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Warfarin-induced Venous Limb Gangrene.  


Warfarin is a commonly used anticoagulant that has been associated with several significant cutaneous side effects, most notably warfarin-induced skin necrosis. A lesser known adverse reaction to warfarin is warfarin-induced venous limb gangrene. Both cutaneous adverse effects share the same pathophysiology, but are clinically quite different. The majority of cases of warfarin-induced venous limb gangrene has been in patients with cancer or heparin-induced thrombocytopenia. However, other hypercoagulable disease states, such as the antiphospholipid antibody syndrome, can be associated with venous limb gangrene. In order to increase recognition of this important condition, the authors report a case of warfarin-induced venous limb gangrene in a patient with presumed antiphospholipid antibody syndrome and review the literature on warfarin-induced venous limb gangrene. PMID:23198012

Grim Hostetler, Sarah; Sopkovich, Jennifer; Dean, Steven; Zirwas, Matthew





Gangrene is the death of tissues in your body. It happens when a part of your body loses its blood supply. Gangrene can happen on the surface of the body, ... that produce a foul-smelling discharge. If the gangrene is internal, you may run a fever, feel ...


Safety of Salvaging Impending Flap Congestion in Breast Reconstruction by Venous Supercharging of the Cephalic Vein.  


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

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





... skin. In severe cases of gangrene, an affected body part, such as a toe, finger or limb, may need to be surgically removed (amputated). In some cases, you may later be fitted with an artificial limb (prosthesis). Antibiotics. Antibiotics given through a vein ( ...


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.



Gas gangrene (image)  


Gas gangrene is a severe form of gangrene (tissue death) caused by the bacterium Clostridium perfringens. It generally occurs at a wound or surgical site, causing painful swelling and destruction of ...


Peripheral gangrene in children  

Microsoft Academic Search

The case histories of 36 patients treated for peripheral gangrene between 1973 and 1987 were reviewed. The commonest causes of gangrene were disseminated intravascular coagulation due to bacterial septicaemia (15 patients) and dehydration due to gastro-intestinal fluid loss (8 patients). In only 2 patients was gangrene of truly iatrogenic origin; in 4 no apparent cause could be found. Secondary or

D. H. Bass; S. Cywes



Penile Fournier's Gangrene.  


Fournier's gangrene is a fulminant, necrotizing soft-tissue infection of the genital, perineal, and perianal regions. Fournier's isolated to the penis is a rare occurrence due the highly vascular nature of the penis. Reported occurrences of penile Fournier's gangrene have occurred in the setting of a clear vascular or traumatic insult. Here we present a case of Fournier's gangrene isolated to the penis in an adult with calciphylaxis secondary to end-stage renal disease. PMID:24075005

Yecies, Todd; Lee, Daniel J; Sorbellini, Maximiliano; Ramasamy, Ranjith



Fournier's Gangrene: Current Practices  

PubMed Central

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

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



Neonatal Fournier's gangrene.  


Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any ages but it is rare in neonates and infants. Here, we report a case of Fournier's gangrene in a 21 day old male neonate who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gives good results and probably in our setting, to some extent, it is a preventable condition. PMID:20597572

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



[Discrete distal gangrene].  


The authors present their statistical findings from 114 cases of discrete distal gangrene. They stress the importance of a rigorous methodology to detect mechanical causes from the thoracic outlet syndrome and immunological causes, predominantly scleroderma, especially in women. It is important not to overlook blood diseases nor those cases which are a presentation of underlying cancer. Finally, the iatrogenic cause is now well known. Treatment depends on the causes of this distal lesion. However, in cases of severe connective tissue disease, the use of plasmapheresis is beginning to give interesting results. PMID:6842102

Cloarec, M; Graisely, B; Dumas, R; Caillard, P; Wurm, M; Le Moigne, C; Solvay, H; Kahn, M



Fournier gangrene and unexpected death.  


Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70-year-old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case. PMID:22471925

Bury, Danielle; Byard, Roger W



Discrimination of gangrenous from uncomplicated acute cholecystitis: accuracy of CT findings.  


In acute cholecystitis, the presence of gangrene is associated with higher morbidity and mortality and necessitates open surgical intervention rather than laparoscopic cholecystectomy. As Murphy's sign may be absent, gangrene may not be detected ultrasonographically. This retrospective study evaluated indications of acute gangrenous cholecystitis on computed tomography (CT) in 25 patients, who were proven as having acute cholecysitis surgically and pathologically within 3 days of pre-operative CT. The CT images were reviewed by two board-certified radiologists blind to the initial CT report. Acute gangrenous cholecystitis was significantly correlated with the CT signs of perfusion defect (PD) of the gallbladder wall (P = 0.02), pericholecystic stranding (PS) (P = 0.028), and no-gallstone condition (No-ST) (P = 0.026). The presence of PD was associated with acute gangrenous cholecystitis with a relatively high accuracy (80%), a sensitivity of 70.6%, a specificity of 100%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 61.5%. The combination CT signs of PD or No-ST improved the accuracy for acute gangrenous cholecystitis to 92%, with a sensitivity, specificity, PPV, and NPV of 88.2%, 100%, 100%, and 80%, respectively. Other CT signs were highly specific for acute gangrenous cholecystitis but of low sensitivity, including mucosal hemorrhage, mucosal sloughing, wall irregularity, pericholecystic abscess, gas formation, and portal venous thrombosis. CT was found to accurately diagnose acute cholecystitis, with the presence of PD, PS, or No-ST significantly correlated with that of gangrenous change. Thus, CT is useful in the preoperative detection of acute gangrenous cholecystitis. PMID:20425109

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



Impending Airway Compromise due to Cystic Hygroma.  


We report on a 3-month-old infant, who arrived in the pediatric emergency department (ED) with a cervical cystic hygroma causing an impending compromise of the airway. We recognize that such a lesion can rapidly progress, and the judicious use of imaging in the ED may help to avoid airway compromise and possibly fatal complications. PMID:22224119

Weiser, Giora; Beck-Razi, Nira; Shavit, Itai



Bilateral testicular gangrene: does it occur in Fournier’s gangrene?  

Microsoft Academic Search

Fournier’s gangrene (FG) is an infective necrotizing fascitis of the perineum, genital and perianal area leading to gangrene\\u000a of the overlying skin and subcutaneous tissue. Testis and epididymis tend to be spared. We report a case of a young male with\\u000a bilateral gangrene of the testis.

Anubhav Gupta; Diwaker Dalela; S. N. Sankhwar; Madhu Mati Goel; Sandeep Kumar; Apul Goel; V. Singh



Devastating penile mycosis leading to penile gangrene.  


Infective penile gangrene is a rare but known complication of circumcision. The causes may vary from neutropenia, diabetes mellitus, and human immunodeficiency virus infection to lymphoproliferative malignancy. Penile mycosis leading to penile gangrene is a rare entity. Only 1 case has been reported in an adult. Juvenile diabetes mellitus is a peculiar predisposing factor for mycotic infections. We report a case of mycotic penile gangrene in a diabetic child to highlight its potentially preventable disastrous outcome. PMID:23830080

Hombalkar, N N; Vaze, Dhananjay; Guha, Poonam; Dhandore, Priya D; Gurav, Prakash D



Fournier's gangrene: A general surgery problem  

Microsoft Academic Search

Fournier's gangrene is a specific form of synergistic gangrene involving the scrotum and perineum. The disease may follow a variety of clinical conditions or occur without an apparent precipitating cause. It is associated with severe systemic toxicity and a significant mortality rate, and it demands prompt recognition and urgent, aggressive surgical intervention. Its treatment calls on the full armamentarium of

Nancy A. Diettrich; James H. Mason



Rectal diversion without colostomy in Fournier's gangrene.  


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

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



Sources of Gas Gangrene in Hospital  

Microsoft Academic Search

Of four cases of postoperative gas gangrene in three hospitals three followed amputation of legs with gangrenous lesions, and one followed gastrectomy. Clostridium welchii was isolated from the wounds and the faeces of each patient; small numbers of Cl. welchii were found on the floors of the theatres where the operations had been performed.Two infections occurred in one hospital on

G. A. J. Ayliffe; E. J. L. Lowbury



Hyperbaric Oxygen Treatment of Gangrene in Pneumococcemia.  

National Technical Information Service (NTIS)

In a man with bilateral symmetrical gangrene resulting from pneumococcemia, hyperbaric oxygen therapy was successful after a trial of antibiotics, vasodilators, and nerve block had proved of no avail. Treatment consisted of 2 atmospheres absolute oxygen, ...

S. C. Karz R. E. Thompson F. L. Depenbusch G. B. Hart



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



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.



Salvage liver transplantation for hepatic gas gangrene.  


Hepatic gas gangrene is an uncommon situation mainly due to bacterial infection by Clostridium perfringens. It remains a life-threatening condition associated with a high mortality rate. Quick diagnosis and aggressive therapy including liver transplantation should be proposed to improve the outcome. This report describes a rare case of hepatic gas gangrene on native liver, secondary to iatrogenic hepatic artery thrombosis and instrumental biliary tree infection, which was successfully treated by liver transplantation. PMID:22669442

Birnbaum, David Jérémie; Grégoire, Emilie; Hardwigsen, Jean; Le Treut, Yves Patrice





... Lavery LA. Diabetic foot ulcers. In: Cronenwett JL, Johnston W, eds. Rutherford’s Vascular Surgery . 7th ed. Philadelphia, ... Lower extremity amputation: General considerations. In: Cronenwett ... W, eds. Rutherford’s Vascular Surgery . 7th ed. Philadelphia, ...


Closed-loop monitoring systems for detecting impending instability  

Microsoft Academic Search

Monitoring systems are proposed for the detection of impending instability in uncertain nonlinear systems. The work employs generic features associated with the response to noise inputs of systems bordering on instability. These features, called \\

Taihyun Kim; Eyad H. Abed



[Fournier's gangrene: our experience of 10 cases.  


Fournier's gangrene, described for the first time by Alfred Jean Fournier in 1883, is a very uncommon disease. It is characterized by an acute process of cellulites and necrotizing fasciitis of the external genitalia, perineum and abdominal wall; its mortality rate is about 30-50%. We retrospectively reviewed 10 patients affected by Fournier's gangrene admitted to our Department of Urology from 1997 to 2006. At a mean follow-up of 37 months (range 0-108) 7 patients are alive and disease free, 1 patient is alive bearing the signs of the gangrene, and 2 patients died because of the disease complications. We have noted that patients' survival depends on early intervention and extremely aggressive approach. The combination of these factors with antibiotic therapy and supportive care have made this disease treatable and curable. PMID:21086362

Rahmati, M; Sarti, A; Rubilotta, E; Chierigo, P; Lazzarotto, M; Franzolin, N


Ultrasound in the diagnosis of Fournier's gangrene.  


Fournier's gangrene (FG) is a life-threatening, rapidly progressive necrotizing infection. If not recognized and treated early, it is associated with high morbidity and mortality. The classic physical exam findings of crepitus are seen in approximately two-thirds of patients during the early stages of FG. Focused bedside sonography performed in cases of suspected gangrene represents an excellent adjunct in confirming the presence of subcutaneous gas and other signs of necrotizing infection. We present an illustrative case of a patient with FG who was evaluated with focused bedside ultrasonography. PMID:22837898

Kube, Erika; Stawicki, Stanislaw P; Bahner, David P



Successful treatment of mediastinal gas gangrene due to esophageal perforation  

Microsoft Academic Search

Esophageal perforation and mediastinal gas gangrene developed in a 55-year-old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. Initially, extensive gangrene of the esophagus and the mediastinum was treated by esophagectomy; however, an abundance of Clostridium perfringens in the Gram stain verified the presence of gas gangrene. Subsequently, the patient was transferred to a hyperbaric oxygen center, wherein

Jarmo A Salo; Jukka K Savola; Vesa J Toikkanen; Vesa J Perhoniemi; Ville Y. O Pettilä; Jorma A Klossner; Hannu J Toivonen



Fournier's gangrene and its emergency management  

PubMed Central

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

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



A life-threatening infection: Fournier's gangrene  

Microsoft Academic Search

Fournier's gangrene is a life-threateningdisorder in which infection of the perineum andscrotum spreads along fascial planes, causingsoft tissue necrosis. If urgent surgery isdelayed, the disease will soon result in septicshock, multiorgan failure, and death. In thisstudy, we present 21 patients with Fournier'sgangrene who were treated in period between1994 and 2001. Patients' charts were reviewedretrospectively and are discussed in the lightof

Irfan Huseyin Atakan; Mustafa Kaplan; Esat Kaya; Tevfik Aktoz; Osman Inci



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



Outcome Analysis in Patients With Fournier’s Gangrene  

Microsoft Academic Search

INTRODUCTION: Despite antibiotics and aggressive debridement, the mortality rate of Fournier’s gangrene remains high. Attempts have been made to study factors that may affect prognosis; however, reliable criteria are still lacking. METHODS: The medical records of 45 patients with Fournier’s gangrene who presented at the Ege University Medical Faculty Hospital from January 1990 to May 2001 were reviewed retrospectively to

Mustafa Korkut; Gökhan ?çöz; Murat Dayangaç; Erhan Akgün; Levent Yeniay; Özgür Erdo?an; Ça? Çal



Carcinoma of the Cecum: an Unusual Cause of Fournier's Gangrene  

Microsoft Academic Search

Fournier's gangrene is a rapidly progressive necrotizing fasciitis involving the genitalia (1). This disease may be caused by a variety of urological as well as gastrointestinal tract and retroperitoneal diseases (2). We report a case of cecum carcinoma manifesting as Fournier's gangrene. Case Report A 58-year-old male presented with a history of right lower abdominal pain for 1 month and

Atila ÇORUH; Galip K. GÜNAY


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


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

Boisdenghien, A; Zorman, D



Impending myocardial rupture: is an early surgical treatment enough?  


A 53-year-old man with a high-risk cardiovascular profile presented to the emergency department for a subacute myocardial infarction with signs and symptoms suggesting impending myocardial rupture. The case seemed to be resolved by an early successful surgical intervention. At 6-month follow-up, after repeated cycles of cardiac rehabilitation, the echocardiography revealed a pseudo-aneurysm of the apex and a left-to-right shunt through an inter-ventricular septum defect. The patient needed a new surgical intervention to repair this unexpected complication. PMID:22679259

Lanzellotti, Davide; Marzot, Filippo; Guglielmi, Cosimo; Panfili, Marco



Impending myocardial rupture: is an early surgical treatment enough?  

PubMed Central

A 53-year-old man with a high-risk cardiovascular profile presented to the emergency department for a subacute myocardial infarction with signs and symptoms suggesting impending myocardial rupture. The case seemed to be resolved by an early successful surgical intervention. At 6-month follow-up, after repeated cycles of cardiac rehabilitation, the echocardiography revealed a pseudo-aneurysm of the apex and a left-to-right shunt through an inter-ventricular septum defect. The patient needed a new surgical intervention to repair this unexpected complication.

Lanzellotti, Davide; Marzot, Filippo; Guglielmi, Cosimo; Panfili, Marco



Impending paradoxical embolism across a patent foramen ovale: case report.  


We describe a case of impending paradoxical embolism in a 43-year-old male patient with pulmonary embolism. Transesophageal echocardiography revealed a thromboembolus straddling a patent foramen ovale. The patient underwent emergency removal of the intracardiac clot with closure of the patent foramen ovale. A postoperative work-up for a hypercoagulable state revealed a protein-S deficiency and bilateral lower extremity deep vein thromboses. A Greenfield inferior vena cava filter was inserted, anticoagulation was performed, and warfarin treatment was continued after the patient was discharged home. PMID:15769715

Kavarana, Minoo N; Boice, Todd; Gray, Laman A



Critical evaluation of Mirels' rating system for impending pathologic fractures.  


This project examined the hypothesis that Mirels' rating system for impending pathologic fractures is reproducible, valid, and applicable across various experience levels and training backgrounds. Twelve true clinical histories and corresponding radiographs for patients with femoral metastatic lesions were reviewed by 53 participants from five experience levels: orthopaedic residents, musculoskeletal radiologists, orthopaedic attendings, fellowship-trained practicing orthopaedic oncologists, and radiation or medical oncologists. Each examiner provided individual and total Mirels' scores and independent determination of impending fracture using clinical judgment. A subset of seven histories without prophylactic fixation provided a natural history group. There was highly significant agreement across experience categories for overall Kappa and for the concordance for individual and overall scores. Kappa analysis showed good agreement for site, moderate agreement for type, and fair agreement for size and pain. There was no significant difference in overall scores across experience levels. The pooled odds ratio favored Mirels rating system over clinical judgment regardless of experience level. Overall sensitivity was 91% and specificity was 35%. Mirels' system seems to be reproducible, valid, and more sensitive than clinical judgment across experience levels. However, although the system is a valuable screening tool, more specific parameters are needed. PMID:14600611

Damron, Timothy A; Morgan, Hannah; Prakash, Dave; Grant, William; Aronowitz, Jesse; Heiner, John



Halo sign on indium-111 leukocyte scan in gangrenous cholecystitis  

SciTech Connect

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

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



Congenital gangrene of the extremities in a newborn.  


Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting. PMID:21860149

Onalo, R; Ogala, W N; Lawal, Y Z; Chom, N D; Odogu, O; Ige, S O


Fournier’s gangrene: Exists and it is still lethal  

Microsoft Academic Search

Background: Fournier’s gangrene is an aggressive form of necrotizing fascitis of the perineal, perianal or genital regions, caused by\\u000a a polymicrobial infection that includes virulent organisms. Patients and methods: Eleven cases of Fournier’s gangrene were treated in our department during the last 20 years. Portals of entry were ischiorectal\\u000a abscess, perirectal abscesses, scrotal abscess and trauma in the perianal area. The

M. Safioleas; M. Stamatakos; G. Mouzopoulos; A. Diab; K. Kontzoglou; A. Papachristodoulou



Peripheral gangrene in Plasmodium vivax malaria: a rare manifestation.  


Symmetrical peripheral gangrene (SPG) is an extremely rare complication of malaria that has been well described in multiple case reports of Plasmodium falciparum and mixed infection. We present a case of malaria with isolated Pl. vivax infection complicated by SPG. This index case is the first reported case of peripheral gangrene involving bilateral hands and feet in Pl. vivax infection in an adult. PMID:23550200

Arora, Neha; Gogna, Arun; Kumar, Dilip; Puri, Karan




Microsoft Academic Search

Islam M. N., Hoque M. F., Rima U. K., Fatema B. Z., Aziz F. B., Faruk M. I.and Akter M. R. 2008. Gangrenous Mastitis in Cows: Pathological, Microbiological and Surgicotherapeutical Investigation. J.Soil .Nature. 2(3): 29-36 Gangrenous mastitis in cows was investigated at Dinajpur district of Bangladesh. The animals brought to clinics for the diagnosis and treatments were examined clinically, pathomicrobiologically



Legal abortion: the impending obsolescence of the trimester framework.  


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



Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur  

SciTech Connect

Objective: Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. Methods: We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score {>=}8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. Results: The mean Mirels' score was 9.8 {+-} 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 {+-} 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 {+-} 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. Conclusions: POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.

Deschamps, Frederic, E-mail:; Farouil, Geoffroy, E-mail:; Hakime, Antoine, E-mail:; Teriitehau, Christophe, E-mail:; Barah, Ali, E-mail:; Baere, Thierry de, E-mail: [Institut Gustave Roussy, Interventional Radiology Department (France)



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)



Chronic venous insufficiency and venous leg ulceration  

Microsoft Academic Search

Venous ulcers are the most common form of leg ulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the

Isabel C. Valencia; Anna Falabella; Robert S. Kirsner; William H. Eaglstein



A complex approach to the treatment of Fournier's gangrene.  


Fournier's gangrene is a necrotizing, life-threatening fasciitis of the perineal, genital and perianal region which can spread to the abdominal wall, causing soft-tissue necrosis and sepsis. It is usually a polymicrobial infection. The prevalence of the disease is low, but the mortality rate remains high. Several urogenital and anorectal diseases, as well as diabetes mellitus and conditions associated with the immunosuppressive reaction, may predispose an individual to the development of Fournier's gangrene. A diagnosis of Fournier's gangrene is clinical, but radiological examinations may be helpful in establishing the extent of the necrotic process. The treatment consists mainly of aggressive surgical debridement, broad-spectrum antibiotic combinations and hyperbaric oxygen therapy. The Fournier's gangrene severity index (FGSI) score can be used to evaluate patients. Because of its heterogeneity and aggressiveness, Fournier's gangrene is a very serious and complex medical condition that should be under the care of an interdisciplinary team with access not only to the best surgical and critical care but also to a hyperbaric chamber. PMID:23468272

Sroczy?ski, Maciej; Sebastian, Maciej; Rudnicki, Jerzy; Sebastian, Agata; Agrawal, Anil K


Current hypotheses on synergistic microbial gangrene.  


We have reviewed spreading infections of the dermis, with special reference to the importance of synergy in their causation. Evidence for this is accumulating from both clinical studies and from studies in laboratory animals. Necrotizing fasciitis (rapid spread over 24 h) can be caused by beta-haemolytic streptococci, sometimes with Staphylococcus aureus, or by mixed infections of aerobes and anaerobes, often of gut origin. Animal studies provide good evidence that S. aureus can potentiate the beta-haemolytic streptococcal infection in necrotizing fasciitis. There is also evidence that mixtures of aerobes and anaerobes can act synergistically, but animal models for necrotizing fasciitis have not been developed. Anaerobic cellulitis (variable rate of spread from hours to days) can be caused by mixed aerobes and anaerobes or by mixed clostridia. Animal studies provide good evidence for synergy in the former. Meleney's synergistic postoperative gangrene (slow spread over weeks) may be cutaneous amoebiasis: the animal model of Brewer and Meleney relates to the more rapid infections of anaerobic cellulitis. PMID:2182177

Kingston, D; Seal, D V



Leukocytosis of Unknown Origin: Gangrenous Cholecystitis  

PubMed Central

There have been case reports where patients admitted with acute cholecystitis, who were managed conservatively, had subsequently developed GC (gangrenous cholecystitis). The current case is unique, since our patient denied any prior episodes of abdominal pain and the only tip off was leukocytosis. A high index of suspicion is essential for the early diagnosis and treatment of GC. GC has a mortality rate of up to 22% and a complication rate of 16–25%. Complications associated with GC include perforation, which has been reported to occur in as many as 10% of cases of acute cholecystitis. The radiological investigations may not be conclusive. Ultrasonography usually serves as the first-line imaging modality for the evaluation of patients with clinically suspected acute cholecystitis. However, CT can play an important role in the evaluation of these patients if sonography is inconclusive. There is a need for an early (if not urgent) surgical intervention in acute cholecystitis (whether laparoscopic or open surgery) in order to decrease the time elapsed from the start of symptoms to admission and treatment.

Nidimusili, Amara Jyothi; Alraies, M. Chadi; Eisa, Naseem; Alraiyes, Abdul Hamid



Gas gangrene: An unusual cause of graft failure in an orthotopic pediatric liver transplant  

Microsoft Academic Search

Gas gangrene of the liver is a very unusual cause of graft failure, and gas gangrene caused byEnterobacter cloacae is also exceedingly rare. Although Clostridial infection could not be excluded in this case, the literature and our case show thatEnterobacter cloacae can be present in gas gangrene tissue whether or not it is the only infecting organism.

T. R. Hall; A. Poon; H. Yaghsczian; M. I. Boechat



Symmetrical peripheral gangrene: a rare complication of dengue fever.  


Symmetric peripheral gangrene is associated with a variety of infective and non-infective etiologies. SPG is always presented with disseminated intravascular coagulation (DIC) and carries a higher mortality. Herein, we describe a 42-year-old female with dengue fever and rash developed bilateral symmetric dry gangrene of 2 nd and 3 rd toes. There was no history of taking B-blockers, ergot etc. All the peripheral pulses of the affected limbs were palpable. Color Doppler of lower limb vessels was done, which indicated normal flow. Blood was positive for Fibrin degradation products and D dimers. Patient was managed with IV fluids, LMWH, FFP etc. Her general condition improved within 72 hours with no further progression of gangrene. PMID:23897526

Modak, Dolanchampa; Guha, Subhasish K


[Perineal gangrene: report of 30 cases observed at Abidjan].  


Perineal gangrene may be classified as primary, e.g. Fournier's gangrene of the external genitals, or secondary due to locoregional injury. Perineal gangrene is still a topic of interest in tropical zones where mortality remains high despite current therapeutic modalities. The purpose of this retrospective study was to analyze etiologic, bacteriologic, and therapeutic data in 30 cases observed over a one-year period in a surgical setting in the Ivory Coast. There were 26 men and 4 women with a mean age of 43 years. All were treated by extensive removal of necrotic tissue in association with antimicrobial therapy for the likeliest agent and appropriate supportive measures. Colostomy was performed in 6 cases and drainage of the urinary tract was required in 11 cases. Anti-tetanus treatment was administered in all cases. Thirteen patients were HIV-positive, five were diabetic, and two presented chronic renal insufficiency. Perineal gangrene was classified as secondary in 17 cases and primary (Fournier's gangrene) in 13 cases. Bacteriologic study of puss and tissue specimens collected from necrotic areas demonstrated a mixed population of microbial organisms predominated by streptococcus A (n = 19) and Escherichia coli (n = 13). Positive diagnostic results were obtained in 5 of 20 hemocultures and in 8 of 11 cystobacteriologic tests. Eight patients died and nine presented complications including necrosis of the testicles, atrophy of the testicles, shock, and coma. Healing was obtained without skin grafting in 22 survival cases but 5 of them required secondary suturing. The mean duration of hospitalization was 45 days. In our experience, perineal gangrene led to severe consequences despite adequate management especially in HIV-infected patients. The treatment of choice is still extensive emergency surgical removal (repeated, if necessary) of necrotic tissue in association with adequate supportive measures and wide spectrum antimicrobial therapy. PMID:10088100

Kouadio, K; Kouame, Y J; Bi, K L; Turquin, H H



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


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

Fejes, I; Dégi, R; Végh, M



Fulminant abdominal gas gangrene in metastatic colon cancer.  


We report a case of fulminant abdominal gas gangrene in a patient with metastatic colon cancer. A 39-year-old patient with descending colon, high-grade adenocarcinoma and coexisting liver and lymph node metastases received two courses of chemotherapy. The patient developed sudden acute abdominal symptoms accompanied by septic shock parameters. The imaging findings on computed tomography were characteristic for abdominal gas gangrene, involving liver metastases, portal vein and lymph nodes with associated pneumoperitoneum. The patient succumbed to the disease within hours following the onset of symptoms. PMID:22740933

Bozkurt, Mustafa; Okutur, Kerem; Aydin, Kübra; Namal, Esat; Oztürk, Akin; Balci, Cem; Demir, Gökhan



Sudden Cardiac Death and the Onset of Myocardial Infarction. Biology of Impending Myocardial Infarction.  

National Technical Information Service (NTIS)

Investigators have studied forty patients with 'the impending myocardial infarction syndrome' in an effort to define the clinical course of the syndrome during the first few days in the hospital and to elucidate the pathophysiologic mechanisms present. Th...

D. C. Harrison J. S. Schroeder



Sudden Cardiac Death and the Onset of Myocardial Infarction: Biology of Impending Myocardial Infarction.  

National Technical Information Service (NTIS)

Six areas of research include: Natural history of the patient admitted to the CCU with chest thought to be due to myocardial infarct; hemodynamic changes with impending MI; comparison of spontaneous and pacing-induced angina hemodynamics; correlation of c...

D. C. Harrison J. S. Schroeder



Superficial venous disease.  


Superficial venous disease is a common clinical problem. The concerning disease states of the superficial venous system are venous reflux, varicose veins, and superficial venous thrombosis. Superficial venous reflux can be a significant contributor to chronic venous stasis wounds of the lower extremity, the treatment of which can be costly both in terms of overall health care expenditure and lost working days for affected patients. Although commonly thought of as a benign process, superficial venous thrombosis is associated with several underlying pathologic processes, including malignancy and deep venous thrombosis. PMID:23885940

Brown, Kellie R; Rossi, Peter J



Aeromonas hydrophila myonecrosis and gas gangrene in a nonimmunocompromised host.  


Aeromonas hydrophila myonecrosis with gas gangrene and bacteremia developed in an elderly patient after minor trauma from a fishbone. Despite aggressive medical and surgical therapy, she experienced a rapidly fatal outcome. Literature on Aeromonas muscle infection is reviewed and implications for therapy are discussed. PMID:6625789

Heckerling, P S; Stine, T M; Pottage, J C; Levin, S; Harris, A A




Microsoft Academic Search

Purpose:Fournier’s gangrene is a necrotizing fasciitis of the genitalia that is associated with high morbidity and mortality. Groups at many institutions have initiated routine adjuvant hyperbaric oxygen (HBO) therapy. We examined whether HBO has made a difference in the morbidity, mortality and costs associated with treating this disease. We also analyzed predictors of extended hospital stay and mortality.




Fournier’s Gangrene: Series of Twenty Patients  

Microsoft Academic Search

Background and Purpose: Fournier’s gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Our aim is to investigate the clinical signs, symptoms and factors which affect the clinical results of patients with FG in our clinic. Patients and Methods: 20 patients having FG were admitted to our department during the

A. Simsek Celik; H. Erdem; D. Guzey; F. Celebi; S. Birol; F. Erozgen; R. Kaplan



Sudden unexpected death due to Fournier’s gangrene  

Microsoft Academic Search

A 43-year-old Japanese male vagrant collapsed suddenly in a police station. The man was resuscitated in hospital but died\\u000a about 13 h later. An autopsy revealed necrotizing fasciitis in the genitalia and lower abdominal wall. The man was considered\\u000a to have died from endotoxic shock following on Fournier’s gangrene.

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



Non-mechanical traumatic gas gangrene: forgotten but not gone.  


We report a case of gas gangrene (GG) in a non-diabetic HIV seronegative man who died within 60 hours following an intramuscular injection in rural India. The occurrence of GG after intramuscular injection is rare and only a few cases have been reported in the published literature. PMID:22337732

Senthilkumaran, Subramanian; Menezes, Ritesh G; Pant, Sadip; Khartode, Chhagan P; Balamurugan, Namasivayam; Thirumalaikolundusubramanian, Ponniah



Phlebotomy as a Source of Clostridium septicum Gas Gangrene  

Microsoft Academic Search

ISSUE: Phlebotomy is often performed by personnel without nursing or infection prevention education. Infection Control (IC) was notified regarding a potential Clostridium septicum gas gangrene inoculation in an outpatient phlebotomy setting. A 70-year-old patient expired 52 hours after receiving phlebotomy. The patient presented to an outside facility with pain and swelling of the right antecubital space. After the diagnosis of

K. Mackie; S. Mayoryk; S. E. Cosgrove; T. Perl



Peripheral gangrene in children with atypical hemolytic uremic syndrome.  


Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy with severe clinical manifestation, frequent recurrence, and poor long-term prognosis. It is usually caused by abnormalities in complement regulation. We report 2 cases of children affected by a catastrophic extrarenal complication. A 4-year-old Indian girl developed gangrene of the finger tips 2 days after initial presentation of aHUS. Factor H autoantibodies were identified. Renal function continued to decline despite daily plasma exchanges, and she was started on peritoneal dialysis 5 days after admission. The distal tips of the left hand remained gangrenous with a line of demarcation. Three weeks later, she did not return for follow-up and died at home because of dialysis-related complications. An Arabic girl developed end-stage renal disease due to aHUS in the fourth month after birth. A de novo activating C3 mutation was found. At age 9 months, she suddenly developed ischemic changes in fingers of both hands and several toes. The lesions progressed, and several finger tips became gangrenous despite intense plasma exchange therapy. The decision was made to administer complement blocking therapy with the C5 antibody eculizumab. All nonnecrotic digits rapidly regained perfusion. The 3 already gangrenous fingers healed with loss of the end phalanges. During maintenance, eculizumab aHUS activity subsided completely and some late recovery of renal function was observed. aHUS may present by thrombotic macroangiopathy of small peripheral arteries. Eculizumab appears effective in preserving tissue viability if administered before gangrene occurs and should be considered as first-line rescue therapy in such cases. PMID:23230076

Malina, Michal; Gulati, Ashima; Bagga, Arvind; Majid, Mohammad A; Simkova, Eva; Schaefer, Franz



Venous flaps.  


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

Thatte, M R; Thatte, R L



Combined Treatment with Compression Therapy and Ablation of Incompetent Superficial and Perforating Veins Reduces Ulcer Recurrence in Patients with CEAP 5 Venous Disease  

Microsoft Academic Search

Objective:Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent superficial and\\/or perforating veins on ulcer recurrence rates in CEAP 5 patients who have progressive lipodermatosclerosis and impending ulceration.

Michael Harlander-Locke; Peter Lawrence; Juan Carlos Jimenez; David Rigberg; Brian DeRubertis; Hugh Gelabert


Laparoscopic management of gallstone presenting as obstructive gangrenous appendicitis.  


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



Fournier's gangrene after unrelated cord blood stem cell transplantation  

Microsoft Academic Search

A 16-year-old boy with refractory acute myelogenous leukemia developed Fournier's gangrene as an early complication after two-antigen HLA-mismatched unrelated cord blood stem cell transplantation. On day 25 after the transplantation, he noted abrupt onset of penile swelling with miction pain. The penile inflammation rapidly extended posteriorly to involve the scrotum and perianal tissues, inferiorly to involve the thighs, and superiorly

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



[Pheochromocytoma presenting as ischaemic gangrene of lower limbs].  


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

Galsgaard, Kristina; Hilberg, Ole; Hjorthaug, Karin



Oro-Facial Gangrene (Noma\\/Cancrum Oris): Pathogenetic Mechanisms  

Microsoft Academic Search

Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from I to 7 cases per 1000 population. The risk factors are poverty, malnutrition,

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



Peripheral gangrene complicating idiopathic and recessive hemolytic uremic syndromes  

Microsoft Academic Search

Three patients with hemolytic uremic syndrome (HUS) developed peripheral gangrene. Bilateral carotid artery thromboses occurred\\u000a in one of these patients after recovery from HUS. One patient had a long history of juvenile rheumatoid arthritis. In the\\u000a second patient, a flu-like illness preceded the onset of HUS. The third was one of two sisters, with the HUS appearing more\\u000a than 1

Bernard S. Kaplan; Clotilde D. Garcia; Russell W. Chesney; William E. Segar; Katia Giugno; Roberto Chem



Structure of the key toxin in gas gangrene  

Microsoft Academic Search

Clostridium perfringens ?-toxin is the key virulence determinant in gas gangrene and has also been implicated in the pathogenesis of sudden death syndrome in young animals. The toxin is a 370-residue, zinc metalloenzyme that has phospholipase C activity, and can bind to membranes in the presence of calcium. The crystal structure of the enzyme reveals a two-domain protein. The N-terminal

Claire E. Naylor; Julian T. Eaton; Angela Howells; Neil Justin; David S. Moss; Richard W. Titball; Ajit K. Basak



Gas gangrene infections of the small intestine, colon and rectum  

Microsoft Academic Search

Summary  Thirty-three cases of gas gangrene infections originating from the small bowel, colon, and rectum are reviewed. The distinction\\u000a between localized and diffuse, spreading, type of infection is made. The overall mortality rate was 42.4 per cent and mortality\\u000a was highest for infections following elective bowel resections.\\u000a \\u000a Treatment consisted of antibiotics and surgical debridement, with hyperbaric oxygen used as adjunctive therapy

Claude R. Hitchcock; Melvin P. Bubrick



Surgical therapy for necrotizing pneumonia and lung gangrene.  


Objective Necrotizing pneumonia, pulmonary abscess, and lung gangrene are rare complications of severe pulmonary infection with devitalization and sloughing of lung tissue. Pulmonary necrosis is often associated with alcoholism and other chronic disorders with known immunodeficiency. Mortality is significant and both treatment strategies as well as the role of surgery are controversially debated.Methods In a retrospective review at a German tertiary referral hospital, 20 patients with pulmonary resection for necrotizing lung disorders were identified since 2008. At hospital admission, all patients suffered from pulmonary sepsis and despite adequate medical treatment progressing parenchymal destruction and devitalization took place. The majority of the patients sustained pleural empyema (13/20) and five patients a persisting air leak. On account of failing medical therapy, eight patients (40%) developed severe sepsis with septic shock and four patients (20%) were already preoperatively ventilated. Chronic alcoholism was present in 10 patients (50%).Results Gangrene of a complete lung was seen in four cases. Lobar gangrene or necrotizing pneumonia complicated by fulminate abscess was seen in the right lower lobe (8/20), middle lobe (4/20), right upper lobe (2/20), and left lower lobe (2/20). Procedures included pneumectomy (4/20), lobectomy (13/20), and limited resection (3/20). The bronchial stump was reinforced with a pedicle muscle flap in seven cases. There were three postoperative deaths due to septic shock with multiorgan failure. The remaining 17 patients (85%) recovered well and were transferred to rehabilitation clinics specialized on pulmonary disorders.Conclusion Necrotizing pulmonary infections are infrequent but are life-threatening disease entities. Patients often present with severe comorbidity and chronic disorders causing immunodeficiency. If initial medical therapy fails surgery offers a reasonable therapeutic approach. Aim of surgical therapy is resection of all gangrenous lung parenchyma and effective drainage of pleural empyema. Then recovery is feasible in up to 80%. PMID:23034873

Schweigert, Michael; Dubecz, Attila; Beron, Martin; Ofner, Dietmar; Stein, Hubert J



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


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

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



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

PubMed Central

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

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



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


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

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



Paging Inspector Sands: The Costs of Informing the Public about Impending Events  

Microsoft Academic Search

We study the effects of providing the public with information about impending events. Specifically, we draw on a natural experiment to evaluate the impact that pedestrian countdown signals - timers that indicate when traffic lights will change from green to yellow - have on the behavior and safety of road users. The experiment generates exogenous differences in when a countdown

Sacha Kapoor; Arvind Magesan



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

ERIC Educational Resources Information Center

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

Fauske, Janice R.; Ogawa, Rodney T.


Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms.  


Prompt diagnosis of rupture and impending rupture of abdominal aortic aneurysms is imperative. The computed tomographic (CT) findings of ruptured abdominal aortic aneurysms are often straightforward. Most ruptures are manifested as a retroperitoneal hematoma accompanied by an abdominal aortic aneurysm. Periaortic blood may extend into the perirenal space, the pararenal space, or both. Intraperitoneal extravasation may be an immediate or a delayed finding. Discontinuity of the aortic wall or a focal gap in otherwise continuous circumferential wall calcifications may point to the location of a rupture. There usually is a delay of several hours between the initial intramural hemorrhage and frank extravasation into the periaortic soft tissues. Contained or impending ruptures are more difficult to identify. A small amount of periaortic blood may be confused with the duodenum, perianeurysmal fibrosis, or adenopathy. Imaging features suggestive of instability or impending rupture include increased aneurysm size, a low thrombus-to-lumen ratio, and hemorrhage into a mural thrombus. A peripheral crescent-shaped area of hyperattenuation within an abdominal aortic aneurysm represents an acute intramural hemorrhage and is another CT sign of impending rupture. Draping of the posterior aspect of an aneurysmal aorta over the vertebrae is associated with a contained rupture. PMID:17374865

Rakita, Dmitry; Newatia, Amit; Hines, John J; Siegel, David N; Friedman, Barak


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

Microsoft Academic Search

Terminally ill patients and their families are often referred to as being “in denial” of impending death. This study uses the qualitative method of discourse analysis to investigate the usage of the term “denial” in the contemporary hospice and palliative care literature. A Medline search (1970–2001) was performed combining the text words “deny” and “denial” with the subject headings “terminal

Camilla Zimmermann



Gangrenous Cystitis: Report of a Case and Review of the Literature  

Microsoft Academic Search

Gangrenous cystitis is an extremely rare condition: only a total of 240 cases worldwide have been reported so far. Most of these cases have occurred in the preantibiotic era. After the advent and widespread use of antibiotics in clinical practice, only sporadic cases have been observed. We report a case of gangrenous cystitis in an 83-year-old woman who presented with

Alexander Hinev; Deyan Anakievski; Ivan Krasnaliev



The Incidence and Significance of Gas Gangrene in a Diabetic Population  

Microsoft Academic Search

One hundred consecutive patients with Diabetes Mellitus and lower limb complications (infection and\\/or gangrene) needing elective surgery were screened for gas gangrene. The incidence was found to be 10 per cent (one being due to Clostridium welchii). With orthodox conservative treatment, no mortal ity was encountered.

Otto Kahn



Venous leg ulcers.  


In 1837, Piorry, a French professor of medicine stated, "It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries." Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite the fact that millions of Americans are afflicted with chronic venous insufficiency and hundreds of thousands suffer from debilitating lower extremity venous ulcers. A better understanding of the pathophysiology of venous disease is necessary to provide appropriate and efficient medical care for patients suffering from lower extremity venous ulcerations. PMID:14614698

Gonsalves, Carin F



The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s Gangrene Severity Index on the outcomes  

Microsoft Academic Search

Fournier’s gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal\\u000a and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this\\u000a study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier’s Gangrene Severity\\u000a Index (FGSI) score on

Sahin Kabay; Mehmet Yucel; Faik Yaylak; Mustafa C. Algin; Alper Hacioglu; Burhan Kabay; Ahmet Y. Muslumanoglu



Fournier’s Gangrene: Risk Factors and Strategies for Management  

Microsoft Academic Search

Objective  The prognosis of Fournier’s gangrene (FG) depends on early diagnosis and management. In this study, our objective was to identify\\u000a the distinct features of FG that may influence the clinical outcome.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective chart review was performed in patients with a diagnosis of FG between January 1999 and December 2003. Etiological\\u000a and predisposing factors, causative microbiological organisms, and clinical outcome

Hakan Yanar; Korhan Taviloglu; Cemalettin Ertekin; Recep Guloglu; Unal Zorba; Neslihan Cabioglu; Irfan Baspinar



Fournier's Gangrene of the Penis: A Rare Entity  

PubMed Central

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

Talwar, Ashutosh; Puri, Neerja; Singh, Majhail



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


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

Kiel, Natalie; Ho, Vincent; Pascoe, Andrew



Cerebral venous angiomas  

SciTech Connect

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

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



Lymphangioma-Like Kaposi's Sarcoma Presenting as Gangrene  

PubMed Central

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

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



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


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

Battin, Jacques


Gangrenous appendicitis in a child with Henoch-Schonlein purpura.  


Abdominal pain is common feature of Henoch-Schonlein purpura, which may mimic appendicitis, leading to unnecessary laparotomy. Accordingly, the diagnosis must be confirmed by ultrasonography or computed tomography scan before laparotomy is performed. The authors report a case of simultaneous occurrence of Henoch-Schonlein Purpura and gangrenous appendicitis in an 18 year-old boy. The patient was admitted with abdominal pain, cramps, and mild dehydration. He also complained of small reddish purple on his lower limbs, bilateral knee pain, low-grade fever, as well as bloody stools. The symptoms subsided completely. Eight days later, he returned with nonbloody, nonbilious emesis, abdominal cramps, and right lower quadrant abdominal tenderness. Abdominal ultrasound evaluation was performed to rule out an intussusception but demonstrated appendiceal dilatation with a possible appendicolith without any evidence of intussusception. A laparotomy was undertaken, and appendectomy was performed for gangrenous appendicitis. Simultaneous occurrence of Henoch-Schonlein purpura and acute appendicitis is rarely observed. Clinical features of the patients may mislead the clinicians, resulting in delayed diagnosis or misdiagnosis. The use of ultrasonography and computed tomography scan would confirm the diagnosis before surgery. PMID:18970918

Jangjoo, Ali; Amouzeshi, Ahmad; Jalali, Ali Najib



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


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


Epidemiology of venous thromboembolism.  

PubMed Central

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

Coon, W W



Orphans of the HIV\\/Aids epidemic: An impending crisis for South African development  

Microsoft Academic Search

Despite the fact that there are currently millions of HIV-infected people living in South Africa, the worst effects of the HIV\\/AIDS epidemic have yet to be felt. The most long lasting of these is the anticipated dramatic increase in orphanhood. This paper examines the extent of the impending orphan crisis in South Africa (predominantly using the ASSA2000 model), the impacts

Megan Louw



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.



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


Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection. Herein we present a case of gas gangrene of the arm in an intravenous drug user with a history of intramuscular injections with normal saline in the shoulder used to provoke pain for recovery after drug induced coma. The patient was early treated with surgery and antibiotics rendering possible the preservation of the limb and some of its function. Additionally, a review of the literature regarding case reports of limb salvage after gas gangrene is presented. PMID:21846405

Aggelidakis, John; Lasithiotakis, Konstantinos; Topalidou, Anastasia; Koutroumpas, John; Kouvidis, Georgios; Katonis, Paulos



A Controlled Retrospective Study of Blackfoot Disease, an Endemic Peripheral Gangrene Disease in Taiwan.  

National Technical Information Service (NTIS)

Blackfoot (BF) disease, which affects young and old individuals of both sexes, clinically resembles thromboangiitis obliterans; toes generally and fingers occasionally are lost due to dry or wet gangrene. An association between the disease and the consump...

I. C. Ch'i R. Q. Blackwell



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


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

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



Impending Crisis.  

ERIC Educational Resources Information Center

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

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


Impending Crisis.  

ERIC Educational Resources Information Center

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

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


Case study: shock waves treatment of diabetic gangrene.  


This case study illustrates the option of treating poorly healing diabetic wounds with shock waves. A case study was performed with a 75-year-old male patient with diabetic gangrene of both feet facing the prospect of imminent amputation. On a visual analogue pain scale (0-10), the patient reported a pain score of between 7 and 9. In the past, focused shock waves have been used to successfully treat poorly healing wounds and in this case are adopted for the treatment of severe peripheral arterial occlusive disease. Over a time interval of nearly a year, 11 treatments were delivered. At the end of the treatment the necrotic areas vanished. By then the pain score decreased to 2 and no further pain medication was needed. PMID:21385321

Jankovic, Danilo



Late presentation with whole limb gangrene following open traumatic hemipelvectomy.  


Traumatic hemipelvectomy is a rare type of devastating injury with a very high mortality rate and often the result of high energy transfer trauma. Most patients, who survive this injury, do so on the basis of prompt and immediate advanced medical care. Abdominal and pelvic visceral injuries are frequently seen in those cases that survive. We present an unusual case of a 17-year-old patient who survived this injury after presenting 4 days following a motor cycle crash with whole limb gangrene and clinical evidence of septicaemia and without associated abdominal and pelvic visceral injury. She had successful management of her wound and was rehabilitated with axillary crutches and without a prosthetic limb due to financial constraints. The possible mechanism of injury was reviewed and peculiarities of management of this case in our environment were highlighted. PMID:22350051

Bafor, Anirejuoritse; Ogbemudia, Alfred O; Ijekeye, Ferdinand; Igbinovia, Efosa; Akpojevwe, Emmanuel



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


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



Fournier's Gangrene: Management and Mortality Predictors in a Population Based Study  

PubMed Central

Purpose The Fournier's gangrene literature comes almost exclusively from tertiary referral centers. We used a population based database to evaluate variations in management and outcomes. Materials and Methods Inpatients with Fournier's gangrene who underwent surgical débridement or died were identified from select states in the State Inpatient Databases. Multivariate logistic regression analysis was done to evaluate patient and hospital related predictors of mortality. Results We identified 1,641 males with Fournier's gangrene treated at a total of 593 hospitals. At teaching hospitals more Fournier's gangrene cases were treated per year, and more surgical procedures, débridements and supportive care were reported. Patients treated at teaching hospitals had longer length of stay, greater hospital charges and a higher case fatality rate. Patient related predictors of mortality were increasing age (adjusted OR 4.0 to 15.0), Charlson comorbidity index (adjusted OR 1.20 per additional comorbidity), preexisting conditions, ie congestive heart failure (adjusted OR 2.1), renal failure (adjusted OR 3.2) and coagulopathy (adjusted OR 3.4), and hospital admission via transfer (adjusted OR 1.9), after adjusting for hospital factors and Fournier's gangrene experience. Teaching hospitals had higher mortality due primarily to more acutely ill patients (adjusted OR 1.9). Hospitals where more than 1 Fournier's gangrene case per year were treated had 42% to 84% lower mortality after adjusting for patient age, race, Charlson comorbidity index and admission via transfer (p <0.0001). Conclusions Teaching and nonteaching hospitals differ substantially in the populations, case definitions, and severity and management of Fournier's gangrene. Hospitals where more patients with Fournier's gangrene were treated had lower mortality rates, supporting the rationale for regionalized care for this rare disease.

Sorensen, Mathew D.; Krieger, John N.; Rivara, Frederick P.; Klein, Matthew B.; Wessells, Hunter



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



Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis  

PubMed Central

Appendicitis is one of the most common and costly acute abdominal states of illnesses. Previous studies suggest two types of appendicitis which may be different entities, one which may resolve spontaneously and another that progresses to gangrene and perforation. Gangrenous appendicitis has a positive association to states of Th1 mediated immunity whereas Th2 associated immune states are associated with lower risk of appendicitis. This study investigated the inflammatory response pattern in patients previously appendicectomized for gangrenous (n = 7), or phlegmonous appendicitis (n = 8) and those with a non-inflamed appendix (n = 5). Peripheral blood mononuclear cells were analysed with ELISPOT analysis for number of spontaneous or antigen/mitogen stimulated IFN-?, IL-4, IL-10 and IL-12 secreting cells or with ELISA for concentration of spontaneous or antigen/mitogen stimulated IFN-?, IL-5 and IL-10. Spontaneously IL-10 secreting cells/100 000 lymphocytes were increased in the gangrenous group compared to the phlegmonous group (P = 0·015). The median concentration of IL-10 secreted after Tetanus toxoid (TT)-stimulation were higher in the gangrenous group and the control group, than the phlegmonous group (P = 0·048 and P = 0·027, respectively). The median concentration of TT induced IFN-? secretion was higher for the gangrenous group compared to both the phlegmonous group and the control group (P = 0·037 and P = 0·003). Individuals with a history of gangrenous appendicitis demonstrated ability to increased IL-10 and IFN-? production. The increased IFN-? may support the notion of gangrenous appendicitis as an uncontrolled Th1 mediated inflammatory response and increased IL-10 may speculatively indicate the involvement of cytotoxic cells in the progression to perforation.

Ruber, M; Berg, A; Ekerfelt, C; Olaison, G; Andersson, R E



Non-traumatic gas gangrene in the abdomen: report of six autopsy cases  

Microsoft Academic Search

:   Six autopsy cases of non-traumatic gas gangrene in the abdomen are reported. Five of the six were caused by clostridia, as identified by culture or histology. There were associated underlying diseases, such as alcoholism, liver cirrhosis, diabetes\\u000a mellitus, and malignant disease. Three of the six patients had gas gangrene in the liver. Bacterial proliferation and gas\\u000a accumulation were found

Toshiki Sasaki; Hiroshi Nanjo; Masato Takahashi; Tatsuo Sugiyama; Iwao Ono; Hirotake Masuda



Delayed antemortem diagnosis of adenocarcinoma of the cecum presenting as lower extremity gas gangrene  

Microsoft Academic Search

The rare entity of nontraumatic metastatic gas gangrene is commonly associated with occult gastrointestinal malignancies.\\u000a Normally the patient's course is fulminant, with rapid demise prior to ascertaining the correct etiology at autopsy. An unusual\\u000a case is presented in that 65 days following hip disarticulation for gas gangrene the diagnosis of colonic cancer was appropriately\\u000a suspected and then proven.

Geoffrey G. Hallock



Developmental venous anomalies (DVA): The so-called venous angioma  

Microsoft Academic Search

Summary Following a review of the literature it is possible to demonstrate the “normality” of the so called venous angiomas. They should be named Developmental Venous Anomaly (DVA). They illustrate in their two extreme types (superfical and deep) the hemodynamic equilibrium of the transcortical venous drainage in the periependymal zones. Venous ectasias and varices which can be encountered, associated with

Pierre Lasjaunias; Patricia Burrows; Chantal Planet



[Chronic venous insufficiency (CVI)].  


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

Renner, R; Simon, J



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.



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



Venous thrombosis: an overview  

SciTech Connect

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

Peterson, C.W.



Venous Thromboembolism in Pregnancy  

Microsoft Academic Search

Pregnancy is a hypercoagulable state accompanied by changes in maternal physiology that also contribute to an increased risk\\u000a of thrombosis. Diagnosis and treatment of venous thromboembolism (deep venous thrombosis and pulmonary embolism) during pregnancy\\u000a present unique challenges. In non-pregnant patients, there is ample clinical research upon which recommendations are based,\\u000a but there is a paucity of data in pregnancy resulting

Karen Rosene-Montella; Ghada Bourjeily


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

PubMed Central

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

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



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


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



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

PubMed Central

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



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



[Severe toe gangrene as an early manifestation of Wegener granulomatosis in a young patient].  


Gangrene of digits is a very rare manifestation of Wegener's granulomatosis (WG). We report a case of a 29-year-old woman with nonspecific symptoms like fever, weight loss, arthralgia, arthritis and high systemic inflammatory signs. On the grounds of a presumed infection the patient was treated with antibiotics which showed no effect. Within short she complained of pain and paresthesia of the right foot with a rapid lividity. Angiography demonstrated multiples stenoses and multisegmental occlusions of the lower leg arteries. Together with renal and pulmonal symptoms a WG was suspected, the diagnosis being confirmed by kidney biopsy and positive cANCAs. A few months after starting a combined therapy with cyclophosphamide and corticosteroids the patient showed a partial remission with a residual toe gangrene. Comparing the five worldwide reported cases with digital gangrene and our presentation there is a concordance of all in the occurrence of an extremely high disease activity together with a glomerulonephritis. The findings of p-ANCAs in our patient and positive Hbs antigen in another case of WG with digital gangrene suggests a relation to panarteriitis nodosa, where gangren is more common. PMID:9782604

Binder, C; Schattenkirchner, M; Krüger, K



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


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

Chan, Cyrus C; Williams, Mallory


Spontaneous uterine perforation due to clostridial gas gangrene associated with endometrial carcinoma.  


Few cases of clostridial gas gangrene associated with uterine malignancy have been reported. We report on a 46-year-old woman with clostridial sepsis. On the day of admission due to severe abdominal pain, peritonitis was diagnosed, and computed tomography showed free air in the abdomen. At emergency laparotomy, perforation of the necrotic uterine wall was observed. During hysterectomy, septic shock developed, and life-saving therapy was performed in the intensive care unit after surgery. Pathological examination of the necrotic uterine wall showed grade III endometrial adenocarcinoma of the uterine endometrium (International Federation of Gynecology and Obstetrics stage IIIa) with gas gangrene due to Clostridium perfringens. This report aims to alert gynecologists to the possibility that clostridial gas gangrene of the uterus can occur in patients with peritonitis and intra-abdominal free air. Early recognition and aggressive therapy can save patients' lives. PMID:20610901

Kurashina, Ryuhei; Shimada, Hiromi; Matsushima, Takashi; Doi, Daisuke; Asakura, Hirobumi; Takeshita, Toshiyuki



Venous leg ulcer pain.  


Venous disease and venous leg ulcers are frequently painful. The pain experienced may be constant or intermittent. Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting edema, collagen (lipodermatosclerosis), infection, or scarring (atrophie blanche). Ulcer region pain is often episodic and may be due to surgical or other debridement procedures. Intermittent pain is often related to dressing removal or recent applications of new dressings. An approach to pain control will consider the cause of pain and utilize local measures, regional approaches to edema control, and systemic medication aimed at constant, episodic, or intermittent pain triggers. PMID:12856289

Ryan, Siobhan; Eager, Cathy; Sibbald, R Gary



Chronic venous insufficiency.  


Like the noninvasive assessment of arterial occlusive disease, the various methods for evaluation of chronic venous insufficiency (CVI) can be divided into those that provide hemodynamic information and those that provide anatomic detail. The majority of noninvasive methods for evaluation of CVI are directed toward assessing hemodynamic events in large vessels by detecting abnormally directed blood flow, elevated venous pressure, increased limb-volume changes, or valvular reflux. B-mode ultrasound, the principal non-invasive method for anatomic assessment of CVI, defines either valvular incompetence, obstruction, or recanalization changes. PMID:2406965

O'Donnell, T F; McEnroe, C S; Heggerick, P



Prognostic indicators in venous ulcers  

Microsoft Academic Search

Background: Venous ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. Objective: The objective of this study was to analyze the results of a large multicenter venous ulcer trial to retrospectively establish prognostic factors for venous ulcer healing. Methods: This study examined data from a previously published prospective randomized placebo-controlled trial of an

Tania J. Phillips; Fidelis Machado; Richard Trout; John Porter; Jeffrey Olin; Vincent Falanga



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


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

Trombold, John M



The role of x-rays in the treatment of gas gangrene: a historical assessment.  


While the use of x-rays to treat patients with gas gangrene ended in the early 1940's with the advent of antibiotics, x-ray had been widely accepted as a useful and highly effective treatment for this condition. The present paper re-assesses the historical foundations of this belief, the quality of the data, use of confirmatory animal models, and underlying mechanisms that might account for the therapeutic role of x-rays in the treatment of gas gangrene. PMID:23304109

Calabrese, Edward J; Dhawan, Gaurav



Venous Hum Tinnitus  

Microsoft Academic Search

Venous hum tinnitus is an uncommon but treatable cause of objective tinnitus. Ligation of the internal jugular vein has been described with favorable results when the tinnitus is loud enough to disturb sleep or hearing. Careful history and physical examination is helpful in establishing the diagnosis, but other causes should be excluded prior to ligation. Angiography is indicated to rule

Saud Al Turki; Hussein Al-Kohlani; Sumayyah Shabra



Venous leg ulcers  

Microsoft Academic Search

In 1837, Piorry, a French professor of medicine stated, “It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries.” Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite

Carin F. Gonsalves



Portal venous occlusion  

Microsoft Academic Search

Summary Morbidly obese patients are significantly more susceptible to clotting phenomena, including recurrent deep venous thrombosis, pulmonary emboli, inferior vena caval thrombosis, and renal vein thrombosis. The patient described in this report developed the sudden onset of massive ascites two years following jejunoileal bypass for morbid obesity. Occlusion of the portal vein and its tributaries was demonstrated. Our experience and

Richard Metz; Robert Gray; Leonard Goldstein



Venous insufficiency (image)  


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


Central venous catheter use  

Microsoft Academic Search

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

Kees H. Polderman; Armand R. J. Girbes



Management of Venous Thromboembolism  

Microsoft Academic Search

enous thromboembolism, including deep vein thrombosis and pulmonary embolism, represents a significant source of morbidity and mortality in the United States and worldwide. The pharmacologic management of venous thromboembolic disease has witnessed significant advances since oral anticoagulant and heparin therapies began to gain widespread use more than 50 years ago. Cumulative clinical experience gained from using these 2 classes of

Thomas M. Hyers



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



Venous thrombosis - series (image)  


... cardiac arrest and sometimes death. This is called pulmonary embolism. ... Post-operative patients are at risk for pulmonary embolism because of the time spent in bed after surgery. One method for reducing the risk of venous thrombosis is the use of sequential ...


Posttraumatic Portal Venous Gas  

Microsoft Academic Search

Portal venous gas (PVG) is a rare condition that can occur after blunt abdominal trauma. The case of a young boy with PVG after a car crash is reported. The boy died after surgery because of major posttraumatic bowel necrosis. The aim of this article is to show that PVG can be a serious condition after blunt abdominal trauma in

Christophe Laplace; Emil Nini; Denis Pezet; Alain Tanguy



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

Microsoft Academic Search

INTRODUCTION: Fournier gangrene is a rare necrotising fascitis of the perineum and genitals caused by a mixture of aerobic and anaerobic microorganisms. The first case was described by Baurienne in 1764 but the condition was named by Fournier in 1883 who reported the cases of five men with the condition with no apparent etiology. Infection most commonly arises from the

Mohammd Kazem Moslemi; Mohammad Ali Sadighi Gilani; Ali Akbar Moslemi; Ali Arabshahi



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


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

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



Fracture dislocation of the interphalangeal joint of the big toe resulting in gangrene and amputation  

Microsoft Academic Search

Dislocation or fracture dislocation of the toes is a rare injury. Hallux is reported as the most common location for these injuries. We report the case of a dislocation of interphalangeal jointof big toe resulting in gangrene of the toe and amputation.

M. A. Farooq; S. Kutty; J. P. McElwain



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

Microsoft Academic Search

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

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



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



Wound Infection Incidence in Patients with Simple and Gangrenous or Perforated Appendicitis  

Microsoft Academic Search

Background: Performing a delayed primary wound closure is often recommended in patients with gangrenous or perforated appendicitis who have undergone an appendectomy. It can result in increased pain as well as an extended hospital stay which, in turn, increases hospital costs. Delayed primary wound closure remains controversial. The general policy in our institution is to perform a primary wound closure.

Mostafa Mehrabi Bahar; Ali Jangjoo; Ahmad Amouzeshi; Kamran Kavianifar


Combined Effects of Hyperbaric Oxygen and Antimicrobials in a Model of Gas Gangrene.  

National Technical Information Service (NTIS)

The efficacy of hyperbaric oxygen (HBO) alone and in combination with several antimicrobial agents was evaluated in a lethal model of gas gangrene in mice. Myonecrosis was induced by injecting -1079 washed C. perfringens into the right upper thigh'-muscle...

K. H. Muhvich L. H. Anderson W. J. Mehm



Effect of Hyperbaric Oxygen and Surgery on Experimental Multimicrobial Gas Gangrene  

Microsoft Academic Search

An experimental multimicrobial gas gangrene rat model was developed and the therapeutic effect of surgery was compared to the combined effect of surgery and hyperbaric oxygen (HBO). The infection was caused by an intramuscular injection of a mixture of bacteria including Clostridium perfringens, Bacteroides fragilis, Escherichia coli and Streptococcus faecalis. The mortality, morbidity and wound healing were assessed during a

M. Hirn; J. Niinikoski; O.-P. Lehtonen



Clostridial abdominal gas gangrene masquerading as a bowel perforation in an advanced-stage ovarian cancer patient.  


The coexistence of clostridial gas gangrene and a gynecologic malignancy is extremely rare, with very few cases involving ovarian cancer. A patient originally presented to our gynecologic oncology service with stage IV ovarian cancer; she underwent a diagnostic laparoscopy and neoadjuvant chemotherapy. On postoperative day 6, the patient developed severe abdominal pain, nausea, and emesis, suggestive of a bowel perforation. Further evaluation confirmed that her symptoms were attributed to Clostridium perfringens-related gas gangrene. Despite immediate surgical intervention, the patient succumbed to her disease. Clostridial gas gangrene is associated with an extremely high mortality rate. Therefore, accurate detection and prompt management are indispensable to ensuring a favorable patient outcome. PMID:23494868

Abaid, L N; Thomas, R H; Epstein, H D; Goldstein, B H



Venous thromboembolism in pregnancy.  


In Western nations, venous thromboembolism (VTE) is an important cause of morbidity and the most common cause of maternal death during pregnancy and the puerperium. Pregnancy is a hypercoagulable state in which coagulation is activated and thrombolysis inhibited. This prothrombotic risk is compounded when hereditary and acquired thrombophilias and other prothrombotic risk factors are present. The risk of venous thrombotic events is increased fivefold during pregnancy and 60-fold in the first 3 months after delivery (postpartum period) compared with nonpregnant women. Many of the signs and symptoms of VTE overlap those of a normal pregnancy, which complicates the diagnosis. Patients with history of previous VTE should use graduated compression stockings throughout pregnancy and the puerperium, and should receive postpartum anticoagulant prophylaxis. The indications for antepartum anticoagulant prophylaxis are somewhat controversial. This article reviews the management of VTE during pregnancy and in the postpartum period. PMID:21047579

Marik, Paul E



ArterioVenous Malformations  

Microsoft Academic Search

Intracranial arterio-venous malformations (AVM) are relatively uncommon, but increasingly recognized lesions that can cause\\u000a serious neurological symptoms or death. Although AVM can initially present with hemorrhages or seizures, an increasing number\\u000a is detected before symptomatic bleeding due to the recently developed imaging techniques. Over the last decades, the management\\u000a of AVM has been widely modified due to the availability of

Markus W. Gross; Rita Engenhart-Cabillic


Venous thromboembolism in pregnancy  

Microsoft Academic Search

Opinion statement  Low molecular weight heparins (LMWHs) appear to be as safe and effective as unfractionated heparin (UFH) for venous thromboembolic\\u000a disease (VTED) treatment or prophylaxis during pregnancy. Experience with other parenteral anticoagulant drugs is very limited,\\u000a and no alternative oral anticoagulants are available to date. In addition to cost, challenges of long-term LMWH use during\\u000a pregnancy that have not been

Marcelo P. Villa-Forte Gomes



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


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, may represent a nutritional signal against gas gangrene development. Here we demonstrate, for the first time, that sugars (sucrose, glucose) inhibited the production of the main protein toxins, PLC (alpha-toxin) and PFO (theta-toxin), responsible for the onset and progression of gas gangrene. Transcription analysis experiments using plc-gusA and pfoA-gusA reporter fusions as well as RT-PCR analysis of mRNA transcripts confirmed that sugar represses plc and pfoA expression. In contrast an isogenic C. perfringens strain that is defective in CcpA, the master transcription factor involved in carbon catabolite response, was completely resistant to the sugar-mediated inhibition of PLC and PFO toxin production. Furthermore, the production of PLC and PFO toxins in the ccpA mutant strain was several-fold higher than the toxin production found in the wild type strain. Therefore, CcpA is the primary or unique regulatory protein responsible for the carbon catabolite (sugar) repression of toxin production of this pathogen. The present results are analyzed in the context of the role of CcpA for the development and aggressiveness of clostridial gas gangrene and the well-known, although poorly understood, anti-infective and wound healing effects of sugars and related substances. PMID:22079896

Méndez, M B; Goñi, A; Ramirez, W; Grau, R R



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

PubMed Central

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

Jones, Peter W.



A systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life.  


To optimally manage patient care, knowledge of the prevalence of signs of impending death and common symptoms in the last days is needed. Two reviewers independently conducted searches of PubMed, CINAHL, PsychINFO and the Web of Knowledge from January, 1996 to May, 2012. No limits to publication language or patient diagnosis were imposed. Peer reviewed studies of adults that included contemporaneous documentation of signs and symptoms were included. Articles were excluded if they assessed symptoms by proxy or did not provide information on prevalence. Reviewers independently extracted data. Twelve articles, representing 2416 patients, in multiple settings were analyzed. Of the 43 unique symptoms, those with the highest prevalence were: dyspnea (56.7%), pain (52.4%), respiratory secretions/death rattle (51.4%), and confusion (50.1%). Overall prevalence may be useful in anticipating symptoms in the final days and in preparing families for signs of impending death. PMID:23236090

Kehl, Karen A; Kowalkowski, Jennifer A



Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux  

Microsoft Academic Search

Chronic venous insufficiency which produces lipodermatosclerosis, varicosities, or ulceration, is frequently caused by superficial venous reflux and deep venous incompetence. The anatomy of venous insufficiency has been clarified with duplex ultrasound, thus allowing appropriately directed therapy. However, postoperative venous physiology in patients undergoing superficial venous ablation has been infrequently reported. This study was undertaken to document the effect of superficial

Clifford M. Sales; Michael L. Bilof; Kathleen A. Petrillo; Norman L. Luka



Cerebral venous thrombosis  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Cerebral venous thrombosis is a rare disorder with highly variable and nonspecific clinical presentations. For these reasons,\\u000a specific treatment should be given only when the diagnosis has been firmly established. Etiologic diagnosis should begin in\\u000a the emergency department to identify underlying conditions that require specific treatment.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a The mainstay of treatment is anticoagulation with heparin, even in

Philippe Niclot; Marie Germaine Bousser



Management of venous thromboembolism  

Microsoft Academic Search

\\u000a Abstract\\u000a Purpose  To describe the drugs used to treat venous thromboembolism (VTE) and to review particular aspects of the management (elastic\\u000a stockings, thrombolysis, thrombectomy, vena cava filter).\\u000a \\u000a \\u000a \\u000a Source  Our review of the literature is focused on consensus documents and recent large randomized trials.\\u000a \\u000a \\u000a \\u000a Principal findings  Subcutaneous low molecular weight heparins (LMWH) have been shown to be both safe and effective for the initial

Philippe de Moerloose; Charles Marc Samama; Serge Motte



Inherited thrombophilia and venous thromboembolism  

Microsoft Academic Search

Pulmonary thromboembolism (PTE) is the major cause of maternal death in the UK. Underlying PTE is the problem of deep venous thrombosis (DVT). Inherited thrombophilia will be found in about 50% of women with a personal history of venous thromboembolism (VTE), and screening for thrombophilia should be considered in women with a personal or family history of VTE. There is

Ian A Greer



Venous air embolism: A review  

Microsoft Academic Search

Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is forced under-pressure into a body cavity. Though classically associated with neurosurgery, VAE is also a potential complication of laparoscopic, pelvic, and orthopedic procedures. It is, therefore, essential for the practicing anesthesiologist to

Sally C. Palmon; Laurel E. Moore; Jeany Lundberg; Thomas Toung



Skin demarcation and amputation level for foot gangrene following meningococcal septicemia.  


A case report of a 55-year-old woman who was being considered for bilateral below knee or Syme's amputations after gangrene at the level of both forefeet due to meningococcal septicaemia is described. An expectant approach for 6 months revealed that the tissues deep to the necrotic skin were viable and she was subsequently able to mobilize independently with normal footwear after bilateral toe amputations at the metatarsophalangeal joint levels. This case and a literature review suggest that the demarcation of healthy skin from necrotic skin (eschar) should not dictate the level of amputation in dry gangrene of the foot following meningococcal septicemia. Magnetic resonance imaging can overestimate the degree of muscle necrosis. Treatment should be individualized for each patient, but advice should include the option of prolonged conservative treatment to preserve limb length and function. Level of Evidence: Therapeutic, Level IV: Case study. PMID:23966262

Singh, Dishan; Swann, Amanda



Necrotizing fasciitis and gangrene associated with topical herbs in an infant  

Microsoft Academic Search

A 4-mo-old Chinese infant developed necrotizing fasciitis and gangrene from a small skin infection on his buttock that was\\u000a treated with topical herbs. Sequential cultures revealed a number of organisms:Enterococcus species, sensitive to ampicillin, were isolated throughout the course, and coagulasenegative staphylococci replaced gram-negative\\u000a rods during the later phase of the illness. The infant required prolonged intravenous antibiotic treatment and

Kam-Iun Ellis Hon; Erica Leung; David Andrew Burd; Alexander K. C. Leung



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

Microsoft Academic Search

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

V Nigam; T A Halim; H S Chhabra



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

Microsoft Academic Search

Three patients with ANLL developed Fournier’s gangrene as an early complication after allo-BMT (two cases) and auto-BMT (one case); two patients were in first CR, the third had resistant disease. Patients developed fever, perineal pain, swelling and blistering of the genital area. Pseudomonas aeruginosa was isolated from the lesions and patients received systemic antibiotic therapy, surgical debridement and medication with

G Martinelli; EP Alessandrino; P Bernasconi; D Caldera; A Colombo; L Malcovati; Gaviglio; GP Vignoli; G Borroni; C Bernasconi; P Alessandrino



Nontraumatic, clostridial, gas gangrene of the right arm and adenocarcinoma of the cecum  

Microsoft Academic Search

Summary  A fatal case of nontraumatic, clostridial, gas gangrene of the right arm is presented. The probable entry site for the organisms\\u000a was an ulcerating, cecal adenocarcinoma which was found at postmortem examination. If future experience with high-pressure\\u000a oxygen proves to be beneficial in the treatment of clostridial myositis, we may see an increase in the survival rate of this\\u000a disease.

Alan B. Gazzaniga



Role of Clostridium perfringens phospholipase C in the pathogenesis of gas gangrene  

Microsoft Academic Search

Gas gangrene is an acute and devastating infection most frequently caused by Clostridium perfringens and characterized by severe myonecrosis, intravascular leukocyte accumulation, and significant thrombosis. Several lines of evidence indicate that C. perfringens phospholipase C (Cp-PLC), also called alpha-toxin, is the major virulence factor in this disease. This toxin is a Zn2+ metalloenzyme with lecithinase and sphingomyelinase activities. Its three

Marietta Flores-D??az; Alberto Alape-Girón



Renal cortical necrosis, peripheral gangrene, perinephric and retroperitoneal haematoma in a patient with a viper bite.  


Snakebites are estimated to affect more than 2.5 million people annually, of whom more than 100,000 die. Viper bites cause various systemic symptoms such as: coagulopathy; haemolysis; acute renal failure; a generalized increase in capillary permeability; rhabdomyolysis; and neurotoxicity. Wide spectrums of vascular complications are seen. We report the case of a patient developing gangrenous changes in a lower limb along with the development of perinepheric and retroperitoneal haematoma with acute cortical necrosis of the kidneys. PMID:22316624

Kumar, Susheel; Sharma, Aman; Sodhi, Kushaljit S; Wanchu, Ajay; Khandelwal, Niranjan; Singh, Surjit



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 Galì; Stefano Cotrufo; Marco Romeo; Carlo Magno



A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease.  


Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy. PMID:23837143

Lee, Heon Ju; Oh, Myung Jin



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



Management of venous malformations.  


Venous malformations (VMs) frequently occur in the head and neck with a predilection for the parotid gland, submandibular triangle, buccal space, muscles of mastication, lips, and upper aerodigestive tract. They are composed of congenitally disrupted ectatic veins with inappropriate connections and tubular channels. Because VMs have poorly defined boundaries and a tendency to infiltrate normal tissue, they require calculated treatment decisions in the effort to preserve surrounding architecture. Sclerotherapy, surgical excision, neodymium:yttrium aluminum garnet laser therapy, or a combination of these modalities is employed in the management of VMs. Although many small VMs can be cured, the objective is often to control the disease with periodic therapy. Location, size, and proximity to vital structures dictate the type of therapy chosen. Vigilance with long-term follow up is important. This review outlines current diagnostic and therapeutic approaches to simple and extensive cervicofacial VMs. PMID:23188688

Richter, Gresham T; Braswell, Leah



Venous air embolism: a review.  


Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is forced under pressure into a body cavity. Though classically associated with neurosurgery, VAE is also a potential complication of laparoscopic, pelvic, and orthopedic procedures. It is, therefore, essential for the practicing anesthesiologist to recognize and treat venous air entrainment. An in-depth review of the pathophysiology, clinical presentation, detection, prevention, and treatment of VAE is presented. PMID:9172037

Palmon, S C; Moore, L E; Lundberg, J; Toung, T



Pressure induced cellular senescence-a possible mechanism linking venous hypertension to venous ulcers  

Microsoft Academic Search

Introduction: Slowed healing and venous ulcers are the soft tissue effects of chronic venous insufficiency (CVI). Chronic venous hypertension has long been thought to be the root cause of these soft tissue effects, but mechanisms linking venous hypertension to delayed wound healing have been elusive. Dermal fibroblasts isolated from venous ulcers have morphologies and protein production suggestive of premature aging.

N. Fernandez; K. M. Lounsbury; T. Osler; K. A. Corrow; C. Healey; P. Forgione; A. C. Stanley



Correlation of clinical findings with venous hemodynamics in 386 patients with chronic venous insufficiency.  


Deep venous insufficiency secondary to deep valvular incompetence predominated over superficial venous insufficiency in an unselected patient population with advanced chronic venous insufficiency. Venous obstruction was uncommon (5 percent), suggesting that venous bypass surgery may have limited applicability in the management of chronic venous insufficiency. Although the majority of patients (72 percent) with stage III venous disease (ulcer) had deep venous insufficiency alone and would be potential candidates for deep valvular reconstruction, 13 percent were found to have superficial venous insufficiency alone, and the remaining 15 percent, deep venous insufficiency with a hemodynamically significant component of superficial venous insufficiency. These findings suggest that not all patients with stage III disease have altered hemodynamics on the basis of deep venous valvular incompetency. Although most stage III chronic venous insufficiency is secondary to altered deep venous hemodynamics, as demonstrated by shortened venous refill time, there is a significant group of patients with severe chronic venous insufficiency having superficial venous insufficiency alone or in combination with deep venous insufficiency (28 percent). Thus, it is imperative that those patients with superficial venous insufficiency be identified by a widely available and reproducible method, such as light reflection rheography, since they may respond to surgery of the superficial venous system alone. PMID:3400816

McEnroe, C S; O'Donnell, T F; Mackey, W C



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.



Arterial emboli of venous origin.  


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



Total anomalous systemic venous return.  


We have described an 18-year-old boy who is asymptomatic nine years after surgical correction of total anomalous systemic venous return. His clinical course and anatomy are compared to the eight previously reported patients. PMID:7355335

Pearl, W R; Spicer, M J



Idiopathic venous thromboembolism and thrombophilia  

PubMed Central

During the past decade idiopathic venous thromboembolism has become a separate entity, a chronic illness which has required prolonged anticoagulation and other prevention strategies to avoid recurrences. This article reviews recent developments regarding unprovoked venous thromboembolism and its relation with thrombophilia. In the beginning, the latest definition of idiopathic venous thromboembolism is presented. The article continues with statistics about thrombophilia, related venous thromboembolism, and a classification of major thrombophilic factors according to their intrinsic risk of thrombosis and of thrombotic recurrences. Great interest is given to the predictors of recurrence and the importance of prolonged anticoagulation is underlined. The antiphospholipid antibody syndrome, the most common acquired thrombophilia, is presented separately. The revised diagnosis criteria are discussed. Some characteristics of the antiphospholipid syndrome are worth presenting: the risk of both venous and arterial thrombosis, the high risk of thrombotic recurrence and the diversity of antiphospholipid antibodies. Patients experiencing idiopathic venous thromboembolic event have a great risk of recurrence, and highly benefit from long time anticoagulation. Natural coagulation inhibitors deficiencies, homozygous factor V Leiden and prothrombin G20210A and the antiphospholipid syndrome, increase the risk of first venous thrombosis and their recurrences and require adequate prevention. Abbreviations: VTE–venous thromboembolism, HRT–hormone replacement therapy, AVK–antivitamin K, FVL–factor V Leiden, PT G20210A–prothrombin G20210A, TAFI–thrombin activatable fibrinolysis inhibitor, PAI–1–plasminogen activator inhibitor 1, T–PA–tissue plasminogen activator, APS–antiphospholipid syndrome, LA–lupus anticoagulant, Abeta2GP1–anti beta2 glycoprotein 1.

Hostiuc, M; Bartos, D



Understanding Guyton's venous return curves  

PubMed Central

Based on observations that as cardiac output (as determined by an artificial pump) was experimentally increased the right atrial pressure decreased, Arthur Guyton and coworkers proposed an interpretation that right atrial pressure represents a back pressure restricting venous return (equal to cardiac output in steady state). The idea that right atrial pressure is a back pressure limiting cardiac output and the associated idea that “venous recoil” does work to produce flow have confused physiologists and clinicians for decades because Guyton's interpretation interchanges independent and dependent variables. Here Guyton's model and data are reanalyzed to clarify the role of arterial and right atrial pressures and cardiac output and to clearly delineate that cardiac output is the independent (causal) variable in the experiments. Guyton's original mathematical model is used with his data to show that a simultaneous increase in arterial pressure and decrease in right atrial pressure with increasing cardiac output is due to a blood volume shift into the systemic arterial circulation from the systemic venous circulation. This is because Guyton's model assumes a constant blood volume in the systemic circulation. The increase in right atrial pressure observed when cardiac output decreases in a closed circulation with constant resistance and capacitance is due to the redistribution of blood volume and not because right atrial pressure limits venous return. Because Guyton's venous return curves have generated much confusion and little clarity, we suggest that the concept and previous interpretations of venous return be removed from educational materials.

Feigl, Eric O.



Venous thromboembolism in pregnancy.  


The purpose of this review is to summarize the epidemiology of venous thromboembolism (VTE) in pregnancy and describe strategies used to prevent and treat it. The main reason for the increased risk of VTE in pregnancy is hypercoagulability. The hypercoagulability of pregnancy, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth, is present as early as the first trimester and so is the increased risk of VTE. Other risk factors include a history of thrombosis, inherited and acquired thrombophilia, certain medical conditions, and complications of pregnancy and childbirth. Candidates for anticoagulation are women with a current thrombosis, a history of thrombosis, thrombophilia, and a history of poor pregnancy outcome, or postpartum risk factors for VTE. For fetal reasons, the preferred agents for anticoagulation in pregnancy are heparins. There are no large trials of anticoagulants in pregnancy and recommendations are based on case series and the opinion of experts. Nonetheless, anticoagulants are believed to improve the outcome of pregnancy for women who have or have had VTE. PMID:19228606

James, Andra H



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

PubMed Central

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

Alamelu, V



Dry gangrene of the extremities in calves associated with Salmonella dublin infection; a possible immune-mediated reaction.  


Dry gangrene of the extremities in calves is a circulatory error that may occur after infection with Salmonella dublin. This report describes an examination of three affected, 12 in-contact and five control calves, a main objective being to investigate the possible role of cold agglutination in pathogenesis. The lesions included dry gangrene of the hind legs, ears and tail. A cold agglutination test gave positive results in all animals examined except the controls. The three affected calves had high titres of S. dublin antibodies, as also did four of the in-contact animals. The results suggested a relationship between cold agglutination and the occurrence of the disease. PMID:16707135

Loeb, E; Toussaint, M J M; Rutten, V P M G; Koeman, J P



Peripheral gangrene associated with Kawasaki disease and successful management using prostacycline analogue: a case report.  


We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifested with coronary aneurysms and peripheral gangrene of the lower limbs. Therapy with intravenous immunoglobulins, corticosteroids, aspirin, anticoagulants, and ilomedine, a prostacyclin analogue, resulted in rapid improvement in the patient's condition without extremity loss. Those treating patients with Kawasaki disease must be aware of possible vascular ischemia in the disease process that is reversible by early intervention treatments, including the use of a prostacycline analogue, that improve quality of life. PMID:17311768

Dogan, Omer Faruk; Kara, Ates; Devrim, Ilker; Tezer, Hasan; Besbas, Nesrin; Ozen, Seza; Secmeer, Gulten; Yorgancioglu, Cem; Boke, Erkmen



Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil.  


Diabetic foot wounds represent a class of chronic non-healing wounds that can lead to the development of soft tissue infections and osteomyelitis. We reviewed the case of a 44-year-old female with a diabetic foot wound who developed gas gangrene while treating her wound with tea tree oil, a naturally derived antibiotic agent. This case report includes images that represent clinical examination and x-ray findings of a patient who required broad-spectrum antibiotics and emergent surgical consultation. Emergency Department (ED) detection of these complications may prevent loss of life or limb in these patients. PMID:21559069

Cooney, Derek R; Cooney, Norma L



Fournier’s gangrene: analysis of prognostic variables in 34 patients  

Microsoft Academic Search

Introduction  Fournier’s gangrene (FG) is the necrotizing fasciitis of the perineum and genital area. The objective of this study was to\\u000a assess risk factors for mortality.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  We conducted an analytic and retrospective study of the patients with FG treated at our institution between 1998 and 2008.\\u000a Statistical analysis was performed with the Statistical Package for Social Science for Windows,

A. García Marín; J. Martín Gil; A. Vaquero Rodríguez; T. Sánchez Rodríguez; J. de Tomás Palacios; J. Lago Oliver; F. Turégano Fuentes



Prediction of the date, magnitude and affected area of impending strong earthquakes using integration of multi precursors earthquake parameters  

NASA Astrophysics Data System (ADS)

Usually a precursor alone might not be useful as an accurate, precise, and stand-alone criteria for the earthquake parameters prediction. Therefore it is more appropriate to exploit parameters extracted from a variety of individual precursors so that their simultaneous integration would reduce the parameters's uncertainty. In our previous studies, five strong earthquakes which happened in the Samoa Islands, Sichuan (China), L'Aquila (Italy), Borujerd (Iran) and Zarand (Iran) have been analyzed to locate unusual variations in the time series of the different earthquake precursors. In this study, we have attempted to estimate earthquake parameters using the detected anomalies in the mentioned case studies. Using remote sensing observations, this study examines variations of electron and ion density, electron temperature, total electron content (TEC), electric and magnetic fields and land surface temperature (LST) several days before the studied earthquakes. Regarding the ionospheric precursors, the geomagnetic indices Dst and Kp were used to distinguish pre-earthquake disturbed states from the other anomalies related to the geomagnetic activities. The inter-quartile range of data was utilized to construct their upper and lower bound to detect disturbed states outsides the bounds which might be associated with impending earthquakes. When the disturbed state associated with an impending earthquake is detected, based on the type of precursor, the number of days relative to the earthquake day is estimated. Then regarding the deviation value of the precursor from the undisturbed state the magnitude of the impending earthquake is estimated. The radius of the affected area is calculated using the estimated magnitude and Dobrovolsky formula. In order to assess final earthquake parameters (i.e. date, magnitude and radius of the affected area) for each case study, the earthquake parameters obtained from different earthquake precursors were integrated. In other words, for each case study using the median and inter-quartile range of earthquake parameters, the bounds of the final earthquake parameters were defined. For each studied case, a close agreement was found between the estimated and registered earthquake parameters.

Saradjian, M. R.; Akhoondzadeh, M.



Systemic venous drainage: can we help Newton?  


In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton. PMID:17336540

Corno, Antonio F



Iliofemoral venous obstruction without thrombosis.  


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



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



Pathophysiology of Spontaneous Venous Gas Embolism.  

National Technical Information Service (NTIS)

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...

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



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



Epidemiology and Costs of Venous Diseases in Central ItalyThe San Valentino Venous Disease Project  

Microsoft Academic Search

The Prevalence of Early Atherosclerosis study aims to define the prevalence of subclinical atherosclerosis in a typical population of central Italy. A concomitant study evaluates the prevalence of venous diseases. The prevalence of superficial and deep venous disease, the prevalence of venous thrombosis and pulmonary embolism, and the prevalence of the most common venous malformations were studied through use of

M. R. Cesarone; G. Belcaro; A. N. Nicolaides; G. Laurora; M. T. De Sanctis; L. Incandela; A. Barsotti



Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases  

Microsoft Academic Search

We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry,\\u000a microbiology, and scanning electron microscopy. The causative pathogen was Clostridium perfringens in four cases, C. sordellii in one case, and a mixed infection with both C. perfringens and C. sordellii in one case. According to the previous medical history and autopsy findings, clostridial infection was related

Michael Tsokos; Sarah Schalinski; Friedrich Paulsen; Jan P. Sperhake; Klaus Püschel; Ingo Sobottka



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



Imaging of head and neck venous malformations  

Microsoft Academic Search

Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated

Christine M. Flis; Stephen E. Connor



Acute lipodermatosclerosis is associated with venous insufficiency  

Microsoft Academic Search

Background: Acute lipodermatosclerosis is characterized by pain and tenderness in the medial aspect of the leg. It is thought to be the result of venous insufficiency and to be the acute counterpart of chronic lipodermatosclerosis, a hallmark of venous disease. However, there is no direct evidence linking acute lipodermatosclerosis to venous disease.Objective: Our purpose was to determine whether acute lipodermatosclerosis

Adam S Greenberg; Anthony Hasan; Berta M Montalvo; Anne Falabella; Vincent Falanga



The Use of Somatosensory Evoked Potentials to Determine the Relationship Between Patient Positioning and Impending Upper Extremity Nerve Injury During Spine Surgery: A Retrospective Analysis  

Microsoft Academic Search

Somatosensory evoked potential (SSEP) monitoring is used to prevent nerve damage in spine surgery and to detect changes in upper extremity nerve function. Up- per extremity SSEP conduction changes may indicate impending nerve injury. We investigated the effect of operative positioning on upper extremity nerve func- tion retrospectively in 1000 consecutive spine surgeries that used SSEP monitoring. The vast majority

Ihab R. Kamel; Elizabeth T. Drum; Stephen A. Koch; Joseph A. Whitten; John P. Gaughan; Rodger E. Barnette; Woodrow W. Wendling



Risk factors for venous thromboembolism  

Microsoft Academic Search

Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in patients hospitalized with a wide variety of acute medical illnesses have demonstrated a risk of VTE in medical patients comparable with that seen after major general surgery. In addition, epidemiologic

Frederick Anderson; Frederick A. Spencer



Antiphospholipid Antibodies and Venous Thromboembolism  

Microsoft Academic Search

NTIPHOSPHOLIPID antibodies (APLA) are a hetero- geneous group of antibodies that can be detected as lupus anticoagulants (LA) and anticardiolipin antibodies (ACLA).' It is generally assumed that an association exists between APLA and venous thromboembolism (VTE). This assumption is based primarily upon the results of cross- sectional studies of patients with systemic lupus erythemato- sus The results of studies in

J. S. Ginsberg; P. S. Wells; P. Brill-Edwards; D. Donovan; K. Moffatt; M. Johnston; P. Stevens; J. Hirsh



Unanswered questions in venous thromboembolism  

Microsoft Academic Search

We have made great strides in the diagnosis, treatment and prevention of venous thromboembolism (VTE). Despite these advances, however, questions remain. Perhaps the most important unmet need is the development and implementation of strategies to increase the uptake of guidelines for thromboprophylaxis. VTE is largely preventable with appropriate prophylaxis. New oral anticoagulants have the potential to further streamline VTE prevention

Jeffrey I. Weitz



Venous thromoboembolic disease and pregnancy  

Microsoft Academic Search

Although venous thromboembolism is a preventable and treatable condition, it remains the most common cause of direct maternal death in the UK, with a four-fold increased incidence compared to that of the non-pregnant population. The risk of VTE is apparent from early pregnancy and maximal immediately postpartum. Increasing rates of obesity and maternal age over 35 years are in part

M Martineau; C Nelson-Piercy



Multiple venous aneurysms of neck  

PubMed Central

Venous aneurysm of neck is a rare anomaly, usually presenting as a painless mass which increases in size on valsalva maneuver. A child with multiple aneurysms of the right common facial and external jugular veins diagnosed on Doppler ultrasonography and magnetic resonance venography is reported.

Swaika, Sweta; Basu, Sudipta; Bhadra, Ram C.; Maitra, Sujay



Managing venous stasis disease and ulcers.  


Venous leg ulcers are arguably the most common type of venous ulcers seen in clinical practice. Compression therapy is the essential intervention in venous leg ulcer treatment, but coexisting arterial vascular insufficiency must be excluded before compression is initiated. No single topical dressing has been shown to be superior for all wounds. Venous leg ulcers are chronic and often difficult to heal, with only 40% to 70% healing after 6 months of treatment. Surgical procedures to reduce venous hypertension do not accelerate healing of a chronic ulcer, but trials suggest a decreased rate of future recurrence after surgery. PMID:23571036

Thomas, David R



Molecular mechanisms in chronic venous insufficiency.  


Chronic venous disease (CVD) is common. Its manifestations include varicose veins; skin changes such as dermatitis, hyperpigmentation, and lipodermatosclerosis; and chronic leg ulcers. Recent advances in the understanding of its pathophysiology have shown how molecular mechanisms in the inflammatory cascade are involved in these diverse findings. Venous hypertension and associated fluid shear stress alterations on the endothelial surface may initiate this cascade and may lead to adverse changes in the venous wall, venous valves, and skin that can eventually result in varicose veins and in venous ulcers. PMID:17484957

Bergan, John



Cerebral venous outflow and arterial microsphere flow with elevated venous pressure.  


The cerebral blood flow response to cerebral venous pressure elevation was studied in pentobarbital-anesthetized dogs using the cerebral venous outflow and radiolabeled microsphere techniques. Cerebral venous pressure elevation resulted in a significant reduction in cerebral venous outflow at a pressure of approximately 2.0 mmHg (referenced at the level of the external auditory meatus). At higher pressures, cerebral venous outflow decreased at a rate of 0.5 ml x min-1 x mmHg-1. Mean arterial pressure was 102.0 mmHg, and thus cerebral perfusion pressure (mean arterial pressure minus cerebral venous pressure) was well within the range for cerebral autoregulation. These results were obtained regardless of whether cerebrospinal fluid pressure was allowed to rise concomitantly with cerebral venous pressure (11 dogs) or was maintained at atmospheric pressure (7 dogs). However, simultaneous measurement of cerebral venous outflow and total and regional cerebral blood flow with the radiolabeled microsphere technique with venous pressure elevation (6 dogs) produced discrepant results. As cerebral venous pressure was elevated to approximately 16.0 mmHg, cerebral venous outflow decreased to 40% of control while total and regional cerebral blood flow values remained unchanged, so that regional and cerebral vascular resistances decreased. These results suggest that cerebral venous pressure elevation opens intracranial venous anastomotic channels and diverts blood flow from the measured venous drainage through other drainage sites. In addition, our results suggest that the dominant mechanism of cerebral autoregulation is metabolic, not myogenic. PMID:6404180

Wagner, E M; Traystman, R J



[Fournier's gangrene in a patient with Hodgkin's disease: a clinical case].  


The authors report a case of Fournier's gangrene in a 54-year-old patient subjected 6 days earlier to chemotherapy for mediastinal Hodgkin's disease. The patient had fever and reported the onset of worsening pain and heat sensations in the inguinal, perineal and scrotal areas. Objectively, there was local oedema followed by the onset of crepitation. The patient had a very low white blood cell count (900/ The Patient underwent emergency surgery with multiple, communicating incisions in the inguinal, perineal and scrotal areas, with the removal of necrotic tissue and daily washing with physiological solution and 12% H2O2. He also received antibiotic treatment with metronidazole and gentamicin and 5 cycles of high-pressure oxygen therapy, with disappearance of pain and fever and good local tissue repair. PMID:11824071

Castellini, C; De Nitto, F; Bonomo, S; Bottura, D; Mazzola, F; Ballarin, A; Rosa, G


Necrotizing fasciitis and gangrene associated with topical herbs in an infant.  


A 4-mo-old Chinese infant developed necrotizing fasciitis and gangrene from a small skin infection on his buttock that was treated with topical herbs. Sequential cultures revealed a number of organisms: Enterococcus species, sensitive to ampicillin, were isolated throughout the course, and coagulasenegative staphylococci replaced gram-negative rods during the later phase of the illness. The infant required prolonged intravenous antibiotic treatment and underwent multiple surgical procedures for debridement and reconstruction. This report serves to alert the public of the importance of avoiding application of unknown topical herbs in children with skin disease. A seemingly small wound, if inappropriately treated, may result in extensive tissue destruction and require extensive surgery. PMID:17901041

Hon, Kam-Lun Ellis; Hon, Kam-Iun Ellis; Leung, Erica; Burd, David Andrew; Leung, Alexander K C


Indian Tick Typhus Presenting with Gangrene: A Case Report from an Urban Slum of Delhi.  


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



Cerebral venous development in relation to developmental venous anomalies and Vein of Galen aneurysmal malformations.  


Cerebrovascular venous development and intracranial vascular malformations are extensive topics for which volumes of text may be devoted. However, a basic knowledge of the embryology of cerebral venous system and venous architecture is essential for understanding of cerebral vascular malformations. The aim of this work is to provide the reader with a brief overview of the development of the cranial venous anatomy. We will highlight the superficial and deep venous systems with special attention to developmental venous anomalies and vein of Galen aneurysmal malformations. PMID:21596280

Pearl, Monica; Gregg, Lydia; Gandhi, Dheeraj



Gas Gangrene  


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Mixed Capillary Venous Retroperitoneal Hemangioma  

PubMed Central

We report a case of mixed capillary venous hemangioma of the retroperitoneum in a 61-year-old man. Abdominal ultrasonography showed a mass to be hypoechoic with increased flow in color Doppler imaging. Dynamic contrast-enhanced computed tomography revealed a centripetal filling-in of the mass, located anterior to the left psoas muscle at the level of sacroiliac joint. On the basis of imaging features, preoperative diagnosis of hemangioma was considered and the mass was excised by laparoscopic method. Immunohistochemical studies were strongly positive for CD31 and CD34, and negative for calretinin, EMA, WT1, HMB45, Ki67, synaptophysin, and lymphatic endothelial cell marker D2–40. Histologically, the neoplasm was diagnosed as mixed capillary venous hemangioma.

Godar, Mohit; Yuan, Qinghai; Shakya, Rukeshman; Xia, Yang



[Mechanical prophylaxis of venous thromboembolism].  


Mechanical devices for the prevention of venous thromboembolism (VTE) act on venous stasis and include static systems: the graduated compression stockings (or elastic stockings or anti-embolism stockings) and dynamical systems: intermittent pneumatic compression and venous foot pump. The main advantage of these devices is that they have no risk of bleeding. If the prevention of VTE is based primarily on drug prophylaxis, mechanical devices are recommended primarily for patients with high risk of bleeding, if there is contraindication to anticoagulants. Alone or in combination with drug prophylaxis, their efficacy on deep vein thrombosis prevention is well documented in surgery, but the evidence is insufficient for the prevention of pulmonary embolism and in other settings. Their interest in stroke is called into question after the results of the CLOTS 1 and 2 studies. These results, beyond the context of stroke, have raised numerous questions about the real benefit/risk ratio of mechanical devices for the prevention of VTE. They highlight the need to assess or re-evaluate mechanical devices by rigorous clinical trials. PMID:22308805

Lacut, Karine



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


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


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.



Co-infection with Toxoplasma gondii and Clostridium perfringens in a postpartum woman with uterine gas gangrene: a case report.  


Toxoplasmosis is a protozoan infection caused by Toxoplasma gondii. We report a case of Toxoplasma gondii and Clostridium perfringens co-infection complicating uterine gas gangrene following a term pregnancy. The histological examination of the necrotic uterine tissues and uterine swab cultures obtained at laparotomy revealed T. gondii and C. perfringens, respectively. Treatment was administered with bactericidal activity against both pathogens and the patient had an uneventful post-operative recovery. Although there have been some cases that have documented an association between toxoplasmosis and non-uterine C. perfringens infection, such a relationship has not been established. It is of interest to determine if the presence of both organisms can explain the severe myonecrosis that occurs in some cases of uterine gas gangrene. PMID:22487420

Alsammani, Mohamed Alkhatim; Ahmed, Salah Roshdy; Alsheeha, Muneera A; Saadia, Zaheera; Khairi, Somia A



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



Adrenergic mechanisms in canine nasal venous systems  

PubMed Central

We investigated the adrenergic mechanisms of the two venous systems that drain the nasal mucosa, thereby their exact role in eliciting nasal decongestion. The action of endogenously released noradrenaline and exogenous adrenergic agonists on different segments of the nasal venous systems, i.e. collecting (LCV, SCV) and outflow (SPV) veins of posterior venous system, collecting (ACV) and outflow (DNV) veins of anterior venous system and venous sinusoids of the septal mucosa (SM), were studied. In vitro isometric tension of the vascular segments was measured. Transmural nerve stimulation (TNS) produced constriction in ACV, DNV and SM, primary constriction followed by secondary dilatation in LCV and SCV and dilatation in SPV. Tetrodotoxin (10?6 M) abolished all responses. Phentolamine (10?6 M), prazosin (10?6 M) and rauwolscine (10?7 M) inhibited the constriction in all venous vessels. Propranolol (10?6 M), atenolol (10?6 M) and ICI 118,551 (10?6 M) inhibited the relaxation in SPV but not in LCV and SCV. Phenylephrine and clonidine constricted whereas dobutamine and terbutaline relaxed all venous vessels dose-dependently. These results indicate ?1-, ?2-, ?1- and ?2-adrenoceptors are present in both venous systems. TNS causes constriction of anterior venous system, venous sinusoids and posterior collecting veins primarily via postjunctional ?2-adrenoceptors but relaxation of posterior outflow vein equally via postjunctional ?1- and ?2-adrenoceptors. The combined action of the two adrenergic mechanisms can reduce nasal airway resistance in vivo by decreasing vascular capacitance and enhancing venous drainage via the posterior venous system.

Wang, Min; Lung, Mary A



Venous thromboembolism in obstetrics and gynecology.  


The diagnosis of venous thromboembolism can present a clinical challenge. Using D-dimer testing and spiral or helical computed tomography scans has simplified the diagnosis of venous thromboembolism. In addition, the use of low molecular weight heparin has become widely accepted in the prevention and treatment of venous thromboembolism. However, further studies are needed to determine optimal prevention and treatment strategies, particularly in the obstetric population. PMID:17329532

Krivak, Thomas C; Zorn, Kristin K



Venous air embolism during knee arthrography  

Microsoft Academic Search

A 34-year-old man developed a nonfatal venous air embolism during arthrography of his post-traumatically contractured knee joint. From the arthrographic findings, injected air was assumed to have entered the great saphenous vein via the venous opening in the knee joint. Venous air embolism is an extremely rare complication of knee arthrography, but can occur. As it is potentially fatal, prompt

S. Kobayashi; T. Takei



The impact of irregularly rising prostate-specific antigen and “impending failure” on the apparent outcome of localized prostate cancer following radiotherapy  

Microsoft Academic Search

Purpose: To examine the impact of irregularly rising prostate-specific antigen (PSA) and “impending” biochemical failure on the apparent rate of biochemical relapse following radiotherapy for localized prostate cancer.Methods and Materials: We analyzed the outcome of 572 patients with T1\\/T2 prostate cancer treated with radiotherapy alone at the Princess Margaret Hospital (median follow-up, 4.21 years). Biochemical outcomes were analyzed using 2

David C Hodgson; Charles N Catton; Padraig Warde; Mary K Gospodarowicz; Michael F Milosevic; Michael McLean M. B; Pamela Catton



Treating venous thromboembolism in pregnancy.  


This review summarizes the currently available data concerning risk, diagnosis, and management of venous thromboembolism (VTE) in pregnant women. While the actual incidence of VTE in pregnancy remains low, the hypercoagulable state and increased risk requires clinicians to be aware of the specific aspects of presentation, diagnosis, and treatment in this population. The authors outline the strategies, efficacy, and safety of the diagnostic approach, as well as the available data concerning treatment. Considerations in treatment include maternal and fetal bleeding risk, as well as management of labor and delivery. The optimal approach to treatment requires collaboration between obstetrics, hematology, and anesthesia. PMID:21444036

Fogerty, Annemarie E; Connors, Jean M



Current Treatment of Venous Thromboembolism  

PubMed Central

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common disorder with at least 250,000 new events occurring each year in the United States alone. Treatment of VTE entails anticoagulation, which is achieved initially with the use of a parenterally administered anticoagulant followed by a more prolonged course of treatment with an oral vitamin K antagonist. The duration of anticoagulation depends on the clinical assessment of the benefit-risk ratio of prolonged anticoagulation versus the risk of recurrent events. In this review, we discuss some of the issues that we believe are among the most critical unanswered questions in the management of VTE in the present era.

Key, Nigel S.; Kasthuri, Raj S.



Body odor attractiveness as a cue of impending ovulation in women: evidence from a study using hormone-confirmed ovulation.  


Scent communication plays a central role in the mating behavior of many nonhuman mammals but has often been overlooked in the study of human mating. However, a growing body of evidence suggests that men may perceive women's high-fertility body scents (collected near ovulation) as more attractive than their low-fertility body scents. The present study provides a methodologically rigorous replication of this finding, while also examining several novel questions. Women collected samples of their natural body scent twice--once on a low-fertility day and once on a high-fertility day of the ovulatory cycle. Tests of luteinizing hormone confirmed that women experienced ovulation within two days of their high-fertility session. Men smelled each woman's high- and low-fertility scent samples and completed discrimination and preference tasks. At above-chance levels, men accurately discriminated between women's high- and low-fertility scent samples (61%) and chose women's high-fertility scent samples as more attractive than their low-fertility scent samples (56%). Men also rated each scent sample on sexiness, pleasantness, and intensity, and estimated the physical attractiveness of the woman who had provided the sample. Multilevel modeling revealed that, when high- and low-fertility scent samples were easier to discriminate from each other, high-fertility scent samples received even more favorable ratings compared with low-fertility scent samples. This study builds on a growing body of evidence indicating that men are attracted to cues of impending ovulation in women and raises the intriguing question of whether women's cycling hormones influence men's attraction and sexual approach behavior. PMID:22137971

Gildersleeve, Kelly A; Haselton, Martie G; Larson, Christina M; Pillsworth, Elizabeth G



Extensive thrombosis of the caval venous system after central venous catheters in severely burned patients.  


Central venous thrombosis is a rare but extremely dangerous complication following central venous catheter placement. Two cases of massive central venous thrombosis in severely burned patients are reported. The clinical course, diagnostic problems and treatment options are described and discussed. From these cases we conclude that central venous catheter thrombosis should be included early in the differential diagnosis of trunk and extremity oedema in patients with indwelling central venous catheters and that thrombolytic therapy is safe and effective even in the severely burned patient. PMID:7546266

Germann, G; Kania, N M



Lymphatic Leak Complicating Central Venous Catheter Insertion  

Microsoft Academic Search

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.

Alex M. Barnacle; Tricia M. Kleidon



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)



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



Diagnosis and treatment of venous ulcers.  


Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. PMID:20387775

Collins, Lauren; Seraj, Samina



Prevention of venous thromboembolism in pregnancy  

Microsoft Academic Search

Pulmonary thromboembolism, rising from deep venous thrombosis (DVT), is a major cause of maternal death in the developed World. DVT is a significant source of morbidity in pregnancy and the puerperium with long-term sequelae such as post-thrombotic syndrome. The major risk factors for venous thromboembolism (VTE) are: increasing age, particularly over 35 years; operative vaginal delivery; Caesarean section, especially emergency

Ian A Greer



Venous air embolism during operative hysteroscopy  

Microsoft Academic Search

The world literature, including hospital and medicolegal case records, was reviewed to collate cases of venous air embolism resulting from the increasing number of operative hysteroscopies being performed. Seven women undergoing operative hysteroscopy for five different indications had clear-cut evidence of venous air embolism early in the course of the procedure. Five of these patients died. This complication is rare

Philip G. Brooks



An association between atherosclerosis and venous thrombosis  

Microsoft Academic Search

background In about a third of patients with venous thromboembolism, the cause of the disorder is unexplained. In patients with atherosclerosis, activation of both platelets and blood co- agulation and an increase in fibrin turnover are detectable, which may lead to thrombotic complications. Whether atherosclerosis is associated with an increased risk of venous thrombosis is unknown. methods We performed ultrasonography

Paolo Prandoni; Franca Bilora; Antonio Marchiori; Enrico Bernardi; Francesco Petrobelli; Anthonie W. A. Lensing; Martin H. Prins; Antonio Girolami



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.



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:; Kleidon, Tricia M. [Great Ormond Street Hospital for Children, Department of Radiology (United Kingdom)



Heritability of chronic venous disease  

PubMed Central

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

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



Coronary venous oximetry using MRI.  


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

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



Intracranial venous thrombosis in the parturient.  


Intracranial venous thrombosis is a rare but potentially fatal complication of pregnancy and the postpartum period. The presenting symptoms can mimic those of a postdural puncture headache and are easily misdiagnosed, especially in a parturient who has undergone regional anesthesia. The incidence of 10-20 per 100,000 is likely higher than reported. The etiology, clinical presentation and course, risk factors, management, and relation of intracranial venous thrombosis to pregnancy are presented. Published case reports and series of intracranial venous thrombosis that have either occurred during the puerperium or involved women of childbearing age after dural puncture are summarized. Finally, the diagnosis and management of intracranial venous thrombosis in parturients, focusing on parturients who have undergone regional anesthesia, is discussed. When intracranial venous thrombosis occurs in a parturient after regional anesthesia, it is often treated as a post-dural puncture headache. PMID:17893462

Lockhart, Ellen M; Baysinger, Curtis L



Venous and arterial thrombosis in dialysis patients.  


Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Furthermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis prior to dialysis treatment increases mortality risk. A total of 455 dialysis patients were followed for objectively verified symptomatic thrombotic events between January 1997 and June 2009. The incidence rates in dialysis patients as compared to the general population was 5.6-fold (95% CI 3.1-8.9) increased for venous thrombosis, 11.9-fold (95% CI 9.3-14.9) increased for myocardial infarction, and 8.4-fold (95% CI 5.7-11.5) increased for ischaemic stroke. The combination of haemodialysis, lowest tertile of albumin, history of venous thrombosis, and malignancy was associated with subsequent venous thrombosis. Increased age, renal vascular disease, diabetes, high cholesterol levels, history of venous thrombosis, and history of arterial thrombosis were associated with subsequent arterial thrombosis. The all-cause mortality risk was 1.9-fold (95% CI 1.1-3.3) increased for patients with a history of venous thrombosis and 1.9-fold (95% CI 1.4-2.6) increased for patients with a history of arterial thrombosis. A potential limitation of this study was that in some risk categories associations with venous thrombosis did not reach statistical significance due to small numbers. In conclusion, dialysis patients have clearly elevated risks of venous thrombosis and arterial thrombosis and occurrence of venous thrombosis or arterial thrombosis prior to the start of dialysis is associated with an increased mortality risk. PMID:22012181

Ocak, Gurbey; Vossen, Carla Y; Rotmans, Joris I; Lijfering, Willem M; Rosendaal, Frits R; Parlevliet, Karien J; Krediet, Ray T; Boeschoten, Els W; Dekker, Friedo W; Verduijn, Marion



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.


Impending proliferation of asbestos.  


The international asbestos industry is under considerable pressure in some countries to control dust exposures in the workplace and restrict pollution. In addition, major firms in the United States face mounting compensation costs for past failures to protect asbestos workers. At the same time, however, the asbestos industry is expanding in developing nations, largely on the strength of sales of asbestos-cement construction materials. This report describes problems encountered with the use of asbestos-cement in schools and low-income housing in Puerto Rico, resulting in the condemnation of these buildings and the relocation of over 1,000 families at public expense. The manufacturer of the asbestos-cement panels, a Colombian affiliate of the European-based multinational Eternit, escaped all liability. The issue is presented as a needless, expanding threat to public health worldwide. Safe, economic alternatives exist, such as the use in some cases of crop waste fibers in place of asbestos as a cement binder. There have also been major advances in the commercialization of asbestos-free brake and clutch friction products. PMID:7419310

Castleman, B I; Vera Vera, M J



In vivo studies of Clostridium perfringens in mouse gas gangrene model.  


Understanding the pathogenesis of infectious diseases requires comprehensive knowledge of the proteins expressed by the pathogen during in vivo growth in the host. Proteomics provides the tools for such analyses but the protocols required to purify sufficient quantities of the pathogen from the host organism are currently lacking. In this study, we have separated Clostridium perfringens, a highly virulent bacterium and potential BTW agent, from the peritoneal fluid of infected mice using Percoll density gradient centrifugation. The bacterium could be isolated in quantities sufficient to carry out meaningful proteomic comparisons with in vitro grown bacteria. Furthermore, the isolates were found to be virtually free from contaminating host proteins. Microscopy revealed major morphological changes under host conditions at different stages of infection. Profile of immunogenic proteins from in vivo- and TPYG-grown whole cell lysate using mouse anti-gangrene serum indicated over-expression of several proteins especially in the low molecular weight region. Expression of two virulence determinants, ornithine carbamoyl transferase (cOTC), and cystathionine beta-lyase (CBL), under in vivo conditions has also been studied. Two-dimensional gel analysis revealed a host induced proteome which was apparently different in comparison to in vitro grown cells. Detailed proteomic elucidation of differentially expressed proteins shown here is likely to provide valuable insight towards understanding the complexity of the adaptive response of C. perfringens to the host environment. PMID:21086128

Sengupta, Nabonita; Alam, Syed Imteyaz



Klinefelter's syndrome and venous thrombosis.  


Klinefelter's syndrome is the most common cause of primary testicular failure. Previous reports have associated Klinefelter's syndrome with increased risk of thrombosis. The exact cause for this association is unknown, but hypoandrogenism affecting fibrinolysis has been implicated. The authors described a unique patient with Klinefelter's syndrome who presented with deep vein thrombosis of the leg and underlying mutations of MTHFR gene, increased factor VIII coagulant activity and an elevated anticardiolipin antibody. To the authors' knowledge, this combination of hypercoagulability risk factors in such a patient has not been previously reported. The authors also reviewed previously published reports of similar patients and discuss potential genetic mutations that may in part predispose this group of patients to venous thrombosis. PMID:23377169

Seth, Abhishek; Rajpal, Saurabh; Penn, Robert L



Venous effects of oral contraceptives  

PubMed Central

In a five-year analysis of an oral contraceptive trial by the Council for the Investigation of Fertility Control venous effects were the third most troublesome group of side-effects with both combined and sequential therapy. Vein complaints, leg cramps, and thrombophlebitis were significantly more frequent with the combined preparations that contained a relatively low dose of progestogen and a high dose of oestrogen than with the other groups tested. No cases of thrombophlebitis occurred in women taking the strongly oestrogenic sequential groups. Histological examination of uterine curettings showed that most progestogenic combined preparations were associated with a high incidence of dilated endometrial sinusoids, while the oestrogenic sequential regimens and low-dose progestogen-only regimens had a low incidence. The incidence of stromal condensation round the sinusoids correlated with the incidence of leg cramps, and these effects appeared to be specific for each preparation tested.

Grant, Ellen C. G.



Risk factors for venous thromboembolism.  


Risk factors for venous thromboembolism (VTE) are often modifiable and overlap with risk factors for coronary artery disease. Encouraging our patients to adopt a heart-healthy lifestyle by abstaining from cigarettes, maintaining lean weight, limiting red meat intake, and controlling hypertension might lower the risk of pulmonary embolism and deep vein thrombosis (DVT), although a cause-effect relationship has not been firmly established. For hospitalized patients, guidelines have provided evidence-based strategies to identify patients at risk, such as elderly persons and those with cancer, congestive heart failure, or chronic obstructive pulmonary disease or undergoing major surgery. Most should receive pharmacological prophylaxis, which will minimize the risk of VTE. Because approximately 3 of every 4 pulmonary embolism and DVT events occur outside the hospital setting, patients should also be assessed for persistent high-risk of VTE at the time of hospital discharge. PMID:20620709

Goldhaber, Samuel Z



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.




Anomalous pre-seismic transmission of VHF-band radio waves resulting from large earthquakes, and its statistical relationship to magnitude of impending earthquakes  

NASA Astrophysics Data System (ADS)

To confirm the relationship between anomalous transmission of VHF-band radio waves and impending earthquakes, we designed a new data-collection system and have documented the anomalous VHF-band radio-wave propagation beyond the line of sight prior to earthquakes since 2002 December in Hokkaido, northern Japan. Anomalous VHF-band radio waves were recorded before two large earthquakes, the Tokachi-oki earthquake (Mj = 8.0, Mj: magnitude defined by the Japan Meteorological Agency) on 2003 September 26 and the southern Rumoi sub-prefecture earthquake (Mj = 6.1) on 2004 December 14. Radio waves transmitted from a given FM radio station are considered to be scattered, such that they could be received by an observation station beyond the line of sight. A linear relationship was established between the logarithm of the total duration time of anomalous transmissions (Te) and the magnitude (M) or maximum seismic intensity (I) of the impending earthquake, for M4-M5 class earthquakes that occurred at depths of 48-54 km beneath the Hidaka Mountains in Hokkaido in 2004 June and 2005 August. Similar linear relationships are also valid for earthquakes that occurred at different depths. The relationship was shifted to longer Te for shallower earthquakes and to shorter Te for deeper ones. Numerous parameters seem to affect Te, including hypocenter depths and surface conditions of epicentral area (i.e. sea or land). This relationship is important because it means that pre-seismic anomalous transmission of VHF-band waves may be useful in predicting the size of an impending earthquake.

Moriya, T.; Mogi, T.; Takada, M.



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.



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



Assisted venous drainage presents the risk of undetected air microembolism  

Microsoft Academic Search

Objectives: The proliferation of minimally invasive cardiac surgery has increased dependence on augmented venous return techniques for cardiopulmonary bypass. Such augmented techniques have the potential to introduce venous air emboli, which can pass to the patient. We examined the potential for the transmission of air emboli with different augmented venous return techniques. Methods: In vitro bypass systems with augmented venous

Angelo LaPietra; Eugene A. Grossi; Bradley B. Pua; Rick A. Esposito; Aubrey C. Galloway; Christopher C. Derivaux; Lawrence R. Glassman; Alfred T. Culliford; Greg H. Ribakove; Stephen B. Colvin



Neutrophil Activation and Mediators of Inflammation in Chronic Venous Insufficiency  

Microsoft Academic Search

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

Philip D. Coleridge Smith



Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case  

Microsoft Academic Search

Background  Abdominal gas gangrene caused by clostridia species is rare and usually associated with organ perforation, immune suppression,\\u000a or advanced malignoma.\\u000a \\u000a \\u000a \\u000a Case report  A 61-year-old man was admitted with severe back pain 1 day after uncomplicated colonoscopic polypectomy. With the exception\\u000a of preexisting minor depression, the patient had been previously in excellent health. The computed tomography scan showed\\u000a retroperitoneal emphysema in the left

L. Boenicke; M. Maier; M. Merger; M. Bauer; C. Buchberger; C. Schmidt; A. Thiede; H.-J. Gassel



Trends in the incidence of venous stasis syndrome and venous ulcer: A 25-year population-based study  

Microsoft Academic Search

Background: The incidence rates of venous stasis syndrome and venous ulcer are uncertain, and trends in incidence are unknown. Methods: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of venous stasis syndrome and venous ulcer during the 25-year period, 1966 to 1990, and to

John A. Heit; Thom W. Rooke; Marc D. Silverstein; David N. Mohr; Christine M. Lohse; Tanya M. Petterson; W. Michael O'Fallon; L. Joseph Melton



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



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


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

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



Pulmonary embolism caused by popliteal venous aneurysm.  


Venous aneurysms are uncommon in the lower limb and are more frequently found in the neck and thoracic and visceral veins. However, they have been reported to cause thrombosis, pulmonary thromboembolism, and other related complications. Popliteal venous aneurysms are often undetected because they are usually asymptomatic, but they may cause pulmonary thromboembolic events. We experienced a case of a 44-year-old man who was referred for recurrent pulmonary thromboembolism. He showed no other symptoms or signs except shortness of breath. A popliteal venous aneurysm was diagnosed incidentally because the examinations were performed to detect a deep vein thrombosis in relationship to the patient's history of pulmonary thromboembolism. We report a case of surgical treatment for a popliteal venous aneurysm that was complicated by pulmonary thromboembolism. PMID:23423692

Hong, Daejin; Song, Suk-Won



Pulmonary Embolism Caused by Popliteal Venous Aneurysm  

PubMed Central

Venous aneurysms are uncommon in the lower limb and are more frequently found in the neck and thoracic and visceral veins. However, they have been reported to cause thrombosis, pulmonary thromboembolism, and other related complications. Popliteal venous aneurysms are often undetected because they are usually asymptomatic, but they may cause pulmonary thromboembolic events. We experienced a case of a 44-year-old man who was referred for recurrent pulmonary thromboembolism. He showed no other symptoms or signs except shortness of breath. A popliteal venous aneurysm was diagnosed incidentally because the examinations were performed to detect a deep vein thrombosis in relationship to the patient's history of pulmonary thromboembolism. We report a case of surgical treatment for a popliteal venous aneurysm that was complicated by pulmonary thromboembolism.

Hong, Daejin



Cerebral Venous and Dural Sinus Thrombosis  

Microsoft Academic Search

Cerebral venous and sinus thrombosis (CVST) constitutes a rare but important cause of stroke. It occurs in all age groups,\\u000a but affects predominately young and middle-aged females. Three subtypes of CVST can be differentiated: sinus thrombosis (ST),\\u000a deep cerebral venous thrombosis (DCVT), and cortical vein thrombosis (CVT). Both DCVT and CVT can present either in isolated\\u000a forms or – more

Jennifer Linn; Hartmut Brückmann



Venous air embolism during radical perineal prostatectomy  

Microsoft Academic Search

An abrupt decrease in end-tidal carbon dioxide (CO2) occurred in an anesthetized male who was placed in the head down position during radical perineal prostatectomy. The end-tidal CO2 was restored after insertion of a wet pack into the operative site, which strongly indicated venous air embolism as the cause. Predisposing factors, detection, and treatment of venous air embolism in this

Michael P. Jolliffe; Michael A. Lyew; Ines H. Berger; Thomas Grimaldi



Advances in the Diagnosis of Venous Thromboembolism  

Microsoft Academic Search

This review summarizes recent information about the diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE)\\u000a using noninvasive imaging tests, clinical assessment, and D-dimer assays, and describes how these tests can be employed in\\u000a diagnostic testing algorithms for the investigation of patients with suspected DVT and PE. The clinical diagnosis of deep\\u000a venous thrombosis is unreliable, but clinical prediction

Philip S. Wells



CD34(+) lineage specific donor cell chimerism for the diagnosis and treatment of impending relapse of AML or myelodysplastic syndrome after allo-SCT.  


After allo-SCT, analysis of CD34(+) lineage-specific donor cell chimerism (DCC) is a sensitive method for monitoring minimal residual disease in patients with AML or myelodysplastic syndrome (MDS) with CD34 expression. To substantiate evidence of whether immune interventions in patients with impending relapse, defined by incomplete lineage-specific DCC, may prevent hematological relapse, we performed a retrospective nested case control study. Unsorted and lineage-specific DCC were measured in 134 patients. Forty-three patients had an incomplete CD34(+)-DCC with no other evidence of relapse. After immediate tapering of immunosuppressive treatment (30 patients) and/or infusion of donor lymphocytes (10 patients), 21 patients remained in remission (conversion to complete lineage-specific DCC) and 22 relapsed. Relapse-free survival at 3 years of the 91 patients with stable DCC and of the 43 patients with incomplete DCC was 74% (95% confidence interval (CI), 64-83%) and 40% (95% CI, 24-58%), respectively. OS rates were 79% (95% CI, 70-88%) and 52% (95% CI, 35-69%), respectively. These results, with 49% of patients with impending relapse successfully treated with immune intervention, highly suggest that analysis of CD34(+)-DCC is an important tool for monitoring and the management of AML and MDS patients after allo-SCT. PMID:23376821

Rosenow, F; Berkemeier, A; Krug, U; Müller-Tidow, C; Gerss, J; Silling, G; Groth, C; Wieacker, P; Bogdanova, N; Mesters, R; Büchner, T; Kienast, J; Berdel, W E; Stelljes, M



Haemodynamics of angioaccess venous anastomoses.  


A large percentage of arteriovenous haemodialysis angioaccess loop grafts (AVLG) fail within the first year after surgery, the occlusive lesions being found predominantly at the venous anastomosis site. This paper presents a detailed flow dynamic study of the AVLG system using three elastic, transparent bench-top flow models, which were based on the geometry of silicone rubber casts obtained at different times from a chronic animal model. Each model thus represented a different stage of the lesion development. Flow visualization and laser Doppler anemometer surveys of the flow field confirmed that the hydrodynamic factors favour lesion development near the stagnation point opposite the anastomotic toe, where the momentum of the impinging jet stream, combined with the oscillating wall shear stress generated in the vicinity of the stagnation point, acts in both directions. The accumulation of tracer particles in the region of flow separation is believed to be a combined contribution from the hydraulic forces and the inward motion of the vessel wall. As these hydrodynamic factors are enhanced upon further development of the occlusive lesion, a vicious cycle may be formed. PMID:2033945

Shu, M C; Hwang, N H



Central venous catheter related infections.  


Infusion therapy carries a substantial risk of producing iatrogenic sepsis, bacteremia or fungemia originating from the device used for vascular access or from the contaminated infusate. This study, a semiquantitative assay of the central venous catheter tips (CVC) was carried out and correlated with the blood culture results to determine the probable cause of sepsis in our post operated patients. One thousand six hundred and thirty one surgeries were performed in the Institute of Cardio-Vascular Diseases from January to December 1997. We received 150 CVC tips which were in place for more than five days for culture. Fifty one (51) CVC tips showed growth in either contents or roll. There was associated blood stream infection in 23 patients. The age groups of patients ranged from two months to 67 years and male to female ratio was 109:41. Children below the age of 12 years were 62 in number. Candida spp. (32.4%) and Staphylococcus spp. (33.9%) formed the predominant isolates from the CVC tips. PMID:10810578

Verghese, S; Padmaja, P; Sudha, P; Sorna, E; Johni, D; Vasu, S



Limb fitting for quadruple amputees: Report of two cases of symmetrical peripheral gangrene caused by pneumococcal purpura fulminans.  


Background:We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans.Case description and methods:The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock.Findings and outcomes:The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases.Conclusion:Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability.Clinical relevanceWe have reported our experience of limb fitting in two patients who had undergone quadruple amputation after suffering peripheral gangrene. Appropriate limb fitting that provides support in daily activities can address impairments and minimize disability. PMID:23558402

Yoshimoto, Kenji; Okuma, Yusuke; Nakamura, Takashi; Mita, Tomoki; Mitsumoto, Atsuko; Yamasaki, Nobuya; Tobimatsu, Yoshiko; Akai, Masami



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.



Effects of thrombolysis and venous thrombectomy on valvular competence, thrombogenicity, venous wall morphology, and function  

Microsoft Academic Search

Purpose: The experiments were designed to compare the effects of thrombolytic therapy (TL) and balloon-catheter thrombectomy (TX) on valvular competence, thrombogenicity, venous wall morphology, and function after acute deep venous thrombosis (DVT) in canine veins. Methods: The femoral veins of male mongrel dogs were ligated proximally and distally for 48 hours to induce DVT. The thrombosed veins were treated with

Jae-Sung Cho; Eugenio Martelli; Geza Mozes; Virginia M. Miller; Peter Gloviczki



Central venous catheter related thrombosis in children: Analysis of the Canadian Registry of Venous Thromboembolic Complications  

Microsoft Academic Search

Background: Central venous lines (CVLs) are frequently associated with deep venous thrombosis (DVT) in children; however, little is known about the epidemiologic characteristics or outcome of CVL-related DVT. Methods: The Canadian Childhood Thrombophilia Registry monitored 244 consecutive patients with objectively diagnosed CVL-related DVT for a median duration of 24 months (range 3 months to 7 years). Results: The incidence of

M. Patricia Massicotte; David Dix; Paul Monagle; Margaret Adams; Maureen Andrew



Surgical management of progressive pulmonary venous obstruction after repair of total anomalous pulmonary venous connection  

Microsoft Academic Search

Background: The occurrence of a progressive pulmonary venous obstruction after the repair of the total anomalous pulmonary venous connection is a severe complication. Objectives: The objectives of this study were to retrospectively review the patients with this condition and to report our experience with a new surgical technique with a sutureless in situ pericardium repair. Methods: Of 178 patients who

François Lacour-Gayet; Joy Zoghbi; Alain E. Serraf; Emré Belli; Dominique Piot; Christian Rey; François Marçon; Jacqueline Bruniaux; Claude Planché



Experimental Clostridial Wounds in Rabbits. I. The Effect of Debridement Delay, Tetanus Immunization, and Topical Antibiotics on the Mortality from Gas Gangrene.  

National Technical Information Service (NTIS)

A method of producing clostridial wounds in the rabbit was studied. All of the major conditions known to contribute to the development of clinical gas gangrene are simulated and the use of rabbits allows statistically significant numbers to be studied. In...

R. B. Rutherford J. R. Evans A. Progrebniak R. M. Hardaway



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



Risk factors for peripheral venous disease resemble those for venous thrombosis: the San Diego Population Study  

PubMed Central

Background Clinically silent deep vein thrombosis (DVT) is common and may cause chronic venous disease that resembles post-thrombotic syndrome. Objective We evaluated whether peripheral venous disease in a general population shares risk factors with DVT. Methods In an established cohort of 2,404 men and women, the San Diego Population Study, peripheral venous disease was evaluated using physical exam, symptom assessment, and venous ultrasound. We performed a case control study including 308 cases in 4 hierarchical groups by severity, and 346 controls without venous abnormalities, frequency matched to cases by 10-year age group, race and sex. Cases and controls had no prior history of venous thrombosis. Hemostatic risk factors were measured in cases and controls. Results Accounting for age, obesity and family history of leg ulcer, ORs for elevated factor VIII, von Willebrand factor, D-dimer, and for factor V Leiden were 1.4 (95% CI 0.9–2.1), 1.5 (CI 1.0–2.3), 1.7 (CI 1.1–2.8), and 1.1 (CI 0.5–2.4), respectively. These associations were larger in the two most severe case groups; ORs 2.0 (CI 1.0–3.8), 1.7 (CI 0.9–3.3), 2.7 (CI 1.2–6.1) and 2.3 (CI 0.8–7.1). Each hemostatic factor was also associated with severity of venous disease, for example elevated D-dimer was associated with a 2.2-fold increased odds of being in one higher severity group. Prothrombin 20210A was not associated with venous disease. Conclusions DVT risk factors are associated with presence and severity of peripheral venous disease. Results support a hypothesis that peripheral venous disease may sometimes be post-thrombotic syndrome due to previous unrecognized DVT.

Cushman, M; Callas, PW; Denenberg, JO; Bovill, EG; Criqui, MH



Venous waterfalls in coronary circulation.  


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

Gosselin, R E; Kaplow, S M



Compression therapy for chronic venous insufficiency.  


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

Felty, Cindy L; Rooke, Thom W



Cytotoxic therapy. Role of durable venous access.  


Aggressive chemotherapy regimens and supportive measures in haemato-oncology patients demand reliable venous access. Experience with this method in India has been limited. During a period of six months, we have used 42 subclavian indwelling catheters and 31 cubital Cavafix long lines. The mean age of patients in the two groups was 32 years and 7 years respectively. Subclavian catheters had a median duration of catheter placement of 46 days (range 4-145) and total 1494 catheter days, while cubital longlines yielded a median duration of insertion of 14 days (range 4-27) and total 508 catheter days. Catheter related complications were infection in 25% of patients, thrombophlebitis in 22%, blockade in 12% and misplacement in 17% in both groups taken together. The patients and families were extremely satisfied with the devices. Our experience supports further use of durable venous access in cancer patients. Implanted central venous catheters should be preferred whenever feasible. PMID:2096122

Rao, V K; Charak, B S; Giri, N K; Banavali, S D; Pai, S K; Pai, V R; Nadkarni, K S; Kurkure, P A; Saikia, T K; Gopal, R



Clinical features and diagnosis of venous thrombosis  

SciTech Connect

The clinical diagnosis of venous thrombosis is inaccurate because the clinical findings are both insensitive and nonspecific. The sensitivity of clinical diagnosis is low because many potentially dangerous venous thrombi are clinically silent. The specificity of clinical diagnosis is low because the symptoms or signs of venous thrombosis all can be caused by nonthrombotic disorders. A current approach to the diagnosis of clinically suspected venous thrombosis favors the use of impedance plethysmography over Doppler ultrasonography as the main test for this disorder. This is because impedance plethysmography is precise and objective, whereas the interpretation of Doppler ultrasonography is subjective and requires considerable skill and experience to form reliable diagnoses. The use of serial impedance plethysmography has been evaluated recently in a prospective study. The rationale of repeated impedance plethysmography evaluation is based on the premise that calf vein thrombi are only clinically important when they extend into the proximal veins, at which point detection with impedance plethysmography is possible. Therefore, by performing repeated examinations with impedance plethysmography in patients with clinically suspected venous thrombosis, it is possible to identify patients with extending calf vein thrombosis who can be treated appropriately. Impedance plethysmography is performed immediately on referral; if it is positive in the absence of clinical conditions that are known to produce falsely positive results, the diagnosis of venous thrombosis is established, and the patient is treated accordingly. If the result of the initial impedance plethysmography evaluation is negative, anticoagulant therapy is withheld, and impedance plethysmography is repeated the following day, again on day 5 to 7 and on day 10 to 14. 87 references.

Hirsh, J.; Hull, R.D.; Raskob, G.E.



Venous malformations of the genitals: a therapeutic dilemma.  


Venous malformations may occur anywhere in the body but are rare in the genitourinary tract and external genitalia. The authors report a case of a venous malformation in the glans penis and discuss the controversy over optimal management. PMID:20442077

Kaufman, Daniel; Feber, Kevin M; Palmer, Lane S; Freedman, Alan M



Cardiac Pressure Changes with Venous Gas Embolism and Decompression.  

National Technical Information Service (NTIS)

Venous air embolism is reported with decompression to a decreased ambient pressure. With severe decompressions or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological...

B. D. Butler G. B. Kemper



Anatomic considerations for central venous cannulation.  


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

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



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



Intracranial venous thrombosis in the first trimester of pregnancy.  

PubMed Central

We describe a fatal case of intracranial venous thrombosis occurring in early pregnancy. Such thrombosis usually occurs in late pregnancy or the puerperium but rarely during the first trimester of pregnancy. Computerized axial tomography suggested massive cerebral venous infarction. Necropsy findings showed not only cerebral venous thrombosis but also extensive pelvic and iliac vein thromboses. The relationship of cerebral venous thrombosis and pregnancy is discussed and the literature reviewed. Images

Lavin, P J; Bone, I; Lamb, J T; Swinburne, L M



Greater forearm venous compliance in resistance-trained men  

Microsoft Academic Search

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

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




Microsoft Academic Search

hronic venous disease (CVD) is an umbrella term that encompasses a variety of clinical presentations, which include venous symp- toms and signs. A review of the literature shows that the most commonly expressed CVD-related symp- toms are heaviness, pain, sensation of swelling, rest- less legs, paresthesias, night time cramps, tiredness, throbbing, and itching. The signs of chronic venous disorders are

Françoise PITSCH; Neuilly-sur-Seine FRANCE


Dermatologic complications of chronic venous disease: medical management and beyond.  


Patients with venous insufficiency commonly develop complications which can result in significant morbidity and occasional mortality. Venous leg ulcers, the most prevalent type of lower extremity ulcer, are the most frequent sequela of venous insufficiency and negatively affect quality of life for the patient. Most have focused on venous ulceration, but other complications may arise including dermatitis, atrophie blanche, lipodermatosclerosis, and malignancy. Contact dermatitis is a common complication seen in the treatment of venous disease. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis. Venous dermatitis is often the first manifestation of venous insufficiency and needs to be addressed promptly. Atrophie blanche, an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. Lipodermatosclerosis is an indurated plaque in the medial malleolus which can, at times, be quite tender and painful. Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive. Pain is a feature of venous disease often overlooked and commonly undertreated. Finally, psychosocial issues such as anxiety and depression are more common in patients with venous disease and should be adequately addressed. Recognizing these complications of chronic venous insufficiency is important as early intervention is the key to preventing unnecessary patient suffering and discomfort. PMID:17823046

Barron, Gregory S; Jacob, Sharon E; Kirsner, Robert S



Comparative Study of Different Venous Reflux Duplex Quantitation Parameters  

Microsoft Academic Search

The objective of this study was to compare different quantitation parameters of venous reflux by duplex scan in different venous disease manifestations. Duplex scan is a new modality to quantify venous reflux. Several studies propose different parameters. In addition, there is controversy about the importance of deep and superficial involvement in different disease manifestations. It is not clear whether there

Leonardo I. Valentín; Wilmer H. Valentín



Severe Chronic Venous Insufficiency Treated by Foamed Sclerosant  

Microsoft Academic Search

Our objective was to chronicle our experience in using sclerosant foam to treat severe chronic venous insufficiency (CVI). Forty-four patients with 60 limbs severely affected by severe CVI were entered into the study. They had lipodermatosclerosis, CEAP 4 (seven limbs); atrophie blanche or scars of healed venous ulcerations, CEAP 5 (18 limbs); and frank, open venous ulcers, CEAP 6 (35

Luigi Pascarella; John J. Bergan; Lisa V. Mekenas



Management of venous thromboembolism in the intensive care unit  

Microsoft Academic Search

Venous thromboembolism, manifested as either deep venous thrombosis or pulmonary embolism (PE), is a major cause of morbidity and mortality in patients admitted to the intensive care unit. Clinically, PE may present as massive thromboembolism associated with cardiogenic shock or may be asymptomatic, as may occur with anatomically small emboli without hemodynamic or respiratory compromise. The management of venous thromboembolism

Stephen M. Pastores



Epidemiology of venous thromboembolism in neonates and children  

Microsoft Academic Search

Venous thromboembolism is an increasingly recognised problem in paediatric practice, particularly in the context of tertiary care paediatric services. In recent years, several national and international registries have helped to define the epidemiology of venous thromboembolism in both neonates and older children. These studies have generated information on the incidence and risk factors associated with venous thromboembolism in different age

Elizabeth A. Chalmers



Venous air embolism and the sitting position: A case series  

Microsoft Academic Search

Venous air embolism is a potentially serious complication of neurosurgery that occurs more commonly when the patient is in the sitting position. In this study, we aimed to quantify the incidence of venous air embolism during neurosurgical procedures performed with the patient in the sitting position in our institution. We performed a prospective audit of venous air embolism in 100

K. Leslie; R. Hui; A. H. Kaye



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

National Technical Information Service (NTIS)

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 cer...

D. E. Watenpaugh



Dural sinus and cerebral venous thrombosis  

Microsoft Academic Search

Summary Eighty patients with ‘primary’ dural sinus and cerebral venous thrombosis were seen over a period of 16 years. There was an equal distribution amongst the sexes and the largest number of patients presented in the third decade. The commonest predisposing factors were puerperium, pregnancy, synthetic steroid contraceptives and anaemia. Seventy patients presented in an acute fashion with headache, focal

R. D. Nagpal



Cerebral venous sinus thrombosis and antiphospholipid antibodies.  

PubMed Central

We report two cases of cerebral venous sinus thrombosis associated with an antibody to phospholipids, namely the lupus anticoagulant. Both patients later developed further immunologically mediated conditions. The importance of screening for the lupus anticoagulant in addition to anticardiolipin antibodies in this condition and the need for follow-up of such patients is discussed. Images Figure 2

Boggild, M. D.; Sedhev, R. V.; Fraser, D.; Heron, J. R.



How we manage venous thromboembolism during pregnancy  

Microsoft Academic Search

During pregnancy, physiologic and ana- tomic changes can complicate the diag- nosis of venous thromboembolism (VTE) as well as the management of patients with a high risk of or established VTE. As in nonpregnant subjects, clinical di- agnosis of VTE by itself is unreliable and accurate objective testing is essen- tial. Few diagnostic studies of VTE have been performed in

Shannon M. Bates; Jeffrey S. Ginsberg



Management of venous thromboembolism in pregnancy  

Microsoft Academic Search

Pulmonary thromboembolism (PTE) is the major cause of maternal death in the UK, with recent trends showing an increase in the numbers of deaths. Underlying PTE is the problem of deep venous thrombosis (DVT). An appreciation of risk factors, particularly, thrombophilia, and signs or symptoms suggestive of thromboembolism, coupled with objective diagnosis and treatment should reduce mortality and morbidity. There

I. A Greer; A. J Thomson



Venous Air Embolism in Deep Brain Stimulation  

Microsoft Academic Search

Background\\/Aims: During the placement of electrodes for deep brain stimulation (DBS), patients are commonly in a seated position, awake, and spontaneously breathing. Air may be entrained through bone or dural veins causing venous air emboli (VAE) and this phenomenon can result in significant hemodynamic changes. Although VAEs have been described in many types of neurosurgical procedures, their incidence during DBS

Amanda K. Hooper; Michael S. Okun; Kelly D. Foote; Ihtsham U. Haq; Hubert H. Fernandez; Dustin Hegland; Steven A. Robicsek



Survival following portal venous air embolization  

Microsoft Academic Search

The first reported case of nonfatal air embolization of the portal venous system was observed in a patient with chronic ulcerative colitis subsequent to barium-air contrast enema examination. The literature is reviewed and pathogenetic mechanisms are discussed. It is suggested that this phenomenon is probably overlooked in other surviving cases, and careful roentgenographic evaluation of the right upper quadrant will

Harold P. Lazar



Medical management of venous thromboembolic disease  

Microsoft Academic Search

Venous thromboembolic disease (deep vein thrombosis and pulmonary embolism) are common disorders with serious morbid and mortal complications. Given the varied modes of presentation, a high clinical index of suspicion in patients at risk must exist among physicians. Standard therapy has consisted of intravenous unfractionated heparin and overlapping administration of an oral Vitamin K antagonist, commonly Warfarin. Although an effective

Steven Deitelzweig; Michael R Jaff



Cardiac tamponade from central venous catheters  

Microsoft Academic Search

Background: This retrospective study was undertaken to determine the mechanism by which cardiac tamponade (CT) occurs after placement of central venous catheters (CVC), and to determine if physicians are aware of this potentially lethal complication.Materials and Methods: Twenty-five previously unreported cases of CT from CVC were reviewed. The chest radiographs and postmortem records were reviewed when available. Two hundred physicians

Paul E. Collier; Sterling H. Blocker; Daniel M. Graff; Peter Doyle



Transfemoral Repositioning of Malpositioned Central Venous Catheters  

SciTech Connect

Purpose: To determine the efficacy of the transfemoral vein approach to repositioning malpositioned central venous catheters. Methods: During a 41/2-year period, malpositioned central venous catheters were repositioned 91 times in 83 patients via the transfemoral vein approach. All repositioning was initially attempted with a Grollman catheter or other pigtail catheter and a tip-deflecting wire. If these techniques failed or the venous anatomy was unfavorable, gooseneck or long loop snares were used. Results: During 48 repositionings, rotating a pigtail-type catheter alone was used successfully in 39 (81%). In 6 of 9 failures, the addition of a tip-deflecting wire also failed. A Grollman catheter and tip-deflecting wire were used initially in 39 repositionings (6 failures; 85% success). Successful repositioning required a snare in 8 (4 as the primary repositioning technique) and a long-loop technique in 5. All repositionings were ultimately successful and there were no complications. Conclusion: Central venous catheters can be repositioned consistently by the transfemoral route. Pigtail catheters or tip-deflecting wires alone are successful in over 80% of cases.

Hartnell, George Gordon; Gates, Julia; Suojanen, James Norman; Clouse, Melvin Eugene [Department of Radiological Sciences, Deaconess Hospital and Harvard Medical School, 1 Deaconess Road, Boston, MA 02215 (United States)



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



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.



Extensive Intramuscular Venous Malformation in the Lower Extremity  

PubMed Central

Typical venous malformations are easily diagnosed by skin color changes, focal edema or pain. Venous malformation in the skeletal muscles, however, has the potential to be missed because their involved sites are invisible and the disease is rare. In addition, the symptoms of intramuscular venous malformation overlaps with myofascial pain syndrome or muscle strain. Most venous malformation cases have reported a focal lesion involved in one or adjacent muscles. In contrast, we have experienced a case of intramuscular venous malformation that involved a large number of muscles in a lower extremity extensively.

Chul, Jung Ho; Park, Byung Kyu; Park, Myung Kyu



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

PubMed Central

Introduction Fournier’s gangrene is an infectious necrotizing fasciitis of the perineum and genital regions and has a high mortality rate. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms and predisposing factors, including diabetes mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a case of Fournier’s gangrene in a patient with unknown type II diabetes submitted to 24-hour catheterization 15 days before gangrene onset. Case presentation The patient, a 60-year-old Caucasian man, presented with a swollen, edematous, emphysematous scrotum with a crepitant skin and a small circle of necrosis. A lack of resistance along the dartos fascia of the scrotum and Scarpa’s lower abdominal wall fascia combined with the presence of gas and pus during the first surgical debridement also supported the diagnosis of Fournier’s gangrene. On the basis of the microbiological culture, the patient was given multiple antibiotic therapy, combined hypoglycemic treatment, hyperbaric oxygen therapy, and several surgical debridements. After five days the infection was not completely controlled and a vacuum-assisted closure device therapy was started. Conclusions This report describes the successful multistep approach of an immediate surgical debridement combined with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted closure is a well-known method used to treat complex wounds. In this case study, vacuum-assisted closure treatment was effective and the patient did not require reconstructive surgery. Our report shows that bladder catheterization, a minimally invasive maneuver, may also cause severe infective consequences in high-risk patients, such as patients with diabetes.



Rapid Parathyroid Hormone Analysis During Venous Localization  

PubMed Central

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

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



Venous leg ulcers and the family physician.  


Family physicians often are the first contact for patients with venous leg ulcerations (VLUs). A random survey of 2,000 family physicians was conducted to determine patterns for diagnosis and treatment of VLUs, including type of leg ulcer (arterial, venous, diabetic), whether compression therapy was ordered, whether a Doppler system was available to aide in diagnosis, and which health care professional ultimately cared for the patient. Of the 325 family physicians who participated, 96% (311/325) see patients with VLUs, averaging 1.5 VLUs per week. Compression therapy is prescribed by 96% of family physicians, and 83% (259/325) refer these patients to other health care professionals. Only 27% (89/325) have a Doppler system in the office to measure the ankle-brachial index (ABI). These findings document for the first time in the United States the large number of patients with VLUs seen by family physicians. PMID:10326351

McGuckin, M; Kerstein, M D


Intracranial venous thrombosis complicating oral contraception  

PubMed Central

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

Dindar, F.; Platts, M. E.



Partial anomalous pulmonary venous connections: surgical management.  


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



Deep venous thrombophlebitis following aortoiliac reconstructive surgery  

SciTech Connect

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

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



Central venous blood composition and the pulmonary ventilation during hemodialysis.  


The elimination of CO2 across the dialyzer has been reported as the cause of pulmonary hypoventilation during hemodialysis. There are some evidences that the venous line blood composition could influence the central venous blood and this one the pulmonary ventilation. Our purpose was to analyze (1) the influence of the changes in composition of the venous line blood on the central venous blood and (2) the possible role of the central venous blood composition on the pulmonary ventilation of 10 chronic renal failure patients during hemodialysis performed twice in the same patients in two different conditions: acetate dialysate without (condition I) and with (condition II) constant addition of 100% CO2 bubbling into the dialysis bath. During condition I the venous line blood pH was kept in a normal range, and the PCO2 was low, whereas during condition II the pH was very low and the PCO2 extremely high. The patients during condition I decreased their pulmonary ventilation and lost CO2 across the dialyzer as the central venous blood pH and HCO3- increased, and PCO2 did not change. The same patients during condition II increased their pulmonary ventilation and absorbed CO2 across the dialyser as the central venous blood pH decreased and PCO2 increased. Thus, the venous line blood has influence on the central venous blood composition, and this plays a role on the control of pulmonary ventilation of these patients. PMID:3929151

Faro, S; Stabile, C; Lopes dos Santos, M; Romaldini, H; Ratto, O R



The distal venous anatomy of the finger.  


An exhaustive anatomic dissection of all of the veins of the finger distal to the proximal interphalangeal joint was done. More than 3200 segments of veins were individually dissected out, measured, and recorded. From this survey new schematic diagrams have been drawn emphasizing the pertinent venous anatomy at the proximal, distal interphalangeal joints and eponychial levels. Suggestions are made for regions that are apt to have the largest vessels available for anastomosis. PMID:2022842

Smith, D O; Oura, C; Kimura, C; Toshimori, K



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



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



Functional outcome after severe cerebral venous thrombosis  

Microsoft Academic Search

\\u000a Abstract\\u000a   Severe cerebral venous thrombosis (CVT) is a rare cerebrovascular condition which in the more severe cases warrants intensive\\u000a care treatment. While the outcome in the majority of uncomplicated CVT cases is good, it may be fatal in more affected patients.\\u000a We provide long-term functional and quality of life (QOL) outcome data in the form of a retrospective analysis of

Andreas Bender; Gernot Schulte-Altedorneburg; Thomas E. Mayer; Thomas Pfefferkorn; Tobias Birnbaum; Berend Feddersen; Hartmut Brückmann; Hans-Walter Pfister; Andreas Straube



Update on totally implantable venous access devices.  


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



Severe pulmonary oedema after venous air embolism  

Microsoft Academic Search

We present a 59-yr-old Chinese male patient who developed acute pulmonary oedema and cardiovascular collapse following multiple\\u000a episodes of venous air emboli while in the sitting position for removal of a cervical meningioma. The severity of the pulmonary\\u000a oedema and cardiovascular disturbance were surprising. Postoperative ventilation and inotropic support were required and five\\u000a litres of plasma were needed to replace

Kwok K. Lam; Robert C. Hutchinson; Tony Gin



Venous thrombosis of the upper extremities  

Microsoft Academic Search

Opinion statement  The goals of treating patients with upper-extremity deep vein thrombosis (UEDVT) are to relieve acute symptoms of venous occlusion,\\u000a prevent pulmonary embolism, reduce the likelihood of recurrent thrombosis, and avoid the development of postphlebitic syndrome.\\u000a Although the details of management differ, depending on the underlying cause and precipitating factors, anticoagulant therapy\\u000a should be the first-line treat-ment of choice in

Agnes Y. Y. Lee; Jeffrey S. Ginsberg



[Venous vascular changes in prostatic adenomyomatosis].  


An important role should be attributed to the prostatic venous complex and to its pathology in the clinical aspects of prostate adenoma. This appears to be responsible for the acute retention of urine as well as for the hemorrhages that accompany the disease. The authors, on the occasion of 50 adenomectomies by the trans-vesical method, have carried out histological investigations on the excised tissues and made a correlation with the microscopic aspects of the peri-orificial urethra and of the prosthatic urethra, in connection with the changes noted in the venous system. The veins have displayed more or less important changes in all the cases. These consisted in stasis, lacunar dilatations or of the varicose type, inflammations or parietal modifications of a different origin. At the same time were noted signs of inflammation in the submucosa as well as in the muscular layer of the bladder wall, which appeared to be distrophic. The pathogenic role is stressed of the venous system in the developement of the clinical aspects especially in type II and III of a personal classification. PMID:52878

Kótay, P; Lakatos, O; Pop, A; Balogh, E


Arterial-venous shunting in liver cirrhosis.  


Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extraction is very high in normal subjects, while being directly related to circulatory alterations in liver cirrhosis. Because of this property, the systemic bioavailability of D-sorbitol during hepatic arterial infusion can be assumed to reflect arterial-venous shunting. Thirteen biopsy-proven cirrhotic patients (ages 35-66 years), who required diagnostic arterial catheterization, entered the study. Patients were studied on two subsequent days, in which a sterile pyrogen-free solution (1.5%) of D-sorbitol was administered by direct low-rate infusion (15 mg/min for 20 min) into the hepatic artery and the systemic circulation, respectively. Urine samples were spontaneously collected for 8-hr periods before and during/after each infusion. The hepatic arterial bioavailability of D-sorbitol was calculated as the ratio between the net cumulative urinary outputs of D-sorbitol after infusions into the hepatic artery and the systemic vein. Observed values confirm the existence and the large variability (0-88.7%) of hepatic arterial-venous shunting in cirrhotic patients. PMID:9508535

Molino, G; Bar, F; Battista, S; Torchio, M; Niro, A G; Garello, E; Avagnina, P; Fava, C; Grosso, M; Spalluto, F



[Anatomic and functional features of venous valves].  


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

Griton, P; Vanet, P; Cloarec, M



Medical management of venous thromboembolic disease.  


Venous thromboembolic disease (deep vein thrombosis and pulmonary embolism) are common disorders with serious morbid and mortal complications. Given the varied modes of presentation, a high clinical index of suspicion in patients at risk must exist among physicians. Standard therapy has consisted of intravenous unfractionated heparin and overlapping administration of an oral Vitamin K antagonist, commonly Warfarin. Although an effective strategy, many practical limitations exist, including the need for prolonged hospitalization, frequent laboratory monitoring for anticoagulant effect, and erratic dose-response curves. Recently, subcutaneous low-molecular-weight heparins have emerged as safe and effective alternatives for unfractionated heparin. Appropriate patients may be treated with low-molecular-weight heparins and oral Warfarin entirely as outpatients, with similar efficacy and risk of recurrent thromboembolic events and hemorrhage. Thrombolytic therapy is a reasonable alternative in patients with iliofemoral venous thrombosis and/or pulmonary embolism resulting in hemodynamic compromise or obstructing significant pulmonary vasculature. Risks of serious hemorrhagic side effects including intracranial hemorrhage, along with the added economic burden, have limited widespread acceptance of thrombolytic therapy as primary treatment. Emerging oral direct thrombin inhibitors and other novel agents stand to move the treatment of patients with venous thromboemboli to even greater levels of safety and efficacy. PMID:15252762

Deitelzweig, Steven; Jaff, Michael R



Identification by 16S ribosomal RNA gene sequencing of Arcobacter butzleri bacteraemia in a patient with acute gangrenous appendicitis  

PubMed Central

Aims: To identify a strain of Gram negative facultative anaerobic curved bacillus, concomitantly isolated with Escherichia coli and Streptococcus milleri, from the blood culture of a 69 year old woman with acute gangrenous appendicitis. The literature on arcobacter bacteraemia and arcobacter infections associated with appendicitis was reviewed. Methods: The isolate was phenotypically investigated by standard biochemical methods using conventional biochemical tests. Genotypically, the 16S ribosomal RNA (rRNA) gene of the bacterium was amplified by the polymerase chain reaction (PCR) and sequenced. The sequence of the PCR product was compared with known 16S rRNA gene sequences in the GenBank by multiple sequence alignment. Literature review was performed by MEDLINE search (1966–2000). Results: The bacterium grew on blood agar, chocolate agar, and MacConkey agar to sizes of 1 mm in diameter after 24 hours of incubation at 37°C in 5% CO2. It grew at 15°C, 25°C, and 37°C; it also grew in a microaerophilic environment, and was cytochrome oxidase positive and motile, typically a member of the genus arcobacter. Furthermore, phenotypic testing showed that the biochemical profile of the isolate did not fit into the pattern of any of the known arcobacter species. 16S rRNA gene sequencing showed one to two base differences between the isolate and A butzleri, but 35 to 39 base differences between the isolate and A cryaerophilus, indicating that the isolate was a strain of A butzleri. Only three cases of arcobacter bacteraemia with detailed clinical characteristics were found in the English literature. The sources of the arcobacter species in the three cases were largely unknown, although the gastrointestinal tract is probably the portal of entry of the A butzleri isolated from the present case because the two concomitant isolates (E coli and S milleri) in the blood culture were common flora of the gastrointestinal tract. In addition, A butzleri has previously been isolated from the abdominal contents or peritoneal fluid of three patients with acute appendicitis. Conclusions: 16S rRNA gene sequencing was useful in the identification of the strain of A butzleri isolated from the blood culture of a patient with acute gangrenous appendicitis. Arcobacter bacteraemia is rare. Further studies using selective medium for the delineation of the association between A butzleri and acute appendicitis are warranted.

Lau, S K P; Woo, P C Y; Teng, J L L; Leung, K W; Yuen, K Y



Use of central venous catheters for prolonged venous access in cancer chemotherapy.  


A preliminary experience in the use of central venous catheters, including Hickman (15), subclavian jugular (Desseret) (50) and Secalon Hydrocath (3), in cancer chemotherapy is presented. There were no technical complications and no mortality attributable to catheterisation. Infections formed the major complication in Hickman (30%) and subclavian jugular (Desseret) (36%) catheters, while the use of Secalon Hydrocath was event-free. The commonest organism isolated was P aeruginosa (60%), followed by staphylococci (30%). Prolonged venous access was achieved with minimum morbidity. It is concluded that central venous catheters are safe and convenient both for the patient and the treating team, and should be used in all patients undergoing protracted chemotherapy and supportive care. PMID:2387816

Rajoor, B G; Charak, B S; Banavali, S D; Iyer, R S; Saikia, T K; Gopal, R; Advani, S H



Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension  

Microsoft Academic Search

The pathophysiology of elevated intracranial pressure in idiopathic intracranial hypertension (IIH) is unclear. Cerebral venous\\u000a outflow obstruction and elevated intracranial venous pressure may play an etiological role. We examined jugular valve insufficiency\\u000a as a potential factor contributing to intracranial hypertension. Jugular venous valve function was assessed bilaterally by\\u000a duplex sonography in 20 consecutive patients with diagnosis of IIH and in

Max Nedelmann; Manfred Kaps; Wibke Mueller-Forell



Extrinsic cerebral venous sinus obstruction resulting in intracranial hypertension  

PubMed Central

We report the case of a 70-year-old man reporting with headache and visual disturbances who was being treated for prostate cancer. Investigations showed him to have intracranial hypertension caused by venous sinus obstruction. Patients with metastatic disease and raised intracranial pressure in the absence of focal signs should be considered as possible cases of venous outflow obstruction.???Keywords: intracranial hypertension; venous sinus thrombosis; malignancy

Goldsmith, P; Burn, D; Coulthard, A; Jenkins, A



[New oral anticoagulants in the treatment of venous thromboembolism].  


Rivaroxaban (with initial increased dosage) may be used as a stand-alone therapy in patients with venous thrombo-embolism. The development of new anticoagulant drugs opened several options in the management of venous thrombo-embolism. The efficacy and safety of these new oral anticoagulants in specific population as elderly and those with renal impairment deserve future research. At that time, only rivaroxaban is licensed in France, in the treatment of deep venous thrombosis. PMID:23876652

Bertoletti, Laurent; Lega, Jean-Christophe; Moulin, Nathalie; Buchmuller, Andréa; Mismetti, Patrick; Decousus, Hervé



A Latex D-Dimer Reliably Excludes Venous Thromboembolism  

Microsoft Academic Search

Background: D-Dimer, a cross-linked fibrin degrada- tion product, has a high sensitivity in patients with sus- pected venous thrombosis. Traditional latex D-dimer as- says, however, have not been sufficiently sensitive to exclude venous thromboembolism. Methods: To determine the clinical utility of a latex D- dimer assay (MDA D-Dimer; Organon Teknika Corpora- tion, Durham, NC) in patients with suspected venous thromboembolism,

Shannon M. Bates; Anne Grand' Maison; Marilyn Johnston; Ivy Naguit; Michael J. Kovacs; Jeffrey S. Ginsberg



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

PubMed Central

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.

Chatterjee, Sasanka S.



Mixed venous oxygenation in fatal gram-negative septicemia.  


Changes in mixed venous and arterial PO2 values were examined during the early, middle and late stages of fatal gram-negative septicemia in seven patients. The early stage of septicemia was characterized by tachycardia (mean rate 108/min), mild hypotension (mean arterial pressure (MAP) 83 mmHg), arterial hypoxemia requiring supplemental oxygen therapy, and high, low or normal mixed venous PO2 (mean 37 mmHg). During the middle stage, hypotension was severe (MAP 67 mmHg) and mixed venous PO2 invariably rose (mean 50 mmHg). Arterial PO2 increased in association with the rise in mixed venous PO2, despite constant FIO2 and expired ventilation. Severe metabolic acidosis developed in six of the seven patients. In the final stage, mixed venous PO2 was normal (mean 42 mmHg) in the presence of continuing metabolic acidosis. We postulate that the elevations of mixed venous PO2 seen result from systemic arterial-venous shunting, and that during septicemia, the mixed venous PO2 is an unreliable index of tissue oxygenation. A theoretical model of the relationship of tissue oxygenation and mixed venous oxygenation in septicemia, based upon the above study, is presented. PMID:7335964

Miller, M J; Cook, W R; De Olazabal, J R; Mithoefer, J C



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

PubMed Central

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

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



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


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

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



Changes of peripheral venous tone and central transmural venous pressure during immersion in a thermo-neutral bath  

Microsoft Academic Search

Peripheral venous tone, central venous and oesophageal pressures were recorded while the upright sitting subjects were immersed to the neck in a thermoneutral water bath. The central venous pressure rose from 3.4 to 15.2 mm Hg and the oesophageal pressure from -0.4 to +3.4 mm Hg. The transmural pressure, which determines the enddiastolic volume of the heart, increased by 8.0

Martin Echt; Lothar Lange; Otto H. Gauer



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

Microsoft Academic Search

Anomalous connections between an extracranial venous sac and intracranial dural sinuses through dilated diploic and emissary\\u000a veins of the skull result in sinus pericranii (SP). In this study, two patients with the rare presentation of multiple, congenital\\u000a SP with associated dural venous lakes and venous anomalies are described. In one patient, multiple SPs were located in the\\u000a frontal, parasagittal region

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



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



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



Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis  

Microsoft Academic Search

A small proportion of patients with deep vein thrombosis develop recurrent ve- nous thromboembolic complications or bleeding during anticoagulant treatment. These complications may occur more fre- quently if these patients have concomi- tant cancer. This prospective follow-up study sought to determine whether in thrombosis patients those with cancer have a higher risk for recurrent venous thromboembolism or bleeding during an-

Paolo Prandoni; Anthonie W. A. Lensing; Andrea Piccioli; Enrico Bernardi; Paolo Simioni; Bruno Girolami; Antonio Marchiori; Paola Sabbion; Martin H. Prins; Franco Noventa; Antonio Girolami


Deep venous thrombosis and venous thrombophlebitis associated with alprostadil treatment for erectile dysfunction  

Microsoft Academic Search

We report a patient who developed deep vein thrombosis of the calf and thrombophlebitis after treatment with intracorporeal alprostadil (Viridal®). The reaction recurred on rechallenge with Viridal®. This adverse effect has not been reported in the literature but six patients have been reported to the Medicines Control Agency in Great Britain. The history of deep venous thrombosis or thrombophlebitis may

L Barthelmes; C Chezhian; E K Aihaku



Tamoxifen and risk of idiopathic venous thromboembolism  

PubMed Central

Aims To evaluate a possible positive association between tamoxifen treatment and the risk of developing idiopathic venous thromboembolism (VTE) in women with breast cancer in the absence of clinical risk factors for venous thromboembolism other than breast cancer itself. Methods Using information from the large UK-based General Practice Research Database, we identified, within a cohort of more than 10 000 women with breast cancer, all women who developed a first-time diagnosis of deep vein thrombosis or pulmonary embolism of uncertain cause between January 1, 1991 and December 31, 1996. In a case-control analysis, we compared their tamoxifen exposure experience prior to the thromboembolic event with that of a randomly selected group of control women with breast cancer who were matched to cases on age, year of the breast cancer diagnosis and calendar time. Results We identified 25 cases of idiopathic VTE and 172 controls, all of whom had breast cancer, but were otherwise free from other risk factors for VTE. Past tamoxifen exposure was not materially associated with an elevated risk of developing VTE, and we therefore combined never and past users as reference group. The relative risk estimate of VTE for current tamoxifen exposure, as compared with never and past use combined, was 7.1 (95% CI 1.5–33), adjusted for body mass index, smoking status and hysterectomy status. High body mass index was an independent predictor of VTE itself. Conclusions Our study provides evidence that current use of tamoxifen increases the risk of idiopathic venous thromboembolism.

Meier, Christoph R; Jick, Hershel



Role of Tissue Factor in Venous Thrombosis  

PubMed Central

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

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



Obstructive Hydrocephalus from Venous Sinus Thrombosis  

Microsoft Academic Search

Background  Cerebral venous sinus thrombosis (CVST) is a rare form of stroke. Although increased intracranial pressure is a well-described\\u000a complication of CVST, hydrocephalus has rarely been reported.\\u000a \\u000a \\u000a \\u000a Case  We present the case of a 49-year-old woman who presented with one week of headache, vomiting, and progressive neurologic deterioration\\u000a leading to coma. Head CT and MRI identified extensive CVST and accompanying hydrocephalus. She

Michael T. Mullen; Lauren H. Sansing; Robert W. Hurst; John B. Weigele; Rajeev S. Polasani; Steven R. Messé



[Prophylaxis of venous thromboembolism in orthopedic surgery].  


The patients undergoing major orthopedic surgery, which includes total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS), represent a group that has a particularly high risk for venous thromboembolism (VTE), and routine thromboprophylaxis has been standard of care for >20 years. The following article summarizes data derived from numerous randomized clinical trials of thromboprophylaxis following THR, TKR, and HFS; areas of orthopedic surgery for which there are much less data, including knee arthroscopy and isolated lower extremity injuries, are also reviewed. PMID:20228720

Giuseppini, M U; Guiducci, S; Bardelli, M



[Definition, classification and diagnosis of chronic venous insufficiency - part II].  


Venous insufficiency can be defined as a fixed venous outflow disturbance of the limbs. It is caused by the malfunction of the venous system, that may or may not be associated with venous valvular insufficiency and may involve the superficial or deep venous system of the lower limbs, or both. The CEAP scale includes clinical, etiologic, anatomic and pathophysiologic aspects and has been used in the assessment of venous insufficiency Clinical classification comprises of 7 groups. It takes into account the appearance of the skin of the lower limbs, presence of edema, teleangiectasis and varicose ulcers. CLINICAL GRADING: Group C0 - no visible changes in the clinical examination; Group C1 - telangiectasis, reticular veins, redness of the skin around the ankles; Group C2 - varicose veins, Group C3 - the presence of edema without skin changes; Group C4 - lesions dependent of venous diseases (discoloration, blemishes, lipodermatosclerosis); C5 Group - skin changes described above with signs of healed venous ulcers; Group C6 - skin lesions such as in groups C1 to C4 plus active venous ulcers. ETIOLOGICAL CLASSIFICATION INCLUDES: Ec - congenital defects of the venous system, Ep - primary pathological changes of the venous system, without identification of their causes; Es - secondary causes of venous insufficiency of known etiology (post-thrombotic, post-traumatic, etc.). There are many methods of assessing the venous system. One of the most accurate methods is an ascending phlebography which is especially useful in determining detailed anatomy of the venous system, venous patency and identification of perforans veins. The second method may be a descending phlebography useful in determining the venous reflux and morphology of venous valves. Another radiological method is varicography in which the injection of the contrast medium directly into the veins is performed. It is especially useful in the ,,mapping" of venous connections. Trans-uterine phlebography when contrast medium is injected into the bottom of the uterus and its flow is observed, is a very rare test. A similar method is used in a selective phlebography of the ovarian vein and internal iliac vein. This examination is performed when there is a suspicion of connections between varicose veins of the inferior extremities and the pelvis, in case of the occluded iliac and femoral veins. However these tests are highly invasive, causing a lot of discomfort and are connected with numerous complications, particularly the development of venous thromboembolism. An invasive study but not exposing to the emission of ionizing radiation, is a measurement of the marching pressure (known also as ambulatory venous pressure - AVP). Ultrasound Doppler is the "gold standard" in the diagnosis of venous system. Color Doppler technique is irreplaceable due to its non-invasiveness, availability constantly improving of the ultrasound machines and is the method of choice in pregnancy Unfortunately clinical correlation of Doppler ultrasound and thrombosis is bad. Invasive methods, which include various types of phlebographies, have been reserved only for cases of very high diagnostic doubt. PMID:23488310

Kasperczak, Jaros?aw; Ropacka-Lesiak, Mariola; Breborowicz, H Grzegorz



Venous Stasis Ulcers Due to Primary, Isolated Deep Venous Insufficiency in a Patient with Systemic Lupus Erythematosus: Report of a Case  

Microsoft Academic Search

.  \\u000a Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis\\u000a ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence,\\u000a which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated\\u000a deep venous incompetence is rare, it is

Toshiya Nishibe; Fabio Kudo; Jorge Flores; Takahiro Imai; Keiko Miyazaki; Keishu Yasuda



Venous stasis ulcers due to primary, isolated deep venous insufficiency in a patient with systemic lupus erythematosus: report of a case.  


Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence, which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated deep venous incompetence is rare, it is important to bear this possibility in mind when a patient presents with leg ulcers. PMID:12376799

Nishibe, Toshiya; Kudo, Fabio; Flores, Jorge; Imai, Takahiro; Miyazaki, Keiko; Yasuda, Keishu



Experimental tracheal reconstruction with free prefabricated arterialized venous flap  

Microsoft Academic Search

A technique of tracheal reconstruction in the rat model has been developed using the microvascular transfer of a prefabricated compound flap. This flap consists of a tubed cartilage graft incorporated within an arterialized venous flap created in the abdominal skin. Twenty-five Wistar male rats were operated on in three stages. First, the subcutaneous venous network was arterialized by doing an

P. C. Cavadas; P. Baena-Montilla; F. Vera



Complications and risks of central venous catheter placement in children  

Microsoft Academic Search

Background: Since Aubaniac's first description in 1952, the use of central venous catheters has increased dramatically; they are now considered commonplace. Placement of these catheters, however, has an associated risk of morbidity and mortality. In most cases, this risk is outweighed by the benefit gained, especially when long-term access to the central venous system is needed for multiple transfusions, chemotherapy,

Eric M. Johnson; Daniel A. Saltzman; Gina Suh; Rachel A. Dahms; Arnold S. Leonard



Venous Ulcer Reappraisal: Insights from an International Task Force  

Microsoft Academic Search

An international task force made up of a panel of 16 experts was mandated to review and objectively evaluate all aspects of chronic venous disease of the leg. All available publications on chronic venous disease of the leg from 1983 to 1997 were identified through computerized search. Three different screenings were then performed in order to select only relevant papers

D. L. Clement



Hemispheric cerebrovascular venous thrombosis due to closed head injury  

Microsoft Academic Search

Case report We present the case of an 8-month-old infant who was admitted to our Neurosurgery Department with venous infarction related to sagittal sinus thrombosis. The infarction was radiologically detected 5 days after the baby had undergone surgery for acute subdural hematoma due to a closed head injury. Results and conclusions Cerebrovascular venous thrombosis is a rare clinical entity that has

Bulent Erdogan; Hakan Caner; M. Volkan Aydin; Tulin Yildirim; Suat Kahveci; Orhan Sen



Mesenteric venous thrombosis as sole complication of decompression sickness  

Microsoft Academic Search

Summary A 27-year-old male commercial diver developed massive mesenteric venous thrombosis following a dive. Symptoms at presentation included abdominal pain and diarrhea. A severe upper gastrointestinal bleed developed. Exploratory laparotomy demonstrated 130 cm of infarcted small bowel. The pathophysiologic events in decompression sickness predispose to vascular obstruction and venous infarction. This patient had a past history of possible thrombophlebitis and

Stanford L. Gertler; Joseph Stein; Thomas Simon; Katsumi Miyai



Microangiopathy in Chronic Venous Insufficiency: Quantitative Assessment by Capillary Microscopy  

Microsoft Academic Search

Background: patients with lipodermatosclerosis (LDS) due to chronic venous disease (CVD) of the lower limb show proliferation and convolution of their skin capillaries. There has been no previous attempt to quantify the severity of venous disease according to the extent of morphological change.Aim: to quantify capillary damage in patients with CVD using capillary microscopy.Method: 132 patients attending the vascular clinic

M. H. Howlader; P. D. Coleridge Smith



Distally based sural flap in treatment of chronic venous ulcers.  


The treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipodermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 x 3 to 11 x 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only 1 patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recurrent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect. PMID:16034246

Top, Husamettin; Benlier, Erol; Aygit, A Cemal; Kiyak, Medeni



Outcome of complex venous reconstructions in patients with trauma  

Microsoft Academic Search

Purpose: The role of complex venous reconstructions (CVRs) in patients with major trauma remains a controversial topic. This study evaluates the patency and clinical outcome of CVRs in a major urban trauma center.Methods: Between 1979 and 1994 the records of 92 patients with 100 injuries to the iliac, femoral, and popliteal venous system were reviewed. The incidence of edema, pulmonary

Peter J. Pappas; Paul B. Haser; Edwin P. Teehan; Audra A. Noel; Michael B. Silva; Zafar Jamil; Kenneth G. Swan; Frank T. Padberg; Robert W. Hobson



Microvascular changes in chronic venous insufficiency—a review  

Microsoft Academic Search

Chronic venous insufficiency is the result of an impairment of the main venous conduits, causing microvascular changes. The driving force responsible for the alterations in the microcirculation is probably the intermittently raised pressure propagated from the deep system into the capillaries. The capillaries are dilated, elongated and tortuous and their endothelium is injured (irregular luminal surface, increased cytopempsis, dilated interendothelial

A. J. Leu; H.-J. Leu; U. K. Franzeck; A. Bollinger



Prevention and Treatment of Venous Thromboembolism (VTE) in Obstetrics  

Microsoft Academic Search

Objective: to identify risk factors for venous thromboembolism (VTE) in the peripartum period and to provide guidelines for risk assessment and thromboprophylactic measures for VTE in pregnant women. Guidelines for diagnostic testing and for acute and long term treatment of VTE are also provided. Options: specific subgroups of pregnant women are defined and appropriate prophylactic measures are outlined. Outcomes: venous

Nancy Kent; QC Joan Crane; NF Dan Farine; Gregory J. Reid; John Van Aerde



Protocol for the successful treatment of venous ulcers  

Microsoft Academic Search

Venous ulcers affect up to 2.5 million patients per year in the United States. Although not usually fatal, these chronic wounds severely affect patients' quality of life because of impaired mobility and substantial loss of productivity. Although venous ulcers are typically small initially, they are often undertreated, progressing to larger ulcers that are associated with more serious complications requiring more

Harold Brem; Robert S Kirsner; Vincent Falanga



Venous leg ulcer: Incidence and prevalence in the elderly  

Microsoft Academic Search

Background: Venous leg ulcer is a disease most common in those aged 65 years and older. However, the incidence and prevalence have not been well established. Objective: Our purpose was to estimate the prevalence and incidence of venous leg ulcers in the elderly. Methods: We studied the General Practice Research Database, validated our case ascertainment strategy, and estimated the annual

David J. Margolis; Warren Bilker; Jill Santanna; Mona Baumgarten



Controlled trial of Iodosorb in chronic venous ulcers  

Microsoft Academic Search

Cadexomer iodine (Iodosorb) is a hydrophilic starch powder containing iodine, which is a suitable dressing for granulating wounds such as venous ulcers. A total of 61 outpatients with chronic venous ulcers participated in a randomised optional crossover trial using cadexomer iodine or a standard dressing for their ulcers. The trial lasted for 24 weeks or until the ulcer had healed.

M C Ormiston; M T Seymour; G E Venn; R I Cohen; J A Fox



Microsurgical anatomy of the internal vertebral venous plexuses  

Microsoft Academic Search

Few studies have been done about the venous vascularization of the spine since neuroradiologic studies in the 1960s and 70s. The aim of this study was to clarify the topography of the internal vertebral venous plexuses in relation to the posterior longitudinal ligament and the dura. The relationships of the vv. were studied at different levels of the spine. The

P. Chaynes; J. C. Verdié; J. Moscovici; J. Zadeh; Ph. Vaysse; J. Becue



Microsurgical anatomy of the internal vertebral venous plexuses  

Microsoft Academic Search

Summary Few studies have been done about the venous vascularization of the spine since neuroradiologic studies in the 1960s and 70s. The aim of this study was to clarify the topography of the internal vertebral venous plexuses in relation to the posterior longitudinal ligament and the dura. The relationships of the vv. were studied at different levels of the spine.

P. Chaynes; J. C. Verdié; J. Moscovici; J. Zadeh; Ph. Vaysse; J. Becue



Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators  

Microsoft Academic Search

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

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



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



Surgical treatment of venous malformations in Klippel-Trénaunay syndrome  

Microsoft Academic Search

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

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



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.



Percutaneous treatment of symptomatic central venous stenosis angioplasty  

Microsoft Academic Search

ObjectivesThe increased use of central venous access primarily for hemodialysis has led to a significant increase in clinically relevant central venous occlusive disease (CVOD). The magnitude of and the optimal therapy for CVOD are not clearly established. The purpose of this study is to define the problem of CVOD and determine the success of percutaneous therapy for relieving symptoms and

L. Richard Sprouse II; Christopher J Lesar; George H Meier III; F. Noel Parent; Richard J Demasi; Robert G Gayle; Michael J Marcinzyck; Marc H Glickman; Raseh M Shah; C. Scott McEnroe; Martin A Fogle; Gordon K Stokes; John O Colonna



Safely Ruling Out Deep Venous Thrombosis in Primary Care  

Microsoft Academic Search

Measurements: The primary outcome was symptomatic, objec- tively confirmed, venous thromboembolism during 3-month follow- up. Results: The mean age of the 1028 study patients was 58 years, and 37% of patients were men. A valid score was obtained in 1002 patients (98%). In 500 patients (49%), with a score of 3 or less, 7 developed venous thromboembolism within 3 months

Harry R. Buller; Arno W. Hoes; Manuela A. Joore; Karel G. M. Moons; Ruud Oudega; Martin H. Prins; Henri E. J. H. Stoffers; Diane B. Toll; Eit F. van der Velde; Henk C. P. M. van Weert



[Diagnosis of venous thrombosis by using radioisotopes].  


Thromboembolism problem is a grave complication which occurs with great frequency in patients hospitalized in a critical state. The association between periferical venous thrombosis and the thromboembolic accident is plainly demonstrated, although the accurate establishment of the clinical diagnosis of phlebothrombosis is only feasible in 50% of the cases. In the present work, we describe the methodology and the experience which we have acquired with the use of radioisotops in the diagnosis of these problems. We studied 64 patients to whom in the supine position we injected into a vein in both heels, from 3 to 5 millicuries of 99m-Tecnecio, practicing three stages: dynamic venography, a static study, and a pulmonary gammagram. In the normal cases, we clearly identified the tracts of the principal femural, iliac, and the inferior third of the inferior vena cava veins. In the abnormal studies, we observed the obstructive process manifested by the absence of radioactivity in the affected venous tract, with appearence of collateral circulation, definitive data which establishes with certainty the diagnosis. It can be concluded that the method is rapid and easily carried out, meaning that it could be a routine practice in all of those patients who are suspected of having this problem. PMID:1015903

Gordon, F; Ramírez, F; Muñoz, R; Alcántara, R; Flores Izquierdo, G


Imaging of venous thromboemboli with labeled platelets  

SciTech Connect

Prevention and optimal treatment of venous thromboembolism requires techniques that can: (1) monitor patients at high risk; (2) promptly detect thromboemboli; (3) follow the course of patients during treatment. Multiple techniques have been introduced to assist in these tasks. Some have not been well validated. Others, while established as of substantial value, have limitations with respect to specificity, sensitivity, patient access, patient acceptability, or risk. The dynamic nature of venous thromboembolism makes it unlikely that any one procedure will satisfy all diagnostic needs. Platelets labeled with 111In (111In-P) have promise as a useful addition to the existing diagnostic armamentarium. Because 111In-P are incorporated into forming and growing thromboemboli, and can provide a gamma camera image, they offer certain potential advantages versus other techniques. However, to establish the clinical value and proper use of the 111In-P technique, additional investigations are needed to determine the impact of thrombus location, age, anticoagulant therapy, and imaging technique and timing upon in vivo visualization of thromboemboli.

Moser, K.M.; Fedullo, P.F.



Basic Mechanisms and Pathogenesis of Venous Thrombosis  

PubMed Central

In 1856 Virchow proposed a triad of causes for venous thrombosis, postulating that stasis, changes in the vessel wall or changes in the blood could lead to thrombosis. We now know that abnormally high levels of some coagulation factors and defects in the natural anticoagulants contribute to thrombotic risk. Among these, factor V Leiden, which renders factor Va resistant to activated protein C, is the most prevalent with approximately 5% of the Caucasian population having this genetic alteration. These genetically controlled variants in coagulation factors work in concert with other risk factors, such as oral contraceptive use, to dramatically increase thrombotic risk. While these abnormalities in the blood coagulation proteins are associated with thrombotic disease propensity, they are less frequent contributors to thrombosis than age or cancer. Cancer increases thrombotic risk by producing tissue factor to initiate coagulation, by shedding procoagulant lipid microparticles or by impairing blood flow. Age is the strongest risk factor for thrombosis. Among possible reasons are fragility of the vessels potentially contributing to stasis, increased coagulation factor levels, impaired function of the venous valves, decreases in the efficacy of natural anticoagulants associated with the vessel wall, increased risk of immobilization and increased risk of severe infection.

Esmon, Charles T.



Intraosseous venous drainage of pretibial varices.  


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



Severe venous congestive encephalopathy secondary to a dialysis arteriovenous graft.  


The clinical presentation and imaging of venous congestive encephalopathy (VCE) can mimic several neurological conditions, making the diagnosis challenging. We report a patient with end stage renal disease on dialysis who presented with a right occipital infarction. The patient developed progressive encephalopathy and increased intracranial pressure. Extensive imaging, electroencephalography and serum analysis did not explain the cause of his infarction and progressive neurological deterioration. Finally, cerebral angiography and venography demonstrated severe generalized VCE due to arterial shunting from a right upper extremity arteriovenous graft (AVG) and an occluded right innominate venous trunk. The right arm shunt resulted in severe cerebral venous hypertension due to ipsilateral occlusion of the innominate venous trunk. After the AVG was repaired, the cerebral venous hypertension resolved and the patient returned to baseline. PMID:22904102

Samaniego, Edgar A; Abrams, Kevin J; Dabus, Guilherme; Starr, Rosanne; Linfante, Italo



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


Ventilation-perfusion scans were used in a prospective study to determine the prevalence of occult pulmonary embolus in proven deep venous thrombosis. Fifty-eight patients without symptoms of pulmonary embolism, but with venographically proven deep venous thrombosis, were subjected to chest radiographs, 99mTc macroaggregated-albumin perfusion scans, and 133Xe ventilation scans. Of the 49 patients with deep venous thrombosis proximal to the calf veins, 17 (35%) had high-probability scans. Of all 58 patients, only 12 (21%) had normal scans. When the study population was compared with a group of 430 patients described in reports of pulmonary perfusion in asymptomatic persons, a significantly higher percentage of high-probability scans was found in the study population with deep venous thrombosis. Baseline ventilation-perfusion lung scanning is valuable for patients with proven above-knee deep venous thrombosis. PMID:3492100

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



Occult pulmonary embolism: a common occurrence in deep venous thrombosis  

SciTech Connect

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

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



[Cerebral venous thrombosis and hereditary protein C deficiency].  


Protein C together with its plasmatic cofactor protein S and antithrombin III probably represent the most important plasmatic inhibitor in coagulation. Protein C deficiency constitutes a high risk factor for venous thrombosis. Cerebral venous thrombosis is a manifestation which is scarcely referred to in protein C deficiency. The case of a 32 year old patient with protein C deficiency is presented. The patient was admitted for an endocraneal hypertension syndrome. CT and MR demonstrated multiple hemorrhagic cerebral infarctions. Arteriography confirmed vertebral venous thrombosis. Only six cases sufficiently documenting cerebral venous thrombosis due to protein C deficiency were found in the literature. In most cases coadjuvant factors exist predisposing thromboembolic disease. The present clinical case demonstrates the importance of considering protein C deficiency in the diagnosis of cerebral venous thrombosis in young adults. PMID:1596402

Massons, J; Arboix, A; Oliveres, M; Besses, C; Muñoz, C; Titus, F



Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia.  


The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material. PMID:20922446

Moussi, A; Daldoul, S; Bourguiba, B; Othmani, D; Zaouche, A



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



Venous volume displacement plethysmography: Its diagnostic value in deep venous thrombosis as determined by receiver operator characteristic curves  

PubMed Central

The pitfall of several reviews of noninvasive venous assessment has been the expression of the test data solely in terms of diagnostic accuracy (the number of correct tests in ratio to all tests performed), where results of a test will vary according to disease prevalence. The advantages of receiver operator characteristic curve analysis are twofold: (1) it describes the dynamic relationship between sensitivity (the ratio of the number of true positive tests to the patients with deep venous thrombosis) and specificity (the ratio of true negative tests to the number of patients with no deep venous thrombosis) independent of disease prevalence; and (2) the threshold criteria that defines a positive test can be set by the best balance between sensitivity and specificity and then applied to a given patient population for its diagnostic accuracy. Venous volume plethysmography is a widely used, simple and rapid method. It was compared to the “gold standard” of phlebography in a prospective blind study of 70 limbs that were clinically suspect of having deep venous thrombosis (DVT). Venous volume displacement plethysmography was defined objectively by three quantitative parameters: (1) maximum venous outflow, (2) integer ratio, and (3) segmental venous capacitance ratio. The DVT (22 to 70 positive phlebograms) was divided by anatomic location into either calf vein DVT or proximal DVT (popliteal vein or above). By combining these three parameters, a balance between sensitivity and specificity was obtained to provide a rapid, objective method for screening patients with suspected DVT.

McBride, Kevin J.; O'Donnell, Thomas F.; Pauker, Stephen G.; Millan, Victor A.; Callow, Allan D.



Impending United States Energy Crisis  

Microsoft Academic Search

The U.S. oil and gas industry has been dramatically weakened by the recent oil price collapse. Domestic drilling activity reached a new post-World War II low during the summer of 1986. Given a weak, unstable oil price outlook, U.S. capability will continue to deteriorate. In the last year U.S. imports of foreign oil have risen significantly, and if market forces

Robert L. Hirsch



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




Impending United States energy crisis.  


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

Hirsch, R L



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



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


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



Effect of vasopressin on portal venous pressure.  


Portal venous pressure measurements were made through percutaneous transhepatic portal vein catheterization in 29 cirrhotics with portal hypertension and in seven controls before and after intravenous vasopressin infusion in a dosage of 0.24 IU/min. In cirrhotic patients the decrease in portal pressure was 8.5% being not statistically significant, while in the control group the decrease was 12% (p less than 0.05). Five of six cirrhotic patients (85%) whose acute bleedings were previously controlled with i.v. vasopressin infusion had reversed portal vein flow. On the other hand, only three of ten (30%) patients whose bleeding failed to be controlled with vasopressin had reversed flow in the portal vein. The difference between these two groups is statistically significant (p less than 0.05) and may suggest that variceal bleeding is most effectively controlled with i.v. vasopressin in cirrhotics with well developed collaterals and reversed portal vein flow. PMID:6601347

Kallio, H; Lempinen, M



Physician alerts to prevent venous thromboembolism.  


Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common but usually preventable complication of hospitalization associated with substantial mortality, morbidity, and health care costs. Despite published guidelines for the prevention of VTE among hospitalized patients, underutilization of prophylaxis continues to be a problem in the United States, Canada, and worldwide. Although much of the emphasis placed on prevention has focused on improving in-hospital prophylaxis, nearly 75% of patients develop VTE in the outpatient setting. Of these patients, a substantial proportion had undergone surgery or hospitalization in the three months preceding the diagnosis of VTE. While extended out-of-hospital prophylaxis has been validated in the orthopedic and surgical oncology literature, data regarding the prevention of VTE in other hospitalized patient populations after discharge have been limited. In this review article, we discuss decision support strategies for improving VTE prevention during hospitalization and at the time of discharge. PMID:19888553

Piazza, Gregory; Goldhaber, Samuel Z



Management of varicose veins and venous insufficiency.  


Chronic venous disease, reviewed herein, is manifested by a spectrum of signs and symptoms, including cosmetic spider veins, asymptomatic varicosities, large painful varicose veins, edema, hyperpigmentation and lipodermatosclerosis of skin, and ulceration. However, there is no definitive stepwise progression from spider veins to ulcers and, in fact, severe skin complications of varicose veins, even when extensive, are not guaranteed. Treatment options range from conservative (eg, medications, compression stockings, lifestyle changes) to minimally invasive (eg, sclerotherapy or endoluminal ablation), invasive (surgical techniques), and hybrid (combination of ?1 therapies). Ms L, a 68-year-old woman with varicose veins, is presented. She has had vein problems over the course of her life. Her varicose veins recurred after initial treatment, and she is now seeking guidance regarding her current treatment options. PMID:23268520

Hamdan, Allen



[Pregnancy, contraception and HRT and venous thromboembolism].  


Endogeneous and exogeneous hormonal factors may favor venous thromboembolism (VTE) in the woman. Pregnancy and post-partum, combined contraception and hormonal replacement therapy (HRT) of menopause are associated with an increased risk of VTE. Even when the relative risk is statistically significant, the absolute risk remains generally low unless additional factors are present. The occurrence of a thrombosis depends on the conditions associated to these risk factors: multiparity, caesarean section, type of contraception or HRT, and also on risk factors associated to the woman such as age, obesity, personal history of VTE, hereditary or acquired thrombophilia. The detection of high-risk women because of personal history of VTE, associated risk factors and/or thrombophilia should improve the clinical management and thrombosis prophylaxis, especially when hormonal treatments are prescribed. PMID:17626321

Conard, Jacqueline; Gompel, Anne



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



[Diagnosis and treatment of venous thrombosis].  


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

Hach-Wunderle, V



[Diagnosis and treatment of venous thrombosis].  


In the diagnosis of deep vein thrombosis in ambulatory patients, the recommended initial steps are assessment of clinical probability (CP) and a sensitive D-dimer test. With a low CP and negative D-dimer, thrombosis can be ruled out. All other constellations require further investigation with imaging techniques. Compression ultrasonography is the first-line investigation. Low-molecular weight heparin or fondaparinux is the treatment of choice for uncomplicated venous thrombosis. Secondary prophylaxis with a vitamin K antagonist is introduced in parallel as quickly as possible. The duration of treatment depends on the exposure and predisposing factors, weighing carefully the risk of recurrence on the one hand against the risk of bleeding on the other. The danger of a post thrombotic syndrome is reduced by the immediate begin of a long lasting compression therapy. PMID:19132168

Hach-Wunderle, V



Adverse pacemaker hemodynamics evaluated by pulmonary venous flow monitoring.  


The pacemaker syndrome refers to symptoms and signs in the pacemaker patient caused by an inadequate timing of atrial and ventricular contractions. The lack of normal atrioventricular synchrony may result in a decreased cardiac output and venous cannon A waves. The objective of this study was to define the left atrial and pulmonary venous flow response to ventricular pacing in a group of 14 unselected consecutive patients with total heart block and sinus rhythm. Pulmonary venous flow was assessed by transesophageal pulsed Doppler echocardiography in the VVI and DDD pacing modes. An inappropriate atrial timing caused a marked augmentation of the normally small pulmonary venous z wave in all patients ("negative atrial kick," peak z wave in DDD pacing 14.5 +/- 4.6 cm/s, VVI pacing 51.8 +/- 15.0 cm/s). Restoration of AV synchrony (DDD pacing, AV interval 100 ms) abolished these "cannon z waves" in all patients, and a normal pattern of pulmonary venous flow was achieved. Abnormal pulmonary venous flow characteristics were observed in 2 of 14 patients during DDD pacing with short AV intervals (100 ms). The Doppler pattern was similar to the findings seen in VVI pacing. Assessment of pulmonary venous flow by transesophageal pulsed Doppler echocardiography may provide a simple, sensitive, and relatively noninvasive technique to evaluate patients with suspected pacing induced adverse hemodynamics. PMID:8552517

Stierle, U; Krüger, D; Mitusch, R; Potratz, J; Taubert, G; Sheikhzadeh, A



Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis  

SciTech Connect

The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis.

Inada, K.; Shirai, N.; Hayashi, M.; Matsumoto, K.; Hirose, M.



Strategies for venous thromboembolism prophylaxis programs.  


Prevention of venous thromboembolism (VTE) is often overlooked in clinical practice, despite being a frequent and serious complication of various medical conditions and surgical procedures. The need to reduce hospital-acquired VTE is becoming increasingly recognized in the United States, and various quality-improvement initiatives have been developed. Prevention of VTE through evidence-based, practice-informed pathways includes assessing the patient's risk of VTE and provision of VTE at different stages: at admission, during hospitalization, and after hospital discharge. A multidisciplinary approach, involving physicians working with pharmacists, nurses, and other staff, can ensure that VTE prevention is routinely addressed. Patients admitted to hospitals should undergo VTE risk assessment, and the appropriate dose, type, and duration of medication should be administered with regular monitoring for VTE events and bleeding complications. Venous thromboembolism risk assessment should continue throughout hospitalization with appropriate prophylaxis when necessary. Patients may need to continue anticoagulation into the outpatient setting to achieve adequate prophylaxis duration. Useful approaches to ensure successful transition of care include patient education and support, with the accurate and timely transfer of information from the hospital to the primary care physician. Various strategies and tools are available to help physicians establish good VTE practices at each stage, including risk assessment models, reminders, clinical decision support systems, educational programs, and online resources, such as those from the Society of Hospital Medicine. Effective use of these strategies by physicians, with the engagement and support of nurses and pharmacists, should help to improve current practices and to reduce the considerable burden of VTE. PMID:22104458

Lenchus, Joshua D



Techniques for prospective detection of venous stenosis.  


The vascular access device continues to be a bottleneck in the quest for improved dialysis efficiency and cost reduction. Stenotic lesions occur frequently in synthetic arteriovenous fistulas (AVFs), usually at the venous end, and less often in native AVFs. The reduction in blood flow and other thrombogenic effects of the stenosis, such as local turbulence, eventually lead to loss of the access. Before thrombosis occurs, reduced blood flow through the AVF limits inflow to the dialyzer and predisposes to local recirculation. Recirculation decreases the effective solute clearance of the dialyzer, jeopardizing the adequacy of treatment. Regular evaluation of the access using methods such as routine physical examination, measurement of recirculation, measurement of venous dialysis pressure, and radiographic or ultrasonic imaging when combined with percutaneous or surgical interventions have been shown to prolong access life and eliminate recirculation. Physical examination includes inspection and palpation to detect edema, palpation and auscultation to detect local increases in the intensity of a thrill or bruit, and optional occlusion of the fistula during dialysis to detect recirculation. Recirculation can be measured directly using classical solute dilution techniques or indicator dilution methods provided by a variety of devices now appearing on the market. Recirculation may also be detected indirectly from the results of urea modeling. The difference between modeled and expected urea clearance is a measure of recirculation provided no other error (eg, in blood flow) contributes to the difference. Pressure monitoring has proven useful in many centers. A strict protocol is required to normalize other influences such as blood flow and needle size that may alter pressure independently of access stenosis. Duplex Doppler ultrasonography has been evaluated and found useful in several studies but suffers from relatively high cost and operator dependency. Controlled studies of these screening techniques are needed, especially for those that incur high costs. PMID:7614312

Depner, T A



Proteomics of Microparticles after Deep Venous Thrombosis  

PubMed Central

Background Microparticles (MP) are submicron size membrane vesicles released from activated cells that are associated with thrombosis and inflammation. MP present diverse biological expressions that may be linked to a unique subset of proteins derived from their origin cells. Methods To identify these proteins, plasma samples were taken from 9 patients with deep venous thrombosis (DVT) documented by duplex ultrasound, 9 with leg pain but negative for DVT by duplex, and 6 healthy controls without a history of thrombosis, for fold variation. MP were extracted from platelet-poor plasma, digested separately with trypsin and tagged using iTRAQ reagents. The digests were subjected to 2-D LC separation followed by MALDI tandem mass spectrometry. Peak lists were generated and searched against all human sequences. For protein identification, a minimum of two peptides at 95% confidence was required. Later, iTRAQ ratios were generated comparing relative protein levels of DVT patients to baseline. The proteomic analysis was performed twice for each blood sample. Proteins were considered elevated or depressed if the iTRAQ ratio (R) deviated by 20% change from normal and a p-value less than 0.05. Results Two proteins (Galectin-3 Binding Protein, [Gal3BP], R=1.76 and Alpha-2 macroglobulin [A2M] R=1.57) were differentially expressed on DVT patients. Nine proteins were depleted including fibrinogen beta and gamma chain precursors (R=0.65). Conclusions These proteins influence thrombosis through inflammation, cell shedding, inhibition of fibrinolysis and hemostatic plug formation. Further studies are needed to confirm the mechanistic role of these proteins in the pathogenesis of venous thrombosis in humans.

Ramacciotti, Eduardo; Hawley, Angela E.; Wrobleski, Shirley K.; Myers, Daniel D.; Strahler, John R.; Andrews, Philip C.; Guire, Kenneth E.; Henke, Peter K.; Wakefield, Thomas W.



Computed tomography of pulmonary venous variants and anomalies.  


Radiofrequency ablation of the pulmonary veins is a well-established technique in the management of atrial fibrillation. Computed tomography (CT) plays an important role in the evaluation of these patients, especially delineating pulmonary venous anatomy, anatomic variations, and complications after radiofrequency ablation. CT scan is characterized by high spatial and temporal resolutions, multiplanar reconstruction capabilities, and wide field of view. Knowledge of the normal pulmonary venous anatomy, anatomic variants, and optimal scanning protocol is essential for preablation planning and for evaluation of postablation complications. In this pictorial review, the CT appearance of various pulmonary venous variants and anomalies are discussed and illustrated. PMID:20427256

Rajiah, Prabhakar; Kanne, Jeffrey P



Total Anomalous Pulmonary Venous Connection to the Portal Vein  

SciTech Connect

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

Wyttenbach, Marina [Department of Diagnostic Radiology, Division of Children's Radiology, University Hospital, Inselspital, CH-3010 Bern (Switzerland); Carrel, Thierry; Schuepbach, Peter [Department of Thoracic and Cardiovascular Surgery, University Hospital, Inselspital, CH-3010 Bern (Switzerland); Tschaeppeler, Heinz; Triller, Juergen [Department of Diagnostic Radiology, Division of Children's Radiology, University Hospital, Inselspital, CH-3010 Bern (Switzerland)



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.



In search of venous thromboembolism: the first 2913 years.  


OBJECTIVE. Venous thromboembolism was first described in India around 600-900 BC. It was not until the 17th through 19th centuries that Western researchers began to understand the anatomy, physiology, and pathology of deep venous thrombosis and pulmonary embolism. Roentgen's discovery of x-rays in 1895 led to the first objective imaging. CONCLUSION. Currently, scintigraphy, helical CT, MRI, and sonography provide accurate in vivo images. These high-quality images have forced clinicians to reevaluate many preimaging assumptions about and treatments for venous thromboembolism. PMID:24059395

Goodman, Lawrence R



Leukocyte activity in the microcirculation of the leg in patients with chronic venous disease  

Microsoft Academic Search

Purpose: It has been suggested that leukocyte trapping and activation in the microcirculation of the leg skin causes lipodermatosclerosis and ulceration in patients with chronic venous disease. Ambulatory venous hypertension is accepted as the physiologic factor that leads to ulceration. We investigated leukocyte endothelial adhesion in patients who were subjected to short-term venous hypertension.Methods: Two groups of patients with venous

Mrinal Saharay; David A. Shields; John B. Porter; John H. Scurr; Philip D. Coleridge Smith



Intracranial Hypotension as a Cause of Radiculopathy from Cervical Epidural Venous Engorgement: Case Report  

Microsoft Academic Search

Summary: We describe the case of a 40-year-old man with spontaneous intracranial hypotension who presented with cervical radiculopathy associated with epidural venous en- gorgement. Epidural venous engorgement can occur sec- ondary to intracranial hypotension and manifests intracra- nially as pachymeningeal venous engorgement. In the cervical spine, two cases of epidural venous engorgement due to intracranial hypotension have been reported in

Sait Albayram; Bruce A. Wasserman; David M. Yousem; Robert Wityk


Venous thrombosis of the upper extremity: effect of blood group and coagulation factor levels on risk  

Microsoft Academic Search

Venous thrombosis of the upper extremity is a rare form of thrombosis, accounting for around 4% of all venous thromboses, and for which only a few risk factors are known. This case-control study investigated the effect of coagulation factors on risk of venous thrombosis of the upper extremity. Patients with venous thrombosis of the arm and partner controls were selected

Linda E. Flinterman; Hylckama Vlieg van Astrid; Frits R. Rosendaal; Carine J. M. Doggen



Assisted venous drainage, venous air, and gaseous microemboli transmission into the arterial line: an in-vitro study.  


The objective of this study was to examine the interaction of cardiopulmonary bypass venous air with assisted venous drainage, focusing on its production of gaseous microemboli in the arterial line. An in-vitro recirculating cardiopulmonary bypass circuit containing fresh whole bovine blood was monitored with a pulsed-doppler microbubble detector. Air of specific amounts was injected into the venous line and gaseous microemboli counts were obtained distal to the arterial filter. Data was recorded for unassisted drainage, vacuum-assisted drainage, and centrifugal pump-assisted drainage. Centrifugal pump-assisted drainage produced over 300 microbubbles in one minute distal to the arterial filter when venous air was introduced into the circuit. Of these, 220 were greater than 80 microns in size. Vacuum-assisted drainage produced no microbubbles when the same amount of venous air was introduced into the circuit. However, vacuum-assisted drainage did produce some microbubbles in the arterial line when a stopcock was left open on the venous line for 30 seconds. Unassisted drainage produced no microbubbles at all levels of venous air entrainment. Air becomes entrained in the venous line from a variety of sources. In a typical gravity-drained situation, the air remains whole and is dissipated in the venous reservoir by buoyancy and filtration. In an assisted-drainage situation, the air is subjected to additional forces. The air is subjected to a greater degree of negative pressure and, with centrifugal pump assisted drainage, is subjected to kinetic energy imparted by the cones or vanes of the pump. The kinetic energy from the centrifugal pump appears to break the air into small bubbles which become suspended in the blood, passing through the reservoir, oxygenator, and arterial filter. In a clinical setting, these bubbles would be passed into a patient's arterial system. PMID:10537575

Rider, S P; Simon, L V; Rice, B J; Poulton, C C



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  

Microsoft Academic Search

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




Decompressive craniectomy in severe cerebral venous and dural sinus thrombosis  

Microsoft Academic Search

Objective. To evaluate the outcome of patients with most severe cerebral venous and dural sinus thrombosis (CVT) after decompressive craniectomy. Indications and techniques for decompressive craniectomy and intensive care regimen are discussed.

E. Keller; A. Pangalu; J. Fandino; D. Könü; Y. Yonekawa


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...



Venous and arterial thrombosis: Two aspects of the same disease?  

PubMed Central

An increasing body of evidence suggests the likelihood of a link between venous and arterial thrombosis. The two vascular complications share several risk factors, such as age, obesity, diabetes mellitus, blood hypertension, hypertriglyceridemia, and metabolic syndrome. Moreover, there are many examples of conditions accounting for both venous and arterial thrombosis, such as the antiphospholipid antibody syndrome, hyperhomocysteinemia, malignancies, infections, and the use of hormonal treatment. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic complications than matched control individuals. We, therefore, speculate the two vascular complications are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.

Prandoni, Paolo



Central venous catheter-related Rhodotorula rubra fungemia.  


With the increased use of indwelling central venous catheters, increasing numbers of cases of Rhodotorula fungemia have been observed in patients with neoplasia and neutropenia. In most patients with catheter-related Rhodotorula fungemia, the condition has been treated with broadspectrum antibiotics. We report two cases of central venous catheter-related Rhodotorula rubra fungemia that occurred in patients with acute myeloblastic leukemia. Both patients were in a state of neutropenia. One patient was treated with amphotericin B and his central venous catheter was removed, but he died of Klebsiella pneumoniae bacteremia. The other patient was treated with amphotericin B and discharged, with a central venous catheter, after recovery from neutropenia. Although the management of catheter-related Rhodotorula fungemia infections remains controversial, resolution of the underlying disease is more important than catheter removal for recovery from Rhodotorula rubra fungemia. PMID:11957131

Chung, Jin-Won; Kim, Baek-Nam; Kim, Yang Soo



21 CFR 876.5955 - Peritoneo-venous shunt.  

Code of Federal Regulations, 2013 CFR

...implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous system for the treatment of intractable ascites. (b) Classification. Class...



Inspired Gas Composition Influences Recovery from Experimental Venous Air Embolism.  

National Technical Information Service (NTIS)

Venous air embolism (VAE) is a potentially fatal occurrence frequently encountered in neurosurgical procedures performed in the sitting position. The morbidity of this event has been reduced primarily by efforts at early detection and prevention. Clinical...

J. A. Bettencourt C. M. Harrison T. Plemons P. L. Schleiff W. J. Mehm



Pharmacologic prevention of venous thromboembolism in obese patients.  


Venous thromboembolism, a collective term for pulmonary embolism and deep venous thrombosis accounts for a large amount of mortality and morbidity in hospitalized patients. Obesity has been considered as an important risk factor for the development of venous thromboembolism. Anticoagulation with fixed doses of low molecular weight heparin, anti-factor Xa inhibitors and unfractionated heparin is widely used in hospitals and has shown to be an effective measure in prevention of venous thromboembolism in multiple major randomized, double-blind controlled trials. Appropriate dosing of anticoagulation in obese patients is still controversial, since obese and morbidly obese population of patients is consistently underrepresented or often excluded from most clinical trials, raising a concern for adequacy of standard dosing in this high risk population. PMID:23180282

Bakirhan, K; Strakhan, M



Complications associated with venous access devices: Part two.  


In the second of two articles the author discusses the secondary complications that can arise following insertion of venous access devices (VADs). Part one, published last week, examined the primary complications that can arise when inserting VADs. PMID:16566340

Hamilton, Helen


Cardiac arrhythmias associated with umbilical venous catheterisation in neonates  

PubMed Central

Umbilical venous catheters (UVCs) are commonly used in the management of severely ill neonates. Several life-threatening complications have been described, including catheter-related infections, myocardial perforation, pericardial effusion and cardiac arrhythmias. This report describe two neonates with cardiac arrhythmias due to umbilical venous catheterisation. One neonate had a supraventricular tachycardia requiring treatment with intravenous adenosine administration. Another neonate had an atrial flutter and was managed successfully with synchronised cardioversion. The primary cause of cardiac arrhythmias after umbilical venous catheterisation is inappropriate position of the UVC within the heart and the first step to treat them should be to pull back or even remove the catheter. Cardiac arrhythmia is a rare but potentially severe complication of umbilical venous catheterisation in neonates.

Verheij, Gerdina; Smits-Wintjens, Vivianne; Rozendaal, Lieke; Blom, Nico; Walther, Frans; Lopriore, Enrico



Novel biomarkers of arterial and venous ischemia in microvascular flaps.  


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

Nguyen, Gerard K; 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



Venous obstruction in permanent pacemaker patients: an isotopic study  

SciTech Connect

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

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



Venous thoracic outlet syndrome caused by a congenital rib malformation  

PubMed Central

Summary Venous thoracic outlet syndrome (VTOS) represents a rare disorder. Hypertrophy of the anterior scalene musculature is the cause of the compression syndrome in most cases. To our knowledge, we describe the first reported case worldwide of a venous compression syndrome caused by a congenital malformation of the 1st and 2nd ribs. Treatment by transaxillary partial rib resection was necessary and a very good postoperative result was achieved.

Kirschbaum, Andreas; Palade, Emanuel; Csatari, Zoltan; Passlick, Bernward



Venous pressures in the isolated upper limb during saline injection  

Microsoft Academic Search

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

Barry A. Finegan; M. David Bukht



Investigation of the venous system in impotence of vascular origin  

Microsoft Academic Search

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

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



Central venous catheter-related Rhodotorula rubra fungemia  

Microsoft Academic Search

With the increased use of indwelling central venous catheters, increasing numbers of cases of Rhodotorula fungemia have been observed in patients with neoplasia and neutropenia. In most patients with catheter-related Rhodotorula fungemia, the condition has been treated with broadspectrum antibiotics. We report two cases of central venous catheter-related\\u000a Rhodotorula rubra fungemia that occurred in patients with acute myeloblastic leukemia. Both

J.-W. Chung; B.-N. Kim; Y. S. Kim



Marjolin's Ulcer in a Patient With Chronic Venous Stasis.  


Marjolin's ulcer is an aggressive form of squamous cell carcinoma that develops over time from chronic wounds and scars, including burns and chronic venous stasis ulcers. The incidence of malignant transformation is low, resulting in a delay in diagnosis and increased morbidity and mortality in these patients. We report a case of Marjolin's ulcer that was incidentally found after limb amputation for chronic venous stasis ulcer along with a comprehensive literature review on the etiology, diagnosis, and treatment of this disease. PMID:23972640

Eliassen, Anna; Vandy, Frank; McHugh, Jonathan; Henke, Peter K



Venous thromboembolism in patients with chronic obstructive pulmonary disease  

PubMed Central

Purpose Our aim was to compare clinical characteristics, prophylaxis, treatment, and outcomes of venous thromboembolism in patients with and without previously diagnosed chronic obstructive pulmonary disease. Methods We analyzed the population-based Worcester Venous Thromboembolism Study of 2,488 consecutive patients with validated venous thromboembolism to compare clinical characteristics, prophylaxis, treatment, and outcomes in patients with and without chronic obstructive pulmonary disease. Results Of 2,488 venous thromboembolism patients, 484 (19.5%) had a history of clinical chronic obstructive pulmonary disease and 2,004 (80.5%) did not. Chronic obstructive pulmonary disease patients were older (mean age 68 years vs. 63 years) and had a higher frequency of heart failure (35.5% vs. 12.9%) and immobility (53.5% vs. 43.3%) than patients without chronic obstructive pulmonary disease (all p<0.0001). Chronic obstructive pulmonary disease patients were more likely to suffer in-hospital death (6.8% vs. 4%, p=0.01) and death within 30 days of venous thromboembolism diagnosis (12.6% vs. 6.5%, p<0.0001). Chronic obstructive pulmonary disease patients demonstrated increased mortality despite a higher frequency of venous thromboembolism prophylaxis. Immobility doubled the risk of in-hospital death (adjusted odds ratio 2.21; 95% confidence interval 1.35–3.62) and death within 30 days of venous thromboembolism diagnosis (adjusted odds ratio 2.04; 95% confidence interval 1.43–2.91). Conclusion Patients with chronic obstructive pulmonary disease have an increased risk of dying during hospitalization and within 30 days of venous thromboembolism diagnosis. Immobility in chronic obstructive pulmonary disease patients is an ominous risk factor for adverse outcomes.

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



Pathogenesis and Management of Venous Thromboembolism in Cancer  

Microsoft Academic Search

One hundred and forty one years have passed since Armand Trousseau’s initial observation that venous thromboembolism (VTE)\\u000a is a common manifestation of an underlying malignancy (1). Despite widespread recognition of this association and the availability of a multiple options for prevention and treatment\\u000a of venous thrombosis, VTE remains a common cause of morbidity and mortality in cancer patients. The purpose

Michael B. Streiff


Successful management of venous air embolism with inotropic support  

Microsoft Academic Search

Purpose: Since venous air embolism may occur during many different types of surgery, management of this clinical emergency\\u000a can be required in patients who do not have a previously established central venous access for aspiration of air. Recent reviews\\u000a suggest that management of right heart syndromes in patients with embolism is critical in improving outcome.\\u000a \\u000a Clinical Features: Abrupt decreases in

David P. Archer; Michael P. Pash; M. Elizabeth MacRae



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



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



Sustained compression and healing of chronic venous ulcers  

Microsoft Academic Search

STUDY OBJECTIVE--Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN--Part of larger randomised trial of five different dressings. SETTING--Outpatient venous ulcer clinic in university hospital. PATIENTS--(a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer

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



Oxpentifylline treatment of venous ulcers of the leg  

Microsoft Academic Search

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

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



Multiple medullary venous malformations decreasing cerebral blood flow: Case report  

SciTech Connect

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

Tomura, N.; Inugami, A.; Uemura, K.; Hadeishi, H.; Yasui, N. (Research Institute for Brain and Blood Vessels, Akita (Japan))



Right Ventricular Perforation during Femoral Venous Cannulation - Lessons Learned.  


Peripheral cannulation for cardiopulmonary bypass is increasingly used for minimally invasive and re-operative cardiac surgery. Transoesophageal echo (TOE) is used routinely to guide placement of the peripheral venous cannula in the right atrium/superior vena cava (SVC). We here present a case where despite use of TOE, placement of the venous cannula led to perforation of the right ventricular apex. We describe the surgical management of the problem and highlight strategies to avoid this complication. PMID:23337263

Passage, Jurgen; Joshi, Pragnesh



Venous air embolism during semi-sitting craniotomy evokes thrombocytopenia.  


Venous air embolism activates platelets in vitro and can evoke platelet dysfunction in swine. We tested the hypothesis that venous air embolism during semi-sitting craniotomy induces thrombocytopenia in humans. We analysed the charts of 799 patients who had an elective craniotomy in the semi-sitting position between 1990 and June 2009. Venous air embolism occurred in 52 patients (6.5%) and was associated with a decrease in mean (SD) in platelet count from 270 (75) × 10? l?¹ to 194 (62) × 10? l?¹ (p < 0.001). In age-matched controls without venous air embolism mean (SD) platelet count did not change (254 (82) × 10? l?¹ vs. 250 (97) × 10? l?¹ (NS). While mean (SD) haematocrit fell slightly in both groups (venous air embolism: 0.40 (0.05) to 0.32 (0.04), p <0.001; no venous air embolism: 0.41 (0.04) to 0.35 (0.05), p < 0.001), normalising platelet count to haematocrit did not alter the results. PMID:21198503

Schäfer, S T; Sandalcioglu, I E; Stegen, B; Neumann, A; Asgari, S; Peters, J



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.



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.



[Prevention of venous thromboembolism in medical patients].  


Thromboembolism, which frequently associates deep venous thrombosis and pulmonary embolism, is a serious and potentially fatal condition that often complicates the outcome of patients hospitalized in the medical area. This disease is multifactorial and chronic, due to the risks of recurrence, and can cause severe complications (death, pulmonary hypertension, residual postphlebitic syndrome). Randomized, controlled clinical trials (Medenox, Prevent, Artemis) demonstrated the unquestionable preventive benefits of low-molecular-weight heparins and fondaparinux from hospitalization on, in a specific group of "medical" patients at minimum risk of bleeding. These findings support the systematic use of medical thromboprophylaxis in patients meeting the study criteria, as per the ACCP 2008 guidelines. However, only 50% of the patients in which thromboprophylaxis is indicated receive a treatment. This under-use can be explained by with the wide variety of patients, as well as the difficulty to assess thromboembolic risks. Overall risk assessment models, simple and clinically relevant, were developed to facilitate the decision to initiate an appropriate thromboprophylaxis in patients hospitalized in medical area. PMID:22308802

Szwebel, Tali-Anne; Le Jeunne, Claire



Venous Thromboembolism in Patients With Prior Stroke.  


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

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



Statins and venous thromboembolic disease prophylaxis.  


Statins have dramatically improved the treatment of hyperlipidemia and cardiovascular disease through its inhibition of hydroxymethylglutaryl-coenzyme A reductase. Although its main effect has long been known, much is yet to be understood about the wide and varied pleiotropic properties of statins. Some studies have demonstrated that statins contain antiplatelet, antithrombotic, antiinflammatory, cardioprotective, and neuroprotective properties independent of their ability to lower plasma low-density lipoprotein cholesterol. More recently, statins have been used in novel ways in the treatment of Alzheimer disease, sepsis, pneumonia, and bacteremia. In 2000, it was first suggested that statins could decrease the incidence of venous thromboembolisms (VTEs). A recent publication showed that not only do statins lower the incidence of deep vein thrombosis and pulmonary embolism, but they do so in a dose-dependent manner. Although there is certainly strong evidence demonstrating that statins do indeed lower VTEs, the mechanism is not understood. Possible hypotheses include their antiinflammatory and antithrombotic properties. With only one randomized clinical trial available, further studies must be conducted before routinely recommending statins for prophylaxis of VTEs. PMID:23707992

Wang, Cindy; Lerner, Robert G; Frishman, William H


Mesenteric venous thrombosis in inflammatory bowel disease.  


Mesenteric venous thrombosis (MVT) is a rare but potentially catastrophic clinical complication, which may lead to ischemia or infarction of the intestine and/or the emergence of portal hypertension. An association between inflammatory bowel disease (IBD) and MVT has previously been described, but clinical factors that may contribute to this complication in the setting of IBD are not well characterized. Diagnosis of MVT in IBD is difficult, as patients frequently present with nonspecific abdominal discomfort, which may delay diagnosis and initiation of treatment. We report 6 of 545 IBD patients at our center (1.1%) that developed MVT, and describe presentation, diagnostic approaches, treatment options, underlying contributing factors, and outcome. The diagnosis was determined with abdominal computed tomography (CT) in 5 of 6 cases. Clinical factors, which were thought to contribute to MVT, included underlying hypercoagulability, low-flow state, uncontrolled inflammation, perioperative time period, and prior surgical manipulation of the portal vein following orthotopic liver transplantation. There were no deaths as a result of MVT, although 1 patient developed severe portal hypertension and another experienced intestinal infarction requiring extensive resection. We conclude that MVT is an important clinical consideration in IBD patients, specifically during the perioperative setting, and diagnosis is facilitated with the use of CT scan. PMID:15599206

Hatoum, Ossama A; Spinelli, Kristi S; Abu-Hajir, Majed; Attila, Tan; Franco, Jose; Otterson, Mary F; Telford, Gordon L; Binion, David G



Turbulent flow evaluation of the venous needle during hemodialysis.  


Arteriovenous (AV) grafts and fistulas used for hemodialysis frequently develop intimal hyperplasia (IH) at the venous anastomosis of the graft, leading to flow-limiting stenosis, and ultimately to graft failure due to thrombosis. Although the high AV access blood flow has been implicated in the pathogenesis of graft stenosis, the potential role of needle turbulence during hemodialysis is relatively unexplored. High turbulent stresses from the needle jet that reach the venous anastomosis may contribute to endothelial denudation and vessel wall injury. This may trigger the molecular and cellular cascade involving platelet activation and IH, leading to eventual graft failure. In an in-vitro graft/needle model dye injection flow visualization was used for qualitative study of flow patterns, whereas laser Doppler velocimetry was used to compare the levels of turbulence at the venous anastomosis in the presence and absence of a venous needle jet. Considerably higher turbulence was observed downstream of the venous needle, in comparison to graft flow alone without the needle. While turbulent RMS remained around 0.1 m/s for the graft flow alone, turbulent RMS fluctuations downstream of the needle soared to 0.4-0.7 m/s at 2 cm from the tip of the needle and maintained values higher than 0.1 m/s up to 7-8 cm downstream. Turbulent intensities were 5-6 times greater in the presence of the needle, in comparison with graft flow alone. Since hemodialysis patients are exposed to needle turbulence for four hours three times a week, the role of post-venous needle turbulence may be important in the pathogenesis of AV graft complications. A better understanding of the role of needle turbulence in the mechanisms of AV graft failure may lead to improved design of AV grafts and venous needles associated with reduced turbulence, and to pharmacological interventions that attenuate IH and graft failure resulting from turbulence. PMID:16502656

Unnikrishnan, Sunil; Huynh, Thanh N; Brott, B C; Ito, Y; Cheng, C H; Shih, A M; Allon, M; Anayiotos, Andreas S



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 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 venous air embolisms end-tidal nitrogen increased when the emission spectrometer was used, but venous air embolisms less than 1.0 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))



Prediction of venous thromboembolism in cancer patients.  


The risk of venous thromboembolism (VTE) is increased in cancer patients. To improve prediction of VTE in cancer patients, we performed a prospective and observational cohort study of patients with newly diagnosed cancer or progression of disease after remission. A previously developed risk scoring model for prediction of VTE that included clinical (tumor entity and body mass index) and laboratory (hemoglobin level and thrombocyte and leukocyte count) parameters was expanded by incorporating 2 biomarkers, soluble P-selectin, and D-Dimer. Of 819 patients 61 (7.4%) experienced VTE during a median follow-up of 656 days. The cumulative VTE probability in the original risk model after 6 months was 17.7% in patients with the highest risk score (? 3, n = 93), 9.6% in those with score 2 (n = 221), 3.8% in those with score 1 (n = 229), and 1.5% in those with score 0 (n = 276). In the expanded risk model, the cumulative VTE probability after 6 months in patients with the highest score (? 5, n = 30) was 35.0% and 10.3% in those with an intermediate score (score 3, n = 130) as opposed to only 1.0% in patients with score 0 (n = 200); the hazard ratio of patients with the highest compared with those with the lowest score was 25.9 (8.0-84.6). Clinical and standard laboratory parameters with addition of biomarkers enable prediction of VTE and allow identification of cancer patients at high or low risk of VTE. PMID:20829374

Ay, Cihan; Dunkler, Daniela; Marosi, Christine; Chiriac, Alexandru-Laurentiu; Vormittag, Rainer; Simanek, Ralph; Quehenberger, Peter; Zielinski, Christoph; Pabinger, Ingrid



Venous thromboembolism in patients with symptomatic atherosclerosis.  


Patients with atherosclerosis have an increased risk of venous thromboembolism (VTE). We studied patients in the population-based Worcester VTE Study of 1,822 consecutive patients with validated VTE to compare clinical characteristics, prophylaxis, treatment, and outcomes of VTE in patients with and without symptomatic atherosclerotic cardiovascular disease, defined as history of ischaemic heart disease, history of positive cardiac catheterisation, percutaneous coronary intervention, or coronary artery bypass graft surgery, or history of peripheral artery disease. Of the 1,818 patients with VTE, 473 (26%) had a history of symptomatic atherosclerosis. Patients with atherosclerosis were significantly older (mean age 71.9 years vs. 61.6 years) and were more likely to have immobility (57.2% vs. 46.7%), prior heart failure (36.9% vs. 10.7%), chronic lung disease (26.4% vs. 15.5%), cerebrovascular disease (18.1% vs. 9.8%), and chronic kidney disease (4.9% vs. 1.9%) (all p<0.001) compared with non-atherosclerosis patients. Thromboprophylaxis was omitted in more than one-third of atherosclerosis patients who had been hospitalised for non-VTE-related illness or had undergone major surgery within the three months prior to VTE. Patients with atherosclerosis were significantly more likely to suffer in-hospital major bleeding (7.6% vs. 3.8%, p=0.0008). In conclusion, patients with atherosclerosis and VTE are more likely to suffer a complicated hospital course. Despite a high frequency of comorbid conditions contributing to the risk of VTE, we observed a low rate of thromboprophylaxis in patients with symptomatic atherosclerosis. PMID:22012325

Piazza, Gregory; Goldhaber, Samuel Z; Lessard, Darleen M; Goldberg, Robert J; Emery, Catherine; Spencer, Frederick A



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

SciTech Connect

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

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



Nontraumatic Gas Gangrene  

Microsoft Academic Search

A 77-year-old man with a history significant only for coronary artery disease presented to the ED with left-arm pain, shortness of breath, nausea, and diaphoresis. Six hours after the patient's admission to the hospital for presumed unstable angina, fever and left arm swelling, associated with crepitus and violaceous bullae, developed. The patient was taken to the operating room, where he

Elizabeth G Valentinecol



A systematic review of compression treatment for venous leg ulcers.  

PubMed Central

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

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



[Intracranial dural arteriovenous fistula with perimedullary venous drainage].  


Two cases of intracranial dural arterio-venous fistula (DAVF) with perimedullary venous drainage are reported. In both cases, MRI T2-weighted (T2W) images showed an hypersignal within the cervical cord with sparing of the thoracic cord. In one case perimedullary vessels were demonstrated on T1W images after gadolinium i.v. administration. A complete spinal angiogram did not show evidence of fistula but demonstrated the lack of opacification of the conus medullaris venous drainage. Cerebral angiogram demonstrated in the first case a foramen magnum DAVF and in the second case a petrous apex DAVF. Hypersignal limited to the cervical cord at MRI on T2W images remain exceptionnal in case of intracranial DAVF with perimedullary venous drainage. When neurological symptoms are suggestive, post gadolinium T1W sequences should be conducted, followed by selective spinal angiogram. If normal venous drainage is not objectivated (e.g. opacification of radiculo-medullary veins on the late phase), cerebral angiogram should be done to rule out an intracranial DAVF. PMID:9763784

Brunet, E; Tache, R; Lafitte, F; Piotin, M; Miaux, Y; Martin-Duverneuil, N; Chiras, J



Cerebral venous thrombosis as a first presentation of diabetes.  


This report presents a case of cerebral venous thrombosis and venous infarction in a diabetic patient, the third in the world literature (the second in a child). An 8-year-old male was admitted to the hospital due to abdominal pain, vomiting, polydypsia, and polyuria, lasting for 4 days. Laboratory studies revealed marked hyperglycemia and ketoacidosis. Two hours after admission the child lost consciousness. Emergency computed tomography performed 3 hours after admission (4 days after the onset of symptoms) revealed hyperdensity in the vein of Galen and superior sagittal sinus, consistent with thrombosis, accompanied by bilateral venous infarction. Follow-up computed tomography performed 6 days after admission (10 days after the onset of symptoms) documented evolution of thrombosis. Magnetic resonance imaging and magnetic resonance venography performed 22 days after admission (26 days after the onset of symptoms) confirmed venous infarction and thrombosis. This report discusses possible mechanisms of cerebral venous thrombosis in diabetic hyperglycemia and stresses the importance of imaging studies despite the extreme rarity of such cases. PMID:16876012

Sasiadek, Marek J; Sosnowska-Pacuszko, Dorota; Zielinska, Marzena; Turek, Tomasz



Vessel Arterial-Venous Plasticity in Adult Neovascularization  

PubMed Central

Objective Proper arterial and venous specification is a hallmark of functional vascular networks. While arterial-venous identity is genetically pre-determined during embryo development, it is unknown whether an analogous pre-specification occurs in adult neovascularization. Our goal is to determine whether vessel arterial-venous specification in adult neovascularization is pre-determined by the identity of the originating vessels. Methods and Results We assessed identity specification during neovascularization by implanting isolated microvessels of arterial identity from both mice and rats and assessing the identity outcomes of the resulting, newly formed vasculature. These microvessels of arterial identity spontaneously formed a stereotypical, perfused microcirculation comprised of the full complement of microvessel types intrinsic to a mature microvasculature. Changes in microvessel identity occurred during sprouting angiogenesis, with neovessels displaying an ambiguous arterial-venous phenotype associated with reduced EphrinB2 phosphorylation. Conclusions Our findings indicate that microvessel arterial-venous identity in adult neovascularization is not necessarily pre-determined and that adult microvessels display a considerable level of phenotypic plasticity during neovascularization. In addition, we show that vessels of arterial identity also hold the potential to undergo sprouting angiogenesis.

Nunes, Sara S.; Rekapally, Harish; Chang, Carlos C.; Hoying, James B.



Upper extremity venous aneurysm as a source of pulmonary emboli.  


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



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



Fatal Cardiovascular Collapse During Ethanol Sclerotherapy of a Venous Malformation  

PubMed Central

Summary We report a case of fatal cardiovascular collapse that occurred during Ethanol sclerotherapy of a venous malformation in a 21-year-old woman. The malformation was located on the anterior part of the thigh. Fifty ml of a mixture of Ethanol, Ethibloc and Lipiodol containing 35 ml of Ethanol (0.52 ml / kg) were injected under fluoroscopy. A major drop in arterial pressure was recorded after release of the tourniquet placed at the thigh root. The patient died after four hours of intensive cardiac reanimation. Her blood alcohol level was 0.4 g/l one hour after the end of the intervention. The cardiac toxicity of ethanol depends more on the potential acute venous contamination than on the blood alcohol concentration. The currently admitted “safety limit” of 1 ml/kg of bodyweight for ethanol sclerotherapy of venous malformations is certainly unsafe and must be redefined.

Chapot, R.; Laurent, A.; Enjolras, O.; Payen, D.; Houdart, E.



Venous thromboembolism: epidemiology and magnitude of the problem.  


Pulmonary embolism is the third most common cardiovascular disease after myocardial infarction and stroke. The death rate from pulmonary embolism exceeds the death rate from myocardial infarction, because myocardial infarction is much easier to detect and to treat. Among survivors of pulmonary embolism, chronic thromboembolic pulmonary hypertension occurs in 2-4 of every 100 patients. Post-thrombotic syndrome of the legs, characterized by chronic venous insufficiency, occurs in up to half of patients who suffer deep vein thrombosis or pulmonary embolism. We have effective pharmacological regimens using fixed low dose unfractionated or low molecular weight heparin to prevent venous thromboembolism among hospitalized patients. There remains the problem of low rates of utilization of pharmacological prophylaxis. The biggest change in our understanding of the epidemiology of venous thromboembolism is that we now believe that deep vein thrombosis and pulmonary embolism share similar risk factors and pathophysiology with atherothrombosis and coronary artery disease. PMID:22959540

Goldhaber, Samuel Z



Complicated cerebral venous sinus thrombosis with intracranial hemorrhage and mastoiditis.  


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



Valves of the deep venous system: an overlooked risk factor  

PubMed Central

Deep venous valves are frequent sites of deep venous thrombosis initiation. However, the possible contribution of the valvular sinus endothelium has received little attention in studies of thrombosis risk. We hypothesized that the endothelium of valve sinus differs from that of vein lumen with up-regulation of anticoagulant and down-regulation of procoagulant activities in response to the local environment. In pursuit of this hypothesis, we quantified endothelial protein C receptor (EPCR), thrombomodulin (TM), and von Willebrand factor (VWF) by immunofluorescence in great saphenous veins harvested at cardiac bypass surgery. We found significantly increased expression of EPCR and TM in the valvular sinus endothelium as opposed to the vein lumenal endothelium, and the opposite pattern with VWF (paired t test for TM and EPCR, each P < .001; for VWF, P = .01). These data support our hypothesis and suggest that variation in valvular sinus thromboresistance may be an important factor in venous thrombogenesis.

Brooks, Erin G.; Trotman, Winifred; Wadsworth, Marilyn P.; Taatjes, Douglas J.; Evans, Mark F.; Ittleman, Frank P.; Callas, Peter W.; Esmon, Charles T.



[Retrograde cavernous sinus air embolism after central venous catheter removal].  


Air embolism is a rare, but occasionally fatal complication of peripheral and central venous catheterization. We present a case of an 89-year-old female, who had a central venous catheter placed in her right jugular vein during the perioperative period for right femoral subtrochanteric fracture. On the day following her operation, level of consciousness worsened a few minutes after the catheter was removed. CT scan showed air bubbles in bilateral cavernous sinuses and brachiocephalic vein. Administration of 100% oxygen was started, and she regained consciousness a few hours later, finally air bubbles disappeared on a CT scan performed 10 hours after onset. Air embolism should be taken into consideration when treating venous catheters, and appropriate O? administration and radiological examinations must be performed immediately if level of consciousness or vital signs deteriorate. PMID:23100388

Yamanaka, Takumi; Miyazaki, Yuko; Sato, Masaharu



Varicose Veins: Role of Mechanotransduction of Venous Hypertension  

PubMed Central

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

Atta, Hussein M.



Paterns of Cranial Venous System from the Comparative Anatomy in Vertebrates  

PubMed Central

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

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



Effect of the Venous Pressure to the Blood Pressure Signals Measured by the Electronic Palpation Method.  

National Technical Information Service (NTIS)

This paper describes the venous pressure effect to blood pressure signals measured by the electronic palpation method. It was shown, that in 52 percent of blood pressure measurements made with inflating cuff the linear increase in venous blood pressure wa...

E. I. Vieri-Gashi H. S. Sorvoja R. A. Myllyla S. M. Nissila M. Sorvisto



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


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



Reversible Parkinsonism caused by deep cerebral venous sinus thrombosis.  


Cerebral venous sinus thrombosis (CVST) is an uncommon but serious disorder with highly variable clinical presentation. Over the past decade, more cases of CVST have been diagnosed more frequently and at an early stage of the disease process. This is mainly attributed to increased awareness by neurologists and the availability of sensitive non-invasive neuro-imaging techniques. Cerebral venous sinus thrombosis often affects children, adolescents, and young adults with female preponderance. We report a case of Parkinsonism secondary to deep CVST (DCVST), which recovered completely following treatment. Recognition of DCVST as a cause for Parkinsonism is of paramount importance due to its reversibility and favorable outcome when appropriately managed. PMID:24141463

Algahtani, Hussein A; Aldarmahi, Ahmed A; Al-Rabia, Mohammed W; Yar, Wail N



Severe chronic venous insufficiency treated by foamed sclerosant.  


Our objective was to chronicle our experience in using sclerosant foam to treat severe chronic venous insufficiency (CVI). Forty-four patients with 60 limbs severely affected by severe CVI were entered into the study. They had lipodermatosclerosis, CEAP 4 (seven limbs); atrophie blanche or scars of healed venous ulcerations, CEAP 5 (18 limbs); and frank, open venous ulcers, CEAP 6 (35 limbs). Patients and limbs were collected into three groups. In group I, all limbs were treated with compression without intervention. Group II consisted of crossover patients who failed compression treatment. Group III consisted of patients treated promptly with sclerosant foam therapy without a waiting period of compression. A standing Doppler duplex reflux examination was done in all cases. Compression was by Unna boot or long stretch elastic bandaging. Foam was generated from Polidocanol 1%, 2%, or 3% by the two-syringe technique and administered under ultrasound guidance. Posttreatment compression was used for 14 days. In addition to clinical and ultrasound evaluation at 2, 7, 14, and 30 days, venous severity scoring was noted at entry and discharge. In group I, 12 patients were discharged from care within 6 weeks of initiating compression. All eight of the class 6 limbs had healed. Group II consisted of four CEAP class 5 limbs and eight class 6 limbs that had failed to heal with compression. Five of eight venous ulcers healed within 2 weeks, two more healed by 4 weeks, and one required 6 weeks to heal. In group III, 7 of 11 venous ulcers healed within 2 weeks and four more within 4 weeks. Venous severity scores reflected the success of treatment, with the greatest change occurring in group III and the least in group I. Limbs treated with foam had a statistically better outcome than those without (p = 0.041). One patient failed foam sclerotherapy, another had pulmonary emboli 4 months after foam treatment, and a single medial gastrocnemius thrombus was discovered 24 hr after treatment. Treatment of severe CVI with compression and foam sclerotherapy causes more rapid resolution of the venous insufficiency complications and does so without an increase in morbidity. PMID:16378144

Pascarella, Luigi; Bergan, John J; Mekenas, Lisa V



Venous Air Embolism during Elective Craniotomy for Parasagittal Meningioma.  


We report a case of a 59 year old man who developed venous air embolism (VAE) during an elective craniotomy for parasagittal meningioma resection. The surgery was done in the supine position with slightly elevated head position. VAE was provisionally diagnosed by sudden decreased in the end tidal carbon dioxide pressure from 34 to 18 mmHg, followed by marked hypotension and atrial fibrillation. Prompt central venous blood aspiration, aggressive resuscitation and inotropic support managed to stabilize the patient. Post operatively, he was admitted in neuro intensive care unit and made a good recovery without serious complications. PMID:23466772

Mohd Nazaruddin, W H W; Asmah, Z; Saedah, A



Paradoxical air embolism following central venous catheter removal.  


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



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


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

Durandy, Yves



Hemodynamics of the Hepatic Venous Three-Vessel Confluences Using Particle Image Velocimetry  

Microsoft Academic Search

Despite rapid advancements in the patient-specific hemodynamic analysis of systemic arterial anatomies, limited attention has been given to the characterization of major venous flow components, such as the hepatic venous confluence. A detailed investigation of hepatic flow structures is essential\\u000a to better understand the origin of characteristic abnormal venous flow patterns observed in patients with cardiovascular venous\\u000a disease. The present

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



Microbubble generation and transmission of medtronic's affinity hardshell venous reservoir and collapsible venous reservoir bag: an in-vitro comparison.  


Microemboli are implicated in neurological injury; therefore, the extracorporeal circuit (ECC) should not generate microbubbles or transmit introduced air. The venous reservoir is the first component in the ECC designed to remove introduced air. The purpose of this study was to investigate the relative safety of two kinds of adult venous reservoirs--the closed soft-shell venous reservoir (SSVR [Medtronic CBMVR 1600]) and the open hard-shell venous reservoir (HSVR [Affinity NT CVR])--in terms of microbubble generation and introduced air transmission. A recirculating in-vitro circuit was used to compare the two reservoirs with the SSVR further assessed in a fully closed or partially open state. Microbubbles were counted using a Hatteland CMD-10 Doppler in the outflow of the reservoirs before (microbubble generation) and after infusing 20 mL/min of air into the venous line (microbubble transmission) while altering pump flow rates (3 L/min; 5 L/min) and reservoir prime (200 mL; 700 mL). Negligible bubble generation was noted in the SSVRs at both flow rates and either reservoir volume. However, microbubble generation was significant in the HSVR at the higher flow rate of 5 L/min and lower reservoir volume of 200 mL. When infusing air, a flow of 3 L/min was associated with insignificant to small increases in microbubble transmission for all reservoirs. Conversely, infusing air while flowing at 5 L/min was associated with significantly more microbubble transmission for all reservoirs at both low and high reservoir volumes.The SSVR is as safe as the HSVR in microbubble handling as the generation and transmission of microbubbles by the SSVR is not more than the HSVR over a range of prime volumes and flow rates. As both reservoirs transmitted microbubbles at higher pump flow rates regardless of reservoir volumes, it is important to eliminate venous air entrainment during cardiopulmonary bypass. PMID:22164449

Potger, Kieron C; McMillan, Darryl; Ambrose, Mark



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

Microsoft Academic Search

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

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



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



The microcirculation and survival of experimental flow-through venous flaps  

Microsoft Academic Search

The subject of venous flaps is controversial. The purpose of this study was to investigate the haemodynamic changes and the survival process of venous flow-through flaps. Venous flaps and composite grafts were elevated along the axis of the thoracoepigastric veins in rabbits. The microcirculation was studied by capillaroscopy and injection studies. For the first 72 h, the flaps were nourished

Z.-F. Xiu; Z.-J. Chen



Clinically Unsuspected Venous Malformations Limited to the Submandibular Triangle: CT Findings  

Microsoft Academic Search

PURPOSE: To present the CT characteristics of histologically confirmed venous vascular malfor- mations limited to the submandibular triangle in patients without clinical stigmata of venous vascular malformations. METHODS: The clinical records and CT scans of five women with venous vascular malformations limited to the submandibular triangle were reviewed. Patients ranged from 39 to 70 years of age. None of the

Martin J. Fine; Roy A. Holliday; J. Thomas Roland



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



Right atrial bypass grafting for central venous obstruction associated with dialysis access: Another treatment option  

Microsoft Academic Search

Purpose: Central venous obstruction is a common problem in patients with chronic renal failure who undergo maintenance hemodialysis. We studied the use of right atrial bypass grafting in nine cases of central venous obstruction associated with upper extremity venous hypertension. To better understand the options for managing this condition, we discuss the roles of surgery and percutaneous transluminal angioplasty with

Rafik A. El-Sabrout; J. Michael Duncan



Free tissue transfer provides durable treatment for large nonhealing venous ulcers  

Microsoft Academic Search

Background: Most venous ulcers (VUs) will heal with conventional treatment, which focuses on improving regional venous hemodynamics. This treatment, however, often fails to heal large, recurrent VUs that are associated with severe lipodermatosclerosis (LDS). These complicated ulcers may require correction of local venous hemodynamics and replacement of the surrounding LDS with healthy tissue. We report our experience managing 24 especially

Norman H. Kumins; Norman Weinzweig; James J. Schuler



Morphometric assessment of the dermal microcirculation in patients with chronic venous insufficiency  

Microsoft Academic Search

Purpose: Ultrastructural assessments of the dermal microcirculation in patients with chronic venous insufficiency have been limited to qualitative morphologic descriptions of venous ulcer edges or venous stasis dermatitis. The purpose of this investigation was to quantify differences in endothelial cell structure and local cell type with emphasis on leukocytes and their relationship to arterioles, capillaries, and postcapillary venules (PCVs).Methods: Two

Peter J. Pappas; David O. DeFouw; Lisa M. Venezio; Raghuram Gorti; Frank T. Padberg; Michael B. Silva; Mark C. Goldberg; Walter N. Durán; Robert W. Hobson



Pulmonary venous air embolism following accidental patient laceration of a hemodialysis catheter  

Microsoft Academic Search

As the number of patients at home with indwelling central venous catheters increases, more complications from their use will present to the emergency department. We report a case of pulmonary venous air embolism after a patient inadvertently severed the distal few centimeters of an indwelling central venous catheter.

Irene Y Tien; Michael J Drescher



The Evolving Management of Venous Bullet Emboli: A case series and literature review  

Microsoft Academic Search

Bullet emboli are an infrequent and unique complication of penetrating trauma. Complications of venous and arterial bullet emboli can be devastating and commonly include limb-threatening ischaemia, pulmonary embolism, cardiac valvular incompetence, and cerebrovascular accidents. Bullets from penetrating wounds can gain access to the venous circulation and embolise to nearly every large vascular bed. Venous emboli are often occult phenomenon and

Keith R. Miller; Matthew V. Benns; Jason D. Sciarretta; Brian G. Harbrecht; Charles B. Ross; Glen A. Franklin; Jason W. Smith



Implantable venous access devices in children with hemophilia: A report of low infection rates  

Microsoft Academic Search

Objective: The objective of this study was to define the efficacy and complications of implantable venous access devices (IVADs) in children with hemophilia. Study design: Records were reviewed on all patients with congenital blood coagulation disorders monitored at two children's hospitals in whom one or more central venous catheters had been placed. Results: Since 1989 external and implantable central venous

Kim Miller; George R. Buchanan; Susan Zappa; Cynthia Cochran; Joan Laufenberg; Desiree Medeiros; Joann Sanders



[Pathophysiology and clinical aspects of the venous low-pressure system].  


The pathophysiology especially of the venous low-pressure system, the venous muscle pump, and the pressure-volume relation is represented. The clinical manifestations--varicous veins-varicophlebitis, phlebothrombosis, and chronic venous insufficiency--are described. Consecutively, the ways of possible therapy are shown. PMID:437977

Schneider, W



Non-invasive estimation of jugular venous oxygen saturation: a comparison between near infrared spectroscopy and transcutaneous venous oximetry.  


The ability of practitioners to assess the adequacy of global oxygen delivery is dependent on an accurate measurement of central venous saturation. Traditional techniques require the placement of invasive central venous access devices. This study aimed to compare two non-invasive technologies for the estimation of regional venous saturation (reflectance plethysmography and near infrared spectroscopy [NIRS]), using venous blood gas analysis as gold standard. Forty patients undergoing cardiac surgery were recruited in two groups. In the first group a reflectance pulse oximeter probe was placed on the skin overlying the internal jugular vein. In the second group, a Somanetics INVOS oximeter patch was placed on the skin overlying the internal jugular vein and overlying the ipsilateral cerebral hemisphere. Central venous catheters were placed in all patients. Oxygen saturation estimates from both groups were compared with measured saturation from venous blood. Twenty patients participated in each group.Data were analyzed by the limits of agreement technique suggested by Bland and Altman and by linear regression analysis. In the reflectance plethysmography group, the mean bias was 4.27% and the limits of agreement were 58.3 to -49.8% (r(2) = 0.00, p = 0.98). In the NIRS group the mean biases were 10.8% and 2.0% for the sensors attached over the cerebral hemisphere and over the internal jugular vein, respectively, and the limits of agreement were 33.1 to -11.4 and 19.5 to -15.5% (r(2) = 0.22, 0.28;p = 0.04, 0.03) for the cerebral hemisphere and internal jugular sites, respectively. While transcutaneous regional oximetry and NIRS have both been used to estimate venous and tissue oxygen saturation non-invasively, the correlation between estimates of ScvO(2) and SxvO(2) were statistically significant for near infrared spectroscopy, but not for transcutaneous regional oximetry. Placement of cerebral oximetry patches directly over the internal jugular vein (as opposed to on the forehead) appeared to approximate internal jugular venous saturation better (lower mean bias and tighter limits of agreement), which suggests this modality may with refinement offer the practitioner additional clinically useful information regarding global cerebral oxygen supply and demand matching. PMID:22290065

Colquhoun, Douglas A; Tucker-Schwartz, Jason M; Durieux, Marcel E; Thiele, Robert H



Diffusion-Weighted MR in Cerebral Venous Thrombosis  

Microsoft Academic Search

The diagnosis of cerebral venous thrombosis is often difficult both clinically and radiologically and until now there is no method available to predict if brain lesions, detected clinically and using conventional brain imaging methods, may lead to full recovery, as expected in vasogenic edema or ischemic infarcts and even a hematoma. New fast neuroimaging techniques such as diffusion-weighted imaging (DWI)

Karl-Olof Lövblad; Claudio Bassetti; Jacques Schneider; Raphael Guzman; Marwan El-Koussy; Luca Remonda; Gerhard Schroth



Partial abnormal pulmonary venous return in Turner syndrome  

Microsoft Academic Search

Three cases of partial anomalous pulmonary venous return, in one case combined with coarctation of the aorta and in another with discrete subaortic stenosis, are described in patients with Turner syndrome. In two of them the right and left superior pulmonary veins drained into the right superior vena cava and left innominate vein respectively. Remarkably, in all three cases the

A. G. Wassenaer; L. J. Lubbers; G. Losekoot



Cerebral Venous Thrombosis as the Initial Presentation of Behcet's Disease  

Microsoft Academic Search

Neurological symptoms are rare manifestations of Behcet's disease. In this paper, we report cerebral venous thrombosis as the initial presentation of Behcet's disease in a 40 year- old man. Our patient presented with a six-week history of headache, progressive loss of vision in the right eye and recurrent oral ulcers. Physical examination revealed oral ulcers and posterior synechia in the

Ali Ibrahim Rahil; Mehdi Errayes; Khaled M. Salem


Surgical and endovascular treatment of lower extremity venous insufficiency.  


Lower extremity venous insufficiency is a highly prevalent condition. Now it is understood that telangiectasias, reticular varicosities, and true varicose veins are physiologically similar and etiologically identical. The four main influences causing these abnormalities are heredity, female sex, gravitational hydrostatic forces, and hemodynamic muscular compartment pressure. There are clear indications and goals for intervention. A cornerstone in the treatment of venous insufficiency is elimination of sources of venous hypertension. One of these is the refluxing greater saphenous vein. Minimally invasive saphenous ablation can be achieved by radiofrequency energy and laser light energy. These new techniques eliminate the psychologic barrier to treatment caused by the term "stripping" and allow the objectives of surgery to be achieved with minimal invasion and quick recovery. Endovenous techniques show great promise. They provide minimal invasion, often under local anesthesia and intravenous sedation, thereby eliminating the need for general anesthesia. Objectives of venous insufficiency have been established and the endoluminal minimally invasive techniques developed in recent years appear to accomplish their goals. PMID:12050295

Bergan, John J; Kumins, Norman H; Owens,