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Blood gas analysis was carried out in 80 cases of varicocele. The PO2 of the spermatic vein was lower than that of peripheral vein (P less than 0.01). There was also a significant difference of PO2 between I. and III. of varicocele (P less than 0.05). Blood of the spermatic vein showed metabolic acidosis. It is suggested that hypoxemia of the testes may affect spermatogenic function.
Among the accessory hepatic veins, the thickest one is the IRHV and is a significant vessel in 20 to 24 per cent of the patients. In these patients, if the right hepatic vein is totally resected, the right posteroinferior area can be preserved with the IRHV. Four types of hepatectomies n which the IRHV was preserved were proposed and three of the four procedures were performed upon five patients. In these five operations, the hepatectomies were successfully performed and blood losses were from 1,020 to 3,200 milliliters. These operative procedures, which have not been described before, could widen the indication of hepatectomy in patients with reduced liver function and tumor involving the right hepatic vein. In order to perform these operative procedures successfully, intraoperative sonography is indispensable.
Remaining varicose veins ("Restvarikosis") after phlebexhairesis should be treated with sclerotic- and compression therapy, while often recurrent varicose veins ("Rezidivvarikosis") are an indication for re-operation. Main faults in phlebexhairesis are incomplete ligations of the tributaries of the saphenous vein. Iatrogenic damage of lymphatic vessels in the region of the foramen ovale should be reduced by very careful preparation of this region.
Improved surgical techniques and an aging population have allowed surgeons the opportunity to implant vascular prostheses in patients where the run-off bed is somewhat compromised. We have considered the possibility of homograft venous preservation either by tanning or cryopreservation and now report our preliminary experience in the canine model jugular veins of large mongrel dogs were excised and treated in one of two manners. These veins were preserved for either seven or thirty days and inserted as functional segments in the carotid vessels: each dog received a tanned vein on one side and one which has been cryopreserved on the other side, as either an autograft or allograft. After three months the twenty one dogs were sacrified and the grafts recovered and examined for patency and histology. There appeared to be no difference in patency between the autograft and the allograft groups but there were striking differences in patency between the tanned grafts (8/21) and the cryopreserved grafts (19/21). Tanned grafts showed a fibrous hyperplasia at the anastomotic suture line that seemed to be the causative factor for graft thrombosis. Cryopreserved grafts showed sclerotic degeneration in the midportion of the graft: it was found to be more pronounced in the 30 day preservation specimens. The relatively good results, regarding patency, in the cryopreserved group has sparked our interest to investigate further into this process.
Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Rupture into the portal vein has occasionally been reported, as has associated gastrointestinal bleeding. A case is described in which an unusually large hepatic artery aneurysm ruptured into the portal vein, destroying a major portion of its wall. Reconstruction was accomplished successfully by use of an autogenous saphenous vein patch with preservation of hepatopetal portal flow.
We document a patient with a penetrating peptic ulcer of the first part of the duodenum, that extended into the main portal vein forming a fistula. This is the first reported case of a duodenoportal fistula secondary to peptic ulcer disease. The fistula was complicated by massive gastrointestinal hemorrhage, extra- and intrahepatic portal vein thrombosis, hepatic parenchymal infarction, and intrahepatic portal vein foreign body granulomas containing vegetable matter.
Maternal serum lipids and lipids in umbilical artery and umbilical vein blood were examined immediately after delivery in order to relate maternal and fetal lipid metabolism. Total lipids, phospholipids, triglycerides, total cholesterol, cholesterol esters and free cholesterol were determined. The comparison of arterial and venous umbilical lipid levels showed a significantly higher concentration of phospholipids in the umbilical vein, indicating an enhanced flux of phospholipids from the placenta to the fetus. A positive correlation is established for the amounts of total lipids (p less than 0,05), triglycerides (p less than 0,01), phospholipids (p less than 0,05) and free cholesterol (p less than 0,005) between maternal and umbilical vein blood. It is suggested that free cholesterol passes the placental barrier unchanged. The other correlations are discussed as the expression of a factor influencing simultaneously the maternal and fetal lipid metabolism.
PURPOSE: There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous ligation with multiple stab phlebectomy. METHODS: Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (LF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen. Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed. RESULTS: Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 +/- 0.1 mm (mean +/- SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X2 = 0.465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (chi 2 = 2.916; p = 0.0877; NS). CONCLUSIONS: It is concluded that high saphenofemoral ligation combined with multiple "stab avulsions" preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.
Doppler evaluation of the fetal venous system at present improves assessment of fetal well-being in many conditions. Actually, analysis of ductus venosus waveforms seems to be the most important. It place role in detection of genetic abnormalities (in low pregnancies), prediction of outcomes growth-restricted fetuses, assessment of severity of heart failure due to congestive heart anomalies, fetal infections, hydrops fetalis. Hepatic veins are known rather as an additional parameter (for ductus venosus) in the severely compromised fetus. Doppler evaluation of pulmonary veins may be useful in prediction of fetal lung maturity and in detection some difficult circulatory anomalies.
Results of the complex clinical and phlebographic examination of 106 patients with the varicose disease were studied. It was established that the degree of alterations of the venous outflow was dependent on the spread of ectasia of profound veins, while the clinical form of ectasia of the profound veins--on the state of the valve system.
A case of axillary vein thrombosis in a young man was treated by means of a cephalic vein cross-over bypass graft. A temporary arteriovenous fistula performed in the antecubital fossa resulted in a reasonable enlargement of the graft and prevented its occlusion in the critical postoperative period until healing of the intima resulted. The swelling disappeared and the patient, who was completely incapacitated functionally prior to the operation, resumed normal activity.
Available data suggests that lettuce big-vein disease is caused by the ophiovirus Mirafiori lettuce big-vein virus (MLBVV) but not by the varicosavirus Lettuce big-vein-associated virus (LBVaV), although the latter is frequently associated with the disease. Since the disease occurs worldwide, the putative coat protein (CP) open reading frames of geographically distinct isolates of MLBVV and LBVaV were sequenced. Comparison of both nucleotide and amino acid sequences showed a high level of sequence similarity among LBVaV isolates. Phylogenetic analysis of LBVaV CP nucleotide sequences showed that most of the Spanish isolates clustered in a phylogenetic group whereas English isolates were more similar to the USA isolate. An Australian isolate was closely related to the Dutch isolate. Genetic diversity among MLBVV CP nucleotide sequences was higher ranging from 0.2% to 12%. Phylogenetic analysis of MLBVV CP nucleotide sequences revealed two distinct subgroups. However, this grouping was not correlated with symptom development on lettuce or the geographic origin of the MLBVV isolates. Finally, a quick method based on RFLP analysis of RT-PCR amplicons was developed for assigning MLBVV isolates to the two subgroups.
The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.
This report describes our clinical experience with the VNUS closure. This is a percutaneous catheter-based procedure in which the vein is ablated from within by resistive heating. We performed the UK's first radiofrequency closure without a high tie in March 1999. Between then and March 2000, 40 patients (35:5 F:M, age 22-92, mean 45.1 years) had 59 legs treated. All operations were for varicose veins, eight legs were recurrent, four legs had concomitant ulceration and three legs were treated with additional subfascial endoscopic perforator ligation (SEPS). Only one treatment failure occurred in our series. In all the other successfully treated limbs the long saphenous vein remained without flow on Duplex scan evaluation during our 1 year follow-up. All patients were fully mobile within 12 hours and all patients returned to their daily activities or to work within 72 hours. On questioning, no patient reported pain related to the thigh procedure. This new technique of radiofrequency ablation provides a minimal access alternative to the classical high saphenous tie and strip. Our results to date suggest that this procedure results in minimal post-operative pain and allows early return to normal activities.
The risk of venous thromboembolism associated with long-haul flights is the subject of controversy. In a prospective, controlled study, we examined 160 passengers before and after return from a long-haul flight and 160 age-matched and sex-matched, non-travelling volunteers using venous compression ultrasound. Deep vein thrombosis was not observed in either group. Isolated calf muscle vein thrombosis (ICMVT) was present in 4/160 (2.5%) flight passengers and in 1/160 (0.6%) controls. All subjects with ICMVT were clinically asymptomatic, and ICMVT was located in the soleal muscle veins in all four subjects. Three of the four passengers with ICMVT had other risk factors for thrombosis.
Enzymatically separated leaf tissues of Nicotiana tabacum L., exhibiting good metabolic integrity, were used to evaluate the kinetics of sugar accumulation over the concentration range of 10 to 100 mm. Mesophyll cells exhibited Km values of 16 and 30 mm for glucose and sucrose, respectively; minor veins showed a reverse relationship, with Km values of 58 and 16 mm for glucose and sucrose, respectively. This would suggest that sucrose is preferentially absorbed by the minor vein net. Analysis of V(max) data indicates a reduction in the ability of isolated minor veins to accumulate substrate, implicating a symplastic rather than apoplastic route for intercellular transport. Competition studies demonstrate a common carrier for sucrose and glucose in both tissue types and suggest the presence of a "transport compartment," entry to which is regulated by a critical intracellular sucrose concentration.
Pharmacological responsiveness of isolated strips of the canine hepatic veins was investigated. Circular strips showed a low responsiveness to 5-hydroxytryptamine, a low sensitivity to norepinephrine and a high sensitivity to histamine. Longitudinal strips developed greater tensions to norepinephrine than circular strips. An excitatory cholinergic component was demonstrated in contractile responses of longitudinal strips to transmural stimulation. Acetylcholine-induced contraction was potentiated by physostigmine. These results indicate that the hepatic veins belong to the group of "veins of the digestive tube".
OBJECTIVE: The intimal hyperplasia caused by mig ration and proliferation of the smooth muscle cells play a most important role in the stenosis of the vein grafts. This study is to explore how the C-myc onc ogene and its protein contribute to the intimal hyperplasia after the jugular ve in is transplanted to the abdominal aorta and to assess the effect of Mithramyci n on the intimal hyperplasia. METHODS: In 60 Wistar rats, a 0.8 cm segment of the right j ugular vein graft was interposed at the level of the abdominal aorta. The experi ment group received Mithramycin (150 mug/kg IP) 1 h before and after the operat ion. The control group received normal saline, specimens of vein graft at 2 and 6 h postoperatively were subjected respectively to in situ hybridization. The ve in grafts 4 weeks after operation were perfusion fixed. The specimens were stain ed with hemotoxylin-eosin and the computer morphologic analysis system was used to evaluate the degree of intimal thickening. Immunohistochemistry studies of m uscle-specific &amg;-actin, C-myc protein and 5'-Bromodeoxyuridine were perfor med. RESULTS: The areas of neointimal and the ratios of neointimal t o medial area were significantly smaller and lower in the Mithramycin-treated t han in the control rats (P<0.05). The 5'-Brdu labeli ng rate between the two groups were also different significantly (P<0.05). Muscl-specific alpha-actin showed that the smooth muscle ce lls formed the most area of myointimal hyperplasia. Steady-state C-myc mRNA le vel was incre ased from 2 h to 6 h postoperatively. The positive rate of the placebo-treated group was higher significantly than that of the Mithramycin-treated group (P<0.05). CONCLUSIONS: Mithramycin may effectively inhibits transcription of C-myc in proliferating vascular smooth muscle cells and could be useful in the prevention of restenosis after vascularization. These results support the hy pothesis that systemic administration of Mithramycin might immediately prevent i ntimal proliferation.