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Sample records for abnormal venous drainage

  1. Clinical application of three-dimensional printing to the management of complex univentricular hearts with abnormal systemic or pulmonary venous drainage.

    PubMed

    McGovern, Eimear; Kelleher, Eoin; Snow, Aisling; Walsh, Kevin; Gadallah, Bassem; Kutty, Shelby; Redmond, John M; McMahon, Colin J

    2017-02-06

    In recent years, three-dimensional printing has demonstrated reliable reproducibility of several organs including hearts with complex congenital cardiac anomalies. This represents the next step in advanced image processing and can be used to plan surgical repair. In this study, we describe three children with complex univentricular hearts and abnormal systemic or pulmonary venous drainage, in whom three-dimensional printed models based on CT data assisted with preoperative planning. For two children, after group discussion and examination of the models, a decision was made not to proceed with surgery. We extend the current clinical experience with three-dimensional printed modelling and discuss the benefits of such models in the setting of managing complex surgical problems in children with univentricular circulation and abnormal systemic or pulmonary venous drainage.

  2. Systemic venous drainage: can we help Newton?

    PubMed

    Corno, Antonio F

    2007-06-01

    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.

  3. Biliary Tract Anatomy and its Relationship with Venous Drainage

    PubMed Central

    Ramesh Babu, Chittapuram S.; Sharma, Malay

    2013-01-01

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

  4. Biliary tract anatomy and its relationship with venous drainage.

    PubMed

    Ramesh Babu, Chittapuram S; Sharma, Malay

    2014-02-01

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

  5. A new top-loading venous bag provides vacuum-assisted venous drainage.

    PubMed

    Tamari, Y; Lee-Sensiba, K; Beck, J; Chan, R; Salogub, M; Hall, M; Lee, T; Ganju, R; Mongero, L

    2002-09-01

    A new venous bag has been developed, prototyped, and tested. The new bag has its inlet, outlet purge, and infusion tubes extending upward from the top of the bag, and are threaded through, bonded to, and sealed within a flat rigid top plate. This design allows the bag to be hung from its top plate by its tubes. It also allows the bag to be: 1) dropped into or removed from its holder, as is done with existing hard-shell reservoirs so that its weight pulls it into the holder without the need for eyelets and hooks and 2) placed closer to the floor so that gravity drainage is facilitated. The V-Bag (VB) is easily sealed within an accompanying rigid housing. Once sealed, vacuum applied to the housing is transmitted across the flexible walls of the bag to the venous blood. Thus, vacuum-assisted venous drainage (VAVD) is obtained as it is with a hard-shell reservoir, but without any contact of air with the blood. Bench tests, using a circuit that simulated the venous side of the cardiopulmonary bypass (CPB) circuit, showed that applying suction to the housing increased venous flow, and the fractional increase in flow was not a function of the venous cannula, but of the level of vacuum applied. In the gravity drainage mode, the bubble counts at the outlet of the V-Bag compared to two other bags were lower at any pumping condition. When used in the VAVD mode, bubble counts were two orders of magnitude lower than when using kinetically assisted venous drainage (KAVD) with a centrifugal pump. Results obtained with the VB suggest its clinical usefulness.

  6. The venous drainage of the heart in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Dinç, G; Ozdemir, D

    2004-08-01

    The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae.

  7. Orbital venous pattern in relation to extraorbital venous drainage and superficial lymphatic vessels in rats.

    PubMed

    Maloveska, Marcela; Kresakova, Lenka; Vdoviakova, Katarina; Petrovova, Eva; Elias, Mario; Panagiotis, Artemiou; Andrejcakova, Zuzana; Supuka, Peter; Purzyc, Halina; Kissova, Viktoria

    2017-01-01

    The purpose of this study was to demonstrate the normal and variant anatomy of extraorbital and intraorbital venous drainage together with retroorbital communication, and determine the lymphatic drainage from the superficial orbital region with a potential outlet of lymphatic vessel into the venous bloodstream. The study of the venous system was carried out on 32 Wistar rats by using corrosion casts methods and radiography, while the lymphatic system was studied in 12 Wistar rats following ink injection. Superficially, orbital veins are connected with extraorbital veins running through angular vein of the eye and the superficial temporal vein, and via the pterygoid plexus with the maxillary vein, which provide readily accessible communication routes in the spread of infection. The extent of intraorbital and periorbital venous drainage was ensured by the dorsal and ventral external ophthalmic vein through the infraorbital vein, which together formed the principal part of the ophthalmic plexus. Venous drainage of the eyeball was carried out mainly by the vortex veins, ciliary veins and internal ophthalmic vein. The highest variability, first presented by differences in structural arrangement and formation of anastomoses, was observed within the ventral external ophthalmic vein (22 cases) and the medial vortex vein (10 cases). Four vortex veins, one vein in each quadrant of the eye, were observed in rats. The vortex vein located on the ventral side of the eyeball was occasionally found as two veins (in four cases) in the present study. The lymphatic vessel from the lower eyelid entered into the mandibular lymph centre, and from the upper eyelid entered into the superficial cervical lymph centre, but both drained into the deep cranial cervical lymph node. The direct entry of lymph entering the veins without passing through lymph nodes was not observed.

  8. Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage.

    PubMed

    Baltsavias, Gerasimos; Spiessberger, Alex; Hothorn, Torsten; Valavanis, Anton

    2015-04-01

    Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0%). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5%). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical

  9. Right Renal Vein Aplasia Associated With Diverted Renal Venous Drainage Through Lower Pole

    SciTech Connect

    Bozlar, Ugur; Ugurel, Mehmet Sahin; Bedir, Selahattin; Ors, Fatih; Coskun, Unsal; Aydur, Emin

    2008-07-15

    We report a unique anomalous renal venous drainage on a 25-year-old man who had congenital absence of the right renal vein and an aberrant venous drainage through the lower pole of the kidney into the inferior vena cava. To our knowledge, this anomaly has not been previously reported in the peer-reviewed literature. State-of-the-art imaging findings are presented.

  10. Congenital rubella with agenesis of the inferior cerebellar vermis and total anomalous pulmonary venous drainage.

    PubMed

    Cluver, C; Meyer, R; Odendaal, H; Geerts, L

    2013-08-01

    Congenital rubella infection has been associated with a number of abnormalities including cardiac, central nervous system and placental complications. We present a case with multiple fetal abnormalities detected on prenatal ultrasound, and confirmed postnatally, that included a single umbilical artery, severe tricuspid regurgitation, micrognathia and agenesis of the inferior cerebellar vermis. Postnatal echocardiography additionally revealed unobstructed total anomalous pulmonary venous drainage (TAPVD) into the coronary sinus. Placental examination showed signs of placentitis, and polymerase chain reaction on neonatal serum was positive for rubella. Following a multidisciplinary team review, it was decided to provide only supportive care, and the infant died at 6 months of age owing to a respiratory tract infection. To our knowledge, TAPVD and agenesis of the inferior cerebellar vermis have not been reported previously in association with congenital rubella infection. This case illustrates how congenital infection may present in atypical ways and stresses the importance of considering congenital infection in the differential diagnosis of fetal anomalies when multiple features are present.

  11. Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage.

    PubMed

    Fukuda, Hitoshi; Miyake, Kosuke; Kunieda, Takenobu; Murao, Kenichi

    2014-07-01

    Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. One patient revealed complete obliteration of dAVF by a single session of transarterial embolization (TAE). As part of strategic TAE for this complex dAVF, we used a novel approach to create a complete flow-arrest condition in which coils and an occlusion balloon were combined. A liquid agent was then injected across the pathological fistula and into the parent venous apparatus, thereby occluding the lesion. The other patient was treated with percutaneous TVE after TAE was unsuccessful. With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.

  12. Left Brachiocephalic Vein Cannulation in Bicaval Venous Drainage Is Safe, Effective, and Technically Advantageous.

    PubMed

    Aazami, Mathias Hossain; Gholoobi, Arash; Amini, Shahram; Abdollahi-Moghadam, Alireza; Soltani, Ghassem

    2016-04-01

    Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) is cannulated instead of the superior vena cava. From 2012 through 2014, we performed routine LBCV cannulation in 150 consecutive patients as part of bicaval venous drainage before right atrial isolation. We prospectively collected demographic information, operative data, total pump and LBCV cannula flows with their respective calculated and indexed rates, central venous pressures, and perioperative complications. All patients survived surgery. There were no adverse technical outcomes or functional deficits associated with the technique. The mean indexed LBCV cannula flow was 1,520 ± 216 mL/min/m(2), representing an LBCV cannula-to-calculated pump-flow ratio of 64%. The mean central venous pressure during right atrial isolation was 3.7 ± 1.9 mmHg. Cannulation of the LBCV is intrinsically a safe and reproducible procedure with proven hemodynamic adequacy. Its versatility can be an asset to surgical techniques and perfusion methods. Furthermore, the hemodynamic results in our series promise alternative intrathoracic and extracardiac cannulation sites for mini-extracorporeal circulation, on-pump beating-heart procedures, and short-term circulatory assist device implementation.

  13. Left Brachiocephalic Vein Cannulation in Bicaval Venous Drainage Is Safe, Effective, and Technically Advantageous

    PubMed Central

    Gholoobi, Arash; Amini, Shahram; Abdollahi-Moghadam, Alireza; Soltani, Ghassem

    2016-01-01

    Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) is cannulated instead of the superior vena cava. From 2012 through 2014, we performed routine LBCV cannulation in 150 consecutive patients as part of bicaval venous drainage before right atrial isolation. We prospectively collected demographic information, operative data, total pump and LBCV cannula flows with their respective calculated and indexed rates, central venous pressures, and perioperative complications. All patients survived surgery. There were no adverse technical outcomes or functional deficits associated with the technique. The mean indexed LBCV cannula flow was 1,520 ± 216 mL/min/m2, representing an LBCV cannula-to-calculated pump-flow ratio of 64%. The mean central venous pressure during right atrial isolation was 3.7 ± 1.9 mmHg. Cannulation of the LBCV is intrinsically a safe and reproducible procedure with proven hemodynamic adequacy. Its versatility can be an asset to surgical techniques and perfusion methods. Furthermore, the hemodynamic results in our series promise alternative intrathoracic and extracardiac cannulation sites for mini-extracorporeal circulation, on-pump beating-heart procedures, and short-term circulatory assist device implementation. PMID:27127430

  14. Insufficient Lymph Drainage Causes Abnormal Lipid Accumulation and Vein Wall Degeneration

    PubMed Central

    Tanaka, Hiroki; Yamamoto, Naoto; Suzuki, Minoru; Mano, Yuuki; Sano, Masaki; Zaima, Nobuhiro; Sasaki, Takeshi; Setou, Mitsutoshi

    2016-01-01

    Objective: Previously, we analyzed human varicose veins (VV) using imaging mass spectrometry (IMS) and detected the abnormal accumulation of lipid molecules in the walls of VV, possibly due to insufficient lipid drainage by the lymphatic vessels. In this study, we created an animal model of lymphatic insufficiency to investigate the effects of insufficient lymph drainage on vein walls. Methods: In rats, the lymphatic collecting vessels surrounding the femoral vein were ligated on one side (the model tissue), which caused the local retention of lymphatic fluid in the perivascular tissue. The equivalent contralateral tissue was used as a control. A histological study of the femoral vein and the surrounding perivascular tissue was conducted. IMS was used to analyze the distribution of lipid molecules in the perivascular tissue. Results: Fourteen days after the procedure, the lymphatic vessels in the model tissue were significantly dilated. Furthermore, IMS revealed that the composition of the lipid molecules in the perivascular regions of the model tissue had altered. Compared with the control tissue, the model tissue exhibited marked perivascular accumulation of lysophosphatidylcholine (1-acyl 16:0), phosphatidylcholine (16:0/20:4), and triglycerides (52:2). Interestingly, the walls of the femoral veins running through the model tissue were 3.4-fold thicker than those of the femoral veins running through the control tissue. The number of tumor necrosis factor α-positive adipocytes was increased in the perivascular regions of the model tissue. Conclusion: The findings of this study indicated that the accumulation of lymphatic fluid due to insufficient lymph drainage changes the structure of vein walls, and such changes might be associated with chronic venous insufficiency. (This is a translation of Jpn J Phlebol 2015; 26: 227–235.) PMID:28018498

  15. Atresia of right pulmonary veins and anomalous left pulmonary venous drainage into portal circulation

    PubMed Central

    Šamánek, M.; Tůma, S.; Benešová, D.; Povýšilová, V.; Pražský, F.; Čápová, E.

    1974-01-01

    Šamánek, M., Tůma, S., Benešová, D., Povýšilová, V., Pražský, F., and Čápová, E. (1974).Thorax, 29, 446-450. Atresia of right pulmonary veins and anomalous left pulmonary venous drainage into portal circulation. An anomaly of pulmonary venous drainage in a male newborn infant is described whereby the left pulmonary veins entered the portal vein and the right pulmonary veins were atretic. A correct diagnosis was made by detecting high-oxygen saturation in the hepatic veins, right-to-left shunt at atrial level, and increased pulmonary artery wedge pressure in comparison with the left atrial pressure, and was confirmed by angiography. Images PMID:4850684

  16. Stenting of vertical vein in an infant with obstructed supracardiac total anomalous pulmonary venous drainage

    PubMed Central

    Lim, WK; Leong, MC; Samion, H

    2016-01-01

    A 1.7 kg infant with obstructed supracardiac total anomalous pulmonary venous drainage (TAPVD) presented with severe pulmonary hypertension secondary to vertical vein obstruction. The child, in addition, had a large omphalocele that was being managed conservatively. The combination of low weight, unoperated omphalocele, and severe pulmonary hypertension made corrective cardiac surgery very high-risk. Therefore, transcatheter stenting of the stenotic vertical vein, as a bridge to corrective surgery was carried out. The procedure was carried out through the right internal jugular vein (RIJ). The stenotic segment of the vertical vein was stented using a coronary stent. After procedure, the child was discharged well to the referred hospital for weight gain and spontaneous epithelialization of the omphalocele. Stenting of the vertical vein through the internal jugular vein can be considered in very small neonates as a bridge to repair obstructed supracardiac total anomalous venous drainage. PMID:27212859

  17. Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver.

    PubMed

    Breen, David J; Rutherford, Elizabeth E; Stedman, Brian; Lee-Elliott, Catherine; Hacking, C Nigel

    2004-12-01

    The increased use of high-contrast volume, arterial-phase studies of the liver has demonstrated the frequent occurrence of arterioportal shunts within both the cirrhotic and non-cirrhotic liver. This article sets out to explain the underlying microcirculatory mechanisms behind these commonly encountered altered perfusion states. Similarly, well-recognised portal perfusion defects occur around the perifalciform and perihilar liver and are largely caused by anomalous venous drainage via the paraumbilical and parabiliary venous systems. The underlying anatomy will be discussed and illustrated. These vascular anomalies are all caused by or result in diminished portal perfusion and are often manifest in the setting of portal venous thrombosis. The evolving concept of zonal re-perfusion following portal vein thrombosis will be discussed.

  18. Renal transplantation with venous drainage through the superior mesenteric vein in cases of thrombosis of the inferior vena cava.

    PubMed

    Aguirrezabalaga, Javier; Novas, Serafín; Veiga, Francisco; Chantada, Venancio; Rey, Ignacio; Gonzalez, Marcelino; Gomez, Manuel

    2002-08-15

    Renal transplantation usually is performed by placing the graft in the iliac fossa, anastomosing the renal vein to the iliac vein or, when this is not possible, to the vena cava. When vascular complications occur, particularly on the venous side, the position of the graft may have to be changed. This report describes orthotopic renal grafts and positioning of the organ with anastomosis to the splenic vessels. Venous drainage was established directly into the mesenteric-portal territory, with two cases to the portal vein and one to the inferior mesenteric vein. A new technique for the venous drainage of the renal graft is shown. We have used this model in two cases of infrarenal inferior vena cava thrombosis. The kidney was located in a retroperitoneal position, with venous drainage to the superior mesenteric vein through an orifice in the posterior peritoneum.

  19. Spontaneous Aggressive Conversion of Venous Drainage Pattern in Dural Arteriovenous Fistula Treated with Onyx Embolization

    PubMed Central

    Chung, Yeongu; Choi, Seok Keun; Lee, Sung Ho

    2016-01-01

    We report a case of dural arteriovenous fistula (DAVF) that showed spontaneous conversion of venous drainage pattern from Borden type II to type III within a four month period of follow-up. Upon admission, the patient presented with aggravated neurologic status and newly developed seizure. After admission, endovascular embolization was performed through the middle meningeal artery with Onyx®. Complete obliteration of dural arteriovenous shunt was confirmed by angiography, and the patient's clinical symptoms improved. Although most cases of DAVF show benign clinical course and conversion pattern, close follow-up is required to detect potential aggravation. PMID:28184352

  20. Vacuum-assisted venous drainage: to air or not to air, that is the question. Has the bubble burst?

    PubMed

    Willcox, Timothy W

    2002-03-01

    Assisted venous drainage is a recent development in cardiopulmonary bypass (CPB) and was introduced to overcome limitations in achieving adequate blood flow through small diameter cannulas used in minimally invasive surgery. The more common application, vacuum assisted venous drainage (VAVD) is now widely used in both adult and pediatric CPB. During a clinical investigation into pharmacological cerebral protection at Green Lane Hospital, we repeatedly observed evidence of emboli in the right common carotid artery following both entrainment of air into the venous line, and also, reductions in the blood level of the hard-shell venous reservior. We subsequently embarked upon a series of in vitro experiments designed to identify sources of emboli from the CPB circuit, and to evaluate the ability of CPB circuit components to remove air entrained into the venous line under conditions of both gravity and vacuum assisted venous drainage. Initial experiments revealed design features of certain hard-shell venous reservoirs that generated gaseous emboli. In further studies using adult circuits, entrainment of air into the venous line under conditions of conventional gravity venous drainage resulted in emboli distal to the arterial filter. When these studies were repeated using VAVD, arterial line emboli increased eight to tenfold. Initial experiments with a pediatric circuit showed similar findings. Cerebral emboli during CPB have been positively correlated with increasing neurocognitive deficits. The application of VAVD has been employed clinically without any significant redesign of the components of the CPB circuit. While VAVD may be efficacious in certain scenarios, a thorough understanding of its influence on CPB is essential. Advantages must be balanced against potential hazards. The safe use of VAVD necessitates refinement of perfusion techniques, judicious choice of application, and further development of the CPB circuit.

  1. Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

    PubMed Central

    Yi, Jian-hua; Liu, Hua-bo; Zhang, Mao; Wu, Jun-song; Yang, Jian-xin; Chen, Jin-ming; Xu, Shan-xiang; Wang, Jian-an

    2012-01-01

    Objective: To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter (CVC), compared with using a conventional chest tube. Methods: A prospective controlled study with the Ethics Committee approval was undertaken. A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs (n=214) or conventional chest tubes (n=193). The Seldinger technique was used for drainage by CVC, and the conventional technique for drainage by chest tube. If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days, the treatment was considered successful. The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0. A P value of less than 0.05 was taken as indicating statistical significance. Results: Compared with the chest tube group, the operation time, fraction of analgesic treatment, time of surgical wound healing, and infection rate of surgical wounds were significantly decreased (P<0.05) in the CVC group. There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications (P>0.05), or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully (P>0.05). Conclusions: Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube. Its complications can be prevented and it has the potential to replace the large-bore chest tube. PMID:22205619

  2. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging.

    PubMed

    Riesenkampff, Eugénie Marie-Christine; Schmitt, Boris; Schnackenburg, Bernhard; Huebler, Michael; Alexi-Meskishvili, Vladimir; Hetzer, Roland; Berger, Felix; Kuehne, Titus

    2009-05-01

    Studies of larger patient groups for systematic assessment of the anatomical accuracy of magnetic resonance imaging (MRI) for partial anomalous pulmonary venous drainage (PAPVD) have been performed so far only in adults. This study was undertaken to evaluate whether MRI can precisely depict pulmonary venous anatomy in infants and young children. Data on 26 children under 10 years old that underwent MRI over the past 2 years for suspected PAPVD were assessed. The MRI protocol included shunt quantification by velocity-encoded cine as well as morphological and functional assessment by multislice multiphase and contrast-enhanced MR techniques. MRI was performed in the compliant patient in breath-hold (n = 8; age range, 4.6-9.5 years) and in the noncompliant patient in conscious-sedation free breathing (n = 18; age range, 0.4 to 7.5 years). In 22 patients, PAPVD was diagnosed with MRI and confirmed during surgery. In four patients with large atrial septal defects not accessible to percutaneous closure, normal pulmonary venous return was demonstrated by MRI and confirmed during surgery. MRI under conscious sedation accurately specifies the anatomy of pulmonary veins in infants and small children. Therefore, we suggest performing MRI in patients with inconclusive transthoracic echocardiographic results in the preoperative assessment of PAPVD.

  3. [Partial abnormal pulmonary venous return. An underestimated and unknown association in Turner-Ullrich syndrome. Presentation of an original case].

    PubMed

    Neel, G; Fournie, J M; Maillard, L; Rioux, P; Desveaux, B; Quilliet, L; Raynaud, P

    1991-11-01

    The authors report the case of a 59-year-old woman with a complex cardiac lesion consisting of degenerative major mitral insufficiency masking partial abnormal pulmonary venous return. These cardiac abnormalities fell within a context of genetic disease since the patient had Turner's syndrome, confirmed at the age of 58 by a 45 x 0 karyotype. They detail the originality of the clinical manifestations of partial abnormal pulmonary venous return and review the literature concerning cardiac malformations in Turner's syndrome.

  4. The evolution of anterior sector venous drainage in right lobe living donor liver transplantation: does one technique fit all?

    PubMed Central

    Tokat, Yaman

    2016-01-01

    In living donor liver transplantation (LDLT), an adequate hepatic venous outflow constitutes one of the basic principles of a technically successful procedure. The issue of whether the anterior sector (AS) of the right lobe (RL) graft should or should not be routinely drained has been controversial. The aim of this 10-year, single-center, retrospective cohort study was to review the evolution of our hepatic venous outflow reconstruction technique in RL grafts and evaluate the impact of routine AS drainage strategy on the outcome. The study group consisted of 582 primary RL LDLT performed between July 2004 and December 2014. The cases were divided into 3 consecutive periods with different AS venous outflow reconstruction techniques, which included middle hepatic vein (MHV) drainage in Era 1 (n=119), a more selective AS drainage with cryopreserved homologous grafts in Era 2 (n=391), and routine segment 5 and/or 8 oriented AS drainage with synthetic grafts in Era 3 (n=72). Intraoperative portal flow measurement with routine splenic artery ligation (SAL) technique (in RL grafts with a portal flow of ≥ 250 mL/min/100 g liver tissue) was added later in Era 3. These 3 groups were compared in terms of recipient and donor demographics, surgical characteristics and short-term outcome. The rate of AS venous drainage varied from 58.8% in Era 1 and 35.0% in Era 2 to 73.6% in Era 3 (P<0.001). Perioperative mortality rate of recipients significantly decreased over the years (15.1% in Era 1 and 8.7% in Era 2 vs. 2.8% in Era 3, P=0.01). After the addition of SAL technique in the 45 cases, there was only 1 graft loss and no perioperative mortality. One-year recipient survival rate was also significantly higher in Era 3 (79.6% in Era 1 and 86.1% in Era 2 vs. 92.1% in Era 3, P=0.002). Routine AS drainage via segment 5 and/or 8 veins using synthetic grafts is a technique to fit all RL grafts in LDLT. Addition of SAL effectively prevents early graft dysfunction and significantly

  5. A simulation model to study the role of the extracranial venous drainage pathways in intracranial hemodynamics.

    PubMed

    Gadda, G; Taibi, A; Sisini, F; Gambaccini, M; Sethi, S K; Utriainen, D; Haacke, E M; Zamboni, P; Ursino, M

    2015-01-01

    Alterations in the extracranial venous circulation due to posture changes, and/or extracranial venous obstructions in patients with vascular diseases, can have important implications on cerebral hemodynamics. A hemodynamic model for the study of cerebral venous outflow was developed to investigate the correlations between extracranial blood redistributions and changes in the intracranial environment. Flow data obtained with both magnetic resonance (MR) and Echo-Color Doppler (ECD) technique are used to validate the model. The very good agreement between simulated supine and upright flows and experimental results means that the model can correctly reproduce the main factors affecting the extracranial venous circulation.

  6. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use

    PubMed Central

    Lensing, Anthonie W. A.; Middeldorp, Saskia; Levi, Marcel; Beyer-Westendorf, Jan; van Bellen, Bonno; Bounameaux, Henri; Brighton, Timothy A.; Cohen, Alexander T.; Trajanovic, Mila; Gebel, Martin; Lam, Phuong; Wells, Philip S.; Prins, Martin H.

    2016-01-01

    Women receiving vitamin K antagonists (VKAs) require adequate contraception because of the potential for fetal complications. It is unknown whether the use of hormonal therapy, especially those containing estrogens, is associated with recurrent venous thromboembolism (VTE) during anticoagulation. Despite the absence of data, World Health Organization guidelines state that use of estrogen-containing contraceptives confers an “unacceptable health risk” during established anticoagulation for VTE. We compared the incidences of recurrent VTE and abnormal uterine bleeding with and without concomitant hormonal therapy in women aged <60 years who were receiving anticoagulation with rivaroxaban or enoxaparin/VKA for confirmed VTE. Incidence densities in percentage per year were computed for the on and off estrogen-containing or progestin-only therapy periods. Cox regression models were fitted, with hormonal therapy (on vs off) as a time-dependent variable to derive the hazard ratio (HR) for the effects on recurrent VTE and abnormal uterine bleeding. In total, 1888 women were included. VTE incidence densities on and off hormonal therapy were 3.7%/year and 4.7%/year (adjusted HR, 0.56; 95% confidence interval [CI], 0.23-1.39), respectively, and were 3.7%/year and 3.8%/year, respectively, for estrogen-containing and progestin-only therapy. The adjusted HR for all abnormal uterine bleeding (on vs off hormonal therapy) was 1.02 (95% CI, 0.66-1.57). Abnormal uterine bleeding occurred more frequently with rivaroxaban than with enoxaparin/VKA (HR, 2.13; 95% CI, 1.57-2.89). Hormonal therapy was not associated with an increased risk of recurrent VTE in women receiving therapeutic anticoagulation. The observed increased risk of abnormal uterine bleeding with rivaroxaban needs further exploration. PMID:26696010

  7. Arterial supply, venous drainage and collateral circulation in the nose of the anaesthetized dog.

    PubMed

    Lung, M A; Wang, J C

    1987-10-01

    1. In pentobarbitone-anaesthetized dogs, nasal blood flows were measured with electromagnetic flow sensors. 2. The terminal internal maxillary artery was found to supply 22 +/- 2.2 ml min-1 (one side) to the nasal mucosa via the sphenopalatine and major palatine branches; the artery was found to receive multiple supply routes from common carotid, vertebral and subclavian arteries. 3. Nasal mucosa was found to receive collateral flow from contralateral terminal internal maxillary artery (about 5 to 10% of normal flow) and branches of subclavian arteries (about 36% of normal flow). 4. Nasal mucosa was found to have two venous systems: the low-flow (12 +/- 1.0 ml min-1; both sides) and low-pressure (7 +/- 0.6 mmHg) sphenopalatine veins draining the posterior nasal cavity and the high-flow (30 +/- 1.4 ml min-1; both sides) and high-pressure (17 +/- 1.0 mmHg) dorsal nasal veins draining the anterior nasal cavity. 5. PO2 of nasal venous blood was found to range from 62 +/- 2.9 mmHg to 65 +/- 3.4 mmHg. During nitrogen challenge to the nose, the sphenopalatine venous PO2 dropped to 35 +/- 3.0 mmHg while the dorsal nasal venous PO2 remained unchanged, suggesting that the sphenopalatine veins were responsible for draining capillary flow and dorsal nasal veins arteriovenous anastomotic flow as well. 6. Microscopic examination of the vascular casts confirmed that arteriovenous anastomoses were located only in the anterior nasal cavity.

  8. Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to manual lymph drainage: a case report.

    PubMed

    Mihara, Makoto; Hayashi, Yohei; Hara, Hisako; Iida, Takuya

    2011-12-01

    Conservative and surgical treatment for lymphedema are performed independently, and combined treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly reported. However, a problem with this approach is that manual massage cannot be initiated immediately after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this problem, we developed a treatment method using a cosmetic roller instead of manual massage, which allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb compared to that in the left lower limb. The results in this case suggest that further studies should be performed to examine the new method in various types of patients.

  9. Cross-sectional imaging of congenital and acquired abnormalities of the portal venous system

    PubMed Central

    Özbayrak, Mustafa; Tatlı, Servet

    2016-01-01

    Knowing the normal anatomy, variations, congenital and acquired pathologies of the portal venous system are important, especially when planning liver surgery and percutaneous interventional procedures. The portal venous system pathologies can be congenital such as agenesis of portal vein (PV) or can be involved by other hepatic disorders such as cirrhosis and malignancies. In this article, we present normal anatomy, variations, and acquired pathologies involving the portal venous system as seen on computed tomography (CT) and magnetic resonance imaging (MRI). PMID:27731302

  10. Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial

    PubMed Central

    Kruczyński, Jacek; Molski, Andrzej; Molski, Stanislaw

    2013-01-01

    Introduction Manual lymphatic drainage (MLD) is an adjunctive method of chronic venous disease (CVD) therapy. Evaluation of the change at the clinical stage, hemodynamic parameters and quality of life (QoL) following venous system surgery in CVD patients undergoing MLD preoperatively are the most interesting aspects of the study. Material and methods The CVD patients qualified for elective surgery of the venous system were randomly divided into 2 groups: the MLD group (n = 38) and the control group (n = 32). In the preoperative period, the MLD group underwent a series of MLD through a period of 2 weeks. The control group did not undergo MLD preoperatively. Both groups were evaluated for CVD staging on the day of qualification for surgery and between 25 and 30 days post-operatively. Additionally, the MLD group was evaluated after the series of MLD. The CVD staging was evaluated in both groups with a QoL questionnaire (CIVIQ), CEAP classification, foot volumetry (FV) and venous refilling time (VRT). Results Parameter values obtained in the MLD group (before treatment/after MLD/after surgery): CEAP 2.23/2.15/2.10, VRT 15/13/15.6, FV 3625/3472/3418, CIVIQ-complaints: 54.4/43.8/38.2 and CIVIQ-meaning: 57.3/49.3/43.1. Parameter values obtained in control group (before surgery/after surgery): CEAP 2.4/2.12, VRT 13/14.9, FV 3581/3559, CIVIQ-complaints: 51.9/38.7 and CIVIQ-meaning: 53.7/40.6. The CVD patients statistically improved in CEAP staging, FV and QoL in both groups (p < 0.05). Conclusions The MLD alone significantly reduced FV in patients with CVD, also improving their QoL. The MLD applied in CVD patients at the preoperative stage results in better surgical outcome, which is demonstrated by reduced disease progression, FV reduction and improvement in the QoL. PMID:23847666

  11. Submental Perforator Flap Design with a Near-Infrared Fluorescence Imaging System: The Relation between Number of Perforators, Flap Perfusion, and Venous Drainage

    PubMed Central

    Matsui, Aya; Lee, Bernard T.; Winer, Joshua H.; Laurence, Rita G.; Frangioni, John V.

    2009-01-01

    Background The submental flap is a reliable alternative to microsurgical reconstruction of facial deformities, providing an excellent cosmetic match with the contour and color of the face. In this study, we evaluated submental flap design by employing near-infrared (NIR) fluorescence angiography to identify perforator arteries (PAs). The impact of the number of preserved PAs on flap perfusion and venous drainage were quantified. Methods Indocyanine green was injected intravenously into n = 18 pigs. Three groups of 6 animals each had one, two, or three PAs preserved. The FLARE™ NIR fluorescence imaging system was employed for image acquisition. Images were recorded before and after flap creation, and every h, for 6 h. The time to maximum perfusion, the drainage ratio (an indicator of venous drainage), and the percentage of perfused flap area were analyzed statistically at each time point. Results Flaps with a single dominant PA had an initial mean perfused area of 80%, which improved to 97% at 6 h. For flaps with two and three preserved PAs, perfused area at 6 h was 99.8% and 100%, respectively. A significant increase was observed in all three metrics as more vessels were preserved. Regardless of the number of PAs preserved, though, all three metrics improved over 6 h. Conclusions NIR fluorescence angiography can reliably identify submental PAs for flap design, and can be used to assess flap perfusion and venous drainage in real-time. Flap metrics at 6 h were equivalent when either one, or multiple PAs, were preserved. PMID:19935293

  12. Quantitative Analysis of Metabolic Abnormality Associated with Brain Developmental Venous Anomalies

    PubMed Central

    Timerman, Dmitriy; Thum, Jasmine A

    2016-01-01

    Background and Purpose: Abnormal hypometabolism is common in the brain parenchyma surrounding developmental venous anomalies (DVAs), although the degree of DVA-associated hypometabolism (DVAAh) has not been quantitatively analyzed. In this study, we demonstrate a simple method for the measurement of DVAAh and test the hypothesis that DVAs are associated with a quantifiable decrement in metabolic activity. Materials and Methods: Measurements of DVAAh using ratios of standardized uptake values (SUVs) and comparison to a normal database were performed on a cohort of 25 patients (12 male, 13 female), 14 to 76 years old, with a total of 28 DVAs (20 with DVAAh, seven with isometabolic activity, and one with hypermetabolic activity). Results: Qualitative classification of none, mild, moderate, and severe DVAAh corresponded to quantitative measurements of DVAAh of 1 ± 3%, 12 ± 7%, 18 ± 6%, and 37 ± 6%, respectively. A statistically significant linear correlation between DVAAh and age was observed (P = 0.003), with a 3% reduction in metabolic activity per decade. A statistically significant linear correlation between DVAAh and DVA size was observed (P = 0.01), with a 4% reduction in metabolic activity per each 1 cm in the longest dimension. The SUVDVA-based measures of DVAAh correlated (P = 0.001) with measures derived from comparison with a standardized database. Conclusion: We present a simple method for the quantitative measurement of DVAAh using ratios of SUVs, and find that this quantitative analysis is consistent with a qualitative classification. We find that 54% (15 of 28) of DVAs are associated with a greater than 10% decrease in metabolic activity. PMID:27774365

  13. Risk Factors in Patients with Venous Stasis-Related Skin Lesions without Major Abnormalities on Duplex Ultrasonography.

    PubMed

    Suehiro, Kotaro; Morikage, Noriyasu; Yamashita, Osamu; Harada, Takasuke; Samura, Makoto; Takeuchi, Yuriko; Mizoguchi, Takahiro; Hamano, Kimikazu

    2016-01-01

    Purpose: To clarify the risk factors for venous stasis-related skin lesions in the legs in patients without major abnormalities on duplex ultrasonography (DUS). Methods: Fifty patients (nine males and 41 females, age 27-93 years) with symptoms of C4 or greater according to the Clinical, Etiological, Anatomical, Pathological (CEAP) classification, but having no abnormalities on DUS were reviewed for known risk factors for chronic venous insufficiency (CVI) such as older age (>70 years), obesity (body mass index [BMI] >30 kg/m(2)), short walking distance (<200 m/day), reduced ankle range of motion (<20°), and occupation requiring prolonged standing (>8h per day). Results: The risk factor was different between male and female patients; although all patients had at least one of the above risk factors, the most commonly found risk factor in male patients was occupation requiring prolonged standing (63%), while advanced age (78%) and limited walking distance (83%) were risk factors in female patients. Conclusions: Although male and female patients had different risk factors, insufficient walking seemed to be closely related to the development of venous stasis-related skin lesions.

  14. Risk Factors in Patients with Venous Stasis-Related Skin Lesions without Major Abnormalities on Duplex Ultrasonography

    PubMed Central

    Morikage, Noriyasu; Yamashita, Osamu; Harada, Takasuke; Samura, Makoto; Takeuchi, Yuriko; Mizoguchi, Takahiro; Hamano, Kimikazu

    2016-01-01

    Purpose: To clarify the risk factors for venous stasis-related skin lesions in the legs in patients without major abnormalities on duplex ultrasonography (DUS). Methods: Fifty patients (nine males and 41 females, age 27–93 years) with symptoms of C4 or greater according to the Clinical, Etiological, Anatomical, Pathological (CEAP) classification, but having no abnormalities on DUS were reviewed for known risk factors for chronic venous insufficiency (CVI) such as older age (>70 years), obesity (body mass index [BMI] >30 kg/m2), short walking distance (<200 m/day), reduced ankle range of motion (<20°), and occupation requiring prolonged standing (>8h per day). Results: The risk factor was different between male and female patients; although all patients had at least one of the above risk factors, the most commonly found risk factor in male patients was occupation requiring prolonged standing (63%), while advanced age (78%) and limited walking distance (83%) were risk factors in female patients. Conclusions: Although male and female patients had different risk factors, insufficient walking seemed to be closely related to the development of venous stasis-related skin lesions. PMID:27738462

  15. Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography.

    PubMed

    Bulbul, Erdogan; Yanik, Bahar; Demirpolat, Gulen; Koksal, Vildan

    2015-12-01

    An extraordinary cerebral venous drainage pathway and dilated vein at the left posterior cervical region were detected with routine contrast-enhanced neck computed tomography exam. The left sigmoid sinus was drained by dilated mastoid emissary vein (MEV). The MEV continued as posterior auricular and posterior external jugular veins (PEJVs). The left PEJV directly drained into subclavian vein. Atretic right transverse sinus, left facial vein forming the external jugular vein, atresia and hypoplasia of upper internal jugular veins at the right and left sides, respectively, were the other uncommon findings in our case. Detecting venous variations may prevent complications during surgical and interventional procedures, so the radiologists should examine the superficial cervical veins closely.

  16. Mini-circuit cardiopulmonary bypass with vacuum assisted venous drainage: feasibility of an asanguineous prime in the neonate.

    PubMed

    Lau, C L; Posther, K E; Stephenson, G R; Lodge, A; Lawson, J H; Darling, E M; Davis, R D; Ungerleider, R M; Jaggers, J

    1999-09-01

    Conventional cardiopulmonary bypass (CPB) in neonates results in increased transfusion requirements and hemodilution. There has been little advancement in CPB for the neonatal population. There is evidence that increased priming volumes and blood product transfusion enhances inflammatory response to CPB and increases myocardial and pulmonary dysfunction. We have devised a miniaturized CPB circuit that utilizes vacuum-assisted venous drainage (VAVD) in an effort to decrease priming volume and avoid transfusion requirements. The purpose of this study was to evaluate the safety and efficacy of this miniaturized CPB system and determine the feasibility of an asanguineous prime. Ten 1-week-old piglets were randomized to five mini- and five conventional CPB pump circuits. Subjects were supported with CPB at 100 ml/kg/min, cooled to 28 degrees C, exposed to 10 min aortic crossclamp with cardioplegic arrest, rewarmed to 37 degrees C, weaned from bypass, and subjected to modified-ultrafiltration (MUF) for approximately 10 min. This method was chosen to simulate a situation with all the elements of clinical CPB. Blood transfusion trigger was a hematocrit <15 on CPB. Serum samples were obtained pre-CPB, at 15 min of CPB onset, immediately post-CPB completion, and immediately post-MUF. Indices of hemolysis (SGOT, LDH), production of inflammatory mediators (interleukin (IL)-8, tumor necrosis factor-alpha (TNFalpha)), and physiologic parameters of inflammation were measured. The overall blood requirement was significantly less in the mini-circuit compared to conventional CPB (47.0+/-5.8 ml vs 314.2+/-31.6 ml; p < 0.0001). The only significant blood requirement in the mini-circuit was to replace the volume removed for samples. During the study, mean arterial pressure (MAP) (p = 0.004), static pulmonary compliance (p = 0.04), platelets (p = 0.0003), and white blood cells (p = 0.003) significantly decreased across the groups. Lung water content (p = 0.02), TNFalpha levels (p = 0

  17. Recommendations for multimodal noninvasive and invasive screening for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency: a position statement of the International Society for Neurovascular Disease.

    PubMed

    Zivadinov, Robert; Bastianello, Stefano; Dake, Michael D; Ferral, Hector; Haacke, E Mark; Haskal, Ziv J; Hubbard, David; Liasis, Nikolaos; Mandato, Kenneth; Sclafani, Salvatore; Siddiqui, Adnan H; Simka, Marian; Zamboni, Paolo

    2014-11-01

    Under the auspices of the International Society for Neurovascular Disease (ISNVD), four expert panel committees were created from the ISNVD membership between 2011 and 2012 to determine and standardize noninvasive and invasive imaging protocols for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency (CCSVI). The committees created working groups on color Doppler ultrasound (US), magnetic resonance (MR) imaging, catheter venography (CV), and intravascular US. Each group organized a workshop focused on its assigned imaging modality. Non-ISNVD members from other societies were invited to contribute to the various workshops. More than 60 neurology, radiology, vascular surgery, and interventional radiology experts participated in these workshops and contributed to the development of standardized noninvasive and invasive imaging protocols for the detection of extracranial venous abnormalities indicative of CCSVI. This ISNVD position statement presents the MR imaging and intravascular US protocols for the first time and describes refined color Doppler US and CV protocols. It also emphasizes the need for the use of for noninvasive and invasive multimodal imaging to diagnose adequately and monitor extracranial venous abnormalities indicative of CCSVI for open-label or double-blinded, randomized, controlled studies.

  18. [Double-balloon angioplasty of pulmonary venous drainage obstruction after the Senning procedure in transposition of the great vessels].

    PubMed

    Benito Bartolomé, F; Sánchez Fernández-Bernal, C

    1999-10-01

    A six and half-year old boy with Senning operation for transposition of the great arteries, showed recurrent atrial flutter and obstruction of the pulmonary venous atrium from the early postoperative period. By Doppler examination a peak gradient of 13 mmHg at the isthmus level was recorded in the pulmonary venous atrium. A successful double-balloon dilatation of stenotic area was performed via a retrograde, transaortic, approach through angioplasty. Six months after the procedure the enlargement of the stenosis persists, and the patient is clinically asymptomatic and arrhythmia-free without medication.

  19. Developmental Venous Anomaly: Benign or Not Benign

    PubMed Central

    AOKI, Rie; SRIVATANAKUL, Kittipong

    2016-01-01

    Developmental venous anomalies (DVAs), previously called venous angiomas, are the most frequently encountered cerebral vascular malformations. However, DVA is considered to be rather an extreme developmental anatomical variation of medullary veins than true malformation. DVAs are composed of dilated medullary veins converging centripetally into a large collecting venous system that drains into the superficial or deep venous system. Their etiology and mechanism are generally accepted that DVAs result from the focal arrest of the normal parenchymal vein development or occlusion of the medullary veins as a compensatory venous system. DVAs per se are benign and asymptomatic except for under certain unusual conditions. The pathomechanisms of symptomatic DVAs are divided into mechanical, flow-related causes, and idiopathic. However, in cases of DVAs associated with hemorrhage, cavernous malformations (CMs) are most often the cause rather than DVAs themselves. The coexistence of CM and DVA is common. There are some possibilities that DVA affects the formation and clinical course of CM because CM related to DVA is generally located within the drainage territory of DVA and is more aggressive than isolated CM in the literature. Brain parenchymal abnormalities surrounding DVA and cerebral varix have also been reported. These phenomena are considered to be the result of venous hypertension associated with DVAs. With the advance of diagnostic imagings, perfusion study supports this hypothesis demonstrating that some DVAs have venous congestion pattern. Although DVAs should be considered benign and clinically silent, they can have potential venous hypertension and can be vulnerable to hemodynamic changes. PMID:27250700

  20. Contrast radiographic study of venous drainage of the corpus cavernosum and the corpus spongiosum of the cat penis.

    PubMed

    Amiri, Ali Akbar; Gilanpour, Hassan; Veshkini, Abbas

    2014-01-01

    The aim of this study was to determine the drainage routes of the corpus cvernosum penis and the corpus spongiosum penis in the cat using contrast cavernosography. Five male cats, 1.5-2.5 years old, weighing between 4.5 and 5.5 kg were investigated. The cats were anesthetized and the root and the proximal part of the penis were exposed by an incision on the perineum reaching the scrotum. Each cat was radiographed in lateral and dorsal recumbency before and during injection of contrast medium into the erectile bodies. The corpus spongiosum penis was injected at the bulb of the penis and the corpus cavernosum penis at the root. Injection of contrast media into the cavernous bodies showed that both the external and internal iliac veins drain the erectile bodies into the caudal vena cava. Drainage from the corpus spongiosum penis was from the bulb for the proximal part and from the glans for the distal part. The corpus cavernosum penis was drained only proximally, from the crura. There was a network of veins above the pelvic symphysis and the drainage of erectile bodies where through various routes into the internal and external iliac veins.

  1. Fluid Flow along Venous Adventitia in Rabbits: Is It a Potential Drainage System Complementary to Vascular Circulations?

    PubMed Central

    Li, Hong-yi; Chen, Min; Yang, Jie-fu; Yang, Chong-qing; Xu, Liang; Wang, Fang; Tong, Jia-bin; Lv, You; Suonan, Caidan

    2012-01-01

    Background Our previous research and other studies with radiotracers showed evidence of a centripetal drainage pathway, separate from blood or lymphatic vessels, that can be visualized when a small amount of low molecular weight tracer is injected subcutaneously into a given region on skin of humans. In order to further characterize this interesting biological phenomenon, animal experiments are designed to elucidate histological and physiologic characteristics of these visualized pathways. Methods Multiple tracers are injected subcutaneously into an acupuncture point of KI3 to visualize centripetal pathways by magnetic resonance imaging or fluorescein photography in 85 healthy rabbits. The pathways are compared with venography and indirect lymphangiography. Fluid flow through the pathways is observed by methods of altering their hydrated state, hydrolyzing by different collagenases, and histology is elucidated by optical, fluorescein and electron microscopy. Results Histological and magnetic imaging examinations of these visualized pathways show they consist of perivenous loose connective tissues. As evidenced by examinations of tracers’ uptake, they appear to function as a draining pathway for free interstitial fluid. Fluorescein sodium from KI3 is found in the pathways of hind limbs and segments of the small intestines, partial pulmonary veins and results in pericardial effusion, suggesting systematical involvement of this perivenous pathway. The hydraulic conductivity of these pathways can be compromised by the collapse of their fiber-rich beds hydrolyzed by either of collagenase type I, III, IV or V. Conclusions The identification of pathways comprising perivenous loose connective tissues with a high hydraulic conductivity draining interstitial fluid in hind limbs of a mammal suggests a potential drainage system complementary to vascular circulations. These findings may provide new insights into a systematically distributed collagenous connective tissue with

  2. [Abnormal catheter mobility in a totally implantable venous access depending on the upright or supine position in an obese patient].

    PubMed

    Bernard, P; Vrignaud, S; Letessier, E; Denimal, F; Le Néel, J C

    2001-10-01

    The authors advise on an exceptional complication in a totally implantable venous access and give recommendations on how to avoid this problem. In an obese person, one week after the implantation of a totally implantable venous access, a chest X-ray showed that the catheter was too short. In the operative room, at the time of the second intervention, the radioscopy did not find this anomaly. The subcutaneous injection port was positioned too low. When the patient was in a supine position, the subcutaneous injection port was in the correct position but when she was in an upright position, the breast descended and pulled down the subcutaneous injection port and the catheter.

  3. Abnormalities in the cellular phase of blood fibrinolytic activity in systemic lupus erythematosus and in venous thromboembolism

    SciTech Connect

    Moroz, L.A.; MacLean, L.D.; Langleben, D.

    1986-09-15

    Fibrinolytic activities of whole blood and plasma were determined by /sup 125/I-fibrin radiometric assay in 16 normal subjects, and in 11 patients with systemic lupus erythematosus (SLE), 14 with progressive systemic sclerosis (PSS), 23 with venous thromboembolic disease, and 20 patients awaiting elective surgery. Mean whole blood and plasma activities for patients with PSS, and for those awaiting elective surgery, were similar to normal values, as was the mean plasma activity in patients with SLE. However, mean whole blood activity in SLE was significantly decreased compared with normals (p less than 0.05), with mean plasma activity accounting for 44% of mean whole blood activity (compared with 17% in normal subjects), representing a 67% decrease in mean calculated cellular phase activity in SLE, when compared with normals. Since the numbers of cells (neutrophils, monocytes) possibly involved in cellular activity were not decreased, the findings suggest a functional defect in fibrinolytic activity of one or more blood cell types in SLE. An additional finding was the participation of the cellular phase as well as the well-known plasma phase of blood in the fibrinolytic response to thromboembolism.

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

    PubMed

    Ghezzi, A; Comi, G; Federico, A

    2011-02-01

    Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS caused by the interplay of genetic and environmental factors. In the last years, it has been suggested that an abnormal venous drainage due to stenosis or malformation of the internal jugular and/or azygous veins may play a major pathogenetic role in MS. This abnormality called chronic cerebro-spinal venous insufficiency (CCSVI) could result in increased permeability of blood brain barrier, local iron deposition and secondary multifocal inflammation. In the present paper, literature data in favour and against this hypothesis are reported. A great variability of CCSVI has been found in both MS patients (ranging from 0 to 100%) and in control subjects (from 0 to 23%). This large variability is explained by methodological aspects, problems in assessing CCSVI, and differences among clinical series. It is urgent to perform appropriate epidemiological studies to define the possible relationship between CCSVI and MS.

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

    PubMed Central

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

    2016-01-01

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

  6. Venous ulcer: epidemiology, physiopathology, diagnosis and treatment.

    PubMed

    Abbade, Luciana P Fernandes; Lastória, Sidnei

    2005-06-01

    This review discusses the epidemiology, pathogenesis, diagnosis and current therapeutic options for venous ulcer. Venous ulcer is a severe clinical manifestation of chronic venous insufficiency (CVI). It is responsible for about 70% of chronic ulcers of the lower limbs. The high prevalence of venous ulcer has a significant socioeconomic impact in terms of medical care, days off work and reduced quality of life. Long-term therapeutics are needed to heal venous ulcers and recurrence is quite common, ranging from 54 to 78%. Thrombophlebitis and trauma with long-term immobilization predisposing to deep venous thrombosis are important risk factors for CVI and venous ulcer. The most recent theories about pathogenesis of venous ulcer have associated it with microcirculatory abnormalities and generation of an inflammatory response. Management of venous leg ulcers is based on understanding the pathogenesis. In recent years novel therapeutic approaches for venous ulcers have offered valuable tools for the management of patients with this disorder.

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

    PubMed

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

    2014-08-01

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

  8. Potentially prothrombotic abnormalities of coagulation in benign intracranial hypertension.

    PubMed Central

    Sussman, J; Leach, M; Greaves, M; Malia, R; Davies-Jones, G A

    1997-01-01

    OBJECTIVE: Benign intracranial hypertension (BIH) may be caused by intracranial venous sinus thrombosis. Cerebral angiograms may, however, be normal in patients with BIH that are associated with conditions with an increased risk of venous thrombosis. This raises the possibility that unrecognised non-occlusive venous thrombus might impede CSF drainage. This study therefore examined the strength of the association between risk factors for thrombosis and BIH. METHODS: The incidence of prothrombotic abnormalities among a mixed prospectively and retrospectively investigated cohort of 38 patients with BIH, was compared with healthy obese subjects, and patients with other neurological diseases. Prothrombotic abnormalities investigated included anticardiolipin antibodies, lupus anticoagulant, antithrombin III, proteins C and S, plasma fibrinogen, kaolin cephalin clotting time, prothrombin time, and full blood counts. RESULTS: Evidence for the presence of an antiphospholipid antibody was found in 32% of cases. Cases of familial deficiency of antithrombin III, thrombocytosis, and polycythaemia were also noted. Additionally, an increased concentration of plasma fibrinogen was found in 26%. A coagulation abnormality was more often detectable in those subjects with normal or low body mass index and in those tested within six months of onset. CONCLUSION: There is a thrombotic pathogenesis in some cases of BIH. Images PMID:9069476

  9. Posterior foss avenous angiomas with drainage through the brain stem

    SciTech Connect

    Damiano, T.R.; Truwit, C.L. ); Dowd, C.F. ); Symonds, D.L. )

    1994-04-01

    To describe 11 cases of posterior fossa venous angiomas with drainage through the brain stem. Eleven cases of posterior fossa venous angioma with drainage through the brain stem were evaluated using MR. Correlation with known routes of venous drainage for the cerebellum and brain stem is made. Six of the 11 venous angiomas were found in the cerebellum, four in the brain stem; one involved both the cerebellum and brain stem. The cerebellar venous angiomas drained to subependymal veins about the fourth ventricle and dorsal pons. These then connected with an enlarged transmesencephalic or transpontine vein, to drain anteriorly to the anterior pontine veins. The brain stem angiomas had variable drainage depending on location. Evidence of hemorrhage was seen in five cases. Cerebellar and brain stem venous angiomas have several potential routes of drainage, including an enlarged vein traversing the pons, midbrain, or medulla. A knowledge of the normal venous anatomy of this region helps to understand the occurrence of these uncommon routes of venous drainage. 15 refs., 8 figs., 1 tab.

  10. [Homocysteine and venous thromboembolism].

    PubMed

    Monnerat, C; Hayoz, D

    1997-09-06

    Congenital homocysteinuria is a rare inherited metabolic disorder with early onset atherosclerosis and arterial and venous trombosis. Moderate hyperhomocysteinemia is more frequently encountered and is recognized as an independent cardiovascular risk factor. Several case-control studies demonstrate an association between venous thromboembolism and moderate hyperhomocysteinemia. A patient with moderate hyperhomocysteinemia has a 2-3 relative risk of developing an episode of venous thromboembolism. The occurrence of mild hyperhomocysteinemia in heterozygotes for the mutation of Leiden factor V involves a 10-fold increase in the risk of venous thromboembolism. The biochemical mechanism by which homocysteine may promote thrombosis is not fully recognized. Homocysteine inhibits the expression of thrombomodulin, the thrombin cofactor responsible for protein C activation, and inhibits antithrombin-III binding. Treatment with folic acid reduces the plasma level of homocysteinemia, but no study has demonstrated its efficacy in reducing the incidence of venous thromboembolism or atherosclerosis. Hyperhomocysteinemia should be included in the screening of abnormalities of hemostasis and thrombosis in patients with idiopathic thromboembolism, and mild hyperhomocysteinemia may justify a trial of folic acid.

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

    PubMed

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

    2015-01-01

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

  12. Catheter venography and endovascular treatment of chronic cerebrospinal venous insufficiency.

    PubMed

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

    2012-06-01

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

  13. Venous Sampling

    MedlinePlus

    ... parts of the body, including: Adrenal venous sampling (AVS) , in which blood samples are taken from the ... for a few days before the procedure. For AVS, you will be asked to stop taking certain ...

  14. Venous Ulcers

    PubMed Central

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

    2013-01-01

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

  15. Varicose veins and chronic venous insufficiency.

    PubMed

    Partsch, H

    2009-11-01

    Varicose veins are a very frequent disorder with prevalence in our adult population between 14% for large varices and 59% for small teleangiectasias. Subjective symptoms may be very non-specific. The term "chronic venous insufficiency (CVI)" defines functional abnormalities of the venous system producing advanced symptoms like oedema, skin changes or leg ulcers. Both entities, varicose veins and CVI, may be summarized under the term "chronic venous disorders" which includes the full spectrum of morphological and functional abnormalities of the venous system. A classification system to describe chronic venous disorders regarding clinical appearance, etiology, anatomical distribution and pathophysiology has been proposed under the acronym of CEAP. The revised version of the CEAP classification contains also definitions of clinical signs and suggests three levels of apparative investigations adjusted to the clinical stage. Concerning the etiology of venous disorders controversial theories exist leading to different therapeutic concepts. As a matter of fact there is a vicious circle between structural changes in valves and venous wall and hemodynamic forces leading to reflux and venous hypertension. Different methods for treating varicose veins are available producing satisfactory early outcome in most cases, but followed by a high recurrence rate after years. Chronic venous insufficiency requires "chronic management". Compression therapy by bandages for initial treatment of severe stages and maintenance therapy using medical compression stockings is essential. In addition correction of venous refluxes by surgery or endovenous procedures including echo-guided foam sclerotherapy should be considered in every single case.

  16. Cerebral venous thrombosis presenting with cerebellar ataxia and cortical blindness.

    PubMed

    Ben Sassi, Samia; Mizouni, Habiba; Nabli, Fatma; Kallel, Lamia; Kefi, Mounir; Hentati, Fayçal

    2010-01-01

    Venous infarction in the cerebellum has been reported only rarely, probably because of the abundant venous collateral drainage in this region. Bilateral occipital infarction is a rare cause of visual loss in cerebral venous thrombosis. We describe a 50-year-old woman with a history of ulcerative colitis who developed acute cerebellar ataxia and cortical blindness. She had bilateral cerebellar and occipital lesions related to sigmoid venous thrombosis and achieved complete recovery with anticoagulation therapy. Cerebral venous thrombosis should be considered in cases of simultaneous cerebellar and occipital vascular lesions.

  17. Inflammation in chronic venous ulcers.

    PubMed

    Raffetto, J D

    2013-03-01

    Chronic venous ulcers (CVUs) occur in approximately 1% of the general population. Risk factors for chronic venous disease (CVD) include heredity, age, female sex and obesity. Although not restricted to the elderly, the prevalence of CVD, especially leg ulcers, increases with age. CVD has a considerable impact on health-care resources. It has been estimated that venous ulcers cause the loss of approximately two million working days and incur treatment costs of approximately $3 billion per year in the USA. Overall, CVD has been estimated to account for 1-3% of the total health-care budgets in countries with developed health-care systems. The pathophysiology of dermal abnormalities in CVU is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in microcirculation, cytokine and matrix metalloproteinase (MMP) activation, resulting in altered cellular function and delayed wound healing.

  18. Foam drainage

    SciTech Connect

    Kraynik, A.M.

    1983-11-01

    Transient drainage from a column of persistent foam has been analyzed theoretically. Gravity-driven flow was assumed to occur through an interconnected network of Plateau borders that define the edges of foam cells taken to be regular pentagonal dodecahedrons. A small liquid volume fraction and monodisperse cell size distribution were assumed. In the basic model, it is assumed that all liquid is contained in Plateau borders that are bounded by rigid gas-liquid interfaces. The predicted half life, the time required for one half of the liquid to drain from the foam, is inversely proportional to the square of the cell diameter, illustrating the importance of foam structure in drainage. Liquid hold up in the films separating adjacent cells, nonuniform initial liquid volume fraction distribution and interfacial mobility are explored. Border suction due to reduced pressure in the Plateau borders provides a mechanism for film drainage. Simultaneous film drainage and flow through the Plateau borders are analyzed. Sufficient conditions for neglecting film drainage kinetics are obtained. The results indicate that improved foam stability is related to small cells, liquid hold up in the films and slow film drainage kinetics.

  19. Caudal fluoroscopy to guide venous access for pacemaker device implantation: should this now be standard practice?

    PubMed Central

    Patel, Hitesh C; Hayward, Carl; Nanayakkara, Shane; Broughton, Archer; Mariani, Justin A

    2017-01-01

    We describe a technique that uses both posterior-anterior and caudal fluoroscopy to achieve venous access for pacemaker device implantation. A significant advantage of this technique is the ability to clearly demarcate both the anatomy of venous drainage and the lung border. We would encourage all centres to adopt this technique as a safe approach to venous access. PMID:28321268

  20. Lower extremity venous reflux

    PubMed Central

    Baliyan, Vinit; Tajmir, Shahein; Ganguli, Suvranu; Prabhakar, Anand M.

    2016-01-01

    Venous incompetence in the lower extremity is a common clinical problem. Basic understanding of venous anatomy, pathophysiologic mechanisms of venous reflux is essential for choosing the appropriate treatment strategy. The complex interplay of venous pressure, abdominal pressure, venous valvular function and gravitational force determine the venous incompetence. This review is intended to provide a succinct review of the pathophysiology of venous incompetence and the current role of imaging in its management. PMID:28123974

  1. Cerebral sinus venous thrombosis

    PubMed Central

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

    2013-01-01

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

  2. [Diagnosing venous and venous/arterial ulcers].

    PubMed

    Perceau, Géraldine

    2012-01-01

    A venous ulcer can be diagnosed on the basis of elements arising from the questioning and the clinical examination of the patient. A venous Doppler ultrasound can specify the type of reverse flow (superficial and/or deep). Measuring the ankle brachial pressure index helps to eliminate or confirm any arterial involvement. Depending on the systolic pressure index, the ulcer will be considered as purely venous, mixed (arterial-venous) or predominantly arterial.

  3. Congenital Abnormalities

    MedlinePlus

    ... Listen Español Text Size Email Print Share Congenital Abnormalities Page Content Article Body About 3% to 4% ... of congenital abnormalities earlier. 5 Categories of Congenital Abnormalities Chromosome Abnormalities Chromosomes are structures that carry genetic ...

  4. Normal and abnormal development of pulmonary veins: state of the art and correlation with clinical entities.

    PubMed

    Douglas, Yvonne L; Jongbloed, Monique R M; Deruiter, Marco C; Gittenberger-de Groot, Adriana C

    2011-02-17

    Interest for the pulmonary veins has increased in the past decade after the potential arrhythmogenicity of the myocardial sleeve surrounding these structures has been recognized. Furthermore, there are several clinical entities, such as anomalous connection pattern and pulmonary vein stenosis, that are related to abnormal pulmonary vein development. In this review, we will describe current literature and aim to elucidate and reorganize current opinions on normal and abnormal pulmonary vein development in relation to clinical (management of) diseases. Several unresolved questions will be addressed, as well as current conceptual controversies. First, a general overview of development of structures at the venous pole of the heart, including normal development of the pulmonary vein from a primitive Anlage, will be provided. Recent insights indicate an important contributory role of the mesoderm behind the heart, the so-called second heart field, to this area. Subsequently, the formation of a myocardial and smooth muscle vascular wall of the pulmonary veins and the left atrium is described, as well as current insights in the mechanisms involved in the differentiation of these different cell types in this area. Next, developmental concepts of normal pulmonary venous drainage patterns are reviewed, and an overview is provided of clinical entities related to abnormal development at several anatomical levels. Lastly, attention is paid to arrhythmogenesis in relation to pulmonary vein development, as well the consequences for clinical management.

  5. Cardiovascular and Interventional Radiological Society of Europe Commentary on the Treatment of Chronic Cerebrospinal Venous Insufficiency

    SciTech Connect

    Reekers, J. A.; Lee, M. J.; Belli, A. M.; Barkhof, F.

    2011-02-15

    Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS). The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the 'venous hemodynamic insufficiency severity score' (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called 'liberation treatment,' and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists, who are

  6. Using central venous catheter for suprapubic catheterization in cardiac surgery.

    PubMed

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2-3 attempts).

  7. Calcium micro-depositions in jugular truncular venous malformations revealed by Synchrotron-based XRF imaging.

    PubMed

    Pascolo, Lorella; Gianoncelli, Alessandra; Rizzardi, Clara; Tisato, Veronica; Salomé, Murielle; Calligaro, Carla; Salvi, Fabrizio; Paterson, David; Zamboni, Paolo

    2014-10-07

    It has been recently demonstrated that the internal jugular vein may exhibit abnormalities classified as truncular venous malformations (TVMs). The investigation of possible morphological and biochemical anomalies at jugular tissue level could help to better understand the link between brain venous drainage and neurodegenerative disorders, recently found associated with jugular TVMs. To this end we performed sequential X-ray Fluorescence (XRF) analyses on jugular tissue samples from two TVM patients and two control subjects, using complementary energies at three different synchrotrons. This investigation, coupled with conventional histological analyses, revealed anomalous micro-formations in the pathological tissues and allowed the determination of their elemental composition. Rapid XRF analyses on large tissue areas at 12.74 keV showed an increased Ca presence in the pathological samples, mainly localized in tunica adventitia microvessels. Investigations at lower energy demonstrated that the high Ca level corresponded to micro-calcifications, also containing P and Mg. We suggest that advanced synchrotron XRF micro-spectroscopy is an important analytical tool in revealing biochemical changes, which cannot be accessed by conventional investigations. Further research on a larger number of samples is needed to understand the pathogenic significance of Ca micro-depositions detected on the intramural vessels of vein walls affected by TVMs.

  8. Alveolar abnormalities

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/001093.htm Alveolar abnormalities To use the sharing features on this page, please enable JavaScript. Alveolar abnormalities are changes in the tiny air sacs in ...

  9. Nail abnormalities

    MedlinePlus

    Beau's lines; Fingernail abnormalities; Spoon nails; Onycholysis; Leukonychia; Koilonychia; Brittle nails ... 2012:chap 71. Zaiac MN, Walker A. Nail abnormalities associated with systemic pathologies. Clin Dermatol . 2013;31: ...

  10. Stormwater Drainage Wells

    EPA Pesticide Factsheets

    Provides information for identifying stormwater drainage wells, learn how to comply with regulations for storm water drainage wells, and how to reduce the threat to ground water from stormwater injection wells.

  11. Urine drainage bags

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000142.htm Urine drainage bags To use the sharing features on this page, please enable JavaScript. Urine drainage bags collect urine. Your bag will attach ...

  12. [Lung cancer and lymph drainage].

    PubMed

    Riquet, M

    2007-01-01

    Lung cancer is lymphophile and may involve lymph nodes (LN) belonging to lung lymph drainage. LN metastases are figured within stations numbered 1 to 14. These stations are located along lymph vessels. The lymph vessels and the LN are forming together anatomical chains. Lymph vessels are valved and pulsatile and travel to the cervical venous confluence where they pour the lung lymph into the blood circulation. They may be totally or partly nodeless along their travel, anastomose with each other around the trachea, and connect with the thoracic duct within the mediastinum. Within the anatomical LN chains, LN are variable in number and in size from one individual to another. They may be absent from one or several stations of the international mapping. Stations are located along the anatomical chains: pulmonary ligament (9), tracheal bifurcation(8 and 7), right paratracheal (4R, 2R and 1), preaortic (5 and 6), left paratracheal (4L, 2L and 1). Station 3 is located on 2 differents chains (phrenic and right esophagotracheal). Station 10 are located at the beginning of the mediastinal lymph nodes chains. Each chain connects with the blood circulation, anastomoses with he neighbouring chains and behave as an own entity whatever the number of its LN. International station mapping misknowns this anatomy and occults the true pronostic value of lung lymph drainage.

  13. Transient drainage summary report

    SciTech Connect

    1996-09-01

    This report summarizes the history of transient drainage issues on the Uranium Mill Tailings Remedial Action (UMTRA) Project. It defines and describes the UMTRA Project disposal cell transient drainage process and chronicles UMTRA Project treatment of the transient drainage phenomenon. Section 4.0 includes a conceptual cross section of each UMTRA Project disposal site and summarizes design and construction information, the ground water protection strategy, and the potential for transient drainage.

  14. Epidemiology of venous thromboembolism.

    PubMed Central

    Coon, W W

    1977-01-01

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

  15. Hygienic drainage for healthcare.

    PubMed

    Jennings, Peter

    2012-08-01

    Peter Jennings, technical director for ACO Building Drainage, which specialises in the development of corrosion-resistant drainage systems and building products, looks at the key issues to consider when specifying and installing pipework and drainage for hygiene-critical environments such as hospitals and other healthcare facilities.

  16. Arterialized Venous Bone Flaps: An Experimental Investigation

    PubMed Central

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

    2016-01-01

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

  17. Lymphatic and venous function in lipoedema.

    PubMed

    Harwood, C A; Bull, R H; Evans, J; Mortimer, P S

    1996-01-01

    Lipoedema is a common but infrequently recognized condition causing bilateral enlargement of the legs in women. Although generally considered to be the result of an abnormal deposition of subcutaneous fat with associated oedema, the precise mechanisms responsible for oedema formation have yet to be fully established. In order to evaluate the possible role of lymphatic or venous dysfunction in the pathogenesis of lipoedema, 10 patients were investigated by photoplethysmography (venous function) and quantitative lymphoscintigraphy (lymphatic function). The results were compared with those from patients with primary lymphoedema and those from healthy volunteers. The results demonstrated minor abnormalities of venous function in only two patients. One patient had moderately impaired lymphatic function in both legs and seven patients had a marginal degree of impairment in one or both legs. However, in none of these cases did the impairment attain the low levels seen in true lymphoedema. Lipoedema appears to be a distinct clinical entity best classified as a lipodystrophy rather than a direct consequence of any primary venous or lymphatic insufficiency.

  18. CEREBRAL VENOUS THROMBOSIS AND TURNER SYNDROME: A RARE REPORTED ASSOCIATION.

    PubMed

    Guler, A; Alpaydin, S; Bademkiran, F; Sirin, H; Celebisoy, N

    2015-01-01

    Turner Syndrome is the only known viable chromosomal monosomy, characterised by the complete or partial absence of an X chromosome. It's the most common chromosomal abnormality in females. Apart from the well known dysmorphic features of the syndrome, it has been associated with a number of vascular pathologies; mainly involving the cardiovascular, renovascular, peripheral vascular and cerebrovascular system. It seems striking that thromboembolism is not considered as a feature of the syndrome. Most of the thromboembolism cases are related to the arterial vascular system; except for some rare reported portal venous thrombosis cases, peripheral venous thrombosis cases and to the best of our knowledge a single case of cerebral venous thrombosis with Dandy Walker malformation and polymicrogyria. We herein report a cerebral venous thrombosis case with Turner Syndrome. With no other found underlying etiology, we want to highlight that Turner Syndrome, itself, may have a relationship not only with the cerebral arterial vascular system pathologies but also with the cerebral venous thrombosis.

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

    SciTech Connect

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

    1991-02-01

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

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

    SciTech Connect

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

    1981-01-01

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

  1. Cardiac tamponade caused by central venous catheter in two newborns.

    PubMed

    Monteiro, Andrey José; Canale, Leonardo Secchin; Barbosa, Rodrigo; Méier, Milton

    2008-01-01

    Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  2. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis

    PubMed Central

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

    2009-01-01

    Background: The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. Methods: Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined transcranial and extracranial colour-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. Results: CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29 to 65, p<0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; this provides a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated with CCSVI patterns significantly different from those of primary progressive (p<0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. Conclusion: CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease. PMID:19060024

  3. WATER DRAINAGE MODEL

    SciTech Connect

    J.B. Case

    2000-05-30

    The drainage of water from the emplacement drift is essential for the performance of the EBS. The unsaturated flow properties of the surrounding rock matrix and fractures determine how well the water will be naturally drained. To enhance natural drainage, it may be necessary to introduce engineered drainage features (e.g. drilled holes in the drifts), that will ensure communication of the flow into the fracture system. The purpose of the Water Drainage Model is to quantify and evaluate the capability of the drift to remove water naturally, using the selected conceptual repository design as a basis (CRWMS M&O, 1999d). The analysis will provide input to the Water Distribution and Removal Model of the EBS. The model is intended to be used to provide postclosure analysis of temperatures and drainage from the EBS. It has been determined that drainage from the EBS is a factor important to the postclosure safety case.

  4. Meiotic abnormalities

    SciTech Connect

    1993-12-31

    Chapter 19, describes meiotic abnormalities. These include nondisjunction of autosomes and sex chromosomes, genetic and environmental causes of nondisjunction, misdivision of the centromere, chromosomally abnormal human sperm, male infertility, parental age, and origin of diploid gametes. 57 refs., 2 figs., 1 tab.

  5. Dealing with the venous congestion of free flaps: venous catheterization.

    PubMed

    Gürsoy, Koray; Kankaya, Yüksel; Uysal, Afşin; Koçer, Uğur

    2008-11-01

    For head and neck reconstruction after tumor ablation surgery, free flaps are mostly the chosen treatment modality for most of the centers. Coping with venous insufficiency and increasing venous outflow of the flap during this process increases the success rate. To increase venous outflow, triple-lumen central venous catheter is inserted to one of the donor veins of the flap that has venous insufficiency and one intact vein anastomosis.

  6. Martian drainage densities

    USGS Publications Warehouse

    Carr, M.H.; Chuang, F.C.

    1997-01-01

    Drainage densities on Mars range from zero over large areas of volcanic plains to 0.3-0.5 km-1 locally on some volcanoes. These values refer to geologic units, not to drainage basins, as is normal for terrestrial drainage densities. The highest values are close to the lowest terrestrial values derived by similar techniques. Drainage densities were determined for every geologic unit portrayed on the 1:15,000,000 geologic map of Mars. Except for volcanoes the geologic unit with the highest drainage density is the dissected Noachian plains with a drainage density of 0.0074 km-1. The average drainage density for Noachian units is 0.0032 km-1, for Hesperian units is 0.00047 km-1, and for Amazonian units is 0.00007 km-1, excluding the volcanoes. These values are 2-3 orders of magnitude lower than typical terrestrial densities as determined by similar techniques from Landsat images. The low drainage densities, despite a cumulative record that spans billions of years, indicate that compared with the Earth, the channel-forming processes have been very inefficient or have operated only rarely or that the surface is extremely permeable. The high drainage density on volcanoes is attributed to a local cause, such as hydrothermal activity, rather than to a global cause such as climate change. Copyright. Published in 1997 by the American Geophysical Union.

  7. [Chronic venous insufficiency (CVI)].

    PubMed

    Renner, R; Simon, J

    2009-10-01

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

  8. Venous thrombosis: an overview

    SciTech Connect

    Peterson, C.W.

    1986-07-01

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

  9. Chronic Venous Insufficiency

    MedlinePlus

    ... with your doctor. Do not ignore these symptoms. Risk Factors The most important factors leading to the development of chronic venous insufficiency and varicose veins include: • Family history • Increasing ...

  10. Diagnosing Deep Venous Thrombosis

    PubMed Central

    Doyle, D. Lynn

    1992-01-01

    Patients often present with unexplained lower limb pain and swelling. It is important to exclude deep venous thrombosis in the diagnosis because of the threat of sudden death. Simple clinical diagnosis is unacceptable, and noninvasive tests should be used initially. Serial testing detects proximal extension of isolated calf thrombi. Multiple diagnostic modalities are employed to diagnose a new deep venous thrombosis in patients with postphlebitic syndrome. PMID:21221369

  11. Venous ulcer review

    PubMed Central

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

  12. Drainage water management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This article introduces a series of papers that report results of field studies to determine the effectiveness of drainage water management (DWM) on conserving drainage water and reducing losses of nitrogen (N) to surface waters. The series is focused on the performance of the DWM (also called contr...

  13. Percutaneous Abscess Drainage

    MedlinePlus

    ... the local anesthetic is injected. Most of the sensation is at the skin incision site which is numbed using local anesthetic. ... open surgical drainage. Risks Any procedure where the skin is penetrated ... organ may be damaged by percutaneous abscess drainage. Occasionally ...

  14. Biotreatment of mine drainage

    SciTech Connect

    Bender, J.; Phillips, R.

    1996-12-31

    Several experiments and field tests of microbial mats are described. One study determined the removal rate of Uranium 238 and metals from groundwater by microbial mats. Free floating mats, immobilized mats, excised mats, and pond treatment were examined. Field tests of acid coal mine drainage and precious metal mine drainage are also summarized. The mechanisms of metal removal are briefly described.

  15. Neonatal repair of total anomalous pulmonary venous connection and lung agenesis.

    PubMed

    Kaku, Yuji; Nagashima, Mitsugi; Matsumura, Goki; Yamazaki, Kenji

    2015-07-01

    Here we report a neonatal case of total anomalous pulmonary venous connection with left lung agenesis. Diagnostic imaging demonstrated that the left pulmonary veins were totally absent and the right pulmonary veins connected with the common pulmonary chamber. Drainage from the common pulmonary venous chamber entered the persistent left suerior vena cava. In addition, it revealed complete absence of the left main bronchus and left lung vessels. The neonate successfully underwent surgical repair 18 days after birth.

  16. Foam consolidation and drainage.

    PubMed

    Jun, S; Pelot, D D; Yarin, A L

    2012-03-27

    A theoretical model of foam as a consolidating continuum is proposed. The general model is applied to foam in a gravity settler. It is predicted that liquid drainage from foam in a gravity settler begins with a slow drainage stage. Next, a stage with faster drainage occurs where the drainage rate doubles compared to the initial stage. The experiments conducted within the framework of this work confirmed the theoretical predictions and allowed measurements of foam characteristics. Foams of three different concentrations of Pantene Pro-V Classic Care Solutions shampoo were studied, as well as the addition of polyethylene oxide (PEO) in one case. The shampoo's main foaming components are sodium lauryl sulfate and sodium laureth sulfate. It is shown to what extent foam drainage is slowed down by using higher shampoo concentrations and how it is further decreased by adding polymer (PEO).

  17. Near-infrared fluorescence lymphatic imaging in a patient treated for venous occlusion

    PubMed Central

    Rasmussen, John C.; Aldrich, Melissa B.; Guilliod, Renie; Fife, Caroline E.; O’Donnell, Thomas F.; Sevick-Muraca, Eva M.

    2015-01-01

    Although lower extremity edema/lymphedema can result from venous and/or lymphatic abnormalities, effective treatment depends upon understanding their relative contributions to the condition. Herein we use near-infrared fluorescence lymphatic imaging in a 16 year-old female diagnosed with unilateral lymphedema of the right leg and previously treated with left iliac vein stenting in an attempt to alleviate lymphedema. The imaging shows that abnormal lymphatic anatomy, rather than venous occlusion, was likely responsible for unilateral swelling.

  18. Partial anomalous pulmonary venous connection (including scimitar syndrome).

    PubMed

    van de Woestijne, Pieter C; Verberkmoes, Niels; Bogers, Ad J J C

    2013-01-01

    Partial anomalous pulmonary venous connection (PAPVC) is defined to exist when some but not all venous drainage enters the left atrium, while the remaining veins connect to the right-sided circulation. Scimitar syndrome is a specialized example, in which an anomalous pulmonary vein descends from the right lung and drains into the inferior caval vein. PAPVC is associated with sinus venosus-type atrial septal defect (ASD). Diagnosis was, in the past, based on echocardiographic imaging and could be difficult. Multislice spiral computed tomography and magnetic resonance imaging improved the imaging quality. The surgical correction is dependent on the type of anomalous connection and the presence of an ASD. Outcome is good but obstructed venous return is an important issue.

  19. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis.

    PubMed

    Zhang, Qi-dong; Guo, Wan-shou; Zhang, Qian; Liu, Zhao-hui; Cheng, Li-ming; Li, Zi-rong

    2011-12-01

    From individual randomized studies, it is not clear whether a closed suction drainage should be used after total knee arthroplasty. Our meta-analysis compares the clinical outcomes of closed suction drainage with nondrainage after total knee arthroplasty in randomized controlled trials reported between January 1966 and May 2010. Fifteen eligible trials involving 1361 knee incisions (686 knees with closed suction drainage and 675 knees without drainage) satisfied the inclusion criteria for our meta-analysis. The result of the meta-analysis indicates that closed suction drainage reduces the incidence of soft tissue ecchymosis and requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference between drainage and nondrainage was observed in the incidence of infection, deep venous thrombosis, or postoperative range of motion.

  20. [Radionuclide studies of congenital kidney abnormalities].

    PubMed

    Vlakhov, N

    1984-06-01

    Using the potentialities of isotope nephrograms as a screening test a total of 4746 patients suspected of renal abnormalities were examined. The author established pathological deviations in 561 cases (11.8%). During further verification using scintigraphy unsuspected congenital renal abnormalities (aplasia, hypoplasia, dystopia, double kidney, horseshoe kidney, solitary cyst and polycystic renal disease) were found in 46 patients (8.2%). The diagnosis was confirmed at subsequent venous x-ray urography. A conclusion has been made as to the role of comprehensive nephrographic-scintigraphic examination in the diagnosis of congenital renal abnormalities.

  1. Endovascular Interventions for Idiopathic Intracranial Hypertension and Venous Tinnitus: New Horizons.

    PubMed

    Hui, Ferdinand K; Abruzzo, Todd; Ansari, Sameer A

    2016-05-01

    Pulsatile tinnitus from intracranial venous abnormalities is an uncommon cause of pulse synchronous tinnitus. Endovascular therapies may have applications in many of these disease conditions. They have the advantage of being minimally invasive and may selectively eliminate the site of turbulence. Venous stenting has been used successfully to treat venous stenoses with low complication rates and high success rates in patients with idiopathic intracranial hypertension though randomized controlled data are lacking. Careful exclusion of other causes of tinnitus should be performed before consideration for surgical or endovascular treatment of presumed causative lesions of venous tinnitus.

  2. [Endovascular thrombolysis for massive cerebral venous thrombosis in a teenager with nephrotic syndrome].

    PubMed

    Costa, Paula; Biscoito, Luísa; Vieira, Marisa; Marçal, Mónica; Camilo, Cristina; Neto, Lia; Abecasis, Francisco; Almeida, Margarida; Correia, Manuela

    2010-01-01

    Cerebral venous thrombosis is a rare but potentially severe condition in children. We present the case of a teenager with corticodependent nephrotic syndrome diagnosed at five months of age and treated with cyclosporine A. In the context of recurrence of nephrotic syndrome he presented with headache, vomiting and severe intracranial hypertension. While the raised intracranial pressure and the status epilepticus were controlled, the brain imaging revealed venous thrombosis of all venous sinus, with absence of venous drainage. He was submitted to local thrombolysis with recombinant tissue plasminogen activator, with recanalization of the venous sinuses. The outcome was favourable, without neurological deficits. In this case, the early radiologic intervention was crucial, enabling a full neurological recovery, in a teenager whose initial prognosis was very poor.

  3. Ear drainage culture

    MedlinePlus

    ... needed. Your health care provider will use a cotton swab to collect the sample from inside the ... Using a cotton swab to take a sample of drainage from the outer ear is not painful. However, ear pain may ...

  4. Venous Thromboembolism Prophylaxis

    PubMed Central

    Laryea, Jonathan; Champagne, Bradley

    2013-01-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile. PMID:24436666

  5. Venous thromboembolism prophylaxis.

    PubMed

    Laryea, Jonathan; Champagne, Bradley

    2013-09-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile.

  6. Leukocyte abnormalities.

    PubMed

    Gabig, T G

    1980-07-01

    Certain qualitative abnormalities in neutrophils and blood monocytes are associated with frequent, severe, and recurrent bacterial infections leading to fatal sepsis, while other qualitative defects demonstrated in vitro may have few or no clinical sequelae. These qualitative defects are discussed in terms of the specific functions of locomotion, phagocytosis, degranulation, and bacterial killing.

  7. Airport Pavement Drainage

    DTIC Science & Technology

    1990-06-01

    drainage layer and trench drains can be found in Cedergren (10). 4.2 COMPONENTS OF SUBSURFACE DRAINAGE SYSTEM 4.2.1 Outflow Once the water has found...According to Cedergren (10) the open graded aggregate can replace the normally used dense graded materials on an inch-for-inch basis. A main problem in...the perforated pipe to prevent fines from entering, Figure 4.24 (11). Cedergren (10) suggests that collector pipes should be 42 laid with the

  8. Central venous access.

    PubMed

    Ganeshan, Arul; Warakaulle, Dinuke R; Uberoi, Raman

    2007-01-01

    Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article.

  9. Using central venous catheter for suprapubic catheterization in cardiac surgery

    PubMed Central

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2–3 attempts). PMID:28116283

  10. The jugular venous pressure revisited

    PubMed Central

    CHIACO, JOHN MICHAEL S. CHUA; PARIKH, NISHA I.; FERGUSSON, DAVID J.

    2016-01-01

    Assessment of the jugular venous pressure is often inadequately performed and undervalued. Here, we review the physiologic and anatomic basis for the jugular venous pressure, including the discrepancy between right atrial and central venous pressures. We also describe the correct method of evaluating this clinical finding and review the clinical relevance of the jugular venous pressure, especially its value in assessing the severity and response to treatment of congestive heart failure. Waveforms reflective of specific conditions are also discussed. PMID:24085809

  11. Venous imaging-based biomarkers in acute ischaemic stroke.

    PubMed

    Munuera, Josep; Blasco, Gerard; Hernández-Pérez, María; Daunis-I-Estadella, Pepus; Dávalos, Antoni; Liebeskind, David S; Wintermark, Max; Demchuk, Andrew; Menon, Bijoy K; Thomalla, Götz; Nael, Kambiz; Pedraza, Salvador; Puig, Josep

    2017-01-01

    Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography. Finally, the presence of hypodense veins on T2* -based MRI. From the physiological point of view, the venous imaging-based biomarkers would detect the alteration of brain perfusion (flow), as well as the optimisation of extraction oxygen mechanisms (misery perfusion). Several studies have correlated the venous imaging-based biomarkers with grade of collateral circulation, the ischaemic penumbra and clinical functional outcome. Although venous imaging-based biomarkers still have to be validated, growing evidence highlights a potential complementary role in the acute stroke clinical decision-making process.

  12. Exocrine drainage in vascularized pancreas transplantation in the new millennium

    PubMed Central

    El-Hennawy, Hany; Stratta, Robert J; Smith, Fowler

    2016-01-01

    The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to re-create the natural physiology of the pancreas with first-pass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the literature on exocrine drainage in the new millennium (the purported

  13. Venous oxygen saturation.

    PubMed

    Hartog, Christiane; Bloos, Frank

    2014-12-01

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

  14. Central venous line - infants

    MedlinePlus

    A central venous line (CVL) is a long, soft, plastic tube that is put into a large vein in the chest. WHY IS A CVL USED? A CVL is often put in when a baby cannot get a ... (MCC). A CVL can be used to give nutrients or medicines to a ...

  15. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency.

    PubMed

    Zaniewski, Maciej; Simka, Marian

    2012-05-01

    This article discusses the biophysical aspects of venous outflow from the brain in healthy individuals and in patients with chronic cerebrospinal venous insufficiency. Blood flows out of the brain differently, depending on body position. In the supine position it flows out mainly through internal jugular veins, while in the upright position it uses the vertebral veins. This phenomenon is probably not due to the active regulation of the flow but instead results from the collapse of jugular veins when the head is elevated. Such a collapse is associated with a significant increase in flow resistance, which leads to redirection of the flow towards the vertebral pathway. Theoretical calculations respecting the rules of fluid mechanics indicate that the pressure gradients necessary for moving blood from the brain toward the heart differ significantly between the supine and upright positions. The occlusion of internal jugular veins, according to fluid mechanics, should result in significant increase in the flow resistance and the restriction of cerebral flow, which is in line with clinical observations. Importantly, the biophysical analysis of cerebral venous outflow implies that the brain cannot easily compensate for increased peripheral venous resistance (namely, an occlusion of the large extracranial veins draining this organ), either by elevating the pressure gradient or by decreasing the vascular resistance through the recruitment of additional drainage pathways. This may mean that chronic cerebrospinal venous insufficiency may cause the destruction of the delicate nervous tissue of the central nervous system.

  16. Predicted burden of venous disease.

    PubMed

    Onida, Sarah; Davies, Alun Huw

    2016-03-01

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

  17. Glycosaminoglycan sulodexide modulates inflammatory pathways in chronic venous disease.

    PubMed

    Mannello, F; Ligi, D; Raffetto, J D

    2014-06-01

    Inflammation represents an important epiphenomenon in the etiopathogenesis of chronic venous disease, a worldwide debilitating condition affecting millions of subjects. The pathophysiology of chronic venous disease (CVD) is based on the hemodynamic abnormalities in conjunction to alterations in cellular and extracellular matrix biocompounds. The endothelial dysfunction results from early perturbation in the endothelium linked to glycocalyx injury and promoted by inflammatory cells and mediators (such as matrix metalloproteinases and interleukins), which lead to progressive dilation of the vein resulting in chronic venous insufficiency. Activated leukocytes during the inflammatory process release enzymes, free radicals, chemokines and inflammatory cytokines in the vessel microenvironment, which are responsible for the changes of the venous wall and venous valve, reflux and venous hypertension, and the development/progression of tissue destruction and skin changes. Sulodexide, a highly purified mixture of glycosaminoglycans composed by 80% fast moving heparin and 20% of dermatan sulphate, exhibits anti-thrombotic and profibrinolytic properties, restoring also the essential endothelial glycocalyx. Glycosaminoglycan sulodexide has been also characterized to reduce the release of inflammatory cytokines/chemokines and to inhibit the matrix metalloproteinases-related proteolytic cascades, counteracting endothelial dysfunctions. The pleiotropic effects of sulodexide set the basis for a very promising agent in treating the spectrum of CVD.

  18. [Roentgendiagnostic of the peritoneovenous drainage after Le Veen for ascitestreatment (author's transl)].

    PubMed

    Vogel, H; Dahm, K

    1978-12-01

    The peritoneovenous drainage after Le Veen offers a possibility of the ascitestreatment. The roentgenexamination showed wrong positions of the katheter as the most frequent cause of dysfunctions. They were regularly combined with venous obstructions. The intraoperativ x-ray diagnostic can fascilate the shunt application and may help to spare a second operation.

  19. Venous Thromboembolism in Children with Cancer and Blood Disorders

    PubMed Central

    Ko, Richard H.; Thornburg, Courtney D.

    2017-01-01

    Venous thromboembolism (VTE) in children is multifactorial and most often related to a combination of inherited and acquired thrombophilias. Children with cancer and blood disorders are often at risk for VTE due to disease-related factors such as inflammation and abnormal blood flow and treatment-related factors such as central venous catheters and surgery. We will review risk factors for VTE in children with leukemia, lymphoma, and solid tumors. We will also review risk factors for VTE in children with blood disorders with specific focus on sickle cell anemia and hemophilia. We will present the available evidence and clinical guidelines for prevention and treatment of VTE in these populations. PMID:28220143

  20. Malfunctioning central venous catheters in children: a diagnostic approach

    PubMed Central

    Barnacle, Alex; Arthurs, Owen J.; Roebuck, Derek

    2007-01-01

    Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or ‘linogram’ technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications. PMID:17932667

  1. Drainage networks after wildfire

    USGS Publications Warehouse

    Kinner, D.A.; Moody, J.A.

    2005-01-01

    Predicting runoff and erosion from watersheds burned by wildfires requires an understanding of the three-dimensional structure of both hillslope and channel drainage networks. We investigate the small-and large-scale structures of drainage networks using field studies and computer analysis of 30-m digital elevation model. Topologic variables were derived from a composite 30-m DEM, which included 14 order 6 watersheds within the Pikes Peak batholith. Both topologic and hydraulic variables were measured in the field in two smaller burned watersheds (3.7 and 7.0 hectares) located within one of the order 6 watersheds burned by the 1996 Buffalo Creek Fire in Central Colorado. Horton ratios of topologic variables (stream number, drainage area, stream length, and stream slope) for small-scale and large-scale watersheds are shown to scale geometrically with stream order (i.e., to be scale invariant). However, the ratios derived for the large-scale drainage networks could not be used to predict the rill and gully drainage network structure. Hydraulic variables (width, depth, cross-sectional area, and bed roughness) for small-scale drainage networks were found to be scale invariant across 3 to 4 stream orders. The relation between hydraulic radius and cross-sectional area is similar for rills and gullies, suggesting that their geometry can be treated similarly in hydraulic modeling. Additionally, the rills and gullies have relatively small width-to-depth ratios, implying sidewall friction may be important to the erosion and evolutionary process relative to main stem channels.

  2. ABNORMAL FRAGILARIA SPP. (BACILLARIOPHYCEAE) IN STREAMS IMPACTED BY MINE DRAINAGE

    EPA Science Inventory

    Periphytic diatom samples from a metal-contaminated Rocky Mountain river in Colorado, U.S.A. were analyzed on two occasions for the presence of morphological abnormalites. Samples were collected from natural (rocks) and artificial (tiles) substrates at 12 sites displaying a range...

  3. Association Between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage

    PubMed Central

    Alexander, Matthew D.; Cooke, Daniel L.; Nelson, Jeffrey; Guo, Diana E.; Dowd, Christopher F.; Higashida, Randall T.; Halbach, Van V.; Lawton, Michael T.; Kim, Helen; Hetts, Steven W.

    2015-01-01

    Background and Purpose Intracranial hemorrhage is the most serious outcome for brain arteriovenous malformations (AVM). This study examines associations between venous characteristics of these lesions and intracranial hemorrhage. Materials and Methods Statistical analysis was performed on a prospectively maintained database of brain AVMs evaluated at an academic medical center. DSA, CT, and MRI studies were evaluated to classify lesion side, drainage pattern, venous stenosis, number of draining veins, venous ectasia, and venous reflux. Logistic regression analyses were performed to identify association of these angiographic features with intracranial hemorrhage of any age at initial presentation. Results Exclusively deep drainage (OR 3.42, 95% CI 1.87–6.26, p<0.001) and a single draining vein (OR 1.98, 95% CI 1.26–3.08, p=0.002) were associated with hemorrhage, whereas venous ectasia (OR 0.52, 95% CI 0.34–0.78, p=0.002) was inversely associated with hemorrhage. Conclusion Analysis of venous characteristics of brain AVMs may help determine their prognosis and thereby identify lesions most appropriate for treatment. PMID:25634722

  4. Image Findings in Brain Developmental Venous Anomalies

    PubMed Central

    Lee, Mong

    2012-01-01

    Objective Developmental venous anomalies (DVAs) are benign anatomic variations; therefore, they are usually discovered incidentally. The aim of this article was to describe radiological findings of DVAs. Methods A retrospective search for DVAs of the brain was performed in 1899 patients who had undergone magnetic resonance imaging (MRI) with contrast enhancement between January 1, 2005 and April 25, 2011. We also reviewed the results of computed tomography (CT), magnetic resonance angiography (MRA), CT angiography, and transfemoral cerebral angiography (TFCA) studies performed in patients with DVAs. Results Thirty-two DVAs were identified in 31 of the 1899 patients (1.63%). These 31 patients underwent five enhanced CTs, three MRAs, two CT angiographies, and two TFCAs. Thirty of the 32 DVAs were supratentorial (ST) and two were infratentorial (IT). All enhanced MRI studies exhibited excellent resolution of DVAs. All DVAs had only one draining vein. The venous drainage system was an IT vein in three DVAs and an ST vein in 29 DVAs. Two out of five enhanced CTs presented good visualization of the draining vein. None of the MRAs, including the source image, revealed the presence of DVAs. The two CT angiographies exhibited good resolution of DVAs. One of the two TFCAs yielded an excellent illustration of the DVA. Conclusion CT angiography and MRI with contrast enhancement yielded detailed findings of DVAs. In contrast, MRA did not identify the DVAs. Enhanced CT presented only the draining vein of DVAs. PMID:23210028

  5. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis

    PubMed Central

    2013-01-01

    Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular. CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation. Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius. CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917

  6. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

  8. Venous Leg Ulcers.

    PubMed

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

    2016-08-02

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

  9. Unusual venous sinuses.

    PubMed

    Srijit, D; Shipra, P

    2007-01-01

    The dural venous sinuses lie in between the two layers of the dura mater. The dural venous sinuses are important, because they receive blood from the brain and the cranial bones. All sinuses are related to the inner surface of the skull, except for the inferior sagittal and the straight sinus. The sinuses related to the inner surface of the skull produce impressions on it. During routine ostelogical teaching for undergraduate medical students, we observed an unusual oblique sinus, which connected the right and the left transverse sinuses. This unusual oblique sinus measured 2 cm and had a course from the right to the left side. The superior sagittal sinus turned onto the right but at a much higher level than the left transverse sinus. Although these sinuses communicated with each other, the normal position of the confleunce of the sinus (meeting point of superior sagittal sinus, right and left transverse sinus and the occipital sinus) was not seen. The impression meant for the posterior lobe of the left cerebral hemisphere was distinctly greater than that of the right side. The presence of such an anomaly suggests a possible developmental defect or handedness of the individual. The knowledge of the anatomical variations of the dural venous sinuses may have great clinical implications during venography, shunt surgeries and also helpful for neurologists and radiologists in addition to academic interest (Fig. 2, Ref 10) Full Text (Free, PDF) www.bmj.sk.

  10. [Drainage in thyroid surgery].

    PubMed

    Ardito, G; Revelli, L; Guidi, M L; Murazio, M; Lucci, C; Modugno, P; Di Giovanni, V

    1999-01-01

    Bleeding represents a rare complication of thyroid surgery but when it occurs it may be life-threatening. To prevent this complication drainage is widely used. However no study has demonstrated the drains' value and recent reports have questioned its benefits. Therefore we have analyzed our experience of a 10 year-period in which 1.217 thyroidectomies were performed by the same surgical team and prophylactic routine drainage was always adopted. In 13 patients (1.06%) a benign hematoma occurred with spontaneous remission. In 6 patients the bleeding was severe and compressive hematoma occurred; it required surgical re-exploration. Such a complication is unusual in the neck surgery (0.49% in the authors' series) performed by experienced surgeons and when life-threatening hematomas do occur they depend on various uncontrolled factors and drainage is often not helpful. Otherwise a meticulous haemostatic technique is necessary and patients should be observed very closely during the few first hours following surgery on the thyroid gland. Therefore on the basis of the analysis of their series, although it is not always possible to prove the benefit of the drainage, the authors suggest its indication in the neck surgery, as in other fields with dead space, to remove blood and secretions reducing postoperative complications. They have never observed wound infections and patients were discharged within 72 hours.

  11. Drainage Water Filtration

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tile drainage discharge from managed turf is known to carry elevated concentrations of agronomic fertilizers and chemicals. One approach being considered to reduce the transport is end-of-tile-filters. Laboratory and field studies have been initiated to address the efficacy of this approach. Result...

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

    PubMed

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

    2001-02-01

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

  13. Venous leg ulcers

    PubMed Central

    2011-01-01

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

  14. Baller-Gerold syndrome associated with congenital portal venous malformation.

    PubMed Central

    Savarirayan, R; Tomlinson, P; Thompson, E

    1998-01-01

    We report a 4 year old boy in whom the clinical features of craniosynostosis and bilateral absent radii led to a diagnosis of Baller-Gerold syndrome. Additional congenital abnormalities included midface hypoplasia, atrial and ventricular septal defects, right hydronephrosis, partial sacral agenesis, and anterior ectopic anus. Evidence of portal venous hypertension was present from 8 months and a congenital portal venous malformation was discovered at 2 years. This is the first reported case of Baller-Gerold syndrome associated with a congenital portal venous malformation. We discuss the diagnostic confusion between this syndrome and other overlapping malformation syndromes and propose optimal evaluation strategies aimed at clarifying the nosology of these syndromes. Images PMID:9733037

  15. Wound Drainage Culture (For Parents)

    MedlinePlus

    ... Your 1- to 2-Year-Old Wound Drainage Culture KidsHealth > For Parents > Wound Drainage Culture Print A A A What's in this article? ... de heridas What It Is A wound drainage culture is a test to detect germs such as ...

  16. Compression therapy for venous disease.

    PubMed

    Attaran, Robert R; Ochoa Chaar, Cassius I

    2017-03-01

    For centuries, compression therapy has been utilized to treat venous disease. To date it remains the mainstay of therapy, particularly in more severe forms such as venous ulceration. In addition to mechanisms of benefit, we discuss the evidence behind compression therapy, particularly hosiery, in various forms of venous disease of the lower extremities. We review compression data for stand-alone therapy, post-intervention, as DVT prevention, post-thrombotic syndrome and venous ulcer disease. We also review the data comparing compression modalities as well as the use of compression in mixed arteriovenous disease.

  17. Medical management of venous ulcers.

    PubMed

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

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

  18. Acid mine drainage

    USGS Publications Warehouse

    Bigham, Jerry M.; Cravotta, Charles A.

    2016-01-01

    Acid mine drainage (AMD) consists of metal-laden solutions produced by the oxidative dissolution of iron sulfide minerals exposed to air, moisture, and acidophilic microbes during the mining of coal and metal deposits. The pH of AMD is usually in the range of 2–6, but mine-impacted waters at circumneutral pH (5–8) are also common. Mine drainage usually contains elevated concentrations of sulfate, iron, aluminum, and other potentially toxic metals leached from rock that hydrolyze and coprecipitate to form rust-colored encrustations or sediments. When AMD is discharged into surface waters or groundwaters, degradation of water quality, injury to aquatic life, and corrosion or encrustation of engineered structures can occur for substantial distances. Prevention and remediation strategies should consider the biogeochemical complexity of the system, the longevity of AMD pollution, the predictive power of geochemical modeling, and the full range of available field technologies for problem mitigation.

  19. Evaluation and treatment of leg ulcers associated with chronic venous insufficiency.

    PubMed

    Marston, William

    2007-10-01

    The successful management of patients who have leg ulcers related to chronic venous disease requires optimal management of the wound bed, elimination of edema with compression, and correction of venous hypertension whenever possible. Healing of the wound itself requires compression, debridement, bacterial control, and stimulation of the wound bed. Prevention of ulcer recurrence is most effective if the patient is amenable to correction of the venous insufficiency. This is most successful when the superficial or perforator veins are the primary source. Quality diagnostic studies are critical in determining the anatomy and hemodynamic importance of various venous abnormalities and can guide appropriate interventional treatment. Venous corrective procedures usually can be performed using minimally invasive endovenous methods, which are associated with fewer complications and more rapid recovery than are major surgical techniques.

  20. [Travel and venous thromboembolism].

    PubMed

    Hallundbæk Mikkelsen, Kristian; Knudsen, Stine Ulrik; Nannestad Jørgensen, Lars

    2013-10-28

    A literature study on the association between travel and venous thromboembolism (VTE) is conducted. Studies examining the risk of travel-associated VTE, predisposing factors and prophylactic measures are presented. It is concluded that the absolute risk of travel-associated VTE is low and holds a 2-4 fold increase after travel. The risk increases with duration, presence of other risk factors for VTE and extremes of height. Stockings reduces the risk of asymptomatic VTE. Heparin is presumed to constitute protection whereas there is no evidence of a prophylactic effect of acetylsalicylic acid.

  1. Venous thromboembolism and pregnancy

    PubMed Central

    D’Uva, Maristella; Di Micco, Pierpaolo; Strina, Ida; De Placido, Giuseppe

    2010-01-01

    In recent decades, the association between a hypercoagulable state and its causes and adverse pregnancy outcome, in particular recurrent pregnancy loss (RPL) has been studied extensively. Although the first studies were focused only on the association between thrombophilia and RPL, subsequent studies underlined also a potential role of antithrombotic treatment to prevent vascular complication such as venous thromboembolism (VTE) during pregnancy. Thromboprophylaxis should be considered also for pregnant subjects carriers of molecular thrombophilia or that previously experienced VTE, in order to prevent VTE during pregnancy, while antithrombotic treatment for VTE should be performed during all pregnant periods. PMID:22282678

  2. Retrofitting for watershed drainage

    SciTech Connect

    Bennett, D.B. ); Heaney, J.P. )

    1991-09-01

    Over the past 8 years, degradation in Florida's Indian River Lagoon has taken the form of fish kills, reduced viable recreational and commercial fisheries, and loss of seagrass beds. Stormwater drainage practices in the watershed have been identified as the primary culprit in the slow demise of the lagoon. Specific drainage problems include an increased volume of freshwater runoff to the estuarine receiving water and deposition of organic sediments, reduced water clarity because of increased discharge of suspended solids and tea colored' groundwater - a result of drainage-canal-induced land dewatering, and eutrophication caused by nutrient loadings. In addition, poor flushing in lagoon segments makes runoff impacts even more damaging to the ecosystem. Recently, the lagoon has received national, regional, state, and local attention over its degradation and citizens' action and multi-agency efforts to restore it. To mitigate damage to the Indian River lagoon, agencies are considering alternatives such as retrofitting to reduce pollutant loads and implementing a more comprehensive watershed approach to stormwater management instead of individual controls on new development currently widely practiced. A comprehensive, long-term watershed control approach avoids unnecessary construction expenses, encourages cost-effective tradeoffs based on specific objectives, facilities performance monitoring, and accounts for cumulative impacts of continued growth in the watershed.

  3. Pathophysiology of chronic venous disease.

    PubMed

    Raffetto, J D; Mannello, F

    2014-06-01

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

  4. Imaging of venous compression syndromes

    PubMed Central

    Ganguli, Suvranu; Ghoshhajra, Brian B.; Gupta, Rajiv; Prabhakar, Anand M.

    2016-01-01

    Venous compression syndromes are a unique group of disorders characterized by anatomical extrinsic venous compression, typically in young and otherwise healthy individuals. While uncommon, they may cause serious complications including pain, swelling, deep venous thrombosis (DVT), pulmonary embolism, and post-thrombotic syndrome. The major disease entities are May-Thurner syndrome (MTS), variant iliac vein compression syndrome (IVCS), venous thoracic outlet syndrome (VTOS)/Paget-Schroetter syndrome, nutcracker syndrome (NCS), and popliteal venous compression (PVC). In this article, we review the key clinical features, multimodality imaging findings, and treatment options of these disorders. Emphasis is placed on the growing role of noninvasive imaging options such as magnetic resonance venography (MRV) in facilitating early and accurate diagnosis and tailored intervention. PMID:28123973

  5. [Eye and lymph drainage].

    PubMed

    Grüntzig, J; Schicha, H; Huth, F

    1979-06-01

    Up to now lymphatics in the eye could not be pointed out. An ocular lymph drainage is denied. Földi succeeded in producing experimentally the syndrome of "lymphostatic encephalopathy and ophthalmopathy" by operative blockade of the cervical lymphatics in animals. In the first part of the present paper a historical view considering the subject "Eye and lymphatic system" is given. In the second part it is entered into the particulars of own experimental studies. As to our own investigations, rabbits have been injected 99mTc-sulfur-colloid, 99mTc-microcolloid, 99mTc-Albumin and 198Au-colloid into the retrobulbar space, anterior chamber, vitreous body and subconjuctival space of one eye. Measurements of the activity's distribution have been made in vivo with an Anger type camera (pho-Gamma-IV Hp, Searle Nuclear Chicago) and in vitro after section with a sodium iodine crystal well counter (Clinimat-200, Picker). In some animals the investigation has been combined with a bilateral dissection of the cervical lymph nodes. After injection in the retrobulbar space a significant concentration of the activity could be observed for the most part in the equilateral Lymphonodulus cervicalis profundus. By the cervical lymph blockade the removal of lymphoctopic substances from the retrobulbar space was largely inhibited. After injection in the anterior chamber a significant concentration could be observed for the most part in the equilateral Lymphonodulus cervicalis superficialis. After intravitreal injection a drainage to the bilateral deep cervical lymph nodes could be observed. After injection into the subconjunctival space a significant accumulation of activity could be registered in the equilateral Lymphonoduli mandibulares and cervicales superficiales. The data substantiate a segmental lymph drainage from the eye: vitreous body and retrobulbar space for the most part into the Lymphonoduli cervicales profundi, anterior chamber and subconjunctival space for the most part into

  6. Massive multicystic dilatation of the uterine wall with myometrial venous thrombosis during pregnancy.

    PubMed

    Uotila, J; Dastidar, P; Martikainen, P; Kirkinen, P

    2004-09-01

    We present a pregnancy complicated by multicystic dilatation of the uterine wall during the second trimester, leading to massive uterine distension, anemia and preterm Cesarean section. The cystic changes detected by ultrasound and magnetic resonance imaging involved the whole uterine wall surrounding the entire amniotic cavity. Histopathological examination revealed the benign nature of the cystic changes, which represented dilated and thrombosed venous lacunae. Disturbed venous drainage, combined with local thrombosis, was likely to have led to the collection of a large volume of blood in the uterine wall and the subsequent multicystic change of the myometrium.

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

    PubMed

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

    2014-08-21

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

  8. Lymph drainage in pregnant women.

    PubMed

    Cataldo Oportus, Sylvia; de Paiva Rodrigues, Lilian; Pereira de Godoy, José Maria; Guerreiro Godoy, Maria de Fátima

    2013-01-01

    Aim. The aim of this study was to evaluate the efficacy of lymph drainage to reduce edema of pregnant women. Method. Pregnant women (30 limbs) from the Obstetrics Outpatient Clinic of the Medical School of Santa Casa in São Paulo in the period December 2009 to May 2010 were enrolled in this quantitative, prospective study. The patients, in the 5th to 8th months of gestation, were submitted to one hour of manual lymph drainage of the legs. The volume of the legs was measured by water displacement volumetry before and after one hour of drainage using the Godoy & Godoy manual lymph drainage technique. The paired t-test was used for statistical analysis with an alpha error of 5% being considered significant. Results. Manual lymph drainage significantly reduced swelling of the legs of pregnant women during the day (P = 0.04). Conclusion. Manual lymph drainage helps to reduce limb size during the day of pregnant women.

  9. Hyperhomocysteinaemia and chronic venous ulcers.

    PubMed

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

    2015-02-01

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

  10. Retinal abnormalities in β-thalassemia major

    PubMed Central

    Bhoiwala, Devang L.; Dunaief, Joshua L.

    2015-01-01

    Patients with beta (β)-thalassemia (β-TM: thalassemia major, β-TI: thalassemia intermedia) have a variety of complications that may affect all organs, including the eye. Ocular abnormalities include retinal pigment epithelium degeneration, angioid streaks, venous tortuosity, night blindness, visual field defects, decreased visual acuity, color vision abnormalities, and acute visual loss. Patients with β-TM are transfusion dependent and require iron chelation therapy (ICT) in order to survive. Retinal degeneration may result from either retinal iron accumulation from transfusion-induced iron overload or retinal toxicity induced by ICT. Some who were never treated with ICT exhibited retinopathy, and others receiving ICT had chelator-induced retinopathy. We will focus on retinal abnormalities present in individuals with β-TM viewed in light of new findings on the mechanisms and manifestations of retinal iron toxicity. PMID:26325202

  11. Venous complications of pancreatitis: a review.

    PubMed

    Aswani, Yashant; Hira, Priya

    2015-01-31

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

  12. Symptomatic Infratentorial Thrombosed Developmental Venous Anomaly: Case Report and Review of the Literature

    PubMed Central

    Amuluru, Krishna; Al-Mufti, Fawaz; Hannaford, Stephen; Singh, Inder Paul; Prestigiacomo, Charles J.; Gandhi, Chirag D.

    2016-01-01

    Background Developmental venous anomalies (DVAs) are variations of normal transmedullary veins draining white and gray matter. In the vast majority of cases, DVAs are diagnosed incidentally and should be considered as benign entities. In extremely rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. Thrombosis of the collector vein of a DVA is a rare type of a flow-related complication with only 29 cases reported in the literature, the majority of which are supratentorial. Infratentorial thrombosed DVAs are thus extremely rare and the few cases reported have typically caused symptoms due to venous ischemic infarctions. Summary We report a case of an infratentorial DVA with a thrombosed drainage vein in a patient with nonhemorrhagic, noninfarcted venous congestive edema, which was successfully treated with high-dose glucocorticoids and short-term anticoagulation. We review the pertinent venous anatomy of the posterior fossa as well as the literature of symptomatic infratentorial thrombosed DVAs. Key Message The presented case of an infratentorial thrombosed DVA with cerebellar and pontine venous congestive edema is extremely rare. A working knowledge of posterior fossa venous anatomy and possible pathomechanisms responsible for the rarely symptomatic lesion will aid in the timely and efficacious treatment of such lesions. PMID:27051409

  13. Contralateral Hypoplastic Venous Draining Sinuses Are Associated with Elevated Intracranial Pressure in Unilateral Cerebral Sinovenous Thrombosis.

    PubMed

    Farias-Moeller, R; Avery, R; Diab, Y; Carpenter, J; Murnick, J

    2016-12-01

    Variations in cerebral venous development can influence the ability to regulate drainage. In cerebral sinovenous thrombosis, these variations can be associated with elevated intracranial pressure. We present a series of pediatric patients with unilateral cerebral sinovenous thrombosis and investigate whether the contralateral venous sinus size increases the risk of developing elevated intracranial pressure. Patients diagnosed with a unilateral cerebral sinovenous thrombosis were identified by querying our institutional radiology data base. The difference in the occurrence of elevated intracranial pressure in patients with cerebral sinovenous thrombosis with and without hypoplastic venous sinuses was studied. Twelve cases of unilateral cerebral sinovenous thrombosis met the inclusion criteria and had sufficient images. Six patients had hypoplastic contralateral venous sinuses. The presence of hypoplastic contralateral venous sinus in the setting of thrombosis of a dominant sinus was associated with elevation of intracranial pressure (83% versus 0%, P = .015). Patients with cerebral sinovenous thrombosis and contralateral hypoplastic venous sinuses are at higher risk of developing elevated ICP and may benefit from screening with an ophthalmologic examination.

  14. Variability in the cardiac venous system of Wistar rats.

    PubMed

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

    2015-01-01

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

  15. Variability in the Cardiac Venous System of Wistar Rats

    PubMed Central

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

    2015-01-01

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

  16. Radiological evaluation of the chronic venous stasis syndrome

    SciTech Connect

    Train, J.S.; Schanzer, H.; Peirce, E.C. II; Dan, S.J.; Mitty, H.A.

    1987-08-21

    Chronic venous stasis is an extremely complex clinical syndrome of pain and changes in the skin that can involve the superficial, deep, and perforating veins. This syndrome is commonly referred to as the postphlebitic syndrome, implying that thrombophlebitis is its sole etiology. To test this hypothesis, the authors performed ascending venography on 51 limbs of patients with the chromic venous stasis syndrome and demonstrated that 32 had no radiological evidence of recent or old thrombophlebitis. Instead, they had normal-appearing veins, suggesting primary incompetence of the deep and/or perforating venous valves rather than thrombophlebitis as the etiology. Since various operations have recently been proposed to correct or bypass malfunctioning valves, precise demonstration of pathological change is required to choose the appropriate procedure and to evaluate results. Descending venograms were combined with the ascending studies in 42 limbs for this purpose. In addition to outlining the abnormalities responsible for chronic venous stasis syndrome in individual cases, interesting conclusions regarding the syndrome itself were reached.

  17. Clinicopathologic correlation of retinal to choroidal venous collaterals of the optic nerve head.

    PubMed

    Schatz, H; Green, W R; Talamo, J H; Hoyt, W F; Johnson, R N; McDonald, H R

    1991-08-01

    An optic nerve meningioma developed in an elderly woman and was followed for 13 years until her death. The optic nerve was initially normal. Over time it became swollen and then atrophic and developed retinal venous to choroidal venous collaterals. Five hundred serial sections were prepared through the optic nerve and for approximately 1.5 mm superiorly and inferiorly to the optic nerve to trace the course of the collaterals that were seen ophthalmoscopically and angiographically in the optic nerve head. This clinicopathologic study shows clearly that the abnormal channels are, in fact, retinal venous to choroidal venous collaterals (bypass channels). Four collaterals extended around the end of Bruch's membrane at the optic nerve head. Two more collaterals extended through the retinal pigment epithelium to become continuous with a subretinal pigment epithelial neovascular membrane, the vessels of which connected with the choroidal vessels through a defect in Bruch's membrane.

  18. Preoperative biliary drainage in Perihilar Cholangiocarcinoma: Identifying patients who require percutaneous drainage after failed endoscopic drainage

    PubMed Central

    Wiggers, Jimme K; Koerkamp, Bas Groot; Coelen, Robert J; Rauws, Erik A; Schattner, Mark A; Nio, C Yung; Brown, Karen T; Gonen, Mithat; van Dieren, Susan; van Lienden, Krijn P; Allen, Peter J; Besselink, Marc GH; Busch, Olivier RC; D’Angelica, Michael I; DeMatteo, Robert P; Gouma, Dirk J; Kingham, T Peter; Jarnagin, William R; van Gulik, Thomas M

    2016-01-01

    Background and study aims Preoperative biliary drainage is often initiated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with potentially resectable perihilar cholangiocarcinoma (PHC), but additional percutaneous transhepatic catheter (PTC) drainage is frequently required. This study aimed to develop and validate a prediction model to identify patients with a high risk of inadequate ERCP drainage. Patients and Methods Patients with potentially resectable PHC and preoperative (attempted) ERCP drainage were included from two specialty center cohorts between 2001 and 2013. Indications for additional PTC drainage were failure to place an endoscopic stent, failure to relieve jaundice, cholangitis, or insufficient drainage of the future liver remnant. A prediction model was derived from the European cohort and externally validated in the USA cohort. Results 108 of 288 patients (38%) required additional preoperative PTC after inadequate ERCP drainage. Independent risk factors for additional PTC were proximal biliary obstruction on preoperative imaging (Bismuth 3 or 4) and pre-drainage total bilirubin level. The prediction model identified three subgroups: patients with a low risk of 7%, a moderate risk of 40%, and a high risk of 62%. The high-risk group consisted of patients with a total bilirubin level above 150 μmol/L and Bismuth 3a or 4 tumours, who typically require preoperative drainage of the angulated left bile ducts. The prediction model had good discrimination (AUC 0.74) and adequate calibration in the external validation cohort. Conclusions Selected patients with potentially resectable PHC have a high risk (62%) of inadequate preoperative ERCP drainage requiring additional PTC. These patients might do better with initial PTC instead of ERCP. PMID:26382308

  19. Prenatal diagnoses of an uncommon isolated obstructed supracardiac total anomalous pulmonary venous connection

    PubMed Central

    Muntean, Iolanda; Mărginean, Claudiu; Stanca, Răzvan; Togănel, Rodica; Pop, Marian; Gozar, Liliana

    2017-01-01

    Abstract Introduction: Total anomalous pulmonary venous connection is an uncommon congenital heart disease. Four types are described based on the site of pulmonary venous drainage: supracardiac, cardiac, infradiaphragmathic, and mixed connection. In most cases of supracardiac type, the common venous confluence drains through an ascending left vertical vein into the brachiocephalic vein, right superior vena cava, and then into the right atrium. Anomalous connection of the pulmonary venous confluence directly to the right SVC, especially the obstructed form is an unusual and severe supracardiac variant. The prenatal diagnosis is challenging. Patient concerns: We present a case report of a fetus diagnosed with TAPVC at 23 gestational weeks. Diagnosis interventions: The 4-chamber view showed a small left atrium, with a “smooth” posterior wall and the absence of pulmonary vein connection. This is the first case of prenatally diagnosed isolated, obstructed supracardiac type with drainage directly into the right superior vena cava. Conclusion: The obstetrician and fetal cardiologist should be cautious at the direct and indirect echocardiographic signs of this condition. A prenatal diagnose of isolated, obstructed form is important for adequate planning of delivery and postnatal surgery in a tertiary center. PMID:28151919

  20. Management of Venous Thromboembolism

    PubMed Central

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

    2016-01-01

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

  1. Epidemiology of chronic venous disease.

    PubMed

    Robertson, L; Evans, C; Fowkes, F G R

    2008-01-01

    Chronic venous disease of the legs occurs commonly in the general population in the Western world. Estimates of the prevalence of varicose veins vary widely from 2-56% in men and from 1-60% in women. These variations reflect differences in variability of study populations including age, race and gender, methods of measurement and disease definition. Definitions of chronic venous disease may rely on reports of varicose veins by study participants, based on self-diagnosis or recall of a diagnosis, or on a standardized physical examination. Venous ulceration is less common, affecting approximately 0.3% of the adult population. Age and pregnancy have been established as risk factors for developing varicose veins. Evidence on other risk factors for venous disease is inconclusive. Prolonged standing has been proposed, but results of studies should be interpreted with caution given the difficulty in measuring levels of posture. Obesity has been suggested as a risk factor in women, but appears to be an aggravating factor rather than a primary cause. Other postulated risk factors include dietary intake and smoking, but evidence is lacking. Longitudinal studies using standardized methods of evaluation are required before the true incidence of chronic venous disease and associated risk factors can be determined.

  2. Percutaneous catheter drainage in intraabdominal fluid collections including infected biliary ducts and gallbladders

    SciTech Connect

    Miller, M.H.; Frederick, P.R.; Tocino, I.; Bahr, A.L.

    1982-12-01

    Sixty-five abscesses, including 6 infected biliary systems and 15 sterile fluid collections, were treated by percutaneous catheter drainage in 77 febrile patients who were evaluated by computerized tomography or ultrasonography of intraabdominal infection. Percutaneous catheter drainage and systemic antibiotic administration without surgery provided satisfactory control of infection in 52 of 65 abscesses (80 percent). Catheter drainage followed by surgical exploration for abscess control was performed in an additional 5 of 65 abscesses (7 percent). Nine death (14 percent) occurred in the abscess group of 64 patients. In 15 patients, aspirations, Gram stain, and culture of the abnormal fluid collection revealed sterile fluid. Drainage with a single catheter allowed complete resolution in 14 of 15 sterile collections. Surgery was performed electively in one patient with a fistula from a pancreatic pseudocyst in the small bowel. No deaths occurred in the noninfected group of 15 patients, 2 of whom underwent drainage of coexisting abscesses.

  3. Filter Fabrics for Airport Drainage.

    DTIC Science & Technology

    1979-09-01

    Systems for *r- field Pavements," Harry R. Cedergren . d. "Development of Guidelines for the Design of Subsurfac( Drainage Systems for Highway Pavement...Structural 4Sectic s," H. R. Cedergren , J. A. Arman, and K. H. O’Brien. e. Drainage of Highway and Airfield Pavements, Harry R. Cedergren .> Five...by Cedergren (974).5 Additionally, several references were used, particularly those describing experimental anu construction prolects using filter

  4. Dutch Venous Ulcer guideline update.

    PubMed

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

    2014-05-01

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

  5. Pharmacological prophylaxis of venous thrombo-embolism.

    PubMed

    Flute, P T

    1976-02-07

    The pathogenesis of venous thrombosis is briefly discussed as a basis for the understanding of preventive measures used in this condition. Prophylaxis in venous thrombosis is then reviewed with emphasis on pharmacological treatment, and more particularly on heparin.

  6. Preventing venous ulcer recurrence: a review.

    PubMed

    Vowden, Kathryn R; Vowden, Peter

    2006-03-01

    This review article examines the available evidence on both the primary and secondary prevention of venous ulceration, exploring both the individual, social and financial implications of system failures that allow patients to remain at increased risk of recurrent ulceration. The role of both venous disease assessment and corrective superficial venous surgery are discussed in the light of recently published randomised controlled studies on the role of superficial venous surgery as both an adjunct to ulcer healing and ulcer prevention.

  7. Urine - abnormal color

    MedlinePlus

    ... medlineplus.gov/ency/article/003139.htm Urine - abnormal color To use the sharing features on this page, please enable JavaScript. The usual color of urine is straw-yellow. Abnormally colored urine ...

  8. Tooth - abnormal colors

    MedlinePlus

    ... medlineplus.gov/ency/article/003065.htm Tooth - abnormal colors To use the sharing features on this page, please enable JavaScript. Abnormal tooth color is any color other than white to yellowish- ...

  9. Abnormal Head Position

    MedlinePlus

    ... cause. Can a longstanding head turn lead to any permanent problems? Yes, a significant abnormal head posture could cause permanent ... occipitocervical synostosis and unilateral hearing loss. Are there any ... postures? Yes. Abnormal head postures can usually be improved depending ...

  10. Skeletal limb abnormalities

    MedlinePlus

    ... medlineplus.gov/ency/article/003170.htm Skeletal limb abnormalities To use the sharing features on this page, please enable JavaScript. Skeletal limb abnormalities refers to a variety of bone structure problems ...

  11. Comparison of viscoelastic properties of walls and functional characteristics of valves in lymphatic and venous vessels.

    PubMed

    Ohhashi, T

    1987-12-01

    The principal function of the lymphatic and venous system is to maintain a favorable environment for cells of the body. As a consequence mainly of hydrostatic forces, shifts of fluid usually occur between the vascular system and the extracellular space. To compensate for these shifts the veins are capable of active and passive changes in capacity that serve to modulate the filling pressure of the heart by adjusting the central blood volume. In addition to the venous function, the lymphatic function also contributes to compensate for the fluid shifts by drainage from the interstitial space. Namely, the general function of the lymphatic system is to return fluid and protein which escapes from the blood capillaries to the lymph circulation. To elucidate the mode of venous and lymph transport, therefore, it is of essential importance to obtain basic knowledge of the mechanical characteristics of the walls of the vessels and the functional characteristics of the lymphatic and venous valves dividing two adjacent compartments. In this communication, in order to answer the question, "Are Lymphatics Different From Blood Vessels?", I would like to review a comparison of viscoelastic properties of walls and functional characteristics of valves in lymph and venous vessels by use of our original data obtained with isolated canine veins and thoracic ducts and with isolated bovine mesenteric lymphatics (1-9).

  12. Abnormal Uterine Bleeding FAQ

    MedlinePlus

    ... PROBLEMS Abnormal Uterine Bleeding • What is a normal menstrual cycle? • When is bleeding abnormal? • At what ages is ... treat abnormal bleeding? •Glossary What is a normal menstrual cycle? The normal length of the menstrual cycle is ...

  13. Air travel and venous thromboembolism.

    PubMed Central

    Mendis, Shanthi; Yach, Derek; Alwan, Ala

    2002-01-01

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

  14. Duplex evaluation of venous insufficiency.

    PubMed

    Labropoulos, Nicos; Leon, Luis R

    2005-03-01

    Duplex ultrasound is the most useful examination for the evaluation of venous valvular incompetence. Multi-frequency 4 to 7-MHz linear array transducers are typically used for this assessment of superficial and deep reflux. The examination is done with the patient standing and manual compression maneuvers are used to initiate reflux. Automatic rapid inflation and deflation cuffs may be used when a standard stimulus is needed. Cutoff values for reflux have been defined. Perforating veins must be identified and flow direction during compression recorded. When ulcers are present, duplex ultrasound is used to investigate veins of the ulcerated legs. Venous outflow obstruction is also studied by duplex ultrasound and chronic changes in deep and superficial veins following deep venous thrombosis noted. The main drawback in evaluation of chronic obstruction is inability to quantify hemodynamic significance. Anatomic variations in superficial and deep veins are common and their identification is necessary. Reporting results of duplex ultrasound studies must take into consideration the proper classification of venous disease as well as the new anatomic terms that have been accepted.

  15. Venous ulceration, fibrinogen and fibrinolysis.

    PubMed Central

    Leach, R. D.

    1984-01-01

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

  16. Anatomical basis of central venous catheter fracture.

    PubMed

    Jensen, Mark O

    2008-03-01

    Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.

  17. Intraosseous anomalous drainage: a rare case of pretibial varicose vein.

    PubMed

    Moraes, Frederico Barra de; Camelo, Carolina Parreira Ribeiro; Brandão, Marcelo Luiz; Fávaro, Pedro Ivo; Barbosa, Tercília Almeida; Barbosa, Raul Carlos

    2016-01-01

    Valve failure with reflux and post-thrombotic syndrome are the factors most commonly correlated with varicose disease. Other rare etiologies can be put forward when these two main causes are ruled out. We report a case in which a young man presented chronic pain in the left tibia, varicose veins in the lower limbs and frequent occurrences of erysipelas. During investigation of the etiology of the varicose veins, radiographs and magnetic resonance imaging of the left leg were requested. These showed images suggestive of an osteolytic lesion in the tibia, but led us to the diagnosis of an intraosseous vein with anomalous drainage. This was confirmed through vascular examinations comprising Doppler venous flow measurement and phlebography. Recognition of this rare intraosseous anomaly is fundamental for proper patient management, but an intraosseous surgical approach is unnecessary.

  18. Heimlich valve for chest drainage.

    PubMed

    Heimlich, H J

    1983-01-01

    The Heimlich chest drainage valve was developed so that the process of draining the pleural cavity could be accomplished in a safe, relatively simple, and efficient manner. Replacing the cumbersome underwater drainage bottle system, the Heimlich valve connects to chest tubing and allows fluid and air to pass in one direction only. The valve, which functions in any position, need never be clamped, and regulated suction can be attached to it if necessary. The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by carrying the bag. The construction and function of the valve is easily understood by medical and nursing staffs. It is presterilized, stored in a sterile package, and readily utilized on emergency vehicles and in the operating room.

  19. Abnormal Large Central Occipital Emissary Vein: A Case Report and Review of Literature

    PubMed Central

    Dolati, Parviz; Fusco, Matthew R; Ogilvy, Christopher S; Thomas, Ajith J.

    2016-01-01

    A detailed description of the anatomy of the central occipital emissary vein, its embryology, anatomy, and abnormal variations is not available in the literature. This is the first known case report. A 48-year-old female underwent cerebral angiography to rule out dural arterio-venous fistula. Her angiography revealed an abnormally large central occipital emissary vein originating from the torcula, penetrating the cranium and draining into the suboccipital venous plexus. We provide discussion of the case with a review of the related literature. This case and its attached radiological images introduce a new type of entity to the existing data about the cranial emissary veins. PMID:27330871

  20. Case of Cerebral Venous Thrombosis with Unusual Venous Infarcts

    PubMed Central

    Kamaraju, Susheel Kumar; Pasupaleti, Bhimeswarao; Juluri, Naganarasimharaju

    2015-01-01

    Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed. PMID:26023623

  1. Venous thromboembolic disease and cancer

    PubMed Central

    Fennerty, A

    2006-01-01

    Venous thromboembolic disease is a common cause of mortality and morbidity in patients with cancer. Patients have a 5–6‐fold increase in the risk for a venous thromboembolism (VTE) compared with the general population, increasing to 6–7‐fold for some cancers. Prophylaxis for VTE should be considered whenever additional risk factors intervene. About 10% of patients with an idiopathic VTE will harbour an occult cancer. Half of these can probably be detected after a focused history, examination, routine blood tests and a chest x ray. The remaining cases may be diagnosed with an intensive screening protocol. About 60% of patients diagnosed on screening will have early disease, but we do not know whether screening improves the outcome. Evidence suggests that patients with cancer and a VTE should be treated with low‐molecular‐weight heparin, and treatment continued until the cancer is cured. PMID:17068274

  2. [Bases of central venous catheterization].

    PubMed

    Schmalz-Ott, Stéphane; Monti, Matteo; Vollenweider, Peter

    2008-10-29

    Central venous catheterization is a frequently performed procedure in internal medicine units. Residents in training frequently share the same questions, doubts and fears about this procedure : "Should I perform a subclavian catheterization in a patient with mild thrombopenia?"; "Which site has the lesser complication rate?"; "After how long does a catheter need to be replaced?". This mini-review of the current literature tries to answer this and other questions.

  3. Fibrinogen and red blood cells in venous thrombosis.

    PubMed

    Aleman, Maria M; Walton, Bethany L; Byrnes, James R; Wolberg, Alisa S

    2014-05-01

    Deep vein thrombosis and pulmonary embolism, collectively termed venous thromboembolism (VTE), affect over 1 million Americans each year. VTE is triggered by inflammation and blood stasis leading to the formation of thrombi rich in fibrin and red blood cells (RBCs). However, little is known about mechanisms regulating fibrin and RBC incorporation into venous thrombi, or how these components mediate thrombus size or resolution. Both elevated circulating fibrinogen (hyperfibrinogenemia) and abnormal fibrin(ogen) structure and function, including increased fibrin network density and resistance to fibrinolysis, have been observed in plasmas from patients with VTE. Abnormalities in RBC number and/or function have also been associated with VTE risk. RBC contributions to VTE are thought to stem from their effects on blood viscosity and margination of platelets to the vessel wall. More recent studies suggest RBCs also express phosphatidylserine, support thrombin generation, and decrease fibrinolysis. RBC interactions with fibrin(ogen) and cells, including platelets and endothelial cells, may also promote thrombus formation. The contributions of fibrin(ogen) and RBCs to the pathophysiology of VTE warrants further investigation.

  4. Direct cholangiography and biliary drainage.

    PubMed

    Burcharth, F; Kruse, A

    1996-01-01

    Direct cholangiography by percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography has greatly improved diagnostic work-up of patients with known or suspected biliary obstruction. These diagnostic procedures were introduced in Denmark in the early 1970s, and technical refinements and clinical research of the methods were initiated. The Danish contribution led to definition of indications for direct cholangiography and general acceptance of the methods in daily clinical practice; nationally as well as internationally. The transhepatic cholangiography with selective catheterization of the biliary ducts permitted external drainage of obstructed ducts. The disadvantages of this technique inspired the innovation of internal biliary drainage and the invention of the biliary endoprosthesis. The endoscopic approach to the biliary tract and the technical improvements of accessory instruments led to the early introduction of therapeutic procedures, i.e. papillotomy, stone removal, biliary drainage and treatment of strictures and post-traumatic lesions. Experimental and clinical research with endoprostheses improved their function and prevented dislodgment. Clinical research documented that biliary drainage by endoprosthesis is a valuable alternative to surgical bypass in patients with inoperable biliary obstructions. Endoscopic therapeutic procedures for common bile duct stones have almost replaced conventional surgical treatment. Endoluminal imaging techniques are under evaluation and may contribute to future improvements.

  5. Recurrent Hemorrhagic Venous Infarctions Caused by Thrombosis of a Pontine Developmental Venous Anomaly and Protein S Mutation.

    PubMed

    Nakamura, Yuri; Takase, Kei-Ichiro; Matsushita, Takuya; Yoshimura, Satoshi; Yamasaki, Ryo; Murai, Hiroyuki; Kikuchi, Kazufumi; Kira, Jun-Ichi

    2016-11-01

    A 34-year-old man presented with an acute onset of upbeat nystagmus, slurred speech, and limb and truncal ataxias. The patient had a history of limb ataxia and gait disturbance previously treated as brainstem encephalitis with corticosteroids 3 years previously. Brain magnetic resonance imaging showed pontine developmental venous anomaly (DVA) and hemorrhagic infarction within the drainage territory of the DVA. Three months later, the patient exhibited recurrent limb ataxia, double vision, and numbness of the left side of the body. The brain magnetic resonance imaging revealed recurrent hemorrhagic venous infarction within the same territory of the pontine DVA. Laboratory tests disclosed a hypercoagulable state owing to a decrease of protein S activity despite the normal antigen level. Genetic testing indicated that the patient was a homozygous carrier of protein S Tokushima. The patient's severe disability remained unchanged in spite of treatment with anticoagulation therapy using warfarin. We propose that further research on hereditary coagulopathy be carried out in patients with recurrent episodes of DVA-related infarction.

  6. Drainage-Area Data for Wisconsin Streams

    DTIC Science & Technology

    1983-01-01

    drainage areas for gaging stations, sewage-treatment plants, dams , major highway crossings, and other sites where discharge measurements or water-quality...streams of 10 mil or more . Also, areas have been determined for sewage-treatment plants, dams , major highway crossings, gaging stations, and other...plants, ma- jor highway crossings, dam , and powerplants . Drainage Area The column under the drainage-area heading lists the drainage-area of the site

  7. Misplaced central venous catheter in the jugular venous arch exposed during dissection before sternotomy.

    PubMed

    Jung, Tae-Eun; Jee, Daelim

    2008-11-01

    Subclavian vein catheterization rarely results in misplacement of the central venous catheter (CVC) into the jugular venous arch (JVA). We present a case of misplacement of the CVC into the JVA during cardiac surgery.

  8. Asplenia and polysplenia syndromes with abnormalities of lateralisation in a sibship.

    PubMed Central

    Zlotogora, J; Elian, E

    1981-01-01

    In the family presented here the first child had asplenia syndrome with cor biloculare' transposition of the great vessels, pulmonary stenosis, and anomalous pulmonary venous drainage. Another sib had situs inversus with polysplenia syndrome, including very similar cardiovascular defects and biliary atresia. The possibility that these two syndromes, namely asplenia and polysplenia, are different manifestations of a similar defect in the normal asymmetrical development of internal organs is discussed. PMID:7277426

  9. Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage

    SciTech Connect

    Stockland, Andrew H.; Willingham, Darrin L.; Paz-Fumagalli, Ricardo; Grewal, Hani P.; McKinney, J. Mark; Hughes, Christopher B.; Walser, Eric M.

    2009-03-15

    Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean, 9 days). Five patients were systemic-enteric (donor portal vein anastomosis to recipient iliac vein) and one patient was portal-enteric (donor portal vein anastomosis to recipient superior mesenteric vein). Conventional venography confirmed the diagnosis of venous thrombosis in all patients. One patient was treated with catheter-directed venous thrombolysis and balloon thrombectomy. Another patient was treated with rheolytic thrombectomy alone. The remaining four patients were treated with a combination of these mechanical and thrombolytic techniques. Completion venography revealed >50% clot reduction and resumption of venous drainage in all patients. One patient required additional intervention 16 days later for recurrent thrombosis. Two patients required metal stent placement for anastomotic stenoses or kinks. One patient required pancreatectomy 36 h after attempted salvage secondary to a major hemorrhage and graft necrosis. Two patients recovered pancreatic function initially but lost graft function at 8 and 14 months, respectively, from severe chronic rejection. Patient survival was 100%, long-term graft survival was 50%, rethrombosis rate was 16.6%, and graft loss from rejection was 33%. In conclusion, early recognition and treatment of venous thrombosis after pancreas transplantation has acceptable morbidity and no mortality using short-term endovascular pharmacomechanical therapy.

  10. Structurally abnormal human autosomes

    SciTech Connect

    1993-12-31

    Chapter 25, discusses structurally abnormal human autosomes. This discussion includes: structurally abnormal chromosomes, chromosomal polymorphisms, pericentric inversions, paracentric inversions, deletions or partial monosomies, cri du chat (cat cry) syndrome, ring chromosomes, insertions, duplication or pure partial trisomy and mosaicism. 71 refs., 8 figs.

  11. Drainage-area data for Wisconsin streams

    USGS Publications Warehouse

    Henrich, E.W.; Daniel, D.N.

    1983-01-01

    Drainage areas were delineated on U.S. Geological Survey topographic maps. Drainage areas are shown in tabular form under six headings : station number; stream name, rank, and location; township, range, and section ; county; type of site; and drainage area. Eleven major-river-basin maps show the location and station number of key sites .

  12. Mine Drainage Control and Treatment Options

    EPA Science Inventory

    This presentation is the third in a series of webinars for Region 10's Hardrock Mine Geochemistry and Hydrology Webinar Workshops. It will discuss briefly how mine drainage forms, some suggested mitigation methods, how ions in the drainage change if drainage does get to the envi...

  13. Misplaced central venous catheters: applied anatomy and practical management.

    PubMed

    Gibson, F; Bodenham, A

    2013-03-01

    Large numbers of central venous catheters (CVCs) are placed each year and misplacement occurs frequently. This review outlines the normal and abnormal anatomy of the central veins in relation to the placement of CVCs. An understanding of normal and variant anatomy enables identification of congenital and acquired abnormalities. Embryological variations such as a persistent left-sided superior vena cava are often diagnosed incidentally only after placement of a CVC, which is seen to take an abnormal course on X-ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after such attempts. Catheters can also be misplaced outside veins in a patient with otherwise normal anatomy with potentially disastrous consequences. We discuss the possible management options for these patients including the various imaging techniques used to verify correct or incorrect catheter placement and the limitations of each. If the course of a misplaced catheter can be correctly identified as not lying within a vulnerable structure then it can be safely removed. If the misplaced catheter is lying within or traversing large and incompressible arteries or veins, it should not be removed before consideration of what is likely to happen when it is removed. Advice and further imaging should be sought, typically in conjunction with interventional radiology or vascular surgery. With regard to misplaced CVCs, in the short term, a useful aide memoir is: 'if in doubt, don't take it out'.

  14. Unicameral bone cyst: radiographic assessment of venous outflow by cystography as a prognostic index.

    PubMed

    Ramirez, Ana; Abril, Juan Carlos; Touza, Alberto

    2012-11-01

    The aim of this study was to determine the benefits of cystography in the management of a simple bone cyst, its implication in the final result of the treatment after corticoid intracystic injections, and the presence of secondary effects. We retrospectively reviewed 42 patients diagnosed with a simple bone cyst. Cystography was performed before the corticoid injection. The presence or absence of loculation intracyst and the existence and number of venous outflows were determined. According to the venous drainage, cysts were classified as type 0 when a venous outflow did not exist and as type 1 when there was a rapid venous outflow (<3 min). The treatment protocol included a maximum of three corticoid injections at an interval of 6 months. Healing of the cyst was determined on the basis of Neer's criteria. Secondary effects and surgical complications were assessed. Cystography studies showed a unicameral bone cyst with absent loculation in 16 cases (37.3%), whereas the lesion showed multiloculation in 26 cases (62.7%). There was no statistical difference between loculation intracyst (present or absent) and the final outcomes of the 42 cysts treated with a steroid injection (P=0.9). Cystography showed a negative venogram in 10 cases (23.8%), whereas the cysts showed a rapid venous outflow in 32 cases (76.2%). On the basis of Neer's classification, all patients with a negative venogram achieved complete healing of the cyst. Patients with a rapid venous outflow achieved complete healing in 14 cases (Neer I). In two patients, the healing was incomplete at the end of the follow-up period (Neer IV). In most cases (21 cysts), healing was partial (Neer II). Five patients showed a recurrence after initial healing of the cyst (Neer III) (P<0.05). The number or the size of veins did not affect healing of a bone cyst (P=0.6). Two patients with a rapid venous outflow showed a generalized hypertrichosis after the first injection of corticosteroids. Sex and age at the initiation

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

    PubMed Central

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

    1991-01-01

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

  16. Morphological abnormalities among lampreys

    USGS Publications Warehouse

    Manion, Patrick J.

    1967-01-01

    The experimental control of the sea lamprey (Petromyzon marinus) in the Great Lakes has required the collection of thousands of lampreys. Representatives of each life stage of the four species of the Lake Superior basin were examined for structural abnormalities. The most common aberration was the presence of additional tails. The accessory tails were always postanal and smaller than the normal tail. The point of origin varied; the extra tails occurred on dorsal, ventral, or lateral surfaces. Some of the extra tails were misshaped and curled, but others were normal in shape and pigment pattern. Other abnormalities in larval sea lampreys were malformed or twisted tails and bodies. The cause of the structural abnormalities is unknown. The presence of extra caudal fins could be genetically controlled, or be due to partial amputation or injury followed by abnormal regeneration. Few if any lampreys with structural abnormalities live to sexual maturity.

  17. Venous Cannula Positioning in Arterial Deoxygenation During Veno‐Arterial Extracorporeal Membrane Oxygenation—A Simulation Study and Case Report

    PubMed Central

    Lindfors, Mattias; Frenckner, Björn; Sartipy, Ulrik; Bjällmark, Anna

    2016-01-01

    Abstract Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is indicated in reversible life‐threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed‐loop real‐time simulation model has been developed including vascular segments, the heart with valves and pericardium. ECMO was simulated with a fixed flow pump and a selection of clinically relevant venous cannulation sites. A clinical case with no tidal volumes due to pneumonia and an arterial saturation of below 60% in the right hand despite VA‐ECMO flow of 4 L/min was described. The case was compared with simulation data. Changing the venous cannulation site from the inferior to the superior caval vein increased arterial saturation in the right arm from below 60% to above 80% in the patient and from 64 to 81% in the simulation model without changing ECMO flow. The patient survived, was extubated and showed no signs of hypoxic damage. We conclude that venous drainage from the superior caval vein improves upper body arterial saturation during veno‐arterial ECMO as compared with drainage solely from the inferior caval vein in patients with respiratory failure. The results from the simulation model are in agreement with the clinical scenario. PMID:27086941

  18. Venous Cannula Positioning in Arterial Deoxygenation During Veno-Arterial Extracorporeal Membrane Oxygenation-A Simulation Study and Case Report.

    PubMed

    Lindfors, Mattias; Frenckner, Björn; Sartipy, Ulrik; Bjällmark, Anna; Broomé, Michael

    2017-01-01

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in reversible life-threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed-loop real-time simulation model has been developed including vascular segments, the heart with valves and pericardium. ECMO was simulated with a fixed flow pump and a selection of clinically relevant venous cannulation sites. A clinical case with no tidal volumes due to pneumonia and an arterial saturation of below 60% in the right hand despite VA-ECMO flow of 4 L/min was described. The case was compared with simulation data. Changing the venous cannulation site from the inferior to the superior caval vein increased arterial saturation in the right arm from below 60% to above 80% in the patient and from 64 to 81% in the simulation model without changing ECMO flow. The patient survived, was extubated and showed no signs of hypoxic damage. We conclude that venous drainage from the superior caval vein improves upper body arterial saturation during veno-arterial ECMO as compared with drainage solely from the inferior caval vein in patients with respiratory failure. The results from the simulation model are in agreement with the clinical scenario.

  19. Aldosterone-cortisol imbalance immediately after fontan operation with implications for abnormal fluid homeostasis.

    PubMed

    Saiki, Hirofumi; Kuwata, Seiko; Kurishima, Clara; Iwamoto, Yoichi; Ishido, Hirotaka; Masutani, Satoshi; Senzaki, Hideaki

    2014-11-15

    Abnormal water metabolism is frequently observed after Fontan surgery. We hypothesized that patients' adrenal hormones show unique responses immediately after Fontan operation and that such a hormonal profile is related to postoperative hemodynamics and water imbalance. Twenty-eight patients who underwent a Fontan operation (n = 16) or a non-Fontan type operation (n = 12; controls) under cardiopulmonary bypass were studied. Postoperative urine cortisol and aldosterone levels were measured daily to minimize the influence of circadian rhythms and temporal hemodynamic variations. Cortisol excretion was markedly elevated on postoperative day (POD) 0 in controls, consistent with a stress-induced cortisol response. Cortisol excretion was not high on POD 0 in Fontan patients and was markedly lower than that in the controls (444 ± 150 vs 34 ± 6 μg/m(2)/day, p <0.05), indicating an adrenal insufficiency status. Conversely, aldosterone levels were significantly higher in Fontan patients than in controls immediately after surgery and remained so thereafter. The cortisol-to-aldosterone ratio was significantly lower in Fontan patients on POD 0 (p <0.05 vs controls); low cortisol-to-aldosterone ratios were associated with a longer pleural drainage duration and intensive care unit stay. Daily cortisol and aldosterone levels were significantly associated with postoperative hemodynamics; low cortisol levels correlated with low cardiac and urine outputs, whereas high aldosterone levels correlated with low cardiac output and increased blood pressure and central venous pressure. Thus, aldosterone-to-cortisol imbalance occurred specifically after the Fontan operation. This unique hormonal profile significantly affected patients' postoperative water balance and hemodynamics. Modulation of the adrenal hormone could be useful for reducing postoperative complications after the Fontan operation.

  20. Computed tomographic observations pertinent to intracranial venous thrombotic and occulsive disease in childhood: state of the art, some new data, and hypotheses

    SciTech Connect

    Segall, H.D.; Ahmadi, J.; McComb, J.G.; Zee, C.S.; Becker, T.S.; Han, J.S.

    1982-05-01

    Selected topics are discussed and new observations recorded regarding computed tomographic (CT) evaluation of intracranial venous thrombotic and occlusive disease in childhood. High density of the vein of Galen and adjacent venous sinuses (relative to brain) can be seen normally in children. A number of potential pitfalls in the diagnosis of superior sagittal sinus thrombosis are also disclosed. A case of cavernous sinus thrombosis with abnormal CT changes is included. In addition, the normal CT appearance of the cavernous sinus is described. In some cases, filling defects occur which appear to correlate with normal cranial nerves. An unusual case of venous sinus occlusion by neoplasm (sarcoma) is presented. Finally, new findings in the Sturge-Weber syndrome are analyzed. Enhancement of the brain in this condition may have its basis in altered circulation resulting from fundamental venous abnormalities.

  1. Venous thromboembolism in cystic fibrosis.

    PubMed

    Takemoto, Clifford M

    2012-02-01

    The incidence of venous thromboembolism (VTE) is increasing in the pediatric population. Individuals with cystic fibrosis (CF) have an increased risk of thrombosis due to central venous catheters (CVCs), as well as acquired thrombophilia secondary to inflammation, or deficiencies of anticoagulant proteins due to vitamin K deficiency and/or liver dysfunction. CVC-associated thrombosis commonly results in line occlusion, but may develop into serious life-threatening conditions such as deep venous thrombosis (DVT), superior vena cava syndrome or pulmonary embolism (PE). Post-thrombotic syndrome (PTS) may be a long complication. Local occlusion of the catheter tip may be managed with instillation of thrombolytics (such as tPA) within the lumen of the catheter; however, CVC-associated thrombosis involving the proximal veins is most often is treated with systemic anticoagulation. Initial treatment with heparin is a standard approach, but thrombolytic therapy, which may carry higher bleeding risks, should be considered for life and limb threatening episodes of VTE. Recommended duration of anticoagulation with low molecular weight heparin (LMWH) or warfarin ranges from 3 to 6 months for major removable thrombotic risks; longer anticoagulation is considered for recurrent thrombosis, major persistent thrombophilia, or the continued presence of a major risk factor such as a CVC. While CVCs are the most common risk for development of VTE in children, studies have not demonstrated a clear benefit with routine use of systemic thromboprophylaxis. The incidence and risk factors of VTE in CF patients will be reviewed and principles of diagnosis and management will be summarized.

  2. Travel, venous thromboembolism, and thrombophilia.

    PubMed

    Gallus, Alexander S

    2005-02-01

    Current evidence indicates that prolonged air travel predisposes to venous thrombosis and pulmonary embolism. An effect is seen once travel duration exceeds 6 to 9 hours and becomes obvious in long-haul passengers traveling for 12 or more hours. A recent records linkage study found that increase in thrombosis rate among arriving passengers peaked during the first week and was no longer apparent after 2 weeks. Medium- to long-distance travelers have a 2- to 4-fold increase in relative thrombosis risk compared with nontravelers, but the averaged absolute risk is small (approximately one symptomatic event per 2 million arrivals, with a case-fatality rate of approximately 2%) and there is no evidence that thrombosis is more likely in economy class than in business- or first-class passengers. It remains uncertain whether and to what extent thrombosis risk is increased by short-distance air travel or prolonged travel by motorcar, train, or other means. Most travelers who develop venous thrombosis or pulmonary embolism also have one or more other predisposing risk factors that may include older age, obesity, recent injury or surgery, previous thrombosis, venous insufficiency, malignancy, hormonal therapies, or pregnancy. Limited (though theoretically plausible) evidence suggests that factor V Leiden and the prothrombin gene mutation predispose to thrombosis in otherwise healthy travelers. Given that very many passengers with such predispositions do not develop thrombosis, and a lack of prospective studies to link predisposition with disease, it is not now possible to allocate absolute thrombosis risk among intending passengers or to estimate benefit-to-risk ratios or benefit-to-cost ratios for prophylaxis. Randomized comparisons using ultrasound imaging indicate a measurable incidence of subclinical leg vein thrombosis after prolonged air travel, which appears to increase with travel duration and is reduced by graded pressure elastic support stockings. Whether this

  3. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

    PubMed Central

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed. PMID:28168186

  4. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism.

    PubMed

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

  5. Venous Access Devices: Clinical Rounds

    PubMed Central

    Matey, Laurl; Camp-Sorrell, Dawn

    2016-01-01

    Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented. PMID:28083553

  6. Drainage Areas of Selected Streams in Virginia

    USGS Publications Warehouse

    Hayes, Donald C.; Wiegand, Ute

    2006-01-01

    Drainage areas were determined for more than 1,600 basins in the three major river basins of Virginia -- the North Atlantic Slope, South Atlantic Slope, and Ohio River Basins. Drainage areas range from 0.004 square mile to 7,866 square miles. A geographic information system was used to digitize and store data associated with the drainage basins. Drainage divides were digitized from digital U.S. Geological Survey 7.5-minute, 1:24,000-scale, topographic quadrangles using procedures recommended by the Subcommittee on Hydrology, Federal Interagency River Basin Committee. Digital drainage basins were quality assured, polygons of the closed drainage basins were generated, and drainage areas were computed.

  7. Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

    PubMed

    Torgay, A; Pirat, A; Candan, S; Zeyneloglu, P; Arslan, G; Haberal, M

    2005-09-01

    The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

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

    SciTech Connect

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

    2011-12-15

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

  9. The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

    PubMed Central

    2013-01-01

    The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the “gold standard” for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven. PMID:23806142

  10. The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants.

    PubMed

    Dolic, Kresimir; Siddiqui, Adnan H; Karmon, Yuval; Marr, Karen; Zivadinov, Robert

    2013-06-27

    The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the "gold standard" for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven.

  11. Lacrimal drainage surgery in a patient with dry eyes.

    PubMed

    Rose, Geoffrey E

    2008-01-01

    The dry-eyed patient has both inadequate surface wetting, and a severe inability to clear the ocular surface of extrinsic debris, lid-margin bacteria (and their toxins), and the intrinsic inflammatory mediators secreted from the inflamed conjunctival surface. Tear evaporation compounds the problem of impaired production, this leading to significant concentration of inflammatory mediators on the abnormal ocular surface - this concentration being even greater where tear drainage is impaired. Nasolacrimal duct obstruction is, moreover, associated with a backwash of toxic debris from the lacrimal sac and, in the patient with dry eye, this backwash exacerbates an already compromised ocular surface. Surgery to re-establish tear drainage and eliminate the reservoir within the lacrimal sac may, therefore, improve the ocular status of patients with dry eye: many patients will benefit from external dacryocystorhinostomy, this being combined with retrograde canaliculostomy where there is proximal canalicular blockage. Secondary placement of a canalicular bypass tube may be required where these procedures have failed and tear drainage is needed. Where there is no risk of ocular surface toxicity due to complete stasis of the tear lake, the canaliculi can be ablated with thermal coagulation or canalicular excision. Rarely required as a primary procedure, dacryocystectomy may be used where dacryocystitis occurs in the presence of long-established canalicular occlusion.

  12. Iliofemoral Venous Thrombosis Mainly Related to Iliofemoral Venous Obstruction by External Tumor Compression in Cancer Patients

    PubMed Central

    Liao, Tzu-Yao; Hsu, Hui-Ching; Wen, Min-Sheng; Juan, Yu-Hsiang; Hung, Yu-Hsin; Liaw, Chuang-Chi

    2016-01-01

    Background To study iliofemoral venous thrombosis related to iliofemoral venous obstruction in cancer patients. Methods In this case series study, 829 cancer patients were surveyed for iliofemoral obstruction/thrombosis within 10 years. The criteria for inclusion were: (1) presence of unilateral lower-extremity swelling; (2) computed tomography (CT) scans showing a tumor with external compression of the iliac or femoral vein, and (3) duplex ultrasound scans showing venous thrombosis or venous flow insufficiency over a femoral vein or saphenous vein. Results Sixty-three patients (8%) developed an iliofemoral venous obstruction. The presence of iliofemoral venous thrombosis was detected in 21 of these patients (33%). The rate of iliofemoral venous thrombosis was significantly higher in patients with an invasion of the inguinal region, D-dimer levels >3,000 ng/ml, gastrointestinal cancer, or invasion of the inguinal lymph nodes. However, none of our patients with iliofemoral venous thrombosis had a detection of iliofemoral venous obstruction. Improved lower-extremity swelling was reported in 84% of the patients following combination therapy involving low-molecular-weight heparin (LMWH) and systemic therapy. Conclusion Patients with an iliofemoral venous thrombosis mainly had iliofemoral venous obstruction by external tumor compression. Combination therapy with LMWH and systemic therapy were mandatory for these patients. PMID:27990113

  13. "Jeopardy" in Abnormal Psychology.

    ERIC Educational Resources Information Center

    Keutzer, Carolin S.

    1993-01-01

    Describes the use of the board game, Jeopardy, in a college level abnormal psychology course. Finds increased student interaction and improved application of information. Reports generally favorable student evaluation of the technique. (CFR)

  14. Stent Placement on Fresh Venous Thrombosis

    SciTech Connect

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

    1997-09-15

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

  15. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

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

  16. Diagnosis and treatment of venous ulcers.

    PubMed

    Collins, Lauren; Seraj, Samina

    2010-04-15

    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.

  17. Reversible changes in diffusion- and perfusion-based imaging in cerebral venous sinus thrombosis.

    PubMed

    Lin, Ning; Wong, Andrew K; Lipinski, Lindsay J; Mokin, Maxim; Siddiqui, Adnan H

    2016-02-01

    Diffusion- and perfusion-based imaging studies are regularly used in patients with ischemic stroke. Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and is primarily treated by systemic anticoagulation. Endovascular intervention can be considered in cases of failed medical therapy, yet the prognostic value of diffusion- and perfusion-based imaging for CVST has not been clearly established. We present a patient with CVST whose abnormal findings on MRI and CT perfusion images were largely reversed after endovascular treatment.

  18. Heritability of chronic venous disease

    PubMed Central

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

    2010-01-01

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

  19. Venous pressure in man during weightlessness

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

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

  20. Cervical venous reflux in dynamic brain scintigraphy.

    PubMed

    Hayt, D B; Perez, L A

    1976-01-01

    Cervical venous reflux, shown by dynamic brain scintigraphy, was investigated through three avenues of approach: (A) by reviewing 371 randomly chosen routine dynamic intracerebral bloodflow studies to estimate its incidence; (B) by correlative positive-contrast superior venacavography in patients with characteristic cervical venous reflux; and (C) by performing dynamic brain scintigraphy while utilizing various positional and physiologic maneuvers to attempt to produce cervical venous reflux in patients who did not exhibit this phenomenon on earlier examination. Although any obstruction of the superior vena cava or a properly timed Valsalva maneuver in selected patients can produce the scintigraphic picture of cervical venous reflux, in most cases it is a normal phenomenon due to incompetent or absent cervical venous valves.

  1. Abnormal distribution of pulmonary blood flow in aortic valve disease

    PubMed Central

    Goodenday, Lucy S.; Simon, George; Craig, Hazel; Dalby, Lola

    1970-01-01

    Wasted ventilatory volume (VD) and its ratio to tidal volume (VD/VT) were measured at rest and during exertion in 17 patients with aortic valve disease. We considered VD/VT to indicate abnormal ventilation: perfusion relations if it did not decrease on exertion, or if the exercising value was greater than 40 per cent. Plain chest radiographs were independently examined for evidence of diversion of pulmonary blood to the upper lobes. There was significant agreement (p<0·05) between radiographic and pulmonary function estimations of abnormality. This suggests that the raised pulmonary venous pressure associated with left ventricular failure creates an abnormal pattern of blood flow through the lung, which is responsible for causing inadequate perfusion with respect to ventilation. Images PMID:5420086

  2. Venous and arterial thrombosis in dialysis patients.

    PubMed

    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

    2011-12-01

    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.

  3. Drainage area data for Alabama streams

    USGS Publications Warehouse

    Stallings, J.S.; Peirce, L.B.

    1957-01-01

    The drainage area of a river basin is an important parameter in many engineering equations used for hydrologic design. It is not a parameter, however, that always requires precise measurement. Factors in the hydrologic cycle such as rainfall, runoff, transpiration, and infiltration cannot be measured nearly as closely as drainage area. Largely for this reason, drainage areas are often measured to varying degrees of precision depending upon the immediate need, with little thought to some other use or some other user of the figure obtained. It can readily be appreciated that this practice, continued for long by many different agencies, will result in a heterogeneous collection of drainage area figures, often discordant and of an accuracy unknown to any but those who computed them. Figures of drainage area published by various Federal agencies are frequently discrepant or contradictory, giving rise to confusion in the use of drainage area data. Seeking to better this situation, the Federal Inter-Agency River Basin Committee (FIARBC) in November 1951 published its Bulletin No. 4, Inter-Agency Coordination of Drainage Area Data. That Bulletin recommended procedures to be followed by the interested Federal agencies “for coordinating drainage area data in the interest of promoting uniformity, reducing confusion and contradiction of published figures, and improving the ready availability of drainage area data pertaining to drainage basins of the United States and its possessions.”

  4. Treatment of a periorbital cyst in a dog by creation of a permanent drainage opening.

    PubMed

    Kaiser, S; Driesen, A; Malberg, S; Kramer, M; Thiel, C

    2015-01-01

    An inflammatory periorbital cyst with secondary pressure atrophy of the maxilla was treated by surgical creation of a drainage opening to the nasal cavity in a 4-year-old Yorkshire Terrier. Following treatment, clinical signs resolved and computed tomography 5 weeks after surgery confirmed the permanence of the drainage opening. Eight months later, the dog showed no clinical abnormalities. Therefore, the procedure described in this report may offer a suitable treatment option in cases where the cyst's size or localization prevents complete excision.

  5. Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion.

    PubMed

    Mattei, Tobias A; Rehman, Azeem A; Dinh, Dzung H

    2015-10-01

    Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a subdural hematoma after a percutaneous vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of venous congestion caused by cement obstruction. Results Because the subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the vertebroplasty, we discuss the possible role of venous congestion as the main etiologic factor leading to rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of spinal subdural hematoma in which venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous hypertension may shed new light into the pathophysiology of spinal subdural hematomas.

  6. [Suppurative thrombophlebitis central venous catheterization].

    PubMed

    Ramos Martínez, A; Sánchez Romero, I; Saura Lorente, P A; Parajón Díaz, A

    2008-06-01

    Suppurative thrombophlebitisis a very infrequent complication of the central venous catheterization. The majority of the cases are produced by species of staphylococci. A 22-year-old colombian-woman, student, without toxic habits was admitted because of temporary left astrocytoma (grade II). Nine days after implementing a catheter in the right subclavian vein she presented high fever (39.5 degrees C), shivers, progressive right side neck swelling and odinofagia. She had leukocytosis (26,300 cells/microl) and normal cerebrospinal fluid. After withdrawing the catheter, Staphylococcus aureus was isolated in the tip of the catheter and in four bottles of blood cultures. A neck CT demonstrated expansion and absence of contrast in the right internal jugular vein. The patient evolved satisfactorily with cloxacillin, gentamycin and low molecular weight heparin.

  7. Venous thromboembolism in colorectal cancer patients with central venous catheters for 5-FU infusion-based pharmacokinetic modulating chemotherapy.

    PubMed

    Yoshikawa, Reigetsu; Yanagi, Hidenori; Noda, Masafumi; Ikeuchi, Hiroki; Nakano, Hiroki; Gega, Makoto; Tsukamoto, Kiyoshi; Oshima, Tsutomu; Inoue, Takashi; Fujiwara, Yoshinori; Shoji, Yasutsugu; Sakaki, Takatoshi; Higasa, Satoshi; Hashimoto-Tamaoki, Tomoko; Yamamura, Takehira

    2005-04-01

    Colorectal cancer patients with central venous catheters (CVC) for pharmacokinetic modulating chemotherapy (PMC) have a substantial risk of venous thromboembolism (VTE). PMC, designed as a hybrid of lower metronomic and higher shorter plasma 5-FU concentrations, has been clinically successful. To determine the effectiveness and safety of D-dimer tests and multidetector-row CT (MDCT) for diagnosis in cancer patients with suspected VTE, we carried out a clinical outcome study on PMC outpatients. Patients received a D-dimer test before and after commencing the PMC regimen. MDCT was performed additionally if the D-dimer test appeared positive or showed signs of VTE. When CT results were positive for thromboembolism, anticoagulation was started. The overall prevalence of VTE in PMC patients was 2.0% (7 of 350 patients). In this study, 34 out of 102 colorectal cancer patients gave a positive D-dimer test (33.3%). CT identified venous thrombi in 2 of the 102 patients (2.0%), mural thrombosis on catheterized veins in another 3 patients (2.9%), and endothelial hyperplasia on catheterized veins in 8 patients (7.8%). The catheters of these patients did not show any significant abnormalities. Patients with negative D-dimer tests showed no signs or symptoms of VTE. In colorectal cancer patients receiving continuous 5-FU infusion via CVC, a D-dimer test can be safely used as the primary diagnostic test for ruling out VTE. We suggest 7.0 microg/ml as the D-dimer cut-off value. Thromboprophylaxis should be considered in the patients showing values >7.0 microg/ml.

  8. Drainage in a rising foam.

    PubMed

    Yazhgur, Pavel; Rio, Emmanuelle; Rouyer, Florence; Pigeonneau, Franck; Salonen, Anniina

    2016-01-21

    Rising foams created by continuously blowing gas into a surfactant solution are widely used in many technical processes, such as flotation. The prediction of the liquid fraction profile in such flowing foams is of particular importance since this parameter controls the stability and the rheology of the final product. Using drift flux analysis and recently developed semi-empirical expressions for foam permeability and osmotic pressure, we build a model predicting the liquid fraction profile as a function of height. The theoretical profiles are very different if the interfaces are considered as mobile or rigid, but all of our experimental profiles are described by the model with mobile interfaces. Even the systems with dodecanol are well known to behave as rigid in forced drainage experiments. This is because in rising foams the liquid fraction profile is fixed by the flux at the bottom of the foam. Here the foam is wet with higher permeability and the interfaces are not in equilibrium. These results demonstrate once again that it is not only the surfactant system that controls the mobility of the interface, but also the hydrodynamic problem under consideration. For example liquid flow through the foam during generation or in forced drainage is intrinsically different.

  9. Fluid Drainage from Porous Reservoirs

    NASA Astrophysics Data System (ADS)

    Zheng, Zhong; Soh, Beatrice; Huppert, Herbert; Stone, Howard; Stone Group Team

    2012-11-01

    We report theoretical and experimental studies to describe buoyancy-driven fluid drainage from a porous medium. We first study homogeneous porous systems. To investigate the influence of heterogeneities, we consider the case where the permeability varies transverse to the flow direction, exemplified by a V-shaped Hele-Shaw cell. Finally, we analyze a model where both the permeability and the porosity vary transverse to the flow direction. In each case, a self-similar solution for the shape of the gravity current is found and a power-law behavior in time is derived for the mass remaining in the system. Laboratory experiments are conducted in homogeneous and V-shaped Hele-Shaw cells, and the measured profile shapes and the mass remaining in the cells agree well with our model predictions. Our study provides new insights into drainage processes such as may occur in a variety of natural and industrial activities including the geological storage of carbon dioxide. This work is supported by a grant from Carbon Mitigation Initiative at Princeton University.

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

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.

    1996-01-01

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

  11. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  12. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  13. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  14. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  15. [Mechanical complication of central venous catheterization].

    PubMed

    Koja, Hiroki; Tokumine, Joho; Sugahara, Kazuhiro

    2007-01-01

    Central venous catheterization is a procedure with a high success rate. However, life-threatening complications are occasionally caused by mechanical injury during the catheterization process. Therefore, surgeons should have sufficient knowledge of the potential complications and the effective use of preventative measures when performing catheterization. We herein review and discuss the mechanical complications previously reported to have occurred in association with central venous catheterization. Comprehensive knowledge about various complication-inducing factors, the ability to make a quick and accurate diagnosis of such complications, and sufficient skill to prevent worsening of these complications can thus help patients from suffering lethal complications due to central venous catheterization.

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

    NASA Technical Reports Server (NTRS)

    Thirsk, R. B.

    1992-01-01

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

  17. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency.

    PubMed

    Tracz, Edyta; Zamojska, Ewa; Modrzejewski, Andrzej; Zaborski, Daniel; Grzesiak, Wilhelm

    2015-01-01

    The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.

  18. Asian venous thromboembolism guidelines: prevention of venous thromboembolism.

    PubMed

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

    2012-12-01

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

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

    SciTech Connect

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

    2015-11-17

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-11-01

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

  1. Subsurface drainage volume reduction with drainage water management: Case studies in Ohio, USA

    Technology Transfer Automated Retrieval System (TEKTRAN)

    One of the main contributors to poor water quality in the Mississippi River and aeral increase in the hypoxic zone in the Gulf of Mexico is intensive drainage of the cropland within the watershed. Controlled drainage has been demonstrated as an approach to curb totla drainage outflow and nutrient di...

  2. [The relativity of abnormity].

    PubMed

    Nilson, Annika

    2006-01-01

    In the late 19th century and in the beginning of the 20th century, mental diseases and abnormal behavior was considered to be a great danger to culture and society. "Degeneration" was the buzzword of the time, used and misused by artists and scientists alike. At the same time, some scientists saw abnormity as the key to unlock the mysteries of the ordinary mind. Naturalistic curiosity left Pandoras box open when religion declined in Darwins wake. Two swedish scientists, the physician Bror Gadelius (1862-1938) and his friend the philosopher Axel Herrlin (1870-1937), inspired by the French psychologist Theodule Ribots (1839-1916) "psychology without a soul", denied all fixed demarcation lines between abnormity and normality. All humans are natures creatures ruled by physiological laws, not ruled by God or convention. Even ordinary morality was considered to be an utterly backward explanation and guideline for complex human behavior. Different forms of therapy, not various kinds of penalties for wicked and disturbing behavior, are the now the solution for lots of people, "normal" as well as "abnormal". Psychiatry is expanding.

  3. Abnormalities of gonadal differentiation.

    PubMed

    Berkovitz, G D; Seeherunvong, T

    1998-04-01

    Gonadal differentiation involves a complex interplay of developmental pathways. The sex determining region Y (SRY) gene plays a key role in testis determination, but its interaction with other genes is less well understood. Abnormalities of gonadal differentiation result in a range of clinical problems. 46,XY complete gonadal dysgenesis is defined by an absence of testis determination. Subjects have female external genitalia and come to clinical attention because of delayed puberty. Individuals with 46,XY partial gonadal dysgenesis usually present in the newborn period for the valuation of ambiguous genitalia. Gonadal histology always shows an abnormality of seminiferous tubule formation. A diagnosis of 46,XY true hermaphroditism is made if the gonads contain well-formed testicular and ovarian elements. Despite the pivotal role of the SRY gene in testis development, mutations of SRY are unusual in subjects with a 46,XY karyotype and abnormal gonadal development. 46,XX maleness is defined by testis determination in an individual with a 46,XX karyotype. Most affected individuals have a phenotype similar to that of Klinefelter syndrome. In contrast, subjects with 46,XX true hermaphroditism usually present with ambiguous genitalia. The majority of subjects with 46,XX maleness have Y sequences including SRY in genomic DNA. However, only rare subjects with 46,XX true hermaphroditism have translocated sequences encoding SRY. Mosaicism and chimaerism involving the Y chromosome can also be associated with abnormal gonadal development. However, the vast majority of subjects with 45,X/46,XY mosaicism have normal testes and normal male external genitalia.

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

    PubMed

    Uhl, J-F; Gillot, C

    2012-08-01

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

  5. Usefulness of saturation pulses in magnetic resonance imaging of partial anomalous pulmonary venous return.

    PubMed

    Kimura, K; Uemura, S; Handa, S; Terasaka, M; Takeuchi, T; Moriwaki, C; Hano, T; Nishio, I

    2001-05-01

    The authors evaluated partial anomalous pulmonary venous return by magnetic resonance (MR) images. Seven patients with this congenital anomaly underwent MR imaging examination. Conventional spin-echo and gradient-echo imaging were performed. In addition, during acquisition of gradient-echo images, saturation pulses were imposed on the affected lung. Spin-echo images showed the anatomical situation of the anomalous veins, and gradient-echo images revealed the blood flow in the veins. With saturation technique, the direction and drainage of blood flow in the anomalous veins were well defined. The study suggests that MR imaging with spin-echo method and gradient-echo method with or without saturation pulses is a useful and noninvasive method of diagnosing partial anomalous pulmonary venous return. MR images with spin- and gradient-echo methods were useful in defining the anatomical situation and blood flow in the anomalous veins. By imposing saturation pulses on the affected lung field, the direction and drainage of blood flow in the anomalous veins were clearly demonstrated.

  6. Links between arterial and venous disease.

    PubMed

    Prandoni, P

    2007-09-01

    An increasing body of evidence suggests the likelihood of a link between arterial and venous disease. According to the results of recent studies, atherosclerosis and venous thromboembolism (VTE) share common risk factors, including age, obesity, diabetes mellitus and metabolic syndrome. Atherosclerosis has the potential to promote the development of thrombotic disorders in the venous system. Another scenario assumes that the two clinical conditions are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Several recent studies have consistently shown that patients with VTE of unknown origin are at a higher risk of cardiovascular diseases, including atherosclerotic complications, than patients with secondary VTE and matched control individuals. Future studies are needed to clarify the nature of this association, to assess its extent and to evaluate its implications for clinical practice.

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2015-02-01

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

  9. Pathophysiology of spontaneous venous gas embolism

    NASA Technical Reports Server (NTRS)

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

    1991-01-01

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

  10. 24 CFR 3285.604 - Drainage system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... § 3285.604 Drainage system. (a) Crossovers. Multi-section homes with plumbing in more than one section require drainage system crossover connections to join all sections of the home. The crossover design requirements are located in, and must be designed in accordance with, § 3280.610 of this chapter. (b)...

  11. Modeling coastal plain drainage ditches with SWAT

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In the low-relief Eastern Shore region of Maryland, extensive land areas used for crop production require drainage systems either as tile drains or open ditches. The prevalence of drainage ditches in the region is being linked to increased nutrient loading of the Chesapeake Bay. Process-based water ...

  12. 24 CFR 3280.610 - Drainage systems.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... siphonage, aspiration, or forcing of trap seals under conditions of ordinary use. (b) Materials—(1) Pipe... iron, or other listed or approved materials. (2) Fittings. Drainage fittings shall be recessed drainage pattern with smooth interior waterways of the same diameter as the piping and shall be of a...

  13. Acid mine drainage prediction and remediation

    SciTech Connect

    Robb, G.; Robinson, J.

    1996-12-31

    The use of constructed wetlands for treatment of acid mine drainage is discussed in the article. Drainage characteristics and mine water flow rate are identified as important predictors of remediation success. Aerobic and anaerobic chemical reaction processes are described. Problems and potential uses of wetlands are briefly described.

  14. Microcirculation and venous ulcers: a review.

    PubMed

    Pascarella, Luigi; Schönbein, Geert W Schmid; Bergan, John J

    2005-11-01

    Recent histological and immunocytochemical analyses of venous leg ulcers suggest that lesions observed in the different stages of chronic venous insufficiency (CVI) may be related to an inflammatory process. This inflammatory process leads to fibrosclerotic remodeling of the skin and then to ulceration. The vascular network of the most superficial layers of the skin appears to be the target of the inflammatory reaction. Hemodynamic forces such as venous hypertension, circulatory stasis, and modified conditions of shear stress appear to play an important role in an inflammatory reaction accompanied by leukocyte activation which clinically leads to CVI: venous dermatitis and venous ulceration. The leukocyte activation is accompanied by the expression of integrins and by synthesis and release of many inflammatory molecules, including proteolytic enzymes, leukotrienes, prostaglandin, bradykinin, free oxygen radicals, cytokines, and possibly other classes of inflammatory mediators. The inflammatory reaction perpetuates itself, leading to liposclerotic skin and subcutaneous tissue remodeling. In light of the mechanisms of venous ulcer formation cited above, therapy in the future might be directed against leukocyte activation in order to diminish the magnitude of the inflammatory response. With this in mind, the attention of many investigators has been drawn to two different drugs with an anti-inflammatory effect: pentoxifylline and flavonoids.

  15. Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma

    SciTech Connect

    Arbeit, J.M.; Lowry, S.F.; Line, B.R.; Jones, D.C.; Brennan, M.F.

    1981-01-01

    Deep venous thromboembolism (DVT) was studied in 44 patients with clinical Stage I, II, and III melanoma undergoing staging and therapeutic inguinal lymph node dissection. The ability of two noninvasive methods of surveillance, the phleborheograph (PRG) and the /sup 125/I fibrinogen scan to detect deep venous thrombosis was determined by comparison with prospective bilateral lower extremity venograms. In addition, the therapeutic impact, both beneficial and detrimental, of low dose heparin, 5000 units administered subcutaneously two hours prior to and every eight hours after operation was determined in a double blind study. The sensitivity of the PRG and /sup 125/I fibrinogen scan were both 20%. There were five deep venous thrombi, and two pulmonary emboli for a combined incidence of DVT of 13.6% for the entire patient population. However, there was no significant difference in the incidence of DVT between the two groups. The heparin-treated patients had an increased total volume (796 +/- 516 versus 388 +/- 208 ml; p less than 0.05), and duration of wound drainage (9 +/- 4 versus 13 +/- 6 days; p less than 0.05).

  16. Deep venous thromboembolism in patients undergoing inguinal lymph node dissection for melanoma

    SciTech Connect

    Arbeit, J.M.; Lowry, S.F.; Line, B.R.

    1981-11-01

    Deep venous thromboembolism (DVT) was studied in 44 patients with clinical Stage I, II, and III melanoma undergoing staging and therapeutic inguinal lymph node dissection. The ability of two noninvasive methods of surveillance, the phleborheograph (PRG) and the /sup 125/I fibrinogen scan to detect deep venous thrombosis was determined by comparison with prospective bilateral lower extremity venograms. In addition, the therapeutic impact, both beneficial and detrimental, of low dose heparin, 5000 units administered subcutaneously two hours prior to and every eight hours after operation was determined in a double blind study. The sensitivity of the PRG and /sup 125/I fibrinogen scan were both 20%. There were five deep venous thrombi, and two pulmonary emboli for a combined incidence of DVT of 13.6% for the entire patient population. However, there was no significant difference in the incidence of DVT between the two groups. The heparin-treated patients had an increased total volume (796 +/- 516 versus 388 +/- 208 ml; p < 0.05), and duration of wound drainage (9 +/- 4 versus 13 +/- 6 days; p < 0.05).

  17. Extra- and transcranial echo colour Doppler in the diagnosis of chronic cerebrospinal venous insufficiency.

    PubMed

    Van den Berg, P J; Visser, L H

    2012-03-01

    A new venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis (MS). It is a vascular condition characterized by an impaired cerebrospinal venous drainage due to obstructions in the main extracranial cerebrovenous outflow routes (i.e. internal jugular veins [IJV] and/or azygos veins). In this review, the studies which assessed the prevalence of CCSVI in MS by echo colour Doppler (ECD) will be discussed. The technical aspects of determination of the five CCSVI criteria: (1) reflux in the IJV and/or vertebral veins in supine and upright position, (2) reflux in the deep cerebral veins, (3) high-resolution B-mode proximal IJV stenosis, (4) flow not Doppler detectable in IJVs and/or vertebral veins (VVs) and (5) reverted postural control of the main cerebrovenous outflow pathway are described in detail. We conclude that so far there are many studies with contradictory results, and as yet a strong scientific base to support the evidence for a causative relationship of CCSVI and MS is lacking. Recent studies call into question the validity of using ECD as a proper and reliable test for the diagnosis of CCSVI. One explanation for the variety in interpretation of the individual CCSVI criteria, with the wide-ranging percentages CCSVI, could be the different methods by using ECD to determine various criteria.

  18. Compensatory dilatation of the Azygos Venous system Secondary To Superior Vena Cava Occlusion

    PubMed Central

    Paoletti, Francesco; Pellegrino, Valeria; Antonelli, Melissa; Ripani, Umberto; Mosca, Stefano; Durì, Davide; Galzerano, Antonio

    2009-01-01

    Superior vena cava (SVC) occlusion can be clinically recognized in the acute setting when the stenosing process does not allow the development of collateral venous channels, which guarantee the venous drainage to the right heart. On the contrary, when the obstruction develops progressively, the diagnosis of SVC obstruction may remain undiagnosed. In the present case, the presence of SVC thrombosis was purely coincidental. In fact, the obstruction was first noticed on diagnostic tests performed because of the malfunction of a totally implantable Porth a Cath placed into the superior vena cava (through right subclavian access), five years before, in a patient suffering from non-Hodgkin disease. Venography is the most appropriate diagnostic methodology which reveals the presence of a dilated azygos vein as a compensatory mechanism. Comparison with computed tomography allows to confirm the diagnosis and to identify the possible causes. Dilatation of the azygos vein, secondary to superior vena cava thrombosis, although a rare event, should be taken into consideration in those patients with CVC and who present with frequent episodes of deep venous thrombosis. PMID:22470636

  19. Compensatory dilatation of the Azygos Venous system Secondary To Superior Vena Cava Occlusion.

    PubMed

    Paoletti, Francesco; Pellegrino, Valeria; Antonelli, Melissa; Ripani, Umberto; Mosca, Stefano; Durì, Davide; Galzerano, Antonio

    2009-01-01

    Superior vena cava (SVC) occlusion can be clinically recognized in the acute setting when the stenosing process does not allow the development of collateral venous channels, which guarantee the venous drainage to the right heart. On the contrary, when the obstruction develops progressively, the diagnosis of SVC obstruction may remain undiagnosed. In the present case, the presence of SVC thrombosis was purely coincidental. In fact, the obstruction was first noticed on diagnostic tests performed because of the malfunction of a totally implantable Porth a Cath placed into the superior vena cava (through right subclavian access), five years before, in a patient suffering from non-Hodgkin disease. Venography is the most appropriate diagnostic methodology which reveals the presence of a dilated azygos vein as a compensatory mechanism. Comparison with computed tomography allows to confirm the diagnosis and to identify the possible causes. Dilatation of the azygos vein, secondary to superior vena cava thrombosis, although a rare event, should be taken into consideration in those patients with CVC and who present with frequent episodes of deep venous thrombosis.

  20. Characterization of immune cells and perforin mutations in familiar venous thromboembolism

    PubMed Central

    Duan, Qianglin; Lv, Wei; Yang, Minjun; Yang, Fan; Zhu, Yongqiang; Kang, Hui; Song, Haoming; Wang, Shengyue; Dong, Hui; Wang, Lemin

    2015-01-01

    Aim: This study was to carry out exome sequencing in a Han Chinese family with venous thromboembolism. Methods: Three venous thromboembolism (VTE) patients and five members from a Han Chinese family were evaluated by exome sequencing. Results: Among the 3 VTE patients, mutations of 2 genes including PRF1 and HTR2A were identified and predicted to be functionally damaged to their encoded proteins. In addition, the PRF1 mutation and the HTR2A mutation identified in our study were absent in 100 non-related controls, indicating that venous thromboembolism has a genetic component. The R357W mutation is located in the membrane attack complex/perforin domain of PRF1 protein, which exists in both the perforin. The steps of killing foreign or pathological antigen cells by NK cells, CD8 +T cells and the membrane attack complex include membrane perforation and release of the granzyme, either of which is abnormal can lead to immune dysfunction. Conclusions: The mutations of immune related genes in familial VTE might provide new understanding of the pathogenesis of familial venous thromboembolism. PMID:26221353

  1. Illinois drainage water management demonstration project

    USGS Publications Warehouse

    Pitts, D.J.; Cooke, R.; Terrio, P.J.; ,

    2004-01-01

    Due to naturally high water tables and flat topography, there are approximately 4 million ha (10 million ac) of farmland artificially drained with subsurface (tile) systems in Illinois. Subsurface drainage is practiced to insure trafficable field conditions for farm equipment and to reduce crop stress from excess water within the root zone. Although drainage is essential for economic crop production, there have been some significant environmental costs. Tile drainage systems tend to intercept nutrient (nitrate) rich soil-water and shunt it to surface water. Data from numerous monitoring studies have shown that a significant amount of the total nitrate load in Illinois is being delivered to surface water from tile drainage systems. In Illinois, these drainage systems are typically installed without control mechanisms and allow the soil to drain whenever the water table is above the elevation of the tile outlet. An assessment of water quality in the tile drained areas of Illinois showed that approximately 50 percent of the nitrate load was being delivered through the tile systems during the fallow period when there was no production need for drainage to occur. In 1998, a demonstration project to introduce drainage water management to producers in Illinois was initiated by NRCS4 An initial aspect of the project was to identify producers that were willing to manage their drainage system to create a raised water table during the fallow (November-March) period. Financial assistance from two federal programs was used to assist producers in retrofitting the existing drainage systems with control structures. Growers were also provided guidance on the management of the structures for both water quality and production benefits. Some of the retrofitted systems were monitored to determine the effect of the practice on water quality. This paper provides background on the water quality impacts of tile drainage in Illinois, the status of the demonstration project, preliminary

  2. Geohydrologic reconnaissance of drainage wells in Florida

    USGS Publications Warehouse

    Kimrey, J.O.; Fayard, L.D.

    1984-01-01

    Drainage wells are used to inject surface waters directly into an aquifer, or shallow ground waters directly into a deeper aquifer, primarily by gravity. Such wells in Florida may be grouped into two broad types: (1) surface-water injection wells, and (2) interaquifer connector wells. Drainage wells of the first type are further categorized as either Floridan aquifer drainage wells or Biscayne aquifer drainage wells. Floridan aquifer drainage wells are commonly used to supplement drainage for urban areas in karst terranes of central and north Florida. Data are available for 25 wells in the Ocala, Live Oak, and Orlando areas that allow comparison of the quality of water samples from these Floridan aquifer drainage wells with allowable contaminant levels. Comparison indicates that maximum contaminant levels for turbidity, color, and iron, manganese, and lead concentrations are equaled or exceeded in some drainage-well samples, and relatively high counts for coliform bacteria are present in most wells. Biscayne aquifer drainage wells are used locally to dispose of stormwater runoff and other surplus water in southeast Florida, where large numbers of these wells have been permitted in Dade and Broward Counties. The majority of these wells are used to dispose of water from swimming pools or to dispose of heated water from air-conditioning units. The use of Biscayne aquifer drainage wells may have minimal effect on aquifer potability so long as injection of runoff and industrial wates is restricted to zones where chloride concentrations exceed 1,500 milligrams per liter. Interaquifer connector wells are used in the phosphate mining areas of Polk and Hillsborough Counties, to drain mines and recharge the Floridan aquifer. Water-quality data available from 13 connector wells indicate that samples from most of these wells exceed standards values for iron concentration and turbidity. One well yielded a highly mineralized water, and samples from 6 of the other 12 wells exceed

  3. Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation

    PubMed Central

    Brescia, Marília D’Elboux Guimarães; Massarollo, Paulo Celso Bosco; Imakuma, Ernesto Sasaki; Mies, Sérgio

    2015-01-01

    Background This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15) or piggyback (n = 17) liver transplantation. Methods Free hepatic vein pressure (FHVP) and central venous pressure (CVP) measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr) was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO). The prevalence of acute renal failure (ARF) up to the 28th PO was analyzed by RIFLE-AKIN criteria. A Generalized Estimating Equation (GEE) approach was used for comparison of longitudinal measurements of renal function. Results FHVP-CVP gradient > 3 mm Hg was observed in 26.7% (4/15) of the patients in the conventional group and in 17.6% (3/17) in the piggyback group (p = 0.68). Median FHVP-CVP gradient was 2 mm Hg (0–8 mmHg) vs. 3 mm Hg (0–7 mm Hg) in conventional and piggyback groups, respectively (p = 0.73). There is no statistically significant difference between the conventional (1/15) and the piggyback (2/17) groups regarding massive ascites development (p = 1.00). GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02). The conventional method presented a higher prevalence of severe ARF during the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048). Conclusion Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft. Conventional with venovenous bypass technique significantly increases the harm of postoperative renal dysfunction. Trial Registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01707810 PMID:26115520

  4. Coupling between arterial and venous cerebral blood flow during postural change.

    PubMed

    Ogoh, Shigehiko; Washio, Takuro; Sasaki, Hiroyuki; Petersen, Lonnie G; Secher, Niels H; Sato, Kohei

    2016-12-01

    In supine humans the main drainage from the brain is through the internal jugular vein (IJV), but the vertebral veins (VV) become important during orthostatic stress because the IJV is partially collapsed. To identify the effect of this shift in venous drainage from the brain on the cerebral circulation, this study addressed both arterial and venous flow responses in the "anterior" and "posterior" parts of the brain when nine healthy subjects (5 men) were seated and flow was manipulated by hyperventilation and inhalation of 6% carbon dioxide (CO2). From a supine to a seated position, both internal carotid artery (ICA) and IJV blood flow decreased (P = 0.004 and P = 0.002), while vertebral artery (VA) flow did not change (P = 0.348) and VV flow increased (P = 0.024). In both supine and seated positions the ICA response to manipulation of end-tidal CO2 tension was reflected in IJV (r = 0.645 and r = 0.790, P < 0.001) and VV blood flow (r = 0.771 and r = 0.828, P < 0.001). When seated, the decrease in ICA blood flow did not affect venous outflow, but the decrease in IJV blood flow was associated with the increase in VV blood flow (r = 0.479, P = 0.044). In addition, the increase in VV blood flow when seated was reflected in VA blood flow (r = 0.649, P = 0.004), and the two flows were coupled during manipulation of the end-tidal CO2 tension (supine, r = 0.551, P = 0.004; seated, r = 0.612, P < 0001). These results support that VV compensates for the reduction in IJV blood flow when seated and that VV may influence VA blood flow.

  5. Venous catheterization with ultrasound navigation

    SciTech Connect

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

    2015-11-17

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

  6. A South Indian cadaveric study on obturator neurovascular bundle with a special emphasis on high prevalence of 'venous corona mortis'.

    PubMed

    Nayak, Satheesha B; Deepthinath, R; Prasad, A M; Shetty, Surekha D; Aithal, Ashwini P

    2016-07-01

    Surgical procedures in the pelvic region are very challenging because of the complex anatomy of this region. "Corona mortis" is a term used to describe retro-pubic anastomosis between the obturator and external iliac vessels. It is considered as a key structure as significant haemorrhage may occur if the vessels are cut accidentally during pelvic surgeries. Earlier studies have documented a high frequency of venous anastomosis compared to its arterial counterpart. The objective of our study was to document the prevalence of venous corona mortis in South Indian human adult cadaveric pelvises. We conducted this study on 73 cadaveric pelvic halves. Out of the 73 hemi pelvises, 36 were normal without any variations of the obturator vessels while 37 hemi pelvises (51%) showed the presence of abnormal obturator vessels which proves to be a very high incidence in terms of variations. Out of the 37 hemi pelvises, 25 (68%) showed the presence of 2 obturator veins, out of which 1 was normal and the other was an abnormal obturator vein. 8 hemi pelvises (22%) had only abnormal obturator vein. Most of the abnormal obturator veins drained into the external iliac vein, while two veins drained into inferior epigastric veins. Venous corona mortis is said to be frequently encountered during surgery and is considered to be as important as arterial corona mortis in its clinical implications. Individual evaluation of this risky anatomical structure should be done prior to any surgical interventions.

  7. Heritable bovine fetal abnormalities.

    PubMed

    Whitlock, B K; Kaiser, L; Maxwell, H S

    2008-08-01

    The etiologies for congenital bovine fetal anomalies can be divided into heritable, toxic, nutritional, and infectious categories. Although uncommon in most herds, inherited congenital anomalies are probably present in all breeds of cattle and propagated as a result of specific trait selection that inadvertently results in propagation of the defect. In some herds, the occurrence of inherited anomalies has become frequent, and economically important. Anomalous traits can affect animals in a range of ways, some being lethal or requiring euthanasia on humane grounds, others altering structure, function, or performance of affected animals. Veterinary practitioners should be aware of the potential for inherited defects, and be prepared to investigate and report animals exhibiting abnormal characteristics. This review will discuss the morphologic characteristics, mode of inheritance, breeding lines affected, and the availability of genetic testing for selected heritable bovine fetal abnormalities.

  8. Liver abnormalities in pregnancy.

    PubMed

    Than, Nwe Ni; Neuberger, James

    2013-08-01

    Abnormalities of liver function (notably rise in alkaline phosphatase and fall in serum albumin) are common in normal pregnancy, whereas rise in serum bilirubin and aminotransferase suggest either exacerbation of underlying pre-existing liver disease, liver disease related to pregnancy or liver disease unrelated to pregnancy. Pregnant women appear to have a worse outcome when infected with Hepatitis E virus. Liver diseases associated with pregnancy include abnormalities associated hyperemesis gravidarum, acute fatty liver disease, pre-eclampsia, cholestasis of pregnancy and HELLP syndrome. Prompt investigation and diagnosis is important in ensuring a successful maternal and foetal outcome. In general, prompt delivery is the treatment of choice for acute fatty liver, pre-eclampsia and HELLP syndrome and ursodeoxycholic acid is used for cholestasis of pregnancy although it is not licenced for this indication.

  9. Transluminally Placed Endovascular Grafts for Venous Lesions in Patients on Hemodialysis

    SciTech Connect

    Quinn, S.F. Kim, J.; Sheley, R.C.

    2003-08-15

    This report summarizes a feasibility study of transluminally placed endovascular grafts (TPEG) using pre-expanded polytetrafluoroethylene (PTFE) to treat venous abnormalities inpatients on hemodialysis. Seventeen patients with peripheral(n = 11) or central (n = 6) venous lesions were treated with TPEG devices. Covered Gianturco stents were used for the peripheral lesions and covered Palmaz stents were used for central lesions. Venous abnormalities included vascular rupture after balloon angioplasty or surgical thrombectomy (n = 4),stenosis associated with an aneurysm (n = 2) and occlusive disease and central stenoses not responsive to balloon angioplasty (n = 11). The mean primary patency period was 37 days. The mean secondary patency period was 215 days. At 60,180, and 360 days the primary and secondary patency rates were 40%,32%, and 32%, and 70%, 55%, and 39%, respectively. Follow-up studies have shown various outcomes of the implanted TPEG devices,which have included stenoses within the TPEG (n = 2),stenoses central to the TPEG (n = 1), stenoses peripheral to the TPEG (n = 3), acute thrombosis extending to the TPEG without a stenosis (n = 1), graft abandoned with patent TPEG (n = 6), and TPEG patent within primary patency period at last follow-up (n =4). The TPEG devices, made with pre-expanded PTFE, appear safe in the short term, do not prevent progressive dialysis access site failure, and need to be compared to PTA and endovascular stenting in a randomized prospective trial.

  10. Morphological abnormalities in elasmobranchs.

    PubMed

    Moore, A B M

    2015-08-01

    A total of 10 abnormal free-swimming (i.e., post-birth) elasmobranchs are reported from The (Persian-Arabian) Gulf, encompassing five species and including deformed heads, snouts, caudal fins and claspers. The complete absence of pelvic fins in a milk shark Rhizoprionodon acutus may be the first record in any elasmobranch. Possible causes, including the extreme environmental conditions and the high level of anthropogenic pollution particular to The Gulf, are briefly discussed.

  11. Anatomical Abnormalities in Autism?

    PubMed

    Haar, Shlomi; Berman, Sigal; Behrmann, Marlene; Dinstein, Ilan

    2016-04-01

    Substantial controversy exists regarding the presence and significance of anatomical abnormalities in autism spectrum disorders (ASD). The release of the Autism Brain Imaging Data Exchange (∼1000 participants, age 6-65 years) offers an unprecedented opportunity to conduct large-scale comparisons of anatomical MRI scans across groups and to resolve many of the outstanding questions. Comprehensive univariate analyses using volumetric, thickness, and surface area measures of over 180 anatomically defined brain areas, revealed significantly larger ventricular volumes, smaller corpus callosum volume (central segment only), and several cortical areas with increased thickness in the ASD group. Previously reported anatomical abnormalities in ASD including larger intracranial volumes, smaller cerebellar volumes, and larger amygdala volumes were not substantiated by the current study. In addition, multivariate classification analyses yielded modest decoding accuracies of individuals' group identity (<60%), suggesting that the examined anatomical measures are of limited diagnostic utility for ASD. While anatomical abnormalities may be present in distinct subgroups of ASD individuals, the current findings show that many previously reported anatomical measures are likely to be of low clinical and scientific significance for understanding ASD neuropathology as a whole in individuals 6-35 years old.

  12. [Central venous access by the Seldinger technic in neonatology].

    PubMed

    Goñi Orayen, C; Pérez Martínez, A; Ruiz Cano, R; Carrascosa Romero, M C; Vázquez García, M S; Martínez Gutiérrez, A

    1999-10-01

    Eighteen catheterizations were attempted in 17 patients catheters (Arrow 3ChFr and 4ChFr), between january of 1996 and december of 1997. The patients ranged in age from 3 to 148 days (mean of 43.3 and standard deviation of 47.5) and in weight from 1110 to 4000 grams (mean of 3182 grams and standard deviation 767.2 grams). Overall successful catheterization rate was 94.5%. Complications included a pneumothorax that needed pleural drainage, one self-limited femoral artery spasm and one stenosis of femoral vein that did not require any treatment. The mean catheterism time was 6.64 days (deviation of 3.84 days), and the causes of removal were end of treatment in 8 patients, accidental removal in 5, infectious suspicion in 2 and limb edema in 2. Seldinger technique may be a useful approach for central venous catheterization in neonates. Careful catheterization, extensive experience and appropriate selection of material, help to keep the risk of complications low.

  13. Abnormal pressures as hydrodynamic phenomena

    USGS Publications Warehouse

    Neuzil, C.E.

    1995-01-01

    So-called abnormal pressures, subsurface fluid pressures significantly higher or lower than hydrostatic, have excited speculation about their origin since subsurface exploration first encountered them. Two distinct conceptual models for abnormal pressures have gained currency among earth scientists. The static model sees abnormal pressures generally as relict features preserved by a virtual absence of fluid flow over geologic time. The hydrodynamic model instead envisions abnormal pressures as phenomena in which flow usually plays an important role. This paper develops the theoretical framework for abnormal pressures as hydrodynamic phenomena, shows that it explains the manifold occurrences of abnormal pressures, and examines the implications of this approach. -from Author

  14. [Molecular abnormalities in lymphomas].

    PubMed

    Delsol, G

    2010-11-01

    Numerous molecular abnormalities have been described in lymphomas. They are of diagnostic and prognostic value and are taken into account for the WHO classification of these tumors. They also shed some light on the underlying molecular mechanisms involved in lymphomas. Overall, four types of molecular abnormalities are involved: mutations, translocations, amplifications and deletions of tumor suppressor genes. Several techniques are available to detect these molecular anomalies: conventional cytogenetic analysis, multicolor FISH, CGH array or gene expression profiling using DNA microarrays. In some lymphomas, genetic abnormalities are responsible for the expression of an abnormal protein (e.g. tyrosine-kinase, transcription factor) detectable by immunohistochemistry. In the present review, molecular abnormalities observed in the most frequent B, T or NK cell lymphomas are discussed. In the broad spectrum of diffuse large B-cell lymphomas microarray analysis shows mostly two subgroups of tumors, one with gene expression signature corresponding to germinal center B-cell-like (GCB: CD10+, BCL6 [B-Cell Lymphoma 6]+, centerine+, MUM1-) and a subgroup expressing an activated B-cell-like signature (ABC: CD10-, BCL6-, centerine-, MUM1+). Among other B-cell lymphomas with well characterized molecular abnormalies are follicular lymphoma (BCL2 deregulation), MALT lymphoma (Mucosa Associated Lymphoid Tissue) [API2-MALT1 (mucosa-associated-lymphoid-tissue-lymphoma-translocation-gene1) fusion protein or deregulation BCL10, MALT1, FOXP1. MALT1 transcription factors], mantle cell lymphoma (cycline D1 [CCND1] overexpression) and Burkitt lymphoma (c-Myc expression). Except for ALK (anaplastic lymphoma kinase)-positive anaplastic large cell lymphoma, well characterized molecular anomalies are rare in lymphomas developed from T or NK cells. Peripheral T cell lymphomas not otherwise specified are a heterogeneous group of tumors with frequent but not recurrent molecular abnormalities

  15. Pharmacologic treatment of venous leg ulcers.

    PubMed

    Dormandy, J A

    1995-01-01

    In terms of prevalence, total cost and morbidity, venous leg ulcers are probably by far the most important type of ulcerations in the leg. The macrocirculatory defect leading to a raised ambulatory venous pressure is now accepted as a common initial pathologic pathway. Most current treatment modalities, such as surgery or external compression, are designed to control the macrovascular defect. However, it is the microcirculatory consequences of the venous hypertension that give rise to the trophic skin changes and ultimately to ulceration. At this microcirculatory level, pharmacotherapy may be a useful adjunct in the treatment of venous leg ulcers. The microcirculatory pathophysiologic changes include decreased fibrinolytic activity, elevated plasma fibrinogen, microcirculatory thrombi, and inappropriate activation of the white blood cells. The oxidative burst from the activated white cells probably plays a key role by releasing locally leukocyte-derived free radicals, proteolytic enzymes, cytokines, platelet-activating factor, and a number of other noxious mediators. An important additional component in recalcitrant venous ulcers is co-existing arterial disease, which is probably present in 15-20% of cases. Decreased arterial perfusion pressure will further aggravate the ischemic changes caused by the venous hypertension. Pentoxifylline downregulates leukocyte activation, reduces leukocyte adhesion, and also has fibrinolytic effects. A number of clinical studies have therefore been carried out to examine the clinical efficacy of pentoxifylline in treatment of venous leg ulcers. Probably the largest published placebo-controlled, double-blind randomized study was reported in 1990. In this study, 80 patients received either pentoxifylline 400 mg three times a day orally or matching placebo for 6 months or until their reference ulcer healed if this occurred sooner. Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with pentoxifylline

  16. Mixed total anomalous pulmonary venous connection: Case report with bilateral venous collectors.

    PubMed

    Cayre, Raul O; Civetta, Julio D; Roldan, Alberto O; Rousseau, Juan J; Knudson, Ole A; Valdes-Cruz, Lilliam M

    2003-01-01

    We present a case report of a 3-month-old boy with a mixed total anomalous pulmonary venous connection. The patient had situs solitus, small atrial septal defect, and 2 separate venous collectors. The right pulmonary veins drained through a right-sided venous collector into the coronary sinus. The left-sided pulmonary veins drained through the left-sided venous collector directly into the right superior vena cava. The use of the echocardiogram and Doppler color flow mapping to establish a detailed morphologic analysis, the sites of connection, and the presence of pulmonary venous obstructions as well as the value of this information to facilitate a successful surgical repair are discussed.

  17. Studies of lymphatic drainage from testes by lymphoscintigraphy

    SciTech Connect

    Yeh, S.D.J.; Morse, M.J.; Grando, R.; Kleinert, E.L.; Whitmore, W.F. Jr.

    1985-05-01

    Severe lymphedema of lower extremity may cause functional disability and foster recurrent lymphangitis. Surgical transportation of the testis to the thigh offers the possibility of enhancing lymphatic drainage from the leg via spermatic cord lymphatics. Testicular lymphoscintigraphy was employed to assess the quality of testicular lymphatic drainage prior to testis transposition. Images of abdomen and measurement of testis radioactivity were made serially after injection of Au 198 colloid into the testis of dogs before and after litigation of the spermatic cord. In the intact dogs, the residual radioactivities in the testis (5 dogs) were 53.5 +- 13.25, 41.6 +- 7.80 and 26.3 +- 5.66% at 2, 4 and 24 hours post injection. After ligation of spermatic cord, the residual activities in the testis were 95.0 +- 3.33, 86.4 +- 6.49 and 74.2 +- 6.28% at corresponding intervals post injection. Paraaortic nodes and liver were visualized in the abdominal images 1 hour after injection in the intact animals but only poorly seen in dogs following ligation. /sup 99m/Tc antimony colloid was used similarly in 5 patients who had severe lymphedema and abnormal pelvic lymphoscintigraphy following bipedal injection. With intratesticular injection, paraaortic lymph nodes and liver were visualized in 7 studies between 3 to 5 hours. Poor visualization was noted in two studies in patients who had previous radiation to the abdomen. The findings suggest that this simple technic can aid in the assessment of testicular lymphatic drainage and help to select patients for appropriate surgical intervention.

  18. [Thoracic drainage in trauma emergencies].

    PubMed

    Bergaminelli, C; De Angelis, P; Gauthier, P; Salzano, A; Vecchio, G

    1999-10-01

    A group of 191 cases of emergency tube thoracostomy for acute trauma reviewed retrospectively from March 1993 to March 1998 is reported. Of this group 169 were men and 22 were women. Their ages ranged from 16 to 73 years. The causes were as follows: 89 cases (46%) road accident; 33 cases (17%) accidental trauma; 33 cases (17%) someone else violence (assault, gunshot or stab wound); 15 cases (8%) work accident; 11 cases (6%) domestic accident and 5 cases (3%) iatrogenic trauma. In 32 patients a diagnosis of pneumothorax was made (2 tension, 11 for penetrating chest injuries, 19 after blunt trauma). In 2 cases of tension pneumothorax and in 3 cases of open pneumothorax a chest tube (24-28 Fr) in the third space in the mid-clavicular line was introduced. In the other patients it was decided to place a chest tube in the mid-axillary line in the fifth intercostal space to drain pneumothorax. Only in 7 cases suction was necessary. Fifty-four hemothorax (3 bilateral) were treated in 11 cases using thoracentesis, while the remaining cases were treated using the insertion of multiple drainage holes in the intercostal space (fifth in the mid-axillary line directed inferiorly and posteriorly). One hundred and three were the cases of hemopneumothorax: 24 of them received 2 chest tubes, the first (20-26 Fr) apically in the second intercostal space in the mid-clavicular line, the second (32-38 Fr) in the fifth intercostal space in the mid-axillary line. All the other cases were treated using a single thoracostomy. In 14 cases suction was applied. Two cases of chylothorax resolved by a large tube positioned in the chest (fifth intercostal space in the mid-axillary line) with a constant negative pressure were also observed. Duration of tube drainage ranged from 4 and 18 days, with an average of 11 days. Five infections of thoracostomy site and 1 empyema resolved by rethoracotomy were observed. Moreover, there were 3 complications: 2 subcutaneous placements and 1 little laceration

  19. Endoscopic Gallbladder Drainage for Acute Cholecystitis

    PubMed Central

    Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

    2015-01-01

    Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

  20. The Geochemistry of Acid Mine Drainage

    NASA Astrophysics Data System (ADS)

    Blowes, D. W.; Ptacek, C. J.; Jambor, J. L.; Weisener, C. G.

    2003-12-01

    Mine wastes are the largest volume of materials handled in the world (ICOLD, 1996). The generation of acidic drainage and the release of water containing high concentrations of dissolved metals from these wastes is an environmental problem of international scale. Acidic drainage is caused by the oxidation of sulfide minerals exposed to atmospheric oxygen. Although acid drainage is commonly associated with the extraction and processing of sulfide-bearing metalliferous ore deposits and sulfide-rich coal, acidic drainage can occur wherever sulfide minerals are excavated and exposed to atmospheric oxygen. Engineering projects, including road construction, airport development, and foundation excavation are examples of civil projects that have resulted in the generation of acidic drainage. On United States Forest Service Lands there are (2-5)×104 mines releasing acidic drainage (USDA, 1993). Kleinmann et al. (1991) estimated that more than 6,400 km of rivers and streams in the eastern United States have been adversely affected by mine-drainage water. About (0.8-1.6)×104 km of streams have been affected by metal mining in the western United States. The annual worldwide production of mine wastes exceeded 4.5 Gt in 1982 (ICOLD, 1996). Estimated costs for remediating mine wastes internationally total in the tens of billions of dollars ( Feasby et al.,1991).

  1. Water Flow and Lake Drainage Beneath Antarctica

    NASA Astrophysics Data System (ADS)

    Willis, I. C.; Long, S. M.; Peters, N. J.; Arnold, N. S.

    2008-12-01

    We use 5 km resolution surface and bed DEMs of Antarctica to calculate the subglacial hydraulic potential, and location of drainage catchments and major drainage pathways for the Antarctic Ice Sheet. We find close correlations between sinks in the hydraulic potential, the location of major drainage pathways and the position of known subglacial lakes. We use a thermo-mechanical ice sheet dynamics model with an assumed geothermal heat-flux to calculate energy supply and melt rates beneath the ice sheet. Accumulating this water along the drainage pathways allows us to calculate the steady state water flux to all known lakes (which range between ~ 0.1 and ~ 10m3 s-1) and in the drainage pathways as they enter the ocean (which range from ~ 1 to ~ 100m3 s-1). For different assumed lake drainage event discharges, we estimate a range of jokulhlaup frequencies for each lake. For the observed 1996-8 Adventure Subglacial Trench lake drainage event of ~ 1.8 km3, we estimate a flood frequency of 25 years. Finally, we use Nye's (1976) theory to model the time dependent discharge associated with the Adventure Trench jokulhlaup and can match theory to the observed surface altimetry data for realistic values of initial conduit diameter and roughness.

  2. Rescue N-butyl-2 cyanoacrylate embolectomy using a Solitaire FR device after venous glue migration during arteriovenous malformation embolization: technical note.

    PubMed

    Fahed, Robert; Clarençon, Frédéric; Sourour, Nader-Antoine; Chauvet, Dorian; Le Jean, Lise; Chiras, Jacques; Di Maria, Federico

    2016-07-01

    One of the procedural risks in arteriovenous malformation (AVM) embolization is possible migration of the embolic agent into the venous drainage with an incomplete nidus occlusion, which may lead to severe hemorrhagic complications. This report presents the case of a 29-year-old man who presented with a deep intraparenchymal hematoma on the left side secondary to the spontaneous rupture of a claustral AVM. Upon resorption of the hematoma, the patient underwent an initial therapeutic session of N-butyl-2 cyanoacrylate endovascular embolization, with the purpose of reducing the AVM volume and flow before performing Gamma Knife radiosurgery. After glue injection into one of the arterial feeders, the control angiography showed a partial migration of the glue cast into the straight sinus, with most of the nidus still visible. Because of the bleeding risk due to possible venous hypertension, it was decided to try to retrieve the glue from the vein by using a stent retriever via jugular access. This maneuver allowed a nearly complete removal of the glue cast, thereby restoring normal venous flow drainage. The patient showed no clinical worsening after the procedure. To the authors' knowledge, this is the first report of the use of the Solitaire FR device as a rescue glue retriever. This method should be considered by physicians in cases of unintended glue migration into the venous circulation during AVM embolization.

  3. Feeling Abnormal: Simulation of Deviancy in Abnormal and Exceptionality Courses.

    ERIC Educational Resources Information Center

    Fernald, Charles D.

    1980-01-01

    Describes activity in which student in abnormal psychology and psychology of exceptional children classes personally experience being judged abnormal. The experience allows the students to remember relevant research, become sensitized to the feelings of individuals classified as deviant, and use caution in classifying individuals as abnormal.…

  4. Venous waterfalls in coronary circulation.

    PubMed

    Gosselin, R E; Kaplow, S M

    1991-03-21

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

  5. [Successful treatment of extreme hypernatremia by continuous veno-venous hemodiafiltration].

    PubMed

    Giabicani, Mikhael; Guitard, Pierre-Gildas; Guerrot, Dominique; Grangé, Steven; Teule, Lauranne; Dureuil, Bertrand; Veber, Benoît

    2015-11-01

    Extreme hypernatremia in intensive care unit are frequently associated with a poor prognosis and their treatment, when associated with acute renal failure, is not consensual. We report the case of a 39-year-old man admitted in our intensive care unit for coma who presented extreme hyperosmolar hypernatremia (sodium 180 mmol/L, osmolarity 507 mOsm/L) associated with acute renal failure (urea 139.3 mmol/L, creatinine 748 μmol/L) and many other metabolic abnormalities. He was treated with hypotonic fluid administration and continuous renal replacement therapy (veno-venous hemodiafiltration) using an industrial dialysate fluid. Natremia was controlled by modulating intravenous water and sodium intake according to biological data. After 10 days, continuous renal replacement therapy was stopped and neurological exam was normal. Continuous veno-venous hemodiafiltration may be useful for treatment of extreme hypernatremia by allowing gradual correction of fluid and electrolyte disorders.

  6. Venous and arterial thrombotic risks with thalidomide: evidence and practical guidance

    PubMed Central

    Palladino, Carmela

    2012-01-01

    Oral immunomodulatory drugs (IMiDs), namely thalidomide, lenalidomide and pomalidomide, interfere with several pathways important for disease progression. Today they play a crucial role in the treatment of multiple myeloma patients, and have considerably improved myeloma outcomes. These agents, and thalidomide in particular, are associated with higher rates of thromboembolic events, both venous and arterial. Individual risk factors for thromboembolic events include advanced age, previous history of thromboembolism, an indwelling central venous catheter, comorbid conditions (e.g. infections, diabetes, cardiac disease, obesity), current or recent immobilization, recent surgery and inherited thrombophilic abnormalities. Cancer therapy and cancer itself also increase the risk of thromboembolic events. The aim of this review is to help clinicians to define the risk of thrombotic events in patients treated with thalidomide and thus to provide practical recommendations to manage thromboprophylaxis in these patients. PMID:25083240

  7. Pulmonary artery catheter insertion in a patient of dextrocardia with anomalous venous connections.

    PubMed

    Tripathi, Mukesh; Kumar, Naresh; Singh, Prabhat K

    2004-08-01

    In a young adult patient having situs solitus with dextrocardia the attempted pulmonary artery catheter placement for emergency mitral valve replacement required an unduly long length (50cm) of catheter insertion to get into right ventricle and then into pulmonary artery. Although catheter coiling was suspected initially, chest x-ray taken after successfully placement revealed an uncommon congenital anomalous venous connection i.e. right internal jugular opening into left sided superior vena cava then into inferior vena cava after running all along the left border of the heart. With the result, it required to pass 50cm of PA catheter to get into right ventricle in our patient. This emphasizes the need to look for abnormal venous connections during echocardiography and x-ray screening in congenital heart disease. Fluoroscopy is recommended when an unusual length of pulmonary artery catheter insertion is required to enter the pulmonary artery.

  8. Exercises to Improve Gait Abnormalities

    MedlinePlus

    ... Home About iChip Articles Directories Videos Resources Contact Exercises to Improve Gait Abnormalities Home » Article Categories » Exercise and Fitness Font Size: A A A A Exercises to Improve Gait Abnormalities Next Page The manner ...

  9. Abnormal human sex chromosome constitutions

    SciTech Connect

    1993-12-31

    Chapter 22, discusses abnormal human sex chromosome constitution. Aneuploidy of X chromosomes with a female phenotype, sex chromosome aneuploidy with a male phenotype, and various abnormalities in X chromosome behavior are described. 31 refs., 2 figs.

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

    PubMed Central

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

    2011-01-01

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

  11. [Venous malformations: clinical characteristics and differential diagnosis].

    PubMed

    Casanova, D; Boon, L-M; Vikkula, M

    2006-01-01

    Venous malformations (VM) are localized defects of blood vessels that are due to vascular dysmorphogenesis. These slow-flow lesions can affect any tissue or organ. Clinically, a cutaneous VM is characterized by a bluish mass that is compressible on palpation. Phleboliths are commonly present. Symptoms depend on location and size. VM are often sporadic and isolated, however, they can be associated with other malformations and be part of a syndrome; Klippel-Trenaunay (capillary-lymphatico-venous malformation with limb hypertrophy) is the most common. Glomuvenous malformation (GVM) is another type of venous anomaly. In contrast to VM, GVM is often painful on palpation and not compressible. Clinical diagnosis of VM is often made in the presence of a bluish cutaneous lesion: however, other lesions can mimick VM. The most frequent anomalies are a blue naevus, a hemorrhagic lymphatic malformation, a sub-cutaneous hemangioma or even the presence of dilated superficial normal veins due to underlying venous stenoses. This chapter will detail the clinical characteristics of venous anomalies and their differential diagnosis.

  12. Drainage Pathway of the Superior Petrosal Vein Evaluated by CT Venography in Petroclival Meningioma Surgery.

    PubMed

    Kaku, Shougo; Miyahara, Kosuke; Fujitsu, Kazuhiko; Hataoka, Shunsuke; Tanino, Shin; Okada, Tomu; Ichikawa, Teruo; Abe, Toshiaki

    2012-10-01

    Objectives This study aimed to clarify the drainage location of the superior petrosal vein (SPV) in relation to Meckel's cave and the internal acoustic meatus (IAM) and to discuss its significance in petroclival meningioma surgery. Design Prospective clinical study. Setting Hospital-based. Participants Five patients with petroclival meningioma and 50 patients (primarily unruptured supratentorial aneurysm patients, with a few hemifacial spasm patients) with no posterior fossa lesions. Main Outcome Measures On computed tomography venography (CTV), the drainage site was classified into three patterns based on its relationship to Meckel's cave and the IAM: Meckel's cave type, Intermediate type, and Meatal type. Results In all patients, the SPV was patent and emptied into the superior petrosal sinus (SPS). In patients without posterior fossa lesions, 35% had Meckel's cave type, 54% had Intermediate type, and 11% had Meatal type. Of the five patients with petroclival meningioma, three had Intermediate type, and two had Meckel's cave type. Conclusion The SPV is a significant vein that should be preserved to prevent venous complications. Preoperative knowledge of the SPV drainage site is helpful for planning the approach and preserving the SPV in petroclival meningioma surgery.

  13. Fractal Analysis of Drainage Basins on Mars

    NASA Technical Reports Server (NTRS)

    Stepinski, T. F.; Marinova, M. M.; McGovern, P. J.; Clifford, S. M.

    2002-01-01

    We used statistical properties of drainage networks on Mars as a measure of martian landscape morphology and an indicator of landscape evolution processes. We utilize the Mars Orbiter Laser Altimeter (MOLA) data to construct digital elevation maps (DEMs) of several, mostly ancient, martian terrains. Drainage basins and channel networks are computationally extracted from DEMs and their structures are analyzed and compared to drainage networks extracted from terrestrial and lunar DEMs. We show that martian networks are self-affine statistical fractals with planar properties similar to terrestrial networks, but vertical properties similar to lunar networks. The uniformity of martian drainage density is between those for terrestrial and lunar landscapes. Our results are consistent with the roughening of ancient martian terrains by combination of rainfall-fed erosion and impacts, although roughening by other fluvial processes cannot be excluded. The notion of sustained rainfall in recent Mars history is inconsistent with our findings.

  14. AGRICULTURAL DRAINAGE WELLS: IMPACT ON GROUND WATER

    EPA Science Inventory

    This document discusses agricultural drainage well practices, potential contamination problems that may occur, and possible management practices or regulatory solutions that could be used to alleviate those problems. The document has been written for use by state and Agency deci...

  15. Epilepsy and chromosomal abnormalities

    PubMed Central

    2010-01-01

    Background Many chromosomal abnormalities are associated with Central Nervous System (CNS) malformations and other neurological alterations, among which seizures and epilepsy. Some of these show a peculiar epileptic and EEG pattern. We describe some epileptic syndromes frequently reported in chromosomal disorders. Methods Detailed clinical assessment, electrophysiological studies, survey of the literature. Results In some of these congenital syndromes the clinical presentation and EEG anomalies seems to be quite typical, in others the manifestations appear aspecific and no strictly linked with the chromosomal imbalance. The onset of seizures is often during the neonatal period of the infancy. Conclusions A better characterization of the electro clinical patterns associated with specific chromosomal aberrations could give us a valuable key in the identification of epilepsy susceptibility of some chromosomal loci, using the new advances in molecular cytogenetics techniques - such as fluorescent in situ hybridization (FISH), subtelomeric analysis and CGH (comparative genomic hybridization) microarray. However further studies are needed to understand the mechanism of epilepsy associated with chromosomal abnormalities. PMID:20438626

  16. Capillo-venous flow in the brain: significance of intravascular RBC aggregation for venous flow regulation.

    PubMed

    Tomita, Minoru; Tanahashi, Norio; Takeda, Hidetaka; Schiszler, Istvan; Osada, Takashi; Unekawa, Miyuki; Suzuki, Norihiro

    2006-01-01

    Despite numerous reports on the regulation of cerebral arterial blood flow, little work has been done on that of the capillary and venous system. We have examined capillo-venous blood flow in the rat intraparenchymal cerebral cortex, employing a high-speed video confocal fluorescence microscope and our own software (KEIOIS-2) to track individual RBCs and to document velocity changes in single capillaries and veins. We found temporal and spatial heterogeneous changes in capillary RBC density (hematocrit), RBC recruitment, oscillation of capillary flow or vasomotion, and capillary density unrelated to arteriolar diametric changes. In veins, blood flow was also quite variable in time and space, and at a high frame rate venous blood per se was observed as a moving column of amorphous RBC aggregates with irregular edges; we believe this is the first report of such an observation under physiological conditions. The formation of such intravascular RBC aggregates would enforce slowing of blood flow and vice versa: RBC aggregation was in turn entirely flow-dependent. In rapid venous flow, RBCs appeared as a straight gathering of individually separated and dispersed cells. At capillo-venous junctions, an "RBC pouring" process appeared to occur, with RBCs either being sucked up from the capillary, merging, or being held back in the capillary. Changes in venous blood viscosity due to RBC aggregation are likely to be involved in this process. These findings suggest that the capillo-venous junction somehow participates in the regulation of appropriate tissue capillary flow in toto.

  17. Noninvasive measurement of central venous pressure

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

  18. Infections associated with the central venous catheters.

    PubMed

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  19. Venous thromboembolic disease in colorectal patients.

    PubMed

    McNally, Michael P; Burns, Christopher J

    2009-02-01

    Venous thromboembolic disease, which includes deep vein thromboses as well as pulmonary emboli, can be a significant complication in the postoperative patient. In particular, colorectal patients often carry a higher risk for venous thromboembolism when compared with patients undergoing other operative procedures. Features unique to colorectal patients are the high incidence of inflammatory bowel disease or malignancy. Typically, these patients will undergo lengthy pelvic procedures, which also contribute to a cumulative risk of venous thrombosis. It is critical that all patients and the proposed operative procedure are appropriately risk stratified. Risk stratification allows for easier implementation of an appropriate prophylactic strategy. There are a wide range of safe and effective mechanical and pharmacologic measures available. The authors provide very specific recommendations, but note that clinical judgment plays a significant role.

  20. The Role of Platelets in Venous Thromboembolism.

    PubMed

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

    2016-04-01

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

  1. Anticoagulation Therapy for Venous Thromboembolism

    PubMed Central

    Cundiff, David K

    2004-01-01

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

  2. [Superficial venous thrombosis. A state of art].

    PubMed

    Sándor, Tamás

    2017-01-01

    For a long time superficial thrombophlebitis has been thought to be a rather benign condition. Recently, when duplex ultrasound technique is used for the diagnosis more and more often, the disease is proved to be more dangerous than anticipated. Thrombosis propagates to the deep veins in 6-44% and pulmonary embolism was observed on the patients in 1,5-33%. We can calculate venous thromboembolic complications on every fourth patient. Diagnosis is clinical, but duplex ultrasound examination is mandatory, for estimation of the thrombus extent, for exclusion of the deep venous thrombosis and for follow up. Both legs should be checked with ultrasound, because simultaneous deep venous thrombosis can develop on the contralateral limb. Two different forms can be distinguished: superficial venous thrombosis with, or without varicose veins. In cases of spontaneous, non varicous form, especially when the process is migrating or recurrent, a careful clinical examination is necessery for exclusion of malignant diseases and thrombophilia. The treatment options are summarised on the basis of recent international consensus statements. The American and German guidelines are similar. Compression and mobilisation are cornerstones of the therapy. For a short segment thrombosis non steroidal antiinflammatory drugs are effective. For longer segments low molecular-weight heparins are preferred. Information on the effect of the novel oral anticoagulants for the therapy is lacking but they may appear to be effective in the future for this indication. When thrombus is close to the sapheno-femoral or sapheno-popliteal junction crossectomy (high ligation), or low molecular-weight heparin in therapeutic doses are indicated. The term superficial thrombophlebitis should be discouraged, because inflammation and infection is not the primary pathology. It should be called correctly superficial venous thrombosis in order to avoid the unnecessary administration of antibiotics and the misconception

  3. Thrombolytic therapy for central venous catheter occlusion

    PubMed Central

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

    2012-01-01

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

  4. Drainage through subglacial water sheets

    NASA Astrophysics Data System (ADS)

    Creyts, Timothy T.; Schoof, Christian G.

    2009-10-01

    Subglacial drainage plays an important role in controlling coupling between glacial ice and underlying bed. Here, we study the flow of water in thin, macroporous sheets between ice and bed. Previous work shows that small perturbations in depth of a nearly parallel-sided water film grow unstably because these areas have enhanced viscous dissipation that leads to enhanced melting of an ice roof. We argue that in the presence of bed protrusions bridging a water sheet, downward motion of the ice roof can stabilize this sheet. Stability results when the rate of roof closure increases faster with water depth than the rate of viscous dissipation. We therefore modify existing theory to include protrusions that partially support the overlying glacier. Differences in the pressure on protrusions relative to water pressure drive roof closure. The mechanisms of both regelation and creep normal to the bed close the overlying ice roof and decrease the ice-bed gap. In order to account for multiple protrusion sizes along the bed (for instance, resulting from an assortment of various-sized sediment grains), we incorporate a method of partitioning overburden pressure among different protrusion size classes and the water sheet. Partitioning is dependent on the amount of ice protrusion contact and, therefore, water depth. This method allows prediction of roof closure rates. We then investigate stable, steady sheet configurations for reasonable parameter choices and find that these steady states can occur for modest water depths at very low effective pressures, as is appropriate for ice streams. Moreover, we find that multiple steady sheet thicknesses exist, raising the possibility of switches between low and high hydraulic conductivity regimes for the subglacial water system.

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

    SciTech Connect

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

    1984-01-01

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

  6. Whole-Brain Computed Tomographic Perfusion Imaging in Acute Cerebral Venous Sinus Thrombosis

    PubMed Central

    Mokin, Maxim; Ciambella, Chelsey C.; Masud, Muhammad W.; Levy, Elad I.; Snyder, Kenneth V.; Siddiqui, Adnan H.

    2016-01-01

    Background Acute cerebral venous sinus thrombosis (VST) can be difficult to diagnose because of its diverse clinical presentation. The utility of perfusion imaging for diagnosing VST is not well understood. Summary We retrospectively reviewed cases of acute VST in patients who underwent whole-brain (320-detector-row) computed tomographic (CT) perfusion imaging in combination with craniocervical CT venography. Perfusion maps that were analyzed included cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time, and time to peak. Among the 10 patients with acute VST included in this study, 9 had perfusion abnormalities. All perfusion abnormalities were localized in areas adjacent to the occluded sinus and did not match typical anterior or posterior circulation arterial territories. Bilateral perfusion deficits were seen in 4 cases. In 2 cases, parenchymal hemorrhage was diagnosed on noncontrast CT imaging; in those cases, focal CBV and CBF were reduced. Key Messages Whole-brain CT perfusion imaging with 320-detector-row scanners can further assist in establishing the diagnosis of VST by detecting perfusion abnormalities corresponding to venous and not arterial territories. CT perfusion could assist in the differentiation between focal reversible changes, such as those caused by vasogenic edema, and irreversible changes due to infarction. PMID:27051406

  7. ASSESSMENT OF VENOUS THROMBOSIS IN ANIMAL MODELS

    PubMed Central

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

    2016-01-01

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

  8. Prevention and treatment of venous ulceration.

    PubMed Central

    Negus, D.

    1985-01-01

    Venous ulcers are related to incompetence of the direct calf and ankle perforating veins, the majority of which follow deep vein thrombosis. Prevention of the latter by intravenous micro-dose heparin (1 unit/kg/hour) is effective, safe and inexpensive. Its efficacy has been proved in two controlled clinical trials. Venous ulcers have been treated by perforating vein ligation, with saphenous ligation and stripping where necessary, and with the addition of permanent knee-length elastic compression stockings in patients with femoro-popliteal incompetence. This regimen has achieved a 92% long-term success rate in patients without rheumatoid arthritis. Images Fig. 3 PMID:3890671

  9. Venous angiomata: treatment with sclerosant foam.

    PubMed

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

    2005-07-01

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

  10. Minimally invasive treatments for venous compression syndromes

    PubMed Central

    Hulsberg, Paul C.; McLoney, Eric; Partovi, Sasan; Davidson, Jon C.

    2016-01-01

    The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods. We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. The clinical aspects and pathophysiology of Paget-Schroetter syndrome (PSS), nutcracker syndrome, and May-Thurner syndrome are discussed in detail, with particular emphasis on the role that interventionalists can play in minimally invasive treatment. PMID:28123978

  11. [Deep venous thrombosis related to cranioencephalic injury].

    PubMed

    Yáñez Baña, R M; Rossi López, R E; Romero López, J; Pareja Grande, J A; González-Elipe, J

    1989-09-01

    The clinical onset of cerebral venous thrombosis (CVT) is very variable and the causes that may lead to its development are also quite numerous. Although characteristic CT diagnostic signs have been described, in most cases only nonspecific findings are present and angiography is required to confirm the diagnosis. The prognosis is variable. Classically, the mortality is high when the deep venous system is involved. We report a male with CVT involving Galen's vein and its major tributary vessels, who had a favorable outcome with heparin therapy and drugs for cerebral edema. We discuss the etiologic factors in this patient, the characteristic neuroradiologic findings, and their evolution during the course of therapy.

  12. Developmental Venous Anomaly Responsible for Hemifacial Spasm

    PubMed Central

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

    2013-01-01

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

  13. Anatomic considerations for central venous cannulation

    PubMed Central

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

    2011-01-01

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

  14. Skeletal abnormalities in homocystinuria.

    PubMed Central

    Brenton, D. P.

    1977-01-01

    The skeletal changes of thirty-four patients with the biochemical and clinical features of cystathionine synthase deficiency are described. It is emphasized that there is clinical evidence of excessive bone growth and the formation for bone which is structurally weaker than normal. The similarities and differences between this condition and Marfan's syndrome are stressed and the possible nature of the connective tissue defect leading to the skeletal changes discussed. The most characteristic skeletal changes in homocystinuria are the skeletal disproportion (pubis-heel length greater than crown-pubis length), the abnormal vertebrae, sternal deformities, genu valgum and large metaphyses and epiphyses. Images Fig. 2 Fig. 3 Fig. 4 Fig. 8 Fig. 9 Fig. 10 PMID:917963

  15. Eye movement abnormalities.

    PubMed

    Moncayo, Jorge; Bogousslavsky, Julien

    2012-01-01

    Generation and control of eye movements requires the participation of the cortex, basal ganglia, cerebellum and brainstem. The signals of this complex neural network finally converge on the ocular motoneurons of the brainstem. Infarct or hemorrhage at any level of the oculomotor system (though more frequent in the brain-stem) may give rise to a broad spectrum of eye movement abnormalities (EMAs). Consequently, neurologists and particularly stroke neurologists are routinely confronted with EMAs, some of which may be overlooked in the acute stroke setting and others that, when recognized, may have a high localizing value. The most complex EMAs are due to midbrain stroke. Horizontal gaze disorders, some of them manifesting unusual patterns, may occur in pontine stroke. Distinct varieties of nystagmus occur in cerebellar and medullary stroke. This review summarizes the most representative EMAs from the supratentorial level to the brainstem.

  16. Venous leg ulcer treatment and practice--part 1: the causes and diagnosis of venous leg ulcers.

    PubMed

    Rajendran, S; Rigby, A J; Anand, S C

    2007-01-01

    This article, the first of a series of four on venous leg ulceration, discusses theories relating to the pathophysiology underlying the condition, and the range of diagnostic procedures undertaken to establish that ulceration is of venous origin.

  17. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  18. [Chronic venous insufficiency in postthrombotic syndrome and varicose veins].

    PubMed

    Hafner, Jürg; Mayer, D; Amann, B; French, L E; Läuchli, S; Hofer, T; Ramelet, A-A; Jeanneret, Ch

    2010-10-06

    Venous disorders have a high prevalence and require approximately 1% of health budgets of industrialized countries. The postthrombotic syndrome (PTS) is defined by subjective symptoms and morphologic trophical skin changes following deep venous thrombosis. Prevention of venous thromboembolism in risk situations, easy availability of diagnostic tools (D-dimers, colour-coded duplex sonography) and early detection of deep venous thrombosis, as well as immediate therapeutic anticoagulation along with leg compression during the acute phase and over a two year period of time significantly reduce the incidence of PTS. Chronic venous insufficiency (CVI) includes trophical skin and soft tissue pathologies of the lower leg due to venous hypertension in the distal venous system of the lower extremity. Roughly, two main causes can be distinguished. (A) Deep venous insufficiency (A1 in postthrombotic syndrome; A2 in primary deep venous insufficiency) and (B) superficial venous reflux, usually varicose veins. Compression therapy, surgical ablation of superficial venous reflux, and tangential ablation with split skin graft (shave treatment) of refractory venous ulcers are the mainstays in the treatment of CVI.

  19. Serendipitous detection of an errant central venous catheter

    SciTech Connect

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

    1985-09-01

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

  20. New method to assess manual lymph drainage using lymphoscintigraphy.

    PubMed

    de Godoy, José Maria Pereira; Iozzi, Adriana Joaquim; Azevedo, Walter Ferreira; Godoy, Maria de Fátima Guerreiro

    2012-08-27

    The aim of this study was to describe a new variation of the technique to evaluate lymph drainage utilizing lymphoscintigraphy. A LS scan marks the route of lymphatic vessels and may be used to assess both manual lymph drainage and lymph drainage after using some apparatuses. This evaluation may be dynamic, collecting images whilst performing lymph drainage or static, with scans before and after the lymph drainage procedure.

  1. Patterns of venous reflux and obstruction in patients with skin damage due to chronic venous disease.

    PubMed

    Labropoulos, Nicos; Patel, Parag J; Tiongson, Jay E; Pryor, Landon; Leon, Luis R; Tassiopoulos, Apostolos K

    2007-01-01

    Identified were characteristics of individuals with skin damage related to chronic venous disease. Patients with chronic venous disease (n = 164) were evaluated with duplex ultrasound imaging and were placed in classes 4, 5, and 6 according to the CEAP classification. Their findings were compared with 100 class 2 controls. The prevalence of deep venous thrombosis was higher in the study group (23.7%) versus controls (5.1%; P < .0001), as was the prevalence of deep, perforator, and combined patterns of disease (P < .0001, P < .0007, and P < .0001). The mean duration of disease in controls 2 was shorter compared with the study group (P = .0019). The prevalence of reflux and obstruction within the study group was higher than in controls (P = .0021). Skin changes accurately reflect severity of chronic venous disease. Superficial and perforator vein reflux is the major cause of disease.

  2. Surgical Repair of Total Anomalous Pulmonary Venous Connection in a Neonate With Mosaic Trisomy 8.

    PubMed

    Hasegawa, Tomomi; Oshima, Yoshihiro; Sato, Yumi; Tanaka, Akiko

    2016-03-01

    Trisomy 8 mosaicism is a relatively rare chromosomal abnormality and has extremely variable phenotype with a wide range of clinical manifestations. Although no well-defined criteria for cardiac surgical indications are available for patients with mosaic trisomy 8, we present a case of hypoplastic left heart syndrome with total anomalous pulmonary venous connection (TAPVC) in a neonate with mosaic trisomy 8. Although primary sutureless repair of TAPVC with concomitant bilateral pulmonary artery banding was performed successfully in this case, the indications for cardiac surgery in patients with mosaic trisomy 8 should be carefully individualized. The entire dialog with parents and family, including the process of informed consent, is of great importance.

  3. Percutaneous catheter drainage of pancreatic pseudocysts.

    PubMed

    Adams, D B; Harvey, T S; Anderson, M C

    1991-01-01

    Pancreatic pseudocysts represent a complication of severe pancreatic inflammatory disease. Although operative drainage is the cornerstone of therapy for pseudocysts, we have undertaken percutaneous catheter drainage in a selected group of 28 patients over a six-year period (1982-88). This represents 42 per cent of pseudocyst patients managed by the senior author and 1.7 per cent of admissions for pancreatitis at the Medical University Hospitals during that period of time. There were 26 men and two women with an age range of 26-66 years (mean = 42.1). Twenty-six patients had alcohol abuse as the cause of pancreatitis; two were due to surgical trauma. Nondilated pancreatic ducts were demonstrated in 25 patients. Six had pancreatic ascites associated with pseudocysts. Four had previous operative drainage (2 internal and 2 external drainage procedures). Five patients received octreotide acetate, a synthetic peptide which mimics the action of somatostatin, in an attempt to aid closure of external fistulas. The mean length of catheter drainage was 48 days (range 7-210 days). Eight (29%) patients developed procedure-related complications (1 pneumothorax, 1 sheared guidewire, six drain tract infections). There was no mortality. Successful resolution of pseudocysts was achieved in 26 patients (93%). Two patients subsequently had elective caudal pancreaticojejunostomy (CPJ), and one lateral pancreaticojejunostomy (LPJ) to drain obstructed pancreatic ducts. One patient has required repeat external drainage. Percutaneous external drainage is successful in pseudocyst eradication. When underlying pancreatic pathology remains uncorrected, elective surgical decompression of obstructed, dilated ducts may be necessary.

  4. Nonclinical aspects of venous thrombosis in pregnancy.

    PubMed

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

    2015-09-01

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

  5. [Chronic venous disease. A state of art].

    PubMed

    Sándor, Tamás

    2010-01-24

    Chronic venous disease affecting one-third of the European population has a considerable socioeconomic impact. There is increasing evidence, that the structural remodelling of the vein wall is caused by two etiological factors: the disturbed flow patterns in cosequence of the high venous pressure and a progressive inflammatory cascade. In the microcirculation the trapping of the white cells and the leukocyte-endothelium interaction lead to skin changes and leg ulcer. The CEAP classification has been adopted world-wide to faciliate the uniform communication and the description of all classes of the disease. For the practising physician the duplex scan is a valuable instrument to provide correct diagnosis and to guide the treatment. This ultrasound technique gives lot of useful information about the venous system of the lower leg, helps to identify the presence and sites of the reflux and the potential occlusion of the proximal veins. The possible treatments are the followings: conservative basis therapy - including compression, venoactive drugs, venous excersises, giving advice to patients and health care - as well as surgery and sclerotherapy. New promising therapeutic procedures, such as endovenous operations with radiofrequency or laser and foam sclerotherapy are spreading rapidly all over the world.

  6. Venous Thromboembolism Following Spinal Cord Injury

    PubMed Central

    Teasell, R.W.; Hsieh, T.J.; Aubut, JA. L.; Eng, J.J.; Krassioukov, A.; Tu, L.

    2011-01-01

    Objective To systematically review the published literature on the treatment of deep venous thromboembolism post-spinal cord injury (SCI). Data Sources MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool. Study Selection Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available. Data Extraction Data extracted included demographics, the nature of the study intervention, and study results. Data Synthesis Levels of evidence were assigned to the interventions using a modified Sackett scale. Conclusions Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in SCI patients. There was strong evidence to support the use of low molecular weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complication was more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments. PMID:19236977

  7. PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ORTHOPAEDIC SURGERY

    PubMed Central

    Leme, Luiz Eugênio Garcez; Sguizzatto, Guilherme Turolla

    2015-01-01

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

  8. [Femoral venous catheter: an unusual complication].

    PubMed

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

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

    PubMed

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

    2015-01-01

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

  10. Location of Agricultural Drainage Pipes and Assessment of Agricultural Drainage Pipe Conditions Using Ground Penetrating Radar

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Methods are needed to not only locate buried agricultural drainage pipe, but to also determine if the pipes are functioning properly with respect to water delivery. The primary focus of this research project was to confirm the ability of ground penetrating radar (GPR) to locate buried drainage pipe ...

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

    PubMed Central

    Eades, Shannan; Turiy, Yuliya

    2015-01-01

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

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

    PubMed

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

    2011-05-01

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

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

    PubMed

    Gulati, Om P

    2014-03-01

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

  14. Sequential venous anastomosis design to enhance patency of arterio-venous grafts for hemodialysis.

    PubMed

    Kabinejadian, Foad; Su, Boyang; Ghista, Dhanjoo N; Ismail, Munirah; Kim, Sangho; Leo, Hwa Liang

    2017-01-01

    Arterio-venous grafts (AVGs), the second best option as long-term vascular access for hemodialysis, face major issues of stenosis mainly due to development of intimal hyperplasia at the venous anastomosis which is linked to unfavorable hemodynamic conditions. We have investigated computationally the utility of a coupled sequential venous anastomotic design to replace conventional end-to-side (ETS) venous anastomosis, in order to improve the hemodynamic environment and consequently enhance the patency of AVGs. Two complete vascular access models with the conventional and the proposed venous anastomosis configurations were constructed. Three-dimensional, pulsatile blood flow through the models was simulated, and wall shear stress (WSS)-based hemodynamic parameters were calculated and compared between the two models. Simulation results demonstrated that the proposed anastomotic design provides: (i) a more uniform and smooth flow at the ETS anastomosis, without flow impingement and stagnation point on the artery bed and vortex formation in the heel region of the ETS anastomosis; (ii) more uniform distribution of WSS and substantially lower WSS gradients on the venous wall; and (iii) a spare route for the blood flow to the vein, to avoid re-operation in case of stenosis. The distinctive hemodynamic advantages observed in the proposed anastomotic design can enhance the patency of AVGs.

  15. Bubble generation and venous air filtration by hard-shell venous reservoirs: a comparative study.

    PubMed

    Mitchell, S J; Willcox, T; Gorman, D F

    1997-09-01

    We have previously shown significant bubble formation in Medtronic Maxima hard-shell venous reservoirs (HSVRs). In the present study, we not only investigated the mechanism of this bubble formation, but also the extent of bubble clearance by membrane oxygenators and arterial line filters. In addition, we also compared the performance of five HSVRs with respect to bubble formation and venous air filtration. Salvaged clinical CPB circuits containing different HSVRs were studied by downstream Doppler monitoring under fixed flow-decreasing volume, fixed volume-increasing flow, and entrained venous air conditions. Bubbles formed in the Medtronic Maxima top entry HSVR at volumes below 800 ml and flows above 3.5 l min-1, and were incompletely removed by a membrane oxygenator and arterial line filter. Decreased bubbling was seen when the reservoir atmosphere was flushed with CO2, suggesting that these bubbles formed in a fountain at the venous inflow. The Medtronic Maxima Forte HSVR formed significantly fewer bubbles at low volumes, and filtered venous air effectively. Negligible bubble formation occurred in the Sorin, Terumo, or Baxter reservoirs. The minimum recommended operating volume for the Medtronic Maxima top entry reservoir should be reset at 600 ml and this device should always be used with an arterial filter. Bubble formation is substantially reduced in the new Medtronic Maxima Forte HSVR and this device is a good filter for venous air.

  16. Treatment of venous leg ulcers with sulodexide.

    PubMed

    Scondotto, G; Aloisi, D; Ferrari, P; Martini, L

    1999-11-01

    Venous ulcers are still today one of the main socioeconomic problems of medical interest in terms of prevalence, morbidity, and costs to the health service. In the past, various studies have been carried out to identify a systemic pharmacologic treatment able to accelerate venous ulcer healing times, but frequently the results have not been satisfactory. The aim of this study was to evaluate the efficacy of sulodexide, a drug with profibrinolytic and antithrombotic activity, in accelerating venous ulcer's healing time. Ninety-four patients (32 men and 62 women), aged 72 years old on average, were randomly distributed between two groups. In the first group ("control group") a standard treatment was applied, which consisted of cleansing by washing with physiological solution and the application of elastic compression with short-extensibility, removable bandages. The second group ("sulodexide group") received the standard treatment plus sulodexide (600 lipoprotein lipase releasing units [LRU] by im route per day for 30 consecutive days, followed by 500 LRU by oral route per day for a further 30 days). After 2 months the venous ulcers were found healed in 15 patients (36%) in the control group and in 30 patients (58%) in the sulodexide group (p = 0.03). The life table showed that the healing times were shorter in the sulodexide group in the first 2 months of treatment. Total healing times amounted to 110 days in the control group and 72 days in the sulodexide group (p = 0.08) and the results were in proportion to the initial severity of the lesion. A significant correlation was noted between ulcer healing times and severity of the initial ulcerous lesion, the duration of the ulcer, and the group the patient belonged to. No correlation was found between age, gender of the patient and the etiology of the ulcer. In conclusion sulodexide was shown effective in the treatment of venous leg ulcers, yielding healing more quickly than the standard treatment.

  17. Foam drainage placed on a porous substrate.

    PubMed

    Arjmandi-Tash, O; Kovalchuk, N; Trybala, A; Starov, V

    2015-05-14

    A model for drainage/imbibition of a foam placed on the top of a porous substrate is presented. The equation of liquid imbibition into the porous substrate is coupled with a foam drainage equation at the foam/porous substrate interface. The deduced dimensionless equations are solved using a finite element method. It was found that the kinetics of foam drainage/imbibition depends on three dimensionless numbers and the initial liquid volume fraction. The result shows that there are three different regimes of the process. Each regime starts after initial rapid decrease of a liquid volume fraction at the foam/porous substrate interface: (i) rapid imbibition: the liquid volume fraction inside the foam at the foam/porous substrate interface remains constant close to a final liquid volume fraction; (ii) intermediate imbibition: the liquid volume fraction at the interface with the porous substrate experiences a peak point and imbibition into the porous substrate is slower as compared with the drainage; (iii) slow imbibition: the liquid volume fraction at the foam/porous substrate interface increases to a maximum limiting value and a free liquid layer is formed between the foam and the porous substrate. However, the free liquid layer disappears after some time. The transition points between these three different drainage/imbibition regimes were delineated by introducing two dimensionless numbers.

  18. Urban Drainage Modeling and Flood Risk Management

    NASA Astrophysics Data System (ADS)

    Schmitt, Theo G.; Thomas, Martin

    The European research project in the EUREKA framework, RisUrSim (Σ!2255) has been worked out by a project consortium including industrial mathematics and water engineering research institutes, municipal drainage works as well as an insurance company. The overall objective has been the development of a simulation to allow flood risk analysis and cost-effective management for urban drainage systems. In view of the regulatory background of European Standard EN 752, the phenomenon of urban flooding caused by surcharged sewer systems in urban drainage systems is analyzed, leading to the necessity of dual drainage modeling. A detailed dual drainage simulation model is described based upon hydraulic flow routing procedures for surface flow and pipe flow. Special consideration is given to the interaction between surface and sewer flow in order to most accurately compute water levels above ground as a basis for further assessment of possible damage costs. The model application is presented for small case study in terms of data needs, model verification, and first simulation results.

  19. Identifying weak points of urban drainage systems by means of VulNetUD.

    PubMed

    Möderl, M; Kleidorfer, M; Sitzenfrei, R; Rauch, W

    2009-01-01

    This article presents the development and application of the software tool VulNetUD. VulNetUD is a tool for GIS-based identification of vulnerable sites of urban drainage systems (UDS) using hydrodynamic simulations undertaken using EPA SWMM. The benefit of the tool is the output of different vulnerability maps rating sewer surcharging, sewer flooding, combined sewer overflow (CSO) efficiency and CSO emissions. For this, seven predefined performance indicators are used to evaluate urban drainage systems under abnormal, critical and future conditions. The application on a case study highlights the capability of the tool to identify weak points of the urban drainage systems. Thereby it is possible to identify urban drainage system components which cause the highest performance decrease across the entire system. The application of the method on a real world case study shows for instance that a reduction of catchment areas which are located upstream of CSOs with relatively less capacity in the downstream sewers achieves the highest increases efficiency of the system. Finally, the application of VulNetUD is seen as a valuable tool for managers and operators of waste water utilities to improve the efficiency of their systems. Additionally vulnerability maps generated by VulNetUD support risk management e.g. decision making in urban development planning or the development of rehabilitation strategies.

  20. Measuring venous insufficiency objectively in the clinical setting.

    PubMed

    Kelechi, Teresa J; Bonham, Phyllis A

    2008-09-01

    The purpose of this article is to propose a screening procedure to assess venous insufficiency with a hand-held photoplethysmography (PPG) instrument in the clinical setting. PPG is noninvasive technology that is used as part of venous assessment of the lower extremities. Although duplex ultrasound remains the industry gold standard for assessment, there are many situations in which access or expertise is not available. The measurement of venous refill time with PPG, one measure of venous insufficiency, is becoming increasingly more prevalent in research settings; however, PPG is underused in clinical settings. Rapid venous refill time venous disorders, and its measurement in clinical settings as a screening mechanism may provide useful data to augment diagnostic and therapeutic decision making. Future research is needed to establish a best-practice guideline for venous assessment in clinical settings to validate using PPG.

  1. Normal venous anatomy and physiology of the lower extremity.

    PubMed

    Notowitz, L B

    1993-06-01

    Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

  2. Mine Drainage and Oil Sand Water.

    PubMed

    Wei, Xinchao; Wolfe, F Andrew; Li, Yanjun

    2015-10-01

    Mine drainage from the mining of mineral resources (coal, metals, oil sand, or industrial minerals) remains as a persistent environmental problem. This review summarizes the scientific literature published in 2014 on the technical issues related to mine drainage or mine water in active and abandoned coal/hard rock mining sites or waste spoil piles. Also included in this review is the water from oil sand operations. This review is divided into the four sections: 1) mine drainage characterization, 2) prediction and environmental impact, 3) treatment technologies, 4) oil sand water. Many papers presented in this review address more than one aspect and different sections should not be regarded as being mutuallyexclusive or all-inclusive.

  3. Testing of a new prototype surgical stapler that automates the rollover sleeve technique for venous anastomoses.

    PubMed

    Carroll, Patricia B; Defaria, Werviston; Gandia, Carlos; Berho, Mariana; Misiakos, Evangelos; Tzakis, Andreas G

    2006-01-01

    The creation of successful vascular anastomoses is of primary importance in many surgical fields. Numerous attempts to automate this process have been made. These techniques have slowly gained acceptance, but their use is still limited. This report details feasibility testing of a new prototype stapler that automates the rollover sleeve technique for venous vascular anastomoses. Male and female mongrel dogs (n=7) (25-32 kg) were used. A segment of the right (n=5) or left (n=2) iliac vein was harvested for interposition grafts after the contra lateral side was transected. In each dog, two end-to-end venous anastomoses at the interposition grafts were performed. The standard anastomosis employed continuous mattress sutures. The experimental anastomosis was performed with a new prototype surgical stapler. The stapled anastomosis was proximal and the sutured was distal. In all experiments, it was possible to perform the experimental anastomosis with the stapler. Complications included two small leaks, one due to misfiring of a single pin in one experimental site. These leaks required suture reinforcement. One dog died of hemorrhage due to a slipped suture at the vein harvest site. One vein had thrombus seen at the sutured site although no technical abnormalities at either of the anastomoses could be found. After two weeks, grafts were inspected grossly and histologically. Healing appeared normal. There was a trend for less inflammatory cells infiltrating stapled sites; however, this was not statistically significant. The experiments demonstrate that this device can automate the rollover sleeve technique for venous anastomoses.

  4. Venous angioma may be associated with epilepsy in children

    PubMed Central

    Kim, Bo Ryung; Lee, Yun Jin; Nam, Sang Ook

    2016-01-01

    Purpose Venous angioma (VA) is the most common congenital abnormality of the intracranial vasculature. This study aimed to investigate the relationship between VA and epilepsy and to identify the characteristics of children with VA and epilepsy. Methods The records of all patients aged less than 18 years who underwent brain magnetic resonance imaging (MRI) at Pusan National University Hospital were retrospectively reviewed. Patients with isolated VA and patients with normal MRI were compared in terms of the prevalence of epilepsy. Results In total, 2,385 pediatric patients who underwent brain MRI were enrolled. Isolated VA was identified in 26 patients (VA group). Among the patients with normal MRI findings, 225 age- and sex-matched patients to the VA-group were assigned to the control group. Nine patients in the VA group (9 of 26, 34.6%) and 27 patients in the control group (26 of 225, 11.5%; P<0.001) had epilepsy. In the VA group, 20 patients (76.9%) had the VA in the cerebral hemispheres, and 6 patients (23.1%) had the VA in the brainstem and cerebellum. The latter showed a higher prevalence of epilepsy (5 of 6, 83.3%) than the former (4 of 20, 20.0%; P=0.004). Among the nine patients who had epilepsy with VA, patients whose VA involved the brainstem and cerebellum showed a significantly higher frequency of abnormal Electroencephalographic findings than patients whose VA involved the cerebral hemispheres (P=0.016). Conclusion VA, especially in the brainstem and cerebellum, might be associated with epilepsy. PMID:27610183

  5. Venous thrombosis and prothrombotic factors in inflammatory bowel disease.

    PubMed

    Magro, Fernando; Soares, João-Bruno; Fernandes, Dália

    2014-05-07

    Patients with inflammatory bowel disease (IBD) may have an increased risk of venous thrombosis (VTE). PubMed, ISI Web of Knowledge and Scopus were searched to identify studies investigating the risk of VTE and the prevalence of acquired and genetic VTE risk factors and prothrombotic abnormalities in IBD. Overall, IBD patients have a two- to fourfold increased risk of VTE compared with healthy controls, with an overall incidence rate of 1%-8%. The majority of studies did not show significant differences in the risk of VTE between Crohn's disease and ulcerative colitis. Several acquired factors are responsible for the increased risk of VTE in IBD: inflammatory activity, hospitalisation, surgery, pregnancy, disease phenotype (e.g., fistulising disease, colonic involvement and extensive involvement) and drug therapy (mainly steroids). There is also convincing evidence from basic science and from clinical and epidemiological studies that IBD is associated with several prothrombotic abnormalities, including initiation of the coagulation system, downregulation of natural anticoagulant mechanisms, impairment of fibrinolysis, increased platelet count and reactivity and dysfunction of the endothelium. Classical genetic alterations are not generally found more often in IBD patients than in non-IBD patients, suggesting that genetics does not explain the greater risk of VTE in these patients. IBD VTE may have clinical specificities, namely an earlier first episode of VTE in life, high recurrence rate, decreased efficacy of some drugs in preventing further episodes and poor prognosis. Clinicians should be aware of these risks, and adequate prophylactic actions should be taken in patients who have disease activity, are hospitalised, are submitted to surgery or are undergoing treatment.

  6. Venous thrombosis and prothrombotic factors in inflammatory bowel disease

    PubMed Central

    Magro, Fernando; Soares, João-Bruno; Fernandes, Dália

    2014-01-01

    Patients with inflammatory bowel disease (IBD) may have an increased risk of venous thrombosis (VTE). PubMed, ISI Web of Knowledge and Scopus were searched to identify studies investigating the risk of VTE and the prevalence of acquired and genetic VTE risk factors and prothrombotic abnormalities in IBD. Overall, IBD patients have a two- to fourfold increased risk of VTE compared with healthy controls, with an overall incidence rate of 1%-8%. The majority of studies did not show significant differences in the risk of VTE between Crohn’s disease and ulcerative colitis. Several acquired factors are responsible for the increased risk of VTE in IBD: inflammatory activity, hospitalisation, surgery, pregnancy, disease phenotype (e.g., fistulising disease, colonic involvement and extensive involvement) and drug therapy (mainly steroids). There is also convincing evidence from basic science and from clinical and epidemiological studies that IBD is associated with several prothrombotic abnormalities, including initiation of the coagulation system, downregulation of natural anticoagulant mechanisms, impairment of fibrinolysis, increased platelet count and reactivity and dysfunction of the endothelium. Classical genetic alterations are not generally found more often in IBD patients than in non-IBD patients, suggesting that genetics does not explain the greater risk of VTE in these patients. IBD VTE may have clinical specificities, namely an earlier first episode of VTE in life, high recurrence rate, decreased efficacy of some drugs in preventing further episodes and poor prognosis. Clinicians should be aware of these risks, and adequate prophylactic actions should be taken in patients who have disease activity, are hospitalised, are submitted to surgery or are undergoing treatment. PMID:24803797

  7. Control of acid mine drainage using surfactants

    SciTech Connect

    Not Available

    1983-02-01

    This news sheet describes US Bureau of Mines work on the reduction or prevention of acid mine drainage from coal refuse piles and surface mines by inhibiting the growth of Thiobacillus ferrooxidans. It has been found that the direct application of a dilute surfactant or detergent solution to coal refuse piles or overburden can be an effective preventive measure or can reduce water treatment costs by controlling acid drainage at its source. Of the anionic surfactants tested to date, sodium lauryl sulphate appears to be the most effective. Alpha olefin sulphonate and alkyl benzene sulphonate are acceptable alternatives. The results of field trials are presented.

  8. Review of 555 cholecystectomies without drainage.

    PubMed

    Carpenter, W S; Kambouris, A A; Allaben, R D

    1978-04-01

    During a 10-year period, 555 cholecystectomies were performed without drainage of the gallbladder bed or subhepatic space. Six per cent of the patients had acute cholecystitis or hydrops of the gallbaldder and 11% had common duct exploration. Only in those patients with frank infection, spillage of obviously infected bile or in whom satisfactory closure of the gallbladder bed could not be accomplished was a drain used. Meticulous closure of the gallbladder bed was performed to minimize leakage of bile. The series was critically studied to evaluate complications, morbidity, mortality and hospital stay. It was concluded that drainage following cholecystectomy or choledochotomy can safely be omitted except for the indications mentioned.

  9. [Laparoscopic abdominal drainage by sterile destructive pancreatitis].

    PubMed

    Kuznetsov, N A; Rodoman, G V; Shalaeva, T I; Trefilova, O I; Sosikova, N L

    2009-01-01

    90 patients with acute pancreatitis were observed, in 60 of them laparoscopic drainage was performed. The procedure by sterile pancreatonecrosis is indicated only in presence of extent amount of exudate in abdominal cavity. Duration of draining the abdominal cavity should be strictly limited because of the high risk of septic complications. Contraindications for the abdominal drainage by acute necrotic pancreatitis are not only adhesions in the abdomen and shock state of the patient at the moment of procedure necessity, but also unstable hemodynamics in anamnesis and even by the arterial pressure downtrend.

  10. Anomalous PiB enhancement in the superior sagittal and transverse venous sinuses.

    PubMed

    Raymond, Scott B; Cohen, Ann D; Becker, Carl; Price, Julie; Klunk, William E

    2012-01-01

    Pittsburgh compound-B (PiB), an amyloid-binding positron emission tomography (PET) tracer, is widely used for imaging amyloid-β in those with and at risk for Alzheimer disease. Here, we report on an otherwise normal 68-year-old female with abnormally high and very focal PiB retention. Coregistered T1-weighted magnetic resonance imaging and dynamic 2-fluoro-2-deoxy-D-glucose (FDG) images confirmed that the focal PiB enhancement was in the superior sagittal and transverse sinuses, outside of the adjacent cortex. Flow through the venous vasculature was normal as assessed by dynamic FDG PET imaging. These features supported the conclusion that PiB retention was not simply due to a hemodynamic abnormality, but may have represented PiB binding to fibrillar deposits of a β-sheet protein (ie, amyloid), whose nature is currently unclear.

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

    PubMed

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

    2014-01-01

    Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters. Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Midlines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the necessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Midlines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In general, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings

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

    PubMed

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

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

  13. Abnormal pressure in hydrocarbon environments

    USGS Publications Warehouse

    Law, B.E.; Spencer, C.W.

    1998-01-01

    Abnormal pressures, pressures above or below hydrostatic pressures, occur on all continents in a wide range of geological conditions. According to a survey of published literature on abnormal pressures, compaction disequilibrium and hydrocarbon generation are the two most commonly cited causes of abnormally high pressure in petroleum provinces. In young (Tertiary) deltaic sequences, compaction disequilibrium is the dominant cause of abnormal pressure. In older (pre-Tertiary) lithified rocks, hydrocarbon generation, aquathermal expansion, and tectonics are most often cited as the causes of abnormal pressure. The association of abnormal pressures with hydrocarbon accumulations is statistically significant. Within abnormally pressured reservoirs, empirical evidence indicates that the bulk of economically recoverable oil and gas occurs in reservoirs with pressure gradients less than 0.75 psi/ft (17.4 kPa/m) and there is very little production potential from reservoirs that exceed 0.85 psi/ft (19.6 kPa/m). Abnormally pressured rocks are also commonly associated with unconventional gas accumulations where the pressuring phase is gas of either a thermal or microbial origin. In underpressured, thermally mature rocks, the affected reservoirs have most often experienced a significant cooling history and probably evolved from an originally overpressured system.

  14. Systemic abnormalities in liver disease

    PubMed Central

    Minemura, Masami; Tajiri, Kazuto; Shimizu, Yukihiro

    2009-01-01

    Systemic abnormalities often occur in patients with liver disease. In particular, cardiopulmonary or renal diseases accompanied by advanced liver disease can be serious and may determine the quality of life and prognosis of patients. Therefore, both hepatologists and non-hepatologists should pay attention to such abnormalities in the management of patients with liver diseases. PMID:19554648

  15. Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach.

    PubMed

    Kodera, Toshiaki; Bozinov, Oliver; Sürücü, Oguzkan; Ulrich, Nils H; Burkhardt, Jan-Karl; Bertalanffy, Helmut

    2011-11-01

    The authors present a microsurgical technique for the resection of a heterogeneous group of pineal-region tumors and discuss the key points for successfully performing this surgery. Twenty-six consecutive patients with pineal-region tumors were resected by the senior author (H.B.) and analyzed retrospectively. For all 26 patients, the operation was conducted using the infratentorial supracerebellar (ITSC) approach in the sitting (23 patients) or Concorde (three patients) positions. Twenty-five patients had symptomatic obstructive hydrocephalus and were treated with ventricular drainage, a previously inserted ventriculoperitoneal shunt, or an endoscopic third ventriculostomy before undergoing resection of the pineal-region tumor. The gross total removal of the tumor was achieved in 23 patients and subtotal removal was achieved in three patients. The tumors were pathologically diagnosed mainly as pineocytomas (10), pilocytic astrocytomas (6), or pineal cysts (4). Twenty-five of the patients clinically improved after surgery, and there was no mortality. Two patients experienced transient postoperative neurological deterioration: one patient developed Parinaud syndrome, and one patient developed intermittent diplopia. Successful surgery and patient outcome when treating tumors of the pineal region using the ITSC approach requires: (i) preservation of the venous flow of the Galenic draining system; (ii) preservation of the thick bridging veins of the tentorial surface of the cerebellum, especially the hemispheric bridging veins; and (iii) minimizing retraction of the cerebellum during surgery to avoid adverse effects caused by both direct cerebellar compression and disturbance of the venous circulation.

  16. Deep venous thrombophlebitis following aortoiliac reconstructive surgery

    SciTech Connect

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

    1982-09-01

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

  17. [Venous thromboembolism in patients with cancer].

    PubMed

    Lecumberri, Ramón; Feliu, Jesús; Rocha, Eduardo

    2006-06-03

    The association between neoplastic diseases and venous thromboembolism (VTE) is known since long time ago. The nature of this association is bidirectional. On one hand, cancer increases the incidence of venous thrombosis and, on the other hand, the hemostatic system does play a key role in the tumorigenesis process. However, despite recent advances in the field, prophylaxis and treatment of VTE in cancer patients is still a challenge, due to the complexity of this type of patients. This review is focused on some important points regarding management of VTE in cancer patients such as physiopathology, epidemiology, search for hidden malignancy, prognostic impact, prophylaxis in the medical and surgical setting, or initial and long-term treatment.

  18. Venous thromboembolism in women taking hormonal contraceptives.

    PubMed

    Blanco-Molina, Angeles; Monreal, Manuel

    2010-02-01

    Hormonal contraceptives are a popular method of contraception, but their use has been associated with an increased risk for venous thromboembolism. In order to reduce such risk, these compounds have been changed in their dosage, chemical composition and route of administration. The absolute risk of death from pulmonary embolism in contraceptive users has been estimated to be 10.5 (95% CI: 6.2-16.6) per million woman-years. The safest option is an oral contraceptive containing levonorgestrel combined with a low dose of estrogen. Identifying women at increased risk for venous thromboembolism is difficult, and greater use of thromboprophylaxis during immobility or minor surgery should be warranted. Several authors have called for all women to be screened for thrombophilia before prescription of hormonal contraceptives, but its cost-effectiveness remains uncertain.

  19. [Prevention of venous thromboembolism in musculoskeletal surgery].

    PubMed

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

    2014-05-01

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

  20. Duct Drainage Alone is Sufficient in the Operative Management of Pancreatic Pseudocyst in Patients With Chronic Pancreatitis

    PubMed Central

    Nealon, William H.; Walser, Eric

    2003-01-01

    Objective To test a hypothesis that definitive management of pseudocyst associated with chronic pancreatitis is predicated on addressing pancreatic ductal anatomy. Summary Background Data The authors have previously confirmed the impact of pancreatic ductal anatomic abnormalities on the success of percutaneous drainage of pancreatic pseudocyst. The authors have further defined a system to categorize the pancreatic ductal abnormalities that can be seen with pancreatic pseudocyst. The authors have published, as have others, the usefulness of defining ductal anatomy when managing pancreatic pseudocysts associated with chronic pancreatitis. Methods Beginning in 1985, all patients with pseudocyst who were candidates for intervention (operative, percutaneous, or endoscopic) have undergone endoscopic retrograde cholangiopancreatography (ERCP). An associated diagnosis of chronic pancreatitis was established by means of ERCP findings. Patients were candidates for longitudinal pancreaticojejunostomy (LPJ) if they had a pancreatic ductal diameter greater than 7 mm. In a nonrandomized fashion, patients were managed with either combined simultaneous LPJ and pseudocyst drainage or with LPJ alone. Results Two hundred fifty-three patients with pseudocyst have been evaluated. Among these there have been 103 patients with chronic pancreatitis and main pancreatic duct (MPD) dilatation (>7 mm). Among these 103 patients, 56 underwent combined LPJ/pseudocyst drainage and 47 had LPJ alone. Compared to combined LPJ/pseudocyst drainage, the patients undergoing LPJ alone had a shorter operative time, slightly less transfusion requirement, slightly reduced length of hospital stay, and slightly reduced complication rate. Long-term pain relief was achieved in 90%, and pseudocyst recurrence was less than 1%. Rates of each of these long-term outcomes were nearly incidental among the two groups. Conclusions Ductal drainage alone (LPJ) is sufficient in patients with chronic pancreatitis (MPD > 7

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

    PubMed

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

    2016-04-01

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

  2. Multiple venous thrombosis complicating central venous cannulation in a non cancer patient - a case report.

    PubMed

    Peters, Ce; Menkiti, Id; Desalu, I; Thomas, Mo

    2013-01-01

    Central venous catheterization is a common procedure for critically ill patients. Like all procedures, it has its complications, one of which is thrombosis. Reports of thrombosis are commoner among cancer patients. We present a 37 year old non cancer patient who developed thrombi in both right and left internal jugular veins, 10 and 13 days respectively after insertion of central venous catheter. This was detected by ultrasound scans of the neck while attempting re-cannulation for parenteral feeding. She also had left lower limb deep venous thrombosis, confirmed by doppler scan, which was managed with low molecular weight heparin and warfarin. The patient was subsequently treated with streptokinase. A repeat scan of the internal jugular veins 4 days after thrombolysis revealed a reduction in size of the thrombi. Symptoms of deep venous thrombosis improved and she was transferred to the wards where she made remarkable improvement. This case illustrates the potential usefulness of ultrasound guided-central line insertion in patients who have had central venous lines inserted previously in order to detect thrombi.

  3. Ultrasound-guided peripheral venous access for therapeutic apheresis procedures reduces need for central venous catheters.

    PubMed

    Salazar, Eric; Garcia, Salvador; Miguel, Robin; Segura, Francisco J; Ipe, Tina S; Leveque, Christopher

    2016-08-10

    Therapeutic and donor apheresis requires adequate vascular access to achieve inlet flow rates of ∼50-100 mL/min. While central dialysis-type venous catheters can usually provide such access, their use includes several associated risks. Some of these risks can be avoided or diminished if adequate peripheral venous access can be established. Some patients have adequate peripheral veins for apheresis that cannot be readily identified visually or by palpation. We hypothesized that ultrasound-guided peripheral venous access would benefit such patients and would lead to placement of fewer central venous catheters. The technique of ultrasound-guided peripheral access for apheresis has been in use at Houston Methodist Hospital since 2012. We performed a prospective review of patients undergoing inpatient and outpatient apheresis at Houston Methodist Hospital from July 1, 2015 to September 30, 2015, to assess its benefit. During this time, we performed 831 procedures on 186 patients, including 787 therapeutic plasma exchanges, three red blood cell exchanges, 41 peripheral stem cell collections. Ultrasound-guided vascular access was used for 68 procedures (8% of all procedures), including 62 therapeutic plasma exchanges, 4 peripheral stem cell collections, and 2 red blood cell changes. Use of ultrasound-guided peripheral access prevented the placement of central venous catheters in 37 (20%) patients, demonstrating its utility in a busy transfusion service.

  4. Sulodexide in the treatment of chronic venous disease.

    PubMed

    Andreozzi, Giuseppe Maria

    2012-04-01

    Chronic venous disease encompasses a range of venous disorders, including those involving the lower limbs resulting from venous hypertension. The spectrum of chronic venous disease signs and symptoms shows variable severity, ranging from mild (aching, pain, and varicose veins) to severe (venous ulcers). The pathophysiology of chronic venous disease is characterized by venous hypertension, which triggers endothelial dysfunction and inflammation leading to microcirculatory and tissue damage, and eventually to varicose veins and venous ulcers. Sulodexide is an orally active mixture of glycosaminoglycan (GAG) polysaccharides with established antithrombotic and profibrinolytic activity. The agent is used in the treatment of a number of vascular disorders with increased risk of thrombosis, including intermittent claudication, peripheral arterial occlusive disease and post-myocardial infarction. Sulodexide differs from heparin because it is orally bioavailable and has a longer half-life and a smaller effect on systemic clotting and bleeding. An increasing body of preclinical evidence shows that sulodexide also exerts anti-inflammatory, endothelial-protective, and pleiotropic effects, supporting its potential efficacy in the treatment of chronic venous disease. Clinical studies of sulodexide have shown that the agent is associated with significant improvements in the clinical signs and symptoms of venous ulcers, and is therefore a recommended therapy in combination with local wound care and bandages for patients with persistent venous leg ulcers. Preliminary evidence supports the use of sulodexide in the prevention of recurrent deep venous thrombosis. Sulodexide was generally safe and well tolerated in clinical trials, without hemorrhagic complications. Sulodexide therefore appears to be a favorable option for the treatment of all stages of chronic venous disease and for the prevention of disease progression.

  5. Treatment of Venous Thromboembolism in Pediatric Patients

    PubMed Central

    Malec, Lynn; Young, Guy

    2017-01-01

    Given the increased incidence of venous thromboembolism (VTE) in pediatric patients, which has been associated with increased survival of medically complex patients and increased use of invasive supportive measures, it is important to understand treatment options and unique aspects of anticoagulant use in children. The objective of this mini-review is to outline the goals of treatment, treatment options, and adverse events associated with the use of anticoagulants in pediatric patients with VTE. PMID:28293549

  6. Venous malformations: clinical diagnosis and treatment

    PubMed Central

    Behravesh, Sasan; Yakes, Wayne; Gupta, Nikhil; Naidu, Sailendra; Chong, Brian W.; Khademhosseini, Ali

    2016-01-01

    Venous malformation (VM) is the most common type of congenital vascular malformation (CVM). They are present at birth and are often symptomatic, causing morbidity and pain. VMs can be challenging to diagnose and are often confused with hemangioma in terminology as well as with imaging. An accurate clinical history and cross-sectional imaging are critical for diagnosis and for devising management. This manuscript will review imaging approaches to diagnosing VMs and current treatment strategies. PMID:28123976

  7. PTA and Stenting of Benign Venous Stenoses in the Pelvis: Long-Term Results

    SciTech Connect

    Wohlgemuth, Walter A.; Weber, Hermann; Loeprecht, Henning; Tietze, Wolfram; Bohndorf, Klaus

    2000-01-15

    Purpose: To provide follow-up data on endovascular intervention for venous stenoses in the pelvis.Methods: Between 1985 and 1995, 35 patients presented with 42 stenoses of the pelvic veins after operative thrombectomy and creation of an arteriovenous fistula, combined with intraoperative venous angioscopy. All patients underwent angioplasty and, if unsuccessful, percutaneous insertion of an endovascular stent (n = 7).Results: Angioplasty with and without endovascular stenting was technically successful in 34 of 35 patients (97%). Average length of the stenoses was 20.6 mm (range 10-90 mm), average diameter before dilation 4.1 mm (range 2-6 mm), and average diameter after dilation 10.1 mm (range 5-18 mm). Intraoperative angioscopy showed pathologic findings (intimal laceration or residual thrombotic material) in 14 patients. After an average follow-up period of 4.13 years, 24 (69%) patients had patent veins. The difference in the primary patency rate between patients with angioscopically abnormal veins (6 of 14 patients, corresponding to a patency rate of 43%) and patients with angioscopically normal veins after thrombectomy (18 of 21 patients, corresponding to a patency rate of 86%) was statistically significant (p < 0.01, log rank test).Conclusions: Percutaneous transluminal angioplasty and/or stenting are good treatment modalities for pelvic vein stenosis following surgical thrombectomy. Angioscopically abnormal veins have a poorer long-term patency, regardless of the type of intervention.

  8. 24 CFR 3280.610 - Drainage systems.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... water seal trap (§ 3280.606(a)). (2) The drainage system shall be designed to provide an adequate circulation of air in all piping with no danger of siphonage, aspiration, or forcing of trap seals under... equipped with a water-tight cap or plug matching the drain outlet. The cap or plug shall be...

  9. 24 CFR 3280.610 - Drainage systems.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... water seal trap (§ 3280.606(a)). (2) The drainage system shall be designed to provide an adequate circulation of air in all piping with no danger of siphonage, aspiration, or forcing of trap seals under... equipped with a water-tight cap or plug matching the drain outlet. The cap or plug shall be...

  10. 24 CFR 3285.203 - Site Drainage.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...) Purpose. Drainage must be provided to direct surface water away from the home to protect against erosion of foundation supports and to prevent water build-up under the home, as shown in Figure to § 3285.203... tile and automatic sump pump system, must be provided to remove any water that may collect under...

  11. 24 CFR 3285.203 - Site Drainage.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... home. (c) All drainage must be diverted away from the home and must slope a minimum of one-half inch per foot away from the foundation for the first ten feet. Where property lines, walls, slopes, or other physical conditions prohibit this slope, the site must be provided with drains or swales...

  12. 24 CFR 3285.203 - Site Drainage.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... home. (c) All drainage must be diverted away from the home and must slope a minimum of one-half inch per foot away from the foundation for the first ten feet. Where property lines, walls, slopes, or other physical conditions prohibit this slope, the site must be provided with drains or swales...

  13. Prevention of acid drainage from stored coal

    SciTech Connect

    Olem, H.

    1983-01-01

    It was found that application of a 50-mg/l solution of the detergent sodium lauryl sulphate to a coal stockpile inhibited the activity of the bacteria causing acid formation and leaching and kept the drainage neutral for 60 days. The cost of a single application would be 0.4 cents/t of coal.

  14. GROUNDWATER IMPACTED BY ACID MINE DRAINAGE

    EPA Science Inventory

    The generation and release of acidic, metal-rich water from mine wastes continues to be an intractable environmental problem. Although the effects of acid mine drainage (AMD) are most evident in surface waters, there is an obvious need for developing cost-effective approaches fo...

  15. Drainage Studies Using Pore-Scale Approaches

    NASA Astrophysics Data System (ADS)

    Liu, E. B.; Reed, A. H.; Hilpert, M.

    2007-12-01

    The process of drainage has wide spread applications in soil hydrology, irrigation, and the remediation of contaminants in the subsurface. In this paper, we present the comparison of experimental and pore-scale modeling results for drainage. Using a HD-500 microCT system, X-ray tomographic images (21 micron voxels) of saturation during a drainage experiment were obtained in a porous medium consisting of 20/30 mesh (590- 840 microns) Accusand. Utilizing the segmented microtomographic images of the pore space, we modeled drainage using two pore-scale approaches: (1) the pore-morphology-based simulator (PMBS) developed by Hilpert and Miller (2001), and (2) a Lattice Boltzmann (LB) model. Invasion pathways and pressure-saturation relations obtained from both the PMBS and the LB model were compared with those obtained from experiments. The results of PMBS modeling displayed good agreement with experimental observations, except at high suction and low water saturation values, where both CT resolution and model assumptions become an issue. The LB model is currently being refined, and the results of these simulations will also be presented.

  16. Use of Water Fluxmeters to Measure Drainage

    SciTech Connect

    Gee, Glendon W.; Ward, Andy L.; Zhang, Z. F.; Anandacoomaraswamy, A.

    2004-03-24

    Water supplies throughout the world are rapidly diminishing in quantity and quality. Efforts over the next decade must focus on methods which use water more efficiently for agriculture, industry, and recreational purposes, and at the same time reduce the potential for groundwater pollution. To assist in this effort, we have developed an improved method to simultaneously measure drainage quantity and quality using a water fluxmeter. Our water fluxmeter is a wick-lysimeter fitted with a small tipping-spoon and a solution-collection system. The only moving part is the tipping spoon. We have tested our fluxmeters under a range of conditions, from non-vegetated desert settings in Washington State USA, to irrigated tea plantations in Sri Lanka. Conditions of over-irrigation have been documented with our fluxmeters. When 4200 mm of water was applied to sandy soil via drip irrigation, at the Washington State site, over 3100 mm of drainage occurred. In contrast, at the same site, in the absence of both irrigation and vegetation, drainage was found to range from 0 mm/yr for a 1-m-deep silt loam soil to more than 100 mm/yr for a coarse-gravel surface. Solute transport, related to nitrate leaching can also be analyzed using water fluxmeters. Water fluxmeters have provided a reliable and inexpensive method to assess both quantity and quality of drainage waters over a wide range of environmental conditions.

  17. Drainage hydraulics of permeable friction courses

    NASA Astrophysics Data System (ADS)

    Charbeneau, Randall J.; Barrett, Michael E.

    2008-04-01

    This paper describes solutions to the hydraulic equations that govern flow in permeable friction courses (PFC). PFC is a layer of porous asphalt approximately 50 mm thick that is placed as an overlay on top of an existing conventional concrete or asphalt road surface to help control splash and hydroplaning, reduce noise, and enhance quality of storm water runoff. The primary objective of this manuscript is to present an analytical system of equations that can be used in design and analysis of PFC systems. The primary assumptions used in this analysis are that the flow can be modeled as one-dimensional, steady state Darcy-type flow and that slopes are sufficiently small so that the Dupuit-Forchheimer assumptions apply. Solutions are derived for cases where storm water drainage is confined to the PFC bed and for conditions where the PFC drainage capacity is exceeded and ponded sheet flow occurs across the pavement surface. The mathematical solutions provide the drainage characteristics (depth and residence time) as a function of rainfall intensity, PFC hydraulic conductivity, pavement slope, and maximum drainage path length.

  18. Reality named endoscopic ultrasound biliary drainage.

    PubMed

    Guedes, Hugo Gonçalo; Lopes, Roberto Iglesias; de Oliveira, Joel Fernandez; Artifon, Everson Luiz de Almeida

    2015-10-25

    Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.

  19. Calculation of exit gradients at drainage ditches

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Seepage gradients play an important role in the detachment of soil particles from the side walls of stream channels and drainage ditches. Most seepage studies have focused on water losses. Relatively few have addressed the determination of these gradients as causes of soil loss and incipient gully d...

  20. 24 CFR 3285.203 - Site Drainage.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...) Purpose. Drainage must be provided to direct surface water away from the home to protect against erosion of foundation supports and to prevent water build-up under the home, as shown in Figure to § 3285.203... tile and automatic sump pump system, must be provided to remove any water that may collect under...

  1. [Artificial drainage devices--history, indications].

    PubMed

    Barac, Ileana Ramona; Pop, Monica

    2012-01-01

    Glaucoma is a degenerative optic neuropathy progressive, multifactorial, which can lead to blindness. Blindness in patients with glaucoma is defined as visual field reduction below 10 degrees. Artificial drainage systems are a solution for refractory to medication, laser treatment or conventional surgery. Used by over 100 years, improved with good surgical technique and careful patient follow-up surgery, postoperative results are satisfactory.

  2. Transpulmonary passage of venous air emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Hills, B. A.

    1985-01-01

    Twenty-seven paralyzed anesthetized dogs were embolized with venous air to determine the effectiveness of the pulmonary vasculature for bubble filtration or trapping. Air doses ranged from 0.05 to 0.40 ml/kg min in 0.05-ml increments with ultrasonic Doppler monitors placed over arterial vessels to detect any microbubbles that crossed the lungs. Pulmonary vascular filtration of the venous air infusions was complete for the lower air doses ranging from 0.05 to 0.30 ml/kg min. When the air doses were increased to 0.35 ml/kg min, the filtration threshold was exceeded with arterial spillover of bubbles occurring in 50 percent of the animals and reaching 71 percent for 0.40 ml/kg min. Significant elevations were observed in pulmonary arterial pressure and pulmonary vascular resistance. Systemic blood pressure and cardiac output decreased, whereas left ventricular end-diastolic pressure remained unchanged. The results indicate that the filtration of venous bubbles by the pulmonary vasculature was complete when the air infusion rates were kept below a threshold value of 0.30 ml/kg min.

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

    PubMed

    Griton, P; Vanet, P; Cloarec, M

    1997-05-01

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

  4. Why is placentation abnormal in preeclampsia?

    PubMed Central

    Fisher, Susan J.

    2015-01-01

    The causes of preeclampsia remain one of the great medical mysteries of our time. This syndrome is thought to occur in two stages with abnormal placentation leading to a maternal inflammatory response. Specific regions of the placenta have distinct pathological features. During normal pregnancy, cytotrophoblasts emigrate from the chorionic villi and invade the uterus, reaching the inner third of the myometrium. This unusual process is made even more exceptional by the fact that the placental cells are hemi-allogeneic, co-expressing maternal and paternal genomes. Within the uterine wall, cytotrophoblasts deeply invade the spiral arteries. Cytotrophoblasts migrate up these vessels and replace, in a retrograde fashion, the maternal endothelial lining. They also insert themselves amongst the smooth muscle cells that form the tunica media. As a result, the spiral arteries attain the physiological properties that are required to adequately perfuse the placenta. In comparison, invasion of the venous side of the uterine circulation is minimal, sufficient to enable venous return. In preeclampsia, cytotrophoblast invasion of the interstitial uterine compartment is frequently shallow, although not consistently so. In many locations, spiral artery invasion is incomplete. There are many fewer endovascular cytotrophoblasts and some vessels retain portions of their endothelial lining with relatively intact muscular coats while others are not modified. Work from our group showed that these defects mirror deficits in the differentiation program that enables cytotrophoblast invasion of the uterine wall. During normal pregnancy, invasion is accompanied by downregulation of epithelial-like molecules that are indicative of their ectodermal origin and upregulation of numerous receptors and ligands that are typically expressed by endothelial or vascular smooth muscle cells. For example, the expression of epithelial-cadherin, the cell-cell adhesion molecule that many ectodermal

  5. Late Pleistocene drainage systems beneath Delaware Bay

    USGS Publications Warehouse

    Knebel, H. J.; Circe, R.C.

    1988-01-01

    Analyses of an extensive grid of seismic-reflection profiles, along with previously published sedimentary data and geologic information from surrounding coastal areas, outline the ancestral drainage systems of the Delaware River beneath lower Delaware Bay. Major paleovalleys within these systems have southeast trends, relief of 10-35 m, widths of 1-8 km, and axial depths of 31-57 m below present sea level. The oldest drainage system was carved into Miocene sands, probably during the late Illinoian lowstand of sea level. It followed a course under the northern half of the bay, continued beneath the Cape May peninsula, and extended onto the present continental shelf. This system was buried by a transgressive sequence of fluvial, estuarine, and shallow-marine sediments during Sangamonian time. At the height of the Sangamonian sea-level transgression, littoral and nearshore processes built the Cape May peninsula southward over the northern drainage system and formed a contiguous submarine sedimentary ridge that extended partway across the present entrance to the bay. When sea level fell during late Wisconsinan time, a second drainage system was eroded beneath the southern half of the bay in response to the southerly shift of the bay mouth. This system, which continued across the shelf, was cut into Coastal Plain deposits of Miocene and younger age and included not only the trunk valley of the Delaware River but a large tributary valley formed by the convergence of secondary streams that drained the Delaware coastal area. During the Holocene rise of sea level, the southern drainage system was covered by a transgressive sequence of fluvial, estuarine, and paralic deposits that accumulated due to the passage of the estuarine circulation cell and to the landward and upward migration of coastal sedimentary environments. Some Holocene deposits have been scoured subsequently by strong tidal currents. The southward migration of the ancestral drainage systems beneath Delaware

  6. Physical modeling of transverse drainage mechanisms

    NASA Astrophysics Data System (ADS)

    Douglass, J. C.; Schmeeckle, M. W.

    2005-12-01

    Streams that incise across bedrock highlands such as anticlines, upwarps, cuestas, or horsts are termed transverse drainages. Their relevance today involves such diverse matters as highway and dam construction decisions, location of wildlife corridors, better-informed sediment budgets, and detailed studies into developmental histories of late Cenozoic landscapes. The transient conditions responsible for transverse drainage incision have been extensively studied on a case-by-case basis, and the dominate mechanisms proposed include: antecedence, superimposition, overflow, and piracy. Modeling efforts have been limited to antecedence, and such the specific erosional conditions required for transverse drainage incision, with respect to the individual mechanisms, remains poorly understood. In this study, fifteen experiments attempted to simulate the four mechanisms and constructed on a 9.15 m long, 2.1 m wide, and 0.45 m deep stream table. Experiments lasted between 50 and 220 minutes. The stream table was filled with seven tons of sediment consisting of a silt and clay (30%) and a fine to coarse sand (70%) mixture. The physical models highlighted the importance of downstream aggradation with regard to antecedent incision versus possible defeat and diversion. The overflow experiments indicate that retreating knickpoints across a basin outlet produce a high probability of downstream flooding when associated with a deep lake. Misters used in a couple of experiments illustrate a potential complication with regard to headward erosion driven piracy. Relatively level asymmetrically sloped ridges allow for the drainage divide across the ridge to retreat from headward erosion, but hindered when the ridge's apex undulates or when symmetrically sloped. Although these physical models cannot strictly simulate natural transverse drainages, the observed processes, their development over time, and resultant landforms roughly emulate their natural counterparts. Proposed originally from

  7. Percutaneous transluminal angioplasty in a patient with chronic cerebrospinal venous insufficiency and persistent left superior vena cava.

    PubMed

    Lupattelli, T; Benassi, F; Righi, E; Bavera, P; Bellagamba, G

    2014-04-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses of the internal jugular veins (IJVs) and/or azygos veins and formation of collateral venous channels. A case of a 57-year-old patient with CCSVI in whom the venous outflow from the left IJV to the right atrium occurred through a venous anomaly, the persistent left superior vena cava (PLSVC), is reported. PLSVC is caused by persistence of the left anterior cardinal vein that drains blood from the limb effluent from the left and the left side of head and neck into coronary sinus (Type a), or in the left atrium (Type b). PLSVC can be associated either with innominate vein hypoplasia or other congenital heart abnormalities. Because of evidence of left innominate vein hypoplasia, angioplasty was not performed using the ordinary route but passing with the balloon directly through the PLSVC up to the left IJV. Finally, angioplasty was carried out in a standard manner in the right IJV as well as in the azygous vein. Confirmation angiogram revealed complete reopening of all treated vessels with no evidence of peri- and postoperative complications. The patient was discharged home the following day in good general conditions. PLSVC is a rare congenital vein anomaly but in case of concomitant innominate vein hypoplasia may prove to be a valuable alternative to treat patients with IJV diseases.

  8. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group.

    PubMed

    Vasquez, Michael A; Rabe, Eberhard; McLafferty, Robert B; Shortell, Cynthia K; Marston, William A; Gillespie, David; Meissner, Mark H; Rutherford, Robert B

    2010-11-01

    In response to the need for a disease severity measurement, the American Venous Forum committee on outcomes assessment developed the Venous Severity Scoring system in 2000. There are three components of this scoring system, the Venous Disability Score, the Venous Segmental Disease Score, and the Venous Clinical Severity Score (VCSS). The VCSS was developed from elements of the CEAP classification (clinical grade, etiology, anatomy, pathophysiology), which is the worldwide standard for describing the clinical features of chronic venous disease. However, as a descriptive instrument, the CEAP classification responds poorly to change. The VCSS was subsequently developed as an evaluative instrument that would be responsive to changes in disease severity over time and in response to treatment. Based on initial experiences with the VCSS, an international ad hoc working group of the American Venous Forum was charged with updating the instrument. This revision of the VCSS is focused on clarifying ambiguities, updating terminology, and simplifying application. The specific language of proven quality-of-life instruments was used to better address the issues of patients at the lower end of the venous disease spectrum. Periodic review and revision are necessary for generating more universal applicability and for comparing treatment outcomes in a meaningful way.

  9. Chromosomal abnormalities and mental illness.

    PubMed

    MacIntyre, D J; Blackwood, D H R; Porteous, D J; Pickard, B S; Muir, W J

    2003-03-01

    Linkage studies of mental illness have provided suggestive evidence of susceptibility loci over many broad chromosomal regions. Pinpointing causative gene mutations by conventional linkage strategies alone is problematic. The breakpoints of chromosomal abnormalities occurring in patients with mental illness may be more direct pointers to the relevant gene locus. Publications that describe patients where chromosomal abnormalities co-exist with mental illness are reviewed along with supporting evidence that this may amount to an association. Chromosomal abnormalities are considered to be of possible significance if (a) the abnormality is rare and there are independent reports of its coexistence with psychiatric illness, or (b) there is colocalisation of the abnormality with a region of suggestive linkage findings, or (c) there is an apparent cosegregation of the abnormality with psychiatric illness within the individual's family. Breakpoints have been described within many of the loci suggested by linkage studies and these findings support the hypothesis that shared susceptibility factors for schizophrenia and bipolar disorder may exist. If these abnormalities directly disrupt coding regions, then combining molecular genetic breakpoint cloning with bioinformatic sequence analysis may be a method of rapidly identifying candidate genes. Full karyotyping of individuals with psychotic illness especially where this coexists with mild learning disability, dysmorphism or a strong family history of mental disorder is encouraged.

  10. Chromosomal abnormalities in human sperm

    SciTech Connect

    Martin, R.H.

    1985-01-01

    The ability to analyze human sperm chromosome complements after penetration of zona pellucida-free hamster eggs provides the first opportunity to study the frequency and type of chromosomal abnormalities in human gametes. Two large-scale studies have provided information on normal men. We have studied 1,426 sperm complements from 45 normal men and found an abnormality rate of 8.9%. Brandriff et al. (5) found 8.1% abnormal complements in 909 sperm from 4 men. The distribution of numerical and structural abnormalities was markedly dissimilar in the 2 studies. The frequency of aneuploidy was 5% in our sample and only 1.6% in Brandriff's, perhaps reflecting individual variability among donors. The frequency of 24,YY sperm was low: 0/1,426 and 1/909. This suggests that the estimates of nondisjunction based on fluorescent Y body data (1% to 5%) are not accurate. We have also studied men at increased risk of sperm chromosomal abnormalities. The frequency of chromosomally unbalanced sperm in 6 men heterozygous for structural abnormalities varied dramatically: 77% for t11;22, 32% for t6;14, 19% for t5;18, 13% for t14;21, and 0% for inv 3 and 7. We have also studied 13 cancer patients before and after radiotherapy and demonstrated a significant dose-dependent increase of sperm chromosome abnormalities (numerical and structural) 36 months after radiation treatment.

  11. Venous ulcers of the lower extremity: Definition, epidemiology, and economic and social burdens.

    PubMed

    Lal, Brajesh K

    2015-03-01

    Venous ulcer is a common vascular condition affecting 1% of the population, and a prevalence that increases with age. Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." The economic and social burden of this condition is significant to both the affected individual and the health care system. The recurrent nature of venous ulcers underscore the need for treatment of the underlying pathophysiology, that is, ambulatory venous hypertension produced by venous valve reflux alone or in conjunction with venous obstruction.

  12. Topological Analysis of Urban Drainage Networks

    NASA Astrophysics Data System (ADS)

    Yang, Soohyun; Paik, Kyungrock; McGrath, Gavan; Rao, Suresh

    2016-04-01

    Urban drainage networks are an essential component of infrastructure, and comprise the aggregation of underground pipe networks carrying storm water and domestic waste water for eventual discharge to natural stream networks. Growing urbanization has contributed to rapid expansion of sewer networks, vastly increasing their complexity and scale. Importance of sewer networks has been well studied from an engineering perspective, including resilient management, optimal design, and malfunctioning impact. Yet, analysis of the urban drainage networks using complex networks approach are lacking. Urban drainage networks consist of manholes and conduits, which correspond to nodes and edges, analogous to junctions and streams in river networks. Converging water flows in these two networks are driven by elevation gradient. In this sense, engineered urban drainage networks share several attributes of flows in river networks. These similarities between the two directed, converging flow networks serve the basis for us to hypothesize that the functional topology of sewer networks, like river networks, is scale-invariant. We analyzed the exceedance probability distribution of upstream area for practical sewer networks in South Korea. We found that the exceedance probability distributions of upstream area follow power-law, implying that the sewer networks exhibit topological self-similarity. The power-law exponents for the sewer networks were similar, and within the range reported from analysis of natural river networks. Thus, in line with our hypothesis, these results suggest that engineered urban drainage networks share functional topological attributes regardless of their structural dissimilarity or different underlying network evolution processes (natural vs. engineered). Implications of these findings for optimal design of sewer networks and for modeling sewer flows will be discussed.

  13. 46 CFR 116.1110 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ARRANGEMENT Drainage and Watertight Integrity of Weather Decks § 116.1110 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck vessel must...

  14. 46 CFR 178.410 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.410 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck...

  15. 46 CFR 116.1110 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ARRANGEMENT Drainage and Watertight Integrity of Weather Decks § 116.1110 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck vessel must...

  16. 46 CFR 116.1110 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ARRANGEMENT Drainage and Watertight Integrity of Weather Decks § 116.1110 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck vessel must...

  17. 46 CFR 116.1110 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ARRANGEMENT Drainage and Watertight Integrity of Weather Decks § 116.1110 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck vessel must...

  18. 46 CFR 178.410 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.410 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck...

  19. 46 CFR 178.430 - Drainage of well deck vessels.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.430 Drainage of well deck vessels. (a) The weather deck on a well deck vessel must be watertight. (b) The area required on a...

  20. 46 CFR 178.430 - Drainage of well deck vessels.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.430 Drainage of well deck vessels. (a) The weather deck on a well deck vessel must be watertight. (b) The area required on a...

  1. 46 CFR 178.430 - Drainage of well deck vessels.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.430 Drainage of well deck vessels. (a) The weather deck on a well deck vessel must be watertight. (b) The area required on a...

  2. 46 CFR 178.430 - Drainage of well deck vessels.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.430 Drainage of well deck vessels. (a) The weather deck on a well deck vessel must be watertight. (b) The area required on a...

  3. 46 CFR 178.410 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.410 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck...

  4. 46 CFR 178.430 - Drainage of well deck vessels.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.430 Drainage of well deck vessels. (a) The weather deck on a well deck vessel must be watertight. (b) The area required on a...

  5. 46 CFR 178.410 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.410 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck...

  6. 46 CFR 178.410 - Drainage of flush deck vessels.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.410 Drainage of flush deck vessels. (a) Except as provided in paragraph (b) of this section, the weather deck on a flush deck...

  7. Haematological abnormalities in mitochondrial disorders

    PubMed Central

    Finsterer, Josef; Frank, Marlies

    2015-01-01

    INTRODUCTION This study aimed to assess the kind of haematological abnormalities that are present in patients with mitochondrial disorders (MIDs) and the frequency of their occurrence. METHODS The blood cell counts of a cohort of patients with syndromic and non-syndromic MIDs were retrospectively reviewed. MIDs were classified as ‘definite’, ‘probable’ or ‘possible’ according to clinical presentation, instrumental findings, immunohistological findings on muscle biopsy, biochemical abnormalities of the respiratory chain and/or the results of genetic studies. Patients who had medical conditions other than MID that account for the haematological abnormalities were excluded. RESULTS A total of 46 patients (‘definite’ = 5; ‘probable’ = 9; ‘possible’ = 32) had haematological abnormalities attributable to MIDs. The most frequent haematological abnormality in patients with MIDs was anaemia. 27 patients had anaemia as their sole haematological problem. Anaemia was associated with thrombopenia (n = 4), thrombocytosis (n = 2), leucopenia (n = 2), and eosinophilia (n = 1). Anaemia was hypochromic and normocytic in 27 patients, hypochromic and microcytic in six patients, hyperchromic and macrocytic in two patients, and normochromic and microcytic in one patient. Among the 46 patients with a mitochondrial haematological abnormality, 78.3% had anaemia, 13.0% had thrombopenia, 8.7% had leucopenia and 8.7% had eosinophilia, alone or in combination with other haematological abnormalities. CONCLUSION MID should be considered if a patient’s abnormal blood cell counts (particularly those associated with anaemia, thrombopenia, leucopenia or eosinophilia) cannot be explained by established causes. Abnormal blood cell counts may be the sole manifestation of MID or a collateral feature of a multisystem problem. PMID:26243978

  8. Liver Abnormalities in Cardiac Diseases and Heart Failure

    PubMed Central

    Alvarez, Alicia M.; Mukherjee, Debabrata

    2011-01-01

    Heart failure (HF) is characterized by the inability of systemic perfusion to meet the body's metabolic demands and is usually caused by cardiac pump dysfunction and may occasionally present with symptoms of a noncardiac disorder such as hepatic dysfunction. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion due to increased central venous pressure may cause elevations of liver enzymes and both direct and indirect serum bilirubin. Impaired perfusion from decreased cardiac output may be associated with acute hepatocellular necrosis with marked elevations in serum aminotransferases. Cardiogenic ischemic hepatitis (“shock liver”) may ensue following an episode of profound hypotension in patients with acute HF. We discuss pathophysiology and identification of liver abnormalities that are commonly seen in patients with HF. PMID:22942628

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

    PubMed

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

    2016-06-01

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

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

    ERIC Educational Resources Information Center

    Shen, Tao; Baker, Keith

    2015-01-01

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

  11. A case of multiple abnormalities with eustachian tube obstruction by a protruded internal carotid artery.

    PubMed

    Shinnabe, Akihiro; Hara, Mariko; Matsuzawa, Shingo; Hasegawa, Masayo; Kodama, Kozue; Kanazawa, Hiromi; Yoshida, Naohiro; Iino, Yukiko

    2011-03-01

    We report a case of multiple abnormalities with eustachian tube obstruction by a protruded internal carotid artery. A 10-year-old male presented with multiple abnormalities including anomalous pinna, poor eyesight, facial palsy, moderate conductive deafness, and otitis media with effusion. Temporal bone computed tomography demonstrated obstruction of the right eustachian tube by a protruded internal carotid artery. Insertion of a tympanostomy tube did not improve his hearing, indicating a possible ossicular chain anomaly. Although tympanoplasty is necessary to improve the patients' hearing, the poor drainage function makes this difficult. Knowledge of this vascular anomaly is important when performing myringotomy or tympanoplasty.

  12. Clinical features of venous insufficiency and the risk of venous thrombosis in older people.

    PubMed

    Engbers, Marissa J; Karasu, Alev; Blom, Jeanet W; Cushman, Mary; Rosendaal, Frits R; van Hylckama Vlieg, Astrid

    2015-11-01

    Venous thrombosis is common in older age, with an incidence of 0·5-1% per year in those aged >70 years. Stasis of blood flow is an important contributor to the development of thrombosis and may be due to venous insufficiency in the legs. The risk of thrombosis associated with clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, obtained with a standardized interview was assessed in the Age and Thrombosis Acquired and Genetic risk factors in the Elderly (AT-AGE) study. The AT-AGE study is a case-control study in individuals aged 70 years and older (401 cases with a first-time venous thrombosis and 431 control subjects). We calculated odds ratios (ORs) and corresponding 95% confidence intervals (CI) adjusted for age, sex and study centre. Varicose veins and leg ulcer were associated with a 1·6-fold (95% CI 1·2-2·3) and 3·3-fold increased risk of thrombosis (95% CI 1·6-6·7), respectively, while the risk was increased 3·0-fold (95% CI 2·1-4·5) in the presence of leg oedema. The risk of thrombosis was highest when all three risk factors occurred simultaneously (OR: 10·5; 95% CI 1·3-86·1). In conclusion, clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, are risk factors for venous thrombosis in older people.

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

    PubMed

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

    2014-10-01

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

  14. [Myelopathies in impairment of extravertebral venous blood circulation].

    PubMed

    Tsuladze, I I; Dreval', O N; Kornienko, V N

    2009-01-01

    Development of myelopathies of venous genesis is based on venous hypertension inside vertebral canal which was initially described by J. Aboulker. According to anatomical and functional features of epidural venous system, two factors contribute in development of venous congestion: decreased outflow and increased inflow. Clinical manifestation is presented by spastic movement disorders. Morphological study performed in 18 cadavers allowed to discover so called 'narrow areas' which cause impaired circulation through large feeders of caval veins, which can be discovered by selective phlebography. Main phlebographic features include stenosis, compression, atresia, thrombosis and retrograde flow towards epidural venous plexus. We examined 58 patients with spastic para- and tetraparesis of unknown nature. Phlebographic signs of venous dyscirculation were revealed in 34 cases. 28 surgical operations were performed: 24 on feeders of vena cava superior and 4 on feeders of vena cava inferior. In 18 cases we obtained satisfactory results. This investigation should be continued.

  15. Core content for training in venous and lymphatic medicine

    PubMed Central

    Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F

    2014-01-01

    The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. PMID:25059735

  16. Microparticles: new light shed on the understanding of venous thromboembolism

    PubMed Central

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

    2014-01-01

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

  17. Systemic venous atrium stimulation in transvenous pacing after mustard procedure

    PubMed Central

    Puntrello, Calogero; Lucà, Fabiana; Rubino, Gaspare; Rao, Carmelo Massimiliano; Gelsomino, Sandro

    2014-01-01

    We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case presented demonstrates that, when the systemic venous atrium is separate from the left atrial appendage, the lead can be easily and safely placed in the systemic venous left atrium gaining satisfactory sensing and pacing thresholds despite consisting partially of pericardial tissue. PMID:25276305

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

    PubMed Central

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

    2015-01-01

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

  19. 14 CFR 27.1187 - Ventilation and drainage.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Ventilation and drainage. 27.1187 Section... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Powerplant Powerplant Fire Protection § 27.1187 Ventilation... for ventilation and drainage of flammable fluids. The drainage means must be— (a) Effective...

  20. 14 CFR 27.1187 - Ventilation and drainage.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Ventilation and drainage. 27.1187 Section... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Powerplant Powerplant Fire Protection § 27.1187 Ventilation... for ventilation and drainage of flammable fluids. The drainage means must be— (a) Effective...

  1. 14 CFR 27.1187 - Ventilation and drainage.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Ventilation and drainage. 27.1187 Section... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Powerplant Powerplant Fire Protection § 27.1187 Ventilation... for ventilation and drainage of flammable fluids. The drainage means must be— (a) Effective...

  2. 14 CFR 27.1187 - Ventilation and drainage.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Ventilation and drainage. 27.1187 Section... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Powerplant Powerplant Fire Protection § 27.1187 Ventilation... for ventilation and drainage of flammable fluids. The drainage means must be— (a) Effective...

  3. 14 CFR 27.1187 - Ventilation and drainage.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Ventilation and drainage. 27.1187 Section... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Powerplant Powerplant Fire Protection § 27.1187 Ventilation... for ventilation and drainage of flammable fluids. The drainage means must be— (a) Effective...

  4. PASSIVE TREATMENT OF ACID ROCK DRAINAGE FROM A SUBSURFACE MINE

    EPA Science Inventory

    Acidic, metal-contaminated drainages are a critical problem facing many areas of the world. Acid rock drainage results when metal sulfide minerals, particularly pyrite, are oxidized by exposure to oxygen and water. The deleterious effects of these drainages on receiving streams a...

  5. 46 CFR 171.155 - Drainage of an open boat.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Drainage of an open boat. 171.155 Section 171.155 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.155 Drainage of an open boat....

  6. 46 CFR 171.155 - Drainage of an open boat.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Drainage of an open boat. 171.155 Section 171.155 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.155 Drainage of an open boat....

  7. 46 CFR 178.420 - Drainage of cockpit vessels.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Drainage of cockpit vessels. 178.420 Section 178.420 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.420 Drainage of...

  8. 46 CFR 171.155 - Drainage of an open boat.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Drainage of an open boat. 171.155 Section 171.155 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.155 Drainage of an open boat....

  9. 46 CFR 171.155 - Drainage of an open boat.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Drainage of an open boat. 171.155 Section 171.155 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.155 Drainage of an open boat....

  10. 46 CFR 178.420 - Drainage of cockpit vessels.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Drainage of cockpit vessels. 178.420 Section 178.420 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.420 Drainage of...

  11. 46 CFR 178.440 - Drainage of open boats.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Drainage of open boats. 178.440 Section 178.440 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.440 Drainage of open boats. The...

  12. 46 CFR 178.420 - Drainage of cockpit vessels.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Drainage of cockpit vessels. 178.420 Section 178.420 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.420 Drainage of...

  13. 46 CFR 171.155 - Drainage of an open boat.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Drainage of an open boat. 171.155 Section 171.155 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.155 Drainage of an open boat....

  14. 46 CFR 178.440 - Drainage of open boats.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Drainage of open boats. 178.440 Section 178.440 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.440 Drainage of open boats. The...

  15. 46 CFR 178.440 - Drainage of open boats.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Drainage of open boats. 178.440 Section 178.440 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.440 Drainage of open boats. The...

  16. 46 CFR 178.440 - Drainage of open boats.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Drainage of open boats. 178.440 Section 178.440 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.440 Drainage of open boats. The...

  17. 46 CFR 178.440 - Drainage of open boats.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Drainage of open boats. 178.440 Section 178.440 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.440 Drainage of open boats. The...

  18. 46 CFR 178.420 - Drainage of cockpit vessels.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Drainage of cockpit vessels. 178.420 Section 178.420 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.420 Drainage of...

  19. 46 CFR 178.420 - Drainage of cockpit vessels.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Drainage of cockpit vessels. 178.420 Section 178.420 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) INTACT STABILITY AND SEAWORTHINESS Drainage of Weather Decks § 178.420 Drainage of...

  20. Endoscopic naso-pancreatic drainage for the treatment of pancreatic fistula occurring after LDLT.

    PubMed

    Nagatsu, Akihisa; Taniguchi, Masahiko; Shimamura, Tsuyoshi; Suzuki, Tomomi; Yamashita, Kenichiro; Kawakami, Hiroshi; Abo, Daisuke; Kamiyama, Toshiya; Furukawa, Hiroyuki; Todo, Satoru

    2011-08-14

    Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation (LDLT). However, in the cases that show pancreatic fistula, the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula. As a result, the pancreatic fistula may result in the death of the patient. We present 2 cases in which endoscopic treatment was effective against pancreatic fistulas that developed after LDLT. In case 1, a 61-year-old woman underwent LDLT for primary biliary cirrhosis. Because of a portal venous thrombus caused by a splenorenal shunt, the patient underwent portal vein reconstruction, and a splenorenal shunt was ligated on postoperative day (POD) 7. The main pancreatic duct was injured during the manipulation to achieve hemostasis, thereby necessitating open drainage. However, discharge of pancreatic fluid continued even after POD 300. Endoscopic naso-pancreatic drainage (ENPD) was performed, and this procedure resulted in a remarkable decrease in drain output. The refractory pancreatic fistula healed on day 40 after ENPD. In case 2, a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus. When the portal vein was exposed during thrombectomy, the pancreatic head was injured, which led to the formation of a pancreatic fistula. Conservative therapy was ineffective; therefore, ENPD was performed. The pancreatic fistula healed on day 38 after ENPD. The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.

  1. Arterial Abnormalities Leading to Tinnitus.

    PubMed

    Miller, Timothy R; Serulle, Yafell; Gandhi, Dheeraj

    2016-05-01

    Tinnitus is a common symptom that usually originates in the middle ear. Vascular causes of pulsatile tinnitus are categorized by the location of the source of the noise within the cerebral-cervical vasculature: arterial, arteriovenous, and venous. Arterial stenosis secondary to atherosclerotic disease or dissection, arterial anatomic variants at the skull base, and vascular skull base tumors are some of the more common causes of arterial and arteriovenous pulsatile tinnitus. Noninvasive imaging is indicated to evaluate for possible causes of pulsatile tinnitus, and should be followed by catheter angiography if there is a strong clinical suspicion for a dural arteriovenous fistula.

  2. Fibrinogen, red blood cells, and factor XIII in venous thrombosis.

    PubMed

    Walton, B L; Byrnes, J R; Wolberg, A S

    2015-06-01

    Cardiovascular disease is the leading cause of death and disability worldwide. Among cardiovascular causes of death, venous thrombosis (VT) is ranked third most common in the world. Venous thrombi have high red blood cell and fibrin content; however, the pathophysiologic mechanisms that contribute to venous thrombus composition and stability are still poorly understood. This article reviews biological, biochemical, and biophysical contributions of fibrinogen, factor XIII, and red blood cells to VT, and new evidence suggesting interactions between these components mediate venous thrombus composition and size.

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

    PubMed Central

    Chatterjee, Sasanka S.

    2012-01-01

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

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

    PubMed

    Chatterjee, Sasanka S

    2012-05-01

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

  5. Congenital abnormalities and selective abortion.

    PubMed

    Seller, M J

    1976-09-01

    The technique of amniocentesis, by which an abnormal fetus can be detected in utero, has brought a technological advance in medical science but attendant medical and moral problems. Dr Seller describes those congenital disabilities which can be detected in the fetus before birth, for which the "remedy" is selective abortion. She then discusses the arguments for and against selective abortion, for the issue is not simple, even in the strictly genetic sense of attempting to ensure a population free of congenital abnormality.

  6. Non invasive detection of venogenic impotence: real-time US evaluation of periprostatic (Santorini's) venous plexus after (PGE1) induced erection.

    PubMed

    Castellani, R; Avogadro, A; Quadraccia, A

    1991-06-01

    The diagnosis of venous impotence is actually reached through cavernometry and cavernography. These procedures are somewhat painful, invasive, time consuming and not always free from side effects. Anatomo-physiological studies have assessed connections between periprostatic (Santorini's) plexus and deep venous drainage of the penis. Moreover, dilated periprostatic plexus is a common ultrasound finding in the phlogistic pathology of the prostate and it is often the cause of temporary functional impotence. 20 Patients suffering from venous impotence, previously assessed by flow/pressure studies, underwent real time transrectal scan (Kretz Combison 330 equipped with 7.5 MHertz multiplanar probe) before and after Prostaglandins E1 (PGE1) (Prostin VR-Upjohn) induced erection recorded by computerised rigidometer (RigiScan-Dacomed). Dilated periprostatic venous plexus associated with tumescence or unstable valid erection ("tooth-saw-trace") was considered diagnostic for venogenic impotence. Real time ultrasound evaluation after PGE1 induced erection is to be considered a reliable method in the qualitative assessment of venogenic impotence. The procedure allows, moreover, a more accurate urologic assessment and is also useful in the early detection of various prostatic disease which are, like erection disorders, often age-related. Customary diagnostic procedures (cavernometry and caverography) may represent a second-line or pre-surgical assessment policy.

  7. Aberrant positioning of a central venous dialysis catheter to reveal a left-sided partial anomalous pulmonary venous connection

    PubMed Central

    Chintu, Manohar R; Chinnappa, Shammikumar; Bhandari, Sunil

    2008-01-01

    We describe the identification of a rare, left-sided, partial anomalous pulmonary venous connection during routine central venous catheterization. To our knowledge, this is the first report in the literature to describe this anomaly in a hemodialysis patient. A young man had anomalous connection of the veins draining the upper lobe of the left lung and left innominate vein. Our case demonstrates the importance of routine fluoroscopy during insertion of central venous catheters to detect these anomalies and minimize complications. PMID:19183765

  8. Aberrant positioning of a central venous dialysis catheter to reveal a left-sided partial anomalous pulmonary venous connection.

    PubMed

    Chintu, Manohar R; Chinnappa, Shammikumar; Bhandari, Sunil

    2008-01-01

    We describe the identification of a rare, left-sided, partial anomalous pulmonary venous connection during routine central venous catheterization. To our knowledge, this is the first report in the literature to describe this anomaly in a hemodialysis patient. A young man had anomalous connection of the veins draining the upper lobe of the left lung and left innominate vein. Our case demonstrates the importance of routine fluoroscopy during insertion of central venous catheters to detect these anomalies and minimize complications.

  9. Diagnosis and Management of Spontaneous Lumbar Venous Retroperitoneal Hematoma in Setting of Deep Venous Thrombosis: A Case Report and Algorithm

    PubMed Central

    Tseng, Joseph; Chapman, Todd; Scott, Ryan; Kalinkin, Olga

    2016-01-01

    Retroperitoneal hematoma is rare and benefits from a systematic approach to prevent morbidity and mortality. Management of such bleeds is based upon patient stability, the cause (spontaneous or posttraumatic), and source (arterial or venous). Herein, the authors describe a diagnostic and management algorithm for retroperitoneal hemorrhage with an example of a rare lumbar venous bleed under the complicated clinical setting of deep venous thrombosis. PMID:27795865

  10. Living-donor liver transplant using the right hepatic lobe without the right hepatic vein: solving the drainage problem.

    PubMed

    Akbulut, Sami; Yilmaz, Mehmet; Eris, Cengiz; Kutlu, Ramazan; Yilmaz, Sezai

    2013-06-01

    Although rare, major congenital defects of the hepatic veins are detectable at autopsy, advanced, noninvasive imaging techniques such as Doppler ultrasonography and multislice computed tomography can accurately define these anomalies. One of these anomalies is congenital absence of the main right hepatic vein. We present a 21-year-old woman living-liver donor candidate with congenital absence of the right hepatic vein who underwent an extended right donor hepatectomy. She was tested for transplant compatibility with her 45-year-old brother, who had chronic liver failure secondary to hepatitis B. Multislice computed tomography revealed an absence of the right hepatic vein, and the right hepatic lobe was drained by 4 inferior hepatic veins with diameters ranging from 4 to 8.4 mm. An extended right-donor hepatectomy was performed. A common-large opening drainage reconstruction model that included all of the inferior hepatic veins and middle hepatic vein was created using the saphenous vein and an aortic homograft. There were no postoperative complications related to hepatic venous drainage thanks to the common-large opening model. We demonstrate that a right donor hepatectomy is feasible in congenital absence of the right hepatic vein solving the drainage problem using common-large opening reconstruction technique.

  11. Thermokarst lakes, drainage, and drained basins

    USGS Publications Warehouse

    Grosse, G.; Jones, B.; Arp, C.; Shroder, John F.

    2013-01-01

    Thermokarst lakes and drained lake basins are widespread in Arctic and sub-Arctic permafrost lowlands with ice-rich sediments. Thermokarst lake formation is a dominant mode of permafrost degradation and is linked to surface disturbance, subsequent melting of ground ice, surface subsidence, water impoundment, and positive feedbacks between lake growth and permafrost thaw, whereas lake drainage generally results in local permafrost aggradation. Thermokarst lakes characteristically have unique limnological, morphological, and biogeochemical characteristics that are closely tied to cold-climate conditions and permafrost properties. Thermokarst lakes also have a tendency toward complete or partial drainage through permafrost degradation and erosion. Thermokarst lake dynamics strongly affect the development of landscape geomorphology, hydrology, and the habitat characteristic of permafrost lowlands.

  12. Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure!

    PubMed

    Redaelli, Sara; Zanella, Alberto; Milan, Manuela; Isgrò, Stefano; Lucchini, Alberto; Pesenti, Antonio; Patroniti, Nicolò

    2016-12-01

    Daily nursing in critical care patients may alter vital parameters, especially in the most critically ill patients. The aim of our study was to evaluate feasibility and safety of daily nursing on patients undergoing venous-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure. Daily nursing was performed following defined phases (sponge bath, elevation with scooping stretcher, change position of endotracheal tube, dressing replacement). We recorded physiological and ECMO parameters before and during daily nursing in 5 patients for several days (total: 25 daily nursing) and adverse events: desaturation, hypertension, reduction of mixed venous oxygen saturation, arterial oxygen saturation or ECMO blood flow and elevation in minute ventilation. Sedative drug dosage and additional bolus were recorded. Daily nursing was performed in 92 % of cases (23/25), with a minimum of two adverse events per daily nursing. Hypertension and tachycardia were mostly recorded at the beginning, while desaturation, reduction in mixed venous oxygen saturation and blood flow were recorded during elevation with scooping stretcher. Increase in minute ventilation was frequent in spontaneous breathing patients. Additional bolus of sedation was required before and/or during nursing. Daily nursing significantly alters physiologic parameters; thus, it should be performed only when physicians are readily available to treat adverse events.

  13. Flood Response Along a Drainage Network

    NASA Astrophysics Data System (ADS)

    Meierdiercks, K. L.; Smith, J. A.; Miller, A. J.; Baeck, M.

    2007-12-01

    Flooding in urban areas is complex. As water overtops stream banks, it comes into contact with structural obstacles on the land surface, such as bridge constrictions, that dominate flow pathways. Furthermore, at small, or local, spatial scales, other hydraulic controls such as pipe surcharge and stormwater management ponds play a significant role in flood response. A major obstacle towards a better understanding of how these controls impact flood response is the scarcity of data available to characterize them. One watershed where both hydraulic and hydrologic data is available is the Dead Run watershed in Metropolitan Baltimore, Maryland. Dead Run is a research watershed of the Baltimore Ecosystem Study (BES), part of the Long Term Ecological Research network established by the National Science Foundation. Dead Run geospatial data is available through the BES and Baltimore County; hydrologic data was collected by the authors during field campaigns in the 2003-2005 field seasons; and hydraulic information including storm drain pipes, stormwater management ponds, and bridge constrictions was digitized by the author. The availability of this data in Dead Run allows us to detail not only the impact of impervious surfaces and hydrologic forcing on flood response, but also structural aspects of the urban drainage network. In this study, we integrate the three types of observations - geospatial, hydrologic, and hydraulic - to characterize drainage network structure along Dead Run's tributaries. We use these characterizations and the Environmental Protection Agency's Stormwater Management Model (EPA SWMM) to estimate the 10- and 100-year floods over the drainage network. Analyses focus on two extreme floods in Dead Run: the 7 July 2004 and 28 June 2005 events. Results highlight the importance of incorporating drainage network structure into the models we use to predict flooding in urban environments.

  14. Risk factors and prevention of venous thromboembolism.

    PubMed

    Storti, S; Crucitti, P; Cina, G

    1996-01-01

    In the last 20 years within the clinical research on venous thromboembolism a major objective was to identify and develop increasingly effective and safe methods of prevention. This trend is justified by the high incidence of thromboembolism as well as by the relevant mortality for acute pulmonary embolism and postphlebitic sequels of difficult treatment. A significant contribution to the rational application of methods of prevention was given by the knowledge of risk factors. Together with acquired risks, as surgery, age, malignant tumors, in the last 30 years some conditions of thrombophilia were identified. They are caused by deficiencies in coagulation inhibitors (antithrombin III, protein C, protein S) or other alteration of the anticoagulation system as resistance to activated protein C or antiphospholipid antibodies. The primary prophylaxis of venous thromboembolism is aimed at the prevention of thrombosis by pharmacologic methods able to oppose the procoagulant alterations while avoiding hemorrhagic complications. The physical methods tend to reduce the stasis in the veins of the lower extremities. Subcutaneous calcium heparin at the dose of 5000 U twice or three times a day is the most common pharmacologic method used. It was shown to be safe and effective especially in postoperative prophylaxis of venous thromboembolism in general surgery. More recently, low molecular weight heparin fractions have been introduced. As compared to standard heparin they have the advantage of a single daily dose and a better efficacy in some groups of patients, as those undergoing hip replacement. Among the substances under clinical experimentation, dermatan sulfate seems promising. Most common physical prevention methods consist in the use of elastic graduated compression stockings and systems of intermittent pneumatic calf compression. The former can be used also in presence of a hemorrhagic risk as in neurosurgery. The latter have shown a good efficacy in increasing flow

  15. Hepatic venous reconstruction using the superficial femoral vein in a right-lobe living donor liver transplant patient with interrupted inferior vena cava.

    PubMed

    Sato, Kazushige; Sekiguchi, Satoshi; Kawagishi, Naoki; Akamatsu, Yorihiro; Miyagi, Shigeto; Yamaya, Hideyuki; Takeda, Ikuo; Fukushima, Daizo; Sato, Akira; Ohuchi, Noriaki; Satomi, Susumu

    2014-02-01

    Anatomical abnormalities in patients with BA often include polysplenia, preduodenal portal vein, interrupted retrohepatic IVC, cardiac abnormalities, and situs inversus. In LDLT patients who had congenital vascular anomalies, additional surgical modifications for the reconstruction of hepatic venous branches are sometimes necessary to prevent venous parenchymal congestion. We report a 12-yr-old female with post-Kasai BA with interrupted retrohepatic IVC who underwent right-lobe LDLT because the left liver graft volume was insufficient. The donor right liver graft had three major hepatic branches, including the RHV, IRHV, and MHV tributary (V8). We performed hepatic venous reconstruction by creating a large, wide triple orifice consisting of the RHV and two SFVs, which were anastomosed to the V8 and IRHV using the donor's SFV as an interposition graft. In conclusion, the reconstruction of venous orifices for right-lobe LDLT patients with the absent retrohepatic IVC is can be carried out using an SFV graft derived from the living donor or the recipient.

  16. [Diagnosticum of abnormalities of plant meiotic division].

    PubMed

    Shamina, N V

    2006-01-01

    Abnormalities of plant meiotic division leading to abnormal meiotic products are summarized schematically in the paper. Causes of formation of monads, abnormal diads, triads, pentads, polyads, etc. have been observed in meiosis with both successive and simultaneous cytokinesis.

  17. Drainage and Stratification Kinetics of Foam Films

    NASA Astrophysics Data System (ADS)

    Zhang, Yiran; Sharma, Vivek

    2014-03-01

    Baking bread, brewing cappuccino, pouring beer, washing dishes, shaving, shampooing, whipping eggs and blowing bubbles all involve creation of aqueous foam films. Foam lifetime, drainage kinetics and stability are strongly influenced by surfactant type (ionic vs non-ionic), and added proteins, particles or polymers modify typical responses. The rate at which fluid drains out from a foam film, i.e. drainage kinetics, is determined in the last stages primarily by molecular interactions and capillarity. Interestingly, for certain low molecular weight surfactants, colloids and polyelectrolyte-surfactant mixtures, a layered ordering of molecules, micelles or particles inside the foam films leads to a stepwise thinning phenomena called stratification. Though stratification is observed in many confined systems including foam films containing particles or polyelectrolytes, films containing globular proteins seem not to show this behavior. Using a Scheludko-type cell, we experimentally study the drainage and stratification kinetics of horizontal foam films formed by protein-surfactant mixtures, and carefully determine how the presence of proteins influences the hydrodynamics and thermodynamics of foam films.

  18. Numerical simulations of drainage flows on Mars

    NASA Technical Reports Server (NTRS)

    Parish, Thomas R.; Howard, Alan D.

    1992-01-01

    Data collected by Viking Landers have shown that the meteorology of the near surface Martian environment is analogous to desertlike terrestrial conditions. Geological evidence such as dunes and frost streaks indicate that the surface wind is a potentially important factor in scouring of the martian landscape. In particular, the north polar basin shows erosional features that suggest katabatic wind convergence into broad valleys near the margin of the polar cap. The pattern of katabatic wind drainage off the north polar cap is similar to that observed on Earth over Antarctica or Greenland. The sensitivity is explored of Martian drainage flows to variations in terrain slope and diurnal heating using a numerical modeling approach. The model used is a 2-D sigma coordinate primitive equation system that has been used for simulations of Antarctic drainage flows. Prognostic equations include the flux forms of the horizontal scalar momentum equations, temperature, and continuity. Parameterization of both longwave (terrestrial) and shortwave (solar) radiation is included. Turbulent transfer of heat and momentum in the Martian atmosphere remains uncertain since relevant measurements are essentially nonexistent.

  19. Drawdown behavior of gravity drainage wells

    SciTech Connect

    Aasen, J.A.; Ramey, H.J. Jr.

    1993-10-01

    An analytical solution for drawdown in gravity drainage wells is developed. The free-surface flow is viewed as incompressible, and anisotropy effects are included. The well is a line source well, and the reservoir is infinitely large. The model is valid for small drawdowns. The uniform wellbore potential inner boundary condition is modelled using the proper Green`s function. The discontinuity at the wellbore is solved by introducing a finite skin radius, and the formulation produces a seepage face. The calculated wellbore flux distribution and wellbore pressures are in fair agreement with results obtained using a numerical gravity drainage simulator. Three distinct flow periods are observed. The wellbore storage period is caused by the moving liquid level, and the duration is short. During the long intermediate flow period, the wellbore pressure is nearly constant. In this period the free surface moves downwards, and the liquid is produced mainly by vertical drainage. At long times the semilog straight line appears. The confined liquid solutions by Theis (1935) and van Everdingen and Hurst (1949) may be used during the pseudoradial flow period if the flowrate is low. New type curves are presented that yield both vertical and horizontal permeabilities.

  20. Channelized subglacial drainage over a deformable bed

    USGS Publications Warehouse

    Walder, J.S.; Fowler, A.

    1994-01-01

    We develop theoretically a description of a possible subglacial drainage mechanism for glaciers and ice sheets moving over saturated, deformable till. The model is based on the plausible assumption that flow of water in a thin film at the ice-till interface is unstable to the formation of a channelized drainage system, and is restricted to the case in which meltwater cannot escape through the till to an underlying aquifer. In describing the physics of such channelized drainage, we have generalized and extended Rothlisberger's model of channels cut into basal ice to include "canals' cut into the till, paying particular attention to the role of sediment properties and the mechanics of sediment transport. We show that sediment-floored Rothlisberger (R) channels can exist for high effective pressures, and wide, shallow, ice-roofed canals cut into the till for low effective pressures. Canals should form a distributed, non-arborescent system, unlike R channels. Geologic evidence derived from land forms and deposits left by the Pleistocene ice sheets in North America and Europe is consistent with predictions of the model. -from Authors

  1. Hydrologic Response Differences Between Drainage Network Classifications

    NASA Astrophysics Data System (ADS)

    Coleman, M. L.; Gironas, J. A.; Niemann, J. D.

    2013-12-01

    Basin drainage networks have been grouped into classifications such as dendritic, parallel, pinnate, rectangular and trellis based on their planform structures. While it has long been known that the size and shape of a drainage basin affect its hydrologic response to precipitation events, the effects of the network organization have not been investigated as extensively. The objective of this work is to simulate and analyze the instantaneous unit hydrographs (IUHs) and hydrologic responses of networks from different classifications for potential systematic differences between the classifications. That goal is accomplished by calculating the IUH for ten previously-classified basins of each network type listed above using a spatially-distributed travel time (SDTT) model applied to the outlet flow length distributions (i.e., width functions) of each drainage network. We find that the width functions, IUHs and the resulting hydrologic responses of the different network classifications are each largely distinguishable from one another based on statistical tests of their moments. Additionally, we find that the differences in hydrologic responses are at least partially independent of the differences in the basin vertical characteristics, as represented by the slope-area relationships. The results indicate that network classification-dependent inputs to semi-distributed rainfall-runoff models could improve model performance.

  2. Venous Thromboembolism and Prognosis in Cancer

    PubMed Central

    Khorana, Alok A.

    2010-01-01

    Venous thromboembolism (VTE) is a frequent complication of malignancy, and its incidence has increased markedly in recent years. VTE itself can directly lead to patient mortality, and is the second leading cause of death in patients with cancer. Furthermore, emerging data suggest that activation of coagulation in malignancy is integrally linked with tumor biology, particularly with angiogenesis. The development of the clinical hypercoagulable state is also linked with adverse prognosis in patients with cancer, including patients receiving systemic chemotherapy. This review focuses on the clinical evidence documenting a link between VTE and adverse short-term and long-term prognosis in patients with cancer. PMID:20097409

  3. Umbilical venous catheterization gone wrong: Hepatic complications

    PubMed Central

    Sherwani, Poonam; Vire, Adweta; Anand, Rama; Jajoo, Mamta

    2016-01-01

    Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur due to extravasation of hypertonic fluids and the blood products in the liver tissue. Various hepatic complications include thrombosis of hepatic vessels, hepatic necrosis, hepatic fluid collections, and hematoma, with the intraparenchymal liver lesions seen along the course of ductus venosus. Radiologists must be aware of these complications and their imaging findings, as the timely recognition and immediate management can prevent the fatal outcome. Here, we present a rare case of intraparenchymal liver lesions associated with malposition of UVC in a preterm baby. PMID:27081222

  4. Deep venous thrombosis of the upper extremity.

    PubMed

    Stephens, M B

    1997-02-01

    Deep venous thrombosis (DVT) of the upper extremity is a relatively uncommon but important cause of morbidity, especially in young active persons. The causes of upper extremity DVT may be categorized as catheter-related, spontaneous (effort-related) and miscellaneous (e.g., trauma, intravenous drug use). Diagnosis is based on clinical history and confirmed by either duplex ultrasonography or contrast venography. Significant controversy surrounds the optimal management of upper extremity DVT. Treatment options include conservative therapy, anticoagulation, catheter-directed thrombolysis and surgical intervention to remove intravascular clot or revise the anatomy of the costoclavicular space. Early aggressive treatment of active young patients may decrease long-term morbidity.

  5. Cerebral Venous Thrombosis in Paroxysmal Nocturnal Hemoglobinuria

    PubMed Central

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

    2015-01-01

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

  6. Modeling of subglacial hydrological development following rapid supraglacial lake drainage

    PubMed Central

    Dow, C F; Kulessa, B; Rutt, I C; Tsai, V C; Pimentel, S; Doyle, S H; van As, D; Lindbäck, K; Pettersson, R; Jones, G A; Hubbard, A

    2015-01-01

    The rapid drainage of supraglacial lakes injects substantial volumes of water to the bed of the Greenland ice sheet over short timescales. The effect of these water pulses on the development of basal hydrological systems is largely unknown. To address this, we develop a lake drainage model incorporating both (1) a subglacial radial flux element driven by elastic hydraulic jacking and (2) downstream drainage through a linked channelized and distributed system. Here we present the model and examine whether substantial, efficient subglacial channels can form during or following lake drainage events and their effect on the water pressure in the surrounding distributed system. We force the model with field data from a lake drainage site, 70 km from the terminus of Russell Glacier in West Greenland. The model outputs suggest that efficient subglacial channels do not readily form in the vicinity of the lake during rapid drainage and instead water is evacuated primarily by a transient turbulent sheet and the distributed system. Following lake drainage, channels grow but are not large enough to reduce the water pressure in the surrounding distributed system, unless preexisting channels are present throughout the domain. Our results have implications for the analysis of subglacial hydrological systems in regions where rapid lake drainage provides the primary mechanism for surface-to-bed connections. Key Points Model for subglacial hydrological analysis of rapid lake drainage events Limited subglacial channel growth during and following rapid lake drainage Persistence of distributed drainage in inland areas where channel growth is limited PMID:26640746

  7. Human cerebral venous outflow pathway depends on posture and central venous pressure

    PubMed Central

    Gisolf, J; van Lieshout, J J; van Heusden, K; Pott, F; Stok, W J; Karemaker, J M

    2004-01-01

    Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R2 = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins. PMID:15284348

  8. OPEN DRAINAGE VERSUS PERCUTANEOUS DRAINAGE IN THE TREATMENT OF TROPICAL PYOMYOSITIS. PROSPECTIVE AND RANDOMIZED STUDY

    PubMed Central

    Palacio, Evandro Pereira; Rizzi, Nívea Gitahy; Reinas, Gustavo Serra; Júnior, Melvis Michiuti; Júnior, Alcides Durigan; Mizobuchi, Roberto Ryuiti; Yanasse, Ricardo Hideki; da Silva, Marcos Vinícius Muriano; Branco, Rodrigo Borsatto; Galbiatti, José Antônio

    2015-01-01

    Objective: To compare the results from treating tropical pyomyositis through percutaneous drainage of abscesses versus open surgical drainage of abscesses, by means of a randomized prospective study. Methods: Twenty-five patients with tropical pyomyositis (Chiedozi grade II) were included in this study. They were randomized into two groups: group A (n = 13), treated with antibiotics and open drainage of the abscesses; and group B (n = 12), treated with antibiotics and percutaneous drainage of the abscesses. Results: The mean age was 35.3 years (± 19.2) in group A and 30.1 years (± 9) in group B (p = 0.41). There were eight female patients (61.5%) and five male patients (38.5%) in group A; in group B, three were female (25%) and nine were male (75%) (p = 0.11). Staphylococcus aureus was the microorganism most frequently found (72%). The mean hospital stay in group A was 12.7 days (± 2.3), and in group B, 10.6 days (± 1.6) (p = 0.01). The mean duration of antibiotic use in group A was 12.2 days (± 2.3), and in group B, 10.1 days (± 1.5) (p = 0.02). Conclusion: Percutaneous drainage of the abscesses, in association with antibiotic therapy, is an efficient treatment method for tropical pyomyositis grade II, with shorter antibiotic use and hospital stay for patients. PMID:27022550

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

    PubMed

    Kasperczak, Jarosław; Ropacka-Lesiak, Mariola; Breborowicz, H Grzegorz

    2013-01-01

    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

  10. [Umbilical and peripherally inserted venous central catheterization of the newborn].

    PubMed

    Bouissou, A; Rakza, T; Storme, L; Lafarghe, A; Fily, A; Diependaele, J-F; Dalmas, S

    2008-09-01

    Umbilical venous and peripherally inserted venous central catheters are widely used to perfuse low-weight preterm and term newborns in intensive care units. This catheter must be inserted carefully and monitored rigorously to prevent complications. This paper develops today's knowledge on the use and complications in the newborn population.

  11. Spontaneous Intrahepatic Portal Venous Shunt: Presentation and Endovascular Treatment.

    PubMed

    Sheth, Nakul; Sabbah, Nathanael; Contractor, Sohail

    2016-07-01

    Spontaneous intrahepatic portal venous shunts are rare with only few case reports published. Treatments using various endovascular techniques have been described, although no single technique has been shown to be preferred. We present a patient who was referred for treatment of a spontaneous portal venous shunt and describe our treatment approach and present a review on previously reported cases.

  12. [Extensive mesenteric venous thrombosis treatment by regional thrombolysis].

    PubMed

    Espeel, B; Gérard, C; Mansvelt, B; Bertrand, C; Vermonden, J

    2005-03-01

    Two cases of mesenteric venous thrombosis with portal extension are reported. The first patient was treated right away by local intra-arterial thrombolysis, the second one benefited from local venous thrombolysis immediately after intestinal resection. No significant complication was observed.

  13. A Rare Case of Popliteal Venous Aneurysm

    PubMed Central

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

    2010-01-01

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

  14. Central Vein Preservation in Critical Venous Access.

    PubMed

    Davidson, J; Paul, A; Patel, S; Davenport, M; Ade-Ajayi, N

    2016-08-01

    Introduction The lack of suitable veins in children with critical central venous access requirements is a major obstacle to optimal care and is potentially life-threatening. We present outcomes following the use of vein-preserving (VP) surgical techniques, notably the sheath exchange for tunneled lines (SETL). Materials and Methods A retrospective, single observer analysis of a prospectively maintained departmental logbook as well as the medical records of patients. Two broad groups of central line replacements were identified; those inserted following removal of a previous line and a traditional "plastic-free" (PF) period and those exchanged without such an interval. Results Overall, 19 lines were directly exchanged during the study period and compared with 34 inserted after a PF period. Similar catheter life spans and infection rates were demonstrated in each group; 125 (range, 78-173) days in VP exchanges versus 122 (range, 70-175) days in PF replacements (p = 0.41). Line Sepsis resulting in removal or change of line occurred at 103 (range, 60-147) days in VP group versus 104 (range, 45-164) days in PF (p = 0.73). Conclusion For children with critical venous access requirements, direct line exchange procedures are a robust and reproducible means of vein preservation. The outcomes compare favorably with those following the more traditional removal, a PF period and reinsertion.

  15. Risk Factors for Cerebral Venous Thrombosis.

    PubMed

    Silvis, Suzanne M; Middeldorp, Saskia; Zuurbier, Susanna M; Cannegieter, Suzanne C; Coutinho, Jonathan M

    2016-09-01

    Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involving the cerebral veins and dural sinuses. In contrast to more common sites of venous thromboembolism (VTE), such as the legs and lungs, CVT mainly affects young adults and children, and women are affected three times more often than men. Although presenting symptoms are variable, headache is usually the first symptom, often in combination with focal neurologic deficits and epileptic seizures. The primary therapy for CVT consists of heparin followed by oral anticoagulation for at least 3 to 6 months. The mortality in the acute phase is 5 to 10% and a substantial proportion of survivors suffer from long-term disabilities. A large number of risk factors have been linked to CVT, although the scientific evidence for an association varies considerably between risk factors. Some risk factors, such as hereditary thrombophilia, correspond with risk factors for more common sites of VTE, whereas others, such as head trauma, are specific to CVT. In most patients, at least one risk factor can be identified. In this review, we provide an overview of the risk factors for CVT.

  16. [Deep venous thrombosis in an amputation stump].

    PubMed

    Baars, E C T; Ettema, H B; Fritschy, W M

    2007-09-15

    A 34-year-old patient underwent a knee exarticulation amputation and developed symptoms of pain, redness and swelling of the stump in combination with a feeling of tightness in the chest. These symptoms were first attributed to muscle pain and exertion but further examination revealed deep venous thrombosis (DVT) of the stump and a pulmonary embolism for which he was treated with nadroparine and acenocoumarol. Shortly after treatment he could resume the use of the prosthesis. A DVT in the amputation stump is not frequently encountered, but is a serious complication that can, together with a pulmonary embolism, be life threatening. The literature mentions an incidence ranging from 0-12%. Physical examination is often not conclusive and further examination of the patient with duplex scanning is necessary, with a ventilation-perfusion scan if a pulmonary embolism is suspected. Patients with a lower extremity amputation have a higher risk of developing a DVT because of immobility and increased venous pooling in the residual limb. Symptoms of a red, swollen, warm and painful stump should trigger the physician to suspect a DVT.

  17. Immunological aspects of chronic venous disease pathogenesis

    PubMed Central

    Grudzińska, Ewa

    2014-01-01

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

  18. Abnormal insulin levels and vertigo.

    PubMed

    Proctor, C A

    1981-10-01

    Fifty patients with unexplained vertigo (36) or lightheadedness (14) are evaluated, all of whom had abnormal ENGs and normal audiograms. Five hour insulin glucose tolerance tests were performance on all patients, with insulin levels being obtained fasting and at one-half, one, two, and three hours. The results of this investigation were remarkable. Borderline or abnormal insulin levels were discovered in 82% of patients; 90% were found to have either an abnormal glucose tolerance test or at least borderline insulin levels. The response to treatment in these dizzy patients was also startling, with appropriate low carbohydrate diets improving the patient's symptoms in 90% of cases. It is, therefore, apparent that the earliest identification of carbohydrate imbalance with an insulin glucose tolerance test is extremely important in the work-up of the dizzy patients.

  19. Complex patterns of abnormal heartbeats

    NASA Technical Reports Server (NTRS)

    Schulte-Frohlinde, Verena; Ashkenazy, Yosef; Goldberger, Ary L.; Ivanov, Plamen Ch; Costa, Madalena; Morley-Davies, Adrian; Stanley, H. Eugene; Glass, Leon

    2002-01-01

    Individuals having frequent abnormal heartbeats interspersed with normal heartbeats may be at an increased risk of sudden cardiac death. However, mechanistic understanding of such cardiac arrhythmias is limited. We present a visual and qualitative method to display statistical properties of abnormal heartbeats. We introduce dynamical "heartprints" which reveal characteristic patterns in long clinical records encompassing approximately 10(5) heartbeats and may provide information about underlying mechanisms. We test if these dynamics can be reproduced by model simulations in which abnormal heartbeats are generated (i) randomly, (ii) at a fixed time interval following a preceding normal heartbeat, or (iii) by an independent oscillator that may or may not interact with the normal heartbeat. We compare the results of these three models and test their limitations to comprehensively simulate the statistical features of selected clinical records. This work introduces methods that can be used to test mathematical models of arrhythmogenesis and to develop a new understanding of underlying electrophysiologic mechanisms of cardiac arrhythmia.

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

    SciTech Connect

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

    1987-02-01

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

  1. Unilateral Loss of Spontaneous Venous Pulsations in an Astronaut

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  2. An anatomical study of the laterotrigeminal venous system.

    PubMed

    Simões, S

    1993-04-01

    The middle cranial fossa of 100 cadavers were dissected under stereoscopic loupe in order to identify and systematize the venous vessels located along the lateral margin of the trigeminal cave. The author found that at the sensitive root and trigeminal ganglion level a dural venous canal was present in most individuals examined and that the upper side of this canal communicated with the superior petrosal sinus. However, at the level of the lateral border of the intracranial segment of the mandibular nerve, venous lacunae were found to prevail, and these lacunae communicated with several other venous formations in the peritrigeminal region. The author concludes that the venous vascularization of this area constitutes a major risk in surgical interventions made in the middle cranial fossa. In addition, it is a relevant factor in the hemodynamics of the intracranial circulation.

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

    NASA Technical Reports Server (NTRS)

    Mastenbrook, S. M., Jr.

    1974-01-01

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

  4. Medical and surgical therapy for advanced chronic venous insufficiency.

    PubMed

    Word, Ronnie

    2010-12-01

    Venous ulceration is the most serious consequence of chronic venous insufficiency. The disease has been known for more than 3.5 millennia with wound care centers established as early as 1500 bc. Unfortunately, still today it is a very poorly managed medical condition by most physicians despite that a great deal has been learned about the pathogenesis and treatment for venous ulcerations. We find that many wound care clinics treat the wound and not the cause of the problem. In this article, we review the basic pathophysiology of advanced chronic venous insufficiency and review the most up-to-date information with regard to medical therapy and different options of surgical therapy to address the underlying venous pathology responsible for chronic ulcers.

  5. Onychomycosis in patients with chronic leg ulcer and toenail abnormalities.

    PubMed

    Cabete, Joana; Galhardas, Célia; Apetato, Margarida; Lestre, Sara

    2015-01-01

    Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects.

  6. Ectodermal dysplasia and abnormal thumbs.

    PubMed

    Lucky, A W; Esterly, N B; Tunnessen, W W

    1980-05-01

    Two unrelated children, a girl and a boy, with alopecia, anomalous cutaneous pigmentation, abnormal thumbs, and endocrine disorders, including short stature and delayed bone age in one patient and juvenile onset diabetes mellitus in the other, are described. In one instance, the mother and the maternal grandmother had similar abnormalities, although of a less severe nature. Both children had normal nails and no unusual susceptibility to infections. We believe these two patients represent a previously undescribed syndrome of ectodermal dysplasia that may be inherited as an autosomal-dominant trait.

  7. The role of venous blood gas in the emergency department: a systematic review and meta-analysis.

    PubMed

    Bloom, Benjamin M; Grundlingh, Johann; Bestwick, Jonathan P; Harris, Tim

    2014-04-01

    The aim of this study is to provide a systematic review of the literature reporting agreement between arterial and venous pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3⁻), base excess and lactate; and to perform a meta-analysis of the differences. Medline and Embase searches using Eduserv Athens from 1950 to present were conducted using the terms 'VBG', 'ABG', 'arterial', 'venous', 'blood', 'gas', 'lactate', 'emergency' and 'department'. References of the published papers were hand searched and full-text versions of those deemed helpful to the question were obtained. Mean difference (MD) and 95% limits of agreement (LOA) were either reported or calculated from the published data. Pooled MDs with 95% confidence intervals (CIs) were calculated for differences between arterial and venous pH, PCO2, bicarbonate and lactate. Thirteen articles relevant to pH, 12 relevant to PCO2, 10 relevant to bicarbonate and three relevant to lactate were found. The pooled MD (venous-arterial) for pH was -0.033 pH units (95% CI -0.039 to 0.027) with narrow 95% LOA, the pooled MD for PCO2 was 4.41 mmHg (95% CI 2.55-6.27) with 95% LOA ranging from -20.4 to 25.8 mmHg, the pooled MD for bicarbonate was 1.03 mmol/l (95% CI 0.56-1.50) with 95% LOA ranging from -7.1 to 10.0 mmol/l and the pooled MD for lactate was 0.25 mmol/l (95% CI 0.15-0.35) with 95% LOA ranging from -2.0 to 2.3 mmol/l. Venous and arterial pH and bicarbonate agree reasonably at all values, but the agreement is highest at normal values. Arteriovenous agreement for PCO2 is poor and PvCO2 cannot be relied upon as an absolute representation of PaCO2. However, normal peripheral PvCO2 has a good negative predictive value for normal arterial PCO2, and a normal PvCO2 can be used as a screen to exclude hypercapnic respiratory disease. There may be a poor agreement between arterial and venous lactate at abnormal values; however, if the venous lactate is normal, it is likely the arterial values of this parameter

  8. Relationship between venous pressure and tissue volume during venous congestion plethysmography in man.

    PubMed

    Christ, F; Gamble, J; Baschnegger, H; Gartside, I B

    1997-09-01

    1. Venous congestion strain-gauge plethysmography enables the non-invasive assessment of arterial blood flow, fluid filtration capacity (Kf), venous pressure (Pv) and isovolumetric venous pressure (Pvi) in man. One of the major assumptions of this technique, that cuff pressure (Pcuff) applied to the limb equals Pv at the level of the strain gauge, was tested in this study. 2. In nine healthy male volunteers (mean age, 29.3 +/- 1.2 years) the saphenous vein was cannulated with an 18-gauge catheter proximal to the medial malleolus. The subjects were supine and Pv was continuously measured during the application of small step (8-10 mmHg) increases in congestion Pcuff (up to 70 mmHg). Pcuff, changes in limb circumference and Pv were recorded by computer for off-line analysis. Since the determination of Kf is influenced by the changes in plasma oncotic pressure, venous blood samples were obtained at the start of the study, when Pcuff was raised to 30 mmHg and again to 65 mmHg and 4 min after deflation of the cuff. 3. The relationship between Pv and Pcuff was linear over the range of 10-70 mmHg (n = 9, 69 measurements, slope 0.91, r = 0.97, P < 0.001). The non-invasively measured calf Pv, based on the intercept of the relationship between the vascular compliance component (Va) and Pcuff, was 8.0 +/- 0.4 mmHg, which was not significantly different from the corrected invasively measured Pv value of 8.8 +/- 0.3 mmHg (P = 0.08). 4. Venous blood lactate and haemoglobin concentrations, as well as colloid osmotic pressure, total protein and albumin concentrations were unchanged throughout the protocol, whereas significant decreases in PO2 and blood glucose concentration were observed when Pcuff reached 65 mmHg. Assuming a constant oxygen consumption, this may suggest a reduction in tissue perfusion. 5. This study demonstrates the close correlation between Pcuff and Pv in the saphenous vein. Since the small congestion Pcuff step protocol does not cause significant increase in

  9. Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous Doppler follow-up at 1-year.

    PubMed

    Srinivas, B C; Patra, Soumya; Reddy, Babu; Nagesh, C M; Agarwal, Naveen; Manjunath, C N

    2015-10-01

    Functional outcome of venous stent placement for the management of acute iliofemoral deep vein thrombosis (DVT) following catheter-directed thrombolysis (CDT), remain undefined. The purpose of this study was to assess immediate and intermediate term outcomes among patients treated with venous stenting following CDT in patients with proximal lower limb DVT. Thirty consecutive patients aged between 20-70 years with proximal lower limb DVT formed the study group. The mean duration of CDT done with streptokinase was 4.5 ± 1.3 days. Patients with residual venous obstruction and/or large clot burden were treated further with venous angioplasty and/or stenting. Primary endpoint was to evaluate the safety, efficacy and patency of venous stenting in the management of incomplete result following CDT. After 12 months, post-thrombotic syndrome (PTS) was assessed clinically using Villalta scale and deep venous patency was assessed through duplex ultrasound. We studied 8 (5 female and 3 male) patients with 9 (3 left and 6 right) limb involvement and 13 stent (4 balloon expandable and 9 self expandable) placement. All patients improved clinically immediately following venous stenting. Technical success was achieved in all patients. One patient developed pulmonary embolism during course of hospital stay. One patient had stent thrombosis and PTS and another patient died due to carcinoma breast during follow-up. Deep venous stenting is an effective mode of treatment in proximal acute lower limb DVT with high late patency rate up to 1-year.

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

    PubMed

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

    2014-03-01

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

  11. Vestibular abnormalities in congenital disorders.

    PubMed

    Sando, I; Orita, Y; Miura, M; Balaban, C D

    2001-10-01

    This paper reviews the histopathologic features of vestibular abnormalities in congenital disorders affecting the inner ear, based upon a comprehensive literature survey and a review of cases in our temporal bone collection. The review proceeds in three systematic steps. First, we surveyed associated diseases with the major phenotypic features of congenital abnormalities of the inner ear (including the internal auditory canal and otic capsule). Second, the vestibular anomalies are examined specifically. Finally, the anomalies are discussed from a developmental perspective. Among vestibular anomalies, a hypoplastic endolymphatic duct and sac are observed most frequently. Anomalies of the semicircular canals are also often observed. From embryological and clinical viewpoints, many of these resemble the structural features from fetal stages and appear to be associated with vestibular dysfunction. It is expected that progress in genetic analysis and accumulation of temporal bone specimens with vestibular abnormalities in congenital diseases will provide crucial information not only for pathology of those diseases, but also for genetic factors that are responsible for the specific vestibular abnormalities.

  12. Natural water loss in selected drainage basins

    USGS Publications Warehouse

    Williams, Gordon R.

    1940-01-01

    Determinations of areal rainfall, run-off, and water loss, comprising largely evaporation from land surfaces and transpiration by vegetation, are essential in indicating the hydrologic characteristics of river basins. This report is primarily a statistical study that presents the results of computations of annual water loss, or annual rainfall minus annual run-off, for river basins in the humid or semiarid regions east of the Rocky Mountains. The basic period for which the computations are made is the water year or year ending September 30. As it is impractical to present in this report all the basic data used in arriving at the results, only sample computations are given. The various steps in the computations and the probable accuracy of the results are discussed. The drainage areas for which data are presented are those above river-measuring stations that have records for 3 years or more. For each area there are determinations of annual rainfall, annual run-off, and annual water loss for each year of record .as well as the means for the period of record. Results are given for about 200 drainage areas with an aggregate period of record of more than 2,000 years. As an illustration of the magnitude involved, the annual water loss from the eastern streams draining directly into the Atlantic Ocean varies more or less closely with latitude from about 20 inches as an average in northern New England to about 30 inches in Georgia. As the annual water loss from a basin is affected by the temperature, a supplemental study was made of the relation between water loss and temperature. For 28 drainage areas selected in various parts 8f eastern and central United States, average temperatures were computed for each year of the period shown in table 1. The results indicate a relation between average annual water loss and average annual temperature.

  13. Doppler velocimetry of ductus venous in preterm fetuses with brain sparing effect: neonatal outcome

    PubMed Central

    Cosmo, Ynesmara Coelho; Júnior, Edward Araujo; de Sá, Renato Augusto Moreira; de Carvalho, Paulo Roberto Nassar; Mattar, Rosiane; Lopes, Laudelino Marques; Nardozza, Luciano Marcondes Machado; de Souza, Eduardo; Moron, Antonio Fernandes

    2012-01-01

    Summary Objective to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses. Methods the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4. Results 42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade 3 or 4). Only one fetus presented cystic periventricular leukomalatia. We found statistically significant association between abnormal DV S/A ratio and neonatal mortality (CI 95%, 1.28 –38.22, p< 0.002). Conclusions our results suggest that abnormal DV blood flow detected by Doppler examination isn’t associated with severe neonatal morbidity but with neonatal mortality. PMID:23181172

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2011-12-01

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

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

    PubMed Central

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

    2015-01-01

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

  17. Venous hypertension induces increased platelet reactivity and accumulation in patients with chronic venous insufficiency.

    PubMed

    Lu, Xinwu; Chen, Yujie; Huang, Yin; Li, Weimin; Jiang, Mier

    2006-01-01

    The objective of this study was to determine whether there are changes in platelet activation and rheology in patients with chronic venous insufficiency (CVI) and what their impact is on this disease. Anticoagulated peripheral venous blood collected from 21 patients with CVI and 13 normal control subjects in different bodily positions was incubated either with 0.5 mumol/L adenosine diphosphate (ADP) or without agonist and analyzed by whole blood flow cytometry. Soluble P-selectin was analyzed in obtained sera by enzyme-linked immunosorbent assay. Platelet count was determined by a whole blood analyzer. Circulating platelets were more reactive to stimulation with 0.5 mumol/L ADP in patients with CVI compared with control subjects. There was no statistically significant change in platelet activation without ADP and the level of soluble P-selectin as a function of posture. Under simulated venous hypertension, platelet accumulation was observed in patients with CVI. Patients with CVI had increased platelet reactivity and accumulation during orthostasis, suggesting this might be a contributory factor to CVI pathogenesis.

  18. Systemic Venous Inflow to the Liver Allograft to Overcome Diffuse Splanchnic Venous Thrombosis

    PubMed Central

    Lupascu, Cristian; Darius, Tom; Goffette, Pierre; Lerut, Jan

    2015-01-01

    Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious challenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis, and finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients with preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition (4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous radiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients had excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal bleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although cavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate allograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the complications of (segmental) portal hypertension. PMID:26539214

  19. Prevention of central venous catheter bloodstream infections.

    PubMed

    Walz, J Matthias; Memtsoudis, Stavros G; Heard, Stephen O

    2010-01-01

    The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. The most frequent causative organisms for CRBSI are coagulase-negative staphylococci (CoNSs), Staphylococcus aureus, enterococci, and Candida species. The path to infection frequently includes migration of skin organisms at the insertion site into the cutaneous catheter tract, resulting in microbial colonization of the catheter tip and formation of biofilm. Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of antiseptic dressings, and the use of antiseptic or antibiotic impregnated catheters. Achieving and maintaining very low rates of CRBSI requires a multidisciplinary approach involving the entire health care team, the use of novel technologies in patients with the highest risk of CRBSI, and frequent reeducation of staff.

  20. Contraception-related venous thromboembolism in adolescents.

    PubMed

    O'Brien, Sarah H

    2014-02-01

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