 95% of cases the clinicians said they would use the same combination of products again and 73% of patients were satisfied with it. PMID:26266566

  11. Intraventricular hemorrhage caused by intracranial venous sinus thrombosis: Case report.

    PubMed

    Zhang, Hongbo; Song, Shuijiang; Ouyang, Zhiyuan

    2016-07-01

    Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. The underlying risk factors include hypertension and aneurysms, among others. However, not all the exact etiologies are known. In this study, a case of a 24-year-old man who suffered from a headache and a decline in memory has been reported. A brain computed tomography scan suggested the diagnosis of spontaneous intraventricular hemorrhage. However, brain magnetic resonance imaging, magnetic resonance venography, and other tests eventually confirmed cerebral venous sinus thrombosis.Cerebral venous sinus thrombosis may be one of the causes of intraventricular hemorrhage and should be considered for unexplained intraventricular hemorrhage. PMID:27428184

  12. Cerebral venous sinus thrombosis as presenting feature of ulcerative colitis.

    PubMed

    Ennaifer, R; Moussa, A; Mouelhi, L; Salem, M; Bouzaidi, S; Debbeche, R; Trabelsi, S; Najjar, T

    2009-01-01

    Thrombosis is a well recognized complication of inflammatory bowel disease that occurs in 1.3 to 6.4% of patients, however, cerebral vascular involvement is unusual. We present the case of a 16-year-old female in whom cerebral venous thrombosis was the presenting symptom of an active ulcerative pancolitis. Thrombophilia screen (plasma levels of proteins C and S, antithrombin, antibeta2-glycoprotein, lupus anticoagulant and anticardiolipin antibodies, activated protein C resistance, homocystein level antinuclear antibodies) was negative. The patient was successfully treated with anticoagulant therapy, phenobarbital and sulfasalazine. Cerebral venous thrombosis is an exceptional presenting feature of ulcerative colitis. Disease activity may play a major role in the occurrence of thrombosis. PMID:19902870

  13. Venous thromboembolism in hematopoietic stem cell transplant recipients.

    PubMed

    Chaturvedi, S; Neff, A; Nagler, A; Savani, U; Mohty, M; Savani, B N

    2016-04-01

    Venous thromboembolism (VTE) is an increasingly recognized problem in the post-hematopoietic stem cell transplantation (HSCT) setting, with a lack of high-quality evidence-based data to recommend best practices. Few patients with hematologic malignancies and even fewer post-HSCT patients were included in randomized trials of VTE prophylaxis and treatment. Prior VTE, GVHD, infections and indwelling venous catheters are risk factors for thrombosis. The increasing use of post-transplant maintenance therapy with lenalidomide in patients with multiple myeloma adds to this risk after autologous HSCT. These patients are also at high risk of bleeding complications because of prolonged thrombocytopenia and managing the competing risks of bleeding and thrombosis can be challenging. This review aims to provide a practical, clinician-focused approach to the prevention and treatment of VTE in the post-HSCT setting. PMID:26691425

  14. [New anticoagulants in the treatment of venous thromboembolism].

    PubMed

    Bura-Rivière, Alessandra

    2013-09-01

    Anticoagulant therapy is the cornerstone of treatment of venous thromboembolism (VTE). The treatment needs rapid initial anticoagulaton to minimize the risk of thrombus extension and fata pulmonary embolism, followed by an extended anticoagulation, aimed at preventing recurrent VTE. Till very recently, immediate anticoagulation can only be achieved with parenteral agents, such as heparin, low-molecular-weight heparin, or fondaparinux. Extended treatment usually involves the administration of vitamin K antagonists, such as warfarin. Emerging direct oral anticoagulants have the potential to streamline VTE treatment. These agents include oral anticoagulants that target thrombin or factor Xa. This article reviews the characteristics of these agents, describes the results of clinical trials in venous thromboembolic disease and outlines their strengths and weakness. PMID:24167902

  15. Cerebral venous thrombosis in a patient with acute postinfectious glomerulonephritis.

    PubMed

    Morkhandikar, S; Priyamvada, P S; Srinivas, B H; Parameswaran, S

    2016-01-01

    Thrombosis of the cerebral venous sinuses (CVT) is described in nephrotic syndrome. A 13-year-old girl was admitted with acute post-infectious glomerulonephritis (APIGN). Subsequently she developed recurrent seizures with focal neurological deficits. On evaluation, she was found to have CVT. To the best of our knowledge, this is the first report of CVT in APIGN. Identifying this complication is imperative, as timely diagnosis and treatment could be lifesaving. PMID:27194837

  16. A unique case of venous air embolus with survival

    PubMed Central

    Davare, Dafney L.; Chaudry, Zishan; Sanchez, Rafael; Lee, Seong K.; Kiffin, Chauniqua; Rosenthal, Andrew A.; Carrillo, Eddy H.

    2016-01-01

    Venous air embolus (VAE) occurs when gas, specifically atmospheric air, enters into the vascular system. Although rare, they can be fatal due to risk of cardiovascular collapse. In this report, we present a unique case of a 66-year-old female trauma patient with an inferior vena cava air embolism. An overview of the potential cause is presented, along with a review of the management of VAE. PMID:27587307

  17. 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.

  18. Cerebral venous thrombosis associated with micro-abscesses: case report.

    PubMed

    Katayama, Wataru; Fujita, Keishi; Onuma, Kuniyuki; Kamezaki, Takao; Sakashita, Shingo; Sugita, Shintarou

    2013-01-01

    We present a case that is most likely Lemierre's syndrome. A 19-year-old man presented to us with -common-cold-like symptoms, which he had had for 2 days, such as slight fever, general malaise, anorexia, sore throat, and headache. Eight days after the onset of these symptoms, he died of brain herniation due to cerebral venous thrombosis associated with micro-abscesses detected in pathological examination. PMID:23564158

  19. Superficial venous insufficiency from the infernal to the endothermal.

    PubMed

    Carradice, D

    2014-01-01

    This review presents the common diseases associated with superficial venous insufficiency of the leg. These include varicose veins, swelling, skin damage and ulceration. The benefits and rationale behind treatment are discussed, followed by the historical advances from ancient mortality and prayer to the modern endovenous revolution. Finally, an overview of modern treatment options will discuss the evidence supporting the gold standard of endothermal ablation and the cost effectiveness of treatment at this time of challenging resource limitation. PMID:24417822

  20. Cross-sectional echocardiographic diagnosis of systemic venous return.

    PubMed Central

    Huhta, J C; Smallhorn, J F; Macartney, F J; Anderson, R H; de Leval, M

    1982-01-01

    To determine the sensitivity and specificity of cross-sectional echocardiography in diagnosing anomalous systemic venous return we used the technique in 800 consecutive children with congenital heart disease and whom the diagnosis was ultimately confirmed by angiography. Cross-sectional echocardiography was performed without prior knowledge of the diagnosis in all but 11 patients, who were recalled because of a known abnormality of atrial situs. The sensitivity of cross-sectional echocardiographic detection of various structures was as follows: right superior vena cava 792/792 (100%); left superior vena cava 46/48 (96%); bilateral superior vena cava 38/40 (95%); bridging innominate vein with bilateral superior vena cava 13/18 (72%); connection of superior caval segment to heart (coronary sinus or either atrium) (100%); absence of suprarenal inferior vena cava 23/23 (100%); azygos continuation of the inferior vena cava 31/33 (91%); downstream connection of azygos continuation, once seen, 21/21 (100%); partial anomalous hepatic venous connection (one hepatic vein not connected to the inferior vena cava) 1/1 (100%); total anomalous hepatic venous connection (invariably associated with left isomerism) 23/23 (100%). The specificity of each above diagnoses was 100% except in one infant with exomphalos in whom absence of the suprarenal inferior vena cava was incorrectly diagnosed. Thus cross-sectional echocardiography is an extremely specific and highly sensitive method of recognizing anomalous systemic venous return. It is therefore of great value of planning both cardiac catheterisation and cannulation for open heart surgery. Images PMID:6751361

  1. Nonprescription, padded, lightweight support socks in treatment of mild to moderate lower extremity venous insufficiency.

    PubMed

    Brown, J R; Brown, A M

    1995-03-01

    Currently, strength greater than 20 mm Hg of compression is considered necessary for support hose used to treat symptomatic venous insufficiency in lower extremities. This strength is frequently uncomfortable, which reduces compliance and therefore clinical effectiveness. Whether more comfortable, nonprescription, light-compression support hose is effective in the treatment of mild to moderate venous insufficiency was investigated in 36 men with subjective complaints and objective signs (per Doppler ultrasound) of lower extremity venous insufficiency. All participants wore padded, light-compression (6 mm Hg), crew-height socks for 1 month. Then, participants were assigned to one of two groups on the basis of initial Doppler results. The half with the worst results wore stronger-compression (12 mm Hg) over-the-calf support socks, on the assumption that patients with worse venous insufficiency would require more support; those with the better Doppler results continued to wear the light-compression socks. Participants were retested at monthly intervals for 3 months. In each group, data indicated that the venous insufficiency for all patients improved objectively and subjectively. Many of the objective venous values improved with either statistical or highly statistical significance--specifically deep venous valve function, superficial venous valve functions, and venous capacity--without statistically altering arterial function. Improvement occurred in the first month of the trial and continued throughout the study. The use of light-compression support socks is effective and should be considered as a first line of therapy in treatment of mild to moderate venous insufficiency. PMID:7751167

  2. 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

  3. Vacuum-assisted Venous Drainage and Gaseous Microemboli in Cardiopulmonary Bypass

    PubMed Central

    Wang, Shigang; Ündar, Akif

    2008-01-01

    Abstract: When conventional gravity siphon venous drainage cannot achieve satisfactory venous drainage during minimally invasive cardiac and neonatal surgeries, assisted venous drainage techniques are needed to ensure adequate flow. One assisted venous drainage technique, vacuum-assisted venous drainage (VAVD), the aid of a vacuum in the venous reservoir, is now widely used to augment venous drainage during cardiopulmonary bypass (CPB) procedures. VAVD permits the use of smaller venous cannulae, shorter circuit tubing, and lower priming and blood transfusion volumes, but increases risk of arterial gaseous microemboli and blood trauma. The vacuum should be set as low as possible to facilitate full venous return, and realtime monitoring of gaseous microemboli in the arterial and venous line should be used to achieve the safest conditions. With current ultrasound technology, it is possible to simultaneously detect and classify gaseous microemboli in the CPB circuit. In this article, we summarize the components, setup, operation, advantages, and disadvantages of VAVD techniques and clinical applications and describe the basic principles of microemboli detectors, such as the Emboli Detection and Classification (EDAC) Quantifier (Luna Innovations, Roanoke, VA) and Bubble Counter Clinical 200 (GAMPT, Zappendorf, Germany). These novel gaseous microemboli detection devices could help perfusionists locate the sources of entrained air, eliminate hidden troubles, and minimize the postoperative neurologic impairments attributed to gaseous microemboli in clinical practice. PMID:19192754

  4. The venous drainage of the heart in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Dinç, G; Ozdemir, D

    2004-08-01

    The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae. PMID:15239815

  5. Exercise-Induced Systemic Venous Hypertension in the Fontan Circulation.

    PubMed

    Navaratnam, Devaraj; Fitzsimmons, Samantha; Grocott, Michael; Rossiter, Harry B; Emmanuel, Yaso; Diller, Gerard-Paul; Gordon-Walker, Timothy; Jack, Sandy; Sheron, Nick; Pappachan, John; Pratap, Jayant Nick; Vettukattil, Joseph J; Veldtman, Gruschen

    2016-05-15

    Increasingly end-organ injury is being demonstrated late after institution of the Fontan circulation, particularly liver fibrosis and cirrhosis. The exact mechanisms for these late phenomena remain largely elusive. Hypothesizing that exercise induces precipitous systemic venous hypertension and insufficient cardiac output for the exercise demand, that is, a possible mechanism for end-organ injury, we sought to demonstrate the dynamic exercise responses in systemic venous perfusion (SVP) and concurrent end-organ perfusion. Ten stable Fontan patients and 9 control subjects underwent incremental cycle ergometry-based cardiopulmonary exercise testing. SVP was monitored in the right upper limb, and regional tissue oxygen saturation was monitored in the brain and kidney using near-infrared spectroscopy. SVP rose profoundly in concert with workload in the Fontan group, described by the regression equation 15.97 + 0.073 watts per mm Hg. In contrast, SVP did not change in healthy controls. Regional renal (p <0.01) and cerebral tissue saturations (p <0.001) were significantly lower and decrease more rapidly in Fontan patients. We conclude that in a stable group of adult patients with Fontan circulation, high-intensity exercise was associated with systemic venous hypertension and reduced systemic oxygen delivery. This physiological substrate has the potential to contribute to end-organ injury. PMID:27032711

  6. Catheter venography and endovascular treatment of chronic cerebrospinal venous insufficiency.

    PubMed

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

    2012-06-01

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

  7. Fate of venous repair after shock and trauma

    SciTech Connect

    Barkun, J.S.; Terazza, O.; Daignault, P.; Chiu, R.C.; Mulder, D.S.

    1988-09-01

    To assess the role of shock and trauma in the subsequent thrombosis of a venous repair, the following experiments were performed. Two groups of unsplenectomized dogs were studied: control dogs (Gr.C) underwent replacement of a segment of superficial femoral vein by an autogenous vein graft. Trauma group (Gr.T) dogs were subjected to hypovolemic shock using a modified Wiggers' technique and received standardized hindleg trauma. After resuscitation, venous repairs identical to Gr.C dogs were performed. Gr.T dogs exhibited a 78% thrombosis rate as opposed to 12% in Gr.C animals. To elucidate possible mechanisms, platelets were drawn from another ten animals, divided into similar groups, and labelled with Indium-111-oxine. In Gr.T animals, graft activity increased over time and platelet distribution along the graft was homogeneous. These results contrasted markedly with those of Gr.C animals. We conclude that shock and trauma predispose venous repairs to failure and that altered platelet-endothelium interactions may be implicated.

  8. Alcohol consumption and venous thromboembolism: friend or foe?

    PubMed

    Lippi, Giuseppe; Mattiuzzi, Camilla; Franchini, Massimo

    2015-12-01

    A light to moderate consumption of certain types of alcoholic beverages may exert a favorable effect on cardiovascular risk, but no conclusive information is available on the putative relationship between alcohol intake and the risk of venous thromboembolism (VTE). We performed an electronic search on Medline and Scopus, using the keywords "venous thromboembolism", "venous thrombosis" and "alcohol", to identify clinical studies linking alcohol intake and VTE risk. The literature search generated 16 studies, 4 of which are case-control, 1 cross-sectional and 11 prospective. Significant reduction of VTE associated with alcohol intake is observed in only 4/16 studies, and in all these the association is only meaningful for a moderate amount of alcohol (i.e., 2-4 glasses). Unlike these trials, two other studies observe that alcohol intake is associated with an increased risk of VTE, whereas the association is insignificant in the remainder. Binge drinking increases the VTE risk in one study but not in another. The consumption of beer is associated with a decreased VTE risk in one study but not in two others. We hence conclude that the relationship between intake of alcoholic beverages and increased or decreased risk of VTE is largely elusive. PMID:26446524

  9. 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

  10. [Conservative therapy adapted to findings of superficial chronic venous ulcers].

    PubMed

    Billmann, M K; Köhler, Ch; Varelas, X; Mayer, D

    2004-05-01

    A successful treatment of venous ulcers represents a special clinical challenge. The following conservative wound management of a high-risk patient presents an alternative to primary surgical treatment. A patient of 79 years in reduced general state with multiple underlying concomitant diseases is hospitalized with superinfected, necrotic and painful ulcers. Due to the severe morbidity of the patient the regular therapy of the underlying venous insufficiency consisting of stripping of great saphenous vein and ligation of perforator veins, is contraindicated. After interdisciplinary discussion conservative therapy is carried on. The conservative therapy includes initial local debridement, moist wound-healing dressings, compression therapy, systemic antibiotic and analgesic therapy, completed by stabilization of patient's general state. In regular intervals a photographic documentation of the wound is carried out. The period of treatment and observation is 63 days. Due to conservative wound management a clear improvement of the wound condition and of the patient's general state is observed. The period needed for change of wound dressing can be reduced from 2 hours to 30 minutes. The painscore is reduced from 8/10 to 4/10 as well as the analgesic need. The photographic documentation shows a clear progress of healing within 9 weeks. Under antibiotic therapy and conservative wound management the increased inflammation parameters are declining. By choosing a conservative therapeutical regime adapted to clinical findings superinfected, chronic venous ulcers are turned into a stable condition. PMID:15224464

  11. Variability in the Cardiac Venous System of Wistar Rats

    PubMed Central

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

    2015-01-01

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

  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. A slide-rule for assessment of venous admixture.

    PubMed

    Zetterström, H

    1989-04-01

    Determination of venous admixture (physiological shunt, Qva/Qt) requires analysis of both arterial and mixed venous blood. When a pulmonary arterial catheter is not in use, the pulmonary oxygenating capacity may be assessed from arterial blood gas data, the fraction of inspired oxygen (FIO2) and an assumed value of the arterial-mixed venous oxygen content difference. To facilitate this process, a slide-rule based on the "virtual shunt" concept is presented. It permits rapid assessment of Qva/Qt from known values of arterial oxygen tension (PaO2) or saturation (SaO2) and FIO2 and may promote the choice of appropriate FIO2. The limitations of the slide-rule were studied theoretically and its validity was tested by comparing 100 determinations of virtual shunt with the corresponding Qva/Qt values. The slide-rule was found to estimate Qva/Qt more accurately than commonly used oxygenation indices such as the PaO2/FIO2 ratio. PMID:2499154

  14. Enhanced global mathematical model for studying cerebral venous blood flow.

    PubMed

    Müller, Lucas O; Toro, Eleuterio F

    2014-10-17

    Here we extend the global, closed-loop, mathematical model for the cardiovascular system in Müller and Toro (2014) to account for fundamental mechanisms affecting cerebral venous haemodynamics: the interaction between intracranial pressure and cerebral vasculature and the Starling-resistor like behaviour of intracranial veins. Computational results are compared with flow measurements obtained from Magnetic Resonance Imaging (MRI), showing overall satisfactory agreement. The role played by each model component in shaping cerebral venous flow waveforms is investigated. Our results are discussed in light of current physiological concepts and model-driven considerations, indicating that the Starling-resistor like behaviour of intracranial veins at the point where they join dural sinuses is the leading mechanism. Moreover, we present preliminary results on the impact of neck vein strictures on cerebral venous hemodynamics. These results show that such anomalies cause a pressure increment in intracranial cerebral veins, even if the shielding effect of the Starling-resistor like behaviour of cerebral veins is taken into account. PMID:25169660

  15. [An optimum donor site for venous grafting for microsurgery].

    PubMed

    Grimaud, O; Delpit, X; Hardy, P

    2011-06-01

    We report the results of an anatomic study based on 10 cadavers. The aim of this work is to find an optimum donor site for venous grafts which is safe, reproducible, and suitable for microsurgery stitches especially in finger reimplantation, when a long and small calibre graft is needed. This study describes the deep venous network of the radial artery, an original donor site for microsurgical venous grafts. The second aim is to describe our technique of harvesting. Dissections always show two satellite veins, that can be harvested with optimal average diameter of 1.8mm constant over the whole length. The maximum length available is about 126.5mm for the radial satellite vein, and 125 mm for the ulnar one, with a few number of collateral ligatures needed. No tying is required in 60% cases for radial satellite vein, and one ligature for the other 40%, whereas in the ulnar satellite vein, no tying is needed in 80% and just one in the other 20%. This original site is advantageous in microsurgery of the upper limb, offering an easy, quick, safe and reproducible option in an emergency situation. PMID:21621446

  16. Occupational effect on the occurrence of idiopathic venous thromboembolism.

    PubMed

    Freeman, Randall J; Jankosky, Christopher; Olsen, Cara H; Mallon, Timothy

    2012-10-01

    Few studies have explored the effects of various occupations on venous thromboembolism occurrence. We examined idiopathic venous thromboembolism (IVTE) occurrence by occupation, body size, and age in the U.S. military. To capture idiopathic cases, exclusion criteria included recognized venous thromboembolism risk factors. Each case was matched to three controls on branch of service, sex, rank/grade, race, and education level. Body mass index, age, and occupation were analyzed with chi2 and logistic regression. Of 2,167 cases, most were male (87%), white (69%), enlisted (78%), averaging 36 years old. IVTE odds increased with age (p < 0.001). Every occupation showed greater odds than pilots/aircrew (p < 0.001), especially infantry/artillery/combat arms, which showed twice the odds, followed by health care workers. Normal weight was protective, especially in pilots/aircrew (OR 0.52, p = 0.03) and repair/engineering (OR 0.72, p < 0.001). Our analysis found a lower risk of IVTE among pilots and aircrew compared to other military occupations. Body size had less impact than expected in aircraft and vehicle operators. Greater odds in health care workers and infantry/artillery/combat arms than in pilots/aircrew and armor/motor transport occupational groups may reflect prolonged standing. Limitations include potential miscoding of health records and potential misclassification. Future IVTE research should explore job functions and worker characteristics. PMID:23113451

  17. Postsurgical Inflammation as a Causative Mechanism of Venous Thromboembolism.

    PubMed

    Albayati, Mostafa A; Grover, Steven P; Saha, Prakash; Lwaleed, Bashir A; Modarai, Bijan; Smith, Alberto

    2015-09-01

    Surgery is associated with an increased risk of venous thromboembolic events (VTE) including deep vein thrombosis and pulmonary embolism. Although the current treatment regiments such as mechanical manipulation and administration of pharmacological prophylaxis significantly reduced the incidence of postsurgical VTE, they remain a major cause of postoperative morbidity and mortality worldwide. The pathophysiology of venous thrombosis traditionally emphasizes the series of factors that constitute Virchow triad of factors. However, inflammation can also be a part of this by giving rise to a hypercoagulable state and endothelial damage. The inflammatory response after surgery, which is initiated by a cytokine "storm" and occurs within hours of surgery, creates a prothrombotic environment that is further accentuated by several cellular processes including neutrophil extracellular traps formation, platelet activation, and the generation of tissue factor-bearing microparticles. Although such inflammatory markers are elevated in undergoing surgery, the precise mechanism by which they give rise to venous thrombosis is poorly understood. Here, we discuss the potential mechanisms linking inflammation to thrombosis, and highlight strategies that may minimize surgical inflammation and reduce the incidence of postoperative VTE. PMID:26276933

  18. Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?

    SciTech Connect

    Solar, Miroslav; Ceral, Jiri; Krajina, Antonin; Ballon, Marek; Malirova, Eva; Brodak, Milos; Cap, Jan

    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.

  19. 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.

  20. Pacemaker wire central venous stenosis and one more reason to not run central venous catheters for dialysis in reverse flow.

    PubMed

    Ash, Stephen R; Ugianskis, Erika J

    2013-01-01

    A 75-year-old man on chronic peritoneal dialysis had unrecognized stenosis of the superior vena cava (SVC) due to pacemaker wires placed 5 years earlier. The patient was placed on hemodialysis after hernia surgery. When a tunneled central venous catheter for dialysis was placed from the right internal jugular (IJ) vein, the venous lumen extended through the stenotic area but not the arterial lumen. Probably due to a subsequent clot at the arterial lumen port the patient developed SVC syndrome and when the catheter was run in the reversed flow direction he developed hypovolemic shock. The stenosis and SVC syndrome resolved with angioplasty of the SVC stenosis, removal of the IJ catheter and use of a femoral vein catheter. The patient eventually returned to peritoneal dialysis and the femoral catheter was removed. PMID:22860886