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Sample records for renal venous outflow

  1. Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation.

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    Marília D'Elboux Guimarães Brescia

    Full Text Available This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15 or piggyback (n = 17 liver transplantation.Free hepatic vein pressure (FHVP and central venous pressure (CVP measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO. The prevalence of acute renal failure (ARF up to the 28th PO was analyzed by RIFLE-AKIN criteria. A Generalized Estimating Equation (GEE approach was used for comparison of longitudinal measurements of renal function.FHVP-CVP gradient > 3 mm Hg was observed in 26.7% (4/15 of the patients in the conventional group and in 17.6% (3/17 in the piggyback group (p = 0.68. Median FHVP-CVP gradient was 2 mm Hg (0-8 mmHg vs. 3 mm Hg (0-7 mm Hg in conventional and piggyback groups, respectively (p = 0.73. There is no statistically significant difference between the conventional (1/15 and the piggyback (2/17 groups regarding massive ascites development (p = 1.00. GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02. The conventional method presented a higher prevalence of severe ARF during the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048.Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft. Conventional with venovenous bypass technique significantly increases the harm of postoperative renal dysfunction.ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01707810.

  2. Cerebral venous outflow and cerebrospinal fluid dynamics

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    Clive B. Beggs

    2014-12-01

    Full Text Available In this review, the impact of restricted cerebral venous outflow on the biomechanics of the intracranial fluid system is investigated. The cerebral venous drainage system is often viewed simply as a series of collecting vessels channeling blood back to the heart. However there is growing evidence that it plays an important role in regulating the intracranial fluid system. In particular, there appears to be a link between increased cerebrospinal fluid (CSF pulsatility in the Aqueduct of Sylvius and constricted venous outflow. Constricted venous outflow also appears to inhibit absorption of CSF into the superior sagittal sinus. The compliance of the cortical bridging veins appears to be critical to the behaviour of the intracranial fluid system, with abnormalities at this location implicated in normal pressure hydrocephalus. The compliance associated with these vessels appears to be functional in nature and dependent on the free egress of blood out of the cranium via the extracranial venous drainage pathways. Because constricted venous outflow appears to be linked with increased aqueductal CSF pulsatility, it suggests that inhibited venous blood outflow may be altering the compliance of the cortical bridging veins.

  3. Hepatic venous outflow obstruction: Three similar syndromes

    Institute of Scientific and Technical Information of China (English)

    Ulas Darda Bayraktar; Soley Seren; Yusuf Bayraktar

    2007-01-01

    Our goal is to provide a detailed review of venoocclusive disease (VOD), Budd-Chiari syndrome (BCS),and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed,enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS,and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions.However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction.Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure.

  4. [Automatic regulator of venous pressure and venous outflow in the perfusion system].

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    Smirnov, L M; Levinskiĭ, M M; Kharnas, S Sh; Cherniak, V A

    1976-01-01

    A scheme for automatic regulation of the venous pressure and venous blood outflow during extracorporeal circulation is proposed. The system consists of a photoelectric sensor placed on a tube led out of the major venous trunkline, a converter and an electromechanical eccentric clamp that compresses the venous trunkline, all of which secures stabilization of the controlled values.

  5. Human cerebral venous outflow pathway depends on posture and central venous pressure

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    Gisolf, J; van Lieshout, J J; van Heusden, K

    2004-01-01

    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 during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 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...

  6. Alternative venous outflow vessels in microvascular breast reconstruction.

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    Mehrara, Babak J; Santoro, Timothy; Smith, Andrew; Arcilla, Eric A; Watson, James P; Shaw, William W; Da Lio, Andrew L

    2003-08-01

    The lack of adequate recipient vessels often complicates microvascular breast reconstruction in patients who have previously undergone mastectomy and irradiation. In addition, significant size mismatch, particularly in the outflow veins, is an important contributor to vessel thrombosis and flap failure. The purpose of this study was to review the authors' experience with alternative venous outflow vessels for microvascular breast reconstruction. In a retrospective analysis of 1278 microvascular breast reconstructions performed over a 10-year period, the authors identified all patients in whom the external jugular or cephalic veins were used as the outflow vessels. Patient demographics, flap choice, the reasons for the use of alternative venous drainage vessels, and the incidence of microsurgical complications were analyzed. The external jugular was used in 23 flaps performed in procedures with 22 patients. The superior gluteal and transverse rectus abdominis musculocutaneous (TRAM) flaps were used in the majority of the cases in which the external jugular vein was used (72 percent gluteal, 20 percent TRAM flap). The need for alternative venous outflow vessels was usually due to a significant vessel size mismatch between the superior gluteal and internal mammary veins (74 percent). For three of the external jugular vein flaps (13 percent), the vein was used for salvage after the primary draining vein thrombosed, and two of three flaps in these cases were eventually salvaged. In three patients, the external jugular vein thrombosed, resulting in two flap losses, while the third was salvaged using the cephalic vein. A total of two flaps were lost in the external jugular vein group. The cephalic vein was used in 11 flaps (TRAM, 64.3 percent; superior gluteal, 35.7 percent) performed in 11 patients. In five patients (54.5 percent), the cephalic vein was used to salvage a flap after the primary draining vein thrombosed; the procedure was successful in four cases. In three

  7. Leiomyosarcoma of inferior vena cava involving bilateral renal veins: Surgical challenges and reconstruction with upfront saphenous vein interposition graft for left renal vein outflow

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    Rishi Nayyar

    2010-01-01

    Full Text Available Leiomyosarcoma of inferior vena cava (IVC involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

  8. Human cerebral venous outflow pathway depends on posture and central venous pressure

    DEFF Research Database (Denmark)

    Gisolf, J; van Lieshout, J J; van Heusden, K

    2004-01-01

    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...... and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 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...

  9. Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein

    Institute of Scientific and Technical Information of China (English)

    WU Hong; LU Qiang; CHEN Zhe-yu; MA Yu-kui; LI Jin; YANG Jia-yin; YAN Lü-nan; LI Bo; ZENG Yong; WEN Tian-fu; ZHAO Ji-chun; WANG Wen-tao; XU Ming-qing

    2007-01-01

    Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent "chocking" of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV.Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor's right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.Results No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepaticvein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1),left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure.Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.

  10. Successful management of neonatal renal venous thrombosis.

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    Piscitelli, Antonio; Galiano, Rossella; Piccolo, Vincenzo; Concolino, Daniela; Strisciuglio, Pietro

    2014-10-01

    Renal vein thrombosis is the most common vascular condition involving the newborn kidney and it can result in severe renal damage. We report a newborn with renal vein thrombosis treated with continuous infusion of unfractionated heparin who had normal total renal function after 3 years of follow up, despite reduction of the functional contribution of the affected kidney.

  11. Hepatic venous outflow obstruction after piggyback liver transplantation by an unusual mechanism: Report of a case

    Institute of Scientific and Technical Information of China (English)

    Simon Siu-Man Ng; Simon Chun-Ho Yu; Janet Fung-Yee Lee; Paul Bo-San Lai; Wan-Yee Lau

    2006-01-01

    Hepatic venous outflow obstruction after piggyback liver transplantation is a very rare complication. An unusual mechanism aggravating it is reported. A 33-year-old man with end-stage hepatitis B liver cirrhosis underwent a piggyback orthotopic liver transplantation using a fullsize cadaveric graft. Two months after transplantation,he developed gross ascites refractory to maximal diuretic therapy. Doppler ultrasound showed patent portal and hepatic veins. Serial computed tomography scans revealed a hypoperfused right posterior segment of the liver which subsequently underwent atrophy. Hepatic venography demonstrated a high-grade stenosis with an element of torsion of venous drainage at the anastomosis. The stenosis was successfully treated with repeated percutaneous balloon angioplasty. The patient remained asymptomatic six months afterwards with complete resolution of ascites and peripheral edema. We postulate that liver allograft segmental hypoperfusion and atrophy may aggravate or result in a hepatic venous outflow problem by the mechanism of torsion effect. Percutaneous balloon angioplasty is a safe and effective treatment modality for anastomotic stenosis.

  12. Congestive renal failure: the pathophysiology and treatment of renal venous hypertension.

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    Ross, Edward A

    2012-12-01

    Longstanding experimental evidence supports the role of renal venous hypertension in causing kidney dysfunction and "congestive renal failure." A focus has been heart failure, in which the cardiorenal syndrome may partly be due to high venous pressure, rather than traditional mechanisms involving low cardiac output. Analogous diseases are intra-abdominal hypertension and renal vein thrombosis. Proposed pathophysiologic mechanisms include reduced transglomerular pressure, elevated renal interstitial pressure, myogenic and neural reflexes, baroreceptor stimulation, activation of sympathetic nervous and renin angiotensin aldosterone systems, and enhanced proinflammatory pathways. Most clinical trials have addressed the underlying condition rather than venous hypertension per se. Interpreting the effects of therapeutic interventions on renal venous congestion are therefore problematic because of such confounders as changes in left ventricular function, cardiac output, and blood pressure. Nevertheless, there is preliminary evidence from small studies of intense medical therapy or extracorporeal ultrafiltration for heart failure that there can be changes to central venous pressure that correlate inversely with renal function, independently from the cardiac index. Larger more rigorous trials are needed to definitively establish under what circumstances conventional pharmacologic or ultrafiltration goals might best be directed toward central venous pressures rather than left ventricular or cardiac output parameters. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Renal perfusion with venous blood extends the permissible suprarenal clamp time in abdominal aortic surgery

    National Research Council Canada - National Science Library

    Pichlmaier, Maximilian; Hoy, Ludwig; Wilhelmi, Mathias; Khaladj, Nawid; Haverich, Axel; Teebken, Omke E

    2008-01-01

    ... suprarenal clamping for aortic reconstructive surgery. Renal perfusion was achieved using a roller pump supplied with venous blood from a central venous catheter under medium-level heparinization to feed two perfusion balloon catheters...

  14. Laparoscopic living donor right hemihepatectomy with venous outflow reconstruction using cadaveric common iliac artery allograft

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    Li, Jiaxin; Huang, Jiwei; Wu, Hong; Zeng, Yong

    2017-01-01

    Abstract Rationale: With the development of laparoscopic technique, the total laparoscopic living donor right hemihepatectomy (LLDRH) procurement surgery has been successfully performed in many liver transplant centers all over the world, and the number of cases is continuing to increase. We report our case of laparoscopic right graft resection with venous outflow reconstruction using cadaveric common iliac artery allograft in our center and review literatures about total LLDRH surgery. Patient concerns and Diagnoses: A 40-year-old male living donor for right hepatectomy was selected after pretransplant evaluation including laboratory tests, liver volume, anatomy of hepatic vein, artery, portal vein, and bile duct. Living donor liver transplantation surgery was approved by Sichuan Provincial Health Department and the ethics committee of the West China Hospital, Sichuan University. Interventions: Hepatic parenchyma transection was performed by ultrasonic scalpel and Cavitron Ultrasonic Surgical Aspirator (CUSA). Right branch of portal vein, right hepatic artery, right hepatic duct, and right hepatic vein were meticulously dissected. The right hepatic duct was ligated and transected 2 mm far from the bifurcation of common hepatic duct, right hepatic artery, and portal vein were also ligated and transected, the right hepatic vein was transected by laparoscopic linear cutting stapler. The gap between short hepatic veins and right hepatic vein was bridged and reconstructed by cadaveric common iliac artery allograft. Outcomes: The operation time was 480 minutes and warm ischemia time was 4 minutes. Blood loss was 300 mL without blood transfusion. The donor was discharged on postoperative day 7 uneventfully without complications. Literatures about laparoscopic living donor right hemihepatectomy are compared and summarized in table. Lessons: The total laparoscopic living donor right hemihepatectomy is technically feasible and safe in some transplant centers which

  15. Hepatic venous outflow block in a young patient with Systemic Lupus Erythematosus

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    Ali Ghavidel

    2015-08-01

    Full Text Available Introduction: Hepatic venous outflow block or Budd-Chiari syndrome is a severe liver disease with a 3 years survival rate of 50%. Several conditions have been implicated as a cause of Budd-Chiari syndrome, including myeloproliferative disorders, paroxysmal nocturnal hemoglobinuria, the presence of lupus anti-coagulant, oral contraceptives, pregnancy, and others. In a small number of cases, Budd-Chiari syndrome is associated with the presence of lupus anticoagulant. Anticardiolipin antibodies (ACA are similar to lupus anti-coagulant antiphospholipid antibodies (APLAs, which have been described in patients with recurrent arterial and venous thrombosis, thrombocytopenia, fetal loss, or miscarriage. Case Report: A 23-year-old woman is reported with Budd-Chiari syndrome in whom lupus anticoagulant and anticardiolipin antibodies were shown; 9 months after diagnosis of systemic lupus erythematosus (SLE treatment with steroids admitted with gastrointestinal problems, abdominal pain and ascites and treated oral anticoagulants induced a considerable improvement. This treatment was continued after 1 year, but interruption was followed by redevelopment of ascites. Further treatment with anticoagulants was continued for 5 years with noticeable improvement. Conclusion: Patients with Budd-Chiari syndrome should be tested for lupus anticoagulants and anticardiolipin antibodies, Budd-Chiari syndrome resulting from this cause may have a good response to treatment with oral anticoagulants; this treatment should be maintained permanently, and pregnancy in such patients may initiate serious difficulties. The condition of the patient at follow-up was good.

  16. Regional renal venous hypertension and left-sided varicocele

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    O. B. Zhukov

    2013-01-01

    Full Text Available One of the most frequent correctable causes of male infertility is a varicocele. The etiology and pathogenesis of varicocele to date is a matter of debate. The aim of our study was to determine the causes and incidence of regional renal hypertension in patients with leftsided varicocele. The study involved 110 patients with left-sided varicocele in age from 18 to 35 years. Algorithm for evaluation of patients with left-sided varicocele included: physical examination, ultrasound with Doppler kidney, basin area left renal vein, aorto-mesenteric portion; the scrotum with a sample Trombetta, phlebography аnd phlebotonometry basin left renal vein and the common iliac vein. Renospermatic reflux was detected in 89 (81 %, ileospermatic 12 (11 % and mixed 9 (8 % patients. Patients with reflux ileospermatic excluded from the study. The 96 patients with left-sided varicocele underwent venography and phlebotonometry in 37 (38.5 % were renal venous hypertension, with 35 of them that it was due to aorto-mesenteric compression, and in 2 cases an anomaly development – annular renal vein. Our data are comparable with the results of other authors. Patients with mesenteric compressed statistically significant reduction in the diameter of renal veins in the aorto-mesenteric portion and increased blood flow in this region, and expand prestenosis left renal vein and reduce flow velocity in this region compared with the group without renal phlebohypertension. Patients with renal phlebohypertension subsequently held shunt types of operations performed in patients with normotension occlusive types of operations. An integrated assessment of patients with left-side allows to make a holistic understanding of the basic mechanisms of disease etiology and select the appropriate type of surgery.

  17. . Effect of the venous outflow ways from pancreatic transplant on carbohydrate metabolism after autotransplantation of pancreas in the experiment

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    Voskanyan S.E..

    2013-12-01

    Full Text Available The aims: to compare the state of carbohydrate metabolism in animals after pancreatectomy with autotransplantation of the pancreatic segment and with organization of the venous outflow in the inferior vena or portal vein. Material and methods. Proximal resection of the pancreas (group 1, pancreatectomy with autologous transplantation of the pancreas and with reconstruction of the venous outflow from the transplant into the inferior vena cava (group 2 and pancreatectomy with autologous transplantation of the pancreas and with reconstruction of the venous outflow from the transplant into the portal vein (group 3 were performed in 45 animals in the experiment. Examining the status of carbohydrate metabolism was performed by intravenous test for glucose tolerance. Results. Primary higher increase in glucose concentrations as compared to the values obtained at the intact animals and its slower decrease have been observed in animals after pancreatectomy with autotransplantation of the segment of the pancreas on iliac vessels (group 2, as well as on the mesenteric vessels (group 3. Higher blood glucose compared to animals subjected proximal pancreatectomy after 40 minutes after administration of glucose was detected in animals undergoing autotransplantation of the pancreas on iliac vessels (group 2 and in animals after autotransplantation of the pancreas on mesenteric vessels (group 3— 11.82 (11,39-12,26 mmol/l and 10.65 (10,03-11,32 mmol/l, respectively. The glucose concentration in the blood plasma was lower in the animals of groups 2 and 3 below in comparison with the animals in group 1 to 120 minutes of the experiment. Significant differences in plasma glucose concentration between animals of groups 2 and 3 were not found. Conclusion. Significant effects of the ways of organization of the venous outflow from pancreatic transplant on the concentration of the glucose in the blood plasma by the carbohydrate load after pancreatectomy with

  18. Preservation of venous outflow improves transverse rectus abdominis musculocutaneous flap survival following vascular delay.

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    Tsoutsos, D; Gravvanis, A; Kakagia, D; Ghali, S; Papalois, A

    2009-01-01

    The rat abdominal island model has proved to be a reliable and reproducible model for the study of surgical delay procedures. It has been customary to simultaneously divide both the artery and the accompanying vein to obtain maximum survival of the rat TRAM flap undergoing delay procedure. This study evaluates the effect of selective arterial interruption compared to standard vascular delay on flap survival in the rat TRAM flap model. Thirty-six Wistar rats were randomly assigned to three groups (n=12), depending on the vascular ligation selected for the initial experimental delay stage. In group A (control group) no vessels were ligated. In group B the right deep inferior epigastric vessels were preserved and the right superior and left inferior and superior deep vessels were ligated. In group C the right inferior epigastric vessels and the left inferior epigastric vein were preserved while superior epigastric vessels and the left inferior epigastric artery were ligated. For the second stage one week later, TRAM flaps were elevated based on the right deep inferior epigastric vessels, re-inset in their original position and digitally photographed. Skin island viability was determined 96 hours later using digital photography and image-analysis software SigmaScan (SPSS, Inc., Chicago, IL). The percentage of flap survival in control group A was 50+/-6%, in group B 60+/-4% and in group C 85+/-4%. The occlusion of the three vascular pairs in group B improved the survival percentage in comparison to the control group A, but this did not achieve statistical significance. In contrast, the percentage of flap survival in control group C was statistically significant compared to groups A and B (p<0.05, ANOVA). Zone IV exhibited no necrosis in any group C animals. This indicates that delay with preservation of the venous outflow of zone IV results in increased blood supply.

  19. Possible contribution of cytomegalovirus infection to the high risk of (recurrent) venous thrombosis after renal transplantation

    NARCIS (Netherlands)

    Lijfering, Willem M.; de Vries, Aiko R. J.; Veeger, Nic J. G. M.; van Son, Willem J.; Bakker, Stephan J. L.; van der Meer, Jan

    2008-01-01

    Renal transplant recipients are at an increased risk of venous thrombosis, which has been regarded as a postoperative complication, although it may persist afterwards. As numerous case reports have shown that active cytomegalovirus (CMV) infection can be found at time of onset of venous thrombosis,

  20. Renal venous thrombosis in an infant with predisposing thrombotic factors: color Doppler ultrasound and MR evaluation

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    Argyropoulou, Maria I.; Papadopoulou, Frederica; Nikolopoulos, Pangiotis [Department of Radiology, Medical School, University of Ioannina, 45110, Ioannina (Greece); Giapros, Vassilios I.; Drougia, Aikaterini A.; Andronikou, Styliani [Neonatology Clinic, Medical School, University of Ioannina, 45110, Ioannina (Greece); Vartholomatos, Georgios A. [Department of Haematology, Medical School, University of Ioannina, 45110, Ioannina (Greece)

    2003-08-01

    We report a case of a neonate with hereditary thrombophilia presenting with renal venous thrombosis (RVT). Early color Doppler findings of RVT were lacking venous flow, and the arterial diastolic flow was reversed. This very high-resistance arterial flow is for the first time described in neonatal RVT. Magnetic resonance imaging showed low signal intensity of the renal pyramids on T1- and T2-weighted images, suggesting acute hemorrhage. After intravenous contrast injection, persistent cortical enhancement was observed along with lack of medullary enhancement. Despite the progressive reestablishment of some venous drainage, the kidney showed atrophy and loss of function. (orig.)

  1. Topical and systemic anticoagulation in the treatment of absent or compromised venous outflow in replanted fingertips.

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    Han, S K; Lee, B I; Kim, W K

    2000-07-01

    Adequate venous repair is not always possible in fingertip replantation. We have used topical and systemic anticoagulation for fingertip replantation to overcome venous congestion in cases without venous repair or in cases in which there is obstruction of a repaired vein. Our technique consists of continuous external bleeding via a stab incision on the paraungal area and dripping heparinized saline solution at the incision site to maintain external bleeding. From July 1985 to December 1993, 157 fingers in 140 patients with complete amputation of the fingertip were replanted at Korea University Guro Hospital. Of these, 74 fingers in 68 patients were managed by topical and systemic anticoagulation due to the impossibility of repair or obstruction of a repaired vein. The overall survival rate of the fingertip replantations was 76%; that of the topical and systemic anticoagulation group was 64%.

  2. [Continuous veno-venous renal replacement therapies in critically ill neonates and children].

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    López-Herce Cid, J; Carrillo Alvarez, A; Panadero Carlavilla, E; Sánchez Sánchez, C; Moral Torrero, R; Bustinza Arriourtúa, A

    1998-07-01

    The objective of this study was to analyze the efficacy of continuous veno-venous renal replacement therapies in neonates and children. We analyzed 10 episodes of acute renal failure in 9 patients, between 7 days and 2 years of age and weighing between 2.9 and 13 kg, treated with continuous veno-venous renal replacement therapies (hemofiltration or hemodiafiltration) by using a BSM-32-IC (Hospal) monitor and two types of hemofilters, Miniflow of 0.04 m2 (Hospal) and FH22 of 0.2 m2 (Gambro). We used a blood flow between 15 and 40 ml/min and obtained an ultrafiltration rate of 190 +/- 61 ml/hour. The mean life of the hemofilters was 16 +/- 14 hours, with the duration of the technique between 5 and 58 hours. In three episodes the technique was ended because of normalization of renal function. All patients tolerated continuous renal replacement therapies without important secondary effects (one patient had moderate ischemia of the leg because of erroneous arterial catheterization, 3 patients had electrolyte alterations. 1 patient had hypothermia and 5 patients needed platelet transfusions). Seven patients died because of shock and multiple organ failure which was not related to the technique. Continuous veno-venous renal replacement therapies are useful in the treatment of critically ill children. Veno-venous techniques can be used in term neonate and infants.

  3. Systemic arterial and venous determinants of renal hemodynamics in congestive heart failure.

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    Braam, Branko; Cupples, William A; Joles, Jaap A; Gaillard, Carlo

    2012-03-01

    Heart and kidney interactions are fascinating, in the sense that failure of the one organ strongly affects the function of the other. In this review paper, we analyze how principal driving forces for glomerular filtration and renal blood flow are changed in heart failure. Moreover, renal autoregulation and modulation of neurohumoral factors, which can both have repercussions on renal function, are analyzed. Two paradigms seem to apply. One is that the renin-angiotensin system (RAS), the sympathetic nervous system (SNS), and extracellular volume control are the three main determinants of renal function in heart failure. The other is that the classical paradigm to analyze renal dysfunction that is widely applied in nephrology also applies to the pathophysiology of heart failure: pre-renal, intra-renal, and post-renal alterations together determine glomerular filtration. At variance with the classical paradigm is that the most important post-renal factor in heart failure seems renal venous hypertension that, by increasing renal tubular pressure, decreases GFR. When different pharmacological strategies to inhibit the RAS and SNS and to assist renal volume control are considered, there is a painful lack in knowledge about how widely applied drugs affect primary driving forces for ultrafiltration, renal autoregulation, and neurohumoral control. We call for more clinical physiological studies.

  4. [POSSIBILITIES OF VACUUM THERAPY APPLICATION IN DISORDERS OF VENOUS OUTFLOW IN ISLET GRAFTS].

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    Badyul, P O; Samoylenko, G E; Nor, N M; Slesarenko, K S

    2015-07-01

    The experience of "distressed" (problematic) flaps application in 33 patients with soft tissue defects over 2010-2014 years were analysed. It was proposed to use the local negative pressure for the prevention and treatment of complications associated with venous insufficiency or trombosis in using of plastics with vascularised complexes of tissues. Vacuum-therapy was conducted with the help of negative pressure apparatus "AGATE-Dnepr" (Ukraine) by attaching silver-containing polyurethane sponge on the operating zone, covering the flap with the surrounding skin netting band "Grassolind". The recommended standard of negative pressure of 75-125 mm Hg, both in impulse and in continuous mode was used. The high efficiency of vacuum-therapy for survival of grafts has been demonstrated. Thus, it might be considered as an effective element of prevention and treatment of complications associated with venous insufficiency or trombosis using of vascularised tissue complex plastics of defects.

  5. CT and MRI Findings of Primary Renal Angiosarcoma with Spontaneous Rupture and Venous Thrombosis: Case Report

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    Kim, Young Hwan; Kim, See Hyung; Kim, Young Hwan [Dept. of Radiology, Keimyung University Dongsan Hospital, Daegu (Korea, Republic of)

    2011-06-15

    Primary renal angiosarcoma is a very rare malignant mesenchymal tumor. CT shows a well-margined enhancing mass with hemorrhage, perirenal hematoma and renal vein thrombosis in the lower pole of the right kidney. MRI shows heterogeneous low- and high-signal intensities of the mass on T1- and T2-weighted images, as well as a relatively homogeneous enhancement on contrast enhanced T1-weighted images. We report here on a rare case of primary renal angiosarcoma with spontaneous rupture and venous thrombosis.

  6. "Single Oval Ostium Technique" using Polytetrafluoroethylene Graft for Outflow Reconstruction in Right Liver Grafts with venous Anomalies in Living Donor Liver Transplantation.

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    Thorat, Ashok; Jeng, Long-Bin; Li, Ping-Chun; Li, Ming-Li; Yang, Horng-Ren; Yeh, Chun-Chieh; Chen, Te-Hung; Hsu, Shih-Chao

    2015-05-01

    Right lobe living donor liver transplantation form a major source of liver allografts in Asia because of the scarcity of deceased donation. However, the transplant surgeons often face challenges while managing right lobe liver allografts due to variations in vascular anatomy. Such variations have led the transplant team to adopt modifications in existing techniques of inflow and outflow reconstruction. One of such variations is presence of multiple draining inferior right hepatic veins (IRHVs). This hepatic venous anomaly pose a lot of technical difficulties in the outflow reconstruction as second and/or third anastomosis to inferior vena cava is not always possible in limited retrohepatic space. Herein, we describe the "Single oval ostium technique" using dual synthetic vascular grafts ensuring a common outflow channel for all the hepatic veins.

  7. Increased expression of HIF-1α, VEGF-A and its receptors, MMP-2, TIMP-1, and ADAMTS-1 at the venous stenosis of arteriovenous fistula in a mouse model with renal insufficiency

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    Misra, Sanjay; Shergill, Uday; Yang, Binxia; Janardhanan, Rajiv; Misra, Khamal D.

    2010-01-01

    Purpose A mouse model of renal insufficiency with arteriovenous fistula (AVF) and venous stenosis was created. We tested the hypothesis that there is increased gene expression of hypoxia inducible factor-1 alpha (HIF-1α), vascular endothelial growth factor- A (VEGF-A) and its receptors (VEGFR-1, -2), matrix metalloproteinase-2 (MMP-2), -9 (MMP-9), tissue inhibitor of metalloproteinase-1, -2 (TIMP-1, -2), and a disintegrin and metalloproteinase thrombospondin-1 (ADAMTS-1) at the venous stenosis. Materials and methods Nineteen male C57BL/6 mice underwent a left nephrectomy and a surgical occlusion of the right upper pole to induce renal insufficiency and characterized in eight mice. Twenty eight days later, an AVF (n=11) was created from the right carotid artery to ipsilateral jugular vein and the mice were sacrificed at day 7 (n=4) and day 14 (n=4). The outflow and control veins were removed for gene expression. Three mice were sacrificed at day 28 for histologic analysis. Results The mean serum blood urea nitrogen remained significantly elevated for 8 weeks when compared to baseline (P<0.05). By day 7, there was a significant increase in the expression of HIF-1α, VEGF-A, VEGFR-1, VEGFR-2, MMP-2, TIMP-1, and ADAMTS-1 at the outflow vein with HIF-1α and TIMP-1 being significantly elevated at day 14 (P<0.05). By day 28, the venous stenosis was characterized by a thickened vein wall and neointima. Conclusions A mouse model of renal insufficiency with AVF was developed which had increased expression of HIF-1α, VEGF-A, VEGFR-1, VEGFR-2, MMP-2, TIMP-1, and ADAMTS-1 at the outflow vein with venous stenosis by day 28. PMID:20598569

  8. Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy.

    Science.gov (United States)

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co-located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing.

  9. Regional renal venous hypertension and left-sided varicocele

    OpenAIRE

    O. B. Zhukov; A. V. Verzin; P. L. Penkov

    2014-01-01

    One of the most frequent correctable causes of male infertility is a varicocele. The etiology and pathogenesis of varicocele to date is a matter of debate. The aim of our study was to determine the causes and incidence of regional renal hypertension in patients with leftsided varicocele. The study involved 110 patients with left-sided varicocele in age from 18 to 35 years. Algorithm for evaluation of patients with left-sided varicocele included: physical examination, ultrasound with Doppler k...

  10. Pre-operative renal artery embolization and suprarenal IVC filter placement for prevention of fat embolization in renal angiomyolipoma with venous extension.

    Science.gov (United States)

    Cornman-Homonoff, Joshua; Li, David; Schiffman, Marc

    2017-01-26

    Though generally considered benign, angiomyolipomas can invade through the renal vein into the inferior vena cava, putting patients at risk of catastrophic pulmonary fat embolization. Venous invasion is thus an indication for surgical resection but is thought to increase the risk of adverse operative outcomes including intraoperative hemorrhage and embolization of fat and/or tumor thrombus. We report a novel approach to mitigating these complications illustrated in the case of a 43-year-old woman with IVC-invasive renal AML who underwent successful radical nephrectomy after concurrent pre-operative renal artery embolization and placement of a retrievable suprarenal IVC filter.

  11. 'Chronic cerebrospinal venous insufficiency' in multiple sclerosis. Is multiple sclerosis a disease of the cerebrospinal venous outflow system?; 'Chronische zerebrospinale venoese Insuffizienz' bei Multipler Sklerose. Ist die Multiple Sklerose eine Erkrankung des zerebrospinalen venoesen Abflusssystems?

    Energy Technology Data Exchange (ETDEWEB)

    Wattjes, M.P. [VU Univ. Medical Center, Amsterdam (Netherlands). Dept. of Radiology; Doepp, F. [Universitaetsklinik Charite, Berlin (Germany). Neurologische Klinik; Bendszus, M. [Heidelberg Univ. (Germany). Abt. fuer Neuroradiologie; Fiehler, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik fuer Neuroradiologische Diagnostik und Intervention

    2011-06-15

    Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients. (orig.)

  12. Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing's syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Andereggen, Lukas [Bern University Hospital, University Institute of Diagnostic and Interventional Neuroradiology, Bern (Switzerland); Bern University Hospital, Department of Neurosurgery, Bern (Switzerland); Schroth, Gerhard; Gralla, Jan; Ozdoba, Christoph [Bern University Hospital, University Institute of Diagnostic and Interventional Neuroradiology, Bern (Switzerland); Seiler, Rolf; Mariani, Luigi; Beck, Juergen; Widmer, Hans-Rudolf; Andres, Robert H. [Bern University Hospital, Department of Neurosurgery, Bern (Switzerland); Christ, Emanuel [Bern University Hospital, Division of Endocrinology, Diabetology and Clinical Nutrition, Bern (Switzerland)

    2012-05-15

    Conventional MRI may still be an inaccurate method for the non-invasive detection of a microadenoma in adrenocorticotropin (ACTH)-dependent Cushing's syndrome (CS). Bilateral inferior petrosal sinus sampling (BIPSS) with ovine corticotropin-releasing hormone (oCRH) stimulation is an invasive, but accurate, intervention in the diagnostic armamentarium surrounding CS. Until now, there is a continuous controversial debate regarding lateralization data in detecting a microadenoma. Using BIPSS, we evaluated whether a highly selective placement of microcatheters without diversion of venous outflow might improve detection of pituitary microadenoma. We performed BIPSS in 23 patients that met clinical and biochemical criteria of CS and with equivocal MRI findings. For BIPSS, the femoral veins were catheterized bilaterally with a 6-F catheter and the inferior petrosal sinus bilaterally with a 2.7-F microcatheter. A third catheter was placed in the right femoral vein. Blood samples were collected from each catheter to determine ACTH blood concentration before and after oCRH stimulation. In 21 patients, a central-to-peripheral ACTH gradient was found and the affected side determined. In 18 of 20 patients where transsphenoidal partial hypophysectomy was performed based on BIPSS findings, microadenoma was histologically confirmed. BIPSS had a sensitivity of 94% and a specificity of 67% after oCRH stimulation in detecting a microadenoma. Correct localization of the adenoma was achieved in all Cushing's disease patients. BIPSS remains the gold standard in the detection of a microadenoma in CS. Our findings show that the selective placement of microcatheters without venous outflow diversion might further enhance better recognition to localize the pituitary tumor. (orig.)

  13. Renal stones on portal venous phase contrast-enhanced CT: does intravenous contrast interfere with detection?

    Science.gov (United States)

    Dym, R. Joshua; Duncan, Dameon R.; Spektor, Michael; Cohen, Hillel W.; Scheinfeld, Meir H.

    2015-01-01

    Purpose To determine the sensitivity of portal venous phase contrast-enhanced CT for the detection of renal stones. Methods This retrospective study included 97 CT examinations of the abdomen without and with intravenous contrast, including 85 (87.6%) examinations with at least one renal stone on the “gold standard” noncontrast images, as scored by a single radiologist. Three other radiologists each independently reviewed only the contrast-enhanced images from all 97 examinations and recorded all renal stones. Reviewer sensitivity for stones was categorized by stone diameter. Reviewer sensitivity and specificity for stone disease were also calculated on a per-kidney basis. Results The 97 cases included a total of 238 stones ≥1 mm, with a mean (±SD) of 1.2 ± 1.9 stones per kidney and a stone diameter of 3.5 ± 3.0 mm. Pooling data for the three reviewers, sensitivity for all stones was 81%; sensitivity for stones ≥2, ≥3, ≥4, and ≥5 mm was 88%, 95%, 99%, and 98%, respectively. Sensitivity for stone disease on a per-kidney basis was 94% when considering all stones; when considering only stones ≥2, ≥3, and ≥4 mm, sensitivity was 96%, 99%, and 100%, respectively. Specificity for stone disease on a per-kidney basis was 98% overall, 99% when considering only stones ≥2 mm, and 100% when considering only stones ≥3 mm. Conclusion: Contrast-enhanced CT is highly sensitive for the detection of renal stones ≥3 mm in diameter and less sensitive for smaller stones. In cases where the clinical diagnosis is uncertain and performance of a CT examination is being contemplated, intravenous contrast utilization would allow assessment for stone disease while also optimizing evaluation for other conditions. PMID:24504541

  14. Robotic partial nephrectomy for renal cell carcinomas with venous tumor thrombus.

    Science.gov (United States)

    Abaza, Ronney; Angell, Jordan

    2013-06-01

    To describe the first report of robotic partial nephrectomies (RPNs) for renal cell carcinoma (RCC) with venous tumor thrombus (VTT). Partial nephrectomy for RCC extending into the renal vein has been described in limited fashion, but such a complex procedure has not previously been reported in minimally-invasive fashion. We demonstrate the feasibility of robotic nephron-sparing surgery despite vein thrombi and the results of the initial four highly-selected patients to have undergone this novel procedure. Two patients underwent RPN for RCC with VTT involving intraparenchymal vein branches, and 2 others had VTT involving the main renal vein. Mean patient age was 65 years (range 50-74 years). Mean tumor size was 7.75 cm (range 4.3-12.8 cm) with mean RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score of 9.75 (range 8-12). Mean warm ischemia time was 24.2 minutes (range 19-27 minutes) and mean estimated blood loss was 168.8 mL (range 100-300 mL). No patients required transfusion, and there were no intraoperative complications. No patients required conversion to open or standard laparoscopic surgery. All 4 patients were discharged home on the first postoperative day. A single postoperative complication occurred in 1 patient who was readmitted with an ileus that resolved spontaneously. All patients had negative surgical margins. Two patients developed metastatic disease on surveillance imaging. RPN in patients with VTT is safe and feasible in selected patients. Given the risk of metastatic disease in patients with pathologic stage T3a RCC, the role of nephron sparing requires further evaluation such that radical nephrectomy remains the standard of care. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Natural history of untreated renal cell carcinoma with venous tumor thrombus.

    Science.gov (United States)

    Reese, Adam C; Whitson, Jared M; Meng, Maxwell V

    2013-10-01

    The natural history of untreated renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is poorly characterized. We aimed to describe the natural history of this disease, and to identify prognostic factors associated with disease-specific survival. We identified patients in the Surveillance, Epidemiology, and End Results (SEER) database with untreated renal cell carcinoma and venous tumor thrombi. Disease-specific median and 1-year survival rates were determined, and disease-free survival curves were plotted using the Kaplan-Meier method. Multivariable Cox regression analyses were performed to identify factors associated with disease-specific and overall survival in this patient group. Of 2,265 patients with RCC and VTT, 390 (17%) underwent no treatment; 278 (71%) patients died during follow-up; of these, 243 deaths (87%) were due to RCC. Median and 1-year disease-specific survival for this group was 5 months and 29%, respectively. On multivariable analysis, the extent of tumor thrombus (HR 1.7 for T3c vs. T3b, 95% CI 1.0-2.7) and the presence of metastases (HR 3.1 for M+ vs. M0, 95% CI 1.7-5.5) were most strongly associated with disease-specific mortality. Prognosis is poor for the majority of untreated patients with RCC and VTT. Supradiaphragmatic thrombi and distant metastases are adverse prognostic factors in this patient group. This information is important when counseling patients as to the risk and benefits of surgical vs. nonoperative management of RCC and VTT. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Venous Outflow Reconstruction in Adult Living Donor Liver Transplant: Outcome of a Policy for Right Lobe Grafts without the Middle Hepatic Vein

    Directory of Open Access Journals (Sweden)

    Mohamed Ghazaly

    2013-01-01

    Full Text Available Introduction. The difficulty and challenge of recovering a right lobe graft without MHV drainage is reconstructing the outflow tract of the hepatic veins. With the inclusion or the reconstruction of the MHV, early graft function is satisfactory. The inclusion of the MHV or not in the donor’s right lobectomy should be based on sound criteria to provide adequate functional liver mass for recipient, while keeping risk to donor to the minimum. Objective. Reviewing the results of a policy for right lobe grafts transplant without MHV and analyzing methods of venous reconstruction related to outcome. Materials and Methods. We have two groups Group A (with more than one HV anast. (n=16 and Group B (single HV anast. (n=24. Both groups were compared regarding indications for reconstruction, complications, and operative details and outcomes, besides describing different modalities used for venous reconstruction. Results. Significant increase in operative details time in Group A. When comparison came to complications and outcomes in terms of laboratory findings and overall hospital stay, there were no significant differences. Three-month and one-year survival were better in Group A. Conclusion. Adult LDLT is safely achieved with better outcome to recipients and donors by recovering the right lobe without MHV, provided that significant MHV tributaries (segments V, VIII more than 5 mm are reconstructed, and any accessory considerable inferior right hepatic veins (IRHVs or superficial RHVs are anastomosed.

  17. PGI2 synthesis and excretion in dog kidney: evidence for renal PG compartmentalization

    Energy Technology Data Exchange (ETDEWEB)

    Boyd, R.M.; Nasjletti, A.; Heerdt, P.M.; Baer, P.G.

    1986-01-01

    To assess the concept of compartmentalization of renal prostaglandins (PG), we compared entry of PGE2 and the PGI2 metabolite 6-keto-PGF1 alpha into the renal vascular and tubular compartments, in sodium pentobarbital-anesthetized dogs. Renal arterial 6-keto-PGF1 alpha infusion increased both renal venous and urinary 6-keto-PGF1 alpha outflow. In contrast, renal arterial infusion of arachidonic acid (AA) or bradykinin (BK) increased renal venous 6-keto-PGF1 alpha outflow but had no effect on its urinary outflow. Both urinary and renal venous PGE2 outflows increased during AA or BK infusion. Ureteral stopped-flow studies revealed no postglomerular 6-keto-PGF1 alpha entry into tubular fluid. During renal arterial infusion of (3H)PGI2 and inulin, first-pass 3H clearance was 40% of inulin clearance; 35% of urinary 3H was 6-keto-PGF1 alpha, and two other urinary metabolites were found. During renal arterial infusion of (3H)6-keto-PGF1 alpha and inulin, first-pass 3H clearance was 150% of inulin clearance; 75% of urinary 3H was 6-keto-PGF1 alpha, and only one other metabolite was found. We conclude that in the dog PGE2 synthesized in the kidney enters directly into both the renal vascular and tubular compartments, but 6-keto-PGF1 alpha of renal origin enters directly into only the renal vascular compartment.

  18. Hemodialysis improves endothelial venous function in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    A.M.V. Silva

    2008-06-01

    Full Text Available The objective of the present study was to determine the acute effect of hemodialysis on endothelial venous function and oxidative stress. We studied 9 patients with end-stage renal disease (ESRD, 36.8 ± 3.0 years old, arterial pressure 133.8 ± 6.8/80.0 ± 5.0 mmHg, time on dialysis 55.0 ± 16.6 months, immediately before and after a hemodialysis session, and 10 healthy controls matched for age and gender. Endothelial function was assessed by the dorsal hand vein technique using graded local infusion of acetylcholine (endothelium-dependent venodilation, EDV and sodium nitroprusside (endothelium-independent venodilation. Oxidative stress was evaluated by measuring protein oxidative damage (carbonyls and antioxidant defense (total radical trapping antioxidant potential - TRAP in blood samples. All patients were receiving recombinant human erythropoietin for at least 3 months and were not taking nitrates or a-receptor antagonists. EDV was significantly lower in ESRD patients before hemodialysis (65.6 ± 10.5 vs controls (109.6 ± 10.8; P = 0.010 and after hemodialysis (106.6 ± 15.7; P = 0.045. Endothelium-independent venodilation was similar in all comparisons performed. The hemodialysis session significantly decreased TRAP (402.0 ± 53.5 vs 157.1 ± 28.3 U Trolox/µL plasma; P = 0.001. There was no difference in protein damage comparing ESRD patients before and after hemodialysis. The magnitude of change in the EDV was correlated negatively with the magnitude of change in TRAP (r = -0.70; P = 0.037. These results suggest that a hemodialysis session improves endothelial venous function, in association with an antioxidant effect.

  19. Prognostic significance of venous tumour thrombus consistency in patients with renal cell carcinoma (RCC).

    Science.gov (United States)

    Weiss, Valerie L; Braun, Martin; Perner, Sven; Harz, Andreas; Vorreuther, Roland; Kristiansen, Glen; Müller, Stefan C; Ellinger, Jörg

    2014-02-01

    To identify the prognostic impact of venous tumour thrombus (VTT) in locally advanced renal cell carcinomas (RCCs). To further differentiate the clinical course of patients with VTT who have similar clinicopathological characteristics. We determined the VTT consistency (solid vs friable) in a retrospective cohort of 200 patients with RCC who had undergone nephrectomy between 1994 and 2011. We examined the correlation of VTT consistency in these patients with clinical and pathological variables. A total of 65% of the patients had solid VTT and 35% had friable VTT, which has a significantly lower amount of cell-cell adhesion molecules and connective tissue than solid VTT. We found that friable VTT was associated with advanced pT stage, higher VTT level, papillary RCC subtype and a lower age. Patients with friable VTT had a significantly shorter median overall survival than those with solid VTT (29 vs 89 months), but VTT consistency was not found to be an independent predictor of patients' survival in the multivariate Cox analysis. We found that VTT consistency was an independent significant predictor of overall survival in patients without evidence of distant and nodal metastases (N = 119). The VTT consistency is caused by the tumour and not by different surgical handling. Friable VTT is an important adverse prognostic predictor of overall survival in patients with non-metastatic RCC. © 2013 The Authors. BJU International © 2013 BJU International.

  20. Surgical treatment of Renal Cell Carcinoma (RCC with level III–IV tumor venous thrombosis

    Directory of Open Access Journals (Sweden)

    M. I. Davydov

    2016-01-01

    Full Text Available Objective: to assess the results of nephrectomy, thrombectomy in RCC patients with level III–IV tumor venous thrombosis with and without cardiopulmonary bypass.Materials and methods. Medical data of 167 consecutive RCC patients with level III–IV tumor venous thrombosis underwent nephrectomy thrombectomy in N.N. Blokhin Russian Cancer Research Center between 1998 and 2012 were collected. Right side tumor was in 122 (73.1 %, left side – in 42 (25.1 %, bilateral – in 3 (1.8 % cases. The extent of thrombus was defined as intrahepatic in 82 (49.1 %, supradiaphragmatic – in 85 (50.9 % (intrapericardial – in 44 (26.3 %, intraatrial – in 39 (23.4 %, intraventricular – in 2 (1.2 % cases. Nephrectomy, thrombectomy with cardiopulmonary bypass was used in 9 (5.4 %, 158 (94.6 % patients underwent radical nephrectomy with thrombectomy without CPBP and sternotomy. Intrapericardial IVC and right atrium were exposed through transdiaphragmatic approach and providing vascular control over infradiaphragmatic IVC and renal veins.Results. Median blood loss was 6000 (600–27 000 ml. Complications rate was 62.8 %, 90-day mortality – 13.2 %. Intraoperative complications were registered in 80 (47.9 %, postoperative – in 66 (40.5 % (grade II – 16 (9.8 %, grade IIIb – 1 (0.6 %, grade IVа – 28 (17.2 %, grade IVb – 3 (1.8 %, grade V – 18 (11.1 % patients. Modified thrombectomy technique insignificantly decreased blood loss compared to thrombectomy with CPB, did nоt increase complications rate including pulmonary vein thromboembolism, or mortality. Five-year overall, cancer-specific and recurrence-free survival was 46.2, 58.3 and 47.1 %, respectively. Thrombectomy technique did nоt affect survival.Conclusion. In selected patients with mobile thrombi transdiaphragmatic approach allows to avoid the use of CPBP and decrease surgical morbidity without survival compromising.

  1. Does a venous tumor thrombus exclude renal transitional cell carcinoma? Implications for neo-adjuvant treatment strategies.

    Science.gov (United States)

    Huber, Johannes; Teber, Dogu; Hatiboglu, Gencay; Popeneciu, Valentin; Jakobi, Hildegard; Hallscheidt, Peter; Pahernik, Sascha; Hohenfellner, Markus

    2014-02-01

    A venous tumor thrombus (VTT) is well-known in renal cell carcinoma, but we experienced a series of five patients with VTT due to renal transitional cell carcinoma (TCC). Our study aimed to determine the incidence and clinical relevance of this entity. From our prospectively-maintained tumor database, we identified 102 patients with renal TCC according to postoperative histology and analyzed the incidence of VTT in renal TCC from 1990 to 2010. Five out of 102 patients with TCC (5%) had a VTT. None of these five patients experienced gross haematuria and we presumed correct diagnosis preoperatively in one out of five patients. Univariate analysis revealed that TNM stage and resection status were inferior in the VTT group. All five patients from the VTT group died from their disease, with a median survival of 8.9 months. With regard to all diagnosed VTT, the effective incidence of vena cava involvement in RCC was 48-fold higher than in renal TCC. A VTT is very suggestive of renal cell carcinoma. However, before neo-adjuvant treatment, the diagnosis should be assured whenever there is doubt.

  2. Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus.

    Science.gov (United States)

    Whitson, Jared M; Reese, Adam C; Meng, Maxwell V

    2013-02-01

    To identify prognostic factors for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) and determine the significance of thrombus level on survival. Patients within the Surveillance, Epidemiology, and End Results (SEER) database with RCC and VTT were identified and included if managed surgically. The Kaplan-Meier method and Cox regression analyses were performed to identify factors associated with disease-specific survival. A total of 1,875 patients met the inclusion criteria. One-year survival for patients undergoing surgery was 60% for patients with metastases and 90% for those without. Factors associated with worse survival included larger tumor size (HR 1.2, 95% CI 1.0-1.4), medullary, collecting duct, or sarcomatoid histology (HR 2.2, 95% CI 1.5-3.3), Fuhrman grade 3 (HR 2.2, 95% CI 1.5-3.3) or grade 4 (HR 2.9, 95% CI 1.8-4.5) tumors, positive lymph nodes (HR 1.5, 95% CI 1.0-2.0), and metastases (HR 3.5, 95% CI 2.6-4.8). Thrombus level above the diaphragm (T3c) was not significantly associated with worse survival (HR 1.4, 95% CI 0.8-2.5). In this large, population-based study of patients with RCC and VTT, we identify several disease-specific factors strongly associated with cancer-specific mortality. After controlling for adverse prognostic factors, thrombus level was not associated with worse outcome. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Fluid loss, venous congestion, and worsening renal function in acute decompensated heart failure.

    Science.gov (United States)

    Aronson, Doron; Abassi, Zaid; Allon, Eyal; Burger, Andrew J

    2013-06-01

    To investigate the relationship between decongestion, central venous pressure, and risk of worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). We studied 475 patients with ADHF, of whom 238 underwent right heart catheterization. Right atrial pressure (RAP) was measured at baseline and at 24 h. Net fluid loss was recorded in the first 24 h. WRF was defined as a >0.3 mg/dL increase in serum creatinine above baseline. WRF occurred in 84 catheterized patients (35.3%). There was a weak correlation between baseline RAP and baseline estimated glomerular filtration rate (r = -0.17, P = 0.009). The amount of fluid removed during the first 24 h did not correlate with the magnitude of RAP reduction (r = 0.06, P = 0.35). No association was observed between WRF and baseline RAP [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.80-1.41, P = 0.68 per 6.6 mmHg] or the decrease in RAP (adjusted OR 1.13, 95% CI 0.85-1.49, P = 0.40 per 5.3 mmHg reduction in RAP). In contrast, smaller net fluid loss was strongly associated with increased WRF risk. Compared with the first net fluid loss tertile, the adjusted OR was 1.85 (95% CI 0.90-3.80, P = 0.10) and 2.58 (95% CI 1.27-5.25; P = 0.009) for the second and third tertile, respectively (P for trend fluid loss is associated with increased risk for WRF. RAP is not a reliable surrogate of the magnitude of decongestion and risk of WRF. Future research is necessary to determine if targeting congestion may help prevent WRF.

  4. Effect of renal venous pressure elevation on tubular sodium and water reabsorption in the dog kidney

    DEFF Research Database (Denmark)

    Abildgaard, U; Amtorp, O; Holstein-Rathlou, N H;

    1988-01-01

    unaffected by acute surgical denervation of the kidneys. In contrast, chronic renal denervation or infusion of phentolamine (5 micrograms kg-1 min-1) into the renal artery eliminated the increase in APR and FPR during RVP elevation to 20 mmHg. Chronic, but not acute renal denervation depleted renal tissue...

  5. A re-appraisal of volume status and renal function impairment in chronic heart failure: combined effects of pre-renal failure and venous congestion on renal function.

    Science.gov (United States)

    Sinkeler, Steef J; Damman, Kevin; van Veldhuisen, Dirk J; Hillege, Hans; Navis, Gerjan

    2012-03-01

    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal impairment in chronic heart failure is traditionally assumed to be mainly due to a decrease in cardiac output and a subsequent decrease in renal perfusion. This will lead to a decrease in glomerular filtration rate and a compensatory increase in tubular sodium retention. The latter is a physiological renal response aimed at retaining fluids in order to increase cardiac filling pressure and thus renal perfusion. In heart failure, however, larger increases in cardiac filling pressure are needed to restore renal perfusion and thus more volume retention. In this concept, in chronic heart failure, an equilibrium exists where a certain degree of congestion is the price to be paid to maintain adequate renal perfusion and function. Recently, this hypothesis was challenged by new studies, wherein it was found that the association between right-sided cardiac filling pressures and renal function is bimodal, with worse renal function at the highest filling pressures, reflecting a severely congested state. Renal hemodynamic studies suggest that congestion negatively affects renal function in particular in patients in whom renal perfusion is also compromised. Thus, an interplay between cardiac forward failure and backward failure is involved in the renal function impairment in the congestive state, presumably along with other factors. Only few data are available on the impact of intervention in volume status on the cardio-renal interaction. Sparse data in cardiac patients as well as evidence from cohorts with primary renal disease suggest that specific targeting of volume overload may be beneficial for long-term outcome, in spite of a certain further decrease in renal function, at least

  6. Biopsy Induced Arteriovenous Fistula and Venous Stenosis in a Renal Transplant

    Directory of Open Access Journals (Sweden)

    Sridhar R. Allam

    2015-01-01

    Full Text Available Renal transplant vein stenosis is a rare cause of allograft dysfunction. Percutaneous stenting appears to be safe and effective treatment for this condition. A 56-year-old Caucasian female with end stage renal disease received a deceased donor renal transplant. After transplant, her serum creatinine improved to a nadir of 1.2 mg/dL. During the third posttransplant month, her serum creatinine increased to 2.2 mg/dL. Renal transplant biopsy showed BK nephropathy. Mycophenolate was discontinued. Over the next 2 months, her serum creatinine crept up to 6.2 mg/dL. BK viremia improved from 36464 copies/mL to 15398 copies/mL. A renal transplant ultrasound showed lower pole arteriovenous fistula and abnormal waveforms in the renal vein. Carbon dioxide (CO2 angiography demonstrated severe stenosis of the transplant renal vein. Successful coil occlusion of fistula was performed along with angioplasty and deployment of stent in the renal transplant vein. Serum creatinine improved to 1.5 mg/dL after.

  7. The extent of tumour fat invasion affects survival in patients with renal cell carcinoma and venous tumour thrombosis.

    Science.gov (United States)

    Bertini, Roberto; Roscigno, Marco; Freschi, Massimo; Angiolilli, Diego; Strada, Elena; Petralia, Giovanni; Sozzi, Francesco; Capitanio, Umberto; Cremonini, Anna; Rigatti, Patrizio

    2011-09-01

    • To investigate the effect of presence and extent of tumour fat invasion (TFI) - perinephric invasion (PFI), renal sinus fat invasion (RSFI) or both PFI and RSFI - on cancer-specific mortality (CSM) in patients with renal cell carcinoma (RCC) and venous tumour thrombus (VTT). • We examined 184 consecutive patients with RCC with VTT treated with nephrectomy between 1987 and 2007. Associations with CSM were evaluated by univariable and multivariable Cox proportional hazard models. • Median follow up was 21 months. The 5-year CSM-free survival estimates were 75%, 36% and 20% in patients with VTT without TFI, those with VTT with PFI or RSFI, and those with VTT with both PFI and RSFI, respectively (P VTT-only cases. • The inclusion of the variable describing the presence and extent of TFI in a base model including pT stage, Fuhrman grade and presence of nodal disease and metastatic disease significantly increased the accuracy in predicting CSM (+2.1%; P VTT. • Patients affected by RCC with VTT and TFI have a higher risk of CSM relative to cases with VTT only. Patients with both PFI and RSFI showed increased CSM compared with patients with either PFI or RSFI. • Our results suggest TFI should be accurately evaluated and included in routine pathological reports to provide better patient risk stratification. © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.

  8. A proposal of post-operative nomogram for overall survival in patients with renal cell carcinoma and venous tumor thrombus.

    Science.gov (United States)

    Gu, Liangyou; Wang, Zihuan; Chen, Luyao; Ma, Xin; Li, Hongzhao; Nie, Wenyuan; Peng, Cheng; Li, Xintao; Gao, Yu; Zhang, Xu

    2017-06-01

    To identify the predictors of overall survival (OS) and create a post-operative prognostic model for patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). The study cohort included patients with RCC and VTT that underwent full surgical resection between 2006 and 2016. Univariate and multivariate analyses were used to determine the prognostic factors of OS. A nomogram was developed and internally calibrated by bootstrap resampling method. A total of 185 patients were identified, including patients with thrombus present in the renal vein (109 patients, 58.9%), infrahepatic inferior vena cava (IVC; 68 patients, 36.8%), and suprahepatic IVC (8 patients, 4.3%). After a median follow-up of 30.2 months (interquartile range, 12.1-48.4 months), 63 (34.1%) patients died. Independent prognostic factors for OS included histological subtype, collecting system invasion, metastasis at surgery, De Ritis ratio (AST/ALT), and serum albumin. Independently predictive variables were used to create a nomogram, which achieved a concordance index of 0.75 for OS. For patients with RCC and VTT, the developed and internally validated post-operative nomogram can be used to select patients who may benefit from aggressive surveillance regimens or adjuvant therapy clinical trials. © 2017 Wiley Periodicals, Inc.

  9. A re-appraisal of volume status and renal function impairment in chronic heart failure : combined effects of pre-renal failure and venous congestion on renal function

    NARCIS (Netherlands)

    Sinkeler, Steef J.; Damman, Kevin; van Veldhuisen, Dirk J.; Hillege, Hans; Navis, Gerjan

    2012-01-01

    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal imp

  10. Venous Outflow Reconstruction in Adult Living Donor Liver Transplant: Outcome of a Policy for Right Lobe Grafts without the Middle Hepatic Vein

    OpenAIRE

    Mohamed Ghazaly; Badawy, Mohamad T.; Hosam El-Din Soliman; Magdy El-Gendy; Tarek Ibrahim; Davidson, Brian R.

    2013-01-01

    Introduction. The difficulty and challenge of recovering a right lobe graft without MHV drainage is reconstructing the outflow tract of the hepatic veins. With the inclusion or the reconstruction of the MHV, early graft function is satisfactory. The inclusion of the MHV or not in the donor's right lobectomy should be based on sound criteria to provide adequate functional liver mass for recipient, while keeping risk to donor to the minimum. Objective. Reviewing the results of a policy for righ...

  11. Impact of venous tumour thrombus consistency (solid vs friable) on cancer-specific survival in patients with renal cell carcinoma.

    Science.gov (United States)

    Bertini, Roberto; Roscigno, Marco; Freschi, Massimo; Strada, Elena; Angiolilli, Diego; Petralia, Giovanni; Matloob, Rayan; Sozzi, Francesco; Capitanio, Umberto; Da Pozzo, Luigi Filippo; Colombo, Renzo; Guazzoni, Giorgio; Cremonini, Anna; Montorsi, Francesco; Rigatti, Patrizio

    2011-08-01

    To our knowledge, the impact of venous tumour thrombus (VTT) consistency in patients affected by renal cell carcinoma (RCC) has never been addressed. To analyse the effect of VTT consistency on cancer-specific survival (CSS). We retrospectively analysed 174 consecutive patients with RCC and renal vein or inferior vena cava (IVC) VTT who underwent surgical treatment between 1989 and 2007 at our institute. All patients underwent radical nephrectomy and thrombectomy. Pathologic specimens were reviewed by a single uropathologist. In addition to traditional pathologic features, the morphologic aspect of the tumour thrombus was evaluated to distinguish solid from friable patterns. The prognostic role of thrombus consistency (solid vs friable) on CSS was assessed by means of Cox regression models. The VTT was solid in 107 patients (61.5%) and friable in 67 patients (38.5%). The presence of a friable VTT increased the risk of having synchronous nodal or distant metastases, higher tumour grade, higher pathologic stage, and simultaneous perinephric fat invasion (all p VTT and 55 mo in patients with a solid VTT (p VTT was an independent predictor of CSS (p = 0.02). The power of our conclusion may be somewhat limited by the relatively small study population and the retrospective nature of the study. In patients with RCC and VTT, the presence of a friable thrombus is an independent predictor of CSS. If our finding is confirmed by further studies, the consistency of the tumour thrombus should be introduced into routine pathologic reports to provide better patient risk stratification. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  12. Noncontrast-enhanced magnetic resonance renal angiography using a repetitive artery and venous labelling technique at 3 T: comparison with contrast-enhanced magnetic resonance angiography in subjects with normal renal function

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Yoon [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Severance Hospital, Yonsei University College of Medicine, Department of Radiology and Research Institute of Radiological Science, Seoul (Korea, Republic of); Kim, Chan Kyo; Park, Byung Kwan [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Kim, EunJu [Philips Healthcare Korea, Seoul (Korea, Republic of)

    2014-09-13

    To investigate the feasibility of noncontrast-enhanced MR angiography (NC-MRA) using the repetitive artery and venous labelling (RAVEL) technique to evaluate renal arteries compared to contrast-enhanced MR angiography (CE-MRA). Twenty-five subjects with normal renal function underwent NC-MRA using a RAVEL technique and CE-MRA at 3 T. Two independent readers analysed the MRA images. Image quality, number of renal arteries, presence or absence of an early branching vessel, and diameter of the main renal arteries were evaluated. The overall image quality of NC-MRA was fair or greater in 88 % of right and 92 % of left renal arteries, while it was 96 % in both sides with CE-MRA. On NC-MRA, the number of renal arteries in all subjects was perfectly predicted by both readers. Sensitivity and specificity for predicting early branching vessels were 82 % and 100 % for reader 1 and 82 % and 95 % for reader 2. Inter-modality agreement for comparing the diameters of main renal arteries was good or excellent at all segments for both readers. Inter-reader agreement was moderate or good at all segments except at the right distal segment on NC-MRA. NC-MRA with the RAVEL technique at 3 T may have comparable diagnostic feasibility for evaluating renal arteries compared to CE-MRA. (orig.)

  13. [VENOUS THROMBOSIS OF THE LEFT OVARIAN AND EXTENSION TO THE RENAL VEIN].

    Science.gov (United States)

    Jean, F; Claudot, A; Istace, B; Petit, P; Nisolle, M

    2016-01-01

    Ovarian vein thrombosis is a rare, but potentially serious postpartum complication. In 80% of the cases, it occurs on the right side and in less than 6% on the left side; it is bilateral in 14% of cases. The usual clinical features include abdominal pain, fever and leucocytosis. However, the diagnosis is often complicated by other non specific signs and symptoms. Ovarian vein thrombosis may cause sepsis, pulmonary thromboembolism, and thrombosis of the inferior vena cava and the renal vein. The diagnosis can be established by CT scan or nuclear magnetic resonance imaging, which has a high sensitivity and specificity. Treatment for the ovarian vein thrombosis includes antibiotics and anticoagulation. The complications can sometimes be surgically managed. Prompt diagnosis and treatment can decrease the morbidity and the mortality. Nowadays, the fatal issue is rare as the appropriate treatment is quickly instaured.

  14. Protostellar Outflows

    Science.gov (United States)

    Bally, John

    2016-09-01

    Outflows from accreting, rotating, and magnetized systems are ubiquitous. Protostellar outflows can be observed from radio to X-ray wavelengths in the continuum and a multitude of spectral lines that probe a wide range of physical conditions, chemical phases, radial velocities, and proper motions. Wide-field visual and near-IR data, mid-IR observations from space, and aperture synthesis with centimeter- and millimeterwave interferometers are revolutionizing outflow studies. Many outflows originate in multiple systems and clusters. Although most flows are bipolar and some contain highly collimated jets, others are wide-angle winds, and a few are nearly isotropic and exhibit explosive behavior. Morphologies and velocity fields indicate variations in ejection velocity, mass-loss rate, and in some cases, flow orientation and degree of collimation. These trends indicate that stellar accretion is episodic and often occurs in a complex dynamical environment. Outflow power increases with source luminosity but decreases with evolutionary stage. The youngest outflows are small and best traced by molecules such as CO, SiO, H2O, and H2. Older outflows can grow to parsec scales and are best traced by shock-excited atoms and ions such as hydrogen-recombination lines, [Sii], and [Oii]. Outflows inject momentum and energy into their surroundings and provide an important mechanism in the self-regulation of star formation. However, momentum injection rates remain uncertain with estimates providing lower bounds.

  15. CERTIFY: prophylaxis of venous thromboembolism in patients with severe renal insufficiency.

    Science.gov (United States)

    Bauersachs, R; Schellong, S M; Haas, S; Tebbe, U; Gerlach, H-E; Abletshauser, C; Sieder, C; Melzer, N; Bramlage, P; Riess, H

    2011-06-01

    Patients with severe renal insufficiency (sRI) have been suggested to be at an increased risk of bleeding with low-molecular-weight heparins (LMWH). We aimed at assessing the benefits and risks of certoparin in comparison to unfractionated heparin (UFH) in these patients. In this subgroup analysis of the CERTIFY trial, acutely ill, non-surgical patients ≥70 years received certoparin 3,000U aXa o.d. or UFH 5,000 IU t.i.d. One hundred eighty-nine patients had a glomerular filtration rate (GFR) ≤30 ml/min/1.73 m2, 3,050 patients served as controls. Patients with sRI had a mean age of 85.9 ± 6.6 years (controls 78.4 ± 6.0) and were treated for a mean of 9.3 ± 3.7 days (9.9 ± 4.3). Thromboembolic event rates were comparable (4.55 vs. 4.21%; OR1.08; 95%CI 0.5-2.37) but bleeding was increased in sRI (9.52 vs. 3.54%; OR2.87; 95%CI 1.70-4.83). The incidence of the combined end-point of proximal DVT, symptomatic non-fatal PE and VTE related death was 6.49% with certoparin and 2.60% with UFH (OR2.60; 95%CI 0.49-13.85). There was a decrease in total bleeding with certoparin (OR0.33; 95%CI 0.11-0.97), which was non-significant in patients with GFR >30 ml/min/1.73 m2. In two multivariable regression models certoparin and immobilisation 30 ml/min/1.73 m2). In conclusion, certoparin 3,000U anti Xa o.d. was as efficacious as 5,000 IU UFH t.i.d. in patients with sRI but had a reduced risk of bleeding.

  16. Arterio-venous concentration difference of [51Cr]EDTA after a single injection in man. Significance of renal function and local blood flow

    DEFF Research Database (Denmark)

    Rehling, M; Hyldstrup, Lars; Henriksen, Jens Henrik

    1989-01-01

    introduced in the measurement of renal plasma clearance and total plasma clearance by using venous blood samples instead of arterial. In 13 patients with GFR ranging from 29 to 150 ml min-1, Ca was higher than Cv immediately after the injection. After mean 38 min (range 12-82 min) the two curves crossed......, and 180-300 min post-injection (p.i.) Cv was 5.9% higher than Ca (range 0.5-13.9%, P less than 0.001). The more reduced renal function, the smaller was the concentration difference. The areas under the arterial and the venous plasma concentration curves did not differ significantly at either 0-infinity......, whereas the difference was very sensitive to even small changes in forearm blood flow within the physiological range. For measurement of renal plasma clearance it is recommended to use one long period: from the time of injection until 300 min p.i. or longer. If the clearance period is too short, the use...

  17. Venous manifestations of spinal arteriovenous fistulas

    NARCIS (Netherlands)

    Andersson, T; van Dijk, JMC; Willinsky, RA

    2003-01-01

    Impairment of the spinal cord venous outflow may create symptoms caused by venous hypertension and congestion. This has been referred to as venous congestive myelopathy. Spinal dural arteriovenous fistulas, as well as some of the epidural arteriovenous fistulas and perimedullary spinal cord arteriov

  18. Case report of cadaveric kidney transplantation with renal-portal venous drainage: A feasible way for a venous drainage in a complex generalized thrombosed vessels setting

    Directory of Open Access Journals (Sweden)

    Mauricio Millan

    2016-01-01

    Conclusion: We can conclude that new surgical alternatives exist for those patients with chronic renal failure that have no vascular access. These patients are a priority for kidney transplants and the surgeon must take in to account the need for a new surgical assessment.

  19. Arterio-venous concentration difference of [51Cr]EDTA after a single injection in man. Significance of renal function and local blood flow

    DEFF Research Database (Denmark)

    Rehling, M; Hyldstrup, L; Henriksen, Jens Henrik Sahl

    1989-01-01

    The present investigation was undertaken in order to study (1) the difference in arterial (Ca) and venous (Cv) concentration of [51Cr]EDTA (ethylenediaminetetraacetate) after a single intravenous injection, (2) the impact of different physiological variables on this difference, and (3) the error......, and 180-300 min post-injection (p.i.) Cv was 5.9% higher than Ca (range 0.5-13.9%, P less than 0.001). The more reduced renal function, the smaller was the concentration difference. The areas under the arterial and the venous plasma concentration curves did not differ significantly at either 0-infinity...... or 0-300 min p.i. whereas the venous area 0-100 min p.i. underestimated the arterial area in the same period by 4.1% (P less than 0.05). In a computer simulation model, variation in the forearm capillary permeability-surface area product did not have any significant influence on the Cv-Ca difference...

  20. Association of haemodynamic changes measured by serial central venous saturation during ultrafiltration for acutely decompensated heart failure with diuretic resistance and change in renal function.

    Science.gov (United States)

    Vazir, Ali; Simpkin, Victoria L; Marino, Philip; Ludman, Andrew; Banya, Winston; Tavazzi, Guido; Bastin, Anthony J; Trenfield, Sarah; Ghori, Arshad; Alexander, Peter D; Griffiths, Mark; Price, Susanna; Sharma, Rakesh; Cowie, Martin R

    2016-10-01

    Patients with acute decompensated heart failure with diuretic resistance (ADHF-DR) have a poor prognosis. The aim of this study was to assess in patients with ADHF-DR, whether haemodynamic changes during ultrafiltration (UF) are associated with changes in renal function (Δcreatinine) and whether Δcreatinine post UF is associated with mortality. Seventeen patients with ADHF-DR underwent 20 treatments with UF. Serial bloods (4-6 hourly) from the onset of UF treatment were measured for renal function, electrolytes and central venous saturation (CVO2). Univariate and multivariate analysis were performed to assess the relationship between changes in markers of haemodynamics [heart rate (HR), systolic blood pressure (SBP), packed cell volume (PCV) and CVO2] and Δcreatinine. Patients were followed up and mortality recorded. Cox-regression survival analysis was performed to determine covariates associated with mortality. Renal function worsened after UF in 17 of the 20 UF treatments (baseline vs. post UF creatinine: 164±58 vs. 185±69μmol/l, Pchanges in SBP, HR and PCV [Pchanges during UF as measured by the surrogate of cardiac output was associated with Δcreatinine. Worsening renal function at end of UF treatment occurred in the majority of patients and was associated with mortality. Copyright © 2016. Published by Elsevier Ireland Ltd.

  1. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  2. Monitoring of renal venous PO2 and kidney oxygen consumption in rats by a near-infrared phosphorescence lifetime technique

    NARCIS (Netherlands)

    E.G. Mik (Egbert); T. Johannes (Tanja); C. Ince (Can)

    2008-01-01

    textabstractRenal oxygen consumption (V̇O2,ren) is an important parameter that has been shown to be influenced by various pathophysiological circumstances. VV̇O2,renhas to be repeatedly measured during an experiment to gain insight in the dynamics of (dys)regulation of oxygen metabolism. In small

  3. Pharmacomechanical thrombolysis for renal salvage after filter migration and renal vein thrombosis.

    Science.gov (United States)

    Kiguchi, Misaki; McDonald, Kerry-Ann; Govindarajan, Siddarth; Makaroun, Michel S; Chaer, Rabih A

    2011-05-01

    A 64-year-old woman underwent prophylactic inferior vena cava filter placement immediately after spinal surgery for pulmonary embolus prophylaxis. One week after surgery, acute renal failure developed, and she required hemodialysis secondary to filter migration with iliocaval and renal vein thrombosis. Pharmacomechanical thrombolysis was performed, with complete recovery of renal function and no evidence of recurrence on follow-up imaging. This report highlights an important and rare complication of filter placement and the importance of prompt thrombus debulking to preserve end organ function while reducing the risks of hemorrhagic complications. Pharmacomechanical thrombolysis allows prompt clearance of venous outflow channels and is attractive in patients with end-organ compromise and high risk for bleeding.

  4. A retrospective analysis of renal cell carcinoma patients with venous thrombosis in 51 cases%肾癌并发静脉血栓患者51例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    张伟; 付强; 姜涛; 李治钢; 张博; 鞠长亮

    2015-01-01

    目的:探讨不同临床特征的肾癌患者并发静脉血栓比例,为肾癌并发静脉血栓的风险评估提供临床依据。方法:收治肾癌并发静脉血栓患者51例,分别记录不同年龄、性别、分期、病理类型、ECOG评分阶段中发生静脉血栓患者数量及实验室检查指标在伴有静脉血栓者和无静脉血栓者的分布情况,进行统计学分析。结果:①患者年龄与静脉血栓形成概率呈正相关(P=0.004),当年龄≥60.2岁患者并发静脉血栓风险显著增加(P=0.005)。②ECOG评分≤2分者静脉血栓发生率明显高于ECOG评分>2分者,差异具有统计学意义(P=0.001)。③发生静脉血栓者纤维蛋白原水平明显高于无静脉血栓者,差异具有统计学意义(P=0.006)。结论:年龄≥60.2岁、ECOG评分≤2分、纤维蛋白原水平升高是初治肾透明细胞癌患者并发静脉血栓的高危因素。%Objective:To investigate the proportion of combined with venous thrombosis in patients with renal cell carcinoma with different clinical characteristics,and to provide the clinical basis for the risk assessment of renal cell carcinoma patients with venous thrombosis.Methods:51 renal cell carcinoma patients with venous thrombosis were selected.We respectively recorded the number of patients with venous thrombosis in different age,gender,pathological type,stage,ECOG score and distribution situation of patients with or without venous thrombosis in index of laboratory examination,we made a statistical analysis.Results:①The age of patients was positively related to the probability of forming venous thromboembolism(P=0.004),when more than 60.2 years old, the risk of patients with venous thrombosis was significantly increased(P=0.005).②In patients with ECOG score less than 2 points, venous thrombosis incidence was significantly higher than that of ECOG score more than 2 points,the difference was statistically significant(P=0.001).③In patients

  5. The impact of histology on clinicopathologic outcomes for patients with renal cell carcinoma and venous tumor thrombus: a matched cohort analysis.

    Science.gov (United States)

    Kaushik, Dharam; Linder, Brian J; Thompson, R Houston; Eisenberg, Manuel S; Lohse, Christine M; Cheville, John C; Leibovich, Bradley C; Boorjian, Stephen A

    2013-07-01

    To evaluate the impact of tumor histology on clinicopathologic outcomes for patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). We identified 807 patients with RCC and VTT who underwent nephrectomy at our institution between 1970 and 2008. All pathologic specimens were re-reviewed by a single urologic pathologist. Patients with non-clear cell RCC (non-ccRCC, n = 56) were matched 1:2 to patients with clear cell RCC (ccRCC) VTT based on symptoms at presentation, regional lymph node involvement, distant metastases, tumor thrombus level, nuclear grade, and sarcomatoid differentiation. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. The 56 patients with non-ccRCC VTT included 26 papillary, 11 chromophobe, 5 collecting duct tumors, and 14 RCCs not otherwise specified. Compared to unmatched patients with ccRCC VTT (n = 751), patients with non-ccRCC VTT presented with larger tumor size (P = .02), higher nuclear grade (P = .04), and more frequent sarcomatoid differentiation (P VTT is associated with a high rate of adverse pathologic features. Nevertheless, when matched to patients with ccRCC, patients with non-ccRCC VTT did not have increased rate of recurrence or adverse survival. Aggressive surgical resection represents the mainstay of treatment in these cases, whereas continued efforts to optimize a multimodal management approach to such patients remain necessary. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Impact of Microscopic Wall Invasion of the Renal Vein or Inferior Vena Cava on Cancer-specific Survival in Patients with Renal Cell Carcinoma and Tumor Thrombus: A Multi-institutional Analysis from the International Renal Cell Carcinoma-Venous Thrombus Consortium.

    Science.gov (United States)

    Rodriguez Faba, Oscar; Linares, Estefania; Tilki, Derya; Capitanio, Umberto; Evans, Christopher P; Montorsi, Francesco; Martínez-Salamanca, Juan I; Libertino, John; Gontero, Paolo; Palou, Joan

    2017-02-09

    Microscopic vein invasion (MVI), with local destruction and invasion of the endothelium by tumor, is of controversial predictive value in renal cell carcinoma (RCC). To assess the impact of venous extension and wall invasion in RCC on survival. Data for 1023 RCC patients with vena cava thrombus treated with radical nephrectomy and complete tumor thrombectomy were collected within a prospectively maintained international consortium (1995-2012). The Kaplan-Meier method and univariable and multivariable Cox regression analyses were used to assess the impact of MVI on cancer-specific survival (CSS). The main two variables of interest were microscopic renal vein wall invasion (MRVI) and microscopic vena cava wall invasion (MVCI). MRVI was found in 725 cases (70.9%) and MVCI in 230 (22.5%). Patients with MRVI had larger tumors (p=0.005), longer hospital stay (pmicroscopic renal vein wall invasion experience significantly worse cancer-specific survival. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Effect of controlled low central venous pressure on renal function in major liver resection%控制性低中心静脉压对肝切除术患者肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective:To investigate the effects of low central venous pressure (LVCP) on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods: Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group (n = 23) and control group (n = 23). In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results: There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss (P < 0.01) and RBC transfusion (P < 0.05). Conclusion: Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.

  8. Venous thromboembolism: The intricacies

    Directory of Open Access Journals (Sweden)

    Dutta T

    2009-01-01

    Full Text Available Venous thromboembolism (VTE has been a subject of great interest of late. Since Rudolph Virchow described the famous Virchow′s triad in 1856, there have been rapid strides in the understanding of the pathogenesis and factors responsible for it. Discovery of various thrombophilic factors, both primary and acquired, in the last 40 years has revolutionized prognostication and management of this potentially life-threatening condition due to its associated complication of pulmonary thromboembolism. Detailed genetic mapping and linkage analyses have been underlining the fact that VTE is a multifactorial disorder and a complex one. There are many gene-gene and gene-environment interactions that alter and magnify the clinical picture in this disorder. Point in case is pregnancy, where the risk of VTE is 100-150 times increased in the presence of Factor V Leiden, prothrombin mutation (Prothrombin 20210A and antithrombin deficiency. Risk of VTE associated with long-haul air flight has now been well recognized. Thrombotic events associated with antiphospholipid syndrome (APS are 70% venous and 30% arterial. Deep venous thrombosis and pulmonary embolism are the most common venous events, though unusual cases of catastrophes due to central vein thrombosis like renal vein thrombosis and Budd-Chiari syndrome (catastrophic APS may occur.

  9. Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal replacement therapy for acute renal failure (VERROU-REA study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bruyère, Rémi; Soudry-Faure, Agnès; Capellier, Gilles; Binquet, Christine; Nadji, Abdelouaid; Torner, Stephane; Blasco, Gilles; Yannaraki, Maria; Barbar, Saber Davide; Quenot, Jean-Pierre

    2014-11-19

    The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus heparin in terms of event-free survival of the first non-tunneled hemodialysis catheter inserted in ICU patients with AKI requiring RRT. Secondary objectives are the rate of fibrinolysis, incidence of catheter thrombosis and catheter-related infection per 1,000 catheter days, length of stay in ICU and in-hospital and 28-day mortality. The VERROU-REA study is a randomized, prospective, multicenter, double-blind, parallel-group, controlled superiority study carried out in the medical, surgical and nephrological ICUs of two large university hospitals in eastern France. A catheter lock solution composed of trisodium citrate at 4% will be compared to unfractionated heparin at a concentration of 5,000 IU/mL. All consecutive adult patients with AKI requiring extracorporeal RRT, and in whom a first non-tunneled catheter is to be inserted by the jugular or femoral approach, will be eligible. Catheters inserted by the subclavian approach, patients with acute liver failure, thrombopenia or contraindication to systemic anticoagulation will be excluded. Patients will be followed up daily in accordance with standard practices for RRT until death or discharge. Data is scarce regarding the use of non-tunneled catheters in the ICU setting in patients with AKI. This study will provide an evidence base for

  10. Molecules in Bipolar Outflows

    CERN Document Server

    Tafalla, Mario

    2012-01-01

    Bipolar outflows constitute some of the best laboratories to study shock chemistry in the interstellar medium. A number of molecular species have their abundance enhanced by several orders of magnitude in the outflow gas, likely as a combined result of dust mantle disruption and high temperature gas chemistry, and therefore become sensitive indicators of the physical changes taking place in the shock. Identifying these species and understanding their chemical behavior is therefore of high interest both to chemical studies and to our understanding of the star-formation process. Here we review some of the recent progress in the study of the molecular composition of bipolar outflows, with emphasis in the tracers most relevant for shock chemistry. As we discuss, there has been rapid progress both in characterizing the molecular composition of certain outflows as well as in modeling the chemical processes likely involved. However, a number of limitations still affect our understanding of outflow chemistry. These i...

  11. Increased risk of arterial thromboembolism after a prior episode of venous thromboembolism : results from the Prevention of REnal and Vascular ENd stage Disease (PREVEND) Study

    NARCIS (Netherlands)

    van Schouwenburg, Inge M.; Gansevoort, Ron T.; Mahmoodi, Bakhtawar K.; Visser, Margaretha M.; Kluin-Nelemans, Hanneke C.; Lijfering, Willem M.; Veeger, Nic J. G. M.

    2012-01-01

    Large population-based studies are needed to establish the magnitude and duration of the recently suggested association between arterial and venous thromboembolism. In 199798, all inhabitants of Groningen, the Netherlands, aged 2875 years (n = 85 421), were invited to participate in a study that

  12. Increased risk of arterial thromboembolism after a prior episode of venous thromboembolism : results from the Prevention of REnal and Vascular ENd stage Disease (PREVEND) Study

    NARCIS (Netherlands)

    van Schouwenburg, Inge M.; Gansevoort, Ron T.; Mahmoodi, Bakhtawar K.; Visser, Margaretha M.; Kluin-Nelemans, Hanneke C.; Lijfering, Willem M.; Veeger, Nic J. G. M.

    2012-01-01

    Large population-based studies are needed to establish the magnitude and duration of the recently suggested association between arterial and venous thromboembolism. In 199798, all inhabitants of Groningen, the Netherlands, aged 2875 years (n = 85 421), were invited to participate in a study that fol

  13. Venous Ultrasound (Extremities)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Ultrasound - Venous (Extremities) Venous ultrasound uses sound waves to ... limitations of Venous Ultrasound Imaging? What is Venous Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  14. [A mathematical analysis of strain-gauge curves in the diagnosis of deep venous thrombosis].

    Science.gov (United States)

    Vega Gómez, M E; Ley Pozo, J; Aldama Figueroa, A; Alvarez Sánchez, J A; Charles-Edouard Otrante, D; Fernández Boloña, A; Gutierrez Jiménez, O

    1991-01-01

    The plethysmographic strain gauge venous outflow curves were studied by means of an exponential function. The parameters analyzed made possible the establishment of differences between patients with and without DVT.

  15. Ex-situ liver surgery without veno-venous bypass

    Institute of Scientific and Technical Information of China (English)

    Ke-Ming Zhang; Xiong-Wei Hu; Jia-Hong Dong; Zhi-Xian Hong; Zhao-Hai Wang; Gao-Hua Li; Rui-Zhao Qi

    2012-01-01

    AIM:To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.METHODS:In 3 patients with liver tumor,the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation.It was impossible to resect the tumors by the routine hepatectomy,so the patients underwent ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.All surgical procedures were carried out or supervised by a senior surgeon.A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.We also compared our data with the 9 cases of Pichlmayr's group.RESULTS:Three patients with liver tumor were analysed.The first case was a 60-year-old female with a huge haemangioma located in S1,S4,S5,S6,S7 and S8 of liver; the second was a 64-year-old man with cholangiocarcinoma in S1,S2,S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1,S5,S7 and S8.The operation time for the three patients were 6.6,6.4 and 7.3 h,respectively.The anhepatic phases were 3.8,2.8 and 4.0 h.The volume of blood loss during operation were 1200,3100,2000 mL in the three patients,respectively.The survival periods without recurrence were 22 and 17 mo in the first two cases.As for the third case complicated with postoperative hepatic vein outflow obstruction,emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day,and finally died of liver and renal failure on the third day.Operation time (6.7 ± 0.47h vs 13.7 ± 2.6 h) and anhepatic phase (3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr's group and our series (P =0.78).CONCLUSION:Ex-situ liver resection and liver autotransplantation has shown a potential

  16. Deep venous thrombosis and postthrombotic syndrome: invasive management.

    Science.gov (United States)

    Comerota, A J

    2015-03-01

    Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava.

  17. Piggy-back Hepatic Transplant Technique and Veno-venous Bypass Without Cardiac Arrest: A Multidisciplinary Approach in Borderline T3b/T3c Renal Tumors

    Directory of Open Access Journals (Sweden)

    Nechifor-Boila IA

    2015-06-01

    Full Text Available Surgery for renal cell carcinomas with tumor thrombus extending in the Inferior Vena Cava (IVC can be particularly challenging, especially in the retrohepatic and intraatrial situations (T3b and T3c. Classically, these tumors require the intraoperative use of cardio-pulmonary by-pass (CPB and deep hypothermic circulatory arrest (DHCA, that can result in specific complications (stroke, platelet dysfunction, with increased postoperative morbidity rates.

  18. Disks and Outflows

    Science.gov (United States)

    Rodriguez, L. F.

    2002-05-01

    The presence of disks and outflows characterizes the earliest stages of stellar evolution. I will review recent results that exemplify how the radio observations have become powerful tools in the study of these extremely young objects. Binarity and multiplicity seem to be factors that we are only starting to understand. Outflows are now seen as laboratories for the chemistry of shocked regions. Finally, the efforts to extend the paradigm for low-mass stellar formation to more massive protostars can be tested critically in the radio wavelengths. I acknowledge the support from CONACyT, Mexico.

  19. Clinical aspects of venous thrombophilia.

    Science.gov (United States)

    Girolami, Antonio; Fabris, Fabrizio; Girolami, Bruno

    2002-01-01

    Venous thrombophilia is the result of clotting changes namely of a hypercoagulable state together with blood flow and vessel wall changes. There is no need for all these components to be present in order for thrombosis to occur. As the matter of fact, thrombosis may occur even if only one of these conditions is present. In clinical practice a combination of factors is usualy seen. In comparison with arterial thrombophilia, clotting changes and blood flow seen to play a major role in venous thrombosis. Venous thrombophilia may remain asynptomatic or may result in a series of clinical syndromes. The commonest of these are: 1. Superficial vein thrombosis, 2. Deep vein thrombosis of legs, 3. Deep vein thrombosis of arms, 4. Caval veins thrombosis, 5. Portal vein thrombosis, 6. Hepatic veins thrombosis, 7. Renal vein thrombosis, 8. Cerebral sinuses thrombosis, 9. Right heart thrombosis, 10. Miscellaneous (ovarian, adrenal veins thrombosis, etc.). Since the first two are widely and easily recognized, these is no need for an extensive discussion. Deep vein thromboses of upper limbs are not as frequent as those of lower limbs or of superficial phlebitis but they can still be recognized on clinical grounds and non invasive techniques. The remaining 7 syndromes are less common and therefore less frequently suspected and recognized. Of particular interest, among these less common manifestations of venous thrombophilia are hepatic vein and renal vein thrombosis. Hepatic veins thrombosis, sometimes part of inferior vena cava thrombosis is most frequently due to an isolated occlusion of hepatic veins thereby causing a form of venocclusive disease. Occasionally diagnosis may be difficult because of slow onset of symptoms (hepatomegaly, right flank pain, fever, ascites etc.). The same is true for renal vein thrombosis which may also be of difficult diagnosis since it causes proteinuria and flank pain. The proteinuria is often interpreted as due to a nephrotic syndrome which

  20. Mediterranean Outflow Mixing Dynamics

    Science.gov (United States)

    1993-02-01

    tugal. G. Parrnlla is at Instituto EspaWol Oceanografia , Fig. 2A. [Adapted from (36)] (C) The maximum observed velocity of outflow currents in the eastern...its sur- Oceanografia Fisica del Estrecho de Gibraltar, J. of Mediterranean water that we observed at the roundings (34) and retains its chemical L

  1. Metallicity and Quasar Outflows

    CERN Document Server

    Wang, Huiyuan; Yuan, Weimin; Wang, Tinggui

    2012-01-01

    Correlations are investigated of the outflow strength of quasars, as measured by the blueshift and asymmetry index (BAI) of the CIV line (Wang et al. 2011), with intensities and ratios of broad emission lines, based on composite quasar spectra built from the Sloan Digital Sky Survey. We find that most of the line ratios of other ions to CIV prominently increases with BAI. These behaviors can be well understood in the context of increasing metallicity with BAI. The strength of dominant coolant, CIV line, decreases and weak collisionally excited lines increase with gas metallicity as a result of the competition between different line coolants. Using SiIV+OIV]/CIV as an indicator of gas metallicity, we present, for the first time, a strong correlation between the metallicitiy and the outflow strength of quasars over a wide range of 1.7 to 6.9 times solar abundance. Our result implies that the metallicity plays an important role in the formation of quasar outflows, likely via affecting outflow acceleration. This ...

  2. GALAXY OUTFLOWS WITHOUT SUPERNOVAE

    Energy Technology Data Exchange (ETDEWEB)

    Sur, Sharanya [Indian Institute of Astrophysics, 2nd Block, Koramangala, Bangalore 560034 (India); Scannapieco, Evan [School of Earth and Space Exploration, Arizona State University, P.O. Box 876004, Tempe-85287 (United States); Ostriker, Eve C., E-mail: sharanya.sur@iiap.res.in, E-mail: sharanya.sur@asu.edu [Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544 (United States)

    2016-02-10

    High surface density, rapidly star-forming galaxies are observed to have ≈50–100 km s{sup −1} line of sight velocity dispersions, which are much higher than expected from supernova driving alone, but may arise from large-scale gravitational instabilities. Using three-dimensional simulations of local regions of the interstellar medium, we explore the impact of high velocity dispersions that arise from these disk instabilities. Parametrizing disks by their surface densities and epicyclic frequencies, we conduct a series of simulations that probe a broad range of conditions. Turbulence is driven purely horizontally and on large scales, neglecting any energy input from supernovae. We find that such motions lead to strong global outflows in the highly compact disks that were common at high redshifts, but weak or negligible mass loss in the more diffuse disks that are prevalent today. Substantial outflows are generated if the one-dimensional horizontal velocity dispersion exceeds ≈35 km s{sup −1}, as occurs in the dense disks that have star-formation rate (SFR) densities above ≈0.1 M{sub ⊙} yr{sup −1} kpc{sup −2}. These outflows are triggered by a thermal runaway, arising from the inefficient cooling of hot material coupled with successive heating from turbulent driving. Thus, even in the absence of stellar feedback, a critical value of the SFR density for outflow generation can arise due to a turbulent heating instability. This suggests that in strongly self-gravitating disks, outflows may be enhanced by, but need not caused by, energy input from supernovae.

  3. [Heterolateral renal dystopia (2 cases)].

    Science.gov (United States)

    Anastasov, G; Peneva, S; Mushmov, D; Salambashev, L

    1982-01-01

    The authors observed two cases with crossed renal dystopia, to which venous urography, renal scintigraphy, echographic and gamma-chamber investigations were performed. The venous urography, in case of the appropriate symptomatics, is stressed to be able to establish the presence of heterolateral dystopia by as far as the distributional function of the anomaly is concerned--the gamma-chamber investigation is with the highest information value.

  4. Galaxy Outflows Without Supernovae

    CERN Document Server

    Sur, Sharanya; Ostriker, Eve C

    2016-01-01

    High surface density, rapidly star-forming galaxies are observed to have $\\approx 50-100\\,{\\rm km\\,s^{-1}}$ line-of-sight velocity dispersions, which are much higher than expected from supernova driving alone, but may arise from large-scale gravitational instabilities. Using three-dimensional simulations of local regions of the interstellar medium, we explore the impact of high velocity dispersions that arise from these disk instabilities. Parametrizing disks by their surface densities and epicyclic frequencies, we conduct a series of simulations that probe a broad range of conditions. Turbulence is driven purely horizontally and on large scales, neglecting any energy input from supernovae. We find that such motions lead to strong global outflows in the highly-compact disks that were common at high redshifts, but weak or negligible mass loss in the more diffuse disks that are prevalent today. Substantial outflows are generated if the one-dimensional horizontal velocity dispersion exceeds $\\approx 35\\,{\\rm km\\...

  5. Searching for Brown Dwarf Outflows

    CERN Document Server

    Whelan, E T; Bacciotti, F; Randich, S; Natta, A

    2009-01-01

    As outflow activity in low mass protostars is strongly connected to ac- cretion it is reasonable to expect accreting brown dwarfs to also be driving out- flows. In the last three years we have searched for brown dwarf outflows using high quality optical spectra obtained with UVES on the VLT and the technique of spectro-astrometry. To date five brown dwarf outflows have been discovered. Here the method is discussed and the results to date outlined.

  6. Absorbing Outflows in AGN

    Science.gov (United States)

    Mathur, Smita

    2002-01-01

    The goal of this program was a comprehensive multiwavelength study of absorption phenomena in active galactic nuclei (AGN). These include a variety of associated absorption systems: X-ray warm absorbers, X-ray cold absorbers. UV absorbers with high ionization lines, MgII absorbers, red quasars and BALQSOs. The aim is to determine the physical conditions in the absorbing outflows, study their inter-relations and their role in AGN. We designed several observing programs to achieve this goal: X-ray spectroscopy, UV spectroscopy, FLAY spectroscopy and X-ray imaging. We were very successful towards achieving the goal over the five year period as shown through following observing programs and papers. Copies of a few papers are attached with this report.

  7. Astrophysical Jets and Outflows

    CERN Document Server

    De Gouveia dal Pino, E M

    2004-01-01

    Highly collimated supersonic jets and less collimated outflows are observed to emerge from a wide variety of astrophysical objects. They are seen in young stellar objects (YSOs), proto-planetary nebulae, compact objects (like galactic black holes or microquasars, and X-ray binary stars), and in the nuclei of active galaxies (AGNs). Despite their different physical scales (in size, velocity, and amount of energy transported), they have strong morphological similarities. What physics do they share? These systems either hydrodynamic or magnetohydrodynamic (MHD) in nature and are, as such, governed by non-linear equations. While theoretical models helped us to understand the basic physics of these objects, numerical simulations have been allowing us to go beyond the one-dimensional, steady-state approach extracting vital information. In this lecture, the formation, structure, and evolution of the jets are reviewed with the help of observational information, MHD and purely hydrodynamical modeling, and numerical si...

  8. Novel biomarkers of arterial and venous ischemia in microvascular flaps.

    Directory of Open Access Journals (Sweden)

    Gerard K Nguyen

    Full Text Available The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and

  9. Renal involvement in antiphospholipid syndrome.

    Science.gov (United States)

    Pons-Estel, Guillermo J; Cervera, Ricard

    2014-02-01

    Renal involvement can be a serious problem for patients with antiphospholipid syndrome (APS). However, this complication has been poorly recognized and studied. It can be present in patients who have either primary or systemic lupus erythematosus-associated APS. Clinical and laboratory features of renal involvement in APS include hypertension, hematuria, acute renal failure, and progressive chronic renal insufficiency with mild levels of proteinuria that can progress to nephrotic-range proteinuria. The main lesions are renal artery stenosis, venous renal thrombosis, and glomerular lesions (APS nephropathy) that may be acute (thrombotic microangiopathy) and/or chronic (arteriosclerosis, arterial fibrous intimal hyperplasia, tubular thyroidization, arteriolar occlusions, and focal cortical atrophy). APS can also cause end-stage renal disease and allograft vascular thrombosis. This article reviews the range of renal abnormalities associated with APS, and their diagnosis and treatment options.

  10. Chronic cerebrospinal venous insufficiency: current perspectives

    Directory of Open Access Journals (Sweden)

    Simka M

    2014-03-01

    Full Text Available Marian Simka Department of Nursing, College of Applied Sciences, Ruda Slaska, Poland Abstract: This review summarizes the research to date on chronic cerebrospinal venous insufficiency (CCSVI. CCSVI was initially defined as a clinical syndrome comprising stenoses of the internal jugular and/or azygos veins, characterized by collateral venous outflows and reduced cerebral blood flow, and was found primarily in patients with multiple sclerosis. However, the published evidence on CCSVI is very discordant. Catheter venography studies gave a regular picture, with the majority of patients with multiple sclerosis presenting with demonstrable outflow abnormalities in the veins draining the central nervous system. The prevalence of these lesions was over 50%, and even higher (about 90% when more liberal definition of an abnormality or intravascular sonography was used. Further, the results of magnetic resonance venography studies have been quite consistent, in that stenoses of the internal jugular veins have been found in 25%–70% of patients with multiple sclerosis. In contrast, Doppler sonography studies have revealed CCSVI in 0% to 100% of patients. The research is currently suggesting that CCSVI is not a single entity, but rather a group of different anatomic and functional venous abnormalities. Regarding venous outflow from the brain, a patient can present either with diminished inflow to the internal jugular veins resulting from decreased cerebral circulation or with externally compressed or hypoplastic internal jugular veins or stenotic jugular valves. Considering these many faces of CCSVI, it becomes more comprehensible as to why the results of the studies, especially those utilizing Doppler sonography, have been so discordant. Not only were investigators using different diagnostic modalities and distinct protocols, but they were not looking for the same pathology. Since these abnormalities were indeed differently prevalent in patients and

  11. Astrophysical jets and outflows

    Science.gov (United States)

    de Gouveia Dal Pino, Elisabete M.

    Highly collimated supersonic jets and less collimated outflows are observed to emerge from a wide variety of astrophysical objects. They are seen in young stellar objects (YSOs), proto-planetary nebulae, compact objects (like galactic black holes or microquasars, and X-ray binary stars), and in the nuclei of active galaxies (AGNs). Despite their different physical scales (in size, velocity, and amount of energy transported), they have strong morphological similarities. What physics do they share? These systems are either hydrodynamic or magnetohydrodynamic (MHD) in nature and are, as such, governed by non-linear equations. While theoretical models helped us to understand the basic physics of these objects, numerical simulations have been allowing us to go beyond the one-dimensional, steady-state approach extracting vital information. In this lecture, the formation, structure, and evolution of the jets are reviewed with the help of observational information, MHD and purely hydrodynamical modeling, and numerical simulations. Possible applications of the models particularly to YSOs and AGN jets are addressed.

  12. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Marc A. Lazzaro

    2011-07-01

    Full Text Available Recent reports have emerged suggesting that multiple sclerosis (MS may be due to abnormal venous outflow from the central nervous system, termed Chronic Cerebrospinal Venous Insufficiency (CCSVI. These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.

  13. Energy exchanges in reconnection outflows

    Science.gov (United States)

    Lapenta, Giovanni; Goldman, Martin V.; Newman, David L.; Markidis, Stefano

    2017-01-01

    Reconnection outflows are highly energetic directed flows that interact with the ambient plasma or with flows from other reconnection regions. Under these conditions the flow becomes highly unstable and chaotic, as any flow jets interacting with a medium. We report here massively parallel simulations of the two cases of interaction between outflow jets and between a single outflow with an ambient plasma. We find in both case the development of a chaotic magnetic field, subject to secondary reconnection events that further complicate the topology of the field lines. The focus of the present analysis is on the energy balance. We compute each energy channel (electromagnetic, bulk, thermal, for each species) and find where the most energy is exchanged and in what form. The main finding is that the largest energy exchange is not at the reconnection site proper but in the regions where the outflowing jets are destabilized.

  14. Renal blood flow and metabolism after cold ischaemia

    DEFF Research Database (Denmark)

    Henriksen, J H; Petersen, H K

    1984-01-01

    Peroperative measurements of renal blood flow (RBF), renal O2-uptake, and renal venous lactate/pyruvate (L/P) ratio were performed before and after a period of 30-71 min of hypothermic (10-15 degrees C) renal ischaemia in nine patients, undergoing surgery for renal calculi. Before ischaemia, RBF.......01) immediately after re-established perfusion and 36% (P less than 0.02) 30 min later. In one additional patient, who had a short warm ischaemia (8 min), the flow pattern was the same. As arterial pressure remained constant, the reduced RBF signifies an increased renal vascular resistance. Renal O2-uptake...... and renal venous L/P ratio were almost constant, indicating no significant anaerobic processes being involved in the flow response. None of the patients showed any signs of reactive hyperaemia. It is concluded that hypothermic renal ischaemia may be followed by an increased renal vascular resistance even...

  15. Plasma endothelin in coronary venous blood from patients with either stable or unstable angina.

    OpenAIRE

    Stewart, J T; Nisbet, J A; Davies, M J

    1991-01-01

    STUDY OBJECTIVE--To test the hypothesis that the active coronary endothelial lesions in unstable angina raise the endothelin concentration in coronary venous blood. DESIGN--Systemic and coronary venous blood samples were obtained from unselected patients with the clinical syndromes of either stable or unstable angina at the time of cardiac catheterisation and coronary arteriography. Control venous blood samples were obtained from healthy laboratory workers and from patients with chronic renal...

  16. Outflow from Hot Accretion Flows

    CERN Document Server

    Yuan, Feng; Wu, Maochun

    2012-01-01

    Numerical simulations of hot accretion flows have shown that the mass accretion rate decreases with decreasing radius. Two models have been proposed to explain this result. In the adiabatic inflow-outflow solution (ADIOS), it is thought to be due to the loss of gas in outflows. In the convection-dominated accretion flow (CDAF) model, it is explained as because that the gas is locked in convective eddies. In this paper we use hydrodynamical (HD) and magnetohydrodynamical (MHD) simulations to investigate which one is physical. We calculate and compare various properties of inflow (gas with an inward velocity) and outflow (gas with an outward velocity). Systematic and significant differences are found. For example, for HD flows, the temperature of outflow is higher than inflow; while for MHD flows, the specific angular momentum of outflow is much higher than inflow. We have also analyzed the convective stability of MHD accretion flow and found that they are stable. These results suggest that systematic inward an...

  17. Emergence of a Quasar Outflow

    CERN Document Server

    Hamann, F; Hidalgo, P Rodriguez; Prochaska, J X; Herbert-Fort, S

    2008-01-01

    We report the first discovery of the emergence of a high-velocity broad-line outflow in a luminous quasar, J105400.40+034801.2 at redshift z ~ 2.1. The outflow is evident in ultraviolet CIV and SiIV absorption lines with velocity shifts v ~ 26,300 km/s and deblended widths FWHM ~ 4000 km/s. These features are marginally strong and broad enough to be considered broad absorption lines (BALs), but their large velocities exclude them from the standard BAL definition. The outflow lines appeared between two observations in the years 2002.18 and 2006.96. A third observation in 2008.48 showed the lines becoming ~40% weaker and 10% to 15% narrower. There is no evidence for acceleration or for any outflow gas at velocities 21.2 and average space density n_H > 2 x 10^5 cm^-3. We attribute the emergence of the outflow lines to a substantial flow structure moving across our line of sight, possibly near the ragged edge of the main BAL flow or possibly related to the onset of a BAL evolutionary phase.

  18. Lifestyle and venous thrombosis

    NARCIS (Netherlands)

    Pomp, Elisabeth Rebekka

    2008-01-01

    In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA study), a large population-based case-control study, we investigated lifestyle factors as risk factors for venous thrombosis. Overweight, smoking and alcohol consumption were addressed and pregnancy and

  19. Knowledge Outflows from Foreign Subsidiaries

    DEFF Research Database (Denmark)

    Perri, Alessandra; Andersson, Ulf

    This paper analyzes the MNC subsidiaries’ trade-off between the need for knowledge creation and the need for knowledge protection, and relates it to the extent of knowledge outflows generated within the host location. Combining research in International Business with Social Theory, we find......-mediated local knowledge outflows, as well as to the broad IB literature on the relationship between subsidiaries and their host regions. The implications for managers and policy-makers are also discussed....... that subsidiaries that extensively draw on external knowledge sources are also more likely to generate knowledge outflows to local firms. We argue that this may be explained by the subsidiaries’ willingness to build the trust that facilitates the establishment of reciprocal knowledge linkages. However, when...

  20. Molecular Outflows: Explosive versus Protostellar

    Science.gov (United States)

    Zapata, Luis A.; Schmid-Burgk, Johannes; Rodríguez, Luis F.; Palau, Aina; Loinard, Laurent

    2017-02-01

    With the recent recognition of a second, distinctive class of molecular outflows, namely the explosive ones not directly connected to the accretion–ejection process in star formation, a juxtaposition of the morphological and kinematic properties of both classes is warranted. By applying the same method used in Zapata et al., and using 12CO(J = 2-1) archival data from the Submillimeter Array, we contrast two well-known explosive objects, Orion KL and DR21, to HH 211 and DG Tau B, two flows representative of classical low-mass protostellar outflows. At the moment, there are only two well-established cases of explosive outflows, but with the full availability of ALMA we expect that more examples will be found in the near future. The main results are the largely different spatial distributions of the explosive flows, consisting of numerous narrow straight filament-like ejections with different orientations and in almost an isotropic configuration, the redshifted with respect to the blueshifted components of the flows (maximally separated in protostellar, largely overlapping in explosive outflows), the very-well-defined Hubble flow-like increase of velocity with distance from the origin in the explosive filaments versus the mostly non-organized CO velocity field in protostellar objects, and huge inequalities in mass, momentum, and energy of the two classes, at least for the case of low-mass flows. Finally, all the molecular filaments in the explosive outflows point back to approximately a central position (i.e., the place where its “exciting source” was located), contrary to the bulk of the molecular material within the protostellar outflows.

  1. Better innovate than compromise: a novel hepatic outflow reconstruction technique in pediatric living donor liver transplantation.

    Science.gov (United States)

    Cherian, P Thomas; Mishra, Ashish K; Bangaari, Ashish; Kota, Venugopal; Sathyanarayanan, Mohan; Raya, Ravichandra; Rela, Mohamed

    2015-05-01

    Pediatric LDLT using donors with unfavorable vascular anatomy is challenging in terms of donor safety, and complexity of reconstruction in the recipient. We describe an innovative technique of hepatic venous outflow reconstruction involving the recipient RHV, in the presence of a rudimentary RHV in the donor. The postoperative course of the donor and recipient was uneventful with satisfactory venous outflow in both. This technique avoided the use of prosthetic material, an important consideration given the recipient age and requirement for growth. This shows that donors previously considered unsuitable for donation can be utilized safely as long as principles of vascular anastomosis are adhered to. Moreover, it highlights that innovation is sometimes necessary to avoid compromise in donor safety.

  2. Cutting balloon angioplasty for undilatable venous stenoses causing dialysis graft failure.

    Science.gov (United States)

    Bittl, John A; Feldman, Robert L

    2003-04-01

    Dialysis fistulas and bridge grafts frequently develop outflow stenoses in the venous limb, leading to graft failure. The venous stenoses are fibrotic and require percutaneous transluminal angioplasty with high-pressure balloons. We have encountered venous stenoses in 3 out of 219 hemodialysis patients with graft failure that were undilatable with 6-8 mm high-pressure balloons inflated to more than 24 atm. In each of these cases, treatment with a 4 mm cutting balloon successfully facilitated subsequent balloon dilation at lower pressures. Copyright 2003 Wiley-Liss, Inc.

  3. Effects of alkaloid sinomenine on interleukin-6 levels in venous blood of rat renal allograft models%青藤碱对肾移植大鼠静脉血白细胞介素6的影响

    Institute of Scientific and Technical Information of China (English)

    廖德怀; 陈正; 罗志刚; 王毅; 潘光辉; 李光辉; 方佳丽; 徐璐; 杜杨春

    2009-01-01

    BACKGROUND:Alkaloid sinomenine has pharmacologic actions such as sedative,analgesia,relieving cough,arrhythmia resistance,anti-inflammatory and immunosuppression.Recently,its effect of anti-rejection has been explored.Interleukin-6 (IL-6)is an important factor that involved in cell-mediated graft injury.It has important clinical significance in the diagnosis of acute rejection and the evaluation of the efficacy of anti-rejection.OBJECTIVE:To evaluate the immunosuppressive efficacy and outcome of alkaloid sinomenine in acute refection after rat renal allograft and the synergistic effect in combination with Cyclosprin A(CsA)by monitoring the levels of IL-6 in venous blood.DESIGN,TIME AND SETTING:A randomized,controlled animal trial was performed at the Surgical Laboratory of Second Affiliated Hospital of Guangzhou Medical College between March 2008 and March 2009.MATERIALS:A total of 60 inbred F344 rats and 80Wistar rats were selected.METHODS:The acute rejection models were established with inbred F344 rats as donors and inbred Wistar rats as recipients;48 recipients were randomly divided into 4 groups(n=12),and respectively intraperitoneally injected with normal saline,alkaloid sinomenine,CsA,and alkaloid sinomenine plus CsA,once daily.The remaining 12 Wistar rats were served as control.MAIN OUTCOME MEASURES:ELISA was used to test the levels of IL-6 quantitatively 7 days after transplantation.The transplanted kidneys were used to observe the pathological changes.According to the Banff criteria,the pathological changes in acute rejection after renal transplantation were graded.RESULTS:The levels of IL-6 in alkaloid sinomenine,CsA,and alkaloid sinomenine plus CsA were significantly less than normal saline group(P<0.05),and no differences were found between alkaloid sinomenine and CsA groups(P>0.05);the levels of IL-6 in alkaloid sinomenine plus CsA group was significantly less than alkaloid sinomenine and CsA groups(P<0.05).With the Banff criteria of

  4. Prevalence of extracranial venous abnormalities: results from a sample of 586 multiple sclerosis patients.

    Science.gov (United States)

    Simka, M; Latacz, P; Ludyga, T; Kazibudzki, M; Swierad, M; Janas, P; Piegza, J

    2011-01-01

    The aim of this study was to assess the prevalence of chronic cerebrospinal venous insufficiency in an unselected cohort of multiple sclerosis (MS) patients. A total of 586 patients with clinically defined MS underwent catheter venography of the internal jugular veins, brachiocephalic veins and azygos vein. The following findings were regarded as pathologic: no outflow, slowed outflow, reversal of flow direction, prestenotic dilation accompanied by impaired outflow, outflow through collaterals, intraluminal structures obstructing the vein, hypoplasia, agenesia or significant narrowing of the vein. Venous abnormalities were found in 563 patients (96.1%). Lesions in one vein were found in 43.5%, in two veins in 49.5%, and in three veins in 3.1% of patients. Venous pathologies in the right internal jugular vein were found in 64.0% of patients, in the left internal jugular vein in 81.7%, in the left brachiocephalic vein in 1.0%, and in the azygos vein in 4.9%. Venous pathologies were found to be highly associated with MS, yet the clinical relevance of this phenomenon remains to be established.

  5. Protostellar Outflows in L1340

    CERN Document Server

    Walawender, Josh; Smutko, Michael; O'Linger-Luscusk, JoAnn; Moriarty-Schieven, Gerald

    2016-01-01

    We have searched the L1340 A, B, and C clouds for shocks from protostellar outflows using the H$_2$ 2.122 $\\mu$m near-IR line as a shock tracer. Substantial outflow activity has been found in each of the three regions of the cloud (L1340 A, L1340 B, & L1340 C). We find 42 distinct shock complexes (16 in L1340 A, 11 in L1340 B, and 15 in L1340 C). We were able to link 17 of those shock complexes in to 12 distinct outflows and identify candidate source stars for each. We examine the properties (A$_{V}$, T$_{bol}$, and L$_{bol}$) of the source protostars and compare that to the properties of the general population of Class 0/I and flat SED protostars and find that there is an indication, albeit at low statistical significance, that the outflow driving protostars are drawn from a population with lower A$_{V}$, higher L$_{bol}$, and lower T$_{bol}$ than the general population of protostars.

  6. Molecular outflows in starburst nuclei

    CERN Document Server

    Roy, Arpita; Sharma, Prateek; Shchekinov, Yuri

    2016-01-01

    Recent observations have detected molecular outflows in a few nearby starburst nuclei. We discuss the physical processes at work in such an environment in order to outline a scenario that can explain the observed parameters of the phenomenon, such as the molecular mass, speed and size of the outflows. We show that outflows triggered by OB associations, with $N_{OB}\\ge 10^5$ (corresponding to a star formation rate (SFR)$\\ge 1$ M$_{\\odot}$ yr$^{-1}$ in the nuclear region), in a stratified disk with mid-plane density $n_0\\sim 200\\hbox{--}1000$ cm$^{-3}$ and scale height $z_0\\ge 200 (n_0/10^2 \\, {\\rm cm}^{-3})^{-3/5}$ pc, can form molecules in a cool dense and expanding shell. The associated molecular mass is $\\ge 10^7$ M$_\\odot$ at a distance of a few hundred pc, with a speed of several tens of km s$^{-1}$. We show that a SFR surface density of $10 \\le \\Sigma_{SFR} \\le 50$ M$_\\odot$ yr$^{-1}$ kpc$^{-2}$ favours the production of molecular outflows, consistent with observed values.

  7. Outflow forces in intermediate mass star formation

    CERN Document Server

    van Kempen, T A; van Dishoeck, E F; Kristensen, L E; Belloche, A; Klaassen, P D; Leurini, S; Jose-Garcia, I San; Aykutalp, A; Choi, Y; Endo, A; Frieswijk, W; Harsono, D; Karska, A; Koumpia, E; van der Marel, N; Nagy, Z; Perez-Beaupuits, J P; Risacher, C; van Weeren, R J; Wyrowski, F; Yildiz, U A; Guesten, R; Boland, W; Baryshev, A

    2015-01-01

    Intermediate mass protostarsprovide a bridge between theories of low- and high-mass star formation. Emerging molecular outflows can be used to determine the influence of fragmentation and multiplicity on protostellar evolution through the correlation of outflow forces of intermediate mass protostars with the luminosity. The aim of this paper is to derive outflow forces from outflows of six intermediate mass protostellar regions and validate the apparent correlation between total luminosity and outflow force seen in earlier work, as well as remove uncertainties caused by different methodology. By comparing CO 6--5 observations obtained with APEX with non-LTE radiative transfer model predictions, optical depths, temperatures, densities of the gas of the molecular outflows are derived. Outflow forces, dynamical timescales and kinetic luminosities are subsequently calculated. Outflow parameters, including the forces, were derived for all sources. Temperatures in excess of 50 K were found for all flows, in line wi...

  8. Idiopathic venous thromboembolism and thrombophilia

    OpenAIRE

    Sinescu, C; Hostiuc, M; Bartos, D.

    2011-01-01

    During the past decade idiopathic venous thromboembolism has become a separate entity, a chronic illness which has required prolonged anticoagulation and other prevention strategies to avoid recurrences. This article reviews recent developments regarding unprovoked venous thromboembolism and its relation with thrombophilia. In the beginning, the latest definition of idiopathic venous thromboembolism is presented. The article continues with statistics about thrombophilia, related venous thromb...

  9. Central venous catheter - flushing

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - dressing change Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/22/2016 Updated by: ...

  10. Cerebral venous sinus thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Renowden, Shelley [Frenchay Hospital, Bristol BS16 1LE (United Kingdom)

    2004-02-01

    A comprehensive synopsis on cerebral venous thrombosis is presented. It emphasizes the various aetiologies, the wide clinical spectrum and the unpredictable outcome. Imaging techniques and pitfalls are reported and the therapeutic options are discussed. (orig.)

  11. Venous thrombosis: an overview

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Venous thrombosis: the history of knowledge.

    Science.gov (United States)

    Mannucci, P M

    2002-01-01

    Venous thrombosis is a frequent disease. It is surprising, therefore, that no case truly compatible with a diagnosis of venous thrombosis was apparently reported in the antiquity. There is no case that could be reasonably attributed to a venous thrombus in the writings of Hippocrates, Galenus, Celius Aurelianus, Ibn an-Nafiz, Avicenna and others. Venous thrombosis is not among the many diseases mentioned in the Bible. The term "leucophlegmasia", first used by Hippocrates and then by Celius Aurelianus, refers to cases of bilateral leg edema, most likely due to conditions such as heart failure, liver cirrhosis and renal insufficiency. Nothing compatible with a diagnosis of venous thrombosis can be found in pieces of art from ancient Egypt, Greece, Rome, Persia and South America. While in these sources there are sometimes representations of varicose veins and ulcers, unilateral leg edema or other pictures compatible with venous thrombosis are not featured. The first well documented case of venous thrombosis is depicted in a beautifully illustrated manuscript written in the 13th century and currently preserved in Paris at the Bibliothèque Nationale (MS Fr 2829, Folio 87). The manuscript describes the case of a young man from Normandy named Raoul who at the age of twenty developed unilateral edema in the right ankle that subsequently extended up to the thigh, with no obvious symptoms in the contralateral leg. Raoul was advised to visit the tomb of Saint Louis who was buried in the church of Saint Denis, where the patient spent several days confessing his sins and praying the saint. Afterwards he chose to collect the dust accumulating below the stone that covered the tomb and to apply it on the fistulae and ulcers of his foot. The openings stopped running and were filled with flesh. He was first obliged to use crutches but subsequently he could walk with a cane, to be eventually able to dispose of all devices, even though his foot throbbed a little. Raoul was cured as

  13. Eppur Si Muove: The dynamic nature of physiological control of renal blood flow by the renal sympathetic nerves.

    Science.gov (United States)

    Schiller, Alicia M; Pellegrino, Peter Ricci; Zucker, Irving H

    2016-08-03

    Tubuloglomerular feedback and the myogenic response are widely appreciated as important regulators of renal blood flow, but the role of the sympathetic nervous system in physiological renal blood flow control remains controversial. Where classic studies using static measures of renal blood flow failed, dynamic approaches have succeeded in demonstrating sympathetic control of renal blood flow under normal physiological conditions. This review focuses on transfer function analysis of renal pressure-flow, which leverages the physical relationship between blood pressure and flow to assess the underlying vascular control mechanisms. Studies using this approach indicate that the renal nerves are important in the rapid regulation of the renal vasculature. Animals with intact renal innervation show a sympathetic signature in the frequency range associated with sympathetic vasomotion that is eliminated by renal denervation. In conscious rabbits, this sympathetic signature exerts vasoconstrictive, baroreflex control of renal vascular conductance, matching well with the rhythmic, baroreflex-influenced control of renal sympathetic nerve activity and complementing findings from other studies employing dynamic approaches to study renal sympathetic vascular control. In this light, classic studies reporting that nerve stimulation and renal denervation do not affect static measures of renal blood flow provide evidence for the strength of renal autoregulation rather than evidence against physiological renal sympathetic control of renal blood flow. Thus, alongside tubuloglomerular feedback and the myogenic response, renal sympathetic outflow should be considered an important physiological regulator of renal blood flow. Clinically, renal sympathetic vasomotion may be important for solving the problems facing the field of therapeutic renal denervation.

  14. Shining A Light On Galactic Outflows: Photo-Ionized Outflows

    CERN Document Server

    Chisholm, John; Leitherer, Claus; Chen, Yanmei; Wofford, Aida

    2016-01-01

    We study the ionization structure of galactic outflows in 37 nearby, star forming galaxies with the Cosmic Origins Spectrograph on the Hubble Space Telescope. We use the O I, Si II, Si III, and Si IV ultraviolet absorption lines to characterize the different ionization states of outflowing gas. We measure the equivalent widths, line widths, and outflow velocities of the four transitions, and find shallow scaling relations between them and galactic stellar mass and star formation rate. Regardless of the ionization potential, lines of similar strength have similar velocities and line widths, indicating that the four transitions can be modeled as a co-moving phase. The Si equivalent width ratios (e.g. Si IV/Si II) have low dispersion, and little variation with stellar mass; while ratios with O I and Si vary by a factor of 2 for a given stellar mass. Photo-ionization models reproduce these equivalent width ratios, while shock models under predict the relative amount of high ionization gas. The photo-ionization mo...

  15. Dorsalis pedis arterialized venous flap for hand and foot reconstruction

    Institute of Scientific and Technical Information of China (English)

    YU Guang; LEI Hong-yu; GUO Shuang; HUANG Jian-hua; YU Hao

    2012-01-01

    Objective:To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.Methods:Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps,including five patients with skin defects of the hands,and one with defects at the dorsum of the foot.The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm×5.5 cm to 6 cm×11 cm.Two veins at the proximal margin of the flap were retained,one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.Results:All flaps demonstrated mild edema and survived completely.Blisters appeared on four flaps.Using this technique,we achieved good functional and cosmetic results in this series.Conclusions:Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps,thereby improves reliability and utility for extremity reconstruction.

  16. Hot Outflows in Galaxy Clusters

    CERN Document Server

    Kirkpatrick, C C

    2015-01-01

    The gas-phase metallicity distribution has been analyzed for the hot atmospheres of 29 galaxy clusters using {\\it Chandra X-ray Observatory} observations. All host brightest cluster galaxies (BCGs) with X-ray cavity systems produced by radio AGN. We find high elemental abundances projected preferentially along the cavities of 16 clusters. The metal-rich plasma was apparently lifted out of the BCGs with the rising X-ray cavities (bubbles) to altitudes between twenty and several hundred kiloparsecs. A relationship between the maximum projected altitude of the uplifted gas (the "iron radius") and jet power is found with the form $R_{\\rm Fe} \\propto P_{\\rm jet}^{0.45}$. The estimated outflow rates are typically tens of solar masses per year but exceed $100 ~\\rm M_\\odot ~yr^{-1}$ in the most powerful AGN. The outflow rates are 10% to 20% of the cooling rates, and thus alone are unable to offset a cooling inflow. Nevertheless, hot outflows effectively redistribute the cooling gas and may play a significant role at ...

  17. Visceral and renal tissue oxygenation during supraceliac aortic crossclamping and left heart bypass with selective organ perfusion.

    Science.gov (United States)

    Idu, M M; Heintjes, R J; Scholten, E W; Balm, R; de Mol, B A J M; Legemate, D A

    2004-02-01

    Left-heart bypass (LHB) and selective organ perfusion (SOP) are used during thoracoabdominal aortic surgery to prevent ischemic damage to the kidneys and visceral organs after supraceliac aortic crossclamping. We studied the hypothesis, in a porcine model, that despite LHB and maximal SOP, visceral and renal ischemia still occurred during surgery. Eleven pigs (54-70 kg) were coupled to a non-pulsatile LHB with inflow and outflow at the lower thoracic and distal infrarenal aorta, respectively. After supracoeliac and infrarenal aortic crossclamping, SOP was started using perfusion catheters. The proximal and distal mean aortic blood pressures were kept above 70 and 50 mmHg, respectively, while the mean blood pressure within the SOP system was above 60 mmHg. The visceral and renal tissue oxygenation was measured by intermittent blood gas analysis, from the portal and both renal veins. The jejunal mucosal oxygenation was measured by tonometric measurement of the luminal pCO2. Measured median blood blood flow through the LHB and the SOP system were 800 and 1140 ml/min, respectively. Median blood flow prior to, and during LHB and SOP through the celiac artery, superior mesenteric artery, and left renal artery were 300 and 240, 762 and 295, and 235 and 235 ml/min, respectively. During 3 h of LHB and SOP no significant changes in the renal tissue oxygenation were noted compared with the physiological situation prior to supracoeliac aortic crossclamping and cannulation. However, in the visceral vascular bed median mixed venous oxygen saturation dropped from 79 to 63% (poxygen extraction ratio increased from 26 to 41% (p0.05). During 3 h of LHB and SOP no hemolysis was detected, as there was no rise in serum LDH. LHB and SOP preserves renal but not visceral tissue oxygenation during supraceliac aortic crossclamping and does not induce hemolysis.

  18. Quantitative Analysis of Fundus-Image Sequences Reveals Phase of Spontaneous Venous Pulsations

    Science.gov (United States)

    Moret, Fabrice; Reiff, Charlotte M.; Lagrèze, Wolf A.; Bach, Michael

    2015-01-01

    Purpose Spontaneous venous pulsation correlates negatively with elevated intracranial pressure and papilledema, and it relates to glaucoma. Yet, its etiology remains unclear. A key element to elucidate its underlying mechanism is the time at which collapse occurs with respect to the heart cycle, but previous reports are contradictory. We assessed this question in healthy subjects using quantitative measurements of both vein diameters and artery lateral displacements; the latter being used as the marker of the ocular systole time. Methods We recorded 5-second fundus sequences with a near-infrared scanning laser ophthalmoscope in 12 young healthy subjects. The image sequences were coregistered, cleaned from microsaccades, and filtered via a principal component analysis to remove nonpulsatile dynamic features. Time courses of arterial lateral displacement and of diameter at sites of spontaneous venous pulsation or proximal to the disk were retrieved from those image sequences and compared. Results Four subjects displayed both arterial and venous pulsatile waveforms. On those, we observed venous diameter waveforms differing markedly among the subjects, ranging from a waveform matching the typical intraocular pressure waveform to a close replica of the arterial waveform. Conclusions The heterogeneity in waveforms and arteriovenous phases suggests that the mechanism governing the venous outflow resistance differs among healthy subjects. Translational relevance Further characterizations are necessary to understand the heterogeneous mechanisms governing the venous outflow resistance as this resistance is altered in glaucoma and is instrumental when monitoring intracranial hypertension based on fundus observations. PMID:26396929

  19. [Homocysteine and venous thromboembolism].

    Science.gov (United States)

    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.

  20. Ileofemoral venous thrombectomy.

    Science.gov (United States)

    Lindhagen, J; Haglund, M; Haglund, U; Holm, J; Scherstén, T

    1978-01-01

    Twentyeight patients with ileofemoral venous thrombosis were treated surgically. Five of the patients had moderate degree of venous congestion, 18 patients had phlegmasia alba dolens and five patients had phlegmasia coerulea dolens. The mean age was 54 years, range 15-80 years, and 15 were men and 13 were women. In all cases the thrombosis was verified by phlebography. Thrombectomy was performed with a Fogarty venous thrombectomy catheter. Peroperative phlebography was used in most cases to guarantee complete extraction of thrombotic material. No operative pulmonary embolism or mortality was encountered. Postoperative continuous heparin infusion in the thrombectomized segment was used for the first week followed by dicumarol treatment. The patients were followed from 6 months to 4 years postoperatively. In two patients thrombectomy was not possible to perform. One of these patients developed a pronounced postthrombotic syndrome, the other developed venous congestion of more moderate degree. Excellent long-term time results were obtained in 82% of the patients and satisfactory in 14%. Thrombectomy is an efficient treatment of ileofemoral venous thrombosis.

  1. Obstruction of left ventricular outflow tract by a calcified mass at mitral valve

    Directory of Open Access Journals (Sweden)

    Miro Bakula

    2010-08-01

    Full Text Available A case of an unusual left ventricular outflow tract obstruction by mitral valve pathology in a 35-year old female with diabetes and end-stage renal disease is presented in the study. The patient sufferedfrom fever of an unknown origin after lower-leg amputation. Although the wound healed well, fever persisted for three weeks despite a triple antibiotic treatment until the infection was resolved with vancomycin.Three months later echocardiography displayed a floating mass attached to mitral valve, producing a newly developed systolicmurmur and a mild haemodynamic obstruction of the left ventricular outflow tract. The calcified vegetation was probably formed during an unrecognized subacute infective endocarditis.

  2. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas;

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  3. 血浆置换联合日间连续性血液滤过治疗肝衰竭并肾功能不全的护理%Nursing care of plasma exchange combined with daytime continuous ve-nous-venous hemofiltration in the treatment of liver failure accompanied with renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    李颖; 周莉; 陈占军; 郑素军; 段钟平

    2015-01-01

    Objective To summarize the nursing care of plasma exchange combined with daytime continuous venous-venous hemofiltration in liver failure patients accompanied with renal insufficiency. Methods 187 liver failure patients accompanied with renal insufficiency received plasma exchange combined with daytime continuous venous-venous hemofiltration in Artificial Liver Center, Beijing You'an Hospital Affiliated to Capital Medical University from January 2013 to May 2014 were selected as research objects. Liver and kidney function and blood coagulation indexes before and after treatment were compared. The nursing measures included the pretreatment conversation with patient, close observation, correct handling to adverse reactions with effective nursing intervention during treatment, health education and follow up after treatment. Results Alanine transaminase [(220.2±109.9) v s (366.4±153.3) U/L], aspartate transami-nase [(148.2±71.7) vs (219.8±90.0) U/L], total bilirubin [(283.0±78.2) vs (420.0±106.3)μmol/L], direct bilirubin [(141.5±38.1) vs (206.7±52.4)μmol/L], serum urea [(25.0±5.8) vs (28.8±5.6) mmol/L], creatinine [(176.6±38.6) vs (290.7±63.3)μmol/L] of patient after treatment was significantly lower than that before treatment respectively, albumin [(28.1±3.0) v s (26.6±3.1) g/L], prothrombin activity [(32.3±7.1)%v s (27.7±7.0)%] of patient after treatment was significantly higher than that before treatment respectively, with significantly statistical difference (P﹤ 0.01). Conclusion The combination of plas-ma exchange and daytime continuous venous-venous hemofiltration provides a good option for treatment of liver failure patients accompanied with renal insufficiency. Nurs-ing care support during the whole treatment proce-dures is the key of success.%目的:总结肝衰竭合并肾功能不全患者行血浆置换联合日间连续性血液滤过治疗的护理。方法选取首都医科大学附属北京佑安医院人工肝中心2013年1

  4. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

    of the venous system require at least three elements: a resistor, a capacitor and an inductor, with the latter being of more importance in the venous than in the arterial system. Non-linearities must be considered in pressure/flow relations in the small venules, during venous collapse, or low flow conditions...

  5. Unconventional aqueous humor outflow: A review.

    Science.gov (United States)

    Johnson, Mark; McLaren, Jay W; Overby, Darryl R

    2017-05-01

    Aqueous humor flows out of the eye primarily through the conventional outflow pathway that includes the trabecular meshwork and Schlemm's canal. However, a fraction of aqueous humor passes through an alternative or 'unconventional' route that includes the ciliary muscle, supraciliary and suprachoroidal spaces. From there, unconventional outflow may drain through two pathways: a uveoscleral pathway where aqueous drains across the sclera to be resorbed by orbital vessels, and a uveovortex pathway where aqueous humor enters the choroid to drain through the vortex veins. We review the anatomy, physiology and pharmacology of these pathways. We also discuss methods to determine unconventional outflow rate, including direct techniques that use radioactive or fluorescent tracers recovered from tissues in the unconventional pathway and indirect methods that estimate unconventional outflow based on total outflow over a range of pressures. Indirect methods are subject to a number of assumptions and generally give poor agreement with tracer measurements. We review the variety of animal models that have been used to study conventional and unconventional outflow. The mouse appears to be a promising model because it captures several aspects of conventional and unconventional outflow dynamics common to humans, although questions remain regarding the magnitude of unconventional outflow in mice. Finally, we review future directions. There is a clear need to develop improved methods for measuring unconventional outflow in both animals and humans. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. The COMPLETE Survey of Outflows in Perseus

    CERN Document Server

    Arce, Hector G; Goodman, Alyssa A; Pineda, Jaime E; Halle, Michael W; 10.1088/0004-637X/715/2/1170

    2010-01-01

    We present a study on the impact of molecular outflows in the Perseus molecular cloud complex using the COMPLETE survey large-scale 12CO(1-0) and 13CO(1-0) maps. We used three-dimensional isosurface models generated in RA-DEC-Velocity space to visualize the maps. This rendering of the molecular line data allowed for a rapid and efficient way to search for molecular outflows over a large (~ 16 sq. deg.) area. Our outflow-searching technique detected previously known molecular outflows as well as new candidate outflows. Most of these new outflow-related high-velocity features lie in regions that have been poorly studied before. These new outflow candidates more than double the amount of outflow mass, momentum, and kinetic energy in the Perseus cloud complex. Our results indicate that outflows have significant impact on the environment immediately surrounding localized regions of active star formation, but lack the energy needed to feed the observed turbulence in the entire Perseus complex. This implies that oth...

  7. SWAS Observations of Water in Molecular Outflows

    CERN Document Server

    Franklin, J; Kaufman, M J; Melnick, G J; Neufeld, D A; Hollenbach, D J; Bergin, E A

    2007-01-01

    We present SWAS detections of the ground-state 1(10)-1(01) transition of o-H2O at 557 GHz in 18 molecular outflows. These results are combined with ground-based observations of the J=1-0 transitions of 12CO and 13CO obtained at the FCRAO and, for a subset of the outflows, data from ISO. Assuming the SWAS water line emission originates from the same gas traced by CO emission, we find that the outflowing gas in most outflows has an o-H2O abundance relative to H2 of between 10(-7) and 10(-6). Analysis of the water abundance as a function of outflow velocity reveals a strong dependence. The water abundance increases with velocity, and at the highest outflow velocities some outflows have relative o-H2O abundances of order 10(-4). However the mass of gas with such elevated water abundances represents less that 1% of the total outflow gas mass. The ISO LWS observations of high-J rotational lines of CO and the 179.5 micron transition of o-H2O provide evidence for a warmer outflow component than required to produce ei...

  8. Morphologies of protostellar outflows: An ALMA view

    CERN Document Server

    Peters, Thomas; Seifried, Daniel; Banerjee, Robi; Klessen, Ralf S

    2014-01-01

    The formation of stars is usually accompanied by the launching of protostellar outflows. Observations with the Atacama Large Millimetre/sub-millimetre Array (ALMA) will soon revolutionalise our understanding of the morphologies and kinematics of these objects. In this paper, we present synthetic ALMA observations of protostellar outflows based on numerical magnetohydrodynamic collapse simulations. We find significant velocity gradients in our outflow models and a very prominent helical structure within the outflows. We speculate that the disk wind found in the ALMA Science Verification Data of HD 163296 presents a first instance of such an observation.

  9. ``Aggressive`` renal angiomyolipoma

    Energy Technology Data Exchange (ETDEWEB)

    Cittadini, G. Jr. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, F. [Univ. of Trieste (Italy). Dept. of Radiology; Danza, F.M. [Catholic Sacro Cuore Univ., Rome (Italy). Dept. of Radiology; Derchi, L.E. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, R.S. [Univ. of Trieste (Italy). Dept. of Radiology

    1996-11-01

    We describe the US and CT examinations of 4 patients with renal angiomyolipoma with an `aggressive` appearance, and review the literature. The imaging findings in 4 patients with benign renal angiomyolipomas associated with thrombosis of the renal vein and/or inferior vena cava are presented. CT demonstrated fat densities within both tumor and thrombus. In one patient, small lymph nodes with low density internal areas were detected in the para-aortic region. When considering our patients together with those reported in the literature, we found that most angiomyolipomas with venous invasion were large and centrally located within the kidney. Venous thrombosis was observed in 9 lesions of the right kidney, and in only 4 of the left one. One patient only had symptoms due to the thrombus; 10 had problems due to the tumor; and 3 were asymptomatic. Only 4 patients with pararenal enlarged lymph nodes have been reported on in the imaging literature. Fat-containing nodes were detected by CT in one case only; the others had enlarged nodes of soft-tissue density. In one patient the diagnosis of hamartomatous lymph node invasion was established by angiography. In patients with renal angiomyolipoma, demonstration of both fatty thrombus and the fatty infiltration of lymph nodes of the renal hilum cannot be regarded as an indication of malignancy, but only of local aggessive behavior. Conservative treatment seems possible. Detection of enlarged lymph nodes of soft tissue density may cause difficult diagnostic problems, with the diagnosis addressed only by the presence of associated lesions. (orig./MG).

  10. Chronic venous disorders

    African Journals Online (AJOL)

    evaluated by clinical assessment and duplex ultrasound. The rate ... History and physical examination. The most common ... deep venous thrombosis or phlebitis, use of anticoagulation therapy, unexplained ... veins and pulsed Doppler assessment of the direction of ... effective in healing ulcers and preventing recurrences ...

  11. Venous oxygen saturation.

    Science.gov (United States)

    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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Central venous line - infants

    Science.gov (United States)

    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 ...

  13. Jugular venous oximetry

    Directory of Open Access Journals (Sweden)

    Avanish Bhardwaj

    2015-01-01

    Full Text Available The measurement of saturation of venous blood as it drains out of brain by sampling it from the jugular bulb provides us with an estimate of cerebral oxygenation, cerebral blood flow and cerebral metabolic requirement. Arterio-jugular venous difference of the oxygen content (AVDO 2 and jugular venous oxygen saturation (SjVO 2 values per se helps clinicians in identifying the impairment of cerebral oxygenation due to various factors thereby prompting implementation of corrective measures and the prevention of secondary injury to the brain due to ischaemia. SjVO 2 values are also used for prognostication of patients after traumatic brain injury and in other clinical situations. Sampling and measuring SjVO 2 intermittently or continuously using fibreoptic oximetry requires the tip of the catheter to be placed in the jugular bulb, which is a relatively simple bedside procedure. In the review below we have discussed the relevant anatomy, physiology, techniques, clinical applications and pitfalls of performing jugular venous oximetry as a tool for measurement of cerebral oxygenation.

  14. Venous Thromboembolism in China

    Institute of Scientific and Technical Information of China (English)

    赵永强

    2005-01-01

    @@ Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are two manifesttions of venous thromboembolism (VTE) . Although the controversy remained,it has been widely accepted for many years that Chinese people have lower incidence of VTE than Caucasians with the different etiology and clinical features.

  15. Cerebral Venous Thrombosis.

    Science.gov (United States)

    Sassi, Samia Ben; Touati, Nahla; Baccouche, Hela; Drissi, Cyrine; Romdhane, Neila Ben; Hentati, Fayçal

    2016-01-01

    Data regarding cerebral venous thrombosis in North Africa are scarce. This study aims to identify the clinical features, risk factors, outcome, and prognosis of cerebral venous thrombosis in Tunisia. Data of 160 patients with radiologically confirmed cerebral venous thrombosis, hospitalized in Mongi Ben Hmida National Institute of Neurology (Tunis, Tunisia), were retrospectively collected and analyzed. The mean age was 37.3 years with a female predominance (83.1%). The mode of onset was subacute in most cases (56.2%). Headache was the most common symptom (71.3%), and focal neurologic symptoms were the main clinical presentation (41.8%). The most common sites of thrombosis were the superior sagittal sinus (65%) and the lateral sinus (60.6%). More than 1 sinus was involved in 114 (71.2%) patients. Parenchymal lesions observed in 85 (53.1%) patients did not correlate with cerebral venous thrombosis extent. Major risk factors were obstetric causes (pregnancy and puerperium) found in 46 (38.6% of women aged <50 years) patients, followed by anemia (28.1%) and congenital or acquired thrombophilia (16.2%). Mortality rate was of 6.6%. Good outcome at 6 months (modified Rankin Scale ≤2) was observed in 105 (87.5%)of 120 patients available for follow-up. Predictors of poor outcome were altered consciousness and elevated plasma C-reactive protein levels. Clinical and radiologic presentation of cerebral venous thrombosis in Tunisia was quite similar to other parts of the world with, however, a particularly high frequency of obstetric causes. Plasma C-reactive protein level should be considered as a prognostic factor in CVT.

  16. Reversible Renal Insufficiency Secondary to Extrinsic Splenic Compression of the Kidney in a Patient with Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Miriam Hadj-Moussa

    2010-01-01

    Full Text Available While increased renal venous and direct renal parenchymal pressure may cause renal insufficiency, there are no prior reports of hypersplenism secondary to chronic lymphocytic leukemia (CLL doing so. This first report of massive splenomegaly leading to marked compression of the left kidney associated with renal insufficiency that resolved after splenectomy illustrates that profound extrinsic renal compression from splenomegaly may significantly compromise left renal function and splenectomy should be considered in this situation.

  17. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  18. Renal arteriography

    Science.gov (United States)

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  19. Involvement of systemic venous congestion in heart failure.

    Science.gov (United States)

    Rubio Gracia, J; Sánchez Marteles, M; Pérez Calvo, J I

    2017-04-01

    Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Outflow - Core Interaction in Barnard 1

    CERN Document Server

    Hiramatsu, Masaaki; Takakuwa, Shigehisa

    2010-01-01

    In order to study how outflows from protostars influence the physical and chemical conditions of the parent molecular cloud, we have observed Barnard 1 (B1) main core, which harbors four Class 0 and three Class I sources, in the CO (J=1-0), CH3OH (J_K=2_K-1_K), and the SiO (J=1-0) lines using the NRO 45 m telescope. We have identified three CO outflows in this region; one is an elongated (~ 0.3 pc) bipolar outflow from a Class 0 protostar B1-c in the submillimeter clump SMM 2, another is a rather compact (~ 0.1 pc) outflow from a Class I protostar B1 IRS in the clump SMM 6, and the other is extended outflow from a Class I protostar in SMM 11. In the western lobe of the SMM 2 outflow, both the SiO and CH3OH lines show broad redshifted wings with the terminal velocities of 25 km/s and 13 km/s, respectively. It is likely that the shocks caused by the interaction between the outflow and ambient gas enhance the abundance of SiO and CH3OH in the gas phase. The total energy input rate by the outflows (1.1x10^{-3} Ls...

  1. Morphometric analysis of aqueous humor outflow structures with spectral-domain optical coherence tomography.

    Science.gov (United States)

    Francis, Andrew W; Kagemann, Larry; Wollstein, Gadi; Ishikawa, Hiroshi; Folz, Steven; Overby, Darryl R; Sigal, Ian A; Wang, Bo; Schuman, Joel S

    2012-08-07

    To describe morphometric details of the human aqueous humor (AH) outflow microvasculature visualized with 360-degree virtual castings during active AH outflow in cadaver eyes and to compare these structures with corrosion casting studies. The conventional AH outflow pathways of donor eyes (n = 7) and eyes in vivo (n = 3) were imaged with spectral-domain optical coherence tomography (SD-OCT) and wide-bandwidth superluminescent diode array during active AH outflow. Digital image contrast was adjusted to isolate AH microvasculature, and images were viewed in a 3D viewer. Additional eyes (n = 3) were perfused with mock AH containing fluorescent tracer microspheres to compare microvasculature patterns. Observations revealed components of the conventional outflow pathway from Schlemm's canal (SC) to the superficial intrascleral venous plexus (ISVP). The superficial ISVP in both our study and corrosion casts were composed of interconnected venules (10-50 μm) forming a hexagonal meshwork. Larger radial arcades (50-100 μm) drained the region nearest SC and converged with larger tortuous vessels (>100 μm). A 360-degree virtual casting closely approximated corrosion casting studies. Tracer studies corroborated our findings. Tracer decorated several larger vessels (50-100 μm) extending posteriorly from the limbus in both raw and contrast-enhanced fluorescence images. Smaller tracer-labeled vessels (30-40 μm) were seen branching between larger vessels and exhibited a similar hexagonal network pattern. SD-OCT is capable of detailed morphometric analysis of the conventional outflow pathway in vivo or ex vivo with details comparable to corrosion casting techniques.

  2. Compartment syndrome in patients with massive venous thrombosis after inferior vena cava filter placement.

    Science.gov (United States)

    Mesfin, Addisu; Lum, Ying Wei; Nayfeh, Tariq; Mears, Simon C

    2011-03-11

    Massive venous thrombosis, which can occur acutely after inferior vena cava filter placement, has 2 forms: phlegmasia cerulea dolens and phlegmasia alba dolens. In phlegmasia cerulea dolens, complete occlusion of venous outflow occurs. In the milder phlegmasia alba dolens version, collateral venous flow out of the limb remains despite the venous thrombosis. This article presents, to our knowledge, the first 2 cases of massive venous thrombosis (1 phlegmasia cerulea dolens, 1 phlegmasia alba dolens) below inferior vena cava filters occurring after the acute period. Phlegmasia cerulea dolens and phlegmasia alba dolens can present as compartment syndrome. Prompt fasciotomies were performed, but the underlying massive venous thrombosis was not addressed surgically. Phlegmasia cerulea dolens and phlegmasia alba dolens have high morbidity and mortality. The patient with phlegmasia alba dolens required leg and thigh fasciotomies and eventually required an above-knee amputation. The patient with phlegmasia cerulea dolens developed compartment syndrome in the left leg, right leg, and right thigh. Although he underwent decompression of all of these compartments, he died from multiple organ failure. A multidisciplinary approach with the vascular service and the intensivists is required in the treatment of patients with massive venous thrombosis. Treatment goals include preventing additional propagation of the thrombus via anticoagulation, with strong consideration for catheter-directed thrombolysis or thrombectomy and fasciotomies for compartment syndrome. The orthopedic surgeon should keep phlegmasia cerulea dolens and phlegmasia alba dolens in the differential for compartment syndrome, especially in patients who have had a history of acute or chronic inferior vena cava filter placement.

  3. Congenital agenesis of inferior vena cava: a rare cause of unprovoked deep venous thrombosis.

    Science.gov (United States)

    Parsa, Pouria; Lane, John S; Barleben, Andrew R; Owens, Erik L; Bandyk, Dennis

    2015-07-01

    Congenital anomalies of the inferior vena cava (IVC), although rare, are a risk factor for lower limb deep venous thrombosis (DVT). A 19-year-old male presented with a left flank and groin pain caused by iliofemoral venous thrombosis. Vascular imaging by computed tomography (CT) scanning and venography demonstrated agenesis of the IVC. Catheter-directed thrombolysis via a popliteal vein was attempted but did not alter the patency of the common femoral vein outflow collaterals into the retroperitoneal azygous venous system. The patient was anticoagulated using systemic heparin infusion and clinical symptoms resolved within 5 days. He was transitioned to oral Coumadin anticoagulation, and follow-up venous duplex testing demonstrated no infrainguinal DVT and phasic venous flow with respiration in the femoral vein indicating patent collateral veins. Anomalies of the IVC are present in 0.3-0.5% of otherwise healthy individuals. Agenesis of the IVC has an incidence of 0.0005-1% in the general population but is found in almost 5% of patients venous collaterals on noncontrast CT imaging. In young adults presenting with unprovoked lower limb DVT, the presence of an IVC anomaly should be considered and evaluated for by venous duplex testing and if necessary CT venography.

  4. Venous thromboembolism and pregnancy

    Directory of Open Access Journals (Sweden)

    Maristella D’Uva

    2010-03-01

    Full Text Available Maristella D’Uva1, Pierpaolo Di Micco2, Ida Strina1, Giuseppe De Placido1Department of Obstetrics and Gynecology and Human Reproduction, “Federico II” University of Naples, Naples, Italy; 2Internal Medicine Division, Buonconsiglio Fatebenefratelli Hospital of Naples, Naples, ItalyAbstract: 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.Keywords: thrombophilia, venous thromboembolism, recurrent pregnancy loss, factor V Leiden

  5. Venous thromboembolism in children

    Directory of Open Access Journals (Sweden)

    Helena Pereira

    2016-02-01

    Full Text Available Introduction: Venous thromboembolism is rare among children and has a multi-factorial aetiology. It’s important to establish the diagnosis and evaluate the functional prognosis. Case report: A previously healthy 11 year old adolescent was observed in the emergency room with clinical signs of superficial venous thrombosis of the upper limb. Laboratorial evaluation showed a sedimentation rate, coagulation study, autoimmune antibodies and homocysteine with normal values. Testing for heritable thrombophilia revealed prothrombin mutation (G20210A, heterozigosity and mutation of PAI-1 (4G e -844A, both of which are associated with hypercoagulable state and indication to do prophylaxis with low molecular weight heparin in higher risk situations. Discussion/Conclusion: The rarity of thromboembolic events at this age and the atypical localization lead to an exhaustive laboratorial evaluation. Thrombophilia mutations may clinically become evident in adolescence, and its detection is important because of children’s lifestyle and the need of prophylactic treatment in some situations.

  6. Venous Leg Ulcers.

    Science.gov (United States)

    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.

  7. 连续性血液滤过在肝移植术后并发急性肾功能衰竭中的治疗价值%The therapeutic value of continuous veno-venous hemofiltration in acute renal failure after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    沈清; 梁少梅; 甘华; 杜小刚; 李正荣

    2011-01-01

    Objective To evaluate the therapeutic value of continuous veno venous hemofiltration(CVVH) in the treatment of acute renal failure(ARF) after liver transplantation. Methods 22 patients with ARF after liver transplantation were treated with CVVH. Their vital signs, hemodynamic, hepatic and renal functions, sera electrolyte, blood gas analysis, thromboxane function and blood platelet count were compared before and after the treatment. The mortality was observed and the efficacy and safety of the treatment were evaluated. Results After CVVH,the vital signs and hemodynamic were irnproved(P<0. 05) ;serum BUN, Ct, TB and DB were significantly decreased (P<0. 05); hyperkalemia, hyponatremia and metabolic acidosis were corrected(P<0. 05). But there were no remarkable changes in coagulogram and blood platelet count before and after the treatment(P>0. 05). The mortality was to some extent reduced. During the treatment of CVVH, the survivability of the patients was good, without obvious side effects. Conclusion CVVH is an effective and safe treatment for patients with acute renal failure after liver transplantation.%目的 探讨连续性静脉-静脉血液滤过(CVVH)对肝移植术后并发急性肾功能衰竭的临床应用价值.方法 应用CVVH对该院的22例肝移植术后并发急性肾功能衰竭的患者进行治疗,比较治疗前、后患者的生命体征,血流动力学,肾、肝功能,电解质,动脉血气分析,凝血象,血小板计数的变化,并观察其病死率,以评价CVVH的治疗效果及不良反应.结果 CVVH治疗后患者生命体征和血流动力学平稳(P0.05);患者病死率有所下降.CVVH治疗过程中,患者耐受性好,无明显不良反应.结论 CVVH是肝移植术后并发急性肾功能衰竭的有效治疗方法之一.

  8. Venous thromboembolism at uncommon sites in neonates and children.

    Science.gov (United States)

    Pergantou, Helen; Avgeri, Maria; Komitopoulou, Anna; Xafaki, Panagiota; Kapsimali, Zoey; Mazarakis, Michail; Adamtziki, Eftychia; Platokouki, Helen

    2014-11-01

    We retrospectively analyzed the data of 24 children (whereof 11 neonates), with non-central venous line-related and nonmalignancy-related venous thromboembolism (VTE) at uncommon sites, referred to our Unit from January 1999 to January 2012. Thirty patients who also suffered deep vein thrombosis, but in upper/low extremities, were not included in the analysis. The location of rare site VTE was: portal (n=7), mesenteric (n=2) and left facial vein (n=1), spleen (n=3), lung (n=3), whereas 10 neonates developed renal venous thrombosis. The majority of patients (91.7%) had at least 1 risk factor for thrombosis. Identified thrombophilic factors were: antiphospholipid antibodies (n=2), FV Leiden heterozygosity (n=6), MTHFR C677T homozygosity (n=4), protein S deficiency (n=2), whereas all neonates had age-related low levels of protein C and protein S. All but 6 patients received low-molecular-weight heparin, followed by warfarin in 55% of cases, for 3 to 6 months. Prolonged anticoagulation was applied in selected cases. During a median follow-up period of 6 years, the clinical outcome was: full recovery in 15 patients, evolution to both chronic portal hypertension and esophageal varices in 2 children, and progression to renal failure in 7 of 10 neonates. Neonates are greatly vulnerable to complications after VTE at uncommon sites, particularly renal. Future multicentre long-term studies on neonatal and pediatric VTE at unusual sites are considered worthwhile.

  9. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea

    2011-12-21

    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. 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). 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. 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, pentoxifylline, rutosides, stanozolol, sulodexide

  10. Pulmonary thromboembolism associated with renal insufficiency due to renal artery thrombosis

    Directory of Open Access Journals (Sweden)

    Vučičević-Trobok Jadranka

    2002-01-01

    Full Text Available Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. Case Report The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. Discussion Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. Conclusion This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

  11. Increased renal production of C-type natriuretic peptide (CNP) in patients with cirrhosis and functional renal failure

    DEFF Research Database (Denmark)

    Gülberg, V; Møller, S; Henriksen, Jens Henrik Sahl

    2000-01-01

    .05; mean (SEM)). In contrast, urinary CNP was higher in patients with impaired renal function compared with those with normal renal function and healthy controls (47.2 (7.4) v. 20.8 (1.9) and 17.0 (3.0) ng CNP/g creatinine, respectively; pUrinary CNP was found to be inversely related to urinary...... homeostasis. Therefore, the aim of the present study was to investigate the possible role of CNP in renal function disturbances in patients with cirrhosis of the liver. METHODS: Peripheral venous and urinary concentrations of CNP were determined in samples from 11 healthy controls, 20 cirrhotic patients...... with normal renal function (creatinine clearance 117 (8) ml/min), and 20 cirrhotic patients with impaired renal function (creatinine clearance 35 (4) ml/min). In a second protocol, arterial and renal venous plasma concentrations of CNP were determined in 37 patients with cirrhosis of the liver to estimate...

  12. Understanding Guyton's venous return curves

    National Research Council Canada - National Science Library

    Beard, Daniel A; Feigl, Eric O

    2011-01-01

    ...) was experimentally increased the right atrial pressure decreased, Arthur Guyton and coworkers proposed an interpretation that right atrial pressure represents a back pressure restricting venous return...

  13. Medical management of venous ulcers.

    Science.gov (United States)

    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.

  14. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

    Cardiac output is largely controlled by venous return, the driving force of which is the energy remaining at the postcapillary venous site. This force is influenced by forces acting close to the right atrium, and internally or externally upon the veins along their course. Analogue models....... The venous capacitance is also non-linear, but may be considered linear under certain conditions. The models have to include time varying pressure sources created by respiration and skeletal muscles, and if the description includes the upright position, the partly unidirectional flow through the venous...

  15. Chronic Venous Disease under pressure

    OpenAIRE

    Reeder, Suzan

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with regard to non-healing and recurrence rates. Annually 6% of the total healthcare costs are spent on the treatment of venous diseases. CVD results from ambulatory venous hypertension and is the conse...

  16. Renal transplantation in a child with thrombosed inferior vena cava

    Directory of Open Access Journals (Sweden)

    Surjeet Kumar

    2014-01-01

    Full Text Available The external iliac vein is commonly used in renal transplantation for vascular anastomosis of the allograft renal vein. However, there are rare instances when the transplant surgeon may encounter thrombosis of the ilio-caval vein during surgery, making renal transplantation a challenge. Often, these patients are considered unsuitable for renal transplantation. We report a case of thrombosis of the inferior vena cava in an asymptomatic pediatric patient in whom the splenic vein was used, at transplantation, for venous drainage. This case highlights that pre-operative Doppler screening should be performed in all potential renal transplant recipients.

  17. Renal involvement in antiphospholipid syndrome.

    Science.gov (United States)

    Sciascia, Savino; Cuadrado, Maria José; Khamashta, Munther; Roccatello, Dario

    2014-05-01

    Antiphospholipid syndrome (APS) is an autoimmune disease defined by the presence of arterial or venous thrombotic events and/or pregnancy morbidity in patients who test positive for antiphospholipid antibodies (aPLs). APS can be isolated (known as primary APS) or associated with other autoimmune diseases, such as systemic lupus erythematosus (SLE; known as secondary APS). The kidney is a major target organ in APS and renal thrombosis can occur at any level within the vasculature of the kidney (renal arteries, intrarenal arteries, glomerular capillaries and renal veins); events reflect the site and size of the involved vessels. Histological findings vary widely, including ischaemic glomeruli and thrombotic lesions without glomerular or arterial immune deposits on immunofluorescence. Renal prognosis is affected by the presence of aPLs in patients with lupus nephritis and can be poor. In patients with SLE and aPLs, biopsy should be performed because inflammatory and thrombotic lesions require different therapeutic approaches. Renal involvement in patients with definite APS is treated by anticoagulation with long-term warfarin. The range of renal manifestations associated with APS is broadening and, therefore, aPLs have increasing relevance in end-stage renal disease, transplantation and pregnancy.

  18. Accretion and Outflow Activity in Brown Dwarfs

    CERN Document Server

    Riaz, B

    2013-01-01

    An investigation of the magnetospheric accretion and outflow signatures in sub-stellar objects is a natural extension of similar studies conducted on classical T Tauri stars (CTTS), and helps understand if brown dwarfs (BDs) follow the same formation mechanism as stars. Over the past decade, evidence for accretion in very low-mass stars (VLMs) and BDs has been accumulated using various techniques, which indicates that the overall accretion characteristics are continuous across the sub-stellar boundary. Outflow activity in VLMs and BDs has been confirmed based on spectro-astrometry of forbidden emission lines observed in the optical, and in millimetre continuum images of CO J=2-1 emission. This review summarizes the past and current state of observational work on accretion and outflow activity in VLMs and BDs, particularly with the advent of new instruments such as VLT/X-Shooter which has allowed the study of several accretion and outflow indicators over a wider wavelength range.

  19. Disks, accretion and outflows of brown dwarfs

    CERN Document Server

    Joergens, V; Liu, Y; Pascucci, I; Whelan, E; Alcala, J; Biazzo, K; Costigan, G; Gully-Santiago, M; Henning, Th; Natta, A; Rigliaco, E; Rodriguez-Ledesma, V; Sicilia-Aguilar, A; Tottle, J; Wolf, S

    2012-01-01

    Characterization of the properties of young brown dwarfs are important to constraining the formation of objects at the extreme low-mass end of the IMF. While young brown dwarfs share many properties with solar-mass T Tauri stars, differences may be used as tests of how the physics of accretion/outflow and disk chemistry/dissipation depend on the mass of the central object. This article summarizes the presentations and discussions during the splinter session on 'Disks, accretion and outflows of brown dwarfs' held at the CoolStars17 conference in Barcelona in June 2012. Recent results in the field of brown dwarf disks and outflows include the determination of brown dwarf disk masses and geometries based on Herschel far-IR photometry (70-160 um), accretion properties based on X-Shooter spectra, and new outflow detections in the very low-mass regime.

  20. Electron-positron outflow from black holes

    CERN Document Server

    Van Putten, M H P M

    2000-01-01

    Gamma-ray bursts (GRBs) appear as the brightest transient phenomena in the Universe. The nature of the central engine in GRBs is a missing link in the theory of fireballs to their stellar mass progenitors. Here it is shown that rotating black holes produce electron-positron outflow when brought into contact with a strong magnetic field. The outflow is produced by a coupling of the spin of the black hole to the orbit of the particles. For a nearly extreme Kerr black hole, particle outflow from an initial state of electrostatic equilibrium has a normalized isotropic emission of $\\sim external magnetic field strength, B_c=4.4 x 10^{13}G, and M is the mass of the black hole. This initial outflow has a half-opening angle given.

  1. Radio jets and outflows of cold gas

    CERN Document Server

    Morganti, Raffaella

    2011-01-01

    Massive gas outflows are considered a key component in the process of galaxy formation and evolution. It is, therefore, not surprising that a lot of effort is going in quantifying their impact via detailed observations. This short contribution presents recent results obtained from HI and CO observations of different objects where the AGN - and in particular the radio jet - is likely playing an important role in producing the gas outflows. These preliminary results are reinforcing the conclusion that these outflows have a complex and multiphase structure where cold gas in different phases (atomic and molecular) is involved and likely represent a major component. These results will also provide important constraints for establishing how the interaction between AGN/radio jet and the surrounding ISM occurs and how efficiently the gas should cool to produce the observed properties of the outflowing gas. HI likely represents an intermediate phase in this process, while the molecular gas would be the final stage. Wh...

  2. Biological characteristics of the cerebral venous system and its hemodynamic response to intracranial hypertension

    Institute of Scientific and Technical Information of China (English)

    CHEN Jie; WANG Xi-ming; LUAN Li-ming; CHAO Bao-ting; PANG Bo; SONG Hui; PANG Qi

    2012-01-01

    Background The role of the cerebral venous system (CVS) in intracranial pressure (ICP) regulation remains largely unclear.In the present study,the interaction between ICP and the cerebral venous system and its possible mechanism were investigated with respect to the biological characteristics of the cerebral venous system and its hemodynamic response under increased ICP.@@Methods We created intracranial hypertension animal model,measured and calculated the venous flow velocity and diameter of the outflow terminal of the CVS with color ultrasonic system and recorded the vascular morphology by 3-dimensional anatomical microscopy.Patients who suffered from raised ICP underwent MRI and digital subtraction angiography (DSA) examination to show the length in the vertical direction of the wall of the bridging vein representing the diameter value.Pathological autopsy was performed from bodies of patients who had died from non-cerebral causes to observe the juncture part between the venous sinuses and tributary vertical brain veins.@@Results Under increased ICP conditions,venous drainage through the outlet cuff segment,a unique structure between the bridge vein and sinus,was obstructed and in turn venous blood became congested.Therefore,the increased blood volume worsened the pre-existing ICP according to the well-accepted theory regarding volume-pressure relationship.This phenomenon was described as concurrent “Venogenic intracranial hypertension”,which is characterized by intracranial venous blood stasis responsive to and together with the original increased ICP.@@Conclusions The existence of this special pathophysiological process is prevalent,rather than rare,in various intracranial disorders.This finding would definitely provide new insight into the area of cerebral venous system research.

  3. Detection of CO Outflow in Rotating Cores

    Institute of Scientific and Technical Information of China (English)

    Xin Guan; Yue-Fang Wu

    2008-01-01

    We investigate the effect of bulk motion on the detection of molecular outflows in the sources S 146, GGD27, and IRAS 22566+5830. The traditional techniques do allow for bulk motions or systematic VLSR shifts of the core emissions, which may cause contamination of the high velocity gas emissions, and outflows may either fail to be detected or have their properties miscalculated. We used a program to follow the systematic shift of VLSR and better results have been obtained.

  4. Radiative transfer in ultra-relativistic outflows

    OpenAIRE

    Beloborodov, Andrei M.

    2010-01-01

    Analytical and numerical solutions are obtained for the equation of radiative transfer in ultra-relativistic opaque jets. The solution describes the initial trapping of radiation, its adiabatic cooling, and the transition to transparency. Two opposite regimes are examined: (1) Matter-dominated outflow. Surprisingly, radiation develops enormous anisotropy in the fluid frame before decoupling from the fluid. The radiation is strongly polarized. (2) Radiation-dominated outflow. The transfer occu...

  5. Quantifying Supernovae-driven Multiphase Galactic Outflows

    Science.gov (United States)

    Li, Miao; Bryan, Greg L.; Ostriker, Jeremiah P.

    2017-06-01

    Galactic outflows are observed everywhere in star-forming disk galaxies and are critical for galaxy formation. Supernovae (SNe) play the key role in driving the outflows, but there is no consensus as to how much energy, mass, and metal they can launch out of the disk. We perform 3D, high-resolution hydrodynamic simulations to study SNe-driven outflows from stratified media. Assuming the SN rate scales with gas surface density Σgas as in the Kennicutt-Schmidt relation, we find that the mass loading factor, η m, defined as the mass outflow flux divided by the star formation surface density, decreases with increasing Σgas as {η }{{m}}\\propto {{{Σ }}}{gas}-0.61. Approximately Σgas ≲ 50 M ⊙ pc-2 marks when η m ≳ 1. About 10%-50% of the energy and 40%-80% of the metals produced by SNe end up in the outflows. The tenuous hot phase (T > 3 × 105 K), which fills 60%-80% of the volume at the midplane, carries the majority of the energy and metals in the outflows. We discuss how various physical processes, including the vertical distribution of SNe, photoelectric heating, external gravitational field, and SN rate, affect the loading efficiencies. The relative scale height of gas and SNe is a very important factor in determining the loading efficiencies.

  6. Quantifying Supernovae-Driven Multiphase Galactic Outflows

    CERN Document Server

    Li, Miao; Ostriker, Jeremiah P

    2016-01-01

    Galactic outflows are ubiquitously observed in star-forming disk galaxies and are critical for galaxy formation. Supernovae (SNe) play the key role in driving the outflows, but there is no consensus as to how much energy, mass and metal they can launch out of the disk. We perform 3D, high-resolution hydrodynamic simulations to study SNe-driven outflows from stratified media. Assuming SN rate scales with gas surface density $\\Sigma_{\\rm{gas}}$ as in the Kennicutt-Schmidt (KS) relation, we find the mass loading factor, defined as the mass outflow flux divided by the star formation surface density, decreases with increasing $\\Sigma_{\\rm{gas}}$ as $\\propto \\Sigma^{-0.61}_{\\rm{gas}}$. Approximately $\\Sigma_{\\rm{gas}} \\lesssim$ 50 $M_\\odot/pc^2$ marks when the mass loading factor $\\gtrsim$1. About 10-50\\% of the energy and 40-80\\% of the metals produced by SNe end up in the outflows. The tenuous hot phase ($T>3\\times 10^5$ K) carries the majority of the energy and metals in outflows. We discuss how various physical...

  7. Theory of photospheric emission from relativistic outflows

    CERN Document Server

    Ruffini, R; Vereshchagin, G V

    2013-01-01

    (shortened) In this paper we reexamine the optical depth of ultrarelativistic spherically symmetric outflows and reevaluate the photospheric radius for each model during both the acceleration and coasting phases. It is shown that for both the wind and the shell models there are two asymptotic solutions for the optical depth during the coasting phase of the outflow. In particular we show that quite counterintuitively a geometrically thin shell may appear as a thick wind for photons propagating inside it. For this reason we introduce notions of photon thick and photon thin outflows, which appear more general and better physically motivated with respect to winds and shells. Photosphere of relativistic outflow is a dynamic surface. We study its geometry and find that the photosphere of photon thin outflow has always a convex shape, while in the photon thick one it is initially convex (there is always a photon thin layer in any outflow) and then it becomes concave asymptotically approaching the photosphere of an i...

  8. Fast cold gas in hot AGN outflows

    CERN Document Server

    Costa, Tiago; Haehnelt, Martin

    2014-01-01

    Observations of the emission from spatially extended cold gas around bright high-redshift QSOs reveal surprisingly large velocity widths exceeding 2000 km s^(-1), out to projected distances as large as 30 kpc. The high velocity widths have been interpreted as the signature of powerful AGN-driven outflows. Naively, these findings appear in tension with hydrodynamic models in which AGN-driven outflows are energy-driven and thus very hot with typical temperatures T = 10^6-7 K. Using the moving-mesh code Arepo, we perform 'zoom-in' cosmological simulations of a z = 6 QSO and its environment, following black hole growth and feedback via energy-driven outflows. In the simulations, the QSO host galaxy is surrounded by a clumpy circum-galactic medium pre-enriched with metals due to supernovae-driven galactic outflows. As a result, part of the AGN-driven hot outflowing gas can cool radiatively, leading to large amounts (> 10^9 M_sun) of cold gas comoving with the hot bipolar outflow. This results in velocity widths of...

  9. The internist and the renal resistive index: truths and doubts.

    Science.gov (United States)

    Boddi, Maria; Natucci, Fabrizia; Ciani, Elisa

    2015-12-01

    The renal resistive index (RRI) is measured by Doppler sonography in an intrarenal artery, and is the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. The RRI is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. Renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, aortic stiffness, pulse pressure) determinants that combine to determine the RRI values, and not the most important one. RRI cannot always be considered a specific marker of renal disease. To summarize from the literature: (1) hydronephrosis, abdominal hypertension, renal vein thrombosis and acute kidney injury are all associated with an acute increase in interstitial and venous pressure that determine RRI values. In all these conditions, RRI is a reliable marker of the severity of renal damage. (2) The hemodynamic impact of renal artery stenosis can be assayed by the RRI decrease in the homolateral kidney by virtue of decreasing pulse pressure. However, renal diseases that often coexist, increase renal vascular stiffness and hide the hemodynamic effect of renal stenosis. (3) In transplant kidney and in chronic renal disease, high RRI values (>0.80) can independently predict renal and clinical outcomes, but systemic (pulse pressure) rather than renal hemodynamic determinants sustain the predictive role of RRI. (4) Higher RRI detects target renal organ damage in hypertension and diabetes when renal function is still preserved, as a marker of systemic atherosclerotic burden. Is this the fact? We attempt to answer.

  10. Cerebral sinus venous thrombosis

    Science.gov (United States)

    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

  11. Cerebral sinus venous thrombosis

    Directory of Open Access Journals (Sweden)

    Hernando Raphael Alvis-Miranda

    2013-01-01

    Full Text Available 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.

  12. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  13. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

    . The venous capacitance is also non-linear, but may be considered linear under certain conditions. The models have to include time varying pressure sources created by respiration and skeletal muscles, and if the description includes the upright position, the partly unidirectional flow through the venous...

  14. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  15. Retinal abnormalities in multiple sclerosis patients with associated chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Aneta Adamczyk-Ludyga

    2012-06-01

    Full Text Available Optical coherence tomography (OCT is a non-invasive method for the assessment of optic nerve fibers and retinal ganglion cells. This study was aimed at the assessment of retinal abnormalities in multiple sclerosis patients in the context of chronic cerebrospinal venous insufficiency using OCT of the retina and the optic nerve. We examined 239 multiple sclerosis (MS patients, including 220 patients with associated chronic cerebrospinal venous insufficiency and 19 MS patients without venous pathology. The following OCT parameters were assessed: average ganglion cell complex thickness, global loss volume, focal loss volume and average retinal nerve fibre layer thickness. Abnormalities in the azygous and internal jugular veins were evaluated using catheter venography. We found a higher prevalence of abnormal OCT parameters in the patients with previous history of optic neuritis, not only on the side of inflammatory event, but also in the contralateral eye, which is in line with already existing body of evidence. The new and intriguing discovery is that we found statistically significant higher prevalence of abnormal OCT values in multiple sclerosis patients with unilateral stenosis of internal jugular vein. Patients who were not found venous abnormalities, as well as those presenting with pathologic azygous or bilateral internal jugular venous outflows, did not demonstrate a changed frequency of abnormal OCT parameters. Potential association between venous malformations and eye manifestations of multiple sclerosis, as has been demonstrated in this report, justifies further studies on this topic.

  16. Renal Osteodystrophy

    Directory of Open Access Journals (Sweden)

    Aynur Metin Terzibaşoğlu

    2004-12-01

    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  17. Venous rupture during percutaneous treatment of hemodialysis fistulas and grafts.

    Science.gov (United States)

    Bittl, John A

    2009-12-01

    The aim of this study was to analyze the risk and consequences of venous rupture during angioplasty of malfunctioning hemodialysis grafts and fistulas. Venous stenoses in the outflow limb of hemodialysis accesses often require ultra-high balloon pressure for optimal dilatation. Baseline characteristics and outcomes were analyzed for a consecutive series of patients treated between 1999 and 2008. Venous rupture or perforation occurred in 11 of 1242 (0.9%) procedures. No patient with a rupture or perforation died or required emergency or urgent surgical repair. Two of 11 patients (18.2%) required transfusions, 8 of 11 patients (72.7%) required stenting, and 6 of 8 (75.0%) who needed stenting received covered stents to achieve hemostasis. Rupture led to access thrombosis within 30 days in 9 of 11 cases (82%). Multivariable logistical regression analysis suggested that using a balloon catheter more than 2 mm larger than the diameter of the hemodialysis access or using peripheral cutting balloons increased the risk of rupture or perforation. Rupture or perforation is a rare complication of treatment of malfunctioning hemodialysis grafts and fistulas. The complication may be managed with nonsurgical methods and might be avoided by optimal balloon selection and sizing.

  18. Cerebral Arteriovenous Malformation Flow Is Associated With Venous Intimal Hyperplasia.

    Science.gov (United States)

    Shakur, Sophia F; Hussein, Ahmed E; Amin-Hanjani, Sepideh; Valyi-Nagy, Tibor; Charbel, Fady T; Alaraj, Ali

    2017-04-01

    The pathogenesis of venous intimal hyperplasia and venous outflow stenosis associated with cerebral arteriovenous malformation (AVM) draining veins is poorly understood. We sought to determine the relationship between maximum vein wall thickness and AVM flow. Patients who underwent AVM surgical resection and had flow measured before treatment using quantitative magnetic resonance angiography were retrospectively reviewed. Specimens were mounted on slides and stained with elastin special stain. Perinidal veins were identified, and maximum wall thickness was measured from digitized images. Relationship between maximum vein wall thickness and AVM flow was assessed. Twenty-eight patients were included. Spearman correlation revealed a statistically significant relationship between maximum vein wall thickness and total AVM flow (ρ=+0.51; P=0.006), AVM flow per draining vein (ρ=+0.41; P=0.03), and mean intranidal vessel diameter (ρ=+0.39; P=0.04). Maximum vein wall thickness increases with higher total AVM flow and AVM flow per draining vein. This finding implicates chronically high AVM inflow in venous intimal hyperplasia. © 2017 American Heart Association, Inc.

  19. Active Galactic Nuclei Feedback and Galactic Outflows

    Science.gov (United States)

    Sun, Ai-Lei

    Feedback from active galactic nuclei (AGN) is thought to regulate the growth of supermassive black holes (SMBHs) and galaxies. The most direct evidence of AGN feedback is probably galactic outflows. This thesis addresses the link between SMBHs and their host galaxies from four different observational perspectives. First, I study the local correlation between black hole mass and the galactic halo potential (the MBH - Vc relation) based on Very Large Array (VLA) HI observations of galaxy rotation curves. Although there is a correlation, it is no tighter than the well-studied MBH - sigma* relation between the black hole mass and the potential of the galactic bulge, indicating that physical processes, such as feedback, could link the evolution of the black hole to the baryons in the bulge. In what follows, I thus search for galactic outflows as direct evidence of AGN feedback. Second, I use the Atacama Large Millimeter Array (ALMA) to observe a luminous obscured AGN that hosts an ionized galactic outflow and find a compact but massive molecular outflow that can potentially quench the star formation in 10. 6 years.The third study extends the sample of known ionized outflows with new Magellan long-slit observations of 12 luminous obscured AGN. I find that most luminous obscured AGN (Lbol > 1046 ergs s-1) host ionized outflows on 10 kpc scales, and the size of the outflow correlates strongly with the luminosity of the AGN. Lastly, to capitalize on the power of modern photometric surveys, I experiment with a new broadband imaging technique to study the morphology of AGN emission line regions and outflows. With images from the Sloan Digital Sky Survey (SDSS), this method successfully constructs images of the [OIII]lambda5007 emission line and reveals hundreds of extended emission-line systems. When applied to current and future surveys, such as the Large Synoptic Survey Telescope (LSST), this technique could open a new parameter space for the study of AGN outflows. In

  20. A robust measurement of the mass outflow rate of the galactic outflow from NGC 6090

    Science.gov (United States)

    Chisholm, John; Tremonti Christy, A.; Leitherer, Claus; Chen, Yanmei

    2016-11-01

    To evaluate the impact of stellar feedback, it is critical to estimate the mass outflow rates of galaxies. Past estimates have been plagued by uncertain assumptions about the outflow geometry, metallicity, and ionization fraction. Here we use Hubble Space Telescope ultraviolet spectroscopic observations of the nearby starburst NGC 6090 to demonstrate that many of these quantities can be constrained by the data. We use the Si IV absorption lines to calculate the scaling of velocity (v), covering fraction (Cf), and density with distance from the starburst (r), assuming the Sobolev optical depth and a velocity law of the form: v ∝ (1 - Ri/r)β (where Ri is the inner outflow radius). We find that the velocity (β = 0.43) is consistent with an outflow driven by an r-2 force with the outflow radially accelerated, while the scaling of the covering fraction (Cf ∝ r-0.82) suggests that cool clouds in the outflow are in pressure equilibrium with an adiabatically expanding medium. We use the column densities of four weak metal lines and CLOUDY photoionization models to determine the outflow metallicity, the ionization correction, and the initial density of the outflow. Combining these values with the profile fitting, we find Ri = 63 pc, with most of the mass within 300 pc of the starburst. Finally, we find that the maximum mass outflow rate is 2.3 M⊙ yr-1 and the mass-loading factor (outflow divided by the star formation rate) is 0.09, a factor of 10 lower than the value calculated using common assumptions for the geometry, metallicity, and ionization structure of the outflow.

  1. Scimitar syndrome with renal agenesis

    Directory of Open Access Journals (Sweden)

    Hasan Kahraman

    2012-01-01

    Full Text Available Partial pulmonary venous connection anomaly is relatively uncommon form of congenital heart diseases. The quite rare combination of this anomaly with hypoplasia of the right lung and dextroposition of the heart is designated as scimitar syndrome. Most cases are presented in infantile period and adult presentation is exceedingly rare. Our patient, a 38-year-old man, was admitted to a doctor with flu-like complaint and because of abnormalities on chest X-ray he was sent to our clinic. He did not have any chronic complaints such as shortness of breath and fatigue. After investigation, scimitar syndrome was diagnosed. Left renal agenesis was determined with abdominal examination. Best of our knowledge in literature we did not detect any case both with Scimitar syndrome and renal agenesis, and we wanted to report the asymptomatic adult Scimitar syndrome case with left renal agenesis.

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

    Directory of Open Access Journals (Sweden)

    Paolo Zamboni

    2016-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    Zamboni, Paolo

    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.

  4. Focus on renal congestion in heart failure.

    Science.gov (United States)

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2016-02-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.

  5. Bursty star formation feedback and cooling outflows

    Science.gov (United States)

    Suarez, Teresita; Pontzen, Andrew; Peiris, Hiranya V.; Slyz, Adrianne; Devriendt, Julien

    2016-10-01

    We study how outflows of gas launched from a central galaxy undergoing repeated starbursts propagate through the circum-galactic medium (CGM), using the simulation code RAMSES. We assume that the outflow from the disc can be modelled as a rapidly moving bubble of hot gas at ˜1 kpc above disc, then ask what happens as it moves out further into the halo around the galaxy on ˜100 kpc scales. To do this, we run 60 two-dimensional simulations scanning over parameters of the outflow. Each of these is repeated with and without radiative cooling, assuming a primordial gas composition to give a lower bound on the importance of cooling. In a large fraction of radiative-cooling cases we are able to form rapidly outflowing cool gas from in situ cooling of the flow. We show that the amount of cool gas formed depends strongly on the `burstiness' of energy injection; sharper, stronger bursts typically lead to a larger fraction of cool gas forming in the outflow. The abundance ratio of ions in the CGM may therefore change in response to the detailed historical pattern of star formation. For instance, outflows generated by star formation with short, intense bursts contain up to 60 per cent of their gas mass at temperatures <5 × 104 K; for near-continuous star formation, the figure is ≲5 per cent. Further study of cosmological simulations, and of idealized simulations with e.g. metal-cooling, magnetic fields and/or thermal conduction, will help to understand the precise signature of bursty outflows on observed ion abundances.

  6. A follow-up study of the fate of small asymptomatic deep venous thromboses

    Directory of Open Access Journals (Sweden)

    Persson Lena M

    2010-02-01

    Full Text Available Abstract Background Postoperative asymptomatic deep venous thromboses (ADVT can give rise to posttthrombotic syndrome (PTS, but there are still many unresolved issues in this context. For example, there is a lack of knowledge regarding the fate of small ADVT following minor orthopedic surgery. This follow-up study evaluates postthrombotic changes and clinical manifestations of PTS in a group of patients with asymptomatic calf vein DVT after surgery for Achilles tendon rupture. Methods Forty-six consecutive patients with distal ADVT were contacted and enrolled in a follow-up consisting of a single visit at the hospital at a mean time of 5 years postoperatively, including clinical examination and scoring, ultrasonography and venous plethysmography. All patients had participated in DVT-screening with colour duplex ultrasound (CDU 3 and 6 weeks postoperatively and 80% of them were treated with anticoagulation. Results With CDU postthrombotic changes and deep venous reflux were detected at follow-up in more than 50% of the patients, more commonly in somewhat larger calf DVT:s initially affecting more than one vessel. However, only about 10% of the patients had significant venous reflux according to venous plethysmography. No patient had plethysmographic evidence of remaining outflow obstruction, but presence of postthrombotic changes shown with CDU negatively influenced venous outflow capacity measured with plethysmography. A clinical entity of PTS was rarely found and occurred only in two patients (4% and then classified by Villalta scoring as of mild degree with few clinical signs of disease. Distal ADVT:s detected in the early postoperative period (3 weeks showed DVT-progression in 75% of the limbs that were still immobilized and without anticoagulation. Conclusions Asymptomatic postoperative distal DVT:s following surgery for Achilles tendon rupture have a good prognosis and a favourable clinical outcome. In our material of 46 patients the

  7. Pressurized groundwater outflow experiments and numerical modeling for outflow channels on Mars

    NARCIS (Netherlands)

    Marra, Wouter A.; Hauber, Ernst; McLelland, Stuart J.; Murphy, Brendan J.; Parsons, Daniel R.; Conway, Susan J.; Roda, Manuel; Govers, Rob; Kleinhans, Maarten G.

    2014-01-01

    The landscape of Mars shows incised channels that often appear abruptly in the landscape, suggesting a groundwater source. However, groundwater outflow processes are unable to explain the reconstructed peak discharges of the largest outflow channels based on their morphology. Therefore, there is a d

  8. [Cerebral venous thrombosis in minimal change nephrotic syndrome].

    Science.gov (United States)

    Hirata, M; Kuroda, M; Koni, I

    1999-06-01

    A 46-year old man presented with an eight-day history of edema and was found to be nephrotic, with a plasma albumin level of 1.1 g/dl and urine protein excretion of 13.3 g/24 hrs. The level of plasma creatinine was normal at 1.0 mg/dl. A finding of renal biopsy was consistent with minimal change glomerulopathy. On the 6th hospital day, he suddenly developed a severe headache and was noted to have bilateral papilledema. Lumbar puncture revealed an opening pressure of 250 mm of water. Magnetic resonance venography showed an irregular flow in the superior sagittal sinus and right transverse sinus, a finding consistent with thrombus. The diagnosis of cerebral venous thrombosis was made, and the patient was given both Warfarin 2 mg/day and prednisolone 60 mg/day. A complete recovery from nephrotic syndrome was achieved within eight weeks. Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. The most common clinical features are renal vein thrombosis, femoral vein thrombosis, and pulmonary embolism, however, cerebral venous sinus thrombosis is rare in patients with nephrotic syndrome. It is important to be aware of this complication, since prompt treatment with anticoagulation and control of nephrotic syndrome can lead to a successful outcome.

  9. Renal Sinus Fat Invasion and Tumoral Thrombosis of the Inferior Vena Cava-Renal Vein: Only Confined to Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Turker Acar

    2014-01-01

    Full Text Available Epithelioid angiomyolipoma (E-AML, accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC. In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC.

  10. Management of venous malformations.

    Science.gov (United States)

    Richter, Gresham T; Braswell, Leah

    2012-12-01

    Venous malformations (VMs) frequently occur in the head and neck with a predilection for the parotid gland, submandibular triangle, buccal space, muscles of mastication, lips, and upper aerodigestive tract. They are composed of congenitally disrupted ectatic veins with inappropriate connections and tubular channels. Because VMs have poorly defined boundaries and a tendency to infiltrate normal tissue, they require calculated treatment decisions in the effort to preserve surrounding architecture. Sclerotherapy, surgical excision, neodymium:yttrium aluminum garnet laser therapy, or a combination of these modalities is employed in the management of VMs. Although many small VMs can be cured, the objective is often to control the disease with periodic therapy. Location, size, and proximity to vital structures dictate the type of therapy chosen. Vigilance with long-term follow up is important. This review outlines current diagnostic and therapeutic approaches to simple and extensive cervicofacial VMs. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed...... is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together...... therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS...

  12. Chronic kidney disease stages 1-3 increase the risk of venous thrombosis

    NARCIS (Netherlands)

    Ocak, G.; Verduijn, M.; Vossen, C. Y.; Lijfering, W. M.; Dekker, F. W.; Rosendaal, F. R.; Gansevoort, R. T.; Mahmoodi, B. K.

    2010-01-01

    P>Background: End-stage renal disease has been associated with venous thrombosis (VT). However, the risk of VT in the early stages of chronic kidney disease (CKD) has not yet been investigated. The aim of this study was to investigate whether CKD patients with stage 1-3 disease are at increased risk

  13. Statin use in patients with nephrotic syndrome is associated with a lower risk of venous thromboembolism

    NARCIS (Netherlands)

    Resh, Mohammad; Mahmoodi, Bakhtawar K.; Navis, Gerjan J.; Veeger, Nic J. G. M.; Lijfering, Willem M.

    2011-01-01

    Background: Nephrotic syndrome (NS) is a well-known risk factor for venous thromboembolism (VTE), however preventive measures are not routinely taken. In non-renal populations, statins are associated with lower risk of VTE. Hence, we set up this single-center retrospective cohort study to assess whe

  14. Antiphospholipid Antibody Syndrome: Raised Intracranial Pressure Without Cerebral Venous Sinus Thrombosis.

    Science.gov (United States)

    Rudich, Danielle S; Yun, Samuel H; Liebling, Anne; Silbert, Jonathan E; Moeckel, Gilbert W; Lesser, Robert L

    2015-12-01

    Antiphospholipid antibody syndrome (APS) has been reported to cause elevated intracranial pressure, but usually this is due to cerebral venous sinus thrombosis (CVST). We present a 36-year old man with APS with elevated intracranial pressure with neuro-ophthalmic, renal and hematological involvement without identifiable CVST.

  15. Overview of venous thromboembolism.

    Science.gov (United States)

    Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Rocha, Eduardo

    2010-12-14

    Thrombosis occurs at sites of injury to the vessel wall, by inflammatory processes leading to activation of platelets, platelet adherence to the vessel wall and the formation of a fibrin network. A thrombus that goes on to occlude a blood vessel is known as a thromboembolism. Venous thromboembolism begins with deep vein thrombosis (DVT), which forms in the deep veins of the leg (calf) or pelvis. In some cases, the DVT becomes detached from the vein and is transported to the right-hand side of the heart, and from there to the pulmonary arteries, giving rise to a pulmonary embolism (PE). Certain factors predispose patients toward the development of venous thromboembolism (VTE), including surgery, trauma, hospitalization, immobilization, cancer, long-haul travel, increased age, obesity, major medical illness and previous VTE; in addition, there may also be a genetic component to VTE. VTE is responsible for a substantial number of deaths per annum in Europe. Anticoagulants are the mainstay of both VTE treatment and VTE prevention, and many professional organizations have published guidelines on the appropriate use of anticoagulant therapies for VTE. Treatment of VTE aims to prevent morbidity and mortality associated with the disease, and any long-term complications such as VTE recurrence or post-thrombotic syndrome. Generally, guidelines recommend the use of low molecular weight heparins (LMWH), unfractionated heparin (UFH) or fondaparinux for the pharmacological prevention and treatment of VTE, with the duration of therapy varying according to the baseline characteristics and risk profile of the individual. Despite evidence showing that the use of anticoagulation prevents VTE, the availability of several convenient, effective anticoagulant therapies and the existence of clear guideline recommendations, thromboprophylaxis is underused, particularly in patients not undergoing surgery. Greater adherence to guideline-recommended therapies, such as LMWH, which can be

  16. Protostellar Outflows and Radiative Feedback from Massive Stars. II. Feedback, Star Formation Efficiency, and Outflow Broadening

    CERN Document Server

    Kuiper, Rolf; Yorke, Harold W

    2016-01-01

    We perform two-dimensional axially symmetric radiation-hydrodynamic simulations to assess the impact of outflows and radiative force feedback from massive protostars by varying when the protostellar outflow starts, the ratio of ejection to accretion rates, and the strength of the wide angle disk wind component. The star formation efficiency, i.e. the ratio of final stellar mass to initial core mass, is dominated by radiative forces and the ratio of outflow to accretion rates. Increasing this ratio has three effects: First, the protostar grows slower with a lower luminosity at any given time, lowering radiative feedback. Second, bipolar cavities cleared by the outflow are larger, further diminishing radiative feedback on disk and core scales. Third, the higher momentum outflow sweeps up more material from the collapsing envelope, decreasing the protostar's potential mass reservoir via entrainment. The star formation efficiency varies with the ratio of ejection to accretion rates from 50% in the case of very we...

  17. Evolution of Mass Outflow in Protostars

    CERN Document Server

    Watson, Dan M; Fischer, William J; Forrest, W J; Manoj, P; Megeath, S Thomas; Melnick, Gary J; Najita, Joan; Neufeld, David A; Sheehan, Patrick D; Stutz, Amelia M; Tobin, John J

    2015-01-01

    We have surveyed 84 Class 0, Class I, and flat-spectrum protostars in mid-infrared [Si II], [Fe II] and [S I] line emission, and 11 of these in far-infrared [O I] emission. We use the results to derive their mass outflow rates. Thereby we observe a strong correlation of mass outflow rates with bolometric luminosity, and with the inferred mass accretion rates of the central objects, which continues through the Class 0 range the trend observed in Class II young stellar objects. Along this trend from large to small mass-flow rates, the different classes of young stellar objects lie in the sequence Class 0 -- Class I/flat-spectrum -- Class II, indicating that the trend is an evolutionary sequence in which mass outflow and accretion rates decrease together with increasing age, while maintaining rough proportionality. The survey results include two which are key tests of magnetocentrifugal outflow-acceleration mechanisms: the distribution of the outflow/accretion branching ratio b, and limits on the distribution of...

  18. Bursty star formation feedback and cooling outflows

    CERN Document Server

    Suarez, Teresita; Peiris, Hiranya V; Slyz, Adrianne; Devriendt, Julien

    2016-01-01

    We study how outflows of gas launched from a central galaxy undergoing repeated starbursts propagate through the circumgalactic medium (CGM), using the simulation code RAMSES. We assume that the outflow from the disk can be modelled as a rapidly moving bubble of hot gas at $\\mathrm{\\sim1\\;kpc}$ above disk, then ask what happens as it moves out further into the halo around the galaxy on $\\mathrm{\\sim 100\\;kpc}$ scales. To do this we run 60 two-dimensional simulations scanning over parameters of the outflow. Each of these is repeated with and without radiative cooling, assuming a primordial gas composition to give a lower bound on the importance of cooling. In a large fraction of radiative-cooling cases we are able to form rapidly outflowing cool gas from in situ cooling of the flow. We show that the amount of cool gas formed depends strongly on the 'burstiness' of energy injection; sharper, stronger bursts typically lead to a larger fraction of cool gas forming in the outflow. The abundance ratio of ions in th...

  19. Extra-abdominal venous thromboses at unusual sites.

    Science.gov (United States)

    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.

  20. Severe venous neointimal hyperplasia prior to dialysis access surgery

    Science.gov (United States)

    Lee, Timmy; Chauhan, Vibha; Krishnamoorthy, Mahesh; Wang, Yang; Arend, Lois; Mistry, Meenakshi J.; El-Khatib, Mahmoud; Banerjee, Rupak; Munda, Rino; Roy-Chaudhury, Prabir

    2011-01-01

    Background. Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement. Methods. Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples. Results. Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present. Conclusion. Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created. PMID:21220751

  1. Epidemiology of recurrent venous thrombosis

    Directory of Open Access Journals (Sweden)

    D.D. Ribeiro

    2012-01-01

    Full Text Available Venous thrombosis, including deep vein thrombosis and pulmonary embolism, is a common disease that frequently recurs. Recurrence can be prevented by anticoagulants, but this comes at the risk of bleeding. Therefore, assessment of the risk of recurrence is important to balance the risks and benefits of anticoagulant treatment. This review briefly outlines what is currently known about the epidemiology of recurrent venous thrombosis, and focuses in more detail on potential new risk factors for venous recurrence. The general implications of these findings in patient management are discussed.

  2. Observations of Protostellar Outflow Feedback in Clustered Star Formation

    CERN Document Server

    Nakamura, Fumitaka

    2015-01-01

    We discuss the role of protostellar outflow feedback in clustered star formation using the observational data of recent molecular outflow surveys toward nearby cluster-forming clumps. We found that for almost all clumps, the outflow momentum injection rate is significantly larger than the turbulence dissipation rate. Therefore, the outflow feedback is likely to maintain supersonic turbulence in the clumps. For less massive clumps such as B59, L1551, and L1641N, the outflow kinetic energy is comparable to the clump gravitational energy. In such clumps, the outflow feedback probably affects significantly the clump dynamics. On the other hand, for clumps with masses larger than about 200 M$_\\odot$, the outflow kinetic energy is significantly smaller than the clump gravitational energy. Since the majority of stars form in such clumps, we conclude that outflow feedback cannot destroy the whole parent clump. These characteristics of the outflow feedback support the scenario of slow star formation.

  3. Renal perfusion scintiscan

    Science.gov (United States)

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  4. Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis

    DEFF Research Database (Denmark)

    Blinkenberg, M; Akeson, P; Sillesen, H;

    2012-01-01

    The traditional view that multiple sclerosis (MS) is an autoimmune disease has recently been challenged by the claim that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). Although several studies have questioned this vascular theory, the CCSVI controversy is still ongoing. Our...... aim was to assess the prevalence of CCSVI in Danish MS patients using sonography and compare these findings with MRI measures of venous flow and morphology....

  5. Magnetospheric outflows in young stellar objects

    Directory of Open Access Journals (Sweden)

    Zanni Claudio

    2014-01-01

    Full Text Available Different classes of outflows are associated with the magnetospheric activity of accreting T Tauri protostars. Stellar winds are accelerated along the open field lines anchored in the stellar surface; disk winds (extended or X-type can be launched along the open magnetic surfaces threading the accretion disk; another type of ejection can arise from the region of interaction of the closed magnetosphere with the accretion disk (magnetospheric ejections, conical winds, where the magnetic surfaces undergo quasiperiodic episodes of inflation and reconnection. In this chapter I will present the main dynamical properties of these different types of outflow. Two main issues will be addressed. First, I will try to understand if these ejection phenomena can account for the origin of the jets often observed in young forming stellar systems. Second, I will evaluate the impact of these outflows on the angular momentum evolution of the central protostar.

  6. Doppler ultrasound study and venous mapping in chronic venous insufficiency.

    Science.gov (United States)

    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. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  7. Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation.

    Science.gov (United States)

    Martinho, Gláucia Helena; Romanelli, Roberta M C; Teixeira, Gustavo Machado; Macedo, Antonio V; Chaia, Juliana M C; Nobre, Vandack

    2013-07-01

    In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

  8. Renal neurohormonal regulation in heart failure decompensation.

    Science.gov (United States)

    Jönsson, Sofia; Agic, Mediha Becirovic; Narfström, Fredrik; Melville, Jacqueline M; Hultström, Michael

    2014-09-01

    Decompensation in heart failure occurs when the heart fails to balance venous return with cardiac output, leading to fluid congestion and contributing to mortality. Decompensated heart failure can cause acute kidney injury (AKI), which further increases mortality. Heart failure activates signaling systems that are deleterious to kidneys such as renal sympathetic nerve activity (RSNA), renin-angiotensin-aldosterone system, and vasopressin secretion. All three reduce renal blood flow (RBF) and increase tubular sodium reabsorption, which may increase renal oxygen consumption causing AKI through renal tissue hypoxia. Vasopressin contributes to venous congestion through aquaporin-mediated water retention. Additional water retention may be mediated through vasopressin-induced medullary urea transport and hyaluronan but needs further study. In addition, there are several systems that could protect the kidneys and reduce fluid retention such as natriuretic peptides, prostaglandins, and nitric oxide. However, the effect of natriuretic peptides and nitric oxide are blunted in decompensation, partly due to oxidative stress. This review considers how neurohormonal signaling in heart failure drives fluid retention by the kidneys and thus exacerbates decompensation. It further identifies areas where there is limited data, such as signaling systems 20-HETE, purines, endothelin, the role of renal water retention mechanisms for congestion, and renal hypoxia in AKI during heart failure.

  9. Endovascular treatment of dural fistulas with the venous outflow of laterocavernous sinus

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Jiang Chuhan; Li Youxiang; Lv Ming [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing, 100050 (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing, 100050 (China)

    2010-08-15

    Objective: To report our findings concerning the laterocavernous sinus (LCS) drainage of dural fistulas, focusing our attention on the important implications in treatment of the LCS, which is one of the principal drainage pathways of the superficial middle cerebral vein (SMCV). Methods: Consecutive 32 patients with dural fistulas treated endovascularly between 2005 and 2008 were reviewed. Seven patients had angiographic features such as dural fistulas draining with SMCV via LCS. Clinical records for these 7 patients were focused to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Results: Over 3 years, 7 patients had 7 dural fistulas drained with SMCV via LCS were treated. Six-vessel angiography confirmed the presence of the dural fistulas. All fistulas were Cognard Type III featured by leptomeningeal veins drainage. One fistula involving the lesser sphenoid wing and 6 fistulas involving CS were supplied by external carotid artery branches with or without dural branches of the internal carotid artery. LCS was identified as a contiguous to SMCV drainage in these cases. One patient was treated with transvenous coil embolization alone, two with transvenous a combination of Onyx and coil embolization, and 4 with transarterial embolization. An angiographic obliteration and clinical cure was achieved in all patients. Complication was local hair loss due to X-ray radiation in one patient. Conclusion: It is very important to diagnose the presence of LCS in dural fistulas during the diagnostic angiography. It is believed that the knowledge of LCS might be relevant for the understanding and treatment of dural fistulas involving the LCS.

  10. Central venous catheter - dressing change

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - flushing Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/17/2016 Updated by: ...

  11. Venous Thromboembolism and Atherosclerosis link

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2011-01-01

    @@ Past always venous thrombosis and arterial thrombo-sis as a separate system to be discussed, the main reason is because there is between the anatomical and pathologi-cal physiological differences, the clinical manifestations are very different.

  12. Venous complications of pancreatitis: a review.

    Science.gov (United States)

    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.

  13. Neonatal Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Kristina M. Haley

    2017-06-01

    Full Text Available Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE, and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow’s triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the

  14. Management of venous stenosis in living donor liver transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Jie Yang; Ming-Qing Xu; Lu-Nan Yan; Wu-Sheng Lu; Xiao Li; Zheng-Rong Shi; Bo Li; Tian-Fu Wen; Wen-Tao Wang; Jia-Ying Yang

    2009-01-01

    AIM: To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation (LDLT).METHODS: From February 1999 to May 2009, 1 intraoperative hepatic vein (HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients. Postoperative portal vein (PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT. Patients ranged in age from 9 to 56 years (median, 44 years). An air balloon was used to correct the intraoperative HV tension. Emergent surgical reoperation, transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3, 15, 50, 55, and 270 after LDLT, respectively. Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.RESULTS: The intraoperative HV tension was corrected with an air balloon. The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later. HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients. The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared, while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later. Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites, respectively. Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT, and this patient has survived for 9 mo without recurrent PV stenosis and ascites.CONCLUSION: Intraoperative balloon placement, emergent reoperation, proper

  15. Outflow reconstruction with arterial patch in domino liver transplantation:a new technical option

    Institute of Scientific and Technical Information of China (English)

    Laura Lladó; Emilio Ramos; Sofia De LaSerna; Joan Fabregat

    2014-01-01

    Domino liver transplantation (LT), using livers from familial amyloidotic polyneuropathy (FAP) patients, is a well described technique useful to expand donor pool. One of the main difficulties of this type of LT arises from the necessity to share the vascular pedicles between the graft and the donor. The most important challenge resides in restoring a proper hepatic venous outflow in the FAP-liver recipient. This is specially challenging when using the piggy-back technique, because the hepatic stumps may be too short. To overcome this issue, surgeons explored several techniques using different types of venous grafts. We describe a new technical option by using an arterial graft from the deceased donor. By using both iliac arteries a long graft is created and sutured as needed to the hepatic vein stump. We describe herein this new technique employed in a domino liver recipient who underwent retransplantation for ischemic cholangitis. The procedure was performed using the piggy-back technique; the venous stump of the FAP liver was reconstructed with the arterial graft. The patient had uneventful postoperative and mid-term hepatic function, and anastomosis was patent 24 months after LT.

  16. Acesso venoso trans-hepático percutâneo para hemodiálise: uma alternativa para pacientes portadores de insuficiência renal crônica Percutaneous transhepatic venous access for hemodialysis: an alternative route for patients with end-stage renal failure

    Directory of Open Access Journals (Sweden)

    Joaquim Maurício da Motta-Leal-Filho

    2010-09-01

    Full Text Available CONTEXTO: Acesso venoso trans-hepático percutâneo para hemodiálise é uma opção para pacientes que já exauriram acessos venosos tradicionais. OBJETIVO: Apresentar uma série de casos que demonstram a factibilidade e a funcionalidade da implantação dos cateteres semi-implantáveis por meio de acesso venoso trans-hepático percutâneo em pacientes sem possibilidades de outros acessos. MÉTODOS: Análise observacional retrospectiva dos prontuários de seis pacientes que foram submetidos à implantação de nove cateteres trans-hepáticos percutâneos para hemodiálise. Os cateteres foram implantados na ausência de acessos venosos periféricos disponíveis. No seguimento dos pacientes, procurou-se avaliar: sucesso técnico do procedimento, taxa de complicação, taxa de infecção e patência do acesso. RESULTADOS: Quatro homens e duas mulheres com idades entre 31 e 85 anos (média: 55 anos. Sucesso técnico obtido em 100%. A média de duração dos cateteres foi de 300,5 dias (2 a 814 dias. Médias de patência primária e secundária foram de 179,60 e 328,33 dias, respectivamente. Taxa de trombose dos cateteres foi de 0,05 por 100 cateteres-dias, assim como a taxa de infecção. Houve três complicações precoces (30 primeiros dias de implantação dos cateteres: dois deslocamentos dos cateteres e uma infecção. Duas complicações tardias foram observadas: uma trombose e uma migração. Três pacientes (50% tiveram que trocar seus cateteres. Taxa de mortalidade em 30 dias foi de 33%, porém não relacionada ao procedimento. CONCLUSÃO: Implantação do cateter para hemodiálise por meio do acesso venoso trans-hepático percutâneo parece ser uma técnica segura, porém a utilização desse acesso deve ser aplicada somente em casos de esgotamento de outros acessos vasculares profundos.BACKGROUND: Percutaneous transhepatic venous access is an option for hemodialysis patients who have exhausted all traditional sites of venous access

  17. Protostellar Outflow Evolution in Turbulent Environments

    Energy Technology Data Exchange (ETDEWEB)

    Cunningham, A; Frank, A; Carroll, J; Blackman, E; Quillen, A

    2008-04-11

    The link between turbulence in star formatting environments and protostellar jets remains controversial. To explore issues of turbulence and fossil cavities driven by young stellar outflows we present a series of numerical simulations tracking the evolution of transient protostellar jets driven into a turbulent medium. Our simulations show both the effect of turbulence on outflow structures and, conversely, the effect of outflows on the ambient turbulence. We demonstrate how turbulence will lead to strong modifications in jet morphology. More importantly, we demonstrate that individual transient outflows have the capacity to re-energize decaying turbulence. Our simulations support a scenario in which the directed energy/momentum associated with cavities is randomized as the cavities are disrupted by dynamical instabilities seeded by the ambient turbulence. Consideration of the energy power spectra of the simulations reveals that the disruption of the cavities powers an energy cascade consistent with Burgers-type turbulence and produces a driving scale-length associated with the cavity propagation length. We conclude that fossil cavities interacting either with a turbulent medium or with other cavities have the capacity to sustain or create turbulent flows in star forming environments. In the last section we contrast our work and its conclusions with previous studies which claim that jets can not be the source of turbulence.

  18. Accretion, Outflows, and Winds of Magnetized Stars

    CERN Document Server

    Romanova, M M

    2016-01-01

    Many types of stars have strong magnetic fields that can dynamically influence the flow of circumstellar matter. In stars with accretion disks, the stellar magnetic field can truncate the inner disk and determine the paths that matter can take to flow onto the star. These paths are different in stars with different magnetospheres and periods of rotation. External field lines of the magnetosphere may inflate and produce favorable conditions for outflows from the disk-magnetosphere boundary. Outflows can be particularly strong in the propeller regime, wherein a star rotates more rapidly than the inner disk. Outflows may also form at the disk-magnetosphere boundary of slowly rotating stars, if the magnetosphere is compressed by the accreting matter. In isolated, strongly magnetized stars, the magnetic field can influence formation and/or propagation of stellar wind outflows. Winds from low-mass, solar-type stars may be either thermally or magnetically driven, while winds from massive, luminous O and B type stars...

  19. The Resolved Outflow from 3C 48

    Science.gov (United States)

    Shih, Hsin-Yi; Stockton, Alan

    2014-10-01

    We investigate the properties of the high-velocity outflow driven by the young radio jet of 3C 48, a compact-steep-spectrum source. We use the Space Telescope Imaging Spectrograph on board the Hubble Space Telecope to obtain (1) low-resolution UV and optical spectra and (2) multi-slit medium-resolution spectra of the ionized outflow. With supporting data from ground-based spectrographs, we are able to accurately measure the ratios of diagnostic emission lines such as [O III] λ5007, [O III] λ3727, [N II] λ6548, Hα, Hβ, [Ne V] λ3425, and [Ne III] λ3869. We fit the observed emission-line ratios using a range of ionization models, powered by active galactic nucleus (AGN) radiation and shocks, produced by the MAPPINGS code. We have determined that AGN radiation is likely the dominant ionization source. The outflow's density is estimated to be in the range n = 103-104 cm-3, the mass is ~6 × 106 M ⊙, and the metallicity is likely equal to or higher than solar. Compared with the typical outflows associated with more evolved radio jets, this young outflow is denser, less massive, and more metal rich. Multi-slit observations allow us to construct a two-dimensional velocity map of the outflow that shows a wide range of velocities with distinct velocity components, suggesting a wide-angle clumpy outflow. Based in part on observations made with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These observations are associated with program GO-11574. Some of the data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation. Some of the

  20. Intracranial venous sinus thrombosis complicating AIDS-associated nephropathy.

    Science.gov (United States)

    Afsari, Khosrow; Frank, Jeffrey; Vaksman, Yulia; Nguyen, Thanhan V

    2003-03-01

    An alert and oriented 27-year-old African American woman with AIDS presented with a 10-day history of fever, cough productive of yellow sputum, nausea, and vomiting and a 1-day history of excruciating headache and photophobia. Her condition rapidly deteriorated into a coma with decorticate and then decerebrate posture, and she died 3 weeks later. There was evidence of extensive intracranial venous sinus thrombosis (ICVST), renal vein thrombosis (RVT), and multiple cerebral hemorrhagic infarcts due to a hypercoagulable state complicating AIDS-associated nephrotic syndrome. This is the first reported case of fatal ICVST and RVT with extensive cerebral hemorrhagic infarcts complicating nephrotic syndrome in a patient with AIDS.

  1. Outflow Entrainment and Feedback: A Case Study with HH46/47 Molecular Outflow

    Science.gov (United States)

    Zhang, Yichen; Arce, H.; Mardones, D.; Cabrit, S.

    2017-06-01

    Our ALMA multi-cycle multi-band observations of HH46/47 outflow show co-existence of entrainment by both wide-angle wind and jet bow-shock and this outflow is at a moment that the former has just become dominant. The estimated outflow mass and strength suggest that it has already strongly affected the core-to-star efficiency to 1/3 at this early stage. The zoom-in observation also reveals multiple wide outflowing shells with positions and shapes smoothly changing over a wide range of velocity, which may be an evidence of episodic eruption not only in jet but also in the wide-angle wind.

  2. The three-dimensional organisation of the post-trabecular aqueous outflow pathway and limbal vasculature in the mouse.

    Science.gov (United States)

    van der Merwe, Elizabeth L; Kidson, Susan H

    2014-08-01

    The mouse eye has been used as a model for studies on the microanatomy of the outflow pathways but most of what is known comes from histological sections. These studies have focused mainly on the morphological features of the trabecular meshwork, Schlemm's canal and aqueous channels that link to the superficial episcleral vasculature. However, the anatomical architecture of the aqueous outflow vessels and their relationship to each other and to the general vascular circulation is not well understood. The aim of this study was to provide a detailed description of the microarchitecture of the aqueous outflow vessels and their relationship to the superficial limbal/episcleral vasculature throughout the entire limbus. The aqueous outflow vessels and blood and lymphatic vessels were imaged in PECAM-1 and LYVE-1 immunostained whole anterior segments of adult mice and three-dimensional (3-D) reconstructions of the optical sections were generated to reveal the aqueous, blood and lymphatic architecture. The arterial supply, venous drainage, organisation of perilimbal vasculature, collector channels/aqueous veins and the morphology of Schlemm's canal were revealed in their entirety and the relationships between these structures is described. Schlemm's canal was PECAM-1 positive but there was no affinity for the lymphatic marker LYVE-1. We show that Schlemm's canal is a continuous circular structure and more often seen as a single, broad, varicose vessel with short regions appearing as a plexus. Aqueous veins link Schlemm's canal to the superficial vasculature and there were no direct links seen between the canal and the lymphatic vessels.

  3. Contemporary diagnosis of venous malformation

    Directory of Open Access Journals (Sweden)

    Lee BB

    2013-11-01

    Full Text Available BB Lee,1 I Baumgartner21Department of Surgery, George Washington University, Washington, DC, USA; 2Swiss Cardiovascular Center, University Hospital Bern, Bern, SwitzerlandAbstract: Venous malformation is a congenital vascular malformation resulting from defective development during various stages of embryogenesis and selectively affecting the venous system. Depending on the embryologic stage when the developmental arrest occurred, the clinical presentation of venous malformation is extremely variable in location, extent, severity, natural progression, and hemodynamic impact. Extratruncular lesions occur in the earlier stages of embryonic life, and retain characteristics unique to mesenchymal cells (angioblasts, growing and proliferating when stimulated internally (eg, by menarche, pregnancy, and hormones or externally (eg, by trauma or surgery. These lesions also have a significant hemodynamic impact on the venous system involved, in addition to the risk of localized intravascular coagulopathy. However, truncal lesions, as defective developments along the late stage, no longer carry the risk of proliferation and recurrence due to lack of mesenchymal characteristics. Although, they often have serious hemodynamic consequences due to direct involvement of the main vein trunk. Therefore, a thorough clinical history and careful physical examination should be followed by an appropriate combination of noninvasive and less invasive tests (eg, Doppler ultrasonography, magnetic resonance imaging, computed tomography to confirm the clinical impression as well as to define the extent and severity of the venous malformation. Invasive tests, eg, phlebography or angiography, are seldom needed for the diagnosis per se. Additional evaluation for coagulation abnormalities, eg, D-dimer and fibrinogen levels, is generally recommended, especially for the treatment of surgery and endovascular candidates with extensive lesions to assess the localized intravascular

  4. Venous chest anatomy: clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Chasen, M.H.; Charnsangavej, C. [Department of Diagnostic Imaging, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 (United States)

    1998-03-01

    This article provides a practical approach to the clinical implications and importance of understanding the collateral venous anatomy of the thorax. Routine radiography, conventional venography, computed tomography (CT), and magnetic resonance (MR) imaging studies provide correlative anatomic models for the demonstration of how interconnecting collateral vascular networks within the thorax maintain venous stability at all times. Five major systems comprise the collateral venous network of the thorax ( Fig. 1 ). These include the paravertebral, azygos-hemiazygos, internal mammary, lateral thoracic, and anterior jugular venous systems (AJVS). The five systems are presented in the following sequence: (a) a brief introduction to the importance of catheter position and malposition in understanding access to the thoracic venous system, (b) the anatomy of the azygos-hemiazygos systems and their relationship with the paravertebral plexus, (c) the importance of the AJVS, (d) 'loop' concepts interconnecting the internal mammary and azygos-hemiazygos systems by means of the lateral thoracic and intercostal veins, and (e) the interconnecting venous networks on the thoracic side of the thoracoabdominal junction. Certain aspects of the venous anatomy of the thorax will not be discussed in this chapter and include (a) the intra-abdominal anastomoses between the superior and inferior vena cavae (IVC) via the internal mammary, lateral thoracic, and azygos-hemiazygos systems (beyond the scope of this article), (b) potential collateral vessels involving vertebral, parascapular, thyroidal, thymic, and other smaller veins that might anastomose with the major systems, and (c) anatomic variants and pitfalls that may mimic pathologic conditions (space limitations). (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  5. Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter.

    Science.gov (United States)

    Al Shakarchi, Julien; Inston, Nicholas; Jones, Robert G; Maclaine, Grant; Hollinworth, David

    2016-04-01

    In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK. A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs. In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft. The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for

  6. The Implications of Extreme Outflows from Extreme Starbursts

    OpenAIRE

    Heckman, Timothy M.; Borthakur, Sanchayeeta

    2016-01-01

    Interstellar ultraviolet absorption-lines provide crucial information about the properties of galactic outflows. In this paper, we augment our previous analysis of the systematic properties of starburst-driven galactic outflows by expanding our sample to include a rare population of starbursts with exceptionally high outflow velocities. In principle, these could be a qualitatively different phenomenon from more typical outflows. However, we find that instead these starbursts lie on, or along ...

  7. RENAL CRYOABLATION

    Directory of Open Access Journals (Sweden)

    A. V. Govorov

    2012-01-01

    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  8. Renal angiomyolipoma

    DEFF Research Database (Denmark)

    Holm-Nielsen, P; Sørensen, Flemming Brandt

    1988-01-01

    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  9. Numerical Study on Outflows in Seyfert Galaxies I: Narrow Line Region Outflows in NGC 4151

    Science.gov (United States)

    Mou, Guobin; Wang, Tinggui; Yang, Chenwei

    2017-07-01

    The origin of narrow line region (NLR) outflows remains unknown. In this paper, we explore the scenario in which these outflows are circumnuclear clouds driven by energetic accretion disk winds. We choose the well-studied nearby Seyfert galaxy NGC 4151 as an example. By performing 3D hydrodynamical simulations, we are able to reproduce the radial distributions of velocity, mass outflow rate, and kinetic luminosity of NLR outflows in the inner 100 pc deduced from spatial resolved spectroscopic observations. The demanded kinetic luminosity of disk winds is about two orders of magnitude higher than that inferred from the NLR outflows, but is close to the ultrafast outflows (UFO) detected in the X-ray spectrum and a few times lower than the bolometric luminosity of the Seyfert. Our simulations imply that the scenario is viable for NGC 4151. The existence of the underlying disk winds can be confirmed by their impacts on higher density ISM, e.g., shock excitation signs, and the pressure in NLR.

  10. Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

    Energy Technology Data Exchange (ETDEWEB)

    Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

    2012-09-15

    Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

  11. Extra- and transcranial echo colour Doppler in the diagnosis of chronic cerebrospinal venous insufficiency.

    Science.gov (United States)

    Van den Berg, P J; Visser, L H

    2012-03-01

    A new venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis (MS). It is a vascular condition characterized by an impaired cerebrospinal venous drainage due to obstructions in the main extracranial cerebrovenous outflow routes (i.e. internal jugular veins [IJV] and/or azygos veins). In this review, the studies which assessed the prevalence of CCSVI in MS by echo colour Doppler (ECD) will be discussed. The technical aspects of determination of the five CCSVI criteria: (1) reflux in the IJV and/or vertebral veins in supine and upright position, (2) reflux in the deep cerebral veins, (3) high-resolution B-mode proximal IJV stenosis, (4) flow not Doppler detectable in IJVs and/or vertebral veins (VVs) and (5) reverted postural control of the main cerebrovenous outflow pathway are described in detail. We conclude that so far there are many studies with contradictory results, and as yet a strong scientific base to support the evidence for a causative relationship of CCSVI and MS is lacking. Recent studies call into question the validity of using ECD as a proper and reliable test for the diagnosis of CCSVI. One explanation for the variety in interpretation of the individual CCSVI criteria, with the wide-ranging percentages CCSVI, could be the different methods by using ECD to determine various criteria.

  12. Venous hemodynamic changes in lower limb venous disease

    DEFF Research Database (Denmark)

    Lee, Byung Boong; Nicolaides, Andrew N; Myers, Kenneth

    2016-01-01

    ). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various......There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due...... not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect...

  13. Thrombosis in end-stage renal disease.

    Science.gov (United States)

    Casserly, Liam F; Dember, Laura M

    2003-01-01

    Although renal failure has classically been associated with a bleeding tendency, thrombotic events are common among patients with end-stage renal disease (ESRD). A variety of thrombosis-favoring hematologic alterations have been demonstrated in these patients. In addition, "nontraditional" risk factors for thrombosis, such as hyperhomocysteinemia, endothelial dysfunction, inflammation, and malnutrition, are present in a significant proportion of chronic dialysis patients. Hemodialysis (HD) vascular access thrombosis, ischemic heart disease, and renal allograft thrombosis are well-recognized complications in these patients. Deep venous thrombosis and pulmonary embolism are viewed as rare in chronic dialysis patients, but recent studies suggest that this perception should be reconsidered. Several ESRD treatment factors such as recombinant erythropoietin (EPO) administration, dialyzer bioincompatibility, and calcineurin inhibitor administration may have prothrombotic effects. In this article we review the pathogenesis and clinical manifestations of thrombosis in ESRD and evaluate the evidence that chronic renal failure or its management predisposes to thrombotic events.

  14. Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.

    Directory of Open Access Journals (Sweden)

    Pasquale Marchione

    Full Text Available 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

  15. MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Andreas Pomschar

    Full Text Available PURPOSE: To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI and age- and gender-matched controls. METHODS: Thirty adult subjects (15 with mTBI and 15 age- and gender-matched controls were investigated using a 3T MR scanner. Time since trauma was 0.5 to 29 years (mean 11.4 years. A 2D-time-of-flight MR-venography of the upper neck was performed to visualize the cervical venous vasculature. Cerebral venous drainage through primary and secondary channels, and intracranial compliance index and pressure were derived using cine-phase contrast imaging of the cerebral arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial compliance index is the defined as the ratio of maximal intracranial volume and pressure changes during the cardiac cycle. MR estimated ICP was then obtained through the inverse relationship between compliance and ICP. RESULTS: Compared to the controls, subjects with mTBI demonstrated a significantly smaller percentage of venous outflow through internal jugular veins (60.9±21% vs. controls: 76.8±10%; p = 0.01 compensated by an increased drainage through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03. Mean intracranial compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls 8.4±1.9; p<0.0007. Consequently, MR estimate of intracranial pressure was significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg; p<0.0007. CONCLUSIONS: mTBI is associated with increased venous drainage through secondary pathways. This reflects higher outflow impedance, which may explain the finding of reduced intracranial compliance. These results suggest that hemodynamic and hydrodynamic changes following mTBI persist even in the absence of clinical symptoms and abnormal findings in conventional MR imaging.

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

    Science.gov (United States)

    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

  17. [Extracorporeal renal replacement therapies in acute renal failure].

    Science.gov (United States)

    Schaefer, R M; Barenbrock, M; Teschner, M; Bahner, U

    2000-05-15

    The most serious forms of acute renal failure (ARF) are nowadays encountered in the intensive care unit (ICU), where up to 25% of new patients are reported to develop ARF. Lethality rates may reach 50 to 90% when the ARF is part of a multiple organ dysfunction syndrome. A multitude of extracorporeal procedures have been introduced into intensive care medicine. Applied with adequate skills and experience, most of these techniques will suffice to replace excretory renal function. However, because of low efficacy arterio-venous procedures (CAVH and CAVHD) have been abandoned for the veno-venous, pump-driven techniques (CVVH and CVVHD). Up to now, there is no consensus whether continuous or intermittent renal replacement therapy is more advantageous. In many cases, oliguric patients with circulatory instability will be treated by CVVH, even though there is no prospective study to show that in terms of outcome continuous treatment is superior to intermittent hemodialysis. It is equally conceivable to treat such patients with daily, prolonged (intermittent) hemodialysis. Apparently, the dose of replacement therapy, be it continuous filtration (36 to 48 l/24 h) or intermittent hemodialysis (daily 3 to 4 h) with a target BUN of less than 50 mg/dl, is more important than the modality of treatment. Moreover, there is good evidence that the use of biocompatible membranes (no complement- or leukocyte activation) is preferable and that with high-volume hemofiltration bicarbonate-containing replacement fluids should be used. However, despite all the technical advances, we firmly believe that the skills and the experience of those physicians and nurses who actually perform renal replacement therapy in the ICU are more important than the modality of treatment applied.

  18. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  19. Renal fallure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  20. Renal cancer.

    NARCIS (Netherlands)

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  1. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  2. Cerebral venous thrombosis in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Huisman, T.A.G.M.; Martin, E.; Willi, U.V. [Dept. of Diagnostic Imaging and Radiology, University Children' s Hospital Zurich (Switzerland); Holzmann, D. [Dept. of Otorhinolaryngology, University Children' s Hospital Zurich, Zurich (Switzerland)

    2001-09-01

    This was a retrospective study to determine different etiologies of cerebral venous thrombosis (CVT) in childhood and to correlate extent and location of thrombosis with the etiology and the age of the child as well as the final outcome. In addition, the radiologic approach is discussed. This was a retrospective analysis of 19 children with CVT. The children were examined by contrast-enhanced dynamic CT. Radiologic findings were correlated with the etiology of CVT. Cerebral venous thrombosis is not as infrequent in children as has been thought. Cerebral venous thrombosis in children can occur due to trauma (n=9), infections (n=7), or coagulation disorders (n=3). Extent and location of thrombosis, as well as complications, final outcome, and therapy, depend on the etiology. Computed tomography remains a valuable primary imaging modality in the diagnosis of CVT in the acutely injured or diseased child. (orig.)

  3. The role of magnetic resonance imaging in assessing venous vascular abnormalities in the head and neck: a demonstration of cerebrospinal venous insufficiency in a subset of multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    E. Mark Haacke

    2015-06-01

    Full Text Available The study of chronic cerebrospinal venous insufficiency (CCSVI and its impact on the development and progression of multiple sclerosis (MS remains controversial. Although the initial thrust in evaluating CCSVI was with ultrasound, other modalities including magnetic resonance imaging (MRI have been used to study venous vascular abnormalities. This review focuses on the findings of a number of past MRI studies including a look at a combined study of four previous works with a cohort of 559 MS patients regarding structure and function of the extra-cranial vasculature. Strengths and limitations of each paper are discussed which give insight into conflicting reports of venous abnormalities in MS patients and healthy controls. Guidelines for data acquisition and analysis for future studies related to extra-cranial structure and flow, both arterial and venous, are discussed. This includes the grading of stenosis of the internal jugular veins (IJVs as well as normalized flows through major veins of the neck. The lack of agreement between most studies is likely due to inconsistent data acquisition and incomplete data analysis. Our own work over four independent sites shows good agreement, indicating that there is a high incidence of stenosis and structural venous abnormalities in the MS population and that this change results in reduced outflow of the IJVs and increased collateralization of venous return to the heart compared to healthy controls.

  4. Dutch Venous Ulcer guideline update.

    Science.gov (United States)

    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.

  5. An extremely rare case of an incidentally detected renal vein aneurysm and review of literature

    Directory of Open Access Journals (Sweden)

    Dilliraj Prabakar

    2013-02-01

    Full Text Available Congenital renal vein aneurysms are a truncular type of venous malformation and are believed to be the outcome of defective development during the later stage of embryogenesis while the venous trunk is being formed. There have been 9 case reports so far. Here, we add the report of a patient who was incidentally detected to have a renal vein aneurysm on computed tomography angiogram. In addition, this is the first description of inferior vena cava thrombosis associated with a thrombosed saccular aneurysm of the renal vein.

  6. Influence of Mediterranean Outflow on climate

    Science.gov (United States)

    Rahmstorf, Stefan

    A cover article in Eos last year [Johnson, 1997] called for a dam across the Strait of Gibraltar to prevent a new Ice Age. In this article, R. G. Johnson argued that reduced Nile River flow after building the Aswan Dam increases Mediterranean Sea salinity, leading to enhanced outflow of salty water into the Atlantic Ocean. This, in turn, would alter the thermohaline (that is, temperature and salinity driven) circulation of the Atlantic, heat up the Labrador Sea and enhance evaporation there, and increase snowfall in Canada until a new ice sheet builds up. Ocean circulation model experiments, however, suggest that this fear is unfounded. While Mediterranean saltwater outflow (Figure 1a) does appear to have some effect on North Atlantic circulation and surface climate, the change in Mediterranean salt budget resulting from the Aswan Dam is far too small to have any noticeable impact.

  7. Protostellar outflows with Smoothed Particle Magnetohydrodynamics (SPMHD)

    CERN Document Server

    Bürzle, Florian; Stasyszyn, Federico; Dolag, Klaus; Klessen, Ralf S

    2011-01-01

    The protostellar collapse of a molecular cloud core is usually accompanied by outflow phenomena. The latter are thought to be driven by magnetorotational processes from the central parts of the protostellar disc. While several 3D AMR/nested grid studies of outflow phenomena in collapsing magnetically supercritical dense cores have been reported in the literature, so far no such simulation has been performed using the Smoothed Particle Hydrodynamics (SPH) method. This is mainly due to intrinsic numerical difficulties in handling magnetohydrodynamics within SPH, which only recently were partly resolved. In this work, we use an approach where we evolve the magnetic field via the induction equation, augmented with stability correction and divergence cleaning schemes. We consider the collapse of a rotating core of one solar mass, threaded by a weak magnetic field initially parallel to the rotation axis so that the core is magnetically supercritical. We show, that Smoothed Particle Magnetohydrodynamics (SPMHD) is a...

  8. A young man with nonhealing venous ulcers

    NARCIS (Netherlands)

    Vloedbeld, M. G.; Venema, A. W.; Smit, A. J.

    2006-01-01

    A 35-year-old man presented with nonhealing ulcers at an atypical location on his left foot, caused by a combination of venous insufficiency (after deep venous thrombosis) and arterial insufficiency. The underlying cause was Buerger's disease.

  9. Renal blood flow and metabolism after cold ischaemia: peroperative measurements in patients with calculi

    DEFF Research Database (Denmark)

    Petersen, H K; Henriksen, Jens Henrik Sahl

    1984-01-01

    correlated inversely to arterial-renal venous O2-difference (r = -0.74, P less than 0.05, n = 9) and directly to the preoperatively estimated unilateral glomerular filtration rate (r = 0.76, P less than 0.05, n = 8). After hypothermic ischaemia RBF decreased on the average by 42% (P less than 0.......01) immediately after re-established perfusion and 36% (P less than 0.02) 30 min later. In one additional patient, who had a short warm ischaemia (8 min), the flow pattern was the same. As arterial pressure remained constant, the reduced RBF signifies an increased renal vascular resistance. Renal O2-uptake...... and renal venous L/P ratio were almost constant, indicating no significant anaerobic processes being involved in the flow response. None of the patients showed any signs of reactive hyperaemia. It is concluded that hypothermic renal ischaemia may be followed by an increased renal vascular resistance even...

  10. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis.

    Science.gov (United States)

    Minet, Clémence; Potton, Leila; Bonadona, Agnès; Hamidfar-Roy, Rébecca; Somohano, Claire Ara; Lugosi, Maxime; Cartier, Jean-Charles; Ferretti, Gilbert; Schwebel, Carole; Timsit, Jean-François

    2015-08-18

    Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication of critical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis.

  11. Chronic Stress Facilitates the Development of Deep Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    Tao Dong

    2015-01-01

    Full Text Available The increasing pressure of modern social life intensifies the impact of stress on the development of cardiovascular diseases, which include deep venous thrombosis (DVT. Renal sympathetic denervation has been applied as one of the clinical approaches for the treatment of drug-resistant hypertension. In addition, the close relationship between oxidative stress and cardiovascular diseases has been well documented. The present study is designed to explore the mechanism by which the renal sympathetic nerve system and the oxidative stress affect the blood coagulation system in the development of DVT. Chronic foot shock model in rats was applied to mimic a state of physiological stress similar to humans. Our results showed that chronic foot shock procedure could promote DVT which may be through the activation of platelets aggregation. The aggravation of DVT and activation of platelets were alleviated by renal sympathetic denervation or antioxidant (Tempol treatment. Concurrently, the denervation treatment could also reduce the levels of circulating oxidation factors in rats. These results demonstrate that both the renal sympathetic nerve system and the oxidative stress contribute to the development of DVT in response to chronic stress, which may provide novel strategy for treatment of clinic DVT patients.

  12. DLA kinematics and outflows from starburst galaxies

    CERN Document Server

    Razoumov, Alexei O

    2008-01-01

    We present results from a numerical study of the multiphase interstellar medium in sub-Lyman-break galaxy protogalactic clumps. Such clumps are abundant at z=3 and are thought to be a major contributor to damped Ly-alpha absorption. We model the formation of winds from these clumps and show that during star formation episodes they feature outflows with neutral gas velocity widths up to several hundred km/s. Such outflows are consistent with the observed high-velocity dispersion in DLAs. In our models thermal energy feedback from winds and supernovae results in efficient outflows only when cold (~ 300 K), dense (> 100 msun/pc^3) clouds are resolved at grid resolution of 12 pc. At lower 24 pc resolution the first signs of the multiphase medium are spotted; however, at this low resolution thermal injection of feedback energy cannot yet create hot expanding bubbles around star-forming regions -- instead feedback tends to erase high-density peaks and suppress star formation. At 12 pc resolution feedback compresses...

  13. Hot Electromagnetic Outflows I: Acceleration and Spectra

    CERN Document Server

    Russo, Matthew

    2013-01-01

    The theory of cold, relativistic, magnetohydrodynamic outflows is generalized by the inclusion of an intense radiation source. In some contexts, such the breakout of a gamma-ray burst jet from a star, the outflow is heated to a high temperature at a large optical depth. Eventually it becomes transparent and is pushed to a higher Lorentz factor by a combination of the Lorentz force and radiation pressure. We obtain its profile, both inside and outside the fast magnetosonic critical point, when the poloidal magnetic field is radial and monopolar. Most of the energy flux is carried by the radiation field and the toroidal magnetic field that is wound up close to the rapidly rotating engine. Although the entrained matter carries little energy, it couples the radiation field to the magnetic field. Then the fast critical point is pushed inward from infinity and, above a critical radiation intensity, the outflow is accelerated mainly by radiation pressure. We identify a distinct observational signature of this hybrid...

  14. Magnotospheric imaging of high latitude ion outflows

    Directory of Open Access Journals (Sweden)

    D. E. Garrido

    Full Text Available High latitude ion outflows mostly consist of upward streaming O+ and He+ emanating from the ionosphere. At heights above 1000 km, these flows consist of cold and hot components which resonantly scatter solar extreme ultraviolet (EUV light, however, the ion populations respond differently to Doppler shifting resulting from the large relative velocities between the ions and the Sun. The possibility of optical detection of the Doppler effect on the scattering rate will be discussed for the O+ (83.4 nm ions. We have contrasted the EUV solar resonance images of these outflows by simulations of the 30.4 nm He+ and 83.4 nm O+ emissions for both quiet and disturbed geomagnetic conditions. Input data for the 1000 km level has been obtained from the EICS instrument aboard the Dynamics Explorer satellite. Our results show emission rates of 50 and 56 milli-Rayleighs at 30.4 nm for quiet and disturbed conditions and 65 and 75 milli-Rayleighs at 83.4 nm for quiet and disturbed conditions, respectively, obtained for a polar orbiting satellite and viewing radially outward. We also find that an imager at an equatorial distance of 9 RE or more is in a favourable position for detecting ion outflows, particularly when the plasmapause is depressed in latitude. However, an occultation disk is necessary to obscure the bright plasmaspheric emissions.

  15. Outflows of stars due to quasar feedback

    CERN Document Server

    Zubovas, Kastytis; Sazonov, Sergey; Sunyaev, Rashid

    2013-01-01

    Quasar feedback outflows are commonly invoked to drive gas out of galaxies in the early gas-rich epoch to terminate growth of galaxies. Here we present simulations that show that AGN feedback may drive not only gas but also stars out of their host galaxies under certain conditions. The mechanics of this process is as following: (1) AGN-driven outflows accelerate and compress gas filling the host galaxy; (2) the accelerated dense shells become gravitationally unstable and form stars on radial trajectories. For the spherically symmetric initial conditions explored here, the black hole needs to exceed the host's M_sigma mass by a factor of a few to accelerate the shells and the new stars to escape velocities. We discuss potential implications of these effects for the host galaxies: (i) radial mixing of bulge stars with the rest of the host; (ii) contribution of quasar outflows to galactic fountains as sources of high-velocity clouds; (iii) wholesale ejection of hyper velocity stars out of their hosts, giving ris...

  16. Central venous line complications and tip detection

    OpenAIRE

    Ameneh Rezaee Gheshlaghi; Hamid Zamani Moghadam Dolu; Elham Pishbin; Maryam Salehi

    2015-01-01

    Central venous line is one of a creative instrument that saves human’s life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement.Central veno...

  17. A Robust Measurement of the Mass Outflow Rate of the Galactic Outflow from NGC 6090

    CERN Document Server

    Chisholm, John; Leitherer, Claus; Chen, Yanmei

    2016-01-01

    To evaluate the impact of stellar feedback, it is critical to estimate the mass outflow rates of galaxies. Past estimates have been plagued by uncertain assumptions about the outflow geometry, metallicity, and ionization fraction. Here we use Hubble Space Telescope ultraviolet spectroscopic observations of the nearby starburst NGC 6090 to demonstrate that many of these quantities can be constrained by the data. We use the Si~{\\sc IV} absorption lines to calculate the scaling of velocity (v), covering fraction (C$_f$), and density with distance from the starburst (r), assuming the Sobolev optical depth and a velocity law of the form: $v \\propto(1 -R_i/r )^\\beta$ (were R$_i$ is the inner outflow radius). We find that the velocity ($\\beta$=0.43) is consistent with an outflow driven by an r$^{-2}$ force, while the scaling of the covering fraction ($C_f \\propto r^{-0.82}$) suggests that cool clouds in the outflow are in pressure equilibrium with an adiabatically expanding medium. We use the column densities of fou...

  18. Anomalous pulmonary venous return: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Gyeong Min; Kang, MinJin; Lee, Han Bee; Bae, Kyung Eun; Lee, Jaehe; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2013-10-15

    Partial anomalous pulmonary venous return is a type of congenital pulmonary venous anomaly. We present a rare type of partial pulmonary venous return, subaortic vertical vein drains left lung to superior vena cava, accompanying hypoplasia of the ipsilateral lung and pulmonary artery. We also review the previous report and relationship of these structures.

  19. Renal teratogens.

    Science.gov (United States)

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O

    2014-09-01

    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  20. [Right renal arteriovenous fistula after nephrectomy with streptococcal endarteritis].

    Science.gov (United States)

    Natali, J; Emerit, J; Reynier, P; Maraval, M

    1975-01-18

    The authors add a new case, to the 41 already published, of arterio-venous fistula of the renal pedicle after nephrectomy, with the peculiarity of its presentation as a prolonged fever resulting from streptococcal bacterial endarteritis at the site of the fistula (3rd case in the literature). Surgical treatment in association with massive and prolonged antibiotic therapy resulted in recovery.

  1. Hormonal contraceptives and venous thrombosis

    NARCIS (Netherlands)

    Stegeman, Berendina Hendrika (Bernardine)

    2013-01-01

    Oral contraceptive use is associated with venous thrombosis. However, the mechanism behind this remains unclear. The aim of this thesis was to evaluate genetic variation in the first-pass metabolism of contraceptives, to identify the clinical implications of hormonal contraceptive use after a

  2. Venous thrombosis : a patient's view

    NARCIS (Netherlands)

    Korlaar, Inez van

    2006-01-01

    The studies described in this thesis had two main aims: 1) To study the quality of life of patients with venous thrombosis and to examine the role of illness perceptions in explaining the quality of life of these patients. 2) To assess the psychological consequences of genetic testing for thrombop

  3. Familial clustering of venous thromboembolism

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Østergaard, Louise Bruun; Gundlund, Anna

    2016-01-01

    BACKGROUND: Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration. OBJECTIVES: To examine the relative ...

  4. Hormonal contraceptives and venous thrombosis

    NARCIS (Netherlands)

    Stegeman, Berendina Hendrika (Bernardine)

    2013-01-01

    Oral contraceptive use is associated with venous thrombosis. However, the mechanism behind this remains unclear. The aim of this thesis was to evaluate genetic variation in the first-pass metabolism of contraceptives, to identify the clinical implications of hormonal contraceptive use after a thromb

  5. Venous thrombosis : a patient's view

    NARCIS (Netherlands)

    Korlaar, Inez van

    2006-01-01

    The studies described in this thesis had two main aims: 1) To study the quality of life of patients with venous thrombosis and to examine the role of illness perceptions in explaining the quality of life of these patients. 2) To assess the psychological consequences of genetic testing for

  6. Venous thromboembolic disease. CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Goodman, L. R. [Medical College of Wisconsin, Pulmonary Medicine and Intensive Care, Dept. of Diagnostic Radiology, Milwaukee, WI (United States)

    2001-12-01

    Helical and multidetector CT has proven to be a valuable imaging modality for both pulmonary embolism and deep venous thrombosis. This paper will review the sensitivity and specificity of CT and discuss diagnostic algorithms utilizing CT and more established imaging technologies.

  7. Elevated albuminuria associated with increased risk of recurrent venous thromboembolism : results of a population-based cohort study

    NARCIS (Netherlands)

    van Schouwenburg, Inge M.; Mahmoodi, Bakhtawar K.; Veeger, Nic J. G. M.; Kluin-Nelemans, Hanneke C.; Gansevoort, Ron T.; Meijer, Karina

    2012-01-01

    This study examined the risk of recurrent venous thromboembolism (VTE) in patients with elevated albuminuria. In 1997-1998, inhabitants of Groningen, the Netherlands, aged 28-75 years (n = 85 421), were invited to participate in the PREVEND(Prevention of REnal and Vascular ENd stage Disease) Study,

  8. The Prevalence of Gas Outflows in Type 2 AGNs. II. 3D Biconical Outflow Models

    Science.gov (United States)

    Bae, Hyun-Jin; Woo, Jong-Hak

    2016-09-01

    We present 3D models of biconical outflows combined with a thin dust plane for investigating the physical properties of the ionized gas outflows and their effect on the observed gas kinematics in type 2 active galactic nuclei (AGNs). Using a set of input parameters, we construct a number of models in 3D and calculate the spatially integrated velocity and velocity dispersion for each model. We find that three primary parameters, i.e., intrinsic velocity, bicone inclination, and the amount of dust extinction, mainly determine the simulated velocity and velocity dispersion. Velocity dispersion increases as the intrinsic velocity or the bicone inclination increases, while velocity (i.e., velocity shifts with respect to systemic velocity) increases as the amount of dust extinction increases. Simulated emission-line profiles well reproduce the observed [O iii] line profiles, e.g., narrow core and broad wing components. By comparing model grids and Monte Carlo simulations with the observed [O iii] velocity-velocity dispersion distribution of ˜39,000 type 2 AGNs, we constrain the intrinsic velocity of gas outflows ranging from ˜500 to ˜1000 km s-1 for the majority of AGNs, and up to ˜1500-2000 km s-1 for extreme cases. The Monte Carlo simulations show that the number ratio of AGNs with negative [O iii] velocity to AGNs with positive [O iii] velocity correlates with the outflow opening angle, suggesting that outflows with higher intrinsic velocity tend to have wider opening angles. These results demonstrate the potential of our 3D models for studying the physical properties of gas outflows, applicable to various observations, including spatially integrated and resolved gas kinematics.

  9. Sarcoidose renal

    Directory of Open Access Journals (Sweden)

    AQUINO MARIA ENEDINA CLAUDINO DE

    2001-01-01

    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  10. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  11. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  12. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  13. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  14. Renal Hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    İbrahim Halil Bozkurt

    2015-03-01

    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  15. Two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging dialysis catheter.

    Science.gov (United States)

    Yoon, William J; Lorelli, David R

    2015-01-01

    The purpose of this study is to report a novel two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging hemodialysis catheter in internal jugular vein (IJV) catheter-dependent patients with contralateral central venous occlusion. The first stage is to implant the ePTFE component and consists of: 1) performing two to three incisions in the upper arm ipsilateral to the preexisting IJV catheter, 2) tunneling the expanded polytetrafluoroethylene (ePTFE) component through these incision sites, and 3) placing the ePTFE component in the subcutaneous tissue without anastomosing it to the target artery. The preexisting IJV catheter is maintained to provide continuous dialysis access. The second stage is initiated in 4 weeks and includes: 1) thrombectomy and anastomosing the ePTFE component arterial end to the target artery, 2) insertion of the venous outflow component using the preexisting IJV catheter access site, and 3) connecting the venous outflow component to the ePTFE component in the standard fashion. The HeRO graft was successfully implanted in two stages without using a femoral bridging catheter. Immediate postimplant cannulatabilty was achieved upon completion of the second stage procedure. This novel two-stage HeRO implantation technique is simple, yet allows immediate cannulation upon completion of the second stage procedure while avoiding the need of a femoral bridging catheter in IJV catheter- dependent patients with contralateral central venous occlusion, and thus lowering the risk of infection related to a femoral bridging catheter.

  16. [Complex etiology of acute renal failure in a newborn].

    Science.gov (United States)

    Krzemień, Grazyna; Szmigielska, Agnieszka; Bieroza, Iwona; Roszkowska-Blaim, Maria

    2008-01-01

    Acute renal failure (ARF), which is diagnosed in 3.4-20% of newborns, is polyetiological in most cases. We present a newborn with non-oliguric ARF diagnosed in the first day of life, and caused by asphixia, intrauterine infection (IUI) and nephrotoxic effects of metotrexate treatment during pregnancy. Antibiotics, including netilmicin and vankomycin, were given because of IUI and infected central venous catheter. Dosage of drugs was adjusted to renal failure parameters, but monitoring of their serum levels was not available. It could cause augmented acute tubular necrosis and interstitial nephritis. Analysis of ARF risk factors in newborns helps in early diagnosis of renal damage and in prompt implementation of therapy.

  17. A resolved outflow of matter from a Brown Dwarf

    CERN Document Server

    Whelan, E T; Bacciotti, F; Natta, A; Testi, L; Randich, S; Whelan, Emma T.; Ray, Thomas P.; Bacciotti, Francesca; Natta, Antonella; Testi, Leonardo; Randich, Sofia

    2005-01-01

    The birth of stars involves not only accretion but also, counter-intuitively, the expulsion of matter in the form of highly supersonic outflows. Although this phenomenon has been seen in young stars, a fundamental question is whether it also occurs amongst newborn brown dwarfs: these are the so-called 'failed stars', with masses between stars and planets, that never manage to reach temperatures high enough for normal hydrogen fusion to occur. Recently, evidence for accretion in young brown dwarfs has mounted, and their spectra show lines that are suggestive of outflows. Here we report spectro-astrometric data that spatially resolve an outflow from a brown dwarf. The outflow's characteristics appear similar to, but on a smaller scale than, outflows from normal young stars. This result suggests that the outflow mechanism is universal, and perhaps relevant even to the formation of planets.

  18. A resolved outflow of matter from a brown dwarf.

    Science.gov (United States)

    Whelan, Emma T; Ray, Thomas P; Bacciotti, Francesca; Natta, Antonella; Testi, Leonardo; Randich, Sofia

    2005-06-01

    The birth of stars involves not only accretion but also, counter-intuitively, the expulsion of matter in the form of highly supersonic outflows. Although this phenomenon has been seen in young stars, a fundamental question is whether it also occurs among newborn brown dwarfs: these are the so-called 'failed stars', with masses between stars and planets, that never manage to reach temperatures high enough for normal hydrogen fusion to occur. Recently, evidence for accretion in young brown dwarfs has mounted, and their spectra show lines that are suggestive of outflows. Here we report spectro-astrometric data that spatially resolve an outflow from a brown dwarf. The outflow's characteristics appear similar to, but on a smaller scale than, outflows from normal young stars. This result suggests that the outflow mechanism is universal, and perhaps relevant even to the formation of planets.

  19. Radiologically-placed venous ports in children under venous anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Joo Yeon; Jeon, Ung Bae; Choo, Ki Seok; Hwang, Jae Yeon; Kim, Yong Woo; Lee, Yun Jin; Nam, Sang Ool; Lim, Young Tak [Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2015-02-15

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  20. Interferometric Mapping of Perseus Outflows with MASSES

    Science.gov (United States)

    Stephens, Ian; Dunham, Michael; Myers, Philip C.; MASSES Team

    2017-01-01

    The MASSES (Mass Assembly of Stellar Systems and their Evolution with the SMA) survey, a Submillimeter Array (SMA) large-scale program, is mapping molecular lines and continuum emission about the 75 known Class 0/I sources in the Perseus Molecular Cloud. In this talk, I present some of the key results of this project, with a focus on the CO(2-1) maps of the molecular outflows. In particular, I investigate how protostars inherit their rotation axes from large-scale magnetic fields and filamentary structure.

  1. Functional Anatomy of the Outflow Facilities.

    Science.gov (United States)

    Pizzirani, Stefano; Gong, Haiyan

    2015-11-01

    In order to understand the pathophysiology, select optimal therapeutic options for patients and provide clients with honest expectations for cases of canine glaucoma, clinicians should be familiar with a rational understanding of the functional anatomy of the ocular structures involved in this group of diseases. The topographical extension and the structural and humoral complexity of the regions involved with the production and the outflow of aqueous humor undergo numerous changes with aging and disease. Therefore, the anatomy relative to the fluid dynamics of aqueous has become a pivotal yet flexible concept to interpret the different phenotypes of glaucoma.

  2. ATOMIC HYDROGEN IN A GALACTIC CENTER OUTFLOW

    Energy Technology Data Exchange (ETDEWEB)

    McClure-Griffiths, N. M.; Green, J. A.; Hill, A. S. [Australia Telescope National Facility, CSIRO Astronomy and Space Science, Marsfield, NSW 2122 (Australia); Lockman, F. J. [National Radio Astronomy Observatory, Green Bank, WV 24944 (United States); Dickey, J. M. [School of Physics and Mathematics, University of Tasmania, TAS 7001 (Australia); Gaensler, B. M.; Green, A. J., E-mail: naomi.mcclure-griffiths@csiro.au [Sydney Institute for Astronomy, School of Physics, The University of Sydney, NSW 2006 (Australia)

    2013-06-10

    We describe a population of small, high-velocity, atomic hydrogen clouds, loops, and filaments found above and below the disk near the Galactic center. The objects have a mean radius of 15 pc, velocity widths of {approx}14 km s{sup -1}, and are observed at |z| heights up to 700 pc. The velocity distribution of the clouds shows no signature of Galactic rotation. We propose a scenario where the clouds are associated with an outflow from a central star-forming region at the Galactic center. We discuss the clouds as entrained material traveling at {approx}200 km s{sup -1} in a Galactic wind.

  3. Outflows vs. Clouds in AGN Intrinsic Absorbers

    OpenAIRE

    Arav, Nahum

    2003-01-01

    We discuss the crucial role of a dynamical picture in the analysis of AGN intrinsic absorbers data. High quality FUSE data of Mrk 279 are used to demonstrate that the line of sight covering fraction is a strong function of velocity. In Mrk 279, as well as in most cases where the data is of high enough quality, the shape of the absorption troughs is mainly determined by the velocity-dependent covering fraction. We argue that the traditional ``cloud'' picture of AGN outflows is hard pressed to ...

  4. Misalignment of Magnetic Fields and Outflows in Protostellar Cores

    OpenAIRE

    Hull, Charles L. H.; Plambeck, Richard L.; Bolatto, Alberto D.; Bower, Geoffrey C.; Carpenter, John M.; Crutcher, Richard M.; Fiege, Jason D.; Franzmann, Erica; Hakobian, Nicholas S.; Heiles, Carl; Houde, Martin; Hughes, A. Meredith; Jameson, Katherine; Kwon, Woojin; Lamb, James W.

    2012-01-01

    We present results of λ1.3 mm dust-polarization observations toward 16 nearby, low-mass protostars, mapped with ~2."5 resolution at CARMA. The results show that magnetic fields in protostellar cores on scales of ~1000 AU are not tightly aligned with outflows from the protostars. Rather, the data are consistent with scenarios where outflows and magnetic fields are preferentially misaligned (perpendicular), or where they are randomly aligned. If one assumes that outflows emerge along the rotati...

  5. Mixed Capillary Venous Retroperitoneal Hemangioma

    Directory of Open Access Journals (Sweden)

    Mohit Godar

    2013-01-01

    Full Text Available We report a case of mixed capillary venous hemangioma of the retroperitoneum in a 61-year-old man. Abdominal ultrasonography showed a mass to be hypoechoic with increased flow in color Doppler imaging. Dynamic contrast-enhanced computed tomography revealed a centripetal filling-in of the mass, located anterior to the left psoas muscle at the level of sacroiliac joint. On the basis of imaging features, preoperative diagnosis of hemangioma was considered and the mass was excised by laparoscopic method. Immunohistochemical studies were strongly positive for CD31 and CD34, and negative for calretinin, EMA, WT1, HMB45, Ki67, synaptophysin, and lymphatic endothelial cell marker D2–40. Histologically, the neoplasm was diagnosed as mixed capillary venous hemangioma.

  6. [Vaginal metastasis of renal carcinoma (author's transl)].

    Science.gov (United States)

    Carl, P; Marx, F J

    1977-11-01

    Four cases of vaginal metastases of renal carcinoma are reported. This is an incidence of 1.3% in 313 operated patients (from 1/1/70 to 12/31/76). A surgical treatment of primary renal carcinoma and vaginal metastasis seems to be reasonable in there cases. Since in accordance with the literature metastatic involvement of vagina and vulva seems not to be a very rare finding, the diagnostic in renal carcinoma should imply a gynecologic examination. Although in carcinoma of the left kidney metastatic spreading into the external female genitalia most probably occurs by a retrograde venous pathway (left ovarian vein), the way of dissemination in carcinoma of the right side is unclear.

  7. Hydrocephalus in cerebral venous thrombosis.

    Science.gov (United States)

    Zuurbier, Susanna M; van den Berg, René; Troost, Dirk; Majoie, Charles B; Stam, Jan; Coutinho, Jonathan M

    2015-01-01

    Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and 2010 (prospectively since July 2006). Hydrocephalus was defined as a bicaudate index larger than the 95th percentile for age, and/or a radial width of the temporal horn of ≥ 5 mm. We excluded patients in whom hydrocephalus was caused by a disease other than CVT or if it was iatrogenic. 20 out of 99 patients with CVT had hydrocephalus. 6 patients with hydrocephalus were excluded from the analysis. Patients with hydrocephalus more often had focal neurological deficits (86 vs. 49%, p = 0.02) and were more frequently comatose (43 vs. 16%, p = 0.06), as compared to patients without hydrocephalus. Deep cerebral venous thrombosis (64 vs. 9%, p hydrocephalus. Intraventricular hemorrhage was present in 1 patient with hydrocephalus, compared to none among patients without hydrocephalus (7 vs. 0%, p = 0.15). Outcome at follow-up was worse in patients with hydrocephalus (mRS 0-1, 36 vs. 68%, p = 0.02; mortality 29 vs. 9%, p = 0.07). Hydrocephalus occurs more frequently in cerebral venous thrombosis than previously believed, especially in patients with deep cerebral venous thrombosis and edema of the basal ganglia. The presence of hydrocephalus is associated with a worse clinical outcome, but a direct causal relation is unlikely. Routine shunting procedures are not advisable.

  8. Shocks in nova outflows. I. Thermal emission

    CERN Document Server

    Metzger, Brian D; Vurm, Indrek; Beloborodov, Andrei M; Chomiuk, Laura; Sokoloski, J L; Nelson, Thomas

    2014-01-01

    Evidence for shocks in nova outflows include (1) multiple velocity components in the optical spectra; (2) keV X-ray emission weeks to months after the outburst; (3) early radio flare on timescales of months, in excess of that predicted from the freely expanding photo-ionized gas; and (4) ~ GeV gamma-rays. We present a 1D model for the shock interaction between the fast nova outflow and a dense external shell (DES) and its associated thermal X-ray, optical, and radio emission. The forward shock is radiative initially when the density of shocked gas is highest, at which times radio emission originates from the dense cooling layer immediately downstream of the shock. The radio light curve is characterized by sharper rises to maximum and later peak times at progressively lower frequencies, with a peak brightness temperature that is approximately independent of frequency. We apply our model to the recent gamma-ray classical nova V1324 Sco, obtaining an adequate fit to the early radio maximum for reasonable assumpt...

  9. Quasar feedback revealed by giant molecular outflows

    CERN Document Server

    Feruglio, Chiara; Piconcelli, Enrico; Menci, Nicola; Aussel, Herve'; Lamastra, Alessandra; Fiore, Fabrizio

    2010-01-01

    In the standard scenario for galaxy evolution the transformation of young star-forming galaxies into red bulge-dominated spheroids, where star formation has been quenched, is often explained by invoking a strong negative feedback generated by accretion onto a central super-massive black hole. The depletion of gas resulting from quasar-driven outflows should eventually stop star-formation across the host galaxy and lead to the black hole "suicide" for starvation. Direct observational evidence for a major quasar feedback onto the host galaxy is still missing, since outflows previously observed in quasars are associated with the ionized component of the gas, which only accounts for a minor fraction of the total gas content, and typically occur in the central regions. We used the IRAM PdBI to observe the CO(1-0) transition in Mrk 231, the closest quasar known. We detect broad wings of the CO line, with velocities up to 750 km/s and spatially resolved on the kpc scale. Such broad CO wings trace a giant molecular o...

  10. Jet driven molecular outflows in Orion

    CERN Document Server

    Rodríguez-Franco, A; Wilson, T L

    1999-01-01

    We present high sensitivity and high angular resolution images of the high velocity (vLSR>30kms^-1) CO emission in the J=1-0 and J=2-1 lines of the Orion KL region. These results reveal the morphology of the high-velocity CO emission at the most extreme velocities. High velocity emission have been only detected in two regions: BN/KL (IRc2/I) and Orion-S. The Orion-S region contains a very young (dynamical age of 10^3years), very fast (~110kms^-1) and very compact (<0.16pc) bipolar outflow. From the morphology of the high-velocity gas we estimate that the position of the powering source must be ~20'' north of FIR4. For the IRc2/I molecular outflow the morphology of the moderate velocity (<60kms^-1) gas shows a weak bipolarity around IRc2/I. The gas at the most extreme velocities does not show any bipolarity around IRc2/I, if any, it is found ~30'' north from these sources. The blue and redshifted gas at moderate velocities shows similar spatial distribution with a systematic trend for the size of the hig...

  11. Ionized Outflows from Compact Steep Spectrum Sources

    CERN Document Server

    Shih, Hsin-Yi; Kewley, Lisa

    2013-01-01

    Massive outflows are known to exist, in the form of extended emission-line regions (EELRs), around about one-third of powerful FR II radio sources. We investigate the origin of these EELRs by studying the emission-line regions around compact-steep-spectrum (CSS) radio galaxies that are younger (10$^3$ to 10$^5$ years old) versions of the FR II radio galaxies. We have searched for and analyzed the emission-line regions around 11 CSS sources by taking integral field spectra using GMOS on Gemini North. We fit the [\\ion{O}{3}] $\\lambda 5007$ line and present the velocity maps for each detected emission-line region. We find, in most cases, that the emission-line regions have multi-component velocity structures with different velocity dispersions and/or flux distributions for each component. The velocity gradients of the emission-line gas are mostly well aligned with the radio axis, suggesting a direct causal link between the outflowing gas and the radio jets. The complex velocity structure may be a result of diffe...

  12. Multidimensional chemical modelling, II. Irradiated outflow walls

    CERN Document Server

    Bruderer, Simon; Doty, Steven D; van Dishoeck, Ewine F; Bourke, Tyler L

    2009-01-01

    Observations of the high-mass star forming region AFGL 2591 reveal a large abundance of CO+, a molecule known to be enhanced by far UV (FUV) and X-ray irradiation. In chemical models assuming a spherically symmetric envelope, the volume of gas irradiated by protostellar FUV radiation is very small due to the high extinction by dust. The abundance of CO+ is thus underpredicted by orders of magnitude. In a more realistic model, FUV photons can escape through an outflow region and irradiate gas at the border to the envelope. Thus, we introduce the first 2D axi-symmetric chemical model of the envelope of a high-mass star forming region to explain the CO+ observations as a prototypical FUV tracer. The model assumes an axi-symmetric power-law density structure with a cavity due to the outflow. The local FUV flux is calculated by a Monte Carlo radiative transfer code taking scattering on dust into account. A grid of precalculated chemical abundances, introduced in the first part of this series of papers, is used to ...

  13. [DESCRIPTION OF A RETROPERITONEAL ACCESS ROUTE TO THE VESSELS OF THE SPLEEN FOR SPLENORENAL ARTERIAL AND VENOUS ANASTOMOSIS].

    Science.gov (United States)

    Gil-Vernet Vila, José María

    2014-01-01

    To perform arterial or venous spleno-renal anastomoses, surgeons have so far systematically used the transperitoneal way whic is burdened by a high mortality an morbility percentage. On the basis of anatomo-surgical considerations, a retroperitoneal approach has been found reaching the hilus of the spleen via the lumbar region; the first arterial spleno-renal anastomosis by this way was performed in 1972 and the first venous spleno-renal anastomosis due to portal hipertension also by this way was performed in 1974, the alter proving to be the least aggresive by avoiding damaging the páncreas, the most surgical and direct for reaching the splenic vessels thereby enabling a better exposure and an easier performing of the anastomoses. By being retroperitoneal, the loss or infección of the ascitic liquid in the cirrhotic patient is prevented.

  14. Polycystic Ovary Syndrome: The Correlation Between Renal Doppler Ultrasound and Laboratory Parameters

    Directory of Open Access Journals (Sweden)

    Elif Karadeli

    2014-12-01

    Full Text Available Aim: To investigate whether there is alteration both right and left kidney lenght, parenchymal thickness, renal arterial,venous blood flow measurements in normotensive reproductive age women with polycystic ovary syndrome (PCOS. Material and Method: Forty women with PCOS according to Rotterdam criteria and thirty-six healthy volunteers women were included in our study. Hormonal, biochemical analysis, renal Doppler ultrasonography were performed and were investigated in terms of both left and right renal lenght, parenchymal thickness, peak systolic velocity (PSV, resistive index (RI, venous impedance index (VI, metabolic characteristics having insulin resistance, impaired glucose tolerance, serum lipid concentration. The student t test and pearson corelation test were used for statistical analysis.Results: The measurements for kidneys were not different between women with PCOS and healthy women. The peak systolic velocity of mean renal artery was lower in PCOS group. The mean renal venous impedance also was higher in PCOS group than control group. The mean renal resistive index was slightly higher in PCOS but not statistical significant. In bivariate corelation analyse including all patients, it was seen that BMI, WHR, level of serum fasting glucose, insulin, LDL, trigliserides were positively related with mean renal length and mean parenchymal thickness measurements. Discussion: We found that there was alterations kidney blood flow in normotensive reproductive age women with PCOS. This findings may indicate results of long term renal and cardiovascular complications of PCOS.

  15. Measurement of Outflow Facility Using iPerfusion.

    Directory of Open Access Journals (Sweden)

    Joseph M Sherwood

    Full Text Available Elevated intraocular pressure (IOP is the predominant risk factor for glaucoma, and reducing IOP is the only successful strategy to prevent further glaucomatous vision loss. IOP is determined by the balance between the rates of aqueous humour secretion and outflow, and a pathological reduction in the hydraulic conductance of outflow, known as outflow facility, is responsible for IOP elevation in glaucoma. Mouse models are often used to investigate the mechanisms controlling outflow facility, but the diminutive size of the mouse eye makes measurement of outflow technically challenging. In this study, we present a new approach to measure and analyse outflow facility using iPerfusion™, which incorporates an actuated pressure reservoir, thermal flow sensor, differential pressure measurement and an automated computerised interface. In enucleated eyes from C57BL/6J mice, the flow-pressure relationship is highly non-linear and is well represented by an empirical power law model that describes the pressure dependence of outflow facility. At zero pressure, the measured flow is indistinguishable from zero, confirming the absence of any significant pressure independent flow in enucleated eyes. Comparison with the commonly used 2-parameter linear outflow model reveals that inappropriate application of a linear fit to a non-linear flow-pressure relationship introduces considerable errors in the estimation of outflow facility and leads to the false impression of pressure-independent outflow. Data from a population of enucleated eyes from C57BL/6J mice show that outflow facility is best described by a lognormal distribution, with 6-fold variability between individuals, but with relatively tight correlation of facility between fellow eyes. iPerfusion represents a platform technology to accurately and robustly characterise the flow-pressure relationship in enucleated mouse eyes for the purpose of glaucoma research and with minor modifications, may be applied

  16. Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure

    Science.gov (United States)

    2016-01-01

    For 200 years, the ‘closed box’ analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine’s “truth or relative untruth” depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies. The slow production of CSF (0.35 ml/min) is dwarfed by the dynamic blood in and outflow (∼700 ml/min). Neuro-critical care practice focusing on arterial and ICP regulation has been questioned. Failure of venous efferent flow to precisely match arterial afferent flow will yield immediate and dramatic changes in intracranial blood volume and pressure. Interpreting ICP without interrogating its core drivers may be misleading. Multiple clinical conditions and the cerebral effects of altitude and microgravity relate to imbalances in this dynamic rather than ICP per se. This article reviews the Monro-Kellie doctrine, categorises venous outflow limitation conditions, relates physiological mechanisms to clinical conditions and suggests specific management options. PMID:27174995

  17. Percutaneous transluminal angioplasty of a non-mainstream venous route to restore an occluded hemodialysis fistula.

    Science.gov (United States)

    Miyayama, Shiro; Yamashiro, Masashi; Ikuno, Masaya; Okumura, Kenichiro; Yoshida, Miki; Kato, Tamayo; Ushiogi, Yasuyuki

    2014-02-01

    To report the usefulness of percutaneous transluminal angioplasty (PTA) of a non-mainstream venous route in an occluded native hemodialysis fistula when a mainstream outflow vein could not be traversed. This cohort included seven patients with an occulted hemodialysis fistula with difficulty in traversing via a mainstream route. A non-mainstream vein near the occluded portion was traversed until it connected with a proximal large-sized vein and the route was dilated using a 4- or 5-mm balloon catheter. Metallic stent placement was performed, if necessary. Technical aspects and long-term patency was evaluated. PTA could be performed in all patients; however, stent placement was required in two because of residual stenosis and clotting. The clinical success rate of fistula restoration was 100 %. Fistula dysfunction recurred in six patients 17-668 days (mean ± standard deviation 229.3 ± 225.0) later. PTA was repeated in four patients, but not in two. The mean duration of the primary patency was 336.6 ± 417.2 days (range 17-1,190) and that of the secondary patency was 897.1 ± 801.4 days (range 17-2,230). PTA of a non-mainstream venous route is useful for restoring an occluded hemodialysis fistula when the mainstream outflow vein cannot be traversed.

  18. Ruptured venous aneurysm of cervicomedullary junction

    Directory of Open Access Journals (Sweden)

    Ashish Aggarwal

    2014-01-01

    Full Text Available Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM or developmental venous anomaly (DVA. However, isolated venous aneurysm is unusual. Case Description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH and intraventricular hemorrhage (IVH. Digital substraction angiography (DSA revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ. Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 Χ 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein. Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.

  19. Calf venous compliance measured by venous occlusion plethysmography: methodological aspects.

    Science.gov (United States)

    Skoog, Johan; Zachrisson, Helene; Lindenberger, Marcus; Ekman, Mikael; Ewerman, Lea; Länne, Toste

    2015-02-01

    Calf venous compliance (C calf) is commonly evaluated with venous occlusion plethysmography (VOP) during a standard cuff deflation protocol. However, the technique relies on two not previously validated assumptions concerning thigh cuff pressure (P cuff) transmission and the impact of net fluid filtration (F filt) on C calf. The aim was to validate VOP in the lower limb and to develop a model to correct for F filt during VOP. Strain-gauge technique was used to study calf volume changes in 15 women and 10 age-matched men. A thigh cuff was inflated to 60 mmHg for 4 and 8 min with a subsequent decrease of 1 mmHg s(-1). Intravenous pressure (P iv) was measured simultaneously. C calf was determined with the commonly used equation [Compliance = β 1 + 2β 2 × P cuff] describing the pressure-compliance relationship. A model was developed to identify and correct for F filt. Transmission of P cuff to P iv was 100 %. The decrease in P cuff correlated well with P iv reduction (r = 0.99, P < 0.001). Overall, our model showed that C calf was underestimated when F filt was not accounted for (all P < 0.01). F filt was higher in women (P < 0.01) and showed a more pronounced effect on C calf compared to men (P < 0.05). The impact of F filt was similar during 4- and 8-min VOP. P cuff is an adequate substitute for P iv in the lower limb. F filt is associated with an underestimation of C calf and differences in the effect of F filt during VOP can be accounted for with the correction model. Thus, our model seems to be a valuable tool in future studies of venous wall function.

  20. Measuring the seeds of thermal ion outflow

    Science.gov (United States)

    Fernandes, Philip A.

    The ionosphere is the primary source for heavy ions which are ubiquitous in the terrestrial magnetosphere. Low-altitude energization in the auroral ionosphere results in bulk heating and transverse acceleration of ions, which begin to upwell and/or be accelerated upward by the mirror force, starting upflow and leading to the outflow process. The details of the processes that seed ion outflow at low altitudes are difficult to measure in situ and thus remain an open question. We examine the observational parameter regime in which ion upflow/outflow initiates. Emphasis is placed on making measurements of the thermal ion kinetic distribution function, allowing for accounting of processes which affect in situ plasma measurements. We consider an electrostatic analyzer (ESA) instrument capable of making the measurements necessary to quantify the roles of various heating mechanisms in initiating ion upflow in the low-altitude auroral ionosphere. We present the difficulties associated with making these measurements and identify instrument design choices that mitigate some of these measurement challenges. Analysis of ESA measurements of the thermal ion distribution function taken on the MICA auroral sounding rocket is presented. Using a Maxwellian model to replicate possible measured spectra, we calculate integrated parameters from the model and compare with equivalent parameters calculated from the in situ data. Through Liouville's theorem and the thin-sheath approximation we couple the measured and forward-modeled parameters such that measurements inside the sheath provide information about the state of the plasma outside the sheath. Throughout the MICA flight, ion upflow is observed and attributed to ambipolar electric fields and/or ion-neutral interactions. Late in the flight we observe quasi-static frictional process driving the ion temperature. Early in the flight we observe ion heating weakly correlated with ELF wave activity; our analysis suggests we must consider

  1. Transpleural central venous catheter discovered during thoracotomy

    Directory of Open Access Journals (Sweden)

    Ashima Malhotra

    2014-01-01

    Full Text Available We report an uncommon complication of subclavian central venous catheterization, discovered at thoracotomy. The central venous catheter (CVC was placed by left infraclavicular route after induction of general anesthesia. CVC was secured after aspiration of blood and satisfactory central venous tracing. On thoracotomy, CVC was noticed to traverse the pleural cavity while the tracing was normal. CVC was thus removed consequent to which bleeding from each puncture site was noticed, that were secured surgically.

  2. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy

    OpenAIRE

    Xu, Xiaoying; Khadzhynov, Dmytro; Peters, Harm; Chaves, Ricardo L.; Hamed, Kamal; Levi, Micha; Corti, Natascia

    2016-01-01

    Aim The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). Methods A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno?venous haemodialysis (CVVHD; n?=?9) and continuous veno?venous haemodiafiltration (CVVHDF; n?=?8). Model?based simulations were performed to compare the 24?h AUC, C max an...

  3. Collective outflow from a small multiple stellar system

    Energy Technology Data Exchange (ETDEWEB)

    Peters, Thomas [Institut für Theoretische Physik, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich (Switzerland); Klaassen, Pamela D. [Leiden Observatory, Leiden University, P.O. Box 9513, 2300 RA Leiden (Netherlands); Mac Low, Mordecai-Mark [Department of Astrophysics, American Museum of Natural History, 79th Street at Central Park West, New York, NY 10024-5192 (United States); Schrön, Martin; Klessen, Ralf S. [Zentrum für Astronomie der Universität Heidelberg, Institut für Theoretische Astrophysik, Albert-Ueberle-Strasse 2, D-69120 Heidelberg (Germany); Federrath, Christoph [Monash Centre for Astrophysics, School of Mathematical Sciences, Monash University, Vic 3800 (Australia); Smith, Michael D., E-mail: tpeters@physik.uzh.ch [Centre for Astrophysics and Space Science, University of Kent, Canterbury, CT2 7NH (United Kingdom)

    2014-06-10

    The formation of high-mass stars is usually accompanied by powerful protostellar outflows. Such high-mass outflows are not simply scaled-up versions of their lower-mass counterparts, since observations suggest that the collimation degree degrades with stellar mass. Theoretically, the origins of massive outflows remain open to question because radiative feedback and fragmentation of the accretion flow around the most massive stars, with M > 15 M {sub ☉}, may impede the driving of magnetic disk winds. We here present a three-dimensional simulation of the early stages of core fragmentation and massive star formation that includes a subgrid-scale model for protostellar outflows. We find that stars that form in a common accretion flow tend to have aligned outflow axes, so that the individual jets of multiple stars can combine to form a collective outflow. We compare our simulation to observations with synthetic H{sub 2} and CO observations and find that the morphology and kinematics of such a collective outflow resembles some observed massive outflows, such as Cepheus A and DR 21. We finally compare physical quantities derived from simulated observations of our models to the actual values in the models to examine the reliability of standard methods for deriving physical quantities, demonstrating that those methods indeed recover the actual values to within a factor of two to three.

  4. Standing Shocks around Black Holes and Estimation of Outflow Rates

    Indian Academy of Sciences (India)

    Santabrata Das; Sandip K. Chakrabarti

    2002-03-01

    We self-consistently obtain shock locations in an accretion flow by using an analytical method. One can obtain the spectral properties, quasi-periodic oscillation frequencies and the outflowrates when the inflow parameters are known. Since temperature of the CENBOL decides the spectral states of the black hole, and also the outflow rate, the outflow rate is directly related to the spectral states.

  5. Scaling Relations Between Warm Galactic Outflows and Their Host Galaxies

    CERN Document Server

    Chisholm, John; Leitherer, Claus; Chen, Yanmei; Wofford, Aida; Lundgren, Britt

    2014-01-01

    We report on a sample of 51 nearby, star-forming galaxies observed with the Cosmic Origin Spectrograph on the Hubble Space Telescope. We calculate Si II kinematics and densities arising from warm gas entrained in galactic outflows. We use multi-wavelength ancillary data to estimate stellar masses (M$_\\ast$), star-formation rates (SFR), and morphologies. We derive significant correlations between outflow velocity and SFR$^{\\sim 0.1}$, M$_\\ast^{\\sim 0.1}$ and v$_\\text{circ}^{\\sim 1/2}$. Some mergers drive outflows faster than these relations prescribe, launching the outflow faster than the escape velocity. Calculations of the mass outflow rate reveal strong scaling with SFR$^{\\sim 1/2}$ and M$_\\ast^{\\sim 1/2}$. Additionally, mass-loading efficiency factors (mass outflow rate divided by SFR) scale approximately as M$_\\ast^{-1/2}$. Both the outflow velocity and mass-loading scaling suggest that these outflows are powered by supernovae, with only 0.7% of the total supernovae energy converted into the kinetic energ...

  6. Renal Cysts

    Science.gov (United States)

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  7. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  8. The impact of obesity on venous insufficiency.

    Science.gov (United States)

    Seidel, A C; Belczak, C E Q; Campos, M B; Campos, R B; Harada, D S

    2015-08-01

    Association between chronic venous disease and obesity has recently been studied, with indications that it may worsen in obese patients. The aim of study was to correlate clinical classes of chronic venous disease according to Clinical Etiology Anatomy Pathophysiology (CEAP) classification and body mass index, as well as to compare the severity of chronic venous disease in obese and nonobese patients. This retrospective cross-sectional prevalence study was conducted at the Maringá State University and Belczak Vascular Center along a period of 2 years, consisting of a random sample of 482 patients with complaints compatible with chronic venous disease. Data obtained from patient's files included gender, age, weight and height (for calculating body mass index), and clinical class (C) of chronic venous disease according to CEAP classification. Statistical analysis included Spearman's correlation coefficient, Chi-square test (for comparing frequencies), and Student's t-test (for comparing means). Significant positive correlation between body mass index and clinical classes was established for women (0.43), but not for men (0.07). Obesity (body mass index  : ≥  : 30.0) was significantly more frequent in patients with chronic venous disease in clinical classes 3 (p venous disease in clinical class 1 (p venous disease in women, but not in men. It also corroborated the negative impact of obesity on the clinical severity of chronic venous disease.

  9. Central vein stenosis masquerading as venous thrombosis

    National Research Council Canada - National Science Library

    Nagapriya Vellalacheruvu; Naresh Monigari; Tom Devasia; Hashir Kareem

    2014-01-01

    .... 3 Learning points Central venous stenosis (CVS), although rare, is a known complication in patients requiring maintenance haemodialysis but symptomatic CVS requiring intervention is not common...

  10. Central venous line complications and tip detection

    Directory of Open Access Journals (Sweden)

    Ameneh Rezaee Gheshlaghi

    2015-06-01

    Full Text Available Central venous line is one of a creative instrument that saves human’s life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement.Central venous line might have some complications and complication follow-up should be considered. Thromboembolism and infection are two important medical complications. Arterial puncture, hematoma, pneumothorax and hemothorax are mechanical Central venous line complications. Chest X-ray and some other techniques should be used for detecting these complications.Central venous line tip misplace is a considerable problem for emergency department staffs, previously chest X-ray has been used for central venous line misplace detection. In some recent studies, contrast-enhanced ultrasonography and intravascular electrocardiography have been used for central venous line misplace.

  11. Drug-induced renal injury

    African Journals Online (AJOL)

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  12. Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency.

    LENUS (Irish Health Repository)

    Reekers, J A

    2011-02-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1]. The core foundation of this theory is that there is abnormal venous drainage from the brain due to outflow obstruction in the draining jugular vein and\\/or azygos veins. This abnormal venous drainage, which is characterised by special ultrasound criteria, called the "venous hemodynamic insufficiency severity score" (VHISS), is said to cause intracerebral flow disturbance or outflow problems that lead to periventricular deposits [2]. In the CCSVI theory, these deposits have a great similarity to the iron deposits seen around the veins in the legs in patients with chronic deep vein thrombosis. Zamboni, who first described this new theory, has promoted balloon dilatation to treat the outflow problems, thereby curing CCSVI and by the same token alleviating MS complaints. However, this theory does not fit into the existing bulk of scientific data concerning the pathophysiology of MS. In contrast, there is increasing worldwide acceptance of CCSVI and the associated balloon dilatation treatment, even though there is no supporting scientific evidence. Furthermore, most of the information we have comes from one source only. The treatment is called "liberation treatment," and the results of the treatment can be watched on YouTube. There are well-documented testimonies by MS patients who have gained improvement in their personal quality of life (QOL) after treatment. However, there are no data available from patients who underwent unsuccessful treatments with which to obtain a more balanced view. The current forum for the reporting of success in treating CCSVI and thus MS seems to be the Internet. At the CIRCE office and the MS Centre in Amsterdam, we receive approximately 10 to 20 inquiries a month about this treatment. In addition, many interventional radiologists

  13. FIRE simulations: galactic outflows and their consequences

    Science.gov (United States)

    Keres, Dusan; FIRE Team

    2016-06-01

    We study gaseous outflows and their consequences in high-resolution galaxy formation simulations with explicit stellar feedback from the Feedback in Realistic Environments project. Collective, galaxy scale, effect of stellar feedback results in episodic ejections of large amount of gas and heavy elements into the circum-galactic medium. Gas ejection episodes follow strong bursts of star formation. Properties of galactic star formation and ejection episodes depend on galaxy mass and redshift and, together with gas infall and recycling, shape the evolution of the circum-galactic medium and galaxies. As a consequence, our simulated galaxies have masses, star formation histories and heavy element content in good agreement with the observed population of galaxies.

  14. An Intergalactic Magnetic Field from Quasar Outflows

    CERN Document Server

    Furlanetto, S; Furlanetto, Steven; Loeb, Abraham

    2001-01-01

    Outflows from quasars inevitably pollute the intergalactic medium (IGM) with magnetic fields. The short-lived activity of a quasar leaves behind an expanding magnetized bubble in the IGM. We model the expansion of the remnant quasar bubbles and calculate their distribution as a function magnetic field strength at different redshifts. We find that by a redshift z ~ 3, about 5-80% of the IGM volume is filled by magnetic fields with an energy density > 10% of the mean thermal energy density of a photo-ionized IGM (at ~ 10^4 K). As massive galaxies and X-ray clusters condense out of the magnetized IGM, the adiabatic compression of the magnetic field could result in the fields observed in these systems without a need for further dynamo amplification.

  15. Relativistic Outflows in Gamma-Ray Bursts

    CERN Document Server

    Aloy, M A

    2007-01-01

    The possibility that gamma-ray bursts (GRBs) were not isotropic emissions was devised theoretically as a way to ameliorate the huge energetic budget implied by the standard fireball model for these powerful phenomena. However, the mechanism by which after the quasy-isotropic release of a few $10^{50} $erg yields a collimated ejection of plasma could not be satisfactory explained analytically. The reason being that the collimation of an outflow by its progenitor system depends on a very complex and non-linear dynamics. That has made necessary the use of numerical simulations in order to shed some light on the viability of some likely progenitors of GRBs. In this contribution I will review the most relevant features shown by these numerical simulations and how they have been used to validate the collapsar model (for long GRBs) and the model involving the merger of compact binaries (for short GRBs).

  16. Simulating Supersonic Turbulence in Galaxy Outflows

    CERN Document Server

    Scannapieco, Evan

    2010-01-01

    We present three-dimensional, adaptive mesh simulations of dwarf galaxy out- flows driven by supersonic turbulence. Here we develop a subgrid model to track not only the thermal and bulk velocities of the gas, but also its turbulent velocities and length scales. This allows us to deposit energy from supernovae directly into supersonic turbulence, which acts on scales much larger than a particle mean free path, but much smaller than resolved large-scale flows. Unlike previous approaches, we are able to simulate a starbursting galaxy modeled after NGC 1569, with realistic radiative cooling throughout the simulation. Pockets of hot, diffuse gas around individual OB associations sweep up thick shells of material that persist for long times due to the cooling instability. The overlapping of high-pressure, rarefied regions leads to a collective central outflow that escapes the galaxy by eating away at the exterior gas through turbulent mixing, rather than gathering it into a thin, unstable shell. Supersonic, turbul...

  17. Ice sculpture in the Martian outflow channels

    Science.gov (United States)

    Lucchitta, B. K.

    1982-01-01

    Viking Orbiter and terrestrial satellite images are examined at similar resolution to compare features of the Martian outflow channels with features produced by the movement of ice on earth, and many resemblances are found. These include the anastomoses, sinuosities, and U-shaped cross profiles of valleys; hanging valleys; linear scour marks on valley walls; grooves and ridges on valley floors; and the streamlining of bedrock highs. Attention is given to the question whether ice could have moved in the Martian environment. It is envisaged that springs or small catastrophic outbursts discharged fluids from structural outlets or chaotic terrains. These fluids built icings that may have grown into substantial masses and eventually flowed like glaciers down preexisting valleys. An alternative is that the fluids formed rivers or floods that in turn formed ice jams and consolidated into icy masses in places where obstacles blocked their flow.

  18. Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement

    OpenAIRE

    Wisecup, Sarah; Eades, Shannan; Turiy, Yuliya

    2015-01-01

    OBJECTIVES: With the apparent increase in venous thromboembolism noted in the pediatric population, it is important to define which children are at risk for clots and to determine optimal preventative therapy. The purpose of this study was to determine the risk factors for venous thromboembolism in pediatric patients with central venous line placement.

  19. Searching for molecular outflows in Hyper-Luminous Infrared Galaxies

    CERN Document Server

    Calderón, D; Veilleux, S; Graciá-Carpio, J; Sturm, E; Lira, P; Schulze, S; Kim, S

    2016-01-01

    We present constraints on the molecular outflows in a sample of five Hyper-Luminous Infrared Galaxies using Herschel observations of the OH doublet at 119 {\\mu}m. We have detected the OH doublet in three cases: one purely in emission and two purely in absorption. The observed emission profile has a significant blueshifted wing suggesting the possibility of tracing an outflow. Out of the two absorption profiles, one seems to be consistent with the systemic velocity while the other clearly indicates the presence of a molecular outflow whose maximum velocity is about ~1500 km/s. Our analysis shows that this system is in general agreement with previous results on Ultra-luminous Infrared Galaxies and QSOs, whose outflow velocities do not seem to correlate with stellar masses or starburst luminosities (star formation rates). Instead the galaxy outflow likely arises from an embedded AGN.

  20. Reconnection outflow generated turbulence in the solar wind

    CERN Document Server

    Vörös, Z; Semenov, V S; Zaqarashvili, T V; Bruno, R; Khodachenko, M

    2014-01-01

    Petschek-type time-dependent reconnection (TDR) and quasi-stationary reconnection (QSR) models are considered to understand reconnection outflow structures and the features of the associated locally generated turbulence in the solar wind. We show that the outflow structures, such as discontinuites, Kelvin-Helmholtz (KH) unstable flux tubes or continuous space filling flows cannot be distinguished from one-point WIND measurements. In both models the reconnection outflows can generate more or less spatially extended turbulent boundary layers (TBDs). The structure of an unique extended reconnection outflow is investigated in detail. The analysis of spectral scalings and break locations show that reconnection outflows can control the local field and plasma conditions which may play in favor of one or another turbulent dissipation mechanisms with their characteristic scales and wavenumbers.

  1. The Implications of Extreme Outflows from Extreme Starbursts

    CERN Document Server

    Heckman, Timothy M

    2016-01-01

    Interstellar ultraviolet absorption-lines provide crucial information about the properties of galactic outflows. In this paper, we augment our previous analysis of the systematic properties of starburst-driven galactic outflows by expanding our sample to include a rare population of starbursts with exceptionally high outflow velocities. In principle, these could be a qualitatively different phenomenon from more typical outflows. However, we find that instead these starbursts lie on, or along the extrapolation of, the trends defined by the more typical systems studied previously by us. We exploit the wide dynamic range provided by this new sample to determine scaling relations of outflow velocity with galaxy stellar mass (M*), circular velocity, star-formation rate (SFR), SFR/M*, and SFR/area. We argue that these results can be accommodated within the general interpretational framework we previously advocated, in which a population of ambient interstellar or circum-galactic clouds is accelerated by the combine...

  2. AN EXCEPTIONAL CASE OF QUADRUPLE RENAL ARTERIES & T WIN RENAL VEINS WITH CROWDED HILAR ANATOMY

    Directory of Open Access Journals (Sweden)

    Sreekanth

    2013-02-01

    Full Text Available ABSTRACT: The renal vasculature was always a subject of varia tions both in the number and pattern of portal of entry into kidney and Perihilar placement of the artery, vein and pelvis. Good anatomical insight is an essential prerequisite besides the surgical expertise. The cadaveric dissection revealed a Right Kidney supplied by Quadruple renal arteries & Drained by two renal veins. The main renal artery (MRA was arising from antero lateral aspect and the accessory renal artery was arising from anterior as pect of aorta 1cm distal to the former vessel. Only the MRA showed Fork Pattern Branching with fou r anterior segmental arteries and one posterior segmental artery in the pre hilar region. T he first and fourth segmental arteries showed a small subsidiary branch and a large tortuo us subsidiary branch respectively. The later along with the branch running downwards and lateral from lower renal artery formed a common trunk and pierced the capsule and entered int o the substance of the kidney anteriorly about 2cm lateral to the hilum, thus forming an abe rrant artery. The upper polar artery was seen arising from the lower supra renal artery. The main renal vein (MRV, was formed by two formative tributaries of which one is larger and ot her being smaller. The later was seen just anterior to the third anterior segmental branch of MRA. Accessory renal vein was formed by only one tributary encircled by the fourth anterior segmental artery and posterior segmental artery. There was crowding of structures seen with altered hilar anatomy in both vertical and horizontal disposition. Such a rare combination of extra renal multiple arterio-venous variation is of worth concern to the urologists harvesting ki dneys from the live donors for performing transplantation procedures. Partial nephrectomies for the hilar tumors and for Radiologists during interpretation of the angiograms.

  3. Evolution of active region outflows throughout an active region lifetime

    Science.gov (United States)

    Zangrilli, L.; Poletto, G.

    2016-10-01

    Context. We have shown previously that SOHO/UVCS data allow us to detect active region (AR) outflows at coronal altitudes higher than those reached by other instrumentation. These outflows are thought to be a component of the slow solar wind. Aims: Our purpose is to study the evolution of the outflows in the intermediate corona from AR 8100, from the time the AR first forms until it dissolves, after several transits at the solar limb. Methods: Data acquired by SOHO/UVCS at the time of the AR limb transits, at medium latitudes and at altitudes ranging from 1.5 to 2.3 R⊙, were used to infer the physical properties of the outflows through the AR evolution. To this end, we applied the Doppler dimming technique to UVCS spectra. These spectra include the H i Lyα line and the O vi doublet lines at 1031.9 and 1037.6 Å. Results: Plasma speeds and electron densities of the outflows were inferred over several rotations of the Sun. AR outflows are present in the newly born AR and persist throughout the entire AR life. Moreover, we found two types of outflows at different latitudes, both possibly originating in the same negative polarity area of the AR. We also analyzed the behavior of the Si xii 520 Å line along the UVCS slit in an attempt to reveal changes in the Si abundance when different regions are traversed. Although we found some evidence for a Si enrichment in the AR outflows, alternative interpretations are also plausible. Conclusions: Our results demonstrate that outflows from ARs are detectable in the intermediate corona throughout the whole AR lifetime. This confirms that outflows contribute to the slow wind.

  4. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

    Science.gov (United States)

    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

  5. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism.

    Science.gov (United States)

    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.

  6. [Long-term effect of polystan monocusp ventricular outflow patch after right ventricular outflow tract reconstruction].

    Science.gov (United States)

    Sugita, T; Matsumoto, M; Ogino, H; Nishizawa, J; Matsuyama, K; Yoshimura, S; Yoshioka, T; Tokuda, Y; Matsumura, M; Suda, K; Ueda, Y

    2000-09-01

    Forty-eight patients who underwent right ventricular outflow tract reconstruction with Monocusp Ventricular Outflow Patch (MVOP) fifty-five times and survived surgery, were reviewed in this study. Mean age at surgery was 6.4 years-old and mean follow-up interval was 75.2 months. There was no late death, however reoperation was performed 7 times. Freedom from reoperation rate was 97.2% and 80.7% after 5 and 10 years after surgery, respectively. The main cause for reoperation were right ventricular outflow obstruction RVOTO (5 cases). All of the RVOTO occurred at the distal end of the anastomosis. However, there was no RVOTO in patients who underwent RVOTR with MVOP during the past ten years. So, we considered the cause of RVOTO a technical problem. Pulmonary regurgitation was one to two degree early after surgery, and had worsened by almost two or three degrees more than 5 years after surgery. Moreover, five of six patients who underwent cardiac catheterization more than 10 years after surgery had three degrees of pulmonary regurgitation as well as a large CTR. In conclusion, according to long-term results, especially more than 10 years post operatively, pulmonary regurgitation was the most important problem.

  7. Feedback from Mass Outflows in Nearby Active Galactic Nuclei. II. Outflows in the Narrow-Line Region of NGC 4151

    CERN Document Server

    Crenshaw, D M; Kraemer, S B; Schmitt, H R

    2014-01-01

    We present a detailed study of AGN feedback in the narrow-line region (NLR) of the Seyfert 1 galaxy NGC 4151. We illustrate the data and techniques needed to determine the mass outflow rate and kinetic luminosity of the outflowing ionized gas as a function of position in the NLR. We find that the mass outflow rate peaks at a value of 3 solar masses per year at a distance of 70 pc from the central supermassive black hole (SMBH), which is about 10 times the outflow rate coming from inside 13 pc, and 230 times the mass accretion rate inferred from the bolometric luminosity of NGC 4151. Thus, most of the outflow must arise from "in situ" acceleration of ambient gas throughout the NLR. The kinetic luminosity peaks at 90 pc and drops rapidly thereafter, indicating that most of the kinetic energy is deposited within about 100 pc from the SMBH. Both values exceed the mass outflow rate and kinetic luminosity determined for the UV/X-ray absorber outflows in NGC 4151, indicating the importance of NLR outflows in providi...

  8. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  9. A Forgotten Guidewire: Complication of Central Venous Catheterization

    Directory of Open Access Journals (Sweden)

    Funda Gümüş

    2011-08-01

    Full Text Available Central venous catheterization is an invasive procedure commonly preferred for hemodynamic monitorization, total parenteral nutrition, cardiac pacemaker implantation, long-term use of vasoactive or irritating agents and hemodialysis. We present a 19-year-old woman with acute renal failure scheduled for hemodialysis catheterization. A catheter guidewire extending from the right internal jugular vein to the right external iliac vein was detected in the chest X-ray, taken two hours following catheterization after occurrence of arrhythmia and hypotension. Catheteter guidewire was extracted noninvasively without any complications. Most common reasons for this complication are stated to be attention deficits, lack of experience, overtired staff, and inadequate supervision of trainees. In this paper, we discussed this complication’s causes and preventive methods. (Journal of the Turkish Society Intensive Care 2011; 9:64-7

  10. Influence of ion outflow in coupled geospace simulations: 2. Sawtooth oscillations driven by physics-based ion outflow

    Science.gov (United States)

    Varney, R. H.; Wiltberger, M.; Zhang, B.; Lotko, W.; Lyon, J.

    2016-10-01

    We present the first simulations of magnetospheric sawtooth oscillations under steady solar wind conditions that are driven internally by heavy ion outflow from a physics-based model. The simulations presented use the multifluid Lyon-Fedder-Mobarry magnetohydrodynamics model two-way coupled to the ionosphere/polar wind model (IPWM). Depending on the type of wave-particle interactions utilized within IPWM, the coupled simulations exhibit either sawtooth oscillations or steady magnetospheric convection. Contrasting the simulations that do and do not develop sawtooth oscillations yields insights into the relationship between outflow and sawtooth oscillations. The total outflow rate is not an adequate predictor of the convection mode that will emerge. The simulations that develop sawtooth oscillations are characterized by intense outflow concentrated in the midnight auroral region. This outflow distribution mass loads the tail reconnection region without excessively mass loading the dayside reconnection region and leads to an imbalance between the dayside and nightside reconnection rates.

  11. Evaluation of the hemodynamic impact of continuous renal replacement therapy in healthy dogs.

    Science.gov (United States)

    Shimokawa Miyama, Takako; Itamoto, Kazuhito; Yoshioka, Chihiro; Minami, Koji; Okawa, Takumi; Fujisaki, Yuka; Hiraoka, Hiroko; Mizuno, Takuya; Okuda, Masaru

    2010-04-01

    We performed continuous renal replacement therapy (CRRT) on clinically healthy dogs to evaluate the effects of CRRT on hemodynamics. Heart rate, arterial blood pressure, and central venous pressure of the dogs (n=6) were recorded during the procedure, which was performed under general anesthesia. Throughout the CRRT, heart rate and arterial blood pressure were stable. Central venous pressure increased after CRRT termination but returned to the basal level within 30 min. In this study, hemodynamic alterations, including hypotension, hypertension, and arrhythmias, were not observed during CRRT. These observations suggest that the CRRT protocol used in the present study can be safely applied to clinical cases with acute renal failure.

  12. [Central venous blood gas analysis].

    Science.gov (United States)

    Marano, Marco; D'Amato, Anna; Guiotto, Giovanna; Schiraldi, Fernando

    2015-01-01

    The hemodialysis might interfere with patients hemodynamic, as the technique allows a sophisticated game with extra and intravascular fluids. As the cardiocirculatory response could sometimes be unpredictable, it is interesting to collect valuable information by reaching a deep understanding of the tissue metabolism which is mirrored by the blood gas analysis of variations in arterial and central venous blood samples. Particularly interesting are the time course variations of the central venous hemoglobin saturation (ScvO2), which are directly related to the patient with O2-demand as well as to the O2-Delivery (DO2). The ScvO2 is determined by four parameters (cardiac output, Hb concentration, arterial Hb saturation and O2 consumption): If the fluids subtraction during dialysis was about to determine an occult hypoperfusion, the ScvO2 reduction would be a timely warning sign to be considered. Moreover, while the normal veno-arterial PCO2 difference is 2-4 mmHg, whenever a mismatch between O2-demand and DO2arise, a larger v-aPCO2 difference should be observed.

  13. Venous thromboembolism in cancer patients

    Directory of Open Access Journals (Sweden)

    Mehmet Fuat Eren

    2013-09-01

    Full Text Available Venous thromboembolism (VTE is a major complication of cancer and represents an important cause of morbidity and mortality. The incidence of VTE is 0.6-7.8% in patients with cancer more than double the incidence of VTE in patients without cancer. The risk of VTE which includes deep venous thrombosis (DVT and pulmonary embolism (PE is increased two to seven fold in patients with cancer. VTE risk is especially high among certain groups such as hospitalized patients with cancer and those receiving active antineoplastic therapy. Also cancer patients, who undergoing major surgery, are increased risk of VTE. Trauma, long-haul travel, increased age, obesity, previous VTE and genetic component are also predisposing factors for VTE. Patients with cancer who develop VTE should be managed multidisciplinary treatment guidelines. The primary goal of thromboprophylaxis in patients with cancer is to prevent VTE. The large majority of cancer patients should be treated with therapeutic doses of unfractioned heparin (UFH or low molecular weight heparin (LMWH. Prophylaxis should include cancer patients who underwent major surgery for cancer and patients with a history of VTE.

  14. Wartime major venous vessel injuries.

    Science.gov (United States)

    Hudorovic, Narcis

    2008-02-01

    The aim of this study is to declare our experience and to identify the important factors that influence the mortality and morbidity in patients with combat-related penetrating wounds of the abdomen (CR-PWA) with major venous vessel injuries. Twenty-six wounded with combat-related injuries of major abdominal venous vessels, admitted in the University Clinic cardiovascular surgery department during the period from 1 August 1991 through 30 October 1995, were analyzed. Patients with concomitant injured arteries and extra-abdominal injuries (n=150; 85.2%) were excluded from this study. The Penetrating Abdominal Trauma Index (PATI) score for each patient was calculated. Fifteen patients (57.69%) sustained with PATI score greater than 25 died. The mean duration of hospitalization was 16 days (range 0-86). The average hospitalization time for those surviving their complications was 17 days with a PATI of 25 or less, and 43 days with a score more than 25. Three clinical assessments of the long-term outcome were performed after a median of about 3, 5 and 10 years, respectively. Surviving patients (42.31%) were symptom free and had normal Duplex scans as well as no other surgical related complications. Higher PATI scores, postoperative complications and reoperations exert an unfavorable effect on patient outcome.

  15. Developmental Venous Anomaly: Benign or Not Benign

    Science.gov (United States)

    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. Risk factors for venous thromboembolism during pregnancy

    DEFF Research Database (Denmark)

    Jensen, Thomas Bo; Gerds, Thomas Alexander; Grøn, Randi;

    2013-01-01

    Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated.......Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated....

  17. Diagnosis and treatment of venous ulcers.

    Science.gov (United States)

    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.

  18. An unusual Complication of Central Venous Cannulation

    Directory of Open Access Journals (Sweden)

    Ashvini Kumar

    2013-04-01

    Full Text Available Central venous catheter (CVC hub fracture is a rare complication of central venous cannulation. We report a case where catheter hub fracture was detected immediately after CVC insertion. Causes of catheter hub fracture and its complications are discussed.

  19. Sex-specific aspects of venous thrombosis

    NARCIS (Netherlands)

    Roach, Rachel Elizabeth Jo

    2014-01-01

    Venous thrombosis is a disease that occurs in 1-2 per 1000 people per year. At the time of their first venous thrombosis, approximately 50% of women are exposed to reproductive risk factors (oral contraception, postmenopausal hormone therapy, pregnancy and the puerperium). In this thesis, we showed

  20. U turn to venous air embolism

    Directory of Open Access Journals (Sweden)

    Singh Harsimran

    2009-01-01

    Full Text Available There is a definitive risk of venous air embolism when the fluid infusion is complete and the drip set is still open in a glass bottle.We have devised a novel way of preventing the chances of air embolism when the fluid in the glass bottle finishes. It really gives a "U" turn to the chances of venous air embolism.

  1. Renale Osteopathie

    OpenAIRE

    Horn S

    2001-01-01

    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  2. Renale Knochenerkrankungen

    Directory of Open Access Journals (Sweden)

    Mayer G

    2008-01-01

    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  3. Clinical application of hepatic venous occlusion for hepatectomy

    Institute of Scientific and Technical Information of China (English)

    PAN Ze-ya; YANG Yuan; ZHOU Wei-ping; LI Ai-jun; FU Si-yuan; WU Meng-chao

    2008-01-01

    Background Most liver resections require clamping of the hepatic pedicle (Pringle maneuver) to avoid excessive blood loss. But Pringle maneuver can not control backflow bleeding of hepatic vein, Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from the injuries of the hepatic veins. Although total hepatic vascular exclusion can prevent bleeding of the hepatic veins effectively, it also may result in systemic hemodynamic disturbance because of the inferior vena cava being clamped. Hepatic venous occlusion, a new technique, can control the inflow and outflow of the liver without clamping the vena cava.Methods A total of 71 cases of liver tumors underwent resection with occlusion of more than one of the main hepatic veins. All tumors involved the second porta hepatis and at least one main hepatic vein. Ligation or occlusion with serrefines, tourniquets and auricular clamps were used in hepatic venous occlusion.Results Of the 71 patients, ligation of the hepatic veins was used in 28 cases, occlusion with a tourniquet in 26, and occlusion with a serrefine in 17. Right hepatic veins were occluded in 38 cases, both right and middle hepatic veins in 2,the common trunk of the left and middle hepatic veins in 24, branches of the left and middle hepatic veins in 2, and all three hepatic veins in 5. Thirty-five cases underwent hemihepatic vascular occlusion, 4 alternate hemihepatic vascular occlusion, 23 portal triad clamping plus selective hepatic vein occlusion, and 9 portal triad clamping plus total hepatic vein occlusion. The third porta hepatis was isolated in 26 cases. The amount of intraoperative blood loss averaged (540±283) (range 100 to 1000) ml in the group of total hemihepatic vascular occlusion and in the group of alternate hemihepatic vascular occlusion, (620±317) (range 200-6000) ml in the group of portal triad clamping plus selective or total hepatic vein occlusion. All tumors were completely removed

  4. Suppression of galactic outflows by cosmological infall and circumgalactic medium

    CERN Document Server

    Singh, Priyanka; Bagla, Jasjeet S; Nath, Biman B

    2016-01-01

    We investigate the relative importance of two galactic outflow suppression mechanisms : a) Cosmological infall of the intergalactic gas onto the galaxy, and b) the existence of a hot circumgalactic medium (CGM). Considering only radial motion, the infall reduces the speed of outflowing gas and even halts the outflow, depending on the mass and redshift of the galaxy. For star forming galaxies there exists an upper mass limit beyond which outflows are suppressed by the gravitational field of the galaxy. We find that infall can reduce this upper mass limit approximately by a factor of two (independent of the redshift). Massive galaxies ($\\gtrsim 10^{12} M_{\\odot}$) host large reservoir of hot, diffuse CGM around the central part of the galaxy. The CGM acts as a barrier between the infalling and outflowing gas and provides an additional source of outflow suppression. We find that at low redshifts ($z\\lesssim3.5$), the CGM is more effective than the infall in suppressing the outflows. Together, these two processes...

  5. Multiple Fast Molecular Outflows in the PPN CRL 618

    CERN Document Server

    Lee, Chin-Fei; Contreras, Carmen Sánchez; Huang, Po-Sheng; Tay, Jeremy Jian Hao

    2013-01-01

    CRL 618 is a well-studied pre-planetary nebula. It has multiple highly collimated optical lobes, fast molecular outflows along the optical lobes, and an extended molecular envelope that consists of a dense torus in the equator and a tenuous round halo. Here we present our observations of this source in CO J=3-2 and HCN J=4-3 obtained with the Submillimeter Array at up to ~ 0.3" resolutions. We spatially resolve the fast molecular-outflow region previously detected in CO near the central star and find it to be composed of multiple outflows that have similar dynamical ages, and are oriented along the different optical lobes. We also detect fast molecular outflows further away from the central star near the tips of the extended optical lobes and a pair of equatorial outflows inside the dense torus. We find that two episodes of bullet ejections in different directions are needed, one producing the fast molecular outflows near the central star, and one producing the fast molecular outflows near the tips of the ext...

  6. Collective outflow from a small multiple stellar system

    CERN Document Server

    Peters, Thomas; Mac Low, Mordecai-Mark; Schrön, Martin; Federrath, Christoph; Smith, Michael D; Klessen, Ralf S

    2014-01-01

    The formation of high-mass stars is usually accompanied by powerful protostellar outflows. Such high-mass outflows are not simply scaled-up versions of their lower-mass counterparts, since observations suggest that the collimation degree degrades with stellar mass. Theoretically, the origins of massive outflows remain open to question because radiative feedback and fragmentation of the accretion flow around the most massive stars, with M > 15 M_Sun, may impede the driving of magnetic disk winds. We here present a three-dimensional simulation of the early stages of core fragmentation and massive star formation that includes a subgrid-scale model for protostellar outflows. We find that stars that form in a common accretion flow tend to have aligned outflow axes, so that the individual jets of multiple stars can combine to form a collective outflow. We compare our simulation to observations with synthetic H_2 and CO observations and find that the morphology and kinematics of such a collective outflow resembles s...

  7. The role of cosmic ray pressure in accelerating galactic outflows

    CERN Document Server

    Simpson, Christine M; Marinacci, Federico; Pfrommer, Christoph; Springel, Volker; Glover, Simon C O; Clark, Paul C; Smith, Rowan J

    2016-01-01

    We study the formation of galactic outflows from supernova explosions (SNe) with the moving-mesh code AREPO in a stratified column of gas with a surface density similar to the Milky Way disk at the solar circle. We compare different simulation models for SNe placement and energy feedback, including cosmic rays (CR), and find that models that place SNe in dense gas and account for CR diffusion are able to drive outflows with similar mass loading as obtained from a random placement of SNe with no CRs. Despite this similarity, CR-driven outflows differ in several other key properties including their overall clumpiness and velocity. Moreover, the forces driving these outflows originate in different sources of pressure, with the CR diffusion model relying on non-thermal pressure gradients to create an outflow driven by internal pressure and the random-placement model depending on kinetic pressure gradients to propel a ballistic outflow. CRs therefore appear to be non-negligible physics in the formation of outflows...

  8. Simulation of California's Major Reservoirs Outflow Using Data Mining Technique

    Science.gov (United States)

    Yang, T.; Gao, X.; Sorooshian, S.

    2014-12-01

    The reservoir's outflow is controlled by reservoir operators, which is different from the upstream inflow. The outflow is more important than the reservoir's inflow for the downstream water users. In order to simulate the complicated reservoir operation and extract the outflow decision making patterns for California's 12 major reservoirs, we build a data-driven, computer-based ("artificial intelligent") reservoir decision making tool, using decision regression and classification tree approach. This is a well-developed statistical and graphical modeling methodology in the field of data mining. A shuffled cross validation approach is also employed to extract the outflow decision making patterns and rules based on the selected decision variables (inflow amount, precipitation, timing, water type year etc.). To show the accuracy of the model, a verification study is carried out comparing the model-generated outflow decisions ("artificial intelligent" decisions) with that made by reservoir operators (human decisions). The simulation results show that the machine-generated outflow decisions are very similar to the real reservoir operators' decisions. This conclusion is based on statistical evaluations using the Nash-Sutcliffe test. The proposed model is able to detect the most influential variables and their weights when the reservoir operators make an outflow decision. While the proposed approach was firstly applied and tested on California's 12 major reservoirs, the method is universally adaptable to other reservoir systems.

  9. High-velocity molecular outflows hear massive young stellar objects

    Institute of Scientific and Technical Information of China (English)

    吴月芳; 李月兴; 杨传义; 雷成明; 孙金江; 吕静; 韩溥

    1999-01-01

    By mapping the 12CO J=1—0 lines in IRAS 05391-0217, 06114+1745 and 06291+0421, three new high-velocity bipolar molecular outflows are found. Parameters of these outflows are derived, which suggest that they are massive and energetic outflows with total kinetic energies of about 1038 J and mass loss rates about 10-5 M⊙/a. The driving sources are identified by analyzing the positions, intensities and color temperatures of the associated infrared sources. These outflows are most likely driven by single sources which correspond to massive young stellar objects. In these regions H2O masers have been detected located near the embedded infrared sources, which indicates that their exciting mechanism may be correlated with that of the CO outflows. The relationship between the parameters of outflows and central sources shows that high-velocity outflow and thermal radiation of a star are two basic correlated but different features in the evolution of young stars.

  10. Susceptibility-weighted imaging of the venous networks around the brain stem

    Energy Technology Data Exchange (ETDEWEB)

    Cai, Ming; Lin, Zhong-Xiao; Zhang, Nu [Wenzhou Medical University, Department of Neurosurgery, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou (China); Zhang, Xiao-Fen; Qiao, Hui-Huang; Chen, Cheng-Chun [Wenzhou Medical University, Department of Human Anatomy, Wenzhou (China); Ren, Chuan-Gen; Li, Jian-Ce [Wenzhou Medical University, Department of Radiology, The 1nd Affiliated Hospital of Wenzhou Medical University, Wenzhou (China)

    2014-10-18

    The venous network of the brainstem is complex and significant. Susceptibility-weighted imaging (SWI) is a practical technique which is sensitive to veins, especially tiny veins. Our purpose of this study was to evaluate the visualization of the venous network of brainstem by using SWI at 3.0 T. The occurrence rate of each superficial veins of brainstem was evaluated by using SWI on a 3 T MR imaging system in 60 volunteers. The diameter of the lateral mesencephalic vein and peduncular vein were measured by SWI using the reconstructed mIP images in the sagittal view. And the outflow of the veins of brainstem were studied and described according to the reconstructed images. The median anterior pontomesencephalic vein, median anterior medullary vein, peduncular vein, right vein of the pontomesencephalic sulcus, and right lateral anterior pontomesencephalic vein were detected in all the subjects (100 %). The outer diameter of peduncular vein was 1.38 ± 0.26 mm (range 0.8-1.8 mm). The lateral mesencephalic vein was found in 75 % of the subjects and the mean outer diameter was 0.81 ± 0.2 mm (range 0.5-1.2 mm). The inner veins of mesencephalon were found by using SWI. The venous networks around the brain stem can be visualized by SWI clearly. This result can not only provide data for anatomical study, but also may be available for the surgical planning in the infratentorial region. (orig.)

  11. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  12. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  13. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T

    2005-01-01

    In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid...... and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...

  14. ALMA OBSERVATIONS OF THE HH 46/47 MOLECULAR OUTFLOW

    Energy Technology Data Exchange (ETDEWEB)

    Arce, Hector G. [Department of Astronomy, Yale University, P.O. Box 208101, New Haven, CT 06520-8101 (United States); Mardones, Diego; Garay, Guido [Departamento de Astronomia, Universidad de Chile, Casilla 36-D, Santiago (Chile); Corder, Stuartt A. [Joint ALMA Observatory, Av. Alonso de Cordova 3107, Vitacura, Santiago (Chile); Noriega-Crespo, Alberto [Infrared Processing and Analysis Center, California Institute of Technology, Pasadena, CA 91125 (United States); Raga, Alejandro C. [Instituto de Ciencias Nucleares, UNAM, Ap. 70-543, 04510 D.F. (Mexico)

    2013-09-01

    The morphology, kinematics, and entrainment mechanism of the HH 46/47 molecular outflow were studied using new ALMA Cycle 0 observations. Results show that the blue and red lobes are strikingly different. We argue that these differences are partly due to contrasting ambient densities that result in different wind components having a distinct effect on the entrained gas in each lobe. A 29 point mosaic, covering the two lobes at an angular resolution of about 3'', detected outflow emission at much higher velocities than previous observations, resulting in significantly higher estimates of the outflow momentum and kinetic energy than previous studies of this source, using the CO(1-0) line. The morphology and the kinematics of the gas in the blue lobe are consistent with models of outflow entrainment by a wide-angle wind, and a simple model describes the observed structures in the position-velocity diagram and the velocity-integrated intensity maps. The red lobe exhibits a more complex structure, and there is evidence that this lobe is entrained by a wide-angle wind and a collimated episodic wind. Three major clumps along the outflow axis show velocity distribution consistent with prompt entrainment by different bow shocks formed by periodic mass ejection episodes which take place every few hundred years. Position-velocity cuts perpendicular to the outflow cavity show gradients where the velocity increases toward the outflow axis, inconsistent with outflow rotation. Additionally, we find evidence for the existence of a small outflow driven by a binary companion.

  15. The trabecular meshwork outflow pathways: structural and functional aspects.

    Science.gov (United States)

    Tamm, Ernst R

    2009-04-01

    The major drainage structures for aqueous humor (AH) are the conventional or trabecular outflow pathways, which are comprised of the trabecular meshwork (made up by the uveal and corneoscleral meshworks), the juxtacanalicular connective tissue (JCT), the endothelial lining of Schlemm's canal (SC), the collecting channels and the aqueous veins. The trabecular meshwork (TM) outflow pathways are critical in providing resistance to AH outflow and in generating intraocular pressure (IOP). Outflow resistance in the TM outflow pathways increases with age and primary open-angle glaucoma. Uveal and corneoscleral meshworks form connective tissue lamellae or beams that are covered by flat TM cells which rest on a basal lamina. TM cells in the JCT are surrounded by fibrillar elements of the extracellular matrix (ECM) to form a loose connective tissue. In contrast to the other parts of the TM, JCT cells and ECM fibrils do not form lamellae, but are arranged more irregularly. SC inner wall endothelial cells form giant vacuoles in response to AH flow, as well as intracellular and paracellular pores. In addition, minipores that are covered with a diaphragm are observed. There is considerable evidence that normal AH outflow resistance resides in the inner wall region of SC, which is formed by the JCT and SC inner wall endothelium. Modulation of TM cell tone by the action of their actomyosin system affects TM outflow resistance. In addition, the architecture of the TM outflow pathways and consequently outflow resistance appear to be modulated by contraction of ciliary muscle and scleral spur cells. The scleral spur contains axons that innervate scleral spur cells or that have the ultrastructural characteristics of mechanosensory nerve endings.

  16. Effects of hyperventilation and hypocapnic/normocapnic hypoxemia on renal function and lithium clearance in humans

    DEFF Research Database (Denmark)

    Christensen, H; Klausen, T; Fogh-Andersen, N;

    1998-01-01

    Using the renal clearance of lithium as an index of proximal tubular outflow, this study tested the hypothesis that acute hypocapnic hypoxemia decreases proximal tubular reabsorption to the same extent as hypocapnic normoxemia (hyperventilation) and that this response is blunted during normocapni...

  17. The role of the renal afferent and efferent nerve fibers in heart failure.

    Science.gov (United States)

    Booth, Lindsea C; May, Clive N; Yao, Song T

    2015-01-01

    Renal nerves contain afferent, sensory and efferent, sympathetic nerve fibers. In heart failure (HF) there is an increase in renal sympathetic nerve activity (RSNA), which can lead to renal vasoconstriction, increased renin release and sodium retention. These changes are thought to contribute to renal dysfunction, which is predictive of poor outcome in patients with HF. In contrast, the role of the renal afferent nerves remains largely unexplored in HF. This is somewhat surprising as there are multiple triggers in HF that have the potential to increase afferent nerve activity, including increased venous pressure and reduced kidney perfusion. Some of the few studies investigating renal afferents in HF have suggested that at least the sympatho-inhibitory reno-renal reflex is blunted. In experimentally induced HF, renal denervation, both surgical and catheter-based, has been associated with some improvements in renal and cardiac function. It remains unknown whether the effects are due to removal of the efferent renal nerve fibers or afferent renal nerve fibers, or a combination of both. Here, we review the effects of HF on renal efferent and afferent nerve function and critically assess the latest evidence supporting renal denervation as a potential treatment in HF.

  18. Prevention of venous thromboembolism in hospitalized patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Marcora Mandreoli

    2013-04-01

    Full Text Available Despite the high morbidity and mortality associated with venous thromboembolism in hospitalized medical patients with a number of risk factors, and large evidence that prophylaxis is effective, prophylaxis rates remain elusive in medically ill patients. Furthermore, in patients with renal failure, prophylaxis often is omitted or sub-optimal, due to fear of provoking hemorrhage. Patients with end-stage renal disease often have platelet deficits. Low molecular weight heparin (LMWH therapy may also be difficult to manage in these cases because LMWH clearance is largely dependent on the kidneys. Administration of LMWH to patients with some degree of renal failure may lead to bioaccumulation of anti-Xa activity with an increased risk of bleeding. In recent years, LMWH has largely replaced unfractionated heparin (UFH for the treatment and prophylaxis of thromboembolic disease. LMWHs have been shown to be superior to UFH in the prevention of venous thromboembolism. They are also easier to administer and do not require laboratory monitoring. However, several case reports and a metaanalysis indicate that the use of LMWHs at therapeutic doses in patients with advanced renal failure can be associated with major bleeding with serious adverse effects. In this paper, we review recent evidence supporting the safety of LMWHs at prophylactic doses in patients with mild or moderate renal disease. Current evidence suggests that bioaccumulation of enoxaparin (the most widely used LMWH can occur when the drug is used at standard therapeutic doses in patients with severely impaired renal function. This risk can be reduced by empiric dose reduction or monitoring of anti-Xa heparin levels.

  19. Dual-energy computed tomography angiography for evaluating the renal vascular variants

    Institute of Scientific and Technical Information of China (English)

    TAO Xiao-feng; ZHU Jing-qi; WU Ying-wei; TANG Guang-yu; SHI Yu-zhen; ZHANG Lei; LIN Yi

    2013-01-01

    Background Recognizing renal vascular variants preoperatively is important in order to avoid vascular complications during surgery.This study aimed to investigate the renal vascular variants with dual-energy computed tomography (DECT) angiography to provide valuable information for surgery.Methods A total of 378 patients underwent DECT.The number,size,course and relationships of the renal vessels were retrospectively observed from the scans.Anomalies of renal arteries and veins were recorded and classified.Multiplanar reformations (MPR),maximum intensity projections (MIP),and volume renderings (VR) were used for analysis.Results In 378 patients (756 kidneys),renal artery variations were discovered and recorded in 123 kidneys (16.3%,123/756) of 106 patients (28.0%,106/378).Type IB (early branches of the only one main renal artery) and IC (accessory renal artery with only one main renal artery) were found most frequently with an incidence of 11.4% (43/378) and 14.5%(55/378).The incidence of renal artery variations in the left kidney was not statistically different than in the right kidney (12.4% vs.11.1%).The incidence of renal vein variations was detected in 104 patients (27.5%,104/378).The incidence of venous variants in the right kidney was higher than in the left kidney (20.1% vs.7.4%),but left renal vein variations were more complex.Variants of the left renal vein were detected in 28 patients including type 1 (circumaortic left renal vein) in eight cases,type 2 (retroaortic left renal vein) in seven cases,type 3 (abnormal reflux) in six cases,type 4 (late venous confluence of left renal vein) in five cases,and type 5 (rare type) in two cases.The frequency of left renal vein variation associated with the left renal accessory artery was significantly higher than with early branches of the left renal artery (P=0.037).Conclusions The renal vascular variants are rather common and complex.DECT angiography can demonstrate the precise anatomy of the

  20. Outflows of neutral (and ionized) gas in radio galaxies

    OpenAIRE

    Morganti, R.; Oosterloo, T.; Tadhunter, C.

    2004-01-01

    Outflows up to 1500 km/s of atomic neutral hydrogen are detected in a growing number of radio galaxies. Outflows with similar velocities are also detected in ionized gas, suggesting a common origin for the extreme kinematics of these two phases of the gas. The high detection rate ofsuch outflows in young (or restarted) radio sources appears to be related to the existence of a dense ISM around these objects. Such a dense ISM can have important consequences for the evolution of the radio source...

  1. Misalignment of Magnetic Fields and Outflows in Protostellar Cores

    CERN Document Server

    Hull, Charles L H; Bolatto, Alberto D; Bower, Geoffrey C; Carpenter, John M; Crutcher, Richard M; Fiege, Jason D; Franzmann, Erica; Hakobian, Nicholas S; Heiles, Carl; Houde, Martin; Hughes, A Meredith; Jameson, Katherine; Kwon, Woojin; Lamb, James W; Looney, Leslie W; Matthews, Brenda C; Mundy, Lee; Pillai, Thushara; Pound, Marc W; Stephens, Ian W; Tobin, John J; Vaillancourt, John E; Volgenau, N H; Wright, Melvyn C H

    2012-01-01

    Theoretical models of star formation generally assume that bipolar outflows are parallel to the mean magnetic-field direction in protostellar cores. Here we present results of \\lambda1.3 mm dust polarization observations toward 16 nearby, low-mass protostars, mapped with ~2.5" resolution at CARMA. The results show that magnetic fields in protostellar cores on scales of ~1000 AU are not tightly aligned with outflows from the protostars. If one assumes that outflows emerge along the rotation axes of circumstellar disks, then our results imply that these disks are not aligned with the fields in the cores from which they formed.

  2. Renal involvement in primary antiphospholipid syndrome.

    Science.gov (United States)

    Marcantoni, Carmelita; Emmanuele, Carmela; Scolari, Francesco

    2016-08-01

    Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent venous or arterial thrombosis and/or pregnancy-related problems associated with persistently elevated levels of antiphospholipid antibodies. The kidney is a major target organ in both primary and secondary antiphospholipid syndrome. This review describes several aspects of the renal involvement in the primary form of the syndrome, in particular the histological pattern of the so-called antiphospholipid syndrome nephropathy (APSN). APSN is a vascular nephropathy characterized by small vessel vaso-occlusive lesions associated with fibrous intimal hyperplasia of interlobular arteries, recanalizing thrombi in arteries and arterioles, and focal atrophy, a constellation of morphological lesions suggestive of primary antiphospholipid syndrome.

  3. Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury.

    Science.gov (United States)

    Gambardella, Ivancarmine; Gaudino, Mario; Ronco, Claudio; Lau, Christopher; Ivascu, Natalia; Girardi, Leonard N

    2016-11-01

    Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1.99, 95% confidence interval (95% CI) of 1.16-3.40. In cardiac surgery subsets where venous hypertension is a hallmark feature, the incidence of AKI is higher (tricuspid disease 30%, carcinoid valve disease 22%). Even in the non-chronically congested coronary artery bypass population, CVP measured 6 h postoperatively showed significant association to renal failure: risk-adjusted OR for AKI was 5.5 (95% CI 1.93-15.5; P = 0.001) with every 5 mmHg rise in CVP for patients with CVP <9 mmHg; for CVP increments of 5 mmHg above the threshold of 9 mmHg, the risk-adjusted OR for AKI was 1.3 (95% CI 1.01-1.65; P = 0.045). This and other clinical evidence are discussed along with the underlying pathophysiological mechanisms, involving the supremacy of volume receptors in regulating the autonomic output in hypervolaemia, and the regional effect of venous congestion on the nephron. The effect of CVP on renal function was found to be modulated by ventricular function class, aetiology and acuity of venous congestion. Evidence suggests that acute increases of CVP should be actively treated to avoid a deterioration of the renal function, particularly in patients with poor ventricular fraction. Besides, the practice of treating right heart failure with fluid loading should be avoided in favour of other ways to optimize haemodynamics in this setting, because of the detrimental effects on the kidney function.

  4. Intergalactic Magnetic Fields from Quasar Outflows

    CERN Document Server

    Furlanetto, S; Furlanetto, Steven; Loeb, Abraham

    2001-01-01

    Outflows from quasars inevitably pollute the intergalactic medium (IGM) with magnetic fields. The short-lived activity of a quasar leaves behind an expanding magnetized bubble in the IGM. We model the expansion of the remnant quasar bubbles and calculate their distribution as a function of size and magnetic field strength at different redshifts. We generically find that by a redshift z=3, about 5-20% of the IGM volume is filled by magnetic fields with an energy density >10% of the mean thermal energy density of a photo-ionized IGM (at T=10^4 K). As massive galaxies and X-ray clusters condense out of the magnetized IGM, the adiabatic compression of the magnetic field could result in the field strength observed in these systems without a need for further dynamo amplification. The intergalactic magnetic field could also provide a nonthermal contribution to the pressure of the photo-ionized gas that may account for the claimed discrepancy between the simulated and observed Doppler width distributions of the Ly-al...

  5. Optically thick outflows in ultraluminous supersoft sources

    CERN Document Server

    Urquhart, Ryan

    2015-01-01

    Ultraluminous supersoft sources (ULSs) are defined by a thermal spectrum with colour temperatures ~0.1 keV, bolometric luminosities ~ a few 10^39 erg/s, and almost no emission above 1 keV. It has never been clear how they fit into the general scheme of accreting compact objects. To address this problem, we studied a sample of seven ULSs with extensive Chandra and XMM-Newton coverage. We find an anticorrelation between fitted temperatures and radii of the thermal emitter, and no correlation between bolometric luminosity and radius or temperature. We compare the physical parameters of ULSs with those of classical supersoft sources, thought to be surface-nuclear-burning white dwarfs, and of ultraluminous X-ray sources (ULXs), thought to be super-Eddington stellar-mass black holes. We argue that ULSs are the sub-class of ULXs seen through the densest wind, perhaps an extension of the soft-ultraluminous regime. We suggest that in ULSs, the massive disk outflow becomes effectively optically thick and forms a large ...

  6. Simulating galactic outflows with kinetic supernova feedback

    CERN Document Server

    Vecchia, Claudio Dalla

    2008-01-01

    Feedback from star formation is thought to play a key role in the formation and evolution of galaxies, but its implementation in cosmological simulations is currently hampered by a lack of numerical resolution. We present and test a sub-grid recipe to model feedback from massive stars in cosmological smoothed particle hydrodynamics simulations. The energy is distributed in kinetic form among the gas particles surrounding recently formed stars. The impact of the feedback is studied using a suite of high-resolution simulations of isolated disc galaxies embedded in dark halos with total mass 10^{10} and 10^{12} M_sol/h. We focus in particular on the effect of pressure forces within the disc, which we turn off temporarily in some of our runs to mimic a recipe that has been widely used in the literature. We find that (ram) pressure forces on expanding superbubbles determine both the structure of the disc and the development of large-scale outflows. Pressure forces exerted by expanding superbubbles puff up the disc...

  7. Bipolar outflows in OH/IR stars

    CERN Document Server

    Zijlstra, A A; Hekkert, P L; Likkel, L; Comeron, F; Norris, R P; Molster, F J; Cohen, R J; Zijlstra, Albert A.

    2000-01-01

    We investigate the development of bipolar outflows during the early post-AGB evolution. A sample of ten OH/IR stars is observed at high angular resolution, including bipolar nebulae (OH231.8+4.2), bright post-AGB stars (HD 101584) and reflection nebulae (e.g. Roberts 22). The IRAS colour--colour diagram separates the sample into different types of objects. One group may contain the progenitors to the (few) extreme bipolar planetary nebulae. Two objects show colours and chemistry very similar to the planetary nebulae with late IR-[WC] stars. One object is a confirmed close binary. A model is presented consisting of an outer AGB wind which is swept up by a faster post-AGB wind, with either wind being non-spherically symetric. The interface of the two winds is shown to exhibit a linear relation between velocity and distance from the star. The OH data confirms the predicted linear velocity gradients, and reveals torus-like, uniformly expanding components. All sources are discussed in detail using optical/HST imag...

  8. Radiation Transport for Explosive Outflows: Opacity Regrouping

    CERN Document Server

    Wollaeger, Ryan T

    2014-01-01

    Implicit Monte Carlo (IMC) and Discrete Diffusion Monte Carlo (DDMC) are methods used to stochastically solve the radiative transport and diffusion equations, respectively. These methods combine into a hybrid transport-diffusion method we refer to as IMC-DDMC. We explore a multigroup IMC-DDMC scheme that, in DDMC, combines frequency groups with sufficient optical thickness. We term this procedure "opacity regrouping". Opacity regrouping has previously been applied to IMC-DDMC calculations for problems in which the dependence of the opacity on frequency is monotonic. We generalize opacity regrouping to non-contiguous groups and implement this in \\supernu, a code designed to do radiation transport in high-velocity outflows with non-monotonic opacities. We find that regrouping of non-contiguous opacity groups generally improves the speed of IMC-DDMC radiation transport. We present an asymptotic analysis that informs the nature of the Doppler shift in DDMC groups and summarize the derivation of the Gentile-Fleck ...

  9. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ozlem Tiryaki

    2013-01-01

    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  10. Distal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  11. Proximal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  12. Microinjection of glycine into the hypothalamic paraventricular nucleus produces diuresis, natriuresis, and inhibition of central sympathetic outflow.

    Science.gov (United States)

    Krowicki, Zbigniew K; Kapusta, Daniel R

    2011-04-01

    Strychnine-sensitive glycine receptors and glycine-immunoreactive fibers are expressed in the hypothalamic paraventricular nucleus (PVN), yet the functional significance of this innervation is unclear. Therefore, these studies examined the changes in cardiovascular and renal function and renal sympathetic nerve activity (RSNA) produced by the microinjection of glycine (5 and 50 nmol) into the PVN of conscious Sprague-Dawley rats. Microinjection of glycine into, but not outside of, the PVN dose-dependently increased urine flow rate and urinary sodium excretion and decreased RSNA. At the higher dose, PVN glycine also decreased heart rate; neither 5 nor 50 nmol PVN glycine altered mean arterial pressure. The glycine (50 nmol)-evoked diuresis and natriuresis were abolished in rats continuously infused intravenously with [Arg(8)]-vasopressin. Furthermore, chronic bilateral renal denervation prevented the bradycardia and diuresis to PVN glycine and blunted the natriuresis. In other studies, unilateral PVN pretreatment with the glycine receptor antagonist strychnine (1.6 nmol) prevented the effects of PVN glycine (50 nmol) on heart rate, RSNA, and renal excretory function. When microinjected bilaterally, PVN strychnine (1.6 nmol per site) evoked a significant increase in heart rate and RSNA without altering renal excretory function. These findings demonstrate that in conscious rats glycine acts in the PVN to enhance the renal excretion of water and sodium and decrease central sympathetic outflow to the heart and kidneys. Although endogenous PVN glycine inputs elicit a tonic control of heart rate and RSNA, the renal excretory responses to PVN glycine seem to be caused primarily by the inhibition of arginine vasopressin secretion.

  13. Acute scrotal pain: an uncommon manifestation of renal vein thrombosis.

    Science.gov (United States)

    Jou, Yeong-Chin; Jong, Ing-Chin; Hsieh, Ying-Chen; Kang, Chun-Hsiung

    2014-03-01

    The clinical manifestation of renal vein thrombosis varies with the speed and degree of venous occlusion. Such patients may be asymptomatic, have minor nonspecific symptoms such as nausea or weakness, or have more specific symptoms such as upper abdominal pain, flank pain, or hematuria. Acute scrotal pain is a very uncommon clinical expression of renal vein thrombosis. Here, we report a case of membranous glomerulonephritis-induced renal vein thrombosis presented with the symptom of acute scrotal pain caused by thrombosis-induced varicocele. This case report suggests that renal vein thrombosis should be considered in the diagnosis of acute scrotal pain; it also emphasizes that an investigation of retroperitoneum should be performed for adult patients with the sudden onset of varicocele.

  14. Correlation of the CT values of abdominal aorta,renal artery and renal cortex with its thickness on 64-MDCT contrast en-hanced images

    Institute of Scientific and Technical Information of China (English)

    Alomary Mahfooz-Naef; Vikash; Wang Qiu-xia; Zhang Jin-hua; Hu Dao-yu

    2015-01-01

    Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cor-tex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96 patients (50 men and 46 women;16~74 years)with normal kidney function,which was confirmed by kidney function test were enrolled in this stud-y,including bilateral kidneys of 92 cases and unilateral kidney of 4 cases (total of 188 kidneys;92 left,96 right).After intra-venous (IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were per-formed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5 software.Quantitative data were presented as mean ± standard deviation,while qualitative data were presented as frequency (%).P<0.05 was considered to be statistically significant.Results:The mean renal cortex thickness was (5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correla-tion between renal cortex CT values and abdominal aortic CT values was showed (r= 0.584;P<0.001).A statistically sig-nificant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated (r= 0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values (r= 0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.

  15. MISALIGNMENT OF MAGNETIC FIELDS AND OUTFLOWS IN PROTOSTELLAR CORES

    Energy Technology Data Exchange (ETDEWEB)

    Hull, Charles L. H.; Plambeck, Richard L.; Bower, Geoffrey C.; Heiles, Carl; Meredith Hughes, A. [Astronomy Department and Radio Astronomy Laboratory, University of California, Berkeley, CA 94720-3411 (United States); Bolatto, Alberto D.; Jameson, Katherine; Mundy, Lee; Pound, Marc W. [Astronomy Department and Laboratory for Millimeter-wave Astronomy, University of Maryland, College Park, MD 20742 (United States); Carpenter, John M.; Lamb, James W.; Pillai, Thushara [Department of Astronomy, California Institute of Technology, 1200 E. California Blvd., MC 249-17, Pasadena, CA 91125 (United States); Crutcher, Richard M.; Hakobian, Nicholas S.; Kwon, Woojin; Looney, Leslie W. [Department of Astronomy, University of Illinois at Urbana-Champaign, 1002 W Green Street, Urbana, IL 61801 (United States); Fiege, Jason D.; Franzmann, Erica [Department of Physics and Astronomy, University of Manitoba, Winnipeg, MB R3T 2N2 (Canada); Houde, Martin [Department of Physics and Astronomy, University of Western Ontario, London, ON N6A 3K7 (Canada); Matthews, Brenda C., E-mail: chat@astro.berkeley.edu [Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Rd., Victoria, BC V8P 5C2 (Canada); and others

    2013-05-10

    We present results of {lambda}1.3 mm dust-polarization observations toward 16 nearby, low-mass protostars, mapped with {approx}2.''5 resolution at CARMA. The results show that magnetic fields in protostellar cores on scales of {approx}1000 AU are not tightly aligned with outflows from the protostars. Rather, the data are consistent with scenarios where outflows and magnetic fields are preferentially misaligned (perpendicular), or where they are randomly aligned. If one assumes that outflows emerge along the rotation axes of circumstellar disks, and that the outflows have not disrupted the fields in the surrounding material, then our results imply that the disks are not aligned with the fields in the cores from which they formed.

  16. Estimation of cold plasma outflow during geomagnetic storms

    CERN Document Server

    Haaland, S; André, M; Maes, L; Baddeley, L; Barakat, A; Chappell, R; Eccles, V; Johnsen, C; Lybekk, B; Li, K; Pedersen, A; Schunk, R; Welling, D

    2016-01-01

    Low-energy ions of ionospheric origin constitute a significant contributor to the magnetospheric plasma population. Measuring cold ions is difficult though. Observations have to be done at sufficiently high altitudes and typically in regions of space where spacecraft attain a positive charge due to solar illumination. Cold ions are therefore shielded from the satellite particle detectors. Furthermore, spacecraft can only cover key regions of ion outflow during segments of their orbit, so additional complications arise if continuous longtime observations, such as during a geomagnetic storm, are needed. In this paper we suggest a new approach, based on a combination of synoptic observations and a novel technique to estimate the flux and total outflow during the various phases of geomagnetic storms. Our results indicate large variations in both outflow rates and transport throughout the storm. Prior to the storm main phase, outflow rates are moderate, and the cold ions are mainly emanating from moderately sized ...

  17. Outflows of neutral (and ionized) gas in radio galaxies

    CERN Document Server

    Morganti, R; Tadhunter, C

    2004-01-01

    Outflows up to 1500 km/s of atomic neutral hydrogen are detected in a growing number of radio galaxies. Outflows with similar velocities are also detected in ionized gas, suggesting a common origin for the extreme kinematics of these two phases of the gas. The high detection rate ofsuch outflows in young (or restarted) radio sources appears to be related to the existence of a dense ISM around these objects. Such a dense ISM can have important consequences for the evolution of the radio source and the galaxy as a whole. Here we summarize the recent results obtained and the characteristics derived so far for these outflows. We also discuss possible mechanisms (e.g. interaction between the radio plasma and the ISM and adiabatically expanding broad emission lines clouds) that can be at the origin of these phenomena.

  18. About the seasonal and fortnightly variabilities of the Mediterranean outflow

    Directory of Open Access Journals (Sweden)

    C. Millot

    2011-06-01

    Full Text Available CTD time series from the HYDRO-CHANGES programme and INGRES projects have been collected simultaneously (2004–2008 on the shelf of Morocco and at the sills of Camarinal and Espartel in the strait of Gibraltar. They provide information that supports results recently obtained from the analysis of the two former time series, as well as from a reanalysis of GIBEX CTD profiles (1985–1986. The outflow of Mediterranean Waters, which does not show a clear seasonal variability before entering the strait, strongly mixes within the strait, due mainly to the internal tide, with the seasonally variable inflow of Atlantic Water. The outflow thus gets marked seasonal and fortnightly variabilities within the strait. Furthermore, since the outflowing waters entering the strait display marked spatial heterogeneity and long-term temporal variabilities, accurately predicting the characteristics of the Mediterranean outflow into the North Atlantic Ocean appears almost impossible.

  19. Autosomal dominant inheritance of left ventricular outflow tract obstruction

    NARCIS (Netherlands)

    Wessels, Marjolein; Berger, Rudolphus; Frohn-Mulder, Ingrid M E; Roos-Hesselink, Jolien W; Hoogeboom, Jeanette J M; Mancini, Grazia S; Bartelings, Margot M; Krijger, Ronald de; Wladimiroff, Jury W; Niermeijer, Martinus F; Grossfeld, Paul; Willems, Patrick J

    2005-01-01

    Most nonsyndromic congenital heart malformations (CHMs) in humans are multifactorial in origin, although an increasing number of monogenic cases have been reported recently. We describe here four new families with presumed autosomal dominant inheritance of left ventricular outflow tract obstruction

  20. Renal tuberculosis

    Directory of Open Access Journals (Sweden)

    Džamić Zoran

    2016-01-01

    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  1. Haemoptysis due to pulmonary venous stenosis

    Directory of Open Access Journals (Sweden)

    Silke Braun

    2014-06-01

    Full Text Available Haemoptysis is a potentially life-threatening condition with the need for prompt diagnosis. In about 10–20% of all cases the bleeding source remains unexplained with the standard diagnostic approach. The aim of this article is to show the necessity of widening the diagnostic approach to haemoptysis with consideration of pulmonary venous stenosis as a possible cause of even severe haemoptysis and haemoptoe. A review of the literature was performed using the Medline/PubMed database with the terms: “pulmonary venous stenosis”, “pulmonary venous infarction” and “haemoptysis”. Further references from the case reports were considered. 58 case reports and case collections about patients with haemoptysis due to pulmonary venous stenosis were detected. This review gives an overview about the case reports and discusses the underlying pathophysiology and the pros and cons of different imaging techniques for the detection of pulmonary venous stenosis. Several conditions predispose to the obstruction of the mediastinal pulmonary veins. Clinical findings are unspecific and may be misleading. Pulmonary venous stenosis can be detected using several imaging techniques, yet three-dimensional magnetic resonance-angiography and three-dimensional contrast-enhanced computed tomography are the most appropriate. Pulmonary venous stenosis should be considered in patients with haemoptysis.

  2. Moxonidine prevents ischemia/reperfusion-induced renal injury in rats.

    Science.gov (United States)

    Tsutsui, Hidenobu; Sugiura, Takahiro; Hayashi, Kentaro; Ohkita, Mamoru; Takaoka, Masanori; Yukimura, Tokihito; Matsumura, Yasuo

    2009-01-28

    Enhancement of renal sympathetic nerve activity during renal ischemia and its consequent effect on norepinephrine overflow from nerve endings after reperfusion play important roles in the development of ischemic acute kidney injury. In the present study, we evaluated whether moxonidine, an alpha(2)-adrenaline/I(1)-imidazoline receptor agonist which is known to elicit sympathoinhibitory action, would prevent the post-ischemic renal injury. Ischemic acute kidney injury was induced by clamping the left renal artery and vein for 45 min followed by reperfusion, 2 weeks after contralateral nephrectomy. Intravenous (i.v.) injection of moxonidine at a dose of 360 nmol/kg to ischemic acute kidney injury rats suppressed the enhanced renal sympathetic nerve activity during the ischemic period, to a degree similar to findings with intracerebroventricular (i.c.v.) injection of moxonidine at a dose of 36 nmol/kg. On the other hand, suppressive effects of the i.v. treatment on renal venous norepinephrine overflow, renal dysfunction and tissue injury in the post-ischemic kidney were significantly greater than those elicited by the i.c.v. treatment. These results suggest that renoprotective effects of moxonidine on ischemic acute kidney injury probably result from its suppressive action on the ischemia-enhanced renal sympathetic nerve activity followed by norepinephrine spillover from the nerve endings of the post-ischemic kidney.

  3. Renale Osteopathie

    Directory of Open Access Journals (Sweden)

    Horn S

    2001-01-01

    Full Text Available Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Therapiemöglichkeiten. Wir beeinflussen dadurch nicht nur die Morbidität und Lebensqualität, sondern auch die Mortalität unserer Patienten.

  4. Do galaxies that leak ionizing photons have extreme outflows?

    Science.gov (United States)

    Chisholm, J.; Orlitová, I.; Schaerer, D.; Verhamme, A.; Worseck, G.; Izotov, Y. I.; Thuan, T. X.; Guseva, N. G.

    2017-09-01

    Context. To reionize the early universe, high-energy photons must escape the galaxies that produce them. How these photons escape is debated because too many ionizing photons are absorbed even at small H i column densities. It has been suggested that stellar feedback drives galactic outflows out of star-forming regions, creating low density channels through which ionizing photons escape into the inter-galactic medium. Aims: We compare the galactic outflow properties of confirmed Lyman continuum (LyC) leaking galaxies to a control sample of nearby star-forming galaxies to explore whether the outflows from leakers are extreme as compared to the control sample. Methods: We use data from the Cosmic Origins Spectrograph on the Hubble Space Telescope to measure the equivalent widths and velocities of Si ii and Si iii absorption lines, tracing neutral and ionized galactic outflows. We explore whether the leakers have similar outflow properties to the control sample, and whether the outflows from the leakers follow similar scaling relations with host galaxy properties as the control sample. We rederive the escape fraction of ionizing photons for each leaker, and study whether the outflow properties influence the LyC escape fractions. Results: We find that the Si ii and Si iii equivalent widths of the LyC leakers reside on the low-end of the trend established by the control sample. The leakers' velocities are not statistically different than the control sample, but their absorption line profiles have a different asymmetry: their central velocities are closer to their maximum velocities. This possibly indicates a more rapidly accelerated outflow due to the compact size of the leakers. The outflow kinematics and equivalent widths are consistent with the scaling relations between outflow properties and host galaxy properties - most notably metallicity - defined by the control sample. Additionally, we use the Lyα profiles to show that the Si ii equivalent width scales with the

  5. Renal disease in pregnancy.

    Science.gov (United States)

    Thorsen, Martha S; Poole, Judith H

    2002-03-01

    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  6. Getting the most from venous occlusion plethysmography: proposed methods for the analysis of data with a rest/exercise protocol.

    Science.gov (United States)

    Wythe, Stephen; Davies, Thomas; Martin, Daniel; Feelisch, Martin; Gilbert-Kawai, Edward

    2015-01-01

    Venous occlusion plethysmography is a simple yet powerful technique for the non-invasive measurement of blood flow. It has been used extensively in both the experimental and clinical settings. The underlying rationale is that when venous outflow from an extremity is occluded, any immediate increase in volume of this compartment must originate from the on-going arterial inflow. Mercury-in-silastic strain gauges are typically used to measure these volume changes, the rates of which are directly proportional to blood flow. When using a simple rest/exercise protocol to provide a local or systemic metabolic stimulus to increase blood flow, current methods for analysing the data obtained are often rather simplistic, solely considering the mean increment in blood flow induced by exercise. Previous methodological considerations have focused mainly on issues of reproducibility and accuracy (for instance, by comparing unilateral and/or bilateral measurements) but rarely on what the recorded traces may actually mean. In this methodological manuscript, we suggest a more detailed approach to processing venous occlusion plethysmography data, one which could provide additional physiological information. Six parameters are described, all of which are easily derived from a simple and reproducible experimental rest/exercise venous occlusion plethysmography protocol.

  7. Percutaneous transluminal angioplasty in a patient with chronic cerebrospinal venous insufficiency and persistent left superior vena cava.

    Science.gov (United States)

    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.

  8. A case of renal cell carcinoma with an extensive inferior vena cava thrombosis

    Directory of Open Access Journals (Sweden)

    Majd Alfreijat

    2016-10-01

    Full Text Available Renal cell carcinoma (RCC is the most prevalent primary renal malignant neoplasm in adults. Most of the cases are usually found incidentally. It is commonly associated with venous thrombosis. We demonstrate a case of a RCC which was associated with an extensive thrombus that reached the upper part of the inferior vena cava (IVC. We also perform a brief literature review about the association between RCC and IVC thrombosis.

  9. Ultra-fast outflows (aka UFOs) from AGNs and QSOs

    Science.gov (United States)

    Cappi, M.; Tombesi, F.; Giustini, M.

    During the last decade, strong observational evidence has been accumulated for the existence of massive, high velocity winds/outflows (aka Ultra Fast Outflows, UFOs) in nearby AGNs and in more distant quasars. Here we briefly review some of the most recent developments in this field and discuss the relevance of UFOs for both understanding the physics of accretion disk winds in AGNs, and for quantifying the global amount of AGN feedback on the surrounding medium.

  10. Collapse and Outflow Towards an Integrated Theory of Star Formation

    CERN Document Server

    Pudritz, R E; Ouyed, R

    1997-01-01

    Observational advances over the last decade reveal that star formation is associated with the simultaneous presence of gravitationally collapsing gas, bipolar outflow, and an accretion disk. Two theoretical views of star formation suppose that either stellar mass is determined from the outset by gravitational instability, or by the outflow which sweeps away the collapsing envelope of initially singular density distributions. Neither picture appears to explain all of the facts. This contribution examines some of the key issues facing star formation theory.

  11. Wien Fireball Model of Relativistic Outflows in Active Galactic Nuclei

    OpenAIRE

    岩本, 静男; イワモト, シズオ

    2003-01-01

    We study steady and spherically symmetric outflows of pure electron-positron pair plasma as a possible acceleration mechanism of relativistic jets up to the bulk Lorentz factor of greater than 10. These outflows are initiated by the ``Wien fireball'', which is optically thick to Compton scattering but thin to absorption and in a Wien equilibrium state between pairs and photons at a relativistic temperature.

  12. Ultra-fast outflows (aka UFOs) from AGNs and QSOs

    CERN Document Server

    Cappi, M; Giustini, M

    2013-01-01

    During the last decade, strong observational evidence has been accumulated for the existence of massive, high velocity winds/outflows (aka Ultra Fast Outflows, UFOs) in nearby AGNs and in more distant quasars. Here we briefly review some of the most recent developments in this field and discuss the relevance of UFOs for both understanding the physics of accretion disk winds in AGNs, and for quantifying the global amount of AGN feedback on the surrounding medium.

  13. Characterization of molecular outflows in the substellar domain

    Energy Technology Data Exchange (ETDEWEB)

    Phan-Bao, Ngoc; Dang-Duc, Cuong [Department of Physics, International University-Vietnam National University HCM, Block 6, Linh Trung Ward, Thu Duc District, Ho Chi Minh City (Viet Nam); Lee, Chin-Fei; Ho, Paul T. P. [Institute of Astronomy and Astrophysics, Academia Sinica, P.O. Box 23-141, Taipei 106, Taiwan (China); Li, Di, E-mail: pbngoc@hcmiu.edu.vn, E-mail: pbngoc@asiaa.sinica.edu.tw [National Astronomical Observatories, Chinese Academy of Science, Chaoyang District Datun Rd A20, Beijing (China)

    2014-11-01

    We report here our latest search for molecular outflows from young brown dwarfs and very low-mass stars in nearby star-forming regions. We have observed three sources in Taurus with the Submillimeter Array and the Combined Array for Research in Millimeter-wave Astronomy at 230 GHz frequency to search for CO J = 2 → 1 outflows. We obtain a tentative detection of a redshifted and extended gas lobe at about 10 arcsec from the source GM Tau, a young brown dwarf in Taurus with an estimated mass of 73 M {sub J}, which is right below the hydrogen-burning limit. No blueshifted emission around the brown dwarf position is detected. The redshifted gas lobe that is elongated in the northeast direction suggests a possible bipolar outflow from the source with a position angle of about 36°. Assuming that the redshifted emission is outflow emission from GM Tau, we then estimate a molecular outflow mass in the range from 1.9 × 10{sup –6} M {sub ☉} to 2.9 × 10{sup –5} M {sub ☉} and an outflow mass-loss rate from 2.7 × 10{sup –9} M {sub ☉} yr{sup –1} to 4.1 × 10{sup –8} M {sub ☉} yr{sup –1}. These values are comparable to those we have observed in the young brown dwarf ISO-Oph 102 of 60 M {sub J} in ρ Ophiuchi and the very low-mass star MHO 5 of 90 M {sub J} in Taurus. Our results suggest that the outflow process in very low-mass objects is episodic with a duration of a few thousand years and the outflow rate of active episodes does not significantly change for different stages of the formation process of very low-mass objects. This may provide us with important implications that clarify the formation process of brown dwarfs.

  14. A Review on the Hemodialysis Reliable Outflow (HeRO) Graft for Haemodialysis Vascular Access.

    Science.gov (United States)

    Al Shakarchi, J; Houston, J G; Jones, R G; Inston, N

    2015-07-01

    With improved dialysis survival there are increasing numbers of patients who have exhausted definitive access options due to central venous stenosis and are maintaining dialysis on a central venous catheter. The Hemodialysis Reliable Outflow (HeRO) allows an alternative by providing a definitive access solution. The aim of this study is to systematically review the published outcomes of the HeRO graft and discuss the role in complex haemodialysis patients. Electronic databases were searched for studies assessing the use of the HeRO graft for dialysis in accordance with PRISMA published up to December 31 2014. The primary outcomes for this study were 1-year primary and secondary patency rates. Secondary outcomes were rates of dialysis access associated steal syndrome, HeRO-related bacteraemia rates and rates of interventions. Following strict inclusion/exclusion criteria, eight studies including 409 patients were included in our review. Primary and secondary pooled patency rates in this complex cohort of dialysis patients were found to be 21.9% (9.6-37.2%) and 59.4% (39.4-78%). The rate of dialysis access associated steal syndrome was low at 6.3% (1-14.7%) as was the range of HeRO-related bacteraemia (0.13-0.7 events per 1000 days). This literature review shows that the HeRO graft is an acceptable option for complex dialysis patients who are catheter dependent. Owing to device availability, published data are predominantly North American and further longer-term studies in other populations may be necessary. In this challenging patient group, randomized controlled trials are required to allow comparisons with alternative access options. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Sympathetic nervous activity and renal and systemic hemodynamics in cirrhosis: plasma norepinephrine concentration, hepatic extraction, and renal release

    DEFF Research Database (Denmark)

    Ring-Larsen, H; Hesse, B; Henriksen, Jens Henrik Sahl

    1982-01-01

    Systemic and renal neurovascular reactivity was investigated in eight patients with cirrhosis and in eight control subjects with fatty liver during postural changes. In the supine position, mean renal blood flow averaged 1.51 and 2.97 ml per gm per min in patients and controls, respectively (p less...... 60 degrees head-up tilt, the increase in NE was similar in both groups. In another 10 patients with cirrhosis in recumbency, the splanchnic arterial-hepatic venous extraction of NE averaged 0.43 (p less than 0.01), and the hepatic clearance of NE averaged 315 ml per min which is of the same order...... be responsible for renal vasoconstriction in these patients. However, systemic and renal neurovascular reactivity seems to be maintained even at an advanced stage of the disease....

  16. Late renal vein thrombosis associated with recurrence of membranous nephropathy in a renal allograft: a case report.

    Science.gov (United States)

    Carrasco, A; Díaz, C; Flores, J C; Briones, E; Otipka, N

    2008-11-01

    Allograft renal vein thrombosis (RVT) is an uncommon but potentially catastrophic complication. Although it usually occurs in the early posttransplant period and is associated with surgical complications or vascular rejection, it may develop later, when it is generally related with a hypercoagulable state. Typical clinical presentation is sudden oligoanuric acute renal failure, and hematuria, with a painful and swollen renal allograft. Confirmation of the diagnosis requires Doppler ultrasound and computed tomography. Herein we have reported a successfully treated case of late RVT that developed in an allograft with recurrent membranous nephropathy associated with the nephrotic syndrome. The patient fully recovered renal graft function a few days after presentation, which was related to anticoagulant therapy. We demonstrated complete recanalization of the venous thrombosis.

  17. Acute scrotum in a neonate caused by renal vein thrombosis.

    Science.gov (United States)

    Maas, C; Müller-Hansen, I; Flechsig, H; Poets, C F

    2011-03-01

    The authors report on a rare case of neonatal scrotal oedema occurring concurrently with pain upon palpation of the spermatic cord on the first day of life. An ultrasound examination showed poor perfusion of the left testicle and a thrombosis of the left renal vein; intraoperative exploration indicated necrosis of the left testicle without signs of torsion. Gorged vessels with paravasal bleeding were found in the spermatic cord. The authors hypothesise that necrosis of the testicle may result from haemorrhagic infarction caused by renal venous thrombosis. Acute scrotal discolouration with pain upon palpation in neonates is usually attributed to testicular torsion. The authors report a case where these symptoms had a different cause.

  18. Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

    Science.gov (United States)

    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

  19. [Surgical complications in 479 renal transplantations].

    Science.gov (United States)

    Borrego, J; Burgos, F J; Galmes, I; Orofino, L; Rodríguez Luna, J M; Marcen, R; Fernández, E; Escudero, A; Ortuño, J

    1994-04-01

    Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.

  20. [Use of mesoglycan in venous pathology].

    Science.gov (United States)

    Scondotto, G; Catena, G; Aloisi, D

    1997-12-01

    Twenty-five female patients suffering from primary venous insufficiency of the lower limbs underwent parenteral and oral treatment with mesoglycan for 3 months. In addition to an evaluation of the subjective and objective parameters linked to venous insufficiency, all patients underwent lower limb venous echo colour-Doppler and videocapillaroscopy using an optic probe in a perimalleolar or periulcerous site. At the end of treatment, all patients reported an improvement in subjective parameters, which was confirmed by a reduction of distal edema in 22 out of 25 cases. There was also an improvement in capillaroscopic findings (reduction of edema of pericapillary connective tissue, reduction of capillary and venular ectasia.

  1. [Ultrasound-guided peripheral venous access].

    Science.gov (United States)

    Fuzier, Régis; Rougé, Pierre; Pierre, Sébastien

    2016-02-01

    International guidelines advocate the use of first-line ultrasound for central venous catheter, particularly for the internal jugular vein. The role of ultrasound in peripheral venous access remains questionable. In some specific situations, such as pediatrics, obesity and patients with poor venous network, problems to cannulate peripheral vein may occur. Success rate of peripheral intravenous access increases with the diameter of the vein and for a depth of the vein between 0.3 and 1.5 cm. The type of puncture (long-axis or short-axis) and the type of catheters have little influence on the success rate. Specific considerations have to be taken concerning infection control.

  2. Current opinion on iliofemoral venous thrombectomy.

    Science.gov (United States)

    Stephens, G L

    1976-02-01

    Iliofemoral venous thrombosis is discussed and a technique of iliofemoral venous thrombectomy is presented. Operative phlebography is recommended. The personal recommendations of leading American vascular surgeons in treating the patient with acute iliofemoral venous thrombosis are presented. I recommend thrombectomy for phlegmasia cerulea dolens, and in previously healthy, young ambulatory patients with phlegmasia alba dolens who are seen within 48 hours following thrombosis and have failed to show clinical improvement after a trial of bed rest, elevation of the lower extremities, and intravenous heparin. The majority of patients seen with phlegmasia alba dolens will best be served with nonoperative treatment.

  3. Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report

    Directory of Open Access Journals (Sweden)

    Sountoulides P

    2008-05-01

    Full Text Available Abstract Introduction Congenital renal arteriovenous malformations (AVMs are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria whilst preserving renal parenchyma. Case presentation A 72-year-old man, who was heavy smoker, presented with massive hematuria and flank pain. CT scan revealed a filling defect caused by a soft tissue mass in the renal pelvis, which initially led to the suspicion of a transitional cell carcinoma (TCC of the upper tract, in view of the patient's age and smoking habits. However a subsequent retrograde study could not depict any filling defect in the renal pelvis. Selective right renal arteriography confirmed the presence of a renal AVM by demonstrating abnormal arterial communication with a vein with early visualization of the venous system. At the same time successful selective transcatheter embolization of the lesion was performed. Conclusion This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. In the case presented, a congenital renal AVM proved to be the cause of massive upper tract hematuria and flank pain in spite of the initial evidence indicating the likely diagnosis of a renal pelvis tumor.

  4. Evolution of active region outflows throughout an active region lifetime

    CERN Document Server

    Zangrilli, L

    2016-01-01

    We have shown previously that SOHO/UVCS data allow us to detect active region (AR) outflows at coronal altitudes higher than those reached by other instrumentation. These outflows are thought to be a component of the slow solar wind. Our purpose is to study the evolution of the outflows in the intermediate corona from AR 8100, from the time the AR first forms until it dissolves, after several transits at the solar limb. Data acquired by SOHO/UVCS at the time of the AR limb transits, at medium latitudes and at altitudes ranging from 1.5 to 2.3 R_sun, were used to infer the physical properties of the outflows through the AR evolution. To this end, we applied the Doppler dimming technique to UVCS spectra. These spectra include the H I Lyman alpha line and the O VI doublet lines at 1031.9 and 1037.6 A. Plasma speeds and electron densities of the outflows were inferred over several rotations of the Sun. AR outflows are present in the newly born AR and persist throughout the entire AR life. Moreover, we found two t...

  5. The Implications of Extreme Outflows from Extreme Starbursts

    Science.gov (United States)

    Heckman, Timothy M.; Borthakur, Sanchayeeta

    2016-05-01

    Interstellar ultraviolet absorption lines provide crucial information about the properties of galactic outflows. In this paper, we augment our previous analysis of the systematic properties of starburst-driven galactic outflows by expanding our sample to include a rare population of starbursts with exceptionally high outflow velocities. In principle, these could be a qualitatively different phenomenon from more typical outflows. However, we find that instead these starbursts lie on, or along the extrapolation of, the trends defined by the more typical systems studied previously by us. We exploit the wide dynamic range provided by this new sample to determine scaling relations of outflow velocity with galaxy stellar mass (M *), circular velocity, star formation rate (SFR), SFR/M *, and SFR/area. We argue that these results can be accommodated within the general interpretational framework we previously advocated, in which a population of ambient interstellar or circumgalactic clouds is accelerated by the combined forces of gravity and the momentum flux from the starburst. We show that this simple physical picture is consistent with both the strong cosmological evolution of galactic outflows in typical star-forming galaxies and the paucity of such galaxies with spectra showing inflows. We also present simple parameterizations of these results that can be implemented in theoretical models and numerical simulations of galaxy evolution.

  6. Energy- and momentum-conserving AGN feedback outflows

    CERN Document Server

    Zubovas, Kastytis

    2014-01-01

    It is usually assumed that outflows from luminous AGN are either in the energy-conserving (non-radiative) or in the momentum-conserving (radiative) regime. We show that in a non-spherical geometry the effects of both regimes may manifest at the same time, and that it is the momentum of the outflow that sets the $M_{\\rm BH}-\\sigma$ relation. Considering an initially elliptical distribution of gas in the host galaxy, we show that a non-radiative outflow opens up a wide ``escape route'' over the paths of least resistance. Most of the outflow energy escapes in that direction. At the same time, in the directions of higher resistance, the ambient gas is affected mainly by the incident momentum from the outflow. Quenching SMBH growth requires quenching gas delivery along the paths of highest resistance, and therefore, it is the momentum of the outflow that limits the black hole growth. We present an analytical argument showing that such energy-conserving feedback bubbles driving leaky ambient shells will terminate S...

  7. MOS Mapping of the NIR Outflow HH 223

    Science.gov (United States)

    López, R.; Acosta-Pulido, J. A.; Estalella, R.; Gómez, G.; García-Lorenzo, B.

    2016-10-01

    The Multi-Object-Spectroscopy (MOS) mode of LIRIS was used to map the near-IR stellar outflow HH 223, in the dark cloud Lynds 723 (L723). HH 223 spatially coincides with the east-west component of the L723 quadrupolar CO outflow. The radio continuum source SMA2, towards the center of the quadrupolar CO outflow, hides the YSO that seems to power both the near-IR and the CO outflows. To map the S-shaped, near-IR emission of HH 223, extending ˜ 5', an appropriate mask was designed, with 16 rectangular slitlets. J, H and K-band spectra (R ˜eq 2500) were obtained through the mask. The kinematics of the neutral (H2) and ionized ([FeII]) gas outflow was derived from these data. The results confirm that both the near-IR and the CO outflows have a common driving source. To our knowledge, this is the first use of the MOS-LIRIS observing mode with the mask designed ad hoc to fit several extended, nonaligned targets.

  8. Characterization of Molecular Outflows in The Substellar Domain

    CERN Document Server

    Phan-Bao, Ngoc; Ho, Paul T P; Dang-Duc, Cuong; Li, Di

    2014-01-01

    We report here our latest search for molecular outflows from young brown dwarfs and very low-mass stars in nearby star-forming regions. We have observed three sources in Taurus with the Submillimeter Array and the Combined Array for Research in Millimeter-wave Astronomy at 230 GHz frequency to search for CO J=2-1 outflows. We obtain a tentative detection of a redshifted and extended gas lobe at about 10 arcsec from the source GM Tau, a young brown dwarf in Taurus with an estimated mass of 73 M_J, which is right below the hydrogen-burning limit. No blueshifted emission around the brown dwarf position is detected. The redshifted gas lobe that is elongated in the northeast direction suggests a possible bipolar outflow from the source with a position angle of about 36 degrees. Assuming that the redshifted emission is outflow emission from GM Tau, we then estimate a molecular outflow mass in the range from 1.9x10^-6 M_Sun to 2.9x10^-5 M_Sun and an outflow mass-loss rate from 2.7x10^-9 M_Sun yr^-1 to 4.1x10^-8 M_Su...

  9. Discovery of Relativistic Outflow in the Seyfert Galaxy Ark 564

    CERN Document Server

    Gupta, A; Krongold, Y; Nicastro, F

    2013-01-01

    We present Chandra high energy transmission grating spectra of the narrow-line Seyfert-1 galaxy Ark 564. The spectrum shows numerous absorption lines which are well modeled with low velocity outflow components usually observed in Seyfert galaxies (Gupta et al. 2013). There are, however, some residual absorption lines which are not accounted for by low-velocity outflows. Here we present identifications of the strongest lines as K{\\alpha} transitions of OVII(two lines) and OVI at outflow velocities of ~0.1c. These lines are detected at 6.9{\\sigma}, 6.2{\\sigma}, and 4.7{\\sigma} respectively and cannot be due to chance statistical fluctuations. Photoionization models with ultra-high velocity components improves the spectral fit significantly, providing further support for the presence of relativistic outflow in this source. Without knowing the location of the absorber, its mass and energy outflow rates cannot be well constrained; we find E$\\dot{E}(outflow)/L_{bo}$ ranging from < 0.001% to 60% using different a...

  10. Determining the Spatially Resolved Mass Outflow Rate in Markarian 573

    Science.gov (United States)

    Revalski, Mitchell; Crenshaw, D. Michael; Fischer, Travis C.; Kraemer, Steven B.; Schmitt, Henrique R.

    2017-01-01

    We report on current progress in calculating the narrow line region (NLR) mass outflow rate in the Seyfert 2 galaxy Markarian 573. Our goal is to determine the mass outflow rate as a function of distance from the nucleus in 10 nearby Active Galactic Nuclei (AGN) with spatially resolved NLRs. These nearby AGN allow us to study the feeding and feedback of supermassive black holes (SMBHs) that may play an important role in understanding large scale structure, enrichment of the interstellar medium, and coevolution of SMBHs with their host galaxies. Utilizing archival spectra from the Space Telescope Imaging Spectrograph (STIS) on the Hubble Space Telescope (HST) we measured emission line ratios from a wide range of ionized species. Next we used the line ratios to find a reddening correction and determined the physical conditions in the ionized gas using the photoionization code Cloudy. Specifically, we derived the mass of the ionized gas and then estimate the total mass outside of the spectral slit using HST [O III] images. Combined with kinematic models of the outflows we will determine the mass outflow rate and kinetic luminosity as a function of distance from the central AGN. Ultimately, we aim to determine if NLR outflows are effective in regulating AGN feedback by comparing our observed outflow rates with theoretical models.

  11. Identifying the outflow driving sources in Orion-KL

    CERN Document Server

    Beuther, H

    2008-01-01

    The enigmatic outflows of the Orion-KL region have raised discussions about their potential driving sources for several decades. Here, we present C18O(2-1) observations combined from the Submillimeter Array and the IRAM30m telescope. The molecular gas is associated on large scales with the famous northwest-southeast high-velocity outflow whereas the high-velocity gas on small spatial scales traces back to the recently identified submm source SMA1. Therefore, we infer that SMA1 may host the driving source of this outflow. Based on the previously published thermal and maser SiO data, source I is the prime candidate to drive the northeast-southwest low-velocity outflow. The source SMA1 is peculiar because it is only detected in several submm wavelength bands but neither in the infrared nor cm regime. We discuss that it may be a very young intermediate- to high-mass protostar. The estimated outflow masses are high whereas the dynamical time-scale of the outflow is short of the order 10^3yrs.

  12. Current perspective of venous thrombosis in the upper extremity

    NARCIS (Netherlands)

    Flinterman, L.E.; Meer, van der F.J.M.; Rosendaal, F.R.; Doggen, C.J.M.

    2008-01-01

    Venous thrombosis of the upper extremity is a rare disease. Therefore, not as much is known about risk factors, treatment and the risk of recurrence as for venous thrombosis of the leg. Only central venous catheters and strenuous exercise are commonly known risk factors for an upper extremity venous

  13. The Prevalence of Ionized Gas Outflows in Type 2 AGNs II. 3-D Biconical Outflow Models

    CERN Document Server

    Bae, Hyun-Jin

    2016-01-01

    We present 3-D models of biconical outflows combined with a thin dust plane for investigating the physical properties of the ionized gas outflows and their effect on the observed gas kinematics in type 2 active galactic nuclei (AGNs). Using a set of input parameters, we construct a number of models in 3-D and calculate the spatially integrated velocity and velocity dispersion for each model. We find that three primary parameters, i.e., intrinsic velocity, bicone inclination, and the amount of dust extinction, mainly determine the simulated velocity and velocity dispersion. Velocity dispersion increases as the intrinsic velocity or the bicone inclination increases, while velocity (i.e., velocity shift with respect to systemic velocity) increases as the amount of dust extinction increases. Simulated emission-line profiles well reproduce the observed [O III] line profiles, e.g., a narrow core and a broad wing components. By comparing model grids and Monte Carlo simulations with the observed [O III] velocity-velo...

  14. Renal calculus

    CERN Document Server

    Pyrah, Leslie N

    1979-01-01

    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  15. RADIATION TRANSPORT FOR EXPLOSIVE OUTFLOWS: OPACITY REGROUPING

    Energy Technology Data Exchange (ETDEWEB)

    Wollaeger, Ryan T. [Department of Nuclear Engineering and Engineering Physics, University of Wisconsin, Madison 1500 Engineering Drive, 410 ERB, Madison, WI 53706 (United States); Van Rossum, Daniel R., E-mail: wollaeger@wisc.edu, E-mail: daan@flash.uchicago.edu [Flash Center for Computational Science, Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL 60637 (United States)

    2014-10-01

    Implicit Monte Carlo (IMC) and Discrete Diffusion Monte Carlo (DDMC) are methods used to stochastically solve the radiative transport and diffusion equations, respectively. These methods combine into a hybrid transport-diffusion method we refer to as IMC-DDMC. We explore a multigroup IMC-DDMC scheme that in DDMC, combines frequency groups with sufficient optical thickness. We term this procedure ''opacity regrouping''. Opacity regrouping has previously been applied to IMC-DDMC calculations for problems in which the dependence of the opacity on frequency is monotonic. We generalize opacity regrouping to non-contiguous groups and implement this in SuperNu, a code designed to do radiation transport in high-velocity outflows with non-monotonic opacities. We find that regrouping of non-contiguous opacity groups generally improves the speed of IMC-DDMC radiation transport. We present an asymptotic analysis that informs the nature of the Doppler shift in DDMC groups and summarize the derivation of the Gentile-Fleck factor for modified IMC-DDMC. We test SuperNu using numerical experiments including a quasi-manufactured analytic solution, a simple 10 group problem, and the W7 problem for Type Ia supernovae. We find that opacity regrouping is necessary to make our IMC-DDMC implementation feasible for the W7 problem and possibly Type Ia supernova simulations in general. We compare the bolometric light curves and spectra produced by the SuperNu and PHOENIX radiation transport codes for the W7 problem. The overall shape of the bolometric light curves are in good agreement, as are the spectra and their evolution with time. However, for the numerical specifications we considered, we find that the peak luminosity of the light curve calculated using SuperNu is ∼10% less than that calculated using PHOENIX.

  16. [Renal vein infarction, a complication of paroxysmal nocturnal hemoglobinuria].

    Science.gov (United States)

    de Charry, Charlotte; de Charry, Félicité; Lemoigne, François; Lamboley, Jean-Laurent; Pasquet, Florian; Pavic, Michel

    2012-12-01

    Paroxysmal nocturnal hemoglobinuria (Marchiafava-Micheli disease) is a rare acquired clonal disorder of the hematopoietic cell, to a somatic mutation in the phosphatidylinositol glycan (PIG-A). The most frequent clinical manifestations are hemolytic crisis and venous thrombosis of the mesenteric, hepatic, portal or cerebral territories. We report a case of paroxysmal nocturnal hemoglobinuria with renal vein thrombosis, a rare complication of this disease.

  17. Lipopolysaccharide-induced acute renal failure in conscious rats

    DEFF Research Database (Denmark)

    Jonassen, Thomas E N; Graebe, Martin; Promeneur, Dominique

    2002-01-01

    In conscious, chronically instrumented rats we examined 1) renal tubular functional changes involved in lipopolysaccharide (LPS)-induced acute renal failure; 2) the effects of LPS on the expression of selected renal tubular water and sodium transporters; and 3) effects of milrinone, a phosphodies......In conscious, chronically instrumented rats we examined 1) renal tubular functional changes involved in lipopolysaccharide (LPS)-induced acute renal failure; 2) the effects of LPS on the expression of selected renal tubular water and sodium transporters; and 3) effects of milrinone......). LPS-induced fall in GFR and proximal tubular outflow were sustained on day 2. Furthermore, LPS-treated rats showed a marked increase in fractional distal water excretion, despite significantly elevated levels of plasma vasopressin (AVP). Semiquantitative immunoblotting showed that LPS increased......-alpha and lactate, inhibited the LPS-induced tachycardia, and exacerbated the acute LPS-induced fall in GFR. Furthermore, Ro-20-1724-treated rats were unable to maintain MAP. We conclude 1) PDE3 or PDE4 inhibition exacerbates LPS-induced renal failure in conscious rats; and 2) LPS treated rats develop an escape...

  18. Protostellar Outflows and Radiative Feedback from Massive Stars. II. Feedback, Star-formation Efficiency, and Outflow Broadening

    Science.gov (United States)

    Kuiper, Rolf; Turner, Neal J.; Yorke, Harold W.

    2016-11-01

    We perform two-dimensional axially symmetric radiation hydrodynamic simulations to assess the impact of outflows and radiative force feedback from massive protostars by varying when the protostellar outflow starts, and to determine the ratio of ejection to accretion rates and the strength of the wide-angle disk wind component. The star-formation efficiency, i.e., the ratio of final stellar mass to initial core mass, is dominated by radiative forces and the ratio of outflow to accretion rates. Increasing this ratio has three effects. First, the protostar grows slower with a lower luminosity at any given time, lowering radiative feedback. Second, bipolar cavities cleared by the outflow become larger, further diminishing radiative feedback on disk and core scales. Third, the higher momentum outflow sweeps up more material from the collapsing envelope, decreasing the protostar's potential mass reservoir via entrainment. The star-formation efficiency varies with the ratio of ejection to accretion rates from 50% in the case of very weak outflows to as low as 20% for very strong outflows. At latitudes between the low-density bipolar cavity and the high-density accretion disk, wide-angle disk winds remove some of the gas, which otherwise would be part of the accretion flow onto the disk; varying the strength of these wide-angle disk winds, however, alters the final star-formation efficiency by only ±6%. For all cases, the opening angle of the bipolar outflow cavity remains below 20° during early protostellar accretion phases, increasing rapidly up to 65° at the onset of radiation pressure feedback.

  19. The possibility for use of venous flaps in plastic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.; Baytinger, A. V. [Research Institute of Microsurgery, Tomsk (Russian Federation); Dzyuman, A. N. [Siberian State Medical University, Tomsk (Russian Federation)

    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.

  20. The possibility for use of venous flaps in plastic surgery

    Science.gov (United States)

    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.

  1. Upper-extremity deep venous thrombosis: a review.

    Science.gov (United States)

    Mai, Cuc; Hunt, Daniel

    2011-05-01

    Upper-extremity deep venous thrombosis is less common than lower-extremity deep venous thrombosis. However, upper-extremity deep venous thrombosis is associated with similar adverse consequences and is becoming more common in patients with complex medical conditions requiring central venous catheters or wires. Although guidelines suggest that this disorder be managed using approaches similar to those for lower-extremity deep venous thrombosis, studies are refining the prognosis and management of upper-extremity deep venous thrombosis. Physicians should be familiar with the diagnostic and treatment considerations for this disease. This review will differentiate between primary and secondary upper-extremity deep venous thromboses; assess the risk factors and clinical sequelae associated with upper-extremity deep venous thrombosis, comparing these with lower-extremity deep venous thrombosis; and describe an approach to treatment and prevention of secondary upper-extremity deep venous thrombosis based on clinical evidence.

  2. Multiple Extrasplanchnic Venous Thromboses: A Rare Complication of Pancreatitis. A Case Report

    Directory of Open Access Journals (Sweden)

    Hardik Parikh

    2012-05-01

    Full Text Available Context Venous thrombosis has been described in patients with acute and chronic pancreatitis. This is especially common in portal vein, splenic vein and superior mesenteric vein. To the best of our knowledge, involvement of superior vena cava and subclavian vessel due to pancreatitis has not been reported. Case report We present here a case of an adult male with alcoholic chronic pancreatitis who presented with multiple vessel thromboses involving superior vena cava, inferior vena cava, bilateral subclavian, internal jugular vein, axillary, iliac and renal vein without involvement of portal, splenic and superior mesenteric vein that was effectively treated with i.v. anticoagulation therapy. Conclusion Venous thromboses can occur outside the splanchnic circulation in pancreatitis.

  3. Treatment of hepatic venous stenosis by transfemoral venous balloon dilation following living donor liver transplantation: a case report

    Institute of Scientific and Technical Information of China (English)

    Weiwei Jiang; Yangsui Liu; Lianbao Kong

    2009-01-01

    Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation (LDLT). Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT.

  4. Kiloparsec-scale outflows are prevalent among luminous AGN: outflows and feedback in the context of the overall AGN population

    CERN Document Server

    Harrison, C M; Mullaney, J R; Swinbank, A M

    2014-01-01

    We present integral field unit (IFU) observations covering the [O III]4959,5007 and H-Beta emission lines of sixteen z~(6-16) kpc in all targets and observe signatures of spherical outflows and bi-polar superbubbles. We show that our targets are representative of z 5x10^41 erg/s) type 2 AGN and that ionised outflows are not only common but also in >=70% (3 sigma confidence) of cases, they are extended over kiloparsec scales. Our study demonstrates that galaxy-wide energetic outflows are not confined to the most extreme star-forming galaxies or radio-luminous AGN; however, there may be a higher incidence of the most extreme outflow velocities in quasars hosted in ultra-luminous infrared galaxies. Both star formation and AGN activity appear to be energetically viable to drive the outflows and we find no definitive evidence that favours one process over the other. Although highly uncertain, we derive mass outflow rates (typically ~10x the SFRs), kinetic energies (~0.5-10% of L[AGN]) and momentum rates (typically...

  5. Imaging of head and neck venous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Flis, Christine M.; Connor, Stephen E. [King' s College Hospital, Neuroradiology Department, London (United Kingdom)

    2005-10-01

    Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. (orig.)

  6. A Rare Venous Port Complication: Supraventriculer Tachycardia

    Directory of Open Access Journals (Sweden)

    Tamer Yoldaş

    2016-04-01

    Full Text Available Implantable central venous port catheters are widely used in the management of children with cancer undergoing long term chemotherapy. These catheters can manifest a number of complications such as arrhythmia. Central venous port catheter was placed on a ten years old boy for chemotherapy. Before insertion of port catheter his physical examination, laboratory parameters, electrocardiography and echocardiography were normal. The patient felt palpitations shortly after the insertion of the port catheter. At that time the heart rate was 200 beats/minute but immediately normal sinus rhythm was restored. A chest roentgenogram revealed that the distal fragment of the port catheter was inside the right atrium. The port catheter was pulled back somewhat and then tachycardia attacks stopped. To our knowledge there are a few reports of supraventricular tachycardia (SVT in children associated with central venous port catheter. Here we aimed to present a pediatric case with SVT after placement of central venous port catheter and his management.

  7. [Emphysematous gastritis with concomitant portal venous air].

    Science.gov (United States)

    Jeong, Min Yeong; Kim, Jin Il; Kim, Jae Young; Kim, Hyun Ho; Jo, Ik Hyun; Seo, Jae Hyun; Kim, Il Kyu; Cheung, Dae Young

    2015-02-01

    Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.

  8. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    MJP

    thromboprophylaxis among physicians in a tertiary-care hospital. Ekwere TA1* ... Background: Venous thromboembolism (VTE) is a major public health challenge globally due to its ... multicenter study conducted in Canada to determine the ...

  9. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......%) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...

  10. Links between arterial and venous disease.

    Science.gov (United States)

    Prandoni, P

    2007-09-01

    An increasing body of evidence suggests the likelihood of a link between arterial and venous disease. According to the results of recent studies, atherosclerosis and venous thromboembolism (VTE) share common risk factors, including age, obesity, diabetes mellitus and metabolic syndrome. Atherosclerosis has the potential to promote the development of thrombotic disorders in the venous system. Another scenario assumes that the two clinical conditions are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Several recent studies have consistently shown that patients with VTE of unknown origin are at a higher risk of cardiovascular diseases, including atherosclerotic complications, than patients with secondary VTE and matched control individuals. Future studies are needed to clarify the nature of this association, to assess its extent and to evaluate its implications for clinical practice.

  11. Effects of acute hypoxia on renal and endocrine function at rest and during graded exercise in hydrated subjects

    DEFF Research Database (Denmark)

    Olsen, Niels Vidiendal; Kanstrup, I L; Richalet, J P

    1992-01-01

    Renal effects of altitude hypoxia are unclear. Renal and hormonal function was investigated in eight males at rest and during graded exercise at sea level (SL) and 48 h after rapid ascent to 4,350 m (HA). HA did not change resting values of effective renal plasma flow (ERPF), glomerular filtration......-intensity hypoxic exercise may be secondary to increased adrenosympathetic activity. However, antidiuretic and antinatriuretic effects of exercise were maintained in hypoxia and in both environments seemed to be the consequence of decreased proximal tubular outflow. The results demonstrate that renal glomerular...... rate (GFR), sodium clearance (CNa), urine flow, or lithium clearance (CLi), which was used as an index of proximal tubular outflow. At rest, HA increased plasma norepinephrine concentration and decreased plasma concentrations of renin and aldosterone. Exercise decreased ERPF similarly in both...

  12. Venous diethylene glycol poisoning in patients with preexisting severe liver disease in China

    Institute of Scientific and Technical Information of China (English)

    Bing-Liang Lin; Zhi-Xin Zhao; Yu-Tian Chong; Jian-Guo Li; Xing Zuo; Yu Tao; Tan-Qi Lou; Zhi-Liang Gao

    2008-01-01

    AIM:To analyze the clinical presentation of venous diethylene glycol (DEG) poisoning in patients with preexisting severe liver disease and factors that correlate with DEG poisoning.METHODS:Retrospective chart review was performed to analyze the epidemiology,clinical presentation,hepatorenal functions,hemodynamics and pathological characteristics of 64 patients with severe liver disease who received intravenous armillarisin-A,the solvent of which was DEG.Comparative analyses of correlating factors and causes for poisoning were based on the presence or absence of poisoning.RESULTS:Of the 64 patients who received armillarisin-A,15 were found to have DEG poisoning.Twelve poisoned patients died.After a mean of 5 d,the poisoned patients displayed acute renal failure.Metabolic acidosis occurred in 13 cases.BUN,Cr,and CO2 values were significantly elevated and exacerbation of digestive tract symptoms and/or symptom was noted in 11 cases.Neurological system impairment was observed in 10 cases after 2 wk.Compared to the 49 non-poisoned patients,the poisoned patients exhibited significantly lower RBC and Hb values and higher WBC count.Renal biopsy from the poisoned patients revealed acute tubular necrosis and interstitial nephritis.Significant differences in preexisting severe hepatitis,ascites,renal disease,and diuretic therapy were found between groups.Prior to diethylene glycol injections,the mean values for neutral granular cells,BUN,Cr,calcium and phosphorous ions differed significantly between groups.CONCLUSION:Venous diethylene glycol poisoning is characterized by oliguric acute renal failure,metabolic acidosis,digestive symptoms,nervous system impairment,and a high probability of anemia and WBC proliferation.Mortality is high.Correlative factors include preexisting severe liver disease,renal disease,and infection.

  13. Current perspective of venous thrombosis in the upper extremity

    OpenAIRE

    Flinterman, L.E.; Meer, van der, D; Rosendaal, F.R.; Doggen, C. J. M.

    2008-01-01

    Venous thrombosis of the upper extremity is a rare disease. Therefore, not as much is known about risk factors, treatment and the risk of recurrence as for venous thrombosis of the leg. Only central venous catheters and strenuous exercise are commonly known risk factors for an upper extremity venous thrombosis. In this review an overview of the different risk factors, possible treatments and the complications for patients with a venous thrombosis of the upper extremity is given

  14. Detection of renal ischemia by in situ microdialysis - an experimental study

    DEFF Research Database (Denmark)

    Keller, Anna Krarup

    Purpose: Acute vascular thrombosis of the renal artery or vein is a feared and devastating complication after renal operations, especially transplantation. The aim of the present study was to evaluate microdialysis as a possible new tool for fast and reliable detection of renal ischemia...... was placed outside, on the renal capsule. The contra lateral kidney was removed. After two hours of baseline measurements, ischemia was introduced by clamping the renal artery or vein in the first two groups. Microdialysis samples were taken every thirty minutes during baseline and the following five hours...... in a porcine model. Material and methods: Twenty healthy anesthetized pigs were randomized to experiments on left or right kidney and into three groups: arterial ischemia (n=8); venous ischemia (n=8) and controls (n=4). One microdialysis catheter was inserted superficially in the renal cortex and one...

  15. Entrapment of guidewire during central venous catheterization

    Directory of Open Access Journals (Sweden)

    Tarun S.

    2016-07-01

    Full Text Available Central venous catheterization (CVC is common in the setting of ICU for various reasons like monitoring of CVP, fluid administration and vasopressor or drug infusions. Guidewires are routinely used in the Seldinger technique during central venous catheter placement CVC placement is not innocuous as numerous complications may occur, with varying frequency and severity. [Int J Res Med Sci 2016; 4(7.000: 3080-3081

  16. Prospects of Jugular Venous Pulse Assessment

    Directory of Open Access Journals (Sweden)

    M D Bhattarai

    2010-09-01

    Full Text Available There is no controversy regarding the current clinical method of examination of waveform of jugular vein pulse. However there are limitations of clinical assessment of central venous pressure by jugular vein pressure measurement from the level of sternal angle. There are variations in the reported distances from sternal angle to right atrium as well as to upper limit of JVP. In erect position, anterior end of fourth intercostal space is at about the level of mid-right atrium. In patients with visible JVP at neck in erect position, measurement of CVP can be done more accurately directly from the anterior end of fourth intercostal space. For others, the position of mid-right atrium can be marked in lateral chest wall first in erect position at the mid-point of an anteroposterior line from anterior end of fourth intercostal space to back. Subsequently in reclining position, the vertical height of venous pressure can be measured from the horizontal plane of the midpoint marked at lateral chest wall to visible upper limit of JVP. Such measurement can be done in a more reliable way with venous pressure (VP manometer with its indicator rod at the horizontal plane of mid-right atrium and with its horizontal surface at upper limit of JVP. The venous pressure manometer can also be used to measure relatively less reliable upper limb venous pressure (ULVP, as indicated by the vertical distance at which veins of upper limb collapse, especially when JVP is not visualized due to subnormal CVP as in hypovolemia. Keywords: CVP, JVP, right atrium, sternal angle, upper limp venous pressure, venous pressure, venous pressure manometer

  17. Renal actinomycosis with concomitant renal vein thrombosis.

    Science.gov (United States)

    Chang, Dong-Suk; Jang, Won Ik; Jung, Ji Yoon; Chung, Sarah; Choi, Dae Eun; Na, Ki-Ryang; Lee, Kang Wook; Shin, Yong-Tai

    2012-02-01

    Renal actinomycosis is a rare infection caused by fungi of the genus Actinomyces. A 74-year-old male was admitted to our hospital because of gross hematuria with urinary symptoms and intermittent chills. Computed tomography of the abdomen showed thrombosis in the left renal vein and diffuse, heterogeneous enlargement of the left kidney. After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis.

  18. COLOR DOPPLER ULTRASONOGRAPHY APPEARANCES OF RENAL VEIN THROMBOSIS AND ITS DIAGNOSTIC VALUE

    Institute of Scientific and Technical Information of China (English)

    Sheng Cai; Guang-xi Zhong; Jian-chu Li; Yu Xia; Hui-jun Li; Yu-xin Jiang

    2007-01-01

    Objective To evaluate color Doppler ultrasonography (CDU) appearances of renal vein thrombosis (RVT) and its diagnostic value.Methods Ten patients with RVT were analyzed retrospectively. Renal structure, distributions of intrarenal flow signals, echogenicity, and flow fullness in main renal veins were observed with CDU. Resistance index (RI) was recorded from the waveforms of segmental or interlobar renal artery.Results Ten kidneys in nine patients were confirmed to have thrombus within the main renal veins, and one patient was confirmed to have thrombus within the small intrarenal veins. The appearances of the main renal vein thrombosis included full of solid echogenicity or strip echogenicity and complete or partial filling defect within the main renal veins, and absent or a few intrarenal venous flow signals in 70% of kidneys involved. The appearances of intrarenal vein thrombosis included obscure renal structure and no venous flow signal within the involved part of the kidneys. Reverse diastolic flow in the intrarenal artery had only a sensitivity of 36% (4/11) ; in other 7 kidneys without intrarenal arterial reverse diastolic flow, increased RI (mean, 0.84; range, 0.74-0.96) was found.Conclusion CDU is helpful for rapid clinical diagnosis and follow-up of RVT, and therefore can be the first imaging modality of choice for RVT.

  19. TRANSPLANTE RENAL

    Directory of Open Access Journals (Sweden)

    Soraia Geraldo Rozza Lopes

    2014-01-01

    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  20. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930564 Dwell times affect the local host de-fence mechanism of peritoneal dialysis patients.WANG Tao(汪涛),et al.Renal Instit,SunYatsen Med Univ,Guangzhou,510080.Chin JNephrol 1993;9(2):75—77.The effect of different intraperitoneal awelltimes on the local host defence in 6 peritonealdialysis patients was studied.A significant de-crease in the number of peritoneal cells,IgG con-centration and the phagoeytosis and bactericidalactivity of macrophages was determined when thedwell time decreased from 12 to 4 hs or form 4 to0.5hs,but the peroxidase activity in macrophagesincreased significantly.All variables,except theperoxidase activity in macrophages,showed nosignificant difference between patients of high or

  1. Traumatismo renal

    OpenAIRE

    Rocha, Sofia Rosa Moura Gomes da

    2009-01-01

    Introdução: A realização deste trabalho visa a elaboração de uma revisão sistematizada subordinada à temática da traumatologia renal. Objectivos: Os principais objectivos deste trabalho são: apurar a etiologia, definir a classificação, analisar o diagnóstico e expôr o tratamento e as complicações. Desenvolvimento: Os traumatismos são a principal causa de morte antes dos 40 anos. O rim é o órgão do aparelho génito-urinário mais frequentemente atingido. Os traumatismos renais são mais fre...

  2. Microcirculation and venous ulcers: a review.

    Science.gov (United States)

    Pascarella, Luigi; Schönbein, Geert W Schmid; Bergan, John J

    2005-11-01

    Recent histological and immunocytochemical analyses of venous leg ulcers suggest that lesions observed in the different stages of chronic venous insufficiency (CVI) may be related to an inflammatory process. This inflammatory process leads to fibrosclerotic remodeling of the skin and then to ulceration. The vascular network of the most superficial layers of the skin appears to be the target of the inflammatory reaction. Hemodynamic forces such as venous hypertension, circulatory stasis, and modified conditions of shear stress appear to play an important role in an inflammatory reaction accompanied by leukocyte activation which clinically leads to CVI: venous dermatitis and venous ulceration. The leukocyte activation is accompanied by the expression of integrins and by synthesis and release of many inflammatory molecules, including proteolytic enzymes, leukotrienes, prostaglandin, bradykinin, free oxygen radicals, cytokines, and possibly other classes of inflammatory mediators. The inflammatory reaction perpetuates itself, leading to liposclerotic skin and subcutaneous tissue remodeling. In light of the mechanisms of venous ulcer formation cited above, therapy in the future might be directed against leukocyte activation in order to diminish the magnitude of the inflammatory response. With this in mind, the attention of many investigators has been drawn to two different drugs with an anti-inflammatory effect: pentoxifylline and flavonoids.

  3. The chronic cerebrospinal venous insufficiency syndrome.

    Science.gov (United States)

    Zamboni, P; Galeotti, R

    2010-12-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.

  4. OUTFLOW AND HOT DUST EMISSION IN HIGH-REDSHIFT QUASARS

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Huiyuan; Xing, Feijun; Wang, Tinggui; Zhou, Hongyan [Key Laboratory for Research in Galaxies and Cosmology, Department of Astronomy, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, Anhui 230026 (China); Zhang, Kai [Key Laboratory for Research in Galaxies and Cosmology, Shanghai Astronomical Observatory, Chinese Academy of Sciences, 80 Nandan Road, Shanghai 200030 (China); Zhang, Shaohua, E-mail: whywang@mail.ustc.edu.cn [Polar Research Institute of China, Jinqiao Road 451, Shanghai 200136 (China)

    2013-10-10

    Correlations of hot dust emission with outflow properties are investigated, based on a large z ∼ 2 non-broad absorption line quasar sample built from the Wide-field Infrared Survey and the Sloan Digital Sky Survey data releases. We use the near-infrared slope and the infrared to UV luminosity ratio to indicate the hot dust emission relative to the emission from the accretion disk. In our luminous quasars, these hot dust emission indicators are almost independent of the fundamental parameters, such as luminosity, Eddington ratio and black hole mass, but moderately dependent on the blueshift and asymmetry index (BAI) and FWHM of C IV lines. Interestingly, the latter two correlations dramatically strengthen with increasing Eddington ratio. We suggest that, in high Eddington ratio quasars, C IV regions are dominated by outflows so the BAI and FWHM (C IV) can reliably reflect the general properties and velocity of outflows, respectively. In low Eddington ratio quasars, on the other hand, C IV lines are primarily emitted by virialized gas so the BAI and FWHM (C IV) become less sensitive to outflows. Therefore, the correlations for the highest Eddington ratio quasars are more likely to represent the true dependence of hot dust emission on outflows and the correlations for the entire sample are significantly diluted by the low Eddington ratio quasars. Our results show that an outflow with a large BAI or velocity can double the hot dust emission on average. We suggest that outflows either contain hot dust in themselves or interact with the dusty interstellar medium or torus.

  5. Origin of impulsive plasma outflows due to magnetoacoustic shocks

    Science.gov (United States)

    Rao, Y. K.; Srivastava, A. K.; Doyle, J. G.; Dwivedi, B. N.

    2017-09-01

    We study an impulsive plasma outflow in the quiet-Sun using multiwavelength observations from the Atmospheric Imaging Assembly (AIA) onboard the Solar Dynamics Observatory (SDO) on 2011 March 30. The outflow rises to the upper solar atmosphere with a high terminal speed of 1250 km s- 1. Emissions from multiple SDO/AIA channels (log T (K) = 4.7 to log T (K) = 7.0), peak at the same time indicating its highly impulsive origin. We obtain the line-of-sight differential emission measure maps and find that the outflow is made up of multitemperature plasma. Investigation of SDO/HMI magnetic field data at its footpoint shows that the emerging flux of negative polarity is oscillating at the period of 442 s. The oscillations are also observed in the intensity of 1600 Å almost co-temporally at the base of the outflow with the almost same period (≈416 s). The ∼7.0 min periodicity in the magnetic flux and 1600 Å flux is present both prior to and during the onset, and even after the outflows for the duration of ≈1 h. This indicates that the magnetoacoustic waves are generated and present at the base of the outflow and interact with the localized small-scale current sheet and associated X-point. Magnetoacoustic waves encounter with the discontinuity at the X-point that may further develop into the fast magnetic shocks leading to the formation of the observed shock cusp and triggering of the impulsive plasma outflows.

  6. Disk-driven rotating bipolar outflow in Orion Source I

    Science.gov (United States)

    Hirota, Tomoya; Machida, Masahiro N.; Matsushita, Yuko; Motogi, Kazuhito; Matsumoto, Naoko; Kim, Mi Kyoung; Burns, Ross A.; Honma, Mareki

    2017-07-01

    One of the outstanding problems in star formation theory concerns the transfer of angular momentum so that mass can accrete onto a newly born young stellar object (YSO). From a theoretical standpoint, outflows and jets are predicted to play an essential role in the transfer of angular momentum 1,2,3,4 and their rotations have been reported for both low- 5 and high-mass 6,7 YSOs. However, little quantitative discussion on outflow launching mechanisms has been presented for high-mass YSOs due to a lack of observational data. Here we present a clear signature of rotation in the bipolar outflow driven by Orion Source I, a high-mass YSO candidate, using the Atacama Large Millimeter/Submillimeter Array (ALMA). A rotational transition of silicon monoxide (Si18O) reveals a velocity gradient perpendicular to the outflow axis, which is consistent with that of the circumstellar disk traced by a high excitation water line. The launching radii and outward velocity of the outflow are estimated to be >10 au and 10 km s-1, respectively. These parameters rule out the possibility that the observed outflow is produced by the entrainment of a high-velocity jet 8 , and that contributions from the stellar wind 9 or X-wind 10 , which have smaller launching radii, are significant in the case of Source I. Thus these results provide convincing evidence of a rotating outflow directly driven by the magneto-centrifugal disk wind launched by a high-mass YSO candidate 6,11 .

  7. Flux-Velocity Relation for H2 Outflows

    Science.gov (United States)

    Salas, Luis; Cruz-González, Irene

    2002-06-01

    We present an analysis of velocity-resolved near-IR molecular hydrogen observations of a variety of protostellar outflows with very different energetics, degrees of collimation, and morphologies. Observations in the 2.12 μm line of H2 were obtained using an IR Fabry-Pérot interferometer with a spectral resolution of 23 km s-1. The integrated flux-velocity diagrams for each outflow show a flat spectrum for low velocities followed by a decreasing power law dF/dv~vγ, with γ between -1.8 and -2.6, for velocities higher than a clearly defined break velocity at 2-17 km s-1. Contrary to shock model predictions, it is shown that the H2 intensity is constant with velocity. We argue that the flux-velocity relation can then be interpreted as a mass-velocity relation, in striking similarity to the power-law mass spectra observed in CO outflows. By comparing H2 and CO mass-velocity spectra, it is shown that there is a velocity regime in which both molecules coexist and produce similar γ-values. Evolution effects in outflows appear as a correlation between outflow length and γ as outflows age, the spectra becomes steeper. Our results support a common physical origin for both CO and H2 emission and a strong association between the molecular outflows traced in each molecule. Based on observations obtained at the Observatorio Astronómico Nacional at San Pedro Mártir, Mexico.

  8. Changes in renal cortical and medullary perfusion in a patient with renal vein thrombosis

    Directory of Open Access Journals (Sweden)

    Al-Said Jafar

    2010-01-01

    Full Text Available Dynamic renal perfusion computerized tomographic (CT scan was performed to test the cortical and medullary perfusion in a patient with unilateral renal vein thrombosis secondary to idiopathic focal and segmental glomerulosclerosis (FSGS. Forty mL of Iohexol was injected intra-venously. Multiple fixed repeated axial renal CT scan cuts at specific intervals, over the mid pole, were recorded over 400 seconds. Radio density was measured over the aorta, cortex and medulla during that period. Graphs for the radio contrast density against time were plotted. Aortic, cortical and medullary perfusions were calculated by estimating the slopes of the curves. Based on the CT scan findings, perfusion of different parts of the kidney was measured. The reduction in kidney function with renal vein thrombosis seems to be secondary to hypoperfusion of renal cortex and medulla. Further studies are required to confirm this observation. The blood flow to the kidney im-proved within four days after therapy with anticoagulation and pulse steroids. The sequences of events that take place need further studies for validation.

  9. Localization of aldosterone-producing tumours in primary aldosteronism by adrenal and renal vein catheterization

    DEFF Research Database (Denmark)

    Lund, J O; Nielsen, M D; Giese, Jacob;

    1980-01-01

    Regional venous plasma aldosterone concentrations were determined and assessed against concurrent arterial levels in 16 patients with primary aldosteronism. The results obtained by sampling from the left adrenal vein or the left renal vein allowed correct side prediction of the presupposed adenom...

  10. What happens after venous thromboembolism?

    Science.gov (United States)

    Baglin, T

    2009-07-01

    Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) with or without symptomatic pulmonary embolus (PE). The incidence of a first episode of VTE is 1.5 per 1000 person-years [1] (J Thromb Haemost, 2007;5:692-9) with a per-person lifetime incidence of 5% [2] (Arch Intern Med 1998;158:585-93). The risk of recurrence after DVT and PE is similar but the pattern of recurrence tends to reflect the initial event, for example recurrence with PE is more common in patients with previous PE [3] (Circulation 2003;107:122-30). At least 50% of patients, who present with symptomatic DVT, have asymptomatic PE and conversely, a majority presenting with symptomatic PE have asymptomatic DVT [3] (Circulation 2003;107:122-30). This suggests that whilst DVT and PE are manifestations of the same pathology, the phenotypic expression of the disease is predetermined. This may be an important consideration for long-term anticoagulant therapy as the risk of fatal PE is the greatest in patients with previous PE [4] (Ann Intern Med 2007;147:766-74). At present, the only factor reported to be associated with the pattern of VTE is the factor V Leiden mutation [5] (Thromb Haemost 1999;81:345-8). This suggests that the kinetics of thrombin generation and the resulting fibrinolytic response may influence clot structure and likelihood of embolization.

  11. Venous catheterization with ultrasound navigation

    Science.gov (United States)

    Kasatkin, A. A.; Urakov, A. L.; Nigmatullina, A. R.

    2015-11-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient's exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  12. Venous catheterization with ultrasound navigation

    Energy Technology Data Exchange (ETDEWEB)

    Kasatkin, A. A., E-mail: ant-kasatkin@yandex.ru; Nigmatullina, A. R. [Izhevsk State Medical Academy, Kommunarov street, 281, Izhevsk, Russia, 426034 (Russian Federation); Urakov, A. L., E-mail: ant-kasatkin@yandex.ru [Institute of Mechanics Ural Branch of Russian Academy of Sciences, T.Baramzinoy street 34, Izhevsk, Russia, 426067, Izhevsk (Russian Federation); Izhevsk State Medical Academy, Kommunarov street, 281, Izhevsk, Russia, 426034 (Russian Federation)

    2015-11-17

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  13. Living donor renal transplantation in patients with antiphospholipid syndrome

    Science.gov (United States)

    Choi, Ji Yoon; Jung, Joo Hee; Shin, Sung; Kim, Young Hoon; Han, Duck Jong

    2016-01-01

    Abstract Introduction: Antiphospholipid syndrome (APS), autoantibodies directed against phospholipid-binding proteins are associated with cause vascular thrombosis. Patients with APS requiring renal transplantation are at risk of early graft loss due to arterial or venous thrombosis, or thrombotic microangiopathy (TMA). Here, we report 3 cases of successful renal transplantation in patients with APS. Clinical Findings: A 53-year-old man with end-stage renal disease (ESRD) had experienced bilateral deep venous thrombosis (DVT) in the lower extremities 16 years ago and was administered warfarin. However, he frequently experienced recurrent DVT despite of anticoagulation therapy. Before the surgery, APS was confirmed based on positive results lupus anticoagulant in serological tests. A 40-year-old man with polycystic kidney disease and a history recurrent DVT tested positive for lupus anticoagulant and anticardiolipin antibodies. Lastly, a 42-year-old woman with ESRD was diagnosed with APS 7 years ago. She also developed DVT and tested positive for lupus anticoagulant and anti-B2-glycoprotein 1. The anticoagulation protocol was as follows in all cases: Warfarin was stopped 5 days before living donor renal transplantation and intravenous heparin therapy was started. During surgery, bolus heparin injections (3000 U) were administered to prevent arterial or venous thrombosis. Heparin was substituted with warfarin on postoperative day 4. The third patient (42/F) developed clinical rejection indicated by increased serum creatinine levels and donor-specific antibodies (DSA) and received steroid pulse therapy, plasmapheresis, and rituximab. This treatment restored graft function to within the normal range. The latest graft function in all patients was maintained at normal levels in the outpatient clinic. Conclusions: Living donor renal transplantation may be successful in patients with APS following perioperative anticoagulation therapy. However, because of the high risk of

  14. Hemodialysis Reliable Outflow (HeRO) device in end-stage dialysis access: a decision analysis model.

    Science.gov (United States)

    Dageforde, Leigh Anne; Bream, Peter R; Moore, Derek E

    2012-09-01

    The Hemodialysis Reliable Outflow (HeRO) dialysis access device is a permanent tunneled dialysis graft connected to a central venous catheter and is used in patients with end-stage dialysis access (ESDA) issues secondary to central venous stenosis. The safety and effectiveness of the HeRO device has previously been proven, but no study thus far has compared the cost of its use with tunneled dialysis catheters (TDCs) and thigh grafts in patients with ESDA. A decision analytic model was developed to simulate outcomes for patients with ESDA undergoing placement of a HeRO dialysis access device, TDC, or thigh graft. Outcomes of interest were infection, thrombosis, and ischemic events. Baseline values, ranges, and costs were determined from a systematic review of the literature. Total costs were based on 1 year of post-procedure outcomes. Sensitivity analyses were conducted to test model strength. The HeRO dialysis access device is the least costly dialysis access with an average 1-year cost of $6521. The 1-year cost for a TDC was $8477. A thigh graft accounted for $9567 in a 1-year time period. The HeRO dialysis access device is the least costly method of ESDA. The primary determinants of cost in this model are infection in TDCs and leg ischemia necessitating amputation in thigh grafts. Further study is necessary to incorporate patient preference and quality of life into the model. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Line-driven radiative outflows in luminous quasars

    CERN Document Server

    Bowler, Rebecca A A; Allen, James T; Ferland, Gary J

    2014-01-01

    An analysis of ~19500 narrow (<200 km/s) CIV 1548.2,1550.8 absorbers in ~34000 Sloan Digital Sky Survey quasar spectra is presented. The statistics of the number of absorbers as a function of outflow-velocity shows that in approximately two-thirds of outflows, with multiple CIV absorbers present, absorbers are line-locked at the 500 km/s velocity separation of the CIV absorber doublet; appearing as 'triplets' in the quasar spectra. Line-locking is an observational signature of radiative line driving in outflowing material, where the successive shielding of 'clouds' of material in the outflow locks the clouds together in outflow velocity. Line-locked absorbers are seen in both broad absorption line quasars (BALs) and non-BAL quasars with comparable frequencies and with velocities out to at least 20000 km/s. There are no detectable differences in the absorber properties and the dust content of single CIV doublets and line-locked CIV doublets. The gas associated with both single and line-locked CIV absorption...

  16. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriette; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michael A.; Spronk, Peter E.

    2012-01-01

    Objective:  The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design:  Prospective observational controlled study. Setting:  Nonacademic university-affiliated t

  17. Prevention and treatment of venous thromboembolism in the elderly patient

    Directory of Open Access Journals (Sweden)

    Enrico Tincani

    2007-07-01

    Full Text Available Enrico Tincani1, Mark A Crowther2, Fabrizio Turrini1, Domenico Prisco31Unità Operativa di Medicina Interna Cardiovascolare, Nuovo Ospedale Civile di Modena S.Agostino-Estense, Modena, Italy; 2McMaster University, St. Joseph’s Hospital and McMaster University, Hamilton, Canada; 3Dipartimento di Area Critica Medico Chirurgica, Universita’ di Firenze, Florence, ItalyAbstract: Venous thromboembolism (VTE is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both lowmolecular-weight heparins (LMWHs and unfractionated heparin (UFH, all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use.Keywords: venous thromboembolism, elderly patient, fondaparinux

  18. Pharmacologic treatment of venous leg ulcers.

    Science.gov (United States)

    Dormandy, J A

    1995-01-01

    In terms of prevalence, total cost and morbidity, venous leg ulcers are probably by far the most important type of ulcerations in the leg. The macrocirculatory defect leading to a raised ambulatory venous pressure is now accepted as a common initial pathologic pathway. Most current treatment modalities, such as surgery or external compression, are designed to control the macrovascular defect. However, it is the microcirculatory consequences of the venous hypertension that give rise to the trophic skin changes and ultimately to ulceration. At this microcirculatory level, pharmacotherapy may be a useful adjunct in the treatment of venous leg ulcers. The microcirculatory pathophysiologic changes include decreased fibrinolytic activity, elevated plasma fibrinogen, microcirculatory thrombi, and inappropriate activation of the white blood cells. The oxidative burst from the activated white cells probably plays a key role by releasing locally leukocyte-derived free radicals, proteolytic enzymes, cytokines, platelet-activating factor, and a number of other noxious mediators. An important additional component in recalcitrant venous ulcers is co-existing arterial disease, which is probably present in 15-20% of cases. Decreased arterial perfusion pressure will further aggravate the ischemic changes caused by the venous hypertension. Pentoxifylline downregulates leukocyte activation, reduces leukocyte adhesion, and also has fibrinolytic effects. A number of clinical studies have therefore been carried out to examine the clinical efficacy of pentoxifylline in treatment of venous leg ulcers. Probably the largest published placebo-controlled, double-blind randomized study was reported in 1990. In this study, 80 patients received either pentoxifylline 400 mg three times a day orally or matching placebo for 6 months or until their reference ulcer healed if this occurred sooner. Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with pentoxifylline

  19. Mixed total anomalous pulmonary venous connection: Case report with bilateral venous collectors.

    Science.gov (United States)

    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.

  20. The Massive Bipolar Outflow in IRAS 20110+3321

    Institute of Scientific and Technical Information of China (English)

    LI Jing-Jing; XU Ye; MIYAZAKI Atsushi; SHEN Zhi-Qiang; CHEN Xi

    2006-01-01

    @@ Mapping observations were made towards IRAS 20110+3321 using the Nobeyama 45 m and the Delingha 13.7m radio telescopes. The high angular resolution (~ 21″) image with the 45m telescope shows that there is a highvelocity bipolar molecular outflow in this region, which is in the NW-SE direction with a collimation factor of ~ 2.2. The outflow has significantly higher mass loss rate and mechanical luminosity than those from low mass YSOs, indicating that the outflow is driven by the IRAS source. A dense massive core was detected by mapping C18O (J= 1 - 0) line in the area with the 13.7m telescope. The IRAS source lies within the core but slightly offsets from its emission peak.

  1. Precessing jets and molecular outflows a 3-D numerical study

    CERN Document Server

    Cliffe, J A; Frank, Adam

    1996-01-01

    We present 3-D numerical hydrodynamical simulations of precessing supersonic heavy jets to explore how well they serve as a model for generating molecular outflows from Young Stellar Objects. The dynamics are studied with a number of high resolution simulations on a Cartesian grid (128x128x128 zones) using a high order finite difference method. A range of cone angles and precession rates were included in the study. Two higher resolution runs (256x256x256 zones) were made for comparison in order to confirm numerical convergence of global flow characteristics. Morphological, kinematical and dynamical characteristics of precessing jets are described and compared to important properties of straight jets and also to observations of YSOs. In order to examine the robustness of precessing jets as a mean to produce molecular outflows around Young Stellar Objects, ``synthetic observations'' of the momentum distributions of the simulated precessing jets are compared to observations of molecular outflows. It is found tha...

  2. About the seasonal and fortnightly variabilities of the Mediterranean outflow

    Directory of Open Access Journals (Sweden)

    C. Millot

    2010-12-01

    Full Text Available CTD time series from the HYDRO-CHANGES programme and INGRES projects have been collected simultaneously (2004–2008 on the Moroccan shelf and at the Camarinal and Espartel Sills in the strait of Gibraltar. They provide information that supports results recently obtained from the analysis of the two former time series, as well as from a reanalysis of CTD GIBEX profiles (1985–1986. The outflow of Mediterranean Waters, which does not show a clear seasonal variability before entering the strait, strongly mixes within the strait, due mainly to the internal tide, with the seasonally variable inflow of Atlantic Water. The outflow thus gets marked seasonal and fortnightly variabilities within the strait. Furthermore, since the outflow entering the strait displays marked spatial heterogeneity and long-term temporal variabilities, predicting its characteristics when in the ocean appears almost impossible.

  3. The Outflow-Disc Interaction in Young Stellar Objects

    CERN Document Server

    Pestalozzi, M R

    2000-01-01

    In this work the most spectacular phenomena occurring during the formation of a star are briefly reviewed: accretion through a rotating disc of matter and outflow through the poles of the new stellar object. Magnetic fields have been proposed to be principally responsible for the coexistence of these opposed mechanisms of accretion and outflowing. According to different models, the magnetic fields are either twisted or stretched by the accretion disc, allowing the formation of polar channels through which part of the accreting matter can escape. The high degree of coupling between the physical parameters describing the young stellar object (e.g. circular velocity of the disc and the central object, viscosity, strength and freezing of magnetic fields, etc.) makes detailed understanding of the interaction between accretion discs and outflows very difficult. The models presented here provide only a partial answer to this difficult problem.

  4. Starburst Galaxies: Outflows of Metals and Energy into the IGM

    CERN Document Server

    Strickland, David K; Ptak, Andrew; Schlegel, Eric; Tremonti, Christy; Tsuru, Takeshi; Tuellmann, Ralph; Zezas, Andreas

    2009-01-01

    What is the contribution of mass, metals and energy from starburst galaxies to the Intergalactic Medium? Starburst galaxies drive galactic-scale outflows or "superwinds" that may be responsible for removing metals from galaxies and polluting the Intergalactic Medium (IGM). In the last decade tremendous progress was made in mapping cool entrained gas in superwinds through UV/optical imaging and absorption line spectroscopy. These studies demonstrated that superwinds are ubiquitous in galaxies forming stars at high surface densities and that the most powerful starbursts can drive outflows near escape velocity. Theoretical models of galaxy evolution have begun to incorporate superwinds, using various ad-hoc prescriptions based on our knowledge of the cool gas. However, these efforts are fundamentally impeded by our lack of information about the hot phase of these outflows. The hot X-ray emitting phase of a superwind contains the majority of its energy and newly-synthesized metals, and given its high specific ene...

  5. Simulations of Metal Enrichment in Galaxy Clusters by AGN Outflows

    CERN Document Server

    Moll, R; Domainko, W; Kapferer, W; Mair, M; Van Kampen, E; Kronberger, T; Kimeswenger, S; Ruffert, M

    2006-01-01

    We assess the importance of AGN outflows with respect to the metal enrichment of the intracluster medium (ICM) in galaxy clusters. We use combined N-body and hydrodynamic simulations, along with a semi-numerical galaxy formation and evolution model. Using assumptions based on observations, we attribute outflows of metal-rich gas initiated by AGN activity to a certain fraction of our model galaxies. The gas is added to the model ICM, where the evolution of the metallicity distribution is calculated by the hydrodynamic simulations. For the parameters describing the AGN content of clusters and their outflow properties, we use the observationally most favorable values. We find that AGNs have the potential to contribute significantly to the metal content of the ICM or even explain the complete abundance, which is typically ~0.5 Z_sun in core regions. Furthermore, the metals end up being inhomogeneously distributed, in accordance with observations.

  6. Studying the Outflow-Core Interaction with ALMA Cycle 1 Observations of the HH 46/47 Molecular Outflow

    CERN Document Server

    Zhang, Yichen; Mardones, Diego; Cabrit, Sylvie; Dunham, Michael M; Garay, Guido; Noriega-Crespo, Alberto; Offner, Stella S R; Raga, Alejandro C; Corder, Stuartt A

    2016-01-01

    We present ALMA Cycle 1 observations of the HH 46/47 molecular outflow using combined 12m array and 7m array observations. We use 13CO and C18O emission to correct for the 12CO optical depth, to accurately estimate the outflow mass, momentum and kinetic energy. Applying the optical depth correction increases the mass estimate by a factor of 14, the momentum by a factor of 6, and the kinetic energy by a factor of about 2. The new 13CO(1-0) and C18O(1-0) data also allow us to trace denser and slower outflow material than that traced by 12CO. These species are only detected within about 1~2 km/s from the cloud velocity. The cavity wall of the red lobe appears at very low velocities (~0.2 km/s). Combing the material traced only by 13CO and C18O, the measured total mass of the CO outflow is 1.4 Msun, the total momentum is 1.7 Msun km/s and the total energy is 4.7e43 erg, assuming Tex=15 K. The improved angular resolution and sensitivity in 12CO reveal more details of the outflow structure. Specifically, we find th...

  7. Mapping Large-Scale Gaseous Outflows in Ultraluminous Infrared Galaxies with Keck II ESI Spectra: Spatial Extent of the Outflow

    CERN Document Server

    Martin, C L

    2006-01-01

    The kinematics of neutral gas and warm ionized gas have been mapped in one-dimension across ultraluminous starburst galaxies using interstellar absorption and emission lines, in Keck II ESI spectra. Blue-shifted absorption is found along more of the slit than anticipated, exceeding scales of 15 kpc across several systems. The large velocity gradient measured across some of these outflows is inconsistent with a flow diverging from the central starburst -- angular momentum conservation reduces the rotational velocity of an outflow as it expands. More widespread star formation, likely triggered by the merger, probably drives these outflows, although some models suggest the collision itself could generate a wind by shock heating interstellar gas throughout the disk. Young mergers with separated nuclei present the highest outflow masses, due mainly to the larger area over which the cool gas can be detected. In a typical ULIG, the mass carried by the cool phase of the outflow is around 10^8Msun, or a few percent of...

  8. SiO: Not the perfect outflow tracer: Outflow studies of the massive star formation region IRAS 19410+2336

    CERN Document Server

    Widmann, Felix; Schilke, Peter; Stanke, Thomas

    2016-01-01

    Aims: Previous observations of the young massive star formation region IRAS 19410+2336 have revealed strong outflow activity with several interacting outflows. We aim to get a better understanding of the outflow activity in this region by observing the SiO and H$^{13}$CO$^+$ emission with high angular resolution. SiO is known to trace shocked gas, which is often associated with young energetic outflows. With the H$^{13}$CO$^+$ data, we intend to better understand the distribution of the quiescent gaseous component of the region. Methods: The SiO observations in the J=2-1 v=0 transition and H$^{13}$CO$^+$ J=1-0 observations were performed by the Plateau de Bure Interferometer, combined with IRAM 30 m single-dish observations, in order to get the missing short-spacing information. We complement this new high-resolution observation with earlier CO and H$_2$ data. Results: The SiO observations do not trace the previously in CO and H$_2$ identified outflows well. Although we identify regions of highly increased Si...

  9. The evolution of anterior sector venous drainage in right lobe living donor liver transplantation: does one technique fit all?

    Science.gov (United States)

    Tokat, Yaman

    2016-01-01

    In living donor liver transplantation (LDLT), an adequate hepatic venous outflow constitutes one of the basic principles of a technically successful procedure. The issue of whether the anterior sector (AS) of the right lobe (RL) graft should or should not be routinely drained has been controversial. The aim of this 10-year, single-center, retrospective cohort study was to review the evolution of our hepatic venous outflow reconstruction technique in RL grafts and evaluate the impact of routine AS drainage strategy on the outcome. The study group consisted of 582 primary RL LDLT performed between July 2004 and December 2014. The cases were divided into 3 consecutive periods with different AS venous outflow reconstruction techniques, which included middle hepatic vein (MHV) drainage in Era 1 (n=119), a more selective AS drainage with cryopreserved homologous grafts in Era 2 (n=391), and routine segment 5 and/or 8 oriented AS drainage with synthetic grafts in Era 3 (n=72). Intraoperative portal flow measurement with routine splenic artery ligation (SAL) technique (in RL grafts with a portal flow of ≥ 250 mL/min/100 g liver tissue) was added later in Era 3. These 3 groups were compared in terms of recipient and donor demographics, surgical characteristics and short-term outcome. The rate of AS venous drainage varied from 58.8% in Era 1 and 35.0% in Era 2 to 73.6% in Era 3 (P<0.001). Perioperative mortality rate of recipients significantly decreased over the years (15.1% in Era 1 and 8.7% in Era 2 vs. 2.8% in Era 3, P=0.01). After the addition of SAL technique in the 45 cases, there was only 1 graft loss and no perioperative mortality. One-year recipient survival rate was also significantly higher in Era 3 (79.6% in Era 1 and 86.1% in Era 2 vs. 92.1% in Era 3, P=0.002). Routine AS drainage via segment 5 and/or 8 veins using synthetic grafts is a technique to fit all RL grafts in LDLT. Addition of SAL effectively prevents early graft dysfunction and significantly

  10. Renal cell carcinoma metastases to the pancreas - Value of arterial phase imaging at MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Corwin, Michael T. [Univ. of California, Davis Medical Center, Dept. of Radiology, Sacramento (United States)], e-mail: Michael.corwin@ucdmc.ucdavis.edu; Lamba, Ramit; McGahan, John P. [Univ. of California, Davis Medical Center, Dept. of Radiology, Sacramento (United States); Wilson, Machelle [Univ. of California, Davis, Dept. of Public Health Sciences (United States)

    2013-04-15

    Background: The pancreas is an increasingly recognized site of renal cell carcinoma metastases. It is important to determine the optimal MDCT protocol to best detect RCC metastases to the pancreas. Purpose: To compare the rate of detection of renal cell carcinoma metastases to the pancreas between arterial and portal venous phase MDCT. Material and Methods: A retrospective review of CTs of the abdomen yielded six patients with metastatic RCC to the pancreas. Five of six patients had pathologically proven clear cell RCC. Two blinded reviewers independently reported the number of pancreatic lesions seen in arterial and venous phases. Each lesion was graded as definite or possible. The number of lesions was determined by consensus review of both phases. Attenuation values were obtained for metastatic lesions and adjacent normal pancreas in both phases. Results: There were a total of 24 metastatic lesions to the pancreas. Reviewer 1 identified 20/24 (83.3%) lesions on the arterial phase images and 13/24 (54.2%) lesions on the venous phase. Seventeen of 20 (85.0%) arterial lesions were deemed definite and 9/13 (69.2%) venous lesions were definite. Reviewer 2 identified 19/24 (79.2%) lesions on the arterial phase and 14/24 (58.3%) on the venous phase. Seventeen of 19 (89.5%) arterial lesions were definite and 7/14 (50%) venous lesions were definite. Mean attenuation differential between lesion and pancreas was 114 HU and 39 HU for arterial and venous phases, respectively (P<0.0001). Conclusion: Detection of RCC metastases to the pancreas at MDCT is improved using arterial phase imaging compared to portal venous phase imaging.

  11. How stellar feedback simultaneously regulates star formation and drives outflows

    Science.gov (United States)

    Hayward, Christopher C.; Hopkins, Philip F.

    2017-02-01

    We present an analytic model for how momentum deposition from stellar feedback simultaneously regulates star formation and drives outflows in a turbulent interstellar medium (ISM). Because the ISM is turbulent, a given patch of ISM exhibits sub-patches with a range of surface densities. The high-density patches are `pushed' by feedback, thereby driving turbulence and self-regulating local star formation. Sufficiently low-density patches, however, are accelerated to above the escape velocity before the region can self-adjust and are thus vented as outflows. When the gas fraction is ≳ 0.3, the ratio of the turbulent velocity dispersion to the circular velocity is sufficiently high that at any given time, of the order of half of the ISM has surface density less than the critical value and thus can be blown out on a dynamical time. The resulting outflows have a mass-loading factor (η ≡ dot{M}_{out}/M_{star}) that is inversely proportional to the gas fraction times the circular velocity. At low gas fractions, the star formation rate needed for local self-regulation, and corresponding turbulent Mach number, declines rapidly; the ISM is `smoother', and it is actually more difficult to drive winds with large mass-loading factors. Crucially, our model predicts that stellar-feedback-driven outflows should be suppressed at z ≲ 1 in M⋆ ≳ 1010 M⊙ galaxies. This mechanism allows massive galaxies to exhibit violent outflows at high redshifts and then `shut down' those outflows at late times, thereby enabling the formation of a smooth, extended thin stellar disc. We provide simple fitting functions for η that should be useful for sub-resolution and semi-analytic models.

  12. Familial risk of venous thromboembolism: a nationwide cohort study

    DEFF Research Database (Denmark)

    Sørensen, H T; Riis, A H; Diaz, L J

    2011-01-01

    Background: Venous thromboembolism has genetic determinants, but population-based data on familial risks are limited. Objectives: To examine the familial risk of venous thromboembolism. Methods: We undertook a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary...... and expected number of venous thromboembolism cases among siblings, using population-specific, gender-specific and age-specific incidence rates. Results: We identified 30 179 siblings of 19 599 cases of venous thromboembolism. The incidence among siblings was 2.2 cases per 1000 person-years, representing...... with pulmonary embolism. Conclusion: Venous thromboembolism has a strong familial component....

  13. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2015-11-15

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  14. Radiologic placement of tunneled central venous catheter

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seong Tae; Yang, Po Song; Yang, Dong Hunn; Kim, Ki Tae; Kim, Choon Yul; Shinn, Kyung Sub [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of); Yun, Eun Joo [Korea Veterans Hospital, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the efficacy and safety of fluoroscopy-guided, radiologic placement of a tunneled central venous catheter into the superior vena cava (SVC). Thirty five patients underwent tunneled central venous catheter placement to facilitate long-term chemotherapy. They included 33 leukemic patients, one colon cancer patient, and one multiple myeloma patient. After confirming central venous patency with a injection of contrast media via the peripheral cephalic or basilic vein in the wrist joint, the subclavian vein was punctured under fluoroscopic guidance. A 7F double lumen TPN catheter was placed into the SVC through a subcutaneous tunnel in the anterior chest wall. Catheter placements were successful in all patients. The mean procedure time was 17.2minutes, mean fluooscopy time was 1.3minutes, mean number of punctures was 1.4, and mean volume of injhected contrast media was 43.5cc. Only two of all leukemic patients developed mild hematomas at the puncture site, but these soon resolved themselves. None of the patients developed pneumothorax or hemothorax. But late complications included local infection in two patients (6%) and thrombotic occlusion of the catheter in one (3%). The occluded catheter was successfully recanalized with Urokinase infusion. Fluoroscopy-guided, radiologic placement of a tunneled central venous catheter is an easy and safe method, and useful for patients requiring long-term venous access.

  15. Heating of the Intracluster Medium by Quasar Outflows

    Indian Academy of Sciences (India)

    Suparna Roychowdhury; Biman B. Nath

    2002-03-01

    We study the possibility of quasar outflows in clusters and groups of galaxies heating the intracluster gas in order to explain the recent observation of excess entropy in this gas. We show that radio galaxies alone cannot provide the energy required to explain the observations but the inclusion of Broad Absorption Line (BAL) outflows can do so, and that in this scenario most of the heating takes place at ∼ 1–4, the ``preheating” epoch being at a lower redshift for lower mass clusters.

  16. River Outflow of the Conterminous United States, 1939-1988.

    Science.gov (United States)

    Guetter, Alexandre K.; Georgakakos, Konstantine P.

    1993-10-01

    A record of 50 years of daily outflows through the boundaries of the continental United States has been assembled based on observations recorded by U.S. Geological Survey streamflow stations. Only stations with continuous records from 1939 through 1988 were included. These stations (197 total) are near the outlets of rivers located at the vicinity of the Canadian, Mexican, Atlantic (including the Gulf of Mexico), and Pacific borders of the continental United States. The drainage area of the selected stations covers 77% of the conterminous United States, whereas the existing network of gauging stations covers 83% of the conterminous U.S. area. Station daily data were aggregated over the entire boundary of the United States and were integrated in monthly and annual totals. The 50-year average annual streamflow divergence normalized by the aggregated drainage area is 210.2 mm yr1, reaching a peak in April with 27.3 mm month1 and a minimum in September with 8.7 mm month1. The Mississippi-Missouri Basin comprises 50% of the gauged area and dominates the absolute value of the outflow discharge. Spectral analysis of the monthly outflow anomalies shows an 11-year dominant cycle. The 1939-1988 period contains four notable droughts. Two droughts are partially registered in the limits of the records characterized by the negative anomalies extending from 1939 to 1941 and by the 1987-1988 anomalies for the late 1980s drought. The middle 1950s and early 1960s droughts are fully included in the dataset. Periods of high outflows were registered in the middle 1940s, early 1970s, and early 1980s. Analysis of the spatial coherence of the annual anomalies shows large-scale features, whereas analysis of the monthly anomalies yields the frequency and persistence patterns of floods and droughts. An estimate of the climatological land-surface water budget for the continental United States was done based on recorded precipitation, panevaporation, and outflow. Eigenvector analysis of the

  17. Preditores de injúria renal aguda em pacientes submetidos ao transplante ortotópico de fígado convencional sem desvio venovenoso Predictors of acute kidney injury in patients undergoing a conventional orthotopic liver transplant without veno-venous bypass

    Directory of Open Access Journals (Sweden)

    Olival Cirilo L. da Fonseca-Neto

    2011-06-01

    Full Text Available RADICAL: Injúria renal aguda é uma das complicações mais comuns do transplante ortotópico de fígado. A ausência de critério universal para sua definição nestas condições dificulta as comparações entre os estudos. A técnica convencional para o transplante consiste na excisão total da veia cava inferior retro-hepática durante a hepatectomia nativa. Controvérsias sobre o efeito da técnica convencional sem desvio venovenoso na função renal continuam. OBJETIVO: Estimar a incidência e os fatores de risco de injúria renal aguda entre os receptores de transplante ortotópico de fígado convencional sem desvio venovenoso. MÉTODOS: Foram avaliados 375 pacientes submetidos a transplante ortotópico de fígado. Foram analisadas as variáveis pré, intra e pós-operatórias em 153 pacientes submetidos a transplante ortotópico de fígado convencional sem desvio venovenoso. O critério para a injúria renal aguda foi valor da creatinina sérica > 1,5 mg/dl ou débito urinário BACKGROUND: Acute kidney injury is one of the most common complications of orthotopic liver transplantation. The absence of universal criteria for definition of these conditions make comparisons difficult between studies. The conventional technique for transplantation is the total excision of the inferior vena cava during liver retro-native hepatectomy. Controversies about the effect of the conventional technique without venovenous bypass on renal function remain. AIM: To estimate the incidence and risk of acute kidney injury factors among recipients of orthotopic liver transplantation without conventional venovenous bypass. METHODS: Was studied 375 patients undergoing orthotopic liver transplantation. Variables were analyzed in preoperative, intraoperative and postoperative complications in 153 patients undergoing orthotopic liver transplantation without conventional venovenous bypass. The criterion for acute kidney injury was serum creatinine > 1.5 mg/dl or

  18. (abstract) A Test of the Theoretical Models of Bipolar Outflows: The Bipolar Outflow in Mon R2

    Science.gov (United States)

    Xie, Taoling; Goldsmith, Paul; Patel, Nimesh

    1993-01-01

    We report some results of a study of the massive bipolar outflow in the central region of the relatively nearby giant molecular cloud Monoceros R2. We make a quantative comparison of our results with the Shu et al. outflow model which incorporates a radially directed wind sweeping up the ambient material into a shell. We find that this simple model naturally explains the shape of this thin shell. Although Shu's model in its simplest form predicts with reasonable parameters too much mass at very small polar angles, as previously pointed out by Masson and Chernin, it provides a reasonable good fit to the mass distribution at larger polar angles. It is possible that this discrepancy is due to inhomogeneities of the ambient molecular gas which is not considered by the model. We also discuss the constraints imposed by these results on recent jet-driven outflow models.

  19. Thrombolytic therapy in bilateral embolism of renal arteries branches

    Directory of Open Access Journals (Sweden)

    Cassini Marcelo F.

    2003-01-01

    Full Text Available Bilateral renal artery embolism is rare, but it is a significant cause of arterial hypertension and renal failure, and most often is associated with cardiac arrhythmias. We report a case of bilateral renal artery embolism with a satisfactory outcome following use of thrombolytic therapy. A 42 year-old Caucasian man presented a sudden complaint of intense abdominal pain, in mesogastrium and left flank with dorsal irradiation, 3 days after electrical cardioversion due to cardiac arrhythmia. Laboratory tests revealed slight leukocytosis, hematuria, and creatinine of 1.8 mg/dL. Chest radiography was normal and computerized tomography showed an area of massive ischemia in left kidney, and focal ischemia in right kidney and spleen. The patient was then submitted to systemic venous therapy with 1.5 million units of streptokinase, with an excellent outcome.

  20. Central Venous Catheter-Related Hydrothorax

    Directory of Open Access Journals (Sweden)

    Se Hun Kim

    2015-11-01

    Full Text Available This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

  1. Infections associated with the central venous catheters.

    Science.gov (United States)

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  2. Increased rheumatoid factor and deep venous thrombosis

    DEFF Research Database (Denmark)

    Meyer-Olesen, Christine L; Nielsen, Sune F; Nordestgaard, Børge G

    2015-01-01

    in the general population. METHODS: We included 54628 participants from the Copenhagen City Heart Study (1981-83) and the Copenhagen General Population Study (2004-12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome...... was incident deep venous thrombosis. There were no losses to follow-up. RESULTS: During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs ... ratios of 9.0 (95% CI 3.1-26) for 1-year follow-up, 4.3 (2.2-8.5) for 5-year follow-up, and 3.1 (1.7-5.6) for up to 32 years of follow-up. Compared with rheumatoid factor concentrations

  3. Complex central venous catheter insertion for hemodialysis.

    Science.gov (United States)

    Powell, Steven; Belfield, Jane

    2014-01-01

    Despite the introduction of payment by results in the UK, there has been no decrease in central venous catheter (CVC) use. In part, this may relate to a requirement to dialyse through a CVC while autogenous access matures. Mortality data have improved in parallel and patients on hemodialysis live longer, which may lead to an increased exposure to CVCs.Exposure to CVCs carries a significant risk of infection and occlusion requiring their repositioning or exchange. The mid to long-term sequelae of CVC use is central venous occlusion leaving clinical teams with an ever increasing challenge to find adequate venous access.In this article, we will discuss the challenges faced by operators inserting CVCs into the hemodialysis-dependent patient who has exhausted more tradition insertion sites. These include translumbar caval catheters, transocclusion and transcollateral catheters, transjugular Inferior Vena Cava catheter positioning, and transhepatic catheters. We will demonstrate the techniques employed, complications, and anticipated longevity of function.

  4. Experimental extracorporeal membrane oxygenation reduces central venous pressure: an adjunct to control of venous hemorrhage?

    Science.gov (United States)

    Larsson, Magnus; Talving, Peep; Palmér, Kenneth; Frenckner, Björn; Riddez, Louis; Broomé, Michael

    2010-07-01

    Venoarterial ECMO has been utilized in trauma patients to improve oxygenation, particularly in the setting of pulmonary contusions and ARDS. We hypothesized that venoarterial ECMO could reduce the central venous pressure in the trauma scenario, thus, alleviating major venous hemorrhage. Ten swine were cannulated for venoarterial ECMO. Central venous pressure, mean arterial pressure, portal vein pressure and portal vein flow were recorded at three different flow rates in both a hemodynamic normal state and a setting of increased central venous pressure and right ventricular load, mimicking acute lung injury. Venoarterial ECMO reduced the central venous pressure (CVP( sup)) from 9.4+/-0.8 to 7.3+/-0.7 mmHg (p<0.01) and increased the mean arterial pressure from 103+/-8 to 119+/-10 mmHg (p<0.01) in the normal hemodynamic state. In the state of increased right ventricular load, the CVP(sup) declined from 14.3+/-0.4 to 11.0+/-0.7mmHg (p<0.01) and the mean arterial pressure (MAP) increased from 66+/-6 to 113 +/-5 mmHg (p<0.01). Venoarterial ECMO reduces systemic venous pressure while maintaining or improving systemic perfusion in both a normal circulatory state and in the setting of increased right ventricular load associated with acute lung injury. ECMO may be a useful tool in reducing blood loss during major venous hemorrhage in both trauma and selected elective surgery.

  5. Venous thromboembolism in centenarians: Findings from the RIETE registry.

    Science.gov (United States)

    Lacruz, Beatriz; Tiberio, Gregorio; Núñez, Manuel Jesús; López-Jiménez, Luciano; Riera-Mestre, Antoni; Tiraferri, Eros; Verhamme, Peter; Mazzolai, Lucia; González, José; Monreal, Manuel

    2016-12-01

    The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain. We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100years. Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168±42IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148±51IU/kg/day). During the course of anticoagulant therapy (mean duration, 139days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported. Among patients with acute VTE aged ≥100years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  6. News in Pathogenesis of Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Mazuchova J

    2016-08-01

    Full Text Available This review article is concentrating on the news in the pathophysiology of chronic venous insufficiency (CVD. Despite ongoing progress in understanding the molecular aspects of CVD the exact mechanism of its development remains unclear. Many different factors may play role in the pathogenesis of CVD, including changes in hydrostatic pressure, valvular incompetence, increased capillary permeability, endothelial dysfunction, activation of leukocytes, deep venous obstruction, capillary microthrombosis, ineffective function of calf muscle pump, biochemical and structural changes in the vessel wall, extracellular matrix alteration, and several other mechanisms. A better understanding of the pathophysiology is an important step in the finding of new potential treatment.

  7. Lay Stress on Study of Venous Thromboembolism

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2002-01-01

    @@ Venous thromboembolism (VTE) including deep vein thrombosis(DVT) and pulmonary embolism(PE).Its occurs in about 1 per 1 000 individuals per years.Thrombosis is a serious disorder. It may be fatal by PE (case fatality rate of venous thrombosis is estimated at 1% to 2%)(Figure 1 ). A substantial proportion of these deaths occur in the postoperative period, and many events are fatal before diagnosis can be made and therapy initiated. Just as well, the prophylactic treatment of thrombosis is focused on preventing first events and recurrences through adequate knowledge about risks and risk factors.

  8. Management of Peripheral and Truncal Venous Injuries

    Directory of Open Access Journals (Sweden)

    Triantafillos G. Giannakopoulos

    2017-08-01

    Full Text Available Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.

  9. Assessment of Venous Thrombosis in Animal Models.

    Science.gov (United States)

    Grover, Steven P; Evans, Colin E; Patel, Ashish S; Modarai, Bijan; Saha, Prakash; Smith, Alberto

    2016-02-01

    Deep vein thrombosis and common complications, including pulmonary embolism and post-thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here, we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro-computed tomography, and high-frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition.

  10. Imaging characteristics of two patients with isolated cortical venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    Shunchang Han; Hui Zhang; Guoguang Fan; Baohai Sun

    2008-01-01

    BACKGROUND:Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variations to be detected in the cortical vein and venous sinus. Diagnosis of thromboses in the venous system should not depend entirely on angiography of undeveloped veins or venous sinus. Currently, the combination of magnetic resonance imaging and magnetic resonance venography is the gold standard for diagnosing cerebral venous sinus thrombosis, rather than digital subtraction angiography. This article summarizes clinical manifestations, results from computed tomography and magnetic resonance imaging in two cases of isolated cortical venous thrombosis, analyzed relevant literature, and discussed the clinical and imaging characteristics of isolated cortical venous thromboses.

  11. Complement C3 and High Risk of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Nørgaard, Ina; Nielsen, Sune Fallgaard; Nordestgaard, Børge Grønne

    2016-01-01

    BACKGROUND: Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS: We...... similar for deep venous thrombosis and pulmonary embolism separately. The multivariable-adjusted hazard ratio for venous thromboembolism for a 1-g/L increase in complement C3 was 2.43 (1.74-3.40). CONCLUSIONS: High concentrations of complement C3 were associated with high risk of venous thromboembolism...... included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003-2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals...

  12. Effect of Pingyangmycin on human venous malformation endothelial cells

    Institute of Scientific and Technical Information of China (English)

    Yi Fang Zhao; Zhi Jun Sun; Yu Lin Jia; Jun Jia; Ya Meng Si; Ji Hong Zhao; Wen Feng Zhang

    2008-01-01

    @@ Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.

  13. Kidney (Renal) Failure

    Science.gov (United States)

    ... How is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain proper fluid ... marrow and strengthen the bones. The term kidney (renal) failure describes a situation in which the kidneys have ...

  14. Renal arteries (image)

    Science.gov (United States)

    A renal angiogram is a test used to examine the blood vessels of the kidneys. The test is performed ... main vessel of the pelvis, up to the renal artery that leads into the kidney. Contrast medium ...

  15. [Lower limb venous angiodysplasia as a cause of chronic venous insufficiency: specific diagnosis and treatment].

    Science.gov (United States)

    Dan, V N; Sapelkin, S V; Karmazanovskiĭ, G G; Kuntsevich, G I

    2007-01-01

    The paper presents a current understanding of chronic venous insufficiency that develops in venous forms of dysplasia. Management of venous dysplasia must be based on multidisciplinary approach including comprehensive diagnosis (predominantly noninvasive), integrative surgical and non-surgical treatment. Modern therapy must be complex and carried out in highly specialized facilities. Best functional and esthetic results can be achieved only through combined therapy. When surgical or non-surgical interventions are inappropriate or impossible, management focus must be placed on clinical control of vascular anomaly (follow-up and compression-based conservative treatment) aimed at minimization of its unfavorable impact on vital functions and at quality of life improvement.

  16. [Obstruction of outflow tracts in complete transposition of great arteries].

    Science.gov (United States)

    Muñoz Castellanos, Luis; Kuri Nivon, Magdalena; Quiñones Cárdenas, Alma Rosa

    2002-01-01

    The obstructive lesions in the outflow tracts of hearts with complete transposition of the great arteries determine the clinical evolution, prognosis, and the selection of surgical procedures. Their knowledge is basic to interpret the imaging findings. From the pathologic specimens collection of the Instituto Nacional de Cardiología "Ignacio Chávez", seventy-tree hearts with this cardiopathy were studied morphologically with the sequential segmental system. Thirty-two hearts had outflow tracts anomalies, being obstructive twenty-eight; among these lesions were: malposition of the infundibular septum, hipertrophyc left infundibulum, prolapse of tricuspid valve tissue through a ventricular septal defect, accessory mitral valve tissue, septal hipertrophy at the left outflow tract level, abnormal insertion of cord tendinae of the mitral valve, anticlockwise malposition of the mitral valve (first report in the literature). The left outflow tract presented obstructive lesions (92.85%) more frequently than the right one. These lesions produce left ventricular hipertrophy, a fundamental feature for the anatomic surgical procedures to be made.

  17. On the Formation of Molecular Clumps in QSO Outflows

    Science.gov (United States)

    Ferrara, A.; Scannapieco, E.

    2016-12-01

    We study the origin of the cold molecular clumps in quasar outflows, recently detected in CO and HCN emission. We first describe the physical properties of such radiation-driven outflows and show that a transition from a momentum- to an energy-driven flow must occur at a radial distance of R≈ 0.25 {kpc}. During this transition, the shell of swept-up material fragments due to Rayleigh-Taylor instabilities, but these clumps contain little mass and are likely to be rapidly ablated by the hot gas in which they are immersed. We then explore an alternative scenario in which clumps form from thermal instabilities at R≳ 1 {kpc}, possibly containing enough dust to catalyze molecule formation. We investigate this process with 3D two-fluid (gas+dust) numerical simulations of a kpc3 patch of the outflow, including atomic and dust cooling, thermal conduction, dust sputtering, and photoionization from the QSO radiation field. In all cases, dust grains are rapidly destroyed in ≈ {10}4 years; and while some cold clumps form at later times, they are present only as transient features, which disappear as cooling becomes more widespread. In fact, we only find a stable two-phase medium with dense clumps if we artificially enhance the QSO radiation field by a factor of 100. This result, together with the complete destruction of dust grains, renders the interpretation of molecular outflows a very challenging problem.

  18. Radiation pressure confinement - IV. Application to broad absorption line outflows

    CERN Document Server

    Baskin, Alexei; Stern, Jonathan

    2014-01-01

    A fraction of quasars present broad absorption lines, produced by outflowing gas with typical velocities of 3000 - 10,000 km/s. If the outflowing gas fills a significant fraction of the volume where it resides, then it will be highly ionized by the quasar due to its low density, and will not produce the observed UV absorption. The suggestion that the outflow is shielded from the ionizing radiation was excluded by recent observations. The remaining solution is a dense outflow with a filling factor $f<10^{-3}$. What produces such a small $f$? Here we point out that radiation pressure confinement (RPC) inevitably leads to gas compression and the formation of dense thin gas sheets/filaments, with a large gradient in density and ionization along the line of sight. The total column of ionized dustless gas is a few times $10^{22}$ cm$^{-2}$, consistent with the observed X-ray absorption and detectable P V absorption. The predicted maximal columns of various ions show a small dependence on the system parameters, a...

  19. ALMA Observations of the HH 46/47 Molecular Outflow

    CERN Document Server

    Arce, Hector G; Corder, Stuartt; Garay, Guido; Noriega-Crespo, Alberto; Raga, Alejandro C; Cabrit, Sylvie

    2013-01-01

    The morphology, kinematics and entrainment mechanism of the HH 46/47 molecular outflow were studied using new ALMA Cycle 0 observations. Results show that the blue and red lobes are strikingly different. We argue that these differences are partly due to contrasting ambient densities that result in different wind components having a distinct effect on the entrained gas in each lobe. A 29-point mosaic, covering the two lobes at an angular resolution of about 3", detected outflow emission at much higher velocities than previous observations, resulting in significantly higher estimates of the outflow momentum and kinetic energy than previous studies of this source, using the CO(1-0) line. The morphology and the kinematics of the gas in the blue lobe are consistent with models of outflow entrainment by a wide-angle wind, and a simple model may describe the observed structures in the position-velocity diagram and the integrated intensity map. The red lobe exhibits a more complex structure, and there is evidence tha...

  20. Fast outflows and star formation quenching in quasar host galaxies

    CERN Document Server

    Carniani, S; Maiolino, R; Balmaverde, B; Brusa, M; Cano-Díaz, M; Cicone, C; Comastri, A; Cresci, G; Fiore, F; Feruglio, C; La Franca, F; Mainieri, V; Mannucci, F; Nagao, T; Netzer, H; Piconcelli, E; Risaliti, G; Schneider, R; Shemmer, O

    2016-01-01

    Negative feedback from active galactic nuclei (AGN) is considered a key mechanism in shaping galaxy evolution. Fast, extended outflows are frequently detected in the AGN host galaxies at all redshifts and luminosities, both in ionised and molecular gas. However, these outflows are only "potentially" able to quench star formation and we are still missing a decisive evidence of negative feedback in action. Here we present Spectrograph for INtegral Field Observations in the Near Infrared (SINFONI) H- and K-band integral-field spectroscopic observations of two quasars at $z\\sim$2.4 characterised by fast, extended outflows detected through the [OIII]$\\lambda$5007 line (Carniani et al. 2015). The high signal-to-noise ratio of our observations allows us to identify faint narrow (FWHM $< 500$ km/s), and spatially extended components in [OIII]$\\lambda$5007 and H$\\alpha$ emission associated with star formation in the host galaxy. Such star-formation powered emission is spatially anti-correlated with the fast outflow...