PubMed · 14958723
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L EFSKIND. 1952-05-01. [Recent progress in surgery].. https://pubmed.ncbi.nlm.nih.gov/14958723/
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OBJECTIVES: Umbilical venous pulsation is an important sign of hemodynamic compromise, but is also found under normal physiological conditions. Mathematical modeling suggests that vascular compliance is a determinant for pulsation, and we tested this by studying velocity pulsation at three sites on the umbilical vein. METHODS: In a cross-sectional study of 279 low-risk pregnancies (20-40 weeks' gestational age) blood flow velocity in the umbilical vein was determined before, within and after the umbilical ring in the fetal abdominal wall, and the incidence and magnitude of pulsation (the difference between the maximum and minimum velocity during a pulse, and pulsatility index) were noted. Based on the fact that the vessel cross-sectional area is an important determinant of compliance, we measured the diameter and time-averaged maximum velocity to reflect variation in diameter and compliance at the three sites. RESULTS: The incidence of umbilical venous pulsation was higher at the umbilical ring in the abdominal wall (242/279, 87%, 95% CI 82-90) than in the cord (43/198, 22%, 95%CI 16-27) or intra-abdominally (84/277, 30%, 95% CI 25-36) (P < 0.001). When pulsation was observed intra-abdominally, the pulsatility was not different from that at the umbilical ring (P = 0.16). However, the lowest pulsatility was found in the cord vein (P < 0.0001), where the largest vein diameter was found. CONCLUSION: The high incidence of venous pulsation at the umbilical ring where diameter and compliance are low supports the suggestion that local compliance is an important factor influencing pulsation in fetal veins.
Penile strangulation injuries are rare emergency situations, but need a fast urological emergency management for decompression of the penis and for removing of the foreign bodies. Strangulation objects can be metallic or non-metallic objects and are usually used for erotic or autoerotic purposes, for masturbation or increasing erection. We report a case of a 62-year old male with a total infected gangrene of the penis caused by a strangulation of a plastic bottle neck which continued 14 days. A total amputation of the penis was necessary. A perineal urethrostomy was performed as definitive urine diversion. Bacteriologic examination has identified Proteus mirabilis. Thus, a systemic antibiotic therapy was perioperatively applicated. The further course was uneventful with a secondary healing wound.