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A case of renal vein thrombosis following puerperal ovarian vein thrombophlebitis is reported. We review the syndrome of puerperal ovarian vein thrombophlebitis and emphasize the potential for renal vein and vena caval involvement. The utility of computed tomographic scanning for diagnostic confirmation of this postpartum complication is described.
Although intimal hyperplasia is a major cause limiting the long-term patency of the vein grafts, its precise mechanisms, including the effect of poor runoff, has not yet been well characterized. We thus designed the present study to try to determine the effect of poor runoff arterial flow to the phenotypic alterations of the graft wall by immnohistochemistry using anti-intermediate filaments (alpha-SM actin, desmin, and vimentin) and anti-myosin heavy chain (SM1, SM2, and SMemb) specific antibodies. Vein grafts implanted under the poor runoff hind limb of rabbits showed enhanced intimal hyperplasia, however, no apparent difference in the cytoskeleton expression, including intermediate filaments and MHC, between two groups until 4 weeks. Interestingly, six of eight vein grafts at 2 weeks after implantation in both groups showed the accumulations of perivascular fibroblast-like phenotype (negative for SM1, alpha-SM actin, and desmin) in some parts of the outer neointima, whereas the inner neointima at 2 weeks and the whole neointima at 4 weeks were mainly occupied by a smooth muscle phenotype (positive for these three). Although the cellular origin of these cells is still unknown, these results suggest that the migration of non-muscle mesenchymal cells is involved in the neointima and thus may provide a clue for better understanding vein graft remodeling.
Venoocclusive disease is characterized by the occurrence of occlusive lesions of the central and subhepatic veins, usually involving the liver in a diffuse fashion. We report a case showing venoocclusive lesions of the central veins and the portal vein radicles affecting only a portion of the left lobe of the liver following intraarterial 5-fluoro-2'-deoxyuridine therapy for metastatic adenocarcinoma of the colon. Possible mechanisms and the significance of venoocclusive lesions of portal vein radicles are discussed.
Reluctance to use saphenous vein (SV) for patch closure of the carotid arteriotomy is due in part to the concern of vascular surgeons that the SV should be preserved for possible future coronary or lower extremity reconstruction. Even among those who favour vein patch closure of the arteriotomy for improved immediate and late results, an effort has been made to use the ankle portion of the SV, preserving the upper, larger segment for later surgery. Recent reports of rupture of the patches formed from ankle SV and a study showing a decrease in strength of the ankle segment of vein, raised the question of the importance of trying to preserve the proximal SV and the impact of use of this segment in those patients requiring secondary vascular procedures. We reviewed 134 consecutive carotid patients from 1981 who had proximal SV harvested for patch angioplasty. Of those 122 were available (mean 44.9 months). Thirteen had secondary vascular procedures. Adequate saphenous vein was available in twelve. We conclude from this study that (1) less than 15% of patients undergoing carotid surgery will require a secondary vascular surgery within 5 years and (2) harvesting SV from the thigh rarely compromises future revascularisation.
In a 6-year retrospective analysis of 341 consecutive femorodistal autogenous vein bypasses, results from 104 in situ veins (IS) were compared with 209 reversed veins (RV). The groups were comparable for age, sex, diabetes, indication for surgery and calf vessel run-off, but a significantly higher proportion of the in situ group had a lower distal anastomosis (16% IS, 6% RV, chi 2 = 7.1 P less than 0.01). Overall, operative mortality was 2% and early graft failure was similar in both groups (11% IS, 12% RV, P = NS). Cumulative graft patency rates were 74% IS, 79% RV at one year and 71% IS, 71% RV (P = NS) at three years. Cumulative limb survival rates were 81% IS, 85% RV at one year and 79% IS, 81% RV [P = NS) at 3 years. These results demonstrate that the in situ technique has been used in a wider variety of patients and yielded similar early and intermediate term results to reversed vein.
Recently, it has been suspected that venous dural sinus air embolisms could occur as a result of scalp vein infusion. The possible mechanism for this complication has not been documented to date, and procedures to avoid venous dural sinus air embolism have not been presented. We report a preterm neonate who demonstrated venous dural sinus air embolism following daily management of a scalp vein catheter. The air embolism disappeared in a few days without complications. Clinicians should avoid injecting air into a scalp vein catheter and leaving it open to air. Following careful examination and review of the infant's case, we were able to conclude that positioning the infant in either supine or Trendelenburg position during daily management of scalp venous infusions and using an air-occlusive dressing once the catheter is removed could limit the risk of venous dural sinus air embolisms caused by scalp vein infusions.
Transplantation of the intrathoracic inferior vena cava into the abdominal inferior vena cava of the recipient was performed in inbred rat strains of the following combinations: Syngeneic F344 leads to F344, RT-1-identical allogeneic LEW leads to F344, and RT-1-different allogeneic CAP leads to F344. In the RT-1-different combination subgroups with presensitization (blood, skin) were formed. The transplanted veins were evaluated at different times, macro- and microscopically. To test humoral immunology reactivity, we used a modified hemagglutination test, to analyse cell-mediated reactivity, subsequent skin grafts. The following results were obtained: 1) Aside from sporadic mononuclear cells caused by the operation technique, syngeneic vein grafts do not show any macroscopically visible and microscopically detectable changes. 2) Weakly allogeneic vein grafts do not lead to microscopically detectable changes in the graft. Strongly allogeneic vein grafts cause temporary mononuclear cell infiltration, which subsides within 21 days, without influencing the morphologic structure of the vessel wall. 3) In the RT-1-identical allogeneic strain combination, only accelerated skin graft rejection time indicates systemic sensitization, in the strongly allogeneic system, the increase of hemagglutinating antibodies also does this. 4) In both the RT-1-identical allogeneic strain combination and the RT-1-different allogeneic one, a proven sensitization does not lead to a permanent morphologic alteration. 5) Only presensitization with strong antigens (skin) leads to a macroscopically visible, as well as microscopically detectable, rejection reaction.
Modifications of the mean blood-flow velocity in the dorsal veins of the hand were assessed semi-quantitatively with continuous wave (CW) Doppler equipment in 32 anaesthetised patients (17 men and 15 women), 23-78 (median = 56) years of age, before and after venous catheterisation with cannula fixation to the skin. Cannulation of the vein caused a 48% reduction in the mean blood-flow velocity and made it impossible to detect any flow with the equipment used in 22% of the patients. A 10% further reduction in the mean blood-flow velocity and in the number of subjects with undetectable blood flow was observed after fixation of the cannulae. Age, small vein diameter, and hyperventilation (end-tidal carbon dioxide less than or equal to 3.5 volume % appeared to be significant factors reducing blood-flow velocities in the cannulated veins. It is concluded that venous catheterisation and fixation of the cannula induce a significant reduction in the blood-flow velocity.
Autologous saphenous vein bypass grafts (SVG) are frequently compromised by neointimal thickening and subsequent atherosclerosis eventually leading to graft failure. Hyaluronic acid (HA) generated by smooth muscle cells (SMC) is thought to augment the progression of atherosclerosis. The aim of the present study was (1) to investigate HA accumulation in native and explanted arterialized SVG, (2) to identify factors that regulate HA synthase (HAS) expression and HA synthesis, and (3) to study the function of the HAS2 isoform. In native SVG, expression of all 3 HAS isoforms was detected by RT-PCR. Histochemistry revealed that native and arterialized human saphenous vein segments were characterized by marked deposition of HA in association with SMC. Interestingly, in contrast to native SVG, cyclooxygenase (COX)-2 expression by SMC and macrophages was detected only in arterialized SVG. In vitro in human venous SMC HAS isoforms were found to be differentially regulated. HAS2, HAS1, and HA synthesis were strongly induced by vasodilatory prostaglandins via Gs-coupled prostaglandin receptors. In addition, thrombin induced HAS2 via activation of PAR1 and interleukin 1beta was the only factor that induced HAS3. By small interfering RNA against HAS2, it was shown that HAS2 mediated HA synthesis is critically involved in cell cycle progression through G1/S phase and SMC proliferation. In conclusion, the present study shows that HA-rich extracellular matrix is maintained after arterialization of vein grafts and might contribute to graft failure because of its proproliferative function in venous SMC. Furthermore, COX-2-dependent prostaglandins may play a key role in the regulation of HA synthesis in arterialized vein grafts.
We compared the behaviours of rats, and measured various blood parameters, after three blood sampling techniques: orbital puncture while they were under diethyl-ether anaesthesia, blood collection by tail vein puncture under O2-N2O-halothane anaesthesia and puncture of the saphenous vein without anaesthesia. Twelve rats were subjected to the three treatments according to a Latin square design. After each treatment, the behaviour of the rats was automatically monitored using the so-called LABORAS method, which discriminates between grooming, locomotion and inactivity in rats. Based on excitation scores and urine production, it was found that induction of diethyl-ether anaesthesia combined with orbital puncture caused more distress than did the other two blood sampling techniques. The three techniques had no differential effects on the behaviours of grooming, locomotion and inactivity. Collecting 0.5 ml of blood by orbital puncture was +/-7 times faster than doing so by saphenous vein puncture and +/- 15 times faster than collecting blood by tail vein puncture while the rats were under O2-N2O-halothane anaesthesia. The levels of some haematological and plasma variables differed significantly between the three blood collection techniques. These observations may help to select the most appropriate technique of blood sampling with respect to anticipated discomfort in the animals.
A patient was seen for acute exercise-induced left superior limb swelling. Phlebography disclosed left innominate vein stenosis and the lack of subclavian vein thrombosis. Ten months earlier, the patient underwent repeated and prolonged central vein catheterization procedures. No other cause of central vein stenosis was evidenced. Emphasis is placed on the symptomatic presenting event, the very late discovery, and the site of stenosis.
In a patient with a granulosa cell tumour, stage 1a1, peripheral and ovarian vein blood samples were drawn before, during and after bilateral oophorectomy. Before operation inhibin and follicle-stimulating hormone levels were in the premenopausal range, whereas the peripheral level of oestradiol and luteinizing hormone were in the normal postmenopausal range. In the ovarian vein at the side of the tumour, inhibin and oestradiol levels were elevated, whereas in the contralateral ovarian vein the concentrations of inhibin and oestradiol were in the same range as in the peripheral vein. Immunoreactive inhibin levels in the homogenized tumour were 23 times higher than in the contralateral ovary, whereas inhibin bioactivities in the same samples amounted to 126 and 14 U/mg protein, respectively. After removal of the tumour, peripheral serum follicle-stimulating hormone and inhibin levels were in the normal postmenopausal range again. We conclude that inhibin can have a role as a marker for granulosa cell tumours.
We studied the relative contributions of splanchnic congestion and porta-systemic shunting to the maintenance of experimental portal venous hypertension. Three groups of rats were prepared: portal vein-stenosed, superior mesenteric vein-ligated and sham operated. Though elevated in both operated groups compared to controls, mesenteric venous pressure was highest in the portal vein-stenosed animals (PV vs SMV vs Sham: 19.6 +/- 1.3 vs 15.6 +/- 0.7 vs 13 +/- 0.6; p < .05 PV and SMV vs Sham, and PV vs SMV) despite the presence of 50% porta-systemic shunting in the portal vein-stenosed animals. Shunting was negligible in the other two groups. Peripheral plasma glucagon and vasoactive intestinal peptide (VIP) levels were similar in all three groups. We conclude that mesenteric congestion alone plays a minor role in the pathogenesis of portal hypertension, which may instead be related to the porta-systemic shunting of vasoactive substances other than glucagon and VIP.
Rabbits receiving three injections of PFA intravenously in ear, after that first treatment gave a weak antibody response, after the second one a rapid and copious increase of agglutination titre; the third injection induced a very small increase. In rabbits injected with PFA in superior mesenteric vein the first injection produced a little effect, the second induced a little effect too; the third injection performed in auricular vein, gave a substancial rapid and copious antibody response. This behaviour is similar to that obtained after the second injection in the first set of experiments. The PFA injected two times in mesenteric vein caused certainly a massive phagocytosis of antigen by Kupffer cells. Nevertheless this copious phagocytosis can exercise only an action of "priming", not a response of secondary type. For this purpose it is necessary an injection in the ear vein to provoke a direct intervention of lymphonodal reticular phagocytes. The phenomenon can be related to the proteic nature of the antigen.
We have devised a small saphenous island flap and successfully used in 6 patients for repairing soft tissue defect of the hell and the sole. After its transference, the small saphenous vein was anastomosed to the large saphenous vein over the ankle in order to obtain the blood supply from the small saphenous vein and blood return through the large saphenous vein. The advantage of this flap is that the vessels are superficial with large caliber so that it is easy to do anastomosis without any influence to the donor area. We believe that this flap can be used to repair soft tissue defect of the leg and foot. In this article, the operative method and advantages and shortcoming are introduced.
The author submits contemporary views on thrombosis. In all intravascular thromboses three mechanisms participate in varying extents: humoral, i.e. haemocoagulation, fibrinolytic and thrombocyte disorders, disorders of the vascular wall and rheological and haemodynamic disorders resp. Mechanisms of thrombosis are interlinked, activation of one group as a rule does not lead to the development of a thrombus unless it is particularly intense. As a rule combination with another group of factors is necessary. In case of venous thrombosis a key role is played by a combination of stasis and activation of the blood clotting system. In the aetiopathogenesis of occlusion of the retinal vein the author considers impairment of the vascular wall the key factor which leads to changes of the rheological conditions which predispose to thrombosis. The author describes the so-called critical retardation of the blood flow in the retinal vein as the critical level of changed rheological condition humoral factors begin to play a clinical role when in thrombogenesis. On this predisposed background humoral factors act and the result is occlusion of the retinal vein. The author considers occlusion proper a process which develops for a long time and the occlusion of the retinal vein is the final link of a long and very complicated process which is multifactorial and very variable.
A 74-year-old patient with peripheral arterial obstructive disease II B presented a full-length obstruction of the superficial femoral artery and additionally a segmental 10 cm long obstruction of the deep femoral artery. The arteries of the calf were patent. In this situation a bypass with an autologous vein was taken in advice. At surgery in December 1988 the great saphenous vein from the contralateral leg was prepared. It was found to be duplicated and contained numerous bridging veins. The duplication was maintained to compensate for the difference of calibre. The proximal anastomosis was done with the double-lumen graft including in between a split bridging vein. This arrangement provided favourable anatomic and functional outlets to the two saphenous branches. At follow-up in January 1990 the patient was fully reintegrated and had an unlimited walking distance. Doppler sonography showed normal closing pressure in the peripheral arteries. The intravenous digitalized subtraction angiography demonstrated regular perfusion of both branches of the duplicate bypass.
The serum testosterone level (STL) was determined in 181 patients with gastric carcinoma, 128 male and 53 female, and in 98 patients with benign diseases, 67 male and 31 female. As in our previous report, the preoperative STL of the cancer group was significantly lower than that of the control group, in both male and female patients (P less than 0.001). In the present study, the STL of the perigastric vein draining the stomach was determined and compared with the STL of the blood obtained at the same time from the peripheral vein during the operation. It was found that, in the male patients, the STL of the blood obtained from the perigastric vein draining a stomach with carcinoma was significantly lower than that of the peripheral vein in the same patient (P less than 0.001); however, there was no difference between these STL in the control group. On the contrary, in the female patients during operation, no such phenomenon was confirmed. Analysis classifying the patients by histological type revealed almost the same results for all patients as those shown for the cancer group, i.e. there was a proven significant difference in male patients and no significant difference in female patients. It was therefore considered that the mechanism of decrease in preoperative peripheral STL was not always the same in male patients as in female patients, although the STL decrease was observed to be similar in both sexes before surgery.