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1

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

SciTech Connect

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

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

2008-01-15

2

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

SciTech Connect

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

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

2011-12-15

3

Gangrene  

MedlinePLUS

... for gangrene if you have: A serious injury Blood vessel disease (such as arteriosclerosis, also called hardening of the ... the blood vessels) to help plan treatment for blood vessel disease Blood tests (white blood cell [WBC] count may ...

4

Breast Gangrene  

PubMed Central

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

2011-01-01

5

Gas gangrene  

MedlinePLUS

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

6

Fournier gangrene.  

PubMed

Fournier gangrene is a necrotizing infection involving the soft tissues of the male genitalia. It was first described in 1764 by Baurienne and given its eponymous name after Jean-Alfred Fournier in 1883 presented a case of perineal gangrene in an otherwise healthy young man. While only 600 cases of Fournier gangrene have been reported in the world literature since 1996, it is a common and serious disease in Africa. In Maputo Central Hospital alone, between 12 and 16 cases are admitted every year and treated with a 20% mortality. The typical patient is an elderly male in his sixth or seventh decade with co-morbid diseases. While considered to affect males only, a similar condition may occasionally affect the female genitalia. PMID:17034687

Vaz, Igor

2006-10-01

7

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.

8

Gas gangrene (image)  

MedlinePLUS

Gas gangrene is a severe form of gangrene (tissue death) caused by the bacterium Clostridium perfringens. Patients ... vascular diseases are more prone to spontaneously develop gas gangrene, which is rapidly progressive and often fatal.

9

Sonography of gangrenous cholecystitis.  

PubMed

Gangrenous cholecystitis is an acute surgical emergency, which requires early cholecystectomy. Differentiation of patients with gangrenous cholecystitis from those with non-gangrenous cholecystitis can be difficult, both clinically and with imaging. Careful attention to the following sonographic signs suggests the presence of gangrenous cholecystitis decreased focal wall perfusion on Color Doppler, irregular gall bladder mucosal outline, gall bladder wall thickening with signs of de-lamination, gas within the gall bladder, absence of calculi, and large peri-cholecystic collections. Both sonogram with color flow imaging and contrast-enhanced Computed tomography are complementary investigations to establish this important diagnosis in critically ill patients. PMID:22416162

Corr, Peter

2012-01-01

10

Symmetrical peripheral gangrene.  

PubMed Central

Two cases of symmetrical peripheral gangrene associated with intracardiac lesions are described. One had a secondary deposit from a uterine leiomyosarcoma in the wall of the right ventricle, the other had a free ball thrombus in the right atrium; there were no valvular lesions in either case. The published reports of this type of gangrene indicate that it may result from (1) va sospastic conditions, (2) small vessel obstruction, or (3) conditions producing a very low cardiac output. The two patients reported are unusual examples of the last. Images

McGouran, R C; Emmerson, G A

1977-01-01

11

Fournier's Gangrene: Current Practices.  

PubMed

Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20-30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes. PMID:23251819

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

2012-01-01

12

Management of venous ulcers.  

PubMed

Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux, as well as venous obstruction. The most severe clinical manifestation of CVI is venous leg ulceration that can result in significant morbidity, including venous gangrene and amputation, albeit rare. Treatment modalities are aimed at reducing venous hypertension. Diuretic therapy, although widely used, only provides short-term improvement of the edema but provides no long-term benefit. Compression therapy is the cornerstone in the management of CVI. Compression can be achieved using compression bandaging, compression pumps, or graduated compression stockings. Topical steroid creams may reduce inflammation, venous eczema, and pain in the short term, but they can be detrimental in the long run. Apligraf (a living, bilayered, cell-based product) in conjunction with compression therapy was noted to be more effective in healing venous leg ulcerations, when compared with treatment with compression therapy and zinc paste. Endovascular and surgical techniques that minimize valvular reflux and relieve venous obstruction improve venous hemodynamics, promoting wound healing. PMID:24840970

Kolluri, Raghu

2014-06-01

13

Gas Gangrene at Tertiary Care Centre  

Microsoft Academic Search

Objectives : To study gas gangrene isolates at tertiary care centre. Methods : Analysis of a series of 206 cases of gas gangrene was done over a period of 2 yr (Dec. 2004 - Dec. 2006). Results : Clostridium perfringens was cultured in 58 (90.6%) of the cases, Clostridium tertium were isolated in 5 (7.8%) and clostridium tetani in 1

A Sonavane; M Mathur

14

Postpartum Peripheral Symmetrical Gangrene: A Case Report  

PubMed Central

Background Symmetrical peripheral gangrene is usually associated with underlying medical problems and it is seldom seen in pregnancy. Sepsis though common in a setting of delivery by unskilled midwife is rarely accompanied by symmetrical gangrene. Case Presentation We report a case of symmetrical peripheral gangrene which occurred in the winter, triggered possibly by sepsis and a single dose of ergot. A high index of suspicion, early diagnosis and intervention with appropriate measures will result in favorable outcome in such cases. Conclusion Although postpartum period is of high risk for sepsis and use of ergot alkaloids is common in labor but occurrence of peripheral symmetrical gangrene is rare. A high index of suspicion for the diagnosis and timely intervention will prevent irreparable damage and loss of limb.

Sharma, Lipi; Mehta, Sumita; Rajaram, Shalini; Aggarwal, Rachna; Gupta, Sanjay; Goel, Neerja

2012-01-01

15

Pulmonary gangrene as a complication of mucormycosis  

SciTech Connect

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

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

1985-06-01

16

Subconjunctival bevacizumab in the impending recurrent pterygia.  

PubMed

The aim of this study is to evaluate the efficacy and safety of subconjunctival bevacizumab injection(s) in the treatment of impending recurrent pterygia. Twenty-three eyes of 23 patients who developed impending recurrence after pterygium surgery with conjunctival autografting and were treated with subconjunctival bevacizumab injection(s) (2.5 mg/0.1 mL) were included in the study. Anterior segment photographs were taken prior to and at 1 week, 1, 3 and 6 months after the injection, and at the end of the follow-up period. Image analysis was performed using an image processing and analysis software program. Recurrence rate and complications were recorded. The mean age and follow-up time of the patients were 51.2 ± 6.2 (31-60 years) and 16.8 ± 3.1 (12-22 months), respectively. The average number of injections was 2 ± 0.78 (1-3). Sixteen eyes required re-injection (two injections in nine eyes, three injections in seven eyes), due to progression of vascularization. There were significant differences between size percentage of lesions before injection and at 1 week, 1, 3 and 6 months after the injection (p < 0.05 for all). Corneal recurrence developed in only one patient and no ocular or systemic side-effects of bevacizumab were observed. Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, due to its adjuvant role in decreasing lesion size, especially in the first year after surgery. PMID:24026871

Bayar, Sezin Akca; Kucukerdonmez, Cem; Oner, Ozlem; Akova, Yonca A

2014-06-01

17

[Fournier's gangrene caused by Candida albicans].  

PubMed

Fournier's gangrene characterized by fulminant necrotizing fasciitis of the perineal, genital or perianal regions, is generally caused by aerobic and anareobic bacteria. Although it is thought to be an idiopathic process, Fournier's gangrene has been shown to have a predilection for patients with diabetes, long term alcohol misuse and immunocompromised patients. The focus of infection is usually located in the urinary tract, lower gastrointestinal tract or skin. The development and progression of the gangrene is often fulminating and can rapidly lead to multiple organ failures and death. Here, we present a Fournier's gangrene case caused by Candida albicans. A 59-year-old woman was admitted to hospital with the complaint of swelling on the right thigh following a trauma occurred three weeks ago. Her history revealed that she had been hospitalized previously for four times due to diabetes mellitus, essential thrombocytopenia, chronic disease anemia and hypertension. Right trochanteric fracture was detected and the patient was taken under surgical debridement with the pre-diagnosis of secondary anaerobic soft tissue infection. Empirical treatment was started with cephalosporin and metronidazole. Since wo- und and blood cultures revealed C. albicans as the primary microorganism, fluconazole was added to the therapy. However, the patient died on the post-operative 25th day because of multi-organ disfunction secondary to fungal sepsis. This case has been reported to emphasize that yeasts should be considered as pathogenic agents in diabetic patients with gangrene. PMID:19149096

Temiz, Muhyittin; Cetin, Meryem; Aslan, Ahmet

2008-10-01

18

The features and aetiology of Fournier's gangrene.  

PubMed

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

Efem, S E

1994-08-01

19

Uraemic gangrene syndrome: is parathyroidectomy always necessary?  

PubMed

This report presents a case of uraemic gangrene syndrome with multiple ulcerations and calcium (Ca) deposits in the vessel walls. High-dosage oral calcium carbonate (CaCO3) treatment alone resulted in rapid wound healing with decreased serum phosphorus (P), Ca x P product and parathormone and only slightly increased Ca levels. We suggest that this should be the first choice of treatment in such cases because positive clinical response can achieve symptom-free status for the patient until kidney transplantation, thus making parathyroidectomy unnecessary. PMID:11683292

Scharrer, K; Mako, J; Vajda, A; Baló-Bangat, J M

2001-05-01

20

Multiple Urethral Stones Causing Penile Gangrene  

PubMed Central

Penile urethral stones are a rare occurrence resulting from a number of causes including migration of stones within the urinary tract, urethral strictures, meatal stenosis, and obstructing tumours such as adenomatous metaplasia of the uroepithelium, hypospadias, urethral diverticulum, and very rarely primary fossa navicularis calculi. We report the case of a 54-year-old male presenting with penile gangrene and sepsis resulting from impaction of multiple stones within the penile urethra. This paper summarises the topic and discusses the pathophysiology of this unusual condition.

Ramdass, Michael J.

2014-01-01

21

Successful catheter-directed venous thrombolysis in an ankylosing spondylitis patient with phlegmasia cerulea dolens.  

PubMed

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Phlegmasia cerulea dolens is a severe form of deep vein thrombosis characterized by swelling, pain, and bluish discoloration. Treatment delay may cause venous gangrene, tissue ischemia, limb loss or death. Here, we present an AS case who presented with phlegmasia cerulea dolens and treated by catheter-directed thrombolysis. PMID:24046784

Rokni Yazdi, Hadi; Rostami, Nematollah; Hakimian, Homa; Mohammadifar, Mehdi; Ghajarzadeh, Mahsa

2013-06-01

22

Successful Catheter-Directed Venous Thrombolysis in an Ankylosing Spondylitis Patient with Phlegmasia Cerulea Dolens  

PubMed Central

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Phlegmasia cerulea dolens is a severe form of deep vein thrombosis characterized by swelling, pain, and bluish discoloration. Treatment delay may cause venous gangrene, tissue ischemia, limb loss or death. Here, we present an AS case who presented with phlegmasia cerulea dolens and treated by catheter-directed thrombolysis.

Rokni Yazdi, Hadi; Rostami, Nematollah; Hakimian, Homa; Mohammadifar, Mehdi; Ghajarzadeh, Mahsa

2013-01-01

23

Students' Perceptions regarding Their Impending Transition out of College  

ERIC Educational Resources Information Center

Although researchers have argued students experience feelings of stress, fear, and uncertainty as they transition from college to work life, there is limited empirical research supporting this argument. Our study filled this gap by exploring 183 fourth-year students' perceptions regarding their impending transition out of the college environment.…

Yazedjian, Ani; Kielaszek, Becki J.; Toews, Michelle L.

2010-01-01

24

Breast Gangrene in an HIV-Positive Patient  

PubMed Central

Introduction Breast gangrene has been reported as a complication following puerperal sepsis, breast surgery, nipple piercings, warfarin toxicity, etc. We report a case of primary breast gangrene in an HIV-positive individual which, to the best of our knowledge, is the first of its kind. Case report A 40-year-old previously healthy woman presented with fulminating left breast gangrene. She was detected to be HIV positive. Mastectomy was performed. The detailed management of the condition is discussed. Conclusion Severe necrotising infections may be initial manifestations of HIV infection and patients with such infections should be screened for HIV.

Venkatramani, V; Pillai, S; Marathe, S; Rege, SA; Hardikar, JV

2009-01-01

25

Gangrenous cystitis in a 42-year-old male  

PubMed Central

Gangrenous cystitis is now an extremely rare condition since the widespread use of antibiotics. The authors report a case of gangrenous cystitis in a previously fit and normal 42-year-old male who presented in acute urinary retention. He underwent a partial cystectomy during an exploratory laparotomy for clinical deterioration and peritonitis. Diagnosis of this rare disease is challenged by its low incidence and lack of characteristic pathognomic features, resulting in delayed diagnosis and increased morbidity and mortality. The authors review the literature to date on the aetiology, presentation, diagnosis and management of gangrenous cystitis and emphasise the importance of early and aggressive surgical management.

De Rosa, Antonella; Amer, Tarik; Waraich, Naseem; Bello, Alache; Parkinson, Richard

2011-01-01

26

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

PubMed

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

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

2014-06-01

27

Anticipatory control of impending postural perturbation in elite springboard divers  

Microsoft Academic Search

Among athletes, elite springboard divers (ED) should develop an optimal anticipatory control of postural stability, as a result\\u000a of specific training. Postural strategies of ED and healthy subjects (HS) while expecting an impending perturbation were compared.\\u000a The mean center of pressure (COP) position was analyzed during control quiet stance (cQS) and during anticipatory quiet stance\\u000a (aQS1–4), i.e., in expectation of

T. Popa; M. Bonifazi; R. della Volpe; A. Rossi; R. Mazzocchio

2008-01-01

28

Symmetrical peripheral gangrene due to Plasmodium falciparum malaria.  

PubMed

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

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

2014-01-01

29

Computer-aided prediction of gangrenous and perforating appendicitis.  

PubMed Central

The clinical details of 100 patients with proved acute appendicitis were compared with those of 100 patients with perforating or gangrenous appendicitis. Twenty features were found to be significantly different between the two groups. This information was incorporated into a computer data base and used in the differential diagnosis of abdominal pain. A program written to predict the probability that gangrene or perforation was present in patients with appendicitis gave a diagnostic accuracy over 91%. A clinical scoring index, which accurately predicted the state of the appendix in 88% of patients, was constructed from the significant differences between the two groups. When clinical scoring or computer analysis predicts a high probability of perforation or gangrene in patients with appendicitis, surgery should be performed without delay.

Graham, D F

1977-01-01

30

Fournier's gangrene associated with sparganosis in the scrotum.  

PubMed

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

Jeong, Hee Jong

2004-01-01

31

Venous Valves  

NSDL National Science Digital Library

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

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

2009-11-20

32

Fournier's gangrene associated with sparganosis in the scrotum  

Microsoft Academic Search

Fournier's gangrene is a necrotizing fasciitis of the scrotum or perineum that may extend by way of the fascial planes to the penis and the anterior abdominal wall up to the clavicles, buttocks, or lower extremities. It is a life-threatening progressive disease that requires aggressive antibiotic therapy and early radical debridement. Sparganosis is a parasitic infection that occurs principally in

Hee Jong Jeong

2004-01-01

33

Legal abortion: the impending obsolescence of the trimester framework.  

PubMed

Women who wish to terminate a pregnancy, and physicians willing to perform abortions, are subject to increasing harassment from groups which challenge the constitutional abortion right upheld by the Supreme Court in Roe v. Wade. Their vulnerability, in fact, parallels the vulnerability of the abortion right. This Article analyzes the inherent weakness and impending obsolescence of the trimester framework established in Roe. Present medical evidence of maternal health risks and fetal viability demonstrates that the trimester framework is inconsistent with current medical knowledge, and will likely be rendered obsolete by developments in medical technology. The Article suggests that adoption of an alternative constitutional basis for legal abortion is necessary to preserve the abortion right, and explores the utility of two arguments grounded in the equal protection doctrine. Finally, it discusses means of preserving legal abortion within the confines of the trimester framework established in Roe v. Wade. PMID:3068986

Mangel, C P

1988-01-01

34

American Venous Forum  

MedlinePLUS

... Complete free venous disease assessment Promoting venous and lymphatic health through education and disease awareness. Addressing your ... disease questions and needs. Learn about venous and lymphatic diseases Get a free access to the Layman's ...

35

Venous thrombosis - series (image)  

MedlinePLUS

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

36

Laparoscopic management of gallstone presenting as obstructive gangrenous appendicitis.  

PubMed

We present an unusual case of a 55-year-old man with symptoms of recurrent appendicitis. Laparoscopy revealed a 1.5 cm gallstone impacted at the base of the appendix, leading to gangrenous appendicitis. This patient did not have any features of gallstone ileus. On imaging he had an inflammatory mass in the region of the right iliac fossa with a hyperintense shadow in the cecal area which was reported as an appendicolith. There was no demonstrable cholelithiasis or biliary-enteric fistula. There were dense omental adhesions in the pericholecystic area on laparoscopy. The case was successfully managed by laparoscopic appendectomy with retrieval of the gallstone. No surgery was undertaken for the gallbladder. Diagnosis was confirmed by biochemical analysis of the stone, which contained calcium bilirubinate and cholesterol. A gallstone obstructing the appendicular lumen is a very rare etiology of gangrenous perforation of the appendix peritonitis. This case was successfully managed laparoscopically. PMID:16366872

Mehrotra, Prateek K; Ramachandran, C S; Gupta, Lalit

2005-12-01

37

Phagedena: gangrenous and necrotic ulcerations of skin and subcutaneous tissue.  

PubMed

Phagedena is an old term for serious deep, necrotic and gangrenous skin ulcers. In the past these have been regarded as severe infections. A review of 31 cases revealed that except in cases of Streptococcus pyogenes or Clostridium welchii infection a bacterial of fungal infection was only one of several factors that led to the development of phagedenic ulcers. Initiating factors may be a bacterial infection, a debilitated state as a result of immunosuppressive therapy or of such conditions as alcoholism, severe diabetes, inflammatory bowel disease or severe arteriosclerosis, and various types of injury or trauma. Continuing factors include enzymatic mechanisms, the release of toxins from large areas of dead tissue and vascular disorders. In general, antibiotics are of limited value. systemic corticosteroid therapy may be useful in the subacute or chronic case. In acute, spreading, gangrenous phagedena with surrounding erythema, fever and systemic toxic effects, immediate excision of dead tissue may be lifesaving. PMID:7066792

Jackson, R; Bell, M

1982-02-15

38

Management of fournier's gangrene: case report and literature review.  

PubMed

A 65-year-old man was referred to our department with clinical signs of septic shock and necrotizing soft tissue infection of the scrotal, perianal and right inguinal region. Initial presentation was a typical Fournier's gangrene. Because of the life-threatening condition, the initial treatment was extensive removal of necrotic tissue. Antibiotic therapy was administered and several debridements of the wound were done afterwards. Three weeks after the initial treatment, wide wound defects of the perianal, scrotal and inguinal regions were closed secondarily and the patient was discharged from the hospital. Fournier's gangrene is a surgical emergency. Although rare, it remains a life-threatening disease. Rapid and accurate diagnosis remains the key component in achieving successful outcome. Early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics is the essential management to reduce mortality. PMID:21830457

Katusi?, Josip; Stimac, Goran; Benko, Goran; Grubisi?, Igor; Soipi, Soip; Dimanovski, Jordan

2010-12-01

39

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

PubMed

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

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

2014-01-01

40

Fournier's gangrene caused by Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi.  

PubMed

We report the first case of Fournier's gangrene caused by three unusual anaerobic organisms: Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi. The infection occurred in a 73-year-old man without typical risk factors for the development of Fournier's gangrene. Clinical outcome was good after prolonged antibiotic treatment and extensive debridement of the perineum. The case suggests that A. funkei, F. gonidiaformans and C. hathewayi should be considered as potential pathogens of Fournier's gangrene. Human infections caused by these organisms are very rare but can be underestimated because correct identification is very difficult, especially in polymicrobial infections such as Fournier's gangrene. PMID:24631671

Tena, Daniel; Losa, Cristina; Medina-Pascual, María José; Sáez-Nieto, Juan Antonio

2014-06-01

41

Acral gangrene as a presentation of non-uremic calciphylaxis.  

PubMed

We are describing a case of 55-year-old obese female with significant history of uncontrolled rheumatoid arthritis, who recently had decreased her immune-suppression medications. She presented with extensive acral gangrene involving multiple fingers and toes. Clinical picture and laboratory findings were suggestive of vasculitis; however, skin biopsy established diagnosis of calciphylaxis, in settings of normal kidney function. Patient was treated with sodium thiosulfate with gradual improvement in her skin lesions. PMID:24327971

Hammadah, Muhammad; Chaturvedi, Shruti; Jue, Jennifer; Buletko, Andrew Blake; Qintar, Mohammed; Madmani, Mohammed Eid; Sharma, Prashant

2013-10-01

42

Diabetic gangrene in Japan: analysis of 487 cases.  

PubMed

Diabetic gangrene was thought of as a rather rare complication in Japan. Since the first report in 1917, only 16 cases were reported up to 1945. However, the number of reports increased rapidly in the manner of a geometric series after 1965. Sex and age distributions of the syndrome in Japan corresponded closely with those of Western countries. A distinct tendency in the inducement of gangrene was found, i.e. thermal trauma had preceded 43.6% of the cases. This might be the result of the local habit of warming the feet using hot-water bottles or foot warmers. The number of patients with normal pulses in the affected extremities in Japan was distinctly higher compared with that reported in Western countries. But functional and morphological changes in large peripheral vessels were frequently demonstrated when more detailed examinations were conducted. The cause for the rapid increase in the incidence of diabetic gangrene has not been elucidated, but changes in lifestyle may be partly responsible. The most conspicuous change was the increase in meat and fat intake during the 1960's. The changes in total calorie, total protein or sugar intake over this period were inconspicuous. Changes in dietary habits seem to be responsible, but further research will be necessary to clarify the details. PMID:6680535

Okuyama, M; Nagai, K; Miyazaki, S; Kosaka, J; Kamikubo, K; Miura, K; Matsumoto, K; Inada, K

1983-12-01

43

Acute kidney injury due to rhabdomyolysis-associated gangrenous myositis.  

PubMed

Rhabdomyolysis is associated with infectious diseases in approximately 5% of cases and acute kidney injury occurs in 33-50% of cases. Gangrenous myositis is a deep seated infection of the subcutaneous and muscular tissues. We report the case of an 18 year-old man who was admitted to the emergency room with leg pain, fever, nausea, vomiting and oliguria. Physical examination showed moderate dehydration, peripheral cyanosis and skin necrosis with severe myalgia and no subcutaneous gas. Laboratory findings at admission were: serum urea 111 mg/dL, creatinine 1.3 mg/dL, potassium 6.3 mEq/L, creatine kinase (CK) 112,452 IU/L, aspartate amino transaminase (AST) 1116 IU/L, alanine amino transaminase (ALT) 1841 IU/L, pH 7.31, bicarbonate (HCO3) 11 mEq/L and lactate 4.3 mmol/L. Emergency hemodyalisis was started, and antibiotics were given due to high suspicion for bacterial infection. The patient developed respiratory insufficiency and septic shock needing mechanical ventilation and vasoactive drugs. He presented spontaneous gangrenous myositis in both legs and in his left arm. After 26 sessions of hemodialysis, partial recovery of renal function was observed. He was discharged from the ICU after 38 days, still with leg pain. Acute kidney injury due to rhabdomyolysis should be considered as a possible complication of gangrenous myositis. PMID:19260387

Daher, Elizabeth F; Lima, Rafael S A; Silva Júnior, Geraldo B; Almeida, Joăo Paulo C; Siqueira, Francisco Júlio W S; Santos, Silvia Q; Silva, Stephanie W; Libório, Alexandre B

2008-12-01

44

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

PubMed

Background. Fournier's gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier's gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30-39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier's gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome. PMID:23997966

Aliyu, S; Ibrahim, A G; Ali, N; Waziri, A M

2013-01-01

45

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

PubMed Central

Background. Fournier's gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier's gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier's gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome.

Aliyu, S.; Ibrahim, A. G.; Ali, N.; Waziri, A. M.

2013-01-01

46

Ischemic Gangrene of the Glans following Penile Prosthesis Implantation  

PubMed Central

The development of ischemic gangrene of the penis following implantation of prosthesis is unusual, and very few cases are available in the literature. As a result, no established treatment protocol is available. We report our experience within a case of gangrene of the glans following implantation of a three-component prosthesis. We present a 53-year-old male, smoker with diabetes and hypercholesterolemia, who underwent surgery for the insertion of a penile prosthesis with 3 components to correct his erectile dysfunction and severe Peyronie's disease. The procedure was carried out without incidents. During the postoperative period, the patient began to complain from penile and perineal pain. He developed avascular necrosis of the glans. The necrosed area was excised. Four weeks later, he developed fever and perineal pain arriving to the emergency room with the prosthesis extruding through the glans. He had emergency surgery to remove the prosthesis plus surgical lavage and was prescribed broad-spectrum antibiotic therapy. Four weeks later, the penis was completely revascularized and reepithelialized. Ischemic gangrene following penile prosthesis implantation takes place in patients with poor peripheral vascularisation. Diabetes mellitus has been the common denominator to all of the reported cases.

Garcia Gomez, Borja; Romero Otero, Javier; Diez Sicilia, Laura; Jimenez Alcaide, Estibaliz; Garcia-Cruz, Eduardo; Rodriguez Antolin, Alfredo

2013-01-01

47

Enterostomy can decrease the mortality of patients with Fournier gangrene  

PubMed Central

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.

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

2014-01-01

48

Recent advances in the management of Fournier's gangrene: preliminary observations.  

PubMed

Twenty consecutive cases of Fournier's gangrene managed conservatively with systemic antibiotics and topical application of unprocessed honey (group A) were compared with 21 similar cases of Fournier's gangrene managed by the orthodox method (group B) during the same period. Group A received oral amoxicillin/clavulanic acid and metronidazole in addition to daily topical application of honey to the gangrenous scrotum, whereas group B underwent wound debridement, wound excision, secondary suturing, and in some cases scrotal plastic reconstruction in addition to receiving a mixture of systemic antibiotics dictated by culture and sensitivity results. The organisms cultured in both groups were similar. Even though the average duration of hospitalization was slightly longer in group A (4.5 weeks) as opposed to group B (4 weeks), topical application of honey showed distinct advantages over the orthodox method. Three deaths occurred in group B, whereas no deaths occurred in group A. The need for anesthesia and expensive surgical operation was obviated. Response to treatment and alleviation of morbidity were faster in group A. Honey may revolutionize the treatment of this dreadful disease by reducing morbidity and mortality. PMID:8430368

Efem, S E

1993-02-01

49

Investigation of Antioxidant Enzymes and Some Biochemical Parameters in Ewes with Gangrenous Mastitis  

Microsoft Academic Search

This paper investigates the effects of gangrenous mastitis seen with cell necrosis and tissue damage on the activity of erythrocyte glutathione peroxidase (GSH-Px), level of plasma lipid peroxidation (MDA), and some biochemical parameters. To do that, 20 clinically gangrenous mastitis diagnosed and 20 healthy ewes, all from the same flock in a local ewes unit were used as material. Blood

Mehmet Osman ATLI; Ömer KORKMAZ

50

A 12-month-old infant with Fournier gangrene associated with varicella.  

PubMed

Fournier gangrene is a progressive infection of the genital and perianal regions. It is a truly rare entity in association with varicella. There is only a single case published in the literature. We present the second case of a Fournier gangrene associated with varicella in an infant. PMID:18090105

Cortés, Jeff R; Arratia, Jorge A; Jaime, Rodolfo

2007-10-01

51

Gas Gangrene as a Result of Femoral Traction Pin Placement  

PubMed Central

Treatment of adult femoral shaft fractures typically involves operative stabilization with intramedullary implants, external fixation, or a plate and screw construct. However, when stabilization is delayed for any reason, use of a traction pin is recommended to stabilize the fracture, prevent significant shortening, as well as to help with pain control. In this paper, we present the rare complication of a severe gas gangrene infection caused by Clostridium perfringens that led to several amputations and ultimately death. We also discuss risks of temporary skeletal traction and techniques to overcome the morbidity of such a procedure.

Taylor, Benjamin C.; Bramwell, Thomas J.; Formaini, Nathan

2011-01-01

52

Priapism and penile gangrene due to thrombotic thrombocytopenic purpura.  

PubMed

A 51-year-old man presented with 4 days of idiopathic ischemic priapism. Partial detumescence was achieved with aspiration and injection with intracorporeal adrenaline. On further evaluation, the patient was diagnosed with thrombotic thrombocytopenic purpura. This was treated with plasma exchange and steroids. The penis was initially observed for 3 weeks, which subsequently became necrotic and infected, requiring debridement. After debridement of penile shaft skin, it became apparent that the entire penis was necrotic, necessitating total penectomy. The wound was closed secondarily 2 weeks later. Gangrene of the penis after priapism is very rare. Priapism associated with thrombotic thrombocytopenic purpura has not been reported previously in published data. PMID:19896177

Kwok, Benjamin; Varol, Celi

2010-01-01

53

Successful combined approach to a severe Fournier's gangrene  

PubMed Central

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

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

2014-01-01

54

The bacteriology of gangrenous and perforated appendicitis--revisited.  

PubMed Central

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

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

1990-01-01

55

[Fournier's gangrene in an HIV-positive patient. Therapeutic options].  

PubMed

Fournier's gangrene is a life-threatening necrotising infection of the perineal and genital regions. The case presented here refers to an HIV-positive 42-year-old man, admitted in emergency to our department with clinical signs and symptoms of sepsis related to gangrene of the perineum and scrotum. An early wide surgical necrosectomy was performed under epidural anaesthesia. Treatment was completed by intensive care, broad-spectrum antibiotics and hyperbaric oxygen therapy. The wound was managed with advanced dressing (AQUACEL Hydrofiber) until complete healing was obtained, and the scrotum was reconstructed with skin flaps. The disease did not involve the testes, spermatic cord or anorectal canal. The satisfactory aesthetic and functional outcome prompts the authors to stress a number of features of the therapeutic approach adopted: (i) the advantages of epidural anaesthesia with an indwelling catheter that allows further necrosectomy and wound dressing to be performed totally painlessly; (ii) the possibility of avoiding faecal diversion by means of synthetic opioid drugs which are useful to reduce the frequency of defecation; and (iii) the positive impact of advanced dressing on the wound healing process in relation to patient satisfaction and cost management. PMID:18837266

Licheri, Sergio; Erdas, Enrico; Pisano, Giuseppe; Garau, Annalisa; Barbarossa, Michela; Tusconi, Anna; Pomata, Mariano

2008-01-01

56

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

PubMed

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

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

2009-04-01

57

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

PubMed Central

Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection. Herein we present a case of gas gangrene of the arm in an intravenous drug user with a history of intramuscular injections with normal saline in the shoulder used to provoke pain for recovery after drug induced coma. The patient was early treated with surgery and antibiotics rendering possible the preservation of the limb and some of its function. Additionally, a review of the literature regarding case reports of limb salvage after gas gangrene is presented.

2011-01-01

58

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

PubMed Central

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.

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

2007-01-01

59

Venous air embolism through central venous access  

PubMed Central

An 25-year-old man was buried by an avalanche during off-slope skiing. He was rescued by his companions and resuscitated by mouth-to-mouth ventilation. The emergency physician from a helicopter based emergency medical service placed two venous lines in both external jugular veins and secured the airway with a tracheal tube. When transferred to the emergency department an additional central venous catheter was inserted via his right femoral vein. The subsequent computed tomography scan revealed several small air bubbles adjacent to the endothelium of the brachiocephalic vein. In an experimental setting, it was shown that air could enter the circulation via a central venous catheter within a few seconds, but measured values of embolising air were smaller than the calculated values when applying the law of Hagen-Poiseuille. Nevertheless, it is important to keep the lumens of a central venous catheter filled with saline before any manipulation in order to prevent or attenuate venous air embolism.

Schlimp, Christoph J; Loimer, Thomas; Schmidts, Michael B; Rieger, Michael; Lederer, Wolfgang

2009-01-01

60

Opioid analgesics stop the development of clostridial gas gangrene.  

PubMed

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

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

2014-08-01

61

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

PubMed

Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively. PMID:25037301

Pandove, Paras K; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K

2014-01-01

62

Anticoagulant-induced priapism progressing to penile gangrene: a devastating complication!  

PubMed

A 35-year-old man developed priapism with the use of low-molecular-weight heparin and warfarin following repair of left brachial artery sustained after gunshot injury. Priapism progressed to penile gangrene despite decompression and distal shunt procedure leading to total penectomy and perineal urethrostomy. We describe the mechanism of anticoagulant (heparin and warfarin)-induced penile gangrene and the possible methods to avert such a devastating complication. PMID:23175010

Nagathan, Deepak Sharanappa; Pahwa, Harvinder Singh; Kumar, Awanish; Goel, Apul

2012-01-01

63

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

PubMed Central

Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively.

Pandove, Paras K.; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K.

2014-01-01

64

Sugar inhibits the production of the toxins that trigger clostridial gas gangrene  

Microsoft Academic Search

Histotoxic strains of Clostridium perfringens cause human gas gangrene, a devastating infection during which potent tissue-degrading toxins are produced and secreted. Although this pathogen only grows in anaerobic-nutrient-rich habitats such as deep wounds, very little is known regarding how nutritional signals influence gas gangrene-related toxin production. We hypothesize that sugars, which have been used throughout history to prevent wound infection,

M. B. Méndez; A. Gońi; W. Ramirez; R. R. Grau

65

Gangrene of the penis in a diabetic male with multiple amputations and follow up  

PubMed Central

A 60-year-old insulin dependent, diabetic male with severe atherosclerosis requiring multiple amputations in the extremities in the past, with normal renal function presented with gangrene of glans penis. He was initially treated with debridement but as the gangrene progressed, partial penile amputation was performed. He showed no further progress of the disease and had no voiding difficulties even after 4 years of follow up.

Vijayan, P.

2009-01-01

66

The Role of X-Rays in the Treatment of Gas Gangrene: A Historical Assessment  

PubMed Central

While the use of x-rays to treat patients with gas gangrene ended in the early 1940’s with the advent of antibiotics, x-ray had been widely accepted as a useful and highly effective treatment for this condition. The present paper re-assesses the historical foundations of this belief, the quality of the data, use of confirmatory animal models, and underlying mechanisms that might account for the therapeutic role of x-rays in the treatment of gas gangrene.

Calabrese, Edward J.; Dhawan, Gaurav

2012-01-01

67

Long Gamma Nail Stabilization of Pathologic and Impending Pathologic Femur Fractures  

Microsoft Academic Search

Thirteen long Gamma nails were utilized without ad- junctive bone cement in 11 patients for stabilization of 12 impend- ing pathologic fractures and 1 pathologic fracture in the setting of metastatic disease (10 femora) and fibrous dysplasia (3 femora) of the proximal femur. Each femur was reamed to 18 mm proximally and 13 mm distally to accept the 17-mm diameter

TIMOTHY A. DAMRON; KATHRYN PALOMINO; STEPHANIE ROACH

68

Mesenteric venous thrombosis  

MedlinePLUS

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

69

[Fournier's gangrene--our experience with 17 patients].  

PubMed

Fournier's gangrene (FG) is a rare form of the skin and subcutaneous tissue bacterial infection characterized clinically by rapid progression and significant mortality, patohistologically by extensive necrosis of supeficial and deep facial planes and epidemiologically by predilection to patients with diabetes, immunosupression, malignant diseases or other debilitating state. In our retrospective study, we analyze 17 patients with FG hospitalised in our hospital in the 16-year period. Mean age of the patients was 58.9, and female-to-male ratio was 1:16. Among the predisposing factors diabetes mellitus (41.2%) and malignant diseases (29.4%) were the most common. Average length of hospital stay was 36 days (2-81) with lethality of 41.2% (7 patients). We assessed no statistical significance of the analysed prognostic parameters. In conclusion, we emphasize that FG is a surgical emergency and we express our impression that lack of physicians' experience is the main factor leading to delay in diagnosis and treatment of this rare, but life threatening disease. PMID:20540434

Katusin, Davorin; Crnica, Suad

2010-01-01

70

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

PubMed

A total of 50 does were used to determine selected hematological and biochemical parameters with special references to oxidative stress markers, acute phase protein profiles, and proinflammatory cytokines in healthy and gangrenous mastitis affected does. Animals were divided into two equal groups represented as clinically healthy (control) and diseased groups, respectively. The bacteriological examination of milk samples from diseased does revealed many types of bacterial infection. The isolated bacteria were Staphylococcus aureus (N=23/25), Escherichia coli (N=11/25), and Clostridium perfringens (N=4/25). There was a significant increase in the levels of ?-hydroxybutyrate, non-esterified free fatty acids, triglyceride, low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase, and alanine aminotransferase and a significant reduction in the levels of glucose, cholesterol, and high density lipoprotein cholesterol (HDL-C) in does with gangrenous mastitis compared to healthy does. Moreover, there was a significant increase in the levels of malondialdehyde and uric acid with a significant decrease in the levels of reduced glutathione, super oxide dismutase, and catalase in does with gangrenous mastitis compared to healthy does. In addition, there was a significant increase in the haptoglobin, serum amyloid A, fibrinogen, interleukin 6 (IL-6), IL-1?, and tumor necrosis factor-? (TNF-?) in does with gangrenous mastitis compared to healthy ones. Conclusively, oxidative stress biomarkers, acute phase proteins, and proinflammatory cytokines play an essential task as biomarkers for gangrenous mastitis in does. Mastitis may be considered as one of the ketotic stressors in does after parturition. PMID:23303629

El-Deeb, Wael M

2013-01-01

71

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

PubMed Central

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

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

2013-01-01

72

Malignant cervical teratoma in an adult presenting with impending airway obstruction.  

PubMed

Extragonadal teratomas and germ cell tumours are uncommon. Most teratomas of the head and neck present in the paediatric age group. Occurrence of such tumours in an adult is extremely rare and, to date, less than 40 cases have been reported in the literature. We report a case of a young man presenting with impending airway obstruction secondary to a malignant teratoma of the neck. PMID:16024322

Lukman, Mohd Rashid; Jasmi, Ali Yaakub; Sarinah, Basro; Nurismah, Md Isa; Aishah, Md Ali Siti

2005-07-01

73

Healing of Bone Affections and Gangrene with Low-Intensity Laser Irradiation in Diabetic Patients Suffering from Foot Infections.  

PubMed

OBJECTIVE: Evalution of low-intensity laser irradiation on the healing of bone affections and gangrene in patients suffering from diabetic microangiopathy. DESIGN: Case-report study. PATIENTS: Two consecutive diabetic male patients with gangrene, osteomyelitis, and bone fractures. INTERVENTION: Helium-neon laser irradiation (36 J/cm2 ) 50 min/day. MAIN OUTCOME PARAMETER: Healing of gangrene and corticalis lesion as well as remineralisation of bone affections. RESULTS: Within a mean period of 14 weeks not only a complete healing of the diabetic gangrenes but also a radiographically determined reestablishment of corticalis and remineralisation of preexisting bone affections could be achieved. CONCLUSION: We therefore conclude that low-intensity laser irradiation should be further tested as an additional beneficial therapeutic modality for the healing of gangrene and bone affections in diabetic patients. PMID:9892822

Schindl; Schindl; Pölzleitner; Schindl

1998-01-01

74

Squamous cell carcinoma developing in the scar of Fournier's gangrene - Case report  

PubMed Central

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.

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

2004-01-01

75

The need for arteriography in diabetic patients with gangrene and palpable foot pulses.  

PubMed

A group of five diabetic patients had gangrene or failed limited amputations and palpable foot pulses in a total of seven limbs. Because a failure to heal persisted and gangrene progressed, arteriography was performed and disclosed occlusion of all three infrapopliteal arteries. Tibial bypass grafting resulted in complete healing in four of the five patients. The fifth patient refused surgery and died with progressive sepsis. The incidence of this unusual syndrome is unknown, but presumably it is rare. The mechanism of pulse formation in the foot, despite occlusion of the infrapopliteal vessels, is dependent on good flow to the popliteal artery, collateral flow to the rigid distal tibial-peroneal vessels, compliant ankle arteries, and highly resistive distal foot vessels. Although healing of limited amputations is usual in diabetic patients with foot pulses, it is not universal. We recommend that arteriography be performed routinely if gangrene is present and the foot is salvageable, irrespective of pedal pulse status. PMID:6497629

Andros, G; Harris, R W; Dulawa, L B; Oblath, R W; Salles-Cunha, S X

1984-11-01

76

Symmetrical peripheral gangrene and the use of systemic hyperbaric oxygen therapy.  

PubMed

Symmetrical peripheral gangrene (SPG) is a rare but devastating condition when two or more distal sites become gangrenous, as the result of severe illness and treatment in critical care. The striking factor in SPG is that there is no occlusion of the major blood vessels to the affected limbs; the pathogenesis of the condition is not well understood and there are high reported mortality and amputation rates. Here we report the chronological progress report of a case of SPG, which affected both forefeet. This case report supports the view that early amputation should be avoided allowing for stabilisation of the gangrene so that no viable tissue is sacrificed. Further research is necessary to establish the pathogenesis and suitable treatment pathways. PMID:23299273

Stewart, S

2012-12-01

77

Blind axillar venous access.  

PubMed

The axillary vein has been suggested as an alternate site for venous access to avoid the "subclavian crush phenomenon. " Many techniques have been used to access this structure. They include complicated anatomical landmarks, contrast venography, Doppler, and ultrasound. A simple technique using the basic anatomical landmark of the deltopectoral groove and a blind venous stick has been used successfully in 165 of 168 consecutive pacemaker and ICD procedures; there were only three failures. These required an alternate approach. With a thorough knowledge of the regional anatomy, the axillary vein can be safely used as a primary site of venous access. PMID:10456639

Belott, P H

1999-07-01

78

Venous leg ulcers.  

PubMed

Venous ulcers are the most common form of leg ulcers and their incidence is increasing as the population ages. The diagnosis should be confirmed with tests for venous insufficiency and an assessment of arterial disease determined by a Doppler Ankle-Brachial ratio. The most important component of venous ulcer treatment is the use of high compression bandages for pitting edema. Non-healing ulcers may require a skin biopsy of the edge to confirm the diagnosis, medical treatment for woody fibrosis, adjustment of compression therapy, or use of a skin substitute or biological preparation. PMID:9866605

Sibbald, R G

1998-09-01

79

Peripheral gangrene in African children: a clinical report of twelve cases.  

PubMed

Clinical observations of 12 cases of peripheral gangrene in children are reported. All patients presented with ischemia of one or more limbs without any history of trauma, vascular injury or snake bite. Prior to their admission, all these children had received some form of traditional "African" therapy. By means of exclusion severe vasospasm secondary to the traditional treatment was considered the causative factor of the peripheral gangrene in all the children. Surgical exploration of the arteries with a Fogarty embolectomy catheter in two patients and medical treatment in six patients was attempted. The overall results were disappointing, with most resulting in incapacitating amputations. PMID:9008964

Noyez, J F; Sinzobahamvya, N; Kalangu, K

1996-12-01

80

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

PubMed Central

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

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

2012-01-01

81

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

PubMed Central

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.

Zyczkowski, Marcin; Bryniarski, Piotr; Nowakowski, Krzysztof; Muskala, Bartosz; Paradysz, Andrzej

2013-01-01

82

Treatment of chronic venous insufficiency  

Microsoft Academic Search

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

Suman W. Rathbun; Angelia C. Kirkpatrick

2007-01-01

83

Deep Venous Thrombosis  

MedlinePLUS

Deep venous thrombosis is a blood clot that forms in a vein deep inside a part of the body. It mainly ... things you can do to prevent deep vein thrombosis include: Wear the pressure stockings your doctor prescribed. ...

84

Venous ulcer review  

PubMed Central

Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation.

Bevis, Paul; Earnshaw, Jonothan

2011-01-01

85

Altered Heart Rhythm Dynamics in Very Low Birth Weight Infants With Impending Intraventricular Hemorrhage  

PubMed Central

OBJECTIVE Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system’s control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants. METHODS This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was used to assess the fractal dynamics of the heart rhythm. Fractal scaling exponents were calculated by using this analysis. RESULTS Twenty-four infants (mean ± SD, birth weight: 845 ± 213g: gestational age: 26.1 ± 1.9 weeks) participated in the study. The short-term scaling exponent was significantly larger in infants who later developed intraventricular hemorrhage compared with those who did not (0.60 ± 0.1 vs 0.45 ± 0.1). A value of 0.52 resulted in 70% sensitivity and positive predictive value and 79% specificity and negative predictive value. The short-term scaling exponent was the only significant predictor of intraventricular hemorrhage. CONCLUSIONS Fractal dynamics of the heart rhythm is significantly altered in very low birth weight infants before developing intraventricular hemorrhage and may be predictive of impending intraventricular hemorrhage.

Tuzcu, Volkan; Nas, Selman; Ulusar, Umit; Ugur, Ahmet; Kaiser, Jeffrey R.

2010-01-01

86

Fournier’s Gangrene: A Monographic Urology Center Experience with Twenty Patients  

Microsoft Academic Search

Background: Fournier’s gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in males and the vulva in females. The aim of this study was to share our experience in the management of this infectious disease. Methods: A retrospective chart review was performed in 20 patients with

R. Martínez-Rodríguez; J. Ponce de León; J. Caparrós; H. Villavicencio

2009-01-01

87

Foot Gangrene in Patients with End-Stage Renal Disease: A Case Control Study  

Microsoft Academic Search

The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized

Mourad Boufi; Parinaz Ghaffari; Eric Allaire; Hafedh Fessi; Pierre Ronco; Michel Vayssairat

2006-01-01

88

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

PubMed Central

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

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

2014-01-01

89

Neutrophil-to-Lymphocyte Ratio Has a Close Association With Gangrenous Appendicitis in Patients Undergoing Appendectomy  

PubMed Central

The purpose of this study was to clarify the clinical features most closely associated with gangrenous appendicitis. From among 314 patients who had undergone open appendectomy in our collected database, 222 for whom sufficient data were evaluable were enrolled. The results of univariate analysis revealed that age (?40/>40 years), sex (female/male), fever (?37°/>37°C), the serum levels of C-reactive protein and albumin, the Glasgow prognostic score (0, 1/2), and the neutrophil-to-lymphocyte ratio (NLR) (?8/>8) were associated with gangrenous appendicitis. Among these 7 clinical features, multivariate analysis disclosed that age (?40/>40 years) (odds ratio, 3.435; 95% confidence interval 1.744–6.766; P < 0.001) and NLR (?8/>8) (odds ratio, 3.016; 95% confidence interval 1.535–5.926; P ?=? 0.001) were associated with gangrenous appendicitis. The sensitivity and specificity of these two clinical features were 65% and 27%, and 73% and 39%, respectively. NLR (>8) shows a significant association with gangrenous appendicitis in patients undergoing appendectomy.

Ishizuka, Mitsuru; Shimizu, Takayuki; Kubota, Keiichi

2012-01-01

90

Reversal of Gangrenous Lesions in the Blue Toe Syndrome with Lovastatin A Case Report  

Microsoft Academic Search

A seventy-six-year-old man with ischemic heart disease, peripheral vascular disease, and chronic renal failure developed bilateral cyanotic toes, which upon muscle biopsy, were shown to be caused by atheromatous emboli. The probable source was atheromatosis of the abdominal aorta. The toes became gangrenous, but surgical therapy was deferred because the patient was considered a high risk. With lovastatin therapy there

Shaltiel Cabili; Israel Hochman; Yoav Goor

1993-01-01

91

Developmental venous anomalies--two cases with venous thrombosis.  

PubMed

Developmental venous anomalies (DVA) are generally considered the most common vascular anomalies. They are usually asymptomatic and display a benign clinical course. We report two cases of thrombosed developmental venous anomalies. Both patients developed venous infarcts with haemorrhagic transformation from the thrombosed DVA, and 1 patient needed decompressive craniectomy. PMID:22639869

Teo, Mario; St George, Jerome; Jenkins, Sarah; Littlechild, Patricia

2012-12-01

92

[Superficial venous malformations].  

PubMed

Superficial venous malformations are part of a larger group now called superficial vascular anomalies and previously known as angiomas. These include vascular tumors or infantile hemangioma, low-flow vascular malformations (capillary, lymphatic, and superficial venous malformations) and high-flow vascular malformations (arteriovenous malformations). Some of these lesions are complex. This classification facilitates their multidisciplinary therapeutic management. Embolization is an effective curative treatment for malformations of small and intermediate size. The objective for large or complex malformations is to restore anatomic function and improve cosmetic results. PMID:20304597

Barbier, Charlotte; Martin, Arnaud; Papagiannaki, Chrisanti; Cottier, Jean-Philippe; Lorette, Gérard; Herbreteau, Denis

2010-04-01

93

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

PubMed Central

Achieving an aesthetic appearance of the scrotum after extensive Fournier’s gangrene is a reconstructive challenge. Testicular coverage is often prioritized over scrotal cosmesis due to the comorbidities typically seen in this patient population. We describe our treatment of a young, healthy male with extensive Fournier’s gangrene, with loss of the scrotum. Bilateral neurotized anterolateral thigh flaps were used to achieve a sensate and aesthetically acceptable result.

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

2014-01-01

94

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

PubMed Central

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

2014-01-01

95

Central venous catheter use  

Microsoft Academic Search

Central venous catheters (CVCs) are used with increasing frequency in the intensive care unit and in general medical wards. Catheter infection, the most frequent complication of CVC use, is associated with increased morbidity, mortality, and duration of hospital stay. Risk factors in the development of catheter colonisation and bloodstream infection include patient factors (increased risk associated with malignancy, neutropenia, and

K. H. Polderman; A. R. J. Girbes

2002-01-01

96

Arterial vs venous blood gas differences during hemorrhagic shock  

PubMed Central

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

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

2014-01-01

97

The venous circle of Trolard.  

PubMed

A venous anastomotic network is occasionally found at the base of the brain, which closely resembles the vicinal arterial circle of Willis. When present, this venous polygon is composed of the anterior cerebral and communicating veins, the basal vein of Rosenthal and the posterior communicating and lateral mesencephalic veins. We propose that this anastomotic ring be termed the venous circle of Trolard. This venous circle might cause bleeding with such procedures as an endoscopic third ventriculostomy. We believe that information regarding this venous circle may be useful to neuroradiologists or neurosurgeons operating at the base of the brain (Fig. 1, Ref. 10). Full Text (Free, PDF) www.bmj.sk. PMID:18814436

Tubbs, R Shane; Loukas, M; Shoja, M M; Salter, E G; Oakes, W J

2008-01-01

98

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

PubMed

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

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

2014-03-01

99

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

PubMed

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

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

2013-05-31

100

Treatment of two cases of Fournier's gangrene and review of the literature.  

PubMed

Fournier's gangrene is a rare polymicrobial necrotising soft tissue infection affecting the perineum and scrotum. It is rapidly progressive, destructive and associated with high morbidity and mortality. Management protocol includes prompt diagnosis, early institution of antibiotic therapy and adequate wound debridement, usually requiring multiple operations. Rapid accurate diagnosis is crucial for successful outcome, while early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics are essential to reduce mortality. Dermatologists are often the first specialist consulted. Two cases of Fournier's gangrene are reported in this report. The aim of the report is to underline the importance of an immediate diagnostic approach to save patients, favoured by a close collaboration among dermatologist, surgeon and urologist. PMID:23164064

Rubegni, Pietro; Lamberti, Arianna; Natalini, Ylenia; Fimiani, Michele

2014-04-01

101

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

PubMed

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

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

2014-06-01

102

[Penile gangrene: a rare complication of systemic calciphylaxis, to be screened].  

PubMed

Gangrene of the penis is a rare and serious complication of end stage renal disease, being an expression of systemic calciphylaxis. We report the case of a 58-year-old patient with chronic renal failure and diabetes, who presented with a necrosis of the gland. MRI defined the limits of necrosis. The treatment consisted in partial amputation of the penis. Histological examination found a calciphylaxis. PMID:24485086

Bouzouita, A; Kerkeni, W; Cellier, L; Gobet, F; Sibert, L

2014-02-01

103

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

Microsoft Academic Search

Fournier's gangrene is described as a fulminant necrotizing fasciitis of the scrotum and penis. Few cases have been reported\\u000a in the context of acute leukemia. We describe a case, complicating the induction treatment of an acute promyelocytic leukemia\\u000a with all-trans–retinoic acid and chemotherapy. The evolution was favorable, following surgical excision and broad-spectrum antibiotic therapy.\\u000a The respective roles of all-trans–retinoic acid

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

1998-01-01

104

Fournier’s Gangrene: Etiology and Outcome Analysis of 41 Patients  

Microsoft Academic Search

Introduction: Fournier’s gangrene (FG) is the necrotizing fasciitis of the perineum and genital area with high mortality. Materials and Methods: A retrospective review included 41 patients diagnosed with FG in our hospitals from 1995 to 2010, divided into survivors and nonsurvivors. We analyzed anamnestic, clinical and laboratory data. Results: The mortality rate was 36.6% (15\\/41 patients). Elevated heart and respiratory

Silvio Altarac; Davorin Katušin; Suad Crnica; Dino Papeš; Nuhi Arslani

2012-01-01

105

Gangrene of the penis due to strangulation by a metallic ring.  

PubMed

We present a case of a 32-year-old crippled patient who presented with gangrene of the penis due to strangulation by a magnetic metallic ring which is used to increase potency and prolong erection. The ring was removed and conservative treatment was tried for eight days but failed. Amputation of the penis was done was refashioning of the urethra at the tip of the stump. PMID:8727872

Osman, M; al Kadi, H; al Hafi, R

1996-02-01

106

Vacuum-Assisted Closure for the Treatment of Fournier’s Gangrene  

Microsoft Academic Search

Background: Fournier’s gangrene (FG) is a very aggressive necrotizing fasciitis involving subcutaneous fat and skin of scrotal and perineal regions. Vacuum-assisted closure (VAC) is a well-known method used to treat complex wounds. The authors for the first time enhance a multimodal strategy to treat the FG using VAC, reducing the number of surgical debridements, allowing a one-step surgical reconstruction with

Giuseppe Cuccia; Giuseppe Mucciardi; Giuseppe Morgia; Francesco Stagno d’Alcontres; Alessandro Galě; Stefano Cotrufo; Marco Romeo; Carlo Magno

2009-01-01

107

Fournier's gangrene - delayed pedicle flap based upon the anterior abdominal wall.  

PubMed

Introduction: Fournier's gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description: A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier's gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion: Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion: Penile skin recovery following Fournier's gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall. PMID:25010310

Sliwinski, Ania; Kavanagh, Liam E; Bolton, Damien; Lawrentschuk, Nathan; Crock, John G

2014-01-01

108

Fournier's Gangrene: A Case of Neglected Symptoms with Devastating Physical Loss.  

PubMed

Fournier's gangrene is a severe life-threatening infection involving the perianal area, perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles' fascia around the external genitalia. It can extend cephalad to involve the Scarpa's fascia and Camper's fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications. We describe a case of a 58-years-old man presenting with Fournier's gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his loss and disfigurement. PMID:23610554

Singam, Praveen; Wei, Khor Tze; Ruffey, Ammar; Lee, James; Chou, Teh Guan

2012-07-01

109

Fournier's Gangrene: A Case of Neglected Symptoms with Devastating Physical Loss  

PubMed Central

Fournier’s gangrene is a severe life-threatening infection involving the perianal area, perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles’ fascia around the external genitalia. It can extend cephalad to involve the Scarpa’s fascia and Camper’s fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications. We describe a case of a 58-years-old man presenting with Fournier’s gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his loss and disfigurement.

Singam, Praveen; Wei, Khor Tze; Ruffey, Ammar; Lee, James; Chou, Teh Guan

2012-01-01

110

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

PubMed Central

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

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

2012-01-01

111

Anomalous pulmonary venous connections.  

PubMed

Developmental lung anomalies are classified into 3 main categories: bronchopulmonary (lung bud) anomalies, vascular anomalies, and combined lung and vascular anomalies. These anomalies are uncommon, and patients are at times asymptomatic; hence, identifying a developmental lung anomaly in the adult can be a challenge. Pulmonary vascular anomalies include interruption or absence of the main pulmonary artery, anomalous origin of the left pulmonary artery from the right pulmonary artery, anomalous pulmonary venous drainage (partial or complete), and pulmonary arteriovenous malformations. Systemic vascular anomalies comprise persistent left superior vena cava, anomalies of azygos and hemiazygos systems, and anomalies of the thoracic aorta and its major branches. In this article, we present embryology, classification, epidemiology, clinical presentation, and imaging features of anomalous pulmonary venous connections, with special emphasis on multidetector computed tomography and magnetic resonance imaging. These state-of-art imaging techniques have facilitated accurate and prompt diagnosis of these anomalies. PMID:23168060

Katre, Rashmi; Burns, Stephanie K; Murillo, Horacio; Lane, Michael J; Restrepo, Carlos S

2012-12-01

112

Measurement of body venous tone.  

PubMed

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

Pang, C C

2000-01-01

113

Cerebral venous sinus thrombosis.  

PubMed

Cerebral venous sinus thrombosis (CVST) is a rare and potentially deadly condition. Common etiologies include hypercoagulable diseases, low flow states, dehydration, adjacent infectious processes, oral contraceptives, hormonal replacement therapy, pregnancy, and puerperium. Symptoms include nausea, seizures, severe focal neurological deficits, coma, and headache (the most common presenting symptom). Anticoagulation is the mainstay of treatment for CVST. Transvenous clot lysis can be performed using injected thrombolytic agents and specialized catheters for clot retrieval. PMID:16379132

Lemke, Denise M; Hacein-Bey, Lofti

2005-10-01

114

Paediatric cerebral venous thrombosis.  

PubMed

Cerebral venous thrombosis (CVT) in children is a multifactorial serious disease. It is being increasingly diagnosed, mainly because of more sensitive diagnostic procedures and increasing clinical awareness. The clinical manifestations can be life-threatening and cause long-term neurological deficits. Thromboembolism in children is a multifactorial disorder in which both genetic and acquired risk factors play a role. CVT occurs in various clinical settings, including infection, dehydration, renal failure, trauma, cancer and haematological disorder with multiple risk factors. Clinical manifestations of CSVT are nonspecific and may be subtle. Most of the clinical scenarios occur at all ages and the clinician should consider this diagnosis in a wide range of acute neurological presentations in childhood. CVT can have an extremely variable clinical presentation, mode of onset, imaging appearance and outcome. Its prognosis remains largely unpredictable. Diffusion and perfusion MRI may play a role in detecting venous congestion and CT or MR venography are now the methods of choice for investigation of cerebral venous thrombosis. The options for treatment of infants and children include standard or low molecular weight heparin for 7-10 days followed by oral anticoagulants for 3-6 months. Specific treatment with anticoagulation is controversial in children, but has been established as appropriate therapy in adults. Anticoagulant treatment with heparin is probably safe and beneficial for children with sinus thrombosis, even those with intracranial haemorrhages. PMID:17183984

Dai, Alper I

2006-11-01

115

Venous leg ulcers  

PubMed Central

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, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, self-help (advice to elevate leg, to keep leg active, to modify diet, to stop smoking, to reduce weight), short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative pressure, recombinant keratinocyte growth factor, platelet-derived growth factor).

2011-01-01

116

The value of dynamic venous pressure measurements  

Microsoft Academic Search

This article describes the technique of measuring ambulatory venous pressures and their value in the diagnosis and assessment of the severity of venous hypertension as well as their contribution toward our understanding of venous hemodynamics and the pathophysiology of venous disorders. It demonstrates that ambulatory venous pressures are not only of diagnostic significance, but also of prognostic significance. Competent popliteal

Andrew N. Nicolaides; Andrew J. Zukowski

1986-01-01

117

Leg ulceration in venous disease.  

PubMed Central

We have given a brief summary of the scale of the problem caused by venous ulceration in the UK, and have then reviewed the various theories of causation, including a historical survey, and presented the evidence for and against the two main current theories of fibrin cuffs and white cell trapping. We also outline previous hypotheses of the aetiology of venous ulceration, including arteriovenous microanastomoses, stasis and oedema. The contribution of superficial venous incompetence in the pathogenesis of ulceration is also examined.

Shami, S. K.; Shields, D. A.; Scurr, J. H.; Smith, P. D.

1992-01-01

118

Gangrene of the upper extremity following intra-arterial injection of drugs. A case report and review of the literature.  

PubMed

A case of inadvertent intra-arterial self-injection of crushed codeine tablets in an 37-year-old man, resulting in gangrene of an upper extremity, is presented. The problem studied was whether the gangrene was caused by the codeine or by one of the excipients found in the tablets. The cause of the gangrene was investigated in an experimental study. Each of the components of the tablet (codeine, lactose, gelatin, carboxymethyl cellulose, calcium stearate, talc, and microcrystalline cellulose) was injected into the femoral arteries of dogs. The results of the study clearly demonstrate that the unique component producing the gangrene was the micro-crystalline cellulose, while the injection of pure codeine was harmless. To date, the only reported deleterious effects of intravascular injection of micro-crystalline cellulose have been pulmonary embolism and granulomatosis. Some examples of drugs that include microcrystalline cellulose are methadone, methaqualone, oxcycodone, acetaminophen, aspirin with codeine, propoxyphene napsylate, meprobamate, and phenobarbital. Recently, the vulnerability of drug addicts who habitually inject drugs into veins to the accidental injection of an artery has been noted, and it seems likely that in the future the problem of intra-arterial injection will increase in severity. The literature of the last 40 years is reviewed, and a list of drugs known to have produced gangrene when injected intra-arterially is cited. PMID:6380862

Goldberg, I; Bahar, A; Yosipovitch, Z

1984-09-01

119

Treatment of chronic venous insufficiency.  

PubMed

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

Rathbun, Suman W; Kirkpatrick, Angelia C

2007-04-01

120

Venous leg ulcers  

PubMed Central

Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, self-help (advice to elevate leg, advice to keep leg active, advice to modify diet, advice to stop smoking, advice to reduce weight), and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative-pressure recombinant keratinocyte growth factor, platelet-derived growth factor).

2008-01-01

121

Cervicofacial Venous Malformations  

PubMed Central

Summary We retrospectively evaluated 53 consecutive patients with cervicofacial venous malformation who had sclerotherapy. This review included a demographic analysis, MRI reexamination and tabulation of interventional therapeutic strategies. All patients whose MRI studies were included in this review demonstrated characteristic findings: space occupying lesion with hyperintense T2 signal abnormality, patchy contrast enhancement, and no flow signal on the gradient echo images. We concluded that a complete MRI work-up of these patients requires post-contrast scanning and gradient-echo imaging in addition to the standard T1 and T2 weighted spin echo imaging. The majority of patients had sporadic (non-familial) venous anomalies. Sinus pericranii (SP) was identified in six patients (11%) and blue rubber bleb nevus syndrome (BRB-NS) was found in two patients (4%). MRI findings of sinus pericranii are discussed in detail. Although sodium tetradecyl and/or absolute ethanol are the most commonly used sclerosants, a wide variety of therapeutic strategies (depending on the nature of the abnormality) are also needed for these patients.

Konez, O.; Burrows, P. E.; Mulliken, J.B.

2002-01-01

122

Penile Gangrene: An Unusual Complication of Priapism in a Patient with Bladder Carcinoma  

PubMed Central

A 40-year-old, apparently healthy farmer presented with a 4-day history of progressively painful penile erection with no known predisposing or precipitating factor. He had an emergency El-Ghorab shunt which resulted in almost complete detumescence. He was noticed to have developed ischemic changes of the distal part of the penile skin which progressed to gangrene of the distal part of the penis on the 4th day post intervention. Abdomino-pelvic ultrasound revealed an intravesical mass and urine and corpus cavernosa aspiration cytology were positive for malignant cell. The patient, however, declined further treatment and was discharged against medical advice.

Ajape, Abdulwahab A.; Bello, Ahmad

2011-01-01

123

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

PubMed Central

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

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

2014-01-01

124

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

PubMed

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

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

2014-03-01

125

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

PubMed

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

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

1998-02-01

126

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

PubMed Central

Fournier’s gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease. A review of the scientific literature focusing on the topic of FG complicating hematologic disorders is reported

D'Arena, Giovanni; Pietrantuono, Giuseppe; Buccino, Emilio; Pacifico, Giancarlo; Musto, Pellegrino

2013-01-01

127

Strangulated tension viscerothorax with gangrene of the stomach in missed traumatic diaphragmatic rupture.  

PubMed

Acquired diaphragmatic hernias are usually posttraumatic in occurrence. In patients who have blunt trauma and associated diaphragmatic hernia, the diagnosis may be missed or delayed, often leading to poor treatment outcomes. We present a rare occurrence of tension viscerothorax due to missed traumatic diaphragmatic rupture in a 25-year-old woman whose condition was complicated by gangrene and perforation of the fundus as well as questionable viability of the anterior wall of the body of the stomach. The patient had a successful emergency transabdominal suture plication of the diaphragm and gastroplasty and has remained symptomless 3 months postoperatively. PMID:22084758

Onakpoya, Uvie; Ogunrombi, Akinwumi; Adenekan, Anthony; Akerele, William

2011-01-01

128

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

PubMed Central

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

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

2013-01-01

129

Strategies in the treatment of major tissue loss and gangrene: results of 100 consecutive vascular reconstructions.  

PubMed

To determine the features of a successful clinical strategy, we analyzed the results of 100 consecutive lower extremity vascular reconstructions performed exclusively for tissue loss and gangrene of the legs and feet. Eighty patients underwent 100 procedures on 80 limbs. Follow-up was 95% complete (every six months, mean 2.2 years). Forty inflow procedures to the femoral artery were performed with 13 simultaneous infrainguinal bypasses. Sixty bypasses were performed from the femoral artery to the popliteal (25) or tibial arteries (35). Sixty-eight percent of the identified ulcerations healed, and limb salvage was achieved in 70% of patients by life-table analysis. The cumulative patency for all reconstructions was 48% (five years), for tibial bypasses 60% (four years). Femoropopliteal bypasses had the poorest patency and healing rates (less than 40%), while combined inflow-outflow procedures and femorotibial bypasses had the highest rates of healing (77%, 66%). There were two operative deaths, three graft infections, seven wound infections, and 12 acute graft thromboses. Vascular reconstructions for extensive tissue loss or gangrene can be performed with a morbidity and mortality comparable to procedures performed for less severe disease with a high rate of limb salvage. The long term success of surgical therapy depends primarily on the most direct revascularization of ischemic, infected tissues, using autologous conduits whenever possible. PMID:2340245

Reichman, W; Nichols, B; Toner, J; Jenvey, W; Sobel, M

1990-05-01

130

Pycnogenol® in chronic venous insufficiency and related venous disorders.  

PubMed

The present review provides an update of the biological profile of Pycnogenol in the light of its use in the treatment of chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids. Pycnogenol is a French maritime pine bark extract produced from the outer bark of Pinus pinaster Ait. subsp. atlantica. Its strong antioxidant, anti-inflammatory and vasodilator activities, antithrombotic effects and collagen stabilizing properties make it uniquely able to target the multi facet pathophysiology of CVI and related venous disorders. Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration. This review highlights clinical research findings on the safety, compliance and efficacy of Pycnogenol, including its use in combination products. PMID:23775628

Gulati, Om P

2014-03-01

131

Arterial emboli of venous origin.  

PubMed

In a small but significant group of patients with documented systemic emboli, a source is never determined. It is in this group of patients that an arterial embolus of venous origin should be considered. During the past 20 years, we identified four patients who fulfilled the diagnostic criteria for an arterial embolus of venous origin. In each, the diagnosis was made during life. In addition, we reviewed the 40 additional patient reports in the literature that appeared to meet the criteria for the diagnosis of venous origin arterial emboli. Noninvasive methods were useful in determining the presence of thrombus in the venous system, and right to left shunting across an intracardiac defect. We conclude that treatment with heparin is the mainstay of therapy, and that caval interruption should be used only on a selective basis. PMID:1729744

Katz, S; Andros, G; Kohl, R; Harris, R; Dulawa, L; Oblath, R

1992-01-01

132

Varicose Veins and Venous Insufficiency  

MedlinePLUS

... venous system. Varicose Vein Treatments Minimally Invasive Vein Ablation Treatment Endovenous (or vein) ablation is a minimally ... leg, re-establishing normal flow. Benefits of Vein Ablation Treatment The treatment takes less than an hour ...

133

Partial anomalous pulmonary venous return.  

PubMed

Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital abnormality that occurs in 0.4 to 0.7% of postmortem examinations. Ninety percent of these anomalies are associated with an atrial septal defect. Partial anomalous pulmonary venous return occurs more commonly on the right than the left and is manifested by abnormal return of the pulmonary veins to the central venous circulation. Most patients are asymptomatic, but when symptoms are present they are due to shunting of oxygenated blood to the venous circulation. We submit the case of a recently activated solider who presented with dyspnea on exertion refractory to inhaled corticosteroids and an 8.5-mm solitary pulmonary nodule. Further diagnostic imaging revealed PAPVR. Our case appears to be the first report of a solitary pulmonary nodule as the initial presentation of a right upper lobe PAPVR with return to the superior vena cava in the absence of associated atrial septal defect. PMID:18595412

Broy, Charles; Bennett, Steven

2008-06-01

134

Venous Thromboembolism and Marathon Athletes  

MedlinePLUS

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

135

Pycnogenol® in chronic venous insufficiency  

Microsoft Academic Search

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×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

Paolo Arcangeli

2000-01-01

136

Thrombosis of a developmental venous anomaly causing venous infarction and pontine hemorrhage.  

PubMed

Developmental venous anomalies are often incidental findings on brain imaging. We report a case of a thrombosed developmental venous anomaly with venous congestion and pontine hemorrhage that improved after anticoagulation therapy. PMID:23791470

Griffiths, Dayna; Newey, Allison; Faulder, Kenneth; Steinfort, Brendan; Krause, Martin

2013-11-01

137

Hepatic venous outflow obstruction.  

PubMed

Hepatic venous outflow obstruction also called the Budd-Chiari syndrome is increasingly being recognized as a cause of portal hypertension. In western countries the obstruction is usually in the hepatic veins while in reports from South Africa, Japan and India the predominant cause is a block in the IVC at the level of the diaphragm above the entry of the hepatic veins. A hypercoagulable state caused by myeloproliferative haematological disorders, clonal defects in haemopoietic stem cells, lupus anticoagulant, contraceptive pills and postpartum state are some of the aetiological conditions described. However in 25% to 75% cases no cause can be identified. The predominant presenting features in patients with hepatic vein obstruction are hepatomegaly and ascites while those with IVC obstruction show prominent veins on the trunk and back. Ultrasound examination should be the first investigative step. However a liver biopsy is the gold standard of diagnosis. To confirm the site of obstruction inferior vena cavography or functional hepatography may be required. In the acute phase thrombolytic therapy may be useful but for established cases either surgical intervention in the form of shunts or recently balloon angioplasty may be helpful. For patients with established cirrhosis and end-stage liver failure the only alternative is liver transplantation. All these patients however should be put on long term anticoagulants to prevent rethrombosis. Some series have reported that upto 45% of patients may develop hepatocellular carcinoma on long term followup. With proper management a larger proportion of patients can be returned to a useful productive life. PMID:9828703

Pande, G K; Srinath, C; Pal, S; Reddy, K S

1998-01-01

138

Strategy for Bone Metastases Treatment in Patients with Impending Cord Compression or Vertebral Fractures: A Pilot Study  

PubMed Central

Impending spinal cord compression and vertebral fractures are considered contraindications for radionuclide bone pain palliation therapy. However, most of the patients with widespread bone metastases already have weakened vertebral segments that may be broken. Therefore, local field external-beam radiotherapy or percutaneous vertebroplasty (VP) should be considered to improve the patient's quality of life and to institute subsequent appropriate treatment, including radionuclide therapy for bone pain palliation. The objective of this study was to develop a strategy for an effective treatment of bone metastases in patients with widespread bone metastases and intolerable pain, associated with impending cord compression or vertebral fractures. Eleven patients (5 females and 6 males, aged 32-62 years; mean age 53.8 ± 2.7 years) with multiple skeletal metastases from carcinomas of prostate (n = 3), breast (n = 3) and lung (n = 5) were studied. Their mean pain score measured on a visual analogue scale of 10 was found to be 8.64 ± 0.15 (range 8-9) and the mean number of levels with impending cord compression or vertebral fracture was 2.64 ± 0.34 (range 1–4). All patients underwent vertebroplasty and after 3–7 days received Sm-153 ethylene diamine tetra methylene phosphonic acid (EDTMP) therapy. Sm-153 EDTMP was administered according to the recommended standard bone palliation dose of 37 MBq/kg body weight. Whole body (WB) bone scan, computed tomography and magnetic resonance imaging (MRI) were performed before and after treatment in all patients. Pain relief due to stabilization of vertebrae after VP occurred within the first 12 hours (mean 4.8 ± 1.2 hours; range 0.5–12 hours), and the mean pain score was reduced to 4.36 ± 0.39 (range 2–6). Subsequent to Sm-153 EDTMP treatment, further pain relief occurred after 3.91 ± 0.39 days (range 2-6 days) and the pain score decreased to 0.55 ± 0.21 (range 0–2). The responses to treatment were found to be statistically significant (P < 0.0001). Based on the results on this limited patient population, we conclude that spinal stabilization using VP in patients with widespread bone metastases and impending cord compression is an effective way to decrease disability with pain and to facilitate subsequent systemic palliation of painful skeletal metastases by Sm-153 EDTMP therapy.

Rasulova, N.; Lyubshin, V.; Djalalov, F.; Kim, K. H.; Nazirova, L.; Ormanov, N.; Arybzhanov, D.

2011-01-01

139

Indian tick typhus presenting with gangrene: a case report from an urban slum of Delhi.  

PubMed

Indian Tick Typhus has been rarely reported in children from Delhi. A 10-y-old male child from Delhi presented with fever, non specific gastrointestinal symptoms, petechial rash and gangrene of all the toes. Possibility of rickettsial infection was entertained after the child failed to improve with best of the antibiotics. Sample for serology for rickettsial infection was sent and Doxycycline was started empirically. He became afebrile within 72 h of starting Doxycycline. Later, diagnosis of Indian Tick Typhus was confirmed on the basis of IgM positivity against Rickettsia conori. Possibility of rickettsial infection should be entertained in children with history of fever and skin rash, especially if the child fails to improve with a course of antibiotics and common infectious etiologies have been ruled out. PMID:23783766

Kumar, Manish; Singh, Raghvendra; Yadav, Mukesh

2014-01-01

140

[A case of Fournier's gangrene in which Flexi-Seal was effective for evacuation management].  

PubMed

A 67-year-old male was referred to our hospital with septicemia from necrotizing fasciitis of the genitalia of unknown origin. He had a history of diabetes and cerebral infarction. Extensive debridement of necrotizing tissue was performed over an area extending from the lower abdomen to the light inguinal,scrotal and perianal regions. At a suitable point,Flexi-Seal was applied to the wound as a preventive measure against infection. There was no contamination of perianal wounds,allowing them to be closed without infection. The Flexi-Seal was successfully removed after around 3 weeks. This is the second case in which Flexi-Seal was used in Japan to treat Fourier's gangrene. PMID:20372049

Ohzeki, Takayuki; Hayashi, Taiji; Hanai, Tadashi; Uemura, Hirotsugu

2010-03-01

141

Severe gangrene accompanied by varicella zoster virus-related vasculitis mimicking rheumatoid vasculitis.  

PubMed

Herpes zoster infection occurs more frequently and severely in immunosuppressed populations. However, the condition sometimes presents with atypical clinical manifestations of the skin, which makes it difficult to reach a correct diagnosis. We experienced a case of acral gangrene caused by varicella zoster virus (VZV)-related vasculitis in a rheumatoid arthritis (RA) patient. Histologically, necrotic vasculitis was observed; however, there were initially no findings in the epidermis suggestive of a viral infection. We thought that the skin ulcer was related to rheumatoid vasculitis. However, an immunohistochemical analysis for VZV confirmed VZV infection in the vascular endothelium of the dermis, leading to effective treatment with intravenous acyclovir. Since various pathogenic skin phenotypes are observed in RA patients, modified according to the status of immunosuppression, clinicians must recognize the variation in typical and atypical manifestations in order to manage these patients. PMID:24761143

Tanaka, Aya; Hayaishi, Nagako; Kondo, Yukari; Kurachi, Kishiro; Tanemura, Atsushi; Katayama, Ichiro

2014-01-01

142

Fournier's gangrene  

Microsoft Academic Search

Background A 59-year-old man presented with a 4-day history of scrotal pain and swelling and the rapid development of moist, black, foul-smelling lesions on the scrotum and penis. As a liver-transplant recipient, he was immunosuppressed. He also had type 1 (insulin-dependent) diabetes and poor nutrition, which might have compromised immunity further.Investigations Physical examination, blood and tissue cultures, full blood count,

Alessandra Canal; David E Neal; Tevita'Aho

2006-01-01

143

Gas Gangrene  

MedlinePLUS

... Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual ... A Natural Part of Growing Up Healthy Children Radio: AAP ...

144

Fournier's gangrene: early diagnosis. How to diagnose, how to manage it.  

PubMed

Fournier's gangrene (FG) is a rare surgical emergency and a life-threatening condition with a rapidly progressive gangrene defined as a necrotizing fasciitis of the perineal or genital areas leading to septic shock and death if untreated. Risk factors are diabetes, immune compromise, obesity, drug use, or genital trauma. Patients are treated by incision and drainage. Aim of the study is to analyze cases of early manifestations of FG and consider aspect of diagnosis based on clinical presentation and the importance of precocious surgical treatment. We had experience of early lesions of FG in 22 cases. We report three cases in which the initial clinical presentation was typical of precocious signs referable to FG. Foley catheter was used in all cases, no diverting colostomy was performed. The patients were treated by artificial i.v. feeding. No extensive demolition of perineal tissues were operated, neither plastic surgery was required. Antibiotic therapy combined to surgical treatment with incision and drainage were performed in all cases. Admission in the intensive care unit was effective when indicated. No mortality was registered in all 22 cases of the series. FG is rare, severe condition requiring a multidisciplinary approach. An early diagnosis and an aggressive surgical treatment, improved by antibiotic therapy, hyperbaric oxygen therapy and proper wound care are the key points of FG management. In selected patients, colostomy or cystostomy must be considered when simple catheterization is not sufficient. Severe cases must be therefore referred to high-volume and specialized centres with specialist professional and intensive care facilities. PMID:24847898

Polistena, A; Cavallaro, G; D'Ermo, G; Avenia, N; De Toma, G

2014-04-01

145

Role of Mebo (Moist Exposed Burn Ointment) in the Treatment of Fournier'S Gangrene  

PubMed Central

Summary Objectives. Fournier’s gangrene (FG), though rare, is a life-threatening extensive fulminant infection of the genitals, perineum, or abdominal wall caused by a mixture of aerobic and anaerobic micro-organisms. Early and aggressive surgical debridement of the necrotic tissue and complete antibiotic coverage are the gold standards in treating FG. The purpose of our study was to assess the role of MEBO (moist exposed burn ointment) in topical treatment of the wound secondary to surgical debridement. Methods. Eleven patients (age range, 40-75 yr; mean, 55 yr) were admitted to the clinical facilities of the Department of Urology at Al Sabah Hospital, Kuwait, suffering from Fournier’s gangrene, in the 31-month period between January 2004 and July 2006. All these patients were treated with broad-spectrum triple antimicrobial therapy as well as extensive debridement of necrotic tissue. The resultant wounds were treated with MEBO in six randomly selected patients and with a placebo in the remaining five patients. Results. The duration of hospital stay was reduced by 41.7% in the MEBO-treated group (30.0 vs 51.5 days) and pain control of pain was faster, which could be attributed to the faster control of infection and wound healing in this group. Conclusion. A combination of appropriate antibiotic coverage and aggressive surgical therapy is mandatory for the treatment of FG. MEBO promotes the healing of the resulting, quite extensive wound, reducing pain and controlling infection. It is a also a cost-effective therapy as it accelerates healing and reduces hospital stay by 41.7%.

Al-Meshaan, M.; Abdul Hamid, M.; Quider, T.; Al-Sairafi, A.; Dham, R.

2008-01-01

146

Role of mebo (moist exposed burn ointment) in the treatment of fournier's gangrene.  

PubMed

Objectives. Fournier's gangrene (FG), though rare, is a life-threatening extensive fulminant infection of the genitals, perineum, or abdominal wall caused by a mixture of aerobic and anaerobic micro-organisms. Early and aggressive surgical debridement of the necrotic tissue and complete antibiotic coverage are the gold standards in treating FG. The purpose of our study was to assess the role of MEBO (moist exposed burn ointment) in topical treatment of the wound secondary to surgical debridement. Methods. Eleven patients (age range, 40-75 yr; mean, 55 yr) were admitted to the clinical facilities of the Department of Urology at Al Sabah Hospital, Kuwait, suffering from Fournier's gangrene, in the 31-month period between January 2004 and July 2006. All these patients were treated with broad-spectrum triple antimicrobial therapy as well as extensive debridement of necrotic tissue. The resultant wounds were treated with MEBO in six randomly selected patients and with a placebo in the remaining five patients. Results. The duration of hospital stay was reduced by 41.7% in the MEBO-treated group (30.0 vs 51.5 days) and pain control of pain was faster, which could be attributed to the faster control of infection and wound healing in this group. Conclusion. A combination of appropriate antibiotic coverage and aggressive surgical therapy is mandatory for the treatment of FG. MEBO promotes the healing of the resulting, quite extensive wound, reducing pain and controlling infection. It is a also a cost-effective therapy as it accelerates healing and reduces hospital stay by 41.7%. PMID:21991105

Al-Meshaan, M; Abdul Hamid, M; Quider, T; Al-Sairafi, A; Dham, R

2008-03-31

147

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

NASA Astrophysics Data System (ADS)

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 except for only a very few cases. Thus, the precursory variation W appears to load the corresponding stress into the local region to prepare for an impending large EQ whose fault width becomes W. If we use an empirical relation of the fault length (L in km) being L = 2W, we can forecast the M of the impending large EQ by another relation of log L = 0.5M - 1.8 for 6 ? M ? 8.5 [Utsu, 2002]. The triple phase coupling during variation W enables us to forecast the rupture date within one or two day accuracy in weeks and months ahead of time. The linear interpolation of the hypocenter trajectories during variation W enables us to forecast the hypocenter of an impending large EQ. [Takeda, 2003; Takeda and Takeo, 2004]. The accelerations (except for MAG) and running sums of about 70 INT and DEP events each have only three independent variables, suggesting that they are three principal stress components. If we collect the EQs for the entire mesh of about 30 degrees with another M ? 4 window, the number of variables increases to four as expected. The INT and DEP sum are useful for monitoring the stress build-ups and drops in the regional lithosphere, whose cycles show clear critical states precursory to the ruptures of large EQs. Our website regularly updates the cycle of INT sum for Japan.

Takeda, F.

2009-12-01

148

Iliofemoral venous obstruction without thrombosis.  

PubMed

Nonthrombotic iliofemoral venous obstruction, masquerading as deep vein thrombosis, was diagnosed in four patients. In each instance the patient was hospitalized and intravenous heparin therapy was started. Phlebography demonstrated venous outflow obstruction without thrombosis; subsequent CT scanning revealed an obstructing lesion in each case. At surgical exploration, (1) endoaneurysmorrhaphy of a hypogastric artery aneurysm decompressed an obstructed right iliac vein; (2) a primary iliac vein leiomyosarcoma was extirpated; (3) a synovial cyst arising from the right hip joint, which obstructed the femoral vein, was excised; and, (4) a postherniorrhaphy inflammatory mass obstructing the left iliofemoral vein junction was confirmed with biopsy results. Improved diagnostic accuracy with its attendant specific therapy is achieved in suspected cases of iliofemoral vein thrombosis if, in addition to noninvasive venous studies or phlebography, CT scanning of the abdomen and pelvis is performed. PMID:3694758

Harris, R W; Andros, G; Dulawa, L B; Oblath, R W; Horowitz, R

1987-12-01

149

Surgical treatment of acute deep venous thrombosis  

Microsoft Academic Search

In patients with venous thrombotic disease and in whom anticoagulation or thrombolytic therapy is inappropriate, ineffective, or even contraindicated, insertion of vena caval filters or venous thrombectomy must be considered.

Reginald S. A. Lord; Frank C. Chen; Terence J. Devine; Ian V. Benn

1990-01-01

150

Cerebral venous thrombosis: diagnosis dilemma  

PubMed Central

Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.

Chiewvit, Pipat; Piyapittayanan, Siriwan; Poungvarin, Niphon

2011-01-01

151

Arterial versus venous endothelial cells  

PubMed Central

Vascular endothelial cells (ECs) form the inner lining of all blood vessels from the largest artery and veins, viz., the aorta and venae cavae, respectively, to the capillaries that connect the arterial and venous systems. Because these two major conducting systems of the cardiovasculature differ functionally, it is not surprising that the physical makeup of arteries and veins, including the ECs that line their lumina, are also distinct. Although few would argue that the local environment contributes to the differences between arteries and veins, recent evidence has shown that the specification of arterial and venous identity is largely genetically determined.

D'Amore, Patricia A.

2014-01-01

152

[Gangrenous cholecystitis without lithiasis. A report on a case diagnosed by simple radiography of the abdomen (author's transl)].  

PubMed

The authors report a case of gangrenous cholecystitis without lithiasis but with secondary infection of the gallbladder by anaerobic germs. Pre-operative diagnosis was possible from simple x-rays of the abdomen which demonstrated an obvious fluid level in the gallbladder, and by parietography. An immediate cholecystectomy was performed. Bacteriological examination of the bile confirmed the presence of Clostridium perfringens. The main bile duct appeared normal and the bile in the common bile duct was sterile. Convalescence was uneventful with antibiotic cover, in spite of the age and condition of the patient. Gangrenous cholecystitis occurs more frequently without gallbladder stones in humans. Clinical signs are not specific but simple x-rays of the abdomen are pathognomonic and enable pre-operative diagnosis to be made. Urgent cholecystectomy appears to be the ideal treatment. This affection has a high mortality and early operation is therefore justified. PMID:7380889

Vinard, J L; Finet, P; Ohanessian, J; Gelas, P; Latreille, R

1980-02-01

153

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

PubMed Central

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

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

2011-01-01

154

Acute gangrene that developed in the fingers of the hand with arteriovenous fistule in a chronic hemodialysis patient.  

PubMed

Finger gangrene developing due to arterial occlusive disease in the upper extremity is a rare pathology. Although rare, it can especially be seen in patients undergoing chronic hemodialysis. Although there are no established reasons in the etiology of gangrene occurring in the hand following chronic hemodialysis, certain high-risk factors have been defined. Awareness of these high-risk factors is important in the prevention of these types of undesired complications with high morbidity rates. In our study, we report an acutely developed finger necrosis as well as the possible etiologic factors causing the necrosis and its treatment. The necrosis developed in the hand (where an arteriovenous fistule formed) of a 60-year-old patient in menopause, with osteoporosis, diabetes, hypertension, and who was undergoing hemodialysis due to an eight-year history of end-stage renal disease. PMID:17052068

Cebesoy, Oguz; Baltaci, Enver Taner

2006-10-01

155

Acute gangrene that developed in the fingers of the hand with arteriovenous fistule in a chronic hemodialysis patient.  

PubMed Central

Finger gangrene developing due to arterial occlusive disease in the upper extremity is a rare pathology. Although rare, it can especially be seen in patients undergoing chronic hemodialysis. Although there are no established reasons in the etiology of gangrene occurring in the hand following chronic hemodialysis, certain high-risk factors have been defined. Awareness of these high-risk factors is important in the prevention of these types of undesired complications with high morbidity rates. In our study, we report an acutely developed finger necrosis as well as the possible etiologic factors causing the necrosis and its treatment. The necrosis developed in the hand (where an arteriovenous fistule formed) of a 60-year-old patient in menopause, with osteoporosis, diabetes, hypertension, and who was undergoing hemodialysis due to an eight-year history of end-stage renal disease. Images Figure 1 Figure 2

Cebesoy, Oguz; Baltaci, Enver Taner

2006-01-01

156

Capillary versus venous bedside blood glucose estimations  

Microsoft Academic Search

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

R Boyd; B Leigh; P Stuart

2005-01-01

157

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

PubMed Central

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.

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

2011-01-01

158

Use of 2-aminobutane as a fumigant for control of gangrene, skin spot and silver scurf diseases of potato tubers  

Microsoft Academic Search

Fumigation of tubers with 2-aminobutane (sec-butylamine) gas at a dosage of 200 mg\\/kg in simply made fumigation chambers gave very good control of the diseases gangrene (caused byPhoma exigua var.foveata) and skin spot (Oospora pustulans) if treatment was done within 14 days of harvesting. Some control of silver scurf disease (Helminthosporium solani) was also obtained, but results were always poorer

D. C. Graham; G. A. Hamilton; C. E. Quinn; A. D. Ruthven

1973-01-01

159

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

PubMed Central

Background: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. Results: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. Conclusion: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.

Bakari, Abubakar A; Ali, Nuhu; Gadam, Ibrahim A; Gali, Bata M; Tahir, Chubado; Yawe, KDT; Dahiru, Adamu B; Mohammed, Baba S; Wadinga, Dauda

2013-01-01

160

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

PubMed Central

Background Men with spinal cord injury (SCI) appear to have a greater incidence of bacterial colonisation of genital skin as compared to neurologically normal controls. We report a male patient with paraplegia who developed rapidly progressive infection of scrotal skin, which resulted in localised necrosis of scrotum (Fournier's gangrene). Case presentation This male patient developed paraplegia at T-8 level 21 years ago at the age of fifteen years. He has been managing his bladder by wearing a penile sheath. He noticed redness and swelling on the right side of the scrotum, which rapidly progressed to become a black patch. A wound swab yielded growth of methicillin-resistant Staphylococcus aureus (MRSA). Necrotic tissue was excised. Culture of excised tissue grew MRSA. A follow-up wound swab yielded growth of MRSA and mixed anaerobes. The wound was treated with regular application of povidone-iodine spray. He made good progress, with the wound healing gradually. Conclusion It is likely that the presence of a condom catheter, increased skin moisture in the scrotum due to urine leakage, compromised personal hygiene, a neurogenic bowel and subtle dysfunction of the immune system contributed to colonisation, and then rapidly progressive infection in this patient. We believe that spinal cord injury patients and their carers should be made aware of possible increased susceptibility of SCI patients to opportunistic infections of the skin. Increased awareness will facilitate prompt recourse to medical advice, when early signs of infection are present.

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

2002-01-01

161

Plasmodium falciparum Malaria Complicated by Symmetrical Peripheral Gangrene, Bowel Ischemia, Repeated Candidemia, and Bacteraemia  

PubMed Central

A 63-year-old Caucasian woman developed severe Plasmodium falciparum malaria when travelling back from Cameroun. No antimalarial chemoprophylaxis had been observed. The patient was immediately admitted to the intensive care unit after evidence of multiple organ failure (coma, shock, acute respiratory distress syndrome, acute renal failure, etc.). However, initial parasitemia was less than 1%. The patient was managed by intravenous quinine and norepinephrine infusion due to refractory shock. The patient developed as an early complication ischemic lesions of both arms and feet. In addition to laboratory changes consistent with disseminated intravascular coagulation, there was also evidence for a low activity of the von Willebrand factor (VWF) cleaving protease ADAMTS13. Later complications included repeated candidemia and bacteraemia despite appropriate therapy; the origin appeared to be diffuse ischemic injury of the gastrointestinal tract. The patient ultimately recovered, but quadriamputation was necessary to treat symmetrical peripheral gangrene (SPG). In severe Plasmodium falciparum malaria, ischemic changes may be due to microvascular obstruction, but, in patients with low parasitemia, other endothelial factors may also be involved as observed in other groups of thrombotic microangiopathies.

Masse, Emeline

2014-01-01

162

Review of venous vascular ultrasound.  

PubMed

Duplex ultrasound (US) has become the new gold standard in the assessment of acute deep vein thrombosis. In view of the large number of cases with persistent changes, all cases should be reassessed at 6 months to document the extent of residual disease. The role of duplex US in chronic venous disease is less well established but it is evolving as the single most useful examination and is likely to supplant other noninvasive methods in the near future. PMID:10633152

Phillips, G W

2000-02-01

163

Where does venous reflux start?  

Microsoft Academic Search

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

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

1997-01-01

164

Pycnogenol in chronic venous insufficiency.  

PubMed

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

Arcangeli, P

2000-06-01

165

Inflammation in Chronic Venous Insufficiency: Is the Problem Insurmountable?  

Microsoft Academic Search

One of the hallmarks of venous insufficiency is an elevated venous pressure. While a number of mechanisms have been proposed for vascular and parenchymal cell damage following venous pressure elevation, such as white cell infiltration, a key question remains as to what degree venous occlusion and flow interruption per se may constitute a risk factor in venous disease. To gain

Shinya Takase; Frank A. Delano; Laurence Lerond; John J. Bergan; Geert W. Schmid-Schönbein

1999-01-01

166

Amputation of the penis and bilateral orchiectomy due to extensive debridement for Fournier's gangrene: case report and review of the literature.  

PubMed

Fournier's gangrene is a rare disease with rapidly progressive necrotising fasciitis of the genital, perineal and perianal regions and is known to have an impact in the morbidity and the mortality. Despite antibiotics and aggressive debridement, mortality rate is still high. We present a 79-year-old man who was admitted to School of Medicine, Harran University, Sanliurfa, Turkey, with painful swelling of penoscrotal region. Perineal examination revealed the entire perineal skin to be gangrenous, necrotic and foul smelling. Despite the aggressive drainage and broad-spectrum antibiotic therapy, the gangrene progressed rapidly in hours and the patient's general condition worsened. Secondary extensive debridement including bilateral orchiectomy and amputation of the penis was performed. This disease may result in loss of organ such as testes and penis even with sufficient therapy. PMID:22764465

Ciftci, Halil; Verit, Ayhan; Oncel, Halil; Altunkol, Adem; Savas, Murat; Yeni, Ercan; Bitiren, Muharrem; Guldur, M Emin

2012-03-01

167

Transpleural central venous catheter discovered during thoracotomy  

PubMed Central

We report an uncommon complication of subclavian central venous catheterization, discovered at thoracotomy. The central venous catheter (CVC) was placed by left infraclavicular route after induction of general anesthesia. CVC was secured after aspiration of blood and satisfactory central venous tracing. On thoracotomy, CVC was noticed to traverse the pleural cavity while the tracing was normal. CVC was thus removed consequent to which bleeding from each puncture site was noticed, that were secured surgically.

Malhotra, Ashima; Sharma, Prakash; Kumar, Ashvini; Malhotra, Nikhil

2014-01-01

168

Synchronized Coronary Venous Retroperfusion During Coronary Angioplasty  

Microsoft Academic Search

\\u000a Synchronized diastolic coronary venous retroperfusion is a technique by which autologous arterial blood is shunted from the\\u000a femoral artery into the coronary veins. Phasic diastolic occlusion of the coronary sinus by a balloon catheter compartmentalizes\\u000a the coronary venous system, preventing regurgitation of arterial blood into the right atrium. Triggered collapse of the balloon\\u000a during systole facilitates normal physiologic coronary venous

Sheila Kar; Alice K. Jacobs; David P. Faxon

169

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

Microsoft Academic Search

Chronic venous insufficiency (CVI) remains a major health problem worldwide. Direct venous valve surgical repair and venous\\u000a segment transplantation are clinical options; however, they are highly invasive procedures. The objectives of this study were\\u000a to fabricate prosthetic venous valves (PVVs) by electrospinning, for percutaneous treatment of CVI, and evaluate their hydrodynamic\\u000a characteristics in vitro at the same locations and under

Masaki Moriyama; Shinichiro Kubota; Hideo Tashiro; Hiroyuki Tonami

170

Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: Experience with 50 patients.  

PubMed

Abstract Objective. The aim of this study was to evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and compare three different validated scoring systems for outcome prediction: Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) and age-adjusted Charlson Comorbidity Index (ACCI). Material and methods. Fifty men who underwent surgery for FG between July 2005 and August 2012 were included in the study. Data were collected on medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. The FGSI, UFGSI and ACCI were evaluated stratified by survival. Admission and final parameters were measured using the Mann-Whitney test. Results. The results were evaluated for two groups: survivors (n = 43) and non-survivors (n = 7). Survivors were younger than non-survivors (median age 58 vs 68.5 years, p = 0.017). The median extent of body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.04). No significant differences in laboratory parameters were found between survivors and non-survivors at the time of admission, except for haemoglobin, haematocrit, serum urea and albumin levels. Only UFGSI, but not FGSI or ACCI, had any meaning or predictive value in disease severity or patients' survival. Conclusion. Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation. PMID:24521184

Tuncel, Altug; Keten, Tanju; Aslan, Yilmaz; Kayali, Mustafa; Erkan, Anil; Koseoglu, Ersin; Atan, Ali

2014-08-01

171

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

PubMed Central

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

Sarwar, Umran; Akhtar, Nadeem

2012-01-01

172

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

PubMed

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

Armentrout, Debra; Cates, Leigh Ann

2011-01-01

173

Disopyramide stress test: a sensitive and specific tool for predicting impending high degree atrioventricular block in patients with bifascicular block.  

PubMed Central

OBJECTIVE--To study the value of intravenous disopyramide as part of an invasive electrophysiological study in predicting impending high degree atrioventricular block in patients with bifascicular block. DESIGN--An invasive electrophysiological study was performed in the basal state and after the infusion of disopyramide (2 mg/kg body weight). The progression to high degree atrioventricular block was assessed by bradycardia-detecting pacemakers or repeated 12-lead electrocardiogram recordings, or both. PATIENTS--73 patients with bifascicular block were included, of whom 25 had a history of unexplained syncope. The remaining 48 patients had no arrhythmia related symptoms and were included as controls. All patients had an ejection fraction of > 35%. RESULTS--After a mean follow up of 23 months, seven patients in the syncope group and three in the non-syncope group had a documented high degree atrioventricular block or pacemaker-detected bradycardia of < or = 30 beats/min for > or = 6 s. The sensitivity of the disopyramide test was 71% and the specificity 98%. The corresponding figures for an abnormal electrophysiological study in the basal state were 14% and 91%, respectively. CONCLUSIONS--The sensitivity of an invasive electrophysiological study in patients with bifascicular block and syncope can be markedly increased by the use of intravenous disopyramide. A positive test is a highly specific finding and warrants pacemaker implantation.

Englund, A.; Bergfeldt, L.; Rosenqvist, M.

1995-01-01

174

Bronchial venous plexus in left ventricular dysfunction.  

PubMed

Chronic pulmonary venous hypertension causes dilatation and engorgement of bronchial veins because of a close communication between bronchial and pulmonary veins. We report a case of severe left ventricular systolic dysfunction with chronically elevated pulmonary venous pressure leading to characteristic bronchoscopic findings of engorgement of bronchial veins. PMID:24739688

Malik, Sonika; Shah, Parth S; Mehta, Atul C

2014-04-01

175

Absent coronary venous sinus: a rare anomaly.  

PubMed

A 42-year-old man, presenting with dyspnea on exertion and ST segment depression on treadmill test, was found to have absent coronary venous sinus on coronary angiography. We report this case of isolated congenital absence of coronary venous sinus because of its rarity. PMID:11516041

Rao, C V; Raghu, K; Sharada, K; Jaishankar, S

2001-01-01

176

Lymphatic Leak Complicating Central Venous Catheter Insertion  

SciTech Connect

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

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

2005-12-15

177

[Venous aneurysms in the foot region].  

PubMed

Venous aneurysms are rarely mentioned in the literature. Regarding those in the foot region, only 4 cases have been published so far. We report on the clinical and diagnostic features of 2 young women showing venous aneurysms in the first part of the long saphenous vein on the right back of the foot. In both cases, sclerotherapy was successfully performed. PMID:2284837

Rabe, E; Rabe, P

1990-08-01

178

Causes of venous ulceration: a new hypothesis  

Microsoft Academic Search

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

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

1988-01-01

179

Stent Placement on Fresh Venous Thrombosis  

SciTech Connect

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

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

1997-09-15

180

Subacute myelopathy caused by spinal venous infarction.  

PubMed Central

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

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

1987-01-01

181

Venous Pressure in Man during Weightlessness  

Microsoft Academic Search

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

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

1984-01-01

182

Chronic cerebrospinal venous insufficiency and multiple sclerosis  

Microsoft Academic Search

A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular

Adam E. Handel; Matthew R. Lincoln; Sreeram V. Ramagopalan; Frederik Barkhof; Paula Dore-Duffy; Hans Lassmann; Bruce Trapp; Amit Bar-Or; Imad Zak; Marilyn J. Siegel; Robert Lisak

2010-01-01

183

PYCNOGENOL in chronic venous insufficiency.  

PubMed

The aim of out study was to investigate the efficacy of Pycnogenol - a French maritime pine bark extract - in the treatment of chronic venous insufficiency (CVI). The study consisted of a double-blind phase - in which 20 patients were recruited and randomly treated with placebo or Pycnogenol (100 mg 2 3/day for 2 months) - and an open phase - in which other 20 patients were treated with Pycnogenol at the same dose schedule. In total, 40 patients were enrolled; 30 of them were treated with Pycnogenol and 10 with placebo. Pycnogenol significantly improved the legs' heaviness and subcutaneous edema; the venous pressure was also significantly reduced by the Pycnogenol treatment, thus adding further clinical evidence to its therapeutic efficacy in patients with CVI. Pycnogenol was effective, probably by either stabilizing the collagenous subendothelial basal membrane or scavenging the free radicals, or by a combination of these activities. Clinically, capillary leakage, perivascular inflammation and subcutaneous edema were all reduced. The safety of use of Pycnogenol is demonstrated by the lack of side effects or changes in blood biochemistry and hematologic parameters. Pycnogenol can be therefore recommended both for prevention and treatment of CVI and related veno-capillary disturbances. PMID:11081989

Petrassi, C; Mastromarino, A; Spartera, C

2000-10-01

184

Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report  

PubMed Central

Introduction Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented. Case presentation We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal. Conclusion A peritoneal dialysis patient with abdominal pain that persists for more than 48?hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72?hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.

2012-01-01

185

Effect of Zymozane on the Natural, Passive and Active Immunity to the Toxins Produced by the Causative Agents of Gas Gangrene and Tetanus.  

National Technical Information Service (NTIS)

An experiment using white mice was conducted to determine the influence of zymozane on the natural, passive and active resistance to toxins of the causative agents of gas gangrene and tetanus. It was found that the effect of zymazane on natural immunity t...

N. F. Kalichienenko

1968-01-01

186

The Impending Instructional Revolution.  

ERIC Educational Resources Information Center

The last three decades of the twentieth century will witness a drastic change in the business of providing instruction in schools and colleges. The idea of "individualized instruction" has been pursued in a desultory fashion by American educators for most of the century. There have been several different concepts of individualization, the most…

Mitzel, Harold E.

187

Impending Impeachment Vote  

NSDL National Science Digital Library

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

Osmond, Andrew.

188

Venous thromboembolism in malignant gliomas  

PubMed Central

Summary Malignant gliomas are associated with a very high risk of venous thromboembolism (VTE). While many clinical risk factors have previously been described in brain tumor patients, the risk of VTE associated with newer anti-angiogenic therapies such as bevacizumab in these patients remains unclear. When VTE occurs in this patient population, concern regarding the potential for intracranial hemorrhage complicates management decisions regarding anticoagulation, and these patients have a worse prognosis than their VTE-free counterparts. Risk stratification models identifying patients at high risk of developing VTE along with predictive plasma biomarkers may guide the selection of eligible patients for primary prevention with pharmacologic thromboprophylaxis. Recent studies exploring disordered coagulation, such as increased expression of tissue factor (TF), and tumorigenic molecular signaling may help to explain the increased risk of VTE in patients with malignant gliomas.

JENKINS, E. O.; SCHIFF, D.; MACKMAN, N.; KEY, N. S.

2010-01-01

189

Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans  

NASA Technical Reports Server (NTRS)

Human venous compliance hypothetically decreases from upper to lower body as a mechanism for maintenance of the hydrostatic indifference level 'headward' in the body, near the heart. This maintains cardiac filling pressure, and thus cardiac output and cerebral perfusion, during orthostasis. This project entailed four steps. First, acute whole-body tilting was employed to alter human calf and neck venous volumes. Subjects were tilted on a tilt table equipped with a footplate as follows: 90 deg, 53 deg, 30 deg, 12 deg, O deg, -6 deg, -12 deg, -6 deg, O deg, 12 deg, 30 deg, 53 deg, and 90 deg. Tilt angles were held for 30 sec each, with 10 sec transitions between angles. Neck volume increased and calf volume decreased during head-down tilting, and the opposite occurred during head-up tilt. Second, I sought to cross-validate Katkov and Chestukhin's (1980) measurements of human leg and neck venous pressures during whole-body tilting, so that those data could be used with volume data from the present study to calculate calf and neck venous compliance (compliance = (Delta)volume/(Delta)pressure). Direct measurements of venous pressures during postural chances and whole-body tilting confirmed that the local changes in venous pressures seen by Katkov and Chestukhin (1980) are valid. The present data also confirmed that gravitational changes in calf venous pressure substantially exceed those changes in upper body venous pressure. Third, the volume and pressure data above were used to find that human neck venous compliance exceeds calf venous compliance by a factor of 6, thereby upholding the primary hypothesis. Also, calf and neck venous compliance correlated significantly with each other (r(exp 2) = 0.56). Fourth, I wished to determine whether human calf muscle activation during head-up tilt reduces calf venous compliance. Findings from tilting and from supine assessments of relaxed calf venous compliance were similar, indicating that tilt-induced muscle activation is relatively unimportant. Low calf venous compliance probably results from stiffer venous, skeletal muscle, and connective tissues, and better-developed local and central neural controls of venous distensibility. This research establishes that upper-to-lower body reduction of venous compliance can explain headward positioning of the hydrostatic indifference level in humans.

Watenpaugh, Donald E.

1996-01-01

190

Prevention of hemodialysis fistula thrombosis. Early detection of venous stenoses  

Microsoft Academic Search

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

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

1989-01-01

191

Measurement of venous compliance (8-IML-1)  

NASA Technical Reports Server (NTRS)

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

Thirsk, R. B.

1992-01-01

192

Direct puncture angiography in congenital venous malformations  

SciTech Connect

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.

Boxt, L.M. (Harvard Medical School, Boston, MA); Levin, D.C.; Fellows, K.E.

1983-01-01

193

[Current diagnosis of venous diseases of the lower limbs].  

PubMed

The haemodynamic of venous circulation of lower limbs seems to be not yet fully understood and different methods are available to study clinical patterns of venous insufficiency, deep venous incompetence or venous occlusion. Simple and common methods as venography, venous doppler and plethysmography are frequently used but other method as impedance plethysmography, ambulatory venous pressure, photoplethysmography, isotopes and thermography can be used for research or clinical investigation. The techniques and the indications of these tests are reviewed and critically analyzed to evaluate the best approach to the patients with venous pathology. PMID:6738900

Belcaro, G; Caizzi, N; Cotellese, R; D'Aulerio, A; Rotolo, A; Legnini, M; Di Vincenzo, V; Rossi, M; Di Stefano, S

1984-06-16

194

Asian venous thromboembolism guidelines: prevention of venous thromboembolism.  

PubMed

Venous thromboembolism (VTE) prophylaxis is under-utilized in Asia because of the misconception that its incidence is lower in Asians as compared to the Caucasians. The available data on VTE in Asia is limited due to the lack of well-designed multicenter randomized controlled trials as well as non-standardized research designs, making data comparison difficult. Emerging data indicates that the VTE incidence is not low in Asia, and is comparable to that reported in the Western literature in some instances. There is also a trend towards increasing incidence of VTE, as demonstrated by a number of hospital-based studies in Asia. This could be attributed to lifestyle changes, ageing population, increasing awareness of VTE and wider availability of Duplex ultrasound. The risk of VTE in hospitalized patients remain the same in Asians and Caucasians, even though there may be factors that are inherent to patients in Asia that influence the slight variation in incidence. The utilization rate of VTE prophylaxis remains suboptimal in Asia. The Asian Venous Thrombosis Forum (AVTF) comprises participants from various countries such as China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand and experts from Australia and Europe. The forum evaluated the available data on VTE from the Asian region and formulated guidelines tailored to meet the needs of the region. We recommend that serious considerations are given to VTE prophylaxis especially in the at-risk group and a formal hospital policy be established to facilitate the implementation. On admission to the hospital, we recommend assessing the patients for both VTE and bleeding risk. We recommend mechanical prophylaxis for patients at increased risk of bleeding and utilizing it as an adjunctive measure in combination with pharmacological prophylaxis in patients with high risk of VTE. For patients undergoing general or gynecological surgery and with moderate risk for VTE, we recommend prophylaxis with one of the following: low dose unfractionated heparin (LDUH), low molecular weight heparin (LMWH), fondaparinux or intermittent pneumatic compression (IPC). For the same group of patients at high risk of VTE, we recommend pharmacological or combination of pharmacological and mechanical prophylaxis. For patients undergoing major orthopedic surgeries like total hip replacement, total knee replacement and proximal hip fracture surgery, we recommend using one of the following: LMWH, fondaparinux, rivaroxaban, apixaban, edoxaban, dabigatran, warfarin or aspirin with IPC. For patients admitted to the hospital with acute medical illness and has moderate risk of VTE, we recommend prophylaxis with LDUH, LMWH or Fondaparinux. For the same group at high risk of VTE, we recommend combination of pharmacological and mechanical prophylaxis. PMID:23222928

Liew, N C; Chang, Y H; Choi, G; Chu, P H; Gao, X; Gibbs, H; Ho, C O; Ibrahim, H; Kim, T K; Kritpracha, B; Lee, L H; Lee, L; Lee, W Y; Li, Y J; Nicolaides, A N; Oh, D; Pratama, D; Ramakrishnan, N; Robless, P A; Villarama-Alemany, G; Wong, R

2012-12-01

195

Venous pseudo-aneurysm as a late complication of short-term central venous catheterisation  

PubMed Central

Complications following central venous catheterisation abound in the medical literature. This reflects the under-estimated potential hazards associated with this procedure as well as an increase in the number of such procedures performed in high-risk patients. We report on a case where a venous pseudo-aneurysm developed four months after the removal of a short-term central venous catheter in a moderately high-risk patient.

Luckraz, Heyman

2003-01-01

196

Noninvasive measurement of internal jugular venous oxygen saturation by photoacoustic imaging  

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

197

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

PubMed

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

Uhl, J-F; Gillot, C

2012-08-01

198

Spontaneous thrombosis of developmental venous anomaly (DVA) with venous infarct and acute cerebellar ataxia.  

PubMed

Developmental venous anomaly (DVA), formally known as venous angioma, is a congenital anatomic variant of the venous drainage of the brain. Although they typically have a benign clinical course and a low symptomatic rate, thrombosis of a drainage vein may occur, leading to potentially debilitating complications. We report a unique case of spontaneous thrombosis of a posterior fossa developmental venous anomaly with cerebellar infarct in a 61-year-old man who presented with acute onset cerebellar ataxia. DVA thrombosis was well-depicted on CT and MR studies. Patient was put on anticoagulant therapy and complete recanalization was seen on follow-up imaging. PMID:24676737

Agarwal, Amit; Kanekar, Sangam; Kalapos, Paul; Vijay, Kanupriya

2014-08-01

199

Chronic Venous Disease (Beyond the Basics)  

MedlinePLUS

... disease Pathophysiology of chronic venous disease Patient information: Deep vein thrombosis (blood clots in the legs) (The ... from the surface of the legs to the deep veins and back to the heart; the valves ...

200

Cerebral venous sinus thrombosis risk factors.  

PubMed

Cerebral venous sinus thrombosis is an uncommon disease marked by clotting of blood in cerebral venous, or dural sinuses, and, in rare cases, cortical veins. It is a rare but potentially fatal cause of acute neurological deterioration previously related to otomastoid, orbit, and central face cutaneous infections. After the advent of antibiotics, it is more often related to neoplasm, pregnancy, puerperium, systemic diseases, dehydration, intracranial tumors, oral contraceptives, and coagulopathies are the most common causes, but in 30% of cases no underlying etiology can be identified. It has been found in association with fibrous thyroiditis, jugular thrombosis after catheterization, or idiopathic jugular vein stenosis. Other factors include surgery, head trauma, arterio-venous malformations, infection, paraneoplastic, and autoimmune disease. This article presents a comprehensive review of cerebral venous sinus thrombosis etiologies. PMID:19383052

Saadatnia, Mohammad; Fatehi, Farzad; Basiri, Keivan; Mousavi, Seyed Ali; Mehr, Gilda Kinani

2009-04-01

201

Long-term treatment of venous thromboembolism.  

PubMed

Long term treatment of venous thromboembolism is essential to complete therapy of the index episode and to reduce recurrences. Vitamin K antagonists are the mainstay for the long term treatment of venous thromboembolism for the majority of the patients as they allow oral administration. Low-molecular weight heparins are recommended for the long term treatment of cancer patients. The duration of long term anticoagulation depends on the features of the index venous thromboembolism and on the presence of associated risk factors. Patients at high risk for recurrence - mainly those who suffered unprovoked venous thromboembolism and those with cancer - should be evaluated for extended anticoagulation. The risk for major bleeding complications and the inconvenience for monitoring, dose adjustment and drug-food interactions are the main constraints for indefinite anticoagulant treatment. New anticoagulants with more favourable efficacy- safety profile and reduced need for monitoring could improve the feasibility of extended anticoagulation. PMID:24846227

Becattini, Cecilia; Manina, Giorgia

2014-05-01

202

Massive haematemesis due to strangulated gangrenous gastric herniation as the delayed presentation of post-traumatic diaphragmatic rupture.  

PubMed

Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usually associated with abdominal trauma; however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. Patients present with non-specific symptoms and may complain of chest pain, abdominal pain, dyspnoea, tachypnoea and cough, heartburn and symptoms of gastro-oesophageal reflux. Respiratory distress and faeco-pneumothorax have been reported. We present an interesting case of traumatic diaphragmatic hernia presenting 5 years after a road traffic accident as acute abdomen and massive haematemesis due to strangulated gangrenous gastric hernia. PMID:22778192

Wani, Abdul Majid; Al Qurashi, Turki; Rehman, Saif Abdul; Al Harbi, Zeyad S; Sabbag, Abdul Rehman Y; Al Ahdal, Mohd

2010-01-01

203

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

PubMed Central

Thrombosis may play an important role in the pathophysiology of certain complications of sickle cell disease (SCD). While the association between SCD and ulcerative colitis (UC) is still debatable, inflammatory bowel disease is known to be associated with an increased incidence of thromboembolic disease. We report a case of a 16-year old girl known to have homozygous SCD and also diagnosed with UC who presented with digital ischemia of her right lower limb. This led to gangrene and subsequent amputation of the first, second and third digits of that limb. This case highlights that patients with both UC and SCD may have an increased risk of thromboembolism and raises the question as to whether patients with UC and SCD should be screened for thrombophilia.

Rankine-Mullings, Angela E.; Knight-Madden, Jennifer M.; Reid, Marvin; Ferguson, Trevor S.

2014-01-01

204

Thermography in Diagnosis of Deep Venous Thrombosis  

PubMed Central

The possibility that subclinical increased heat of the limb may be an early and reliable sign in the diagnosis of deep venous thrombosis is being investigated using thermography. Of the 35 cases studied 17 have had early deep venous thrombosis confirmed on phlebography. Of these, 16 cases have been previously diagnosed using thermography. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 1FIG. 2

Cooke, E. D.; Pilcher, M. F.

1973-01-01

205

Hepatic Venous Pressure Gradient: Worth Another Look?  

Microsoft Academic Search

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

Sameer Parikh

2009-01-01

206

Pathophysiology of spontaneous venous gas embolism  

NASA Technical Reports Server (NTRS)

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

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

1991-01-01

207

["Difficult" venous ulcers of the legs].  

PubMed

The aim of the study was to analyze the diagnostic and surgical criteria in cases of "critical" venous leg ulcers. This report describes the management of 200 patients with trophic lesions of the lower limbs. Patients with venous leg ulcers were identified with the aid of ultrasonography and echocolor Doppler. Among these patients, according to the chronic evolution of the lesions, we identified all those with critical venous leg ulcers. The management of the lesions involved both medical and fairly aggressive surgical treatment with the use of general anaesthesia and deep surgical toilette of the ulcer. In the cases with poor epithelialisation we adopted oxygen therapy and skin grafts using the "mesh graft" technique. Critical venous leg ulcers were identified in 23 patients (19%). After surgical treatment, we observed complete epithelialisation of the lesion only in 5 cases (21.7%). In 13 patients (56.6%) the use of oxygen therapy was necessary and epithelialisation occurred on postoperative day 12. Skin grafts were used in 5 cases (21.7%). Only one recurrence was observed one year after operation in an area adjacent to the site of the graft. The "golden goal" of critical venous leg ulcer management is to establish a correct aetiological diagnosis, distinguishing between venous leg ulcers and other trophic lesions of the lower limbs. The medical and surgical treatment described in this report reduce healing time and the social costs of the disease, without any significant complications for the patient. PMID:11396072

Mordente, S; Pacca, G; Guarino, A; Benincasa, M; Leo, E

2001-01-01

208

Prediction of impending rupture in aneurysms using 4D-CTA: histopathological verification of a real-time minimally invasive tool in unruptured aneurysms.  

PubMed

The authors describe the use of a 4D-CT angiogram to predict impending rupture in intact aneurysms, as a real-time, less invasive imaging technique. Histopathological verification and immunostaining of the bleb site performed on the study population reveals the significant predictive value of this tool. The point of maximum amplitude of pulsation of the aneurysm wall in unison with the RR interval of the electrocardiogram determines the potential rupture point. This helps in prioritizing the intervention for unruptured aneurysm cases, provides an effective screening of the high-risk population, and aids preoperative planning of clip application. PMID:15343426

Kato, Y; Hayakawa, M; Sano, H; Sunil, M V; Imizu, S; Yoneda, M; Watanabe, S; Abe, M; Kanno, T

2004-06-01

209

Developmental Venous Anomaly with Contralateral Impaired Venous Drainage in a 17-Year-Old Male  

PubMed Central

Summary Developmental venous anomalies (DVA) drain normal neural tissue and are mostly discovered incidentally. We describe a young patient with a left hemisphere superficial to deep DVA and right hemisphere venous outflow restriction presenting with a seizure. The right hemisphere drainage variation is not typical of a DVA but represents another drainage pattern on the border of normality.

Enslin, Jmn; Lefeuvre, D; Taylor, A

2013-01-01

210

Intramedullary nailing without curettage and cement augmentation for the treatment of impending and complete pathological fractures of the proximal or midshaft femur.  

PubMed

Metastases in the proximal femur and in the femoral diaphysis are usually treated with either cephalomedullary or intramedullary nailing. The benefit of curettage and augmentation of the nail with methyl methacrylate remains controversial. The authors retrospectively studied the outcomes with cephalomedullary and intramedullary nailing without curettage and methyl-methacrylate augmentation for lytic metastases of the proximal/diaphyseal femur. Twenty-one complete (11) or impending (10) pathological fractures in 19 consecutive patients were treated between January 2006 and August 2013. There were 11 women and 8 men. Their mean age was 62 years (range, 38 to 87). All patients received adjuvant chemotherapy or radiotherapy.The average postsurgical survival was 9.7 months (range 1-36 months). A single deep infection was debrided. Seventeen out of 19 patients were ambulatory, with or without a walking aid. No implant failure was noted. In other words, patients succumbed to the disease prior to hardware failure. Femoral nail insertion without curettage and cement augmentation provided satisfactory stabilization of proximal and diaphyseal femur fractures, impending or complete, even when there was massive bone destruction. PMID:24873100

Shemesh, Shai; Kosashvili, Yona; Sidon, Eliezer; Yaari, Lee; Cohen, Nir; Velkes, Steven

2014-03-01

211

Venous Malformation: update on etiopathogenesis, diagnosis & management  

PubMed Central

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.

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

2011-01-01

212

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

PubMed

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

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

2014-03-01

213

Anticoagulation Therapy for Venous Thromboembolism  

PubMed Central

Context On the basis of theoretical rationale, heparoids and vitamin K antagonists are prescribed to prevent complications of venous thromboembolism (VTE, including pulmonary emboli [PE] and deep vein thrombosis [DVT]). They have been employed as the standard of care for treatment of VTE for over 40 years. Objective Critique the evidence supporting the efficacy of anticoagulants for the treatment of VTE in reducing morbidity and/or mortality. Data Sources This includes a search of reference lists and Medline. Study Selection This includes studies concerning the diagnosis and incidence of PE and DVT, efficacy of anticoagulants in preventing complications, risks of anticoagulant therapy, and the costs of diagnosis and the treatment of VTE. Data Extraction I analyzed references cited in reviews and meta-analyses of VTE, and from Medline searches concerning diagnosis and treatment. The data quality and validity of studies depended on the consistency of findings and statistical significance of the data. Data Synthesis No placebo-controlled trials of anticoagulants as treatment of PE with objective criteria for diagnosis have been published. Three randomized trials of anticoagulants vs no anticoagulants in DVT showed no benefit with heparin and vitamin K antagonists (combined all-cause mortality: anticoagulants = 6/66, un-anticoagulated controls = 1/60, P = .07). No placebo-controlled trials of low-molecular-weight heparins or thrombolytic drugs have been done; therefore, their efficacy in VTE depends entirely on randomized comparisons with unfractionated heparin. They have not been proven safer or more efficacious than unfractionated heparin. Thrombolysis causes more major and fatal bleeds than heparin and is no more effective in preventing PE. Diagnosing and treating VTE patients in the United States with anticoagulants costs $3.2 to $15.5 billion per year (1992 dollars). Bleeding and complications of angiography cause 1017-3525 deaths annually. Conclusion Anticoagulants have not been proven efficacious or safe in VTE. The bleeding risks and other complications of anticoagulation are unacceptably high. The use of anticoagulants for patients with VTE should be reconsidered.

Cundiff, David K

2004-01-01

214

Anatomic considerations for central venous cannulation  

PubMed Central

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.

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

2011-01-01

215

Developmental venous anomaly responsible for hemifacial spasm.  

PubMed

Hemifacial spasm (HFS) is a facial movement disorder characterized by involuntary, unilateral and intermittent contractions of the facial muscles. It is one of the syndromes related to neurovascular conflict, first described by Jannetta et al. in 1979. Typically, HFS is due to pulsatile compression by the anterior inferior cerebellar artery. We describe a rare case of left developmental venous anomaly in a 59-year-old man referred to us with a six-month history of left-sided HFS. We performed an MR study of the brain and cerebellopontine angles, which demonstrated a compression of the ipsilateral facial nerve by the developmental venous anomaly. PMID:23859243

Chiaramonte, R; Bonfiglio, M; D'Amore, A; Chiaramonte, I

2013-04-01

216

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

PubMed Central

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

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

2008-01-01

217

Detection of deep venous thrombophlebitis by gallium 67 scintigraphy  

SciTech Connect

Deep venous thrombophlebitis may escape clinical detection. Three cases are reported in which whole-body gallium 67 scintigraphy was used to detect unsuspected deep venous thrombophlebitis related to indwelling catheters in three children who were being evaluated for fevers of unknown origin. Two of these children had septicemia from Candida organisms secondary to these venous lines. Gallium 67 scintigraphy may be useful in the detection of complications of indwelling venous catheters.

Miller, J.H.

1981-07-01

218

Venous thromboembolism and antithrombotic therapy in pregnancy.  

PubMed

Objective: To present an approach, based on current evidence, for the diagnosis, treatment, and thromboprophylaxis of venous thromboembolism in pregnancy and postpartum. Evidence: Published literature was retrieved through searches of PubMed, Medline, CINAHL, and The Cochrane Library from November 2011 to July 2013 using appropriate controlled vocabulary (e.g. pregnancy, venous thromboembolism, deep vein thrombosis, pulmonary embolism, pulmonary thrombosis) and key words (e.g., maternal morbidity, pregnancy complications, thromboprophylaxis, antithrombotic therapy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English or French. There were no date restrictions. Grey (unpublished) literature was identified through searching the websites of clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). Recommendations 1. Objective testing is required following clinical suspicion of deep vein thrombosis or pulmonary embolism. (II-2A) 2. For the diagnosis of deep vein thrombosis, ultrasonography is recommended, and should be repeated at least once over 7 days if the initial study is negative. For each examination, the entire length of the venous system from the external iliac to the popliteal vein must be visualized and compression manoeuvres performed from the femoral to the popliteal vein. (II-2B) 3. For the diagnosis of pulmonary embolism, either ventilation-perfusion scan or computed tomographic angiography can be used. (II-2A) In pregnant women, a ventilation-perfusion scan is the preferred test. (III-B) 4. Neither D-dimer alone nor clinical prediction rules should be used to rule out venous thromboembolism in pregnant women without objective testing. (III-D) 5. Pregnant women diagnosed with acute venous thromboembolism should be hospitalized or followed closely as outpatients for the first 2 weeks after the initial diagnosis. (III-C) 6. Low molecular weight heparin is the preferred pharmacologic agent over unfractionated heparin for the treatment of venous thromboembolism in pregnancy. (II-2A) 7. Heparin-induced thrombocytopenia in pregnant women is extremely rare. Consultation with a hematologist or thrombosis specialist is recommended to consider the use of heparanoids for treatment of venous thromboembolism if it occurs. (II-3B) 8. Vitamin K antagonists should only be considered in exceptional circumstances for the treatment of venous thromboembolism in pregnancy. (II-2A) 9. We recommend against the use of oral Xa inhibitors and oral direct thrombin inhibitors for the treatment of venous thromboembolism in pregnancy. (III-D) 10. For the treatment of acute venous thromboembolism in pregnancy we recommend adhering to the manufacturer's recommended dosing for individual low molecular weight heparins based on the woman's current weight. (II-1A) Low molecular weight heparin can be administered once or twice a day depending on the agent selected. (III-C) 11. For pregnant women initiated on therapeutic low molecular weight heparin, baseline platelet counts should be done and repeated a week later to screen for heparin-induced thrombocytopenia. (III-C) 12. For pregnant women with an acute venous thromboembolism we recommend therapeutic anticoagulation for a minimum of 3 months. (I-A) 13. Following initial treatment, anticoagulation intensity can be decreased to intermediate or prophylactic dose for the remainder of the pregnancy and for at least 6 weeks postpartum. (III-C) 14. In pregnant women with acute proximal leg deep vein thrombosis, the use of graded compression stockings can be considered for relief of symptoms. (III-C) 15. Thrombolytic therapy in pregnancy should only be considered in limb-threatening deep vein thrombosis or massive pulmonary embolism. (III-C) 16. Vena cava filters should only

Chan, Wee-Shian; Rey, Evelyne; Kent, Nancy E; Chan, Wee-Shian; Kent, Nancy E; Rey, Evelyne; Corbett, Thomas; David, Michčle; Douglas, M Joanne; Gibson, Paul S; Magee, Laura; Rodger, Marc; Smith, Reginald E

2014-06-01

219

Hepatic necrosis following repair of totally anomalous pulmonary venous connection.  

PubMed

We report a case of an infant with asplenia syndrome, isomerism of the right atrial appendages, and totally anomalous pulmonary venous connection who experienced hepatic failure following surgical correction of the anomalous pulmonary venous connection. We describe associated anomalies of the portal venous system. PMID:17559715

Fischer, Abigail; Long, Fredrick; Feltes, Timothy F

2007-08-01

220

Extracranial venous flow in patients with multiple sclerosis  

Microsoft Academic Search

IntroductionRecently, a chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI) was claimed to be a pathologic condition exclusively seen in patients with multiple sclerosis (MS), suggesting that cerebral venous congestion plays a significant role in the pathogenesis of MS. This hypothesis has gained enormous attention among patients and physicians but has

E. Auriel; A. Karni; N. M. Bornstein; T. Nissel; A. Gadoth; H. Hallevi

2011-01-01

221

[Prevention of venous thromboembolism in psychiatry].  

PubMed

The hospitalized patients of the psychiatric wards represent a risk group for the development of venous thromboembolism. Apart from sedative administration, total movement reduction, bad life style and daily routine and increased body weight, there is negative impact of dehydration, prolonged hospitalization and sometimes immobilisation in consequence of mechanical restraints. A large amount of patients are treated with antipsychotics that have a series of adverse effects. Depending of the drug used, the most frequent of them are somnolence, fatigue, extrapyramidal syndrome, hypotension, hepatotoxicity, increased body weight, prolongation of the QT interval of the ECG with a risk of ventricular arrhythmias, hematopoietic disorders, lipid or glycide metabolism disorders or hyperprolactinemia. Another potential adverse effect of these drugs is the heightened risk of venous thromboembolism development (deep vein thrombosis and/or pulmonary embolism). There is the risk of a pathological blood clotting event in psychiatric patients, especially those treated with antipsychotics. Although it is not high, it can have fatal consequences when combined with a relatively frequent pulmonary embolism and difficult diagnostics of thromboembolism. An algorithm for thromboembolism prevention has been developed. It involves important general risk factors of venous thrombosis (VTE history, immobilisation, malignancy, age over 75 years etc.) and also markers (physical restraints, dehydration, obesity, antipsychotics use) that can participate in the pathogenesis of venous thrombosis in the hospitalized psychiatric patients with limited motility. The authors believe that this prophylaxis is indicated, safe, effective and that it improves the quality of life at relatively low costs. PMID:16637454

Malý, R; Masopust, J; Konupcíková, K

2006-03-01

222

The molecular genetics of familial venous thrombosis  

Microsoft Academic Search

In the past few years, important advances have been made in the identification of factors predisposing to familial thrombophilia. Particular attention has been paid to the characterization of known inherited defects and their genotype–phenotype relationship, and to studying the interaction between single or multiple inherited conditions and acquired risk factors for venous thrombosis. The recent discovery of ‘new’ and very

Paolo Simioni

1999-01-01

223

Unusual causes of Cerebral Venous Thrombosis  

Microsoft Academic Search

Cerebral venous thrombosis is a relatively uncommon condition afflicting mostly young adults. Thrombosis of cere- bral veins or sinuses results in variable and nonspecific clini- cal features, including headache, lethargy, motor or sensory deficits, seizures, neck stiffness and sometimes fever. A mul- titude of conditions have been attributed as risk factors for CVT. The more common conditions include hereditary thrombophilia,

Ismail A. Khatri; Ammar AlKawi; Amir Ilyas; M. Saleem Ilyas

224

Afferent discharges from venous pressoreceptors in liver  

Microsoft Academic Search

Increasing the perfusion pressure of the portal vein in isolated liver preparation in the guinea pig caused an increase in afferent discharge rate. Discharge patterns were compatible with those of the slowly adapting type. Increasing the portal venous pressure by means of intravenous injection of Locke's solution into the left jugular vein in the rabbit in vivo caused an increase

AKIRA NIIJIMA

225

Developmental venous anomaly: MR and angiographic features.  

PubMed

Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. We describe the imaging findings of this vascular anomaly in different patients and the role of different imaging modalities. PMID:24765765

Faure, M; Voormolen, M; Van der Zijden, T; Parizel, P M

2014-01-01

226

Primary Venous Obstruction of the Upper Extremity  

PubMed Central

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

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

1973-01-01

227

Arterial and Venous Thrombosis in Cancer Patients  

PubMed Central

The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.

Blann, Andrew D.; Dunmore, Simon

2011-01-01

228

Venous thromboembolism in pediatric nephrotic syndrome.  

PubMed

Childhood nephrotic syndrome (NS) is one of the most common pediatric kidney diseases, with an incidence of 2-7 per 100,000. Venous thromboembolism (VTE) is associated with significant morbidity and mortality, and occurs in ?3 % of children with NS, though incidence approaches 25 % in high-risk groups. VTE etiology is multifactorial, with disease-associated coagulopathy thought to be a significant contributor. Other risks include age, disease severity, and treatment-related hazards, such as the presence of central venous catheters. Non-pharmacologic preventive measures such as ambulation and compression stockings are recommended for patients with identified VTE risks. Central venous catheters should be avoided whenever possible. Symptoms of VTE include venous catheter dysfunction, unilateral extremity symptoms, respiratory compromise, flank pain, and gross hematuria. When VTE is suspected, confirmatory imaging studies should be obtained, followed by appropriate laboratory evaluation and treatment. Therapeutic goals include limiting thrombus growth, extension, and embolization by early institution of anticoagulant therapy. Anticoagulation is recommended for a minimum of 3 months, but should be continued until NS remission is achieved. Further studies are necessary to identify VTE-risk biomarkers and optimal therapeutic regimens. Observational cohort studies are needed to identify VTE-risk groups who may benefit from thromboprophylaxis and to define disease-specific treatment algorithms. PMID:23812352

Kerlin, Bryce A; Haworth, Kellie; Smoyer, William E

2014-06-01

229

Cerebral venous thrombosis during diabetic ketoacidosis  

Microsoft Academic Search

Neurological deterioration during an episode of diabetic ketoacidosis is usually assumed to be caused by cerebral oedema. We present a case of cerebral venous sinus thrombosis presenting in a similar manner, also associated with severe iron deficiency anaemia. Computed tomography scanning provided the correct diagnosis and allowed institution of anticoagulation with improvement in neurological outcome. Neuroimaging should always be performed

S Keane; A Gallagher; S Ackroyd; M A McShane; J A Edge

2002-01-01

230

Central venous catheter infections: Concepts and controversies  

Microsoft Academic Search

Central venous catheters (CVCs) are widely used in critically ill patients in intensive care units. However, infectious complications are common and may limit their utility. We critically review the literature to determine the impact of CVC design amd composition, insertion site selection, insertion procedures, care and removal of temporary CVCs on infectious complications. Relevant articles were identified and selected for

C. R. Reed; C. N. Sessler; F. L. Glauser; B. A. Phelan

1995-01-01

231

[Postoperative venous thromboembolism in bariatric surgery].  

PubMed

The authors discuss the problem of venous thromboembolism as a complication of bariatric surgery. They consider obese patients at risk for these complications, even if different opinions exist about this topic in the literature. They report their experience in bariatric surgery consisting of 53 patients submitted to biliopancreatic diversion. Antithrombotic prophylaxis consisted for every patient in elastic bandaging of the lower limbs, preoperative hemodilution, early post-operative mobilization, and subcutaneous heparin. Complications consisted in one popliteo-femoral deep venous thrombosis (DVT) (1.6%), and two pulmonary embolisms (PE) (3.2%) of which one caused patient's death; total morbidity for venous thromboembolism. These results compared with literature are similar with other series of bariatriac surgery and slightly higher than general surgery series. This difference is not however significant. Even in the absence of this significance, thromboembolism, as desumed from more than 2900 cases considered in the literature, remains the main cause of morbidity and mortality in the post-operative course of bariatric surgery patients, deserving particular attention in terms of prevention, also because of difficulty existing in early clinical diagnosis of DVT in obese people. Further studies intended to identify pathogenesis and risk factors of venous thromboembolism in obese people will allow a more correct prophylactic and therapeutic approach. PMID:8367068

Bajardi, G; Ricevuto, G; Mastrandrea, G; Latteri, M; Pischedda, G; Rubino, G; Valenti, D; Florena, M

1993-05-31

232

[Impotence caused by venous leakage. Placement of a prosthetic venous bandage].  

PubMed

A new treatment of impotence by venous leakage is reported. It consists of tying the dorsal and lateral aspects of the cavernous body with a bandage of synthetic material. The bandage, inserted on the bulbo-cavernous muscles, restores a "carter effect" and prevents venous leakage during erection. This technique has been used in 20 patients, with satisfactory results in 10 who were followed up for more than 4 months. PMID:2971194

Rossi, D; Serment, G; Hermanowicz, M; Daou, N; Ducassou, J

233

Sinus pericranii with unusual features: multiplicity, associated dural venous lakes and venous anomaly, and a lateral location.  

PubMed

Anomalous connections between an extracranial venous sac and intracranial dural sinuses through dilated diploic and emissary veins of the skull result in sinus pericranii (SP). In this study, two patients with the rare presentation of multiple, congenital SP with associated dural venous lakes and venous anomalies are described. In one patient, multiple SPs were located in the frontal, parasagittal region with an associated subcortical venous angioma; and, in the other, peritorcular and juxta-transverse-sigmoid sinus junction SP coexisted. The venous anomalies drained into venous lakes in close proximity to major sinuses. They also communicated with extracranial tributaries via interosseous veins leading to the development of venous hypertension that presumably caused pressure erosion of the skull. This may have been responsible for the pathogenesis of multiple subgaleal venous sacs of SP and may also lead to profuse hemorrhage, cortical venous thrombosis, or air embolism. Multiplicity, associated venous lakes, venous angioma, and a lateral location are unique presentations of SP. Sac excision, transcranial venous anastomotic channel blockage, and reinforcement/replacement of the underlying bone are the recommended modalities of treatment. PMID:20878339

Rizvi, Meesam; Behari, Sanjay; Singh, Rohit K; Gupta, Devendra; Jaiswal, Awadhesh K; Jain, Manoj; Phadke, Rajendra V

2010-12-01

234

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

PubMed Central

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

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

2013-01-01

235

Venous and arterial thromboembolism in severe sepsis.  

PubMed

The burden of thromboembolism (TE) in severe sepsis is largely unknown. We assessed the prevalence of venous and arterial TE in patients with severe sepsis over a four-week period. We performed a retrospective analysis of a pooled database of three randomized, placebo-controlled trials of two novel pharmacological agents for the treatment of severe sepsis, drotrecogin alfa (activated) (DrotAA) and secretory phospholipase A2 inhibitor (sPLA(2)I). The study was conducted at intensive care units of the participating institutions. A total of 2,649 patients with known or suspected infection and sepsis-associated acute organ dysfunction were enrolled in the three trials and were assigned to treatment groups (DrotAA=850; sPLA2I=578; placebo=1221). The database was queried for venous and arterial TE, using investigator reports of serious adverse events. Eighty-four of 2,649 patients (3.2%; 95% confidence interval, 2.5% to 3.9%) developed at least one thromboembolic event over 28 days. Nearly three-quarters of episodes were atheroembolic (n=62); 25% involved the deep venous system (n=25). Ischemic stroke (n=30) and venous thromboembolism (n=25) each occurred in about 1% of patients. Ischemic stroke and acute coronary syndrome had a higher peak incidence during the first five days compared to venous TE onset, which was more constant over the 28-day period. Subgroup analysis by pooled treatment groups yielded TE rates of 2.0% (DrotAA), 3.5% (placebo), and 4.0% (sPLA2I), respectively. Clinically manifest TE occurred in about 3% of severe sepsis patients treated in the intensive care unit over a 28-day period. Arterial TE may be more common than previously recognized. More accurate estimates of TE prevalence and relationship to sepsis await future studies. PMID:18449418

Levine, Robert L; LeClerc, Jacques R; Bailey, Joan E; Monberg, Matthew J; Sarwat, Samiha

2008-05-01

236

Pulmonary emboli due to venous aneurysm of extremities.  

PubMed

Venous aneurysms are uncommon but they can have devastating consequences, including pulmonary embolism, other thromboembolic events and death. We report six cases of venous aneurysm of the extremities, in which the first sign of presence was acute pulmonary embolism. Surgical resection is recommended whenever possible. Our experience suggests that prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for extremity deep and superficial venous aneurysms for their potential risk of developing thromboembolic complications despite adequate anticoagulation. Other venous aneurysms should be excised only if they are symptomatic or enlarging. PMID:21780059

Gabrielli, R; Rosati, M S; Vitale, S; Millarelli, M; Siani, A; Chiappa, R; Caselli, G

2011-07-01

237

Computed tomographic manifestations of abdominal and pelvic venous collaterals  

SciTech Connect

Obstruction of blood flow through the inferior vena cava and portal vein may produce venous collaterals. These include the paravertebral venous system and its communications with the ascending lumbar veins and azygous/hemiazygous system; gonadal, periureteric, and other retroperitoneal veins; abdominal wall veins; hemorrhoidal venous plexus; and the portal venous system. The anatomic location of these vessels is discussed. Computed tomography demonstrates them as round or tubular structures that are isodens when compared with other venous structures following contrast material administration. Techniques of examination and methods of differentiation of these vascular structures from other abnormalities, especially lymphadenopathy, are discussed.

Pagani, J.J.; Thomas, J.L.; Bernardino, M.E.

1982-02-01

238

A morphological study on human lingual venous valves.  

PubMed

This study deals with the appearance, function and pathophysiological action of the lingual venous valve in the design of surgical tongue flaps and in analyzing inspection of the tongue. Thirty two adult cadavers were studied, of which 7 were corrosive cast specimens. The lingual v. is well supplied with venous valves which may be divided into 3 types morphologically: hemispherical, spherical, and hanging spherical. Venous valves are classified according to their structures: bivalves, monovalves, and venous cristae. The abundant venous valves of the tongue effectively prevent reflux of blood. Various factors that influence venous blood reflux in the head and neck can be observed, analysed and judged by inspection of the tongue; the design of the pedicle and the anastomotic position of tongue flap should comply with the positions and orientations of its venous valves. PMID:9706674

Shangkuan, H; Xinghai, W; Shizhen, Z; Zengxing, W; Shiying, J

1998-01-01

239

Controlled studies of Daflon 500 mg in chronic venous insufficiency.  

PubMed

Although great advances have been made in the operative treatment of vascular disorders, the management of most venous problems is still nonsurgical. Daflon 500 mg* is a micronized flavonoid mixture of 90% diosmin and 10% hesperidin that has phlebotonic properties. The efficacy of Daflon 500 mg has been investigated in three double-blind, randomized trials using strain gauge plethysmography to provide quantitative information on venous hemodynamics in patients with chronic venous insufficiency. In total, 183 patients were treated with Daflon 500 mg versus a control group of equal number of patients. Daflon 500 mg produced a significant decrease in venous capacitance, venous distensibility, and venous emptying time (P < 0.001). In addition, these changes were accompanied by improvement in clinical symptoms and a decrease in the supramalleolar circumference. Clinical side effects were rare and led to treatment withdrawal in only 3 patients. It is concluded that Daflon 500 mg is of benefit to patients with chronic venous insufficiency. PMID:8203786

Geroulakos, G; Nicolaides, A N

1994-06-01

240

Partial anomalous pulmonary venous connections: surgical management.  

PubMed

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

Fragata, José; Magalhăes, Manuel; Baquero, Luis; Trigo, Conceiçăo; Pinto, Fátima; Fragata, Isabel

2013-01-01

241

Cerebellar venous angiomas. A continuing controversy.  

PubMed

We have studied three patients with angiographically documented cerebellar venous angioma (CVA). One patient had a subacute cerebellar hematoma and underwent posterior fossa craniotomy for evacuation of the hematoma and excision of the malformation. A hemorrhagic venous infarction of the brain stem and cerebellum occurred, and the patient died three weeks postoperatively. A second patient with an unruptured CVA had a history of headaches, tinnitus, and vertigo. Conservative treatment was elected, and the patient's condition remains unchanged after 11 months of follow-up. The third patient, recently diagnosed as having an unruptured CVA had episodic vertigo and disequilibrium. Conservative treatment was chosen, and he is asymptomatic after six months of follow-up. Based on a review of 24 other cases of CVA plus our experience we could not conclude any definite trend regarding natural history or treatment. However, conservative treatment seems the logical choice in patients with unruptured CVA. PMID:3985813

Biller, J; Toffol, G J; Shea, J F; Fine, M; Azar-Kia, B

1985-04-01

242

[Prevention of venous thromboembolism in musculoskeletal surgery].  

PubMed

Musculoskeletal surgery is associated with a high risk of venous thrombosis and pulmonary embolism. The introduction of direct oral anticoagulants (DOAK) has broadened the possibilities for prevention of venous thromboembolism in the course of orthopedic and trauma surgery. Addressing this recent development, the Austrian Societies of Orthopedics and Orthopedic Surgery (ÖGO), Trauma Surgery (ÖGU), Hematology and Oncology (OeGHO) and of Anaesthesiology, Reanimation und Intensive Care Medicine (ÖGARI) have taken the initiative to create Austrian guidelines for the prevention of thromboembolism after total hip and knee replacement, hip fracture surgery, interventions at the spine and cases of minor orthopedic and traumatic surgery. Furthermore, the pharmacology of the DOAK and the pivotal trial data for each of the three currently available substances - apixaban, dabigatran, and rivaroxaban - are briefly presented. Separate chapters are dedicated to "anticoagulation and neuroaxial anesthesia" and "bridging". PMID:24825594

Pabinger-Fasching, Ingrid; Eichinger-Hasenauer, Sabine; Grohs, Josef; Hochreiter, Josef; Kastner, Norbert; Korninger, Hans Christian; Kozek-Langenecker, Sibylle; Marlovits, Stefan; Niessner, Herwig; Rachbauer, Franz; Ritschl, Peter; Wurnig, Christian; Windhager, Reinhard

2014-05-01

243

Cerebral venous sinus (sinovenous) thrombosis in children.  

PubMed

Cerebral venous sinus (sinovenous) thrombosis (CSVT) in childhood is a rare, but underrecognized, disorder, typically of multifactorial etiology, with neurologic sequelae apparent in up to 40% of survivors and mortality approaching 10%. There is an expanding spectrum of perinatal brain injury associated with neonatal CSVT. Although there is considerable overlap in risk factors for CSVT in neonates and older infants and children, specific differences exist between the groups. Clinical symptoms are frequently nonspecific, which may obscure the diagnosis and delay treatment. While morbidity and mortality are significant, CSVT recurs less commonly than arterial ischemic stroke in children. Appropriate management may reduce the risk of recurrence and improve outcome, however there are no randomized controlled trials to support the use of anticoagulation in children. Although commonly employed in many centers, this practice remains controversial, highlighting the continued need for high-quality studies. This article reviews the literature pertaining to pediatric venous sinus thrombosis. PMID:20561500

Dlamini, Nomazulu; Billinghurst, Lori; Kirkham, Fenella J

2010-07-01

244

Preparing children for venous blood sampling.  

PubMed

A convenience sample of 100 children, aged 6-12 years, attending Kuwait government hospital laboratories for venous blood sampling was studied. A picture book was used to prepare half of the children for the procedure. Preparation was carried out just prior to sampling and took less than 5 min. The story provided a simple description of venous blood sampling, and why it is carried out; it stressed that the pain is noticeable but not unbearable, and that children will experience less pain if they relax their arm and cooperate with the technician. Prepared children reported significantly less pain, and radial pulse rates confirmed that they were less distressed by the procedure. Observers' and parents' evaluations also indicated that prepared children coped better. Various explanations for the benefits observed are discussed, together with requirements for managing the pain, fear and stress experienced by children during medical treatment. PMID:1876439

Harrison, A

1991-06-01

245

Neutrophil activation and mediators of inflammation in chronic venous insufficiency.  

PubMed

The effect of venous hypertension on the state of activation of leucocytes has been investigated in patients with venous disease and control subjects. Leucocytes become 'trapped' in the circulation of the leg during periods of venous hypertension produced by sitting or standing. This is greater in the limbs of patients with chronic venous disease than controls. Studies of the plasma levels of neutrophil granule enzymes show that these are increased during periods of venous hypertension, suggesting that this causes activation of the neutrophils. Investigation of the leucocyte surface ligand CD11b shows that the more activated neutrophils and monocytes are sequestered during venous hypertension. Measurement of plasma levels of the soluble parts of the vascular (VCAM), intercellular (ICAM) and endothelial leucocyte (ELAM) adhesion molecules show that these are all elevated in patients with chronic venous disease compared to controls. Following 30 min of venous hypertension produced by standing, these levels are further increased. These data suggest that venous hypertension causes neutrophil and monocyte activation, which in turn causes injury to the endothelium. I believe that this may be the mechanism that initiates the pathological processes which lead to venous ulceration. It has recently been shown that the venotonic drug Daflon 500 mg (450 mg diosmin, 50 mg hesperidin, Servier, France) influences these processes. Surface expression of CD62L is reduced in neutrophils and monocytes, and plasma levels of soluble endothelial adhesion molecules are reduced. These observations may explain the anti-inflammatory effects of Daflon 500 mg. PMID:10474048

Smith, P D

1999-01-01

246

[Endoscopic subfascial dissection of venous perforants in treatment of venous trophic ulcers of the legs].  

PubMed

Endoscopic subfascial dissection was performed in patients with chronic venous insufficiency of CEAP class 4-6. 76 surgeries were performed in 68 patients. Mean age of the patients was 56 years. The causes of chronic venous insufficiency were varicose (37) and postthrombotic diseases. Trophic ulcers were in 46 patients. Thirty patients underwent earlier various phlebectomies, including Linton's surgery (6 patients). In 33 patients endoscopic subfascial dissection of venous perforants was combined with various phlebectomy, in 37 patients -- with excision of ulcer with following autodermoplasty few days after surgery. Endoscopic subfascial dissection was carried out with special surgical R.Wolf endoscope with 6 mm instrumental canal, and also standard laparoscopic optical devices "Olympus". Complications during surgery were seen in 2 patients: bleeding in subfascial space (1.3%) and perforation of tissues in ulcer zone (1.3%). In postoperative period long (up to 14 days) lymphorrhea and suppuration of surgical wound were in 2 (2.6%) patients. It is concluded that endoscopic approach is optimal for elimination of pathological reflux through venous perforants in complicated forms of chronic venous insufficiency of the lower extremities, including trophic ulcers resistant to treatment. PMID:16007017

Shishin, K V; Strekalovski?, V P; Starkov, Iu G; Svetukhin, A M; Askerov, N G; Sapelkin, S V

2005-01-01

247

Postintervention duration of anticoagulation in venous surgery.  

PubMed

For a substantial proportion of patients with deep venous thrombosis (DVT), current treatment strategies are suboptimal and new treatment options are needed. Especially for the group of patients who are at the highest risk for post-thrombotic syndrome, new treatment modalities such as catheter-directed thrombolysis and additional stenting are being investigated. With current clinical studies addressing new technical options, the medical management of patients following these interventions deserves attention. The duration of anticoagulant treatment following surgical or radiological interventions for DVT seems not to be influenced by the presence of a venous stent. According to recent ACCP 2012 guidelines the anticoagulant management in patients who have had any method of thrombus removal performed, the same intensity and duration of anticoagulant therapy as in comparable patients who do not undergo thrombosis removal is recommended (Grade 1B). In the acute phase of thrombosis, irrespective of the technique and whether or not stenting is applied, immediate anticoagulation following the procedure is pertinent to reduce the risk of recurrent thrombosis and thrombus propagation. The long-term treatment duration after venous interventions therefore may be tailored based on common risk factors for recurrent thrombosis and the individual risk for bleeding. Selected thrombophilia factors, d-dimer assessment and residual venous thrombosis provide markers for recurrent DVT. Currently, vitamin K antagonists) provide the main anticoagulants for (prolonged) anticoagulation, while the new oral anticoagulants emerge as promising alternatives. In case prolonged anticoagulation after unprovoked DVT is not indicated, cardiovascular risk management is warranted because of an increased rate of arterial thrombotic events after DVT; aspirin may be indicated as secondary prevention against recurrent thrombosis (while providing primary prevention against arterial thrombosis). PMID:23482544

Ten Cate-Hoek, A J; Prins, M H; Wittens, C H A; ten Cate, H

2013-03-01

248

Johanson’s arterio-venous dissociation  

Microsoft Academic Search

Summary  A study was carried out of the frontal projection on carotid angiograms of 324 patients with supratentorial hemispherial expansive\\u000a processes. All cases had been verified surgically or pathoanatomically. The comparative study of the displacements of vena\\u000a cerebri interna and a.pericallosa from the midline showed that: [1] Johanson’s arterio-venous dissociation can occur also\\u000a in association with superficial but massive supratentorial hemispherial

J. Petrov

1972-01-01

249

Venous thromboembolism and cancer: a systematic review  

Microsoft Academic Search

Venous thromboembolism (VTE) is a serious and potentially fatal disorder, which is often associated with a significant impact\\u000a on the quality of life and on the clinical outcome of cancer patients. The pathophysiology of the association between thrombosis\\u000a and cancer is complex: malignancy is associated with a baseline hypercoagulable state due to many factors including release\\u000a of inflammatory cytokines, activation

Celso Arrais Rodrigues; Renata Ferrarotto; Roberto Kalil Filho; Yana A. S. Novis; Paulo M. G. Hoff

2010-01-01

250

Update on totally implantable venous access devices.  

PubMed

The use of totally implantable venous devices (TIVAD) has changed the care and quality of life for cancer patients, these devices allow chemotherapy administration, and blood sampling without the need for repeated venipuncture. These ports are used mainly when IV access is needed only intermittently over a long period of time. We are presenting a brief overview on TIVADs, with focus on the mid and long-term complications associated with these devices with their management. PMID:22425356

Zaghal, Ahmad; Khalife, Mohamed; Mukherji, Deborah; El Majzoub, Nadim; Shamseddine, Ali; Hoballah, Jamal; Marangoni, Gabriele; Faraj, Walid

2012-09-01

251

Cerebral venous sinus thrombosis with autoimmune thyroiditis  

PubMed Central

Cerebral Venous Thrombosis (CVT) is a multifactorial condition which is described as idiopathic in 12.5% of patients. Hyperthyroidism has been associated with CVT in many case reports, and increased levels of factor VIII and von Willebrand factor (vWF) have been proposed as the possible link in this association, but only few rare case reports have described an association of hypothyroidism with CVT. We report here a case of autoimmune thyroiditis presenting with CVT.

Aggarwal, Sameer; Sharma, Nityanand

2013-01-01

252

Cerebral venous sinus thrombosis with autoimmune thyroiditis.  

PubMed

Cerebral Venous Thrombosis (CVT) is a multifactorial condition which is described as idiopathic in 12.5% of patients. Hyperthyroidism has been associated with CVT in many case reports, and increased levels of factor VIII and von Willebrand factor (vWF) have been proposed as the possible link in this association, but only few rare case reports have described an association of hypothyroidism with CVT. We report here a case of autoimmune thyroiditis presenting with CVT. PMID:24251149

Aggarwal, Sameer; Sharma, Nityanand

2013-10-01

253

Venous Leg Ulcerations: A Treatment Update  

Microsoft Academic Search

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

Ronda S. Farah; Mark D. P. Davis

2010-01-01

254

Congenital pseudoarthrosis associated with venous malformation.  

PubMed

Congenital pseudoarthrosis is a pathologic entity that may be isolated, or may be associated with neurofibromatosis. We report the case of a 3-year-old female with congenital pseudoarthrosis involving the right tibia and fibula. Magnetic resonance imaging (MRI) and complementary magnetic resonance angiogram (MRA) revealed a lobulated mass with vivid enhancement, which led to the diagnosis of venous malformation. This is the first report of congenital pseudoarthrosis caused by the presence of a vascular malformation. PMID:16967289

Al-Hadidy, A; Haroun, A; Al-Ryalat, N; Hamamy, H; Al-Hadidi, S

2007-06-01

255

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

PubMed Central

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

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

2013-01-01

256

Deep venous thrombosis in acute stroke patients.  

PubMed

Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine the frequency of DVT in patients with acute stroke, risk factors for its development, and its influence on the 3-month outcome. A total of 323 consecutive patients with acute stroke were enrolled. We performed ultrasound imaging within 7 days after stroke. Deep venous thrombosis was found in 8.7% of patients, only in those with ischemic stroke. Patients with DVT were more frequently female (71.4% vs 49.5%), had prestroke Modified Rankin scale (mRS) 3 to 5 (42.9% vs 15.3%), elevated C-reactive protein (CRP) serum level (65.4% vs 32.5%), and a trend toward elevated serum fibrinogen level (85.7% vs 70.1%; P = .08). In a multivariate analysis, elevated CRP (odds ratio [OR] 3.15) and prestroke disability (OR 2.89) were independent risk factors for DVT. Deep venous thrombosis occurs in <10% of patients with acute stroke and does not significantly affect the 3-month outcome. Prestroke dependency and elevated CRP level at baseline are independent risk factors for DVT. PMID:22067545

Bembenek, Jan P; Karlinski, Micha?; Kobayashi, Adam; Czlonkowska, Anna

2012-06-01

257

[Electromagnetic location of central venous catheters].  

PubMed

A new technique, the Cath Finder (Pharmacia Deltec) system, for locating central venous catheters is described. It was initially designed to facilitate the insertion of the PAS Port (Pharmacia Deltec), a long central venous catheter with an implantable chamber. It is based on a low intensity high frequency electromagnetic field generated by a locator wand. A preconnected sensor guide wire is introduced into the catheter so as to make the catheter tip detectable by the electromagnetic field. The wand is placed over an appropriate landmark on the anterior chest wall (third right rib, parasternally). When the centre of the field has been passed over by the sensor tip in the catheter-sensor assembly, a light signal is set off. This technique is simple and easily mastered. It is far less cumbersome than the usual techniques, like fluoroscopy and chest X-rays. The Cath Finder provides reliable continuous information on the position of the catheter tip during its insertion. It seems to provide an acceptable alternative to peroperative fluoroscopy. The accuracy of this system was assessed in ten patients. All had malignancies and required long term central venous access. In 6 cases, catheterisation and locating of the catheter were uneventful. In 2 cases, the catheter entered a wrong vein. The diagnosis having been made with the Cath Finder system, the false route was amended and the catheter placed accurately. In one case, the sensor in the catheter broke.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1416278

Ranchére, J Y; Gordiani, B; Hassid, C

1992-01-01

258

Aurin tricarboxylic acid inhibits experimental venous thrombosis.  

PubMed

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

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

1994-06-15

259

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

PubMed Central

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

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

2006-01-01

260

Inherited and acquired risk factors for venous thromboembolism.  

PubMed

Venous thrombosis, or venous thromboembolism, comprises deep vein thrombosis with or without symptomatic pulmonary embolus. The development of symptomatic venous thrombosis is highly dependent on gene-environment interaction. In most instances this interaction results in hypercoagulability (the intermediate phenotype) sufficient to result in intraluminal clot formation (the disease phenotype). The genetic framework underlying venous thrombosis is complex, and there is a large material contribution from disease and interaction with environmental factors. For example, venous thrombosis is related to recent hospitalization in approximately half of all adult cases. After a first episode of venous thrombosis patients are 40 times more likely to suffer a further event compared with previously unaffected individuals. However, the risk differs between patients. Duration of anticoagulation (lifelong or not) should be made with reference to whether an episode of thrombosis was provoked and the presence of other risk factors. The results of testing for heritable thrombophilia rarely influence duration of treatment. PMID:22648484

Baglin, Trevor

2012-04-01

261

Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion  

Microsoft Academic Search

.   Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and\\u000a malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous\\u000a occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting.\\u000a \\u000a First, diagnosis and treatment of the most

Patrick Haage; Timo Krings; Thomas Schmitz-Rode

2002-01-01

262

Consideration of the operative indications for posterior fossa venous angiomas.  

PubMed

The case of a patient with a venous angioma located in the midline of the posterior fossa and responsible for a cerebellar hemorrhage is reported. The patient had a good recovery after removal of the hematoma. We reviewed this and seven other cases of venous angioma in the posterior fossa reported in the literature. It appears that those venous angiomas that occur in the cerebellar hemisphere and produce a cerebellar hematoma can be successfully removed. PMID:3961660

Nishizaki, T; Tamaki, N; Matsumoto, S; Fujita, S

1986-05-01

263

Venous endothelial injury in central nervous system diseases.  

PubMed

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

Alexander, Jonathan S; Prouty, Leonard; Tsunoda, Ikuo; Ganta, Chaitanya Vijay; Minagar, Alireza

2013-01-01

264

Venous sinus thrombosis and consumptive coagulopathy: a role for heparin?  

PubMed

Cerebral venous sinus thrombosis is a relatively rare but serious condition, more commonly affecting children and pregnant women. It can be precipitated by dehydration. Despite the frequent coexistence of hemorrhage in venous infarcts of patients, clinical trials in adults recommended the use of anticoagulation. No randomized, clinical trials exist in the pediatric age group. Rarely, consumptive coagulopathy is reported to coexist with cerebral venous sinus thrombosis. We report on a child with venous sinus thrombosis and consumptive coagulopathy developing after routine tonsillectomy and its successful management with anticoagulation. PMID:20691949

Sahaya, Kinshuk; Patel, Nitin C

2010-09-01

265

[Transcutaneous measurement of the central venous pressure (author's transl)].  

PubMed

The intrathoracic pressure rises when exhaling into a manometer to such an extent that finally the venous flow of blood to the right heart stops. It is supposed that this venous stop flow pressure (VSFP) is equal to the central venous pressure. In a clinical trial by two independent examiners in 97% of the cases a correlation within a range of 5 cm H2O was found (70 measurements). Thus the central venous pressure can be measured noninvasively with an ultrasound device. PMID:7233902

Wayand, W; Rendl, K H; Pimpl, W; Waldstein, N

1981-02-28

266

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

PubMed

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

Chatterjee, Sasanka S

2012-05-01

267

Healing of venous ulcers in an ambulatory care program: The roles of chronic venous insufficiency and patient compliance  

Microsoft Academic Search

Purpose: A nurse-managed\\/physician-supervised treatment program for venous ulceration was evaluated to determine the influence of venous hemodynamics, comorbidities, patient behavior, and ulcer characteristics on time to healing and time to recurrence.Methods: The clinical course and long-term follow-up of 71 patients with 99 venous ulcers diagnosed between November 1981 and August 1994 were analyzed by a retrospective review of clinic records.

Curtis A. Erickson; Debbie J. Lanza; Donna L. Karp; Janice W. Edwards; Gary R. Seabrook; Robert A. Cambria; Julie A. Freischlag; Jonathan B. Towne

1995-01-01

268

Portal venous reconstruction in a living liver donor with an anomalous hepatic arterial and portal venous anatomy  

Microsoft Academic Search

Hepatic arterial and portal venous anomalies in living liver donors are not uncommon. Modified surgical techniques may be\\u000a required in such circumstances, although the safety of the living donor must always be given top priority. We describe here\\u000a a successful portal venous reconstruction in a living donor with an anomalous hepatic arterial and portal venous anatomy in\\u000a which the right

Shigeru Marubashi; Keizo Dono; Masato Sakon; Kunihito Gotoh; Hidenori Takahashi; Kazuhiko Hashimoto; Masaru Kubota; Shinji Yamamoto; Atsushi Miyamoto; Hiroaki Nagano; Shoji Nakamori; Koji Umeshita; Morito Monden

2005-01-01

269

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

Microsoft Academic Search

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

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

1995-01-01

270

Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis  

PubMed Central

Background: The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. Methods: Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined transcranial and extracranial colour-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. Results: CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29 to 65, p<0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; this provides a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated with CCSVI patterns significantly different from those of primary progressive (p<0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. Conclusion: CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease.

Zamboni, P; Galeotti, R; Menegatti, E; Malagoni, A M; Tacconi, G; Dall'Ara, S; Bartolomei, I; Salvi, F

2009-01-01

271

Peripheral venous embolized intracardiac foreign body.  

PubMed

Embolized intracardiac foreign bodies have been previously described in the literature. Those related to iatrogenic procedures, such as catheters and pacemaker electrodes, are the most common. However, traumatic embolization of a metal foreign body is scantily described. We report a case of a peripheral venous embolized intracardiac metal foreign body after traumatic elbow injury. A review of the literature is therefore performed. Intracardiac foreign body removal must be considered when its diameter exceeds 5 mm, its shape is irregular or when symptomatic. PMID:19762420

Marcello, Pietro; García-Bordes, Luis; Méndez López, José Manuel

2009-12-01

272

Sinus pericranii associated with a cerebellar venous angioma--case report.  

PubMed

A 64-year-old male presented with sinus pericranii associated with a venous angioma draining through a large venous lake. Increased venous pressure and flow in the dural venous lake in contact with the venous sinus may have developed the sinus pericranii. Three-dimensional computed tomography was very useful in determining the site of the transcranial venous anastomotic channels, and magnetic resonance imaging was also very useful in detecting the intracranial vascular anomalies. PMID:9232098

Sakai, K; Namba, K; Meguro, T; Mandai, S; Gohda, Y; Sakurai, M; Matsumoto, Y

1997-06-01

273

Severe Vascular Complications of Central Venous Line Placement  

Microsoft Academic Search

Objective: To determine the outcome and management of iatrogenic neck-vessel complications after central venous line placement (CVLP). Design: Retrospective study. Setting: Department of Cardiovascular Surgery and the Intensive Care Unit of a 1000-bed university hospital. Patients: Eleven patients with acute central venous line placement complications were identified between 1998 and 2002. Of them, eight were inadvertent arterial punctures (one cannulation

Hannu Savolainen; Jukka Takala; Matthias Widmer; George Heller; Thierry Carrel; Juerg Schmidli

2004-01-01

274

Management of venous thromboembolism in patients with cancer.  

PubMed

The association between venous thromboembolism and cancer has been recognized for over 140 years. This article reviews current prevention, diagnosis and treatment of cancer-related venous thromboembolism, and highlights emerging anticoagulants and the possible anticancer effects of anticoagulants such as low molecular weight heparins. PMID:19584778

Noble, Simon; Jenkins, Debbie A

2009-07-01

275

Ultrasonic locating devices for central venous cannulation: meta-analysis  

Microsoft Academic Search

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

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

2003-01-01

276

Diet as prophylaxis and treatment for venous thromboembolism?  

Microsoft Academic Search

BACKGROUND: Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT) and pulmonary emboli (PE)) with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs) showing

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

2010-01-01

277

Limitations of subfascial ligation for refractory chronic venous stasis ulceration  

Microsoft Academic Search

Eighteen subfascial ligations of deep venous perforators were performed on 17 patients with refractory venous stasis ulceration. Thirteen patients also required concomitant or subsequent split thickness skin grafting. Primary indications included: (1) recurrence of ulceration during adequate support therapy with failure to heal using conservative measures (10 cases–55%) and (2) failure to heal with support therapy alone (eight cases 45%).

Jacob G. Robison; Bruce M. Elliott; Adam J. Kaplan

1992-01-01

278

Increased risk of venous thromboembolism in patients with acute leukaemia  

PubMed Central

Patients with malignancies have an increased risk for venous thromboembolisms (VTE), but data on patients with acute leukaemia are very limited so far. We found VTE in 12% of 455 patients with acute leukaemia, half of which occurred in association with central venous catheters, with equal risk of ALL and AML.

Mohren, M; Markmann, I; Jentsch-Ullrich, K; Koenigsmann, M; Lutze, G; Franke, A

2006-01-01

279

Increased risk of venous thromboembolism in patients with acute leukaemia.  

PubMed

Patients with malignancies have an increased risk for venous thromboembolisms (VTE), but data on patients with acute leukaemia are very limited so far. We found VTE in 12% of 455 patients with acute leukaemia, half of which occurred in association with central venous catheters, with equal risk of ALL and AML. PMID:16421591

Mohren, M; Markmann, I; Jentsch-Ullrich, K; Koenigsmann, M; Lutze, G; Franke, A

2006-01-30

280

Intervention targeted at nurses to improve venous thromboprophylaxis  

Microsoft Academic Search

Objective. To assess the effectiveness of an intervention targeting both physicians and nurses vs. physicians only in impro- ving venous thromboprophylaxis for older patients. Design. Cluster randomized trial. Setting. Fifty hospital-based post-acute care departments in France. Participants. Patients aged 65 years or older. Intervention. A multifaceted intervention to implement a clinical practice guideline addressing venous thromboprophylaxis. Main outcome measures. The

JOSE LABARERE; JEAN-LUC BOSSON; MARIE-ANTOINETTE SEVESTRE; ELODIE SELLIER; CECILE RICHAUD; ANNIE LEGAGNEUX

2007-01-01

281

Optimal Management of Central Venous Catheters for Hemodialysis  

Microsoft Academic Search

Good medical practices for optimizing the management of central venous catheters (CVCs) can be summarized in the following ten commandments: (1) the indications of CVC use you will restrict; (2) the choice of the catheter type and site venous you will discuss; (3) an experienced operator you will choose; (4) validated protocols of use and maintenance of catheters you will

B. Canaud; L. Chenine; D. Henriet; H. Leray

2008-01-01

282

Cerebrofacial venous anomalies, sinus pericranii, ocular abnormalities and developmental delay.  

PubMed

The clinical implications of venous cerebrovascular maldevelopment remain poorly understood. We report on the association of cerebrofacial venous anomalies (including sinus pericranii), ocular abnormalities and mild developmental delay in two children. In addition, one child had a seizure disorder. Complex cerebrofacial slow-flow vascular anomalies may herald an underlying developmental aberration affecting the cerebrofacial and orbital regions. PMID:22681729

Macit, B; Burrows, P E; Yilmaz, S; Orbach, D B; Mulliken, J B; Alomari, A I

2012-06-01

283

Cerebrofacial Venous Anomalies, Sinus Pericranii, Ocular Abnormalities and Developmental Delay  

PubMed Central

Summary The clinical implications of venous cerebrovascular maldevelopment remain poorly understood. We report on the association of cerebrofacial venous anomalies (including sinus pericranii), ocular abnormalities and mild developmental delay in two children. In addition, one child had a seizure disorder. Complex cerebrofacial slow-flow vascular anomalies may herald an underlying developmental aberration affecting the cerebrofacial and orbital regions

Macit, B.; Burrows, P.E.; Yilmaz, S.; Orbach, D.B.; Mulliken, J.B.; Alomari, A.I.

2012-01-01

284

Aortic and venous valve for percutaneous insertion.  

PubMed

The purpose of this paper is to present in vitro and in vivo experimental evaluation of a new, artificial, bicuspid, aortic and venous valve. Valves were constructed from square stents with barbs covered by porcine small intestine submucosa (SIS). A valve 15 mm in diameter was tested in a flow model (2.5 l/min) with pressure measurement. A 100-ml rubber bag attached to a side arm of the flow model simulated heart ejection fraction. In acute (n=6) and short-term (n=3) experiments conducted in four swine and four dogs, valves ranging from 16-28 mm in diameter were placed into the ascending aorta through 10 F sheaths; three were placed subcoronary and six in a supracoronary position. Function and stability of the valves were studied with pressure measurements and aortograms. Three short-term animals were sacrificed for gross and histologic evaluation at one, two and four weeks respectively. In an acute experiment, venous valves with four barbs were placed into the IVC through an 8 F guiding catheter in three dogs. For longer-term testing, valves were placed into the IVCs and iliac veins of three young swine. The animals were followed up after two weeks with venograms, then were sacrificed for gross and histologic evaluation. PMID:20156026

Pavcnik, D; Uchida, B T; Timmermans, H; Corless, C L; Keller, F S; Rösch, J

2000-01-01

285

Venous thromboembolic events in hospitalised medical patients.  

PubMed

The number of acutely ill hospitalised medical patients at risk for acute venous thromboembolism (VTE) has not been well defined. Therefore, we used the 2003 United States Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample database to estimate VTE events among hospitalised medical patients. We then modeled the potential reduction in VTE with universal utilisation of appropriate pharmacological thromboprophylaxis. We calculated that 8,077,919 acutely ill hospitalised medical patients were at risk for VTE. Heart failure, respiratory failure, pneumonia, and cancer were the most common medical diagnoses. We estimated that 196,134 VTE-related events occurred in 2003, afflicting two out of every 100 acutely ill hospitalised medical patients. These VTE-related events were comprised of 122,235 symptomatic deep venous thromboses, 32,654 symptomatic episodes of pulmonary embolism, and 41,245 deaths due to VTE. In our model, rates of pharmacological thromboprophylaxis prescription were low for various acute medical illnesses, ranging from 15.3% to 49.2%. However, with universal thromboprophylaxis, 114,174 VTE-related events would have been prevented. In conclusion, acutely ill medical patients represent a large population vulnerable to the development of VTE during hospitalisation. The number of VTE-related events would be halved with universal thromboprophylaxis. Further efforts focused on improving VTE prevention strategies in hospitalised medical patients are warranted. PMID:19718471

Piazza, Gregory; Fanikos, John; Zayaruzny, Maksim; Goldhaber, Samuel Z

2009-09-01

286

Intraosseous venous drainage of pretibial varices.  

PubMed

In this study, we present the case of a 74-year-old male patient who presented with a painful pretibial swelling. The patient had a history of varices of the ipsilateral leg for which he had undergone stripping and ligation. At physical examination, pretibial varices and an associated soft tissue swelling were found. Ultrasound revealed pretibial varices, one of which caused a defect on the anterior tibial cortex. Plain radiography showed a small subcortical lucency of the tibial shaft. MRI confirmed the presence of pretibial varices, one of which perforated through the anterior tibial cortex and then coursed intramedullary as an enlarged intraosseous vein. Based on these findings, the diagnosis of varices with an intraosseous venous drainage anomaly was made. The patient was subsequently successfully treated by ambulatory minisurgical phlebectomy. Knowledge and recognition of this intraosseous venous drainage anomaly, which is a rare condition, is pivotal for correct patient management. We review clinical and imaging findings, and discuss previously reported cases. PMID:23436033

Kwee, Robert M; Kavanagh, Eoin C; Adriaensen, Miraude E A P M

2013-06-01

287

Hormone replacement therapy and venous thromboembolism.  

PubMed

Hormone replacement therapy (HRT) for post-menopausal women is known to promote venous thromboembolism (VTE), i.e., deep venous thrombosis and pulmonary embolism, though the absolute risk for a given patient is very small. The risk of VTE appears to be greatest soon after the initiation of HRT and returns to the baseline level of risk of non-HRT users after discontinuation. There is inconsistent data about whether estrogen-only or combined estrogen-progestin HRT are associated with similar VTE risk. Retrospective analyses suggest that transdermal HRT is not as prothrombotic as oral HRT, though this has not been evaluated in randomized clinical trials. Increasing age and weight further promote HRT's VTE risk. Some studies have investigated whether prothrombotic combinations may increase HRT's VTE risk and there is evidence that Factor V Leiden may do this. However, no benefit to screening prospective HRT users has been described, yet. Advanced proteomic and genomic studies may hold promise in the future for better elucidating which HRT users are at highest risk for VTE. Presently, physicians and prospective HRT users should discuss the potential risks and benefits for the individual patient, acknowledging there is no way to fully mitigate the risk of VTE. This article is part of a Special Issue entitled 'Menopause'. PMID:24007716

Eisenberger, Andrew; Westhoff, Carolyn

2014-07-01

288

A rare case of popliteal venous aneurysm.  

PubMed

We report a case of a 21-year-old man with a popliteal venous aneurysm of the left popliteal fossa, with local symptoms and pain during palpation. Early diagnosis is fundamental in order to prevent the thromboembolic events or other major complications. Duplex scanning, Computed Tomography scanning, and Magnetic Resonance imaging are considered to be important non-invasive diagnostic methods for the diagnosis of PVA. The Angio Computed Tomography acquisition confirmed a 36 mm x 17 mm oval mass in the left popliteal fossa continuous with the popliteal veins. This lesion had presented contrast enhancement only in delayed acquisition (180 sec) and so appeared to be a true venous aneurysm and no arterial. The PVA was repaired surgically via a posterior approach to the popliteal fossa. A 4 x 2 aneurysm was identified. In the same time open tangential aneurysmectomy and lateral vein reconstruction were realised. This case is interesting because the Angio Computed Tomography study, in delayed acquisition, has allowed a correct diagnostic assessment of PVA and the surgical treatment. PMID:20224754

Fiori, Roberto; Chiappa, Roberto; Gaspari, Eleonora; Simonetti, Giovanni

2010-01-01

289

A Rare Case of Popliteal Venous Aneurysm  

PubMed Central

We report a case of a 21-year-old man with a popliteal venous aneurysm of the left popliteal fossa, with local symptoms and pain during palpation. Early diagnosis is fundamental in order to prevent the thromboembolic events or other major complications. Duplex scanning, Computed Tomography scanning, and Magnetic Resonance imaging are considered to be important non-invasive diagnostic methods for the diagnosis of PVA. The Angio Computed Tomography acquisition confirmed a 36?mm × 17?mm oval mass in the left popliteal fossa continuous with the popliteal veins. This lesion had presented contrast enhancement only in delayed acquisition (180?sec) and so appeared to be a true venous aneurysm and no arterial. The PVA was repaired surgically via a posterior approach to the popliteal fossa. A 4 × 2 aneurysm was identified. In the same time open tangential aneurysmectomy and lateral vein reconstruction were realised. This case is interesting because the Angio Computed Tomography study, in delayed acquisition, has allowed a correct diagnostic assessment of PVA and the surgical treatment.

Fiori, Roberto; Chiappa, Roberto; Gaspari, Eleonora; Simonetti, Giovanni

2010-01-01

290

Drospirenone: high risk of venous thrombosis.  

PubMed

Oral contraceptives increase the risk of venous thrombosis, with the extent depending on the dose of ethinylestradiol and the type of progestin: the risk is about 20 cases per 100,000 woman-years with norethisterone or levonorgestrel and less than 50 microgrammes of ethinylestradiol, and 30 to 40 cases per 100,000 woman-years with gestodene or desogestrel. Since the beginning of this decade, some oral contraceptives have combined ethinylestradiol with drospirenone, a spironolactone-derived progestin with antimineralocorticoid activity, which carries a risk of hyperkalaemia. A Danish cohort study was based on a registry containing 3.3 million woman-years of data on oral contraceptives, including more than 130,000 woman-years of drospirenone exposure. Compared with levonorgestrel, a statistically significant increase in the risk of venous thrombosis was observed in women using drospirenone (relative risk 1.64, 95% confidence interval 1.27-2.10). A case-control study conducted in the Netherlands that included 1524 patients and 1760 controls showed a statistically significant 6-fold increase in the risk of thrombosis among women using combinations containing drospirenone compared to women who did not use oral contraception, and a non-significant 1.7-fold increase compared to women using combinations based on levonorgestrel. In practice, the first-choice combined oral contraceptives are those containing ethinylestradiol plus either levonorgestrel or norethisterone. PMID:21488592

2011-02-01

291

Interventional Treatment of Mesenteric Venous Occlusion  

PubMed Central

Summary Background Mesenteric venous thrombus may be an incidental finding during imaging studies and asymptomatic patients are treated conservatively or with anticoagulant therapy only. Patients with symptomatic acute thrombosis causing bowel ischemia require urgent treatment, which frequently includes extensive surgery. Interventional treatment may be an alternative. Purpose: To present results of interventional treatment in patients with symptomatic occlusion of the mesenteric veins. Material/Methods Eight patients, four men and four women aged 24–74 years (mean 53 years) were treated due to symptomatic portomesenteric venous occlusion of thrombotic origin. Transhepatic (n=5), trans-splenic (n=2), and transjugular (n=4) accesses were used. Patients were treated with mechanical thrombus fragmentation (n=4), pharmacological thrombolysis (n=3) and stent placement (n=8). Additional transjugular intrahepatic portosystemic shunt (TIPS) was created to facilitate the outflow from the treated veins (n=4). Results The majority of the patients required combination of different treatment methods. Resolution of symptoms with initial clinical success was achieved in seven of the eight patients, and one patient died the day after the procedure due to sepsis. Two other patients had procedure-related complications; one of them required embolization. Two patients had documented long-term clinical success with patent stents and no symptoms at one year following intervention. Conclusions Endovascular treatment of portomesenteric occlusion in patients with acute symptomatology showed good short-term clinical success rate.

Wichman, Heather J.; Cwikiel, Wojciech; Keussen, Inger

2014-01-01

292

Complications associated with cerebral venous thrombosis.  

PubMed

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided. The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary embolism. In the chronic stages of CVT, one may encounter dural AV--fistula, progressive psychiatric disease, residual epilepsy and recurrence. Cerebral venous sinus thrombosis is associated with unique acute and chronic complications, some of them may be avoidable, e.g. pulmonary embolism. The chronic complications are rare but are potentially treatable, e.g. dural AVFistula nidus obliteration with intervention. PMID:17183989

Siddiqui, Fazeel Mukhtar; Kamal, Ayeesha K

2006-11-01

293

Venous return curves obtained from graded series of valsalva maneuvers  

NASA Technical Reports Server (NTRS)

The effects were studied of a graded series of valsalva-like maneuvers on the venous return, which was measured transcutaneously in the jugular vein of an anesthetized dog, with the animal serving as its own control. At each of five different levels of central venous pressure, the airway pressure which just stopped venous return during each series of maneuvers was determined. It was found that this end-point airway pressure is not a good estimator of the animal's resting central venous pressure prior to the simulated valsalva maneuver. It was further found that the measured change in right atrial pressure during a valsalva maneuver is less than the change in airway pressure during the same maneuver, instead of being equal, as had been expected. Relative venous return curves were constructed from the data obtained during the graded series of valsalva maneuvers.

Mastenbrook, S. M., Jr.

1974-01-01

294

Automated detection and quantification of venous beading using Fourier analysis.  

PubMed

Venous beading associated with diabetic retinopathy is currently assessed by means of subjective comparison to standard photographs from the modified Airlie House classification scheme. We describe a computerized grading scheme for venous beading. The algorithm, based on Fourier analysis of vessel width measurements, generates a venous beading index (VBI) for digitized colour fundus photographs. Colour photographs of local vessel segments about 1200 microns in length were evaluated by experienced graders. A comparison between the VBI and subjective grading showed good agreement. The mean VBI values across the four levels of clinical grading were significantly different (p = 0.000). Multiple comparison testing indicated that the VBI was able to significantly differentiate between all four categories except the "questionable" (grade 1) category (p < 0.05). We also found that progression of venous beading can be followed with the VBI. The results indicate that further development of automated grading of venous beading is warranted. PMID:1451016

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

1992-10-01

295

The fault width formation of impending large earthquakes: Its observation near the base of the crustal seismogenic zone by the time series analysis of seismicity.  

NASA Astrophysics Data System (ADS)

Dividing Japan into meshes of about 5°, we collect earthquakes (EQ's) for each mesh-area from a 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 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. Taking a moving-average of the series over 15-25 events, we find only two different triple phase couplings of the averaged DEP, INT, and MAG fluctuations precursory to every large EQ (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 becomes comparable to the fault width of large EQ's except for only a very few cases. Thus, the precursory variation W appears to load the corresponding stress into the local region to prepare for an impending large EQ whose fault width becomes W. With the assumption of the fault length (L in km) being L = 2W, we can successfully forecast the M of the impending large EQ by an empirical relation given by Utsu [2002], log L = 0.5M - 1.8 for 6 =< M =< 8.5, [Takeda and Takeo, 2007]. Each triple phase coupling can draw its own physical picture of the seismogenic process in the earth lithosphere consisting of the brittle (B), brittle ductile transition (B-D) and ductile (D) layers. The B-D layer is at the base of the crustal seismogenic zone. The plate driving force of about 3x1012 Nm-1 creates steady state creep in the D part. According to Aki [2004], Zoback and Zoback [2002] gave a new perspective on the role of D part during the EQ loading process as follows. If the creep deformation rate is high, the stress in the B part builds up and the region becomes tectonically active by the coupling of three layers. Thus, the EQ's of various sizes in magnitude (M) occur in the B part. Aki [2004] and Jin and Aki [2005] have proposed a local version of the B and D coupling as "B-D interaction hypothesis" by a time series analysis (completely different from ours) of the decay rate of coda waves and the local selective seismicity. It is extremely intriguing that the hypothesis is in perfect harmony with physical models of the seismogenic zone inferred from the triple phase couplings.

Takeda, F.; Takeo, M.

2008-12-01

296

Venous Thromboembolism Prophylaxis in Acutely Ill Hospitalized Medical Patients: Findings From the International Medical Prevention Registry on Venous Thromboembolism  

Microsoft Academic Search

Background: Evidence-based guidelines recommend that acutely ill hospitalized medical patients who are at risk of venous thromboembolism (VTE) should receive prophylaxis. Our aim was to characterize the clinical practices for VTE prophylaxis in acutely ill hospitalized medical patients enrolled in the International Medical Prevention Registry on Venous Thromboembolism (IM- PROVE). Methods: IMPROVE is an ongoing, multinational, observational study. Participating hospitals

Victor F. Tapson; H. Decousus; M. Pini; B. H. Chong; J. B. Froehlich; M. Monreal; A. C. Spyropoulos; G. J. Merli; R. B. Zotz; J.-F. Bergmann; R. Pavanello; A. G. G. Turpie; M. Nakamura; F. Piovella; A. K. Kakkar; F. A. Spencer; G. FitzGerald; F. A. Anderson

2007-01-01

297

Developmental venous anomaly with contralateral impaired venous drainage in a 17-year-old male. A case report.  

PubMed

Developmental venous anomalies (DVA) drain normal neural tissue and are mostly discovered incidentally. We describe a young patient with a left hemisphere superficial to deep DVA and right hemisphere venous outflow restriction presenting with a seizure. The right hemisphere drainage variation is not typical of a DVA but represents another drainage pattern on the border of normality. PMID:23472726

Enslin, J M N; Lefeuvre, D; Taylor, A

2013-03-01

298

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

PubMed

This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects that had not used the supplement) were compared with normal, unused vein segments harvested for bypass grafting. The segments were suspended and a weight was attached to the distal part of the veins for 3 minutes and dilated with pressurized water. Digital images were recorded; the veins were measured before and after stretching to evaluate elongation. The manipulation of the vein segment was minimal. Tests were completed within 20 minutes after harvesting the veins. All segments were 4 cm long. The stretching test indicated a significantly higher level of passive elongation in control, varicose segments (2.29; 0.65 mm) in comparison with 1.39; 0.2?mm in vein segments from Pycnogenol-using patients. The dilation test showed an average higher dilation (2.19; 0.3 mm) in control varicose veins in comparison with varicose veins from Pycnogenol-using patients (1.32; 0.7 mm) (p?

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

2014-03-01

299

Primary sutureless repair for simple total anomalous pulmonary venous connection with a risk of postoperative pulmonary venous stenosis.  

PubMed

Late mortality following surgical repair of total anomalous pulmonary venous connection (TAPVC) is often associated with pulmonary venous stenosis. We describe here two successful cases of primary sutureless repair for simple TAPVC in patients who had a potential risk of postoperative pulmonary venous stenosis. A 10-day-old neonate with mixed-type TAPVC and a 30-day-old infant with supracardiac TAPVC underwent primary sutureless repair with our modification. In the early follow-up, both patients are now doing well and have no signs of pulmonary venous stenosis. The sutureless repair can be applied as a primary surgical option to prevent postoperative pulmonary venous stenosis in selective patients with simple TAPVC. PMID:23188516

Hasegawa, Tomomi; Oshima, Yoshihiro; Maruo, Ayako; Matsuhisa, Hironori; Kadowaki, Tasuku; Noda, Rei

2013-09-01

300

Clinical guidelines on central venous catheterisation.  

PubMed

Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs. PMID:24593804

Frykholm, P; Pikwer, A; Hammarskjöld, F; Larsson, A T; Lindgren, S; Lindwall, R; Taxbro, K; Oberg, F; Acosta, S; Akeson, J

2014-05-01

301

Syndactyly correction using a venous flap with the plantar cutaneous venous arch.  

PubMed

A combination of skin grafts and local flaps is widely used in the reconstruction of syndactyly of the toes. Covering the skin defect without skin grafts on the unilateral side of the toe is preferred, and for this purpose, a rotated flap from the plantar area is typically used. However, the flap can become ischemic or congested in some cases. To avoid this, we elevated a plantar flap with the plantar cutaneous venous arch using a triangular venous flap and covered the lateral side of the web in 7 cases of syndactyly. The dorsal flap was used to create the new web, and the opposite lateral side was reconstructed using a skin graft. The flap circulation was stable, the pedicle of the flap was narrow, and the flap relocation was simple. No flap in any patient showed any evidence of congestion or ischemia. Follow-up demonstrated that the new web was patent in all cases, with no evidence of contraction. PMID:24841825

Sakamoto, Natsuki; Matsumura, Hajime; Komiya, Takako; Imai, Ryutaro; Niyaz, Ahmatjan; Watanabe, Katsueki

2014-06-01

302

The Impending Death of Psychoanalysis  

Microsoft Academic Search

Although psychoanalysis once dominated psychology, evidence now points to the waning influence of psychoanalytic theory in psychological science, psychiatric diagnosis, undergraduate instruction, and graduate training. In this article I describe 7 self-destructive behaviors exhibited by psychoanalysts that contributed to the precipitous decline of psychoanalytic theory in recent years. I then outline three strategies for retaining those features of psychoanalysis that

Robert F. Bornstein

2001-01-01

303

Impending United States energy crisis  

Microsoft Academic Search

The US 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, US capability will continue to deteriorate. In the last year US imports of foreign oil have risen significantly, and if market forces

R. L. HIRSCH

1987-01-01

304

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

PubMed

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

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

2011-12-01

305

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

PubMed

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

Okubo, Akiko; Sameshima, Munefumi; Sakamoto, Taiji

2013-10-01

306

Choroidal Venous Pulsations at an Arterio-venous Crossing in Polypoidal Choroidal Vasculopathy  

PubMed Central

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

Sameshima, Munefumi; Sakamoto, Taiji

2013-01-01

307

Feline gangrenous mastitis.  

PubMed

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

Wilson, Courtney R

2013-03-01

308

Feline gangrenous mastitis  

PubMed Central

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

Wilson, Courtney R.

2013-01-01

309

[The prevention of venous thromboembolism in Italy].  

PubMed

A questionnaire concerning the prophylaxis of venous thromboembolism was filled in by 326 surgical departments in Italy. In 58% the prophylaxis was routinely used and in 29% more than one method was used. The most used method of prevention was subcutaneous heparin followed by elastic compression. In 51% of the centers the prophylaxis was used only in high risk patients and in 22% it was not used at all. The most relevant risk factors in the development of thrombosis were considered age, tumors and obesity. Finally in a questionnaire sent to 350 vascular laboratories it was found that--according to the operators--76% of all documented thromboses were possibly consequent to surgical procedures (in 86% no prophylaxis had been used). PMID:1470411

Ricci, A; Laurora, G; D'Aulerio, A; Mezzanotte, A; Belcaro, G

1992-10-15

310

Medical Management of Venous Thromboembolic Disease  

PubMed Central

Venous thromboembolism (VTE) accounts for a significant amount of morbidity and mortality in the United States. The diagnostic and therapeutic management has never been so varied with the numerous options now available. My purpose is to briefly review epidemiology, pathogenesis, prophylaxis, diagnosis, and treatment of VTE, highlighting the important studies and consensus recommendations informing current clinical practice. Invasive, noninvasive, direct, and indirect diagnostic modalities are reviewed with an evidence-based theme. Certainly, all patients should undergo a rigorous prophylaxis risk assessment for which various pharmacologic and nonpharmacologic options are available with varied clinical efficacy and safety profiles. Unfractioned heparins, low molecular weight heparins (LMWH), and thrombolytic agents play different roles as we enter the next millennium. Optimal outcomes with high patient satisfaction can be achieved with appropriate use of LMWHs for both deep vein thrombosis and pulmonary emboli.

Deitelzweig, Steven

2000-01-01

311

Prevention of venous thromboembolism in obesity.  

PubMed

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

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

2010-12-01

312

Yasmin and venous thromboembolism: new case reports.  

PubMed

It is not yet known whether Yasmin involves a higher thrombotic risk compared with other contraceptives. We present a serie of eight new cases of women who developed thrombotic events early after starting on Yasmin who were sent to our Thrombosis and Hemostasis Unit for a thrombophilia work-up in the last five years. Only two of them were heterozygous carriers of the prothrombin G20210A mutation and three were obese while none of them were smoker. These new cases provide information about the characteristics of the thrombotic events and the concomitant risk factors, indicating that this pill may not be as safe as had been previously thought, and suggest that new studies regarding safety profile of Yasmin are required to explain the association with venous thrombotic events. PMID:19363241

López, María; Vayá, Amparo; Martínez Triguero, M Luisa; Contreras, M Teresa; Todolí, José; Ricart, Alicia; Laiz, Begońa

2009-01-01

313

Cardiovascular Pressures with Venous Gas Embolism and Decompression  

NASA Technical Reports Server (NTRS)

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

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

1995-01-01

314

[Epidemiology of venous thromboembolie disease in Spain].  

PubMed

The results of epidemiological studies of venous thromboembolic disease (VTD) vary widely, depending both on the geographical area and study type. In Spain, there are no data on the incidence and distribution of VTD. To determine the incidence and distribution of this disease, we analyzed the hospital discharges codified by the Spanish national health system. The results of the analysis showed that VTD represented 0.82% (0.69%-0.92%) of all hospital discharges in Spain between 1999 and 2005. The rate of diagnoses for all hospital discharges in 2005 was 103/100,000 inhabitants, with an estimated number of total diagnoses in Spain (hospitalized or not) of 154/100,000. Fifty-three percent were pulmonary embolisms (PE), which showed a tendency to increase, and 47% were deep venous thrombosis (DVT), which showed a tendency to decrease. The mean age was 65 years in men (51% of cases) and 68 years in women, with the incidence increasing exponentially with age. The mean age in patients with PE was 70 years vs 64 years in DVT. Mortality associated with PE was 11.6% vs 2.3% with DVT. DVT occurred during admission in 4% (3-4.7) of persons hospitalized for any cause, 74% of patients being admitted for medical problems. These data reveal that DVT is a serious health problem in Spain, with high morbidity and mortality. The incidence of this disease seems to be increasing and is particularly associated with medical problems, despite improved diagnosis and the accumulated evidence on thromboprophylaxis. Therefore, greater efforts should be made both to improve identification of at-risk patients and the application of prevention protocols. PMID:19087844

Guijarro Merino, Ricardo; Montes Santiago, Julio; San Román Terán, Carlos M

2008-11-01

315

Absence of venous valves in mice lacking Connexin37.  

PubMed

Venous valves play a crucial role in blood circulation, promoting the one-way movement of blood from superficial and deep veins towards the heart. By preventing retrograde flow, venous valves spare capillaries and venules from being subjected to damaging elevations in pressure, especially during skeletal muscle contraction. Pathologically, valvular incompetence or absence of valves are common features of venous disorders such as chronic venous insufficiency and varicose veins. The underlying causes of these conditions are not well understood, but congenital venous valve aplasia or agenesis may play a role in some cases. Despite progress in the study of cardiac and lymphatic valve morphogenesis, the molecular mechanisms controlling the development and maintenance of venous valves remain poorly understood. Here, we show that in valved veins of the mouse, three gap junction proteins (Connexins, Cxs), Cx37, Cx43, and Cx47, are expressed exclusively in the valves in a highly polarized fashion, with Cx43 on the upstream side of the valve leaflet and Cx37 on the downstream side. Surprisingly, Cx43 expression is strongly induced in the non-valve venous endothelium in superficial veins following wounding of the overlying skin. Moreover, we show that in Cx37-deficient mice, venous valves are entirely absent. Thus, Cx37, a protein involved in cell-cell communication, is one of only a few proteins identified so far as critical for the development or maintenance of venous valves. Because Cxs are necessary for the development of valves in lymphatic vessels as well, our results support the notion of common molecular pathways controlling valve development in veins and lymphatic vessels. PMID:23142761

Munger, Stephanie J; Kanady, John D; Simon, Alexander M

2013-01-15

316

Internal jugular venous abnormalities in transient monocular blindness  

PubMed Central

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

2013-01-01

317

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

Microsoft Academic Search

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

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

2003-01-01

318

[Prevention of deep venous thrombosis in medical care].  

PubMed

Venous thromboembolism is a frequent and potentially severe ailment in medical patients; the clinical signs are unreliable and as early detection of the thrombosis process by non-invasive techniques is not available, prevention appears to be an alternative. Careful definition of the medical situations at risk from venous thromboembolism is necessary. Age, prior history of venous thromboembolism, and immobilization constitute high risk circumstances. Analysis of the published studies advocates prevention in three circumstances: myocardial infarction, stroke and intensive care. In other cases, further controlled studies, randomized versus placebo, are needed. PMID:9033615

Couturaud, F; Leroyer, C; Le Moigne, E; Oger, E; Mottier, D

1996-12-14

319

Clinical tests of noninvasive optoacoustic cerebral venous oxygenation monitoring system  

NASA Astrophysics Data System (ADS)

Monitoring of cerebral venous oxygenation is critically important for management of patients with traumatic brain injury and cardiac surgery patients. At present, there is no technique for noninvasive, accurate monitoring of this important physiologic parameter. We built a compact optoacoustic system for noninvasive, accurate cerebral venous oxygenation monitoring using a novel optoacoustic probe and algorithm that allow for direct probing of sagittal sinus blood with minimal signal contamination from other tissues. We tested the system in large animal and clinical studies and identified wavelengths for accurate measurement of cerebral blood oxygenation. The studies demonstrated that the system may be used for noninvasive, continuous, and accurate monitoring of cerebral venous blood oxygenation.

Petrov, Y. Y.; Petrova, I. Y.; Esenaliev, R. O.; Prough, D. S.

2009-02-01

320

Acute Mesenteric Venous Thrombosis with a Vaginal Contraceptive Ring  

PubMed Central

Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.

Eilbert, Wesley; Hecht, Benjamin; Zuiderveld, Loren

2014-01-01

321

Venous disease and chronic oedema: treatment and patient concordance.  

PubMed

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

Todd, Marie

2014-05-01

322

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

PubMed

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

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

2013-05-01

323

[Giant venous malformation of the tongue: the value of Surgiflo].  

PubMed

Cavernous hemangiomas are rare congenital venous malformations having propensity for the head and neck. These venous malformations, especially the large and intraoral ones, may cause severe symptoms requiring aggressive treatment. Today, the main treatment is based on sclerotherapy, associated or no with surgery. We report on a patient presenting an enormous venous malformation of the face and tongue, which was treated successfully in our department by embolization, sclerotherapy and maxillo-facial surgery, with a special focus on Surgiflo in our technique. PMID:20399053

Slaba, S; Braidy, C; Sader, R B; Hokayem, N; Nassar, J

2010-06-01

324

The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors.  

PubMed

Superficial vein thrombosis (SVT) increases the risk of venous thrombosis fourfold to sixfold. As most individuals with SVT do not develop venous thrombosis, additional risk factors may explain the risk of developing a venous thrombosis. In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis study, we assessed the risk of venous thrombosis in individuals with previous SVT and a mild thrombotic risk factor (smoking or overweight/obesity), a strong risk factor (surgery, hospitalization, plaster cast immobilization, or malignancy), or a reproductive factor in women (oral contraception, postmenopausal hormone therapy, or pregnancy/puerperium). Individuals with previous SVT alone had a 5.5-fold (95% confidence interval [CI], 4.4-6.8) increased risk of venous thrombosis. This was 9.3 (95% CI, 7.2-12.1) combined with a mild thrombotic risk factor, 31.4 (95% CI, 14.6-67.5) with a strong risk factor, and 34.9 (95% CI, 19.1-63.8) in women with a reproductive risk factor. The highest separate risk estimates were found for SVT with surgery (42.5; 95% CI, 10.2-177.6), hospitalization (49.8; 95% CI, 11.9-209.2), or oral contraception (43.0; 95% CI, 15.5-119.3 in women). In conclusion, the risk of venous thrombosis is markedly increased in individuals with previous SVT who have an acquired thrombotic risk factor. PMID:24184685

Roach, Rachel E J; Lijfering, Willem M; van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Rosendaal, Frits R; Cannegieter, Suzanne C

2013-12-19

325

Prevention and treatment of venous thromboembolism--International Consensus Statement.  

PubMed

The aim of this document is to provide a clear and concise account of the evidence regarding efficacy or harm for various methods available to prevent and manage venous thromboembolism (VTE). PMID:24402349

Nicolaides, A N; Fareed, J; Kakkar, A K; Comerota, A J; Goldhaber, S Z; Hull, R; Myers, K; Samama, M; Fletcher, J; Kalodiki, E; Bergqvist, D; Bonnar, J; Caprini, J A; Carter, C; Conard, J; Eklof, B; Elalamy, I; Gerotziafas, G; Geroulakos, G; Giannoukas, A; Greer, I; Griffin, M; Kakkos, S; Lassen, M R; Lowe, G D; Markel, A; Prandoni, P; Raskob, G; Spyropoulos, A C; Turpie, A G; Walenga, J M; Warwick, D

2013-04-01

326

Morphologic studies of the venous drainage of the tongue.  

PubMed

The aim of this work was to study the role of the venous drainage of the tongue in tongue inspection in traditional Chinese medicine and tongue-flap surgery. Thirty-two adult cadavers were observed, including 7 venous corrosivecast specimens. The decreasing order of venous drainage of the tongue, based on the diameter of the vein and size of its drainage area, was the accompanying v. of the hypoglossal n., the epiglottic valleculate v., the accompanying v. of the lingual n., the lingual root v. and the accompanying v. of the lingual a. The veins constituting the picture of the tongue seen in sublingual collateral inspection were the companion vv. of the hypoglossal and lingual nn. The pedicle of a tongue flap must maintain efficient venous drainage canal. PMID:9658525

Shangkuan, H; Xinghai, W; Shizhen, Z; Zengxing, W; Shiying, J; Jiasong, G

1998-01-01

327

Cerebral venous infarction during a high altitude expedition.  

PubMed

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

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

2009-08-01

328

Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Clinician Research Summary.  

National Technical Information Service (NTIS)

A systematic review of 179 articles published between January 1980 and May 2011 sought to determine the comparative effectiveness, benefits, and adverse effects of venous thromboembolism (VTE) prophylaxis for patients undergoing orthopedic surgery. The re...

2012-01-01

329

What is new in duplex scanning of the venous system?  

PubMed

The diagnosis and treatment of chronic venous disease has undergone a quantum leap forward in recent decades. In many ways, the venous system is now considered more complex than the arterial system. This is a result of the advances in understanding due to improvements in duplex ultrasound equipment, diagnostic techniques, and communication standards as they relate to findings in anatomy, pathology, and hemodynamics. Currently, it is self-evident that duplex ultrasound has become the gold standard for diagnosis of the venous system providing anatomic and functional information. Mapping techniques, understanding of superficial reflux, and other factors that affect duplex ultrasound findings are presented. These factors and techniques can affect diagnostic results and therefore have significant impact on the planning and approach to treatment of primary and recurrent venous insufficiency. PMID:19640861

Zygmunt, Joseph

2009-06-01

330

Venous ulcers--an evidence-based update.  

PubMed

Leg ulceration can be defined as any chronic ulcer of the lower leg excluding those on the forefoot or toes (Lees & Lambert, 1992). Venous or stasis ulcers account for 80%-85% of all leg ulcers with an overall prevalence of approximately 1% in the United States (Collins & Seraj, 2010; O'Meara, Al-Kurdi, & Ovington, 2008). Venous ulcers are more common in women and the older population (Abbade & Lastoria, 2005; Bergqvist, Lindholm, & Nelzen, 1999). Venous ulcers are often recurrent and chronic and can persist from weeks to even years. Severe complications include cellulitis, osteomyelitis, and malignant changes (Collins & Seraj, 2010). This column discusses the pathophysiology of venous insufficiency and ulcerations, presentation, diagnosis, and current treatment. PMID:23188154

Spear, Marcia

2012-01-01

331

[Sinus pericranii and developmental venous anomalies: a frequent association].  

PubMed

The authors describe 2 cases of congenital sinus pericranii associated with intracranial venous anomalies. After a review of the literature concerning this association they consider the possible etiopathogenic mechanisms and treatment implications. PMID:7625219

Cerqueira, L; Reis, F C

1995-04-01

332

Infantile Dural Arteriovenous Shunt Draining into a Developmental Venous Anomaly  

PubMed Central

Summary A three-year-old girl with an incidentally discovered infantile type of dural arteriovenous shunts (DAVs) along the superior sagittal sinus during investigation of a minor head trauma is presented. The DAVs drained into a developmental venous anomaly of the right cerebral hemisphere. In addition, there was a small cavernoma within the territory drained by the DVA. The patient underwent multiple transarterial embolizations to decrease the shunt flow and thus the constrained venous drainage of the DVA and right cerebral hemisphere. Pediatric dural arteriovenous shunts are a different entity from the adult type DAVs and should be managed according to the growth and development of the child. DVAs are extreme variations of the venous system with reduced flexibility to increased venous drainage. Regardless of the type of treatment employed, the DVA and its drainage pathway must be preserved.

Geibprasert, S.; Krings, T.; Pereira, V.; Lasjaunias, P.

2007-01-01

333

Further experience with peritoneo-venous shunt for ascites.  

PubMed Central

A specially devised pressure-sensitive valve forms the basis for a new peritoneo-venous shunt operation which delivers ascitic fluid continuously into the venous system. It is effective in ascites attributed to different causes. The procedure is simple and brings a long lasting relief with recovery in strength and nutrition and improved kidney function. Hepatorenal syndrome in ascites is reversed. Images Fig. 6.

LeVeen, H H; Wapnick, S; Grosberg, S; Kinney, M J

1976-01-01

334

Prophylaxis for venous thromboembolism: guidelines translated for the clinician  

Microsoft Academic Search

Venous thromboembolism is a major cause of morbidity and mortality worldwide and most often affects hospitalized postoperative\\u000a surgical and medical patients. Venous thromboembolism prophylaxis undoubtedly improves the care of these patients, as demonstrated\\u000a by the current literature and guidelines. Failure to prescribe prophylaxis when indicated, however, remains a vital health\\u000a care concern. The American College of Chest Physicians (ACCP) published

Gregg Stashenko; Renato D. Lopes; David Garcia; John H. Alexander; Victor F. Tapson

2011-01-01

335

Fibroblasts cultured from venous ulcers display cellular characteristics of senescence  

Microsoft Academic Search

Purpose: A well-recognized characteristic of venous ulcers is impaired healing. Fibroblasts cultured from venous ulcers (wound-fb) have been shown to have reduced growth rates and are larger than normal fibroblasts (normal-fb) from the ipsilateral limb. Reduced growth capacity and morphologic changes are 2 well-known traits of cellular senescence. Other molecular changes are overexpression of matrix proteins, such as cellular fibronectin

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

1998-01-01

336

Novel Biomarkers of Arterial and Venous Ischemia in Microvascular Flaps  

PubMed Central

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

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

337

Impedance Phlebography for the Diagnosis of Venous Thrombosis  

NASA Astrophysics Data System (ADS)

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

Urzic?, Denise; Dorohoi, Dana-Ortansa

2007-04-01

338

Orbital venous-lymphatic malformations (lymphangiomas) mimicking cavernous hemangiomas  

Microsoft Academic Search

PURPOSE: To illustrate that orbital venous-lymphatic malformations (lymphangiomas) may rarely simulate cavernous hemangiomas.METHODS: Retrospective case review.RESULTS: Five patients were identified from a series of 85 patients with venous-lymphatic malformations. The age range was 21 to 69 years, and all cases presented with a history of slowly progressive or long-standing proptosis. Computerized tomography revealed relatively homogeneous intraconal masses that were well

Dinesh Selva; Diego Strianese; Giulio Bonavolonta; Jack Rootman

2001-01-01

339

Novel biomarkers of arterial and venous ischemia in microvascular flaps.  

PubMed

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

Nguyen, Gerard K; Hwang, Brian H; Zhang, Yiqiang; 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

340

Physiological Changes in Venous Hemodynamics Associated with Elective Fasciotomy  

Microsoft Academic Search

It has been postulated that lower extremity fasciotomy may disrupt the calf musculovenous pump and predisposes to development\\u000a of chronic venous insufficiency (CVI). However, studies based on trauma patients who undergo emergent fasciotomy are confounded\\u000a by the possibility of concomitant vascular and soft tissue injury and use historical controls. This is a prospective study\\u000a that evaluates venous hemodynamics in young

Niten Singh; Anton N. Sidawy; Craig R. Bottoni; Elena Antedomenico; Teddie S. Gawley; Denise Harada; David L. Gillespie; Catherine F. T. Uyehara; Paul R. Cordts

2006-01-01

341

Prospective study on central venous line associated bloodstream infections  

Microsoft Academic Search

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

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

2011-01-01

342

Portal Venous System and Its Tributaries: A Radial Endosonographic Assessment  

PubMed Central

The use of Color Doppler in endosonography has enabled detailed real-time assessment of the abdominal vasculature. Standard stations are used during the routine evaluation on endosonography. However, the imaging techniques do not describe the vascular imaging of the portal venous system and its tributaries, in detail. This article demonstrates the normal findings on the portal venous system and its tributaries using radial endosonography.

Sharma, Malay; Babu, C. S. Ramesh; Garg, Shubham; Rai, Praveer

2012-01-01

343

Chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis  

Microsoft Academic Search

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS caused by the interplay of genetic and environmental\\u000a factors. In the last years, it has been suggested that an abnormal venous drainage due to stenosis or malformation of the\\u000a internal jugular and\\/or azygous veins may play a major pathogenetic role in MS. This abnormality called chronic cerebro-spinal\\u000a venous insufficiency

A. Ghezzi; G. Comi; A. Federico

2011-01-01

344

Sex and gender issues and venous thromboembolism.  

PubMed

At least 250,000 episodes of VTE leading to hospitalization or death are estimated to occur in the United States each year. A number of clinical and demographic risk factors for VTE are recognized,with the latter including both age and race. Overall,the incidence of VTE does not appear to vary significantly by sex, as evidenced by a lack of consistency in the magnitude and even direction of effect of sex in a variety of epidemiologic studies of varying design. Several studies have shown a higher incidence among women than men during childbearing age. The issue of a gender effect on the natural history of VTE has not been well studied. The main influence of gender on VTE is the relationship between female gender and several well-recognized clinical risk factors for VTE:oral contraceptive use, hormone replacement therapy, estrogen receptor modulator therapy, and pregnancy. Hormonal therapies are associated with a twofold to threefold increase in VTE incidence. Risk is higher with some formulations than others, during initial use, and among women who are obese, smoke, or have one of several forms of heritable thrombophilia. The pregnant state is associated with a threefold to fivefold increase in VTE risk, and thromboembolism is a major cause of peripartum death. Heritable thrombophilias are also important co-determinants of VTE risk in pregnancy. The mechanisms through which pregnancy and hormonal therapies increase VTE risk have not been definitively established, but hormonal effects on levels of coagulation and anticoagulation factors likely play a role. Venous compression and venous injury also contribute to increased risk during pregnancy and the puerperium. Approaches to diagnosis of VTE in the pregnant woman are largely the same as in the nonpregnant patient, but special treatment considerations do apply. Warfarin is embryopathic, particularly between the 6th and 12th weeks of pregnancy, and should be avoided in favor or heparin or low-molecular weight heparin when treatment of the pregnant woman is necessary. Guidelines have been published to assist the clinician in decision making about prophylaxis of pregnant women at increased risk or pregnancy-related or post-partum VTE. PMID:15099889

Moores, Lisa; Bilello, Kathryn L; Murin, Susan

2004-06-01

345

Aspirin for prevention and treatment of venous thromboembolism.  

PubMed

Venous and arterial thromboses have been regarded for many years as two different diseases requiring anticoagulant or antiplatelet treatment, respectively. Platelets have a role in venous thromboembolism through several mechanisms, including the formation of and adhesion to the neutrophil extracellular traps, as recently demonstrated. When given for antithrombotic prophylaxis in high risk medical or surgical patients, aspirin was shown to reduce the incidence of venous thromboembolism in clinical studies and meta-analyses. However, controversial recommendations have been released on the role of aspirin for the prevention of venous thromboembolism. Two randomized, double blind trials have recently shown a reduction of recurrence by about 30% with aspirin compared to placebo in patients who had completed treatment with vitamin K antagonists for a first episode of unprovoked venous thromboembolism. The clinical value of this risk reduction in comparison to that obtained with warfarin and the new oral anticoagulant agents, should take into account the low risk for bleeding and costs associated with aspirin. Given its safety, worldwide availability and low cost, aspirin can be considered a valid alternative to oral anticoagulants for the extended treatment of venous thromboembolism after a first unprovoked event. PMID:24745726

Becattini, Cecilia; Agnelli, Giancarlo

2014-05-01

346

Atrial natriuretic peptide increases resistance to venous return in rats  

SciTech Connect

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

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

1987-05-01

347

Multifocal Cerebral Venous Malformations and Associated Developmental Venous Anomalies in a Case of Blue Rubber Bleb Nevus Syndrome  

PubMed Central

Summary We report a sporadic case of probable BRBN (blue rubber bleb nevus syndrome) with multiple CNS (central nervous system) involvement. These features consisted of multiple VMs (venous malformations) and DVAs (developmental venous anomalies) in supratentorial brain, cerebellum, and diencephalon. Since its first description by Bean, there have been many cases of BRBN manifesting with gastrointestinal bleeding with or without associated hemorrhage. Cases with CNS involvement were rarely reported and many of the descriptions were confusing with different terminologies used to describe them such as capillary venous malformation, hemangiomas, and vascular malformations. The lesions illustrated are venous malformations similar to our case. The association of DVA was recognized in some cases; they are likely to be underestimated when revisiting the published case illustrations. Although our case is sporadic, the link with HHT1 is unlikely despite the involvement of the same chromosome (Ch 9).

Chung, J.I.; Alvarez, H.; Lasjaunias, P.

2003-01-01

348

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

Microsoft Academic Search

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

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

2010-01-01

349

PROSTAGLANDINS F IN UTERINE VENOUS PLASMA, OVARIAN ARTERIAL AND VENOUS PLASMA AND IN OVARIAN AND LUTEAL TISSUE OF PREGNANT AND NONPREGNANT EWES 1  

Microsoft Academic Search

SUMMARY Ovarian venous, ovarian arterial and uterine venous blood were collected from the same side as a corpus luteum in 10 nonpregnant and 10 pregnant ewes at day 15 postestrus. Both ovarian and uterine venous samples were col- lected by venipuncture. Ovarian arterial blood was collected into heparinized centrifuge tubes after a small portion of the artery was dissected free

J. E. Pexton; C. W. Weems; E. K. Inskeep

2010-01-01

350

Depression in patients with chronic venous ulceration.  

PubMed

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

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

351

Venous thromboembolism in patients with prior stroke.  

PubMed

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

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

2014-01-01

352

Interventional treatment of venous thromboembolism: a review.  

PubMed

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

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

2012-04-01

353

Venous Drainage Patterns in Carotid Cavernous Fistulas  

PubMed Central

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

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

2014-01-01

354

Contraception-related venous thromboembolism in adolescents.  

PubMed

Venous thromboembolism (VTE) is a rare but serious complication of combined hormonal contraception. While the absolute risk of VTE is low in adolescents, thrombotic events in contraception users younger than the age of 20 years account for 5 to 10% of total contraception-related VTE events in population studies, because of the high frequency of contraception use in adolescents. An increased risk of VTE exists not only with oral contraceptives, but also the contraceptive patch and vaginal ring. Most adolescents who experience contraception-related VTE have additional transient or inherited thrombotic risk factors at the time of VTE. Although the presence of inherited thrombophilia impacts the risk of contraception-related VTE, thrombophilia screening before contraception prescribing should be targeted only to high-risk populations. Pediatric institutions, caregivers, and young women need to be aware of the risk of VTE with estrogen-containing contraception, and maintain a high index of suspicion for this complication in women using these agents. PMID:24356931

O'Brien, Sarah H

2014-02-01

355

Oral Clonidine Pretreatment Prior to Venous Cannulation  

PubMed Central

Clonidine is a preferential alpha-2 agonist drug that has been used for over 35 years to treat hypertension. Recently, it has also been used as a preoperative medication and as a sedative/anxiolytic drug. This randomized, double-blind, placebo-controlled crossover clinical trial characterized the effects of oral clonidine pretreatment on intravenous catheter placement in 13 patients. Parameters measured included the bispectral index (BIS), Observer's Assessment of Alertness/Sedation Scale (OAA/S), frontal temporal electromyogram (EMG), 30-Second Blink Count (Blink), Digit Symbol Substitution Test (DSST), State Anxiety Inventory (SAI), fingertip versus forearm skin temperatures, and multiple questionnaires. Oral clonidine significantly decreased SAI scores, OAA/S, EMG, and Blink, but did not cause statistically significant BIS or DSST reductions. Subjects preferred oral clonidine pretreatment prior to venipuncture compared to placebo. Questionnaires also indicated that clonidine provided minimal sedation, considerable anxiolysis, and some analgesia. Fingertip versus forearm skin temperature differentials were decreased. Reduced fingertip versus forearm temperature differentials suggest increased peripheral cutaneous blood flow prior to venous cannulation. Oral clonidine pretreatment not only helped control patient anxiety and pain but also provided cardiovascular stability.

Hall, David L; Rezvan, Ehsan; Tatakis, Dimitris N; Walters, John D

2006-01-01

356

[Prevention of venous thromboembolism and anticoagulant therapy].  

PubMed

Perioperative pulmonary thromboembolism (PTE) occurred in 2.93 per 10,000 cases and mortality of PTE was 14% in Japan according to the surveillance of Japanese Society of Anesthesiologists from 2009 to 2011. Anesthesiologists have to evaluate perioperative venous thromboembolism (VTE) risk carefully and take adequate measures to prevent PTE. The first step is the assessment of the preoperative probability of VTE and the next step is the assessment of the risk for VTE during and after operation. If a patient has moderate probability of VTE preoperatively, diagnostic procedures are recommended. If the d-dimer is positive, whole-leg ultrasound is recommended. If DVT is positive in proximal vein, further investigation or anticoagulant therapy are considered. Primary preventions of VTE during and after surgeries are as follows. In patients with low or moderate risks for VTE, intermittent pneumatic compression is recommended. In patients with high risks for VTE, pharmacologic prophylaxes are recommended. In recent years newly developed anticoagulants can be available other than low-dose unfractionated heparin. However, the incidence of VTE in Japanese populations is different from western countries. Moreover our own evidence has not fully been accumulated yet. Therefore further investigations for prevention of perioperative VTE in Japan are expected for our own new guidelines. PMID:24724437

Yorozu, Tomoko

2014-03-01

357

Incidence and distribution of extravascular compression of extracranial venous pathway in patients with chronic cerebrospinal venous insufficiency and multiple sclerosis.  

PubMed

OBJECTIVE: To examine the incidence and distribution of extravascular compression of the extracranial venous pathway (the jugular and/or azygous veins) in multiple sclerosis patients with chronic cerebrospinal venous insufficiency evaluated by mulitislice computer tomographic angiography. METHODS AND RESULTS: Study group consisted of 51 consecutive patients with multiple sclerosis in whom chronic cerebrospinal venous insufficiency was diagnosed by color Doppler sonography (CDS). Mulitislice computer tomographic angiography was performed in all patients, and it revealed significant extravascular compression (>70%) of extracranial venous pathway in 26 patients (51%), while in 25 patients (49%) no significant extravascular compression was seen. Extracranial compression due to transverse processus of cervical vertebrae was seen in 23 patients, carotid bulb compression was seen in two patients, and in one case, compression presented as a thoracic outlet syndrome. CONCLUSION: Our data indicate that extravascular compression of the extracranial venous pathway is frequent in multiple sclerosis patients with chronic cerebrospinal venous insufficiency, and that it is mainly due to compression caused by transverse processus of cervical vertebrae. Further studies are needed to evaluate potential clinical implications of this phenomenon. PMID:23761866

Djordje, Radak; Nenad, Ilijevski; Jovo, Kolar; Dragan, Sagic; Zelimir, Antonic; Slobodan, Tanaskovic; Nikola, Aleksic; Srdjan, Babic; Petar, Otasevic

2013-05-01

358

Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model.  

PubMed

There are few reported cases of death attributed to retrograde cerebral air embolism from central venous catheter. The pathophysiological mechanism and the necessary conditions are not fully understood, also because of missing experimental data. We performed experimental simulation while working on a possible case of retrograde cerebral air embolism. A hermetic system consisting of two containers connected to each other and to an electric pump by means of rubber hoses was built. In this system, a fluid (water and blood) could continuously flow under conditions similar to those of the common jugular vein. The part of the system representing the jugular vein could be freely positioned at angles between 0 and 90°. A central venous catheter was inserted into this part. After disconnection, the behavior of the air bubbles entering the hose through the tip of the catheter was evaluated at different positions. At angles between 0 and 45°, the air bubbles followed the fluid flow. At angles >45°, the air bubbles showed the tendency to flow upstream; this phenomenon was more evident the more vertically the hose was located. We were able to demonstrate that a retrograde air embolism can be caused by a disconnected catheter and is even more likely if the neck is in a vertical position. PMID:20887355

Fracasso, Tony; Karger, Bernd; Schmidt, Peter F; Reinbold, Wolf D; Pfeiffer, Heidi

2011-01-01

359

Sonography for deep venous thrombosis: current and future applications.  

PubMed

Deep venous thrombosis (DVT) is a one of the most common problems facing the clinician in medicine today. It is often asymptomatic and goes undiagnosed with potentially fatal consequences. Ultrasound has become the "gold standard" in the diagnosis of deep venous thrombosis and with proper attention to technique sensitivity of this test is approximately 97%. An understanding of anatomy, pathophysiology, and risk factors is important. Thrombus formation usually begins beneath a valve leaflet below the knee. Approximately 40% will resolve spontaneously, 40% will become organized, and 20% will propagate. Whether or not a calf vein thrombus is identified, a repeat examination in 7 to 10 days is recommended in patients with risk factors or when deep venous thrombosis is suspected. The three main risk factors for thrombus formation are age greater than 75 years, previous history of deep venous thrombosis, and underlying malignancy. Other diagnostic studies include the contrast venogram, CT or MRI venogram, Tc99m Apcitide study, and the laboratory test D-Dimer. The D-Dimer study is being used more frequently as a screening test with 99% sensitivity in detecting thrombus, whether deep venous thrombosis or pulmonary embolism. However, specificity is only approximately 50% with many conditions leading to false-positive exams. Therefore, a negative examination is useful in avoiding other diagnostic studies, but a positive one may be misleading. Conditions that can lead to a false-positive examination include, but are not limited to diabetes, pregnancy, liver disease, heart conditions, recent surgery, and some gastrointestinal diseases. Like the sonogram, two negative D-Dimer studies a week apart exclude the diagnosis of deep venous thrombosis. Compression sonography with color Doppler remains the best overall test for deep venous thrombosis. It is easy to perform, less expensive than most "high tech" studies, can be performed as a portable examination, and is highly reliable when done properly. PMID:16344726

Andrews, E James; Fleischer, Arthur C

2005-12-01

360

Living-engineered valves for transcatheter venous valve repair.  

PubMed

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 currently used non-autologous replacement materials and may open new therapeutic concepts for the treatment of CVI in the future. PMID:24156382

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

2014-06-01

361

Detection of venous air embolism in dogs by emission spectrometry  

SciTech Connect

Emission spectrometers provide alternative, relatively inexpensive methods for detecting the concentration of respiratory gas nitrogen. Mass spectrometers are accepted as reliable monitors of end-tidal nitrogen for detection of venous air embolisms. We evaluated an inexpensive emission spectrometer for detecting changes in nitrogen levels and compared it with a mass spectrometer for detecting increased end-tidal nitrogen levels in dogs with venous air embolisms. During in vitro gas flow studies (helium; oxygen; helium/oxygen mixtures; or 70% nitrous oxide/30% oxygen with 0, 1, 2, or 3% isoflurane), air boluses (0.01 to 5.0 ml) were injected into a gas flow circuit and outlet nitrogen levels were measured by a Collins 21232 emission spectrometer. Responses were greater after each bolus when helium rather than oxygen was the major diluent gas. During in vivo studies, 5 dogs were anesthetized, ventilated, denitrogenated, and given venous air embolisms (0.1, 0.5, and 1.0 ml.kg-1) during oxygen and then during Heliox (20% oxygen:80% helium) breathing. End-tidal nitrogen increased approximately two-fold after venous air embolisms given during Heliox as compared with oxygen ventilation. In all 0.1-ml.kg-1 venous air embolisms end-tidal nitrogen increased when the emission spectrometer was used, but venous air embolisms less than 1.0 ml.kg-1 were not consistently detected by mass spectrometry. Emission spectrometry can be used to detect increased end-tidal nitrogen levels indicative of venous air embolism and may be a more sensitive detector than mass spectrometry.

Russell, G.B.; Richard, R.B.; Snider, M.T. (Pennsylvania State Univ., Hershey (USA))

1990-01-01

362

Management of hepatic venous outflow obstruction.  

PubMed

Hepatic venous outflow obstruction (HVOO) is a rare cause of portal hypertension and conservative treatment is usually ineffective. A large series of patients gave us an opportunity to devise a management protocol for this disorder. Between 1978 and 1992, we prospectively studied 75 patients with HVOO. The obstruction was in the hepatic vein in 24, in the inferior vena cava (IVC) in 44, and in both in 7. For hepatic vein obstruction proximal splenorenal shunts were done in 7 (2 died postoperatively); 4 shunts blocked and only 1 patient became completely symptom free. In 2 patients with partial obstruction we performed balloon dilatation of the right hepatic veins but within 6 months the obstruction recurred. In the next 6 patients we constructed a side-to-side portocaval shunt; 2 died of encephalopathy after discharge and 4 are alive and well. For IVC obstruction, after surgical procedures had yielded poor results in 14 patients, we changed to balloon angioplasty which was successful in 28 of the 30 other patients; restenosis occurred in 4. Of the 7 patients with a combined block, 3 have had balloon angioplasty followed by a side-to-side portocaval shunt; 1 died, 2 are well, and the remainder have not completed treatment. Of our 75 patients, 22 have died (5 in hospital and 17 after discharge), 7 have not completed treatment, and 2 have been lost to follow-up. However, 44 are symptom free. We did not encounter any case of hepatocellular carcinoma. We suggest that patients with HVOO should be actively managed with a side-to-side portocaval shunt for hepatic vein obstruction, balloon angioplasty for inferior vena caval obstruction, and perhaps both procedures for those with combined obstructions. PMID:8103826

Kohli, V; Pande, G K; Dev, V; Reddy, K S; Kaul, U; Nundy, S

1993-09-18

363

Venous velocity increase with a pneumatic foot compression garment.  

PubMed

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

Ilgenfritz, F M; Meier, J R

1994-11-01

364

Gangrenous cutaneous mucormycosis caused by Rhizopus oryzae: a case report and review of primary cutaneous mucormycosis in China over Past 20 years.  

PubMed

Cutaneous mucormycosis is a rare opportunistic infection caused by zygomycetes that can be rapidly fatal if unrecognized. We describe the clinical, histopathological, fungal and molecular features of a case of gangrenous cutaneous mucormycosis. The patient presented with great necrosis on his right forearm at the site of detained intravenous cannula needle. He had type II diabetes and chronic renal insufficiency. KOH mount of black eschar showed many broad, aseptate fungal hyphae with right-angle branching. PAS staining of the tissue sample revealed similar broad hyphae in the dermis and cutis. Fungal culture and ITS sequence analysis identified this fungus as Rhizopus oryzae. As no organ involvement was detected, the patient was diagnosed with primary cutaneous mucormycosis. Considering the poor state of the patient, complete excision of the infectious tissue was performed without skin graft instead of amputation. At the same time, intravenous liposomal amphotericin B was given, starting from a small dosage and increased to a total dosage amount of 5.45 g. The wound recovered well with granulation. We emphasize that early recognition and prompt therapy including the control of the primary diseases were important. In this article, we also reviewed the features of primary cutaneous mucormycosis reported in China over the last 20 years. PMID:23615822

Li, HouMin; Hwang, Sonia Kay; Zhou, Cheng; Du, Juan; Zhang, JianZhong

2013-08-01

365

Venous Thromboembolism in the Cancer Population: Pathology, Risk, and Prevention  

PubMed Central

Patients with cancer have an increased risk of developing venous thromboembolism (VTE) and the incidence of these events has been increasing over the past decade. Venous thromboembolic events include both deep venous thrombosis and pulmonary embolism. These events contribute to higher morbidity and mortality rates. Understanding the complex pathogenesis of and risk factors for cancer-associated VTE will help guide advanced practitioners to improve outcomes with prophylaxis. The American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Society of Medical Oncology have utilized this information and developed evidence-based guidelines for prophylactic management for those who are at highest risk of developing cancer-associated VTE. This review will discuss the impact of cancer-associated VTE as well as its underlying pathogenesis, risk factors, and current recommendations for prophylaxis.

Hawbaker, Susan

2012-01-01

366

Cerebral venous thrombosis after ventriculoperitoneal shunting: a case report.  

PubMed

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

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

2014-07-15

367

Complicated cerebral venous sinus thrombosis with intracranial hemorrhage and mastoiditis.  

PubMed

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

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

2012-10-01

368

Bilateral anomalous pulmonary venous connection to bilateral superior caval veins.  

PubMed

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

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

2014-01-01

369

Venous malformations: Sclerotherapy with a mixture of ethanol and lipiodol  

SciTech Connect

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

Suh, Jin-Suck [Yonsei University, College of Medicine, Department of Diagnostic Radiology (Korea, Republic of); Shin, Kyoo-Ho [Yonsei University, College of Medicine, Department of Orthopedic Surgery (Korea, Republic of); Na, Jae-Bum [Kyungsang University, College of Medicine, Department of Diagnostic Radiology (Korea, Republic of); Won, Jong-Yun [Yonsei University, College of Medicine, Department of Diagnostic Radiology (Korea, Republic of); Hahn, Soo-Bong [Yonsei University, College of Medicine, Department of Orthopedic Surgery (Korea, Republic of)

1997-07-15

370

Upper extremity venous aneurysm as a source of pulmonary emboli.  

PubMed

Spontaneous venous aneurysms of the upper extremities and neck are rare and typically asymptomatic. We present the first reported case of a symptomatic, primary upper extremity venous aneurysm in a patient who initially presented with pulmonary emboli. A 22-year-old patient was admitted with chest pain, dyspnea, and a right axillary mass. Computed tomography revealed diffuse, bilateral pulmonary emboli in addition to a thrombosed axillary vein. Venography confirmed the diagnosis, and also revealed a subclavian vein stenosis at the crossing of the first rib. Pharmacomechanical thrombolysis, catheter-directed thrombolysis, and venoplasty were performed with adequate flow restoration, also revealing the presence of a previously thrombosed proximal brachial/distal axillary venous aneurysm. Hematologic testing showed a positive and persistent lupus anticoagulant. The patient declined surgical reconstruction and opted for long-term anticoagulation. At 24 months, the patient continued to remain symptom-free. PMID:23380560

Wallace, Justin R; Baril, Donald T; Chaer, Rabih A

2013-02-01

371

The Need of Slanted Side Holes for Venous Cannulae  

PubMed Central

Well-designed cannulae must allow good flow rate and minimize nonphysiologic load. Venous cannulae generally have side holes to prevent the rupture of blood vessel during perfusion. Optimizing side hole angle will yield more efficient and safe venous cannulae. A numerical modeling was used to study the effect of the angle (0°–45°) and number (0–12) of side holes on the performance of cannulae. By only slanting the side holes, it increases the flow rate up to 6% (in our models). In addition, it was found that increasing the number of side holes reduces the shear rate up to 12% (in our models). A new parameter called “penetration depth” was introduced to describe the interfering effect of stream jets from side holes, and the result showed that the 45°-slanted side holes caused minimum interfering for the flow in cannula. Our quantitative hemodynamic analysis study provides important guidelines for venous cannulae design.

Park, Joong Yull

2012-01-01

372

Central Venous Catheter-associated Nocardia Bacteremia in Cancer Patients  

PubMed Central

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

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

2011-01-01

373

TAFI gene polymorphisms in patients with cerebral venous thrombosis.  

PubMed

Gene polymorphisms of thrombin activatable fibrinolysis inhibition (TAFI) factor have been investigated in various studies in terms of etiology (recurrence) and treatment (fibrinolytic effect) of thrombus formation. Cerebral venous thrombosis (CVT) is a life-threatening disease observed in young persons. Fifty-nine patients with CVT and 100 healthy control subjects were enrolled in the case/control study. The association between TAFI gene polymorphisms -438G>A, +505A>G and +1040C>T and cerebral venous thrombosis was investigated. It was found that frequencies of polymorphic genotype and allele were not different in patients than in control group and that they were not significant for cerebral venous thrombosis. PMID:23264082

Tokgoz, Serhat; Zamani, Ayse Gul; Durakbasi-Dursun, Hatice Gul; Yilmaz, Osman; Ilhan, Nurhan; Demirel, Sennur; Tavli, Mithat; Sinan, Alper

2013-09-01

374

Digital subtraction angiography of the portal venous system  

SciTech Connect

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

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

1983-03-01

375

Multiple Venous Malformations with Phleboliths: Radiological-Pathological Correlation  

PubMed Central

Vascular malformations are congenital lesions that are present at birth and do not regress. However, they often present later in life. They are subdivided into two categories: (1) slow- or low-flow and (2) fast- or high-flow malformations. Low-flow malformations contain combinations of capillary, venous, and lymphatic components. Venous malformations can occur anywhere in the body, but are most frequently seen in the head and neck (40%). These lesions present in a variety of ways, from a vague blue patch to a soft blue mass, which may be single isolated or may occur in multiple areas. Treatment depends on the type of lesion, the location, degree of involvement, and the clinical symptoms. Here we are report the imaging and histopathologic findings in a patient with multiple venous malformations affecting the left side of the face and trunk.

Chava, Venkateswara Rao; Shankar, Ashwini Naveen; Vemanna, Naveen Shankar; Cholleti, Sudheer Kumar

2013-01-01

376

[Thrombotic complications of central venous catheters in hematooncological patients].  

PubMed

Central venous catheters (CVC) are frequently used in patients with a hematological disorders in order to administer drugs, stem cell infusions, blood products, parenteral alimentation as well as for blood sampling. There are known mechanical, infectious and thrombotic complications of central venous catheters in hematological patients. Infectious and thrombotic complications have been considered as separate entities so far, but there are theory and accumulating evidence that they are interrelated. Since data on central venous catheters-related thrombosis in hematological patients have been obtained mainly from retrospective studies of small size, prospective randomized studies are warranted. In this review we present current opinions about epidemiology, pathogenesis, diagnosis of CVC-related thrombosis and also its correlations with infectious CVC-related complications. PMID:20687388

Joks, Monika; Kroll, Renata; Komarnicki, Mieczys?aw

2010-01-01

377

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

SciTech Connect

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

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

1983-08-01

378

Instantaneous venous oxygenation estimation using the Photoplethysmograph (PPG) waveform  

NASA Astrophysics Data System (ADS)

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

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

2011-08-01

379

Guidelines on travel-related venous thrombosis.  

PubMed

Long duration travel is a weak risk factor for the development of venous thromboembolism (VTE). The incidence of VTE after flights of >4 h is 1 in 4656 and for flights of more than 8 h in low and intermediate risk flyers is around 0.5%. Severe symptomatic pulmonary embolism in the period immediately after travel is extremely rare after flights of <8 h. In flights over 12 h the rate is 5 per million. VTE may be attributable to travel if it occurs up to 8 weeks following the journey. The risk of travel-related thrombosis is higher in individuals with pre-existing risk factors for the development of VTE. There is no evidence for an association between dehydration and travel-associated VTE and so whilst maintaining good hydration is unlikely to be harmful it cannot be strongly recommended for prevention of thrombosis (recommendation grade 2, level of evidence, B). There is indirect evidence that maintaining mobility may prevent VTE and, in view of the likely pathogenesis of travel-related VTE, maintaining mobility is a reasonable precaution for all travellers on journeys over 3 h (2B). Global use of compression stockings and anticoagulants for long distance travel is not indicated (1C). Assessment of risk should be made on an individual basis but it is likely that recent major surgery (within 1 month), active malignancy, previous unprovoked VTE, previous travel-related VTE with no associated temporary risk factor or presence of more than one risk factor identifies those travellers at highest thrombosis risk (1C). Travellers at the highest risk of travel-related thrombosis undertaking journeys of >3 h should wear well fitted below knee compression hosiery (2B). Where pharmacological prophylaxis is considered appropriate, anticoagulants as opposed to anti-platelet drugs are recommended based on the observation that, in other clinical scenarios, they provide more effective thromboprophylaxis. Usual contraindications to any form of thromboprophylaxis need to be borne in mind (2C). PMID:21083651

Watson, Henry G; Baglin, Trevor P

2011-01-01

380

[New treatments for venous thromboembolic disease].  

PubMed

Following the landmark study by Barritt and Jordan in 1960, in which patients with venous thromboembolism (VTE) were randomized to no treatment or a combination of heparin and warfarin, antithrombotic therapy for this disease became widely accepted. This study was stopped prematurely because half of the non-treated patients had recurrent pulmonary embolism (PE), or died. It was subsequently found that after a VTE, patients given warfarin alone had a 3-4-fold higher incidence of recurrent VTE than patients given both heparin and warfarin. Since the 1990 s, standard therapy for VTE has comprised an initial 5-7 day course of parenteral anticoagulant plus warfarin continued for at least 3 months. Recently, several orally active small molecules have been evaluated in the treatment of VTE, including a direct thrombin inhibitor and direct Factor Xa inhibitors. Other novel oral agents are also in development for VTE treatment. Although the DTI ximelagatran, the first oral agent to be introduced since warfarin was withdrawn from the market in Europe because of hepatotoxicity, evidence from clinical trial evaluating other single target-specific oral agents in the treatment of VTE is encouraging. It is therefore likely that use of warfarin in the treatment and secondary prevention of VTE will decrease should these novel oral agents be introduced for these indications. Additionally, there will be less distinction between initial and long-term therapy, and a great majority of patients will be treated on an outpatient basis for prolonged periods of time. Recently these expectations were fulfilled by the results of two Phase III studies in patients with VTE. The Recover I study indicated that Dabigatran (150 mg b.d.) following an initial course of LMWH was non-inferior to the standard treatment of LMWH plus warfarin, with also a similar safety profile. The Einstein DVT study revealed that Rivaroxaban as a single agent can safely replace the standard treatment in patients with DVT. Taken together these studies and a few others that have or are about to be completed will indeed introduce a paradigm shift in the way patients with VTE will be treated. PMID:22177764

Combe, S; Büller, H-R

2011-12-01

381

Venous elasticity after treatment with Daflon 500 mg.  

PubMed

It has been demonstrated that patients predisposed to the development of varicose veins have an abnormal venous tone, and may have symptoms in the absence of obvious varicosities. It has been suggested that venotonic drugs relieve the symptoms of chronic venous insufficiency by decreasing capillary leakage and improving venous tone. The aim of this study was to determine the effect of Daflon 500 mg in patients with abnormal venous elasticity without varicose veins. Twenty-five healthy female volunteers aged 18-35 were included in the study. They presented with symptomatic varicose veins in one leg and an abnormal elastic modulus without varicosities in the opposite leg. Treatment group: 12 patients received 2 tablets of Daflon 500 mg (1000 mg/day); control group: 13 patients received no treatment. The elastic modulus K was determined using the air plethysmograph. Simultaneous measurements of calf volume changes were made in response to different venous pressures produced by a thigh pneumatic cuff. In the control group K (mean +/- sd) was 10.8 x 10(3) +/- 4.1 x 10(3) N/m2 at the beginning and 10.2 x 10(3) +/- 3.1 x 10(3) N/m2 at the end of the study (P > 0.1). In the treatment group the initial K was 10.2 x 10(3) +/- 3.9 x 10(3) N/m2 and 14.2 x 10(3) +/- 5.1 x 10(3) N/m2 at the end (P < 0.02). The results of the Wilcoxon rank sum test indicated that 4 weeks' therapy with Daflon 500 mg is effective in improving venous tone in patients with symptoms but without varicose veins. PMID:8995343

Ibegbuna, V; Nicolaides, A N; Sowade, O; Leon, M; Geroulakos, G

1997-01-01

382

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

PubMed

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

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

2013-06-01

383

Accidental Puncture of the Pulmonary Artery during a Subclavian Central Venous Catheterization  

PubMed Central

The complications associated with central venous catheterization are common and well known. Common malplacement locations have been described in the literature. We report the case of a direct puncture of the pulmonary artery during a subclavian central venous catheterization.

Moriceau, Jerome; Compere, Vincent; Bigo, Marc; Dureuil, Bertrand

2012-01-01

384

Erythrocyte volume in acidified venous blood from exercising limbs.  

NASA Technical Reports Server (NTRS)

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

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

1973-01-01

385

Renal venous diversion: an unusual treatment for renal vein thrombosis.  

PubMed

Renal venous thrombosis most commonly occurs in the setting of nephrotic syndrome, hypercoagulability, or dehydration. This can usually be treated with systemic anticoagulation, and the diversion is via natural draining tributaries, eg, adrenal, lumbar, or gonadal veins. Occasionally, renal venous thrombosis results from extension of a thrombotic process, such as a large renal cell carcinoma with tumor thrombus extension into the infrahepatic inferior vena cava resulting in thrombosis of the inferior vena cava and contralateral renal vein. Herein, we report a case of left renal vein thrombosis relieved by diversion through the inferior mesenteric vein. PMID:16765255

Ho, Karen J; Owens, Christopher D; Ledbetter, Stephen M; Chew, David K; Belkin, Michael

2006-06-01

386

Bone cement embolism attached to central venous catheter.  

PubMed

We report on a rare complication of poly(methyl methacrylate) (PMMA), injected into the spine, which then inadvertently leaked into the venous system. This resulted in an embolism of PMMA and produced a mass surrounding a triple lumen central venous catheter located in the superior vena cava. The catheter as well as the attached mass of PMMA was retrieved safely by cardiothoracic surgery. This case emphasizes the importance of prompt diagnosis and treatment and illustrates the need for close monitoring of patients undergoing any spinal surgery that includes vertebroplasty. PMID:24318858

Schummer, W; Schlonski, O; Breuer, M

2014-04-01

387

Congenital extensive central venous thrombosis with chylous ascites and chylothoraces.  

PubMed

We describe a case of congenital extensive central venous thrombosis presenting as polyhydramnios and massive ascites, requiring amnioreduction prenatally and refractory chylous ascites and chylothoraces postnatally. Echocardiography, computed tomography angiogram (CTA), and magnetic resonance venogram (MRV) were helpful in defining the nature and extent of the lesion. The patient underwent staged procedures of repeated abdominal paracentesis, chest drain insertion, and right internal jugular vein exploration initially. Subsequently, open thromboembolectomy from the upper venous system veins and pericardial patch angioplasty of the right internal jugular and right innominate veins were required and managed by catheter-directed thrombolysis for the residual thrombosis with successful recovery. PMID:23414902

Patel, Ramnik; Griselli, Massimo; Barrett, A M

2013-02-01

388

Venous gas embolism during cryosurgery for bone tumors.  

PubMed

Cryosurgery using liquid nitrogen is a method for treating benign- and low-malignant skeletal tumors. The advantage of preserving the supportive function of bone should be compared to the risk for its complications; postoperative fracture is well known, but less so the occurrence of intraoperative venous gas embolism. This paper describes 17 patients: 2 patients who had serious hemodynamic complications during cryosurgery and a study of 15 patients in whom end-tidal N2 tension was measured in an attempt to investigate the clinical incidence of venous gas embolism during cryosurgery. In the 15 cases analyzed, we did not detect any exhaled N2 during cryosurgery. PMID:7475071

Schreuder, H W; van Beem, H B; Veth, R P

1995-11-01

389

Deep venous thrombosis: value of self-augmentation US evaluation.  

PubMed

In 10 healthy volunteers (three men and seven women, aged 24-35 years [mean, 27 years]) and 28 patients (11 men and 17 women, aged 38-74 years [mean, 60 years]) with symptoms for deep venous thrombosis (DVT), self-augmentation ultrasound (US) scanning was performed. The technique resulted in diagnostically useful venous flow augmentation in the femoropopliteal veins in all 10 (100%) limbs of volunteers, in 25 of 27 (93%) limbs of patients without DVT, and in two of seven (29%) limbs of patients with DVT. Of the patients in whom self-augmentation failed, two could not perform the maneuver and five had scans positive for DVT. PMID:8284421

Kliewer, M A; Sandridge, B K; Hertzberg, B S; Bowie, J D

1994-02-01

390

Repositioning of malpositioned or flipped central venous catheters.  

PubMed

Primary misplaced or secondary flipped implanted catheters are located mostly in the right jugular vein. We demonstrate an effective method to replace fix implanted catheters such as Ports, Grochomg or Hickman catheters. Using a femoral venous approach, replacement into the superior vena cava can easily be done with a Sidewinder 1 catheter which is hooked over the misplaced central venous approach. In all our patients the method was successful. The repositioning technique described is simple, fast and has low costs. We can keep sterile conditions and do not need to solve the catheters' fixation. PMID:11870490

Thalhammer, A; Jacobi, V; Balzer, J; Vogl, T J

2002-03-01

391

Successful treatment of cerebral venous thrombosis associated with ulcerative colitis.  

PubMed

Thromboembolic complications, such as deep venous thrombosis and pulmonary embolism, are well described in patients with inflammatory bowel disease, but cerebral venous thrombosis (CVT) is a rare but potentially devastating complication. The authors describe the case of a 36-year-old Japanese man presenting with CVT associated with ulcerative colitis (UC) that was successfully treated with a combination of continuous anticoagulant and pulse steroid therapy. Our observations suggest that aggressive therapy for inducing acute UC remission is vitally important for CVT associated with UC. PMID:23938340

Suda, Satoshi; Katsura, Ken-ichiro; Okubo, Seiji; Abe, Arata; Suzuki, Kentaro; Suzuki, Masanori; Katayama, Yasuo

2013-11-01

392

Paradoxical air embolism following central venous catheter removal.  

PubMed

Central venous catheters are commonly used in the management of critically ill patients. This case report described a rare but potentially fatal complication of central venous catheter use. A 52-year-old man underwent mechanical aortic valve replacement for infective endocarditis. On day 8 postoperatively he accidentally removed his catheter and collapsed with symptoms and signs suggestive of a cerebral air embolism. A transthoracic echocardiogram showed air bubbles in both the right and left ventricles of the heart confirming the presence of a paradoxical air embolism. PMID:24072837

Khan, Hiba; Zaidi, Afzal

2013-01-01

393

Venous thromboembolism is a product in proliferation of cancer cells  

PubMed Central

The pathogenesis of venous thromboembolism (VTE) in patients with cancer is related to the destruction of small veins and the intravenous formation of filamentous mesh-like structure by fibrinogen. The filamentous mesh-like filter can block hematogenous metastasis of cancer cells and also can stagnate blood cells, leading to venous thrombosis. Cancer cells have characteristics of malignancy and fast proliferation, and ischemic necrosis frequently occurs, and small veins were invaded and damaged. The formation of filamentous mesh-like structure has defense function and also may cause the occurrence of VTE. VTE is a product of the proliferation process of malignant cells.

Wang, Le-Min; Duan, Qiang-Lin; Yi, Xiang-Hua; Zeng, Yu; Gong, Zhu; Yang, Fan

2014-01-01

394

Endovascular Therapy for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis  

PubMed Central

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

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

2011-01-01

395

Modification of the trap door technique to treat venous aneurysms in arteriovenous fistulae.  

PubMed

We present a modification of the "trap door" technique to treat true venous aneurysms which complicate vascular access arteriovenous fistula. The technique provides wide exposure of the aneurysm, facilitating aneurysmoraphy and permitting the exploitation of any adequate venous length for autologous reconstruction of the venous outflow. Furthermore, by precluding the proximity of the newly-reconstructed venous segments to the incised skin, their level of compromise from tissue scarring or infection is prevented. PMID:22020527

Kapoulas, Konstantinos C; Georgakarakos, Efstratios I; Georgiadis, George S; Lazarides, Miltos K

2012-01-01

396

[Anatomic and hemodynamic changes in the venous vascular bed in the lower extremities with chronic venous insufficiency].  

PubMed

The authors paid attention to revealing as precisely as possible anatomical and haemodynamic conditions in venous vascular bed in the course of ultrasonographic examination of 309 lower extremities with clinical manifestations of chronic venous insufficiency (CVI). A combined reflux in the superficial and deep venous system (53.7%) or isolated reflux in superficial veins (25.9%) proved to be the most frequent pathogenic bases of CVI. Pathophysiology of varices was mostly based on the venous reflux and the primary idiopathic CVI was mostly present (98.1%). The post-thrombotic partial obstruction of the deep venous system (post-thrombotic venous changes on the walls) was demonstrated exceptionally (1.9%). A high coincidence of reflux in the deep and superficial venous system points out to s.c. secondary reflux in the deep veins originating on the basis of primary reflux in the large or small saphena. An attempt was made to clarify, whether the development and frequency of incompetent perforators is directly connected with the presence and seriousness of reflux in the large and small saphena. The presence and severity of large saphena insufficiency does not univocally indicate the presence of dilated or insufficient perforators on the medical side of the crus, where these anastomoses are present most frequently. The large saphena is a long vein typically suffering from segmental insufficiency, i.e. reflux affecting a certain portion, whereas other parts of the vein may be fully competent. Anatomical venous variability and abnormalities on lower extremities were demonstrated in every fifth extremity (62 extremities, 20.1%). Most of them concerned large saphena (39 extremities, 62.8%), small saphena being second (15 extremities, 25.2%). Other anatomical deviations occurred sporadically as solitary findings. In the large saphena, duplication was present most frequently (54.8%). Insufficient variable superficial veins and anatomical venous anomalies were mostly not the only pathogenic basis of CVI, but were predominantly associated with insufficiently in the area of deep veins and perforators (84%). In our cohort there were altogether 55 extremities (17.8%) after the operation on superficial venous system, where relapses of varices were found. The causes of post-operation relapse of varices may be divided into three groups: 1. insufficiency of the large saphena, 2. insufficiency of the small saphena and 3. insufficiency of the deep veins. A combined simultaneous insufficiency in several venous systems was found most frequently (27 extremities, 49.1%). Even though the reflux in the deep veins was demonstrated in 50.9% of these extremities, a combination with the reflux in superficial veins and perforators (49.1%) was present with the exception of one case of isolated insufficiency. The insufficiency of the large and small saphena was clearly the leading single causes (15 extremities, 27.3%) of varix relapses. The patients should never be operated on the venous system of lower extremities without previous detailed ultrasonographic examination. It is the only way to increase probability of the operation success and to decrease the risk of relapses of CVI manifestations. PMID:14518084

Musil, D; Herman, J

2003-08-01

397

Role of the venous system in hemodynamics during ultrafiltration and bicarbonate dialysis  

Microsoft Academic Search

Role of the venous system in hemodynamics during ultrafiltration and bicarbonate dialysis. A reduced venous compliance (VC) and inadequate venoconstriction may impair hemodynamics during hemodialysis, the first by impairing plasma volume preservation and by inducing a steep fall in central venous pressure (CVP) during minor plasma volume loss, the second by inadequate mobilization of hemodynamically inactive blood volume. For the

Jeroen P Kooman; Ulrich Gladziwa; Georg Böcker; Luc MAB van Bortel; Johannes P van Hooff; Karel ML Leunissen

1992-01-01

398

Confirmation of Peripheral Neuropathy in Patients withVenous Ulceration Through Immunohistochemistry  

Microsoft Academic Search

Patients with venous ulceration demonstrate clinical signs of peripheral neuropathy. Using immunohistochemistry we investigated cutaneous innervations immediately adjacent to chronic and healing venous ulcers. Punch biopsies (4 mm) were taken from sites adjacent to venous ulcers: (1) from nonhealing ulcers (n = 15), (2) from healing ulcers and (n = 14), and (3) from control patients with varicose veins (n

Michael Guest; Jitesh H. Parmar; C. Bunker; A. Rowe; Alun H. Davies

2004-01-01

399

Chronic venous insufficiency and the therapeutic effects of Daflon 500 mg.  

PubMed

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

Bergan, John J

2005-01-01

400

Evaluation by angiography of the lateral dominance of the drainage of the dural venous sinuses  

Microsoft Academic Search

Summary Venous drainage dominance of the dural venous sinuses may be defined as the drainage only or mainly into one of the transverse sinuses, as shown by bilateral carotid angiography. The aim of this study was to evaluate the venous drainage dominance in bilateral carotid angiograms of 189 cases retrospectively. Among these cases 41.3% showed drainage mainly to the right

B Durgun; ET Ilgit; Mo Çizmeli; A Atasever

1993-01-01

401

On-line venous oxygen tensions in rainbow trout during graded exercise at two acclimation temperatures  

Microsoft Academic Search

For most teleost fish, the majority of the myocardial oxygen supply is provided by the oxygen reserve remaining in venous blood after other tissues have extracted oxygen. We examined the effect of graded exercise and water temperature on this venous blood oxygen supply to the heart (termed the cardiac circulation) by performing novel on-line measurements of venous partial pressure of

A. P. Farrell; S. M. Clutterham

2003-01-01

402

Alteration in the Venous Drainage of a Dural Arteriovenous Fistula following Angioplasty  

Microsoft Academic Search

Summary: The pattern of venous drainage from a dural arteriovenous fistula (DAVF) has been shown to affect the natural history of these lesions. Angioplasty and stent placement of the dural sinuses have been described to improve outflow in venous hypertensive states and may improve the venous drainage pattern from a DAVF. We report the case of a patient with a

Arturo Gutierrez; Huy M. Do; Michael P. Marks

403

Effect of beta-aescin extract from Chinese buckeye seed on chronic venous insufficiency.  

PubMed

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

Yu, Zhihong; Su, Ping

2013-06-01

404

Hemoglobin measured by Hemocue and a reference method in venous and capillary blood: a validation study  

Microsoft Academic Search

Objective. To assess the comparability of hemoglobin con- centration (Hb) in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn) and to document the influence of type of blood (capillary or venous) and analysis method on anemia prevalence esti- mates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults

Lynnette Neufeld; Armando García-Guerra; Domingo Sánchez-Francia; Oscar Newton-Sánchez; María Dolores Ramírez-Villalobos; Juan Rivera-Dommarco

2002-01-01

405

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

Microsoft Academic Search

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

Susan R. Kahn; Andrew Hirsch; Ian Shrier

2002-01-01

406

Changing concepts in long-term central venous access: Catheter selection and cost savings  

Microsoft Academic Search

Background And Objectives: Long-term central venous access is becoming an increasingly important component of health care today. Long-term central venous access is important therapeutically for a multitude of reasons, including the administration of chemotherapy, antibiotics, and total parenteral nutrition. Central venous access can be established in a variety of ways varying from catheters inserted at the bedside to surgically placed

Mark C. Horattas; John Trupiano; Steve Hopkins; Debbie Pasini; Carl Martino; Aparna Murty

2001-01-01

407

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

Microsoft Academic Search

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

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

2009-01-01

408

Testosterone Products Must Warn About Risk of Venous Clots: FDA  

MedlinePLUS

... with testosterone treatment. In its statement Friday, the FDA said that after receiving reports of blood clots in the veins unrelated to polycythemia in patients taking testosterone products, it has now decided to require a more general warning on venous blood clots on the labelling. Blood ...

409

Sticky Platelet Syndrome in Patients with Uninduced Venous Thrombosis  

PubMed Central

Objective: Sticky platelet syndrome (SPS) is a common autosomal dominant inherited platelet disorder. SPS is characterized by platelet hyperreactivity and is associated with arterial and venous thrombosis. The aim of this study was to determine the role of SPS in patients with uninduced venous thrombosis. Material and Methods: The study included 28 patients (15 male and 13 female) with uninduced venous thrombosis. SPS was defined according to Mammen’s aggregation method, which is described in detail elsewhere. Results: According to the defined ranges for platelet hyperreactivity, 3 (50%) patients, 2 (33%), and 1 (17%) (n =6 [21%]) with a confirmed diagnosis were classified as type II, I, and III SPS, respectively. In 1 patient SPS was the only hereditary abnormality noted. The other 5 patients carried other inherited coagulation defects, in addition to SPS. Conclusion: The present findings indicate that the prevalence of SPS was 21% in the patients with uninduced venous thrombosis. We therefore suggest that SPS should be considered in the differential diagnosis of such cases. Conflict of interest:None declared.

Tekgunduz, Emre; Demir, Muzaffer; Akyol Erikci, Alev; Akp?nar, Seval; Ozturk, Erman; K?rk?zlar, Onur

2013-01-01

410

Sticky platelet syndrome in patients with uninduced venous thrombosis.  

PubMed

Objective: Sticky platelet syndrome (SPS) is a common autosomal dominant inherited platelet disorder. SPS is characterized by platelet hyperreactivity and is associated with arterial and venous thrombosis. The aim of this study was to determine the role of SPS in patients with uninduced venous thrombosis. Material and Methods: The study included 28 patients (15 male and 13 female) with uninduced venous thrombosis. SPS was defined according to Mammen's aggregation method, which is described in detail elsewhere. Results: According to the defined ranges for platelet hyperreactivity, 3 (50%) patients, 2 (33%), and 1 (17%) (n =6 [21%]) with a confirmed diagnosis were classified as type II, I, and III SPS, respectively. In 1 patient SPS was the only hereditary abnormality noted. The other 5 patients carried other inherited coagulation defects, in addition to SPS. Conclusion: The present findings indicate that the prevalence of SPS was 21% in the patients with uninduced venous thrombosis. We therefore suggest that SPS should be considered in the differential diagnosis of such cases. Conflict of interest:None declared. PMID:24385753

Tekgündüz, Emre; Demir, Muzaffer; Akyol Erikçi, Alev; Akp?nar, Seval; Oztürk, Erman; K?rk?zlar, Onur

2013-03-01

411

Air travel and venous thromboembolism: minimizing the risk.  

PubMed

For those traveling on long flights, the risk of deep vein thrombosis or pulmonary embolism, generally referred to as venous thromboembolism (VTE), is real and dangerous if left unrecognized or untreated. The goal of this publication is to provide an overview of how best to prevent VTE during travel, and how to diagnose and treat it. PMID:21285343

Bartholomew, John R; Schaffer, Jonathan L; McCormick, Georges F

2011-02-01

412

Adrenal venous sampling: evaluation of the German Conn's registry.  

PubMed

In patients with primary aldosteronism, adrenal venous sampling is helpful to distinguish between unilateral and bilateral adrenal diseases. However, the procedure is technically challenging, and selective bilateral catheterization often fails. The aim of this analysis was to evaluate success rate in a retrospective analysis and compare data with procedures done prospectively after introduction of measures designed to improve rates of successful cannulation. Patients were derived from a cross-sectional study involving 5 German centers (German Conn's registry). In the retrospective phase, 569 patients with primary aldosteronism were registered between 1990 and 2007, of whom 230 received adrenal venous sampling. In 200 patients there were sufficient data to evaluate the procedure. In 2008 and 2009, primary aldosteronism was diagnosed in 156 patients, and adrenal venous sampling was done in 106 and evaluated prospectively. Retrospective evaluation revealed that 31% were bilaterally selective when a selectivity index (cortisol adrenal vein/cortisol inferior vena cava) of ?2.0 was applied. Centers completing <20 procedures had success rates between 8% and 10%. Overall success rate increased in the prospective phase from 31% to 61%. Retrospective data demonstrated the pitfalls of performing adrenal venous sampling. Even in specialized centers, success rates were poor. Marked improvements could be observed in the prospective phase. Selected centers that implemented specific measures to increase accuracy, such as rapid-cortisol-assay and introduction of standard operating procedures, reached success rates of >70%. These data demonstrate the importance of throughput, expertise, and various potentially beneficial measures to improve adrenal vein sampling. PMID:21383311

Vonend, Oliver; Ockenfels, Nora; Gao, Xing; Allolio, Bruno; Lang, Katharina; Mai, Knut; Quack, Ivo; Saleh, Andreas; Degenhart, Christoph; Seufert, Jochen; Seiler, Lysann; Beuschlein, Felix; Quinkler, Marcus; Podrabsky, Petr; Bidlingmaier, Martin; Lorenz, Reinhard; Reincke, Martin; Rump, Lars Christian

2011-05-01

413

Endovascular correction of an infantile intracranial venous outflow obstruction.  

PubMed

The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization. PMID:24138142

Soltanolkotabi, Maryam; Rahimi, Shahram; Hurley, Michael C; Bowman, Robin M; Russell, Eric J; Ansari, Sameer A; Shaibani, Ali

2013-12-01

414

Ethanol Sclerotherapy of Superficial Venous Malformation: A New Procedure  

Microsoft Academic Search

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

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

2010-01-01

415

Treatment of Venous Thrombosis in the Cancer Patient  

Microsoft Academic Search

Venous thromboembolism is a common complication in patients with cancer. The management of deep vein thrombosis and pulmonary embolism can be a considerable challenge in patients with cancer. The cancer itself and associated treatments contribute to an ongoing thrombogenic stimulus, while cancer patients are thought to be at increased risk for anticoagulant-induced bleeding. Initial treatment of acute thromboembolism is with

Mark N. Levine; Agnes Y. Y. Lee

2001-01-01

416

Deep venous thrombosis after percutaneous insertion of vena caval filters  

Microsoft Academic Search

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

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

1999-01-01

417

Venous Thromboembolism in Young Patients From Western India: A Study  

Microsoft Academic Search

The goal of this article is to study the association of known markers of thrombophilia with venous thrombosis in young patients (< 45 years) from the Western part of India. A prospective study of 432 patients (252 males and 180 females, age 1-45 years) was conducted between 1994 and 2000 (6 years). The diagnosis was confirmed in all the patients

K. Ghosh; S. Shetty; M. Madkaikar; A. Pawar; S. Nair; A. Khare; A. Pathare; F. Jijina; D. Mohanty

2001-01-01

418

Air travel and venous thromboembolism: minimizing the risk.  

PubMed

For those traveling on long flights, the risk of deep vein thrombosis or pulmonary embolism, generally referred to as venous thromboembolism (VTE), is real and dangerous if left unrecognized or untreated. The goal of this article is to provide an overview of how best to prevent VTE during travel, and how to diagnose and treat it. PMID:21736207

Bartholomew, John R; Schaffer, Jonathan L; McCormick, Georges F

2011-06-01

419

[Cell technologies in complex treatment of venous trophic ulcers].  

PubMed

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

Gavrilenko, A V; Pavlova, O V; Ivanov, A A; Vakhrat'ian, P E; Dashinimaev, É B; Li, R A

2011-01-01

420

Extra-abdominal venous thromboses at unusual sites.  

PubMed

Venous thrombosis typically involves the lower extremities. Rarely, it can occur in cerebral, splanchnic, or renal veins, with a frightening clinical impact. Other rare manifestations are upper-extremity deep vein thrombosis, that can complicate with pulmonary embolism and post-thrombotic syndrome, and retinal vein occlusion, significantly affecting the quality of life. This review is focused on venous thromboses at unusual extra-abdominal sites. Local infections or cancer are frequent in cerebral sinus-venous thrombosis. Upper-extremity deep vein thrombosis is mostly due to catheters or effort-related factors. Common risk factors are inherited thrombophilia and oral contraceptive use. Acute treatment is based on heparin; in cerebral sinus-venous thrombosis, local or systemic fibrinolysis should be considered in case of clinical deterioration. Vitamin-K antagonists are recommended for 3-6 months; indefinite anticoagulation is suggested for recurrent thrombosis or unprovoked thrombosis and permanent risk factors. However, such recommendations mainly derive from observational studies; there are no data about long-term treatment of retinal vein occlusion. PMID:22959543

Martinelli, Ida; De Stefano, Valerio

2012-09-01

421

Right Upper Lobe Partial Anomalous Pulmonary Venous Connection  

PubMed Central

Partial anomalous pulmonary venous return (PAPVR) is a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. We report a case of a 45-year-old male with PAPVR to superior vena cava which was incidentally discovered during a right lower bilobectomy for lung cancer.

Tourmousoglou, Christos; Kalogeropoulou, Christina; Koletsis, Efstratios; Charoulis, Nikolaos; Prokakis, Christos; Alexopoulos, Panagiotis; Margaritis, Emmanoil; Dougenis, Dimitrios

2014-01-01

422

Continuous veno-venous haemofiltration following cardio-pulmonary bypass  

Microsoft Academic Search

Objective: To study the impact of continuous veno-venous haemofiltration on survival in patients with acute renal failure (ARF) following cardio-pulmonary bypass (CPB) surgery. Design: A retrospective study of all patients requiring haemofiltration after CPB over a 2 year period. Setting: A 20 bedded, adult cardothoracic intensive care unit in a postgraduate teaching hospital. Patients.\\

S. V. Baudouin; J. Wiggins; B. F. Keogh; C. J. Morgan; T. W. Evans

1993-01-01

423

What went wrong? The flawed concept of cerebrospinal venous insufficiency  

PubMed Central

In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency (‘CCSVI'). The diagnosis of ‘CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of ‘CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the ‘CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the ‘CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat ‘CCSVI' in the care of MS patients, outside of the setting of scientific research.

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

2013-01-01

424

Neutrophil elastase activity in pulmonary venous blood during lung resection  

PubMed Central

OBJECTIVES Neutrophil elastase has been reported to play an important role in acute lung injury, which is a major cause of postoperative mortality after pulmonary resection. Neutrophil elastase released in the lungs reaches the peripheral circulation via the pulmonary veins. This study was performed to compare neutrophil elastase activity in pulmonary venous blood (collected during lobectomy) with that in the peripheral blood, and to determine the perioperative changes of neutrophil elastase activity. METHODS In 34 patients undergoing lobectomy with mediastinal lymph node dissection, the leucocyte count, neutrophil count, neutrophil elastase activity and levels of tumour necrosis factor-?, interleukin-6 and interleukin-8 were measured in the pulmonary venous blood and peripheral arterial blood before and after surgery. Then, these parameters were compared between before and after surgery with peripheral and pulmonary blood. RESULTS Neutrophil elastase activity was found to be significantly higher in pulmonary venous blood at the completion of surgery than at the start (during thoracotomy), while the neutrophil elastase activity of peripheral arterial blood showed no significant change between the start and completion of surgery. CONCLUSIONS In conclusion, measurement of neutrophil elastase activity in pulmonary venous blood revealed changes associated with lobectomy.

Nagamatsu, Yoshinori; Iwasaki, Yasunori; Omura, Harutaka; Hayashida, Ryozo; Kashihara, Masaki; Nishi, Tatsuya; Yoshiyama, Koichi; Shirouzu, Kazuo

2012-01-01

425

Lower motor neuron facial palsy in cerebral venous sinus thrombosis.  

PubMed

With advances in the neuro-imaging modalities, diverse manifestations of the cerebral venous sinus thrombosis (CVT) are being recognized. There are very few reports of isolated cranial nerve palsies in CVT. In this case report, we describe a patient of lower motor neuron facial palsy with CVT who was successfully treated with anticoagulation, highlighting the atypical manifestation of the disease. PMID:23914113

Kulkarni, Girish Baburao; Ravi, Yadav; Nagaraja, Dindigur; Veerendrakumar, Mustare

2013-04-01

426

Travel as a Risk Factor for Venous Thromboembolic Disease  

Microsoft Academic Search

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

Emile Ferrari; Thierry Chevallier; Alexis Chapelier; Marcel Baudouy

427

Concomitant Cavernous Hemangioma and Venous Angioma of the Orbit  

Microsoft Academic Search

Background An unusual case of cavernous hemangioma coexisting with venous angioma in the ipsilateral orbit is described. Case A 67-year-old woman had a mass in the lower eyelid of her right eye and proptosis. Imaging examinations showed two masses connected to each other in the extraconal space of the right orbit. Observations Anterior orbitotomy was performed to remove the tumors.

Tatsuo Kodama; Nobuhiro Tane; Akihiro Ohira; Yotaro Matsuoka; Riruke Maruyama

2004-01-01

428

Calibrated BOLD using direct measurement of changes in venous oxygenation  

PubMed Central

Calibration of the BOLD signal is potentially of great value in providing a closer measure of the underlying changes in brain function related to neuronal activity than the BOLD signal alone, but current approaches rely on an assumed relationship between cerebral blood volume (CBV) and cerebral blood flow (CBF). This is poorly characterised in humans and does not reflect the predominantly venous nature of BOLD contrast, whilst this relationship may vary across brain regions and depend on the structure of the local vascular bed. This work demonstrates a new approach to BOLD calibration which does not require an assumption about the relationship between cerebral blood volume and cerebral blood flow. This method involves repeating the same stimulus both at normoxia and hyperoxia, using hyperoxic BOLD contrast to estimate the relative changes in venous blood oxygenation and venous CBV. To do this the effect of hyperoxia on venous blood oxygenation has to be calculated, which requires an estimate of basal oxygen extraction fraction, and this can be estimated from the phase as an alternative to using a literature estimate. Additional measurement of the relative change in CBF, combined with the blood oxygenation change can be used to calculate the relative change in CMRO2 due to the stimulus. CMRO2 changes of 18 ± 8% in response to a motor task were measured without requiring the assumption of a CBV/CBF coupling relationship, and are in agreement with previous approaches.

Driver, Ian D.; Hall, Emma L.; Wharton, Samuel J.; Pritchard, Susan E.; Francis, Susan T.; Gowland, Penny A.

2012-01-01

429

Thoracic venous congestion caused by thoracic disc herniation  

PubMed Central

We present what is to our knowledge the first reported case of thoracic disc herniation leading to venous congestive myelopathy (VCM), which was clinically and radiographically suggestive of Foix–Alajouanine syndrome (angiodysgenetic necrotizing myelopathy). In addition, we review current concepts in evaluating the etiology of VCM and discuss indications for surgery.

Roger, Eric P; Chamczuk, Andrea J; Hagan, Marygrace C

2013-01-01

430

Noninvasive methods of measuring oxygen saturation in venous blood  

NASA Astrophysics Data System (ADS)

The feasibility of measuring oxygen saturation in venous blood both by artificial modulation of the volume of tissue filled with blood and by determining the respiratory rhythm from a Fourier spectrum is demonstrated. Both methods have advantages and limitations. The results obtained by the two methods correlate well with one another and with published data.

Yesman, S. S.; Mamilov, S. A.; Asimov, M. M.; Gisbreht, A. I.

2011-07-01

431

Venous Collateral Circulation of the Extracranial Cerebrospinal Outflow Routes  

Microsoft Academic Search

A new nosologic vascular pattern that is defined by chronic cerebrospinal venous insufficiency (CCSVI) has been strongly associated with multiple sclerosis. The picture is characterized by significant obstacles of the main extracranial cerebrospinal veins, the jugular and the azygous system, and by the opening of substitute circles. The significance of collateral circle is still neglected. To the contrary, substitute circles

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

2009-01-01

432

Anomalous venous blood flow and iron deposition in multiple sclerosis  

Microsoft Academic Search

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

Ajay Vikram Singh; Paolo Zamboni

2009-01-01

433

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

PubMed

In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research. PMID:23443168

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

2013-05-01

434

Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis  

Microsoft Academic Search

Background: The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. Methods: Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined

P Zamboni; R Galeotti; E Menegatti; A M Malagoni; G Tacconi; S Dall' Ara; I Bartolomei; F Salvi

2010-01-01

435

Factors affecting umbilical venous perfusion during experimental cord knotting.  

PubMed

The aim was to determine experimentally the factors that increase the risk of venous occlusion by applying a standardised tightening force to isolated perfused umbilical cords tied in a true knot in vitro. Umbilical cords were collected from patients undergoing Caesarean section. Cords were clamped, isolated and studied within 15 min. The umbilical vein was cannulated, the cord tied in a true knot and traction was applied using standard weights. The umbilical vein was perfused with modified Krebs solution at a constant pressure of 40 mmHg and the attached weight increased until perfusion ceased. The cord mass index (weight/length), hydration index/100-[(dry weight/wet weight)x100], and coiling index (coils/length) were determined. Cord morphometric analysis was performed on 193 cords. Intra uterine growth restriction was associated with decreased cord mass index (p=0.002) and increased coiling index (p=0.002). Venous perfusion experiments were performed on 75 cords. Using multivariate regression analysis, cord morphometric factors that increased the risk of cord occlusion were decreased cord mass index (p=0.008), decreased cord hydration index (p=0.004), and low venous flow capacity (p=0.001). During experimental cord knotting with applied traction, the susceptibility to venous occlusion was increased with low cord mass index, low cord hydration index and low venous flow capacity. These cord characteristics were associated with low fetal body weight and intrauterine growth restriction. An increased susceptibility to cord occlusion may contribute to the higher perinatal morbidity and mortality in growth restricted pregnancies. PMID:16226125

Tuxen, A J; Permezel, M; Walker, S P; Georgiou, H M

2005-11-01

436

Cerebral venous-sinus thrombosis: a case series analysis.  

PubMed

Background: Cerebral venous-sinus thrombosis is an uncommon form but important cause of stroke, especially in young-aged women.Methods: We performed a retrospective descriptive-analytical study in which 124 patients with cerebral venous-sinus thrombosis, who referred to Nemazee Hospital, Shiraz University of Medical Sciences from January 2000 to March 2008, were included, and their demographic, etiologic, radiological and prognostic characteristics were evaluated.Results: The patients' mean age was 34.01±10.25. Eighty seven (70.16%) were women and 37 (29.83%) were men. The most frequent clinical manifestations were headache, papilledema and seizures. Fifty seven (65.51%) women took oral contraceptive pills. Twenty of 57 women (35.08%) took the pill longer than one month to be able to fast in Ramadan or perform the Hajj ceremonies. In the mean time they developed cerebral venous-sinus thrombosis. Superior sagital sinus, with or without lateral sinuses, was the most involved area (70.96%). High mortality and morbidity rates (14.51% and 35.48%, respectively) were found in patients. Poor prognostic factors at the time of admission were stupor and coma (P=0.001) and evidence of hemorrhage in primary CT scan (P=0.005).Conclusion: Taking oral contraceptive pills was a main factor associated with cerebral venous-sinus thrombosis. Clinical manifestations, prognostic factors, common involved sinuses and image findings of this study were similar to those of other studies. Health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous-sinus thrombosis, and to educate them the ways to prevent it. PMID:23359749

Ashjazadeh, Nahid; Borhani Haghighi, Afshin; Poursadeghfard, Maryam; Azin, Hoseinjan

2011-09-01

437

Cerebral Venous-Sinus Thrombosis: A Case Series Analysis  

PubMed Central

Background: Cerebral venous-sinus thrombosis is an uncommon form but important cause of stroke, especially in young-aged women. Methods: We performed a retrospective descriptive-analytical study in which 124 patients with cerebral venous-sinus thrombosis, who referred to Nemazee Hospital, Shiraz University of Medical Sciences from January 2000 to March 2008, were included, and their demographic, etiologic, radiological and prognostic characteristics were evaluated. Results: The patients' mean age was 34.01±10.25. Eighty seven (70.16%) were women and 37 (29.83%) were men. The most frequent clinical manifestations were headache, papilledema and seizures. Fifty seven (65.51%) women took oral contraceptive pills. Twenty of 57 women (35.08%) took the pill longer than one month to be able to fast in Ramadan or perform the Hajj ceremonies. In the mean time they developed cerebral venous-sinus thrombosis. Superior sagital sinus, with or without lateral sinuses, was the most involved area (70.96%). High mortality and morbidity rates (14.51% and 35.48%, respectively) were found in patients. Poor prognostic factors at the time of admission were stupor and coma (P=0.001) and evidence of hemorrhage in primary CT scan (P=0.005). Conclusion: Taking oral contraceptive pills was a main factor associated with cerebral venous-sinus thrombosis. Clinical manifestations, prognostic factors, common involved sinuses and image findings of this study were similar to those of other studies. Health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous-sinus thrombosis, and to educate them the ways to prevent it.

Ashjazadeh, Nahid; Haghighi, Afshin Borhani; Poursadeghfard, Maryam; Azin, Hoseinjan

2011-01-01

438

Fingertip Reconstruction Using Free Toe Tissue Transfer Without Venous Anastomosis  

PubMed Central

Background This study was designed to introduce the feasibility of toe tissue transfer without venous outflow for fingertip reconstruction. Methods Five cases of fingertip defects were treated successfully with this method. Four cases were traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp of a great toe or medioinferior portion of a second toe was used as the donor site. An arterial pedicle was dissected only within the digit and anastomosis was performed within 2 cm around the defect margin. The digital nerve was repaired simultaneously. No additional dissection of the dorsal or volar pulp vein was performed in either the donor or recipient sites. Other surgical procedures were performed following conventional techniques. Postoperative venous congestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation. Venous congestion was decompressed with a needle-puncture method intermittently, but did not require continuous external bleeding for salvage. Results Venous congestion was observed in all the flaps, but improved within 3 or 4 days postoperatively. The flap size was from 1.5×1.5 cm2 to 2.0×3.0 cm2. The mean surgical time was 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the first postoperative day, and then every 4 hours thereafter. The amount of blood loss during each puncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy was observed. Conclusions When used properly, the free toe tissue transfer without venous anastomosis method can be a treatment option for small defects on the fingertip area.

Yoon, Won Young

2012-01-01

439

Endoluminal treatment for venous vascular complications of malignant tumors  

PubMed Central

The aim of this study was to explore the efficacy and safety of interventional treatment for venous vascular complications of malignant tumors. Sixty-one patients with venous vascular complications of malignant tumors were treated from May 2002 to May 2009; 37 men and 24 women with mean age 57.8 years (33–82 years). Lesions included acute deep vein thrombosis (n=18); venous stenosis or occlusion (n=32); tumor embolus in vein (n=11). The interventional therapeutic operations included vena cava filter implantation, trans-catheter thrombolytic therapy, recanalization, percutaneous transluminal angioplasty (PTA) and stenting. The success rate of thrombolysis and stent implantation, the clinical success rate, complications, recurrence rate of the treated region and survival duration were recorded. Eighteen patients accepted filter and thrombolytic therapy with a success rate of 100%; total urokinase dosage was 7.42±1.49 (4.5–10) million units. Symptoms disappeared (n=15), were palliated (n=3) and thrombi were completely dissolved (n=2), almost completely dissolved (n=8, >90%), partially dissolved (n=6, 50–90%) and not dissolved (n=2, <50%). No pulmonary embolism emerged after the operation. Forty-three patients accepted recanalization, PTA and stent therapy with a success rate of 95.3% (41/43). Symptoms disappeared (n=25), were palliated (n=16) and did not change (n=2) 3 days following the operation. There were no severe complications during the procedure. During follow-up, 12 patients again suffered symptoms of venous occlusion and 47 patients died of tumor aggravation without symptom recurrence. As a result, interventional therapy has advantages including smaller injuries, well tolerance, high success rate, quick palliation of symptoms and superior clinical efficacy in the treatment of venous vascular complications for malignant tumors.

XIAO, LIANG; TONG, JIA-JIE; SHEN, JING

2012-01-01

440

Use of Genetically Manipulated Strains of Clostridium perfringens Reveals that Both Alpha-Toxin and Theta-Toxin Are Required for Vascular Leukostasis To Occur in Experimental Gas Gangrene  

PubMed Central

A hallmark of gas gangrene (clostridial myonecrosis) pathology is a paucity of leukocytes infiltrating the necrotic tissue. The cause of this paucity most likely relates to the observation of leukocyte aggregates at the border of the area of tissue necrosis, often within the microvasculature itself. Infecting mice with genetically manipulated strains of Clostridium perfringens type A (deficient in either alpha-toxin or theta-toxin production) resulted in significantly reduced leukocyte aggregation when alpha-toxin was absent and complete abrogation of leukocyte aggregation when theta-toxin was absent. Thus, both alpha-toxin and theta-toxin are necessary for the characteristic vascular leukostasis observed in clostridial myonecrosis.

Ellemor, Darren M.; Baird, Rebecca N.; Awad, Milena M.; Boyd, Richard L.; Rood, Julian I.; Emmins, John J.

1999-01-01

441

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

SciTech Connect

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.

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

1984-04-01

442

Routine Diagnostic Venous Ultrasound and LAS for Leg Edema of Unknown Cause  

PubMed Central

Objective: To verify the diagnostic efficiency of venous duplex ultrasound and lymphangioscintigraphy (LAS) in establishing the cause of leg edema and to clarify the pathology of these leg edemas. Materials and Methods: Between April 2009, and March 2010, 62 patients with leg edema of unknown origin were referred to the Edema Clinic of the Yamaguchi University Graduate School of Medicine. All patients underwent a venous duplex ultrasound scan and LAS. Results: Of 62 patients, lymphatic insufficiency, venous insufficiency or both was diagnosed in 42 (68%), and lymphedema, in 29 (47%). Venous duplex ultrasound detected obvious venous disorders in only 13 (21%), and for 20 patients, the ultrasound and LAS did not reveal any abnormalities; however, for 15 of the 20 (24% of all patients), venous edema was attributed to functional causes. Conclusion: Venous duplex ultrasound and LAS assisted in the diagnosis of leg edema of unknown origin and also proved useful in establishing treatment strategies.

2010-01-01

443

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

PubMed Central

Summary Currently, it remains controversial how vascular endothelial progenitor cells (angioblasts) establish their arterial or venous fates. We show using zebrafish that the arterial progenitors of the major axial vessels originate earlier and closer to the midline than the venous progenitors. Both medial and lateral progenitor populations migrate to distinct arterial and venous positions and not into a common precursor vessel as previously suggested. Overexpression of VEGF o