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Sample records for cerebral venous sinus

  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. Cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy

    PubMed Central

    Nie, Quanmin; Guo, Pin; Ge, Jianwei; Qiu, Yongming

    2015-01-01

    Cerebral venous sinus thrombosis (CVST) rarely induces cerebral hemorrhage, and CVST with cerebral hemorrhage during early pregnancy is extremely rare. Upon literature review, we are able to find only one case of CVST with cerebral hemorrhage in early pregnancy. In this paper, we report another case of a 27-year-old patient who developed CVST with cerebral hemorrhage in her fifth week of pregnancy. Although the optimal treatment for this infrequent condition remains controversial, we adopted anticoagulation as the first choice of treatment and obtained favorable results. PMID:25630781

  3. Local Intrasinus Thrombolysis for Cerebral Venous Sinus Thrombosis

    PubMed Central

    Karanam, Lakshmi sudha Prasanna; Baddam, Sridhar Reddy; Pamidimukkala, Vijaya; Vemuri, Ramatharaknath; Byrapaneni, Sravanthi; Polavarapu, Raghavasarma

    2016-01-01

    Background Cerebral venous strokes due to cerebral venous sinus thrombosis (CVST) have varied presentation and clinical outcome. Despite aggressive medical treatment with optimal anticoagulation, some patients develop progressive neurologic deterioration causing significant morbidity and mortality. The aim of the present series is to analyze the safety and efficacy of in situ thrombolysis in patients with cerebral venous sinus thrombosis in severe clinical grade and refractory to conventional medical management. Materials and methods Twenty-nine patients with cerebral venous thrombosis who received in situ thrombolysis during a 3-year period (April 2013 to April 2016) were included in the study. Tissue plasminogen activator (tpa) was used in all the patients. The lytic agent was infused into the sinus via the micro catheter. Data regarding demographic, clinical, and radiologic features were analyzed in all the patients. Results Recanalization of the affected sinuses was achieved in all the cases. Twenty-four patients had good outcome (mRs 0 or1) and three patients had mild deficits (mRs 2). One patient had moderate disability (mRs 3). One patient succumbed due to increased hematoma causing midline shift and transtentorial herniation. At 3 months follow–up, 26 patients were asymptomatic and two patients had minor symptoms. Conclusion Local intrasinus thrombolysis (LIST) is safe and effective method in patients with poor clinical grade and the present study highlights the benefit of thrombolysis, particularly in patients unresponsive to anticoagulation. The improved efficacy of this therapy depends on early recognition of worsening symptoms and timely intervention. PMID:27829970

  4. Cerebral Venous Sinus Thrombosis during Everest Expedition: A Case Report and Review of the Literature

    PubMed Central

    Khanal, P.; Shrestha, A. M.; Bhattarai, S.; Sapkota, D.; Sharma, N.; Devkota, U. P.

    2016-01-01

    Cerebral venous sinus thrombosis (CVST) is a rare but serious disorder that is associated with a poor clinical outcome. We report a 35-year-old man who had a severe headache and diplopia while climbing Mount Everest. His MR venography showed right transverse and right sigmoid sinus thrombosis. He improved on anticoagulant and symptomatic measures. Cerebral venous sinus thrombosis at high altitude is discussed. PMID:27872776

  5. 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.

  6. Antiphospholipid syndrome presenting as cerebral venous sinus thrombosis: a case series and a review.

    PubMed

    Shlebak, Abdul

    2016-04-01

    The cerebral venous sinus system is a rare site for venous thrombosis except in patients with antiphospholipid syndrome. We describe three patients presenting with cerebral venous thrombosis in association with other thrombotic sites in two patients and as an only site in one patient. Antiphospholipid syndrome has varied clinical manifestations but the defining feature is the persistent presence of antiphospholipid antibodies. In this report we will review the clinical and laboratory diagnostic criteria and the management of patients with antiphospholipid syndrome.

  7. 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.

  8. An unusual cause of cerebral venous sinus thrombosis: prothrombin G20210A gene mutation.

    PubMed

    Porres-Aguilar, Mateo; Square, Jaime H; Storey, Raul; Rodriguez-Dunn, Simon; Mohamed-Aly, Mohamed S

    2007-09-01

    Cerebral venous sinus thrombosis represents less than 1% of all strokes, being an uncommon entity with a wide spectrum of clinical scenarios. We present a 45-year-old Hispanic female with a history of long-term oral contraceptive use who was diagnosed with cerebral venous sinus thrombosis due to a heterozygous carrier mutation in the prothrombin G20210A gene. The patient was successfully managed with intravenous heparin with favorable clinical results without adverse effects. The prevalence of inherited primary thrombophilia increases with additional risk factors such as the use of oral contraceptives that can trigger or prothrombotic events in any vascular bed. An increased prevalence in the prothrombin G20210 gene mutation has been demonstrated in the Mexican-Mestizo population. Controversy exists regarding therapy of cerebral venous sinus thrombosis; according to experts, heparin remains the cornerstone of therapy with acceptable outcomes. More clinical trials are required to evaluate long-term outcomes in this subgroup of patients.

  9. Assessment of cerebral venous sinus thrombosis using T2*-weighted gradient echo magnetic resonance imaging sequences

    PubMed Central

    Bidar, Fatemeh; Faeghi, Fariborz; Ghorbani, Askar

    2016-01-01

    Background: The purpose of this study is to demonstrate the advantages of gradient echo (GRE) sequences in the detection and characterization of cerebral venous sinus thrombosis compared to conventional magnetic resonance sequences. Methods: A total of 17 patients with cerebral venous thrombosis (CVT) were evaluated using different magnetic resonance imaging (MRI) sequences. The MRI sequences included T1-weighted spin echo (SE) imaging, T*2-weighted turbo SE (TSE), fluid attenuated inversion recovery (FLAIR), T*2-weighted conventional GRE, and diffusion weighted imaging (DWI). MR venography (MRV) images were obtained as the golden standard. Results: Venous sinus thrombosis was best detectable in T*2-weighted conventional GRE sequences in all patients except in one case. Venous thrombosis was undetectable in DWI. T*2-weighted GRE sequences were superior to T*2-weighted TSE, T1-weighted SE, and FLAIR. Enhanced MRV was successful in displaying the location of thrombosis. Conclusion: T*2-weighted conventional GRE sequences are probably the best method for the assessment of cerebral venous sinus thrombosis. The mentioned method is non-invasive; therefore, it can be employed in the clinical evaluation of cerebral venous sinus thrombosis. PMID:27326365

  10. Poor Prognostic Outcome in Cerebral Venous Sinus Thrombosis Associated with Dyskinesia and Elevated Platelet Volume.

    PubMed

    Wang, Shousen; Xu, Bingyang; Zhao, Qingshuang; Li, Jun; Hong, Jingfang; Wei, Liangfeng; Zhao, Lin

    2016-01-01

    Although about 80% of patients with cerebral venous sinus thrombosis have a good prognosis, some patients develop severe complications and a small proportion do not survive. The study included patients who had been diagnosed with cerebral venous sinus thrombosis in our hospital from May 2008 to February 2014. Based on the modified Rankin Scale (mRS) scores at 3 months for outcome, the patients were divided into two groups: good prognosis (mRS score ≤ 2) and poor prognosis (mRS score > 2). Univariate and multivariate regression analysis were performed to identify significant prognostic factors for poor outcome. A total of 86 patients with cerebral venous sinus thrombosis, 54 males and 32 females, average age 41.3 years (range, 3-83 years), were enrolled. Of these 86 patients, 64 (74.4%) had a good prognosis and 22 (25.6%) a poor prognosis. Univariate analysis revealed that dyskinesia was a significant risk factor (factor with odds ratio >1) for poor prognosis. In multivariate analysis, the risk of poor prognosis in patients with dyskinesia was 23 times higher than for those without dyskinesia (p < 0.001). Thrombosis of the sinus transervus was found to reduce the risk of poor prognosis in both univariate and multivariate analysis. Most patients with cerebral venous sinus thrombosis have a good prognosis but patients with dyskinesia have a poorer prognosis.

  11. 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.

  12. Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosis

    PubMed Central

    Oblak, Janja Pretnar; Popovic, Katarina Surlan

    2016-01-01

    Abstract Background The aim of the study was to investigate the sensitivity and specificity of non-contrast computed tomography (NCCT) in the diagnosis of cerebral venous sinus thrombosis (CVST). Methods. Screening our neurological department database, we identified 53 patients who were admitted to neurological emergency department with clinical signs of CVST. Two independent observers assessed the NCCT scans for the presence of CVST. CT venography and/or MR venography were used as a reference standard. Interobserver agreement between the two readers was assessed using Kappa statistic. Attenuation inside the cerebral venous sinuses was measured and compared between the patient and the control group. Results CVST was confirmed in 13 patients. Sensitivity and specificity of NCCT for overall presence of CVST were 100% and 83%, respectively, with Kappa value of 0.72 (a good agreement between observers). The attenuation values between CVST patients and control group were significantly different (73.4 ± 14.12 HU vs. 58.1 ± 7.58 HU; p = 0.000). The ROC analysis showed an area under the curve (AUC) of 0.916 (95% CI, 0.827 – 1.00) and an optimal cutoff value of 64 HU, leading to a sensitivity of 85% and specificity of 87%. Conclusions NCCT as a first-line investigation has a high value for diagnosis of CVST in the emergency setting. The additional measurement of the sinus attenuation may improve the diagnostic value of the examination. PMID:27679541

  13. A Case of Cerebral Sinus Venous Thrombosis Resulting in Mortality in Severe Preeclamptic Pregnant Woman

    PubMed Central

    Soydinc, Hatice Ender; Ozler, Ali; Evsen, Mehmet Sıddık; Sak, Muhammet Erdal; Basaranoglu, Serdar; Dusak, Abdurrahim; Cetincakmak, Mehmet Guli

    2013-01-01

    Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality. PMID:23509646

  14. 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

  15. Cerebral Venous Thrombosis in the Superior Sagittal Sinus as a Rare Cause of a Paroxysmal Kinetic Tremor

    PubMed Central

    Murao, Kei; Arakawa, Shuji; Furuta, Yoshihiko; Shijo, Masahiro; Ago, Tetsuro; Kitazono, Takanari

    2016-01-01

    Cerebral venous thrombosis (CVT) has a broad spectrum of clinical presentation compared to arterial etiology. Seizure is one of the common symptoms and is more frequent than in other stroke types. Hence, transient neurological symptoms in CVT patients are usually due to epileptic seizures, while transient repetitive movement disorder is extremely rare except as a complication of epilepsy. We report a case of CVT in the superior sagittal sinus with a 1-year history of paroxysmal kinetic tremor without evident epilepsy. PMID:28203183

  16. Concurrent Angioplasty Balloon Placement for Stent Delivery through Jugular Venous Bulb for Treating Cerebral Venous Sinus Stenosis. Technical Report

    PubMed Central

    Qureshi, Adnan I.; Khan, Asif A.; Capistrant, Rachel; Qureshi, Mushtaq H.; Xie, Kevin; Suri, M. Fareed K.

    2016-01-01

    OBJECTIVE To report upon technique of concurrent placement of angioplasty balloon at the internal jugular vein and sigmoid venous sinus junction to facilitate stent delivery in two patients in whom stent delivery past the jugular bulb was not possible. CLINICAL PRESENTATION A 21-year-old woman and a 41-year-old woman with worsening headaches, visual obscuration or diplopia were treated for pseudotumor cerebri associated with transverse venous stenosis. Both patients had undergone primary angioplasty, which resulted in improvement in clinical symptoms followed by the recurrence of symptoms with restenosis at the site of angioplasty. INTERVENTION After multiple attempts at stent delivery through jugular venous bulb were unsuccessful, a second guide catheter was placed in the ipsilateral internal jugular vein through contralateral femoral venous approach. A 6 mm × 20 mm (left) or 5 × 15 mm (right) angioplasty balloon was placed across the internal jugular vein and sigmoid sinus junction and partially inflated until the inflation and relative straightening of the junction was observed. In both patients, the internal jugular vein and sigmoid sinus junction was successfully traversed by the stent delivery system in a parallel alignment to inflated balloon. Balloon mounted stent was deployed at the site of restenosis with near complete resolution of lumen narrowing delivery and improvement in clinical symptoms. CONCLUSION We report a technique for realignment and diameter change with concurrent placement and partial inflation of angioplasty balloon at the jugular venous bulb to facilitate stent delivery into the sigmoid and transverse venous sinuses in circumstances where multiple attempts at stent delivery are unsuccessful. PMID:27829971

  17. A Flare of Ulcerative Colitis Accompanied With Cerebral Sinus Venous Thrombosis And Bilateral Thalamic Infarctus: A Case Report

    PubMed Central

    Dulger, Ahmet Cumhur; Begenik, Huseyin; Demirtas, Levent; Esen, Ramazan; Emre, Habib

    2012-01-01

    Ulcerative colitis (UC) is a chronic inflammatory and recurrent disorder that is characterized by bowel inflammation. Some patients with Inflammatory Bowel Disease (IBD) have acute, severe, and sometimes devastating intracranial complications that require immediate medical intervention. Cerebral sinus vein thrombosis is a rare but serious extraintestinal complication associated with ulcerative colitis. Herein we report a 30-year-old man with UC who presented with a flare of gastrointestinal symptoms with mental obtundation and apathy. Total colonoscopy revealed active colitis and cranial MRI showed extensive cerebral sinus venous thrombosis with thalamic infarcts. Because the patient was clinically unstable metilprednisolon with low molecular weight heparin were administered. Two days after treatment the patient was died despite all medical efforts. PMID:27785183

  18. Cerebral venous sinus thrombosis concomitant with leptomeningeal carcinomatosis, in a patient with epidermal growth factor receptor-mutated lung cancer.

    PubMed

    Oda, Naohiro; Sakugawa, Makoto; Bessho, Akihiro; Horiuchi, Takeshi; Hosokawa, Shinobu; Toyota, Yosuke; Fukamatsu, Nobuaki; Nishii, Kazuya; Watanabe, Yoichi

    2014-12-01

    A 64-year-old woman presented with dizziness, after two weeks of experiencing symptoms. Chest computed tomography revealed a peripheral nodule in her left upper lobe, and brain magnetic resonance imaging (MRI) demonstrated the presence of multiple brain masses. The patient underwent whole-brain radiotherapy based on a tentative diagnosis of lung cancer with multiple brain metastases. The diagnosis was confirmed by endobronchial biopsy as T4N3M1b, stage IV lung adenocarcinoma with an epidermal growth factor receptor mutation. On the 31st day of hospitalization, the patient developed severe headache. Subsequent magnetic resonance venography revealed defects in the superior sagittal, right sigmoid, and right transverse venous sinuses and the right internal jugular vein. Anticoagulation therapy with unfractionated heparin and warfarin was immediately administered following diagnosis of cerebral venous sinus thrombosis (CVST). Brain MRI demonstrated leptomeningeal gadolinium enhancement in front of the pons and medulla. Positive cerebrospinal fluid tumor cytology confirmed the diagnosis of leptomeningeal carcinomatosis. Following four weeks of antithrombotic therapy, complete thrombolysis was confirmed by magnetic resonance venography. Effective treatment with gefitinib was administered, and the patient survived for 10 months after the diagnosis of CVST and leptomeningeal carcinomatosis. Adequate early diagnosis and treatment of CVST enabled an excellent survival rate for the patient, despite leptomeningeal carcinomatosis. Following the development of headaches in patients with lung cancer, CVST, although rare, should be considered. Furthermore, following a diagnosis of CVST, leptomeningeal carcinomatosis should be investigated as an underlying cause.

  19. Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology.

    PubMed

    Ranta, Susanna; Tuckuviene, Ruta; Mäkipernaa, Anne; Albertsen, Birgitte K; Frisk, Tony; Tedgård, Ulf; Jónsson, Ólafur G; Pruunsild, Kaie; Gretenkort Andersson, Nadine; Winther Gunnes, Maria; Saulyte Trakymiene, Sonata; Frandsen, Thomas; Heyman, Mats; Ruud, Ellen; Helgestad, Jon

    2015-02-01

    We present a prospective multicentre cohort of 20 children with acute lymphoblastic leukaemia (ALL) and cerebral sinus venous thrombosis (CSVT). The study covers a period of 5 years and comprises 1038 children treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL 2008 protocol. The cumulative incidence of CSVT was 2%. Sixteen of the thromboses were related to asparaginase and 16 to steroids. Most CSVTs occurred in the consolidation phase. Nearly all were treated with low molecular weight heparin without bleeding complications. Mortality related to CSVT directly or indirectly was 10%, emphasizing the importance of this complication.

  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. Clinical tests of noninvasive optoacoustic cerebral venous oxygenation monitoring system

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

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

    PubMed Central

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

    2016-01-01

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

  3. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review.

    PubMed

    Torres, Ronaldo Afonso; Torres, Bruna Ribeiro; de Castilho, Alessandra Soares Rocha; Honorato, Ronaldo

    2014-01-01

    Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms 'nephrotic syndrome' and 'cerebral sinovenous thrombosis'. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes.

  4. A Rare Case of Transverse Sinus Venous Thrombosis Simulating Postdural Puncture Headache After Cervical Epidural Injection.

    PubMed

    Guirguis, Maged; Jusino, Eduardo; Tolba, Reda; Samuel, Samuel

    2016-08-01

    Postdural puncture headache (PDPH) is a feared complication related to epidural steroid injections. We report a unique case in which all subjective and objective findings indicated the diagnosis of PDPH. However, the patient failed appropriate conservative and interventional management. Therapeutic failure prompted further investigation to establish the correct diagnosis of cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare, difficult to diagnose, but potentially lethal disorder with nonspecific and variable clinical presentations, including headache and focal neurological deficits. Performing magnetic resonance imaging and magnetic resonance venogram should be considered early, especially in patients who fail to respond to standard interventions for PDPH.

  5. A Series of Cerebral Venous Sinus Thromboses Treated with Intra-Arterial tPA infused over Ten Hours with a 0.027-inch Catheter and Literature Review

    PubMed Central

    Ziu, Endrit; Haley, O'Hara; Ibrahimi, Muhammad; Simon, Scott

    2016-01-01

    Cerebral venous sinus thrombosis (CVST) can have devastating results, with mortality reported in 44% of cases. No randomized trials exist in order to define what qualifies as failure of conservative therapy, and there is no specific intervention to date which is considered safe and effective. Case series suggest that thrombolysis infusion is safer than thrombectomy, but methods of administration, dose, and duration of therapy tend to vary widely. We present three consecutive CVST patients treated with heparin who suffered both clinical and radiographic deterioration, and went on to have endovascular therapy. Each patient was successfully recanalized by placing a 0.027-inch microcatheter at the proximal portion of the thrombus and infusing 20 mg of alteplase dissolved in 1 liter of normal saline infused at 100 ml per hour for an infusion of 2 mg of alteplase per hour for ten hours.  PMID:27462480

  6. 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.

  7. [Cerebral venous thrombosis imagiologic features in a pregnant woman].

    PubMed

    Ferreira, Maria Madalena; Rios, Ana Cristina; Fragata, Isabel; Baptista, José Tiago; Manaças, Rui; Reis, João

    2011-01-01

    Cerebral venous thrombosis (CVT) is a relatively rare but serious condition potentially reversible upon accurate diagnosis and adequate therapy. The peri-partum state and pregnancy are predisposing factors and TVC accounts for about 6% of maternal deaths. Its clinical symptoms depend on the the thrombus site and extension, and also on the existing collateral vessels network. We present the case of a 33 year-old woman, 13 weeks pregnant, that complained of headaches and whose cranial magnetic resonance imaging revealed a subtotal oclusión of the superior sagittal sinus. We discuss the imaging features of dural venous thrombosis in the acute phase.

  8. Cerebral arterial occlusion and intracranial venous thrombosis in a woman taking oral contraceptives.

    PubMed Central

    Montón, F.; Rebollo, M.; Quintana, F.; Berciano, J.

    1984-01-01

    Occlusion of the middle cerebral artery and thrombosis of the superior sagittal sinus are reported in a 30-year-old woman taking oral contraceptives (OC). The coexistence of arterial and venous cerebral pathology as a complication of OC use has only been previously reported in one case. The pathogenesis of this rare association is briefly discussed. Images Fig. 1 Fig. 2 PMID:6462985

  9. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review

    PubMed Central

    Torres, Ronaldo Afonso; Torres, Bruna Ribeiro; de Castilho, Alessandra Soares Rocha; Honorato, Ronaldo

    2014-01-01

    Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes. PMID:25607275

  10. [Venous sinuses of the dura mater of the bird brain].

    PubMed

    Krasnikov, Iu A

    1988-04-01

    By means of corrosive, injection and tracheoscopy methods venous formations of the brain have been studied in 19 species of birds--endemical for Far East--from 12 orders. Four types of the venous sinuses structure have been distinguished in the dura mater: the first type of the structure is specific for birds that live an inactive and quiet life (blue rock pigeon, Ussuric pheasant, Tetrastes bonasia, domestic hen). The second type of the sinus structure occurs in birds, that sharply change the speed and height of their flight (Otus bakkamoena). The most manifested changes in the sinus structure are noted in waterfowl and diving birds, that spend much time in flight, in dendrocolaptidae and in day predaceous birds; in them the longitudinal sinus forms a rhombus.

  11. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

    PubMed Central

    Hosaka, Ai; Yamaguchi, Tetsuto; Yamamoto, Fumiko; Shibagaki, Yasuro

    2015-01-01

    Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures. PMID:26693366

  12. Cerebral Venous Thrombosis in Pregnancy-A Poignant Allegory of an Unusual Case

    PubMed Central

    Shailesh, Gaikwad Harsha; Gupta, Sumedha; Sharma, Manjula; Mittal, Pratima

    2016-01-01

    Cerebral Venous Thrombosis (CVT), also known as cortical venous, cerebral sinus, cerebral venous sinus, or dural sinus thrombosis, is an infrequent grave condition affecting pregnant females, resulting from clot formation in one of the many outflow tracts of the brain. Although pregnancy-associated stroke or CVT is uncommon, the risk of stroke is greatly increased above the low baseline rate in young patients during late pregnancy and, even more so, during the puerperium. Haemorrhagic infarction can occur in the acute stage of CVT. The article reports a case of CVT in puerperium in woman without any risk factors for thrombosis, highlighting the difficulties encountered in differentiating this rare cause from common diagnoses such as eclampsia. Also, clinical considerations and relevant literature review on prognostic factors affecting outcome have been addressed. CVT is an uncommon serious neurologic disorder in young gravidas requiring prudent assessment of the potential differential diagnoses and prompt management. PMID:28208950

  13. Cerebral Venous Congestion as Indication for Thrombolytic Treatment

    SciTech Connect

    Tsai, Fong Y. Kostanian, Varoujan; Rivera, Monica; Lee, Kwo-Whie; Chen, Clayton C.; Nguyen, Thong H.

    2007-07-15

    Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods

  14. Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience

    PubMed Central

    Mokin, Maxim; Lopes, Demetrius K; Binning, Mandy J; Veznedaroglu, Erol; Liebman, Kenneth M; Arthur, Adam S; Doss, Vinodh T; Levy, Elad I

    2015-01-01

    Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0–2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder. PMID:26055685

  15. Extreme clinical presentations of venous stasis: coronary sinus thrombosis.

    PubMed

    Kachalia, Amit; Sideras, Panagiotis; Javaid, Mian; Muralidharan, Sethu; Stevens-Cohen, Pilar

    2013-11-01

    Sixty six year old male with history of heart failure was admitted for dysphagia, weight loss. CT scan chest revealed diffuse oesophageal wall thickening. Upper endoscopy, oesophagogram confirmed diagnosis of achalasia. TTE revealed severely reduced biventricular systolic function with LVEF 10%; PASP 75-80 mmHg. Parasternal long views showed dilated coronary sinus with a visible, mobile 2.0 cm thrombus. Pro-thrombotic workup was negative. Coronary sinus thrombosis has been identified as a rare complication to invasive cardiac procedures causing damage to coronary sinus endothelium and in hypercoagulable states.Typically acute thrombosis presents with chest pain, dynamic ECG changes, but chronic development does not present with ischaemic signs due to formation of efficient collateral circulation. We present a case report of stable primary coronary sinus thrombus incidentally diagnosed, secondary to chronic venous stasis in coronary circulation. Currently, there are no guidelines to assist physicians in long term management of such patients and thus warrants further investigations.

  16. Unusual Presentation of Dengue Fever-Cerebral Venous Thrombosis

    PubMed Central

    Vairamon, Pradhosh M; Gowtham, Thiruvengadam; Das, Ashok Kumar

    2015-01-01

    Dengue infection can present as febrile illness with thrombocytopenia, dengue shock syndrome and dengue haemorrhagic fever. Neurological manifestation of dengue infection is more predominant in endemic region. Here, we report a case with unusual neurological presentation of dengue infection. A 16-year-old boy presented with fever for two week duration, headache and double vision involving left eye for two days. He had multiple erythematous rashes all over the body on 3rd day and treated conservatively. On examination he had bilateral papilloedema, left eye restricted abduction. His investigation revealed thrombocytopenia and positive dengue serology. His MRI brain with venogram showed bilateral transverse sinus thrombosis. Hence he was diagnosed as cerebral venous thrombosis due to dehydration with underlying dengue infection. He was hydrated and managed conservatively. On 3rd day his double vision started improving. His repeat MR Venogram was done after two week duration, which revealed recanalisation of bilateral transverse sinus. PMID:26266153

  17. Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

    PubMed Central

    Rim, Hyun Taek; Jun, Hyo Sub; Ahn, Jun Hyong; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho; Cho, Byung Moon

    2016-01-01

    Objective Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers. Materials and Methods A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed. Results Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes. Conclusion Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident. PMID:27847760

  18. [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.

  19. [Thrombosis of the intracranial venous sinuses after ingestion of estroprogestative agents. 4 cases].

    PubMed

    Rousseaux, P; Bernard, M H; Scherpereel, B; Morel, M; Guyot, J F

    1977-06-04

    The authors report 4 cases of thrombosis of the superior longitudinal sinus (SLS) in women taking oestroprogestational agents. This complication is very rare, only 25 cases existing in the literature. The clinical picture consists of premonitory headaches associated with neurological signs suggesting lesions affecting both hemispheres in alternation. In the absence of treatment, sudden deterioration on about the tenth day is to be feared. This picture is similar to that of puerperal thrombosis of the SLS. The diagnosis should be confirmed by carotid arteriography, which demonstrates the presence of collateral varices and the thrombosed sinus giving a "negative" image on the AP view. Cerebral scintigraphy shows one or more areas of uptake in the form of adjacent rounded shapes, corresponding to cerebral infarctions of venous origin. As far as the responsibility of oestro-progenstational agents is concerned, the role is suggested by the analogy with puerperal thromboses and also by the absence of cases in men (with the exception of head injury, infections of the face and haematological malignancies). The prognosis is grave (19 deaths out of 29 cases), but surviving patients are completely cured. This prognosis would seem to be essentially dependent upon the possibilities of venous callateral circulation, which are variable in each individual patient. Anticoagulants and thrombolytic risk, in effective doses, to transform the venous thrombosis into a cerebral haemorrhage. Treatment consists rather of methods to reduce cerebral volume, aimed at maximal use of collateral varices and assisting the patient to overcome to acute phase of the first 2 weeks. Headache would seem to be the principal presenting symptom. In our opinion, no biological test gives a reliable indication as to those women most at risk and contraindictions are in fact of a clinical character.

  20. Cortical blindness as a rare presentation of cerebral venous thrombosis.

    PubMed

    Wang, Bonnie; Moon, Seong-Jin; Olivero, William C; Wang, Huan

    2013-05-09

    Cerebral venous thrombosis (CVT) remains a diagnostic and therapeutic challenge for clinicians. Manifesting in a remarkably wide spectrum of symptoms and signs, CVT often presents in a misleading fashion-if unrecognized or misdiagnosed, it carries potentially fatal consequences. Visual loss is quite rare as the initial presentation of CVT and is typically a finding more frequent in chronic cases with associated papilledema on funduscopy Ferro, Lopes, Rosas and Fontes (Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis. Cerebrovasc Dis 2005;19: :152-6). We report a rare case of acute cortical blindness as the initial presentation of CVT in an 18-year-old female patient and review the current literature.

  1. Dilated cerebral venous system observed in growth restricted fetuses.

    PubMed

    Baron, Joel; Mastrolia, Salvatore Andrea; Shelef, Ilan; Tirosh, Dan; Daniel-Spiegel, Etty; Hershkovitz, Reli

    2017-04-03

    The dilation of the fetal cerebral veins is a rare phenomena that may be associated to a bad obstetric outcome, and is usually connected to antenatal thrombosis of the posterior dural venous sinuses. There are several descriptions of cerebral vein distension on magnetic resonance imaging (MRI), but all of them are detected postnatally. We present herein two cases of fetal antenatal cerebral dilation of the venous system, without any association to any sign of vein thrombosis, and a systematic review of literature regarding pathogenesis, diagnosis and outcomes associated to the antenatal detection of this condition with the use of MRI. To identify potentially eligible studies, we searched PubMed, Scopus, Cochrane Library (all from inception to October 20(th), 2016) and applied no language restrictions. The electronic database search provided a total of 22843 results. After the exclusion of duplicates, manuscripts that resulted not relevant to the review based on title and abstract screening, and analysis of manuscripts eligible for full-text assessment, no papers were found related to the subject reported in the present manuscript.

  2. Novel optoacoustic system for noninvasive continuous monitoring of cerebral venous blood oxygenation

    NASA Astrophysics Data System (ADS)

    Petrov, Yuriy; Petrov, Irene Y.; Prough, Donald S.; Esenaliev, Rinat O.

    2012-02-01

    Traumatic brain injury (TBI) and spinal cord injury are a major cause of death for individuals under 50 years of age. In the USA alone, 150,000 patients per year suffer moderate or severe TBI. Moreover, TBI is a major cause of combatrelated death. Monitoring of cerebral venous blood oxygenation is critically important for management of TBI patients because cerebral venous blood oxygenation below 50% results in death or severe neurologic complications. At present, there is no technique for noninvasive, accurate monitoring of this clinically important variable. We proposed to use optoacoustic technique for noninvasive monitoring of cerebral venous blood oxygenation by probing cerebral veins such as the superior sagittal sinus (SSS) and validated it in animal studies. In this work, we developed a novel, medical grade optoacoustic system for continuous, real-time cerebral venous blood oxygenation monitoring and tested it in human subjects at normal conditions and during hyperventilation to simulate changes that may occur in patients with TBI. We designed and built a highly-sensitive optoacoustic probe for SSS signal detection. Continuous measurements were performed in the near infrared spectral range and the SSS oxygenation absolute values were automatically calculated in real time using a special algorithm developed by our group. Continuous measurements performed at normal conditions and during hyperventilation demonstrated that hyperventilation resulted in approximately 12% decrease of cerebral venous blood oxygenation.

  3. Dangerous Headache: A Case of Dural Venous Sinus Thrombosis with Protein S Deficiency

    PubMed Central

    Deepthi, D Angeline; Singh, Deepak Ningombam; Virupakshappa, Banu; Rahul, R

    2017-01-01

    Dural Venous Sinus Thrombosis (DVST) is a sporadic cause of headache. DVST is a recherché complication of maxillary sinus infection. Maxillary sinusitis infection may spread directly to orbit via lamina papyracea and it is expedited by the presence veins of breschet. The authors present a clinical case of dural sinus thrombosis with protein S deficiency and also describe an effective management approach for DVST. PMID:28274079

  4. 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.

  5. Influence of central venous pressure upon sinus node responses to arterial baroreflex stimulation in man

    NASA Technical Reports Server (NTRS)

    Mark, A. L.; Takeshita, A.; Eckberg, D. L.; Abboud, F. M.

    1978-01-01

    Measurements were made of sinus node responses to arterial baroreceptor stimulation with phenylephrine injection or neck suction, before and during changes of central venous pressure provoked by lower body negative pressure or leg and lower truck elevation. Variations of central venous pressure between 1.1 and 9.0 mm Hg did not influence arterial baroreflex mediated bradycardia. Baroreflex sinus node responses were augmented by intravenous propranolol, but the level of responses after propranolol was comparable during the control state, lower body negative pressure, and leg and trunk elevation. Sinus node responses to very brief baroreceptor stimuli applied during the transitions of central venous pressure also were comparable in the three states. The authors conclude that physiological variations of central venous pressure do not influence sinus node responses to arterial baroreceptor stimulation in man.

  6. 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.

  7. Venous sinus thrombosis after Proteus vulgaris meningitis and concomitant Clostridium abscess formation.

    PubMed

    Bodur, Hürrem; Colpan, Aylin; Gozukucuk, Ramazan; Akinci, Esragul; Cevik, Mustafa Aydin; Balaban, Neriman

    2002-01-01

    A 19-y-old woman presented with Proteus vulgaris meningitis as a complication of chronic otitis media. Despite treatment with ceftazidime and amikacin no clinical improvement was observed. Cranial MRI revealed right-sided mastoiditis/otitis media and venous sinus thrombosis. After mastoidectomy, repeat cranial MRI demonstrated abscess formation in the venous sinuses. The abscess was drained. Clostridium spp. was isolated from the abscess culture.

  8. 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

  9. 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.

  10. Resolution of Pulsatile Tinnitus after Venous Sinus Stenting in Patients with Idiopathic Intracranial Hypertension

    PubMed Central

    Dinkin, Marc; Suurna, Maria; Hannsgen, Kelly; Bui, Xem

    2016-01-01

    Objective Evaluate the role of venous sinus stenting in the treatment of pulsatile tinnitus among patients with Idiopathic Intracranial Hypertension (IIH) and significant venous sinus stenosis. Subjects and Methods A written informed consent approved by the Weill Cornell institutional review board was signed and obtained from the study participants. Thirty-seven consecutive patients with IIH and venous sinus stenosis who were treated with venous sinus stenting between Jan.2012-Jan.2016 were prospectively evaluated. Patients without pulsatile tinnitus were excluded. Tinnitus severity was categorized based on “Tinnitus Handicap Inventory” (THI) at pre-stent, day-0, 1-month, 3-month, 6-month, 12-month, 18-month and 2-year follow-up. Demographics, body-mass index (BMI), pre and post VSS trans-stenotic pressure gradient were documented. Statistical analysis performed using Pearson’s correlation, Chi-square analysis and Fischer’s exact test. Results 29 patients with a mean age of 29.5±8.5 years M:F = 1:28. Median (mean) THI pre and post stenting were: 4 (3.7) and 1 (1) respectively. Median time of tinnitus resolution post VSS was 0-days. There was significant improvement of THI (Δ Mean: 2.7 THI [95% CI: 2.3–3.1 THI], p<0.001) and transverse-distal sigmoid sinus gradient (Δ Mean: -15.3 mm Hg [95% CI: 12.7–18 mm Hg], p<0.001) post-stenting. Mean follow-up duration of 26.4±9.8 months (3–44 months). VSS was feasible in 100% patients with no procedural complications. Three-patients (10%) had recurrent sinus stenosis and tinnitus at mean follow-up of 12 months (6–30 months). Conclusion Venous sinus stenting is an effective treatment for pulsatile tinnitus in patients with IIH and venous sinus stenosis. PMID:27768690

  11. Hereditary thrombophilia in cerebral venous thrombosis: a study from India.

    PubMed

    Pai, Navin; Ghosh, Kanjaksha; Shetty, Shrimati

    2013-07-01

    A systematic study of thrombophilia markers in a large series of patients with cerebral venous thrombosis (CVT) from India is scarce. The present study was undertaken to know the prevalence of common hereditary thrombophilia in a large series of CVT patients from India. Six hundred and twelve (354 men, 219 women and 39 children) consecutive patients with CVT admitted to various hospitals in Mumbai between 2001 and 2010 were investigated for the common thrombophilia markers, that is, protein C (PC), protein S, antithrombin (AT), and factor V Leiden (FVL) mutation. The main presenting clinical manifestations included papilledema (62%), headache (62%), hemiparesis (48%), seizures (31%), and cranial nerve palsy (7%). All the patients were managed with heparin followed by warfarin during the succeeding 6 months. Superior sagittal sinus thrombosis was the commonest site (74%) followed by cortical venous thrombosis (15%). Associated clinical pathologies were dehydration, sepsis, pregnancy and puerperium, malaria, and tuberculosis; but in the majority of patients, there was no obvious cause. Eighteen percent of the patients had any of the thrombophilia markers studied; PC deficiency was the commonest thrombophilia marker followed by deficiency of protein S, FVL mutation and AT deficiency. The men below 45 years with PC deficiency (P=0.03) and women with protein S deficiency were significantly higher (P=0.04). In conclusion, CVT is not an uncommon cause of neurological deficit as was presented in earlier reports. Pregnancy and puerperium-related CVT was much less common. Thrombophilia markers accounted for approximately one-fifth of the patients. Death due to CVT has shown remarkable reduction (13%) because of early diagnosis and appropriate anticoagulation.

  12. Unroofed Coronary Sinus Presenting as Cerebral Abscess: A Case Report

    PubMed Central

    Murthy, Avinash; Jain, Ankit; El-Hajjar, Mohammad

    2013-01-01

    A sixty eight year-old woman with a long-standing history of hypertension, dizziness and a history of congenital heart disease presented with speech difficulties and disorientation. She was diagnosed with a brain abscess, confirmed by a stereotactic biopsy. Transthoracic echocardiographic evaluation revealed a persistent left superior vena cava (PLSVC) with an unroofed coronary sinus (URCS) along with a small secundum atrial septal defect. Her heart catheterization showed a partially unroofed coronary sinus along with a bidirectional shunt. She was referred for surgical closure of her unroofed coronary sinus and the secundum atrial septal defect. Her brain abscess responded well to antibiotic treatment. While waiting for open-heart surgery, she suffered from an acute myocardial infarction and underwent emergent percutaneous coronary intervention to the right coronary artery. Subsequently, she underwent elective surgical repair of the unroofed coronary sinus, along with closure of the atrial septal defect. When she was seen in follow-up she reported a complete resolution of her dizziness and felt more energetic. Unroofed coronary sinus syndrome (URCS) is a rare congenital cardiac anomaly in which there is a communication between the coronary sinus and the left atrium. While non-invasive imaging with echocardiography, MRI or CT is helpful in making the diagnosis, cardiac catheterization remains integral in the evaluation and management planning. Management is guided by the presence of clinical symptoms with consideration of repair when patients become symptomatic. Prognosis after surgery is excellent, recently transcatheter based treatment therapies are becoming more frequent. We present a rare case of URCS with PLSVC presenting as a cerebral abscess in late adulthood. She had bidirectional shunting manifesting as a cerebral abscess. She responded well to the corrective surgery and was doing well on follow up.

  13. Cerebral venous blood oxygenation monitoring during hyperventilation in healthy volunteers with a novel optoacoustic system

    NASA Astrophysics Data System (ADS)

    Petrov, Andrey; Prough, Donald S.; Petrov, Irene Y.; Petrov, Yuriy; Deyo, Donald J.; Henkel, Sheryl N.; Seeton, Roger; Esenaliev, Rinat O.

    2013-03-01

    Monitoring of cerebral venous oxygenation is useful to facilitate management of patients with severe or moderate traumatic brain injury (TBI). Prompt recognition of low cerebral venous oxygenation is a key to avoiding secondary brain injury associated with brain hypoxia. In specialized clinical research centers, jugular venous bulb catheters have been used for cerebral venous oxygenation monitoring and have demonstrated that oxygen saturation < 50% (normal range is 55-75%) correlates with poor clinical outcome. We developed an optoacoustic technique for noninvasive monitoring of cerebral venous oxygenation. Recently, we designed and built a novel, medical grade optoacoustic system operating in the near-infrared spectral range for continuous, real-time oxygenation monitoring in the superior sagittal sinus (SSS), a large central cerebral vein. In this work, we designed and built a novel SSS optoacoustic probe and developed a new algorithm for SSS oxygenation measurement. The SSS signals were measured in healthy volunteers during voluntary hyperventilation, which induced changes in SSS oxygenation. Simultaneously, we measured exhaled carbon dioxide concentration (EtCO2) using capnography. Good temporal correlation between decreases in optoacoustically measured SSS oxygenation and decreases in EtCO2 was obtained. Decreases in EtCO2 from normal values (35-45 mmHg) to 20-25 mmHg resulted in SSS oxygenation decreases by 3-10%. Intersubject variability of the responses may relate to nonspecific brain activation associated with voluntary hyperventilation. The obtained data demonstrate the capability of the optoacoustic system to detect in real time minor changes in the SSS blood oxygenation.

  14. 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.

  15. [A case of total cavopulmonary connection by utilization of coronary sinus as a hepatic venous return].

    PubMed

    Koide, M; Sakai, A; Iwata, Y; Sanae, T; Kunii, Y; Moriki, N; Ayusawa, Y; Seguchi, M

    2000-10-01

    A 2-year-old boy with polysplenia, double outlet right ventricle after pulmonary banding and unilateral bidirectional shunt was operated on. A modified total cavopulmonary connection was done by utilization of coronary sinus as a retrograde route for the hepatic venous return. Left SVC was transected and its distal end was anastomosed to the left pulmonary artery after PA angioplasty. An equine pericardial patch was placed over the ostia of the hepatic vein and coronary sinus. Two ostia of the coronary veins were excluded from the created route. The proximal end of the left SVC was anastomosed to the inferior side of the left pulmonary artery. Postoperative course was uneventful. The postoperative angiogram showed smooth hepatic venous return through the coronary sinus and no pressure gradient was recorded between hepatic vein and pulmonary artery.

  16. Noninvasive optoacoustic monitoring of cerebral venous blood oxygenation in newborns

    NASA Astrophysics Data System (ADS)

    Petrov, Irene Y.; Wynne, Karon E.; Petrov, Yuriy; Esenaliev, Rinat O.; Richardson, C. Joan; Prough, Donald S.

    2012-02-01

    Cerebral ischemia after birth and during labor is a major cause of death and severe complications such as cerebral palsy. In the USA alone, cerebral palsy results in permanent disability of 10,000 newborns per year and approximately 500,000 of the total population. Currently, no technology is capable of direct monitoring of cerebral oxygenation in newborns. This study proposes the use of an optoacoustic technique for noninvasive cerebral ischemia monitoring by probing the superior sagittal sinus (SSS), a large central cerebral vein. We developed and built a multi-wavelength, near-infrared optoacoustic system suitable for noninvasive monitoring of cerebral ischemia in newborns with normal weight (NBW), low birth-weight (LBW, 1500 - 2499 g) and very low birth-weight (VLBW, < 1500 g). The system was capable of detecting SSS signals through the open anterior and posterior fontanelles as well as through the skull. We tested the system in NBW, LBW, and VLBW newborns (weight range: from 675 g to 3,000 g) admitted to the neonatal intensive care unit. We performed single and continuous measurements of the SSS blood oxygenation. The data acquisition, processing and analysis software developed by our group provided real-time, absolute SSS blood oxygenation measurements. The SSS blood oxygenation ranged from 60% to 80%. Optoacoustic monitoring of the SSS blood oxygenation provides valuable information because adequate cerebral oxygenation would suggest that no therapy was necessary; conversely, evidence of cerebral ischemia would prompt therapy to increase cerebral blood flow.

  17. Venous thrombosis in subclavian, axillary, brachial veins with extension to internal jugular vein, right sigmoid sinus and simultaneous pulmonary embolism

    PubMed Central

    Tamizifar, Babak; Beigi, Arash; Rismankarzadeh, Maryam

    2013-01-01

    We present a rare case of Venous Thrombosis in Subclavian, Axillary, Brachial Veins with extension to Internal Jugular vein, right sigmoid sinus and simultaneous Pulmonary embolism during the treatment with low molecular weight heparin. PMID:23901341

  18. Cerebral venous thrombosis after immune thrombocytopenic purpura and anti-D immune globulin therapy.

    PubMed

    Kayyali, Husam R; Abdelmoity, Ahmed T; Morriss, M Craig; Graf, William D

    2008-03-01

    Cerebral venous thrombosis has multiple etiologies and a wide variety of clinical manifestations. This article reports on a young girl who developed cerebral venous thrombosis after intravenous anti-D immune globulin therapy for immune thrombocytopenic purpura. In this case, venous infarction was manifested by an unusual pattern of restricted diffusion limited to the corpus callosum. The cause of cerebral venous thrombosis in this patient may be related to both immune thrombocytopenia and immunoglobulin therapy.

  19. Bilateral Vertebral Venous Sinus Thrombosis Causing Cervical Spinal Cord Compression in a Dog

    PubMed Central

    Rhue, Kathryn E.; Taylor, Amanda R.; Cole, Robert C.; Winter, Randolph L.

    2017-01-01

    A 10-year-old male neutered mixed breed dog was evaluated for cervical hyperesthesia and tetraparesis. Magnetic resonance imaging of the brain and cervical spinal cord identified an extradural compressive lesion over the body of C2 caused by marked dilation of the vertebral venous sinuses. Following intravenous contrast administration both vertebral sinuses had heterogeneous contrast enhancement consistent with incomplete thrombi formation. An abdominal ultrasound also showed a distal aortic thrombus. A definitive cause for the thrombi formation was not identified, but the patient had several predisposing factors which may have contributed. The patient was treated with a combination of warfarin, clopidogrel, and enoxaparin as well as analgesics. Within 48 h of initiation of warfarin therapy, the tetraparesis and hyperesthesia were markedly improved. Repeat abdominal ultrasound 3 weeks after discharge showed reduction in size of aortic thrombus. Neurologic function remained normal for 6 weeks following initiation of treatment. Seventy-four days following initial diagnosis the patient rapidly declined and passed away at home. Necropsy was declined. This is the first report of vertebral venous sinus enlargement leading to spinal cord compression and tetraparesis in a dog. Additionally, warfarin in combination with clopidogrel and enoxaparin appeared to be a safe and effective treatment for the suspected thrombi reported in this case. Vertebral sinus enlargement secondary to thrombi should be considered as a differential diagnosis in patients presenting with tetraparesis and cervical hyperesthesia. PMID:28229071

  20. 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

  1. Sinusitis

    MedlinePlus

    ... my acute sinusitis is caused by viruses or bacteria? Acute viral sinusitis is likely if you have ... to tell if my sinusitis is caused by bacteria? Because sinusitis is treated differently based on cause. ...

  2. Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium

    PubMed Central

    Liang, Zhu-Wei; Gao, Wan-Li; Feng, Li-Min

    2017-01-01

    Due to the specific physiology associated with pregnancy and puerperium, cerebral venous sinus thrombosis (CVT) may manifest different characteristics. This study aimed to identify the clinical manifestations and prognosis of pregnancy-associated CVT. A total of 43 pregnancy-associated CVT patients were enrolled. We analysed the clinical presentations of the disease and performed a multivariate logistic regression analysis to determine which variables were associated with prognosis. Our descriptive results showed the following: 1) the incidence was 202 per 100,000 deliveries, and the mortality rate was 11.63%; 2) the most frequent symptom was headache; 3) the most frequent abnormal laboratory findings were increased levels of fibrinogen and several serum lipoproteins (including triglyceride, cholesterol, high-density lipoprotein, low-density lipoprotein, apolipoprotein A1, and apolipoprotein B); and 4) the superior sagittal sinus and transverse sinus were the most frequently affected locations. Moreover, an increased modified Rankin Scale score was positively associated with infection, seizure, intracerebral haemorrhage (ICH) and hypertensive disorders of pregnancy (HDP). Comparably, the occurrence of death was positively and significantly associated with infection, seizure and ICH. Consequently, timely diagnosis and treatment of pregnancy-associated CVT patients with infection, seizure, ICH or HDP are needed. Patients with infection, seizure or ICH have a greater risk of death. PMID:28262755

  3. Endovascular Treatment of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: Complications, Neurological Outcomes, and Radiographic Results

    PubMed Central

    Starke, Robert M.; Wang, Tony; Ding, Dale; Durst, Christopher R.; Crowley, R. Webster; Chalouhi, Nohra; Hasan, David M.; Dumont, Aaron S.; Jabbour, Pascal; Liu, Kenneth C.

    2015-01-01

    Introduction. Idiopathic intracranial hypertension (IIH) may result in a chronic debilitating disease. Dural venous sinus stenosis with a physiologic venous pressure gradient has been identified as a potential etiology in a number of IIH patients. Intracranial venous stenting has emerged as a potential treatment alternative. Methods. A systematic review was carried out to identify studies employing venous stenting for IIH. Results. From 2002 to 2014, 17 studies comprising 185 patients who underwent 221 stenting procedures were reported. Mean prestent pressure gradient was 20.1 mmHg (95% CI 19.4–20.7 mmHg) with a mean poststent gradient of 4.4 mmHg (95% CI 3.5–5.2 mmHg). Complications occurred in 10 patients (5.4%; 95% CI 4.7–5.4%) but were major in only 3 (1.6%). At a mean clinical follow-up of 22 months, clinical improvement was noted in 130 of 166 patients with headaches (78.3%; 95% CI 75.8–80.8%), 84 of 89 patients with papilledema (94.4%; 95% CI 92.1–96.6%), and 64 of 74 patients with visual symptoms (86.5%; 95% CI 83.0–89.9%). In-stent stenosis was noted in six patients (3.4%; 95% CI 2.5–4.3%) and stent-adjacent stenosis occurred in 19 patients (11.4%; 95% CI 10.4–12.4), resulting in restenting in 10 patients. Conclusion. In IIH patients with venous sinus stenosis and a physiologic pressure gradient, venous stenting appears to be a safe and effective therapeutic option. Further studies are necessary to determine the long-term outcomes and the optimal management of medically refractory IIH. PMID:26146651

  4. Cerebral Venous Thromboembolism in Antiphospholipid Syndrome Successfully Treated with the Combined Use of an Anti-Xa Inhibitor and Corticosteroid.

    PubMed

    Sugie, Masayuki; Iizuka, Natsuko; Shimizu, Yuki; Ichikawa, Hiroo

    2015-01-01

    We herein report a case presenting with cerebral venous sinus thrombosis (CVST) associated with primary antiphospholipid syndrome (APS). The patient developed recurrent CVST followed by a hemorrhagic ischemic stroke despite the use of warfarin during the appropriate therapeutic window. Thus, we substituted warfarin to rivaroxaban with prednisolone and obtained a good clinical course. In addition to the effect of prednisolone of inhibiting elevated lupus anticoagulants and the recurrence of arterial thrombosis, rivaroxaban may prevent CVST and inhibit hypercoagulability induced by corticosteroids. The combination of an anti-Xa inhibitor and corticosteroid may be an alternative treatment for CVST and arterial thrombus with warfarin-resistant APS.

  5. Improvement in venous outflow following superior sagittal sinus decompression after a gunshot wound to the head: Case report

    PubMed Central

    Birk, Daniel M; Tobin, Matthew K; Moss, Heather E.; Feinstein, Eric; Charbel, Fady T; Alaraj, Ali

    2015-01-01

    The most commonly described indications for surgical management of closed depressed skull fractures are hematoma evacuation and repair of extensive cosmetic deformity. Venous sinus injury, which occurs in a subset of depressed skull fractures is not typically listed as an indication for surgical treatment due to the potential for major venous hemorrhage associated with operation near these structures. However, if patients exhibit signs and symptoms of intracranial hypertension and radiographic findings demonstrate sinus compromise, surgical elevation of the depressed skull fragments is indicated. The authors present the case of a 25-year-old woman with a depressed skull fracture secondary to a gunshot wound with symptomatic compromise in venous outflow of the posterior one-third of the superior sagittal sinus. The patient was treated with surgical decompression via bilateral craniectomy along with intracranial pressure lowering medical therapy and had almost full resolution of her presenting symptoms with documented improvement in flow through the superior sagittal sinus. While the use of surgical treatment for these types of injuries is highly debated we demonstrate here that safe, effective surgical management of these patients is possible and that surgical decompression should always be considered in the case of symptomatic venous sinus flow obstruction. PMID:25839927

  6. Regional quantification of cerebral venous oxygenation from MRI susceptibility during hypercapnia

    PubMed Central

    Fan, Audrey P; Evans, Karleyton C; Stout, Jeffrey N; Rosen, Bruce R; Adalsteinsson, Elfar

    2014-01-01

    There is an unmet medical need for noninvasive imaging of regional brain oxygenation to manage stroke, tumor, and neurodegenerative diseases. Oxygenation imaging from magnetic susceptibility in MRI is a promising new technique to measure local venous oxygen extraction fraction (OEF) along the cerebral venous vasculature. However, this approach has not been tested in vivo at different levels of oxygenation. The primary goal of this study was to test whether susceptibility imaging of oxygenation can detect OEF changes induced by hypercapnia, via CO2 inhalation, within selected a priori brain regions. Ten healthy subjects were scanned at 3 tesla with a 32-channel head coil. The end-tidal CO2 (ETCO2) was monitored continuously and inspired gases were adjusted to achieve steady-state conditions of eucapnia (41 ± 3 mmHg) and hypercapnia (50 ± 4 mmHg). Gradient echo phase images and pseudo-continuous arterial spin labeling (pcASL) images were acquired to measure regional OEF and CBF respectively during eucapnia and hypercapnia. By assuming constant cerebral oxygen consumption throughout both gas states, regional CBF values were computed to predict the local change in OEF in each brain region. Hypercapnia induced a relative decrease in OEF of -42.3% in the straight sinus, -39.9% in the internal cerebral veins, and approximately -50% in pial vessels draining each of the occipital, parietal, and frontal cortical areas. Across volunteers, regional changes in OEF correlated with changes in ETCO2. The reductions in regional OEF (via phase images) were significantly correlated (P < 0.05) with predicted reductions in OEF derived from CBF data (via pcASL images). These findings suggest that susceptibility imaging is a promising technique for OEF measurements, and may serve as a clinical biomarker for brain conditions with aberrant regional oxygenation. PMID:25300201

  7. Thrombus in Transit: A Potentially Life-threatening Complication of Cerebral Sinus Thrombosis.

    PubMed

    Petracca, Martina; Calandrelli, Rosalinda; Broccolini, Aldobrando; Caliandro, Pietro; Della Marca, Giacomo; Frisullo, Giovanni; Morosetti, Roberta; Profice, Paolo; Lamendola, Priscilla; Pennestrì, Faustino; Pilato, Fabio

    2017-01-01

    We report the case of a 41-year-old, 7-weeks-pregnant patient, presenting with headache and generalized seizure due to cerebral venous thrombosis complicated by jugular thrombosis and thrombus dislocation into right cardiac cavities. The patient was treated with intravenous heparin, and underwent embolectomy in extracorporeal circulation. This case illustrates the variability of cerebral venous thrombosis progression and a potentially life-threatening condition even during anticoagulant therapy.

  8. Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus

    PubMed Central

    Guo, Ping

    2015-01-01

    Objectives To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography. Methods Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months. Results Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided. Conclusion Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus

  9. Lessons from surgical outcome for intracranial meningioma involving major venous sinus

    PubMed Central

    Han, Moon-Soo; Kim, Yeong-Jin; Moon, Kyung-Sub; Lee, Kyung-Hwa; Yang, Jung-In; Kang, Woo Dae; Lim, Sa-Hoe; Jang, Woo-Youl; Jung, Tae-Young; Kim, In-Young; Jung, Shin

    2016-01-01

    Abstract Intracranial meningiomas involving the major venous sinus (MVS) pose several complication risks upon performing radical resection. Some surgeons consider MVS invasion a contraindication for a complete resection of meningioma, and others suggest total resection followed by venous reconstruction. The aim of the study was to analyze our surgical results and discuss management strategy for intracranial meningiomas involving the MVS. Between 1993 and 2011, 107 patients with intracranial meningiomas involving MVS underwent surgery in our institution. Clinicoradiological features including pathological features and operative findings were retrospectively analyzed. Median follow-up duration was 60.2 months (range, 6.2–218.2 months). Distributions of tumor cases according to the involved sinus were as follows: 86% parasagittal, 10.3% tentorial, and 3.7% peritorcular. Simpson Grade I/II removal was achieved in 93 of 107 patients (87%). Partially or totally occluded MVS by their meningiomas (Sindou classification IV and V) was found in 39 patients (36%). Progression rate was 12% (13/107) and progression-free survival rates were 89%, 86%, and 80% at 5, 7, and 10 years, respectively. Sindou classification (IV/V) and Karnofsky performance status (KPS) score 6 month after the surgery (KPS < 90) were predictive factors for progression in our study (P = 0.044 and P = 0.001, respectively). The resection degree did not reach statistical significance (P = 0.484). Interestingly, there was no progression in patients that underwent radiation therapy or gamma knife radiosurgery for residual tumor. There were no perioperative deaths. Complication rate was 21% with brain swelling being the most common complication. There was no predictive factor for occurrence of postoperative complication in this study. In conclusion, complete tumor resection with sinus reconstruction did not significantly prevent tumor recurrence in intracranial meningioma involving MVS

  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. 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.

  12. Noninvasive monitoring of cerebral blood oxygenation in ovine superior sagittal sinus with novel multi-wavelength optoacoustic system.

    PubMed

    Petrova, I Y; Petrov, Y Y; Esenaliev, R O; Deyo, D J; Cicenaite, I; Prough, D S

    2009-04-27

    Noninvasive monitoring of cerebral blood oxygenation with an optoacoustic technique offers advantages over current invasive and noninvasive methods. We report the results of in vivo studies in the sheep superior sagittal sinus (SSS), a large central cerebral vein. We changed blood oxygenation by increasing and decreasing the inspired fraction of oxygen (FiO(2)). Optoacoustic measurements from the SSS were performed at wavelengths of 700, 800, and 1064 nm using an optical parametric oscillator as a source of pulsed near-infrared light. Actual oxygenation of SSS blood was measured with a CO-Oximeter in blood samples drawn from the SSS through a small craniotomy. The amplitude of the optoacoustic signal induced in the SSS blood at lambda = 1064 nm closely followed the changes in blood oxygenation, at lambda = 800 nm was almost constant, and at lambda = 700 nm was changing in the opposite direction, all in accordance with the absorption spectra of oxy- and deoxyhemoglobin. The optoacoustically predicted oxygenation correlated well with actual blood oxygenation in sheep SSS (R(2) = 0.965 to 0.990). The accuracy was excellent, with a mean difference of 4.8% to 9.3% and a standard deviation of 2.8% to 4.2%. To the best of our knowledge, this paper reports for the first time accurate measurements of cerebral venous blood oxygenation validated against the "gold standard" CO-Oximetry method.

  13. [Takayasu arteritis and cerebral venous thrombosis: report of a case].

    PubMed

    Rodríguez de Mingo, E; Riofrío Cabeza, S; Villa Albuger, T; Velasco Blanco, M J

    2014-01-01

    Palpitations, paresthesias and anxiety are very common reasons of consultation in primary care. We report the case of a 40 year-old Caucasian woman who came to the clinic due to these symptoms, and was finally diagnosed with Takayasu arteritis. Later, she had an episode of headache, as the initial manifestation of cerebral venous thrombosis. Takayasu arteritis is a systemic vasculitis affecting medium and large arteries, mainly leacausing stenosis of the aorta and its branches. It most frequently affects Asian women, being much rarer in Europe. The primary care doctor plays a key role in the initial diagnosis and monitoring of patients with rare diseases, such as Takayasu arteritis, and must be a basic support for the patient and family, providing information and advice, and contributing with his work to reduce the vulnerability of this group.

  14. Quantifying cerebral hypoxia by near-infrared spectroscopy tissue oximetry: the role of arterial-to-venous blood volume ratio

    NASA Astrophysics Data System (ADS)

    Rasmussen, Martin B.; Eriksen, Vibeke R.; Andresen, Bjørn; Hyttel-Sørensen, Simon; Greisen, Gorm

    2017-02-01

    Tissue oxygenation estimated by near-infrared spectroscopy (NIRS) is a volume-weighted mean of the arterial and venous hemoglobin oxygenation. In vivo validation assumes a fixed arterial-to-venous volume-ratio (AV-ratio). Regulatory cerebro-vascular mechanisms may change the AV-ratio. We used hypotension to investigate the influence of blood volume distribution on cerebral NIRS in a newborn piglet model. Hypotension was induced gradually by inflating a balloon-catheter in the inferior vena cava and the regional tissue oxygenation from NIRS (rStO) was then compared to a reference (rStO) calculated from superior sagittal sinus and aortic blood sample co-oximetry with a fixed AV-ratio. Apparent changes in the AV-ratio and cerebral blood volume (CBV) were also calculated. The mean arterial blood pressure (MABP) range was 14 to 82 mmHg. PaCO2 and SaO2 were stable during measurements. rStO mirrored only 25% (95% Cl: 21% to 28%, p<0.001) of changes in rStO. Calculated AV-ratio increased with decreasing MABP (slope: -0.007·mmHg-1, p<0.001). NIRS estimates that CBV decreased with decreasing MABP (slope: 0.008 ml/100 g/mmHg, p<0.001). Thus, cerebral NIRS oximetry responded poorly to changes in tissue oxygenation during hypotension induced by decreased preload. An increase in the AV-ratio during hypotension due to arterial vasodilation and, possibly, cerebral venous collapse may be a part of the explanation.

  15. Cerebral venous thrombosis: a Moroccan retrospective study of 30 cases

    PubMed Central

    Souirti, Zouhayr; Messouak, Ouafae; Belahsen, Faouzi

    2014-01-01

    Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better than arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnosis. We studied 30 cases of CVT diagnosed in the department of neurology at the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%), consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behçet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes were observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated. PMID:25317229

  16. Cerebral venous thrombosis in a child with nephrotic syndrome: case report.

    PubMed

    Bhoobun, Shalinee; Jalloh, Alhaji Alusaine; Jacobsen, Kathryn H

    2012-01-01

    Cerebral venous thrombosis (CVT), a rare and life threatening complication of nephrotic syndrome, has a variable and non-specific presentation, posing diagnostic challenges. We describe a case of CVT in a Sierra Leonean child with nephrotic syndrome who was successfully treated for the condition despite the resource limitations of the hospital. This case highlights the importance of considering cerebral venous thrombosis as a complication of idiopathic nephrotic syndrome in children presenting with neurological symptoms.

  17. Cerebral Venous Thrombosis as an Extrahepatic Manifestation of Acute Anicteric Hepatitis A Infection

    PubMed Central

    Zis, Panagiotis; Kontogeorgi, Elli; Karakalos, Dimitrios; Pavlopoulou, Despoina; Sevastianos, Vassilios A.

    2012-01-01

    Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis has been regarded as a rare associated condition. We report the case of a 31-year-old woman presenting with CVT associated with hepatitis A virus (HAV) infection, outlining probable pathogenic mechanisms. We suggest that hepatitis A serological markers should be routinely included in the investigation of cerebral venous thrombosis of unknown etiology, in nonvaccinated patients with risk factors of a recent HAV exposure. PMID:22934203

  18. Hormonal Contraceptives and Cerebral Venous Thrombosis Risk: A Systematic Review and Meta-Analysis

    PubMed Central

    Amoozegar, Farnaz; Ronksley, Paul E.; Sauve, Reg; Menon, Bijoy K.

    2015-01-01

    Objectives: Use of oral contraceptive pills (OCP) increases the risk of cerebral venous sinus thrombosis (CVST). Whether this risk varies by type, duration, and other forms of hormonal contraceptives is largely unknown. This systematic review and meta-analysis update the current state of knowledge. Methods: We performed a search to identify all published studies on the association between hormonal contraceptive use and risk of CVST in women aged 15–50 years. Results: Of 861 studies reviewed, 11 were included. The pooled odds of developing CVST in women aged 15–50 years taking OCPs was 7.59 times higher compared to women not taking OCPs (OR = 7.59, 95% CI 3.82–15.09). Data are insufficient to make conclusions about duration of use and other forms of hormonal contraceptives. Conclusion: Oral contraceptive pills use increases the risk of developing CVST in women of reproductive age. Future studies are required to determine if duration and type of hormonal contraceptives modify this risk. PMID:25699010

  19. Effect of echo contrast media on the visualization of transverse sinus thrombosis with transcranial 3-D duplex sonography.

    PubMed

    Delcker, A; Häussermann, P; Weimar, C

    1999-09-01

    Transcranial duplex sonography has the capacity of detecting venous flow as in the transverse sinus. During a 6-month period, 28 consecutive patients (mean age 55 y) with a clinically suspected diagnosis of cerebral sinus thrombosis were included in the study. All patients were examined using 3-D ultrasound equipment within 24 h of having undergone either venous computerized tomography (CT), venous magnetic resonance imaging (MRI) or cerebral angiography. A total of 22 healthy patients had a normal venous CT, venous MRI or cerebral angiography of both transverse sinuses. Before echo contrast enhancement, the transverse sinus could be visualized in only 2 of these 44 sinuses (22 patients). A total of 6 patients with an unilaterally missed transverse sinus in 3-D ultrasound suffered from sinus thrombosis (n = 3), hypoplasia (n = 2) or aplasia (n = 1) of the unilateral transverse sinus in neuroradiological tests. In none of the patients with an thrombosis of the transverse sinus did ultrasound contrast media application improve the visualization of the affected sinus. Our study confirms that the normal transverse sinus, insonated through the contralateral temporal bone, often cannot be visualized without the use of contrast agents. With transcranial 3-D duplex sonography, a differentiation between thrombosis, hypoplasia and aplasia of the sinus was not possible.

  20. The manifestation of vortical and secondary flow in the cerebral venous outflow tract: An in vivo MR velocimetry study.

    PubMed

    Kefayati, Sarah; Amans, Matthew; Faraji, Farshid; Ballweber, Megan; Kao, Evan; Ahn, Sinyeob; Meisel, Karl; Halbach, Van; Saloner, David

    2017-01-04

    Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D flow magnetic resonance imaging (4D-flow MRI) has recently allowed researchers to evaluate blood flow patterns in the arterial structures with great success. We utilized similar imaging techniques and found several distinct flow characteristics in the CVOT of subjects with and without lumenal irregularities. We present the flow patterns of 8 out of 38 subjects who have varying heights of the internal jugular bulb and varying lumenal irregularities including stenosis and diverticulum. In the internal jugular vein (IJV) with an elevated jugular bulb (JB), 4Dflow MRI revealed a characteristic spiral flow that was dependent on the level of JB elevation. Vortical flow was also observed in the diverticula of the venous sinuses and IJV. The diversity of flow complexity in the CVOT illustrates the potential importance of hemodynamic investigations in elucidating venous pathologies.

  1. Sinusitis

    MedlinePlus

    ... will develop sinusitis: Allergic rhinitis or hay fever Cystic fibrosis Going to day care Diseases that prevent the ... Nasal culture Nasal cytology Sweat chloride tests for cystic fibrosis Treatment SELF-CARE Try the following steps to ...

  2. Morphological Variations in the Transverse Venous Sinus Anatomy of Dogs and its Relationship to Skull Landmarks.

    PubMed

    Carreira, L Miguel; Ferreira, A

    2016-08-01

    We characterized the anatomical morphology of the transverse venous sinus (TVS) of 69 canine adult cadavers belonging to three groups: brachycephalic (B), dolichocephalic (D) and mesaticephalic (M). In addition, we outlined its path over the skull using five classic human craniometric points (CPs): the asterion (ast), the bregma (b), the glabella (g), the stephanion (st) and the pterion (pt). The study aimed to establish anatomical differences in the TVS between groups and in the relationship between the TVS and skull. We found that TVS anatomy and its relationships to skull landmarks vary markedly between the groups, with similar anatomical arrangements in B and M. The TVS length can be ranked as M < B < D (with D being the biggest), whereas the width can be ranked as M < D < B (with B being the widest) with the right side being smaller than the left. In the B and M groups, the TVS assumes a craniocaudal trajectory that is closer to the lateral skull wall than in D, where the TVS presents a caudocranial direction. By documenting the morphological characteristics of the TVS, we can create a set of anatomical references allowing construction of a basic framework to greatly decrease the probability of TVS injury during neuronavigation procedures when supported by a good knowledge of the skull, brain anatomies and their relationships.

  3. A Prospective Study of the Clinical Profile, Outcome and Evaluation of D-dimer in Cerebral Venous Thrombosis

    PubMed Central

    Dharanipragada, Subrahmanyam; Basu, Debdatta; Ananthakrishnan, Ramesh; Surendiran, Deepanjali

    2016-01-01

    Introduction Cerebral Venous Thrombosis (CVT) is a well known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in diagnosis of CVT. Aim To study various aspects of CVT and role of D-dimer. Materials and Methods The study period was September 2012 to July 2014 and included 80 imaging proven patients of CVT. We also included 39 controls for assessing D-dimer. Data was collected according to a preformed format. D-dimer was assessed by a rapid semi-quantitative latex agglutination assay. Discharged patients were followed up to six months. Results Of the total 44 were women and 36 were men (F: M=1.2:1). The mean age of the patients was 29.5±9.68 years. Most common clinical features were headache 77 (96.25%), papilloedema (67.5%) and seizures 51 (63.75%). Pregnancy was the most common cause of CVT. Superior sagittal and transverse sinuses were the most common sinuses to be affected. The sensitivity and specificity of D-dimer for diagnosing CVT was 84.62% and 80% respectively. The risk factors for poor prognosis were altered sensorium, presence of sepsis, increased sinus involvement and deep sinus thrombosis. Conclusion CVT affects both sexes equally. Puerperium still contributes to majority of the cases. Iron deficiency anaemia needs to be evaluated as a contributing factor for incidence of CVT. D-dimer is not useful in puerperal female with CVT. Positive D-dimer will strengthen the suspicion of CVT in patients with acute headache followed by a neurological deficit. PMID:27504325

  4. Clinical features, risk factors, and outcome of cerebral venous thrombosis in Tehran, Iran

    PubMed Central

    Yadegari, Samira; Ghorbani, Askar; Miri, S. Roohollah; Abdollahi, Mohammad; Rostami, Mohsen

    2016-01-01

    Introduction: Despite increasing the use of magnetic resonance imaging (MRI), cerebral venous sinus thrombosis (CVST) has remained an under-diagnosed condition. In this study, characteristics and frequency of various risk factors of CVST patients in a tertiary referral hospital were closely assessed. Methods: Patients with an unequivocal diagnosis of CVST confirmed by MRI and magnetic resonance venography during 6 years of the study were included. All data from the onset of symptoms regarding clinical signs and symptoms, hospital admission, seasonal distribution, medical and drug history, thrombophilic profile, D-dimer, neuroimaging, cerebrospinal fluid findings, mortality, and outcome were collected and closely analyzed. Result: A total of 53 patients with female to male ratio of 3.07 and mean age of 33.7 years were included in the study. Headache and papilledema were the most frequent clinical features (44 and 36 patients, respectively). An underlying disease (diagnosed previously or after admission) was the most common identified risk factor for CVST in both females and males (21 patients). A total of 15 women used the oral contraceptive pill (OCP) where 12 of them had simultaneously other predisposing factors. Overall, 19 patients (36%) had more than one contributing factor. D-dimer had a sensitivity of 71.4% in CVST patients. The mortality of patients in this study was 3.7% (n = 2). Focal neurologic deficit and multicranial nerve palsy were associated with poor outcome which defined as death, recurrence, and massive intracranial hemorrhage due to anticoagulation (P = 0.050 and 0.004, respectively). Conclusion: Unlike most of the CVST studies in which OCP was the main factor; in this study, an underlying disease was the most identified cause. Considering the high probability of multiple risk factors in CVST that was shown by this study, appropriate work up should be noted to uncover them. PMID:27695236

  5. Angioarchitectural Changes in Subacute Cerebral Venous Thrombosis. A Synchrotron-based Micro- and Nano-CT Study

    SciTech Connect

    E Stolz; M Yeniguen; M Kreisel; M Kampschulte; S Doenges; D Sedding; E Ritman; T Gerriets; A Langheinrich

    2011-12-31

    It is well known that recanalization of thrombosed cerebral sinuses occurs early but without marked influence on the long-term outcome and on final venous infarct volume on magnetic resonance imaging. To better understand the possible microvascular mechanisms behind these clinical observations, we evaluated the sequels of subacute superior sagittal sinus (SSS) thrombosis in rats using micro- and nano-CT imaging of the same specimen to provide large volume and high resolution CT image data respectively. SSS thrombosis was induced in 11 animals which were euthanized after 6 h (n = 4) or 6 weeks (n = 7). Eight sham-operated rats served as controls. After infusion of contrast into the vasculature of the brains, these were isolated and scanned using micro-, nano-, and synchrotron-based micro-CT ((8 {mu}m{sup 3}), (900 nm){sup 3}, and (1.9 {mu}m{sup 3}) voxel sizes). The cross-sectional area of the superior sagittal sinus, microvessels and cortical veins were quantified. Tissue sections were stained against VEGF antigen. Immunohistochemistry was confirmed using quantitative rtPCR. SSS thrombosis led to a congestion of the bridging veins after 6 h. After 6 weeks, a network of small vessels surrounding the occluded SSS was present with concurrent return towards the diameter of the draining bridging veins of controls. This microvascular network connected to cortical veins as demonstrated by nano- and synchrotron-based micro-CT. Also the volume fraction and number of cortical veins increased significantly. Immunohistochemistry in the region of the microsvascular network demonstrated a strong immunoreactivity against VEGF, confirmed by rtPCR. The sequel of subacute SSS thrombosis induced a network of microvessels ('venogenesis') draining the bridging veins. Also the volume fraction of cortical veins increased significantly.

  6. The post-occipital spinal venous sinus of the Nile crocodile Crocodylus niloticus: its anatomy and use for blood sample collection and intravenous infusions.

    PubMed

    Myburgh, Jan G; Kirberger, Robert M; Steyl, Johan C A; Soley, John T; Booyse, Dirk G; Huchzermeyer, Fritz W; Lowers, Russel H; Guillette, Louis J

    2014-05-05

    The post-occipital sinus of the spinal vein is often used for the collection of blood samples from crocodilians. Although this sampling method has been reported for several crocodilian species, the technique and associated anatomy has not been described in detail in any crocodilian, including the Nile crocodile (Crocodylus niloticus). The anatomy of the cranial neck region was investigated macroscopically, microscopically, radiographically and by means of computed tomography. Latex was injected into the spinal vein and spinal venous sinus of crocodiles to visualise the regional vasculature. The spinal vein ran within the vertebral canal, dorsal to and closely associated with the spinal cord and changed into a venous sinus cranially in the post-occipital region. For blood collection, the spinal venous sinus was accessed through the interarcuate space between the atlas and axis (C1 and C2) by inserting a needle angled just off the perpendicular in the midline through the craniodorsal cervical skin, just cranial to the cranial borders of the first cervical osteoderms. The most convenient method of blood collection was with a syringe and hypodermic needle. In addition, the suitability of the spinal venous sinus for intravenous injections and infusions in live crocodiles was evaluated. The internal diameter of the commercial human epidural catheters used during these investigations was relatively small, resulting in very slow infusion rates. Care should be taken not to puncture the spinal cord or to lacerate the blood vessel wall using this route for blood collection or intravenous infusions.

  7. Cerebral venous thrombosis and secondary polycythemia in a case of nephrotic syndrome.

    PubMed

    Nagaraju, Shankar Prasad; Bairy, Manohar; Attur, Ravindra Prabhu; Sambhaji, Charudutt Jayant

    2016-03-01

    Cerebral venous thrombosis (CVT) and polycythemia are considered as rare and life threatening complications of nephrotic syndrome. We report an unusual combination of both these complications in a case of nephrotic syndrome due to minimal change disease that was treated successfully. There was prompt and complete remission of nephrotic syndrome with steroid therapy, concurrent with complete resolution of polycythemia and CVT.

  8. Comparison of brain tissue and local cerebral venous gas tensions and pH.

    PubMed

    Edelman, G J; Hoffman, W E; Rico, C; Ripper, R

    2000-09-01

    Neurosurgical monitoring devices have recently become available which are capable of measuring cerebral tissue gas tensions and pH. Brain tissue sensors have not been conclusively demonstrated to correlate with other measurements of regional cerebral gas tensions or pH. The present study was undertaken to correlate sensor values for pO2, pCO2 and pH with blood samples taken concurrently from local cerebral veins. Adult mongrel dogs were anesthetized and a craniotomy was performed. A small gyral vein was isolated and cannulated. Adjacent to the venous catheter tip, a Neurotrend brain tissue probe was inserted in an intracortical location. Each subject received a sequence of manipulations in inspired oxygen and end tidal carbon dioxide conditions. Under each experimental condition, samples of arterial and gyral venous blood were obtained and blood gas analysis performed. Concurrent brain probe measurements of tissue pO2, pCO2 and pH were recorded. Statistical analysis determined that local tissue and cerebral venous blood values for pO2, pCO2 and pH were highly correlated (R(s) = 0.62-0.82; p < 0.001). This indicates that there exists a confirmable monotonic relationship between tissue values and conditions in the post-capillary venous bed. Tissue sensors such as the Neurotrend probe can offer reliable trend indications in brain tissue gas tensions and pH.

  9. From presentation to follow-up: diagnosis and treatment of cerebral venous thrombosis.

    PubMed

    Bentley, J Nicole; Figueroa, Ramón E; Vender, John R

    2009-11-01

    Cerebral venous thrombosis is an uncommon cause of stroke but remains a challenge for physicians faced with this diagnosis largely due to the variability in presentation. Anticoagulation, typically with intravenous heparin, remains the mainstay of treatment for stable patients and is sufficient in the majority of cases. However, a significant mortality rate exists for cerebral venous thrombosis due to patients who deteriorate or do not adequately respond to initial treatments. It is in these patients that more aggressive interventions must be undertaken. The neurosurgeon is often called on, either acutely for initial evaluation of the stroke or venous hemorrhage or after the failure of initial therapy for clot evacuation, hemicraniectomy, or thrombectomy. A proper workup must include a search for an underlying, correctable cause as well as thorough follow-up with correction of identified risk factors to decrease the risk of recurrent disease.

  10. Association study of methylenetetrahydrofolate reductase C677T mutation with cerebral venous thrombosis in an Iranian population.

    PubMed

    Ghaznavi, Habib; Soheili, Zahra; Samiei, Shahram; Soltanpour, Mohammad S

    2015-12-01

    There are limited data on the role of methylenetetrahydrofolate reductase C677T polymorphism and hyperhomocysteinemia as risk factors for cerebral venous thrombosis in Iranian population. We examined a possible association between fasting plasma homocysteine levels, methylenetetrahydrofolate reductase C677T polymorphism, and cerebral venous thrombosis in 50 patients with a diagnosis of cerebral venous thrombosis (20-63 years old) and 75 healthy controls (18-65 years old). Genotyping of the methylenetetrahydrofolate reductase C677T gene polymorphism was performed by PCR-restriction fragment length polymorphism analysis, and homocysteine levels were measured by enzyme immunoassay. Fasting plasma homocysteine levels were significantly higher in cerebral venous thrombosis patients than in controls (P = 0.015). Moreover, plasma homocysteine levels were significantly higher in methylenetetrahydrofolate reductase 677TT genotype compared to 677CT and 677CC genotypes in both cerebral venous thrombosis patients (P = 0.01) and controls (P = 0.03). Neither 677CT heterozygote genotype [odds ratio (OR) 1.35, 95% confidence interval (CI) 0.64-2.84, P = 0.556] nor 677TT homozygote genotype (OR 1.73, 95% CI 0.32-9.21, P = 0.833) was significantly associated with cerebral venous thrombosis. Additionally, no significant differences in the frequency of 677T allele between cerebral venous thrombosis patients and controls were identified (OR 1.31, 95% CI 0.69-2.50, P = 0.512). In conclusion, our study demonstrated that elevated plasma homocysteine levels are significant risk factors for cerebral venous thrombosis. Also, methylenetetrahydrofolate reductase 677TT genotype is not linked with cerebral venous thrombosis, but is a determinant of elevated plasma homocysteine levels.

  11. Blood flow in the cerebral venous system: modeling and simulation.

    PubMed

    Miraucourt, Olivia; Salmon, Stéphanie; Szopos, Marcela; Thiriet, Marc

    2017-04-01

    The development of a software platform incorporating all aspects, from medical imaging data, through three-dimensional reconstruction and suitable meshing, up to simulation of blood flow in patient-specific geometries, is a crucial challenge in biomedical engineering. In the present study, a fully three-dimensional blood flow simulation is carried out through a complete rigid macrovascular circuit, namely the intracranial venous network, instead of a reduced order simulation and partial vascular network. The biomechanical modeling step is carefully analyzed and leads to the description of the flow governed by the dimensionless Navier-Stokes equations for an incompressible viscous fluid. The equations are then numerically solved with a free finite element software using five meshes of a realistic geometry obtained from medical images to prove the feasibility of the pipeline. Some features of the intracranial venous circuit in the supine position such as asymmetric behavior in merging regions are discussed.

  12. Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

    PubMed Central

    2016-01-01

    Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders. PMID:27006525

  13. Ultrasonographic Evaluation of Cerebral Arterial and Venous Haemodynamics in Multiple Sclerosis: A Case-Control Study

    PubMed Central

    Marchione, Pasquale; Morreale, Manuela; Giacomini, Patrizia; Izzo, Chiara; Pontecorvo, Simona; Altieri, Marta; Bernardi, Silvia; Frontoni, Marco; Francia, Ada

    2014-01-01

    Objective Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS), controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR), Primary Progressive (PP) Multiple Sclerosis and age and sex-matched controls subjects. Material and Methods All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV) of middle cerebral arteries (MCA), differences between cerebral venous outflow (CVF) in clinostatism and in the seated position (ΔCVF) and non-invasive cerebral perfusion pressure (CPP) were evaluated. Results 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS≥5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3±2 cm/s vs. 54.6±3 cm/s, p = 0.01). No significant differences in CPP were observed within and between groups. Conclusions The quantitative evaluation of cerebral blood flow (CBF) and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an

  14. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    PubMed Central

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2013-01-01

    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  15. Cerebral venous circulatory disturbance as an informative prognostic marker for neonatal hemorrhagic stroke

    NASA Astrophysics Data System (ADS)

    Semyachkina-Glushkovskaya, Oxana; Pavlov, Alexey; Navolokin, Nikita; Lychagov, Vladislav; Abdurashitov, Arkady; Zinchenko, Ekaterina; Gekaluk, Artemiy; Zhu, Dan; Shi, Rui; Luo, Qingming; Tuchin, Valery

    2016-04-01

    Neonatal hemorrhagic stroke (NHS) is a major problem of future generation's health due to the high rate of death and cognitive disability of newborns after NHS. The incidence of NHS in neonates cannot be predicted by standard diagnostic methods. Therefore, the identification of prognostic markers of NHS is crucial. There is evidence that stress-related alterations of cerebral blood flow (CBF) may contribute to NHS. Here, we assessed the stroke-associated CBF abnormalities for high prognosis of NHS using a new model of NHS induced by sound stress in the pre- and post-stroke state. With this aim, we used interdisciplinary methods such as a histological assay of brain tissues, laser speckle contrast imaging and Doppler coherent tomography to monitor cerebral circulation. Our results suggest that the venous stasis with such symptoms as progressive relaxation of cerebral veins, decrease the velocity of blood flow in them are prognostic markers for a risk of NHS and are an informative platform for a future study of corrections of cerebral venous circulatory disturbance related to NHS.

  16. Computed tomographic angiography of the superficial cerebral venous anastomosis based on volume rendering, multi-planar reconstruction, and integral imaging display.

    PubMed

    Fang, Qiong; Chen, Feng; Jiang, Anhong; Huang, Yanping; Deng, Xuefei

    2015-12-01

    As damage to the superficial cerebral venous anastomosis may create catastrophic complications even after successful surgery, it is important to visualize and determine the normal features of the venous anastomosis with computed tomographic angiography. A total of 90 patients underwent a 64-detector row helical CT scan of head. The superficial cerebral venous anastomosis was reconstructed by volume rendering, multi-planar reconstruction, and integral display algorithm. In particular, we examined the vein of Trolard, the vein of Labbe, and the vein of Sylvian, in order to analyze the venous anastomosis. The superficial cerebral venous anastomosis varied across different individuals, and in this study, six types of anastomosis were found. In 28 % of patients, no venous anastomosis was found in the unilateral cerebral hemisphere. The display rate of the vein of Trolard, the vein of Labbe, and the vein of Sylvian in contributing to venous anastomosis was 70, 80, and 91 %, respectively. The number of vein of Trolard and vein of Labbe on the left side was greater than that of those on the right side. We implemented the 64-detector row helical CT as a rapid and noninvasive method to investigate the superficial cerebral venous anastomosis in our group of patients. We performed substantial image processing for the visualization of the superficial cerebral venous anastomosis; this would not only enable the early diagnosis of cerebral venous disease, but also protect the cerebral vein during neurosurgical intervention.

  17. Borderline Intracranial Hypertension Manifesting as Chronic Fatigue Syndrome Treated by Venous Sinus Stenting.

    PubMed

    Higgins, Nicholas; Pickard, John; Lever, Andrew

    2015-11-01

    Chronic fatigue syndrome and cases of idiopathic intracranial hypertension without signs of raised intracranial pressure can be impossible to distinguish without direct measurement of intracranial pressure. Moreover, lumbar puncture, the usual method of measuring intracranial pressure, can produce a similar respite from symptoms in patients with chronic fatigue as it does in idiopathic intracranial hypertension. This suggests a connection between them, with chronic fatigue syndrome representing a forme fruste variant of idiopathic intracranial hypertension. If this were the case, then treatments available for idiopathic intracranial hypertension might be appropriate for chronic fatigue. We describe a 49-year-old woman with a long and debilitating history of chronic fatigue syndrome who was targeted for investigation of intracranial pressure because of headache, then diagnosed with borderline idiopathic intracranial hypertension after lumbar puncture and cerebrospinal fluid drainage. Further investigation showed narrowings at the anterior ends of the transverse sinuses, typical of those seen in idiopathic intracranial hypertension and associated with pressure gradients. Stenting of both transverse sinuses brought about a life-changing remission of symptoms with no regression in 2 years of follow-up. This result invites study of an alternative approach to the investigation and management of chronic fatigue.

  18. Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

    PubMed

    Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

    2008-12-01

    Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

  19. Simultaneous appearance of cerebral venous thrombosis and subdural hematomas as rare cause of headache in puerperium following epidural analgesia: a case report

    PubMed Central

    Župan, Željko; Sotošek Tokmadžić, Vlatka; Matanić-Manestar, Marinka; Šustić, Alan; Antončić, Igor; Dunatov, Siniša; Pavlović, Ivan; Antulov, Ronald

    2012-01-01

    The aim of this study is to report the first case of simultaneous appearance of cerebral venous thrombosis (CVT) and bilateral subdural hematomas (SDHs) following epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum headache. A 26-year old primigravida with a history of epilepsy received epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the headache. Patient responded very well to the pain medication and oral hydration, and the headache was relieved. Ten days after the delivery, the headache reoccurred, and an epidural blood patch was performed that successfully relieved her symptom. Stronger progressive headache with nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with low molecular weight heparin and antiaggregation therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate therapy could be life-threatening. PMID:22911532

  20. Cerebral Venous Thrombosis Revealing Primary Sjögren Syndrome: Report of 2 Cases

    PubMed Central

    Mercurio, A.; Altieri, M.; Saraceni, V. M.; Paolucci, T.; Lenzi, G. L.

    2013-01-01

    Sjögren syndrome (SS) is an autoimmune disease of the exocrine glands, characterized by focal lymphocytic infiltration and destruction of these glands. Neurologic complications are quite common, mainly involving the peripheral nervous system (PNS). The most common central nervous system (CNS) manifestations are myelopathy and microcirculation vasculitis. However, specific diagnostic criteria for CNS SS are still lacking. We report two cases of primary SS in which the revealing symptom was cerebral venous thrombosis (CVT) in the absence of genetic or acquired thrombophilias. PMID:23424596

  1. Cutaneous Venous Malformations in Familial Cerebral Cavernomatosis Caused by KRIT1 Gene Mutations

    PubMed Central

    Toll, Agustí; Parera, Elisabet; Giménez-Arnau, Ana M.; Pou, Alejandro; Lloreta, Josep; Limaye, Nisha; Vikkula, Miikka; Pujol, Ramon M.

    2009-01-01

    Background Cerebral cavernous malformations (CCMs) are vascular lesions characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. Although often asymptomatic, seizures, cerebral haemorrhages and focal neurological deficits are well-documented complications. Mutations in the CCM1 (7q21–22), CCM2 (7p13–15) and CCM3 (3q25.2–27) genes have been identified in familial CCM. In rare instances, the association of congenital hyperkeratotic cutaneous capillary-venous malformations (HCCVMs) with CCM1 has been reported. Observations: We studied 6 members of a family with CCMs. Four members of the family developed late-onset multiple, tiny, bluish, soft, cutaneous papules, mainly located on the face, arm and abdominal area, corresponding histologically to venous malformations. A splice donor site mutation in intron 4 (c. 1146 + 1 G→A) in the CCM1 gene was identified. Conclusions Our findings suggest that mutations in the KRIT1 gene may cause phenotypically heterogeneous cutaneous vascular lesions other than those previously described as HCCVMs. PMID:19182478

  2. Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis

    PubMed Central

    Tanabe, Natsumi; Hiraoka, Eiji; Hoshino, Masataka; Deshpande, Gautam A.; Sawada, Kana; Norisue, Yasuhiro; Tsukuda, Jumpei; Suzuki, Toshihiko

    2017-01-01

    Patient: Female, 49 Final Diagnosis: Cerebral venous thrombosis Symptoms: Altered mental state • weakness in limbs Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare co-existance of disease or pathology Background: Cerebral venous thrombosis (CVT) is a rare but fatal complication of hyperthyroidism that is induced by the hypercoagulable state of thyrotoxicosis. Although it is frequently difficult to diagnose CVT promptly, it is important to consider it in the differential diagnosis when a hyperthyroid patient presents with atypical neurologic symptoms. Care Report: A 49-year-old Japanese female with unremarkable medical history came in with thyroid storm and multiple progressive ischemic stroke identified at another hospital. Treatment for thyroid storm with beta-blocker, glucocorticoid, and potassium iodide-iodine was started and MR venography was performed on hospital day 3 for further evaluation of her progressive ischemic stroke. The MRI showed CVT, and anticoagulation therapy, in addition to the anti-thyroid agents, was initiated. The patient’s thyroid function was successfully stabilized by hospital day 10 and further progression of CVT was prevented. Conclusions: Physicians should consider CVT when a patient presents with atypical course of stroke or with atypical MRI findings such as high intensity area in apparent diffusion coefficient (ADC) mapping. Not only is an early diagnosis and initiation of anticoagulation important, but identifying and treating the underlying disease is essential to avoid the progression of CVT. PMID:28228636

  3. Early pregnancy cerebral venous thrombosis and status epilepticus treated with levetiracetam and lacosamide throughout pregnancy.

    PubMed

    Ylikotila, Pauli; Ketola, Raimo A; Timonen, Susanna; Malm, Heli; Ruuskanen, Jori O

    2015-11-01

    Cerebral venous thrombosis (CVT) is an uncommon cause of stroke, accounting to less than 1% of all strokes. We describe a pregnant woman with a massive CVT in early pregnancy, complicated by status epilepticus. The mother was treated with levetiracetam, lacosamide, and enoxaparin throughout pregnancy. A male infant was born on pregnancy week 36, weighing 2.2kg. Both levetiracetam and and lacosamide were present in cord blood in levels similar to those in maternal blood. The infant was partially breast-fed and experienced poor feeding and sleepiness, starting to resolve after two first weeks. Milk samples were drawn 5 days after the delivery and a blood sample from the infant 3 days later. Lacosamide level in milk was low, resulting in an estimated relative infant dose of 1.8% of the maternal weight-adjusted daily dose in a fully breast-fed infant. This is the first case describing lacosamide use during pregnancy and lactation.

  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. Cerebral venous thrombosis and thrombophilia: a systematic review and meta-analysis.

    PubMed

    Lauw, Mandy N; Barco, Stefano; Coutinho, Jonathan M; Middeldorp, Saskia

    2013-11-01

    Cerebral venous thrombosis (CVT) is a rare manifestation of venous thromboembolism (VTE) and stroke. The aim of our systematic review was to provide an updated summary of the strength of association between CVT and thrombophilia and to explore the relevance of thrombophilia for recurrence of CVT or other VTE, or other outcome variables. MEDLINE (via PubMed), EMBASE (via Ovid), and CENTRAL were systematically searched, including references of retrieved articles. Cohort studies of ≥ 40 patients and case-control studies comparing the prevalence of thrombophilia in patients with CVT and unrelated controls were eligible. Two reviewers independently selected studies, assessed quality, and extracted data. A meta-analysis was performed for high quality case-control studies with unselected cases and healthy controls. Odds ratios with 95% confidence intervals were calculated and pooled. We included 23 cohort studies and 33 case-control studies. A significant association was demonstrated between CVT and all inherited thrombophilic factors, as well as increased levels of homocysteine. Inconclusive results were found on the relevance of thrombophilia for recurrent CVT or other VTE. Although there is a strong association between CVT and thrombophilia, the clinical relevance of thrombophilia testing in patients with CVT seems limited, similarly to other forms of VTE.

  6. Coagulation factor VII R353Q polymorphism and the risk of puerperal cerebral venous thrombosis.

    PubMed

    Kruthika-Vinod, T P; Nagaraja, Dindagur; Christopher, Rita

    2012-01-01

    Puerperal cerebral venous thrombosis (CVT) is a relatively common form of stroke in young women in India. The blood coagulation factor VII (FVII) R353Q polymorphism increases the risk for venous thrombosis. Our aim was to investigate the association of FVII R353Q polymorphism with the risk of puerperal CVT. A total of 100 women with puerperal CVT and 102 age-matched women without postpartum complications were investigated. FVII R353Q genotypes were identified using restriction fragment length polymorphism analysis. Our results showed that the homozygous FVII 353QQ genotype was present in 9% and 8% of patients and controls, respectively; and 42% of patients and 31.4% of controls had the heterozygous 353RQ genotype (odds ratio = 1.55, 95% confidence interval = 0.89-2.70; p = 0.243). Our findings suggest that the FVII R353Q polymorphism is not associated with increased risk for CVT occurring during the puerperal period in Indian women.

  7. Post-coital intra-cerebral venous hemorrhage in a 78-year-old man with jugular valve incompetence: a case report

    PubMed Central

    2010-01-01

    Introduction Spontaneous intra-cerebral hemorrhage can occur in patients with venous disease due to obstructed venous outflow. Case presentation We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage. Conclusions To the best of our knowledge, this is the first case of intra-cerebral hemorrhage due to jugular valve incompetence in association with the physical exertion associated with sexual intercourse. PMID:20659320

  8. Countercurrent transfer of dopamine from venous blood in the cavernous sinus to the arterial blood supplying the brain - the perfused rabbit head as an experimental model.

    PubMed

    Muszak, J; Krzymowski, T; Gilun, P; Stefanczyk-Krzymowska, S

    2014-10-01

    The objective of the current study was to check whether countercurrent transfer of dopamine occurs in the cavernous sinus of the rabbit and whether the rabbit can be used as an animal model to study cavernous sinus function. After exsanguination of the animal, oxygenated and warmed (37°C) Hanseneleit-Krebs buffer with autologous or homologous blood (in a 3:1 or 1:1 ratio) was pumped through both common carotid arteries into the head (60 ml/min; 80-100 mm Hg) and radiolabeled dopamine (3(H)-DA, 10 μCi) was infused into the cavernous sinus through the angular oculi vein. Cerebral blood from the basilar artery was collected from the cannulated vertebral artery during 3(H)-DA infusion and for 10 minutes after completion of infusion. Selected brain tissue samples were collected after completion of the head perfusion. It was demonstrated that dopamine can penetrate from the rabbit's cavernous sinus to the internal carotid artery supplying the brain. Dopamine permeation was greater when the rabbit head was perfused with buffer and blood in a 3:1 ratio than with 1:1 (P<0.01). When the head was perfused with buffer and blood in a 3:1 ratio, significant radioactivity was found in samples collected from the brain basilar artery during and after 3(H)-DA infusion (P<0.001). The radioactivity was identified as 34.13 ± 2.7% unmetabolized 3(H)-DA and 65.9 ± 2.7% its metabolites. Significant radioactivity was also found in some brain tissue samples in both groups (P<0.05). The concentration of free radiolabeled dopamine particles in the dialysate of blood plasma and plasma diluted with buffer did not differ significantly. Because the structures of the cavernous sinus and cavernous fragment of the internal carotid artery of the rabbit are similar to those in humans, it suggests that rabbits can serve as a model for experimental physiological studies of cavernous sinus function and retrograde dopamine transfer in the cavernous sinus should be considered as an important link in

  9. Towards the genetic basis of cerebral venous thrombosis—the BEAST Consortium: a study protocol

    PubMed Central

    Cotlarciuc, Ioana; Marjot, Thomas; Khan, Muhammad S; Hiltunen, Sini; Haapaniemi, Elena; Metso, Tiina M; Putaala, Jukka; Zuurbier, Susanna M; Brouwer, Matthijs C; Passamonti, Serena M; Bucciarelli, Paolo; Pappalardo, Emanuela; Patel, Tasmin; Costa, Paolo; Colombi, Marina; Canhão, Patrícia; Tkach, Aleksander; Santacroce, Rosa; Margaglione, Maurizio; Favuzzi, Giovanni; Grandone, Elvira; Colaizzo, Donatella; Spengos, Kostas; Arauz, Antonio; Hodge, Amanda; Ditta, Reina; Debette, Stephanie; Zedde, Marialuisa; Pare, Guillaume; Ferro, José M; Thijs, Vincent; Pezzini, Alessandro; Majersik, Jennifer J; Martinelli, Ida; Coutinho, Jonathan M; Tatlisumak, Turgut; Sharma, Pankaj

    2016-01-01

    Introduction Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition accounting for <1% of all stroke cases and mainly affects young adults. Its genetic aetiology is not clearly elucidated. Methods and analysis To better understand the genetic basis of CVT, we have established an international biobank of CVT cases, Biorepository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) which aims to recruit highly phenotyped cases initially of European descent and later from other populations. To date we have recruited 745 CVT cases from 12 research centres. As an initial step, the consortium plans to undertake a genome-wide association analysis of CVT using the Illumina Infinium HumanCoreExome BeadChip to assess the association and impact of common and low-frequency genetic variants on CVT risk by using a case–control study design. Replication will be performed to confirm putative findings. Furthermore, we aim to identify interactions of genetic variants with several environmental and comorbidity factors which will likely contribute to improve the understanding of the biological mechanisms underlying this complex disease. Ethics and dissemination BEAST meets all ethical standards set by local institutional review boards for each of the participating sites. The research outcomes will be published in international peer-reviewed open-access journals with high impact and visibility. The results will be presented at national and international meetings to highlight the contributions into improving the understanding of the mechanisms underlying this uncommon but important disease. This international DNA repository will become an important resource for investigators in the field of haematological and vascular disorders. PMID:27881526

  10. Abducens nerve palsy due to inferior petrosal sinus thrombosis.

    PubMed

    Mittal, Shivam Om; Siddiqui, Junaid; Katirji, Bashar

    2017-02-24

    Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello's canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber's ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello's canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello's canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.

  11. New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

    PubMed Central

    Konakondla, Sanjay; Schirmer, Clemens M.; Li, Fengwu; Geng, Xiaogun; Ding, Yuchuan

    2017-01-01

    Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large

  12. 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

  13. Extra-abdominal venous thromboses at unusual sites.

    PubMed

    Martinelli, Ida; De Stefano, Valerio

    2012-09-01

    Venous thrombosis typically involves the lower extremities. Rarely, it can occur in cerebral, splanchnic, or renal veins, with a frightening clinical impact. Other rare manifestations are upper-extremity deep vein thrombosis, that can complicate with pulmonary embolism and post-thrombotic syndrome, and retinal vein occlusion, significantly affecting the quality of life. This review is focused on venous thromboses at unusual extra-abdominal sites. Local infections or cancer are frequent in cerebral sinus-venous thrombosis. Upper-extremity deep vein thrombosis is mostly due to catheters or effort-related factors. Common risk factors are inherited thrombophilia and oral contraceptive use. Acute treatment is based on heparin; in cerebral sinus-venous thrombosis, local or systemic fibrinolysis should be considered in case of clinical deterioration. Vitamin-K antagonists are recommended for 3-6 months; indefinite anticoagulation is suggested for recurrent thrombosis or unprovoked thrombosis and permanent risk factors. However, such recommendations mainly derive from observational studies; there are no data about long-term treatment of retinal vein occlusion.

  14. Sinus thrombosis-do animal models really cover the clinical syndrome?

    PubMed

    Yenigün, Mesut; Jünemann, Martin; Gerriets, Tibo; Stolz, Erwin

    2015-06-01

    Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young patients. CVST represents with 0.5-3% of stroke cases a relatively rare disease. CVST affects 3-4 cases per 1 million overall and 7 cases per 1 million children and neonates. Typical clinical symptoms include headache, visual deficits and seizures. Beside the main condition associated with CVST in women in pregnancy and puerperium, the most frequently identified risk factors are oral hormonal contraceptives in combination with coagulation disorders. The initial treatment contains heparin and its efficacy is based on two randomized placebo-controlled trials including 79 patients together. A lack of understanding of the pathophysiology of CSVT makes animal models of this disease indispensable. Previously developed animal models of sinus sagittalis superior contributes to further clarify the pathophysiologic mechanisms and surrounding circumstances in the topic of cerebral venous thrombosis.

  15. Embolism of cerebral tissue to lungs following gunshot wound to head.

    PubMed

    Hatfield, S; Challa, V R

    1980-04-01

    The case history of a 28-year-old man who sustained a gunshot wound to the head and developed multiple pulmonary emboli composed of cerebral tissue is presented. The brain tissue fragments probably entered the severed end of a bridging vein, traveled along the superior sagittal sinus, and gained access to the internal jugular vein and systemic venous return.

  16. Sinus Tumors

    MedlinePlus

    ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ...

  17. Adult Sinusitis

    MedlinePlus

    ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ...

  18. Ten years of cerebral venous thrombosis: male gender and myeloproliferative neoplasm is associated with thrombotic recurrence in unprovoked events.

    PubMed

    Lim, H Y; Ng, C; Donnan, G; Nandurkar, H; Ho, Prahlad

    2016-10-01

    Cerebral venous thrombosis (CVT) is a rare venous thrombotic event. We review our local experience in the management of CVT in comparison to other venous thromboembolism (VTE) with specific focus on risk factors for thrombotic recurrence. Retrospective evaluation of consecutive CVT presentations from January 2005 to June 2015, at two major tertiary hospitals in Northeast Melbourne, Australia. This population was compared to a separate audit of 1003 consecutive patients with DVT and PE. Fifty-two patients (30 female, 22 male) with a median age of 40 (18-83) years, presented with 53 episodes of CVT. Twenty-nine episodes (55 %) were associated with an underlying risk factor, with hormonal risk factors in females being most common. The median duration of anticoagulation was 6 months with 11 receiving life-long anticoagulation. Eighty-one percent had residual thrombosis on repeat imaging, which was not associated with recurrence at the same or distant site. Nine (17 %) had CVT-related haemorrhagic transformation with two resultant CVT-related deaths (RR 22.5; p = 0.04). All three VTE recurrences occured in males with unprovoked events (RR 18.2; p = 0.05) who were subsequently diagnosed with myeloproliferative neoplasm (MPN). Compared to the non-cancer VTE population, non-cancer CVT patients were younger, had similar rate of provoked events and VTE recurrence, although with significantly higher rate of MPN diagnosis (RR 9.30 (2.29-37.76); p = 0.002) CVT is a rare thrombotic disorder. All recurrences in this audit occurred in male patients with unprovoked events and subsequent diagnosis of MPN, suggesting further evaluation for MPN may be warranted in patients with unprovoked CVT.

  19. [Neonatal cerebral thrombosis and deficit of factor V leiden].

    PubMed

    Moliner Calderón, E; López Bernal, E; Ginovart Galiana, G; Nadal Amat, J; Cubells Riero, J

    2000-01-01

    Background Cerebral venous thrombosis is an inusual disease in neonatal age. Increasing reports of this disorder had described since magnetic resonance angiography is used. Case report Newborn of apropriate seze for gestational age was delivered at 35 weeks of gestation. Refered a severe hipoxic-isquemic disease with multisistemic afectation. The second day of life presented disseminated intravascular coagulation with pulmonary bleeding. The third day, the infant developed seizures that required treatment with diazepam in continuous perfussion. MR angiography visualized superior sagital and transvers sinus thrombosis. Coagulation study detected factor V Leiden. Comments Frecuently venous cerebral thrombosis is presenting with lethargy and seizures. The most common vessels involved are sagital and transvers sinus. It is described in association with exogenous risk factors that increasing blood hyperviscosity and additional inhered coagulation dissorders such as defects on antihrombina III, protein C and S and activate protein C resistance. The last defect has a hight prevalence in subjects with trombosis events.

  20. Sinus Surgery

    MedlinePlus

    ... found in the anterior ethmoid area, where the maxillary and frontal sinuses connect with the nose. This ... chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. ...

  1. Sinus Anatomy

    MedlinePlus

    ... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... ANATOMY > Sinus Anatomy Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ...

  2. Chronic Sinusitis

    MedlinePlus

    Chronic sinusitis Overview By Mayo Clinic Staff Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen for at least 12 weeks, despite treatment attempts. Also known as chronic rhinosinusitis, this condition ...

  3. Sinus Headaches

    MedlinePlus

    ... Achy feeling in your upper teeth Sinusitis or migraine? Migraines and headaches from sinusitis are easy to confuse ... types of headaches often overlap. Both sinusitis and migraine headache pain often gets worse when you bend ...

  4. Cortical venous thrombosis following exogenous androgen use for bodybuilding

    PubMed Central

    Sveinsson, Olafur; Herrman, Lars

    2013-01-01

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic–clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully. PMID:23389726

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

    PubMed

    Sveinsson, Olafur; Herrman, Lars

    2013-02-05

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic-clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully.

  6. The Management of Symptomatic Cerebral Developmental Venous Anomalies: A Clinical Experience of 43 Cases

    PubMed Central

    Yu, Xin-guang; Wu, Chen; Zhang, Hui; Sun, Zheng-hui; Cui, Zhi-qiang

    2016-01-01

    Background Developmental venous anomalies (DVAs) are rare vascular diseases becoming more frequently diagnosed. Most patients with DVAs have no clinical symptoms with the exception of a few patients with epilepsy, intracranial hemorrhage, or neuro-function deficit. There is still controversy with respect to treatment strategies for symptomatic DVAs. Material/Methods Forty-three cases of symptomatic DVAs from January 2006 to October 2015 were retrospectively reviewed and the imaging characteristics of DVAs by CT, MRI, and DSA and the treatment modalities for DVAs were studied. Results Typical imaging characteristics of symptomatic DVAs were wedge or umbrella-shaped collections of dilated medullary veins converging in an enlarged subependymal or transcortical collecting vein, draining to the superficial or deep vein system. Based on location and draining vein features, symptomatic DVAs were tentatively classified into six different subtypes. Of the 43 cases, 19 were treated by surgical methods and 24 were treated conservatively. Conclusions We concluded that the rate of accompanying abnormalities in cases of symptomatic DVAs was high. Intracerebral hemorrhage was usually attributed to associated CMs or AVMs. The associated lesions and the branches responsible for bleeding could be resected while preserving the collecting vein as far as possible. PMID:27815963

  7. A case-series study of cerebral venous thrombosis in women using short course oral contraceptive

    PubMed Central

    Khomand, Payam; Hassanzadeh, Kambiz

    2016-01-01

    Background: We report a case series of cerebral vein thrombosis (CVT) in women who used oral contraceptive pill (OCP) in the Muslims Ramadan and fasting month. Methods: This study was a retrospective case series of 9 patients with diagnosis of CVT, who admitted in the neurology ward of Tohid Hospital of Sanandaj, Iran, in July-August 2014-2015. Results: Patients had no history of thrombosis before. They were treated with oral contraceptive more than 1 month to be able to fast during Ramadan. They did not have other possible risk factors for CVT. A headache was the most common in 9/9 patients (100%) followed by vomiting and vertigo. Conclusion: We found that high rate of CVT in female population during Ramadan indicates that it needs be considered as a specific risk factor and should be considered by healthcare system. PMID:27326364

  8. Effect of ethanol on cerebral blood flow (CBF) and metabolism (CMRO2) in conscious sheep

    SciTech Connect

    Krasney, J.A.; Zubkov, B.; Iwamoto, J. )

    1991-03-11

    A moderate dose of ethanol severely depresses CBF and CMRO2 in the awake sheep fetus. However, the effects of ethanol on CBF and CMRO2 in the adult are unclear. The same dose of ethanol was infused for 2 hr in 5 ewes instrumented with aortic, left ventricular and sagittal sinus catheters. Ethanol caused ataxia accompanied by early modest and variable increases of total and regional CBF and CMRO2, followed by later modest and variable decreases of total and regional CBF (cerebellum) and CMRO2. Ethanol caused a cerebral transcapillary fluid shift as indicated by significant increases of the arterial-cerebral venous differences for hematocrit and hemoglobin. Brain wet-dry ratios increased by 10% above control levels. However, cerebral venous pressures were unchanged. The authors conclude that the adult cerebral response to ethanol differs quantitatively from that of the fetus. The functional significance of the cerebral fluid shift is unclear.

  9. Fatal cerebral air embolism following endoscopic evaluation of rectal stump

    PubMed Central

    Baban, Chwanrow Karim; Murphy, Michael; Hennessy, Tony; O'Hanlon, Deirdre

    2013-01-01

    A 63-year-old man underwent endoscopic evaluation of the rectal stump for rectal bleeding and suffered a massive cerebral air embolism with severe neurological impairment and subsequent death. The patient underwent a Hartmann's procedure 9 month previously for ischaemic bowel and was noted to have portal hypertension at laparotomy. We hypothesise that air entered the venous plexus around rectum and entered the azygos vein via a porto-systemic shunt and travelled retrogradely via the superior vena cava to the venous sinuses of the brain. PMID:23704447

  10. An experimental study on laser-induced suturing of venous grafts in cerebral revascularization surgery

    NASA Astrophysics Data System (ADS)

    Puca, Alfredo; Albanese, Alessio; Esposito, Giuseppe; Maira, Giulio; Rossi, Giacomo; Pini, Roberto

    2005-04-01

    To test laser-assisted high flow bypass in cerebral revascularization procedures, we set up an experimental model on rabbits which included harvesting a jugular vein graft and its implantation on the common carotid artery through a double end-to-side anastomosis. The study was carried out on 25 New Zealand rabbits by performing on each animal the proximal anastomosis using conventional suturing, while the distal one was obtained by means of low-power diode laser welding in association with the topical application of Indocyanine Green (ICG) solution to enhance local absorption of the laser light. After the procedure, the animals were subjected to a follow-up from 2 to 9 days. Bypass patency was evaluated by means of Doppler study. The vascular segments were excised and evaluated by histological and immunohistochemical examinations. Utilization of the diode laser was associated with a substantial shortening of the operative time, as well as with a more active endothelial regeneration process at the anastomotic site.

  11. Sinus Venosus Atrial Septal Defect

    DTIC Science & Technology

    2010-04-01

    chest CT was performed to evaluate for pulmonary embolism (figure 2). The chest radiograph (figure 1) demonstrates increased central pulmonary ...Fig. 5 Sinus venosus defect at birth . The shaded area in purple represents the sinus venosum. The anomalous right pulmonary venous anatomy...department (ED) with chest pain and an ankle fracture after being hit by a car while riding a horse. Chest imaging noted enlarged central pulmonary

  12. Effects of Hypothermic Cardiopulmonary Bypass on Internal Jugular Bulb Venous Oxygen Saturation, Cerebral Oxygen Saturation, and Bispectral Index in Pediatric Patients Undergoing Cardiac Surgery: A Prospective Study.

    PubMed

    Hu, Zhiyong; Xu, Lili; Zhu, Zhirui; Seal, Robert; McQuillan, Patrick M

    2016-01-01

    The objective of this study was to evaluate the effect of hypothermic cardiopulmonary bypass (CPB) on cerebral oxygen saturation (rSO2), internal jugular bulb venous oxygen saturation (SjvO2), mixed venous oxygen saturation (SvO2), and bispectral index (BIS) used to monitor cerebral oxygen balance in pediatric patients.Sixty American Society of Anesthesiologists Class II-III patients aged 1 to 4 years old with congenital heart disease scheduled for elective cardiac surgery were included in this study. Temperature, BIS, rSO2, mean arterial pressure, central venous pressure, cerebral perfusion pressure (CPP), and hematocrit were recorded. Internal jugular bulb venous oxygen saturation and SvO2 were obtained from blood gas analysis at the time points: after induction of anesthesia (T0), beginning of CPB (T1), ascending aortic occlusion (T2), 20 minutes after initiating CPB (T3), coronary reperfusion (T4), separation from CPB (T5), and at the end of operation (T6). The effect of hypothermia or changes in CPP on rSO2, SjvO2, SvO2, and BIS were analyzed.Compared with postinduction baseline values, rSO2 significantly decreased at all-time points: onset of extracorporeal circulation, ascending aortic occlusion, 20 minutes after CPB initiation, coronary reperfusion, and separation from CPB (P < 0.05). Compared with measurements made following induction of anesthesia, SjvO2 significantly increased with initiation of CPB, ascending aortic occlusion, 20 minutes after initiating CPB, coronary reperfusion, and separation from CPB (P < 0.05). Compared with induction of anesthesia, BIS significantly decreased with the onset of CPB, aortic cross clamping, 20 minutes after initiating CPB, and coronary reperfusion (P < 0.05). Bispectral index increased following separation from CPB. There was no significant change in SvO2 during cardiopulmonary bypass (P > 0.05). Correlation analysis demonstrated that rSO2 was positively related to CPP (r = 0.687, P = 0

  13. Surgical management of dural arteriovenous fistulas of the transverse-sigmoid sinus in 42 patients.

    PubMed

    Eftekhar, Behzad; Morgan, Michael Kerin

    2013-04-01

    A retrospective study was performed to analyse a prospectively collected database from a single surgeon (M.K.M.) of transverse-sigmoid sinus dural arteriovenous fistulas (DAVF) between 1991 and August 2011. During the study period, 144 patients with 160 DAVF were managed. Sixty-five of the DAVF were located in the transverse-sigmoid sinus and 42 were treated with surgery, or embolisation and surgery. All patients who underwent surgery were symptomatic with retrograde cortical venous drainage. The average follow-up period was 18months (range, 2-82months). Total elimination of the DAVF was achieved in all instances, including two patients (5%) who required further surgery after postoperative cerebral angiography showed that some venous drainage had persisted after the first operation. There was no new permanent neurological deficit or mortality attributable to surgery. Our institutional experience shows that in selected patients with transverse-sigmoid sinus DAVF, the involved sinus can be surgically resected with a high success rate and it is as safe as many alternative options. We suggest that this definitive treatment option should be offered to patients, and the outcome should be compared to other treatment modalities.

  14. Pediatric Sinusitis

    MedlinePlus

    ... Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to ...

  15. Isolated lateral sinus thrombosis presenting as cerebellar infarction in a patient with iron deficiency anemia.

    PubMed

    Lee, Ji-Hye; Park, Kyung-Jae; Chung, Yong-Gu; Kang, Shin-Hyuk

    2013-07-01

    As a rare cerebrovascular disease, cerebral venous thrombosis (CVT) is caused by various conditions including trauma, infection, oral contraceptive, cancer and hematologic disorders. However, iron deficiency anemia is not a common cause for CVT in adult. Posterior fossa infarction following CVT is not well demonstrated because posterior fossa has abundant collateral vessels. Here, we report a case of a 55-year-old man who was admitted with complaints of headache, nausea, and mild dizziness. The patient was diagnosed with isolated lateral sinus thrombosis presenting as cerebellar infarction. Laboratory findings revealed normocytic normochromic anemia due to iron deficiency, and the patient's symptoms were improved after iron supplementation.

  16. Correlation of brain tissue oxygen tension with cerebral near-infrared spectroscopy and mixed venous oxygen saturation during extracorporeal membrane oxygenation.

    PubMed

    Tyree, Kreangkai; Tyree, Melissa; DiGeronimo, Robert

    2009-09-01

    The aim of this prospective, animal study was to compare brain tissue oxygen tension (PbtO(2)) with cerebral near infrared spectroscopy (NIRS) and mixed venous oxygen saturation (SVO(2)) during venoarterial extracorporeal membrane oxygenation (VA ECMO) in a porcine model. This was accomplished using twelve immature piglets with surgically implanted catheters placed in the superficial cerebral cortex to measure brain PbtO(2) and microdialysis metabolites. The NIRS sensor was placed overlying the forehead to measure cerebral regional saturation index (rSO(2)i) while SVO(2) was measured directly from the ECMO circuit. Animals were placed on VA ECMO followed by an initial period of stabilization, after which they were subjected to graded hypoxia and recovery. Our results revealed that rSO(2)i and SVO(2) correlated only marginally with PbtO(2) (R(2)=0.32 and R(2)=0.26, respectively) while the correlation between rSO(2)i and SVO( 2) was significantly stronger (R(2)=0.59). Cerebral metabolites and rSO(2)i were significantly altered during attenuation of PbtO( 2), p<0.05). A subset of animals, following exposure to hypoxia, experienced markedly delayed recovery of both rSO(2)i and PbtO( 2) despite rapid normalization of SVO(2). Upon further analysis, these animals had significantly lower blood pressure (p=0.001), lower serum pH (p=0.01), and higher serum lactate (p=0.02). Additionally, in this subgroup, rSO(2)i correlated better with PbtO(2) (R(2)=0.76). These findings suggest that, in our ECMO model, rSO(2)i and SVO( 2) correlate reasonably well with each other, but not necessarily with brain PbtO(2) and that NIRS-derived rSO(2)i may more accurately reflect cerebral tissue hypoxia in sicker animals.

  17. Diagnosis of Transverse Sinus Hypoplasia in Magnetic Resonance Venography: New Insights Based on Magnetic Resonance Imaging in Combined Dataset of Venous Outflow Impairment Case-Control Studies: Post Hoc Case-Control Study.

    PubMed

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

    2016-03-01

    In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measured by magnetic resonance venography (MRV) and contrast T1-weighted magnetic resonance (contrast T1) were observed. To investigate these discrepancies, and considering that TS hypoplasia is associated with neurological disorders, we performed a post hoc analysis of prospectively collected data from 3 case-control studies on transient global amnesia (TGA), transient monocular blindness (TMB), and panic disorders while retaining the original inclusion and exclusion criteria. Magnetic resonance (MR) imaging of 131 subjects was reviewed to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction.MRV without contrast revealed that TS hypoplasia was observed in 69 subjects, whom we classified into 2 subgroups according to the concordance with contrast T1 observations: concordance indicated anatomically small TS (30 subjects), and discrepancy indicated that the MRV diagnosis is in fact flow-related and that TS is not anatomically small (39 subjects). The latter subgroup was associated with at least 1 site of venous compression/stenosis in the internal jugular vein (IJV) or the left brachiocephalic vein (BCV) (P < 0.001), which was significantly larger in patients than controls. Compensatory dilatation of contralateral TS diameter was only observed with MRV, not with contrast T1 imaging.The clinical implication of these results is that using MRV only, IJV/BCV compression/stenosis may be misdiagnosed as TS hypoplasia. And contralateral TS have no compensatory dilatation in its diameter in contrast T1 imaging, just compensatory increased flow volume.

  18. Sagittal sinus thrombosis due to L-asparaginase

    PubMed Central

    Wani, Nisar A.; Kosar, Tasleem; Pala, Nazir A.; Qureshi, Umar A.

    2010-01-01

    Cerebral Sinovenous Thrombosis (CSVT) is a serious complication of L-asparaginase chemotherapy for leukemia in children. Clinical features of headache, altered consciousness, focal neurological deficit, and seizures developing during or immediately after treatment with L-asparaginase should alert the treating physician to the possibility of CSVT. Immediate imaging of the brain should be done using CT and MRI and the veins should be visualized noninvasively by CT and MR venography. We report two children on induction therapy for acute leukemia who presented with seizures, headache, and altered consciousness. Venous infarcts with and without hemorrhage were seen on CT in one patient and the empty delta sign was seen after contrast injection; however, the early changes were missed by CT. MRI detected dural sinus thrombosis relatively earlier in another patient, while the CT findings were equivocal; in this patient, contrast-enhanced MRI showed the empty delta sign and MR venography confirmed absent flow in the superior sagittal sinus, which was diagnostic of sinus thrombosis. Rapid anticoagulation was started with heparin and maintained with warfarin. The child with a unilateral small nonhemorrhagic infarct made a complete recovery while the other, with bilateral hemorrhagic infarcts, did not survive. We stress the importance of early diagnosis of CSVT using CT and MRI in children with leukemia being treated with L-asparaginase; this will permit timely treatment. PMID:21042505

  19. Lateral sinus thrombosis associated with zoster sine herpete.

    PubMed

    Chan, James; Bergstrom, Richard T; Lanza, Donald C; Oas, John G

    2004-01-01

    Herpes zoster results from reactivation of the varicella zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. A 55-year-old woman presented with a 3-day history of left temporal and postauricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A computed tomography scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. Magnetic resonance imaging and magnetic resonance angiogram confirmed these findings. Laboratory studies revealed elevated neurotrophic immunoglobulin G levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anticoagulation. Her symptoms improved, and she was discharged 3 days later. LST is generally a complication of middle ear infection. Nonseptic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary in such cases so that a different treatment course can be identified and antiviral medication initiated promptly.

  20. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed Central

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-01-01

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome. PMID:25750219

  1. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-03-06

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome.

  2. Recurrent cerebral venous thrombosis associated with heterozygote methylenetetrahydrofolate reductase C677T mutation and sickle cell trait without homocysteinemia: an autopsy case report and review of literature.

    PubMed

    Ali, Z; Troncoso, J C; Fowler, D R

    2014-09-01

    Elevated blood homocysteine concentration and certain genetic mutations have been associated with increased risk for developing arterial and venous thrombosis. A common mutation of methylenetetrahydrofolate reductase, MTHFR C677T, has been associated with elevated homocysteine concentration and increased risk for developing thrombosis in homozygote carriers. Heterozygote carriers for this gene mutation, if associated with other major or minor risk factors for thrombophilia, appear to be prone to develop thrombosis. A postmortem genetic testing for common mutations resulting in thrombophilia should be performed in all individuals who die as a result of thrombosis, regardless of predisposing risk factors, to determine the true prevalence of mutations in these individuals, and to assess the true role of a certain mutation, such as heterozygote MTHFR C677T, in the pathogenesis of thrombosis. Postmortem genetic testing for common mutations associated with thrombophilia in selected cases has potentially life-saving importance to surviving family members. We report a case of recurrent cerebral venous thrombosis in a 19 year old male with history of sickle cell trait, obesity, and high normal blood homocysteine, who was heterozygote for MTHFR C677T mutation.

  3. An analysis of the use of hyperoxia for measuring venous cerebral blood volume: comparison of the existing method with a new analysis approach.

    PubMed

    Blockley, Nicholas P; Griffeth, Valerie E M; Germuska, Michael A; Bulte, Daniel P; Buxton, Richard B

    2013-05-15

    Hyperoxia is known to cause an increase in the blood oxygenation level dependent (BOLD) signal that is primarily localised to the venous vasculature. This contrast mechanism has been proposed as a way to measure venous cerebral blood volume (CBVv) without the need for more invasive contrast media. In the existing method the analysis modelled the data as a dynamic contrast agent experiment, with the assumption that the BOLD signal of tissue was dominated by intravascular signal. The effects on the accuracy of the method due to extravascular BOLD signal changes, as well as signal modulation by intersubject differences in baseline physiology, such as haematocrit and oxygen extraction fraction, have so far been unexplored. In this study the effect of extravascular signal and intersubject physiological variability was investigated by simulating the hyperoxia CBVv experiment using a detailed BOLD signal model. This analysis revealed substantial uncertainty in the measurement of CBVv using the existing analysis based on dynamic contrast agent experiments. Instead, the modelling showed a simple and direct relationship between the BOLD signal change and CBVv, and an alternative analysis method with much reduced uncertainty was proposed based on this finding. Both methods were tested experimentally, with the new method producing results that are consistent with the limited literature in this area.

  4. Fungal Sinusitis

    MedlinePlus

    ... presence of large granules that attract the reddish-orange eosin stain) to attack fungi, and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation. Chronic Indolent Sinusitis is an invasive form of fungal sinusitis in ...

  5. Using magnetic resonance imaging as a means to study chronic cerebral spinal venous insufficiency in multiple sclerosis patients.

    PubMed

    Utriainen, David; Feng, Wei; Elias, Saba; Latif, Zahid; Hubbard, David; Haacke, Ewart Mark

    2012-06-01

    The goal of this work is to present a broad magnetic resonance imaging (MRI) protocol for use in the study of chronic cerebrospinal venous insufficiency (CCSVI). The CCSVI MRI protocol includes the following sequences: time-resolved contrast-enhanced 3D MR angiography, 2D time-of-flight MR venography, and 3D volumetric interpolated breath-hold examination to assess venous structural abnormalities; phase-contrast MR imaging at different levels in the neck and thoracic cavity to quantify flow through the veins, arteries, and cerebrospinal fluid; T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and pre- and post-contrast T1-weighted imaging of the brain for examinations of parenchymal lesions; and finally, susceptibility-weighted imaging for quantification of iron deposition in the brain. Data from 111 clinically definite multiple sclerosis patients were assessed for potential structural and flow CCSVI risk criteria, including stenosis, atresia, aplasia, dominant to subdominant venous flow ratio (D:sD), and the sum of their flow rates. Of the 111 patients, 50 (45%) were determined to be nonstenotic (NST) with no stenosis or atresia in their internal jugular veins (IJV), and the rest 61 (55%) were stenotic (ST) having at least one internal jugular vein stenosis or atresia. No occurrence of aplasia was observed. A D:sD of greater than 3:1 was observed in 15 (24.6%) patients of the ST group and 2 (4.0%) patients of the NST group. A sum of dominant and subdominant venous flow rate of <8 mL/s was observed in 22 (36.1%) patients of the ST group and 6 (12.0%) patients of the NST group. MRI provides valuable information in the observation of potential CCSVI risk factors. Low total flow in the 2 dominant veins seemed to be the strongest indicator for risk of having stenoses in the multiple sclerosis population.

  6. Complications of Sinusitis

    MedlinePlus

    ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ...

  7. Sinusitis Q and A

    MedlinePlus

    ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ... A Complications of Sinusitis Epistaxis (Nosebleeds) Allergic Rhinitis (Hay Fever) Headaches and Sinus Disease Disorders of Smell & Taste ...

  8. Cerebral and Sinus Vein Thrombosis

    MedlinePlus

    ... Stroke . 2010 ; 41 : 1901 – 1906 . OpenUrl Abstract / FREE Full Text 3. ↵ Saposnik G , Barinagarrementeria F , Brown RD Jr . , ... Stroke . 2011 ; 42 : 1158 – 1192 . OpenUrl Abstract / FREE Full Text View Abstract Back to top Previous Article Next ...

  9. Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

    SciTech Connect

    Erol, Ilknur Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

    2006-06-15

    A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.

  10. Operative management of tumors involving the cavernous sinus.

    PubMed

    Sekhar, L N; Møller, A R

    1986-06-01

    In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

  11. Core curriculum illustration: dural venous sinus thrombosis.

    PubMed

    Rajendran, Sibi; Pereira, Alex; Eckerd, Morgan; Pawley, Barbara

    2016-11-28

    This is the 25th installment of a series that will highlight one case per publication issue from the bank of cases available online as a part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at http://www.aseronline.org/curriculum/toc.htm .

  12. Susceptibility-weighted imaging at 7 T: Improved diagnosis of cerebral cavernous malformations and associated developmental venous anomalies☆☆☆

    PubMed Central

    Frischer, Josa M.; Göd, Sabine; Gruber, Andreas; Saringer, Walter; Grabner, Günther; Gatterbauer, Brigitte; Kitz, Klaus; Holzer, Sabrina; Kronnerwetter, Claudia; Hainfellner, Johannes A.; Knosp, Engelbert; Trattnig, Siegfried

    2012-01-01

    Background and aim In the diagnosis of cerebral cavernous malformations (CCMs) magnetic resonance imaging is established as the gold standard. Conventional MRI techniques have their drawbacks in the diagnosis of CCMs and associated venous malformations (DVAs). The aim of our study was to evaluate susceptibility weighted imaging SWI for the detection of CCM and associated DVAs at 7 T in comparison with 3 T. Patients and methods 24 patients (14 female, 10 male; median age: 38.3 y (21.1 y–69.1 y) were included in the study. Patients enrolled in the study received a 3 T and a 7 T MRI on the same day. The following sequences were applied on both field strengths: a T1 weighted 3D GRE sequence (MP-RAGE) and a SWI sequence. After obtaining the study MRIs, eleven patients underwent surgery and 13 patients were followed conservatively or were treated radio-surgically. Results Patients initially presented with haemorrhage (n = 4, 16.7%), seizures (n = 2, 8.3%) or other neurology (n = 18, 75.0%). For surgical resected lesions histopathological findings verified the diagnosis of CCMs. A significantly higher number of CCMs was diagnosed at 7 T SWI sequences compared with 3 T SWI (p < 0.05). Additionally diagnosed lesions on 7 T MRI were significantly smaller compared to the initial lesions on 3 T MRIs (p < 0.001). Further, more associated DVAs were diagnosed at 7 T MRI compared to 3 T MRI. Conclusion SWI sequences at ultra-high-field MRI improve the diagnosis of CCMs and associated DVAs and therefore add important pre-operative information. PMID:24179744

  13. Acute hypoxia increases the cerebral metabolic rate – a magnetic resonance imaging study

    PubMed Central

    Lindberg, Ulrich; Aachmann-Andersen, Niels Jacob; Lisbjerg, Kristian; Christensen, Søren Just; Law, Ian; Rasmussen, Peter; Olsen, Niels V; Larsson, Henrik BW

    2015-01-01

    The aim of the present study was to examine changes in cerebral metabolism by magnetic resonance imaging of healthy subjects during inhalation of 10% O2 hypoxic air. Hypoxic exposure elevates cerebral perfusion, but its effect on energy metabolism has been less investigated. Magnetic resonance imaging techniques were used to measure global cerebral blood flow and the venous oxygen saturation in the sagittal sinus. Global cerebral metabolic rate of oxygen was quantified from cerebral blood flow and arteriovenous oxygen saturation difference. Concentrations of lactate, glutamate, N-acetylaspartate, creatine and phosphocreatine were measured in the visual cortex by magnetic resonance spectroscopy. Twenty-three young healthy males were scanned for 60 min during normoxia, followed by 40 min of breathing hypoxic air. Inhalation of hypoxic air resulted in an increase in cerebral blood flow of 15.5% (p = 0.058), and an increase in cerebral metabolic rate of oxygen of 8.5% (p = 0.035). Cerebral lactate concentration increased by 180.3% (p<10-6), glutamate increased by 4.7% (p<10-4) and creatine and phosphocreatine decreased by 15.2% (p<10-3). The N-acetylaspartate concentration was unchanged (p = 0.36). In conclusion, acute hypoxia in healthy subjects increased perfusion and metabolic rate, which could represent an increase in neuronal activity. We conclude that marked changes in brain homeostasis occur in the healthy human brain during exposure to acute hypoxia. PMID:26661163

  14. [Case of transient cortical blindness due to thrombosis of the transverse sinus].

    PubMed

    Mitaki, Shingo; Fukuda, Hitoshi; Kitani, Mitsuhiro

    2008-05-01

    An 62-year-old man presented visual impairment and generalized seizure. Brain CT performed on the day of admission showed thrombus in the right transverse sinus, and DWI showed high intensity areas in the bilateral occipital and parietal lobes. According to bilateral occipital lobe lesions, we considered his visual impairment as cortical blindness. He was diagnosed as venous sinus thrombosis and intravenous heparin, edaravone and osmotic diuretics were administered. MR venography performed after starting of intravenous treatment showed flow gap in the left transverse sinus but no abnormalities in the right transverse sinus. On the second day of hospitalization, his cortical blindness showed improvement and thrombus in the right transverse sinus were disappeared. This indicated that his left transverse sinus originally hypoplastic, thrombus and hemostatis in the right transverse sinus (his dominant side) caused his cortical blindness and generalized seizure. There was a recanalization in the right transverse sinus after heparin therapy.

  15. Petrosal sinus sampling: technique and rationale.

    PubMed

    Miller, D L; Doppman, J L

    1991-01-01

    Bilateral simultaneous sampling of the inferior petrosal sinuses is an extremely sensitive, specific, and accurate test for diagnosing Cushing disease and distinguishing between that entity and the ectopic ACTH syndrome. It is also valuable for lateralizing small hormone-producing adenomas within the pituitary gland. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Advance preparation is required for petrosal sinus sampling. Teamwork is a critical element, and each member of the staff should know what he or she will be doing during the procedure. The samples must be properly labeled, processed, and stored. Specific needles, guide wires, and catheters are recommended for this procedure. The procedure is performed with specific attention to the three areas of potential technical difficulty: catheterization of the common femoral veins, crossing the valve at the base of the left internal jugular vein, and selective catheterization of the inferior petrosal sinuses. There are specific methods for dealing with each of these areas. The sine qua non of correct catheter position in the inferior petrosal sinus is demonstration of reflux of contrast material into the ipsilateral cavernous sinus. Images must always be obtained to document correct catheter position. Special attention must be paid to two points to prevent potential complications: The patient must be given an adequate dose of heparin, and injection of contrast material into the inferior petrosal sinuses and surrounding veins must be done gently and carefully. When the procedure is performed as outlined, both inferior

  16. [Dural sinus thrombosis: case report].

    PubMed

    Falavigna, Asdrubal; Pontalti, João Luis; Teles, Alisson Roberto

    2006-06-01

    We report the case of a 24 year-old pregnant woman, seen at the neurology service by presenting agitation, hallucinations, mental confusion, headache, vision loss, aphasia and seizures. The neuroradiologic exam was compatible with thrombosis in dural sinus and cortical veins. Treatment with abciximab was accomplished and the mechanical lysis of the thrombus was made obtaining restoration of cerebral vein flow. After the procedure, she presented frontal hematoma which was withdrawn surgically. We discuss this infrequent pathology in clinical picture, pathogenesis, image exams and therapeutics.

  17. Closure of the sigmoid sinus in lateral skull base surgery.

    PubMed

    Zanoletti, E; Cazzador, D; Faccioli, C; Martini, A; Mazzoni, A

    2014-06-01

    Closure of the sigmoid-jugular complex is generally planned during various surgical procedures on the skull base, either to repair a jugular foramen lesion or as the oncological boundary of the resection. A series of 218 cases of skull base tumour surgeries was analysed in which closure of the sigmoid-jugular complex was systematically planned (bilaterally in one case) in patients treated for jugular foramen paragangliomas, squamous cell carcinomas and other temporal bone tumours. Surgery was performed via a petro-occipital trans-sigmoid approach in 61 cases, an infratemporal A in 128, en bloc subtotal temporal bone resections in 10 and other approaches in 20. In our experience, planned unilateral (and, in one case, bilateral) closure of the sigmoid-jugular complex had no clinical consequences. The vicarious drainage of the skull base was always assessed preoperatively, revealing no contraindications to intraoperative sinus closure. Given the scarcity of literature on this subject, the present report shows that the procedure is associated with low morbidity and helps to improve our understanding of cerebral venous discharge.

  18. [A case of cavernous sinus aspergillosis].

    PubMed

    Hase, Tomomi; Kurita, Hideharu; Matsumoto, Eiji; Kuroda, Hajime; Hashimoto, Masaaki; Shinoda, Souji

    2013-10-01

    We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.

  19. Endoscopic Sinus Surgery

    MedlinePlus

    ... Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure Statement CONDITIONS Adult Sinusitis Pediatric Sinusitis ... information in the popular media may not reflect reality. Although useful, balloon sinuplasty is not for everyone. ...

  20. Sinusitis (For Parents)

    MedlinePlus

    ... and mucus can become trapped in the sinuses. Bacteria, viruses, and fungi can grow there and lead to ... cases of sinusitis thought to be caused by bacteria. Some doctors may recommend ... usually goes away without medical treatment. Acetaminophen, ibuprofen, ...

  1. [Origin of the common pulmonary vein, septation of the primary sinus venosus atrial situs and theory of the "sinus man"].

    PubMed

    Dor, X; Corone, P; Jonhson, E

    1987-04-01

    Situated at the entry to the heart, the sinus venosus regulates at an early stage the distribution of the veins. Originally symmetrical, it receives on either side an omphalomesenteric vein, a common cardinal vein (duct of Cuvieri, ductus cuvieri) and a common pulmonary vein. This symmetrical pattern disappears with the obliteration of the rough right pulmonary vein and the invagination of the left ductus cuvieri into the sinusal cavity. Thus, the pulmonary venous blood is kept on the left side and the systemic venous blood is transferred to the right side. This is the usual situs solitus arrangement. Situs inversus is the opposite arrangement. In situs ambiguus the original symmetry is preserved. A sufficiently early cauterization of the left wall of the sinus venosus prevents the left ductus cuvieri from invaginating and results in "absence of coronary sinus"; this arrangement, where part of the original symmetry is preserved, is in fact similar to situs ambiguus. The situs of the liver and stomach is thought not to be determined by these organs but imposed to them by the sinus venosus, more precisely by the invagination--or lack of invagination--of a ductus cuvieri. This would explain the concordance between their situs and that of the sinus venosus and atria. It would appear that two errors are frequently made: the common pulmonary vein is said to originate from the left atrium, whereas it originates from the sinus venosus and only belongs to the left atrium when the sinus is incorporated in the atrium; the transverse septation of the sinus is incorporated to a shift to the right of the left sinoatrial fold which separates the sinus from the primitive atrium. This fold is indeed displaced to the right, but it is more distal and corresponds, in fact, to the cephalic border of the left ductus cuvieri, and its shift is produced by the invagination of that duct.

  2. Sinusitis (For Teens)

    MedlinePlus

    ... caused by infection. Our sinuses are the moist air spaces within the bones of the face around the nose. The frontal sinuses are located in the area near the eyebrows; the ... our sinuses are filled with air, making our facial bones less dense and much ...

  3. Computed Tomography (CT) -- Sinuses

    MedlinePlus

    ... More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Computed Tomography (CT) - Sinuses Computed tomography (CT) of the sinuses uses special x-ray equipment to evaluate the paranasal sinus cavities – hollow, air-filled spaces within the bones of the face surrounding the ...

  4. Sinusitis in adults - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000563.htm Sinusitis in adults - aftercare To use the sharing features on this page, please enable JavaScript. Your sinuses are chambers in ... They are filled with air. Sinusitis is an infection of these chambers, which causes ...

  5. Sinus x-ray

    MedlinePlus

    Paranasal sinus radiography; X-ray - sinuses ... sinus x-ray is taken in a hospital radiology department. Or the x-ray may be taken ... Brown J, Rout J. ENT, neck, and dental radiology. In: Adam A, Dixon AK, Gillard JH Schaefer- ...

  6. Absence of the superior petrosal veins and sinus: Surgical considerations

    PubMed Central

    Matsushima, Ken; Ribas, Eduardo Santamaria Carvalhal; Kiyosue, Hiro; Komune, Noritaka; Miki, Koichi; Rhoton, Albert L.

    2015-01-01

    Background: The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups. Methods: This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent. Results: The superior petrosal veins, described as 1–3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface. Conclusions: In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes. PMID:25745589

  7. Bilateral Maxillary Sinus Hypoplasia

    PubMed Central

    Khanduri, Sachin; Agrawal, Sumit; Goyal, Swati

    2014-01-01

    Maxillary sinus hypoplasia (MSH) is an uncommon abnormality of paranasal sinuses noted in clinical practice. Computed tomography (CT) scan helps in diagnosing the anomaly along with any anatomical variation that may be associated with it. MSH is usually associated with other anomalies like uncinate process hypoplasia. Three types of MSH have been described. Type 1 MSH shows mild maxillary sinus hypoplasia, type 2 shows significant sinus hypoplasia with narrowed infundibular passage and hypoplastic or absent uncinate process, and type 3 is cleft like maxillary sinus hypoplasia with absent uncinate process. CT and endoscopic examination usually complement each other in diagnosing MSH. PMID:25548709

  8. Allergic Fungal Sinusitis.

    PubMed

    Correll, Daniel P; Luzi, Scott A; Nelson, Brenda L

    2015-12-01

    A 42 year old male presents with worsening pain and an increase in thick chronic drainage of the left sinus. Image studies show complete opacification of the left frontal sinus, left sphenoid sinus, and the left maxillary sinus. The patient was taken to the operating room and tissue for microscopic evaluation was obtained. The microscopic findings were classic for allergic fungal sinusitis: areas of alternating mucinous material and inflammatory cell debris and abundant Charcot-Leyden crystals. Cultures were performed and the patient began steroid therapy and desensitization therapy.

  9. 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 ...

  10. 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

  11. 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.

  12. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  13. Bilateral inferior petrosal sinus sampling

    PubMed Central

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  14. Carotid and cranial nerve reconstruction after removal of cavernous sinus lesions.

    PubMed

    Sekhar, L N; Sen, C N; Lanzino, G; Pomonis, S

    1991-12-01

    During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. 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

  16. Microbiology of sinusitis.

    PubMed

    Brook, Itzhak

    2011-03-01

    Most sinus infections are viral, and only a small proportion develops a secondary bacterial infection. Rhinoviruses, influenza viruses, and parainfluenza viruses are the most common causes of sinusitis. The most common bacteria isolated from pediatric and adult patients with community-acquired acute purulent sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Staphylococcus aureus and anaerobic bacteria (Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.) are the main isolates in chronic sinusitis. Pseudomonas aeruginosa and other aerobic and facultative gram-negative rods are commonly isolated from patients with nosocomial sinusitis, the immunocompromised host, those with HIV infection, and in cystic fibrosis. Fungi and Pseudomonas aeruginosa are the most common isolates in neutropenic patients. The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.

  17. Human paranasal sinuses and selective brain cooling: a ventilation system activated by yawning?

    PubMed

    Gallup, Andrew C; Hack, Gary D

    2011-12-01

    The function of the paranasal sinuses has been a controversial subject since the time of Galen, with many different theories advanced about their biological significance. For one, the paranasal sinuses have been regarded as warmers of respiratory air, when in actuality these structures appear to function in cooling the blood. In fact, human paranasal sinuses have been shown to have higher volumes in individuals living in warmer climates, and thus may be considered radiators of the brain. The literature suggests that the transfer of cool venous blood from the paranasal sinuses to the dura mater may provide a mechanism for the convection process of cooling produced by the evaporation of mucus within human sinuses. In turn, the dura mater may transmit these temperature changes, initiated by the cool venous blood from the heat-dissipating surfaces of the sinuses, to the cerebrospinal fluid compartments. Furthermore, it has recently been demonstrated in cadaveric dissections that the thin bony posterior wall of the maxillary sinus serves as an origin for both medial and lateral pterygoid muscle segments, an anatomic finding that had been previously underappreciated in the literature. The present authors hypothesize that the thin posterior wall of the maxillary sinus may flex during yawning, operating like a bellows pump, actively ventilating the sinus system, and thus facilitating brain cooling. Such a powered ventilation system has not previously been described in humans, although an analogous system has been reported in birds.

  18. [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.

  19. Using near-infrared spectroscopy to measure cerebral metabolic rate of oxygen under multiple levels of arterial oxygenation in piglets.

    PubMed

    Tichauer, Kenneth M; Elliott, Jonathan T; Hadway, Jennifer A; Lee, David S; Lee, Ting-Yim; St Lawrence, Keith

    2010-09-01

    Improving neurological care of neonates has been impeded by the absence of suitable techniques for measuring cerebral hemodynamics and energy metabolism at the bedside. Currently, near-infrared spectroscopy (NIRS) appears to be the technology best suited to fill this gap, and techniques have been proposed to measure both cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2). We have developed a fast and reliable bolus-tracking method of determining CMRO2 that combines measurements of CBF and cerebral venous oxygenation [venous oxygen saturation (CSvO2)]. However, this method has never been validated at different levels of arterial oxygenation [arterial oxygen saturation (SaO2)], which can be highly variable in the clinical setting. In this study, NIRS measurements of CBF, CSvO2, and CMRO2 were obtained over a range of SaO2 in newborn piglets (n=12); CSvO2 values measured directly from sagittal sinus blood samples were collected for validation. Two alternative NIRS methods that measure CSvO2 by manipulating venous oxygenation (i.e., head tilt and partial venous occlusion methods) were also employed for comparison. Statistically significant correlations were found between each NIRS technique and sagittal sinus blood oxygenation (P<0.05). Correlation slopes were 1.03 (r=0.91), 0.73 (r=0.73), and 0.73 (r=0.81) for the bolus-tracking, head tilt, and partial venous occlusion methods, respectively. The bolus-tracking technique displayed the best correlation under hyperoxic (SaO2=99.9±0.03%) and normoxic (SaO2=86.9±6.6%) conditions and was comparable to the other techniques under hypoxic conditions (SaO2=40.7±9.9%). The reduced precision of the bolus-tracking method under hypoxia was attributed to errors in CSvO2 measurement that were magnified at low SaO2 levels. In conclusion, the bolus-tracking technique of measuring CSvO2, and therefore CMRO2, is accurate and robust for an SaO2>50% but provides reduced accuracy under more severe hypoxic levels.

  20. Facial vein thrombophlebitis: an uncommon complication of sinusitis.

    PubMed

    Cotes, Claudia; Riascos, Roy; Swischuk, Leonard E

    2015-07-01

    Facial vein thrombophlebitis is an uncommon complication of sinusitis. In cases where periorbital swelling complicating sinusitis is diagnosed, clinical findings of swelling and erythema extending beyond the orbital region into the cheek should alert the physician about this unusual complication and the need for further contrast-enhanced imaging and venography. The radiologist must be particularly careful in the evaluation of vascular structures of the face and neck in these children. CT and MRI with contrast material and MR venography are studies that clearly demonstrate the vascular anatomy and possible complications. However, MR venography confirms flow abnormalities within the venous system with the advantage of avoiding radiation exposure to the pediatric patient.

  1. 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

  2. Quantifying the cerebral metabolic rate of oxygen by combining diffuse correlation spectroscopy and time-resolved near-infrared spectroscopy.

    PubMed

    Verdecchia, Kyle; Diop, Mamadou; Lee, Ting-Yim; St Lawrence, Keith

    2013-02-01

    Preterm infants are highly susceptible to ischemic brain injury; consequently, continuous bedside monitoring to detect ischemia before irreversible damage occurs would improve patient outcome. In addition to monitoring cerebral blood flow (CBF), assessing the cerebral metabolic rate of oxygen (CMRO2) would be beneficial considering that metabolic thresholds can be used to evaluate tissue viability. The purpose of this study was to demonstrate that changes in absolute CMRO2 could be measured by combining diffuse correlation spectroscopy (DCS) with time-resolved near-infrared spectroscopy (TR-NIRS). Absolute CBF was determined using bolus-tracking TR-NIRS to calibrate the DCS measurements. Cerebral venous blood oxygenation (SvO2) was determined by multiwavelength TR-NIRS measurements, the accuracy of which was assessed by directly measuring the oxygenation of sagittal sinus blood. In eight newborn piglets, CMRO2 was manipulated by varying the anesthetics and by injecting sodium cyanide. No significant differences were found between the two sets of SvO2 measurements obtained by TR-NIRS or sagittal sinus blood samples and the corresponding CMRO2 measurements. Bland-Altman analysis showed a mean CMRO2 difference of 0.0268 ± 0.8340 mLO2/100 g/min between the two techniques over a range from 0.3 to 4 mL O2/100 g/min.

  3. Quantifying the cerebral metabolic rate of oxygen by combining diffuse correlation spectroscopy and time-resolved near-infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Verdecchia, Kyle; Diop, Mamadou; Lee, Ting-Yim; St. Lawrence, Keith

    2013-02-01

    Preterm infants are highly susceptible to ischemic brain injury; consequently, continuous bedside monitoring to detect ischemia before irreversible damage occurs would improve patient outcome. In addition to monitoring cerebral blood flow (CBF), assessing the cerebral metabolic rate of oxygen (CMRO2) would be beneficial considering that metabolic thresholds can be used to evaluate tissue viability. The purpose of this study was to demonstrate that changes in absolute CMRO2 could be measured by combining diffuse correlation spectroscopy (DCS) with time-resolved near-infrared spectroscopy (TR-NIRS). Absolute CBF was determined using bolus-tracking TR-NIRS to calibrate the DCS measurements. Cerebral venous blood oxygenation (SvO2) was determined by multiwavelength TR-NIRS measurements, the accuracy of which was assessed by directly measuring the oxygenation of sagittal sinus blood. In eight newborn piglets, CMRO2 was manipulated by varying the anesthetics and by injecting sodium cyanide. No significant differences were found between the two sets of SvO2 measurements obtained by TR-NIRS or sagittal sinus blood samples and the corresponding CMRO2 measurements. Bland-Altman analysis showed a mean CMRO2 difference of 0.0268±0.8340 mL O2/100 g/min between the two techniques over a range from 0.3 to 4 mL O2/100 g/min.

  4. Infantile Dural Arteriovenous Fistula of the Transverse Sinus Presenting with Ocular Symptoms, Case Reports and Review of Literature

    PubMed Central

    Hassan, Tamer

    2016-01-01

    Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure.This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula. PMID:27226864

  5. The role of intracarotid cold saline infusion on a theoretical brain model incorporating the circle of willis and cerebral venous return.

    PubMed

    Neimark, Matthew A; Konstas, Angelos-Aristeidis; Choi, Jae H; Laine, Andrew F; Pile-Spellman, John

    2007-01-01

    This study describes a theoretical model of brain cooling by intracarotid cold saline infusion which takes into account redistribution of cold perfusate through the circle of Willis (CoW) and cold venous return (VR) from the head. This model is developed in spherical coordinates on a four tissue layer hemispherical geometrical configuration. Temperature evolution is modeled according to the Pennes bioheat transfer equation. Simulations were run over a 1 hour period and 30 ml/min of freezing cold saline with the baseline model (no VR, no CoW), VR model (without CoW), and CoW model (with VR). The VR model demonstrates continuing temperature drop in the treatment region of the brain not observed in the baseline model and its final mean ipsilateral anterior temperature was approximately 31 degrees C. The temperature effect in the CoW model was present but less robust in the ipsilateral anterior region, as final temperature was 32 degrees C. However, cooling was also achieved in contralateral and posterior brain regions. This model continues to demonstrate the feasibility of intracarotid cold saline infusion for ischemic stroke therapy.

  6. 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.

  7. Cerebral emboli of paradoxical origin.

    PubMed

    Jones, H R; Caplan, L R; Come, P C; Swinton, N W; Breslin, D J

    1983-03-01

    A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

  8. Sustained high-altitude hypoxia increases cerebral oxygen metabolism

    PubMed Central

    Smith, Zachary M.; Krizay, Erin; Guo, Jia; Shin, David D.; Scadeng, Miriam

    2013-01-01

    Acute mountain sickness (AMS) is a common condition occurring within hours of rapid exposure to high altitude. Despite its frequent occurrence, the pathophysiological mechanisms that underlie the condition remain poorly understood. We investigated the role of cerebral oxygen metabolism (CMRO2) in AMS. The purpose of this study was to test 1) if CMRO2 changes in response to hypoxia, and 2) if there is a difference in how individuals adapt to oxygen metabolic changes that may determine who develops AMS and who does not. Twenty-six normal human subjects were recruited into two groups based on Lake Louise AMS score (LLS): those with no AMS (LLS ≤ 2), and those with unambiguous AMS (LLS ≥ 5). [Subjects with intermediate scores (LLS 3–4) were not included.] CMRO2 was calculated from cerebral blood flow and arterial-venous difference in O2 content. Cerebral blood flow was measured using arterial spin labeling MRI; venous O2 saturation was calculated from the MRI of transverse relaxation in the superior sagittal sinus. Arterial O2 saturation was measured via pulse oximeter. Measurements were made during normoxia and after 2-day high-altitude exposure at 3,800 m. In all subjects, CMRO2 increased with sustained high-altitude hypoxia [1.54 (0.37) to 1.82 (0.49) μmol·g−1·min−1, n = 26, P = 0.045]. There was no significant difference in CMRO2 between AMS and no-AMS groups. End-tidal Pco2 was significantly reduced during hypoxia. Low arterial Pco2 is known to increase neural excitability, and we hypothesize that the low arterial Pco2 resulting from ventilatory acclimatization causes the observed increase in CMRO2. PMID:23019310

  9. Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase: The GRAALL experience.

    PubMed

    Couturier, Marie-Anne; Huguet, Françoise; Chevallier, Patrice; Suarez, Felipe; Thomas, Xavier; Escoffre-Barbe, Martine; Cacheux, Victoria; Pignon, Jean-Michel; Bonmati, Caroline; Sanhes, Laurence; Bories, Pierre; Daguindau, Etienne; Dorvaux, Véronique; Reman, Oumedaly; Frayfer, Jamile; Orvain, Corentin; Lhéritier, Véronique; Ifrah, Norbert; Dombret, Hervé; Hunault-Berger, Mathilde; Tanguy-Schmidt, Aline

    2015-11-01

    Central nervous system (CNS) thrombotic events are a well-known complication of acute lymphoblastic leukemia (ALL) induction therapy, especially with treatments including l-asparaginase (l-ASP). Data on risk factors and clinical evolution is still lacking in adult patients. We report on the clinical evolution of 22 CNS venous thrombosis cases occurring in 708 adults treated for ALL or lymphoblastic lymphoma (LL) with the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-induction protocol, which included eight L-ASP (6,000 IU/m(2) ) infusions. The prevalence of CNS thrombosis was 3.1%. CNS thrombosis occurred after a median of 18 days (range: 11-31) when patients had received a median of three l-ASP injections (range: 2-7). Patients with CNS thrombosis exhibited a median antithrombin (AT) nadir of 47.5% (range: 36-67%) at Day 17 (range: D3-D28), and 95% of them exhibited AT levels lower than 60%. There were no evident increase in hereditary thrombotic risk factors prevalence, and thrombosis occurred despite heparin prophylaxis which was performed in 90% of patients. Acquired AT deficiency was frequently detected in patients with l-ASP-based therapy, and patients with CNS thrombosis received AT prophylaxis (45%) less frequently than patients without CNS thrombosis (83%), P = 0.0002). CNS thrombosis was lethal in 5% of patients, while 20% had persistent sequelae. One patient received all planned l-ASP infusions without recurrence of CNS thrombotic whereas l-ASP injections were discontinued in 20 patients during the management of thrombosis without a significant impact on overall survival (P = 0.4).

  10. Complications of Sinus Surgery

    MedlinePlus

    ... further intracranial surgeries. Impaired sense of taste or smell : The sense of smell usually improves after the procedure because airflow is ... in their voice after sinus surgery. Impairment of smell or taste: (see above) Infection: The most common ...

  11. Sinus MRI scan

    MedlinePlus

    ... sinuses. The test is noninvasive. MRI uses powerful magnets and radio waves instead of radiation. Signals from ... in the eyes. Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and ...

  12. Fibrin Glue Injection for Cavernous Sinus Hemostasis Associated with Cranial Nerve Deficit: A Case Report

    PubMed Central

    Tavanaiepour, Daryoush; Jernigan, Sarah; Abolfotoh, Mohamad; Al-Mefty, Ossama

    2015-01-01

    Fibrin glue injection has been used to control intraoperative cavernous sinus (CS) venous bleeding. There have been no reported complications related to this maneuver. We present a case where a patient developed a sensory trigeminal nerve deficit after injection of fibrin glue into the posterior CS during resection of a petrosal meningioma. We believe that this deficit was due to the compression of the trigeminal ganglion similar to balloon compression procedures. Although fibrin glue injection may achieve satisfactory cavernous sinus homeostasis, the volume and rate of injection should be kept in mind to avoid a compressive lesion on traversing cranial nerves and surrounding structures, or retrograde filling of the venous tributaries. PMID:26251815

  13. 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.

  14. 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.

  15. [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.

  16. Sinus preservation management for frontal sinus fractures in the endoscopic sinus surgery era: a systematic review.

    PubMed

    Carter, Kenny B; Poetker, David M; Rhee, John S

    2010-09-01

    We systematically reviewed the existing literature supporting the efficacy and safety of sinus preservation management for frontal sinus fractures in the modern era of endoscopic frontal sinus surgery. A systematic review of the English literature for the targeted objective was conducted using the PubMed database between January 1995 and August 2008. The PubMed database was queried using two major search terms of frontal sinus fracture or frontal sinus injury along with manual review of citations within bibliographies. Citations acquired from the primary search were filtered and relevant abstracts were identified that merited full review. Articles were identified that included any cohort of patients with frontal sinus fractures involving the frontal sinus outflow tract or posterior wall with sinus preservation management. A total of 231 citations were generated, and 56 abstracts were identified as potentially relevant articles. Sixteen articles merited full review, with seven articles meeting inclusion criteria for sinus preservation. There were 515 total patients in the studies with 350 patients managed with frontal sinus preservation. Similar short-term complications and effectiveness were found between fractures managed with sinus preservation and those with traditional management. Sinus preservation appears to be a safe and effective management strategy for select frontal sinus fractures. More transparent reporting of management strategies for individual cases or cohorts is needed. A standardized algorithm and categorization framework for future studies are proposed. Longer-term follow-up and larger prospective studies are necessary to assess the safety and efficacy of sinus preservation protocols.

  17. 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

  18. Headaches and sinus disease.

    PubMed

    Blumenthal, H J

    2001-10-01

    Modern diagnostic tools like fiberoptic nasal endoscopy and CT imaging of the sinuses are very sensitive in helping clinicians diagnose sinus disease; we may now reevaluate the symptoms and signs most useful in making a clinical diagnosis of rhinosinusitis. Two major systems of classification and diagnostic criteria relating headaches and sinus disease have achieved currency-that of the International Headache Society (IHS) (1988) and the more recent task force recommendations of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) (1997). This report compares and contrasts the different starting points, certain assumptions, and conflicting conclusions of these two classification systems and recommends a cooperative alliance of the IHS and AAO-HNS when these diagnostic criteria are revised.

  19. Mucopyocele of the maxillary sinus

    PubMed Central

    Kshar, Avinash; Patil, Abhijeet; Umarji, Hemant; Kadam, Sonali

    2014-01-01

    Mucoceles are defined as chronic, cystic lesions in the paranasal sinuses. When the mucocele content becomes infected, the lesion is defined as mucopyocele. Most mucoceles are located in the frontal and anterior ethmoid sinuses and normally they involve the frontal-ethmoid complex, expanding to the superior-medial region of the orbit, leading to ocular disorders; maxillary sinus presentation is rare. In the present article, the authors described a rare case of mucopyocele in the maxillary sinus. PMID:24688571

  20. 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.

  1. Standing equine sinus surgery.

    PubMed

    Barakzai, Safia Z; Dixon, Padraic M

    2014-04-01

    Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the procedure used, appropriate indications for surgery, good patient selection, and familiarity with regional anatomy and surgical techniques are imperative for good results.

  2. [Histopathologic study of chronic sinusitis].

    PubMed

    Wayoff, M; Parache, R M; Bodelet, B; Gazel, P

    1983-01-01

    The conventional histopathology of the sinus is a criterium for the therapeutic indication, since it is possible to distinguish between granulomatous chronic sinusitis, chronic sinusitis with oedema and nasal polyposis. Each one of these clinical pictures has his own etiology and requires a specific therapeutic approach.

  3. [Cerebral salt wasting syndrome and traumatic vasospasm after head trauma: report of two cases].

    PubMed

    Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira

    2009-08-01

    While patients with cerebral salt wasting syndrome and traumatic cerebral arterial spasms have been reported, the underlying pathogenesis of these events remains unclear. We encountered 2 patients with head trauma and cerebral infarction who presented with cerebral salt-wasting syndrome and cerebral arterial spasms. Our findings suggested hypothalamic dysfunction due to venous congestion around the hypothalamus caused cerebral salt wasting syndrome and traumatic cerebral arterial spasms.

  4. Chronic odontogenic maxillary sinusitis.

    PubMed

    Ugincius, Paulius; Kubilius, Ricardas; Gervickas, Albinas; Vaitkus, Saulius

    2006-01-01

    The aim of the present study was to estimate average age of the patients in both sexes treated for MS, distribution by sex, amount of dexter and sinister MS with and without the fistulas into the maxillary sinus, with and without the foreign-bodies, length of stay in the Department of Maxillofacial Surgery at Kaunas Hospital of University of Medicine during the period from 1999 till 2004. The retrospective data analysis of the patients' treated from chronic MS was made. 346 patients (213 females and 133 males) were treated for chronic MS. 55 cases of chronic dexter MS with a fistula into maxillary sinus, 98 cases of chronic dexter MS without a fistula, 45 cases of chronic sinister MS with a fistula, 112 cases chronic sinister MS without a fistula, 16 cases of foreign-bodies in dexter maxillary sinus, 20 cases of foreign-bodies in sinister maxillary sinus have been detected. The main age of the female was 46.6+/-15.0, the main age of the men was 42.1+/-14.4. Statictically significant difference in the age difference of the women and the men was found (p=0.0024). It was determined, that females diagnosed and treated with chronic MS were 1.6 times more than males during the period from 1999 till 2004 in Kaunas Hospital of University of Medicine. Females treated for chronic MS were 4.5 years older than males.

  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. Central venous catheter placement: where is the tip?

    PubMed

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  7. Light and scanning electron microscopical study of the cavernous sinus of the monkey, Macaca fascicularis.

    PubMed Central

    Rajendran, K; Ling, E A

    1985-01-01

    The cavernous sinus of Macaca fascicularis is in many respects similar to the human sinus. It consists predominantly of one main venous channel that, together with the internal carotid artery, occupies a meningo-endocranial compartment lateral to the pituitary gland. Trabeculae are few and do not in any way cause the sinus to appear cavernous. They are mostly flattened in the direction of the main venous channel. Cranial nerves three, four, six and the ophthalmic division of five are all located in the lateral wall of the meningo-endocranial compartment with cranial nerve six located most medially adjacent to the internal carotid artery. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:4077687

  8. Noninvasive, optoacoustic detection and characterization of intra- and extracranial hematomas and cerebral hypoxia

    NASA Astrophysics Data System (ADS)

    Petrov, Andrey; Prough, Donald S.; Petrov, Yuriy; Petrov, Irene Y.; Robertson, Claudia S.; Asokan, Vasantha; Agbor, Adaeze; Esenaliev, Rinat O.

    2015-03-01

    Early diagnosis of intracranial hematomas is necessary to improve outcome in patients with traumatic brain injury (TBI). CT and MRI can diagnose intracranial hematomas, but cannot be used until the patient arrives at a major healthcare facility, resulting in delayed diagnosis. Near infrared spectroscopy may suggest the presence of unilateral intracranial hematomas, but provides minimal information on hematoma type and location due to limitations associated with strong light scattering. We have used optoacoustics (which combines high endogenous optical contrast with the resolution of ultrasound) to diagnose hematomas and monitor cerebral oxygenation. We performed animal and clinical studies on detection and characterization of hematomas and on monitoring cerebral hypoxia by probing the superior sagittal sinus (SSS). Recently, we built a medical grade, multi-wavelength, OPO-based optoacoustic system tunable in the near infrared spectral range. We developed new patient interfaces for noninvasive, transcranial measurements in the transmission mode in the presence of dense hair and used it in patients with TBI. The optoacoustic system was capable of detecting and characterizing intra- and extracranial hematomas. SSS blood oxygenation was measured as well with the new interface. The obtained results indicate that the optoacoustic system in the transmission mode provides detection and characterization of hematomas in TBI patients, as well as cerebral venous blood oxygenation monitoring. The transmission mode approach can be used for optoacoustic brain imaging, tomography, and mapping in humans.

  9. Noninvasive cerebral blood oxygenation monitoring: clinical test of multiwavelength optoacoustic system

    NASA Astrophysics Data System (ADS)

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

    2007-02-01

    Continuous monitoring of cerebral blood oxygenation is critically important for treatment of patients with life-threatening conditions like severe brain injury or during cardiac surgery. We designed and built a novel multiwavelength optoacoustic system for noninvasive, continuous, and accurate monitoring of cerebral blood oxygenation. We use an Optical Parametric Oscillator as a light source. We successfully tested the system in vitro as well as in vivo in large animals (sheep) through thick tissues overlying blood vessels which drain venous blood out of the brain (e.g., superior sagittal sinus or jugular vein). Here we present the results of clinical tests of the system for continuous noninvasive cerebral blood oxygenation monitoring in the internal jugular vein of healthy volunteers. We applied our custom-built optoacoustic probe (which incorporated a wide-band acoustic transducer and an optical fiber) to the neck area overlying the internal jugular vein. We performed measurements with volunteers at 18 wavelengths in the near-infrared spectral range. Despite a thick layer of overlying connective tissue and low energy used in the experiments, we recorded signals with high signal-to-noise ratios for all volunteers. We found that the temporal (independent of signal amplitude) parameters of recorded profiles for different levels of blood oxygenation correlated well with the spectrum of effective attenuation coefficients of blood.

  10. Carotid-cavernous fistula after functional endoscopic sinus surgery.

    PubMed

    Karaman, Emin; Isildak, Huseyin; Haciyev, Yusuf; Kaytaz, Asim; Enver, Ozgun

    2009-03-01

    Carotid-cavernous fistulas (CCFs) are anomalous communications between the carotid arterial system and the venous cavernous sinus. They can arise because of spontaneous or trauma causes. Most caroticocavernous fistulas are of spontaneous origin and unknown etiology. Spontaneous CCF may also be associated with cavernous sinus pathology such as arteriosclerotic changes of the arterial wall, fibromuscular dysplasia, or Ehler-Danlos syndrome. Traumatic CCFs may occur after either blunt or penetrating head trauma. Their clinical presentation is related to their size and to the type of venous drainage, which can lead to a variety of symptoms, such as visual loss, proptosis, bruit, chemosis, cranial nerve impairment, intracranial hemorrhage (rare), and so on. Treatment by endovascular transarterial embolization with electrolytically detachable coils is a very effective method for CCF with good outcomes. Carotid-cavernous fistulas have been rarely reported after craniofacial surgery and are uncommon pathologies in otolaryngology practice. In this study, we report a 40-year-old woman with CCF secondary to blunt trauma of functional endoscopic sinus surgery.

  11. Looks like a stroke, acts like a stroke, but it's more than a stroke: a case of cerebral mucormycosis.

    PubMed

    Ermak, David; Kanekar, Sangam; Specht, Charles S; Wojnar, Margaret; Lowden, Max

    2014-09-01

    Mucormycosis is a fungus that exhibits angiocentric growth and can cause a thrombotic arteritis. Infection with this organism is uncommon and cerebral involvement is most often secondary to direct invasion through the paranasal sinuses. Here, we present a case of mucormycosis with cerebral involvement without sinus disease, which resulted in ischemic stroke with rapid progression resulting in death.

  12. [Orbital complications of sinusitis].

    PubMed

    Šuchaň, M; Horňák, M; Kaliarik, L; Krempaská, S; Koštialová, T; Kovaľ, J

    2014-12-01

    Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal

  13. Odontogenic maxillary sinusitis: a review.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Vaitkus, Saulius

    2014-01-01

    Maxillary sinusitis of odontogenic origin is a well-known condition in both the dental and otolaryngology communities. It occurs when the Schneiderian membrane is violated by conditions arising from dentoalveolar unit. This type of sinusitis differs in its pathophysiology, microbiology, diagnostics and management from sinusitis of other causes, therefore, failure to accurately identify a dental cause in these patients usually lead to persistent symptomatology and failure of medical and surgical therapies directed toward sinusitis. Unilateral recalcitrant disease associated with foul smelling drainage is a most common feature of odontogenic sinusitis. Also, high-resolution CT scans and cone-beam volumetric computed tomography can assist in identifying dental disease. Sometimes dental treatment alone is adequate to resolve the odontogenic sinusitis and sometimes concomitant or subsequent functional endoscopic sinus surgery or Caldwell-Luc operation is required. The aim of this article is to give a review of the most common causes, symptoms, diagnostic and treatment methods of odontogenic maxillary sinusitis. Search on Cochrane Library, PubMed and Science Direct data bases by key words resulted in 35 articles which met our criteria. It can be concluded that the incidence of odontogenic sinusitis is likely underreported in the available literature.

  14. Difference between Sinusitis and a Cold

    MedlinePlus

    ... Disabilities Obesity Orthopedic Prevention Sexually Transmitted ... is an inflammation of the lining of the nose and sinuses. It is a very common infection in children. Viral sinusitis usually accompanies a cold. Allergic sinusitis may ...

  15. [Pott's puffy tumor: a rare complication of frontal sinusitis].

    PubMed

    Aínsa Laguna, D; Pons Morales, S; Muñoz Tormo-Figueres, A; Vega Senra, M I; Otero Reigada, M C

    2014-05-01

    Pott's puffy tumor is a rare complication of frontal sinusitis characterized by swelling and edema in the brow due to a subperiosteal abscess associated with frontal osteomyelitis. Added complications are cellulitis by extension to the orbit and intracranial infection by posterior extension, with high risk of meningitis, intracranial abscess, and venous sinus thrombosis. Early diagnosis and aggressive medical or surgical treatment are essential for optimal recovery of affected patients. In the antibiotic age it is extremely rare, with very few cases described in the recent literature. A case is presented of a Pott inflammatory tumor in a 7 year-old boy, as a complication of acute pansinusitis who presented with front preseptal swelling and intracranial involvement with thrombosis of ophthalmic and superior orbital veins and frontal epidural abscess extending to the subarachnoid space.

  16. Acute bacterial sinusitis in children.

    PubMed

    DeMuri, Gregory; Wald, Ellen R

    2013-10-01

    On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.

  17. Non-invasive Quantification of Whole-brain Cerebral Metabolic Rate of Oxygen by MRI

    PubMed Central

    Xu, Feng; Ge, Yulin; Lu, Hanzhang

    2009-01-01

    Cerebral metabolic rate of oxygen (CMRO2) is an important marker for brain function and brain health. Existing techniques for quantification of CMRO2 with Positron Emission Tomography (PET) or MRI involve special equipment and/or exogenous agent, and may not be suitable for routine clinical studies. In the present study, a non-invasive method is developed to estimate whole-brain CMRO2 in humans. This method applies phase-contrast MRI for quantitative blood flow measurement and T2-Relaxation-Under-Spin-Tagging (TRUST) MRI for venous oxygenation estimation, and uses the Fick principle of arteriovenous difference for the calculation of CMRO2. Whole-brain averaged CMRO2 values in young, healthy subjects were 132.1±20.0 μmol/100g/min, in good agreement with literature reports using PET. Various acquisition strategies for phase-contrast and TRUST MRI were compared, and it was found that non-gated phase-contrast and sagittal sinus TRUST MRI were able to provide the most efficient and accurate estimation of CMRO2. In addition, blood flow and venous oxygenation were found to be positively correlated across subjects. Owing to the non-invasive nature of this method, it may be a convenient and useful approach for assessment of brain metabolism in brain disorders as well as under various physiologic conditions. PMID:19353674

  18. Routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects

    SciTech Connect

    Freed, M.D.; Nadas, A.S.; Norwood, W.I.; Castaneda, A.R.

    1984-08-01

    Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. New insights into the mechanisms of venous thrombosis.

    PubMed

    Mackman, Nigel

    2012-07-01

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

  20. 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.

  1. 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

  2. Calibrated BOLD using direct measurement of changes in venous oxygenation.

    PubMed

    Driver, Ian D; Hall, Emma L; Wharton, Samuel J; Pritchard, Susan E; Francis, Susan T; Gowland, Penny A

    2012-11-15

    Calibration of the BOLD signal is potentially of great value in providing a closer measure of the underlying changes in brain function related to neuronal activity than the BOLD signal alone, but current approaches rely on an assumed relationship between cerebral blood volume (CBV) and cerebral blood flow (CBF). This is poorly characterised in humans and does not reflect the predominantly venous nature of BOLD contrast, whilst this relationship may vary across brain regions and depend on the structure of the local vascular bed. This work demonstrates a new approach to BOLD calibration which does not require an assumption about the relationship between cerebral blood volume and cerebral blood flow. This method involves repeating the same stimulus both at normoxia and hyperoxia, using hyperoxic BOLD contrast to estimate the relative changes in venous blood oxygenation and venous CBV. To do this the effect of hyperoxia on venous blood oxygenation has to be calculated, which requires an estimate of basal oxygen extraction fraction, and this can be estimated from the phase as an alternative to using a literature estimate. Additional measurement of the relative change in CBF, combined with the blood oxygenation change can be used to calculate the relative change in CMRO(2) due to the stimulus. CMRO(2) changes of 18 ± 8% in response to a motor task were measured without requiring the assumption of a CBV/CBF coupling relationship, and are in agreement with previous approaches.

  3. Mycotic encephalitis, sinus osteomyelitis, and guttural pouch mycosis in a 3-year-old Arabian colt.

    PubMed

    Hunter, Barbara; Nation, Patrick N

    2011-12-01

    Mycotic encephalitis caused severe ataxia and other neurologic deficits in a horse. The finding of a single, large focus of cerebral malacia, with histopathologic evidence of fungal elements, suggested infection was a result of direct transfer from the frontal sinuses, rather than hematogenous spread from the guttural pouch.

  4. Northern Sinus Meridiani Stereo

    NASA Technical Reports Server (NTRS)

    2003-01-01

    MGS MOC Release No. MOC2-341, 25 April 2003

    This is a stereo (3-d anaglyph) composite of Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) wide angle images of northern Sinus Meridiani near 2oN, 0oW. The light-toned materials at the south (bottom) end of the picture are considered to be thick (100-200 meters; 300-600 ft) exposures of sedimentary rock. Several ancient meteor impact craters are being exhumed from within these layered materials. To view in stereo, use '3-d' glasses with red over the left eye, and blue over the right. The picture covers an area approximately 113 km (70 mi) wide; north is up.

  5. Management of Frontal Sinus Tumors.

    PubMed

    Selleck, Anne Morgan; Desai, Dipan; Thorp, Brian D; Ebert, Charles S; Zanation, Adam M

    2016-08-01

    The most common primary tumors of the frontal sinus are osteomas and inverted papillomas, although a variety of other tumors involving this space have been reported. With the advent of new surgical techniques and instrumentation, an endoscopic approach to this region has become feasible. The preoperative assessment and decision making must take into account the complexity of frontal sinus anatomy, tumor type, tumor location, and associated attachments. These procedures allow adequate visualization, tumor removal, and postoperative monitoring, and preserve fairly normal sinus function. Open techniques may also be required and should be in the surgeon's armamentarium.

  6. The clinical characteristics and treatment of cerebral AVM in pregnancy

    PubMed Central

    Lv, Xianli; Liu, Peng

    2015-01-01

    Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few, and they provide different results, pregnancy will increase the hemorrhagic risk of AVM and ruptured cerebral AVM in pregnancy should be actively treated. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. Results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy was below the safety value and was safe. For an unruptured AVM in pregnancy, if there are no bleeding factors, e.g. no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, then it should be observed conservatively. PMID:26246089

  7. The clinical characteristics and treatment of cerebral AVM in pregnancy

    PubMed Central

    Lv, Xianli

    2015-01-01

    Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few and there are different results between them, pregnancy will increase the hemorrhagic risk of AVM, and ruptured cerebral AVM in pregnancy should be treated actively. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. The results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy is below the safety value and is safe. Unruptured AVM in pregnancy, if there is no bleeding factor, such as no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, should be observed conservatively. PMID:26427890

  8. Paranasal sinus obliteration in Wegener granulomatosis

    SciTech Connect

    Paling, M.R.; Roberts, R.L.; Fauci, A.S.

    1982-08-01

    The authors report 14 cases of Wegener granulomatosis in which one or more paranasal sinuses were obliterated by bone. The maxillary antra were involved in all cases, with the other sinuses being affected less frequently. These changes are thought to result from chronic bacterial sinusitis superimposed on the granulomatous vasculitic process. Computed tomography dramatically demonstrated the bone changes, consisting of a combination of sinus wall thickening and trabeculated new bone formation within the sinuses.

  9. Cavernous sinus meningiomas: imaging and surgical strategy.

    PubMed

    Sindou, Marc; Nebbal, Mustapha; Guclu, Bulent

    2015-01-01

    Cavernous sinus (CS) meningiomas which are by definition those meningiomas which originate from the parasellar region are difficult skull base tumors to deal with. For deciding the most appropriate surgical strategy, surgeons need detailed preoperative neuroimaging. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. Thin section CT scan with bone windows, 3D spiral CT reconstruction, MRI, MR angiography, and DSA performed with selective arteriography including late venous phases give those required detailed informations about the tumor and its relation with neurovascular and bony structures. The type of craniotomy and complementary osteotomy and the usefulness of an extradural anterior clinoidectomy with unroofing the optic canal can be decided from preoperative neuroimaging. Data collected also help in determining whether extensive exposure of the middle cranial fossa is necessary to ensure substantial devascularization of the tumor and whether proximal control of the internal carotid artery (ICA) at its intrapetrosal portion might be useful. Study of the capacity of blood supply of the Willis circle is wise for deciding the need and way of performing an extra-intracranial bypass together with tumor removal. Currently the concept of operating only the tumors with extracavernous extensions and to limit resection to only their extracavernous portions is the most accepted way of treating these tumors. It was that strategy that was adopted in the senior author's 220-patient series.Radiosurgery or stereotactic fractionated radiotherapy may complement surgery or can be only reserved for growing remnants.

  10. Sinus Rinsing and Neti Pots

    MedlinePlus

    ... D, Van Dyke R, Stern H, Xiao L, Beach MJ. The first association of a primary amebic ... B, Kahler AM, Schneeberger C, da Silva AJ, Beach MJ. Deaths from Naegleria fowleri associated with sinus ...

  11. [Surgical dilemmas. Sinus floor elevation].

    PubMed

    ten Bruggenkate, C M; Schulten, E A J M; Zijderveld, S A

    2008-12-01

    Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a 'top hinge door', that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

  12. Evaluating Complications of Chronic Sinusitis

    PubMed Central

    Hong, Phillip; Pereyra, Charles A.; Breslin, Adam; Melville, Laura

    2017-01-01

    Chronic sinusitis is a relatively common diagnosis throughout the US. In patients with an otherwise unremarkable medical history the treatment is typically supportive, requiring only clinical evaluation. We present the case of a 25-year-old male with a history of chronic sinusitis that was brought to our emergency department with new-onset seizure. Three days before he had presented to his usual care facility with two days of headache and fever and was discharged stating headache, subjective fever, and neck stiffness. After further investigation he was diagnosed with a mixed anaerobic epidural abscess. The evaluation and management of chronic sinusitis are based on the presence of symptoms concerning for complication. Prompt investigation of complicated sinusitis is essential in preventing debilitating and fatal sequelae. Our case study underscores the importance of early diagnosis and appropriate management. PMID:28163938

  13. [Bacteriological study of maxillary sinusitis].

    PubMed

    Renon, P; Casanova, M; Verdier, M; Asperge, A; Le Mouel, C

    1984-01-01

    Suppurated maxillary sinusitis are frequent diseases. Diameatic puncture allows bacteriological investigations. Our results are positive in two thirds of cases. The bacterial flora is very varied, whose identification and antibiograms involve efficient treatment with daily washing and in situ antibiotherapy.

  14. [Sinusitis--judicious antibiotic treatment].

    PubMed

    Niedzielska, Grazyna

    2007-01-01

    The paper presents different forms of sinusitis in children and adults as well as the patomechanism of sinusitis of infective and non-infective origin. The role of bacterial infection has been discussed. Participation of major pathogens of URTI such as S. pneumoniae, H. influenzae and M. catarrhalis has been highlighted and the factors influencing growth of their antibiotic-resistant stains. Guidelines concerning antibiotic therapy in children and adults, depending on disease course, age and factors influencing growth of resistant stains have been presented. Causes of failure in treatment of sinusitis have been analysed eg. in case of bacterial biofilm growth or non-neutrophilic inflammation forms. Antimicrobial treatment concerns mainly acute and aggravated infections. In case of chronic sinusitis, antibiotic therapy is complementary to surgical treatment.

  15. MC-19 Margaritifer Sinus Region

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Mars digital-image mosaic merged with color of the MC-19 quadrangle, Margaritifer Sinus region of Mars. Heavily cratered highlands, which dominate the Margaritifer Sinus quadrangle, are marked by large expanses of chaotic terrain. In the northwestern part, the major rift zone of Valles Marineris connects with a broad canyon filled with chaotic terrain. Latitude range -30 to 0, longitude range 0 to 45 degrees.

  16. MC-20 Sinus Sabeus Region

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Mars digital-image mosaic merged with color of the MC-20 quadrangle, Sinus Sabeus region of Mars. Heavily cratered highlands dominate the Sinus Sabeus quadrangle. The northern part is marked by a large impact crater, Schiaparelli. Schiaparelli is an ancient remnant of the many large impact events that occurred during the period of heavy bombardment. Latitude range -30 to 0 degrees, longitude range -45 to 0.

  17. 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

  18. Balloon protection of the Labbé vein during transarterial embolization of a dural arterio-venous fistula

    PubMed Central

    Manisor, Monica; Wolff, Valérie; Aloraini, Ziad; Tigan, Leonardo; Kehrli, Pierre; Marescaux, Christian; Beaujeux, Rémy

    2015-01-01

    Introduction Endovascular treatment of type III dural arterio-venous fistulas can be challenging if the fistulous point is close to a functionally important cortical vein. Methods A technique is described for temporary balloon protection of the vein of Labbé during transarterial Onyx embolization of a type III dural arterio-venous fistula. One illustrative case is presented. Careful anatomic consideration of the concerned venous segment (at the insertion point into the lateral sinus) and the choice of balloon minimized the risk of venous rupture. Results Using this method, satisfactory progression of Onyx was obtained within the arterio-venous shunt while preserving the patency of the Labbé vein. Conclusion Temporary balloon protection of the Labbé vein is a feasible option to preserve its patency during embolization of dural arterio-venous fistulas. To the authors’ knowledge, this is the first report on the use of temporary balloon protection of a cortical vein. PMID:26438051

  19. Frontal Sinus Fractures: Current Concepts

    PubMed Central

    Strong, E. Bradley

    2009-01-01

    Frontal sinus injuries may range from isolated anterior table fractures resulting in a simple aesthetic deformity to complex fractures involving the frontal recess, orbits, skull base, and intracranial contents. The risk of long-term morbidity can be significant. Optimal treatment strategies for the management of frontal sinus fractures remain controversial. However, it is critical to have a thorough understanding of frontal sinus anatomy as well as the current treatment strategies used to manage these injuries. A thorough physical exam and thin-cut, multiplanar (axial, coronal, and sagittal) computed tomography scan should be performed in all patients suspected of having a frontal sinus fracture. The most appropriate treatment strategy can be determined by assessing five anatomic parameters including the: frontal recess, anterior table integrity, posterior table integrity, dural integrity, and presence of a cerebrospinal fluid leak. A well thought out management strategy and meticulous surgical techniques are critical to success. The primary surgical goal is to provide a safe sinus while minimizing patient morbidity. This article offers an anatomically based treatment algorithm for the management of frontal sinus fractures and highlights the key steps to surgical repair. PMID:22110810

  20. STUDIES ON THE VENOUS PULSE. I : A STUDY OF THE DIASTOLIC WAVES OF THE VENOUS PULSE, WITH ESPECIAL REFERENCE TO THE POSSIBILITY OF A WAVE DUE TO THE CONTRACTION OF THE VENOUS REGION OF THE MAMMALIAN HEART.

    PubMed

    Eyster, J A

    1910-05-01

    A wave is described occurring in the venous pulse of man late in the diastolic period. This wave is a diastolic wave, since in an increase in length of the cardiac cycle it follows the h wave at its regular interval and becomes separated from the a wave of the next cardiac cycle. There is no wave on the venous pulse in man which can be referred to a contraction of the region of the great veins or sinus region of the heart. The h wave is a normal occurrence in the venous pulse curve from man and the dog. It occurs, according to the experience in this work, in all normal individuals in which the heart rate is sufficiently slow to prevent its obliteration by the a wave. The x wave, while not infrequent, is not always present in man even when the cardiac cycle is of sufficient length to prevent its obliteration by the a wave. This wave has not been observed in the dog. There is no wave on the venous pulse curve of the dog that can be referred to a contraction of the sinus region of the heart. Extra-systoles from stimulation of the venous region of the dog's heart produce no contraction of this region sufficiently pronounced to be recorded on a venous pulse tracing. After an interval of from 0.07 to 0.I second, representing the interval of veno-auricular conduction plus the latent period of the auricle, the auricle contracts. Extrasystoles from stimulation of the right auricle show, after an interval following the stimulus much shorter than that noted above and representing the latent period of the auricle, an a wave followed by ventricular systole after the usual a-c interval. It would seem probable that the sinus region of the heart, while capable of irritability, conductivity and rhythmicity (Erlanger and Blackman (I6)), does not normally manifest contractility.

  1. Persistent Left Superior Vena Cava Draining into the Coronary Sinus: A Case Report

    PubMed Central

    Kurtoglu, Ertugrul; Cakin, Ozlem; Akcay, Selahaddin; Akturk, Erdal; Korkmaz, Hasan

    2011-01-01

    Persistent left superior vena cava (PLSVC) is a congenital anomaly of the thoracic venous system resulting from the abnormal persistence of an embryological vessel that normally regresses during early fetal life. This anomaly is often discovered incidentally during surgery, cardiovascular imaging or invasive cardiovascular procedures. In most cases, a PLSVC drains into the right atrium through the coronary sinus. In the remainder of cases, it enters directly or through the pulmonary veins into the left atrium. A dilated coronary sinus on echocardiography should always raise the suspicion of a PLSVC as it has important clinical implications. The diagnosis should be confirmed by saline contrast echocardiography. We report a patient with persistent left superior vena cava with an enlarged coronary sinus and normal right superior vena cava.

  2. Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis.

    PubMed

    Ladner, Travis R; Davis, Brandon J; He, Lucy; Mawn, Louise A; Mocco, J

    2015-12-01

    Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST.

  3. Transorbital superior ophthalmic vein sacrifice to preserve vision in ocular hypertension from aseptic cavernous sinus thrombosis.

    PubMed

    Ladner, Travis R; Davis, Brandon J; He, Lucy; Mawn, Louise A; Mocco, J

    2014-10-29

    Aseptic cavernous sinus thrombosis (CST) is rare and may clinically masquerade as a carotid cavernous fistula. Conventional management includes oral anticoagulation, but cases of ocular hypertension affecting vision may require more aggressive intervention. We report a case of a woman with spontaneous bilaterally occluded cavernous sinuses with elevated intraocular pressure (IOP), which resolved immediately following unilateral superior ophthalmic vein (SOV) sacrifice. She was subsequently placed on oral anticoagulants. By 4 months postoperatively her IOP was normalized and her vision had improved. Repeat angiography demonstrated stable venous filling, with some mild improvement of flow through the cavernous sinus. Coil-mediated sacrifice of the SOV might be an effective means to relieve ocular hypertension and preserve vision in the setting of aseptic CST.

  4. Intercavernous Venous Communications in the Human Skull Base

    PubMed Central

    Aquini, Mauro Guidotti; Marrone, Antonio Carlos Huf; Schneider, Felipe Luis

    1994-01-01

    The intercavernous communications of the skull base were studied in 32 sphenoid blocks using electrolytic decalcification techniques, vascular filling, x-rays, and serial anatomical sections. In this study four intercavernous connections were found: anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), inferior intercavernous sinus (IIS), and basilar plexus (BP). The AIS was present in 100% of the cases, with diameters ranging from 0.57 mm to 5.43 mm; in 17 cases (53.12%) it took up the whole anterior wall of the hypophyseal fossa. The PIS was also detected in 100% of the cases, and its diameters ranged from 0.71 mm to 4.14 mm. The IIS was identified in 31 cases (96.9%), assuming three different forms: plexuslike, venous lake, and mixed. The BP was found in 100% of the material analyzed; in 23 cases (71.9%) it proved to be the widest intercavernous communication. In 12 cases of this series the hypophysis was completely enveloped by venous structures, except at the level of the sellar diaphragm. ImagesFigure 1Figure 2Figure 3 PMID:17171164

  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. [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.

  7. Delayed intracranial hypertension and cerebellar tonsillar necrosis associated with a depressed occipital skull fracture compressing the superior sagittal sinus. Case report.

    PubMed

    Vender, John R; Bierbrauer, Karin

    2005-11-01

    Depressed skull fractures overlying the major venous sinus are often managed nonoperatively because of the high associated risks of surgery in these locations. In the presence of clinical and radiographic evidence of sinus occlusion, however, surgical therapy may be necessary. The authors present the case of a 9-year-old boy with a depressed skull fracture overlying the posterior third of the superior sagittal sinus. After initial conservative treatment, delayed signs of intracranial hypertension and a symptomatic tonsillar herniation with tonsillar necrosis developed. Possible causes as well as diagnostic and treatment options are reviewed.

  8. A novel multipurpose mini-endoscope for frontal sinus endoscopy "sinus view".

    PubMed

    Al Kadah, Basel; Bozzato, Victoria; Bozzato, Alessandro; Papaspyrou, George; Schick, Bernhard

    2015-07-01

    Endoscopic frontal sinus surgery has been proven to enable the treatment of most frontal sinus pathologies but may be challenging for the surgeon in regard to the variable frontal sinus anatomy. Frontal sinus drainage identification and frontal sinus visualization are an essential part of successful frontal sinus surgery. We demonstrate a novel modular mini-endoscopic system for frontal sinus surgery. Fifty-two patients (37 male, 15 female) with a chronic rhino-sinusitis were enrolled. In this study, all patients were subjected to standard endonasal endoscopic sinus surgery with use of the fibre optic endoscope "Sinus View" (1.1 mm diameter, 10,000 pixels, irrigation channel and additional working channel) accessing the frontal sinus. A frontal sinus drainage type I in 38 cases, a frontal sinus drainage type IIa in 9 cases and a frontal sinus drainage type IIb in 5 cases according to Draf were performed. The modular mini-endoscopic system "Sinus view" was used to identify frontal sinus drainage in ten patients before ethmoidectomy and in the remaining patients (N = 42) after ethmoidectomy. Visualization of the frontal sinus drainage or the frontal sinus itself was easily carried out after irrigation. A clear identification of the frontal sinus by illumination was achieved in all cases. In addition the working channel of the endoscope was successfully used to perform visualized balloon dilatation at the frontal sinus drainage or for biopsy. The endonasal visualization of the frontal sinus drainage and frontal sinus itself is facilitated by also using a modular mini-endoscope with the option to use the working channel of the endoscope for biopsy or balloon dilatation.

  9. 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.

  10. 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 ...

  11. Sex determination using maxillary sinus

    PubMed Central

    Kanthem, Ranjith Kumar; Guttikonda, Venkateswara Rao; Yeluri, Sivaranjani; Kumari, Geetha

    2015-01-01

    Background: Individual identification is a subtle concept and often one of the most important priorities in mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases. Matching specific features detected on the cadaver with data recorded during the life of an individual is an important aspect in forensics, and can be performed by fingerprint analysis, deoxyribonucleic acid matching, anthropological methods, radiological methods and other techniques which can facilitate age and sex identification. Sinus radiography is one such method that has been used for determination of the sex of an individual. Hence, an attempt is being made to use the different dimensions of the maxillary sinus in the determination of sex using coronal and axial sections of plain computed tomography (CT) scan. Materials and Methods: A total of 30 patients including 17 male and 13 female, visiting the Outpatient Department of the Mamata General Hospital were included as the study subjects. The dimensions of right and left maxillary sinuses of 30 subjects from plain CT were measured using SYNGO software and statistical analysis was done. Results: Sex determination using height, length, width, and volume of the maxillary sinus on both sides showed statistically significant results with a higher percentage of sexual dimorphism in the case of volume. Conclusion: Volume of the right maxillary sinus can be used as accurate diagnostic parameter for sex determination. PMID:26005308

  12. 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

  13. 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

  14. Cerebral circulation during acceleration stress

    NASA Astrophysics Data System (ADS)

    Cirovic, Srdjan

    A mathematical model of the cerebrovascular system has been developed to examine the influence of acceleration on cerebral circulation. The objective is to distinguish the main factors that limit cerebral blood flow in pilots subjected to accelerations which exceed the gravitational acceleration of the earth (Gz > 1). The cerebrovascular system was approximated by an open-loop network of elastic tubes and the flow in blood vessels was modeled according to a one-dimensional theory of flow in collapsible tubes. Since linear analysis showed that the speed of pulse propagation in the intracranial vessels should not be modified by the skull constraint, the same governing equations were used for the intracranial vessels as for the rest of the network. The steady and pulsatile components of the cerebrospinal fluid pressure were determined from the condition that the cranial volume must be conserved. After the qualitative aspects of the model results were verified experimentally, the open-loop geometry was incorporated into a global mathematical model of the cardiovascular system. Both the mathematical models and the experiment show that cerebral blood flow diminishes for Gz > 1 due to an increase in the resistance of the large veins in the neck, which collapse as soon as the venous pressure becomes negative. In contrast, the conservation of the cranial volume requires that the cerebrospinal and venous pressure always be approximately the same, and the vessels contained in the cranial cavity do not collapse. Positive pressure breathing provides protection by elevating blood arterial and venous pressures at the heart, thus preventing the venous collapse and maintaining the normal cerebral vascular resistance.

  15. Changes in intracranial venous blood flow and pulsatility in Alzheimer's disease: A 4D flow MRI study.

    PubMed

    Rivera-Rivera, Leonardo A; Schubert, Tilman; Turski, Patrick; Johnson, Kevin M; Berman, Sara E; Rowley, Howard A; Carlsson, Cynthia M; Johnson, Sterling C; Wieben, Oliver

    2016-01-01

    Cerebral blood flow, arterial pulsation, and vasomotion may be important indicators of cerebrovascular health in aging and diseases of aging such as Alzheimer's disease. Noninvasive markers that assess these characteristics may be helpful in the study of co-occurrence of these diseases and potential additive and interacting effects. In this study, 4D flow MRI was used to measure intra-cranial flow features with cardiac-gated phase contrast MRI in cranial arteries and veins. Mean blood flow and pulsatility index as well as the transit time of the peak flow from the middle cerebral artery to the superior sagittal sinus were measured in a total of 104 subjects comprising of four groups: (a) subjects with Alzheimer's disease, (b) age-matched controls, (c) subjects with mild cognitive impairment, and (d) a group of late middle-aged with parental history of sporadic Alzheimer's disease. The Alzheimer's disease group exhibited: a significant decrease in mean blood flow in the superior sagittal sinus, transverse sinus, middle cerebral artery, and internal carotid arteries; a significant decrease of the peak and end diastolic blood flow in the middle cerebral artery and superior sagittal sinus; a faster transmission of peak flow from the middle cerebral artery to the superior sagittal sinus and increased pulsatility index along the carotid siphon.

  16. 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.

  17. [Disseminated arterial occlusions revealing bilateral venous thrombosis with paradoxical embolisms].

    PubMed

    Elsendoorn, A; Desport, E; Vialle, R; Frat, J-P; Bridoux, F; Touchard, G

    2009-06-01

    Paradoxical embolism is a diagnosis of exclusion. Clinical triad associates deep venous thrombosis with or without pulmonary embolism, arterial embolism, and intracardiac communication with right-to-left shunt. The intracardiac communication is generally related to a patent foramen ovale (PFO). We report a 75-year-old patient, who presented with bilateral deep venous thrombosis of the legs, complicated by massive pulmonary embolism and paradoxical embolisms through a PFO. This resulted in cerebral, mesenteric, splenic and bilateral kidney infarctions. A promptly initiated anticoagulant treatment allowed a favourable outcome.

  18. Sinusitis: Special Considerations for Aging Patients

    MedlinePlus

    ... ENT Doctor Near You Sinusitis: Special Considerations for Aging Patients Sinusitis: Special Considerations for Aging Patients Patient ... for evaluation and possible surgical management. Sources For Aging Patients: Administration on Aging (AoA), U.S. Department of ...

  19. Unexpected location of pilonidal sinuses.

    PubMed

    Sion-Vardy, N; Osyntsov, L; Cagnano, E; Osyntsov, A; Vardy, D; Benharroch, D

    2009-12-01

    Pilonidal sinuses usually occur in the sacrococcygeal area in young men, and occasionally can be found in other ectopic sites. We present a retrospective case review on unusual locations of pilonidal sinuses in the past 4 years. The lesion sites were as follows: one on the penis, two on the scalp, two on the abdomen, one on the neck, two in the groin and two in the axilla. Abdominal and penile lesions are uncommon, but the other locations reported are unusually rare. To our knowledge, the groin has not been reported previously as a site of a pilonidal sinus, although the histological appearance of hidradenitis suppurativa may well resemble it. When trying to clarify the pathogenesis of these occurrences, we found that recurrent hair removal was a common characteristic of the patients we contacted, and this may have been the initiating trauma.

  20. Modeling the Carotid Sinus Baroreceptor

    PubMed Central

    Srinivasan, Ramachandra; Nudelman, Harvey B.

    1972-01-01

    A mathematical model that describes the relationship between sinus pressure and nerve discharge frequency of the carotid sinus baroreceptor is presented. It is partly based upon the single-fiber data obtained by Clarke from the sinus nerve of a dog. The model takes into account what is currently known about the physiology of the baroreceptor. It consists of two nonlinear ordinary differential equations and eight free parameters. With one set of values for these eight parameters, the model reproduces well the experimental results reported by Clarke for positive ramp pressure inputs. Only three parameters needed to be adjusted in order to fit the dynamic data. The remaining five were obtained from static and steady-state data. PMID:5056961

  1. Venous Oxygenation Mapping using Velocity-Selective Excitation and Arterial Nulling (VSEAN)

    PubMed Central

    Guo, Jia; Wong, Eric C.

    2011-01-01

    A new MRI technique to map the oxygenation of venous blood is presented. The method uses velocity-selective excitation and arterial nulling pulses, combined with phase sensitive signal detection to isolate the venous blood signal. The T2 of this signal along with a T2-Y calibration curve yields estimates of venous oxygenation in situ. Results from phantoms and healthy human subjects under normoxic and hypoxic conditions are shown, and venous saturation levels estimated from both sagittal sinus and grey matter based ROIs are compared to the related techniques TRUST and QUIXOTIC. In addition, combined with an additional scan without arterial nulling pulses, the oxygen saturation level on arterial side can also be estimated. PMID:22294414

  2. Bacterial colonization or infection in chronic sinusitis.

    PubMed

    Pandak, Nenad; Pajić-Penavić, Ivana; Sekelj, Alen; Tomić-Paradžik, Maja; Cabraja, Ivica; Miklaušić, Božana

    2011-12-01

    The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.

  3. [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.

  4. When Sinuses Attack! (For Kids)

    MedlinePlus

    ... you have a cold? continue When Good Sinuses Go Bad What about that cold that won't go away? A cold virus can: damage the delicate ... if you are feeling well enough, you can go to school or go outside and play. In ...

  5. Pneumatization of the sphenoid sinus.

    PubMed

    Terra, E R; Guedes, F R; Manzi, F R; Bóscolo, F N

    2006-01-01

    This paper describes a case of pneumatization of the sphenoid sinus in the pterygoid process and greater wing of the sphenoid bone, observed on a panoramic radiograph. Conventional radiographs and computerized tomography in axial and coronal sections confirmed the presence of the pneumatization of these structures.

  6. 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

  7. 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.

  8. Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein.

    PubMed

    Michels, Kevin S; Ng, John D; Falardeau, Julie; Roberts, Warren G; Petersen, Bryan; Nesbit, Gary M; Barnwell, Stanley L

    2007-01-01

    A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.

  9. Cerebral Palsy

    MedlinePlus

    Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance ... do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have ...

  10. Cavopulmonary window: an extreme form of sinus venosus defect.

    PubMed

    Aramendi, José I; Cubero, Alain; Hamzeh, Gadah; Rey, Estibaliz

    2014-02-01

    We present an unusual variant of the sinus venosus defect in which an obvious window is formed between a single pulmonary vein and the superior vena cava, the pulmonary vein retaining its connection to the left atrium. Two patients were operated on via right anterior minithoracotomy. A large single right pulmonary vein was found connecting to the left atrium. There was a large side-to-side communication between the superior vena cava and the pulmonary vein resulting in partially anomalous pulmonary venous drainage. A side-biting clamp was applied in the superior vena cava and the pulmonary vein at both sides of the communication, and the vein was divided. The incision in both veins was closed with a running suture.

  11. 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.

  12. Fulminant cerebral infarction of anterior and posterior cerebral circulation after ascending type of facial necrotizing fasciitis.

    PubMed

    Lee, Jun Ho; Choi, Hui-Chul; Kim, Chulho; Sohn, Jong Hee; Kim, Heung Cheol

    2014-01-01

    Necrotizing fasciitis is a soft tissue infection that is characterized by extensive necrosis of the subcutaneous fat, neurovascular structures, and fascia. Cerebral infarction after facial necrotizing fasciitis has been rarely reported. A 61-year-old woman with diabetes was admitted with painful swelling of her right cheek. One day later, she was stuporous and quadriplegic. A computed tomographic scan of her face revealed right facial infection in the periorbital soft tissue, parotid, buccal muscle, and maxillary sinusitis. A computed tomographic scan of the brain revealed cerebral infarction in the right hemisphere, left frontal area, and both cerebellum. Four days later, she died from cerebral edema and septic shock. Involvement of the cerebral vasculature, such as the carotid or vertebral artery by necrotizing fasciitis, can cause cerebral infarction. Facial necrotizing fasciitis should be treated early with surgical treatment and the appropriate antibiotic therapy.

  13. 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

  14. Anatomical aspects of sinus floor elevations.

    PubMed

    van den Bergh, J P; ten Bruggenkate, C M; Disch, F J; Tuinzing, D B

    2000-06-01

    Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sinus floor elevation. Absolute contra-indications are maxillary sinus diseases (tumors) and destructive former sinus surgery (like the Caldwell-Luc operation). The lateral sinus wall is usually a thin bone plate, which is easily penetrated with rotating or sharp instruments. The fragile Schneiderian membrane plays an important role for the containment of the bonegraft. The surgical procedure of preparing the trap door and luxating it, together with the preparation of the sinus mucosa, may cause a mucosa tear. Usually, when these perforations are not too large, they will fold together when turning the trap door inward and upward, or they can be glued with a fibrin sealant, or they can be covered with a resorbable membrane. If the perforation is too large, a cortico-spongious block graft can be considered. However, in most cases the sinus floor elevation will be deleted. Perforations may also occur due to irregularities in the sinus floor or even due to immediate contact of sinus mucosa with oral mucosa. Obstruction of the antro-nasal foramen is, due to its high location, not a

  15. Jugular venous reflux on magnetic resonance angiography and radionuclide venography

    PubMed Central

    Okada, Tomohisa; Okuchi, Sachi; Yamamoto, Akira; Kanagaki, Mitsunori; Fujimoto, Koji; Togashi, Kaori

    2016-01-01

    Background The relationship between the signal from retrograde venous flow on magnetic resonance angiography (MRA) and retrograde upward flow from the left brachiocephalic vein has not been explored. Purpose To reveal the frequency of jugular venous reflux using MRA and nuclear venography in patients being evaluated for cerebral volume and blood flow. Material and Methods A total of 229 patients with cognitive disturbance who had undergone brain magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) on the same day to evaluate cerebral blood flow were evaluated. Jugular venous reflux was measured on MRA and nuclear venography, which was conducted just after injection of N-isopropyl-123I-p-iodoamphetamine for the SPECT study. Results MRA showed jugular reflux in seven patients on the right side, and in 22 on the left. Nuclear venography showed jugular reflux in six patients on the right side, and in 20 on the left. Conclusion Jugular venous reflux was observed mostly on the left side. Retrograde flow was observed on both MRA and nuclear venography in half of the cases, with the rest only on one of the modalities. PMID:27994882

  16. Cerebral Accidents in Pediatric Diabetic Ketoacidosis: Different Complications and Different Evolutions.

    PubMed

    Mozzillo, Enza; D'Amico, Alessandra; Fattorusso, Valentina; Carotenuto, Barbara; Buono, Pietro; De Nitto, Elena; Falco, Mariateresa; Franzese, Adriana

    2015-01-01

    Diabetic ketoacidosis (DKA) may be associated with neurologic complications: the most common is cerebral edema while the risk of venous and arterial stroke is rare. There is a pathogenetic link between DKA, hypercoagulability and stroke, whose risk is underestimated by clinicians. Our cases present a wide spectrum of cerebral accidents during DKA, the first one being diffuse cerebral edema, the second one venous stroke after 5 days of DKA resolution, while the third one multifocal edema suspected to be extrapontine myelinolysis although without electrolyte imbalance. Our cases suggest that DKA requires very accurate treatment, particularly at an early age, and it can be complicated by cerebral accidents even with appropriate medical care.

  17. 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.

  18. 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 ...

  19. Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease.

    PubMed

    De Maria, Giovanni Luigi; Kassimis, George; Raina, Tushar; Banning, Adrian P

    2016-08-15

    Coronary sinus interventions (CSI) are a class of invasive techniques (surgical and percutaneous) originally proposed in the first half of the 20th century, aiming to treat ischaemic heart disease by acting on the venous coronary system. Three main classes of CSI have been proposed and tested: (1) retroperfusion technique, (2) retroinfusion technique and (3) coronary sinus occlusion techniques. They all share the principle that a controlled increased pressure within the coronary sinus may promote a retrograde perfusion of the ischaemic myocardium with consequent cardioprotection. Development of arterial treatments including coronary aortic bypass grafting and then percutaneous coronary intervention deflected interest from interventions on the coronary venous system. However, CSI may still have a possible niche role today in specific and selected clinical contexts in which existing therapies are insufficient. In this review paper, we aim to revise the rationale for CSI, describing the details and the evidence collected so far about these techniques and to provide insights about the main clinical scenarios in which these strategies may find a contemporary application in combination or as an alternative to existing approaches.

  20. Beyond the sniffer: frontal sinuses in Carnivora.

    PubMed

    Curtis, Abigail A; Van Valkenburgh, Blaire

    2014-11-01

    Paranasal sinuses are some of the most poorly understood features of mammalian cranial anatomy. They are highly variable in presence and form among species, but their function is not well understood. The best-supported explanations for the function of sinuses is that they opportunistically fill mechanically unnecessary space, but that in some cases, sinuses in combination with the configuration of the frontal bone may improve skull performance by increasing skull strength and dissipating stresses more evenly. We used CT technology to investigate patterns in frontal sinus size and shape disparity among three families of carnivores: Canidae, Felidae, and Hyaenidae. We provide some of the first quantitative data on sinus morphology for these three families, and employ a novel method to quantify the relationship between three-dimensional sinus shape and skull shape. As expected, frontal sinus size and shape were more strongly correlated with frontal bone size and shape than with the morphology of the skull as a whole. However, sinus morphology was also related to allometric differences among families that are linked to biomechanical function. Our results support the hypothesis that frontal sinuses most often opportunistically fill space that is mechanically unnecessary, and they can facilitate cranial shape changes that reduce stress during feeding. Moreover, we suggest that the ability to form frontal sinuses allows species to modify skull function without compromising the performance of more functionally constrained regions such as the nasal chamber (heat/water conservation, olfaction), and braincase (housing the brain and sensory structures).

  1. 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.

  2. Inferior petrosal sinus route microcatheterization study and embolization for primary orbital varix

    PubMed Central

    Singh, Vivek; Udiya, Alok; Shetty, Gurucharan S; Sharma, Kumudini; Kanaujia, Vikas

    2016-01-01

    Purpose Primary orbital varix is a rare lesion but difficult to treat. Our main aim was to demonstrate the varices and their central venous communication and to explore the feasibility of embolization of these lesions. Method In four patients with clinical suspicion of varix, in whom MRI showed retro-global vascular channels, microcatheter digital subtraction angiography (DSA) of the varices was performed using femoral venous access. Embolization was carried out in two patients. Results In all four patients orbital varices could be accessed with a microcatheter through inferior petrosal sinus and ophthalmic vein (superior or inferior) route. Microcatheter angiography showed opacification of varices and demonstrated their central venous communication. Two patients were treated with coil embolization. Complete resolution of symptoms was seen in one patient and partial relief in the other. Conclusion The study presents microcatheterization of orbital varices via the inferior petrosal sinus–cavernous sinus–ophthalmic vein route with injections into distal ophthalmic veins for demonstration of these variceal sacs and their central venous connection. Coiling to disconnect the venous communication should be the primary goal of embolization. PMID:26628456

  3. 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.

  4. Comprehensive review on endonasal endoscopic sinus surgery

    PubMed Central

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  5. Sphenoid sinus barotrauma after scuba diving.

    PubMed

    Jeong, Jin Hyeok; Kim, Kuk; Cho, Seok Hyun; Kim, Kyung Rae

    2012-01-01

    We report the case of an 18-year-old male patient operated on for sphenoid sinus barotrauma after scuba diving. The patient attended our emergency department because of intractable headache but did not improve with conservative treatment. After computed tomography and magnetic resonance imaging examination, he was diagnosed with sphenoid sinusitis that extended to the nasal septum. He therefore underwent surgery for sinus ventilation and abscess drainage.

  6. Odontogenic maxillary sinusitis obscured by midfacial trauma.

    PubMed

    Simuntis, Regimantas; Kubilius, Ričardas; Ryškienė, Silvija; Vaitkus, Saulius

    2015-01-01

    We present a case of odontogenic maxillary sinusitis whose sinonasal symptomatology was thought to be the consequence of a previous midfacial trauma. The patient was admitted to the Clinic of Oral and Maxillofacial Surgery after more than 10 years of exacerbations of sinonasal symptoms, which began to plague soon after a facial contusion. We decided to perform CT of paranasal sinuses, and despite the absence dental symptomatology, the dental origin of sinusitis was discovered. The majority of sinonasal symptoms resolved after appropriate dental treatment, and there was no need for nasal or sinus surgery.

  7. Treatment of chronic sinusitis in a horse with systemic and intra-sinus antimicrobials.

    PubMed

    Gordon, Danielle L; Radtke, Catherine L

    2017-03-01

    A 12-year-old Norwegian Fjord gelding was diagnosed with paranasal sinusitis as a post-operative complication of tooth repulsion surgery. The infection with inspissated purulent material persisted despite sinus trephination and lavage, and systemic antimicrobial therapy. Resolution occurred following infusion of a gelatin/penicillin mixture into the right rostral and caudal maxillary sinus.

  8. 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

  9. 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.

  10. 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.

  11. Treating Sinusitis: Don't Rush to Antibiotics

    MedlinePlus

    ... AAAAI) Treating Sinusitis (AAAAI) Don’t rush to antibiotics DOWNLOAD PDF The sinuses are small, hollow spaces ... or teeth. Each year, millions of people use antibiotic drugs to treat sinus problems. However, they usually ...

  12. How Are Nasal Cavity and Paranasal Sinus Cancers Staged?

    MedlinePlus

    ... nasal cavity or ethmoid sinuses. T categories for maxillary sinus cancer TX: Primary (main) tumor cannot be ... the nose from the brain), and/or the maxillary sinus. T4a: Tumor has grown into other structures ...

  13. Sinus Pain: Can Over-the-Counter Medications Help?

    MedlinePlus

    ... Near You Sinus Pain: Can Over-the-Counter Medications Help? Sinus Pain: Can Over-the-Counter Medications ... OTC) medications. What Is The Role Of OTC Medication For Sinus Pain? There are many different OTC ...

  14. 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

  15. Pseudomeningoceles of the sphenoid sinus masquerading as sinus pathology

    PubMed Central

    Vaezi, Alec; Snyderman, Carl H.; Saleh, Hesham A.; Carrau R., Ricardo L.; Zanation, Adam; Gardner, Paul

    2011-01-01

    Objective To describe the clinical presentation, pathophysiology and treatment of spontaneous cerebrospinal fluid (CSF) leaks of the sphenoid bone, with an emphasis on a previously undescribed form in this location, in which CSF is trapped under the mucosa of the sinonasal cavity or in the soft tissue of the skull base. Study design Case series and literature review. Level of evidence 4. Methods Analysis of cases through medical records and literature review. Results Four examples of unusual spontaneous CSF leaks of the skull base are presented. In each case, a CSF collection was contained behind the sinonasal mucosa of the sphenoid sinus, resembling a nasal polyp or mucocele on exam or imaging. In one case, the fluid collection was also associated with significant bone resorption and extravasation into the soft tissue of the infratemporal fossa. In each case, small defects of the ventral skull base (sphenoid bone) were the source of the CSF leaks. Successful treatment was achieved after transnasal endoscopic repair of the skull base defects using a combination of free abdominal fat grafts, free fascial grafts and pedicled nasoseptal flaps. Postoperatively, a ventriculoperitoneal shunt was placed if the intracranial pressure was elevated. Conclusions Spontaneous CSF leaks arising in the sphenoid sinus may not always present with overt CSF rhinorrhea but with a submucosal fluid collection (pseudomeningocele) that may mimic a mucocoele or nasal polyp. These bona fide pseudomeningoceles of the skull base may be associated with elevated intracranial pressure and can be managed using endoscopic endonasal surgery. PMID:22052361

  16. Cavernous sinus thrombosis during pregnancy.

    PubMed

    López, Fernando; Santamarta, Elena; Martínez, Patricia; Sáiz-Ayala, Antonio; Llorente, José L

    2017-04-01

    Cavernous sinus thrombosis (CST) represents a rare but devastating disease process that may be associated with significant long-term patient morbidity or mortality. Rapid diagnosis and aggressive medical and surgical management are imperative for patients with CST. We present the case of a 24-year-old pregnant woman with intraorbital abscess and CST secondary to Streptococcus milleri. Surgical intervention included orbital abscess drainage and dental extraction, medical therapy included intravenous antibiotic, heparin, and methylprednisolone and an elective cesarean section was performed. The latter was the key point to resolution the disease.

  17. Allergic fungal sinusitis in children.

    PubMed

    Thorp, Brian D; McKinney, Kibwei A; Rose, Austin S; Ebert, Charles S

    2012-06-01

    Allergic fungal sinusitis (AFS) is a subtype of eosinophilic chronic rhinosinusitis (CRS) characterized by type I hypersensitivity, nasal polyposis, characteristic computed tomography scan findings, eosinophilic mucus, and the presence of fungus on surgical specimens without evidence of tissue invasion. This refractory subtype of CRS is of the great interest in the pediatric population, given the relatively early age of onset and the difficulty in managing AFS through commercially available medical regimens. Almost universally, a diagnosis of AFS requires operative intervention. Postoperative adjuvant medical therapy is a mainstay in the treatment paradigm of pediatric AFS.

  18. 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

  19. 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.

  20. 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.

  1. Cerebral infarction due to carotid occlusion and carbon monoxide exposure III. Influence of neck vein occlusion.

    PubMed Central

    Laas, R; Igloffstein, J

    1983-01-01

    Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and a subsequent exposure to carbon monoxide. In animals which had undergone an additional ligation of the external jugular veins leading to a moderate increase of the cephalic venous pressure the outcome of the procedure was ameliorated significantly. Venous pressure elevation was thought to reduce the venous vascular resistance effectively by preventing the leptomeningeal veins from collapsing. Collapse of the leptomeningeal veins probably occurred during the severe carbon monoxide-induced hypotension causing a steep increase of cerebral vascular resistance. Images PMID:6886722

  2. 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.

  3. Maxillary sinus hemangioma: MR and CT studies.

    PubMed

    Kulkarni, M V; Bonner, F M; Abdo, G J

    1989-01-01

    A maxillary sinus hemangioma was detected as an incidental finding during magnetic resonance imaging of the head. The CT findings are more characteristic for the diagnosis of this lesion. Preoperative diagnosis of maxillary sinus hemangioma is important since these lesions can frequently cause a large amount of hemorrhage during surgery.

  4. Paranasal sinus mucoceles: our clinical experiments

    PubMed Central

    Topdag, Murat; Iseri, Mete; Sari, Fatih; Erdogan, Selvet; Keskin, I Gurkan

    2015-01-01

    Objectives: We present the clinical and radiological features, treatment protocols, and medium-long-term results of our patients following surgery for paranasal sinus mucocele, along with a review of the relevant literature. Materials and methods: A total of 18 patients (11 women and 7 men) who underwent surgery for paranasal sinus mucocele at Kocaeli University Faculty of Medicine, Department of Otolaryngology, between 2006 and 2013 were examined retrospectively. The mean patient age was 41 (range 4-73). Demographic and radiological features, symptoms, treatment protocols, and postoperative outcomes were recorded. Results: The most frequently affected sinus was the maxillary sinus (n=9, 50%) followed by the frontal sinus (n=6, 33%) and sphenoidal sinus (n=3, 16%). The main symptom was headache. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the Caldwell-Luc operation was performed in another patient. The Caldwell-Luc procedure was subsequently required in one patient (6%) and endoscopic revision surgery was required in another patient (6%). Conclusion: Sinus mucocele that enlarges, eroding the surrounding bone tissue, and induces various clinical symptoms due to the impression of the expansile mass, is treated surgically, and must be planned carefully to prevent serious complications. PMID:26770462

  5. Cholesterol granuloma of the maxillary sinus.

    PubMed

    Chao, Ting-Kuang

    2006-06-01

    Cholesterol granuloma (CG) of the maxillary sinus is very rare. In this study, the searching of the literature was performed with the keywords of cholesterol granuloma and maxillary sinus. All retrieved literature were reviewed throughout to identify and analyze all individual characteristics. Two additional cases in our hospital were also included. The result showed that, in the overall 37 cases, the ratio of male to female was about 3:1. Caucasian (14/37) and Turkish (10/37) were reported more frequently. CG of maxillary sinus had an opposite sex predilection compared with the fungus balls of the maxillary sinus. In addition, the comorbidity of these two diseases was found only in one patient in the literature. These results suggested that the different mechanisms other than poor aeration of the maxillary sinus played a role in the formation of CG of maxillary sinus. The diagnosis for CG of the maxillary sinus before operation is difficult, but the clear golden yellow rhinorrhea and hemorrhagic signs may provide a good diagnostic evidence. The symptoms were vague and about half of the patients presented with non-specific symptoms. Therefore, it seemed reasonable that CG of the maxillary sinus was under diagnosed in the clinical practice. Treatment consists of complete excision via Caldwell-Luc or endoscopic approach and provides a good prognosis. Bilateral involvements are rare but possible in this disease entity.

  6. [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.

  7. 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

  8. Sinusitis

    MedlinePlus

    ... and face. You may also need imaging tests. Treatments include antibiotics, decongestants, and pain relievers. Using heat pads on the inflamed area, saline nasal sprays, and vaporizers can also help. NIH: National Institute of Allergy and Infectious Diseases

  9. Presentation of Preauricular Sinus and Preauricular Sinus Abscess in Southwest Nigeria

    PubMed Central

    Adegbiji, W. A.; Alabi, B. S.; Olajuyin, O. A.; Nwawolo, C. C.

    2013-01-01

    BACKGROUND AND AIM: Preauricular sinus abscess is a common congenital external ear disease. This abscess is usually misdiagnosed because it is commonly overlooked during physical examination. In Nigeria, the prevalence was 9.3% in Ilorin, north central Nigeria This study is to determine the distribution and clinical presentation of the preauricular sinus abscess in Ekiti, south west Nigeria. MATERIALS AND METHODS: This is a prospective hospital based study of all patients with diagnosis of preauricular sinus abscess seen in our clinic carried out between April 2008 to March 2010. Detailed clinical history, administered interviewer’s assisted questionnaires full examination and. Data obtained were collated and analysed. RESULTS: Preauricular sinus were noticed in 184 (4.4%) out of 4170 patients seen during the study period. Preauricular sinus abscess were noticed in 21 (11.4%) of the preauricular sinuses especially in children. Unilateral preauricular sinus abscess accounted for 90.5%. Common presenting complaints were preauricular swelling (81.0%), 90.5% with recurrent earaches, 76.2% with ear discharges. All patients had antibiotic / analgesic while 17 out of 21 (81.0%) had surgical excisions. CONCLUSION: Preauricular sinus abscess were noticed among 11.4% of the preauricular sinuses especially in children, unilateral preauricular sinus abscess accounted for 90.5%. Common complaints were otorrhoea, earaches, and swelling and they were mostly managed surgically. PMID:24711764

  10. Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting

    PubMed Central

    2016-01-01

    Objectives The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. Materials and Methods The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. Results Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. Conclusion Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis. PMID:27847736

  11. 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.

  12. 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

  13. A rare case of malignant glioma suspected to have arisen from a cavernous sinus.

    PubMed

    Taomoto, Katsushi; Ohnishi, Hideyuki; Kamada, Yoshitaka; Kuga, Yoshihiro; Kohaya, Norimasa; Nakashima, Kazuya; Ichioka, Tsugumichi; Tominaga, Takashi; Nakamura, Mitsutoshi; Nakazato, Yoichi

    2007-01-01

    A 55-year-old woman presented with a right trigeminal dysfunction (dysesthesia) initially, followed by right oculomotor and abducens paresis lasting 1 month. Neuroimaging studies showed an enhanced mass in the right cavernous sinus extending to the trigeminal ganglion. The extraparenchymal tumor located around the right trigeminal ganglion was totally removed, except for an intracavernous lesion, by the orbitozygomatic approach. The solid tumor was completely separated from the brainstem and seemed to be a trigeminal schwannoma arising from the trigeminal ganglion or cavernous sinus at surgery. A histological examination, however, found a typical malignant glioma that consisted primarily of astrocytic tumor cells. Immunohistochemical staining showed the tumor cells stained intensely for GFAP, S-100 protein, and vimentin, but not for NFP, Schwann/2E, CD34, and CD68. The mean MIB-1 index was 12.4%. The tumor recurred after a short time, and then it rapidly disseminated into the subarachnoid space and left the cerebral hemisphere. The patient died 1 year after the initial symptoms in spite of aggressive surgery, radiation, and chemotherapy with temozolomide. There are no previous reports of a malignant glioma arising from either the cavernous sinus or the trigeminal ganglion. From the pathogenetic point of view, this malignant glioma is an extremely rare case that developed clinically and neuroradiologically from the cavernous sinus and was suspected be being derived from ectopic glial tissue.

  14. [Compound odontoma as a cause of chronic maxillary sinusitis].

    PubMed

    Crespo Del Hierro, Jorge; Ruiz González, Manuel; Delgado Portela, Margarita; García Del Castillo, Eduardo; Crespo Serrano, Juan

    2008-01-01

    Sinusitis of dental origin is a relatively frequent entity, but the presence of an odontoma in the sinus as a source of this pathology is exceptional. Here we present a case of a young patient who presented chronic maxillary sinusitis over 2 years, originating in an odontoma located in the sinus drainage area.

  15. Acute cerebrovascular incident in a young woman: Venous or arterial stroke? – Comparative analysis based on two case reports

    PubMed Central

    Sleiman, Katarzyna; Zimny, Anna; Kowalczyk, Edyta; Sąsiadek, Marek

    2013-01-01

    Summary Background Cerebrovascular diseases are the most common neurological disorders. Most of them are arterial strokes, mainly ischemic, less often of hemorrhagic origin. Changes in the course of cerebral venous thrombosis are less common causes of acute cerebrovascular events. Clinical and radiological presentation of arterial and venous strokes (especially in emergency head CT) may pose a diagnostic problem because of great resemblance. However, the distinction between arterial and venous stroke is important from a clinical point of view, as it carries implications for the treatment and determinates patient’s prognosis. Case Report In this article, we present cases of two young women (one with an acute venous infarction, the second with an arterial stroke) who presented with similar both clinical and radiological signs of acute vascular incident in the cerebral cortex. We present main similarities and differences between arterial and venous strokes regarding the etiology, clinical symptoms and radiological appearance in various imaging techniques. Conclusions We emphasize that thorough analysis of CT (including cerebral vessels), knowledge of symptoms and additional clinical information (e.g. risk factors) may facilitate correct diagnosis and allow planning further diagnostic imaging studies. We also emphasize the importance of MRI, especially among young people, in the differential diagnosis of venous and arterial infarcts. PMID:24505227

  16. Exostoses and cavernous venous formation in the external auditory canal of the hooded seal as a functional physiological organ.

    PubMed

    Stenfors, L E; Sade, J; Hellström, S; Anniko, M; Folkow, L

    2000-10-01

    Exostoses of the external auditory canal (EAC) develop after protracted mechanical, chemical or thermal irritation in particular. This is a common disorder among aquatic sportsmen and has been considered unique to Man. We dissected and photodocumented the EACs of 5 newborn and 3 adult Hooded Seals (Cystophora cristata). Serial sections of the EACs were prepared for light microscopic evaluation after staining with haematoxylin-eosin or toluidine blue. All EACs exhibited a firm, broad-based. mountain peak-shaped exostosis on the floor of the meatus, lateral to the eardrum. In addition, the meatal skin of the bony EAC harboured large venous sinuses. The exostosis and venous sinuses of the seal EAC participate in the protection of the sensitive hearing apparatus, particularly the pars tensa portion of the drum, during divine.

  17. Isolated sphenoid sinus lesion: A diagnostic dilemma

    PubMed Central

    Alazzawi, Sarmad; Shahrizal, Tengku; Prepageran, Narayanan; Pailoor, Jayalakshmi

    2014-01-01

    Isolated sphenoid sinus lesions are an uncommon entity and present with non-specific symptoms. In this case report, the patient presented with a history of headaches for a duration of one month without sinonasal symptoms. A computed tomography scan showed a soft tissue mass occupying the sphenoid sinus. An endoscopic biopsy revealed fungal infection. Endoscopic wide sphenoidotomy with excision of the sphenoid sinus lesion was then performed however, the microbiological examination post-surgery did not show any fungal elements. Instead, Citrobacter species was implicated to be the cause of infection. PMID:25320694

  18. Chronic Cutaneous Draining Sinus of Dental Origin

    PubMed Central

    Sisodia, N; Manjunath, MK

    2014-01-01

    Extra oral sinus of odontogenic origin occurs when the purulent by-products of dental pulp necrosis spread along the path of least resistance from the root apex to the skin on the face. Patients presenting with cutaneous sinus usually visit a general physician or dermatologist first, as the lesion can mimic various dermatologic pathologies, ranging from an infected sebaceous cysts to a basal cell carcinoma. Despite systemic antibiotics, symptoms often persist causing further confusion, and at times leading to unnecessary surgical interventions. The location of this sinus in the head and neck region should lead the physician to seek a dental opinion in order to avoid misdiagnosis. PMID:25506495

  19. A Rational Approach to Sinus Augmentation: The Low Window Sinus Lift

    PubMed Central

    Zaniol, Alex

    2017-01-01

    Sinus augmentation is a well-known approach to treating alveolar bone ridge atrophy in the posterior maxilla. The preparation of the lateral window is crucial. Its size, design, and position in the vestibular sinus wall may affect the intra- and postsurgical complication rates and affect the intrasurgical activity of both surgeons and assistants. The present paper describes a rational technique that also exploits the guided surgery approach for design and preparation of a lateral window for sinus augmentation, the Low Window Sinus Lift. To illustrate the use of this approach, a case is presented in which the 50-year-old patient had the left maxillary first molar extracted, followed two months later by sinus augmentation and placement of three implants. One year after delivery of the definitive prosthesis, all three implants were successful, and the prosthesis was fully functional. Controlled studies should be undertaken to assess whether this technique provides significant advantages compared to other sinus augmentation approaches. PMID:28337349

  20. Cardiac resynchronization therapy with special focus on patency of coronary sinus and its branches: conceptual viewpoint and semi-theoretical considerations on lead-induced obstruction.

    PubMed

    Stirbys, Petras

    2006-01-01

    Cardiac resynchronization therapy appears to be useful for patients with severe chronic congestive heart failure. However, many questions still arise concerning the effectiveness of this kind of therapy since hemodynamic improvement is not observed in all patients. Heterogeneity of conclusions reported by several multicenter clinical trials and prominent experts demonstrates that many uncertainties related to cardiac resynchronization therapy still exist. We tried to reveal some inadequacies in clinical results by focusing on cardiac venous blood return which is likely complicated by the presence of lead inside the coronary sinus and its branches. Downstream traversing lead may occlude (partially or completely) the ostia of minor tributaries and target vein of lead final positioning. Thrombosis may also be incited within the coronary sinus itself. Remaining lumen predetermined by the lead body and subsequent thrombosis may be insufficient to provide adequate blood flow. Resulting detrimental venous return presumably may slightly depress myocardial contractility which may be significant in very sensitive group of patients assigned to the New York Heart Association class III or IV. Cardiac venous blood pumping conditions (or venous drainage) are likely also complicated by abnormal activation of left ventricle. The contributory role of these two subtle causes unfavorably influencing venous drainage is still unknown. It may be treated as a hypothetical attempt to find the clue and needs future studies for verification.

  1. Cerebral Paragonimiasis.

    PubMed

    Miyazaki, I

    1975-01-01

    The first case of cerebral paragonimiasis was reported by Otani in Japan in 1887. This was nine years after Kerbert's discovery of the fluke in the lungs of Bengal tigers and seven years after a human pulmonary infection by the fluke was demonstrated by Baelz and Manson. The first case was a 26-year-old man who had been suffering from cough and hemosputum for one year. The patient developed convulsive seizures with subsequent coma and died. The postmortem examination showed cystic lesions in the right frontal and occipital lobes. An adult fluke was found in the occipital lesion and another was seen in a gross specimen of normal brain tissue around the affected occipital lobe. Two years after Otani's discovery, at autopsy a 29-year-old man with a history of Jacksonian seizure was reported as having cerebral paragonimiasis. Some time later, however, it was confirmed that the case was actually cerebral schistosomiasis japonica. Subsequently, cases of cerebral paragonimiasis were reported. However, the majority of these cases were not confirmed histologically. It was pointed out that some of these early cases were probably not Paragonimus infection. After World War II, reviews as well as case reports were published. Recently, investigations have been reported from Korea, with a clinicla study on 62 cases of cerebral paragonimiasis seen at the Neurology Department of the National Medical Center, Seoul, between 1958 and 1964. In 1971 Higashi described a statistical study on 105 cases of cerebral paragonimiasis that had been treated surgically in Japan.

  2. A Case of Arterial and Venous Tear during Single Lead Extraction.

    PubMed

    Green, Michael S; Wu, Daniel; Patel, Vishal; Tariq, Rayhan

    2016-01-01

    Transcutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extraction of a 6-year-old implantable cardioverter-defibrillator lead due to fracture from insulation break. During the lead extraction, blood pressure fell precipitously and echocardiographic findings were consistent with pericardial effusion. After unsuccessful pericardiocentesis, open chest sternotomy and evacuation of hematoma was performed. Subsequent surgical repair of several injuries was completed including the distal coronary sinus, a large degloving injury of posterior portion of the heart, and first obtuse marginal branch bleed. This case demonstrates that when performing transcutaneous lead extraction (TLE) with laser sheath, a degloving injury can cause arterial rupture with concomitant coronary sinus injury. A multidisciplinary team-based approach can ensure patient safety. Learning Objective. Implantable cardioverter-defibrillator leads will falter over time. With the advancement of new technology for extraction more frequent and serious complications will occur. Active fixation CS leads present unique challenges. In the presence of hemodynamic changes during extraction the occurrence of both an arterial and venous injury must be considered.

  3. Hyperhomocysteinaemia and chronic venous ulcers.

    PubMed

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

    2015-02-01

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

  4. Effects of mild (33 degrees C) and moderate (29 degrees C) hypothermia on cerebral blood flow and metabolism, lactate, and extracellular glutamate in experimental head injury.

    PubMed

    Mori, K; Maeda, M; Miyazaki, M; Iwase, H

    1998-12-01

    The effects of mild (33 degrees C) and moderate (29 degrees C) hypothermia were investigated to determine which temperature was more effective against compression-induced cerebral ischemia. Eighteen cats were anesthetized. The animals were divided into three groups according to deep-brain temperature (control, 37 degrees C; mild hypothermia, 33 degrees C; and moderate hypothermia, 29 degrees C). Intracranial pressure (ICP) and cerebral blood flow (CBF) were monitored, the latter by hydrogen clearance. Arteriovenous oxygen difference (AVDO2) and cerebral venous oxygen saturation (ScvO2) were measured in blood samples from the superior sagittal sinus. The cerebral metabolic rate of oxygen (CMRO2) and the cerebral metabolic rate of lactate (CMR lactate) were calculated. Extracellular glutamate was measured by microdialysis. ICP was increased by inflation of an epidural balloon until CBF became zero, and this ischemia was maintained for 5 min, after which the balloon was quickly deflated. All parameters were recorded over 6 h. Evans blue was injected to examine vascular permeability changes. CBF was decreased by 56% by mild hypothermia and by 77% by moderate hypothermia. Mild hypothermia had a coupled metabolic suppression whereas moderate hypothermia significantly increased AVDO2 and decreased ScvO2, producing a low CBF/CMRO2 (relative ischemia). After balloon deflation, all three groups showed reactive hyperemia, which was significantly reduced by mild and moderate hypothermia. CBF then decreased to 50% of pre-inflation values and ScvO2 decreased (post-ischemic hypoperfusion). CBF/CMRO2, ScvO2, and AVDO2 did not differ significantly between the three groups. After balloon deflation, all three groups showed increased CMR lactate, which was significantly reduced by mild and moderate hypothermia. Extracellular glutamate increased in control animals (3.8 +/- 1.72 microM), an effect most effectively suppressed in the mild hypothermia group (1.0 +/- 0.46 microM). Damaged

  5. Cerebral Palsy (For Parents)

    MedlinePlus

    ... Old Feeding Your 1- to 2-Year-Old Cerebral Palsy KidsHealth > For Parents > Cerebral Palsy A A A ... kids who are living with the condition. About Cerebral Palsy Cerebral palsy is one of the most common ...

  6. Cerebral palsy - resources

    MedlinePlus

    Resources - cerebral palsy ... The following organizations are good resources for information on cerebral palsy : National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy. ...

  7. Autoregulation of cerebral blood circulation under orthostatic tests

    NASA Technical Reports Server (NTRS)

    Gayevyy, M. D.; Maltsev, V. G.; Pogorelyy, V. E.

    1980-01-01

    Autoregulation of cerebral blood flow (ACBF) under orthostatic tests (OT) was estimated in acute experiments on rabbits and cats under local anesthesia according to changes of perfusion pressure (PP) in carotid arteries, cerebral blood flow, pressure in the venous system of the brain, and resistance of cerebral vessels. The OT were conducted by turning a special table with the animal fastened to it from a horizontal to a vertical (head up or head down) position at 40 to 80 deg. In most experiments ACBF correlated with the changes of PP. Different variations of ACBF and its possible mechanisms are discussed.

  8. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  9. Palatal sinus elevation revisited: a technical note.

    PubMed

    Seemann, Rudolf; Wagner, Florian; Ewers, Rolf; Ulm, Christian

    2013-08-01

    The palatal sinus lift is a good choice for patients with scarred buccal soft tissue and those with poor wound healing such as smokers or diabetics or when visual side effects such as swelling must be concealed. We provide a surgical protocol for palatal sinus lifting without a vertical release incision. The incision is started in a slightly palatal aspect, at the distal end of the dental arch, and describes a curve laterally on the alveolar crest while running in a mesial direction. As a marginal incision, it can continue to the central incisor. Submucosal exposure will lift the gum and the greater palatine artery. After insertion of a tongue depressor, the sinus is opened on the palatal side, opposite the zygomaticoalveolar crest, using a rose bur or a piezotome. After sinus augmentation, the incision is easy to close, and the wound will heal smoothly.

  10. Frontal sinus recognition for human identification

    NASA Astrophysics Data System (ADS)

    Falguera, Juan Rogelio; Falguera, Fernanda Pereira Sartori; Marana, Aparecido Nilceu

    2008-03-01

    Many methods based on biometrics such as fingerprint, face, iris, and retina have been proposed for person identification. However, for deceased individuals, such biometric measurements are not available. In such cases, parts of the human skeleton can be used for identification, such as dental records, thorax, vertebrae, shoulder, and frontal sinus. It has been established in prior investigations that the radiographic pattern of frontal sinus is highly variable and unique for every individual. This has stimulated the proposition of measurements of the frontal sinus pattern, obtained from x-ray films, for skeletal identification. This paper presents a frontal sinus recognition method for human identification based on Image Foresting Transform and shape context. Experimental results (ERR = 5,82%) have shown the effectiveness of the proposed method.

  11. The forensic importance of frontal sinus radiographs.

    PubMed

    da Silva, Rhonan Ferreira; Prado, Felippe Bevilacqua; Caputo, Isamara Geandra Cavalcanti; Devito, Karina Lopes; Botelho, Tessa de Luscena; Daruge Júnior, Eduardo

    2009-01-01

    The identification of unidentified human remains through the comparison of antemortem and postmortem radiographs has found wide acceptance in recent years. Reported here is the forensic case of an unidentified adult male who had died as the result of a traffic accident, after which the body was identified by matching images of ante- and postmortem radiographs of the frontal sinus. A general discussion on identification using frontal sinus radiographs is presented, highlighting the reliability of this method, in reference to the uniqueness of the frontal sinus in humans. However, it also notes a few difficulties, especially in reference to the X-ray technique in cases where antemortem radiographs are available and a potentially larger number of anatomical, pathological or traumatic features are present. The comparison of frontal sinus outlines is recommended when it may become necessary to provide quantitative substantiation for forensic identification based on these structures.

  12. Major orbital complications of endoscopic sinus surgery

    PubMed Central

    Rene, C; Rose, G; Lenthall, R; Moseley, I

    2001-01-01

    BACKGROUND—The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss.
METHODS—A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery.
RESULTS—All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply.
CONCLUSION—Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed. 

 PMID:11316724

  13. Is Prolactin Measurement of Value during Inferior Petrosal Sinus Sampling in Patients with ACTH-dependent Cushing’s Syndrome?

    PubMed Central

    Sharma, S. T.; Nieman, L. K.

    2014-01-01

    Inferior petrosal sinus sampling (IPSS) is considered the gold standard test to distinguish between Cushing’s disease (CD) and ectopic ACTH syndrome (EAS). Anomalous venous drainage, abnormal venous anatomy and lack of expertise can lead to false-negative IPSS results and thereby misclassification of patients with ACTH-dependent Cushing’s syndrome. Prolactin measurement during IPSS can improve diagnostic accuracy and decrease false negative results. A baseline prolactin inferior petrosal sinus to peripheral (IPS/P) ratio (ipsilateral to the dominant post-CRH ACTH IPS/P ratio) of 1.8 or more suggests successful catheterization during IPSS. Prolactin-normalized ACTH IPS/P ratios can then be used to differentiate between a pituitary and ectopic source of ACTH. Values ≤ 0.7 are suggestive of EAS and those ≥ 1.3 are indicative of CD but the implication of values between 0.7 and 1.3 remains unclear and needs further investigation. Larger prospective studies are also needed for further evaluation of the role of contralateral prolactin IPS/P ratios, post-CRH prolactin values and prolactin-adjusted ACTH inter-sinus ratios for tumor localization in CD. PMID:23887034

  14. Subpubic sinus: a remnant of cloaca.

    PubMed

    Chou, T D; Chu, C C; Diau, G Y; Chiang, J H

    1995-05-01

    A 14-month-old girl had purulent discharge from a sinus over the subpubic region for 2 weeks. Radiography and voiding cystourethrography revealed a 4.5 cm. long fistula extending to the retropubic region without any connection to the lower urinary tract. The fistula was excised. Histological findings revealed that the fistula had 3 different types of epithelium: stratified squamous, transitional and columnar. Clinical and pathological findings indicated that the sinus was most likely a remnant of the cloaca.

  15. Sinus Venosus Atrial Septal Defect Complicated by Eisenmenger Syndrome and the Role of Vasodilator Therapy

    PubMed Central

    Anuwatworn, Amornpol; Bendaly, Edgard; Prescott-Focht, Julia A.; Clark, Richard; Jonsson, Orvar

    2016-01-01

    Sinus venosus atrial septal defect is a rare congenital, interatrial communication defect at the junction of the right atrium and the vena cava. It accounts for 5–10% of cases of all atrial septal defects. Due to the rare prevalence and anatomical complexity, diagnosing sinus venous atrial septal defects poses clinical challenges which may delay diagnosis and treatment. Advanced cardiac imaging studies are useful tools to diagnose this clinical entity and to delineate the anatomy and any associated communications. Surgical correction of the anomaly is the primary treatment. We discuss a 43-year-old Hispanic female patient who presented with dyspnea and hypoxia following a laparoscopic myomectomy. She had been diagnosed with peripartum cardiomyopathy nine years ago at another hospital. Transesophageal echocardiography and computed tomographic angiography of the chest confirmed a diagnosis of sinus venosus atrial septal defect. She was also found to have pulmonary arterial hypertension and Eisenmenger syndrome. During a hemodynamic study, she responded to vasodilator and she was treated with Ambrisentan and Tadalafil. After six months, her symptoms improved and her pulmonary arterial hypertension decreased. We also observed progressive reversal of the right-to-left shunt. This case illustrates the potential benefit of vasodilator therapy in reversing Eisenmenger physiology, which may lead to surgical repair of the atrial septal defect as the primary treatment. PMID:27974976

  16. 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.

  17. Configuration of frontal sinuses: A forensic perspective

    PubMed Central

    Suman, Jhansi Lakshmi; Jaisanghar, Nallusamy; Elangovan, Somasundaram; Mahaboob, Nazargi; Senthilkumar, Balasubramaniyan; Yoithapprabhunath, Thukanayakanpalayam Ragunathan; Srichinthu, Kenniyan Kumar

    2016-01-01

    Background: Identification of an individual whether living or deceased is of paramount importance in maintaining the integrity of the society. A simple, reliable, and efficacious method always finds a way for easier acceptance and inclusion in any discipline. Likewise, identification of an individual using the radiographic frontal sinus patterns is a simple technique which emphasized to conduct the study with a proven result. Objective: The objective of the study is to evaluate the radiographic configurations of frontal sinuses for their uniqueness based on different parameters. Study Group and Methods: Study group consisted of thirty individuals (15 males and 15 females) of age between 20 and 30. Individuals with the history of sinusitis, surgery, or any trauma were not included in the study. Paranasal sinus views were taken using standard exposure parameters, and the radiographs were assessed for their uniqueness. Results: The radiographs were assessed for area size, area asymmetry, superiority of the upper border, outline of the upper border, presence or absence of partial septa and supraorbital cells, and based on these results, a unique code number was assigned to each individual to prove the uniqueness. Conclusion: A frontal sinus comparison is particularly useful when no other means of an individual identification are available. Caution must be taken regarding the physiological and pathological changes (trauma, infection, old age, surgery, etc.) and postmortem changes and about the technical issues while taking a radiograph (distance, angle, orientation of the skull). In spite of all these issues, the configuration of frontal sinus is an excellent individualizing feature. PMID:27829755

  18. High temporal resolution MRI quantification of global cerebral metabolic rate of oxygen consumption in response to apneic challenge.

    PubMed

    Rodgers, Zachary B; Jain, Varsha; Englund, Erin K; Langham, Michael C; Wehrli, Felix W

    2013-10-01

    We present a technique for quantifying global cerebral metabolic rate of oxygen consumption (CMRO2) in absolute physiologic units at 3-second temporal resolution and apply the technique to quantify the dynamic CMRO2 response to volitional apnea. Temporal resolution of 3 seconds was achieved via a combination of view sharing and superior sagittal sinus-based estimation of total cerebral blood flow (tCBF) rather than tCBF measurement in the neck arteries. These modifications were first validated in three healthy adults and demonstrated to produce minimal errors in image-derived blood flow and venous oxygen saturation (SvO2) values. The technique was then applied in 10 healthy adults during an apnea paradigm of three repeated 30-second breath-holds. Subject-averaged baseline tCBF, arteriovenous oxygen difference (AVO2D), and CMRO2 were 48.6 ± 7.0 mL/100 g per minute, 29.4 ± 3.4 %HbO2, and 125.1 ± 11.4 μmol/100 g per minute, respectively. Subject-averaged maximum changes in tCBF and AVO2D were 43.5 ± 9.4% and -32.1 ± 5.7%, respectively, resulting in a small (6.0 ± 3.5%) but statistically significant (P=0.00044, two-tailed t-test) increase in average end-apneic CMRO2. This method could be used to investigate neurometabolic-hemodynamic relationships in normal physiology, to better define the biophysical origins of the BOLD signal, and to quantify neurometabolic responsiveness in diseases of altered neurovascular reactivity.

  19. 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.

  20. Cerebral palsy.

    PubMed

    Colver, Allan; Fairhurst, Charles; Pharoah, Peter O D

    2014-04-05

    The syndrome of cerebral palsy encompasses a large group of childhood movement and posture disorders. Severity, patterns of motor involvement, and associated impairments such as those of communication, intellectual ability, and epilepsy vary widely. Overall prevalence has remained stable in the past 40 years at 2-3·5 cases per 1000 livebirths, despite changes in antenatal and perinatal care. The few studies available from developing countries suggest prevalence of comparable magnitude. Cerebral palsy is a lifelong disorder; approaches to intervention, whether at an individual or environmental level, should recognise that quality of life and social participation throughout life are what individuals with cerebral palsy seek, not improved physical function for its own sake. In the past few years, the cerebral palsy community has learned that the evidence of benefit for the numerous drugs, surgery, and therapies used over previous decades is weak. Improved understanding of the role of multiple gestation in pathogenesis, of gene environment interaction, and how to influence brain plasticity could yield significant advances in treatment of the disorder. Reduction in the prevalence of post-neonatal cerebral palsy, especially in developing countries, should be possible through improved nutrition, infection control, and accident prevention.

  1. 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.

  2. Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis

    SciTech Connect

    Bardin, P.G.; Van Heerden, B.B.; Joubert, J.R. )

    1990-07-01

    The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways.

  3. Sisters of the sinuses: cetacean air sacs.

    PubMed

    Reidenberg, Joy S; Laitman, Jeffrey T

    2008-11-01

    This overview assesses some distinguishing features of the cetacean (whale, dolphin, porpoise) air sac system that may relate to the anatomy and function of the paranasal sinuses in terrestrial mammals. The cetacean respiratory tract has been modified through evolution to accommodate living in water. Lack of paranasal sinuses in modern cetaceans may be a diving adaptation. Bone-enclosed air chambers are detrimental, as their rigid walls may fracture during descent/ascent due to contracting/re-expanding air volumes. Flexible-walled "sinuses" (extracranial diverticula) are a logical adaptation to diving. Odontocetes (toothed whales) exhibit several pairs of paranasal air sacs. Although fossil evidence indicates that paranasal sinuses occur in archaeocetes (ancestors/relatives of living cetaceans), it is not known whether the paranasal sacs derive from these sinuses. Sac pigmentation indicates that they derived from invaginations of the integument. Unlike sinuses, paranasal sacs are not circumferentially enclosed in bone, and therefore can accommodate air volume changes that accompany diving pressure changes. Paired pterygoid sacs, located ventrally along the cetacean skull, connect the pharynx and middle ear cavities. Mysticetes (baleen whales) have a large midline laryngeal sac. Although cetacean air sacs do not appear to be homologous to paranasal sinuses, they may serve some analogous respiratory, vocal, or structural functions. For example, these sacs may participate in gas exchange, thermoregulation, resonance, and skeletal pneumatization. In addition, they may subserve unique aquatic functions, such as increasing inspiratory volume, mitigating pressure-induced volume change, air shunting to reduce respiratory dead space, and facilitating underwater sound production and transmission.

  4. [Effects of combined action of radon baths and transcranial magnetotherapy on cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma].

    PubMed

    Moliavchikova, O V; Cherevashchenko, L A; Grinzaĭd, Iu M; Aĭvazov, V N; Zhuravlev, M E

    2007-01-01

    The authors propose combined therapy improving cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma. The combination consists of radon baths and transcranial magnetotherapy which raise blood volume filling, relieve vascular resistance, improve venous outflow.

  5. What's New in Nasal Cavity and Paranasal Sinus Cancer Research and Treatment?

    MedlinePlus

    ... About Nasal Cavity and Paranasal Sinus Cancer What’s New in Nasal Cavity and Paranasal Sinus Cancer Research ... About Nasal Cavity and Paranasal Sinus Cancers? What’s New in Nasal Cavity and Paranasal Sinus Cancer Research ...

  6. Cerebral ischaemia: A neuroradiological study

    SciTech Connect

    Bories, J.

    1985-01-01

    After a brief clinical and pathophysiological approach, the papers presented in this book are devoted to CT and angiography. Concerning CT, a particular study has been made of cerebral arterial territories on cuts parallel to the orbito-meatal line: these are very important in making the differential diagnosis from some tumors. Also concerning CT, a paper has been devoted to cerebral ''lacunae.'' The term ''lacuna'' as far as CT imaging is concerned, should be reserved only for those hypodense areas corresponding to small cavities containing fluid, which are sequelae of infarcts in the territory of penetrating arteries. Before this sequellar state come all the evolutive states of a small deep infarct. The angiographic study specifies the indications of angiography in the study of cerebral ischemia, and the techniques to be used. It shows the main etiologic aspects. Because of the important place of vascular surgery today, it seemed necessary to show also the main post operative angiographic aspects. After CT and angiography, some pages are reserved to more modern techniques. Finally, some pages are devoted to certain particular associations and etiologies: childhood, cardiopathies, migraine, oral contraception and end with venous infarction.

  7. 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.

  8. Cerebral Malaria.

    PubMed

    Marsden, P D; Bruce-Chwatt, L J

    1975-01-01

    Cerebral malaria is an acute diffuse encephalopathy associated only with Plasmodium falciparum. It is probably a consequence of the rapid proliferation of the parasites in the body of man in relation to red cell invasion, and results in stagnation of blood flow in cerebralcapillaries with thromobotic occlusion of large numbers of cerebral capillaries. The subsequent cerebral pathology is cerebral infarction with haemorrhage and cerebral oedema. The wide prevalence of P. falciparum in highly endemic areas results in daily challenges to patients from several infected mosquitoes. It is thus important to understand the characteristics of P. falciparum, since this is one of the most important protozoan parasites of man and severe infection from it constitutes one of the few real clinical emergencies in tropical medicine. One of the more important aspects of the practice of medicine in the tropics is to establish a good understanding of the pattern of medical practice in that area. This applies to malaria as well as to other diseases. The neophyte might be somewhat surprised to learn, for example that an experienced colleague who lives in a holoendemic malarious area such as West Africa, sees no cerebral malaria. But the explanation is simple when the doctor concerned has a practice which involves treating adults only. Cerebral malaria is rare in adults, because in highly endemic areas, by the age of 1 year most of the infants in a group under study have already experienced their first falciparum infection. By the time they reach adult life, they have a solid immunity against severe falciparum infections. In fact, "clinical malaria" could occur in such a group under only two circumstances: 1) in pregnancy, a patent infection with P. falciparum might develop, probably due to an IgG drain across the placenta to the foetus;2) in an individual who has constantly taken antimalarials and who may have an immunity at such a low level that when antimalarial therapy is interrupted

  9. Rheoreceptors in the carotid sinus of dog.

    PubMed Central

    Hajduczok, G; Chapleau, M W; Abboud, F M

    1988-01-01

    The arterial baroreceptors are known to be sensitive to changes in pressure but there are no known sensors in the cardiovascular system for changes in flow. We tested the hypothesis that changes in flow at constant pressure alter carotid sinus multi-unit nerve activity. In anesthetized dogs with vascularly isolated carotid sinuses, increases in flow at constant pressure resulted in increases in carotid sinus nerve activity in relation to the increase in flow. The increased activity during flow was not caused by an increase in strain of the sinus wall but was directly related to the increase in shear stress (36.6 +/- 11.7% increase in activity per dyne/cm2; 1 dyne = 0.1 MN). The pressure threshold of single baroreceptor units was determined during a slow pressure ramp with and without flow. Flow caused a significant decrease in pressure threshold from 81.1 +/- 6.1 mmHg (1 mmHg = 1.333 x 10(2) Pa) in the absence of flow to 69.3 +/- 5.7 mmHg with flow. We conclude that there are arterial "rheoreceptors" in the carotid sinus that respond to flow at constant pressure and strain. The results with single baroreceptor units indicate also that baroreceptors may be sensitized by increases in flow. Thus, changes in flow per se in addition to changes in arterial pressure may be important determinants of reflex circulatory adjustments. PMID:3174642

  10. 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

  11. Foetal supraventricular tachycardia and cerebral complications.

    PubMed

    Sonesson, S E; Winberg, P; Lidegran, M; Westgren, M

    1996-10-01

    We report on two newborn infants with foetal tachycardia and cerebral lesions. Using foetal echocardiography, the diagnosis of supraventricular tachycardia in a structurally normal heart was made at 28 and 37 weeks of gestation, respectively. One infant had a 3 week period of foetal tachycardia and hydrops before successful pharmacological cardioversion. Even several weeks after a term birth he remained hypotonic and needed gavage feeding. A computed tomography (CT) scan demonstrated cerebral lesions indicating a vascular origin. A possible thrombus was found in the heart. The other infant converted to sinus rhythm during birth by Caesarean section on the day after diagnosis. He had convulsions at the second day of life. On CT scan an infarction was found. The observations of this report suggest that cerebrovascular complications to foetal arrhythmias are more common than previously observed and should be considered when managing cases of foetal tachycardia.

  12. 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.

  13. Endovascular treatment of a traumatic dural arteriovenous fistula of the superior sagittal sinus using dual lumen balloon microcatheter

    PubMed Central

    Tao, Yihao; Niu, Yin; Zhu, Gang; Chen, Zhi

    2016-01-01

    Dural arteriovenous fistula (DAVFs) induced by trauma in the superior sagittal sinus (SSS) are rare and difficult to treat because of their unique midline location, multiplicity of arterial feeders, and critical venous drainage. We report a case of an endovascular treatment using dual lumen balloon microcatheter on a patient with post-traumatic SSS DAVF. By the use of dual lumen Scepter balloon microcatheter, proximal Onyx reflux was prevented. In this case, complete embolization of the DAVFs was achieved and the outcome of the patient was fairly good. PMID:27094527

  14. Device sizing for transcatheter closure of ruptured sinus of Valsalva as per echocardiography color Doppler turbulent flow jet diameter.

    PubMed

    Ahmed, Khurshid; Munawar, Muhammad; Chakraborty, Rabin; Hartono, Beny; Yusri, Achmad

    2015-01-01

    Rupture of sinus of Valsalva (SV) is a rare occurrence with a wide spectrum of presentation, ranging from an asymptomatic murmur to cardiogenic shock or even sudden cardiac death. We hereby report a case which was successfully closed by transcatheter technique. In this case, ruptured SV was entered from the aorta, an arteriovenous loop was created and device was implanted using a venous approach. The procedure was safe, effective and uncomplicated, obviating the need for surgery. In this case, the authors report for the first time the use of echo color Doppler turbulent flow jet diameter as a reference value for sizing the device.

  15. Paranasal Sinus and Nasal Cavity Cancer (Treatment Options by Stage)

    MedlinePlus

    ... tumor sizes. The following stages are used for maxillary sinus cancer: Stage 0 (Carcinoma in Situ) In ... are found in the innermost lining of the maxillary sinus . These abnormal cells may become cancer and ...

  16. Stages of Paranasal Sinus and Nasal Cavity Cancer

    MedlinePlus

    ... tumor sizes. The following stages are used for maxillary sinus cancer: Stage 0 (Carcinoma in Situ) In ... are found in the innermost lining of the maxillary sinus . These abnormal cells may become cancer and ...

  17. Treatment Option Overview (Paranasal Sinus and Nasal Cavity Cancer)

    MedlinePlus

    ... tumor sizes. The following stages are used for maxillary sinus cancer: Stage 0 (Carcinoma in Situ) In ... are found in the innermost lining of the maxillary sinus . These abnormal cells may become cancer and ...

  18. General Information about Paranasal Sinus and Nasal Cavity Cancer

    MedlinePlus

    ... tumor sizes. The following stages are used for maxillary sinus cancer: Stage 0 (Carcinoma in Situ) In ... are found in the innermost lining of the maxillary sinus . These abnormal cells may become cancer and ...

  19. Prevalence of fungal infection among Iranian patients with chronic sinusitis.

    PubMed

    Naghibzadeh, B; Razmpa, E; Alavi, Sh; Emami, M; Shidfar, M; Naghibzadeh, Gh; Morteza, A

    2011-02-01

    Chronic sinusitis is a major cause of morbidity today. Regional variations in the incidence of this disease have been reported. The aim of this study was to evaluate the incidence of fungal infection as the causative agent of chronic sinusitis among Iranian patients. A cross sectional hospital based study was designed; the patients underwent paranasal sinus washing and maxillary sinus biopsy. All specimens were studied by light microscopy. Fungal culturing was employed to confirm diagnosis. The patients underwent Computed Tomography for sinus evaluation. Of 162 participants, 12 samples from patients showed fungal elements, 2 of them Aspergillus fulvous (1.2%), 9 of them Alternaria species (5.56%) and 1 of them Psilomysis (0.6%). All patients presented radiologic evidence of sinusitis, ranging from mucosal thickening to total opacity. In conclusion, results obtained showed a low prevalence of fungal sinusitis among Iranian patients with chronic sinusitis. Findings also showed that Alternaria is the most causative agent.

  20. Paecilomyces lilacinus as the cause of chronic maxillary sinusitis.

    PubMed Central

    Rockhill, R C; Klein, M D

    1980-01-01

    Paecilomyces lilacinus was isolated on two separate occasions from the left antrum of a patient with chronic maxillary sinusitis. The clinical presentation and characteristics of the fungus and the sinus debris histopathology are discussed. Images PMID:7430339

  1. Epidural Abscess Masquerading as Lateral Sinus Thrombosis

    PubMed Central

    Brodner, David C.; Cutler, Jeff; Gianoli, Gerard J.; Amedee, Ronald G.

    2000-01-01

    Controversy regarding the use of anticoagulants, the evacuation of the sinus, or the use of medical treatment alone surrounds the treatment of lateral sinus thrombosis. Treatment of an epidural abscess associated with coalescent mastoiditis is much less controversial-drainage is usually recommended. The differing treatments of these complications mandate accurate diagnosis. The advent of more sophisticated radiological studies has facilitated diagnosis of these complications; however, tests are not infallible. We present three cases in which preoperative imaging demonstrates an epidural abscess mimicking lateral sinus thrombosis by compression of the vessel. A false-positive computed tomography (CT) or magnetic resonance imaging (MRI) study may lead to the wrong diagnosis and, consequently, improper treatment. In light of this possibility, we recommend surgical exploration in all such cases. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:17171148

  2. Medical management of pediatric chronic sinusitis.

    PubMed

    Lippincott, L L; Brown, K R

    2000-10-01

    Pediatric sinusitis can be a challenging disease to treat, whether by a primary care physician or an otolaryngologist. When initial appropriate therapy fails to resolve the disorder, frustration may develop on the part of the patient, the family, and the physician. In addition to treatment with appropriate antibiotics for a sufficient length of time, other associated conditions that can exacerbate the condition must be considered and addressed as necessary. These may include viral upper respiratory infections, allergic rhinitis, immune deficiencies, asthma, and gastroesophageal reflux disease. Unless all associated conditions have been optimized, treatment of chronic sinusitis will often be unsuccessful. Recognition that there may be another factor contributing to the patient's continuing illness should prompt appropriate evaluation and occasionally referral to appropriate specialists. Except for the unusual pediatric patient with a truly anatomic disorder or an underlying chronic illness such as cystic fibrosis, proper medical management will almost always resolve chronic sinusitis.

  3. 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.

  4. Fourth branchial pouch sinus: diagnosis and treatment.

    PubMed

    Rosenfeld, R M; Biller, H F

    1991-07-01

    The fourth branchial pouch sinus (FBPS) is a rare translaryngeal anomaly with diverse manifestations, including neonatal stridor and recurrent deep neck infection. Review of the world literature reveals 23 reports of sinuses consistent with fourth pouch origin. We present two additional cases, including the only example of a right-sided FBPS. Retrograde excision, beginning at the piriform apex, ensures complete removal of the tract and protection of the recurrent nerve. The posterior border of the thyroid ala must be resected or retracted for adequate exposure. Failure to remove the translaryngeal portion of the tract almost guarantees recurrence.

  5. [Anorexia with sinus bradycardia: a case report].

    PubMed

    Wang, Fang-fang; Xu, Ling; Chen, Bao-xia; Cui, Ming; Zhang, Yuan

    2016-02-18

    As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus

  6. Rhinoplasty and Functional Endoscopic Sinus Surgery

    PubMed Central

    Murrell, George L.

    2011-01-01

    An increasing number of patients are opting for combining sinus surgery and cosmetic rhinoplasty. The author has been performing rhinoplasty with FESS since April of 1990. The technique and equipment used in early cases is much different than that used in more recent surgeries. Specific advances include high definition monitor, intraoperative navigation system, and powered dissecting instruments. The benefits of these advances are illustrated by a review of the more recent cases performed by the author. Combined rhinoplasty and FESS can be performed with good results (functional and cosmetic) and minimal complications. Advances in sinus surgery technique and equipment have made the procedure safer, faster, more precise, and more comfortable. PMID:22567242

  7. CSF hydrodynamics in superior sagittal sinus thrombosis.

    PubMed Central

    Kristensen, B; Malm, J; Markgren, P; Ekstedt, J

    1992-01-01

    Cerebrospinal fluid hydrodynamics were investigated with a constant pressure infusion method in patients with superior sagittal sinus thrombosis. Ten patients were studied with serial examinations up to 15 years after the onset of the disease. A total of 70 CSF hydrodynamic examinations were performed. A clear increase in intracranial pressure due to raised pressure in the major dural sinus was seen in all patients. A striking feature was the persistent intracranial pressure increase that declined only gradually. This had no obvious clinical impact. Change in CSF resorption facility played only a minor role in the intracranial pressure elevation. None of the patients developed hydrocephalus. PMID:1583513

  8. Pilonidal sinus (Nadi vrana): A case study

    PubMed Central

    Shinde, Pradeep; Toshikhane, Hemant

    2010-01-01

    Pilonidal sinus (PNS) occurs in the cleavage between the buttocks (natal cleft) and can cause discomfort, embarrassment and absence from work for thousands of young people (mostly men) annually. The incidence of the disease is calculated to be 26 per 100,000 people. It occurs 2.2 times more often in men than in women. Age at presentation is 21 years for men and 19 years for women this case report describes a 22-year-old man with pilonidal sinus who was treated with ksharasutra. PMID:21170212

  9. [Sinusitis is common in small children].

    PubMed

    Herløv-Nielsen, Henrik; Højby, Niels

    2010-11-29

    Children have air-filled paranasal sinuses from birth. Acute sinusitis is common in early childhood and complicates 5-13% of common colds. Bacteriology comprises 30% Streptococcus pneumoniae, 20% Haemophilus influenzae, 20% Moraxella catarrhalis. While suppurative complications are rare, there has been an increasing focus on comorbidity affecting the lower airways (asthma). The diagnosis is based on clinical criteria developed through microbiological studies. Antibiotic treatment is controversial, but evidence suggests an effect when the diagnosis has been made correctly. We advocate antibiotic treatment in selected cases.

  10. Superior sinus of the pericardium: CT appearance

    SciTech Connect

    Aronberg, D.J.; Peterson, R.R.; Glazer, H.S.; Sagel, S.S.

    1984-11-01

    On computed tomography, a mass-like density is often observed, just posterior to the ascending aorta, that occasionally has been mistaken for mediastinal lymph node enlargement. Cadaver studies confirmed this retroaortic structure to be an extension of the periocardial cavity, the superior sinus. Anatomic studies revealed the presence of a superior sinus in all of the 28 cadavers studied. Retrospective review of 116 consecutive adult chest computed tomographic examinations disclosed its presence in 49%. This normal variant has a characteristic location, shape, and attenuation value by CT that should allow recognition and prevent misinterpretation.

  11. Compressive Optic Neuropathy from Allergic Fungal Sinusitis

    PubMed Central

    Tong, Jessica; Jefferson, Niall; Chaganti, Joga; Fraser, Clare L.

    2015-01-01

    ABSTRACT Ophthalmic manifestations of allergic fungal sinusitis (AFS) are rare, but can occur in advanced disease. A 32-year-old man with advanced AFS presented with severe bilateral vision loss and restricted ocular motility. Magnetic resonance imaging and histological analysis confirmed active chronic AFS. Functional endoscopic sinus surgery was performed, with adjunctive steroid therapy. Although AFS is a reasonably well-recognised entity, severe disease causing bilateral visual deficits is rarely encountered. This can confound the diagnosis and appropriate treatment. Ophthalmologists should thus be aware of compressive optic neuropathy as a complication of advanced AFS to prompt early treatment and mitigate visual loss. PMID:27928361

  12. A primo vascular system underneath the superior sagittal sinus in the brain of a rabbit.

    PubMed

    Nam, Min-Ho; Lim, Jaekwan; Choi, Seung-Hoon; Kim, Sungchul; Soh, Kwang-Sup

    2012-10-01

    The primo vascular systems (PVS) observed in the central nervous system have been limited to the ones floating in the cerebrospinal fluid. In those experiments, it was difficult to obtain the same results because the PVS was not fixed in a given anatomical position. In the current work, we report a finding of a PVS in a well-defined location, namely, underneath the superior sagittal sinus in the sagittal fissure, so that repetition of the experiments is possible. This provides a cornerstone for PVS research because the lack of reproducible sample-taking hindered a deeper study of the PVS, such as RNA sequencing or RNA microarray. This obstacle can be overcome through the discovery in the current work. This PVS showed characteristics of the PVS observed in other organs. It showed the bundle structure of subvessels, the parallel distributions of F-actins, and the rod-shaped nuclei. Furthermore, it had a primo node in front of the confluence of sinuses above the pineal body. It had branches shooting off from the main primo vessel in the subarachnoid space toward the cerebral hemispheres. The results indicate that this PVS underneath superior sagittal sinus has proper features to function as a flowing channel.

  13. 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.

  14. Different types of fungal sinusitis occurring concurrently: implications for therapy.

    PubMed

    Rupa, V; Thomas, Meera

    2013-02-01

    The purpose of this study is to describe the clinical and histopathological features, management and outcome of a series of patients with simultaneous occurrence of invasive and non-invasive fungal sinusitis (mixed fungal sinusitis). The histopathological records of patients with fungal sinusitis seen over the last 6 years were reviewed. The clinical, histopathological, treatment and follow up details of all cases with mixed fungal sinusitis were noted. Six cases of mixed fungal sinusitis with concurrent occurrence of chronic granulomatous fungal sinusitis and allergic fungal sinusitis (AFS) were seen during the study period. Most (83.3 %) had bilateral disease. All patients had undergone prior endoscopic sinus surgery at least once within the previous 2 years. Histopathological features showed predominance of invasive disease in half the patients. Except for one patient who did not report for follow up, all patients with predominant chronic granulomatous fungal sinusitis received systemic antifungal therapy and inhaled steroids. Those with predominant features of AFS received oral and inhaled steroids. Five patients with mixed fungal sinusitis who had follow up ranging from 6 months to 5 years were disease free following treatment. Mixed fungal sinusitis should be recognized by the surgeon and pathologist as a separate category of fungal sinusitis whose treatment depends on accurate histological diagnosis. A good outcome may be expected with appropriate therapy.

  15. Sinusitis associated with nasogastric intubation in 3 horses

    PubMed Central

    Nieto, Jorge E.; Yamout, Sawsan; Dechant, Julie E.

    2014-01-01

    Sinusitis has not been reported as a complication of long-term nasogastric intubation in horses. We describe 3 horses that developed nosocomial sinusitis following abdominal surgery with associated perioperative nasogastric intubation. Sinusitis was suspected by the presence of malodorous discharge and confirmed by percussion, upper airway endoscopy, radiographs (n = 3), and bacterial culture (n = 1). PMID:24891638

  16. 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.

  17. Cerebral malaria

    PubMed Central

    Newton, C.; Hien, T. T.; White, N.

    2000-01-01

    Cerebral malaria may be the most common non-traumatic encephalopathy in the world. The pathogenesis is heterogenous and the neurological complications are often part of a multisystem dysfunction. The clinical presentation and pathophysiology differs between adults and children. Recent studies have elucidated the molecular mechanisms of pathogenesis and raised possible interventions. Antimalarial drugs, however, remain the only intervention that unequivocally affects outcome, although increasing resistance to the established antimalarial drugs is of grave concern. Artemisinin derivatives have made an impact on treatment, but other drugs may be required. With appropriate antimalarial drugs, the prognosis of cerebral malaria often depends on the management of other complications—for example, renal failure and acidosis. Neurological sequelae are increasingly recognised, but further research on the pathogenesis of coma and neurological damage is required to develop other ancillary treatments.

 PMID:10990500

  18. Retinal venous blood carbon monoxide response to bright light in male pigs: A preliminary study.

    PubMed

    Oren, Dan A; Duda, Magdalena; Kozioł, Katarzyna; Romerowicz-Misielak, Maria; Koziorowska, Anna; Sołek, Przemysław; Nowak, Sławomir; Kulpa, Magdalena; Koziorowski, Marek

    2017-03-01

    The physical mechanism by which light is absorbed in the eye and has antidepressant and energizing effects in Seasonal Affective Disorder and other forms of psychiatric major depression is of scientific interest. This study was designed to explore one specific aspect of a proposed humoral phototransduction mechanism, namely that carbon monoxide (CO) levels increase in retinal venous blood in response to bright light. Eleven mature male pigs approximately six months of age were kept for 7days in darkness and fasted for 12h prior to surgery. Following mild sedation, anesthesia was induced. Silastic catheters were inserted into the dorsal nasal vein through the angular vein of the eye to reach the ophthalmic sinus, from which venous blood outflowing from the eye area was collected. The animals were exposed to 5000lx of fluorescent-generated white light. CO levels in the blood were analyzed by gas chromatography before and after 80min of light exposure. At baseline, mean CO levels in the retinal venous blood were 0.43±0.05(SE)nmol/ml. After bright light, mean CO levels increased to 0.54±0.06nmol/ml (two-tailed t-test p<0.05). This study provides preliminary mammalian evidence that acute bright light exposure raises carbon monoxide levels in ophthalmic venous blood.

  19. 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.

  20. Prevention of venous thrombotic events in brain injury: review of current practices.

    PubMed

    Glassner, Stuart; Srivastava, Karan; Cofnas, Paul; Deegan, Brian; Demaria, Peter; Denis, Rimsky; Ginzburg, Enrique

    2013-01-01

    Venous thromboembolic event after traumatic brain injury represents a unique clinical challenge. Physicians must balance appropriate timing of chemoprophylaxis with risk of increased cerebral hemorrhage. Despite an increase in the literature since the 1990s, there are clear disparities in treatment strategies. This review discusses the prominent studies and subsequent findings regarding the topic with an attempt to establish recommendations using the existing evidence-based literature.

  1. CT maxillary sinus evaluation-A retrospective cohort study

    PubMed Central

    Vaz, Paula; Faria-Almeida, Ricardo; Braga, Ana-Cristina; Felino, António

    2015-01-01

    Background Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population. Material and Methods Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature. Results 32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus. Conclusions Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis. Key words: Maxillary sinusitis/etiology, odontogenic, computed tomography, maxillary sinus. PMID:25858084

  2. Giant-cell granuloma of the sinuses

    SciTech Connect

    Rhea, J.T.; Weber, A.L.

    1983-04-01

    Three cases are presented which illustrate giant-cell granulomas in the maxillary, ethmoid, and sphenoid sinuses. The radiographic features are nonspecific, and the lesion can mimic carcinoma. Ossification can be demonstrated, especially with computed tomography, and may indicate a benign lesion.

  3. Acute otitis media and acute bacterial sinusitis.

    PubMed

    Wald, Ellen R

    2011-05-01

    Acute otitis media and acute bacterial sinusitis are 2 of the most common indications for antimicrobial agents in children. Together, they are responsible for billions of dollars of health care expenditures. The pathogenesis of the 2 conditions is identical. In the majority of children with each condition, a preceding viral upper respiratory tract infection predisposes to the development of the acute bacterial complication. It has been shown that viral upper respiratory tract infection predisposes to the development of acute otitis media in 37% of cases. Currently, precise microbiologic diagnosis of acute otitis media and acute bacterial sinusitis requires performance of tympanocentesis in the former and sinus aspiration in the latter. The identification of a virus from the nasopharynx in either case does not obviate the need for antimicrobial therapy. Furthermore, nasal and nasopharyngeal swabs are not useful in predicting the results of culture of the middle ear or paranasal sinus. However, it is possible that a combination of information regarding nasopharyngeal colonization with bacteria and infection with specific viruses may inform treatment decisions in the future.

  4. [Congenital left sinus of Valsalva aneurysm].

    PubMed

    Simões, M V; Figueira, R R; Barbato, D; Miziara, H L

    1991-01-01

    Two cases of left sinus of Valsalva congenital aneurysm (SVCA), incidentally found are described. The authors call attention on rarity of them, and present new concepts about their morphogenesis and incidence. They also suggested a higher incidence of asymptomatic and undiagnosed cases of SVCA should be considered.

  5. Stent hypersensitivity and infection in sinus cavities

    PubMed Central

    Soufras, George D.; Hahalis, George

    2013-01-01

    Persistent mucosal inflammation, granulation tissue formation, hypersensitivity, and multifactorial infection are newly described complications of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. In an important report published in Allergy and Rhinology, a 45-year-old male patient suffering from recalcitrant chronic rhinosinusitis underwent functional endoscopic sinus surgery and was found, for the first time, to have steroid-eluting catheters that were inadvertently left in the ethmoid and frontal sinuses. The retained catheters had caused persistent mucosal inflammation and formation of granulation tissue denoting hypersensitivity reaction. These consequences had induced perpetuation of symptoms of chronic rhinosinusitis. Meticulous removal of the retained stents with the nitinol wings from inflamed tissues of the frontal, ethmoidal, and sphenoethmoidal recesses in which they were completely imbedded was successfully performed without polypoid regrowth. Cultures of specimens taken from both left and right stents showed heavy growth of Stenotrophomonas maltophilia and moderate growth of Klebsiella oxytoca, coagulase negative Staphylococcus, and beta-hemolytic Streptococcus anginosus. Fungal infection was not detected. The current knowledge and experience regarding stent hypersensitivity and infection in relation with the use of stents in sinus cavities is reviewed. PMID:24498522

  6. Development of the venous pole of the heart in the frog Xenopus laevis: a morphological study with special focus on the development of the venoatrial connections.

    PubMed

    Jahr, Maike; Männer, Jörg

    2011-06-01

    The heart of lung-breathing vertebrates normally shows an asymmetric arrangement of its venoatrial connections along the left-right (L-R) body axis. The systemic venous tributaries empty into the right atrium while the pulmonary venous tributaries empty into the left atrium. The ways by which this asymmetry evolves from the originally symmetrically arranged embryonic venous heart pole are poorly defined. Here we document the development of the venous heart pole in Xenopus laevis (stages 40-46). We show that, prior to the appearance of the mouth of the common pulmonary vein (MCPV), the systemic venous tributaries empty into a bilaterally symmetric chamber (sinus venosus) that is demarcated from the developing atriums by a circular ridge of tissue (sinu-atrial ridge). A solitary MCPV appears during stage 41. From the time point of its first appearance onwards, the MCPV lies cranial to the sinu-atrial ridge and to the left of the developing interatrial septum and body midline. L-R lineage analysis shows that the interatrial septum and MCPV both derive from the left body half. The CPV, therefore, opens from the beginning into the future left atrium. The definitive venoatrial connections are established by the formation of a septal complex that divides the lumen of the venous heart pole into systemic and pulmonary venous flow pathways. This complex arises from the anlage of the interatrial septum and the left half of the sinu-atrial ridge.

  7. 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

  8. 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.

  9. 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

  10. Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?

    PubMed Central

    Pires de Aguiar, Paulo Henrique; Aires, Rogério; Maldaun, Marcos Vinicius Calfatt; Tahara, Adriana; de Souza Filho, Antonio Marcos; Zicarelli, Carlos Alexandre; Ramina, Ricardo

    2010-01-01

    Objective: Meningiomas arising purely from the falx below the longitudinal sinus represents a surgical challenge for the neurosurgeon. The authors discuss the new aspects of surgical details that may avoid complications and determine the prognosis. Materials and Methods: We retrospectively evaluated our surgical experience from June 2004 to January 2010. Seventy patients harboring falcine meningiomas were included and submitted for surgical resection. All historical records, office charts and images were reviewed in order to sample the most important data regarding epidemiology, clinical pictures, radiological findings and surgical results, as well as the main complications. The patients were divided into three main groups: anterior third 32 patients (Group A), middle third 15 patients (Group B), 23 patients in the posterior third of falx (Group C). Results: In Group A, total macroscopic resection was achieved in 31 out of 32 cases (96.87%). Twenty five patients had Rankin 0, five patients had Rankin 1-2, two patients had Rankin 6. In Group B (15 patients), 10 patients had gross resection and Rankin 0, four patients had Rankin 1-2 and one patient had Rankin 6. In Group C (23 patients), 20 patients were absolutely able, Rankin score 0, after six months postoperative period (83.3% had excellent results) and no mortality. Four cases had Rankin score 1 – 2 (16.6%). Ten cases (43.47%) had Simpson I resection and ten cases (43.47%) had Simpson II. Conclusion: Despite larger lesion volumes, Group A meningiomas had a better outcome due to the position they were in, the tumor and surrounding structures. The preoperative preparation and surgical planning can preserve sagittal sinus; but in some cases, this is not possible. Sagittal sinus resection, as proven by this paper, is still a factor of bad surgical outcome. In the middle and posterior third, resection of sagittal sinus is a factor of a bad outcome, due to cerebral infartion. PMID:21125007

  11. Carcinoma of Maxillary Sinus Masquerading as Odontogenic Infection

    PubMed Central

    Ramachamparambathu, Ashir Kolikkal; Vengal, Manoj; Siyo, Nizaro; Ahmed, Anis

    2016-01-01

    Malignant tumours of maxillary sinus are rare. They are usually diagnosed in the late stages when they perforate the sinus walls. The presence of large air space in the maxillary sinus facilitates asymptomatic growth of the sinus malignancy. The clinical presentation of these tumours depends on the sinus wall involved by the disease. The medial wall is usually the first to become eroded, leading to nasal obstruction, epistaxis or discharge. Rarely, symptoms of maxillary sinus carcinoma can resemble dental infection and the affected patients may visit dental clinic seeking treatment. This report presents a case of carcinoma of maxillary sinus mimicking odontogenic infection. Computed tomographic findings explained the reason for the present lesion to masquerade as an inflammatory condition. The importance of advanced imaging modalities for prompt identification of such lesions is discussed. PMID:27790593

  12. Postdural Puncture Superior Sagittal Sinus Thrombosis in a Juvenile Case of Clinically Isolated Syndrome

    PubMed Central

    Michel, Miriam; Haberlandt, Edda; Baumann, Matthias; Entenmann, Andreas; Wagner, Michaela; Rostasy, Kevin

    2015-01-01

    Background. The causes of cerebral venous thrombosis (CVT) are manifold as is its clinical presentation. Case. We report the case of a CVT following lumbar puncture and intravenous glucocorticosteroid therapy in a female adolescent with a clinically isolated syndrome and risk factors for thrombosis. Conclusion. In adolescent patients with acute inflammatory disease undergoing lumbar puncture followed by intravenous high-dose glucocorticosteroid therapy, one should be aware of the elevated risk for thrombosis. A persistent headache with change in the headache pattern and loss of a postural component might be a sign for CVT, requiring emergency imaging of the brain. PMID:26558127

  13. Postdural Puncture Superior Sagittal Sinus Thrombosis in a Juvenile Case of Clinically Isolated Syndrome.

    PubMed

    Michel, Miriam; Haberlandt, Edda; Baumann, Matthias; Entenmann, Andreas; Wagner, Michaela; Rostasy, Kevin

    2015-01-01

    Background. The causes of cerebral venous thrombosis (CVT) are manifold as is its clinical presentation. Case. We report the case of a CVT following lumbar puncture and intravenous glucocorticosteroid therapy in a female adolescent with a clinically isolated syndrome and risk factors for thrombosis. Conclusion. In adolescent patients with acute inflammatory disease undergoing lumbar puncture followed by intravenous high-dose glucocorticosteroid therapy, one should be aware of the elevated risk for thrombosis. A persistent headache with change in the headache pattern and loss of a postural component might be a sign for CVT, requiring emergency imaging of the brain.

  14. 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.

  15. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.

    PubMed

    Pikwer, A; Bååth, L; Davidson, B; Perstoft, I; Akeson, J

    2008-01-01

    Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.

  16. Frontal sinus parameters in computed tomography and sex determination.

    PubMed

    Akhlaghi, Mitra; Bakhtavar, Khadijeh; Moarefdoost, Jhale; Kamali, Artin; Rafeifar, Shahram

    2016-03-01

    The frontal sinus is a sturdy part of the skull that is likely to be retrieved for forensic investigations. We evaluated frontal sinus parameters in paranasal sinus computed tomography (CT) images for sex determination. The study was conducted on 200 normal paranasal sinus CT images of 100 men and 100 women of Persian origin. We categorized the studied population into three age groups of 20-34, 35-49 and ⩾ 50 years. The number of partial septa in the right frontal sinus and the maximum height and width were significantly different between the two sexes. The highest precision for sex determination was for the maximum height of the left frontal sinus (61.3%). In the 20-34 years age-group, height and width of the frontal sinus were significantly different between the two sexes and the height of the left sinus had the highest precision (60.8%). In the 35-49 years age-group, right anterior-posterior diameter had a sex determination precision of 52.3%. No frontal sinus parameter reached a statistically significant level for sex determination in the ⩾ 50 years age-group. The number of septa and scallopings were not useful in sex determination. Frontal sinus parameters did not have a high precision in sex determination among Persian adults.

  17. [The role of carbocystein in the treatment of sinusitis].

    PubMed

    Dąbrowski, Piotr; Leszczyńska, Małgorzata; Mielcarek-Kuchta, Daniela

    2012-09-01

    Chronic sinusitis is one of the most common presenting complaints of all doctor visits in the United States and Europe, with more than 13% of people affected in any given year. This disease has a wide range of impact on communities. Patients with recurrent or chronic sinusitis report a deteriorative sense of general health and vitality, when compared to general population. In our Department we perform about 600 functional endoscopic sinus surgeries (FESS) per year. Chronic rhinosinusitis represents a spectrum of inflammatory and infectious processes concurrently affecting the nose and paranasal sinuses. Among chronic paranasal sinusitis one must single out paranasal sinusitis with and without polyps. In the paranasal sinusitis patomechanism the blockage of natural ostium plays one of the most important roles. The closure of sinus proper ventilation passages leads to the triggering of many pathological occurrences within mucous membrane of this region. The treatment of paranasal sinusitis is diversified and involves a surgical procedure as well as anti-inflammatory and antiallergic drugs (medications) and mucolytics. Its purpose is to clear the nose through the elimination of bacterial infection, liquidating and removal of lying discharge and the restoration of the proper muco-ciliary transportation, and through this the improvement of local condition and faster recovery. In this work the usage of carboxycysteine to treat paranasal sinus conditions has been presented.

  18. Magnetic Resonance Imaging of Cerebral Aspergillosis: Imaging and Pathological Correlations

    PubMed Central

    Sabou, Marcela; Lannes, Béatrice; Cotton, François; Meyronet, David; Galanaud, Damien; Cottier, Jean-Philippe; Grand, Sylvie; Desal, Hubert; Kreutz, Julie; Schenck, Maleka; Meyer, Nicolas; Schneider, Francis; Dietemann, Jean-Louis; Koob, Meriam

    2016-01-01

    Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection. PMID:27097323

  19. Retrograde coronary sinus versus aortic root perfusion with cold cardioplegia: randomized study of levels of cardiac enzymes in 40 patients

    SciTech Connect

    Guiraudon, G.M.; Campbell, C.S.; McLellan, D.G.; Kostuk, W.J.; Purves, P.D.; MacDonald, J.L.; Cleland, A.G.; Tadros, N.B.

    1986-11-01

    Myocardial injury was assessed with the use of enzyme indexes in 40 patients randomly assigned to one of two groups undergoing coronary artery bypass surgery. Twenty patients received cold cardioplegia delivered by retrograde coronary sinus perfusion and 20 received cardioplegic solution by anterograde aortic root perfusion. Creatine kinase isoenzyme MB and lactate dehydrogenese isoenzyme 1 and isoenzyme 2 assays were carried out on blood samples obtained from the coronary sinus before aortic cross-clamping and 0, 5, and 30 min after aortic unclamping. Levels of these enzymes were also obtained from venous blood samples before aortic cross-clamping and 3, 8, 14, and 20 hr after aortic unclamping and 2, 3, 4, and 5 days after surgery. Preoperative and postoperative hemodynamic measurements (Swan-Ganz catheter) and radionuclide wall motion studies were also obtained for comparison. There was no overall significant difference between the two groups postoperatively in terms of enzyme indexes, hemodynamic measurements, or results of wall motion studies. We conclude that retrograde coronary sinus perfusion is an alternative to aortic root perfusion in delivering cold cardioplegia. More studies are required to determine which subgroup of patients with coronary artery disease may benefit from retrograde coronary perfusion.

  20. 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

  1. 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.

  2. Nasopharyngeal carcinoma presented as cavernous sinus tumour.

    PubMed

    Moona, Mohammad Shafi; Mehdi, Itrat

    2011-12-01

    A 32 year Libyan male presented with the complaints of headache and diplopia. He was diagnosed with a cavernous sinus meningioma on the basis of MRI findings but no initial biopsy was taken. Depending on the radiologic diagnosis the patient was treated with gamma knife surgery twice, abroad. During follow up he developed left ear deafness and left cervical lymph adenopathy. An ENT evaluation with biopsy from the nasopharynx and cervical lymph node was taken. The histopathologic diagnosis of the resected tumour showed a nasopharyngeal carcinoma with cervical lymph node metastasis (poorly differentiated lympho-epithelial carcinoma). The cavernous sinus tumour which was initially treated as a meningioma was in fact metastasis from the nasopharyngeal carcinoma, making this an interesting and rare occurrence.

  3. Sinus pause in association with Lyme carditis.

    PubMed

    Oktay, A Afsin; Dibs, Samer R; Friedman, Harvey

    2015-06-01

    Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement of the atrioventricular node. On rare occasions, Lyme carditis patients present with other conduction system disorders such as bundle branch block, intraventricular conduction delay, and supraventricular or ventricular tachycardia. We report the unusual case of a 59-year-old man who presented with new-onset symptomatic sinus pauses one month after hiking in upstate New York. To our knowledge, this is the first case report from North America that describes the relationship between symptomatic sinus pause and Lyme carditis.

  4. Aspergillosis of the nose and paranasal sinuses.

    PubMed Central

    Milroy, C M; Blanshard, J D; Lucas, S; Michaels, L

    1989-01-01

    Fulminant aspergillosis was diagnosed on nasal biopsy in a 49 year old man who had features of an aspergilloma. Further postmortem examination of this area was performed and the results were contrasted with the histological features of other Aspergillus infections. The nasal biopsy specimen and postmortem examination showed infiltrating Aspergillus hyphae with tissue necrosis and little inflammatory response. The hyphae were easily seen with routine stains. This contrasts with the findings in invasive aspergillosis where there is fibrosis and a granulomatous response to the Aspergillus hyphae. The hyphae are seen in giant cells using fungal stains. In the saprophytic infections aspergilloma and allergic Aspergillus sinusitis there is no tissue invasion or destruction. Aspergillus infections of the nose and paranasal sinuses often require biopsy for accurate diagnosis. As treatment varies pathologists need to be able to distinguish the different patterns of infection. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:2921352

  5. Infantile Maxillary Sinus Osteomyelitis Mimicking Orbital Cellulitis

    PubMed Central

    Krishnan, Nagarajan; Ramamoorthy, Nathan; Panchanathan, Suresh; Balasundaram, Jothiramalingam S

    2014-01-01

    Periorbital soft tissue swelling may result due to primary orbital pathology or from adjacent facio-maxillary or sino-nasal inflammatory causes. Osteomyelitis of maxilla in the pediatric age group is a rare entity in this era of antibiotics. We present an 11-month-old female infant who was brought with peri-orbital selling and purulent nasal discharge. Computed Tomography showed erosions of the walls of maxillary sinus suggestive of osteomyelitis. Culture of sinus scraping showed Staphylococcus aureus growth and the child improved with intravenous cloxacillin therapy. This case is presented due to the rarity of its presentation in this age group and for awareness to consider this entity in children having fever and peri-orbital swelling. PMID:25191055

  6. Cavernous sinus syndrome: need for early diagnosis

    PubMed Central

    Toro, Jaime; Burbano, Lisseth Estefania; Reyes, Saúl; Barreras, Paula

    2015-01-01

    Cavernous sinus syndrome (CSS) is a rare condition characterised by ophthalmoplegia, proptosis, ocular and conjunctival congestion, trigeminal sensory loss and Horner’s syndrome. These signs and symptoms result from the involvement of the cranial nerves passing through the cavernous sinus. We report the case of a 53-year-old man with a history of daily stabbing headache associated with dizziness, progressive blurred vision, right ocular pain, ptosis and ophthalmoplegia. After working up the patient, a meningioma was identified as the cause of the CSS. Despite advances in neuroimaging techniques, in some cases, the aetiology of CSS remains difficult to determine. We highlight the clinical and radiological features of a meningioma, one of the causes of CSS. Early diagnosis and treatment of CSS play a key role in a better prognosis. PMID:25819816

  7. Sinus Pause in Association with Lyme Carditis

    PubMed Central

    Dibs, Samer R.; Friedman, Harvey

    2015-01-01

    Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement of the atrioventricular node. On rare occasions, Lyme carditis patients present with other conduction system disorders such as bundle branch block, intraventricular conduction delay, and supraventricular or ventricular tachycardia. We report the unusual case of a 59-year-old man who presented with new-onset symptomatic sinus pauses one month after hiking in upstate New York. To our knowledge, this is the first case report from North America that describes the relationship between symptomatic sinus pause and Lyme carditis. PMID:26175640

  8. Septic Cavernous Sinus Thrombosis: A Case Report

    PubMed Central

    Arian, Mahdieh; Kamali, Azadeh; Tabatabaeichehr, Mahbubeh; Arashnia, Parisa

    2016-01-01

    Introduction Septic cavernous sinus thrombosis (CST) is a rare condition that can result in high mortality and morbidity rates if not treated immediately. CST may be aseptic or septic. Less common primary sites of infection include the tonsils, soft palate, middle ear, and orbit. Reported cases of middle ear infection are very rare, and response to treatment is poor. Case Presentation The present study is a case report of acute otitis media which led to septic cavernous sinus thrombosis in a 56-year-old woman in Bojnord city, North Khorasan, Iran. Conclusions Findings of laboratory tests and magnetic resonance imaging (MRI) confirmed the clinical diagnosis. Clinical-based medical care led to successful management of the patient with broad spectrum intravenous antibiotics that prevented serious complications. PMID:27781123

  9. [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.

  10. Surgery of the Sinuses and Eyes.

    PubMed

    Schleining, Jennifer A

    2016-11-01

    Conditions of the head requiring surgery in cattle are not uncommon when considering the incidence of conditions such as ocular squamous cell carcinoma and requests for surgical dehorning. Surgery involving the eyes in cattle is relatively common, whereas surgery of the paranasal sinuses is less common. Generally speaking, however, surgery for conditions of the head tend to have a more favorable prognosis when there is early intervention.

  11. Paranasal Sinus Involvement in Metastatic Carcinoma

    PubMed Central

    Abi-Fadel, Francois; Smith, Peter R.; Ayaz, Asim; Sundaram, Krishnamurthi

    2012-01-01

    Metastatic carcinoma involving the paranasal sinuses is uncommon. One hundred-sixty seven cases have been published in the literature since 1951. Symptoms, signs, and rhinoscopic and imaging findings are often nonspecific, and the diagnosis may be missed for considerable time. Therefore, a high level of suspicion is warranted in patients with known malignancies presenting with persistent or recurrent rhinosinusitis or facial complaints. PMID:23946928

  12. [Invasive maxilar sinusitis by Rhizopus oryzae].

    PubMed

    Perea, S; del Palacio, A; Gil, R; de la Serna, J; Mata, R; Arribi, A

    1997-12-01

    We herein present a diabetic with non Hodgkin lymphoma patient that had been treated with steroids and developed fungal invasive sinusitis. The patient had intensive facial pain that did not respond to antibiotics and on clinical inspection had a necrotic lesion on right nasal area. A smear and biopsy tissue showed broad non septate hyphae and on cultures Rhizopus oryzae was isolated. There was an unfavorable outcome, and the patient died even though liposomal Amphotericin B was administered and surgical treatment was performed.

  13. Parietal atretic cephalocele: Associated cerebral anomalies identified by CT and MR imaging

    PubMed Central

    Siverino, Rita Olivia Anna; Attinà, Giancarlo; Chiaramonte, Rita; Milone, Pietro; Chiaramonte, Ignazio

    2015-01-01

    We describe a case of atretic cephalocele (AC) characterized by the presence of various cerebral anomalies of different midline structures. In our patient the presence of a parietal AC was associated with an embryonic position of the straight sinus, fenestration of the superior sagittal sinus, an abnormal insertion of the cerebellar tentorium with prominence of the superior cerebellar cistern and a septum pellucidum cyst. These findings, associated with AC, could lead to a worse prognosis with regard to neurodevelopmental milestones. This suggests that even if AC is a benign lesion, a complete evaluation of the brain structures should always be performed in these young patients. PMID:25963151

  14. EFFECTS OF RAPAMYCIN ON CEREBRAL OXYGEN SUPPLY AND CONSUMPTION DURING REPERFUSION AFTER CEREBRAL ISCHEMIA

    PubMed Central

    CHI, O. Z.; BARSOUM, S.; VEGA-COTTO, N. M.; JACINTO, E.; LIU, X.; MELLENDER, S. J.; WEISS, H. R.

    2016-01-01

    Abstract—Activation of the mammalian target of rapamycin (mTOR) leads to cell growth and survival. We tested the hypothesis that inhibition of mTOR would increase infarct size and decrease microregional O2 supply/consumption balance after cerebral ischemia–reperfusion. This was tested in isoflurane-anesthetized rats with middle cerebral artery blockade for 1 h and reperfusion for 2 h with and without rapamycin (20 mg/kg once daily for two days prior to ischemia). Regional cerebral blood flow was determined using a C14-iodoantipyrine autoradiographic technique. Regional small-vessel arterial and venous oxygen saturations were determined microspectrophotometrically. The control ischemic-reperfused cortex had a similar blood flow and O2 consumption to the contralateral cortex. However, microregional O2 supply/consumption balance was significantly reduced in the ischemic-reperfused cortex. Rapamycin significantly increased cerebral O2 consumption and further reduced O2 supply/consumption balance in the reperfused area. This was associated with an increased cortical infarct size (13.5 ± 0.8% control vs. 21.5 ± 0.9% rapamycin). We also found that ischemia–reperfusion increased AKT and S6K1 phosphorylation, while rapamycin decreased this phosphorylation in both the control and ischemic-reperfused cortex. This suggests that mTOR is important for not only cell survival, but also for the control of oxygen balance after cerebral ischemia–reperfusion. PMID:26742793

  15. Effects of rapamycin on cerebral oxygen supply and consumption during reperfusion after cerebral ischemia.

    PubMed

    Chi, O Z; Barsoum, S; Vega-Cotto, N M; Jacinto, E; Liu, X; Mellender, S J; Weiss, H R

    2016-03-01

    Activation of the mammalian target of rapamycin (mTOR) leads to cell growth and survival. We tested the hypothesis that inhibition of mTOR would increase infarct size and decrease microregional O2 supply/consumption balance after cerebral ischemia-reperfusion. This was tested in isoflurane-anesthetized rats with middle cerebral artery blockade for 1h and reperfusion for 2h with and without rapamycin (20mg/kg once daily for two days prior to ischemia). Regional cerebral blood flow was determined using a C(14)-iodoantipyrine autoradiographic technique. Regional small-vessel arterial and venous oxygen saturations were determined microspectrophotometrically. The control ischemic-reperfused cortex had a similar blood flow and O2 consumption to the contralateral cortex. However, microregional O2 supply/consumption balance was significantly reduced in the ischemic-reperfused cortex. Rapamycin significantly increased cerebral O2 consumption and further reduced O2 supply/consumption balance in the reperfused area. This was associated with an increased cortical infarct size (13.5±0.8% control vs. 21.5±0.9% rapamycin). We also found that ischemia-reperfusion increased AKT and S6K1 phosphorylation, while rapamycin decreased this phosphorylation in both the control and ischemic-reperfused cortex. This suggests that mTOR is important for not only cell survival, but also for the control of oxygen balance after cerebral ischemia-reperfusion.

  16. [Third cranial nerve palsy in sphenoid sinusitis].

    PubMed

    Dores, Luís Almeida; Simão, Marco Alveirinho; Marques, Marta Canas; Dias, Éscar

    2014-01-01

    Sphenoid sinus disease is particular not only for its clinical presentation, as well as their complications. Although rare, these may present as cranial nerve deficits, so it is important to have a high index of suspicion and be familiar with its diagnosis and management. Symptoms are often nonspecific, but the most common are headache, changes in visual acuity and diplopia due to dysfunction of one or more ocular motor nerves. The authors report a case of a 59 years-old male, who was referred to the ENT emergency department with frontal headaches for one week which had progressively worsened and were associated, since the last 12 hours, with diplopia caused by left third cranial nerve palsy. Neurologic examination was normal aside from the left third cranial nerve palsy. Anterior and posterior rhinoscopy excluded the presence of nasal masses and purulent rhinorrhea. The CT scan revealed a soft tissue component and erosion of the roof of the left sphenoid sinus. Patient was admitted for intravenous antibiotics and steroids treatment without any benefit after 48 hours. He was submitted to endoscopic sinus surgery with resolution of the symptoms 10 days after surgery. The authors present this case for its rarity focusing on the importance of differential diagnosis in patients with headaches and cranial nerves palsies.

  17. Atrial septal defect combined with partial anomalous pulmonary venous return: complete anatomic and functional characterization by cardiac magnetic resonance.

    PubMed

    Dellegrottaglie, Santo; Pedrotti, Patrizia; Pedretti, Stefano; Mauri, Francesco; Roghi, Alberto

    2008-11-01

    The presented case regards a 17-year-old male with new-onset right bundle branch block and significantly enlarged right-heart sections as the only pathologic finding on transthoracic echocardiography. Cardiac magnetic resonance (CMR) revealed the presence of a superior sinus venosus atrial septal defect associated with a partial anomalous pulmonary venous return, with the right upper lobe pulmonary vein draining into the superior vena cava. CMR has developed in recent years into an accurate modality for non-invasive evaluation of patients with congenital heart disease, especially through improvements in quality and speed of image acquisition. With echocardiography, sinus venosus defects and anomalous pulmonary vein drainage may be more easily detected by a transoesophageal approach because of the proximity of the transducer to the atrial septum. CMR may be specifically recommended as an alternative to transoesophageal echocardiography in any patient with an unexplained dilatation of the right ventricle.

  18. Look away: arterial and venous intravascular embolisation following shotgun injury.

    PubMed

    Vedelago, John; Dick, Elizabeth; Thomas, Robert; Jones, Brynmor; Kirmi, Olga; Becker, Jennifer; Alavi, Afshin; Gedroyc, Wladyslaw

    2014-01-01

    We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

  19. Isolated Sphenoid Sinus Lesions: Experience with a Few Rare Pathologies

    PubMed Central

    Sadashiva, Nishanth; Nandeesh, B. N.; Shukla, Dhaval; Bhat, Dhananjaya; Somanna, Sampath; Devi, Bhagavatula Indira

    2017-01-01

    Introduction: The sphenoid sinus is often neglected because of its difficult access. The deep position of the sphenoid sinus hinders early diagnosis of pathologies in that location. Delayed diagnosis can cause serious complications due to proximity to many important structures. Objectives: The aim of this study is to demonstrate different pathologies which can affect the sphenoid sinus and elucidate the findings. Methods: Cases of isolated sphenoid sinus lesions encountered in the neurosurgical setting which had rare pathologies are discussed. Pathologies such as Langerhans cell histiocytosis, solitary plasmacytoma, chordoma, pituitary adenoma, leiomyosarcoma, fungal infection, and mucocele which appeared primarily in sphenoid sinus are discussed along with their imaging features and pathological findings. Conclusion: Multitude of different pathologies can occur in sphenoid sinus. Detailed preoperative imaging is very helpful, but transnasal biopsy and histological study are required often for definitive diagnosis. The possible advantages of early diagnosis before spread of pathology for prognosis cannot be overemphasized. PMID:28149092

  20. 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.

  1. Differential diagnosis of allergic rhinitis and sinusitis an expert system

    SciTech Connect

    Creider, R.D.; Sundar Singh, P.S.

    1996-12-31

    Nasal congestion is a common problem for many people. It is a symptom of chronic sinusitis and also a characteristic of allergic rhinitis. Individuals frequently confuse sinusitis and allergic rhinitis. The expert system described below will diagnose the problem to be either rhinitis or sinusitis. In this paper we describe the expert system, the need for such an expert system and the process of developing the system.

  2. Pleomorphic adenoma of the frontal sinus masquerading as a mucocele.

    PubMed

    Chew, Yok Kuan; Brito-Mutunayagam, Sushil; Chong, Aun Wee; Prepageran, Narayanan; Chandran, Patricia Ann; Khairuzzana, Baharudin; Lingham, Omkara Rubini

    2015-12-01

    Pleomorphic adenoma is the most common type of benign salivary gland tumor. It can also be found in the larynx, ear, neck, and nasal septum. It is rarely found in the maxillary sinus, and it has never been reported in the frontal sinus. We report a case of pleomorphic adenoma of the frontal sinus that masqueraded as a mucocele. We discuss the clinical presentation, diagnosis, and treatment of this patient, and we review the literature.

  3. 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

  4. Metastasis of prostate adenocarcinoma to the frontal and ethmoid sinus

    PubMed Central

    Akdemir, Fatih; Aldemir, Mustafa; Çakar, Hasan; Güler, Gülnur

    2016-01-01

    Intracranial metastasis of prostate cancer is rarely seen, and there are few studies in this regard in the literature. Most of these studies in the literature comprise the metastasis of prostate cancer to the sphenoid sinus, and metastasis to the frontal and ethmoid sinus is a much rare entity. Association of visual symptoms, epistaxis, headache, and hematuria may indicate a urologic malignancy in terms of the origin of the primary tumor. This study was aimed to present the prostate cancer case of a 73-year-old patient whose paranasal sinus tomograms revealed the presence of frontal and ethmoid sinus metastasis. PMID:27909626

  5. Anatomic variations of posterior paranasal sinuses and optic nerve.

    PubMed

    Efendić, Alma; Muharemović, Edin; Skomorac, Rasim; Bečulić, Hakija; Šestić, Sabina; Halilović, Benjamin; Mahmić-Kaknjo, Mersiha

    2017-02-01

    Aim To define direct anatomical relations of the sphenoidal (alae minores), ethmoidal sinuses and optic nerve, with an emphasis on determining the effect of age on pneumatisation and dehiscence. Methods This retrospective, descriptive study involved 60 consecutive patients: 30 patients younger than 30 and30 patients older than 60 years of age. All patients underwent computerized tomography(CT). The relationship of the optic nerve and the sphenoidal and ethmoidal sinuses was classified. The presence of dehiscence in the bone structures, forming the optic canal, was checked. Dehiscence was defined as absence of visible bone density located between the sinus and the optic nerve. Protrusion of the optic nerve into the sphenoidal sinus was defined as optic nerve surrounded by pneumatised space. Results The most common type of relation between the optic nerve and sphenoidal sinus was type I, where the optic nerve was immediately adjacent to the lateral or superior wall of the sphenoidal sinus, without impression on the sinus wall. Dehiscence was documented in 15 (25%) cases, it was more common in older patients (8, 27%) than in younger ones (7, 23%). The pneumatisation processes were more frequent in patients over 60 (5, 17%) than in those younger than 30 years (4, 13%). Conclusion Surgeons and ophthalmologists should be aware of high frequency of dehiscence of sphenoidal sinus walls when treating adult patients in our population, especially when evaluating risks and complications of surgical procedures or when diagnosing inflammatory or tumorous processes in the close vicinity of posterior paranasal sinuses.

  6. [Use of bone blocks by sinus floor lifting].

    PubMed

    Nazarian, D N; Karaian, A S; Zakharov, G K; Seniuk, A N; Aliev, S E

    2014-01-01

    The paper presents clinical cases illustrating two sinus floor lifting technique performed for dental implant placement in areas with maxillary sinus floor atrophy: bone block fixation for vertical augmentation (used for immediate implant placement by sinus floor atrophy to 1 mm thickness) and perforation closure. Sinus floor perforations wider than 5 mm were repaired by mandible bone graft providing the possibility of immediate implantation. Bone block was fixed between cortical layers of the maxilla with no internal fixation. Free bone blocks provide additional primary stability of dental implants.

  7. Coronary Flow Impacts Aortic Leaflet Mechanics and Aortic Sinus Hemodynamics.

    PubMed

    Moore, Brandon L; Dasi, Lakshmi Prasad

    2015-09-01

    Mechanical stresses on aortic valve leaflets are well-known mediators for initiating processes leading to calcific aortic valve disease. Given that non-coronary leaflets calcify first, it may be hypothesized that coronary flow originating from the ostia significantly influences aortic leaflet mechanics and sinus hemodynamics. High resolution time-resolved particle image velocimetry (PIV) measurements were conducted to map the spatiotemporal characteristics of aortic sinus blood flow and leaflet motion with and without physiological coronary flow in a well-controlled in vitro setup. The in vitro setup consists of a porcine aortic valve mounted in a physiological aorta sinus chamber with dynamically controlled coronary resistance to emulate physiological coronary flow. Results were analyzed using qualitative streak plots illustrating the spatiotemporal complexity of blood flow patterns, and quantitative velocity vector and shear stress contour plots to show differences in the mechanical environments between the coronary and non-coronary sinuses. It is shown that the presence of coronary flow pulls the classical sinus vorticity deeper into the sinus and increases flow velocity near the leaflet base. This creates a beneficial increase in shear stress and washout near the leaflet that is not seen in the non-coronary sinus. Further, leaflet opens approximately 10% farther into the sinus with coronary flow case indicating superior valve opening area. The presence of coronary flow significantly improves leaflet mechanics and sinus hemodynamics in a manner that would reduce low wall shear stress conditions while improving washout at the base of the leaflet.

  8. Maxillary sinus atelectasis in a wild born gibbon (Hylobates moloch).

    PubMed

    Koppe, Thomas; Röhrer-Ertl, Olav; Breier, Silvana; Wallner, Claus-Peter

    2006-04-01

    In a mixed sex sample of ten adult gibbon (Hylobates moloch) skulls, one cranium of a male with maxillary sinus atelectasis of the left side was identified. While external inspection revealed a slight drop of the left orbital floor, serial coronal computer tomography (CT) scans show characteristic changes of the left maxillary sinus and its surrounding structures. In addition to the sunken orbital floor, radiological features of the specimen include an inward bowing of the medial sinus wall, sinus opacification, and a reduction in maxillary sinus size to a slit-like cavity, which suggest a diagnosis of silent sinus syndrome. This report is the first, to our knowledge, of maxillary sinus atelectasis in a non-human primate. This finding is valuable for the understanding of the pathogenesis and etiology of maxillary sinus atelectasis. At the same time, however, paleoanthropologists and primatologists may refer to this information when dealing with the interpretation of maxillary sinus pneumatization of partially broken archaeological and fossil skulls.

  9. Cerebral cavernous malformations: from molecular pathogenesis to genetic counselling and clinical management.

    PubMed

    Haasdijk, Remco A; Cheng, Caroline; Maat-Kievit, Anneke J; Duckers, Henricus J

    2012-02-01

    Cerebral cavernous (or capillary-venous) malformations (CCM) have a prevalence of about 0.1-0.5% in the general population. Genes mutated in CCM encode proteins that modulate junction formation between vascular endothelial cells. Mutations lead to the development of abnormal vascular structures.In this article, we review the clinical features, molecular and genetic basis of the disease, and management.

  10. Traversing and dilating venous collaterals: a useful adjunct in left ventricular electrode placement.

    PubMed

    Abben, Richard P; Chaisson, Gary; Nair, Vinod

    2010-06-01

    In patients receiving cardiac resynchronization therapy (CRT), the left ventricular electrode cannot always be positioned in the preferred lateral or posterolateral locations due to technical factors and anatomic variations in the coronary sinus. Recent reports also suggest that CRT outcomes are improved by pacing the site of latest dyssynchrony and accessing these regions is not always possible. We report the utility of applying a technique described in the interventional literature over the past 3 years, effectively traversing and dilating collateral channels. Our patients demonstrated either no venous targets in the optimal location, or problems accessing this location using a antegrade approach. Subsequently, collaterals supplying this region were traversed with a guidewire using a retrograde approach and dilated with a balloon catheter. In the first case, the pacing electrode was then advanced in similar fashion and successfully positioned in an ideal lateral location. In the second case, the retrograde guidewire was captured with a vascular snare and pulled into a second guiding catheter, allowing appropriate dilatation and stenting of a problematic proximal venous stenosis with resultant facile placement of the pacing electrode. This technique offers a potential alternative to patients with challenging venous anatomy as a method to facilitate optimal CRT outcomes.

  11. Correlative anatomy for the electrophysiologist, part II: cardiac ganglia, phrenic nerve, coronary venous system.

    PubMed

    Lachman, Nirusha; Syed, Faisal F; Habib, Ammar; Kapa, Suraj; Bisco, Susan E; Venkatachalam, K L; Asirvatham, Samuel J

    2011-01-01

    Cardiac Ganglia, Phrenic Nerve, Coronary Venous System. There is an increasing need for invasive electrophysiologists to appreciate the exact anatomy of the epicardial space and the coronary veins. The location of the epicardial fat, the complementary relationship with the main cardiac veins, and the location of sensitive structures (arteries, phrenic nerve, esophagus) have become required knowledge for electrophysiologists, and accessing the epicardial space with this thorough knowledge of the pericardial sinuses and recesses is essential to allow radiographic correlation during catheter manipulation. In this review, we briefly describe the anatomy of the pericardial space and then discuss the specific correlation for the invasive electrophysiologist, highlighting epicardial access, catheter navigation, and avoidance of collateral injury, with specific attention to the important recesses of the pericardial space, their regional anatomy, and radiographic correlation when navigating catheters to these locations. We also discuss the anatomy of the main cardiac veins in the context of catheter mapping and ablation of the epicardial substrate through the venous system and without subxiphoid pericardial access. In part II of this series we discuss the detailed regional anatomy of the cardiac ganglia, phrenic nerve, and coronary venous system.

  12. Diffuse Proliferative Cerebral Angiopathy: A case report and review of the literature

    PubMed Central

    Rohit; Goh, Poh Sun

    2015-01-01

    Diffuse proliferative cerebral angiopathy is a distinct entity from cerebral arterio-venous malformations; characterized by multiple small arterial feeders and draining veins with normal brain parenchyma seen in-between the abnormal vessels. It is usually seen in younger age group. Here we report a case of diffuse cerebral proliferative angiopathy in a 78-year-old female patient along with discussion of the neuro-imaging findings and review of the literature. It is important to recognize this entity to avoid aggressive surgery or intervention and thus preventing permanent damage to the normal intermingled brain tissue. PMID:26629303

  13. [Prediction of human orthostatic tolerance by changes in arterial and venous hemodynamics in the microgravity environment].

    PubMed

    Kotovskaia, A R; Fomin, G A

    2013-01-01

    The authors intentionally present exclusively the results of their recent studies of arterial and venous hemodynamics as predictors of human orthostatic tolerance (OT) during space flight and on return to Earth. There is a sufficient demonstration of the in-flight OT predictability by arterial hemodynamic reactions to LBNP and venous hemodynamic changes in response to the lower extremities occlusion. Three levels of cerebral blood flow deficits in the course of the lower body negative pressure test (LBNP) performed in microgravity were first defined. The authors offer quantitative arguments for the dependence of cerebral flow deficit on the degree of LBNP tolerance degradation. Patterns of arterial hemodynamics during LBNP were used successfully to diagnose the actual orthostatic tolerance and also to follow its trend as flight extended, which attests to the predictability of OT change in an individual cosmonaut on space flight. Occlusion plethysmography of legs revealed three levels of response of the most informative venous parameters (capacity, distensibility and rate of filling) correlating with severity of OT degradation.

  14. Anatomic (positional) variation of maxillary wisdom teeth with special regard to the maxillary sinus.

    PubMed

    Lanzer, Martin; Pejicic, Rada; Kruse, Astrid L; Schneider, Thomas; Grätz, Klaus W; Lübbers, Heinz-Theo

    2015-01-01

    The removal of wisdom teeth is one of the most common interventions in oral surgery. In order to avoid complications, a profound knowledge of the anatomy of teeth and adjacent tissues is crucial. In the case of maxillary wisdom teeth, their relationship to the maxillary sinus, to the pterygoid fossa, to the maxillary tuber and the adjacent venous plexus is particularly important. Three-dimensional (3D) imaging, for example by means of cone beam computed tomography (CBCT), is increasingly utilized in practice. However, the necessity of CBCT imaging is still a matter of intensive debate. The aim of this study was to describe the anatomic (positional) variation of maxillary wisdom teeth and, based on these findings, to elucidate the additional benefit of such imaging. A retrospective case study was performed using patients examined by means of CBCT imaging in the Department of Dento-Maxillofacial Radiology during the period from 2008 to 2013. Primary study variables comprised the spatial relationship of the teeth to the maxillary sinus, the degree of retention and root development, the covering of the root with bone and mucosa, the root configuration, and the developmental stage of the tooth. In addition, the association of the inclination of teeth in the transversal and sagittal plane with the above variables was evaluated. Descriptive statistical parameters were calculated for all results of the examination. In total, CBCT recordings of 713 maxillary wisdom teeth from 430 patients were evaluated. Their mean age was 29.8 years, and the proportion of male patients slightly prevailed (54.4%). Most teeth exhibited fully developed roots (64.1%). Overall 22.9% of third molars were impacted, 32.3% were retained, and 6.5% were erupting. In more than a third of the patients, wisdom teeth were in occlusion. The inclination of the third molars both in the transversal and sagittal plane was significantly associated with the distance of the root from the maxillary sinus as well

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. [Effects of aminalon, fenibut, and picamilon on the typological parameters of cerebral hemodynamics in swimmers with dysadaptation syndrome].

    PubMed

    Likhodeev, V A; Spasov, A A; Isupov, I B; Mandrikov, V B

    2009-01-01

    The administration of aminalon (0.25 g), fenibut (0.25 g) and picamilon (0.10 g) during 4 weeks as a means of recovery for swimmers with disadaptation syndrome helped to optimize the biochemical status and cerebral circulation 20-min after warm-up. The reaction to the warm-up load under test conditions was characterized by increasing total blood filling of the brain and difficulty of venous outflow. Under the action of drugs, a decrease in blood filling of the brain and increase in venous blood outflow from the cerebral basin was observed 20 min after load in all test groups (except the hypokinetic group taking picamilon).

  20. 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

  1. Olfactory Training in Improving Sense of Smell After Radiation Therapy in Patients With Paranasal Sinus or Nasopharyngeal Cancer

    ClinicalTrials.gov

    2017-04-06

    Stage 0 Nasopharyngeal Carcinoma; Stage 0 Paranasal Sinus Cancer; Stage I Nasopharyngeal Carcinoma; Stage I Paranasal Sinus Cancer; Stage II Nasopharyngeal Carcinoma; Stage II Paranasal Sinus Cancer; Stage IIA Nasopharyngeal Carcinoma; Stage IIB Nasopharyngeal Carcinoma; Stage III Nasopharyngeal Carcinoma; Stage III Paranasal Sinus Cancer; Stage IV Nasopharyngeal Carcinoma; Stage IV Paranasal Sinus Cancer; Stage IVA Nasopharyngeal Carcinoma; Stage IVA Paranasal Sinus Cancer; Stage IVB Nasopharyngeal Carcinoma; Stage IVB Paranasal Sinus Cancer; Stage IVC Nasopharyngeal Carcinoma; Stage IVC Paranasal Sinus Cancer

  2. 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.

  3. Primary endoscopic management of the frontal sinus.

    PubMed

    Kuhn, F A; Javer, A R

    2001-02-01

    Surgical treatment of the frontal sinus continues to be an area of much interest and controversy. The complex anatomy and confined space of this region require the endoscopic surgeon to be knowledgeable and delicate to obtain a positive result. Proper instrumentation is crucial and continues to evolve over time. Postoperative endoscopic care is integral to the success of endoscopic frontal sinusotomy and the availability of proper office equipment to perform this care is critical. In most instances, the intranasal endoscopic approach can be accomplished successfully without the need for an external procedure.

  4. Cerebral Palsy (For Kids)

    MedlinePlus

    ... de los dientes Video: Getting an X-ray Cerebral Palsy KidsHealth > For Kids > Cerebral Palsy Print A A ... the things that kids do every day. What's CP? Some kids with CP use wheelchairs and others ...

  5. Cerebral Palsy (For Kids)

    MedlinePlus

    ... Emergency Room? What Happens in the Operating Room? Cerebral Palsy KidsHealth > For Kids > Cerebral Palsy A A A ... the things that kids do every day. What's CP? Some kids with CP use wheelchairs and others ...

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Distribution of otic postganglionic and recurrent mandibular nerve fibres to the cavernous sinus plexus in monkeys.

    PubMed Central

    Ruskell, G L

    1993-01-01

    The distribution of dorsal rami of the otic ganglion was traced on one or both sides of 1 rhesus and 15 cynomolgus monkeys using interrupted serial sections. From 15 to 24 fine rami containing unmyelinated and small myelinated nerve fibres entered the cranial cavity with the mandibular nerve through the foramen ovale. Most rami contributed to a plexus positioned in the crotch of the mandibular and maxillary nerves adjacent to the trigeminal ganglion. The plexus was augmented by an accessory otic ganglion. Rami then continued dorsally on each side of or through the maxillary nerve and joined the cavernous sinus plexus. The pathway described probably gives otic parasympathetic fibres access to the cerebral arteries and may share a wider distribution in common with other nerves contributing to the cavernous sinus plexus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Figs. 13,15 Fig. 14 PMID:8376193

  12. Heritability of chronic venous disease

    PubMed Central

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

    2010-01-01

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

  13. Calcium hydroxide paste in the maxillary sinus: a case report.

    PubMed

    Fava, L R

    1993-09-01

    A case is reported in which a perforation of the sinus floor of the maxillary sinus occurred with extrusion of a calcium hydroxide paste during routine root canal treatment of a maxillary premolar. All clinical manifestations are described as well as the results of a follow-up evaluation.

  14. Neonatal intensive care: an obvious, yet difficult area for cerebral near-infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Skov, Lotte; Brun, Nikolai C.; Greisen, Gorm

    1997-01-01

    The first clinical application of near-infrared spectroscopy (NIRS) 11 years go was on the head of newborn infants under intensive care. Since then much credible and some important data have been accumulated in this area of research. The best data have been obtained using manipulation of arterial oxygen saturation to obtain single or repeated estimates of cerebral blood flow or cerebral blood volume, or interference with cerebral venous return to obtain measures of venous oxygen saturation. It has been more difficult to take advantage of the continuous and noninvasive nature of NIRS. In particular, the value of the cytochrome signal can still be doubted. A role has not yet developed for NIRS in clinical neonatology.

  15. 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.

  16. 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.

  17. Aging and Cerebral Palsy.

    ERIC Educational Resources Information Center

    Networker, 1993

    1993-01-01

    This special edition of "The Networker" contains several articles focusing on aging and cerebral palsy (CP). "Aging and Cerebral Palsy: Pathways to Successful Aging" (Jenny C. Overeynder) reports on the National Invitational Colloquium on Aging and Cerebral Palsy held in April 1993. "Observations from an Observer" (Kathleen K. Barrett) describes…

  18. [A case of spectacular shrinking deficit caused by paradoxical cerebral embolism secondary to pulmonary arteriovenous fistula].

    PubMed

    Ito, Ai; Ii, Yuichiro; Higashigawa, Takatoshi; Murashima, Shuichi; Tomimoto, Hidekazu

    2013-12-01

    We report a case of spectacular shrinking deficit caused by paradoxical cerebral embolism through pulmonary arteriovenous fistula (AVF). A 79-year-old female suddenly developed right hemiplegia, paresthesia, and speech disturbance symptoms that were improved within 20 min, indicating a diagnosis of spectacular shrinking deficit. Brain magnetic resonance imaging revealed acute cerebral infarcts in the left parietal cortex of the left middle cerebral arterial territory. A contrast-enhanced chest computed tomography scan revealed a pulmonary AVF in the middle lobe of the right lung. The patient had deep venous thrombosis in her left lower leg. She had no clinical signs of telangiectasia, did not exhibit recurrent epistaxis, and had no family history of hereditary hemorrhagic telangiectasia (HHT). Therefore, she was diagnosed with paradoxical cerebral embolism secondary to the pulmonary AVF without HHT. Pulmonary AVF should be considered in patients with cerebral embolism, even when presenting with spectacular shrinking deficit.

  19. Cerebral candidiasis in a 4-year-old boy after intestinal surgery.

    PubMed

    Zhang, Shu-Cheng

    2015-03-01

    Cerebral candidiasis is a devastating disease which contributes to a high mortality. Most of the cerebral candidiasis are never microbiologically or radiologically confirmed. In this case, a 4-year-old boy who developed cerebral candidiasis was successfully rescued and presented. The diagnosis of cerebral candidiasis was established based on both microbiologic and radiologic examinations. The pathogen was revealed to be Candida albicans by cerebrospinal fluid and central venous catheter cultures, and the cerebral involvement was recorded by series head magnetic resonance imaging (MRI) with an appearance of special encephalitis demonstrated. The imaging studies played a critical role throughout the diagnosis and treatment. Familiarity with the imaging findings in the appropriate clinical setting may result in a heightened level of awareness of this infection and, consequently, in earlier diagnosis and treatment.

  20. 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.

  1. [Current controversies in the treatment of frontal sinus fractures].

    PubMed

    Litschel, Ralph; Tasman, A-J

    2009-09-01

    The surgical treatment of frontal sinus fractures is foreshadowed by fears of late complications. Complications such as meningitis and mucoceles should be prevented by cranialization or obliteration of the frontal sinus. These procedures are still standard treatment despite of recent developments over the last two decades in endoscopic sinus surgery, in medical imaging and surgical instrumentation. Nowadays the role of cranialization and obliteration is challenged by refined endoscopic frontal sinus surgery techniques, the widely-used image-guided systems and the multiplanar high-resolution computed tomography along with new data about postoperative complications. This overview summarizes the current literature, taking into account the existing evidence in the treatment of frontal sinus fractures.

  2. Psittacine paranasal sinus--a new definition of compartments.

    PubMed

    Artmann, A; Henninger, W

    2001-12-01

    Documentation of the psittacine paranasal sinuses has been limited. To provide more published detail, spiral computed tomography (CT) was used to scan the cephalic and cervical region from cadavers of 10 psittacine birds (Ara ararauna, Ara chloroptera, Ara macao, and Anodorhynchus hyacinthinus). Skeletal studies, histologic examinations, and evaluation of deep-frozen sections and anatomic preparations confirmed the results of the CT scans. New morphologic details of the paranasal sinus and some compartments were discovered. The paranasal sinuses of these macaws consist of two unpaired rostral compartments, followed caudally by eight paired compartments. Histologic examinations revealed that the walls of the paranasal sinuses consist of flat or cubic monolayer epithelium with underlying connective tissue. The described method of CT examination of these macaws, especially the positioning, scan orientation and parameters, and documentation of the normal paranasal sinus, provides a basis for future clinical use of CT.

  3. [Cerebellar abscesses secondary to infection of an occipital dermal sinus].

    PubMed

    García Galera, A; Martínez León, M I; Pérez da Rosa, S; Ros López, B

    2013-09-01

    A dermal sinus is a congenital defect arising from a closure failure of the neural tube that results in different degrees of communication between the skin and the central nervous system. A dermal sinus can occur anywhere from the root of the nose to the conus medullaris, and the occipital location is the second most common. Dermal sinuses are often found in association with dermoid or epidermoid cysts and less frequently with teratomas. Patients with an occipital dermoid cyst associated with a dermal sinus can develop meningitis and/or abscesses as the first clinical manifestation of the disease due to the dermoid cyst itself becoming abscessed or to the formation of secondary abscesses; few cases of the formation of secondary abscesses have been reported. We present a case of a dermoid cyst associated with an infected dermal sinus and posterior development of cerebellar abscesses and hydrocephalus.

  4. Meta-analytic study of implant survival following sinus augmentation

    PubMed Central

    Barona-Dorado, Cristina; Gómez-Moreno, Gerardo; Fernández-Cáliz, Fernando; Martínez-González, José-María

    2012-01-01

    Objectives: To evaluate graft types used for maxillary sinus augmentation and review success rates of dental implants inserted in these areas, analyzing the graft materials used, implant surface types and the moment of implant placement. Study Design: A meta-analytic study reviewing articles on sinus augmentation published during the last ten years. Results: 3,975 implants placed in sinus augmentations (with bony windows) were registered, of which 3,749 implants survived, a survival rate of 94.3%. Conclusions: When performing sinus augmentation, bone substitute materials are just as effective as autologous bone, whether used alone or in combination with autologous bone. Implant surface treatments can have an important effect on implant survival and it would appear that roughened surfaces are the best option. When implants are inserted simultaneously to grafting, a higher failure rate can be expected. Key words: Sinus augmentation, bone implant, bone regeneration, dental implant. PMID:22157658

  5. Management of orbital complications of sinusitis in pediatric patients.

    PubMed

    Kinis, Vefa; Ozbay, Musa; Bakir, Salih; Yorgancilar, Ediz; Gun, Ramazan; Akdag, Mehmet; Sahin, Muhammed; Topcu, Ismail

    2013-09-01

    The most common reason of orbital infections is sinusitis. Orbital complications of sinusitis are mostly seen in children. Loss of vision and intracranial infections are among the complications of sinusitis. Prompt diagnosis and treatment is very important in the management of orbital complications. The orbital complication can be in the form of cellulitis or abscess. A retrospective review of 26 pediatric patients with orbital complications due to sinusitis was presented in this study. Of 26 patients, there were 13 cases of preseptal cellulitis, 2 cases of orbital cellulitis, and 11 cases of subperiosteal abscess. We grouped the preseptal and orbital cellulites in one category and the subperiosteal abscess in the other. All patients in the cellulitis group recovered by medical treatment. All the patients were treated by surgical drainage. Early diagnosis and appropriate treatment method are vital for the treatment of orbital complications secondary to sinusitis.

  6. Ruptured aneurysms of sinuses of Valsalva

    PubMed Central

    Jugdutt, B. I.; Fraser, R. S.; Rossall, R. E.; Lee, S. J. K.

    1974-01-01

    At least one additional cardiac lesion was present in 18 consecutive patients with ruptured aneurysms of the sinuses of Valsalva who were investigated between 1956 and 1973 at the University of Alberta Hospital. Clinical diagnosis was made in 78% (14/18) of the patients. Confirmation at cardiac catheterization, operation or autopsy was obtained in all but one. The main sites of rupture were the right ventricle (seven cases), right atrium (five) and left ventricle (five). Fifty percent (9/18) are alive and well following prompt operative repair, an average of 8.2 years later (range, six months to 15 years). Replacement of the aortic valve was associated with a high mortality (50% early, 13% late, total 63%) which could be explained by the higher operative risk in this group of very ill patients. Eight patients (44.4%) had had bacterial endocarditis prior to presentation and this may have played a significant role in the rupture of the sinus of Valsalva aneurysm. ImagesFIG. 4FIG. 5 PMID:4278257

  7. Nasal nitric oxide in unilateral sinus disease

    PubMed Central

    Fu, Chia-Hsiang; Tseng, Hsiao-Jung; Huang, Chi-Che; Chang, Po-Hung; Chen, Yi-Wei; Lee, Ta-Jen

    2017-01-01

    Unilateral sinus disease (USD) can sometimes be difficult to accurately diagnose before surgery. The application of nasal nitric oxide (nNO) for USD diagnosis and its surgical outcome in USD has not been reported in the literature. We prospectively enrolled sixty-six USD patients who underwent endoscopic sinus surgery for fungal rhinosinusitis (n = 19), chronic rhinosinusitis (CRS) without nasal polyps (n = 13), CRS with nasal polyps (n = 12) and sinonasal mass lesions (n = 22). nNO levels were measured preoperatively and at three and six months postoperatively. Correlations between nNO levels and potential clinical parameters, type of disease, disease severity, and disease-related quality of life (QOL) were assessed. Unlike bilateral CRS, in USD, nNO levels did not correlate with disease severity or postoperative QOL improvements. Except for fungus group, there were no differences in nNO levels between lesion and non-lesion sides in all the other groups. nNO levels on both sides were significantly elevated six months postoperatively in all groups. Fungal rhinosinusitis patients had the lowest preoperative nNO levels, and a cutoff of 239.3 ppb had the best sensitivity (79.0%) and specificity (87.2%) for preoperative diagnosis. While preoperative nNO levels cannot serve as an alternative marker for disease severity of USD, they were lower in fungal rhinosinusitis patients than in other USD patients and may be useful for more accurate diagnosis prior to surgery. PMID:28199369

  8. Sublingual Immunotherapy for Allergic Fungal Sinusitis.

    PubMed

    Melzer, Jonathan M; Driskill, Brent R; Clenney, Timothy L; Gessler, Eric M

    2015-10-01

    Allergic fungal sinusitis (AFS) is a condition that has an allergic basis caused by exposure to fungi in the sinonasal tract leading to chronic inflammation. Despite standard treatment modalities, which typically include surgery and medical management of allergies, patients still have a high rate of recurrence. Subcutaneous immunotherapy (SCIT) has been used as adjuvant treatment for AFS. Evidence exists to support the use of sublingual immunotherapy (SLIT) as a safe and efficacious method of treating allergies, but no studies have assessed the utility of SLIT in the management of allergic fungal sinusitis. A record review of cases of AFS that are currently or previously treated with sublingual immunotherapy from 2007 to 2011 was performed. Parameters of interest included serum IgE levels, changes in symptoms, Lund-McKay scores, decreased sensitization to fungal allergens associated with AFS, and serum IgE levels. Ten patients with diagnosed AFS were treated with SLIT. No adverse effects related to the use of SLIT therapy were identified. Decreases in subjective complaints, exam findings, Lund-McKay scores, and serum IgE levels were observed. Thus, sublingual immunotherapy appears to be a safe adjunct to the management of AFS that may improve patient outcomes.

  9. Simulating cell apoptosis induced sinus node dysfunction.

    PubMed

    Kharche, Sanjay; Beling, John; Biktasheva, Irina V; Zhang, Henggui; Biktashev, Vadim N

    2013-01-01

    Sinus node dysfunction (SND) is correlated to the pacemaker sinoatrial node (SAN) cell apoptosis. This study explores the effect of such a dysfunctional SAN on electrical propagation into neighboring atrial tissue. The Fenton Karma model was extended to simulate mouse SAN and atrial cell action potentials. The cell models were incorporated into a 2D model consisting of a central SAN region surrounded by atrial tissue. The intercellular gap junctional coupling, as quantified by the diffusion constant, was estimated to give conduction speeds as observed in mouse atrial tissue. The size of mouse SAN pacemaking region was estimated using the 2D model. In multiple simulations, the effects of an increasing proportion of apoptotic pacemaker cells on atrial tissue pacing were simulated and quantified. The SAN size that gave a basal mouse atrial cycle length (ACL) of 295 ms was found to be 0.6 mm in radius. At low pacemaker cell apoptosis proportion, there was a drastic increase of ACL. At modest increase in the number of apoptotic cells, bradycardia was observed. The incidence of sinus arrest was also found to be high. When the number of apoptotic cells were 10% of the total number of pacemaking cells, all pacemaking was arrested. Phenomenological models have been developed to study mouse atrial electrophysiology and confirm experimental findings. The results show the significance of cell apoptosis as a major mechanism of SND.

  10. [Nasal cavity and paranasal sinus cancer].

    PubMed

    Peyraga, G; Lafond, C; Pointreau, Y; Giraud, P; Maingon, P

    2016-09-01

    The nasal cavity and parasinusal cancer are rare (10% of tumors of the head and neck) and are mainly represented by squamous cell carcinoma of the nasal cavity or the maxillary sinus and adenocarcinoma of the ethmoid sinus (occupational disease, wood dust). The most common clinical sign is nasal obstruction, but tumors can also manifest as rhinorrhea and/or epistaxis (usually unilateral signs). A magnetic resonance imaging of the facial structure is systematic for staging before treatment. The treatment consists of a first surgery if the patient is operable with a resectable tumor. If it is not the case, the treatment consists of radiotherapy (RT) associated with chemotherapy (CT) according to the initial data (T3/T4 or N+). After first surgery, RT is indicated (except T1N0 with complete resection) associated with a CT based on postoperative data (capsular effraction or incomplete resection). Lymph node irradiation is considered case by case, but is indicated in any nodal involvement. RT must be an intensity modulated RT (IMRT), static or dynamic, and must be imagery guided (IGRT). According to ICRU 83, doses to organs at risk and target volumes must be carried. Finally, after a post-treatment baseline imaging between 2 and 4 months, monitoring will be alternated with the ENT surgeon every 2 or 3 months for 2 years, then every 4 to 6 months for 5 years.

  11. Cerebral circulation in hypoxia and ischemia.

    PubMed

    Kovách, A G

    1988-01-01

    In conclusion our results clearly suggest that vital functions of the brain, in spite of its well developed autoregulation are impaired during prolonged hypovolemic conditions. Regional cerebral blood flow measured by the 133Xe clearance and 14C-antipyrine autoradiographic techniques demonstrated a progressive reduction in CBF, with the development of patchy and circumscribed ischemic areas during hemorrhagic shock which persisted after reinfusion. The regional distribution of the underperfused regions cannot be explained solely in terms of boundary zones between the main distribution fields of major cerebral arteries. Our results suggest the involvement of the sympathetic nervous system in the impairment of cerebral microcirculation during hemorrhagic shock. The patchy focal brain damage could be the background of the functional impairment. The focal appearances suggests that, in addition to generalized (blood borne) changes, local factors play an important role in the production of ischemic areas in the brain. Afferent neural nociceptive input to the brain seems to be elevated during shock. It may be presumed that this leads to increased tissue metabolism and the accumulation of metabolites. The low flow combined with elevated neuronal activity and cellular metabolism produces an imbalance between oxygen delivery and oxygen utilization. The local nature of afferent activation of the CNS can explain the regional impairment in the brain tissue. Nociceptive afferent stimulation increases, while denervation of the carotid sinus or transsection of the vagus or spinal afferent pathways decreases the sensitivity to shock. We have presented further evidence that stimulation of the C-fibres of the sciatic nerve reduced local cerebral blood flow and the tissue PO2 in the n. VPL thalami and VM hypothalami in cardiovascularly restricted (stabilized blood pressure) animals. Concerning the subcellular events that may lead to neuronal death during hemorrhagic shock, we believe

  12. Near-infrared imaging of the sinuses: preliminary evaluation of a new technology for diagnosing maxillary sinusitis

    NASA Astrophysics Data System (ADS)

    Mahmood, Usama; Cerussi, Albert; Dehdari, Reza; Nguyen, Quoc; Kelley, Timothy; Tromberg, Bruce; Wong, Brian

    2010-05-01

    Diagnosing sinusitis remains a challenge for primary care physicians. There is a need for a simple, office-based technique to aid in the diagnosis of sinusitis without the cost and radiation risk of conventional radiologic imaging. We designed a low-cost near-infrared (NIR) device to transilluminate the maxillary sinuses. The use of NIR light allows for greater interrogation of deep-tissue structures as compared to visible light. NIR imaging of 21 patients was performed and compared with computed tomography (CT) scans. Individual maxillary sinuses were scored on a scale from 0 to 2 based on their degree of aeration present on CT and similarly based on the NIR signal penetration into the maxilla on NIR images. Our results showed that air-filled and fluid/tissue-filled spaces can be reasonably distinguished by their differing NIR signal penetration patterns, with average NIR imaging scores for fluid-filled maxillary sinuses (0.93+/-0.78, n=29) significantly lower than those for normal maxillary sinuses (1.62+/-0.57, n=13) (p=0.003). NIR imaging of the sinuses is a simple, safe, and cost-effective modality that can potentially aid in the diagnosis of sinusitis. Long-term, significant device refinement and large clinical trials will be needed to determine the diagnostic accuracy of this technique.

  13. Assessment of the Diagnostic Accuracy of Limited CT Scan of Paranasal Sinuses in the Identification of Sinusitis

    PubMed Central

    Noorian, Vahid; Motaghi, Arya

    2012-01-01

    Background Paranasal sinus CT has high sensitivity and specificity for sinusitis. However, this modality is costly and involves greater radiation exposure than plain radiographs. Objectives We tried to compare 10-cut limited CT scan and standard CT scan in the diagnosis of sinusitis. Materials and Methods We conducted a cross sectional case series from August to December 2010 on 150 patients with non-randomized sampling method in academic hospitals related to medical school of Shahid Beheshti University of medical sciences. Using standard CT scan as the gold standard, the sensitivity and specificity of limited series were calculated for each sinus group. Results In our study limited CT scan had a sensitivity of 92%, specificity of 94%, positive predictive value of 90% and negative predictive value of 95%. Conclusions The limited CT scan is useful for confirming the clinical diagnosis of sinusitis. PMID:23396584

  14. Treatment of transtentorial herniation unresponsive to hyperventilation using hypertonic saline in dogs: effect on cerebral blood flow and metabolism.

    PubMed

    Qureshi, Adnan I; Wilson, David A; Traystman, Richard J

    2002-01-01

    We tested the hypothesis that transtentorial herniation (TTH) represents a state of cerebral ischemia that can be reversed by hypertonic saline. Because of the high mortality associated with TTH, new therapeutic strategies need to be developed for rapid and effective reversal of this process. We produced TTH (defined by acute dilatation of one or both pupils) by creating supratentorial intracerebral hemorrhage with autologous blood injection in seven mongrel dogs anesthetized using intravenous pentobarbital and fentanyl. We measured serial rCBF (regional cerebral blood flow) using radiolabeled microspheres in regions around and distant to the hematoma. Cerebral oxygen extraction and oxygen consumption (CMRO2) were measured by serial sampling of cerebral venous blood from the sagittal sinus. Mean arterial pressure (MAP) and intracranial pressure (ICP) were continuously monitored. TTH was successfully reversed over a mean period of 25.7 +/- 4.9 minutes after intravenous administration of 23.4% sodium chloride (1.4 mL/kg) in all animals. All measurements were recorded 15, 30, 60, and 90 minutes after administration of 23.4% sodium chloride. Compared to prehematoma ICP (14.1 +/- 1.7 mm Hg, mean +/- SE), elevation in ICP was observed during TTH (36.2 +/- 7.2 mm Hg) with no change in cerebral perfusion pressure (CPP) (80.4 +/- 4.7 vs. 76.7 +/- 10.1 mm Hg) because of concomitant elevation in mean arterial pressure. Compared to baseline values, there was a reduction in rCBF (mL/100 gm/min +/- SE) in brainstem (12.1 +/- 2.0 vs. 21.4 +/- 1.4), gray matter (18.2 +/- 2.1 vs. 31.4 +/- 1.8), and white matter (8.6 +/- 1.7 vs.18.7 +/- 0.9) in the hemisphere contralateral to the hematoma; and gray matter (12.9 +/- 2.9 vs. 27.9 +/- 2.2) and white matter (8.3 +/- 2.0 vs.19.9 +/- 1.0) in the ipsilateral hemisphere distant from the hematoma. Administration of 23.4% sodium chloride resulted in reduced ICP at 15 minutes (12.7 +/- 1.4) and 30 minutes (15.6 +/- 3.1) after administration

  15. Proposition of a new classification of the cerebral veins based on their termination.

    PubMed

    Nowinski, Wieslaw L

    2012-03-01

    The existing classifications of cerebral veins have certain problems, including limited adequacy to uniquely describe neurovascular networks in three dimensions (3D), mixture of deep and superficial veins, and ambiguity of territories-based parcellations as veins may course on multiple territories. Classification discrepancies exist in subdivision, region drained, and parcellation criteria. Recent developments in diagnostic imaging and computers enable to acquire, create, and manipulate complete vascular networks, which also call for a new classification of cerebral veins. We propose a new classification suitable for the description of the complete cerebral veins, providing a clear separation of the superficial cortical veins from deep veins, and facilitating presentation and exploration of cerebral veins in 3D with respect to surrounding neuroanatomy. It is based on terminating vascular subsystems (rather than draining regions). It divides the cerebral veins into cortical, deep, and posterior fossa veins. The cortical veins are subdivided into two groups: terminating in dural sinuses and terminating in deep veins. The posterior fossa veins are subdivided also into two groups: terminating in dural sinuses and terminating in deep veins. This classification was illustrated with a cerebrovascular model containing over 1,300 vessels. This new classification has many advantages. It is simple, clear and didactically useful; avoids mixture of superficial and deep veins; shows overall hierarchical structure and topographical relationships including tributaries; is useful in analysis of 3D vascular trees extracted from imaging; and may be used in conjunction with the existing parcellations.

  16. [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.

  17. Limited endoscopic transsphenoidal approach for cavernous sinus biopsy: illustration of 3 cases and discussion.

    PubMed

    Graillon, T; Fuentes, S; Metellus, P; Adetchessi, T; Gras, R; Dufour, H

    2014-01-01

    Advances in transsphenoidal surgery and endoscopic techniques have opened new perspectives for cavernous sinus (CS) approaches. The aim of this study was to assess the advantages and disadvantages of limited endoscopic transsphenoidal approach, as performed in pituitary adenoma surgery, for CS tumor biopsy illustrated with three clinical cases. The first case was a 46-year-old woman with a prior medical history of parotid adenocarcinoma successfully treated 10 years previously. The cavernous sinus tumor was revealed by right third and sixth nerve palsy and increased over the past three years. A tumor biopsy using a limited endoscopic transsphenoidal approach revealed an adenocarcinoma metastasis. Complementary radiosurgery was performed. The second case was a 36-year-old woman who consulted for diplopia with right sixth nerve palsy and amenorrhea with hyperprolactinemia. Dopamine agonist treatment was used to restore the patient's menstrual cycle. Cerebral magnetic resonance imaging (MRI) revealed a right sided CS tumor. CS biopsy, via a limited endoscopic transsphenoidal approach, confirmed a meningothelial grade 1 meningioma. Complementary radiosurgery was performed. The third case was a 63-year-old woman with progressive installation of left third nerve palsy and visual acuity loss, revealing a left cavernous sinus tumor invading the optic canal. Surgical biopsy was performed using an enlarged endoscopic transsphenoidal approach to the decompress optic nerve. Biopsy results revealed a meningothelial grade 1 meningioma. Complementary radiotherapy was performed. In these three cases, no complications were observed. Mean hospitalization duration was 4 days. Reported anatomical studies and clinical series have shown the feasibility of reaching the cavernous sinus using an endoscopic endonasal approach. Trans-foramen ovale CS percutaneous biopsy is an interesting procedure but only provides cell analysis results, and not tissue analysis. However, radiotherapy and

  18. The extracranial venous system in the heads of beaked whales, with implications on diving physiology and pathogenesis.

    PubMed

    Costidis, Alexander M; Rommel, Sentiel A

    2016-01-01

    Beaked whales are a poorly known but diverse group of whales that have received considerable attention due to strandings that have been temporally and spatially associated with naval sonar deployment. Postmortem studies on stranded carcasses have revealed lesions consistent with decompression sickness, including intravascular gas and fat emboli. These findings have been supported by analyses of intravascular gas emboli showing composition dominated by nitrogen gas. To increase our understanding of the pathophysiology of nitrogen bubble formation and intravascular embolization, we examined the gross and microscopic anatomy of the venous system in the head of beaked whales. Since the potential sources of intravascular fat and gas emboli were of greatest interest, focus was placed on the acoustic fat bodies and pneumatic accessory sinus system. Herein, we describe intimate arteriovenous associations with specialized adipose depots and air sinuses in beaked whales. These vascular structures comprise an extensive network of thin-walled vessels with a large surface area, which is likely to facilitate exchange of nitrogen gas and may, therefore, form anatomic regions that may be important in physiological management of diving gases. These structures may also be vulnerable to pathologic introduction of emboli into the vascular system. Expansive, thin-walled venous lakes are found within the pterygoid region, which suggest the potential for nitrogen exchange as well as for compensation of middle-ear pressures during descent on a dive. These findings warrant further research into the structure and function of this morphology as it relates to normal and pathologic physiology.

  19. [Cholesterol granuloma in paranasal sinus. An unfrequent pseudotumor in maxillary sinuses].

    PubMed

    García de Hombre, Alina María; Pérez Peñate, Armando

    2005-01-01

    The cholesterol granuloma is well known in the middle ear, in the mastoid antrum and the air cells of temporal bone, mostly related to a chronic infectious process. There are other localizations such as the pleura, lung, pericardium, kidneys, arterial wall, nerves, brain, testicles, lymphatic ganglion and in the paranasals sinuses. Its localization in the mediofacial area is very unfrequent, having only been described 44 cases up to the year 2002. We present a 42 year-old patient, who required surgical treatment because of a increase in the volume of area her left facial of one month's old. It resulted to be secundary to an expansion of the maxilar sinus, such as seen on the computerized tomography carried out on the patient. The diagnosis was cholesterol granuloma, performed, through the anatomo-pathology study. We review the litterature on this subject and analyse the possible etiologic cause of this lesion, its clinic, diagnostic methodology and treatment.

  20. 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...

  1. 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...

  2. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section... 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...

  3. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section... 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...

  4. [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.

  5. 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.

  6. Clinical Study on the Etiology of Postthyroidectomy Skin Sinus Formation

    PubMed Central

    Bao, Wuyuntu; Borkhuu, Oyungerel; Yang, Yun-Tian

    2017-01-01

    Background. Thyroidectomy is one of the most frequently performed surgical procedures worldwide. Despite technical advances and high experience of thyroidectomy of specialized centers, it is still burdened by a significant rate of postoperative complications. Among them, the skin sinus formation is an extremely rare postthyroidectomy complication. Here, we first report the incidence of the skin sinus formation after thyroidectomy to identify the causes for skin sinus formation after thyroidectomy and to discuss its prevention and treatment options. Methods. A retrospective analysis was carried out of patients who underwent excision operation of fistula for postthyroidectomy skin sinus formation. Data were retrieved from medical records department of the Affiliated Hospital of Inner Mongolia Medical University. Results. Of the 5,686 patients who underwent thyroid surgery, only 5 patients (0.088%) had developed skin sinus formation. All 5 patients successfully underwent complete excision of fistula. Conclusion. Infection, foreign body, thyroid surgery procedure, combined disease, and iatrogenic factors may be related with skin sinus formation after thyroidectomy. To reduce the recurrence of postoperative infections and sinus formation, intra- and postoperative compliance with aseptic processing, intraoperative use absorbable surgical suture/ligature, repeated irrigation and drainage, and postoperative administration of anti-inflammatory treatment are to be followed. PMID:28386584

  7. CT features of alveolitis and sinusitis in horses.

    PubMed

    Henninger, Wolfgang; Frame, E Mairi; Willmann, Michael; Simhofer, Hubert; Malleczek, Dieter; Kneissl, Sibylle M; Mayrhofer, Elisabeth

    2003-01-01

    Sinusitis is a common disorder in horses and may result from trauma, dental diseases, or space-occupying lesions. Radiography can only provide a limited amount of information. Computed tomography (CT) has been documented as an alternative imaging method. Eighteen horses (mostly Warmblood) with signs of chronic sinusitis were examined preoperatively with CT to assist in diagnosis of the underlying cause. There was a group of common CT features in horses with dental disease and sinusitis. The first molar was the most frequently affected maxillary cheek tooth. Hypoattenuation of the cementum, destruction of the enamel, and filling of the infundibular cavity with gas were the most frequent CT findings associated with caries. Gas bubbles within the bulging root area or fragmentation of the root in combination with swelling of the adjacent sinus lining were the most important CT features of dental decay. CT findings associated with sinusitis included excessive thickening of the respiratory epithelium in the rostral maxillary sinus; the caudal maxillary sinus was less often involved. The infraorbital canal, the nasomaxillary duct, and the frontomaxillary aperture were usually involved. The maxillary bone, however, especially the facial crest, was involved in nearly every horse, being characterized by endosteal sclerosis, thickening, periosteal reaction, and deformation leading to facial swelling in chronic infections. CT images allowed identification of involvement of individual teeth more clearly to reveal the diseased one for treatment. Three-dimensional imaging allowed improved understanding of the extent and severity of the pathologic change.

  8. A weed by any other name.

    PubMed

    Burger, Berdine M; Chavis, Pamela S; Purvin, Valerie

    2013-01-01

    A 39-year-old white man presented with intractable headaches and papilledema. The initial workup, with normal MRI and MRV but elevated cerebrospinal fluid protein raised concerns about the putative diagnosis of idiopathic intracranial hypertension, and his condition remained refractory to maximum medical treatment. Angiography revealed cerebral venous sinus stenosis, thought to represent chronic thrombosis. The diagnosis and treatment of cerebral venous sinus stenosis and thrombosis are discussed.

  9. Relaxation oscillation model of hemodynamic parameters in the cerebral vessels

    NASA Astrophysics Data System (ADS)

    Cherevko, A. A.; Mikhaylova, A. V.; Chupakhin, A. P.; Ufimtseva, I. V.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    Simulation of a blood flow under normality as well as under pathology is extremely complex problem of great current interest both from the point of view of fundamental hydrodynamics, and for medical applications. This paper proposes a model of Van der Pol - Duffing nonlinear oscillator equation describing relaxation oscillations of a blood flow in the cerebral vessels. The model is based on the patient-specific clinical experimental data flow obtained during the neurosurgical operations in Meshalkin Novosibirsk Research Institute of Circulation Pathology. The stability of the model is demonstrated through the variations of initial data and coefficients. It is universal and describes pressure and velocity fluctuations in different cerebral vessels (arteries, veins, sinuses), as well as in a laboratory model of carotid bifurcation. Derived equation describes the rheology of the ”blood stream - elastic vessel wall gelatinous brain environment” composite system and represents the state equation of this complex environment.

  10. 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.

  11. Near-infrared imaging for management of chronic maxillary sinusitis

    NASA Astrophysics Data System (ADS)

    You, Joon S.; Cerussi, Albert E.; Kim, James; Ison, Sean; Wong, Brian; Cui, Haotian; Bhandarkar, Naveen

    2015-03-01

    Efficient management of chronic sinusitis remains a great challenge for primary care physicians. Unlike ENT specialists using Computed Tomography scans, they lack an affordable and safe method to accurately screen and monitor sinus diseases in primary care settings. Lack of evidence-based sinusitis management leads to frequent under-treatments and unnecessary over-treatments (i.e. antibiotics). Previously, we reported low-cost optical imaging designs for oral illumination and facial optical imaging setup. It exploits the sensitivity of NIR transmission intensity and their unique patterns to the sinus structures and presence of fluid/mucous-buildup within the sinus cavities. Using the improved NIR system, we have obtained NIR sinus images of 45 subjects with varying degrees of sinusitis symptoms. We made diagnoses of these patients based on two types of evidence: symptoms alone or NIR images along. These diagnostic results were then compared to the gold standard diagnosis using computed tomography through sensitivity and specificity analysis. Our results indicate that diagnosis of mere presence of sinusitis that is, distinguishing between healthy individuals vs. diseased individuals did not improve much when using NIR imaging compared to the diagnosis based on symptoms alone (69% in sensitivity, 75% specificity). However, use of NIR imaging improved the differential diagnosis between mild and severe diseases significantly as the sensitivity improved from 75% for using diagnosis based on symptoms alone up to 95% for using diagnosis based on NIR images. Reported results demonstrate great promise for using NIR imaging system for management of chronic sinusitis patients in primary care settings without resorting to CT.

  12. HLA-typing analysis following allogeneic bone grafting for sinus lifting.

    PubMed

    Piaia, Marcelo; Bub, Carolina Bonet; Succi, Guilherme de Menezes; Torres, Margareth; Costa, Thiago Henrique; Pinheiro, Fabricio Costa; Napimoga, Marcelo Henrique

    2017-03-01

    According to the Brazilian Association of Organ Transplants, in 2015, 19,408 bone transplants were performed in Brazil, over 90% by Dental Surgeons. The surgical technique itself has a respectable number of reports regarding its clinical efficacy, as measured by long-term survival of dental implants in grafted areas. Uncertainty remains, however, as to whether fresh frozen grafts from human bone donors remain immunologically innocuous in the body of the host. Six male with no previous medical history of note, including systemic diseases, surgery or blood transfusion were selected. These patients underwent reconstructive procedures (sinus lifting) using fresh frozen human bone from a tissue bank. All patients had venous blood samples collected prior to surgery and 6 months after the procedure. Anti-HLA analysis for the detection of HLA (human leukocyte antigen) antibodies was performed using methods such as the LABScreen PRA Class I and Class II, LABScreen Single Antigen Class I and Class II, Luminex Platform. Reactive individuals to the screening tests (LABScreen PRA) were further investigated to determine the specificity of the antibodies detected (LABScreen Single Antigen) with a cutoff value of median fluorescence intensity ≥500. As a result, it was observed that two patients (33%) were positive in screening tests, one presenting with anti-HLA Class I and II sensitization and the other with anti-HLA class II. The specificity analysis showed that the patients sensitized to HLA class II presented 4 specificities, 3 of which immunologically relevant. In the second individual, 23 specificities were identified, 6 of which immunologically important for HLA class I and 4 specificities for HLA class II, 3 of these were immunologically important. All specificities detected had average fluorescence. These findings are suggestive that sinus-lifting procedures with allogeneic bone can induce immunological sensitization.

  13. 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

  14. 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.

  15. 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.

  16. Bradycardia: sinus and AV node dysfunction.

    PubMed

    Pellegrini, Cara N; Scheinman, Melvin M

    2015-09-01

    The surface electrocardiogram (ECG) holds many clues with regard to the etiology of bradycardia and site of atrioventricular (AV) block. Bedside maneuvers may prove helpful in cases of 2:1 AV block or situations where the data is not all concordant. Wenckebach conduction may occur in any region of the heart, and there are nonpathologic mimickers of Mobitz II AV block as well. The surface ECG may aid in the inference of etiology for better than expected or slowed rather than blocked AV conduction. Sinus node dysfunction may present in several forms and often accompanies other conduction system disease. On occasion invasive studies may be required to help elucidate the mechanism of bradycardia.

  17. Giant complex odontoma in maxillary sinus

    PubMed Central

    Carvalho Visioli, Adriano Rossini; de Oliveira e Silva, Cléverson; Marson, Fabiano Carlos; Takeshita, Wilton Mitsunari

    2015-01-01

    In this manuscript, we present a rare case report of giant complex odontoma in the maxillary sinus, where the applied therapy included complete excision of the lesion with a conservative approach. Odontomas are also called benign growth abnormalities or hamartomas. They represent a more common type of odontogenic tumor and are related to various disorders such as bad dental placements, expansion, increased volumetric bone, and no eruption of permanent teeth. Usually they have an asymptomatic evolutionary course. The etiologic factors, although obscure, are related to local trauma, infection, and genetic factor. The structural composition of an odontoma consists of mature dental tissues. Odontomas can be differentiated according to their anatomical presentations: Compound odontoma-clusters of several denticles and complex odontoma-well defined tumefaction mass. The diagnosis can be performed by radiographic examination. PMID:26389051

  18. Aneurysm of the sinus of valsalva.

    PubMed

    Ott, David A

    2006-01-01

    Aneurysms of the sinus of Valsalva (ASVs) are rare. They can be congenital or acquired through infection, trauma, or degenerative diseases. They frequently co-occur with ventricular septal defects, aortic valve dysfunction, or other cardiac abnormalities. Although unruptured ASVs are usually asymptomatic, ruptured ASVs often cause symptoms similar to those of heart failure and produce a continuous, mechanical-sounding murmur. Transsternal or transesophageal echocardiography is usually effective in detecting ASVs. Because symptomatic ASVs pose significant risks for the patient, and because the repair of asymptomatic ASVs generally produces excellent outcomes, surgery is indicated in most cases. The primary goals of surgical repair are to close the ASV securely, remove or obliterate the aneurysmal sac, and repair any associated defects. Operative mortality is generally low except in patients with concomitant bacterial endocarditis or other infections. Late events are uncommon and tend to be related to aortic valve prothesis or Marfan syndrome.

  19. Acute Vision Loss Following Endoscopic Sinus Surgery

    PubMed Central

    Antisdel, Jastin

    2017-01-01

    A 41-year-old female with a history of uterine cancer and Celiac and Raynaud's Disease presented to our institution with frequent migraines and nasal congestion. She underwent functional endoscopic sinus surgery (FESS) and experienced acute unilateral vision loss postoperatively. Rapid recognition of the etiology and effective treatment are paramount given the permanent and irreversible vision loss that can result. Arterial vasospasm following FESS is rare. Patients with autoimmune diseases have perhaps an increased risk for vasospasm secondary to an increased vasoreactive profile. We present the first documented case of nitroglycerin sublingual therapy to successfully treat ophthalmic artery vasospasm following FESS. Nitroglycerin sublingual therapy is a promising treatment for ophthalmic vasospasm secondary to its ability to cross the blood-ocular barrier, its rapid onset of action, and its ability to promote relaxation of vascular smooth muscle. PMID:28286685

  20. Measurement of velocity of air flow in the sinus maxillaris.

    PubMed

    Müsebeck, K; Rosenberg, H

    1979-03-01

    Anemometry with the hot wire and hot film technique previously described, enables the rhinologist to record slow and rapidly changing air flow in the maxillary sinus. The advantages and disadvantages of this method are considered. Anemometry together with manometry may be designated sinumetry and used as a diagnostic procedure following sinuscopy in chronic maxillary sinus disease. The value of the function from velocity of time allows the estimation of flow-volume in the sinus. Furthermore, the method is useful to evaluate the optimal therapy to restore ventilation in the case of an obstructed ostium demonstrated before and after surgical opening in the inferior meatus.