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Ovarian vein dilatation in the so called "ovarian vein syndrome" is classically demonstrated by selective phlebography. The diagnostic value of computed tomography as a non invasive alternative for selective phlebography in a case of ovarian vein syndrome is reported. A definition of the ovarian vein syndrome and a personal view on the pathogenesis of this syndrome are given.
OBJECTIVE: To test the hypothesis that retinochoroidal collateral veins (RCVs), or alternatively, retinociliary or optociliary shunts/collaterals/veins or opticociliary anastomoses, act protectively against the development of anterior segment neovascularization (ASN) following central retinal vein occlusion (CRVO). DESIGN: Case-control retrospective medical record review of patients with CRVO. PATIENTS: We identified 107 patients with CRVO, of whom 34 had developed ASN, by reviewing their medical records. After applying exclusion criteria, a case group and an age-, sex-, and visual acuity-matched control group were selected. We analyzed these groups for the presence or absence of RCVs and noted the time course involved in their development. MAIN OUTCOME MEASURES: Anterior segment neovascularization (including neovascularization of the iris and/or anterior chamber angle), neovascular glaucoma, and RCV development. RESULTS: Only 1 (5.4%) of 19 individuals who developed ASN did so in the presence of RCVs. In contrast, 11 (57.9%) of 19 individuals in the control group developed RCVs. Statistical analysis revealed that patients who developed ASN were roughly 25 times less likely to have had RCVs than individuals who never developed ASN (odds ratio = 24.74; P =.001). CONCLUSION: Retinochoroidal collateral veins are negatively associated with ASN post-CRVO and may function in a protective manner against such an outcome.
A double blind controlled trial of surgery for varicose veins was conducted on the legs of patients with bilateral symmetrical varicose veins. The two treatments, saphenofemoral ligation and avulsion of varices, with and without stripping of the long saphenous vein from ankle to groin, were randomly allocated among the legs of individual patients. At follow-up, between 2.5 and 3.5 years, an objective (observer) assessment was that stripping conferred a significant advantage, but the incidence of paraesthesia and pain biased patient's opinion against stripping.
A macroscopic anatomical investigation was carried out on 67 embalmed dissecting-room legs in order to determine the position, course, and origin of so-called Cockett's perforating veins. This information was considered to be of particular importance because of the frequency with which varicoses in this region are treated with sclerosing agents and the serious adverse effects that can follow a misplaced injection. In view of the almost universal credence given to the accuracy of Cockett's original description (Cockett FP, 1955, Br. J. Surg. 43:260-278), and the general acceptance of the constancy of "Cockett's veins," it was felt to be of importance to see to what extent we could confirm this description. It was found that the origins of these vessels and the places at which they penetrate the deep fascia are not constant, and that--in our series--only 7.3% of the veins belonging to these groups occupy the positions that are repeatedly cited in the literature as the most common. The clinical importance of any discrepancy between expectation and reality can hardly be exaggerated.
Splenic vein aneurysm is a rare disease, and calcifications in the portal venous system are also rare. Here we present a case of splenic vein aneurysm associated with calcification of the splenic and portal veins, a condition that to our knowledge has not been reported before.
A very simple and rapid technique for inserting a catheter in the portal vein and the hepatic vein in the anesthesized rat in vivo is described. The pointed, saline-containing PE tubing is frozen in liquid nitrogen, whereupon it is used as a 'needle' to insert the catheter into the blood vessel. Multiple blood samples can be obtained from the portal and the hepatic vein at the same time, so that in situ extraction of drugs by the liver can be measured in vivo, since hepatic blood flow is uninterrupted.
We succeeded in surgically resecting a leiomyosarcoma of the inferior vena cava (IVC), which originated at the confluent portion of the right renal vein (RRV), together with the IVC and RRV, and also were able to preserve the right kidney by reconstructing the RRV with end-to-end anastomosis using the right gonadal vein. A good blood flow of the reconstructed RRV was thereafter confirmed by color Doppler ultrasonography, and the renal function was also satisfactory. This new procedure, a reconstruction of the RRV using the gonadal vein, has not been previously reported, but is considered to be an easy and effective method which enables the surgeon to preserve the normal right kidney.
We evaluated the 3-year outcome of a series of patients with primary varicose veins who were randomized to radiofrequency endovenous obliteration vs. stripping of the long saphenous vein (LSV). Twenty-eight patients were included in the study: 15 were randomized to the radiofrequency endovenous obliteration procedure and 13 to LSV stripping. At 3-year follow-up, five patients (33.3%) of the endovenous group had recurrent or residual varices and in three of them a reflux in the thigh veins was detected. None of the primarily occluded LSV segments was recanalized. In the stripping group, three patients (23.1%, p = 0.68) showed varicosities at clinical and duplex examinations. In one patient, a patent duplicate LSV trunk was detected. In the remaining two patients, no reflux in the thigh region was detected. According to the present results, radiofrequency endovenous obliteration of the LSV is associated with somewhat poorer short-term results compared with the stripping operation.
BACKGROUND: Lemierre syndrome is a rare and potentially fatal entity characterized by septic emboli from thrombosis of the internal jugular vein after oropharyngeal infection. The etiologic agent is not always an anaerobic bacterium. We report a patient with a Lemierre syndrome variant who presented with thrombosis of both the right internal jugular vein and the splenic vein as well as septic pulmonary emboli caused by Staphylococcus aureus, which proved resistant to methicillin, amoxicillin, and ciprofloxacin. The patient was thought to have acquired the infection during the exploration of a river cave in Turkey 10 days before his admission to the hospital. Such caves are natural reservoirs of infectious microorganisms. METHODS: The patient had a physical examination, coagulation screening tests, tests of thrombin generation and fibrinolysis, coagulation inhibitors, activated protein C resistance, early and late serological tests (including autoantibodies), computed tomographic studies of the chest and abdomen, and bacterial examination of peripheral blood. Bacterial investigations were made on samples collected from the river cave. RESULTS: After having undergone a 6 week course of antimicrobial treatment and anticoagulant therapy, the patient recovered from the infection with no residual complications, and the signs and symptoms of Lemierre syndrome resolved. CONCLUSION: The results probably indicate an exposure of the patient to soil-based Staphylococcus aureus. This observation suggests the action of environmental factors that may contribute to the development of this rare syndrome.
A case of extensive injury to the left femoral artery and vein is presented. As circumstances did not permit the use of autogenous vein grafts, human umbilical cord vein grafts were used. Almost one year afterwards the patient is doing well and both grafts are patent.
OBJECTIVE: Conventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates (up to 50%), many resulting from inadequate surgery. This prospective audit examines the safety and efficacy of EVLA in the treatment of this. METHOD: 65 patients (68 limbs) with varicosities due to primary or recurrent sapheno-popliteal junction (SPJ) and small saphenous vein (SSV) reflux underwent out-patient EVLA (810 nm diode laser). The SSV was ablated from mid-calf to the SPJ. Symptomatic improvement (Aberdeen Varicose Vein Severity Score [AVVSS]), time to return to normal activity, post-EVLA analgesic requirements, and complications were recorded. RESULTS: Duplex ultrasound follow-up (median 6-months) confirmed abolition of SPJ/SSV reflux in all limbs following a median total laser energy delivery of 1131J (IQR 928-1364) at an energy density of 66.3 Joules/cm (IQR 54.2-71.6). AVVSS improved from 15.4 (IQR 11.8-19.7) to 4.6 (IQR 3.2-6.7) at three months (p<0.001). Median analgesia requirement was 3 days (23% [15/65] patients required none) and the median time to normal activity was 0 (0-4) days (65% [42/65] returning to normal daily activity immediately). There were no instances of skin burns or DVT but 3 patients (4.4%) developed transient cutaneous numbness (sural nerve). 98% (64/65) patients would undergo EVLT again. CONCLUSIONS: EVLA abolished SPJ/SSV reflux in all limbs. This is likely to be more effective than conventional surgery, although long-term follow up is required. Data from a randomised control trial would be desirable.
PURPOSE: To study early changes in venous hemodynamics in stripping operation with preservation of the calf saphenous veins. PATIENTS AND METHODS: From October 1999 to December 2000, 110 extremities of 73 patients were treated for primary varicose veins. Based on preoperative ascending venography, 40 extremities underwent the groin-to-knee stripping of the GSV, 20 underwent the proximal division of the LSV, and 50 received combinations of both surgeries. To evaluate venous hemodynamic changes, air plethysmography was performed before operation and 7-14 days after operation. RESULTS: The venous volume, venous filling index and residual volume fraction were improved after surgery, but the ejection fraction did not change. The overall incidence of nerve injury was 4.5% (five limbs). CONCLUSIONS: In stripping operations, the preservation of the calf saphenous veins, which is shown to be advantageous in reducing saphenous or sural nerve injuries, does not adversely affect early venous hemodynamic improvement.
Superior vena cava syndrome due to transvenous pacing leads is an uncommon but potentially life-threatening complication. This case involves a 54-year-old man who developed left innominate vein occlusion due to a pacemaker lead. This complication induced a progressive swelling on the left side of his face, neck, arm, and upper chest. The left innominate vein occlusion was surgically treated using a composite spiral saphenous vein graft. Postoperatively, the patient has received anticoagulation therapy with warfarin to prevent thrombosis and, thereby, the long-term patency of the graft. He has undergone follow-up on a regular outpatient basis without showing any recurrence of clinical symptoms.
Varicosities of the renal veins and of the veins of the upper urinary tract may occur with or without haematuria. The urogram may be negative. Frequently, however, there are single or multiple impressions on the ureters as a result of the venous varicosities. Arteriography, which should always be carried out in the presence of undiagnosed haematuria, is unable to demonstrate the venous abnormalities. Since the symptoms are also not characteristic, it is necessary to carry out renal vein pharmaco-phlebography. The clinical features, radiological appearances and aetiology of this rare condition are illustrated by three cases.
Two adult sheep, A and B, received successively during three experimental periods a forage-based pelleted feed, then the same diet supplemented with 33 mg/kg of lasalocid (L) or cationomycin (C). The feed was given in either eight (sheep A) or two (sheep B) daily meals. After four weeks of adaptation, 11 blood samples were taken through catheters in the rumen vein (RVA) and the mesenteric artery (MAA) in sheep A and in the rumen vein (RVB) and portal vein (PVB) in sheep B over a 5-hour period after the morning meal. Because of a blockage in the catheter it was not possible to measure the effect of C in MAA. Food intake had no immediate effect on the plasma levels measured: the distribution of eight daily meals stabilized plasma levels and made it easier to determine the effect of the ionophores. This effect varied according to the sampling site, the animal and the antibiotic, sometimes contradictorily. All the plasma parameters monitored in RVA were significantly modified by either one of the ionophores. A decrease in plasma albumin concentration (P < 0.05) was observed with L in MAA and with C in RVA and MAA. Aceto-acetate concentration decreased (P < 0.05) with L in MAA but increased with L and C in RVB. A decrease in glycaemia and uraemia (P < 0.05) was observed with L in MAA, RVA and RVB and with C in RVA. Total amino acid concentration decreased (P < 0.05) with C in RVA or increased (P < 0.05) with L in PVB and RVB. These variations in results may be due to different mechanisms of action of L and C on digestion, particularly in the rumen. While the changes undergone by the ketone bodies in the blood suggested a decrease in hepatic ketogenesis with L, there was no evidence that the ionophores had a direct postprandial effect.
Fast magnetic resonance (MR) imaging techniques are assuming importance in imaging of the abdomen in part due to their ability to produce images during breath-holding, which ensures high spatial resolution and no respiratory motion artifacts. One problem with rapid scanning of the liver, shared with other MR techniques, is confusion between portal and hepatic veins due to similarity in signal intensity. The fast low angle shot (FLASH) technique (flip angle 40 degrees, repetition time 28 ms, and echo time 16 ms) produces high signal in both venous systems. To remedy the problem we incorporated presaturation pulses applied across the portal and mesenteric veins to the FLASH technique; this induced a decrease in signal in the portal venous system and facilitated their differentiation from hepatic veins. Moreover, in one patient an intraportal tumor thrombus not detected on the standard FLASH technique was rendered visible by presaturation. Although the presaturation pulses in the present series were confined to the sagittal plane, the technique should be applicable in any plane as dictated by the anatomy and direction of blood flow. We anticipate wide use of combined presaturation and rapid scanning techniques.
Venous outflow problems in right lobe, living-donor liver transplantation are uncommon, but devastating when they occur. We describe the successful use of the recipient's left portal vein as an interposition graft to drain a dominant middle hepatic vein in a right lobe liver transplant. Two weeks after transplantation, the vein graft accounted for 56% of the total venous outflow of the liver.
Clinical signs of central vein thrombosis as a complication of internal jugular vein cannulation are rarely seen. Two infants who developed thrombosis of the superior vena cava and one adult who developed thrombosis of the left brachiocephalic vein are presented.