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Sample records for saphenous vein reflux

  1. Small saphenous vein: where does reflux go?

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    Guillermo Gustavo Rossi

    2013-06-01

    Full Text Available BACKGROUND: The anatomy of small saphenous vein (SSV is very variable because of its complex embryological origin. SSV incompetence often causes reflux that goes to the perforating veins, sometimes not respecting the anatomical course. OBJECTIVE: To analyze differences in reflux direction and reentry in the SSV. METHODS: In this prospective, observational study, 60 lower limbs with SSV incompetence of 43 patients were assessed using a color Doppler ultrasound protocol. RESULTS: Reentry variations were grouped into four types and subtypes. Percentage results were: Type A, perforating veins on the medial side = 25/60 cases (41.66%; subtypes: Cockett, Sherman, paratibial and vertex; Type B, lateral malleolus and perforating veins on the lateral side (fibular 17-26 cm = 15/60 cases (25%; subtypes: fibular and malleolus; Type C, two branches = 19/60 cases (31.66%; subtypes: gastrocnemius and Cockett, gastrocnemius and malleolus, and/or fibular, Cockett and malleolus, Cockett-vertex and fibular; Type D, reflux in the superficial system = 1/60 cases (1.66%. CONCLUSION: On most of the lower limbs assessed, reflux did not follow the classical anatomic course. Our findings demonstrated a high degree of variation in reflux/reentry, but no SSV anatomical variations. Reflux seems to, either look for the most accessible anatomical connection for reentry or be originated in the distal area and then reach the SSV.

  2. Associations between flow in paratibial perforating veins and great saphenous vein patterns of reflux

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    Carlos Alberto Engelhorn

    2015-06-01

    Full Text Available Perforating veins contribute to chronic venous valvular insufficiency (CVVI, subset of CVI of lower extremities (LE. We investigated the role of medial, proximal calf paratibial perforating veins (PTPV. Women with PTPV reflux, diameter ≥3 mm, or tortuosity were selected among 2199 LE mappings. Duplex ultrasonography (US was performed standing. Reflux >0.5 s was abnormal. PTPV conditions were related to great saphenous vein (GSV patterns of reflux. US of 442 LE of 379 women were analyzed, all being Clinical-Etiology-Anatomy-Pathophysiology (CEAP classification C1, C2, and/or having intermittent, conditional swelling. Etiology was primary. Pathophysiology was reflux, not thrombosis or obstruction. Most PTPV drained (n=281, 64% of 442 or 13% of 2199, or were source (n=73, 17%/442, 3%/2199 of GSV reflux; 49 (11%/442, 2%/2199 had reflux not associated with GSV; 39 (9%/442, 2%/2199 did not have reflux. PTPV, when significative for CVVI, primarily drained-GSV reflux. PTPV was linked to reflux in 1 of 5 and was a major source of reflux in 1 of 20 legs. Detailed US of PTPV insured over 80% accuracy in CVVI mapping.

  3. Great saphenous vein dilatation with reflux at the saphenofemoral junction: A rare underlying association of eccrine angiomatous hamartoma

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    Sanjiv Choudhary

    2016-01-01

    Full Text Available Eccrine angiomatous hamartoma (EAH is an exceedingly rare benign tumor-like lesion prevalent in childhood, which can produce pain and marked sweating. Histological features include proliferation of eccrine sweat glands and angiomatous capillary channels. It may be rarely associated with underlying pathological conditions. A 15-year-old female patient presented with multiple tender reddish papules and nodules coalescing to form plaques of 10 × 8 cm over the anterior aspect of the right lower thigh since birth. It was associated with hypertrichosis, hyperhidrosis, pain, and occasional bleeding on trauma. Histopathological examination of the lesion showed increased proliferation of both eccrine and angiomatous channels. Ultrasonography and Color Doppler of the right thigh showed dilatation of the great saphenous vein (GSV above the right knee, with evidence of grade 3 reflux at saphenofemoral junction. Magnetic resonance imaging revealed large dilated GSV with slow flow and venous malformation in the anterior part of the right knee

  4. Probabilidade de refluxo nas veias safenas de mulheres com diferentes graus de insuficiência venosa crônica Reflux probability in saphenous veins of women with different degrees of chronic venous insufficiency

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    Maria Fernanda Cassou

    2007-09-01

    Full Text Available CONTEXTO: A presença de refluxo nas junções safeno-femoral e safeno-poplítea é um dado importante para programação da cirurgia de varizes. Estudos mostraram que, na maioria dos pacientes com insuficiência venosa crônica, as junções estão competentes, e o refluxo está presente ao longo do trajeto das veias safenas. OBJETIVOS: Identificar probabilidade de diferentes padrões de refluxo nas veias safenas de mulheres com vários graus de insuficiência venosa crônica e avaliar se o comprometimento das junções das safenas está associado com gravidade da insuficiência venosa. MÉTODOS: Um total de 1.184 membros inferiores de 672 mulheres foram estudados pela ultra-sonografia vascular com Doppler colorido e avaliados pela classificação clínica, etiológica, anatômica e patológica (CEAP. As extremidades foram agrupadas de acordo com a gravidade da insuficiência venosa em graus leve (CEAP C1-C2, moderado (CEAP C3 e grave (CEAP C4-C6. Para avaliar a classificação clínica CEAP na predição do padrão de refluxo, utilizou-se o Teorema de Bayers. Para avaliar associação entre classificação clínica CEAP e padrões de refluxo com ou sem comprometimento das junções das safenas, utilizou-se o teste qui-quadrado (p BACKGROUND: Presence of reflux in saphenofemoral and saphenopopliteal junctions represents important data for indication of varicose vein surgery. Studies demonstrated that in most patients with chronic venous insufficiency junctions are competent and reflux is present in segments in the course of saphenous veins. OBJECTIVES: To identify the probability of different reflux patterns in the saphenous veins of women with various degrees of chronic venous insufficiency and to evaluate whether junction impairment is associated with severity of venous insufficiency. METHODS: A total of 1,184 lower limbs of 672 women were evaluated by color-flow Doppler ultrasonography and classified according to clinical, etiologic

  5. A RARE VARIATION OF GREAT SAPHENOUS VEIN

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    Nakhate Manisha

    2014-11-01

    Full Text Available The venous system is more complex and variable than arterial system due to its frequent anatomical variations. This paper discusses the anatomy of the great saphenous vein and its variation observed in a male cadaver of around 60 years old.

  6. Associations of anterior accessory or thigh posterior tributary and great saphenous reflux patterns in early stages of chronic venous valvular insufficiency

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    Carlos Alberto Engelhorn

    2014-07-01

    Full Text Available Varicose veins are a common disorder. Extensive ultrasound (US mapping of lower extremity chronic venous valvular insufficiency includes the great saphenous vein (GSV, anterior accessory saphenous vein (AASV and thigh posterior tributary to GSV such as the posterior accessory saphenous vein (PTSV, PASV. The aim of this study was to determine associations between GSV-AASV-PTSV (including PASV reflux in a specific sample population of Southern Brazilian women, mostly euro descendents, with telangiectasias, reticular veins, varices and/or intermittent edema. US performed in 1016 extremities of 513 women, 43±18 (18-81 years old were included. Women with previous venous thrombosis, surgery, suspicion of pelvic congestion syndrome, and men were excluded. Small saphenous vein and related thigh veins were excluded from analysis. GSV-AASV-PTSV reflux patterns were analyzed; prevalence was compared using χ2 statistics. Reflux prevalence in AASV and/or thigh PTSV was 5.8% (59/1016: 1.3% at PTSV (n=13 and 4.5% at AASV (n=46, significantly lower than GSV reflux: 72% (n=727 (P<0.001. AASV and/or PTSV reflux was associated with GSV reflux (81%, n=48/59; common pattern was diffuse reflux, starting at AASV/PTSV saphenous junctions (56%, n=33/59; otherwise, short, non-diffuse reflux was noted in part of the AASV/PTSV evaluated. Isolated AASV or PTSV reflux was rare (1%, n=11/1016: 9 at the AASV, and 2 at the PTSV. US mapping of AASV/PTSV in early stages of disease, in women without pelvic congestion syndrome, increased reflux detection by 1%, and improved definition of reflux patterns in about 6% of the extremities.

  7. Primary leiomyosarcoma of saphenous vein presenting as deep venous thrombosis.

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    Fremed, Daniel I; Faries, Peter L; Schanzer, Harry R; Marin, Michael L; Ting, Windsor

    2014-12-01

    Only a small number of venous leiomyosarcomas have been previously reported. Of these tumors, those of saphenous origin comprise a minority of cases. A 59-year-old man presented with symptoms of deep vein thrombosis and was eventually diagnosed with primary leiomyosarcoma of great saphenous vein origin. The tumor was treated with primary resection and femoral vein reconstruction with autologous patch. Although extremely rare, saphenous leiomyosarcoma can present as deep vein thrombosis. Vascular tumors should be included in the differential diagnosis of atypical extremity swelling refractory to conventional deep vein thrombosis management.

  8. Pressure-diameter relationship in the human greater saphenous vein

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    Stooker, W; Gok, M; Sipkema, P; Niessen, HWM; Baidoshvili, A; Westerhof, N; Jansen, EK; Wildevuur, CRH; Eijsman, L

    2003-01-01

    Background. Compliance of artificial and autologous vascular grafts is related to future patency. We investigated whether differences in compliance exist between saphenous vein grafts derived from the upper or lower leg, which might indicate upper or lower leg saphenous vein preference in coronary a

  9. Multiple ligation of the proximal greater saphenous vein in the CHIVA treatment of primary varicose veins

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    Roberto Delfrate

    2014-06-01

    Full Text Available Saphenous femoral disconnection is the key point of most surgical techniques in the treatment of primary varicose vein surgery. The aim of this study is to compare and analyze different techniques for conservative saphenousfemoral ligation or disconnection. These techniques can be to perform mini invasive open surgery and are suitable for implementation of the conservative hemodynamic correction of venous insufficiency (CHIVA method. The aim was to present the follow-up by retrospective analysis of three different ligation-disconnection techniques of the proximal great saphenous vein (GSV according to the CHIVA method at the GSV end, i.e. between the very end of the GSV and the first arch tributary, according to the CHIVA method. The first thecnique consisted of a surgical division (crossotomy. The other two consisted of triple superposed ligation with No. 2 non-absorbable braided coated suture without division labeled TSFL (triple saphenous flush ligation and No. 0 polypropylenene ligation TPL (triple polypropylene ligation. The difference between TSFL and TPL was in the thickness and type of material of the thread, though both were non-absorbable. The follow up of 56 TPL procedures, 61 crossotomy procedures, and 82 TSFL procedures was analysed. The follow-up consisted of checking the sapheno-femoral junction occlusion with Duplex color ultra sound. The incidence rates of neovascularization (new vessels in the ligation or surgical disconnection site with saphenous-femoral reflux during the Valsalva maneuver were: 4.9% for the crossotomy group, 6.1% for the TSFL group and 37.5% for the TPL group. The data analysed show satisfactory results with both crossotomy and TSFL. Crossotomy has proven to be an effective technique for performing saphenous-femoral disconnection, but TSFL could also be a reliable, safe and low-cost varicose mini-invasive surgery in outpatients. TPL appeared to be less reliable.

  10. Saphenous Vein Sparing Superficial Inguinal Dissection in Lower Extremity Melanoma

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    Muhammed Beşir Öztürk

    2014-01-01

    Full Text Available Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient’s quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.

  11. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

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    Sarac A

    2014-04-01

    Full Text Available Atilla Sarac,1 Artan Jahollari,1 Sureyya Talay,1 Sevket Ozkaya,2 Ertugrul Ozal1 1Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV insufficiency. Methods: External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results: A complete clinical and radiological healing was observed in 50 patients (60%. In 13 cases (15.6%, a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6% developed superficial vein thrombosis, and only one patient (1.2% developed deep vein thrombosis. Contact was lost from 32 patients (38.5% for different reasons. Conclusion: External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping. Keyword: vein, saphenous, insufficiency, external valv, valvuloplasty, varicosis

  12. Numerical simulation of endovenous laser treatment of the incompetent great saphenous vein with external air cooling.

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    Marqa, Mohamad Feras; Mordon, Serge; Hernández-Osma, Esteban; Trelles, Mario; Betrouni, Nacim

    2013-05-01

    Endovenous laser treatment (ELT) has been proposed as an alternative in the treatment of reflux of the great saphenous vein. Before the procedure, peri-saphenous subcutaneous tumescent saline solution infiltration is usually performed. However, diffusion of this tumescent fluid is rapidly observed and can potentially reduce the efficacy as a heat sink. External skin cooling with cold air was proposed as an alternative solution. The objective of this study is to compare endovenous laser treatment without and with air cooling by realistic numerical simulations. An optical-thermal damage model was formulated and implemented using finite element modeling. The general model simulated light distribution using the diffusion approximation of the transport theory, temperature rise using the bioheat equation, and laser-induced injury using the Arrhenius damage model. Parameters, used in clinical procedures, were considered: power, 15 W; pulse duration, 1 s; fiber pull back, 3-mm increments every second; cold air applied in continuous mode during ELT; and no tumescent anesthesia. Simulations were performed for vein locations at 5, 10, and 15 mm in depth, with and without air cooling. For a vein located at 15 mm in depth, no significant difference was observed with and without cooling. For a vein located at 10 mm in depth, surface temperature increase up to 45 °C is observed without cooling. For a vein located at 5 mm, without cooling, temperature increase leads to irreversible damage of dermis and epidermis. Conversely, with air cooling, surface temperature reaches a maximum of 38 °C in accordance with recordings performed on patients. ELT of the incompetent great saphenous vein with external air cooling system is a promising therapy technique. Use of cold air on the skin continuously flowing in the area of laser shot decreased significantly the heat extent and the thermal damage in the perivenous tissues and the skin.

  13. Ultrasound-guided foam sclerotherapy of great saphenous vein with 2% polidocanol – one-year follow-up results

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    Osęka, Marcin; Tworus, Robert; Gałązka, Zbigniew

    2016-01-01

    Introduction Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences. Aim To assess the safety and efficacy of UGFS using a 2% solution of polidocanol (Aethoxysklerol 2%) in the case of great saphenous vein incompetence. Material and methods Fifty-two patients with great saphenous vein incompetence underwent ultrasound-guided foam sclerotherapy. The efficacy criterion was the elimination of reflux measured ultrasonographically and withdrawal or decrease of complaints: 1 week, and 1, 3, 6 and 12 months after the treatment. Complications of sclerotherapy were reported during follow-up. Results Decrease or withdrawal of complaints of chronic venous insufficiency was reported in 96% of cases (50 patients). Disappearance or decrease of varicose veins was noted in all patients (100%). During examination after 12 months, full success of ultrasound was achieved in 38 (73%) cases, and 11 (21%) patients presented a partial desired effect according to the consensus from Tegernsee. Persistence of reflux longer than 1 s in the treated great saphenous vein was reported in 3 (6%) cases. Serious complications, such as deep vein thrombosis, pulmonary embolism, dyspnea, anaphylaxis, or neurological abnormalities, were not recorded. Conclusions Ultrasound-guided foam sclerotherapy of incompetent great saphenous vein and varicosities with 2% polidocanol was found to be an effective and safe method of treatment during 1 year of observation. However, longer observation is necessary. PMID:27458485

  14. Ultrasound assisted great saphenous vein ligation and division: an office procedure

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    Stefano Ricci

    2014-10-01

    Full Text Available The aim of this proof of concept study is to describe an ultrasound (US assisted simplified surgical procedure for pre-terminal great saphenous vein (GSV high ligation/division avoiding groin dissection and tributary interruption, in an office setting, in association to varices phlebectomy and saphenous vein foam occlusion treatment. Inclusion criteria: primary GSV reflux due to terminal valve, vein diameter >6 mm. By ultrasonography in standing position, the point GSV passing over the adductor longus muscle (about 3 cm from the junction is identified. This E (easy point, relatively superficial, free from tributaries and other structures, allows an easy grasping and extraction of the GSV vein through a 3 mm stab incision provided an ultrasonography assistance. The vein is divided/ligated about 2 cm distal from the ostium, the distal stump is cannulated and foam is injected on the distal segment from the E-point incision in a retrograde fashion, varices are avulsed by phlebectomy. Twenty procedures in 18 patients (venous clinical severity score: mean 3.15 - GSV diameter: mean 7.34 were performed, all the cases without inconveniences, with a duration not exceeding 10 min in addition to the phlebectomy procedure time. No complications as hemorrhage, infection, nerve lesion, lymphatic leak or thrombosis have been registered. At one month the residual saphenous stump length was in average 2.16 cm with complete closure of GSV in all. Three patients have been controlled at 6 months showing GSV complete closure. The procedure described is a simple office US assisted method for GSV ligationdivision, leaving the 2 last cm of the saphenofemoral junction. It could be associated to most of the procedures in use with limited additional time and resources required.

  15. Update of endovenous treatment modalities for insufficient saphenous veins-A review of literature

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    van Eekeren, Ramon R. J. P.; Boersma, Doeke; de Vries, Jean-Paul P. M.; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    2014-01-01

    Lower-limb venous insufficiency resulting from saphenous vein incompetence is a common disorder, increasing with age. For decades, surgical stripping of the great saphenous vein has been the gold standard in varicose vein treatment. The desire to optimize outcomes of treatment and reduce surgical tr

  16. Update of endovenous treatment modalities for insufficient saphenous veins-A review of literature

    NARCIS (Netherlands)

    van Eekeren, Ramon R. J. P.; Boersma, Doeke; de Vries, Jean-Paul P. M.; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    Lower-limb venous insufficiency resulting from saphenous vein incompetence is a common disorder, increasing with age. For decades, surgical stripping of the great saphenous vein has been the gold standard in varicose vein treatment. The desire to optimize outcomes of treatment and reduce surgical

  17. Endovenous laser therapy for occlusion of incompetent saphenous veins using 1940nm

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    Sroka, Ronald; Pongratz, Thomas; Esipova, Anna; Dikic, Slobodan; Demhasaj, Sahit; Comsa, Florin; Schmedt, Claus-Georg

    2015-07-01

    Objective: Several studies indicate that ELT using wavelengths of high water absorption showed advantages compared to conventional ELT. Thulium-Lasers emit nearby the local absorption maximum of water at 1940nm. In this clinical study the effectiveness, safety and the feasibility of 1940nm-ELT is proven. Materials and Method: A single centric, prospective observational study was performed. 1940nm-laserenergy was applied using radial emitting fibres with continuous pullback (1mm/s). Treatment was performed under anesthesia (general, spinal, tumescent) thus simultaneous miniphlebectomy and ligation of perforators could be applied. Patient and technical details were systematically collected. Evaluation included: standardized questionnaire, clinical examination, color-duplex ultrasonography preoperatively, 3d, 4w, 6m postoperatively, statistic. Results: The 1940nm-ELT study include 55 patients (female/men=34/21, mean age 55y, range 23-90y) treating n=72 vessels. The mean maximum diameter of great saphenous veins (GSV, n=59) was 7.5mm (range 3.7-11.3mm) and of small saphenous veins (SSV, n=13) was 5.3mm (3.0-10.0mm). The mean applied longitudinal endovenous energy density (LEED) was 64.3J/cm (40.3-98.2J/cm) in GSVs and 51.0J/cm (37.6-72.7J/cm) in SSVs. Complete occlusion of the vein without sign of reflux was achieved in 100%. The mean length of non-occluded stump at the sapheno-femoral junction was 6.0mm (1.0-20.0mm). Postoperative reduction of the diameter of GSV was 1.6mm (21.3%) and 2.0mm (37.7%) in SSV. One (1.4%) endovenous heat induced thrombus (EHIT) was observed. Further adverse events were: paresthesia 10/72 (13.9%), ecchymosis 1/72 (1.4%), lymphocele 1/72 (1.4%), hyperpigmentation 1/72 (1.4%). The mean postoperative pain intensity was 1.3 and 1.8 single doses of analgesics were administered. Normal physical activity was reached after 3d (1-21d). Conclusion: 1940nm-ELT using radial light application effectively eliminates the reflux in insufficient saphenous

  18. The in situ saphenous vein bypass graft: radiologic aspects.

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    Schwarz, W; Nozick, J; Richmand, D; Rodgers, B; Simpson, A; Argila, C; Honickman, S

    1986-03-01

    The use of the in situ saphenous vein for bypassing arterial occlusions in the lower extremities appears to have a higher patency rate than other bypass procedures but presents unique technical problems, such as lysing valves and occluding venous tributaries. Forty-four patients undergoing in situ bypasses had preoperative arteriograms. Special attention was paid to the small runoff vessels around the ankle, which are not suitable for reversed bypass procedures but may be adequate for in situ bypasses. Eight patients also had preoperative saphenous venograms, which revealed surgically important abnormalities in six cases. Postoperative arteriograms obtained within 2 weeks in 10 patients and within 2-12 months in 15 patients revealed persistent arteriovenous fistulas in four patients, stenoses in nine, occlusions in five, and progressive disease in the nonbypassed arteries in five patients. Early recognition of these problems led to 11 surgical repairs; nine repairs used the interventional radiologic procedures of balloon angioplasty, transcatheter embolization, and catheter thrombolysis. In this group of 44 patients, five patients died with patent bypasses and three patients required amputation despite functioning bypasses. Only four amputations were attributed to bypass failure. This low figure may be due to the close cooperation of the vascular surgeons and the vascular radiologists in dealing with these complicated cases.

  19. Thrombosed aneurysm of saphenous vein coronary artery bypass grafting.

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    Queiroz, Rodolfo Mendes; Nastri, Rogério; Ferez, Marcus Antônio; Costa, Mauro José Brandão da; Laguna, Claudio Benedini; Valentin, Marcus Vinicius Nascimento

    2017-06-01

    We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential.

  20. Comparison between mechanical properties of human saphenous vein and umbilical vein

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    Hamedani Borhan

    2012-08-01

    Full Text Available Abstract Background As a main cause of mortality in developed countries, Coronary Artery Disease (CAD is known as silent killer with a considerable cost to be dedicated for its treatment. Coronary Artery Bypass Graft (CABG is a common remedy for CAD for which different blood vessels are used as a detour. There is a lack of knowledge about mechanical properties of human blood vessels used for CABG, and while these properties have a great impact on long-term patency of a CABG. Thus, studying these properties, especially those of human umbilical veins which have not been considered yet, looks utterly necessary. Methods Umbilical vein, as well as human Saphenous vein, are respectively obtained after cesarean and CABG. First, histological tests were performed to investigate different fiber contents of the samples. Having prepared samples carefully, force-displacement results of samples were rendered to real stress–strain measurements and then a fourth-order polynomial was used to prove the non-linear behavior of these two vessels. Results Results were analyzed in two directions, i.e. circumferentially and longitudinally, which then were compared with each other. The comparison between stiffness and elasticity of these veins showed that Saphenous vein’s stiffness is much higher than that of umbilical vein and also, it is less stretchable. Furthermore, for both vessels, longitudinal stiffness was higher than that of circumferential and in stark contrast, stretch ratio in circumferential direction came much higher than longitudinal orientation. Conclusion Blood pressure is very high in the region of aorta, so there should be a stiff blood vessel in this area and previous investigations showed that stiffer vessels would have a better influence on the flow of bypass. To this end, the current study has made an attempt to compare these two blood vessels’ stiffness, finding that Saphenous vein is stiffer than umbilical vein which is somehow as stiff as

  1. Sclerofoam assisted laser therapy for saphenous refluxes: an innovative tumescence-free technique

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    Francesco Zini

    2015-06-01

    Full Text Available Endovenous laser (EL and radiofrequency devices have continuously increased their appealing in the last decade. Even if miniinvasive, such procedure still requires multiple high volume injections of tumescent anesthesia: a medical act that is not totally complications- free. Aim of the present investigation is to evaluate the feasibility of a hybrid technique (so called sclerofoam assisted laser therapy, SFALT combining foam sclerotherapy (FS and EL in a tumescence free approach. Fourty primary chronic venous disease patients (8 males, 32 females, C2-4EpAsPr presenting a sapheno-femoral reflux both at the Valsalva and compression/relaxation maneuver underwent a SFALT procedure. Diameters were measured at mid-thigh in supine. It consists in a EL fiber introduction into the great saphenous vein (GSV, shrinking it for a single cm at 200 J/cm. After a shrunk plug is created, keeping the fiber stuck in it, 5 cc of foam sclerotherapy [Tessari method, 1% polidocanol (POL or 1% sodium tetradecyl sulfate (STS] are injected through the same 6 Fr EL introducer. The consequent spasm allows a following EL mediated shrinkage by means of a significantly reduced fluence. Clinical and sonographic follow up were performed at one and three weeks. At 3 weeks follow up all the 40 cases presented a shrunk GSV, without recanalization signs. Neither major nor minor complications were reported. At the mid-thigh the standing GSV caliber decreased from a preoperative mean value of 0.6±0.2 cm to a post FS injection 0.3±0.1 cm value (P<0.05, showing no statistical difference among STS and POL. SFALT approach is feasible, safe and with potentially interesting outcomes. More investigations are needed in order to define the proper fluence parameters and the chance of eliminating the even mild sedation. This technique offers the chance of a possible tumescence free GSV treatment, even in case of major calibers vessels.

  2. Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation.

    NARCIS (Netherlands)

    Groenendael, L. van; Vliet, J.A. van der; Flinkenflogel, L.; Roovers, E.A.; Sterkenburg, S.M. van; Reijnen, M.M.P.J.

    2009-01-01

    OBJECTIVE: Varicose vein recurrence of the great saphenous vein (GSV) is a common, costly, and complex problem. The aim of the study was to assess feasibility of endovenous laser ablation (EVLA) in recurrent varicose veins of the GSV and to compare this technique with conventional surgical reinterve

  3. Room for improvement in reoperation for varicosities of the small saphenous vein

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    Flamand, Mette Kehlet; Bækgaard, Niels

    2011-01-01

    This study was conducted to evaluate the qualitative and quantitative effects of surgery for recurrent varicosities of the small saphenous vein (SSV). To our knowledge, English-language original articles on this subject have not previously been published....

  4. The effect of arteriovenous fistulas on in situ saphenous vein bypasses

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    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T;

    1991-01-01

    Intraoperative identification and later development of arteriovenous fistulas were investigated prospectively in 70 in situ saphenous vein bypass procedures. Surveillance was performed by completion arteriography and intra- and postoperative continuous wave Doppler examination. The intraoperative...

  5. An Unusual Course and Termination of Small Saphenous Vein: A Case Report

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    Shetty, Prakashchandra; D’Souza, Melanie Rose

    2016-01-01

    The superficial veins of the lower limb can vary in their course and termination. We report a relatively rare type of variation in the course and termination of small saphenous vein. The small saphenous vein had normal origin and course in the leg. However, instead of terminating into the popliteal vein, it continued up in the posterior compartment of the thigh and terminated into the femoral vein after piercing the fleshy part of the adductor magnus muscle. This course might lead to varicosity of the small saphenous vein due to the compression by the fleshy fibres of adductor magus near its termination. The case may be of interest to general and plastic surgeons and even cardiothoracic surgeons. PMID:27134850

  6. Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study

    NARCIS (Netherlands)

    Eekeren, R. van; Boersma, D.; Elias, S.; Holewijn, S.; Werson, D.A.; Vries, J.P. de; Reijnen, M.M.P.J.

    2011-01-01

    PURPOSE: To evaluate the feasibility and safety of endovenous mechanochemical ablation (MOCA) for the treatment of great saphenous vein (GSV) incompetence. METHODS: The newly developed ClariVein device uses a technique that combines mechanical endothelial damage using a rotating wire with the infusi

  7. Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study

    NARCIS (Netherlands)

    Eekeren, R. van; Boersma, D.; Elias, S.; Holewijn, S.; Werson, D.A.; Vries, J.P. de; Reijnen, M.M.P.J.

    2011-01-01

    PURPOSE: To evaluate the feasibility and safety of endovenous mechanochemical ablation (MOCA) for the treatment of great saphenous vein (GSV) incompetence. METHODS: The newly developed ClariVein device uses a technique that combines mechanical endothelial damage using a rotating wire with the

  8. Real time B-mode mapping of the greater saphenous vein

    DEFF Research Database (Denmark)

    Bagi, P; Schroeder, T; Sillesen, H;

    1989-01-01

    Real time ultrasound mapping of the greater saphenous vein (GSV) was performed in 30 consecutive patients admitted for in situ femoro-crural revascularisation. The overall accuracy in predicting the adequacy of the GSV for in situ bypass was 90%. The predictive value of finding the vein usable...

  9. Histological Observations One Year After Mechanochemical Endovenous Ablation of the Great Saphenous Vein

    NARCIS (Netherlands)

    van Eekeren, Ramon R. J. P.; Hillebrands, Jan Luuk; van der Sloot, Kim; de Vries, Jean-Paul P. M.; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    2014-01-01

    Purpose: To report histological analysis of a great saphenous vein (GSV) 1 year after undergoing mechanochemical endovenous ablation (MOCA) and compare the findings with those of a healthy vein. Case Report: A 59-year-old patient with bilateral GSV incompetence was treated with MOCA using the ClariV

  10. A STUDY OF VARIATIONS IN THE TERMINATION OF SHORT SAPHENOUS VEIN

    Directory of Open Access Journals (Sweden)

    Santhini Arulsevli

    2016-05-01

    Full Text Available BACKGROUND The liability of the superficial venous system of the lower limbs to varicosity has naturally attracted the attention of Clinicians and Surgeons. Variations in the superficial veins of the lower limb are very common. The extent of such variations, their connections are usually described. Out of all the veins of the lower limb, the long saphenous and the small saphenous veins mark the major attraction clinically. Both the veins belong to superficial set of the veins, lie in the superficial fascia and possess valves. The long (great saphenous vein, being the longest vein in the body, begins as a continuation of the medial marginal vein of the foot and ends in the femoral vein distal to the inguinal ligament. It ascends in front of the medial malleolus followed by passing obliquely across the medial surface of the tibia. In the upper part of the leg, it is accompanied by saphenous nerve and finally opens into the femoral vein after passing through the saphenous opening. The short saphenous vein can be the natural choice for coronary arterial bypass surgery, and also can be used in arterial reconstruction. The look for the variation in the termination of short saphenous vein should be taken into account before performing any varicose surgeries. This paper puts in a sincere effort to check the variations of termination of short saphenous vein and thus help the surgeons in betterment of the techniques used for various surgeries. METHODS One hundred specimens were studied in the Department of Anatomy, Vinayaka Mission’s Medical College and Hospital, Karaikal. The skin, superficial fascia and the deep fascia was carefully reflected and the formation of the small saphenous vein was identified. The course was followed and finally the termination was identified and noted. The variations in the termination were identified and a note was made. RESULT In the present study, 68% of the cases had type 2 and 38% of the cases had type 1. The other

  11. Relationship between elevated platelet volume and saphenous vein graft disease.

    Science.gov (United States)

    Tavil, Yusuf; Sen, Nihat; Yazici, Hüseyin Uğur; Hizal, Fatma; Açikgöz, Sadik Kadri; Turfan, Murat; Cengel, Atiye

    2010-06-01

    Saphenous vein graft (SVG) disease is the major determinant of long term graft viability in patients undergoing coronary artery bypass graft (CABG) surgery. Although, platelets play a major role in this pathogenetic process the nature of this interaction has not been yet been clarified. Mean platelet volume (MPV) reflects platelet production rate and stimulation. This study was designed to investigate MPV in patients with late stage SVG disease. The study population composed of 188 patients who underwent elective coronary angiography more than one year after coronary artery bypass surgery. The study population was divided in to two groups according to SVG patency. The first group consisted of 90 patients (75 men, 15 women; mean age, 63.4 +/- 9.2 years) with patent SVG's (no-stenosis group). The second group consisted of 98 patients (80 men, 18 women; mean age, 62.1 +/- 10.1 years) with SVG stenosis based on the results of coronary angiography (stenosis group). Greater than 50% stenosis within the SVG was accepted as hemodynamically significant. MPV were significantly higher in patients with SVG disease in comparison with the patients without graft disease group (9.3 +/- 1.19 vs. 8.3 +/- 1.10 fl, respectively, p < 0.001). In a multiple regression model, SVG disease was independently associated with MPV (beta=0.837, p=0.05) along with LDL-cholesterol (beta=0.159, p=0.008) and time interval after bypass surgery (beta=-0.092, p=0.05). Platelet volume, and therefore platelet activation, appears to play a causal role in late SVG disease graft disease; hence, MPV may be useful as a post-operative marker of graft success.

  12. Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins.

    Science.gov (United States)

    Maldonado-Fernández, Nicolás; Linares-Palomino, Jose Patricio; López-Espada, Cristina; Martínez-Gámez, Francisco Javier; Ros-Díe, Eduardo

    2016-03-01

    Traditionally, anterior accessory great saphenous vein insufficiency was managed by crossectomy and resection of varicose veins. The aim of this paper is to show the safety and efficacy of a new therapeutic strategy for anterior accessory great saphenous varicose veins. This non-randomised prospective study included 65 patients with varicose veins from the anterior accessory great saphenous vein. The novelty of the technique is to avoid the great saphenous vein crossectomy and perform just flebectomy of the visible veins. Venous duplex studies were performed preoperatively, a month and a year postoperatively. The clinical assessment was done by the Fligelstone scale. The baseline CEAP clinical classification was: 58% C2, 26% C3 and 15% C4-6. The new strategy was applied to all cases. 3 haematomas, 7 cases of asymptomatic partial anterior saphenous thrombosis. Reduction of the initial average diameter was from 6.4 mm anterior saphenous to 3.4 mm by one year (p <0.001). At twelve months a forward flow is maintained in 82% of cases. Recurrence of varicose veins was 8%. All patients improved their clinical status based on the Fligelstone scale. Cases with saphenous diameter bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome. This modified surgical strategy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Bipolar radiofrequency-induced thermotherapy of great saphenous vein: Our initial experience

    Directory of Open Access Journals (Sweden)

    Venkatesh Kasi

    2012-01-01

    Full Text Available The incidence of varicose veins in lower limbs is increasing in the Indian subcontinent. With the advent of radiofrequency ablation (RFA, an effective minimally invasive technique is now available to treat varicose veins. RFA can be performed with either unipolar or bipolar probes. We present a simple technique for bipolar radiofrequency-induced thermotherapy of the great saphenous vein. This can be a safe and effective alternative to surgical procedures.

  14. Groin Swelling in a Four-Year-Old Boy: Primary Great Saphenous Vein Aneurysm.

    Science.gov (United States)

    Çiçek, Mustafa Cüneyt; Çiçek, Ömer Faruk; Yalçınkaya, Adnan; Taşoğlu, İrfan

    2015-11-01

    Primary venous aneurysm, especially in pediatric population, is a very rare clinical entity. We report a case of primary great saphenous vein aneurysm in a 4-year-old boy. He was initially suspected of suffering from inguinal hernia because the soft mass was detected at the inguinal region when the patient was in the standing position, but color Doppler ultrasonography demonstrated the swelling to be a great saphenous vein aneurysm. We decided that surgery was the best option because of potential risk for thromboembolism. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Pulmonary Embolism following Endovenous Laser Ablation (EVLA of the Great Saphenous Vein

    Directory of Open Access Journals (Sweden)

    Nnamdi Nwaejike

    2008-08-01

    Full Text Available

    A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent long saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the long saphenous vein a year earlier, malignancy, EVLA and phlebitic tributary varices. EVLA has been shown to be an effective treatment for superficial venous insufficiency with low morbidity and high patient satisfaction. The investigation of confounding risk factors and possible causes should not compromise the initial treatment of PE.

  16. Mycotic aortocoronary saphenous vein graft aneurysm presenting with unstable angina pectoris.

    Science.gov (United States)

    Hirsch, Glenn A; Johnston, Peter V; Conte, John V; Achuff, Stephen C

    2004-10-01

    We report the case of a 60-year-old man with a history of coronary bypass surgery 20 years prior who had a fever, chest pain, and a mediastinal mass develop after a complicated postoperative course of abdominal aortic aneurysm resection. A mycotic aneurysm of the saphenous vein graft to his left anterior descending coronary artery was diagnosed based on blood culture results and visualization of the aneurysm before resection. A summary of the saphenous vein graft aneurysm and pseudoaneurysm cause, diagnosis, and management is detailed.

  17. A different management of saphenous vein graft failure related to cardiac tamponade following coronary surgery

    Directory of Open Access Journals (Sweden)

    Hamit Serdar Başbuğ

    2016-03-01

    Full Text Available Cardiac tamponade is a state of constriction of the heart with an excessive fluid or hematoma resulted from various conditions. Postoperative tamponade can occur after coronary bypass surgery. Despite it is uncommon, its results may have a high risk of mortality and morbidity. Acute postoperative cardiac tamponade reveals a vast spectrum of symptoms. Moreover, a compression over the saphenous vein graft is the worst complication that should be managed without delay. We report a rare case of saphenous vein graft failure due to the cardiac tamponade following a coronary surgery and its management with a practical measure.

  18. Continuous Perfusion of Saphenous Vein by Oxygenated Blood during Beating Coronary Surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Mandegar

    2015-09-01

    Full Text Available Background: The saphenous vein remains the most commonly used conduit for coronary artery bypass surgery (CABG. However, the long-term success of surgical revascularization is largely limited by development of occlusion in vein grafts. Objectives: We sought to reduce graft ischemia by maintaining the blood flow into the harvested vein throughout surgery at lowest costs and without special devices. Patients and Methods: This study was conducted on three hundred patients aged 58.5 ± 8 years undergoing elective first-time off-pump CABG with saphenous veins. Results: In addition to preserving nutritional materials and oxygen, the veins harvested via this novel technique did not go into spasm and were not subjected to high-pressure distension, eventually resulting in minimal damage to the endothelium. Conclusions: This technique confers favorable myocardial function and protection in the presence of left ventricular dysfunction, especially in elderly patients.

  19. Decreased morbidity following long saphenous vein harvesting using a minimally invasive technique: a randomised controlled trial comparing two techniques for long saphenous vein harvest

    Directory of Open Access Journals (Sweden)

    Nkere Udim

    2006-06-01

    Full Text Available Abstract Objectives The objective of this study was to compare the morbidity associated with long saphenous vein harvesting using the traditional open technique (A against a minimally invasive technique using the Mayo vein stripper (B that involves multiple short incisions. Design We conducted a prospective randomized controlled study in 80 patients undergoing first time coronary artery bypass grafting. Pain and healing was assessed on each postoperative day. Rings of long saphenous vein were subjected to organ-bath evaluation of endothelium-dependent and endothelium-independent relaxation. Results Three patients were excluded from the study, leaving 38 patients in Group A and 39 in Group B. With respect to operative procedure, Group A had a greater length of vein harvested than Group B. There was no statistical difference in pain scores and endothelium-dependent or endothelium-independent relaxation between the two groups. However there were significantly more infections in Group A compared with Group B. Conclusion Harvesting vein through multiple incisions using the Mayo vein stripper is quicker, results in fewer infections and has no deleterious effect on endothelial function compared to open technique.

  20. Evaluation of endoscopic vein extraction on structural and functional viability of saphenous vein endothelium

    Directory of Open Access Journals (Sweden)

    Lu Xiu-Gui

    2011-06-01

    Full Text Available Abstract Objectives Endothelial injury during harvest influences graft patency post CABG. We have previously shown that endoscopic harvest causes structural and functional damage to the saphenous vein (SV endothelium. However, causes of such injury may depend on the extraction technique. In order to assess this supposition, we evaluated the effect of VirtuoSaph endoscopic SV harvesting technique (VsEVH on structural and functional viability of SV endothelium using multiphoton imaging, biochemical and immunofluorescence assays. Methods Nineteen patients scheduled for CABG were prospectively identified. Each underwent VsEVH for one portion and "No-touch" open SV harvesting (OSVH for another portion of the SV. A two cm segment from each portion was immersed in GALA conduit preservation solution and transported overnight to our lab for processing. The segments were labeled with fluorescent markers to quantify cell viability, calcium mobilization and generation of nitric oxide. Morphology, expression, localization and stability of endothelial caveolin, eNOS, von Willebrand factor and cadherin were evaluated using immunofluorescence, Western blot and multiphoton microscopy (MPM. Results Morphological, biochemical and immunofluorescence parameters of viability, structure and function were well preserved in VsEVH group as in OSVH group. However, tonic eNOS activity, agonist-dependent calcium mobilization and nitric oxide production were partially attenuated in the VsEVH group. Conclusions This study indicates that VirtuoSaph endoscopic SV harvesting technique preserves the structural and functional viability of SV endothelium, but may differentially attenuate the vasomotor function of the saphenous vein graft. Ultramini-Abstract Endoscopic extraction preserved the structure and function, but attenuated the calcium mobilization and nitric oxide generation in human SV endothelium.

  1. Relevant factors affecting the outcome of ultrasound guided foam sclerotherapy of the great saphenous vein

    Directory of Open Access Journals (Sweden)

    Giorgio Falaschi

    2013-09-01

    Full Text Available Ultrasound guided foam sclerotherapy (UGFS constitutes a valid ablative treatment for superficial vein diseases for the great saphenous vein (GSV, but no standardized protocol for its execution has yet been defined. Different variable factors involved in this procedure influence the final outcome and clinical results. The aim of our study was to analyze the respective influence on efficacy and side effects of three variable factors (foam volume, foam concentration, and contact time between the foam and the endothelium for UGFS procedures for GSV insufficiency in order to select the best protocol for treatment. A retrospective analysis was made of UGFS procedures (190 patients, 201 legs performed for GSV insufficiency in our institute from January 2007 to January 2010. All great saphenous veins included in our study exhibited a trans-ostial reflux and caliber range was 7-11 mm. In all cases, foam was prepared according to the Tessari method, using polidocanol (POL and a gas mixture of CO2 (70% and filtered room air (30%, in a proportion of 1:4. A single injection procedure in the GSV was performed under Doppler ultrasound guidance at mid to lower third of the thigh. Legs were randomly assigned to one of three different treatment protocols: - Group A (71 legs: POL 3%, mean foam volume 4.5 cc, intermittent groin pressure 5 min, supine bed rest 10 min; - Group B (61 legs: POL 2%, mean foam volume 9 cc, intermittent groin pressure 5 min, supine bed rest 10 min; - Group C (69 legs: POL 2%, mean foam volume 9 cc, continuous groin pressure 5 min followed by intermittent groin pressure 5 min, continuous leg compression 5 min, supine bed rest 10 min. Efficacy of treatment and occurrence of side effects were evaluated in each group at two weeks and again at two years after the procedure and the cumulative results compared. Analysis of outcomes did not show any significant difference between the complete obliteration rate (P=0.825 or occurrence of local

  2. The Dutch experience in percutaneous transluminal angioplasty of narrowed saphenous veins used for aortocoronary arterial bypass

    NARCIS (Netherlands)

    W.H.T. Plokker; H.J. Meester (Hannie); P.W.J.C. Serruys (Patrick)

    1991-01-01

    textabstractOf 19,994 percutaneous transluminal coronary angioplasty procedures performed in The Netherlands between April 1980 and January 1989, the long-term follow-up of 454 patients who underwent angioplasty of greater than or equal to 1 saphenous vein bypass graft was reviewed. In 46% of patien

  3. Optical coherence tomography for the assessment of pericardium covered stents for the treatment of degenerated saphenous vein grafts

    NARCIS (Netherlands)

    P. Tyczynski (Pawel); N. Kukreja (Neville); R.J.M. van Geuns (Robert Jan); J.J. Wykrzykowska (Joanna); M.N. Sheppard (Mary); C. di Mario (Carlo)

    2010-01-01

    textabstractAims: Pre- and post-interventional optical coherence tomography (OCT) assessment of degenerated saphenous vein grafts (SVG) treated with implantation of pericardium covered stents. Percutaneous treatment of SVG represents one of the major challenges of current percutaneous coronary

  4. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial.

    Science.gov (United States)

    Vuylsteke, M E; Thomis, S; Mahieu, P; Mordon, S; Fourneau, I

    2012-12-01

    This clinical trial aimed to evaluate the clinical results of the use of a tulip fibre versus the use of a bare fibre for endovenous laser ablation. In a multicentre prospective randomised trial 174 patients were randomised for the treatment of great saphenous vein reflux. A duplex scan was scheduled 1 month, 6 months and 1 year postoperatively. Ecchymosis was measured on the 5th postoperative day. In addition, pain, analgesics requirement, postoperative quality of life (CIVIQ 2) and patient satisfaction rate were noted. Patients treated with a tulip fibre had significantly less postoperative ecchymosis (0.04 vs. 0.21; p < 0.001) and pain (5th day) (1.00 vs. 2.00; p < 0.001) and had a better postoperative quality of life (27 vs. 32; p = 0.023). There was no difference in analgesic intake (p = 0.11) and patient satisfaction rate (p = 0.564). The total occlusion rate at 1 year was 97.02% and there was no significant difference between the two groups (p = 0.309). Using a tulip fibre for EVLA of the great saphenous vein results, when compared with the use of a bare fibre, in equal occlusion rates at 1 year but causes less postoperative ecchymosis and pain and in a better postoperative quality of life. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

    Directory of Open Access Journals (Sweden)

    Ulisses A. Croti

    2000-02-01

    Full Text Available A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.

  6. Reinforced long saphenous vein bypass graft for infrainguinal reconstruction procedures: case series and literature review.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2006-03-01

    Poor rehabilitation rates and the high-cost of managing postamputation patients justify an aggressive revascularization policy in critical lower limb ischemia. Endovascular therapy is our first choice for limb salvage in these patients. However there are patients for whom endovascular therapy is not feasible. When bypass is necessary, autologous vein is a superior conduit to synthetic material. However, varicosities usually contraindicate autologous vein bypass because of the risk of aneurysm formation, rupture and increased intimal hyperplasia compared with nonvaricose venous grafts. We report the use of varicosed long saphenous vein (LSV) with external Dacron support in infrainguinal bypass procedures for limb salvage, where endovascular therapy was not feasible. The external Dacron tube was not brought close to the distal anastomotic area itself. With a mean follow-up of 18 months, duplex ultrasonography and computed tomography angiography showed no evidence of stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. External reinforcement with Dacron prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation without compromising graft patency and limb salvage.

  7. Crossectomy and Foam Sclerotherapy of the Great Saphenous Vein versus Stripping of Great Saphenous Vein and Varicectomy in the Treatment of the Legs Ulcers

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    Alvaro Delgado-Beltran

    2013-01-01

    Full Text Available Objective. To show our results in the surgical treatment of legs varicose ulcers, with crossectomy and foam sclerotherapy (CAFE of the great saphenous vein (GSV in group I and stripping of GSV and varicectomy in group II. Methods. 35 patients with active venous leg ulcers were recruited and treated. They were collected in two groups. Group I were treated by crossectomy and foam sclerotherapy of the GSV and group II were treated by stripping of GSV and varicectomy. The healing time of the ulcer and the complications were recorded after the procedure in the follow-up visits. Results. 29 out of the 35 patients completed the follow-up. There were eight cases of incomplete healing of the leg ulcer, 4 in group I (19.04% and 4 in group II (40%, P<0.05. The average rate of healing in group I was 0.38 cm/day and 0.13 in group II, P<0.05. Conclusion. CAFE technique of the great saphenous vein in the treatment of 6 CEAP patients is a procedure that improves the rate of ulcer healing as compared to these two groups. It is a safe and reliable minimally invasive method, with less morbidity.

  8. Failure of cryopreserved saphenous vein allografts following coronary artery bypass surgery.

    Science.gov (United States)

    Sellke, F W; Stanford, W; Rossi, N P

    1991-01-01

    Internal mammary arteries and saphenous vein grafts are the most satisfactory conduits for coronary artery bypass. However, at times these conduits are not available, due to previous use or poor quality. This paper reports our experience with 6 patients who underwent coronary artery bypass operations using 10 cryopreserved saphenous veins and internal mammary arteries. Postoperative graft patency was assessed with ultra fast computed tomography or cardiac catheterization. At operation, venous graft patency was 100% (10/10), at 1-8 weeks was 60% (6/10), and at 6-30 months was 0% (0/9). Alternately, all seven internal mammary artery grafts were patent at 2 to 18 months following surgery. One patient died 6 months following operation. Poor graft patency may be related to destruction of the cellular components or fibrosis resulting from the cryopreservation process or from immunologic factors. Because of poor patency compared to autologous conduits, we conclude the use of cryopreserved saphenous veins for coronary artery bypass should be severely restricted.

  9. Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis.

    Science.gov (United States)

    Yang, Bin; Xu, Xiao-Dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-Ran

    2016-08-23

    BACKGROUND There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). MATERIAL AND METHODS Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. RESULTS The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all Pdeep venous thrombosis.

  10. Comparing frozen saphenous vein with Gore-tex in vascular access for chronic hemodialysis.

    Science.gov (United States)

    Mousavi, Seyed Reza; Moatamedi, Mohammad Reza Kalantar; Me Akbari, Mohamad

    2011-10-01

    Performing chronic hemodialysis in patients suffering from end-stage renal disease needs a suitable vascular access like arteriovenous fistula in the upper limbs and bridge fistula in the upper or lower limbs, and also use of permanent and temporary catheters. The purpose of this study is to compare frozen saphenous vein versus using synthetic Gore-tex vascular graft for A-V fistula. In the prospective randomized study, 70 patients needing for dialysis access were randomly divided into two groups. We performed the frozen saphenous vein A-V fistula in the test group and the Gore-tex fistula in the control group. An assessment included function criteria (fistula thrill and murmur) and complications (infection and thrombosis) in planned intervals. At the end of the follow-up period, the flow rates of all fistulas were assessed by Doppler sonography. The data were compared. Comparing the function criteria (fistula murmur and thrill) and the flow rate of the test group (frozen saphenous A-V fistula) and the control group (Gore-tex method) showed no significant difference and also no significant difference between two groups in thrombosis. Infection rate of the Gore-tex method was significantly high (p Gore-tex arteriovenous graft in some aspects. © 2011 The Authors; Hemodialysis International © 2011 International Society for Hemodialysis.

  11. In situ saphenous vein bypass surgery in diabetic patients

    DEFF Research Database (Denmark)

    Jensen, L P; Schroeder, T V; Lorentzen, J E

    1992-01-01

    .005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic......From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry...... this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0...

  12. Vasorelaxant effect of 17α-ethynylestradiol on human saphenous vein.

    Science.gov (United States)

    Jodati, Ahmad Reza; Babaei, Hossein; Azarmi, Yadollah; Fallah, Sahar; Gharebageri, Afsaneh; Fouladi, Danial Fadaei; Safaei, Naser

    2015-03-01

    A protective effect for estrogens against cardiovascular problems has long been known. The aim of this study was to investigate the vasorelaxant effect of 17α-Ethynylestradiol (17α-EE) on human saphenous vein. The veins were suspended horizontally between two triangular stainless steel hooks for the measurement of isometric tension in individual organ baths containing 10ml Krebs solution, at 37°C and gassed with carbogen under 3gr optimum tension. The effect of different concentrations of 17α-EE (2-40 μM) on vascular tone was investigated in veins precontracted with PGF2α. Relaxation was measured after 40min and expressed as the percent decrease of initial contraction. To determine the involvement of potassium channels, endothelium, nitric oxide synthase, guanylylcyclase and prostaglandins in the vasorelaxant effect of estrogen, the veins were incubated with tetraethyl ammonium, N-nitro-L-arginine methyl ester, methylene blue or indomethacin, respectively for 20min prior to experimentation. Responses to 17α-EE were directly compared to those obtained in the same tissues in the absence of the inhibitors. The mean relaxations induced by 17α-EE with concentrations of 2, 5, 10, 20 and 40μM in tissues precontracted with PGF2α were 19.8 ±5.5%, 26.1±10.8%, 32.2±7.4%, 48.6±10.8%and56±7.6%, respectively. The results of the inhibition of potassium channels, nitric oxide synthase, guanylylcyclase, cyclooxygenase and removing endothelium in relaxation induced by 17α-EE on precontracted veins with PGF2α proved no significant differences. This study showed that 17α-EE has significant vasorelaxant effect on human saphenous vein in a concentration-dependent manner. This effect is probably independent of potassium channels, nitric oxide synthase, guanylylcyclase, prostaglandin synthesis and endothelium functions.

  13. Radiofrequency ablation of varicose veins improves venous clinical severity score despite failure of complete closure of the saphenous vein after 1 year

    Directory of Open Access Journals (Sweden)

    Hyeong Yong Jin

    2017-01-01

    Conclusion: In this study, RFA of varicose veins had an initial success rate of 97.7% and a significantly improved patient VCSS at 1 year. Patients with episodic recanalization of the saphenous vein also exhibited an improved VCSS with favorable duplex findings at 1 year.

  14. Conventional surgery and endovenous laser ablation of recurrent varicose veins of the small saphenous vein: a retrospective clinical comparison and assessment of patient satisfaction.

    NARCIS (Netherlands)

    Groenendael, L. van; Flinkenflogel, L.; Vliet, J.A. van der; Roovers, E.A.; Sterkenburg, S.M. van; Reijnen, M.M.P.J.

    2010-01-01

    OBJECTIVES: Recurrences of varicosities of the small saphenous vein (SSV) are common. Surgical reintervention is associated with increased complication rates. The aim of the study was to assess the feasibility of endovenous laser ablation (EVLA) in recurrent varicose veins of the SSV and to compare

  15. [Surgical technique of saphenous vein harvesting using a Cusco vaginal speculum].

    Science.gov (United States)

    Kikuchi, Keita; Suzuki, Kotaro; Endo, Yoshiki; Matsuyama, Takayoshi; Osaka, Shin-ichi; Kurata, Atsushi

    2014-11-01

    We used Cusco vaginal speculum in harvesting saphenous vein graft (SVG) as an assist device for making a skin tunnel. After making 2 incisions of 3 to 4 cm, the SVG was dissected in a usual procedure. Then Cusco vaginal speculum was inserted into the skin tunnel between the 2 incisions. The SVG was dissected in a usual fashion under direct vision with the speculum. This procedure requires only small incisions, short learning curve and low cost. The new technique using Cusco vaginal speculum can be a reliable option for harvesting SVG.

  16. [Minimally invasive technique for harvesting a saphenous vein via one small incision].

    Science.gov (United States)

    Sato, M; Suenaga, E; Koga, S; Matsuyama, S

    2007-08-01

    We report a minimally invasive technique for harvesting a saphenous vein graft (SVG) via 1 small skin incision. The expected advantages of this technique are better cosmetic results and fewer wound complications than the conventional open technique or the bridging technique. The SVG, 10-15 cm in length, can be harvested by about 3 cm-long single small skin incision. SaphLITE Retractor System (Genzyme Srugical Products, Cambridge), SLS Hematostatic Clip System (Vitalitec International, Plymouth), and curved scissors were necessary instruments for this technique. It is feasible for cases that require a shorter length of SVG.

  17. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; QI Dan-ni; GU Cheng-xiong

    2010-01-01

    @@ Currently coronary artery bypass grafting (CABG) is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft (CVBG), may be the proper therapeutic selection.1 The idea of myocardial revascularization by means of grafting the coronary venous system is more than a century old. However, few clinical trials and long-term outcome data have been presented. The use of venous arterialization has not been widely used. We report the use of a sequential saphenous vein graft from the aorta to middle cardiac vein in a patient with diffuse lesions in right coronary artery during off-pump coronary artery bypass surgery (OPCAB).

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

    Institute of Scientific and Technical Information of China (English)

    Andres; Vargas-Estrada; Dianna; Edwards; Mohammad; Bashir; James; Rossen; Firas; Zahr

    2015-01-01

    Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.

  20. Endovenous ablation of incompetent saphenous veins with a new 1,540-nanometer diode laser and ball-tipped fiber.

    Science.gov (United States)

    Cavallini, Alvise; Marcer, Daniela; Ferrari Ruffino, Salvatore

    2014-04-01

    Endovenous laser ablation (EVLA) is an efficient method to treat incompetent saphenous veins with high occlusion rates. The major side effects are postoperative pain and bruising. Laser systems with higher wavelengths, associated with new energy delivery devices, have recently shown excellent short-term results, while reducing the previously reported side effects. The aim of this study is to show the first outcome after EVLA of incompetent saphenous veins with a newly developed ball-tipped fiber and a new wavelength 1,540-nm diode laser. Forty-five incompetent saphenous veins in 35 patients (27 women) were treated: 33 great saphenous veins, 6 short saphenous veins, and 6 anterior saphenous veins. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology (CEAP) classification, and the severity of symptoms was scored according to the revised Venous Clinical Severity Score. Patient satisfaction was assessed on a 0-3 scale. The average linear endovenous energy density was 63.5 J/cm of vein length. Patients returned to daily activities after a mean of 1.7 days (SD: 2) after treatment. The modified CEAP clinical severity score improved drastically from a preintervention mean of 4.9 (SD: 2.6) to 0.17 (SD: 0.38) at day 30. During the follow-up period (mean: 168 days [range: 90-240 days]), all the veins were occluded. All patients except 1 were satisfied or very satisfied with the method. No severe complications occurred. Two patients (5%) developed mild paresthesia in the treated area, which spontaneously resolved after 3 months. Postoperative ecchymoses are frequent (83%). Sixteen patients (43%) experienced pain, but only 5 patients (14%) described it as quite intense and required analgesic therapy. EVLA of saphenous veins with a 1,540-nm diode laser using a ball-tipped fiber is a safe and efficient therapy option, with a high success rate in the early postoperative period. Copyright © 2014 Elsevier Inc. All rights

  1. [ENDOVENOUS LASER TREATMENT FOR VARICOSE VEINS].

    Science.gov (United States)

    Tezuka, Masahiro; Kanaoka, Yuji; Ohki, Takao

    2015-05-01

    Varicose veins are a common condition attecting approximately 10 million patients in Japan. The main cause of varicose veins is reflux of the saphenous vein, and conventional treatment for several decades was stripping the affected saphenous vein and phlebectomy. Endovenous laser treatment (EVLT) is a less-invasive treatment method in which the saphenous vein is ablated with a laser under local anesthesia. EVLT has been approved by the Japanese Ministry of Health, Labor and Welfare since 2011, and we have performed EVLT on 5,160 legs with saphenous insufficiency with no severe complications including deep vein thrombosis except for one case of arteriovenous fistula. EVLT appears to be a safe, effective treatment option for varicose veins with saphenous insufficiency.

  2. Effect of Troglitazone on Expression of Adhesion Molecules and eNOS in Human Saphenous Vein Gaft

    Institute of Scientific and Technical Information of China (English)

    CHEN Shu; HU Zhiwei; ZHANG Kailun; SU Wei; SUN Zongquan

    2007-01-01

    To investigate whether peroxisome proliferators-activated receptor-y (PPARγ) ligand Troglitazone can reduce endothelial injury and activation during storage of harvested saphenous vein grafts. Segments of human saphenous vein graft were collected from 9 patients undergoing coronary bypass surgery and then divided into two equal parts of control and test specimens, were stored in ei-ther heparinized blood (control group) or heparinized blood containing 20 μmol/L troglitazone (test group) for 1 h at room temperature. Tissue distribution and protein expression of VCAM-1, ICAM-1, and endothelial nitric oxide synthase (eNOS) were compared using immunohistochemistry and West-ern blot analysis. Myeloperoxidase (MPO) activity, a marker of neutrophil sequestration in human saphenous vein grafts, was also measured in each group. The expression of ICAM-1 (753±132 versus 7201±934; P<0.01) , VCAM-1 (3731±294 versus 8292±793; P<0.01), and MPO activity (1.52±0.42 U/g, 5.04±1.26 U/g P<0.01) were significantly lower in test group. In contract, eNOS expression (7983±834 versus 3989±1008; P<0.01) was significantly higher in test group. PPARγ ligand troglita- zone might reduce endothelial injury during the storage period of human saphenous vein grafts.

  3. Nature and origin of the neointima in whole vessel wall organ culture of the human saphenous vein

    NARCIS (Netherlands)

    Slomp, J.; Gittenberger - Groot, A.C. de; Munsteren, J.C. van; Huysmans, H.A.; Bockel, J.H. van; Hinsbergh, V.W.M. van; Poelmann, R.E.

    1996-01-01

    Intimal proliferation is a characteristic feature of arteriosclerosis. Whole vessel wall organ culture systems have been developed to study the early stages of neointima formation. We have cultured a large number of explants of human saphenous vein specimens for several weeks, and have identified th

  4. Endovenous laser ablation of great saphenous veins performed using tumescent cold saline solution without local anesthesia.

    Science.gov (United States)

    Cavallini, Alvise; Marcer, Daniela; Bernardini, Giovanni; Ferrari Ruffino, Salvatore

    2014-05-01

    In recent years, laser systems with higher wavelengths, associated with new optical fibers, have shown excellent short-term results in treating saphenous veins and reducing the side effects and, in particular, the postoperative pain. However, if the patients are not anesthetized, they may feel pain even when using low energy with the high-wavelength laser; the only tumescent local anesthesia often does not guarantee a complete pain control during endovenous laser ablation (EVLA). Aim of this study was to demonstrate that the local anesthesia during EVLA of great saphenous veins (GSVs) is not essential for the perioperative comfort of the patient if a mild sedation is made. Forty-nine incompetent GSVs were treated by EVLA with a cold saline tumescent solution (CSTS) without local anesthetic drugs. EVLA was performed with a 1540-nm diode laser and a 600-μc ball-tipped fiber. Intraoperative ultrasonography was then used to guide delivery of CSTS (cold saline solution 0.9% at 5°C) using a motor pump under intravenous sedation. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology classification. Patients rated surgery global pain according to 4 types: "extremely," "rather," "slightly," and "not at all" painful. Twenty-five cases (51%) were classified as C3, 20 (41%) as C2, 6 (13%) as C4, and 1 (2%) as C6. Midazolam 2.5 mg + a mean of 0.16 mg of fentanil (minimum: 0.10; maximum: 0.20; standard deviation [SD]: 0.4) + a mean of 178.21 mg of propofol (minimum: 100; maximum: 300; SD: 47.1) were administrated as intravenous sedation. The total average linear endovenous energy density was 57.7 J/cm. Approximately 250 mL (minimum: 100; maximum: 780) of CSTS was administered. No Patient has had pain during the procedure. All patients were discharged 2.5 hrs after surgery. EVLA under sedation using CSTS without diluted anesthetic drugs is a suitable technique in an outpatients clinic, especially useful if the ablation

  5. The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation.

    Science.gov (United States)

    Rodriguez-Acevedo, Omar; Elstner, Kristen; Zea, Aaron; Diaz, Jenny; Martinic, Kui; Ibrahim, Nabeel

    2017-02-01

    Background Neurological complications are well documented in association with both surgical stripping or disconnection and thermal ablation of the small saphenous vein. The sural nerve (medial sural cutaneous nerve) is most vulnerable due to its close relationship to the small saphenous vein. Objective This is a cross-sectional observational study of the sonographic anatomy of 115 Australian patients to determine the course of the sural nerve and its relationship to the small saphenous vein, and to identify its relevance in the thermal ablation of the small saphenous vein. Method Sonographic mapping of the right sural nerve was performed with a Philips L12.5 and Sonosite 10.5 MHz ultrasound machine on 115 patients. The sural nerve was traced proximally from the level of the lateral malleolus to the popliteal fossa in order to measure its distance from the small saphenous vein at four reference points in the lower leg. Results A total of 115 patients were studied (females 82, males 33). The sural nerve was identified in 100% of patients; 64 patients (55.7%) showed usual sural nerve anatomy, while 51 patients (44.3%) demonstrated a range of anatomical variations, including the sural nerve becoming epifascial at a higher point than usual. Conclusion The sural nerve was identifiable on duplex ultrasound in 100% of cases. Classic anatomical relations and the perceived protection of the sural nerve conferred by the deep fascia of the upper calf are unreliable. Preoperative strategies can help to approach and protect the sural nerve in the endovenous ablation setting.

  6. New device for saphenous vein-to-aorta proximal anastomosis without side-clamping

    Directory of Open Access Journals (Sweden)

    Tappainer Ernesto

    2007-05-01

    Full Text Available Abstract Background Side clamping to perform saphenous vein-to-aorta proximal anastomosis is a well known cause of cerebral embolization during coronary bypass surgery. Automatic and manual devices have been introduced to avoid aortic clamping and facilitate proximal anastomosis but the manual ones only allow the traditional hand-sewing running suture. Nevertheless, they are not easy to use and very expensive to buy. Methods We developed a simple object that helps to perform a manual proximal anastomosis without the need to clamp the side of the aorta. This device is a steel bar which blocks the aortic hole and simultaneously it provides a slit to receive the needle. Through the slit comes out a thin, sharp, straight, but also well directed and predictable jet of blood which could be easily controlled during the suture. Results The function of the object is quite different from other devices. Nothing is deployed in the aorta. The object is only placed on the aorta with the small appendage slipped into the hole. The main advantage of the device is that while manipulation of the aorta is avoided no foreign bodies are incorporated in the suture and – most importantly – the aortic intima is not touched at all. The main drawback of the device is the blood jet coming from the slit so that the blood pressure has to be lowered by vasodilators during the anastomosis. Moreover, the suture has to change direction and the needle has to enter the aortic wall first to slip out through the slit. Conclusion The object was named "Slit Device" and is not a routine instrument. It would be only an alternative to other anastomotic devices with the same surgical indications. In the case of ascending aortic disease and saphenous vein grafting, the Slit Device avoids aortic clamping thereby preventing atheroembolism and also avoiding the need for hypothermic circulatory arrest in patients with unclampable aorta.

  7. Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe Saphenous Varicose Veins in Japanese Patients.

    Science.gov (United States)

    Izumi, Masafumi; Ikeda, Yuichi; Yamashita, Hiroharu; Asaoka, Yoshinari; Fujishiro, Mitsuhiro; Shin, Masahiro; Abo, Yoshihisa

    2016-01-01

    Endovenous laser ablation (EVLA), which is a relatively new therapeutic option for saphenous varicose veins of the legs, is less invasive than conventional stripping surgery with ligation. In this study, we evaluated the safety and effectiveness of EVLA combined with ligation for severe saphenous varicose veins that were graded as ≥ C4 by the CEAP classification. We treated 119 Japanese patients (141 limbs) between July 2005 and December 2007 utilizing a 1320-nm Nd:YAG laser. The obliteration rate of the treated veins was found to be 100% over the entire follow-up period (2.5 years). Consistent with this finding, all of the patients exhibited improved skin lesions (ie, skin pigmentation and ulceration). No major complications, including deep vein thrombosis (DVT) and nerve injury, were observed. A questionnaire survey with a reasonable response rate (66.4%) demonstrated that subjective symptoms and minor complications that were initially observed after EVLA, such as mild pain, numbness, indurations, and localized hot flashes, were remarkably improved by the end of the follow-up period. Furthermore, high levels of patient satisfaction were noted. Thus, EVLA combined with ligation constituted a safe and effective strategy for treating severe saphenous varicose veins in Japanese patients.

  8. Mechanochemical endovenous Ablation versus RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    van Eekeren, Ramon R. J. P.; Boersma, Doeke; Holewijn, Suzanne; Vahl, Anco; de Vries, Jean Paul P. M.; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    2014-01-01

    Background: Radiofrequency ablation (RFA) is associated with an excellent outcome in the treatment of great saphenous vein (GSV) incompetence. The use of thermal energy as a treatment source requires the instillation of tumescence anesthesia. Mechanochemical endovenous ablation (MOCA) combines

  9. Mechanochemical endovenous Ablation versus RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    van Eekeren, Ramon R. J. P.; Boersma, Doeke; Holewijn, Suzanne; Vahl, Anco; de Vries, Jean Paul P. M.; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    2014-01-01

    Background: Radiofrequency ablation (RFA) is associated with an excellent outcome in the treatment of great saphenous vein (GSV) incompetence. The use of thermal energy as a treatment source requires the instillation of tumescence anesthesia. Mechanochemical endovenous ablation (MOCA) combines mecha

  10. Aberrant Phenotype in Human Endothelial Cells of Diabetic Origin: Implications for Saphenous Vein Graft Failure?

    Directory of Open Access Journals (Sweden)

    Anna C. Roberts

    2015-01-01

    Full Text Available Type 2 diabetes (T2DM confers increased risk of endothelial dysfunction, coronary heart disease, and vulnerability to vein graft failure after bypass grafting, despite glycaemic control. This study explored the concept that endothelial cells (EC cultured from T2DM and nondiabetic (ND patients are phenotypically and functionally distinct. Cultured human saphenous vein- (SV- EC were compared between T2DM and ND patients in parallel. Proliferation, migration, and in vitro angiogenesis assays were performed; western blotting was used to quantify phosphorylation of Akt, ERK, and eNOS. The ability of diabetic stimuli (hyperglycaemia, TNF-α, and palmitate to modulate angiogenic potential of ND-EC was also explored. T2DM-EC displayed reduced migration (~30% and angiogenesis (~40% compared with ND-EC and a modest, nonsignificant trend to reduced proliferation. Significant inhibition of Akt and eNOS, but not ERK phosphorylation, was observed in T2DM cells. Hyperglycaemia did not modify ND-EC function, but TNF-α and palmitate significantly reduced angiogenic capacity (by 27% and 43%, resp., effects mimicked by Akt inhibition. Aberrancies of EC function may help to explain the increased risk of SV graft failure in T2DM patients. This study highlights the importance of other potentially contributing factors in addition to hyperglycaemia that may inflict injury and long-term dysfunction to the homeostatic capacity of the endothelium.

  11. Aberrant phenotype in human endothelial cells of diabetic origin: implications for saphenous vein graft failure?

    Science.gov (United States)

    Roberts, Anna C; Gohil, Jai; Hudson, Laura; Connolly, Kyle; Warburton, Philip; Suman, Rakesh; O'Toole, Peter; O'Regan, David J; Turner, Neil A; Riches, Kirsten; Porter, Karen E

    2015-01-01

    Type 2 diabetes (T2DM) confers increased risk of endothelial dysfunction, coronary heart disease, and vulnerability to vein graft failure after bypass grafting, despite glycaemic control. This study explored the concept that endothelial cells (EC) cultured from T2DM and nondiabetic (ND) patients are phenotypically and functionally distinct. Cultured human saphenous vein- (SV-) EC were compared between T2DM and ND patients in parallel. Proliferation, migration, and in vitro angiogenesis assays were performed; western blotting was used to quantify phosphorylation of Akt, ERK, and eNOS. The ability of diabetic stimuli (hyperglycaemia, TNF-α, and palmitate) to modulate angiogenic potential of ND-EC was also explored. T2DM-EC displayed reduced migration (~30%) and angiogenesis (~40%) compared with ND-EC and a modest, nonsignificant trend to reduced proliferation. Significant inhibition of Akt and eNOS, but not ERK phosphorylation, was observed in T2DM cells. Hyperglycaemia did not modify ND-EC function, but TNF-α and palmitate significantly reduced angiogenic capacity (by 27% and 43%, resp.), effects mimicked by Akt inhibition. Aberrancies of EC function may help to explain the increased risk of SV graft failure in T2DM patients. This study highlights the importance of other potentially contributing factors in addition to hyperglycaemia that may inflict injury and long-term dysfunction to the homeostatic capacity of the endothelium.

  12. Endovenous ablation (radiofrequency and laser and foam sclerotherapy versus conventional surgery for great saphenous vein varices

    Directory of Open Access Journals (Sweden)

    Craig Nesbitt

    Full Text Available BACKGROUND: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS, radiofrequency ablation (RFA and endovenous laser therapy (EVLT. Compared with conventional surgery (high ligation and stripping (HL/S, proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL scores, reduced need for general anaesthesia and equivalent recurrence rates. OBJECTIVE : To review available randomized controlled clinical trials (RCT data comparing USGFS, RFA, EVLT to HL/S for the treatment of great saphenous varicose veins. METHODS : Search methods: The Cochrane Peripheral Vascular Diseases (PVD Group searched their Specialized Register (July 2010 and CENTRAL (The Cochrane Library 2010, Issue 3. In addition the authors performed a search of EMBASE (July 2010. Manufacturers of EVLT, RFA and sclerosant equipment were contacted for trial data. Selection criteria: All RCTs of EVLT, RFA, USGFS and HL/S were considered for inclusion. Primary outcomes were recurrent varicosities, recanalization, neovascularization, technical procedure failure or need for re-intervention, patient quality of life (QoL scores and associated complications. Secondary outcomes were type of anaesthetic, procedure duration, hospital stay and cost. Data collection and analysis: CN, RE, VB, PC, HB and GS independently reviewed, assessed and selected trials which met the inclusion criteria. CN and RE extracted data. The Cochrane Collaboration's tool for assessing risk of bias was used. CN contacted trial authors to clarify details. MAIN RESULTS: Thirteen reports from five studies with a combined total of 450 patients were included. Rates of recanalization were higher following EVLT compared with HL/S, both early (within four months (5/149 versus 0/100; odds ratio (OR 3.83, 95% confidence interval (CI 0.45 to 32.64 and late recanalization (after four months (9/118 versus 1/80; OR 2.97; 95% CI 0

  13. Huge saphenous vein graft aneurysm presenting as non-ST elevation myocardial infarction and compressing the heart.

    Science.gov (United States)

    Zencir, Cemil; Akpek, Mahmut; Onay, Sevil; Selvi, Mithat

    2016-09-01

    Coronary artery bypass grafting (CABG) surgery maintains an important role in the treatment of coronary artery disease. The huge saphenous vein graft aneurysm (HSVGA) is rare and occurs as a late complication after CABG. Here, we reported a case of HSVGA presenting as non-ST elevation myocardial infarction. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  14. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

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    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

  15. Identification and characterization of (/sup 3/H)-rauwolscine binding to alpha2-adrenoceptors in the canine saphenous vein

    Energy Technology Data Exchange (ETDEWEB)

    Gout, B.

    1988-01-01

    The biochemical exploration of the alpha2-adrenergic receptors was investigated in the canine saphenous vein using the highly selective alpha2-adrenergic antagonist rauwolscine as a tritiated ligand. Following an enzymatic digestive pretreatment, the authors isolated a purified smooth muscle cell membranes fraction from saphenous veins in quantity sufficient to permit them to study the venous alpha2-adrenoreceptor content. The binding of tritiated rauwolscine was rapid, specific, saturable and reversible. The presence of high affinity sites with a density of binding Bmax of 125.2 /+ -/ 43.1 fmol/mg protein was demonstrated on a unique class of non interacting sites. The kinetically derived Kd was 1.28 nM, in good agreement with the value obtained from saturation isotherms. The pharmacological profile of these sites was assessed by the comparison of the potency of alpha-adrenergic agonists and antagonists to inhibit 1 nM (/sup 3/H)-rauwolscine. Their efficacy was respectively: rauwolscine > phentolamine > RX 781094 > clonidine >> prazosin > (-)-phenylephrine > (-)-noradrenaline. The results showed that (/sup 3/H)-rauwolscine bound specifically to sites in their membranal preparation, which had the pharmacological characteristics of the alpha2-adrenoceptors. The correlation between biochemical and pharmacological data revealed the usefulness of binding methods in the further study of adrenergic mechanisms in the canine saphenous vein.

  16. Saphenous vein graft thrombus findings by scanning electron microscopy in a patient with acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Marcela Dias; Aguillera, André Haraguti [Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Brilhante, José Joaquim; Caixeta, Adriano [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2013-07-01

    An eighty-year-old male patient with a history of prior (19 years) coronary artery bypass graft surgery was admitted to the hospital with non ST-segment elevation myocardial infarction (NSTEMI). During the hospital stay he was taking acetylsalicylic acid 100mg per day, a loading dose of 600mg clopidogrel, and low molecular weight heparin 1mg/kg twice a day. Twenty-four hours later the patient underwent coronary angiography, which showed a 90% obstruction in the mid portion of the saphenous vein graft to obtuse marginal with signs of degeneration and local thrombus (Figure 1). Thrombus aspiration was performed with a 6-Fr Export{sup ™} catheter (Medtronic, Santa Rosa, CA, USA), which removed small reddish colored fragments. They were fixed in 2,5% glutaraldehyde in a 0.1M sodium cacodilate buffer. The material was processed following the GOTO protocol in which the fragments were washed with osmium tetroxide and titanic acid, after which they were dried in a critical-point device and a golden bath. Scanning electron microscopy and high definition photos (3,000 to 27,221x magnification) were obtained by the FEI Quanta{sup ™} FEG SEM device (FEI Company, Hillsboro, OR, USA). The images showed that the thrombus was rich in activated platelets, with few erythrocytes or inflammatory cells. Many cholesterol crystals were observed (Figures 2 to). The fibrin networks were sparse and thin, which is compatible with a short ischemic time and recent thrombus formation.

  17. Preservação da veia safena magna na cirurgia de varizes dos membros inferiores Varicose vein surgery in lower limbs with preservation of the great saphenous vein

    Directory of Open Access Journals (Sweden)

    Hamilton Almeida Rollo

    2009-06-01

    with alterations that still allow preservation by correcting the cause. Such corrections can be performed surgically. Among the methods currently used, the ambulatory conservative hemodynamic correction of venous insufficiency has yielded good results. A randomized controlled trial confirming the efficacy of this procedure has been recently published. Another largely used technique is flush ligation of the saphenofemoral junction plus saphenous veins stripping and ligation of its tributaries at the groin, which has yielded conflicting results. Finally, there are techniques that correct saphenofemoral reflux by external valvuloplasty of the saphenofemoral junction. An international multicenter, randomized, controlled trial, testing a new device, is currently in progress with favorable preliminary results. This study aimed to review the techniques employed to preserve the great saphenous vein in varicose vein surgery.

  18. Necrotizing fasciitis following saphenofemoral junction ligation with long saphenous vein stripping: a case report

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    Ferguson Graeme

    2010-05-01

    Full Text Available Abstract Introduction Necrotizing fasciitis is a rare condition with a mortality rate of around 34%. It can be mono- or polymicrobial in origin. Monomicrobial infections are usually due to group A streptococcus and their incidence is on the rise. They normally occur in healthy individuals with a history of trauma, surgery or intravenous drug use. Post-operative necrotizing fasciitis is rare but accounts for 9 to 28% of all necrotizing fasciitis. The incidence of wound infection following saphenofemoral junction ligation and vein stripping is said to be less than 3%, although this complication is probably under-reported. We describe a case of group A streptococcus necrotizing fasciitis following saphenofemoral junction ligation and vein stripping. Case Presentation A 39-year-old woman presented three days following a left sided saphenofemoral junction ligation with long saphenous vein stripping at another institution. She had a three day history of fever, rigors and swelling of the left leg. She was pyrexial and shocked. She had a very tender, swollen left groin and thigh, with a small blister anteriorly and was in acute renal failure. She was prescribed intravenous penicillin and diagnosed with necrotizing fasciitis. She underwent extensive debridement of her left thigh and was commenced on clindamycin and imipenem. Post-operatively, she required ventilatory and inotropic support with continuous veno-venous haemofiltration. An examination 12 hours after surgery showed no requirement for further debridement. A group A streptococcus, sensitive to penicillin, was isolated from the debrided tissue. A vacuum assisted closure device was fitted to the clean thigh wound on day four and split-skin-grafting was performed on day eight. On day 13, a wound inspection revealed that more than 90% of the graft had taken. Antibiotics were stopped on day 20 and she was discharged on day 22. Conclusion Necrotizing fasciitis is a very serious complication for a

  19. Endovenous laser therapy for varicose veins

    NARCIS (Netherlands)

    Disselhoff, B.C.V.M.

    2008-01-01

    This thesis describes the technique of endovenous laser ablation and the outcome of various series of patients with varicose veins due to reflux in the great saphenous vein, treated by endovenous laser ablation or cryostripping in a single-centre study. This study has shown clear advantages of endov

  20. A kinetic study of the ouabain-induced efflux of norepinephrine from the dog saphenous vein

    Energy Technology Data Exchange (ETDEWEB)

    Monteiro, J.G. (Laboratorio de Farmacologia, Faculdade de Medicina, Porto (Portugal))

    1991-07-01

    Dog saphenous vein strips were incubated with (3H)norepinephrine ((3H)NE), 1.4 microM, after inhibition of the NE-metabolizing enzymes and extraneuronal uptake, and superfused for up to 290 min. From the 70th min onwards the strips were exposed to 10 microM ouabain, some of them being subject to electrical stimulation from the 140th min onwards. Other strips were exposed to either 1, 10 or 100 microM ouabain from the 70th min onwards. The spontaneous efflux of (3H)NE had a long half-time (156 min), and over 90% of the (3H)NE accumulated did not participate in efflux (bound fraction). Ouabain, 10 microM, induced a pronounced increase of the rate of efflux of (3H)NE, which was delayed in its onset and reached a maximum at t = 135 min of superfusion. Increasing the concentration of ouabain decreased both the delay to the beginning of the overflow and the time to maximum efflux and increased the maximum rate of efflux. In Ca(++)-free medium (during the superfusion period), the maximum rate of efflux was lower than in Ca(++)-containing medium, but was attained earlier. The bound fraction amounted to 22% when the efflux was induced by 10 microM ouabain in Ca(++)-containing medium, a value unnaffected by electrical stimulation but reduced markedly by omitting calcium. The results support the view that the efflux of (3H)NE induced by ouabain is delayed and that it is both carrier-mediated and due to exocytosis.

  1. Arctigenin improves vascular tone and decreases inflammation in human saphenous vein.

    Science.gov (United States)

    Daci, Armond; Neziri, Burim; Krasniqi, Shaip; Cavolli, Raif; Alaj, Rame; Norata, Giuseppe Danilo; Beretta, Giangiacomo

    2017-09-05

    The goal of this study was to test the effects of bioactive phenylpropanoid dibenzylbutyrolactone lignan arctigenin (ATG) in vascular tone. Human bypass graft vessel, from a saphenous vein (SV), were set up in organ bath system and contracted with potassium chloride (KCl, 40mM). Two concentration-response curves of noradrenaline (NE) (10nM-100μM) separated with an incubation period of 30min without (Control) or with ATG (3-100μM) were established. Inhibitors of nitric oxide, prostaglandins, K(+) related channels or calcium influx were used to delineate the molecular mechanisms beyond ATG effects. To investigate anti-inflammatory actions, SV were treated with 10μM or 100μM ATG and incubated for 18h in the absence or presence of both interleukin-1beta (IL-1β) and lipopolysaccharide (LPS) to mimic the physiological or inflamed tissue conditions. Proatherogenic and inflammatory mediators İnterleukine-1 beta (IL-1β), Monocyte Chemoattractant Proteine-1 (MCP-1), Tumor Necrosis Factor- α (TNF-α), İnterleukine-6 (IL-6), Prostaglandin E2 (PGE2) and İnterleukine-8 (IL-8) in the supernatant were measured. ATG significantly decreased vascular contractile response to NE. Moreover, it reduced contractions induced by KCl and cumulative addition of CaCl2. The mediators were significantly increased in inflammatory conditions compared to normal conditions, an effect which was inhibited by ATG (10 and 100µM). ATG reduces contractions in SV and decreases the production of proinflammatory-proatherogenic mediators, setting the stage for further evaluating the effect of ATG in cardiovascular diseases. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The Incidence of Giacomini Vein and Its Association with Lower Extremity venous Insufficiency: An Ultrasonographic Study

    Energy Technology Data Exchange (ETDEWEB)

    Park, Soon Chan; Kwon, Se Hwan; Oh, Joo Hyeong; Ryu, Kyung Nam; Ahn, Hyung Joon; Park, Ho Chul [Kyunghee University Medical Center, Seoul (Korea, Republic of)

    2009-09-15

    We wanted to evaluate the incidence of Giacomini vein and its association with lower extremity venous insufficiency by performing US. From September 2006 to July 2007, 173 patients (58 males and 115 females, mean age: 52.7 years, age range: 22-72 years) who had been diagnosed with unilateral/bilateral varicose veins or telangiectasias were evaluated with duplex Doppler ultrasonography. The presence of Giacomini vein, superficial/deep vein reflux, the anatomical sites of the venous reflux and the abnormal perforating veins was investigated in 346 legs. Giacomini veins were found in 33 limbs (9.5%) of 21 patients (12.1%). Bilateral Giacomini veins were found in 12 patients. Of the 33 limbs that had Giacomini veins, 20 limbs had great saphenous vein (GSV) reflux and 4 limbs had small saphenous vein (SSV) reflux. The patients with Giacomini veins were classified into two groups according to the presence of Giacomini vein. There was no significant difference of the GSV reflux (p = 0.155), the SSV reflux (p = 0.760) and the mean velocity of the GSV reflux or the SSV reflux (p = 0.685, p = 0.431, respectively) between the two groups. Our results indicated that Giacomini vein is not associated with either GSV or SSV reflux, and this is contrary to conventional belief

  3. Piglet saphenous vein contains multiple relaxatory prostanoid receptors: evidence for EP4, EP2, DP and IP receptor subtypes

    OpenAIRE

    Wilson, Richard J; Giles, Heather

    2005-01-01

    Prostaglandin E2 produced endothelium-independent relaxation of phenylephrine- and 5-HT-contracted piglet saphenous vein (PSV; pEC50=8.6±0.2; n=6).The prostanoid EP4 receptor antagonist GW627368X (30–300 nM) produced parallel rightward displacement of PGE2 concentration–effect (E/[A]) curves (pKb=9.2±0.2; slope=1). Higher concentrations of GW627368X did not produce further rightward shifts, revealing the presence of non-EP4 prostanoid receptors.In all, 18 other prostanoid receptor agonists re...

  4. Saphenous vein graft true aneurysms: Report of nine cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2004-01-01

    Full Text Available INTRODUCTION The true aneurysm formation of the autogenous saphenous vein graft (ASVG is a very rare complication after bypass surgery [1 -5]. In 1969 Pillet [1] first described a true fusiform aneurysm formation of the ASVG which had been used as a replacement of the iwured superficial femoral artery in 26-year-old male patient. We present nine cases. CASE!. A 71-year-old man with previous history of arterial hypertension and higher serum lipid level, was admitted with an asymptomatic pulsating swelling of the medial portion on the thigh. Five years ago the bellow knee F-P bypass with ASVG due to occlusive disease has been performed. The transfemoral angiography (Figure 1 showed patent graft with fusiform true aneurysm formation at its mid portion. This aneurysm has been replaced with PTFE graft. The pathohistological examination showed an atherosclerotic origin of the aneurysm. This patient died four years after operation due to myocardial infarction with patent graft. CASE 2. A 57-year-old female with previous history of arterial hypertension and higher serum lipid level, had an elective resection and replacement of the superficial femoral artery aneurysm. For the reconstruction an ASVG was used. The saphenous vein showed postflebitic changes. Four years later she was admitted with asymptomatic pulsating mass of the mid portion of the thigh. The control transfemoral angiography showed patent graft with fusiform aneurysm formation of its mid portion. After aneurismal resection, an above knee F-P bypass with 8 mm PTFE graft was performed. A pathohistological examination showed a partially degenerated elastic membrane with fragmentation and disruption, without atherosclerosis (Figure 2. During the follow up period an elective resection of the subclavian artery aneurysm as well as abdominal aortic aneurysm, were performed. CASE3. A subclavian artery aneurysm caused by TOS has been repaired with sapehnous vein graft at 40-year-old female patient

  5. Inhibition of noradrenaline release from the sympathetic nerves of the human saphenous vein by presynaptic histamine H3 receptors.

    Science.gov (United States)

    Molderings, G J; Weissenborn, G; Schlicker, E; Likungu, J; Göthert, M

    1992-07-01

    The human saphenous vein was used to examine whether presynaptic histamine receptors can modulate noradrenaline release and, if so, to determine their pharmacological characteristics. Strips of this blood vessel were incubated with [3H]noradrenaline and subsequently superfused with physiological salt solution containing desipramine and corticosterone. Electrically (2 Hz) evoked 3H overflow was inhibited by histamine and the H3 receptor agonist R-(-)-alpha-methylhistamine. Histamine-induced inhibition of electrically evoked tritium overflow was not affected by alpha 2-adrenoceptor blockade by rauwolscine. S-(+)-alpha-methylhistamine (up to 10 mumol/l) as well as the histamine H1 and H2 receptor agonists 2-(2-thiazolyl)ethylamine (up to 3 mumol/l) and dimaprit (up to 30 mumol/l), respectively, were ineffective. The selective histamine H3 receptor antagonist thioperamide abolished the inhibitory effect of histamine. The histamine H2 and H1 receptor antagonists ranitidine and pheniramine, respectively, did not affect the histamine-induced inhibition of evoked tritium overflow. The present results are compatible with the suggestion that the sympathetic nerves of the human saphenous vein are endowed with inhibitory presynaptic histamine receptors of the H3 class.

  6. Transaortic Intra-Aortic Balloon Pump Catheter Insertion through a Separate Saphenous Vein Graft in Patients with Severe Aortoiliac Disease

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    Faruk Toktas

    2014-01-01

    Full Text Available Background. Intra-aortic balloon pump (IABP is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases. Methods. This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum. Results. The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0±13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft. Conclusions. This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.

  7. Retrograde endovenous laser ablation through saphenopopliteal junctional area for incompetent small saphenous vein; Comparison with antegrade approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun Seok; Park, Sang Woo; Yun, Ik Jin; Hwang, Jae Joon; Lee, Song Am; Chee, Hyun Keun; Hwang, Jin Ho [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV). Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical and clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits. The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups. The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter.

  8. Reverse Regulatory Pathway (H2S / PGE2 / MMP in Human Aortic Aneurysm and Saphenous Vein Varicosity.

    Directory of Open Access Journals (Sweden)

    Ingrid Gomez

    Full Text Available Hydrogen sulfide (H2S is a mediator with demonstrated protective effects for the cardiovascular system. On the other hand, prostaglandin (PGE2 is involved in vascular wall remodeling by regulating matrix metalloproteinase (MMP activities. We tested the hypothesis that endogenous H2S may modulate PGE2, MMP-1 activity and endogenous tissue inhibitors of MMPs (TIMP-1/-2. This regulatory pathway could be involved in thinning of abdominal aortic aneurysm (AAA and thickening of saphenous vein (SV varicosities. The expression of the enzyme responsible for H2S synthesis, cystathionine-γ-lyase (CSE and its activity, were significantly higher in varicose vein as compared to SV. On the contrary, the endogenous H2S level and CSE expression were lower in AAA as compared to healthy aorta (HA. Endogenous H2S was responsible for inhibition of PGE2 synthesis mostly in varicose veins and HA. A similar effect was observed with exogenous H2S and consequently decreasing active MMP-1/TIMP ratios in SV and varicose veins. In contrast, in AAA, higher levels of PGE2 and active MMP-1/TIMP ratios were found versus HA. These findings suggest that differences in H2S content in AAA and varicose veins modulate endogenous PGE2 production and consequently the MMP/TIMP ratio. This mechanism may be crucial in vascular wall remodeling observed in different vascular pathologies (aneurysm, varicosities, atherosclerosis and pulmonary hypertension.

  9. Reverse Regulatory Pathway (H2S / PGE2 / MMP) in Human Aortic Aneurysm and Saphenous Vein Varicosity.

    Science.gov (United States)

    Gomez, Ingrid; Ozen, Gulsev; Deschildre, Catherine; Amgoud, Yasmine; Boubaya, Lilia; Gorenne, Isabelle; Benyahia, Chabha; Roger, Thomas; Lesèche, Guy; Galardon, Erwan; Topal, Gokce; Jacob, Marie-Paule; Longrois, Dan; Norel, Xavier

    2016-01-01

    Hydrogen sulfide (H2S) is a mediator with demonstrated protective effects for the cardiovascular system. On the other hand, prostaglandin (PG)E2 is involved in vascular wall remodeling by regulating matrix metalloproteinase (MMP) activities. We tested the hypothesis that endogenous H2S may modulate PGE2, MMP-1 activity and endogenous tissue inhibitors of MMPs (TIMP-1/-2). This regulatory pathway could be involved in thinning of abdominal aortic aneurysm (AAA) and thickening of saphenous vein (SV) varicosities. The expression of the enzyme responsible for H2S synthesis, cystathionine-γ-lyase (CSE) and its activity, were significantly higher in varicose vein as compared to SV. On the contrary, the endogenous H2S level and CSE expression were lower in AAA as compared to healthy aorta (HA). Endogenous H2S was responsible for inhibition of PGE2 synthesis mostly in varicose veins and HA. A similar effect was observed with exogenous H2S and consequently decreasing active MMP-1/TIMP ratios in SV and varicose veins. In contrast, in AAA, higher levels of PGE2 and active MMP-1/TIMP ratios were found versus HA. These findings suggest that differences in H2S content in AAA and varicose veins modulate endogenous PGE2 production and consequently the MMP/TIMP ratio. This mechanism may be crucial in vascular wall remodeling observed in different vascular pathologies (aneurysm, varicosities, atherosclerosis and pulmonary hypertension).

  10. Antagonism of lateral saphenous vein serotonin receptors from steers grazing endophyte-free, wild-type, or novel endophyte-infected tall fescue

    Science.gov (United States)

    Pharmacologic profiling of 5-hydroxytryptamine (5HT) receptors of bovine lateral saphenous vein has shown that cattle grazing endophyte-infected (Neotyphodium coenophialum) tall fescue (Lolium arundinaceum) have altered responses to ergovaline (ERV), 5HT, 5HT2A and 5HT7 agonists. To determine if 5HT...

  11. Association of Angiotensin-Converting Enzyme Genotype, Insertion/Deletion Polymorphism and Saphenous Vein Graft Atherosclerosis in Iranian Patients

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    Neda Zeinali

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: The aim of this study was to evaluate possible interactions among Angiotensin-I converting enzyme genotype, insertion/deletion polymorphism and atherosclerosis of vein grafts in Iranian patients, and characterize their clinical and demographic profile. METHODS: In this cross-sectional study, patients who underwent coronary artery bypass graft surgery more than five years ago, were included for angiographic analysis. Atherosclerosis was determined by quantitative angiography and adjusted Gensini score. The gene angiotensin converting enzyme I/D polymorphism was detected by polymerase chain reaction. RESULTS: A total of 102 patients participated in this study. Eighty-four patients were male. The frequency distribution of DD, ID and II polymorphism were 23.6%, 62.7% and 13.7% respectively. There were no differences among genotypic groups in age, sex, number of risk factors, number of vein grafts and months since bypass surgery. According to adjusted Gensini score [0.18±0.12 (II vs. 0.11±0.09 (ID and 0.1±0.09 (DD P=0.021] the II genotype was associated with severity of vein graft atherosclerosis. CONCLUSION: Although there are conflicting results about gene angiotensin converting enzyme I/D polymorphism and the degree of venous bypass graft degeneration, this study suggests an association between ACE genotype II and atherosclerosis of saphenous vein grafts, however, large samples considering clinical, demographic and ethnic profile are necessary to confirm these results.

  12. Treatment of varicose veins of the small saphenous vein by completely minimally phlebectomy.%完全点式剥脱治疗小隐静脉瓣膜功能不全疗效观察

    Institute of Scientific and Technical Information of China (English)

    亓明; 白云清

    2012-01-01

    目的 探讨完全点式剥脱术治疗下肢小隐静脉的手术方法及疗效.方法 对2004年10月至2011年4月间,应用该手术方法治疗的40例患者(47条下肢)下肢小隐静脉曲张的临床资料进行回顾性研究.观察其手术时间、术后住院时间、并发症、手术效果及对切口外观满意度等.结果 本组肢体行小隐静脉完全点式剥脱,手术时间平均45 min;手术后平均1.5 d出院.所有患者术后下肢静脉曲张消失,临床症状缓解.腓肠神经损伤(外侧足背皮肤麻木感)1例(2.5%).无严重并发症发生.全部患者获得随访,平均随访24(1~48)个月,无明确的下肢静脉曲张复发;1例腓肠神经损伤的患者在术后2个月恢复.无下肢深静脉血栓等严重的并发症发生,疗效满意.结论 小隐静脉完全点式剥脱术治疗下肢静脉曲张的手术方法是外科方法中简单、微创、有效的治疗方法.%Objective To evaluate the completely minimally phlebectomy in the treatment of varicose vein. Methods From Oct. 2004 to Oct. 2010,40 patients ( 47 limbs ) with small saphenous vein varices received completely minimally phlebectomy,and the clinical data were analyzed retrospectively. Results Satisfied surgical results with varicose veins reflux disappeared were obtained in all cases. The average operative time and the average hospitalization after operation were 45 minutes and 1.5 days, respectively. Sural nerve damage occurred in 1 (2.5% ) case. Moreover, 580 patients were followed up with a mean time of 24 ( 1 -48 ) months, no remained varicose veins, and cases with sural nerve damage recovered in 2 -3 months postoperatively. JNo serious complications such as deep venous thrombosis occurred and the satisfied cosmetic effects and cost - effect ratio achieved. Conclusion Treatment of varicose veins of small saphenous vein by completely minimally phlebectomy has the benefit of mini - invasion, fast recovery, and good curative effect.

  13. Primary varicose veins: Frequency, clinical significance and surgical treatment

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    Vasić Dragan M.

    2004-01-01

    Full Text Available INTRODUCTION According to the definition of the World Health Organization, varicose veins represent abnormally enlarged superficial veins having baggy or cylindrical shape. The most frequent cause of primary varicose veins is the insufficiency of long saphenous vein (LSV, but especially the basin of its connection with femoral vein and perforating veins. OBJECTIVE The objectives of these investigations were: the determination of insufficiency incidence of SSV in cases of LSV insufficiency; the establishment of association of insufficiency of perforating veins of the basin of LSV and SSV; the study of the results of surgical treatment of insufficiency and varicosity of both short and long saphenous veins. METHODS In this study, 100 patients (66 women and 34 men, average age 52.1 years, with clinical symptoms showing the insufficiency and varicosity of long saphenous vein with no change of deep vein system were examined. Ultrasonographic examinations were made using Color Doppler probes - 7.5 and 3.75 MHz (Toshiba Corevison SSA 350 A; the development of incompetence of long saphenous vein (LSV and short saphenous vein (SSV at the level of the junction as well as other incompetent valves were examined. The reflux was defined as a retrograde flow of the duration longer than 0.5 seconds. RESULTS The insufficiency of short saphenous vein was determined by ultrasonographic examination in 34%, while the insufficiency of perforating veins in 80% of patients. 40% of patients were operated (33.3% of females, and 52.9% of males. The most frequent indications for surgical treatment of superficial veins insufficiency were: strong varicosities, clear symptoms and signs, superficial thrombophlebitis and conditions after superficial thrombophlebitis. Surgical treatment was applied in 16% of patients due to recurrence in the basin of long saphenous vein, and in 6% of cases because of the recurrence in the basin of short saphenous vein. Data analysis failed to

  14. A comparative study on the mechanical properties of the healthy and varicose human saphenous vein under uniaxial loading.

    Science.gov (United States)

    Karimi, Alireza; Navidbakhsh, Mahdi; Kudo, Susumu

    2015-01-01

    Saphenous Vein (SV) due to fatness, age, inactiveness, etc. can be afflicted with varicose. The main reason of the varicose vein is believed to be related to the leg muscle pump which is unable to return the blood to the heart in contradiction of the effect of gravity. As a result of the varicose vein, both the structure and mechanical properties of the vein wall would alter. However, so far there is a lack of knowledge on the mechanical properties of the varicose vein. In this study, a comparative study was carried out to measure the elastic and hyperelastic mechanical properties of the healthy and varicose SVs. Healthy and varicose SVs were removed at autopsy and surgery from seven individuals and then axial tensile load was applied to them up to the failure point. In order to investigate the mechanical behaviour of the vein, this study was benefitted from three different stress definitions, such as 2nd Piola-Kichhoff, engineering and true stresses and four different strain definitions, i.e. Almansi-Hamel, Green-St. Venant, engineering and true strains, to determine the linear mechanical properties of the SVs. A Digital Image Correlation (DIC) technique was used to measure the true strain of the vein walls during load bearing. The non-linear mechanical behaviour of the SVs was also computationally evaluated via the Mooney-Rivlin material model. The true/Cauchy stress-strain diagram exhibited the elastic modulus of the varicose SVs as 45.11% lower than that of the healthy ones. Furthermore, by variation of the stress a significant alteration on the maximum stress of the healthy SVs was observed, but then not for the varicose veins. Additionally, the highest stresses of 4.99 and 0.65 MPa were observed for the healthy and varicose SVs, respectively. These results indicate a weakness in the mechanical strength of the SV when it becomes varicose, owing to the degradation of the elastin and collagen content of the SV. The Mooney-Rivlin hyperelastic and the Finite

  15. 5-Hydroxytryptamine(1F) receptors do not participate in vasoconstriction: lack of vasoconstriction to LY344864, a selective serotonin(1F) receptor agonist in rabbit saphenous vein.

    Science.gov (United States)

    Cohen, M L; Schenck, K

    1999-09-01

    Recently, several novel approaches to the treatment of migraine have been advanced, including selective 5-hydroxytryptamine (or serotonin) 1B/1D (5-HT(1B/1D)) receptor agonists such as sumatriptan and 5-HT(1F) receptor agonists such as LY344864. Many 5-HT(1B/1D) receptor agonists have been identified based on their ability to produce cerebral vascular contraction, whereas LY344864 was identified as an inhibitor of trigeminal nerve-mediated dural extravasation. In our study, several triptan derivatives were compared with LY344864 for their ability to contract the rabbit saphenous vein, a tissue used in the preclinical identification of sumatriptan-related agonists. Sumatriptan, zolmitriptan, rizatriptan, and naratriptan all contracted the rabbit saphenous vein from baseline tone, whereas LY344864 in concentrations up to 10(-4) M did not contract the rabbit saphenous vein. Furthermore, vascular contractions to sumatriptan were markedly augmented in the presence of prostaglandin F(2alpha) (PGF(2alpha)). However, even in the presence of PGF(2alpha) (3 x 10(-7) M), LY344864 did not contract the rabbit saphenous vein in concentrations well in excess of its 5-HT(1F) receptor affinity (pK(i) = 8.2). Only when concentrations exceeded those likely to activate 5-HT(1B) and 5-HT(1D) receptors (>10(-5) M) did modest contractile responses occur in the presence of PGF(2alpha). Use of these serotonergic agonists revealed a significant correlation between the contractile potency in the rabbit saphenous vein and the affinities of these agonists at 5-HT(1B) and 5-HT(1D) receptors, although contractile agonist potencies were not quantitatively similar to 5-HT(1B) or 5-HT(1D) receptor affinities. In contrast, no significant correlation existed between the contractile potencies of these serotonergic agonists in the rabbit saphenous vein and their affinity at 5-HT(1F) receptors. These data support the contention that activation of 5-HT(1F) receptors will not result in vascular

  16. Efficacy of varicose vein surgery with preservation of the great safenous vein

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    Bernardo Cunha Senra Barros

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001 and reduction in the diameter of the great saphenous vein (p <0.001. There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001. CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

  17. Mapping of Autogenous Saphenous Veins as an Imaging Adjunct to Peripheral MR Angiography in Patients with Peripheral Arterial Occlusive Disease and Peripheral Bypass Grafting: Prospective Comparison with Ultrasound and Intraoperative Findings

    OpenAIRE

    Ann-Marie Bintu Munda Jah-Kabba; Guido Matthias Kukuk; Dariusch Reza Hadizadeh; Frank Träber; Arne Koscielny; Mustapha Sundifu Kabba; Frauke Verrel; Hans Heinz Schild; Winfried Albert Willinek

    2014-01-01

    BACKGROUND: Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. METHODS: 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44-88 years) underwent periphera...

  18. Endovenous laser ablation of great saphenous vein with ultrasound-guided perivenous tumescence:early and midterm results

    Institute of Scientific and Technical Information of China (English)

    CHEN Jia-quan; XIE Hui; DENG Hao-yu; YUAN Kai; ZHANG Ji-wei; ZHANG Hao; ZHANG Lan

    2013-01-01

    Background Endovenous laser ablation (EVLA) is an improved method to treat varicose great saphenous veins (GSV)with a high satisfactory rate.This study aimed to evaluate the efficiency and safety of treatment by EVLA procedures with ultrasound-guided perivenous tumescence.Methods Thirty-one patients (31 limbs) with symptomatic varicose vein primary to chronic venous insufficiency (CVI) treated with EVLA were prospectively studied.The entire procedure was performed under ultrasound-guided tumescent local anesthesia.The patients were evaluated with a 18 month follow-up postoperation using clinical examination and venous duplex ultrasonography.Pain scores and quality of life (QOL) were recorded using visual analog scale (VAS) and the chronic venous insufficiency questionnaire (CIVIQ) at 1 week,1 month,and 12 months after operation.Results All patients tolerated EVLA procedure well.The overall success occlusion rates of GSV were 92%,94%,and 94% at 1,12,and 18 months follow-up,respectively.The score of CIVIQ one week preoperation was 69.14±11.44 while that of CIVIQ one month postoperation was 85.32±4.89.The life quality has significantly improved after the operation of EVLA (t=12.71,P <0.05).The VAS one month after treatment was lower than 1 week before therapy (t=8.048,P <0.05).Major complications such as deep vein thrombosis and skin bums were not found.Most of the complications were minor and improved quickly.Conclusions This refinement type of EVLA procedure is a safe and effective treatment with a high satisfaction rate; it displayed noteworthy features including shortening hospitalization,early ambulant activity,and preferable occlusion rates.

  19. The effects of aging on the intimal region of the human saphenous vein: insights from multimodal microscopy and quantitative image analysis.

    Science.gov (United States)

    Fonseca, Cindy; Taatjes, Douglas J; Callas, Peter; Ittleman, Frank; Bovill, Edwin G

    2012-09-01

    We hypothesized that structural remodeling associated with advancing age occurs in human saphenous veins. To address this hypothesis, we have identified structural remodeling in human saphenous veins by applying histochemistry, fluorescence staining and quantitative image analysis to specifically assess intimal area, intimal cellularity and intimal collagen content and organization. Saphenous veins were collected from patients undergoing coronary artery bypass graft surgery. Area measurements and cellularity were quantified using the image analysis software Stereo Investigator, employing planimetry and counting frames, respectively. Collagen content and organization were quantified in MetaMorph image analysis software based on measurements of color (hue, saturation, and intensity) from polarized light images. Intimal area and cellularity showed no statistically significant increases with age; in contrast, total collagen content showed a significant decrease with advancing age. Furthermore, collagen fiber types also demonstrated a statistically significant alteration with age; increases in age resulted in decreases in larger collagen fibers. No significant changes in small collagen fibers were identified. These results raise the possibility that age-associated structural alterations in total collagen content, specifically collagen fiber size, could be a factor in the etiology of age-associated venous diseases.

  20. Factors Associated with Recurrence of Varicose Veins after Thermal Ablation: Results of The Recurrent Veins after Thermal Ablation Study

    Directory of Open Access Journals (Sweden)

    R. G. Bush

    2014-01-01

    Full Text Available Background. The goal of this retrospective cohort study (REVATA was to determine the site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF and laser ablation. Methods. Seven centers enrolled patients into the study over a 1-year period. All patients underwent previous thermal ablation of the great saphenous vein (GSV, small saphenous vein (SSV, or anterior accessory great saphenous vein (AAGSV. From a specific designed study tool, the etiology of recurrence was identified. Results. 2,380 patients were evaluated during this time frame. A total of 164 patients had varicose vein recurrence at a median of 3 years. GSV ablation was the initial treatment in 159 patients (RF: 33, laser: 126, 52 of these patients had either SSV or AAGSV ablation concurrently. Total or partial GSV recanalization occurred in 47 patients. New AAGSV reflux occurred in 40 patients, and new SSV reflux occurred in 24 patients. Perforator pathology was present in 64% of patients. Conclusion. Recurrence of varicose veins occurred at a median of 3 years after procedure. The four most important factors associated with recurrent veins included perforating veins, recanalized GSV, new AAGSV reflux, and new SSV reflux in decreasing frequency. Patients who underwent RF treatment had a statistically higher rate of recanalization than those treated with laser.

  1. Combined subfascial endoscopic perforator surgery and endovenous laser treatment without impact on the great saphenous vein for management of lower-extremity varicose veins

    Institute of Scientific and Technical Information of China (English)

    GAN Shu-jie; QIAN Shui-xian; ZHANG Ci; MAO Jie-qi; LI Ke; TANG Jing-dong

    2013-01-01

    Background Conventional high ligation and stripping of the great saphenous vein (GSV) has a good curative effect but is highly traumatic with a considerable relapse rate.Subfascial endoscopic perforator surgery (SEPS) plus endovenous laser treatment (EVLT) could be applied as individual therapy.This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators.Methods Placement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011.After randomization,SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia,in combination with EVLT to close the superficial varicose veins without impacting the GSV.The remaining 42 limbs were treated using traditional GSV phlebectomy as controls.Results Postoperatively,all varicose veins were resolved,with lightening of the pigmentation and healing of the ulcer.Within a follow-up period of 5-11 months,no symptoms had recurred.Compared with the control group,the operation time,the number of incisions sutured,and the in-hospital time decreased on average by 1.5 hours,4.7,and 6.8 days,respectively (P <0.01 in all cases).Conclusion Combined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.

  2. Pulsatile ex vivo perfusion of human saphenous vein grafts under controlled pressure conditions increases MMP-2 expression

    Directory of Open Access Journals (Sweden)

    Lange Rüdiger

    2011-07-01

    Full Text Available Abstract Background The use of human saphenous vein grafts (HSVGs as a bypass conduit is a standard procedure in the treatment of coronary artery disease while their early occlusion remains a major problem. Methods We have developed an ex vivo perfusion system, which uses standardized and strictly controlled hemodynamic parameters for the pulsatile and non-static perfusion of HSVGs to guarantee a reliable analysis of molecular parameters under different pressure conditions. Cell viability of HSVGs (n = 12 was determined by the metabolic conversion of 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyl-tetrazolium bromide (MTT into a purple formazan dye. Results Under physiological flow rates (10 mmHg HSVGs remained viable for two weeks. Their exposure to arterial conditions (100 mmHg was possible for one week without important reduction in viability. Baseline expression of matrix metalloproteinase-2 (MMP-2 after venous perfusion (2.2 ± 0.5, n = 5 was strongly up-regulated after exposure to arterial conditions for three days (19.8 ± 4.3 or five days (23.9 ± 6.1, p Conclusion Therefore, our system might be helpful to more precisely understand the molecular mechanisms leading to an early failure of HSVGs.

  3. Reflux venous flow in dural sinus and internal jugular vein on 3D time-of-flight MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jinhee; Kim, Bum-soo; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Byun, Jae Young [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, School of Medicine, Seoul (Korea, Republic of)

    2013-10-15

    Reflux venous signal on the brain and neck time-of-flight magnetic resonance angiography (TOF MRA) is thought to be related to a compressed left brachiocephalic vein. This study is aimed to assess the prevalence of venous reflux flow in internal jugular vein (IJV), sigmoid sinus/transverse sinus (SS/TS), and inferior petrosal sinus (IPS) on the brain and neck TOF MRA and its pattern. From the radiology database, 3,475 patients (1,526 men, 1,949 women, age range 19-94, median age 62 years) with brain and neck standard 3D TOF MRA at 3 T and 1.5 T were identified. Rotational maximal intensity projection images of 3D TOF MRA were assessed for the presence of reflux flow in IJV, IPS, and SS/TS. Fifty-five patients (1.6 %) had reflux flow, all in the left side. It was more prevalent in females (n = 43/1,949, 2.2 %) than in males (n = 12/1,526, 0.8 %) (p = 0.001). The mean age of patients with reflux flow (66 years old) was older than those (60 years old) without reflux flow (p = 0.001). Three patients had arteriovenous shunt in the left arm for hemodialysis. Of the remaining 52 patients, reflux was seen on IJV in 35 patients (67.3 %). There were more patients with reflux flow seen on SS/TS (n = 34) than on IPS (n = 25). Venous reflux flow on TOF MRA is infrequently observed, and reflux pattern is variable. Because it is exclusively located in the left side, the reflux signal on TOF MRA could be an alarm for an undesirable candidate for a contrast injection on the left side for contrast-enhanced imaging study. (orig.)

  4. 导管引导下泡沫硬化剂疗法治疗大隐静脉曲张%Catheter-directed foam sclerotherapy of incompetent saphenous reflux: early results

    Institute of Scientific and Technical Information of China (English)

    刘小平; 郭伟; 贾鑫; 杜昕; 熊江; 尹太; 张宏鹏; 刘蒙

    2009-01-01

    Objective To describe observation of availability of catheter-directed foam sclerotherapy for the great saphenous vein varicosis. Methods A selective series of 30 patients of vein varicosis were treated with foam sclerotherapy using a standard technique for foam delivery from April 2008 to August 2008. Patients were treated with 1% polidocanol foam through a catheter, which was inserted percutaneously over a guidewire in the great saphenous vein (GSV). All successfully treated patients were examined by colour duplex two weeks after the procedure. Results Thirty patients with an insufficiency reflux of the GSV were treated with the catheter-directed foam sclerotherapy. Primary technical success was achieved in all the patients. The concentrations (1.0%) and doses (6 to 8 ml) of polidocanol was mainly we used. Five patients experienced transient scotomas and developed segmental phlebitis of a collateral vein. The intervention was well tolerated in all patients without the occurrence of serious side effects. In 27 of the 30 treated patients (90% ) , a closure of the GSV was found at control visits 2 weeks, 3 months after treatment. Conclusion The use of an endovascular catheter inserted percutaneously over a guidewire is feasible in most patients and has resulted in high primary occlusion rates.%目的 探讨导管引导下的泡沫硬化剂疗法治疗下肢静脉曲张的临床效果.方法 选择2008年4月至8月间有微创治疗意愿的30例(条)中重度下肢静脉曲张患者.其中男性11例,女性19例;年龄34-85岁,平均年龄52岁.病史2~30年,平均20年.对其进行导管引导下患肢大隐静脉主干内注射1%聚桂醇泡沫硬化剂,观察大隐静脉主干的闭合情况.结果 30条患肢均在导管引导下成功注射硬化剂,平均每条患肢应用6.2 ml泡沫硬化剂,27条(90%)大隐静脉主干治疗后即刻可见反流消失.术后早期大隐静脉走行轻微浅静脉炎5例(条),2周内自行缓解,无严重

  5. Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

    Institute of Scientific and Technical Information of China (English)

    Xiang HU; Qiang ZHAO

    2011-01-01

    Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left antetior descending coronary arteries is unclear.This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library.Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years,there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right intemal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery

  6. Radiofrequency ablation of the great saphenous vein with the ClosureFAST™ procedure: mid-term experience on 400 patients from a single centre.

    Science.gov (United States)

    Tolva, Valerio S; Cireni, Lea V; Bianchi, Paolo G; Lombardo, Almarosa; Keller, Guido C; Casana, Renato M

    2013-07-01

    Endovascular obliteration of the great saphenous vein (GSV) has been proposed as an alternative to conventional extirpative treatment of varicose veins. This report reviewed the initial experience with the ClosureFAST™ procedure in 407 legs over a one-year period. Occlusion of the GSV was seen on 98 % of completion scans and in all patients within 1 week of the procedure. Persistent occlusion was documented in all cases. One had paresthesias and one had skin pigmentation. Three patients had transient superficial thrombophlebitis in a treated segment of a superficial collateral of the GSV. One patient was found to have extension of an asymptomatic, nonocclusive thrombus into the common femoral vein 1 week after the procedure. Radiofrequency ablation of the GSV appears to be a safe alternative to conventional stripping and ligation. Randomised clinical trials and longer follow-up periods are required to establish the overall superiority of the procedure in comparison to conventional stripping.

  7. Percutaneous laser-assisted thermal coronary angioplasty in native coronary arteries and saphenous vein grafts: initial results and angiographic follow-up.

    Science.gov (United States)

    Linnemeier, T J; Rothbaum, D A; Cumberland, D C; Landin, R J; Hodes, Z I; Ball, M W

    1990-01-01

    Percutaneous laser-assisted thermal coronary angioplasty was attempted in 29 vessels (27 patients): 10 left anterior descending, 2 left circumflex and 17 mid-shaft (non-anastomotic) saphenous vein grafts. Argon or YAG laser thermal energy was applied via a 1.3, 1.6 or 1.9 mm metal capped probe followed by conventional balloon angioplasty in 27 vessels and sole thermal laser therapy in two vessels. The laser probe successfully crossed 83% (24/29) of vessels and subsequent balloon dilatation increased the success rate to 93% (25/27). Perforation occurred in a vein graft resulting in one in-hospital death post repeat emergency coronary artery bypass graft surgery. Angiographic follow-up was obtained in 85% (24/28) of vessels. Angiographic restenosis ( greater than 50% reduction in lumen diameter) occurred in 27% (3/11) of native coronary arteries and 62% (8/13) of saphenous vein grafts. Therefore, despite high initial success rates, the application of laser thermal energy with small laser probes relative to vessel size, followed by conventional balloon angioplasty, does not appear to alter restenosis. Further evaluation of coronary laser systems should be continued only with catheters that are capable of creating channels closer to the size of the vessel treated.

  8. [Hyaluronic acid (hyaluronan) levels in pathological human saphenous veins. Effects of procyanidol oligomers].

    Science.gov (United States)

    Drubaix, I; Maraval, M; Robert, L; Robert, A M

    1997-01-01

    We investigated the hyaluronan content in the pathologic human venous wall using an ELSA assay with hyaluronectin according to the method of Delpech et al. The mean hyaluronan content in the 74 fragments from 12 venous walls studied was 596 +/- 528 ng/mg dry weight. These 12 venous walls could be separated in 3 distinct groups according to their hyaluronan content, low (277 +/- 141 ng/mg dry weight), moderate (552 +/- 361 ng/m dry weight) or high (1299 +/- 568 ng/mg dry weight). The differences between these groups are significant (p < 0.001). The presence of a veino-lymphatic oedema was generally associated with a high hyaluronan level (in 65% of cases). The 3H-glucosamine incorporation in cultured venous wall explants showed a 35% increase (p < 0.002) in varicosis as compared with the non or less modified segments of the vein and a 29% (p < 0.001) increase in presence of a veino-lymphatic oedema. The addition of 1 mg/ml of PCO (Procyanidolic Oligomers) to the culture media induced near to 20% decrease of the 3H-glucosamine incorporation and a 34% decrease of the hyaluronan content. Our results confirm the role of local overproduction of hyaluronan in the establishment of oedema and the potential effect of PCO to counteract it.

  9. Curative Effect Observation on Modified Great Saphenous Varicose Vein High Ligation Joint Peeling Treatment of Primary Great Saphenous Varicose Veins%用改良后的大隐静脉曲张高位结扎联合剥脱术治疗原发性大隐静脉曲张的疗效研究

    Institute of Scientific and Technical Information of China (English)

    宋进军

    2015-01-01

    Objective: To evaluate the modified great saphenous varicose vein high ligation joint peeling technique in the efficacy of treatment of primary great saphenous varicose veins. Method: The data of 30 cases of primary great saphenous varicose veins seen between May.2011 to May.2014 has been collected to divide into two groups with 15 cases in each group. The treatment group was treated with modified great saphenous varicose vein high ligation joint peeling technique, while control group was treated with traditional method. To review and analysis the data, and observe the treatment result. Results: The overall response rate of treatment group was significantly decreased compared to control group (p<0.05). Conclusion: Compared to the traditional method, the modified great saphenous varicose vein high ligation joint peeling technique plays more important role to improve the cure rate of patients, and it is worth to popularize and apply in the clinical treatment.%目的:探讨用改良后的大隐静脉曲张高位结扎联合剥脱术治疗原发性大隐静脉曲张的临床效果。方法:对2011年5月~2014年5月期间我院收治的30例原发性大隐静脉曲张患者的临床资料进行回顾性研究。将这30例患者随机分为对照组和观察组,每组各有15例患者。为观察组患者使用改良后的大隐静脉曲张高位结扎联合剥脱术进行治疗,为对照组患者使用传统的大隐静脉曲张高位结扎联合剥脱术进行治疗。然后,比较两组患者的治疗效果。结果:观察组患者治疗的总有效率明显高于对照组患者,二者相比差异具有显著性(P<0.05)。结论:用改良后的大隐静脉曲张高位结扎联合剥脱术治疗原发性大隐静脉曲张的疗效显著。此疗法值得在临床上推广使用。

  10. 单纯性下肢静脉曲张中医辨证分型与大隐静脉超声观察指标的相关性研究∗%The correlation between Chinese medicine syndrome types of simplex varicose veins in lower extremity and great saphenous vein ultrasound indexes

    Institute of Scientific and Technical Information of China (English)

    王朝歆; 赵晖; 曹建春; 刘艳; 杨玲

    2015-01-01

    目的:探讨单纯性下肢静脉曲张中医辨证分型与大隐静脉超声观察指标之间的相关性。方法将132例单纯性下肢静脉曲张患者分为脉络湿邪阻滞证组、脉络湿邪瘀阻证组、脉络湿毒瘀热证组,分别对3组患者进行超声检查,比较3组大隐静脉近心段管径、返流峰值速度、返流时间。结果3组大隐静脉近心段管径比较差异有统计学意义( P<0.001),3组中每2组管径比较差异均有统计学意义(P<0.05),大隐静脉近心段管径从粗到细的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。3组返流峰值速度比较差异有统计学意义( P<0.001),3组中每2组返流峰值速度比较差异均有统计学意义(P<0.05),大隐静脉近心段的返流峰值速度从高到低的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。3组返流时间比较差异有统计学意义( P<0.001),3组中每2组返流时间比较差异均有统计学意义( P<0.05),大隐静脉近心段的返流时间从长到短的顺序为:脉络湿毒瘀热证组、脉络湿邪瘀阻证组、脉络湿邪阻滞证组。结论大隐静脉超声观察指标与单纯性下肢静脉曲张的中医证型具有一定的相关性,可为单纯性下肢静脉曲张辨证分型提供客观依据。%Objective To explore the correlation between Chinese medicine syndrome differentiation types of simplex varicose veins in lower extremity and great saphenous vein ultrasound indexes. Methods 132 patients suffering simplex varicose veins of lower extremity were divided into 3 groups:dampness blocking channels syndrome, dampness and blood stasis blocking channels syndrome, dampness and stagnant heat syndrome. Great saphenous vein in recent period of pipe diameter, peak reflux velocity ( PRV ) and reflux time ( RT) were compared among the three groups. Results There was significant difference of great saphenous vein

  11. The importance of the time of digitalization for the incidence of spasms evoked by ouabain in strips of human saphenous vein.

    Science.gov (United States)

    Zerkowski, H R; Wagner, J

    1982-10-01

    The extent of contracture induced by ouabain on preparations of the greater saphenous vein obtained from patients undergoing elective coronary bypass surgery was investigated. The medical pretreatment of the various donor patients was similar but differed with regard to the duration of preoperative digitalization ranging from several days to months. Whereas the maximal contraction induced by noradrenaline was not influenced by prior digitalization, the contracture evoked by ouabain showed a strong dependency on the duration of preoperative digitalization. In patients without or with only short-term preoperative digitalization the spasm exerted by ouabain amounted to 48.8% and 49.2%, respectively, of the maximal contraction induced by noradrenaline, and decreased to zero in patients with long-term digitalization. From this result it is concluded that, in patients after coronary artery bypass grafting who did not receive cardiac glycosides for long-term treatment, the acute administration of glycosides may be a mechanism responsible for the early occlusion of saphenous vein bypass grafts.

  12. Antagonism of lateral saphenous vein serotonin receptors from steers grazing endophyte-free, wild-type, or novel endophyte-infected tall fescue.

    Science.gov (United States)

    Klotz, J L; Aiken, G E; Johnson, J M; Brown, K R; Bush, L P; Strickland, J R

    2013-09-01

    Pharmacologic profiling of serotonin (5HT) receptors of bovine lateral saphenous vein has shown that cattle grazing endophyte-infected (Neotyphodium coenophialum) tall fescue (Lolium arundinaceum) have altered responses to ergovaline, 5HT, 5HT2A, and 5HT7 agonists. To determine if 5HT receptor activity of tall fescue alkaloids is affected by grazing endophyte-free (EF), wild-type [Kentucky-31 (KY31)], novel endophyte AR542-infected (MAXQ), or novel endophyte AR584-infected (AR584) tall fescue, contractile responses of lateral saphenous veins biopsied from cattle grazing these different fescue-endophyte combinations were evaluated in presence or absence of antagonists for 5HT2A (ketanserin) or 5HT7 (SB-269970) receptors. Biopsies were conducted over 2 yr on 35 mixed-breed steers (361.5 ± 6.3 kg) grazing EF (n = 12), KY31 (n = 12), MAXQ (n = 6), or AR584 (n = 5) pasture treatments (3 ha) between 84 and 98 d (Yr 1) or 108 to 124 d (Yr 2). Segments (2 to 3 cm) of vein were surgically biopsied, sliced into 2- to 3-mm cross-sections, and suspended in a myograph chamber containing 5 mL of oxygenated Krebs-Henseleit buffer (95% O2/5% CO2; pH = 7.4; 37°C). Veins were exposed to increasing concentrations of 5HT, ergovaline, and ergovaline + 1 × 10(-5) M ketanserin or + 1 × 10(-6) M SB-269970 in Yr 1. In Yr 2, ergotamine and ergocornine were evaluated in presence or absence of 1 × 10(-5) M ketanserin. Contractile response data were normalized to a reference addition of 1 × 10(-4) M norepinephrine. In Yr 1, contractile response to 5HT and ergovaline were least (P endophyte-fescue combinations.

  13. Comparison of Different Surgical Treatment for Varicosis of Great Saphenous Vein%大隐静脉曲张不同手术治疗方法比较

    Institute of Scientific and Technical Information of China (English)

    彭利武; 周恩湘; 唐华; 文星均

    2011-01-01

    目的:探讨大隐静脉高位结扎加腔内激光治疗大隐静脉曲张的临床意义.方法:150例大隐静脉曲张患者分为A、B两组,其中A组70例,采用大隐静脉高位结扎加剥脱术治疗,B组80例,采用高位结扎加腔内激光治疗,比较两组在手术过程、术后疼痛、术后恢复及并发症发生率等方面的差别.结果:B组患者切口个数、手术时间、术中出血量、止痛药使用百分比和平均住院时间均少于A组(P0.05).结论:大隐静脉高住结扎加腔内激光术的临床疗效优于传统的高位结扎加剥脱术,且患者损伤小、恢复快、疼痛轻,值得临床推广.%Objective: To study the clinical significance of high ligation and intracavitary laser in the treatment of varicosis of great saphenous vein.Methods: In the A group, 70 cases with varicosis of great saphenous vein were treated by high ligation and stripping procedure, and 80 cases in B group by high ligation and intracavitary laser.To compare the curative effect of A and B group, the surgical procedure, postoperative pain, postoperative recovery and complication incidence were evaluated and analyzed.Results: The operation incision, surgery duration, amount of intraoperative bleeding, percentage of patients taking painkillers, duration of hospitalisation in group B were all significantly lower than those in group A (P<0.01 or 0.05), but there was no difference in NRE scores, time for first ambulation and complication incidence between the two groups (P>0.05).Conclusion: The high ligation and intracavitary laser procedure for varicosis of great saphenous vein has proved to be more effective than traditional method for low patient injury, rapid recovery and light pain, deserving to be widely used in clinical therapy.

  14. Procedural and clinical outcomes after use of the glycoprotein IIb/IIIa inhibitor abciximab for saphenous vein graft interventions

    Energy Technology Data Exchange (ETDEWEB)

    Harskamp, Ralf E., E-mail: r.e.harskamp@gmail.com [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands); VU University Medical Center, Amsterdam (Netherlands); Duke Clinical Research Institute, Durham, NC (United States); Hoedemaker, Niels [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands); Newby, L. Kristin [Duke Clinical Research Institute, Durham, NC (United States); Woudstra, Pier; Grundeken, Maik J.; Beijk, Marcel A.; Piek, Jan J.; Tijssen, Jan G. [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands); Mehta, Rajendra H. [Duke Clinical Research Institute, Durham, NC (United States); Winter, Robbert J. de [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands)

    2016-01-15

    Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) poses a high-risk for distal coronary thromboembolic events. Glycoprotein IIb/IIIa inhibitors are frequently used in hope of reducing the impact of this, although the safety and efficacy of these drugs to improve outcomes in this setting are understudied. Methods: Patients were included if they had prior coronary artery bypass surgery and subsequently underwent PCI of ≥ 1 SVG graft at a Dutch academic center between 1997 and 2008. These patients were matched 1:1 based on peri-procedural use of abciximab using a propensity-score matching algorithm based on 17 variables. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between abciximab use and MACCE (the composite measure of mortality, myocardial infarction, stroke and repeat revascularization) at 30 days and up to 1 year. Results: The composite of 30-day MACCE occurred in 18 patients (15.3%) in the abciximab group and 16 patients (13.6%) in the propensity matched control group (OR: 1.13, 95% CI: 0.57–2.21, p = 0.73). At 1-year follow-up, MACCE rates were also similar (32.5% vs. 33.9%, HR: 0.97, 95% CI: 0.59–1.59). Major bleeding (BARC types 3a–c) was higher in the abciximab group (11.9% vs. 4.2%, OR: 2.80, 95% CI: 1.01–7.77). Ischemic outcomes did not differ among patients with acute coronary syndromes. Conclusion: The use of intravenous abciximab was not associated with improved clinical outcomes up to 1-year among patients undergoing SVG PCI, but was related to more bleeding. - Highlights: • PCI of SVG poses a high-risk for distal coronary thromboembolic events. • Glycoprotein IIb/IIIa inhibitors are frequently used in an attempt to reduce this risk. • We evaluated the safety and efficacy of abciximab (a glycoprotein IIb/IIIa inhibitor) using a propensity-score matched analysis of 236 patients at a large academic medical center. • Thirty

  15. 超声引导下注射泡沫硬化剂治疗大隐静脉曲张%Follow-up of varicose veins with incompetent great saphenous veintreated with ultrasound guided foam sclerotherapy

    Institute of Scientific and Technical Information of China (English)

    温朝阳; 刘小平; 王月香; 程志刚; 唐杰; 郭伟; 宋奕

    2009-01-01

    Objective To assess the clinical outcome of varicose veins with incompetent great saphenous vein(GSV) treated with ultrasound guided foam sclerotherapy. Methods Forty limbs with moderate to severe symptomatic varicose veins with incompetent GSV in 38 patients were injected with foam sclerosing agent (Fibro-Vein) under ultrasound guidance. There were 36 patients with unilateral varicose veins and 2 with bilateral varicose veins. No of them suffered from deep vein incompetence or perforating vein incompetence. Second injection was performed one month after the initial injection in 7 limbs. Thirty-eight of 40 limbs were followed up with clinical examination and duplex ultrasound scan 30-47 months (mean 40 months) after the treatment. Results Among 38 limbs with follow-up mild debilitation was found in two limbs(5. 3%). There were no other symptoms or complications. Duplex ultrasound demonstrated four type of results: type I, sclerosed GSV trunk with no detectable venous flow in 32 of 38 limbs (84. 2%) ;type II,patent GSV trunk in 3 limbs (7. 9%) ,two of them had mild reflux in the GSV trunk;type III,sclerosed GSV trunk and mild reflux in the GSV tributaries, 1/38(2. 6%) ; type IV,sclerosed proximal GSV trunk,patent distal GSV communicated with a superficial vein and mild reflux in the veins, 2/38 (5. 3% ). Conclusions Clinical examination and duplex ultrasound scan demonstrated excellent results of varicose veins with incompetent GSV treated with ultrasound guided foam sclerotherapy 40 months after the treatment. Sclerotherapy is less invasive treatment option for varicose veins with incompetent GSV with satisfactory clinical and cosmetic outcome.%目的 探讨超声引导下注射泡沫硬化剂治疗大隐静脉曲张的临床疗效.方法 无深静脉及穿静脉功能不全的中、重度大隐静脉曲张40条患肢(38例患者,2例为双侧下肢大隐静脉曲张),在超声引导下注射泡沫硬化剂Fibro-Vein对隐股交界处下方10 cm处及其以远的

  16. Impending rupture of saphenous vein graft aneurysm with floating fractured bare metal stent treated by coil embolization and covered stent implantation.

    Science.gov (United States)

    Kodama, Atsuko; Kurita, Tairo; Kato, Osamu; Suzuki, Takahiko

    2016-11-01

    Aneurysmal degeneration of a saphenous vein graft (SVG) is a rare, but potentially fatal complication of coronary artery bypass graft (CABG) surgery. In this case report, a patient that had undergone prior CABG surgery and bare metal stent (BMS) implantation at the site of a stenotic SVG lesion presented at our hospital with chest pain, and an SVG aneurysm was detected at the previous BMS implantation site. In addition, the implanted BMS was fractured and floating in the SVG aneurysm. The SVG aneurysm was successfully occluded by percutaneous intervention, using a combination of distal covered stent deployment at the site of the anastomosis between the native coronary artery and the SVG and proximal coil embolization of the aneurysm.

  17. Idiopathic great saphenous phlebosclerosis.

    Directory of Open Access Journals (Sweden)

    Ahmadreza Jodati

    2013-06-01

    Full Text Available Arterial sclerosis has been extensively described but reports on venous sclerosis are very sparse. Phlebosclerosis refers to the thickening and hardening of the venous wall. Despite its morphological similarities with arteriosclerosis and potential morbid consequences, phlebosclerosis has gained only little attention. We report a 72 year old male with paralysis and atrophy of the right leg due to childhood poliomyelitis who was referred for coronary artery bypass surgery. The great saphenous vein, harvested from the left leg, showed a hardened cord-like obliterated vein. Surprisingly, harvested veins from the atrophic limb were normal and successfully used for grafting.

  18. Mapping of autogenous saphenous veins as an imaging adjunct to peripheral MR angiography in patients with peripheral arterial occlusive disease and peripheral bypass grafting: prospective comparison with ultrasound and intraoperative findings.

    Directory of Open Access Journals (Sweden)

    Ann-Marie Bintu Munda Jah-Kabba

    Full Text Available BACKGROUND: Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. METHODS: 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44-88 years underwent peripheral MR angiography using the blood pool contrast agent Gadofosveset trisodium. Apart from primary arterial assessment images were evaluated in order to determine great saphenous vein diameters at three levels: below the saphenofemoral junction, mid thigh and 10 cm above the knee joint (usability: diameter range: >3 and 3.5 and <10 mm at a neighboring level. Duplex ultrasound was performed by an independent examiner providing diameter measurements at the same levels. Additionally, vessel usability was determined intraoperatively by the vascular surgeon during subsequent bypass surgery. RESULTS: Mean venous diameters for MR angiography/duplex ultrasound were 5.4±2.6/5.5±2.8 mm (level 1, 4.7±2.7/4.6±2.9 mm (level 2 and 4.4±2.2/4.5±2.3 mm (level 3, respectively, without significant differences between the modalities (P = 0.207/0.806/0.518. Subsequent surgery was performed in 27/38 patients. A suitable saphenous vein was diagnosed in 25 and non-usability was diagnosed in 2 of the 27 patients based on MR angiography/duplex ultrasound, respectively. Usability was confirmed by intraoperative assessment in all of the 24 patients that received a venous bypass graft in subsequent bypass surgery. In 1 case, in which the great saphenous vein was assessed as useable by both MR angiography and duplex ultrasound, it was not used during subsequent bypass surgery due to the patients clinical condition and comorbidities. CONCLUSION: Simultaneous mapping of the great

  19. Avaliação da insuficiência da veia safena magna com classificação C2 e C3 (CEAP pela pletismografia a ar e pelo eco-Doppler colorido Evaluation of the greater saphenous vein with classification C2 e C3 (CEAP by air plethysmography and color Doppler ultrasonography

    Directory of Open Access Journals (Sweden)

    Amélia Cristina Seidel

    2012-09-01

    reflux of the greater saphenous vein (insufficiency in a clinical CEAP C2/C3 by air plethysmography and color Doppler ultrasonography. METHODS: We prospectively investigated 87 limbs with reflux of the greater saphenous vein as ascertained by Doppler ultrasound and 32 limbs without signs or symptoms of the venous disease. All patients underwent clinical examinations using air plethysmography and Doppler ultrasound of the lower limbs. The parameters used with the Doppler ultrasound were: the diameter of the saphenous vein (seven levels and the speed and time of reflux. In the plethysmography, the venous filling index, ejection fraction and residual volume fraction were also considered. RESULTS: Of the 119 limbs, 61 were class C2. In comparing the diameters of the vein of the control group with the study group there were statistically significant differences. There was an exception at the malleolus level. Using the Spearman correlation to analyze the indices for the plethysmography and Doppler ultrasound it showed some difference, but the coefficient of determination (r² showed that they were weak. CONCLUSIONS: The parameters of the plethysmography did not correlate with the degree of reflux in the greater saphenous vein. There was a very weak correlation between their values, time and speed of reflux. Only the venous filling index correlated with venous reflux. The ejection fraction and residual volume fraction were not important for discrimination of clinical severity.

  20. Perivenous application of fibrin glue reduces early injury to the human saphenous vein graft wall in an ex vivo model

    NARCIS (Netherlands)

    Stooker, W; Niessen, HWM; Wildevuur, WR; van Hinsbergh, VWM; Fritz, J; Jansen, EK; Wildevuur, CRH; Eijsman, L

    2002-01-01

    Objectives: From animal and clinical studies it is known that prevention of 'overdistention' of vein grafts by using extravascular support ameliorates the arterialization process in vein grafts with subsequent more favorable patency. The most ideal support is a biodegradable, porous, elastic graft (

  1. 聚桂醇注射联合手术治疗下肢大隐静脉曲张的疗效观察%Effect observation of foam sclerotherapy of lauromacrogol combined with surgery for great saphenous varicose veins

    Institute of Scientific and Technical Information of China (English)

    卢惟钦; 蒋劲松; 杨光唯; 来集富; 卢凯平

    2012-01-01

    目的:探讨泡沫硬化剂聚桂醇联合手术治疗下肢大隐静脉曲张的安全性及有效性.方法:选择本院2010年10月至2011年5月间86例单侧下肢大隐静脉曲张的患者,随机分为A、B两组,每组43例.A组行大隐静脉高位结扎、主干剥脱,小腿曲张静脉内注射聚桂醇泡沫硬化剂.B组行传统大隐静脉曲张手术.结果:86例患者均成功施行治疗.A组手术时间小于B组(P<0.01).A组住院时间也小于B组(P<0.01).术后随访半年,A组3例(6.9%)患肢出现局限的静脉曲张,B组2例(4.7%),复发率无明显差异(P>0.05).结论:聚桂醇注射联合手术治疗下肢静脉曲张安全、有效,较传统手术缩短了手术时间与患者住院时间.%AIM: To evaluate the efficacy and safety of foam sclerotherapy of lauromacrogol combined with surgery for great saphenous varicose veins. METHODS: 86 patients with great saphenous varicose veins were randomized into 2 groups of A and B. Group A was treated by sa-pheno-femoral junction ligation and stripping of great saphenous veins. Verosis veins below the knee underwent foam sclerotherapy. Group B was treated by standard stripping of great saphenous veins. RESULTS: All treatments were completed as intended. The time of completing treatment and hospitalization were shorter in group A than those in group B(P<0. 01). Allpatients were followed up 6 months with satisfactory outcomes except 3 patients in group A and 2 patients in group B with recurrence of varicose veins. CONCLUSION: Foam sclerotherapy of lauromacrogol combined with surgery for great saphenous varicose veins is safe and effective. Compared with traditional stripping operation, it has a shorter treatment and hospitalization time.

  2. The effects of vasoactive agents on flow through saphenous vein grafts during lower-extremity peripheral vascular surgery.

    Science.gov (United States)

    Maslow, Andrew D; Bert, Arthur; Slaiby, Jeffrey; Carney, William; Marcaccio, Edward

    2007-06-01

    The purpose of this study was to assess the effects of hemodynamic alterations on vein graft flow during peripheral vascular surgery. It was hypothesized that vasopressors can be administered without compromising flow through the vein grafts. Tertiary care center, university medical center. Randomized placebo-controlled double-blinded study. The effects of phenylephrine, epinephrine, milrinone, intravenous fluid, and placebo on newly constructed peripheral vein grafts were assessed in 60 patients (12 patients in each of 5 groups). Systemic and central hemodynamics were measured by using intra-arterial and pulmonary artery catheters. Vein graft flow was measured by using a transultrasonic flow probe (Transultrasonic Inc, Ithaca, NY). Phenylephrine increased systemic mean blood pressure (mBP) (68.2-94.0 mmHg, p < 0.01), systemic vascular resistance (SVR) (1,091-1,696 dynes x sec x cm(-5), p < 0.001), and vein graft flow (39.5-58.9 mL/min, p < 0.01), whereas cardiac output remained unchanged. Epinephrine resulted in increased cardiac output (4.4-6.9 L/min, p < 0.01) and mBP (72.7-89.1 mmHg, p < 0.01), whereas vein graft flow was reduced in 6 of 12 patients. Intravenous fluid administration resulted in a relatively smaller increase in graft flow (37.6-46.0 mL/min, p < 0.05), an increase in cardiac output, and an insignificant decrease in SVR. Other treatments had either little or no effect on vein graft flow. The study hypothesis was partly supported. Although both phenylephrine and epinephrine increased blood pressure, only the former increased vein graft flow in all patients. In conjunction with increases in graft flow after fluid administration, these data suggest that factors affecting vein graft flow are not just simply related to systemic hemodynamics.

  3. Arterialization and anomalous vein wall remodeling in varicose veins is associated with upregulated FoxC2-Dll4 pathway.

    Science.gov (United States)

    Surendran, Sumi; S Ramegowda, Kalpana; Suresh, Aarcha; Binil Raj, S S; Lakkappa, Ravi Kumar B; Kamalapurkar, Giridhar; Radhakrishnan, N; C Kartha, Chandrasekharan

    2016-04-01

    Varicose veins of lower extremities are a heritable common disorder. Mechanisms underlying its pathogenesis are still vague. Structural failures such as valve weakness and wall dilatation in saphenous vein result in venous retrograde flow in lower extremities of body. Reflux of blood leads to distal high venous pressure resulting in distended veins. In an earlier study, we observed a positive association between c.-512C>T FoxC2 gene polymorphism and upregulated FoxC2 expression in varicose vein specimens. FoxC2 overexpression in vitro in venous endothelial cells resulted in the elevated mRNA expression of arterial endothelial markers such as Delta-like ligand 4 (Dll4) and Hairy/enhancer-of-split related with YRPW motif protein 2 (Hey2). We hypothesized that an altered FoxC2-Dll4 signaling underlies saphenous vein wall remodeling in patients with varicose veins. Saphenous veins specimens were collected from 22 patients with varicose veins and 20 control subjects who underwent coronary artery bypass grafting. Tissues were processed for paraffin embedding and sections were immunostained for Dll4, Hey2, EphrinB2, α-SMA, Vimentin, and CD31 antigens and examined under microscope. These observations were confirmed by quantitative real-time PCR and western blot analysis. An examination of varicose vein tissue specimens by immunohistochemistry indicated an elevated expression of Notch pathway components, such as Dll4, Hey2, and EphrinB2, and smooth muscle markers, which was further confirmed by gene and protein expression analyses. We conclude that the molecular alterations in Dll4-Hey2 signaling are associated with smooth muscle cell hypertrophy and hyperplasia in varicose veins. Our observations substantiate a significant role for altered FoxC2-Dll4 signaling in structural alterations of saphenous veins in patients with varicose veins.

  4. Preexisting High Expression of Matrix Metalloproteinase-2 in Tunica Media of Saphenous Vein Conduits Is Associated with Unfavorable Long-Term Outcomes after Coronary Artery Bypass Grafting

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    Bartlomiej Perek

    2013-01-01

    Full Text Available Introduction. Migration of the smooth muscle cells (SMCs to the tunica media in the saphenous vein (SV transplants is facilitated by matrix metalloproteinases (MMPs. The aim of this study was to identify any associations between expression of MMP-2 or endogenous tissue inhibitors (TIMP-2 and TIMP-3 in the SV segments and late failure of the SV grafts. Methods. Two hundred consecutive patients with a mean age of 63.1 ± 8.9 years who underwent primary isolated venous CABG were examined. Patients were retrospectively split into two subgroups, with the SV graft disease (SVGD (+; or without it (SVGD (−; . In the SV segments, immunohistochemical analysis of the expression of the MMP-2, TIMP-2, and -3 was performed. Results. In the SVGD (+ patients, tissue expression of MMP-2 was stronger, whereas that of both TIMPs was weaker than in the SVGD (− patients. In majority of the SV segments obtained from the SVGD (− individuals, a balance in MMP and TIMP expressions was found, whereas an upregulation of MMP-2 expression was usually noted in the SVGD (+ subjects. Conclusion. The strong expression of MMP-2 accompanied by reduced immunostaining of both TIMPs is associated with the development of the SV graft disease and unfavorable CABG outcomes.

  5. [Foot defect with vascular and neural injury due to freshwater stingray sting: reconstruction with a lesser saphenous vein adipo-fascial flap].

    Science.gov (United States)

    Moutran, M; Mojallal, A; Chekaroua, K; Martin, E; Braye, F

    2009-04-01

    The emergency care to stingrays envenomation permits, in the majority of cases, to limit the damage caused. In the case of delayed medical care, we can meet deep and extensive lesions that need to be thoroughly explored in order to better address their reconstruction. We report the case of a patient injured by freshwater stingray. He presented a necrotic defect of 6 cm in diameter under the right medial malleolus with bone exposure and neurovascular injury. We opted for a therapeutic strategy in two steps. The first step consisted in a large debridement of the necrotic defect, under appropriate antibiotics and negative pressure therapy. Three weeks later, we covered the defect with a distally based lesser saphenous vein veno-fascia-subcutaneous flap, covered with a split-thickness graft. The coverage of the defect was satisfactory. The infection was controlled with antibiotics, which we prolonged for one month. The patient presented, initially, hypoesthesia of the upper lateral foot in relation with a neurapraxis of the sural nerve. The symptoms resolved at two months. The foot edema due to venous stasis also resolved at two months. The donor site healed without complications. The ability to wear normal shoes was preserved. The patient resumed his daily activities promptly.

  6. Endovenous laser treatment for saphenous varicose vein surgery%腔内激光治疗大隐静脉曲张的手术配合

    Institute of Scientific and Technical Information of China (English)

    王文君

    2011-01-01

    目的 总结腔内激光治疗大隐静脉曲张术手术室护士的配合要点,不断提高手术医生和手术患者的满意率.方法 回顾性分析62例患者的术前准备、术中配合过程,对术中的注意事项进行分析.结果62例患者手术顺利,术后随访1~12个月,无复发.结论手术室护士娴熟的手术配合,是手术成功的重要保障.%Objective To summarize the cooperative highlights of operating room nurses in endovenous laser treatment for saphenous varicose vein surgery, thus enhancing the satisfaction of both surgeons and patients. Methods Retrospective analysis of 62 cases has been done in terms of preoperative preparation and intraoperative cooperation. Some important issues concerning operation have been analyzed as well. Results All patients had smooth surgeries and follow-up visits were paid ranging from one to 12 months after surgery. There were no recurrences. Conclusion The operating room nurses' adept surgery coordination is important in a successful operation.

  7. Experience of great saphenous varicose vein high ligation main stripping operation combined with foam hardening agent in the treatment of varicose vein of lower limb%大隐静脉曲张高位结扎主干剥除术联合泡沫硬化剂治疗下肢静脉曲张的体会

    Institute of Scientific and Technical Information of China (English)

    徐庆; 肖启明; 路鹏

    2016-01-01

    Objective:To explore the curative effect of great saphenous varicose vein high ligation main stripping operation combined with foam hardening agent in the treatment of varicose vein of lower limb.Methods:36 patients with varicose vein of lower limb were selected.They were given great saphenous varicose vein high ligation main stripping operation combined with foam hardening agent.The curative effects were observed.Results:1 case was postoperative limb numbness and pain,1 case had hematoma formation after great saphenous main stripping operation.No wound infection and deep vein thrombosis were found,and no recurrence was found.Conclusion:Great saphenous varicose vein high ligation main stripping operation combined with foam hardening agent in the treatment of varicose vein of lower limb has a better treatment effect.%目的:探讨大隐静脉曲张高位结扎主干剥除术联合泡沫硬化剂治疗下肢静脉曲张疗效。方法:收治下肢静脉曲张患者36例,给予大隐静脉高位结扎主干剥除术联合泡沫硬化剂治疗,观察疗效。结果:术后患肢麻木疼痛1例,大隐静脉主干剥除后血肿形成1例,无伤口感染及深静脉血栓形成,未发现复发病例。结论:大隐静脉曲张高位结扎主干剥除术联合泡沫硬化剂治疗下肢静脉曲张具有较好的疗效。

  8. Ultrasound guided foam sclerotherapy of recurrent varices of the great and small saphenous vein: 5-year follow up

    Directory of Open Access Journals (Sweden)

    Patrizia Pavei

    2014-11-01

    Full Text Available Ultrasound guided foam sclerotherapy (UGFS proved to be effective in recurrent varices. In this observational study from 2006 and 2012 we treated 142 neovascularization, 155 inguinal recurrence and 28 popliteal recurrent varices. For neovascularization 0.3-0.5% polidocanol (POL sclerosant foam (SF was injected for vein having diameter <3 mm and 0.5-1% POL or sodium tetradecylsulphate (STS SF for higher vein diameters. The patients with residual sapheno-femoral or sapheno-popliteal junctions were treated with 1% STS SF for diameter up to 5 mm, while for larger veins 3% STS was used. From 1 to 3 sessions were necessary in both groups with 4 to 10 ml injected per session. In the group of neovascularization the 3-5years follow up revealed good results in 90.8% of the cases. In the group of popliteal recurrences the 3-5 years follow up showed 60.7% of good results, while in the group of inguinal recurrences we observed 80% of good results at 3-5 years. We did not have major complication. As minor complications we had 0.2% of gastrocnemial vein thrombosis, 0.1% of minor neurological problems, 2.8% of superficial vein thrombosis, 3.9% of pigmentation and light to mild post-treatment pain in 16.5% of the cases. In conclusion our data show that UGFS is a well tolerate technique, preferred by previously operated patients, safe and easily repeatable with good medium-term results both in case of neovascularization and of recurrence from residual femoral or popliteal stump.

  9. Comparative Study on Secondary Branches of Saphenous Vein High Lligation Combined with Electrocoagulation and Traditional Operation for Varicose Veins%次高位大隐静脉结扎联合属支电凝术与传统静脉曲张手术的对比研究

    Institute of Scientific and Technical Information of China (English)

    段学军

    2014-01-01

    Objective To investigate the time of great saphenous vein ligation combined with self-made high superiority trocar electrocoagulation of great saphenous veins.Methods Single lower limb varicosis of great saphenous vein in 81 casesdivided into modified group (28) and conventional group (53), respectively, to accept the traditional operation is of great saphenous vein high ligation and stripping of great saphenous vein and high ligation combined with self-madetrocar electrocoagulation, curative ef ect observation. Results The operationtime, bleeding volume, improved group number of the incision, incision lengthis less than the traditional group; quality of life score after operation (CIVIQ) is higher than that of the traditional group; <0.05. Conclusion High saphenous vein ligation combined with self-made trocar electrocoagulation is strippedsaphenous vein trunk, and a thorough treatment of the branches vein, simple and easy operation, smal trauma recovery, more beautiful, reflected thedevelopment direction of minimal y invasive surgery.%目的:探讨次高位大隐静脉结扎联合自制套管针电凝术治疗大隐静脉曲张的优越性。方法将单下肢大隐静脉曲张患者81例分成改良组(28例)和传统组(53例),分别接受传统手术即大隐静脉高位结扎剥脱术和次高位大隐静脉结扎联合自制简易套管针电凝术,观察疗效。结果改良组的手术时间、出血量、切口数量、切口总长度均小于传统组;术后生活质量评分(CIVIQ)高于传统组,<0.05。结论次高位大隐静脉结扎联合自制简易套管针电凝术即剥除了大隐静脉主干,同时彻底治疗了属支静脉,简便易操作,创伤小恢复快,更加美观,体现了外科的微创发展方向。

  10. 内窥镜采集大隐静脉术后下肢切口护理效果的探讨%Discussion Effect of Nursing Lower Limb Incision in Endoscopic Saphenous Vein after Operation

    Institute of Scientific and Technical Information of China (English)

    郭玉宏

    2015-01-01

    目的:探讨冠状动脉旁路移植术(CABG)中应用Medos内窥镜采集大隐静脉后下肢切口的护理效果。方法:回顾性分析300例采用Medos内窥镜采集大隐静脉行不停跳CABG患者的临床资料。观察并记录术后下肢切口的愈合情况,结痂时间,血肿、感觉麻木、伤口水泡、伤口渗液、伤口裂开等发生例数。结果:单侧下肢取大隐静脉233例,双侧下肢取大隐静脉67例,大隐静脉平均采集时间(22.50±8.40)min,大隐静脉平均采集长度(42.40±16.30)cm,下肢切口平均长度(3.90±2.51)cm,下肢切口愈合不良43例。平均结痂时间(7.04±2.14)d,下肢血肿22例、伤口水泡31例,伤口渗液12例,感觉麻木55例、伤口感染2例、伤口裂开2例,气体栓塞0例,下肢深静脉血栓形成0例。下肢切口愈合不良患者经过有效的医疗干预及护理措施均愈合。结论:正规有效的护理措施可明显改善CABG患者内窥镜取大隐静脉下肢切口的愈合情况,降低伤口并发症,促进下肢功能恢复。%Objective: To investigate the coronary artery bypass grafting (CABG) in the application of Medos endoscope nursing effect of leg wound saphenous vein after.Methods:Retrospective analysis of 300 cases clinical data using endoscope mirror saphenous vein for off-pump patients with CABG Medos. Observe and record the healing, postoperative leg incision scabs time, hematoma, feeling numb, wound blisters, wound exudate, wound dehiscence occurred cases.Results:The unilateral lower limb from the saphenous vein in 233 cases, bilateral lower extremity saphenous vein harvesting great saphenous vein in 67 cases, the average acquisition time (22.50±8.40) min, the average length of saphenous vein collection (42.40±16.30) cm, the average length of leg wound (3.90±2.51) cm, poor wound healing in 43 cases of lower extremity. The average time to crusting (7.04±2.14) d, lower extremity hematoma

  11. Pathological alterations of the first venous valve in great saphenous varicose vein%曲张病变大隐静脉第一对瓣膜的病理改变

    Institute of Scientific and Technical Information of China (English)

    王鑫; 乔彤

    2011-01-01

    Objective To investigate the pathological alterations of the first valve in great saphenous varicose vein. Methods The pathological chnges in the first valve of 24 great saphenous varicose veins(group A) and 3 normal great saphenous veins were observed with HE and Sirius red staining. CD31 and α-SMA were detected using immunohistochemistry as well Results Compared to group C, valves of group A appeared to be twisted and lengthened with hyperplasia of collagen fiberand,different expressions of CD31 in endothelium cells on two sides and highly expressed α-SMA (P<0.05). Conclusion Significant alterations in morphology, structure,endothelium in the first valve of great saphenous varicose vein are seen, which may play an important role in the pathogenesis of primary varicose veins.%目的 探讨曲张病变大隐静脉第一对瓣膜的病理改变.方法 大隐静脉曲张(A)组24例,正常对照(C)组3例,分别采用HE、SiriusRed染色及CD31、α-SMA免疫组织化学法检测大隐静脉第一对静脉瓣在曲张病变中的病理改变.结果 与C组比较,A组静脉瓣膜延伸变长、扭曲变形,伴胶原纤维增生,瓣膜两侧内皮细胞表达CD31不一致(P<0.05),并异常高表达α-SMA(P<0.05).结论 曲张大隐静脉中瓣膜的形态、结构、内皮均发生了明显病理改变,提示静脉瓣膜的这些改变在下肢静脉曲张的发病机制中起重要作用.

  12. Mapping the methylation status of the miR-145 promoter in saphenous vein smooth muscle cells from individuals with type 2 diabetes.

    Science.gov (United States)

    Riches, Kirsten; Huntriss, John; Keeble, Claire; Wood, Ian C; O'Regan, David J; Turner, Neil A; Porter, Karen E

    2017-03-01

    Type 2 diabetes mellitus prevalence is growing globally, and the leading cause of mortality in these patients is cardiovascular disease. Epigenetic mechanisms such as microRNAs (miRs) and DNA methylation may contribute to complications of type 2 diabetes mellitus. We discovered an aberrant type 2 diabetes mellitus-smooth muscle cell phenotype driven by persistent up-regulation of miR-145. This study aimed to determine whether elevated expression was due to changes in methylation at the miR-145 promoter. Smooth muscle cells were cultured from saphenous veins of 22 non-diabetic and 22 type 2 diabetes mellitus donors. DNA was extracted, bisulphite treated and pyrosequencing used to interrogate methylation at 11 CpG sites within the miR-145 promoter. Inter-patient variation was high irrespective of type 2 diabetes mellitus. Differential methylation trends were apparent between non-diabetic and type 2 diabetes mellitus-smooth muscle cells at most sites but were not statistically significant. Methylation at CpGs -112 and -106 was consistently lower than all other sites explored in non-diabetic and type 2 diabetes mellitus-smooth muscle cells. Finally, miR-145 expression per se was not correlated with methylation levels observed at any site. The persistent up-regulation of miR-145 observed in type 2 diabetes mellitus-smooth muscle cells is not related to methylation at the miR-145 promoter. Crucially, miR-145 methylation is highly variable between patients, serving as a cautionary note for future studies of this region in primary human cell types.

  13. Relationship between Serum Albumin Level and Monocyte-to-High-Density Lipoprotein Cholesterol Ratio with Saphenous Vein Graft Disease in Coronary Bypass.

    Science.gov (United States)

    Akboga, Mehmet Kadri; Yayla, Cagri; Balci, Kevser Gulcihan; Ozeke, Ozcan; Maden, Orhan; Kisacik, Halil; Temizhan, Ahmet; Aydogdu, Sinan

    2017-06-01

    Background Previous studies proposed that inflammation, oxidative stress, and impaired endothelial dysfunction have a crucial role in occurrence of saphenous vein graft (SVG) disease (SVGD). The aim of this study was to assess the relationship between monocyte-to-high-density lipoprotein cholesterol (HDL-C) ratio (MHR) and serum albumin (SA) level as readily available inflammatory and oxidative stress markers with the presence of SVGD in patients with a coronary bypass. Methods In this retrospective cross-sectional study, a total of 257 patients (n = 112 SVGD [+] [mean age was 65.3 ± 8.4 years, 75.0% males] and n = 145 SVGD [-] [mean age was 66.5 ± 10.1 years, 74.5% males]) were enrolled. At least one SVG with ≥ 50% stenosis was defined as SVGD. Independent predictors of SVGD were determined by logistic regression analysis. Results White blood cell, neutrophil, monocyte, the age of SVG, and MHR were significantly higher, whereas SA level was significantly lower in patients with SVGD. In regression analysis, neutrophil, age of SVG, SA (odds ratio [OR]: 0.232 [0.156-0.370], p MHR (OR: 1.122 [1.072-1.174], p MHR (r = 0.238, p MHR has a 71.4% sensitivity and 60.0% specificity for prediction of SVGD. Conclusion Consequently, to the best of our knowledge, this is the first study showing a significant and independent association between SA and MHR with SVGD. Georg Thieme Verlag KG Stuttgart · New York.

  14. Feasibility, safety, and preliminary efficacy of a novel ePTFE-covered self-expanding stent in saphenous vein graft lesions: the Symbiot II trial.

    Science.gov (United States)

    Laarman, Gerrit J; Kiemeneij, Ferdinand; Mueller, Ralf; Guagliumi, Giuglio; Cobaugh, Michael; Serruys, Patrick W

    2005-03-01

    Compared with percutaneous interventions in native coronary arteries, revascularization of saphenous vein graft (SVG) lesions is associated with increased rates of immediate and long-term major adverse cardiac events (MACE). The Symbiot II trial was a multicenter prospective study designed to evaluate the feasibility and safety of a novel self-expanding polytetrafluoroethylene (ePTFE)-covered stent in the treatment of de novo and restenotic SVG lesions. The primary endpoint was MACE through 30 days postprocedure. Successful Symbiot stent deployment was achieved in 75 of 77 patients (97.4%) with SVG lesions < or = 35 mm in length (visual assessment). The procedural success rate (defined as < 30% residual stenosis at the target site and no clinical complications) was 83%, and all study device procedures provided grade 3 TIMI flow postprocedure. Within the first 30 days postprocedure, four patients (5.2%) experienced MACE (defined as death, Q-wave or non-Q-wave myocardial infarction, and clinically driven target vessel revascularization), of whom three patients (3.9%) experienced periprocedural non-Q-wave myocardial infarction. No subacute stent thrombosis was observed over the 6-month follow-up period. No relevant luminal loss at the target site (mean, 0.3 +/- 0.9 mm) was observed in the 58 patients (77.3% of enrolled patients) who underwent quantitative coronary angiography at 6 months. The incidences of binary in-stent restenosis, in-segment restenosis, and target vessel failure (defined as acute and late-term MACE through 6 months postprocedure) were low (7.0%, 8.6%, and 14.3%, respectively). The Symbiot self-expanding ePTFE membrane-covered stent was associated with a high procedural success rate (97.4%), low incidences of MACE at 30 days (5.2%) and 6 months (14.3%), suggesting that it is safe and effective in the treatment of SVG disease.

  15. The Efficacy of Low Molecular Weight Heparin in Prevention Deep of Vein Thrombosis after the Operation of Great Saphenous Varicose Vein%低分子肝素在预防大隐静脉曲张术后患肢深静脉血栓形成中的作用

    Institute of Scientific and Technical Information of China (English)

    董春锋; 王苏杭

    2012-01-01

    目的 探讨低分子肝素在预防大隐静脉曲张术后患肢深静脉血栓形成中的作用.方法 分析200例大隐静脉曲张术后应用低分子肝素抗凝患者(观察组)及200例术后未应用低分子肝素抗凝患者(对照组)下肢深静脉血栓形成发生情况及术后患肢皮下血肿的发生情况.结果 两组患者术后患肢深静脉血栓形成的发生率比较差异有统计学意义(P0.05).结论 大隐静脉曲张术后应用低分子肝素抗凝治疗,可显著降低下肢深静脉血栓形成的发生,同时不增加患肢术后出血的风险.%Objective To investigate the efficacy of low molecular weight heparin in prevention deep vein thrombosis( DVT )after the operation of great saphenous varicose vein. Methods The DVT incidence of 200 case of great saphenous varicose vein who were given low molecular weight heparin after operation( observation group )and 200 case of great saphenous varicose vein who were not given low molecular weight heparin after operation( control group )were analyzed, and the incidence of subcutaneous hematoma of the two groups were observed. Results There was significant difference between the two groups in DVT incidence ( P 0.05 ). Conclusion The therapy of the low molecular weight heparin after the operation of great saphenous varicose vein can reduce the incidence of DVT,without increasing the incidence of subcutaneous hematoma.

  16. 大隐静脉高位结扎联合剥脱术治疗原发性大隐静脉曲张的疗效观察%Curative Effect Observation on Great Saphenous Vein High Ligation Joint Peeling Treatment of Primary Great Saphenous Varicose Veins

    Institute of Scientific and Technical Information of China (English)

    王晓

    2014-01-01

    目的:评价改良后的大隐静脉曲张高位结扎联合剥脱术在治疗原发性大隐静脉曲张中的疗效。方法:选取2010年9月到2012年10月于我院收治的50例原发性大隐静脉曲张患者,按照患者入院编号,随机分为常规组和改良组,每组25例,比较两组患者药物治疗的疗效以及住院时间、手术时间、出血量等各项指标。结果:常规组患者的总治愈率为80%,手术时间为(54.5±6.3)h,住院时间为(7.2±1.2)d,手术过程中出血量为(133.4±4.4)ml;改良组患者的总治愈率为96%,手术时间为(54.5±6.3)h,住院时间为(6.1±0.9)d,手术过程中出血量为(25.6±1.3)ml;改良组患者治疗效果、手术时间、手术出血量以及住院时间均比常规组要好,组间比较均存在明显差异(P<0.05)。结论:采用改良方法能明显提高患者治愈率,缩短手术以及治疗时间,减少治疗过程中的出血量,降低手术风险。%Objective:To evaluate the modified great saphenous varicose vein high ligation joint peeling technique in the efficacy of the treatment of primary great saphenous varicose veins. Methods:To choose in September 2010 to October 2012 in our hospital of 50 patients of primary great saphenous varicose veins, according to the patients admitted to hospital number, were randomly divided into normal group and improvement group, 25 cases in each group, compare the curative effect of two groups of patients with medication and hospitalization time, operation time, blood loss and other indicators. Results:The routine group of patients with total cure rate was 80%, operation time for (54.5±6.3)h, length of hospital stay for (7.2±1.2)d, blood loss during surgery for (133.4±4.4)ml;Improved group of patients with total cure rate was 96%, operation time for (54.5±6.3)h, length of hospital stay for (6.1±0.9)d, blood loss during surgery for (25.6±1.3)ml;Group of patients improved treatment effect, operation time, surgical blood loss

  17. The experience of blood drive belt used in the operation of varicose great saphenous vein%驱血带在大隐静脉曲张手术中的应用体会

    Institute of Scientific and Technical Information of China (English)

    姚建国

    2015-01-01

    Objective:To summarize the advantages of using blood drive belt in the operation of varicose great saphenous vein. Methods:68 patients with varicose great saphenous vein were selected from August 2008 to August 2014.All of those patients were unilateral great saphenous varicose veins.They were randomly divided into two groups.The first groups of 34 cases took operation after drive blood using blood drive belt,and the second groups of 34 cases took operation directly without using blood drive belt. Results:The operation time of the first group was averaged 43 min,the bleeding volume was averaged 30 mL.While in the second group,the operation time was averaged 62 min,and the bleeding volume was averaged 90 mL.Conclusion:Using of blood drive belt in the operation of varicose great saphenous vein can significantly shorten the operation time,and significantly reduced bleeding, meanwhile,the method of operation is simple,so it is worthy of popularization.%目的:总结在大隐静脉曲张手术中应用驱血带的优点。方法:2008年8月-2014年8月收治大隐静脉曲张患者68例,均为单侧大隐静脉曲张,将患者随机平均分成两组,第1组34例采用驱血带驱血后进行手术,第2组34例不采用驱血带驱血,直接进行手术。结果:第1组平均手术时间43 min,平均出血量30 mL。第2组平均手术时间62 min,平均出血量90 mL。结论:在大隐静脉曲张手术中使用驱血带,不仅手术时间明显缩短,出血量明显减少,而且操作方法简单,值得在各级医院推广使用。

  18. Estenose do enxerto de veia safena magna reversa em revascularização arterial infrainguinal Stenosis of reverse great saphenous vein graft in infrainguinal arterial revascularization

    Directory of Open Access Journals (Sweden)

    Francesco Evangelista Botelho

    2011-04-01

    infrainguinal bypasses stenosis using reverse great saphenous vein graft. METHODS: From March of 2008 to March of 2009, 56 infrainguinal bypasses were performed with reverse great saphenous vein graft in 56 patients. On the 30th post-operative day, 32 out of 56 patients were submitted to vascular ultrasonography. The prevalence of significant graft stenosis was determined. In addition, the diagnosis of stenosis was related to the clinical and surgical characteristics of the patients. The variables analyzed at the moment of diagnosis were the localization of the graft stenosis, the risk factors associated with stenosis and the association of vascular ultrasonography findings with ankle brachial pressure index (ABI. RESULTS: The overall prevalence of significant graft stenosis was 48.4%. Out of the total number of observed stenosis, 19.4% were considered severe, and 29% mild or moderate. There was no significant association between the presence of significant stenosis and the following variables: gender, diabetes, hypertension, smoking, hipercholesterolemia, graft diameter, site of the distal anastomosis, and graft composition. There was a weak agreement between ABI and vascular ultrasonography in detecting stenosis in general (K = 0.30; CL95% 0.232 - 0.473; p = 0.018. However, there was a substantial agreement in detecting severe stenosis (K = 0.75; CL95% 0.655 - 0.811; p = 0.0001. CONCLUSION: There was a high prevalence of stenosis on the 30th post-operative day, mostly localized in the proximal half of the vein graft. There was no significant association of stenosis with clinical and surgical factors analyzed. ABI and vascular ultrasonography had weak agreement with the diagnosis of stenosis in general and an important agreement for the diagnosis of severe stenosis.

  19. Effects of aggressive statin therapy on patients with coronary saphenous vein bypass grafts: a systematic review and meta-analysis of randomized, controlled trials.

    Science.gov (United States)

    Kang, Sheng; Liu, Yong; Liu, Xue-bo

    2013-08-01

    The aim of this study was to investigate the effectiveness and safety of aggressive statin versus moderate statin therapy on patients with saphenous vein grafts (SVGs) in randomized, controlled trials (RCTs). We searched MEDLINE (1980-June 2012), the Cochrane Controlled Trials Register, EMBASE, Science Citation Index, and PubMed (to June 2012), and found 10 relevant RCTs, including 7 substudy analyses from a Post-CABG trial, and 1 pooled analysis of the PROVE-IT TIMI 22 trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators) and A to Z trial. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes; phase Z of the A to Z trial. A total of 6645 of participants, ages ranging from 21 to 75 years old, were treated with coronary artery bypass graft (CABG) and were followed for 2 to 5 years. Eight studies showed that aggressive statin therapy had lower LDL-C levels and a decrease of 39% in graft atherosclerotic progression, 12% in new occlusions, and 19% in new lesions more than moderate statin therapy. Three reports indicated that aggressive statin therapy lowered the risk of repeated myocardial infarction more than moderate statin therapy for coronary revascularization (95% CI, 0.66-0.95; risk ratio [RR] = 0.80; and 95% CI, 0.66-0.85; RR = 0.75) and lowered the risk of cardiac death as well (95% CI, 0.64-1.08; RR = 0.83). Aggressive statin therapy had safety similar to that of moderate statin therapy except for a slight increase in myopathic events and aminotransferase levels. Seventy percent to 90% of patients took statin treatment as prescribed in long-term. Compared with moderate statin therapy, long-term aggressive statin lowered the LDL-C level significantly, further decreased the atherosclerotic progression of SVG, reduced the risks of repeated myocardial infarction and coronary revascularization after CABG, and revealed similar patient compliance

  20. Relationship between the diameter of great saphenous vein and body mass index Relação entre o diâmetro da veia safena magna e o índice de massa corporal

    Directory of Open Access Journals (Sweden)

    Amélia C. Seidel

    2005-09-01

    Full Text Available OBJECTIVE: This study has been designed to correlate the diameter of the greater saphenous vein in different levels of the lower limbs with the body mass index of each individual to determine a possible relation between them. METHODS: Fifty-two lower limbs in 26 volunteers (six males and 20 females without a chronic venous disease record, aged 21-68 were evaluated. Prior to color-flow duplex scanning the body mass index was defined. The deep and superficial venous systems and perforator veins were assessed as described in the literature. The diameter of the greater saphenous vein was measured with ultrasound longitudinal imaging in seven different levels. For the statistical analysis, Student t test for paired data and Spearman test were used. RESULTS: The difference observed in saphenous venous in the second and third levels when compared to the lower right and left limbs was not considered significant and a single group was formed to correlate with body mass index. The correlation was considered statistically irrelevant. CONCLUSION: By correlating the diameters of the greater saphenous vein with the body mass index of each individual it was noted that the relation between them is not significant, therefore it can be assumed that tall thin individuals can have greater saphenous vein with similar diameter as short fat individuals.OBJETIVO: Este estudo teve o objetivo de comparar o diâmetro da veia safena magna em diferentes níveis dos membros inferiores e o índice de massa corporal dos sujeitos para determinar uma possível relação entre esses fatores. MÉTODOS: Cinqüenta e dois membros inferiores de 26 voluntários (seis homens e 20 mulheres sem registro de doença venosa crônica, com idades entre 21 e 68 anos, foram avaliados. O índice de massa corporal foi definido antes do eco-Doppler colorido. Os sistemas venosos superficial e profundo e as veias perfurantes foram avaliados de acordo com a literatura. O diâmetro da veia safena

  1. Study on the Effect of Small-incision Saphenous Vein Stripping Operation Combined With Foam Sclerotherapy Injection in Treatment of Varicose Veins of Lower Extremity%小切口大隐静脉剥脱术联合泡沫硬化剂注射治疗下肢浅静脉曲张的效果研究

    Institute of Scientific and Technical Information of China (English)

    张海龙; 李谊佳; 陈昊泽

    2016-01-01

    Objective Effect of smal-incision saphenous vein stripping operation combined with foam sclerotherapy injection in treatment of varicose veins of lower extremity is to be studied.Methods Chose 52 patients with varicose veins of lower extremity who were treated in hospital from January to December 2015 and separated them into control group(small-incision saphenous vein stripping operation)and study group(small-incision saphenous vein stripping operation combined with foam sclerotherapy injection treatment)by drawing lottery and then compared treatment effects between two groups.Results Patients’every physical index was much better,treatment efficacy was higher and infection rate was much lower in study group than counterparts in control group,there was a differential between these two groups,and such a differential had statistic value(P<0.05). ConclusionSmal-incision saphenous vein stripping operation combined with foam sclerotherapy injection is quiet effective in treatment of varicose veins of lower extremity.%目的:研究小切口大隐静脉剥脱术联合泡沫硬化剂注射治疗下肢浅静脉曲张的疗效。方法研究年度2015年1~12月,研究对象为下肢浅静脉曲张患者52例,给予抽签分组。对照组(小切口大隐静脉剥脱术)和研究组(小切口大隐静脉剥脱术联合泡沫硬化剂注射),对比两组疗效。结果两组中研究组各项指标优,治疗有效率高,感染率低,差异有统计学意义(P<0.05)。结论下肢浅静脉曲张采用小切口大隐静脉剥脱术联合泡沫硬化剂注射治疗,疗效确切。

  2. 大隐静脉高位结扎剥落加局部电凝术对下肢静脉曲张的治疗效果探讨%To Explore the Curative Effect of High Ligation of Great Saphenous Vein Stripping and Bureau of Electrocoagulation on Varicose Veins of Lower Extremity

    Institute of Scientific and Technical Information of China (English)

    潘清文; 叶永生; 陈哲

    2014-01-01

    目的:探讨分析大隐静脉高位结扎剥落加局部电凝术对下肢静脉曲张的临床治疗效果。方法选取在我院接受治疗的59例下肢静脉曲张患者为研究对象,将其随机分成观察组和对照组,观察组30例,对照组29例,观察组实施大隐静脉高位结扎剥落加局电凝术治疗,对照组实施传统大隐静脉高位结扎加分段抽剥手术治疗,分析两组患者的治疗效果。结果观察组总有效率为75.86%,对照组总有效率为93.33%,观察组效果尤为明…显,P <0.05。结论对下肢静脉曲张患者实施大隐静脉高位结扎剥落加局部电凝术治疗具有显著的临床效果。%Objective To investigate the clinical analysis of curative effect of high ligation of great saphenous vein stripping plus local electrocoagulation for varicose veins of lower extremity. Methods 59 patients with varicose vein of lower extremity patients were treated in our hospital as the research object, and were randomly divided into the observation group and control group, 30 cases in observation group, 29 cases in the control group, the observation group to implement the high ligation of great saphenous vein stripping and bureau of electric coagulation treatment, the control group received traditional great saphenous vein high ligation sectional stripping operation treatment, of the two groups of patients with treatment effect. Results the total effective rate of observation group was 75.86%, the control group the total effective rate was 93.33%, the observation group effect is particularly obvious, P<0.05. Conclusion The clinical effect was significant with in patients with lower extremity varicose vein high ligation of great saphenous vein stripping and implementation of local electric coagulation treatment, worthy of clinical application.

  3. Varicose vein stripping

    Science.gov (United States)

    ... vein stripping; Venous reflux - vein stripping; Venous ulcer - veins Images Circulatory system References American Family Physician. Management of varicose veins. www.aafp.org/afp/2008/1201/p1289.html . ...

  4. [RADIOFREQUENCY ABLATION FOR THE TREATMENT OF VARICOSE VEINS].

    Science.gov (United States)

    Sugiyama, Satoru; Miyade, Yoshio; Inaki, Yasuhiko

    2015-05-01

    Significant advances in the endovenous technique for treating incompetent saphenous veins could change the surgical strategy in patients with varicose veins. Radiofrequency ablation (RFA) was approved as a new technique for the treatment of varicose veins in Japan in June 2014. In RFA, the ablation temperature is controlled by a sensor at the upper end of the catheter. The vein wall is heated with stable conductive power of 120 degrees C, resulting in endothelial denudation. The RFA method was approved in 1998 in Europe and in 1999 in the USA. The ClosurePLUS catheter was developed in 2003 and ClosureFAST in 2006. High occlusion rates and lower postoperative complication rates were reported with ClosureFAST than with ClosurePLUS. It is expected that this new ablation technique will control saphenous vein reflux with less pain and less ecchymosis after surgery. The treatment of varicose veins is less invasive with RFA devices and will become widely accepted as an alternative to conventional surgery for varicose veins in Japan.

  5. 血管内激光光凝治疗大隐静脉曲张的超微结构观察%Ultrastructure of the varicose great saphenous vein after the treatment with intravascular laser occlusion

    Institute of Scientific and Technical Information of China (English)

    陈筱春; 文质君

    2005-01-01

    背景:血管内光凝治疗大隐静脉曲张的机制研究尚少.目的:探讨血管内光凝对曲张大隐静脉超微结构的改变.设计:观察性研究.单位:解放军总医院激光科.对象:2004-01/04,解放军总医院门诊大隐静脉曲张并行血管内激光治疗的患者42例.纳入标准:取踝部明显曲张而无明显血栓形成,表面皮肤完好,无明显营养性障碍的大隐静脉,患者均自愿参加,纳入9例.干预:采用810 nm波长激光器,功率为12 W,暴光时间1 s,血管内光凝治疗曲张大隐静脉,3 h后取踝部光凝血管.主要观察指标:行组织病理学检查观察光凝后血管超微结构变化.以正常静脉和治疗前曲张静脉作为对照.结果:正常静脉分三层,内膜为单层血管内皮细胞,中膜为平滑肌细胞、弹力纤维和胶原纤维等,外膜为一疏松排列的结缔组织.曲张静脉组织学检查见内膜不完整,内皮细胞之间连接疏松,平滑肌细胞增生,肥厚或萎缩,弹力纤维减少,胶原纤维增多.光凝后管腔内可见大量血细胞,血小板扁平,伸出伪足,贴附于胶原表面.血管内皮细胞和靠近管腔部位的平滑肌细胞结构破坏,细胞浆外溢,和细胞外基质融合;靠近血管腔部位的弹力纤维和胶原纤维断裂,部分脱落于管腔;靠近外膜部位的弹力纤维和胶原纤维和外膜结构没有改变.结论:激光光凝治疗静脉曲张引起内膜和部分中膜结构破坏,大量血细胞聚集于管腔,促进血小板附着于血管壁.%BACKGROUND: Studies about the mechanism of laser occlusion on the varicose great saphenous vein are rare.OBJECTIVE: To explore the ultrastructural changes of the great varicose saphnous vein after it was occluded with laser.DESIGN: An observational study.SETTING: Laser Department of the General Hospital of Chinese PLA .PARTICI PANTS: There were 42 patients with varicose great saphenous veins that were occluded with laser in clinic of the General Hospital of

  6. 大隐静脉曲张手术所致严重血管损伤的治疗%The management of severe vascular injuries caused by stripping of great saphenous vein varicosis

    Institute of Scientific and Technical Information of China (English)

    程志华; 王宏飞; 陈光; 赵文光; 王嘉桔

    2010-01-01

    目的 总结大隐静脉曲张手术导致严重血管损伤并发症的治疗经验.方法 回顾性分析2004年12月至2009年4月收治的4例(5条肢体)大隐静脉曲张手术发生严重血管损伤患者的临床资料.对1条股总动脉末端至胫后动脉上段动脉被剥脱的肢体应用人工血管行动脉重建术,术后肢体坏疽行膝上截肢术;对3条股浅动脉被剥脱10~15 cm的肢体取自体大隐静脉行动脉重建术,术后5 d对1条坏死肢体行膝上截肢术.1条股浅静脉被切除2 cm的肢体取自体大隐静脉行股浅静脉重建术.结果 4例患者中,围手术期无死亡病例,4条动脉损伤肢体中2条肢体(50%)行膝上截肢术;2条肢体(50%)得到保伞,随访12~46个月,平均29个月,血管通畅良好.1例股浅静脉损伤患者恢复良好.结论 提高对医源性血管损伤的认识,术中规范操作,辨明解剖,可以减少和预防严重血管并发症的发生;一旦有血管损伤应早期而有效的处理.%Objective To summarize our experience on the treatment for severe vascular injuries in the operation of great saphenous varicose vein. Methods The clinical data of 4 cases (5 lower limbs) from December 2004 to April 2009 of severe vascular injuries were retrospectively analyzed. For the lower limbs in which from the end of femoral artery to the upper part of posterior tibial artery were stripped, reconstruction operation using blood vessel prothesis was performed, above knee amputation was performed because of limb gangrene. For three limbs in which 10 cm to 15 cm superficial femoral artery were stripped, reconstruction operation using autologous saphenous vein were performed, above knee amputation was performed for one limb 5 days after the operation. For the limb in which 2 cm superficial femoral vein were cut, reconstruction operation using autologous saphenous vein were performed. Results No cases died perioperatively,for four limbs of injuried artery, ampution were performed

  7. Clinical Efficacy of the Lower Leg Section Reserved thigh Saphenous Vein Stripping Segment Surgical for Elderly Patients with Varicose Veins of Lower Extremity%老年人下肢静脉曲张患者保留小腿段大隐静脉大腿段剥脱术的临床效果

    Institute of Scientific and Technical Information of China (English)

    王兵

    2016-01-01

    目的:观察老年人下肢静脉曲张应用保留小腿段大隐静脉大腿段剥脱术的效果。方法选取2014年3月~2015年3月本院接收的86例下肢静脉曲张患者,随机分作研究组与传统组,每组43例,分别行大隐静脉大腿段剥脱术联合小腿曲张静脉剥脱术、传统大隐静脉高位结扎及全段剥脱术治疗,比较两组手术效果。结果研究组患者平均术中失血量、术程、住院时间分别为(30.52±4.23)ml、(45.40±5.65) min、(4.25±0.36)d;传统组分别为(75.23±5.12)ml、(65.55±6.24) min、(12.36±0.42)d,研究组平均术中失血量、术程、住院时间均较传统组少,差异具统计学意义(P<0.01);研究组并发症发生率与术后1年复发率分别为6.98%与0,传统组分别为23.26%与13.95%,研究组并发症发生率更低,差异具统计学意义(P<0.05)。结论老年下肢静脉曲张应用保留小腿段大隐静脉大腿段剥脱术治疗效果理想,值得应用。%Objective To discuss the clinical efficacy of the lower leg section reserved thigh saphenous vein stripping segment surgical for elderly patients with varicose veins of lower extremity.Methods Selected 86 cases with varicose veins from Mar 2013 to Mar 2014 were randomly divided into study group and the conventional group, each of 43 cases. Study group was treated with the great saphenous vein stripping surgery combined with calf thigh section stripping of varicose veins, and conventional group was treated with the traditional great saphenous vein high ligation and stripping of intact. Clinical efifcacy of two groups was compared.Results Study patients mean intraoperative blood loss, surgery process, duration of hospitalization was (30.52 ± 4.23)ml, (45.40 ± 5.65)min, (4.25 ± 0.36) d; conventional group were (75.23 ± 5.12)ml, (65.55 ± 6.24)min, (12.36 ± 0.42)d, and study group mean intraoperative blood loss, surgery process, length of stay

  8. Analysis of the Clinical Effect of Punctate Stripping in the Treatment of Great Saphenous Varicose Veins%分析点状抽剥在大隐静脉曲张治疗中的临床效果

    Institute of Scientific and Technical Information of China (English)

    祖连平

    2015-01-01

    Objective To explore the clinical effect of punctate stripping in the treatment of great saphenous varicose veins. Methods 50 cases with great saphenous varicose veins admitted in Department of Varicose Veins of our hospital from March 2013 to March 2015 were selected as the subjects and randomly divided into two groups with 25 cases in each. Pa-tients in the control group were treated by cutting and stripping surgery, while those in the observation group were treated by punctate stripping surgery. And the treatment effect of two groups was compared. Results The operation time of the ob-servation group was (43.0±7.8) min, and that of the control group was (60.0±13) min; the amount of intraoperative blood transfusion of the observation group was (53.1±15.1)mL, and that of the control group was (135.0±33.8) mL; the length of hospital stay of the observation group was (7.1±2.1)d, and that of the control group was (9.5±2.5)d, the differences between the two groups were statistically significant (P<0.05). Conclusion Punctate stripping for great saphenous varicose veins can effectively improve the treatment effect, so it is worthy of promotion and application.%目的:探讨在大隐静脉曲张中使用下段点状抽剥治疗的临床效果。方法整群选取该院2013年3月—2015年3月静脉曲张专科中大隐静脉曲张50例患者为研究对象,随机分为2组,每组25例。对照组应用切开剥除技术,观察组应用点状抽剥技术,对比两组的治疗效果。结果观察观察组手术时间为(43.0±7.8) min,对照组手术时间为(60.0±13)min;对照组术中输血量为(135.0±33.8) ml,观察组术中输血量为(53.1±15.1) ml;对照组住院时间为(9.5±2.5) d,观察组住院时间为(7.1±2.1) d,差异有统计学意义(P<0.05)。结论应用点状抽剥技术能有效提高病症治疗量,值得在临床进行推广使用。

  9. Utilização da safena magna in situ para arterialização do arco venoso do pé The great saphenous vein in situ for the arterialization of the venous arch of the foot

    Directory of Open Access Journals (Sweden)

    Cesar Roberto Busato

    2010-09-01

    Full Text Available CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO, 6 com tromboangeíte obliterante (TO e 1 com trombose de aneurisma de artéria poplítea (TA foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6% mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9% foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5%. CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO, 6 with thromboangiitis obliterans (TO and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point

  10. Embolia atrial de trombo flutuante da veia safena magna após escleroterapia com microespuma ecoguiada Atrial embolism of floating thrombus of the great saphenous vein after microfoam ultrasound-guided sclerotherapy

    Directory of Open Access Journals (Sweden)

    Rubens Pierry Ferreira Lopes

    2010-12-01

    Full Text Available A escleroterapia com microespuma vem sendo utilizada amplamente no tratamento da doença venosa varicosa. No entanto, a despeito da sua pouca invasividade e segurança, complicações potencialmente graves e letais já foram descritas, como o acidente vascular cerebral e parada cardiorrespiratória. Descrevemos um caso de embolia atrial tardia de trombo flutuante da junção safeno-femoral de veia safena magna varicosa, após escleroterapia com microespuma de polidocanol guiada por ultrassom, e o tratamento dessa complicação.Microfoam sclerotherapy has been widely used in the treatment of varicose vein disease. However, despite its low invasiveness and safety, potentially serious and lethal complications have been described, such as stroke and cardiorespiratory arrest. We describe a case of delayed atrial embolism of floating thrombus in the saphenofemoral junction of a great saphenous varicose vein after microfoam ultrasound-guided sclerotherapy, as well as the treatment of this complication.

  11. Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density

    Directory of Open Access Journals (Sweden)

    Walter Junior Boim Araujo

    2015-12-01

    Full Text Available Abstract Background Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives To determine great saphenous vein (GSV occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method Nineteen patients (31 GSVs underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS, and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results Mean patient age was 46 years and 17 of the patients were female (89.47%. Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.

  12. 大隐静脉抽剥对下肢深静脉瓣膜功能的影响%Effect of deep venous valve function after the stripping of saphenous vein

    Institute of Scientific and Technical Information of China (English)

    曾昕明; 王鹏程; 赵军

    2010-01-01

    目的 研究大隐静脉激抽剥术治疗下肢慢性静脉功能不全对改善深静脉瓣膜功能的作用.方法 收集45例(50条肢体)住院治疗的下肢下肢慢性静脉功能不全的患者,行大隐静脉高位结扎剥脱术.所有患者术前均经过双功能彩色多普勒超声检查记录深静脉血流动力学指标,手术后3个月对患者进行随访,比较手术前后深静脉瓣膜功能是否有改善及改善的程度.结果 除6例共7条患肢术后3个月未见明显降低级别外,其余患肢所有患肢术后均出现深静脉功能级别下降1级或1级以上;术前深静脉功能记分为139,术后3个月降到93,差异有显著性(P<0.01).血流动力学指数(股浅静脉第一对瓣膜返流时间与返流最大流速)术后均显著改善(P<0.05).结论 大隐静脉激抽剥术治疗下肢慢性静脉功能不全的有效术式,并且确实可以在一定程度上改善深静脉瓣膜功能.%Objective To evaluate the effect on deep venous valve function after proximal saphenous vein ligation and ablation of varicose veins in treatment of chronic venous insufficiency (CVI) of lower limbs.Methods Forty five(50 limbs)cases with CVI were enrolled to accept surgical management of vein systems.Each patient was detected with Color Doppler Ultra sonography, whose deep venous hemodynamics index was measured and recorded pre-operation and three month after operation. Results Except 6 ( 7 limbs) cases without degradation of deep venous valve function class post operation, the others cases are all decrease one or more. The scoring of deep venous valve function post operation are significantly decrease from 139 (pre-operation)to 93 (P<0. 01 ). The index of deep venous hemodynamics( back flow time and peak flow rate of back flow)has prominent improvement after operation(P< 0 05). Conclusion It is effective way of proximal saphenous vein ligation and ablation of varicose veins in treatment of CVI and it is confirmed that it can

  13. Aberrant expression of Tiel gene in venous valves in great saphenous varicose vein%Tiel基因在曲张大隐静脉瓣膜的异常表达

    Institute of Scientific and Technical Information of China (English)

    王鑫; 乔彤; 刘长建

    2012-01-01

    Objective To investigate the aberrant expression of Tiel gene in venous valves in great saphenous varicose vein,and its role in pathogenesis of varicose vein of lower extremity.Methods Varicose veins group ( 15 samples) and normal control group ( 11 samples) were set up.By using immunohistochemistry staining,the expression of CD31 and Tiel in the first valves in great saphenous veins was detected.Western blotting was used to check the expression of Tiel protein in venous valves.Results In normal control group valves,there was no difference between proximal and distal sides endothelium in expressing CD31 (P > 0.05 ).The proximal side endothelium expressed Tie1 stronger than distal side at the basal part (P < 0.05 ),but this difference was not found at valve cusp (P > 0.05 ).In varicose veins group,besides morphological changes of valves,the proximal side endothelia expressed CD31 weaker than diatal side endothelia ( P < 0.05 ),and expressed Tiel much weaker than diatal side endothelia ( P <0.01 ).The expression of Tiel protein was undetectable in venous valves.Conclusion The decreased expression of Tiel in proximal side of venous valves may play a role in the pathogenesis of primary lower extremity varicose veins.%目的 观察下肢静脉曲张疾病中,Tiel基因在曲张大隐静脉第1对瓣膜中的异常表达,探讨其与下肢静脉曲张发病机制之间的关系.方法 大隐静脉曲张组15例,正常对照组11例;用免疫组织化学法检测大隐静脉第一对瓣膜CD31及Tiel的表达,并用Western blot检测瓣膜中Tiel蛋白的表达.结果 正常对照组中瓣膜两侧内皮细胞表达CD31差异无统计学意义(P>0.05),在瓣膜根部近心侧内皮细胞表达Tiel强于远心侧(P<0.05),但在瓣膜尖部差异无统计学意义(P>0.05);静脉曲张组中瓣膜除了形态发生变化外,瓣膜近心侧内皮细胞CD31的表达稍弱于远心侧(P<0.05),而Tiel的表达显著弱于远心侧(P<0.01);Western blot

  14. Association between the Hypomethylation of Osteopontin and Integrin β3 Promoters and Vascular Smooth Muscle Cell Phenotype Switching in Great Saphenous Varicose Veins

    Directory of Open Access Journals (Sweden)

    Han Jiang

    2014-10-01

    Full Text Available Lower extremity varicose veins are a common condition in vascular surgery and proliferation of vascular smooth muscle cells (VSMCs in the intima is a significant pathological feature of varicosity. However, the pathogenesis of varicose veins is not fully understood. Osteopontin (OPN could promote the migration and adhesion of VSMCs through the cell surface receptor integrin β3 and the cooperation of OPN and integrin β3 is involved in many vascular diseases. However, the role of OPN and integrin β3 in varicosity remains unclear. In the current study, we found that the methylation levels in the promoter regions of OPN and integrin β3 genes in the VSMCs of varicose veins are reduced and the protein expression of OPN and integrin β3 are increased, compared with normal veins. Furthermore, it was observed that VSMCs in the neointima of varicose veins were transformed into the synthetic phenotype. Collectively, hypomethylation of the promoter regions for OPN and integrin β3 genes may increase the expression of these genes in varicosity, which is closely related to VSMC phenotype switching. Hypomethylation of the promoter regions for OPN and integrin β3 genes may be a key factor in the pathogenesis of varicosity.

  15. Association between the hypomethylation of osteopontin and integrin β3 promoters and vascular smooth muscle cell phenotype switching in great saphenous varicose veins.

    Science.gov (United States)

    Jiang, Han; Lun, Yu; Wu, Xiaoyu; Xia, Qian; Zhang, Xiaoyu; Xin, Shijie; Zhang, Jian

    2014-10-17

    Lower extremity varicose veins are a common condition in vascular surgery and proliferation of vascular smooth muscle cells (VSMCs) in the intima is a significant pathological feature of varicosity. However, the pathogenesis of varicose veins is not fully understood. Osteopontin (OPN) could promote the migration and adhesion of VSMCs through the cell surface receptor integrin β3 and the cooperation of OPN and integrin β3 is involved in many vascular diseases. However, the role of OPN and integrin β3 in varicosity remains unclear. In the current study, we found that the methylation levels in the promoter regions of OPN and integrin β3 genes in the VSMCs of varicose veins are reduced and the protein expression of OPN and integrin β3 are increased, compared with normal veins. Furthermore, it was observed that VSMCs in the neointima of varicose veins were transformed into the synthetic phenotype. Collectively, hypomethylation of the promoter regions for OPN and integrin β3 genes may increase the expression of these genes in varicosity, which is closely related to VSMC phenotype switching. Hypomethylation of the promoter regions for OPN and integrin β3 genes may be a key factor in the pathogenesis of varicosity.

  16. Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience.

    Science.gov (United States)

    Golbasi, Ilhan; Turkay, Cengiz; Erbasan, Ozan; Kemaloğlu, Cemal; Sanli, Suat; Turkay, Mehtap; Bayezid, Ömer

    2015-01-01

    Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was

  17. Experimental study of surrounding the tendon end with great saphenous vein to prevent the adhesion of extensor tendon%大隐静脉包裹肌腱断端防止伸肌腱粘连的实验研究

    Institute of Scientific and Technical Information of China (English)

    张申申; 王磊; 郭卫中

    2015-01-01

    Objective To observe the effect of surrounding the tendon end with great saphenous vein to prevent the adhesion of extensor tendon. Methods 30 normal domestic chicken were divided into 3 groups at random. Group A: Tendon end of natural healing. Group B: end was surrand the great saphenous vein. Group C: end was reverse packaged by the great saphenous vein (vascular intima turn to outside, blood vessels, outer membrane with the tendon broken contact). After 6 weeks chickens were killed, anatomical extensor tendon was examined by, to measure the indicators. Results Tendon anastomosis in group B, edema degree, mobility in the adhesion area is better than the other two groups, collagen fibers and fibroblasts, collagen fiber orientation is consistent, the vertical axis is arranged along the tendons, have small capillaries angiogenesis. Conclusion With chicken as experimental models, the use of autogenous great saphenous vein as package, can better play a role of great saphenous vein barrier.%目的:观察大隐静脉替代腱周组织预防伸肌腱粘连的临床疗效。方法正常本地鸡30只随机分三组。A组:肌腱断端自然愈合;B组:断端采用大隐静脉包裹;C组:断端采用大隐静脉反向包裹(血管内膜翻转向外,血管外膜与肌腱断端接触)。术后6周将鸡处死,解剖伸肌腱,对各项指标观察测定。结果B组肌腱吻合口处的活动度、水肿度、粘连面积优于其他两组;胶原纤维及纤维母细胞连接、胶原纤维排列方向大部分一致,沿肌腱纵轴排列,有小毛细血管生成。结论以鸡建立实验模型,使用自体大隐静脉正向包裹肌腱断端,可以较好地发挥大隐静脉屏障作用,减轻肌腱粘连。

  18. Coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses: success rate and complications; Erfolgs- und Komplikationsrate der Coil-Embolisation arteriovenoeser Fisteln nach Vena-saphena-magna-in-situ-Bypassanlage

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, K. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Vivantes Humboldt-Klinikum, Berlin (Germany). Inst. fuer Radiologie und Interventionelle Therapie; Wagner, D.; Strohe, D.; Uedelhoven, J.; Lackner, K. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Gawenda, M.; Brunkwall, J. [Vivantes Humboldt-Klinikum, Berlin (Germany). Inst. fuer Radiologie und Interventionelle Therapie

    2007-06-15

    Purpose: To determine the success and complication rate of coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses. Materials and Method: 82 AV-fistulae on 30 bypasses (28 patients, 20 men, age 62.5 {+-} 8.3 years) were treated using coils. The success rate, complications, duration, amount of contrast material and radiation exposure were measured. Color-coded duplex sonography was performed 1 - 2 days and up to 6 - 18 months after embolization. Results: The success rate was 68.3 %. The reasons for persistent fistula perfusion were: 96 % fistula not accessible, 4 % reperfusion during thrombolysis. 7 complications were observed in 6 bypasses: failure of placement and retrieving of coil (n = 4), thrombembolic complications with thrombolysis (n = 3). The duration of intervention was 118.3 {+-} 46.6 min, the contrast material need was 277.03 {+-} 94.0 ml, and the radiation exposure was 10 966 {+-} 11 295 cGy/cm{sup 2}. Additional balloon dilatation was performed in 30 % of the bypasses. All bypasses were open 1 - 2 days after intervention. During follow-up, 11 persistent fistulae were detected. (orig.)

  19. 大隐静脉高位结扎合并腔内电凝闭合术治疗下肢浅静脉曲张疗效分析%Clinical effect of high ligation of the great saphenous vein combined with endovenous electrocoagulation in the treatment of varicose veins in the lower extremities

    Institute of Scientific and Technical Information of China (English)

    陆峻逵; 刘芳君

    2012-01-01

    Objective To explore the clinical effect of high ligation of the great saphenous vein combined with endovenous electrocoagulation for treating varicose veins in the lower extremities. Methods 210 patients with varicose veins in the lower extremity were randomly divided into the study group and the control group. Patients in the control group received endovenous electrocoagulation, while those in the study group were treated with high ligation of the great saphenous vein combined with endovenous electrocoagulation. Results The cure rate in the study group was 98.9%, significantly higher than 85.9% in the control group (P<0.05). 147 cases in the study group were found with complications, significantly lower than 219 cases in the control group (P<0.05). The relapse of varicose veins and ulcer occurred in one leg and 2 legs in the study group, respectively, significantly less than 9 legs and 13 legs in the control group. The incidence of postoperative pain is significantly higher in the study group than the control group (P<0.05). Conclusion For patients with varicose veins in the lower extremities, the combination of high ligation of the great saphenous vein and endovenous electrocoagulation can effectively improve the clinical efficacy and the prognosis.%目的 探讨大隐静脉高位结扎合并腔内电凝闭合术对下肢浅静脉曲张治疗的疗效.方法 将我院收治的210例(共350条肢体)下肢浅静脉曲张患者随机分为实验组和对照组,对照组患者采用腔内电凝闭合术进行治疗,实验组患者采用大隐静脉高位结扎合并腔内电凝闭合术进行治疗.结果 实验组临床治愈率为98.9%,高于对照组的85.9%(P<0.05);实验组患者出现并发症147例次,低于对照组的219例次(P<0.05);实验组静脉曲张复发以及溃疡复发的患肢分别为1肢和2肢,而对照组分别为9肢和13肢(P<0.05);实验组患者术后疼痛的发生机会明显大于对照组(P<0.05).结论 对患者

  20. The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    2001-06-01

    Full Text Available OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA or stent implantation because of an acute myocardial infarction (AMI related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC. From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3% of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47% patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment.

  1. Implante de stent dentro de stent recém-implantado em ponte de veia safena para otimização do resultado angiográfico Stenting a stent in saphenous vein graft to optimize the angiographic result

    Directory of Open Access Journals (Sweden)

    Antonio Esteves Fº

    1998-03-01

    Full Text Available Mulher de 60 anos, com angina progressiva e revascularização do miocárdio, há oito anos, com ponte de veia safena para coronária direita e anastomose de artéria mamaria esquerda para artéria descendente anterior. Submetida a implante de stent Gianturco-Roubin II em terço proximal da ponte de veia safena para artéria coronária direita, com resultado insatisfatório pela persistência de lesão residual, provavelmente, decorrente de prolapso para dentro da luz de material aterosclerótico através dos coils. Foi implantado outro stent (Palmaz-Schatz biliar dentro do stent GRII com sucesso e ótimo resultado angiográfico. Um 2º stent Palmaz-Schatz biliar foi implantado em lesão distal no corpo da ponte, ultrapassando os dois stents, anteriormente implantados, com sucesso. Em algumas situações, implante de stent dentro de outro stent é recurso útil para otimização de resultado angiográfico do implante de um stent.A 60 year-old woman with progressive angina who had been submitted to saphenous bypass-graft to right coronary artery and a left mammary artery graft to anterior descending artery eight years previously, underwent implantation of a Gianturco Roubin II stent in the proximal third of the saphenous vein graft. The result was suboptimal by persistence of a residual stenosis probably due to prolapse of atherosclerotic material through the coil spaces. Another stent (Palmaz-Schatz biliar stent was implanted at the previously stented site with no residual stenosis. Another Palmaz-Schatz biliar stent was successfully implanted in the distal body of the graft to treat another lesion (passing through the previously stents without difficulty. Stenting a stent, in selected situations, is a useful tool to optimize the angiographic result of stent implantation.

  2. Application of minimally invasive stripping of great saphenous vein operation combined with foam sclerotherapy treated on patients with varicose veins of lower extremity%小切口大隐静脉剥脱术联合泡沫硬化剂注射在下肢浅静脉曲张患者中的应用

    Institute of Scientific and Technical Information of China (English)

    邹翰林

    2015-01-01

    Objective:To investigate the clinical effect of minimally invasive stripping of great saphenous vein operation combined with foam sclerotherapy treated on patients with varicose veins of lower extremity.Methods:60 patients with varicose veins of lower extremity were selected from August 2007 to 2013 September.They were divided into the observation group and the control group. Patients in the control group were treated with minimally invasive stripping of great saphenous vein operation,furthermore,the observation group were injected foam sclerotherapy based on the operation,then we compared the clinical efficacy between two groups.Results:The clinical results showed that patients in the observation group improved better than the control group,and the difference in improvement rate was statistically significant(P<0.05);when compared with the control group,the operation time and hospitalization time was shorter in the observation group,and the bleeding volume was lower,the differences were statistically significant(P<0.05);the infection rate of the observation group was lower than that of the control group(P<0.05).Conclusion:Application of minimally invasive stripping of great saphenous vein operation combined with foam sclerotherapy treated on patients with varicose veins of lower extremity has significant clinical effect.It can improve the clinical cure rate,and speed up the rehabilitation progress,so it is worth to be promote.%目的:探讨小切口大隐静脉剥脱术联合泡沫硬化剂注射在下肢静脉曲张患者中的临床应用效果。方法:2007年8月-2013年9月收治下肢静脉曲张患者60例,分成两组(观察组、对照组),对照组给予小切口大隐静脉剥脱术,观察组在该基础上注射泡沫硬化剂,比较两组患者临床疗效。结果:观察组临床好转率优于对照组,差异有统计学意义(P<0.05);观察组手术时间、出血量、住院时间等指标优于对照组

  3. Color Doppler Ultrasound of Lower Extremity Varicose Veins: A Simple Grading of Sapheno-Femoral Junction Reflux

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    Huh, Sik; Hong, Suk Joo; Kim, Shin Kee; Hong, Sun Hwa [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Park, Sang Woo [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of); Kim, Yeon Soo [Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2011-12-15

    To establish a simple grading method for the severity of an incompetent sapheno-femoral junction (SFJ) using color Doppler ultrasound in patients with lower extremity varicose veins. 346 legs of 241 consecutive patients with varicose veins were examined (M:F = 96:145, 11-74 years, mean 50 years). The severity of SFJ and sapheno-popliteal (SPJ) incompetence was graded from I to IV according to the patient's position (standing versus supine or prone) and whether the Valsalva's maneuver had been induced. The extent of varicose veins was graded as I to III by the US findings in the SFJ incompetence group. The grading of SFJ incompetence was compared to the extent of varicose vein. SFJ, SPJ, both SFJ and SPJ, and perforator incompetence was observed in 198 (57.2%), 81 (23.4%), 21 (6.1%) and 54 (15.6%), respectively. Among the SFJ incompetence group, severity grade I - IV were observed in 14 (7.1%), 75 (37.9%), 73 (36.9%), and 36 (18.2%), respectively, and the extent grade I - III were noted in 47 (23.7%), 95 (48.0%), and 56 (28.3%), respectively. The SFJ incompetence grade and varicose extent grade showed a positive correlation (p < 0.0001). Simple sonographic grading of the severity of SFJ incompetence is possible. The extent of varicose veins in the SFJ incompetence group can be determined using this new grading system

  4. Avaliação microscópica e ultra-estrutural do endotélio de veia safena preparada pela técnica "no touch" Microscopic and ultrastructural evaluation of the saphenous vein endothelium for CABG prepared by the no touch technique

    Directory of Open Access Journals (Sweden)

    Virgílio Figueiredo Silva

    2008-09-01

    Full Text Available OBJETIVO: O enxerto de veia safena (VS utilizado em revascularização miocárdica possui uma vida útil, sendo o estágio final a oclusão do vaso. Esforços em adquirir novas técnicas de coleta da VS podem possibilitar uma viabilidade maior do enxerto. MÉTODOS: Vinte pacientes foram randomizados e divididos em dois grupos com o objetivo de avaliação do endotélio vascular. A técnica "no touch" (NT consiste em retirar o segmento de VS com o tecido perivascular. A técnica convencional consiste em retirar a VS, com remoção "in situ" do tecido perivascular e conseqüente vasoespasmo. Houve um padrão de retirada das VS com incisões longitudinais escalonadas. Características da VS foram consideradas. A avaliação do endotélio das VS foi realizada usando microscópio eletrônico (ME pelo método de varredura e de transmissão. Cortes histológicos das VS foram corados em Hematoxilina-Eosina (HE. O colágeno subendotelial foi analisado pelos métodos de Picro-Sirius e Tricrômio de Masson. RESULTADOS: A ME evidenciou que o Grupo NT possui maiores áreas endoteliais não desnudadas, além de um menor número de células degradadas. A coloração em HE nos permitiu verificar a forma e a integridade das camadas das VS. Há um predomínio maior de fibras colágenas coradas no Grupo NT. CONCLUSÕES: A técnica NT permite uma melhor preservação endotelial da VS, sugerindo um enxerto mais viável em longo prazo.OBJECTIVE: Saphenous vein grafts (SV used in coronary artery bypass grafting have a limited life and vein occlusion may be the final adverse effect. Efforts to develop new techniques to harvest the saphenous vein may improve the viability of the graft. METHODS: Twenty patients were randomly divided into two groups with the objective of evaluating the vascular endothelium. The No Touch (NT technique consists in removing the saphenous vein with perivascular tissue. The conventional technique consists in harvesting with "in situ" removal

  5. Day surgery is effective and safe for patients with great saphenous ...

    African Journals Online (AJOL)

    2015-11-02

    Nov 2, 2015 ... surgery (IS) were collected from hospital main clinical database. Baseline characteristics ... and safe for patients with great saphenous vein varices who meet American ..... Financial support and sponsorship. Nil. Conflicts of ...

  6. Disposal of the small saphenous vein trunks during sural neurocutaneous island flap transplantation for repairing soft tissue defects of the foot and ankle%腓肠神经营养皮瓣移植修复足踝软组织缺损中小隐静脉干的处理

    Institute of Scientific and Technical Information of China (English)

    吴文; 章莹; 夏远军; 尹飚

    2008-01-01

    背景:在临床上应用和报道中小隐静脉在皮瓣中所起的作用及血管近端蒂如何处理意见不尽一致.目的:应用腓肠神经营养血管皮瓣逆行转移修复足背、足跟及踝部软组织缺损,观察分析不同方式处理小隐静脉对皮瓣成活的影响.设计、时间及地点:病例对比观察,于1998-03/2007-04在解放军广州军区广州总医院完成.对象:将56例足背、足跟及踝部软组织缺损的患者按手术方式分为2组,结扎小隐静脉近端蒂皮瓣组38例,小隐静脉近端与受区大隐静脉或其属支吻合组18例.方法:应用腓肠神经营养血管皮瓣逆行移植修复时,皮瓣切取面积为3.5 cm×4.0 cm~4.0 cm×4.5 cm的病例35例;皮瓣切取面积为4.0cm×4.5 cm~10.0 cm×12.0 cm的病例21例.主要观察指标:不同切取面积及移植方式的皮瓣成活效果.结果:[1]皮瓣切取面积为(4.0×4.5)cm~(10.0×12.0)cm时,移植后未出现静脉危象:皮瓣切取面积为(3.5×4.0)cm~(4.0×4.5)cm时,结扎小隐静脉近端的患者中5例出现术后静脉危象.[2]在皮瓣切取面积为(3.5×4.0)cm-(4.0×4.5)cm时,移植后小隐静脉近端与受区大隐静脉或其属支吻合皮瓣出现坏死的概率低于结扎小隐静脉近端蒂皮瓣(P=0.017 67).结论:切取皮瓣面积小于(4.0×4.5)cm时,应将小隐静脉近端与受区大隐静脉或其属支吻合.小隐静脉在皮瓣中并非过路浅静脉.对皮瓣有营养作用.%BACKGROUND: Scholars disagree with each other about the small saphenous vein effects on skin flap and how to dispose vascular proximal pedicles.OBJECTIVE: To analyze effects of different methods of the small saphenous vein disposal on flap survival using sural neurocutaneous island flap retrograde metastasis for repairing defects of soft tissue of instep, heelstick and ankle.DESIGN, TIME AND SETTING: The case control observation experiment was performed at the General Hospital of Guangzhou Military Area Command of Chinese PLA

  7. 经皮浅静脉连续环形缝扎术治疗大隐静脉曲张在基层医院的应用%Application of percutaneous continuous circumsuture for superficial varicose veins in treatment of great saphenous vein varicosity in the community hospital

    Institute of Scientific and Technical Information of China (English)

    伍忠礼; 梁发亮; 黄力若

    2016-01-01

    目的:评价经皮下连续环形缝扎术治疗下肢大隐静脉曲张的在基层医院的应用经验。方法回顾分析2009年6月~2013年6月我院治疗86例大隐静脉曲张患者的临床资料,选择行传统大隐静脉高位结扎加剥脱术为传统组(43例),另43例行经皮下连续环形缝扎术为 PCCS组,比较两组患者的临床效果。结果两组患者术后近期下肢浅静脉曲张均消失,比较两组患者的手术时间、切口数量、出血量、并发症和住院时间,差异有统计学意义;而术后发生疼痛天数、足肿以及下肢深静脉血栓两组比较无明显统计学差异。PCCS 组43例平均随访34月,曲张静脉复发1例;传统组平均随访38月,无曲张静脉复发。结论经皮下连续环形缝扎术治疗下肢大隐静脉曲张的操作简单、效果确切,且具有微创、外观美容的效果,适于基层医院。%Objective To summarize up experience and clinical efficacy of percutaneous continuous circumsuture (PCCS) for treatment of great saphenous vein varicosity in the community hospital. Methods A retrospective analysis was conducted on the clinical data of 86 cases of varicosis of great saphenous vein from June 2009 to June 2013. The patients were assigned to tradition group (n=43) and PCCS group (n=43). Patients in tradition group were performed by traditional high ligation and exfoliation procedure. The clinical data of the two groups were compared. Results Superficial varicose veins of lower extremities disappeared in both groups after treatment. There were statistical differences between two groups in operation duration, incision number, blood loss complications and postoperative hospital stay time (all P values were less than 0.05). There was no statistical difference in days of postoperative pain, forced foot and deep veins thrombosis between two groups. Varicose vein recurrence happened on one patient in PCCS group after the average of 34-month

  8. Early Small-incision High-ligation and Stripping for Great Saphenous Varicose Vein Complicated with Acute Superficial Thrombophlebitis%早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张

    Institute of Scientific and Technical Information of China (English)

    袁链; 尹立伟; 张小明

    2013-01-01

    目的 探讨早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张的疗效. 方法 同顾性分析我院2008年10月~2011年5月32例大隐静脉曲张并发急性血栓性浅静脉炎的临床资料.发病2周内行小切口大隐静脉高位结扎剥脱术. 结果 全部患者术后局部红肿疼痛于3天内消退,切口全部甲级愈合,住院时间10~ 16 d,平均12.6 d 全部患者随访5~32个月,平均13.6月,其中11例>12个月,未见复发. 结论 早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张是安全的,术后疗效满意.%Objective To explore the efficacy of high ligation and stripping of the varicose veins through a small incision in early slage for patients with great saphenous varicose vein complicated with acute superficial thrombophlebitis. Methods The clinical data of 32 patients with great saphenous varicose vein complicated with acute superficial thrombophlebitis, who received operation in our hospital from October 2008 to May 2011 , were analyzed retrospectively. All of the patients underwent high ligation and stripping of the varicose veins through a small incision in two weeks since the onset of acute superficial thrombophlebitis. Results All the patients recovered well with grade A wound healing. Local swelling and pain disappeared in 3 days in all the cases. The mean hospital stay was 12. 6 days ( ranged from 10 to 16 days). All the patients were followed up for 5 to 32 months with a mean of 13. 6 months ( > 12 months in 11 cases). No patient had recurrence. Conclusions High ligation and stripping of the varicose veins through a small incision in an early stage is safe and effective for the treatment of great saphenous varicose vein complicated with acute superficial thrombophlebitis. We recommend it to be used in more hospitals.

  9. Management Effect of Clinical Pharmacist on Antibiotics Use during Perioperative Period of Great Saphe-nous Varicose Veins Surgery%临床药师参与大隐静脉曲张手术围术期抗菌药物管理的效果评价

    Institute of Scientific and Technical Information of China (English)

    朱亚兰; 包云光; 郭佳奕; 吕世文; 仝淑花; 徐媛青

    2016-01-01

    目的::评价临床药师参与大隐静脉曲张手术围术期预防应用抗菌药物管理的效果。方法:选取2010年6~9月(干预前)、2011年6~9月(干预后)和2014年6~9月(巩固期)出院的大隐静脉单纯剥脱术、大隐静脉高位结扎加剥脱术及大隐静脉高位结扎加静脉内激光治疗的所有病例,针对预防应用抗菌药物的合理性进行评价。结果:临床药师参与管理后,大隐静脉曲张手术围术期预防应用抗菌药物在用药指征、药物品种选择、用法用量、给药途径、溶媒及溶媒量、给药时机、用药疗程、联合用药方面改善明显;抗菌药物使用率、平均住院日、抗菌药物比例、药品比例及输液率均明显降低,并得以巩固。结论:临床药师对大隐静脉曲张手术围术期预防应用抗菌药物的干预,提高了抗菌药物合理使用率,对降低患者费用,规范医院管理有一定意义。%Objective:To evaluate the management effect of clinical pharmacist on antibiotics use during perioperative period of great saphenous varicose veins surgery. Methods:The medical records of all the patients undergoing simple great saphenous vein strip-ping, great saphenous vein high ligation plus simple stripping and saphenous vein ligation plus endovenous laser treatment between June and September in 2010 ( before the intervention) , 2011 ( after the intervention) and 2014 ( consolidation period) were selected, and the rationality of prophylactic use of antibiotics during perioperative period was evaluated. Results: After the management of clinical pharmacists, the preventive application of antibiotics during perioperative period was markedly improved in the indication, medicine va-riety choice,application and dosage, administration route, solvent and solvent dose, administration time, course of treatment and drug combination when compared with that before the intervention. Antibiotics use ratio, average

  10. Pulmonary embolism after greater saphenous vein ligation and stripping%大隐静脉曲张术后并发肺栓塞11例的治疗

    Institute of Scientific and Technical Information of China (English)

    王晓天; 胡何节; 方征东; 孙小杰; 葛新宝; 刘振明

    2015-01-01

    目的 探讨大隐静脉曲张高位结扎剥脱术后患者并发肺栓塞(pulmonary embolism,PE)的临床特点及预防措施.方法 回顾分析安徽省立医院血管外科2008年1月至2013年6月收治及会诊的大隐静脉曲张术后合并PE的11例患者临床特点、诊疗及预后等资料.结果 该组11例PE患者有6例患者经过心肺复苏、抗凝溶栓等治疗无效死亡,死亡率54.5%.5例患者经过早期的抗凝、溶栓等治疗后康复,在溶栓过程中,2例患者因彩超发现股静脉内漂浮血栓选择下腔静脉滤器植入术.对5例患者经过8 ~ 25个月随访,均无呼吸困难、胸闷、胸痛等症状.患者发病时临床表现以呼吸困难最为常见(90.9%),有胸痛症状3例(27.3%),出现晕厥2例(18.2%),猝死2例(18.2%),均无典型的呼吸困难、胸痛、咯血三联征.结论 PE的早期诊断及早期治疗可能降低大隐静脉曲张高位结扎剥脱术后PE患者的死亡率.%Objective To analyze characteristics and prophylaxis of pulmonary embolism (PE) after greater saphenous vein ligation and stripping.Methods We retrospectively analyzed the clinical characteristics and treatment of 11 inpatients with postoperative PE in Anhui Provincial Hospital and other hospitals from January 2008 to June 2013.Results In this group 6 patients died after failed cardiopulmonary resuscitation (CPR) and other treatments,the mortality was 54.5%.5 patients recovered after anticoagulation,thrombolysis and other treatments.During the process of thrombolysis,floating thrombus was found within the femoral vein in 2 patients and inferior vena cava filter was implanted.After 8-25 months follow-up,all 5 patients were free of difficulty of breathing,chest tightness,chest pain and other symptoms.Among many clinical manifestations,dyspnea (90.9%) was the most common,other clinical manifestations included chest pain (27.3%),syncope (18.2%),sudden death (18.2%).There was no typical triad of dyspnea

  11. Preliminary study on temperature feedback manipulator in endovenous laser ablation for great saphenous vari-cose vein%大隐静脉曲张激光闭合术应用温度反馈式机械臂的初步研究

    Institute of Scientific and Technical Information of China (English)

    茅届齐; 秦钧; 张威浩; 戴雪明

    2016-01-01

    目的:初步探讨温度反馈式机械臂在大隐静脉腔内激光闭合术(endovenous laser ablation,EVLA)中的应用。方法:2012年7月至12月收治的80例大隐静脉曲张病人分成两组:机械臂组(26例)和常规组(54例),分别实施机械臂控制的EVLA和常规EVLA,对两组的并发症发生率、主干再通率、复发率进行比较。结果:机械臂组在皮肤灼伤、患肢麻木并发症方面低于常规组(0比14.8%和15.4%比25.9%,P<0.01);术后2年大隐静脉主干再通率,机械臂组也低于常规组(3.8%比13.0%,P<0.01)。结论:机械臂控制大隐静脉EVLA具有一定的可行性。%Objective To study preliminarily on endovenous laser ablation (EVLA) for great saphenous varicose veins using mechanical arm with temperature feedback. Methods Eighty cases with great saphenous varicose vein from July to Dec 2012 were included in this study and divided into two groups with 26 cases in mechanical arm group and 54 cases in control group. The cases in mechanical arm group underwent EVLA with mechanical arm while those in control group EVLA only. The morbidity, recanalization and recurrence of varicose vein were compared between two groups. Results The skin burn and paralysis were found lower in mechanical arm group than in control group (0 vs 14.8%and 15.4%vs 25.9%, P<0.01). The recanalization two years later was lower in mechanical arm group than in control group (3.8% vs 13.0%, P<0.01). Conclusions Mechanical arm might be useful in the procedure of EVLA for great saphenous varicose veins.

  12. Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency? Deve-se evitar a flebo-extração completa até o tornozelo no tratamento das varizes primárias por insuficiência da veia safena magna?

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    Hakan Uncu

    2009-10-01

    Full Text Available PURPOSE: The most preferred method for the treatment of primary varicose veins due to greater saphenous vein (GSV insufficiency is saphenofemoral high ligation and thigh stripping of the GSV, and ambulatory phlebectomy. Stripping is usually ended at the knee level to prevent nerve injury in the calf. However, different surgical modalities may be used depending on the surgeon's choice and experience. METHODS: We present the results of complete stripping of the GSV to the ankle and ambulatory phlebectomies performed by a single surgeon. Ninety-six patients (102 limbs who underwent standardized surgical procedure were participated in this study. Median follow-up time was 3.4 years. RESULTS: All complaints due to varicose veins were resolved in all extremities. Some temporary complications observed were resolved fully during follow-up. Permanent paresthesia which was the most important complication was found only in two patients (2%. No recurrence was observed. CONCLUSION: The risk of saphenous nerve injury in the calf should not to be considered a reason to avoid complete stripping of the GSV to the ankle. If it is applied carefully and with appropriate technique, complete stripping still seems to be a good treatment option.OBJETIVO: O método de escolha para o tratamento das varizes primárias devido a insuficiência da veia safena magna (VSM é a ligagura safenofemoral e a fleboextração em coxa e a flebectomia ambulatorial. A fleboextração é geralmente feita ao nível do joelho para prevenir a lesão neurológica no tornozelo. Diferentes modalidades operatórias, no entanto, podem ser utilizadas dependendo da escolha e da experiência do cirurgião. MÉTODOS: Apresentamos os resultados da fleboextração completa da VSM até o tornozelo e flebectomias ambulatoriais realizadas por um único cirurgião. Noventa e seis pacientes (102 membros que foram submetidos a procedimento cirúrgico padrão participaram deste estudo. A mediana do tempo de

  13. Early Results of Endovenous Ablation with a 980-nm Diode Laser for an Incompetent Vein of Giacomini

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Woo; Lee, Song Am; Hwang, Jae Joon; Yun, Ik Jin; Kim, Jun Seok; Chang, Seong Hwan; Chee, Hyun Keun; Chang, Il Soo [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    We wanted to evaluate the effectiveness of endovenous ablation of the incompetent vein of Giacomini using a 980-nm diode laser. A total of 18 patients (18 limbs, 4%) had the incompetent vein of Giacomini. Retrograde reflux originating from the great saphenous vein was noted in sixteen limbs and paradoxical diastolic anterograde reflux from the saphenopopliteal junction was observed in two limbs. After tumescent anesthesia, laser ablation using a 980-nm wavelength laser fiber was performed under ultrasound and/or fluoroscopic guidance. Patients were evaluated clinically and with duplex ultrasound at one week and at one, three, six and twelve months after laser ablation for the technical and clinical success. In the 18 limbs, the technical success rate was 100%. Continued closure of the vein of Giacomini was seen in 18 of 18 limbs after one month, in 12 of 12 limbs after three and six months and in six of six limbs after twelve months. No recanalization of the vein and no major complications occurred. Endovenous laser ablation with a 980-nm wavelength is an effective and safe procedure for treating an incompetent vein of Giacomini.

  14. Comparação da perviedade entre artéria radial e veia safena em pacientes em pós-operatório de cirurgia de revascularização miocárdica com retorno dos sintomas Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting post operative with return of the symptoms

    Directory of Open Access Journals (Sweden)

    Herbert Coelho Hortmann

    2010-06-01

    Full Text Available OBJETIVO: Comparar a perviedade da artéria radial e veia safena em pacientes com retorno dos sintomas após cirurgia de revascularização do miocárdio (CRVM. MÉTODOS: Estudo retrospectivo. No período de janeiro de 1998 a dezembro de 2005, foram realizadas 469 CRVMs com o uso da artéria radial dentre os enxertos, no Hospital Vera Cruz, em Belo Horizonte/MG. Destes, 94 pacientes apresentaram alterações isquêmicas no pós-operatório recente ou tardio e foram reestudados com cineangiocoronariografia. Os enxertos foram divididos em três grupos: artéria torácica interna (ATI, artéria radial (AR e veia safena (VS, e foram estratificados segundo a gravidade das lesões: sem lesão grave (OBJECTIVE: To compare the radial artery and saphenous vein's patency in patients with recurrence of symptoms in a coronary artery bypass grafting (CABG. METHODS: Retrospective study. From January 1998 to December 2005, 469 CABGs were performed using the radial artery as a graft, in Vera Cruz Hospital in Belo Horizonte/ MG. Among the patients who underwent those surgeries, 94 presented ischemic changes in early or late postoperative period, which led them to be re-evaluated by coronary angiography. The grafts were divided in three groups: internal thoracic artery (ITA, radial artery (RA and saphenous vein (SV, and they were stratified according to the severity of injury: uninjured or patent (< 70%, severe obstruction (70 to 99% and occlusion. RESULTS: For the 94 patients in the study, 86 grafts of ITA, 94 of RA and 111 of SV were used. For the 86 ITA grafts, 73 (84.88% were found patent. For the 94 RA grafts, 55 (58.51% were found patent, and for the 111 SV grafts, 73 (65.76% were uninjured. A statistically significant difference (P= 0.001 was found between RA and SV grafts, with a higher patency found for VS graft. For the RA grafts, women presented a worse result concerning the RA patency (65.7% and 40.7%, with P = 0.006. Concerning coronary

  15. 三种微创手术方法治疗大隐静脉曲张的临床对比分析%Clinical Comparative Analysis of Three Methods of Minimally Invasive Surgery in the Treatment of Great Saphenous Varicose Veins

    Institute of Scientific and Technical Information of China (English)

    吕兴东

    2016-01-01

    目的:深入探讨在大隐静脉曲张的治疗中,三种微创手术方法的临床效果。方法选取我院2014年10月~2015年7月收治的60例大隐静脉曲张患者为研究对象,随机分为三组:比较三组患者的治疗效果。结果经资料整合,三组患者中血管腔内激光闭合组患者住院时间最短,透光旋切治疗组患者术后愈合时间最短,差异均有统计学意义(P<0.05)。结论研究所选取的三种方法在大隐静脉曲张治疗中都具有一定的效果,在临床实践中应结合患者的实际情况具体选择。%Objective To explore the clinical effect of three methods of minimally invasive surgery in the treatment of great saphenous varicose veins. MethodsSelected 60 patients with great saphenous varicose veins as the research object in our hospital between October 2014 to July 2015, were randomly divided into three groups,the therapeutic effect of three groups were compared.ResultsThrough data integration,three groups of patients with intracavitary laser shortest closed group of patients in the hospital was pervious to light rotary cutting treatment group patients about postoperative healing time,and the difference was statistically significant(P<0.05).ConclusionThree kinds of methods in great saphenous varicose veins therapy has a certain effect,in clinical practice should be combined with the actual situation of patients with specific options.

  16. Catheter-directed thrombolysis for acute iliofemorai deep vein thrombosis via the ipsilateral great saphenous vein approach: a comparative clinical study%经患侧大隐静脉入路置管溶栓治疗急性髂股静脉血栓的临床对比研究

    Institute of Scientific and Technical Information of China (English)

    苏浩波; 顾建平; 楼文胜; 何旭; 陈亮; 陈国平; 宋进华; 汪涛

    2011-01-01

    目的 研究经患侧大隐静脉穿刺入路置管溶栓治疗急性髂股静脉血栓的可行性及临床应用价值.方法 93例经造影明确诊断的急性髂股静脉血栓患者,按照简单随机化方法分为3组,A组经患侧大隐静脉入路置管溶栓(31例),B组经患侧腘静脉入路置管溶栓(27例),C组经足背静脉顺性溶栓(35例).根据临床症状和溶栓后第5天造影复查结果评估疗效.对3组治疗前后消肿率、静脉通畅度采用方差分析(LSD法)进行组间比较;置管组穿刺时间、舒适度评分采用成组t检验分析;3组疗效及并发症发生情况采用x2检验分析.结果 治疗有效率A组90.3% (28/31)、B组92.6% (25/27)、C组68.6% (24/35),A组与B组相比差异无统计学意义(x2=0.09,P=0.759),A组与C组相比差异有统计学意义(x2 =4.65,P=0.031);消肿率A组(83.5±21.1)%、B组(82.4±20.1)%、C组(67.0±23.3)%,3组之间差异有统计学意义(F=6.059,P=0.003),A组与B组相比,差异无统计学意义(P =0.822)、A组与C组相比,差异有统计学意义(P=0.002);静脉通畅度A组(61.2±20.2)%、B组(55.7±20.5)%、C组(44.2±23.6)%,3组之间差异有统计学意义(F=5.342,P=0.006),A组与B组相比差异无统计学意义(P =0.343),A组与C组相比差异有统计学意义(P=0.002).穿刺时间A组为(8.3±3.1) min,较B组的(16.3±3.5) min少(t=9.379,P<0.05);治疗期间患者舒适度评分A组为(2.2±1.2)分、B组为(5.0±1.4)分,差异有统计学意义(t =8.129,P<0.05);置管相关的并发症A组(3例)少于B组(11例),差异有统计学意义(x2=7.60,P<0.05).结论 经患侧大隐静脉入路置管溶栓治疗急性IFVT是可行、有效的方法,具有操作简便、并发症少的优点.%Objective To investigate prospectively the feasibility and clinical value of catheterization via the ipsilateral great saphenous vein in catheter-directed thrombolysis (CDT) for acute iliofemoral deep vein thrombosis (IFVT) by a comparative

  17. Fatores de risco que afetam as complicações da dissecação da veia safena na revascularização cirúrgica do miocárdio The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery

    Directory of Open Access Journals (Sweden)

    Monir Abbaszadeh

    2008-09-01

    Full Text Available OBJETIVO: O problema da cicatrização de feridas é comumente observado após procedimentos de revascularização do miocárdio. Nosso objetivo é determinar a prevalência e os indicadores de complicação na dissecação da veia safena após procedimentos de revascularização coronária. MÉTODOS: Após revisão e aprovação pelo comitê de ética da instituição, uma revisão retrospectiva de 4029 procedimentos de revascularização foi realizada com enxerto da veia safena durante um período de seis anos. Treze fatores de risco para aqueles que desenvolveram complicações extensas nas feridas da perna foram analisados e comparados com toda a coorte de pacientes submetidos a procedimentos de revascularização semelhantes durante o mesmo período. RESULTADOS: Complicações nas feridas do membro inferior ocorreram em 68 pacientes (1,7%, 43 deles precisaram de intervenção cirúrgica adicional. Foram realizados 17 desbridamentos de feridas, nove transplantes de pele, uma angioplastia, 11 fasciotomias, três procedimentos vasculares e duas transferências livre de tecidos. Das treze variáveis analisadas pela análise multivariada, sexo feminino, IMC, uso de enxerto de veia torácica interna, doença vascular periférica, o uso de balão intra-aórtico no pós-operatório e hiperlipidemia pré-existente foram identificados como indicadores independentes significativos de complicações extensas nas feridas a perna (pOBJECTIVE: Problem of wound healing is commonly observed after coronary artery bypass graft procedures. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complication after coronary revascularization procedures. METHODS: After institutional ethical committee review and approval, a retrospective review was undertaken of 4029 bypass procedures with saphenous vein graft performed over a period of six years is conducted. Thirteen risk factors for those who developed major leg wound

  18. Edema de membro inferior secundário a exérese de veia safena magna para utilização como enxerto na revascularização do miocárdio Lower limb edema after great saphenous vein harvesting to be used as graft in myocardial revascularization

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    Cleusa Ema Quilici Belczak

    2009-03-01

    Full Text Available CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5% (a = 0,05. RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p BACKGROUND: Myocardial revascularization using the great saphenous vein is still a very common surgical procedure. The edema that occurs in the operated leg causes much discomfort and requires further studies. OBJECTIVES: To describe lower limb edema secondary to great saphenous vein harvesting using the bridge technique for use as venous graft in myocardial revascularization. METHODS: Forty-four individuals previously submitted to great saphenous vein harvesting for myocardial revascularization more than 3 months before were randomly selected. Patients with factors that might interfere with formation of lower limb edema were excluded. Both operated and non-operated legs were evaluated by volumetry and perimetry of the malleolar region. Differences greater than

  19. 大隐静脉曲张膝位结扎分段剥脱术与传统手术的效果比较%Effect comparison of parallel knee ligation segmentation stripping with traditional operation of the great saphenous varicose vein

    Institute of Scientific and Technical Information of China (English)

    杨毅; 何效东

    2011-01-01

    Objective To compare the effect of parallel knee ligation segmentation stripping with traditional high ligation segmentation stripping on treating the great saphenous varicose vein below knee and explore the surgical methods of the great saphenous varicose vein. Methods From January 2004 to January 2009, our hospital had treated the great saphenous varicose vein below knee 146 cases, 162 affected limbs. In a random contrast principle, they were divided into two groups, used parallel knee ligation segmentation stripping and traditional high ligation segmentation stripping respectively. We compared the three areas of the single limb operation time, the single limb surgery blood loss and the single limb postoperative recurrence rate in 2 years. Results The average single limb operation time and the average single limb surgery blood loss what compared parallel knee ligation segmentation stripping with traditional high hgation segmentation stripping have statistical significant difference (P < 0.01 ). The single limb postoperative recurrence rate in 2 years which compared parallel knee hgation segmentation stripping with traditional high ligation segmentation stripping hasn't statistical significant difference (P > 0.05 ). Conclusion It is feasible that use parallel knee ligation segmentation stripping to treat the great saphenous varicose vein below knee. The clinical effect is certain.%目的 比较大隐静脉曲张发生在膝以下者行膝位结扎分段剥脱术与传统高位结扎分段剥脱术的临床效果.方法 选择我院2004年1月-2009年1月收治的大隐静脉曲张发生在膝以下病人146例,162肢体.按照随机对照原则分成两组,分别行膝位结扎分段剥脱术及传统高位结扎分段剥脱术,在单肢手术时间、单肢手术出血量、单肢术后2年复发率三方面进行比较.结果 膝位结扎分段剥脱术与传统高位结扎分段剥脱术之间的单肢平均手术时间、单肢平均手术出血

  20. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 4...

  1. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G;

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 4...

  2. Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio Clinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique

    Directory of Open Access Journals (Sweden)

    Cleusa Ema Quilici Belczak

    2009-03-01

    Full Text Available OBJETIVO: Avaliar as intercorrências clínicas nos membros submetidos a retirada da veia safena magna por técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Selecionou-se aleatoriamente 44 pacientes submetidos a revascularização do miocárdio utilizando a veia safena magna retirada por incisões escalonadas há mais de 3 meses. Critérios de exclusão: retirada da veia safena de ambos os lados; safenectomia prévia do membro contralateral; etiologias de edema de causas sistêmicas, tais como cardíacas, renais, tireoideanas, hepáticas e insuficiência venosa nos membros inferiores (MMII, representada por varizes exuberantes com ou sem alterações tróficas. Foram avaliados as seguintes variáveis: idade, sexo, diabetes, tempo de cirurgia, presença de intercorrências, como edema, parestesias, infecção, linforréia, erisipela e trombose venosa profunda. A avaliação foi clínica e o diagnóstico do diabete foi feito pelos exames do pré-operatório para cirurgia. Para análise estatística foram empregados o teste qui-quadrado, teste exato de Fisher e teste t de Student, considerando erro alfa de 5%. RESULTADOS: O tempo entre avaliação e cirurgia foi de 3 a 187 meses, com média 47,3 + 42,5 meses. Detectou-se 25% de infecção no leito da safena, edema em 52,3% dos casos, parestesia em 29,5%, erisipela em 9,1%, linforréia em 4,5% e trombose venosa profunda em 2,3%. Não houve associação entre diabetes com as intercorrências. CONCLUSÃO: A exérese escalonada da veia safena magna para revascularização do miocárdio não elimina as intercorrências clínicas no leito da safena, como parestesias, infecção e edemaOBJECTIVE: The aim of this study was to assess clinical complications of limbs undergone harvesting of the great saphenous vein for venous coronary artery bypass graft surgery using bridge technique. METHODS: Fourty-four patients who had undergone CABG

  3. 经鼻内窥镜泪囊窝造口大隐静脉或唇黏膜移植再造泪道:18例分组比较%Lacrimal duct reconstruction with grafting of great saphenous vein or labial mucosa via endoscopic transnasal dacryocystorhinostomy A group comparison in 18 cases

    Institute of Scientific and Technical Information of China (English)

    陶海; 吴海洋; 侯世科

    2009-01-01

    BACKGROUND:There are no ideal methods for treating severe obstruction of lacrimal ducts in the world.How to improve operation method,select suitable transplantation material,elevate therapeutic efficacy,or to be accepted by patients is a topic of worker of diagnosis and treatment of obstruction of lacrimal ducts.OBJECTIVE:To evaluate the efficacy and safety of lacrimal-lake-nasal lacrimal duct reconstruction with grafting of autogenous great saphenous vein or labial mucosa via endoscopic transnasal dacryocystorhinostomy.DESIGN,TIME AND SETTING:This controlled study was conducted at the General Hospital of Armed Police Force from April 2005 to June 2007.PARTICIPANTS:A total of 18 patients(18 eyes)with severe canalicular obstruction combined with lacrimal sac defect or atrophy were enrolled at the General Hospital of Armed Police Force.METHODS:Two groups were set up according to graft material,including a great saphenous vein group(n=9)and a labial mucosa group(n=9).The great saphenous vein group received autogenous great saphenous vein transplantation,whereas the labial mucosa group received autogenous labial mucosa transplantation.Lacrimal duct unobstruction,epiphora improvement and complication were statistically analyzed in patients from both groups following transplantation.MAIN OUTCOME MEASURES:Epiphora improvement during tube wearing after transplantation and irrigation of lacrimal duct after removing the tube were measured.Radioactive nuclide ~(99)Tc~m(TcO_4~-)developing examination was used to detect time of entering nose of nuclide to judge therapeutic efficacy.RESULTS:Epiphora in patients from both groups were alleviated in various degrees during 3 months postoperatively,the period with the silicone tube.In the 12~(th) week after silicone tube was removed,TcO_4~-scintigraphy showed eye-nose time was (8.58±4.3)minutes and(9.16±5.8)minutes respectively.There was no significant difference between both groups(P>0.05).The primarily results showed 6 patients

  4. Classical varicose vein surgery in a diverse ethnic community.

    Science.gov (United States)

    Murli, N L; Navin, I D

    2008-08-01

    Chronic venous disorders range from telangiactasia or spider veins to varicose veins, venous swellings, skin changes and venous ulcerations. The aim of this study is to assess outcome of varicose vein surgery in the ethnically diverse population of Penang, Malaysia. This study is a retrospective analysis of patients seen from 1999 to 2004. All patients who presented to the outpatient clinic of our surgical department with saphenofemoral junction (SFJ) and/or saphenopopliteal junction (SPJ) reflux associated with incompetence of the great saphenous vein (GSV) or small saphenous vein (SSV) respectively underwent classical varicose varicose vein surgery. A single surgeon at a single institution performed the surgeries. Data from pre-operative, post-operative and follow-up procedures were recorded in case report forms. A total of 202 cases were treated. Of these, 200 were qualified by the inclusion criteria and follow-ups, with 23 who were treated bilaterally. Of those treated, Chinese comprised 47.5%, Indians 27.0%, Malays 12.5% and foreigners 13.0% (largely Indonesian Chinese, British and Americans). The average age was 52.1 years. Indians had the highest average BMI of 29.2, compared to the Chinese who had the lowest of 24.6. Based on occupation, housewives (43.0%), blue collar workers (19.0%), salespersons (12.0%) and factory workers (9.5%) were among those afflicted with varicose veins. While local Chinese predominated in the business groups (salespersons and food-related workers), the Indians and Malays in this study were mainly factory workers and/or blue collar workers. Symptomatology in descending order of severity included pain in 80.0% of cases, swelling in 65.5%, heaviness in 53.5%, cramps in 53.0%, lipodermatosclerosis in 39.0%, superficial thrombophlebitis in 33.5%, venous ulceration in 32.0%, eczema 22.0% and cellulitis in 12.5% of patients. Post surgery pains dropped to 9.9%, cramps 6.4%, heaviness 5.5% and swelling 5.3% (p<0.0001 in all groups

  5. Comparação entre o laser endovenoso e a fleboextração total da veia safena interna: resultados em médio prazo Comparison of endovenous laser therapy vs. conventional stripping of the great saphenous vein: midterm results

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    Charles Angotti Furtado de Medeiros

    2006-12-01

    Full Text Available OBJETIVO: Comparar a fotocoagulação endovenosa com laser diodo e a fleboextração total da veia safena interna. MÉTODOS: Trata-se de um estudo prospectivo, controlado e cego de 20 pacientes com varizes sintomáticas e insuficiência bilateral da veia safena interna que foram operados entre março de 2002 e fevereiro de 2004. Para cada caso, foram realizadas aleatoriamente (sorteio as duas técnicas, sendo uma em cada lado. A avaliação pós-operatória consistiu na aplicação de questionários, exame físico e fotografia digital em todos os pacientes desde o 7º dia de pós-operatório. Também foi realizado controle ultra-sonográfico no 30º dia de pós-operatório e pletismografia a ar no 60º dia após a cirurgia. Este projeto foi aprovado pela comissão de ética, e os pacientes foram incluídos ao assinarem o consentimento pós-informação. Os dados foram submetidos a análise estatística com os programas SPSS e SAS. RESULTADOS: A técnica que utilizou o laser endovenoso apresentou dor semelhante, mas menos edema e menos hematoma durante o pós-operatório. O índice de melhora estética e de satisfação com a cirurgia foi de 100% para as duas técnicas, mas a maioria dos pacientes respondeu que o membro operado com o laser foi o mais beneficiado. Houve melhora do tempo de enchimento venoso nos dois grupos, mas sem diferença significativa entre eles. Durante o seguimento (média de 26 meses, houve um caso de parestesia leve e transitória do lado convencional e somente uma recanalização do lado laser. CONCLUSÃO: A fotocoagulação endovenosa para o tratamento da veia safena interna em pacientes com varizes de membros inferiores é segura e apresenta resultados comparáveis aos da fleboextração convencional.OBJECTIVE: To compare endovenous diode laser photocoagulation and conventional stripping of the great saphenous vein. METHODS: A controlled and blind prospective study of 20 patients with symptomatic varicose veins and

  6. Clinical Observation on Radiofrequency Endovenous Obliteration in Treating Great Saphenous Varicose Veins under Ultrasound Monitoring%超声监视引导下行射频闭合术治疗大隐静脉曲张临床观察

    Institute of Scientific and Technical Information of China (English)

    盛丽; 霍树靓; 李亮; 唐晓勇

    2014-01-01

    目的:探讨超声监视引导下行射频闭合术治疗大隐静脉曲张的临床效果及可行性。方法:对大隐静脉曲张患者98例(134条患肢)术前采用彩色多普勒超声进行深静脉功能分级,排除血栓患者,定位标记曲张浅静脉走形,在椎管内麻醉或局部浸润麻醉下行射频闭合手术,术中在彩超监视引导下对小腿曲张团块行点状剥脱、静脉环状缝扎等辅助治疗。结果:98例患者均在超声引导下完成手术治疗,痊愈出院,曲张静脉全部消失,未发生深静脉血栓及肺栓塞等严重并发症,随访6个月无再通、复发。结论:超声监视引导行射频闭合术治疗大隐静脉曲张方法便捷、安全、有目的性,能明显减少手术创口及创面,具微创、美观、并发症少、恢复快、廉价、效果优良等优点。%Objective: To explore clinical effects and the practicability of radiofrequency endovenous obliteration in treating great saphenous varicose veins under ultrasound monitoring. Methods:All 98 patients (134 affected limbs) were classified before the surgery by color Doppler ultrasound according to the functions of deep vein, the patients with thrombosis were removed, the shapes of varicose superficial vein in other patients were fixed and the patients were performed with radiofrequency endovenous obliteration under general anesthesia or local infiltration anesthesia, who received adjunctive therapy of punctuate desquamation and vein ringed transfixion on varicose masses under ultrasound monitoring in the surgery. Results: All 98 patients finished the surgery under ultrasound monitoring, cured and discharged, varicose veins were disappeared totally, severe complications such as deep vein thrombosis, pulmonary embolism and others were not found, there was no repatency or relapse in the follow-ups of six months. Conclusion:Radiofrequency endovenous obliteration in treating great saphenous varicose veins

  7. Endovascular Radiofrequency Ablation for Varicose Veins

    Science.gov (United States)

    2011-01-01

    Executive Summary Objective The objective of the MAS evidence review was to conduct a systematic review of the available evidence on the safety, effectiveness, durability and cost–effectiveness of endovascular radiofrequency ablation (RFA) for the treatment of primary symptomatic varicose veins. Background The Ontario Health Technology Advisory Committee (OHTAC) met on August 26th, 2010 to review the safety, effectiveness, durability, and cost-effectiveness of RFA for the treatment of primary symptomatic varicose veins based on an evidence-based review by the Medical Advisory Secretariat (MAS). Clinical Condition Varicose veins (VV) are tortuous, twisted, or elongated veins. This can be due to existing (inherited) valve dysfunction or decreased vein elasticity (primary venous reflux) or valve damage from prior thrombotic events (secondary venous reflux). The end result is pooling of blood in the veins, increased venous pressure and subsequent vein enlargement. As a result of high venous pressure, branch vessels balloon out leading to varicosities (varicose veins). Symptoms typically affect the lower extremities and include (but are not limited to): aching, swelling, throbbing, night cramps, restless legs, leg fatigue, itching and burning. Left untreated, venous reflux tends to be progressive, often leading to chronic venous insufficiency (CVI). A number of complications are associated with untreated venous reflux: including superficial thrombophlebitis as well as variceal rupture and haemorrhage. CVI often results in chronic skin changes referred to as stasis dermatitis. Stasis dermatitis is comprised of a spectrum of cutaneous abnormalities including edema, hyperpigmentation, eczema, lipodermatosclerosis and stasis ulceration. Ulceration represents the disease end point for severe CVI. CVI is associated with a reduced quality of life particularly in relation to pain, physical function and mobility. In severe cases, VV with ulcers, QOL has been rated to be as bad

  8. Vesicoureteral Reflux

    Science.gov (United States)

    ... causing the reflux. References [1] Pohl HG, Joyce GM, Wise M, Cilento BG. Pediatric urologic disorders. In: ... for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888- ...

  9. Nova técnica cirúrgica de preparo da veia safena para revascularização do miocárdio sem manipulação direta - no-touch Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Fabio de Rueda

    2008-06-01

    Full Text Available FUNDAMENTO: Otimização da veia safena na revascularização miocárdica. OBJETIVO: Apresentar a técnica no-touch de preparo da veia safena. Essa técnica consiste na retirada da veia safena do seu leito, com um pedículo de tecido adiposo, protegendo-a contra espasmos, sendo desnecessário distendê-la. MÉTODOS: Estudo prospectivo e randomizado, incluindo 156 pacientes submetidos a cirurgia de revascularização miocárdica. Comparação da técnica no-touch com duas outras técnicas: convencional e intermediária. Procedeu-se à avaliação da morfologia endotelial, utilizando a microscopia. A perviabilidade das pontes foi determinada com exame angiográfico num período médio de 18 meses após a operação. A enzima óxido nítrico sintetase endotelial (eNOS foi identificada por meio do estudo imunohistoquímico. RESULTADOS: A avaliação morfológica mostrou integridade endotelial de 97% nas veias do grupo no-touch; enquanto quase metade da superfície endotelial das veias tratadas pelas outras técnicas exibiu ausência de células endoteliais. A angiografia revelou perviabilidade de 95,4% para as pontes do grupo no-touch, 88,9 e 86,2% para as pontes do grupo convencional e intermediária, respectivamente. O estudo imunohistoquímico revelou a presença da eNOS nas três camadas que compõem a parede da veia no grupo no-touch e redução dessa enzima no grupo convencional. CONCLUSÃO: A integridade endotelial e a atividade da eNOS foram melhor preservadas com o uso da técnica no-touch. A proteção mecânica fornecida pelo tecido gorduroso circundante à veia e a atividade vasodilatadora e bloqueadora da agregação plaquetária causada pelo óxido nítrico podem ser responsáveis pela proteção da veia contra o espasmo, como também por sua alta perviabilidade imediata.BACKGROUND: Optimization of the saphenous vein for myocardial revascularization. OBJECTIVE: To present the no-touch technique of the saphenous vein preparation. This

  10. DSA引导下泡沫硬化术与大隐静脉高位结扎联合血管腔内激光术治疗下肢静脉曲张的疗效观察%Contrast effect of foam sclerotherapy of polidocanol and high ligation of great saphenous vein combie with cavity laser surgery for varicose vein of lower extremity

    Institute of Scientific and Technical Information of China (English)

    郭惠庄; 余盛龙; 冯惠岗; 庄炜钊; 黄晨; 唐郁宽; 吴鹏; 谢贞静; 陈汉威

    2015-01-01

    目的:探讨DSA引导下聚多卡醇泡沫硬化术与大隐静脉高位结扎术联合血管腔内激光术治疗下肢静脉曲张的临床疗效。方法选取60例下肢静脉曲张患者(共66条腿),随机分为DSA引导下聚多卡醇泡沫硬化术组(A组,30例共33条腿)及大隐静脉高位结扎术联合血管腔内激光术组(B组,30例共33条腿)。分别对两组患者手术时间、住院费用、术后并发症、治疗效果进行对比评价。结果 A组患者手术时间、住院费用明显低于B组(均P<0.01);A组患者术后皮下瘀血、感觉麻木、皮下脂肪液化感染、皮肤灼伤的发生率均显著低于B组(均P<0.01);两组患者静脉炎的发生率差异无统计学意义(P>0.05);两组患者出院时及术后3个月、6个月、1年治疗效果比较差异均无统计学意义(均P>0.05)。结论 DSA引导下聚多卡醇泡沫硬化剂治疗下肢静脉曲张是一项创伤小、并发症少、安全、有效的治疗方法。%Objective To explore the clinical effect of foam sclerotherapy of polidocanol and high ligation of great saphenous vein combie with cavity laser surgery for varicose vein of lower extremity.Methods A total of 60 cases(66 diseased limbs)of varicose vein of lower extremity patients were randomly divided into two groups, A group treated with foam sclerotherapy of polidocanol (n=30, 33 diseased limbs) , B group treated with high ligation of great saphenous vein combie with cavity laser surgery (n=30, 33 diseased limbs). The operation time, hospitalization expenses, the incidence of complications and the treatment effect were compared.Results The operation time and hospitalization expenses of A group signiifcantly lower than B group,there was signiifcant difference(P0.05). There was no significantly statistical difference in treatment effect of two groups(leaving hospital, after 3 months, after 6 months, after 1 year)(P>0.05). Conclusions Foam

  11. Gastroesophageal reflux.

    Directory of Open Access Journals (Sweden)

    Yanet Hidalgo Marrero

    2005-12-01

    Full Text Available Although many infants has smaller degrees of gastroesophageal reflux, it is recognized that 1:3,000 at 1:10,000 of they have a pathological or symptomatic reflux. Near 90% of children vomits during the first 6 weeks of life, due primarily to the physiologic immaturity of antireflux mechanism. However, in 60% of cases, reflux disappears before 18 months, even without treatment. 30% maintains the symptoms, becoming in pathological, and of them, 10% develops serious problems, around 5% esophagitis with stenosis and between the 1 to 5% the death related with aspiration. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005

  12. Doppler ultrasound evaluation of pattern of venous incompetance and relation with skin changes in varicose vein patients

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    HP Pant

    2015-06-01

    Full Text Available BACKGROUND Varicosity of lower limb is a common problem in agricultural country like Nepal. Doppler ultrasound is a standard investigation modality for confirmation of diagnosis, evaluation of severity and venous mapping to plan treatment. We aim to find out the epidemiology, common pattern of incompetance, severity assessment by doppler and association of the important doppler variables with skin changes. METHODOLOGY Doppler venous study was done in 56 patients from june 2013 to july 2014. Patients with deep vein thrombosis and peripheral arterial disease were excluded. Altogether 56 patients, 96 limbs were studied. Data was entered in preformed proforma. Doppler study was conducted by senior radiologist with linear probes. Data was entered in SPSS software version 16 and statistical significance was calculated using chi square test. RESULTS Bilateral limb involvement was seen in 40 patients and unilateral in 16 patuents only. Skin related changes were seen in 58 limbs. Saphenofemoral junction incompetance was seen in 79(82.2% limbs and was most common pattern of incompetance. Overall, superficial veins were involved in 88(91.7% limbs and deep in 30(31.2% limbs. Prolonged duration of varicosity (>9 year (p=0.000, bilateral limb involvement(p=0.024, reflux in deep venous system(p=0.002, larger Greater Saphenous Vein (GSV size(p=0.003, prolonged duration of reflux(p=0.000 and perforator incompetence (p=0.002 were associated with skin changes. GSV diameter more than 7 mm was associated with reflux significantly (P=0.002. CONCLUSION Superficial vein incompetance is common pattern compared to deep venous system. Sapheno Femoral Junction (SFJ incompetance is the commonest pattern. Larger caliber of vein, prolonged duration of reflux, reflux in deep venous system and perforator insufficiency are significantly associated with skin changes.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12770 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3

  13. Preparation of the saphenous vein for coronary artery bypass grafting: a new technique "no touch" that maintains the vein wall integral and provides high immediate patency Preparo da veia safena na cirurgia de revascularização miocárdica: uma nova técnica -"no touch"- que mantém a parede da veia íntegra e proporciona uma alta perviabilidade imediata

    Directory of Open Access Journals (Sweden)

    Domingos S. R. Souza

    2003-12-01

    Full Text Available BACKGROUND: The technique of harvesting the saphenous vein (SV for coronary artery bypass grafting (CABG influences the fate of vein grafts. A new "no touch" (NT technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasms therefore obviating the need for distension. METHOD: A prospective randomized study in 156 patients who underwent CABG was performed comparing three SV harvesting techniques. The techniques were conventional (c (adventitial stripping of the vein, manual distention and storing in saline solution; Intermediate (I (after adventitial stripping, the vein was left in situ, covered with a papaverine-soaked compress, and stored in heparinized blood; and "no touch" (SV dissected with its surrounding tissue was left in situ, covered with a saline-soaked compress and stored in heparinized blood. A morphological study of the endothelium was preformed using scanning electronic microscopy and an angiographic assessment of the vein graft patency was performed at 18 months mean follow-up time. Also an immunohistochemistry assessment was performed to identify the enzyme, nitric oxide synthase (NOS in the vein wall. RESULTS: The preservation of the endothelial cell integrity was greater with the "no touch" technique than with the other procedures. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. The immunohistochemistry assessment revealed NOS in all three layers of the vein wall that was prepared by the "no touch" technique. However, a great reduction of this enzyme in veins treated by the conventional technique was observed. CONCLUSION: The endothelial integrity and NOS activity were better preserved when using the "no touch" technique for vein graft harvesting. The vasorelaxation and thrombo-resistant activities of nitric oxide (NO may be responsible for the reduced of vasospasms and improved

  14. 带小隐静脉-腓肠神经营养血管的筋膜瓣修复足踝组织缺损%Repairing tissue defects in ankle and foot with lesser saphenous vein-sural neurovascular fascial flap

    Institute of Scientific and Technical Information of China (English)

    李永宁; 邵明

    2011-01-01

    目的 探讨应用带小隐静脉-腓肠神经营养血管的筋膜瓣逆行转移修复足踝部软组织缺损的手术方法和临床效果.方法 2007年3月至2010年12月收治29例足踝部软组织缺损患者,在患肢小腿后外侧选择性切开,向远端游离筋膜瓣至外踝尖上约5 cm并以此为旋转点,逆行转移筋膜瓣覆盖足踝软组织缺损区,术中切取筋膜瓣范围约为5 cm×4 cm~14 cm×12 cm,供区直接缝合,蒂根部及筋膜瓣表面游离植皮修复.结果 随访5个月至3年,术后29例筋膜瓣全部成活,仅2例筋膜瓣远端局部回流障碍,浅表组织坏死,经抗感染治疗后愈合,供区Ⅰ期愈合,所有患者皮瓣外形及功能良好,质地柔软,色泽与受区接近,无局限性臃肿,筋膜瓣受力处无破溃,足部功能恢复良好.结论带小隐静脉-腓肠神经营养的逆行筋膜瓣手术方法简单,抗感染能力强,修复组织缺损效果满意.%Objective To investigate the operative technique and clinical results of repairing soft tissue defects of the ankle and foot with reverse extended repair lesser saphenous vein-sural neurovascular fascial flap. Methods In the crural rearselective incision, free fascia flap was corresponded to the palpable posterior border of the fibula when mapped to the surface. The pivot point was placed at the level of the ankle joint distally, repairing soft tissue defects of the ankle and foot with reverse extended repair nutrition fasciall flap. The flaps were designed with the size of 5 cm x 4 cm-14 cm x 12 cm. Donor sites were directy sutured. The surface of roots and fascia flap were repaired by pedicled skin graft. Results Followingup from 5 months to 2 years all 22 adipofascial flap survived after surgery. Partial inadequate venous return and distal superficial necrosis happened in only 2 cases, which also got secondary healing by anti-infective therapy. The donor sites reached primary healing completely. Appearance and function of the flaps

  15. The distally based lateral sural neuro-lesser saphenous veno-fasciocutaneous flap: anatomical basis and clinical applications.

    Science.gov (United States)

    Wang, Chen; Xiong, Zhuyou; Xu, Jing; Zhang, Li; Huang, He; Li, Guangzao

    2014-09-01

    Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the plastic surgeon. The aim of this research was to investigate the anatomical relationships of artery, nerve, vein and other adjacent structures in the posterolateral region of the calf, and our experience with using a distally based island flap pedicled with the lateral sural nerve and the lesser saphenous vein for soft tissue reconstruction of lower third of leg, foot, and ankle defects in 15 patients. Five fresh cadavers (ten lower limbs) were infused with colored red latex. The origin of the nutrient vessel of the lesser saphenous vein and the lateral sural nerve was identified. Based on the anatomical studies, an island flap supplied by the vascular axis of the lesser saphenous vein and the lateral sural nerve was designed for clinical reparative applications in 15 cases. The nutrient vessel of the lesser saphenous vein and the lateral sural nerve originates from the superficial sural artery, musculocutaneous perforators of the posterior tibial artery, and septocutaneous perforators of the peroneal artery in different segment of the calf. Meanwhile, these vessels have many sub-branches nourishing subcutaneous tissue and skin, form a favorable vascular chain around the nerve and the vein, and also communicate with vascular plexus of superficial and deep fascia. Among 15 flaps, 13 showed complete survival (86.66 %), while marginal flap necrosis occurred in one patient (6.67 %) and distal wound dehiscence in another (6.67 %). Their appearance and function were satisfactory, with feeling maintained in the heel and lateral side of the foot. The distally based flap pedicled with the lateral sural nerve and lesser saphenous vein was a reliable source for repairing soft tissue defects in the lower leg and foot due to its advantages of infection control, high survival rate, and sufficient blood supply without the need to sacrifice a major blood vessel.

  16. 电视内镜下大隐静脉采集术在老年冠状动脉搭桥术中的应用%Endoscopic technique for greater saphenous vein harvesting in elderly patients undergoing coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    姚建民; 王东文; 庞中一; 张永; 肖志斌; 赵向东; 陆龙; 刘静

    2011-01-01

    Objective To summarize the experiences in greater saphenous vein harvesting during video-assisted endoscopic technique in elderly patients undergoing coronary artery bypass grafting.Methods Between April 2005 and March 2010, 303 elderly patients with coronary heart disease, aged 60 to 84 (68.6±7.3)years, underwent selective coronary artery bypass grafting.Of the 303 patients, 197 cases received video-assisted endoscopic technique for greater saphenous vein harvesting (ESVH), 106 cases had open procedure for greater saphenous vein harvesting (OSVH).There was no difference in sex, body mass, left ventricular ejection fraction (LVEF), the number of bypass grafting and concomitant diseases.The operative efficacy was compared between the two groups.Results The mean operation time duration was (38.3 ± 8.8) min and (35.5 ± 7.2) min in ESVH and OSVH groups respectively (P < 0.01).The subcutaneous hematoma occurred in 8 (4.1%) cases and 2 (1.9%) cases in ESVH group and OSVH group respectively (P > 0.05).There was no abnormal feeling, incision infection and fat necrosis of lower extremity in ESVH group.The incidence of chronic leg edema in ESVH group was 2.0%, which was remarkably lower than that in OSVH group (19.8%, P < 0.05).Leg pain in ESVH group was much less intensive than that in OSVH group.The patients receiving ESVH had shorter hospital stay than those receiving OSVH [(8.4 ± 1.8) vs (13.3 ± 2.8) d, P < 0.001].Conclusion ESVH, as a minimally invasive technique, can significantly reduce postoperative leg incision complications in elderly patients undergoing coronary artery bypass grafting.%目的 介绍老年冠状动脉旁路移植术(CABG)中应用电视内镜采集大隐静脉血管桥的体会.方法 纳入自2005年4月至2010年3月择期行老年CABG患者303例,年龄60~84(68.6±7.3)岁.术中在电视内镜辅助下采集大隐静脉血管桥197例(ESVH组),采取全程切开采集大隐静脉(OSVH)106例,ESVH组

  17. Vesicoureteral reflux and reflux nephropathy

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, H.S.

    Vesicoureteral reflux (VUR) is mainly a primary phenomenon due to incontinence of the ureterovesical junction, mostly affecting a pediatric population. During micturition cystourethrography (MCU) reflux into the kidney - intrarenal reflux (IRR) - is occasionally seen. In areas with IRR the kidney surface may subsequently be depressed and the papillae retracted (reflux nephropathy (RN)). VUR may lead to hypertension and/or end-stage renal failure. Most commonly, VUR is discovered during evaluation for urinary tract infection, but it may also be present in patients with hypertension, toxemia of pregnancy, chronic renal failure and proteinuria, and it may be found in siblings of patients with VUR. For the time being VUR is demonstrated at radiographic MCU, whereas RN is diagnosed by demonstration of focal scars and of abnormal parenchymal thickness at urography. In children with VUR and no abnormalities of calyces or parenchymal defects standardized measurement of the parenchymal thickness at three sites may identify kidneys which are likely to develop focal scars. Quantitation of focal scarring should be performed in connection with a measure of the overall kidney size. The occurrence of IRR is dependent of the papillary morphology, intrapelvic pressure and urine flow. There may be an important relationship between renal ischemia and IRR in producing a 'vicious circle of deleterious effects' which, combined with parenchymal extravasation, may lead to RN. Treatment of VUR includes medical and surgical management. Since renal scarring may occur in infancy, prevention should focus on infants and young children. Infants and young children with severe VUR may have normal urograms. Therefore a MCU should also be performed, preferably with the recommended standardized technique. (orig.).

  18. Reflux and Lung Disease

    Science.gov (United States)

    ... Healthy Eating Reflux and Lung Disease Reflux and Lung Disease Make an Appointment Ask a Question Find a Doctor Many people with chronic lung disease also suffer from gastroesophageal reflux (GERD). In this ...

  19. Oestradiol levels in varicose vein blood of patients with and without pelvic vein incompetence (PVI): diagnostic implications.

    Science.gov (United States)

    Asciutto, G; Mumme, A; Asciutto, K C; Geier, B

    2010-07-01

    To assess the difference in the oestradiol levels of blood taken from varicose veins in patients with and without pelvic vein incompetence (PVI). Women of child-bearing age with symptomatic primary or recurrent varicose veins of the great saphenous vein (GSV) were included in a prospective study. Patients underwent duplex ultrasonography and pelvic vein phlebography. They were divided into a group with PVI (PVI group) and a control group with GSV reflux alone (VV group). Blood samples were collected from the GSV at the sapheno-femoral junction or lower in the thigh as well as from the arm. Oestradiol levels were determined by electroluminescence. Between January and December 2007, 40 women were studied, of which 19 showed phlebographic evidence of PVI (PVI group), while 21 were included in the VV group. Phlebography revealed an incompetent ovarian vein in 14 (74%) patients of the PVI group, dilated uterine and ovarian plexuses in 12 (63%) and an incompetent internal iliac vein in six cases (32%). In the PVI group, the median oestradiol level in GSV samples was 121 pgml(-1) (range: 12-4300), while in the VV group the median level was 75 pgml(-1) (range: 9-1177). In the upper limb, the PVI group patients had a median level of 78 pgml(-1) (range: 15-121) and the VV group patients 68 pgml(-1) (range: 13-568). The ratio of lower limb/upper extremity was significantly higher (pPVI group (median: 1.9; range: 0.7-33) than in those of the VV group (median: 1.1; range: 0.8-13). A threshold ratio of 1.4 showed the highest combined sensitivity and specificity in differentiating patients with PVI from those without. In patients with varicose veins arising from the GSV, oestradiol levels were significantly higher in the lower limb than in the upper extremity in the subgroup with associated PVI. It may be possible to use this observation as a diagnostic test in patients with suspected PVI. This deserves further study. Copyright 2010 European Society for Vascular Surgery

  20. Endovascular Laser Therapy for Varicose Veins

    Science.gov (United States)

    2010-01-01

    Executive Summary Objective The objective of the MAS evidence review was to conduct a systematic review of the available evidence on the safety, effectiveness, durability and cost–effectiveness of endovascular laser therapy (ELT) for the treatment of primary symptomatic varicose veins (VV). Background The Ontario Health Technology Advisory Committee (OHTAC) met on November 27, 2009 to review the safety, effectiveness, durability and cost-effectiveness of ELT for the treatment of primary VV based on an evidence-based review by the Medical Advisory Secretariat (MAS). Clinical Condition VV are tortuous, twisted, or elongated veins. This can be due to existing (inherited) valve dysfunction or decreased vein elasticity (primary venous reflux) or valve damage from prior thrombotic events (secondary venous reflux). The end result is pooling of blood in the veins, increased venous pressure and subsequent vein enlargement. As a result of high venous pressure, branch vessels balloon out leading to varicosities (varicose veins). Symptoms typically affect the lower extremities and include (but are not limited to): aching, swelling, throbbing, night cramps, restless legs, leg fatigue, itching and burning. Left untreated, venous reflux tends to be progressive, often leading to chronic venous insufficiency (CVI). A number of complications are associated with untreated venous reflux: including superficial thrombophlebitis as well as variceal rupture and haemorrhage. CVI often results in chronic skin changes referred to as stasis dermatitis. Stasis dermatitis is comprised of a spectrum of cutaneous abnormalities including edema, hyperpigmentation, eczema, lipodermatosclerosis and stasis ulceration. Ulceration represents the disease end point for severe CVI. CVI is associated with a reduced quality of life particularly in relation to pain, physical function and mobility. In severe cases, VV with ulcers, QOL has been rated to be as bad or worse as other chronic diseases such as

  1. Gastroesophageal reflux.

    Science.gov (United States)

    Slater, Bethany J; Rothenberg, Steven S

    2017-04-01

    Gastroesophageal reflux disease (GERD) is a very common condition and affects approximately 7-20% of the pediatric population. Symptoms from pathological GERD include regurgitation, irritability when feeding, respiratory problems, and substernal pain. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in the pediatric population include failure of medical therapy with poor weight gain or failure to thrive, continued respiratory symptoms, and complications such as esophagitis. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. The key technical aspects of laparoscopic Nissen fundoplication include creation of an adequate intra-abdominal esophagus, minimal dissection of the hiatus with exposure of the right crus to identify the gastroesophageal junction, crural repair, and creation of floppy, 360° wrap that is oriented at the 11 o׳clock position. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. [Sequence of venous blood flow alterations in patients after recently endured acute thrombosis of lower-limb deep veins based on the findings of ultrasonographic duplex scanning].

    Science.gov (United States)

    Tarkovskiĭ, A A; Zudin, A M; Aleksandrova, E S

    2009-01-01

    veins (to have occurred in 25% of the cases). Of special interest was the finding that insufficiency of the ostial valve of the great saphenous vein, manifesting itself by a superficial vertical veno-venous reflux, was revealed only in two (6.25%) patients examined 12 months after the onset of the disease, which may be regarded as the third stage of the phlebohaemodynamic alterations. That low prevalence and no evidence of varicose transformation of superficial veins appear to suggest an important part they play in compensation of the venous outflow from the extremity affected.

  3. Reflux in Children

    Science.gov (United States)

    ... could be GERD. What causes reflux and GERD in children? There is a muscle (the lower esophageal ... contents don't flow back into the esophagus. In children who have reflux and GERD, this muscle ...

  4. Reflux in Infants

    Science.gov (United States)

    ... to 14 months. What causes reflux and GERD in infants? There is a muscle (the lower esophageal ... contents don't flow back into the esophagus. In babies who have reflux, the lower esophageal sphincter ...

  5. Bioaccumulation of Ergovaline in Bovine Lateral Saphenous Veins in Vitro

    Science.gov (United States)

    Ergot alkaloids have been associated with vasoconstriction in grazing livestock afflicted with the fescue toxicosis syndrome. Previous in vitro investigations studying how ergot alkaloids cause the observed vasoconstriction have shown that ergovaline has a very distinct receptor affinity and sustain...

  6. Minimally invasive treatments for perforator vein insufficiency.

    Science.gov (United States)

    Kuyumcu, Gokhan; Salazar, Gloria Maria; Prabhakar, Anand M; Ganguli, Suvranu

    2016-12-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease.

  7. Connexin43 Inhibition Prevents Human Vein Grafts Intimal Hyperplasia

    Science.gov (United States)

    Longchamp, Alban; Allagnat, Florent; Alonso, Florian; Kuppler, Christopher; Dubuis, Céline; Ozaki, Charles-Keith; Mitchell, James R.; Berceli, Scott; Corpataux, Jean-Marc

    2015-01-01

    Venous bypass grafts often fail following arterial implantation due to excessive smooth muscle cells (VSMC) proliferation and consequent intimal hyperplasia (IH). Intercellular communication mediated by Connexins (Cx) regulates differentiation, growth and proliferation in various cell types. Microarray analysis of vein grafts in a model of bilateral rabbit jugular vein graft revealed Cx43 as an early upregulated gene. Additional experiments conducted using an ex-vivo human saphenous veins perfusion system (EVPS) confirmed that Cx43 was rapidly increased in human veins subjected ex-vivo to arterial hemodynamics. Cx43 knock-down by RNA interference, or adenoviral-mediated overexpression, respectively inhibited or stimulated the proliferation of primary human VSMC in vitro. Furthermore, Cx blockade with carbenoxolone or the specific Cx43 inhibitory peptide 43gap26 prevented the burst in myointimal proliferation and IH formation in human saphenous veins. Our data demonstrated that Cx43 controls proliferation and the formation of IH after arterial engraftment. PMID:26398895

  8. Feasibility of Stripping Surgery of Great Saphenous Vein Varicosity Performed in One-Day Stay Ward%开展大隐静脉曲张剥脱术日间病房运营模式的可行性探讨

    Institute of Scientific and Technical Information of China (English)

    刘思; 吴洲鹏; 罗艳丽

    2012-01-01

    Objective To explore the feasibility and the security of one-day stay ward in stripping surgery of saphenous vein varicosity. Methods Two hundred and eighty two patients treated in our hospital in 2011 were enrolled in this study, according to the operation mode, these patients were divided into 2 groups, ninety patients in one-day stay ward group and one hundred and ninety two patients in in-patient group. Their clinical features and medical operation indexs (included preoperative waiting time, duration of hospital stay, and medical cost) were retrospectively analyzed. Results There was no statistical differences on clinical features between the two groups. But compared with in-patient group, the preoperative waiting time, duration of hospital stay, and medical cost were shorter or lower in one-day stay ward group (P<0. 05) . Conclusions The one-day stay ward operation mode can decrease preoperative waiting time, duration of hospital stay and medical cost significantly, and it also can ensure the safety of clinical treatment. So it's worthy in the clinical promotion.%目的 探讨采用新型运行流程,开展大隐静脉曲张剥脱术日间病房运营模式的可行性和安全性.方法 回顾性分析笔者所在医院2011年内行大隐静脉曲张剥脱术的282例患者的临床资料,根据运营方式不同将其分为日间手术组(n=90)和住院手术组(n=192).对2组患者的临床特征以及医疗运行指标(包括术前等待时间、住院时间以及医疗费用)进行比较分析.结果 2组患者间的基本临床特征差异均无统计学意义(P>0.05);日间手术组患者的术前等待时间和住院时间较住院手术组短(P<0.05),而医疗费用较低(P<0.05).结论 新型的日间病房运营模式可缩短大隐静脉曲张患者的术前等待时间、住院时间以及医疗费用,同时能够保证其临床治疗的安全性,值得在临床中推广.

  9. Laryngopharyngeal reflux in patients with reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Yung-Chih Lai; Pa-Chun Wang; Jun-Chen Lin

    2008-01-01

    AIM: To assess the prevalence of laryngopharyngeal reflux (LPR) in patients with reflux esophagitis and dis-close factors contributing to the development of LPR.METHODS: A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled.ings for the diagnosis of LPR. We used validated ques-tionnaires to identify the presence of laryngopharyn-geal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR.RESULTS: The prevalence rate of LPR in studied sub-jects with reflux esophagitis was 23.9%. Age, hoarse-ness and hiatus hernia were factors significantly as-sociated with LPR. In 23 patients with a hiatus hernia,the group with LPR was found to have a lower trend of esophagitis grading.CONCLUSION: Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagi-tis. The importance of hiatus hernia deserves further study.

  10. Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

    Science.gov (United States)

    Balestrini, Carlos Sebastian; Saaibi, José Federico; Ortiz, Santiago Navas

    2014-09-01

    We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded.

  11. Ação inibitória da Interleucina - 1ß sobre a proliferação de células musculares lisas cultivadas a partir de veias safenas humanas Inhibitory action of the Interleukin 1ß over the cellular proliferation of smooth muscle cells cultivated from human saphenous veins

    Directory of Open Access Journals (Sweden)

    Luís A.O. Dallan

    2005-06-01

    Full Text Available INTRODUÇÃO: A veia safena é um enxerto coronário eficiente. Porém, sua patência pode ser limitada por desenvolvimento de aterosclerose. Estudos experimentais "ex vivo", por nós realizados anteriormente, demonstraram apoptose (ensaio de TUNEL em veias safenas humanas cultivadas sob pressão arterial por 24 horas. Nessas veias safenas, a expressão gênica da Interleucina-1ß avaliada por RT-PCR em tempo real, também mostrou-se elevada. Não há ainda consenso sobre a ação moduladora das citocinas sobre proliferação/apoptose das células musculares lisas das veias safenas. OBJETIVO: Avaliar a influência da Interleucina -1ß na proliferação inicial de cultura de células primárias de músculo liso de veia safena humana. MÉTODO: Foram cultivadas células primárias de músculo liso de seis diferentes veias safenas humanas (em triplicata. O meio de cultura foi o DMEM, suplementado com 10% de soro fetal bovino. O grupo controle não recebeu Interleucina - 1ß. Nos demais grupos, as células cultivadas receberam, respectivamente, 0,1; 1; 10 e 100 ng/mL de Interleucina - 1ß. A proliferação celular foi avaliada através da quantificação de timidina triciada [³H], incorporada às células recém-proliferadas. RESULTADOS: O tratamento com Interleucina - 1ß diminuiu a proliferação celular, a saber: Grupo controle (sem Interleucina - 1ß: definiu-se esse grupo como apresentando 100±4,5% de proliferação celular. Nos demais grupos, a quantidade de Interleucina - 1ß administrada e a proliferação celular aferida foram, respectivamente, 0,1 ng/mL:112±0,7%; 1 ng/mL:83,8±4,7%; 10 ng/mL:69,1±3,8%; 100 ng/mL:67,3±10,9%; (pOBJECTIVE: The saphenous vein (SV is an effective graft used in coronary artery bypass grafting, although, its patency can be affected by the development of atherosclerosis. We have developed an experimental study demonstrating the development of apoptosis in SV grafts cultivated under arterial hemodynamic

  12. Reflux symptom questionnaire in the diagnosis of reflux oesophagitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li; MENG Ling-mei; ZHANG Dong-hong; HUANG Shu-mei; QU Xue-fu; ZHOU Li-ya; LIN San-ren; DING Shi-gang; HUANG Yong-hui; GU Fang; LI Yuan; ZHANG Jing; YAN Xiu-e

    2007-01-01

    @@ Reflux symptom questionnaire (RSQ) is a useful tool in epidemiological study of gastroesophageal reflux disease (GERD),(1,2) but the correlation between RSQ and the refluX oesophagitis (RE) is still unclear.

  13. Varicose Veins

    Science.gov (United States)

    Varicose veins are swollen, twisted veins that you can see just under the skin. They usually occur in ... of the body. Hemorrhoids are a type of varicose vein. Your veins have one-way valves that help ...

  14. Increased infiltration of Chlamydophila pneumoniae in the vessel wall of human veins after perfusion

    NARCIS (Netherlands)

    Kupreishvili, K.; Weeme, M.ter; Morré, S.A.; Brule, A.J.C. van den; Huybregts, M.A.J.M.; Quax, P.H.A.; Velden, J. ten; Hinsbergh, V.W.M. van; Stooker, W.; Eijsman, L.; Niessen, H.W.M.

    2008-01-01

    Background: Several studies have suggested an association between Chlamydophila pneumoniae (Cp) infection and atherosclerosis. A recent study detected Cp DNA in the saphenous vein of 12% of all patients before bypass grafting and in 38% of failed grafts. We used a system in which human veins were pe

  15. Familial vesicoureteral reflux

    OpenAIRE

    朴, 勺; 新井, 豊; 友吉, 唯夫; 吉田, 修

    1983-01-01

    Primary vesicoureteral reflux was seen in 2 siblings in a family of 5 (1 daughter and 2 sons). Voiding cystogram of elder sister, who complained of fever and backache, showed bilateral reflux at the age of 6. Left reflux disappeared soon but right reflux persisted. Right antireflux operation was performed at the age of 9, but right renal function deteriorated gradually. Right nephrectomy was done at the age of 12 because of persistent pyuria and renal stones. The second case was her younger b...

  16. [Reflux nephropathy in absence of obvious vesicoureteral reflux].

    Science.gov (United States)

    Vino, L; Pedrolli, A; Portuese, A; Dal Cerè, M; Pizzini, C; Sinaguglia, G; Fanos, V

    2000-01-01

    Although the majority of patients with vesicoureteric reflux presents DMSA scan alterations, parenchimal renal scars are found also in children without vesicoureteric reflux. Two clinical cases of reflux nephropathy without evidence of reflux are presented. Several explanations could be advocated to justify this picture, including haematogenous source of infection, inadequate timing and/or procedure of cystouretrography, intermittency of reflux, ascending bacteria, previous presence of reflux, and appearance of controlateral reflux during the natural history of a monolateral documented reflux. Tailored diagnostic and therapeutic strategy should discussed for each patient.

  17. Reflux and GERD in Infants

    Science.gov (United States)

    ... Z Celiac Disease Eosinophilic Esophagitis Inflammatory Bowel Disease Nutrition & Obesity Reflux & GERD Reflux & GERD in Infants Symptoms & Diagnosis ... Nutrition (NASPGHAN) Celiac Disease Eosinophilic Esophagitis Pediatric IBD Nutrition & Obesity Reflux & GERD Research & Grants Our Supporters Site Map © ...

  18. Reflux and GERD (in Children)

    Science.gov (United States)

    ... Z Celiac Disease Eosinophilic Esophagitis Inflammatory Bowel Disease Nutrition & Obesity Reflux & GERD Reflux & GERD in Infants GERD in ... Nutrition (NASPGHAN) Celiac Disease Eosinophilic Esophagitis Pediatric IBD Nutrition & Obesity Reflux & GERD Research & Grants Our Supporters Site Map © ...

  19. Standing posture at work and overweight exacerbate varicose veins: Shimane CoHRE Study.

    Science.gov (United States)

    Kohno, Kunie; Niihara, Hiroyuki; Hamano, Tsuyoshi; Takeda, Miwako; Yamasaki, Masayuki; Mizumoto, Kazuo; Nabika, Toru; Morita, Eishin; Shiwaku, Kuninori

    2014-11-01

    Varicose veins (VV) in legs are commonly observed in the general global population. However, the prevalence of and risk factors for VV in Japan are not clear. This study aimed at clarifying the risk factors for VV in traditional rural areas of Shimane prefecture. Subjects (113 men and 205 women aged ≥45 years) were recruited from health examinations in those areas in 2012. VV were defined as a reflux of blood in the great and/or small saphenous vein and incompetent perforating veins detected by ultrasonography. Risk factors for VV were analyzed using logistic regression models that included various parameters. We also investigated the possible interaction between standing at work and overweight and calculated the synergistic index. VV were found in 20.1% of the subjects (12.4% of men and 24.4% of women). The previously known risk factors of prolonged upright standing posture during work, higher body mass index (BMI), female sex, and age were also significant factors for VV. There was a significant combined effect of overweight (BMI ≥25) and prolonged upright standing posture at work [adjusted odds ratio = 3.42; 95% confidence interval (CI), 1.07-10.89], although the synergistic effect was not significant [synergistic index = 1.3; 95% CI, 0.2-8.7]. The prevalence of VV in the traditional rural area of Shimane prefecture was comparable to that reported previously in European countries. Our results confirm that exposure to both prolonged standing at work and overweight exacerbate VV development. This finding is useful to develop strategies for VV prevention.

  20. EVALUATION OF “SEPS” PROCEDURE IN THE MANAGEMENT OF PRIMARY VARICOSE VEINS WITH INCOMPETENT LOWER LIMB PERFORATOR

    Directory of Open Access Journals (Sweden)

    Shaik Ahmad

    2016-03-01

    Full Text Available BACKGROUND Varicose veins affect at least 1 out of 5 in the world and the cost of health care for the society is significant. In a developing country like India, study encompassing the clinical evaluation and management of lower limb varicose veins on the conventional lines seems a necessity to improve the quality care with the available resources. OBJECTIVES To study the relation between site of incompetence and complications, pattern of complications, surgical management and its outcome for lower limb varicose veins. METHODS A total 26 number of patients with primary varicose veins admitted, investigated, operated and followed up. Final outcome evaluated. All the information was taken down in the proforma, designed for the study. RESULTS In the study, it was noted that the varicose veins affect younger, adult, and middle age population. (20 to 60 years. Majority of the patients were male (84.60%. Perforator incompetence only = 42.3% (n=11. Perforator incompetence + saphenofemoral/saphenopopliteal incompetence seen in 57.7%. Long saphenous vein involvement was seen in 90.5% of the patients and both LSV and SSV involvement in 9.5%. A greater portion of the patients had combined valvular incompetence (69.56%. The mean ulcer healing time in our study was 2.8 weeks following surgery (90%. Residual incompetent perforators are seen in 7.6% (n=2. New incompetent perforators seen in 7.6% (n=2. Postoperative wound infection of the incision of SPJ ligation was seen in 3.8% (n=1 of the patients, but not the SEPS wound infection and the total complication rate was 3.85%. The mean postoperative stay for patients undergoing SEPS procedure alone was 3.6 days. The mean postoperative stay for patients who underwent perforator ligation with concomitant stripping procedure was 5 days. INTERPRETATION AND CONCLUSION Majority of the patients present with complications of varicose vein with combined valvular incompetence and surgical treatment with stripping of path

  1. Prospective clinical study of surgical management of varicose veins of lower limb and its complications

    Directory of Open Access Journals (Sweden)

    Nagaraj H.

    2014-02-01

    Methods: Two years prospective study was conducted in our institution from May 2007 to April 2009. During this period 62 cases of varicose veins of lower limbs were admitted to our hospital of which 50 cases were selected and were studies in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 21 (42% had only long saphenous vein involvement, 7 (14% had short saphenous vein involvement and in 5 (10% cases both short and long saphenous system were involved. In addition to long saphenous vein involvement, incompetent perforators were present in 17 (34% cases. Among them prominent veins and pain were the main complain in 38 (78% patients. Itching and pigmentation were present in 4 (8% patients. Ankle edema was present in 6 (12% patients. Pain and ulceration of lower leg were present in 2 (4% patients. After clinical assessment appropriate surgical procedures were followed for each of patients. These cases were followed for 3 year durations. Out of 50 patients 7 (14% patients had recurrence of varicose vein. 7 (14% patient complained of recurrence of pain after 2 years of surgery but no appearance of varicose vein. One patient (2% complained of persistence of pigmentation after surgery. 2 (4% patients complained of persistence of ankle edema and there was complete healing of ulcer which was present earlier. Conclusions: Commonest age group of varicose vein of lower limb was 20 to 40 years. Definite relationship exists between the occupation and the incidence of varicose veins. The patients were in the occupation which required standing for long time had the higher chances of varicose vein. Severity of the symptoms is not proportional to the duration of varicose veins. The involvement of long saphenous vein is more common than the short saphenous vein. Since our study shows very low percentage of recurrence and symptoms related to varicose vein the surgical line of

  2. The Law of Reflux

    OpenAIRE

    Sproul, Michael

    2010-01-01

    The law of reflux is explained using an example of backed money. In the example, government-issued money is backed by the government’s assets (mainly taxes receivable) while bank-issued money is backed by the bank’s assets. The value of both kinds of money is determined by the amount of backing held per unit of money issued. The example shows that reflux maintains money’s value, not by assuring that excessive issues of money reflux to their issuers, but by providing people with access to the ...

  3. Spider Veins

    Science.gov (United States)

    ... How to Choose the Best Skin Care Products Spider Veins Treatment Options Learn more about treatment options ... severe venous disease. What you should know about spider veins The exact cause of spider veins is ...

  4. Conventional operation and laser therapy in the treatment of varicose veins

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To evaluate the effectiveness of endovenous laser therapy and conventional therapy on the varicose of great saphenous vein. Methods: Thirty-two patients received endovenous laser therapy and 32 patients were operated by conventional therapy (high ligation and stripping). The observation results of great saphenous vein(GSV) were recorded by clinical evaluation and duplex ultrasound examination. And the operating time, intraoperative blood loss, time to become moveable, duration of hospitalization and degree of feeling pain were compared between the two groups. Results: Compared with conventional therapy, laser therapy had good curative effect with less complications and no scars and no pains. There were significant differences between the two groups (P<0.01). Conclusion: Laser therapy for varicose of great saphenous vein is better than the conventional therapy. It deserves to be widely used in clinical treatment.

  5. Autogenous Sapheonus Vein Graft Interposition in Arteriovenous Fistula Formation

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    Alper Uzun

    2013-10-01

    Full Text Available Aim: Other techniques are required due to the negative influence of poor superficial venous system calibration (<1.5-2 mm to the long term patency of the arteriovenous fistula which is documented via preoperative Doppler ultrasound examination. The postoperative outcome of 32 patients were compared prospectively whom autologous saphenous vein bridge graft was interposed between brachial artery/high brachial vein and radial artery/basilic vein. Material and Method: Patients were divided into two groups; patients whom radial artery/basilic vein autologous saphenous vein graft interposition was performed were labelled as Group 1 (17 patients while patients whom brachial artery/high brachial vein autologous saphenous vein graft was interpositioned were labelled as Group 2 (15 patients. Patients were followed up for 12 months. Graft related complications were recorded. Primary and secondary patency rate were calculated. Results: Graft infection, edema or ischemia of the hand or arm, congestive heart failure and mortality was not observed. There was not a significant difference in puncture site complications between two groups. Primary patency rate was 76.5% (13 of 17 in Group 1 while it was 93.3% (14 of 15 for Group 2 (p=0,185. Secondary patency rate was 82.4% (14 of 17 in Group1 and 100% (15 of 15 for Group 2 (p=0.093. Primary and secondary patency rate were similar between two groups. Discussion: We sought to compare the complication and patency rate of the proximal (brachial artery/high brachial vein and distal (radial artery/basilic vein located bridge graft interpositions and could not found statistical difference between two groups. It is reasonable to keep proximal regions for further interventions, so radial artery/basilic vein bridge graft interposition can be recommended as the initial option according to our findings.

  6. Refractory gastroesophageal reflux disease

    OpenAIRE

    Joaquim Prado P. Moraes-Filho

    2012-01-01

    CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibito...

  7. Tratamento da congestão pélvica associada a varizes dos membros inferiores: relato de uma pequena série de casos Treatment of pelvic congestion associated with varicose veins of the lower limbs: report of a small number of cases

    Directory of Open Access Journals (Sweden)

    Fábio Augusto Cypreste Oliveira

    2012-03-01

    Full Text Available A síndrome de congestão pélvica é definida por critérios anatômicos, hemodinâmicos e clínicos, decorrentes da hipertensão e estase venocapilar no território pélvico, podendo ser estendido aos membros inferiores. A presença de varizes dos membros inferiores pode estar ou não relacionada ao refluxo do sistema safeno e, nos casos de ausência do refluxo safeno, o refluxo pélvico apresenta-se como importante fator etiológico responsável pelo aparecimento e recidiva da doença venosa nos membros inferiores. Os autores relatam uma pequena série de três casos de pacientes jovens portadoras de síndrome de congestão pélvica associada à varizes dos membros inferiores tratadas por embolização pélvica e tratamento cirúrgico das varizes de membros inferiores, no mesmo tempo cirúrgico, com bons resultados iniciais e ausência de complicações embólicas.The pelvic congestion syndrome is defined by anatomical criteria, hemodynamic and clinical result of hypertension and venocapillary stasis in the pelvic area and can be extended to the lower limbs. The presence of varicose veins of the lower limbs may or may not correlate reflux of the saphenous system and, in cases of absence of saphenous reflux, the reflux pelvic presents itself as an important etiological factor responsible for recurrence of venous disease in lower limbs. The authors report a small series of three cases of young patients suffering from pelvic congestion syndrome associated with varicose veins of the lower limbs treated by pelvic embolization and surgical treatment of varicose veins of the lower limbs during the surgical procedure with good initial results and no embolic complications.

  8. Relationship between patient-reported symptoms, limitations in daily activities, and psychological impact in varicose veins.

    Science.gov (United States)

    Mallick, Rajiv; Lal, Brajesh Kumar; Daugherty, Claire

    2017-03-01

    The objective of this study was to evaluate the relationship between patient-reported symptoms, functional limitations, and psychological impact of varicose veins (VVs) vs pathophysiologic mechanism, incorporating demographic and behavioral factors. We conducted a pooled analysis from two clinical studies (Efficacy and Safety Study of Polidocanol Injectable Foam for the Treatment of Saphenofemoral Junction Incompetence [VANISH-1] and Polidocanol Endovenous Microfoam Versus Vehicle for the Treatment of Saphenofemoral Junction Incompetence [VANISH-2]) in patients with VVs (superficial venous reflux only). Health outcomes were classified on the basis of the Wilson-Cleary conceptual framework continuum linking clinical and anatomic factors (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] clinical class and great saphenous vein [GSV] diameter, respectively) to patient-reported outcomes: Varicose Vein Symptoms Questionnaire (VVSymQ) score; modified Venous Insufficiency Epidemiologic and Economic Study on Quality of Life/Symptoms (m-VEINES-QOL/Sym) limitations in daily activities (functional limitations hereafter) score; and m-VEINES-QOL/Sym psychological impact score. Association of clinical and anatomic categories with each of the patient-reported outcomes was assessed using analysis of variance for statistical significance and standardized mean differences for clinical meaningfulness. Hierarchical regression modeling was applied to evaluate the direct association of the VVSymQ symptom score with the m-VEINES-QOL/Sym functional limitations score and the indirect association with the m-VEINES-QOL/Sym psychological impact score, adjusting for clinical, behavioral, and demographic factors. Among 516 patients, approximately three-fourths were women (mean age, 49 years), approximately 70% were overweight or obese, 42% were C2 and 32% were C3, and 88% reported never or only intermittently wearing compression stockings. VVSymQ (symptom) scores did not vary by GSV

  9. Endovenous radiofrequency ablation for the treatment of varicose veins.

    Science.gov (United States)

    Kayssi, Ahmed; Pope, Marc; Vucemilo, Ivica; Werneck, Christiane

    2015-04-01

    Varicose veins are a common condition that can be treated surgically. Available operative modalities include saphenous venous ligation and stripping, phlebectomy, endovenous laser therapy and radiofrequency ablation. Radiofrequency ablation is the newest of these technologies, and to our knowledge our group was the first to use it in Canada. Our experience suggests that it is a safe and effective treatment for varicose veins, with high levels of patient satisfaction reported at short-term follow-up. More studies are needed to assess long-term effectiveness and compare the various available treatment options for varicose veins.

  10. [MANAGEMENT STANDARDS FOR QUALIFIED PHYSICIANS AND MEDICAL FACILITIES FOR ENDOVENOUS ABLATION OF VARICOSE VEINS].

    Science.gov (United States)

    Ogawa, Tomohiro

    2015-05-01

    Endovenous ablation of saphenous veins using laser energy was approved by the Japanese Ministry of Health, Labor and Welfare in 2011 as a more effective, less-invasive method than classical treatment for varicose veins. New medical laser and radiofrequency devices for this purpose were also approved in 2014. A requirement for the treatment of varicose veins with health insurance reimbursement using these devices is a physician with sufficient knowledge of endovenous ablation. The management standards for endovenous ablation set by varicose vein specialist medical societies are used to accredit qualified physicians who have basic clinical experience in the treatment of varicose veins, qualified instructors, and safe, effective medical facilities.

  11. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Science.gov (United States)

    Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B.

    2014-01-01

    62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. Conclusion The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival. PMID:25568802

  12. Ecoescleroterapia com microespuma em varizes tronculares primárias Microfoam ultrasound-guided sclerotherapy in primary trunk varicose veins

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    Marcondes Figueiredo

    2006-09-01

    Full Text Available OBJETIVO: Avaliar o tratamento de varizes tronculares primárias por ecoescleroterapia com microespuma. MÉTODOS: A amostra foi constituída de 25 membros de seis pacientes do sexo masculino e 19 do sexo feminino, com incompetência das veias safenas magna (21 membros ou parva (quatro membros. Eles foram avaliados de acordo com a classificação clínica, etiológica, anatômica e fisiopatológica (CEAP e classificados nos graus C³ (10 membros, C4 (seis membros, C5 (cinco membros e C6 (quatro membros. A microespuma (5 ml, preparada pela mistura de 1 ml de polidocanol a 3% e 5 ml de ar, era injetada na veia do paciente, em posição de Trendelenburg, com monitoração por ultra-sonografia com Doppler colorido. Os membros eram enfaixados com atadura inelástica por 3 dias; depois disso, os pacientes usavam meias elásticas, 30-40 mmHg, 3/4 ou 7/8, durante 3 meses. A eficiência do tratamento foi avaliada pelo escore clínico da classificação CEAP para dor, edema e claudicação e pelas alterações ultra-sonográficas 12 meses depois. Os escores clínicos antes e depois do tratamento foram comparados pelo teste de Wilcoxon. RESULTADOS: Houve diminuição significante nos escores clínicos (P OBJECTIVE: To evaluate the treatment of primary trunk varicose veins by microfoam ultrasound-guided sclerotherapy. METHODS: The sample was composed of 25 members of six male and 19 female patients, with incompetence of great saphenous vein (21 and short saphenous vein (4. Patients were assessed according to the clinical, etiologic, anatomical and pathophysiological (CEAP classification and divided into degrees C³ (10, C4 (6, C5 (5 and C6 (4. With the patients in the Trendelenburg position, microfoam (5 ml, prepared by mixture of 1 ml polidocanol at 3% and 5 ml of air, was injected in their vein and monitored by color-flow Doppler ultrasonography. The members were then swaddled with inelastic bandage for 3 days; afterward, the patients used 30-40 mmHg, 3

  13. Improving the management of varicose veins.

    Science.gov (United States)

    Onida, Sarah; Lane, Tristan R A; Davies, Alun H

    2013-01-01

    Up to 30% of the UK population are affected by varicose veins. They are a manifestation of increased venous pressure in the lower limb caused by impaired venous return. Primary varicosities result from poor drainage from the superficial to the deep venous system. Secondary varicosities arise as a result of underlying pathology impeding venous drainage, such as deep venous thrombosis or increased intra-abdominal pressure caused by a mass, pregnancy or obesity. Patients with bleeding varicose veins should be referred to a vascular service immediately. Referral is also indicated in the following cases: symptomatic primary or recurrent varicose veins; lower limb skin changes thought to be caused by chronic venous insufficiency; superficial vein thrombosis and suspected venous incompetence; a venous leg ulcer or healed venous leg ulcer. Imaging is crucial in the assessment of the superficial and deep venous system to enable assessment of venous competence. The gold standard imaging technique is colour duplex ultrasonography. Duplex ultrasound should be used to confirm the diagnosis of varicose veins and the extent of truncal reflux, and to plan treatment for patients with suspected primary or recurrent varicose veins. Superficial vein ligation, phlebectomy and stripping have been the mainstay of treatment. In recent years, new techniques have been developed that are minimally invasive, enabling treatment of superficial venous incompetence with reduced morbidity. NICE recommends that endothermal ablation, in the form of radiofrequency or laser treatment, should be offered as treatment for patients with confirmed varicose veins and truncal reflux.

  14. 下肢静脉曲张术后复发的临床分析%Clinical study of recurrence of varicose veins after varicotomy in lower extremity

    Institute of Scientific and Technical Information of China (English)

    孙岩; 金星; 吴学君; 张十一; 种振岳

    2016-01-01

    Objective To investigate the causes and treatment of recurrence of varicose veins after varicotomy in lower extremity.Methods We retrospectively investigated the clinical data of 73 patients (44 male, 29 female) with varicose vein recurrence admitted to department of vascular surgery from Mar 2007 to Dec 2015. The reasons for postoperative recurrence of varicose veins were concluded that residual saphenous vein was recorded for 19 patients, 28 patients showed perforating vein insufficiency, 9 cases showed reflux of the superficial femoral vein, and 10 cases showed varicose small saphenous veins, while 4 had Budd Chiari syndrome and 3 cases due to cockett syndrome. Different methods were taken for different causes, grades and general condition.Results The operation was smooth and perative incisions were primary healing, with no fatality. All patients recovered well, The median length of hospital stay was 11.3 days; At median 21.3 months follow up, No recurrent symptoms were observed in all patients.Conclusions Several factor such as misdiagnose, mistreatment, irregular operations that may contribute to varicose vein recurrencehave been identified. Deep, superficial and perforating veins should be examined carefully to perform the appropriate surgical intervention. Prevention of varicose vein recurrence after surgical correction requires a more extensive use of preoperative examination, to tailor surgical intervention to suit individual patients.%目的:探讨下肢静脉曲张术后复发的原因及诊治策略。方法回顾性分析2007年3月至2015年12月山东大学附属省立医院血管外科收治的73例下肢静脉曲张术后复发患者的临床资料。男性44例,女性29例。临床表现有浅静脉曲张、下肢水肿、皮肤色素沉着及溃疡。复发的原因:大隐静脉主干及其部分属支残存19例;穿通静脉瓣膜功能不全28例;深静脉瓣膜功能不全9例;出现小隐静脉曲张10例;布加综合征4

  15. Decreased PGE₂ content reduces MMP-1 activity and consequently increases collagen density in human varicose vein.

    Directory of Open Access Journals (Sweden)

    Ingrid Gomez

    Full Text Available Varicose veins are elongated and dilated saphenous veins. Despite the high prevalence of this disease, its pathogenesis remains unclear.In this study, we investigated the control of matrix metalloproteinases (MMPs expression by prostaglandin (PGE₂ during the vascular wall remodeling of human varicose veins.Varicose (small (SDv and large diameter (LDv and healthy saphenous veins (SV were obtained after surgery. Microsomal and cytosolic PGE-synthases (mPGES and cPGES protein and mRNA responsible for PGE₂ metabolism were analyzed in all veins. cPGES protein was absent while its mRNA was weakly expressed. mPGES-2 expression was similar in the different saphenous veins. mPGES-1 mRNA and protein were detected in healthy veins and a significant decrease was found in LDv. Additionally, 15-hydroxyprostaglandin dehydrogenase (15-PGDH, responsible for PGE₂ degradation, was over-expressed in varicose veins. These variations in mPGES-1 and 15-PGDH density account for the decreased PGE₂ level observed in varicose veins. Furthermore, a significant decrease in PGE₂ receptor (EP4 levels was also found in SDv and LDv. Active MMP-1 and total MMP-2 concentrations were significantly decreased in varicose veins while the tissue inhibitors of metalloproteinases (TIMP -1 and -2, were significantly increased, probably explaining the increased collagen content found in LDv. Finally, the MMP/TIMP ratio is restored by exogenous PGE₂ in varicose veins and reduced in presence of an EP4 receptor antagonist in healthy veins.In conclusion, PGE₂ could be responsible for the vascular wall thickening in human varicose veins. This mechanism could be protective, strengthening the vascular wall in order to counteract venous stasis.

  16. Gastroesophageal reflux - discharge

    Science.gov (United States)

    ... vegetables, such as citrus fruits, pineapple, tomatoes, or tomato-based dishes (pizza, chili, and spaghetti). Avoid items ... your stress and watch for stressful, tense times. Stress can bother your reflux ... medicines with plenty of water. When you start a new medicine, remember to ...

  17. 戴戒术与单纯浅静脉剥脱术治疗原发性下肢深静脉瓣膜功能不全的比较%Comparison between encircling constriction and simple superficial vein stripping in treatment of lower limb deep venous valve insufficiency

    Institute of Scientific and Technical Information of China (English)

    张鸿源; 管圣; 包文; 段永亮

    2012-01-01

    目的:比较股浅静脉戴戒术与单纯性浅静脉剥脱术治疗下肢深静脉瓣膜功能不全的疗效.方法:将2010年03月-2011年1月收治的48例下肢深静脉瓣膜功能不全伴静脉曲张患者随机分为观察组(股浅静脉戴戒术联合大隐静脉高位结扎剥脱术)和对照组(传统大隐静脉高位结扎剥脱术),通过彩色多普勒检测两组术前及术后股总静脉血管内径、平均血流速度及Valsalva试验下反流持续时间的变化.结果:与术前比较,术后两组患者的静脉瓣膜功能及血流动力学均明显改善,表现为股总静脉管径缩小、平均血流速度增快、静脉血流反流时间缩短(均P<0.05),但观察组上述3个变量手术前后变化程度(差值)均明显大于照组(均P<0.05).结论:两种手术方式均是治疗下肢深静脉瓣膜功能不全的有效手段,但戴戒术的治疗效果优于单纯性浅静脉剥脱术.%Objective: To compare the clinical efficacies between encircling constriction of superficial femoral vein and simple superficial vein stripping in treatment of valve incompetence of the lower limb deep veins. Methods: Forty-eight patients with lower limb deep venous valve insufficiency and varicose veins admitted from March 2010 to January 2011 were randomly assigned to observation group (undergoing encircling constriction of superficial femoral vein combined with high ligation and stripping of the great saphenous vein) and control group (receiving high ligation and stripping of the great saphenous vein only). The inner diameter and average blood flow velocity of the common femoral vein and venous reflux time in response to Valsalva maneuver of the patients in the two groups were measured by color Doppler sonography before and after operation.Results: Compared with the data before operation, the function of venous valves and hemodynamic state of the patients in both groups were significantly improved after operation, as evidenced by the reduced

  18. Percutaneus treatment of varicose veins with bipolar radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Boon, R.; Akkersdijk, G.J.M. [Department of Surgery, Spaarne Hospital, Hoofddorp (Netherlands); Nio, D., E-mail: dnio@spaarneziekenhuis.n [Department of Surgery, Spaarne Hospital, Hoofddorp (Netherlands)

    2010-07-15

    The traditional surgical treatment of an incompetent great saphenous vein (GSV) and small saphenous vein (SSV) is challenged by endovenous techniques. Bipolar radio frequency induced thermo therapy (RFITT) is a new endovenous treatment, which occludes the vein by using the venous wall as a conductor. Linear endovenous energy densitiy (LEED) describes the amount of energy used for vein closure. Material/methods: From March 2007 till April 2009, two cohorts (23 W and 20 W) were compared, respectively 280 and 178 patients. GSV and SSV were separately analyzed. Follow-up was performed at 3 weeks and 1 year post-operatively with duplex ultrasound, to assess vein closure and perioperative complaints. A visual analog scale (VAS) pain score (range 0-10) was documented. For patients operated after October 2008 follow-up was performed at least 6 months after surgery. Results: 528 GSV and 76 SSV were treated. For the GSV a significant difference in LEED 40.8 17.1 in the 20 W cohort was found, resulting in higher occlusion rates 90.6% compared to 82.7% after 3 weeks. Follow-up of 1 year in the 20 W cohort showed 88.7% occlusion. Multivariate analysis showed that pullback speed (OR 3.7, CI 1.1-12.4) and CEAP classification (OR 3.1, CI 1.7-5.6) were significant predictors for vein occlusion. Despite a higher LEED, post-operative complaints were not significantly worse. Conclusion: RFITT is a safe and effective method to treat incompetent saphenous veins. Slower pullback speed with higher LEED results in higher closure rates without causing more pain.

  19. Ultrasound surveillance in endoluminal laser treatment for varicose veins

    Directory of Open Access Journals (Sweden)

    Varetto G

    2013-10-01

    Full Text Available Gianfranco Varetto, Paolo Garneri, Claudio Castagno, Valentina Molinaro, Simone Quaglino, Matteo Ripepi, Emilio Benintende, Lorenzo Gibello, Stefano Zan, Luigi Contessa, Ugo Bertoldo, Pietro Rispoli Vascular Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy Abstract: Venous ultrasonography is an indispensable tool in minimally invasive surgery for the treatment of varicose veins. However, the criteria for defining preoperative imaging parameters, outcome monitoring, and follow up are not well characterized. In this retrospective study, we reviewed the ultrasound periprocedural parameters and the outcomes in 274 patients (280 limbs after endoluminal laser treatment, at early (<30 days and late (1–60 months follow up. Treatment failure was defined as complete recanalization of the saphenous trunk, thigh perforator vein insufficiency, and recanalization of the proximal saphenous trunk. Judicious patient selection correlated with favorable outcome at the follow-up ultrasound examination. Keywords: follow-up, chronic venous disease, intravenous, obliteration

  20. Cryopreserved allograft veins as alternative coronary artery bypass conduits: early phase results.

    Science.gov (United States)

    Laub, G W; Muralidharan, S; Clancy, R; Eldredge, W J; Chen, C; Adkins, M S; Fernandez, J; Anderson, W A; McGrath, L B

    1992-11-01

    Traditional autologous conduits are sometimes unavailable or unsuitable to permit total revascularization during coronary artery bypass grafting. In these patients the results of using nonautologous alternative conduits has been disappointing. Encouraged by the excellent long-term results seen with cryopreserved allograft valves, a clinical protocol was developed to evaluate the use of a commercially cryopreserved allograft saphenous vein (CPV). Our protocol consisted of using CPV when left internal mammary arteries and autologous saphenous vein grafts were unavailable or unsuitable for complete revascularization. Blood group (ABO) typed CPVs were thawed and implanted as required using standard surgical techniques. From December 1989 through June 1991, 19 of 1,602 patients who underwent coronary revascularization had CPVs implanted (1.2%). There were no operative deaths. An attempt was made to evaluate the patency of all grafts with coronary arteriography or ultrafast computed tomographic scans. Fourteen patients were available for patency evaluation. Patency rate in the 14 patients studied at a mean of 7 +/- 2 months (range, 2 to 16 months) were: internal mammary artery, 93% (14/15); saphenous vein graft, 80% (4/5); and CPV, 41% (7/17). The patency of the CPV was significantly less than the patency rate for the saphenous vein and internal mammary artery (p = 0.004). We conclude that the short-term patency rate of CPVs is inferior to that of autologous vessels. Due to its poor patency, we recommend that CPV should only be used when no other autologous conduit is available.

  1. Clinical Features of Primary Vein Grafts in Free Tissue Transfers

    Directory of Open Access Journals (Sweden)

    Mitsuru Nemoto

    2015-01-01

    Full Text Available The outcomes of free tissue transfers combined with vein grafts have been inconsistent, and discussions continue regarding their appropriate use. Of the 142 free tissue transfers that we performed from January 2004 to December 2011, we retrospectively analyzed 15 consecutive patients who underwent free tissue transfers in combination with vein grafts. Etiologies included trauma (8 patients, infection (4, and tumor (3. Types of free tissue transfers were fibula (4, anterolateral thigh (3, groin (3, jejunum (3, latissimus dorsi (1, and dorsal pedis (1. Vein grafts were used for the artery (6, vein (2, or both (7. The donor veins were the saphenous vein (12 and the external jugular vein (3. The mean length of the grafted veins was 10.8 cm (range: 4–18 cm. Even though complications of congestion occurred in 2 patients, these flaps survived by reexploration. The flap success rate was 15 of 15 (100% of vein grafted free flaps versus 124 of 127 (97.6% of free flaps not requiring vein grafts. To improve the success rate of free tissue transfers combined with vein grafts, securing healthy recipient vessels, meticulous surgical handling, a reliable vascular anastomosis technique, and strict postoperative monitoring are crucial.

  2. Biomarkers of Reflux Disease.

    Science.gov (United States)

    Kia, Leila; Pandolfino, John E; Kahrilas, Peter J

    2016-06-01

    Gastroesophageal reflux disease (GERD) encompasses an array of disorders unified by the reflux of gastric contents. Because there are many potential disease manifestations, esophageal and extraesophageal, there is no single biomarker of the entire disease spectrum; a set of GERD biomarkers that each quantifies specific aspects of GERD-related pathology might be needed. We review recent reports of biomarkers of GERD, specifically in relation to endoscopically negative esophageal disease and excluding conventional pH-impedance monitoring. We consider histopathologic biomarkers, baseline impedance, and serologic assays to determine that most markers are based on manifestations of impaired esophageal mucosal integrity, which is based on increased ionic and molecular permeability, and/or destruction of tight junctions. Impaired mucosal integrity quantified by baseline mucosal impedance, proteolytic fragments of junctional proteins, or histopathologic features has emerged as a promising GERD biomarker.

  3. Current perspectives on reflux laryngitis.

    Science.gov (United States)

    Asaoka, Daisuke; Nagahara, Akihito; Matsumoto, Kenshi; Hojo, Mariko; Watanabe, Sumio

    2014-12-01

    Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of gastroesophageal reflux disease (GERD). With the increase of GERD patients, the importance of LPR is acknowledged widely. However, the pathophysiology of LPR is not understood completely and the diagnostic criteria for LPR remain controversial. Unfortunately, a gold standard diagnostic test for reflux laryngitis is not available. Recently, an experimental animal model for reflux laryngitis was developed to investigate the pathophysiology of reflux laryngitis. An empirical trial of lifestyle modification and proton pump inhibitor therapy is a reasonable approach for LPR symptoms. Alternatives after failure with aggressive medical treatment are limited and multichannel intraluminal impedance and pH monitoring is currently the best alternative to detect nonacid reflux. Additional prospective and evidence-based research is anticipated.

  4. Endovascular treatment of iliac vein compression syndrome

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-you; LI Xiao-qiang; QIAN Ai-min; SANG Hong-fei; RONG Jian-jie; ZHU Li-wei

    2011-01-01

    Background Iliac vein compression syndrome (IVCS),the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae,is not an uncommon condition.The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.Methods Between January 1997 and September 2008,296 patients received interventional therapy in the left common iliac vein.In the second stage,170 cases underwent saphenous vein high ligation and stripping.Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases,of whom 272 received stent implantation therapy.Most of the patients achieved satisfactory results on discharge.During the follow-up period,varicose veins were alleviated in 98.7% of the patients,and leg swelling disappeared or was obviously relieved in 84% of cases.About 85% of leg ulcers completely healed.The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

  5. Venous reflux on contrast-enhanced head and neck magnetic resonance angiography: Analysis of causative factors

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Dong Jae; Lee, Eun Ja [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang (Korea, Republic of); Bae, Jong Myon [Dept. of Preventive Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2016-12-15

    The purpose of this study was to analyze the causative factors of venous reflux on contrast-enhanced head and neck magnetic resonance angiography. We retrospectively reviewed 150 patients with right-arm injections and 150 patients with left-arm injections. We included the age, gender, body mass index, history of hypertension, and history of diabetes mellitus in the evaluation of all patients. We measured the shortest width of the left or right brachiocephalic vein (BCV), the diameter of the aortic arch, and the distance between the sternum and vertebral body. The relationship between these factors and the venous reflux was analyzed. In patients with venous reflux, we performed qualitative image scoring for suboptimal images. In patients with venous reflux, the image quality of the left-arm injection group was significantly inferior to the image quality of the right-arm injection group. The mean age and the male-to-female ratio of patients with venous reflux were significantly higher than those of patients without venous reflux. In patients receiving the left-arm injection, the mean shortest width of the left BCV was significantly narrower in patients with venous reflux than in patients without venous reflux. A left-arm injection should be avoided, especially in elderly patients, to acquire an optimal image.

  6. Vesicoureteric reflux in children

    Directory of Open Access Journals (Sweden)

    Jameela A Kari

    2013-01-01

    Full Text Available Aim: This study aimed to identify the differences between primary and secondary vesicoureteric reflux (VUR and the effect of associated bladder abnormalities on kidney function. Patients and Methods: We retrospectively reviewed the medical records of children with VUR who were followed up at King Abdulaziz University Hospital from January 2005 to December 2010. The review included results of radiological investigations and kidney function tests. We used Chi-square test for statistical analysis and paired t-test to compare group means for initial and last creatinine levels. Results: Ninety-nine children were included in this study. Twenty (20.2% had primary VUR, 11 had high-grade VUR, while 9 had low-grade reflux. All children with low-grade VUR had normal dimercaptosuccinic acid (DMSA. Renal scars were present in 72% of the children with high-grade VUR. The mean creatinine levels (initial and last for both groups were normal. Seventy-nine (79.8% children had secondary VUR, which was due to posterior urethral valves (PUV (46.8%, neurogenic bladder caused by meningomyelocele (25.3%, non-neurogenic neurogenic bladder (NNB (21.5%, or neurogenic bladder associated with prune belly syndrome (6.3%. Children with NNB, meningomyelocele and PUV had high creatinine at presentation with no considerable worsening of their kidney functions during the last visit. Renal scars were present in 49.4% of the children with secondary VUR. Conclusion: Children with primary VUR and normal bladder had good-functioning kidneys, while those with secondary VUR associated with abnormal bladder caused by NNB, spina bifida or PUV had abnormal kidney functions. DMSA scans were useful in predicting higher grades of VUR in children with primary reflux.

  7. [Vesicoureteral reflux in adults].

    Science.gov (United States)

    Rollino, Cristiana; D'Urso, Leonardo; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Quarello, Francesco

    2011-01-01

    Vesicoureteral reflux (VUR) may be congenital or acquired. The most frequent form of congenital VUR is primary VUR. Its prevalence in adults is not exactly known, but it is higher in women, whose greater propensity for urinary tract infections increases the likelihood of an instrumental examination leading to the diagnosis of less severe cases. In men, even severe VUR may go undiagnosed for a long time. Primary VUR is due to a defect in the valve mechanism of the ureterovesical junction. In physiological conditions, the terminal ureter enters the bladder wall obliquely and bladder contraction leads to compression of this intravesical portion. Abnormal length of the intravesical portion of the ureter due to a genetic mutation (whose location is yet to be established) leads to VUR. In its less severe forms VUR may be asymptomatic, but in 50-70% of cases it manifests with recurrent cystitis or pyelonephritis. The manifestations leading to a diagnosis of VUR in adults, besides urinary tract infections, are proteinuria, renal failure and hypertension. The gold-standard diagnostic examination is a micturating cystourethrogram. Reflux nephropathy develops as a result of a pathogenetic mechanism unrelated to high cavity pressure or urinary tract infections but due to reduced formation of the normal renal parenchyma (hypoplasia or dysplasia). Abnormal renal parenchyma development is attributable to the same genes that control the development of the ureters and ureterovesical junction. VUR is considered only a marker of this abnormal development, playing no role in scar formation. There is no conclusive evidence regarding the indications for VUR correction. However, the risk that VUR leads to recurrent pyelonephritis and reflux nephropathy must be kept in mind. VUR certainly has to be corrected in women who contemplate pregnancy.

  8. Management Strategy for Patients With Chronic Subclavian Vein Thrombosis.

    Science.gov (United States)

    Keir, Graham; Marshall, M Blair

    2017-02-01

    We performed a systematic review to determine best practice for the management of patients with chronic or subacute subclavian vein thrombosis. This condition is best managed with surgical excision of the first rib followed by long-term anticoagulation. Interventional techniques aimed at restoring patency are ineffective beyond 2 weeks postthrombosis. Additional therapeutic options should be made based on the severity of symptoms as well as vein status. Patients with milder symptoms are given decompression surgery followed by anticoagulation whereas patients with more severe symptoms are considered for either a jugular vein transposition or saphenous patch based on the vein characteristics. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital : The First 400 Procedures

    NARCIS (Netherlands)

    van den Bremer, J.; Joosten, P. Ph. A. Hedeman; Hamming, J. F.; Moll, F. L.

    2009-01-01

    Endovenous Laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our lear

  10. Endoscopic vein harvest in elective off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    Nai-kuan CHOU; Meng-lin LEE; Shoei-shen WANG

    2009-01-01

    While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hema-toma, pain scale, and superlicial and deep wound infection. Coronary events were defined as diagnosis of myocardial infarction during the first year's follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preopera-tive risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complica-tions and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency.

  11. Endoscopic Saphenous harvesting with an Open CO2 System (ESOS trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Campanella Antonio

    2011-11-01

    Full Text Available Abstract Background In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature. Methods/Design Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre. Discussion The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short

  12. 股静脉作为血管移植材料可行性与安全性的应用解剖研究%APPLIED ANATOMICAL STUDY ON FEASIBILITY AND SAFETY OF FEMORAL VEIN AS A VASCULAR GRAFT MATERIAL

    Institute of Scientific and Technical Information of China (English)

    颜井伟; 任为

    2012-01-01

    patients with lower extremity femoral vein thrombosis were analysed, and the venous reflux pathway of the lower extremity was observed. Results The average height of male was 158.3 cm, and the available length of femoral vein was (18.8 ± 2.3) cm (relative length, 0.118 ± 0.013), and squash vein diameter was (15.8 + 0.8) mm. The average height of female was 149.2 cm, and the available length of femoral vein was (15.1 ± 1.5) cm (relative length, 0.101 ± 0.010), and squash vein diameter was (14.0 ± 1.1) mm. There were significant differences in the length of the available femoral vein (t=6.354, P=0.000) and squash vein diameter (r=5.555, P=0.000) between male and female. Positive correlation was found between the length of the available femoral vein and height (r=0.964, P=0.000). Low correlation was found between squash vein diameter and height (r=0.382, P=0.003). Double femoral veins were found in 16 limbs (14.0%), a femoral-popliteal vein communicating branch in 48 limbs (42.1%), a deep femoral-popliteal vein communicating branch in 38 limbs (33.3%). CTV showed that great saphenous vein, femoral-popliteal, or deep femoral-popliteal vein communicating branches had compensative capacity in patients with femora] vein thrombosis. Conclusion It is reliable and safe to harvest femoral vein as a vascular graft because of the existence of the great saphenous vein and communicating branches between the popliteal vein and femoral vein or deep femoral vein.

  13. Assessment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity varicose vein management.

    Science.gov (United States)

    Woźniak, Witold; Mlosek, Robert K; Ciostek, Piotr

    2015-04-01

    For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extremity varicose vein treatment. One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment efficacy based on the VCSS score reduction. There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment.

  14. Arteries masquerading as varicose veins: A trap for phlebologists.

    Science.gov (United States)

    Jones, L; Parsi, K

    2015-12-01

    Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein "stripping", presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of "stripping", the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

  15. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

    Energy Technology Data Exchange (ETDEWEB)

    Koc, Zafer [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)]. E-mail: koczafer@gmail.com; Ulusan, Serife [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey); Oguzkurt, Levent [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)

    2006-09-15

    Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The {chi}{sup 2}-test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices.

  16. 激光联合消痔灵治疗大隐静脉曲张%Treatment of Laser Photocoagulation Integrated with Xiaozhiling Injection in Patients with Great Saphe-nous Varicosis

    Institute of Scientific and Technical Information of China (English)

    王春喜; 魏志成; 王晓玲

    2014-01-01

    目的:探讨激光联合消痔灵治疗大隐静脉曲张370例的疗效。方法:370例大隐静脉曲张患者,458条肢体,选择810 nm波长半导体激光器,行血管内激光光凝术;对曲张的属支静脉行消痔灵局部注射。结果:术后当天即自由活动,曲张静脉均于手术后10 d内完全消失;随访2~6年无复发。结论:激光联合消痔灵治疗下肢静脉曲张,操作简便、创伤小、美观、恢复快。%Objective To investigate the therapeutic results of laser photocoagulation integrated with Xiao-zhiling (消痔灵)injection in patients with great saphenous varicosis. Methods Three hundred and seventy patients with varicosis of great saphenous vein, including 458 legs were treated. The laser wire being delivered into saphenous vein through 5F conductor, the intravenous photocoagulations were made with 810 nm laser wave length; the Chinese medicine of Xiao zhiling was injected into the other branches of superficial varicosis. Results The patients’limbs moved freely after operation. The incisions were healed better without edema, hae-matoma and other complications. Being followed-up from 2 to 6 years in those patients, the great saphenous veins were identified to be obliterans without any reoccurrence. Conclusion The laser photocoagulation inte-grated with Xiaozhiling injection is a convenient, minitraumatic, aesthetic and quick restorative therapeutic meth-od in patients with great saphanous vein varicosis.

  17. Infant Reflux: Symptoms and Causes

    Science.gov (United States)

    ... the stomach contents to have enough acid to irritate the throat or esophagus and to cause signs ... as: GERD. The reflux has enough acid to irritate and damage the lining of the esophagus. Pyloric ...

  18. [Subglottic stenosis and gastroesophageal reflux].

    Science.gov (United States)

    Fligny, I; François, M; Aigrain, Y; Polonovski, J M; Contencin, P; Narcy, P

    1989-01-01

    The authors report the cases of ten children treated for sub-glottic laryngeal stenosis, in the Department of Pr. Narcy in Hospital Robert-Debre. Medical treatment of the laryngeal stenosis had failed in these cases. Treatment, most often surgical, of the gastro-oesophageal reflux present in these ten cases enabled these children to be cured. A review of the literature stresses the role and responsibility of gastro-oesophageal reflux in laryngeal pathology. Based on their experience, the authors suggest: systematic investigation for gastro-oesophageal reflux during management of laryngeal stenosis, especially when laryngeal inflammation is encountered; the adoption of an interventionist attitude vis-a-vis gastro-oesophageal reflux which would seem to have an important pathogenic role in certain laryngeal stenoses.

  19. Endovenous radiofrequency ablation using stent-type electrode for varicose veins: an experimental study in goats

    Energy Technology Data Exchange (ETDEWEB)

    Won, Je Hwan; Han, Jae Ho; Oh, Chang Kwon [Ajou University Hospital, Suwon (Korea, Republic of); Kwak, Young Lan [Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Sung Il [Ulsan University GangNeung Asan Hospital, Gangeung (Korea, Republic of)

    2004-10-15

    The purpose of this study was to investigate the feasibility and the optimal conditions of radiofrequency (RF) ablation by using the stent-type electrode upon the saphenous vein of goats for the endovenous treatment of varicose veins. A self-expandable nitinol stent electrode (6 mm diameter, 2 cm length, cell size; 1.3 x 2 mm) was designed to expose the distal 1 cm segment to allow for contact with the venous wall. The proximal part of the electrode was connected to the RF generator by insulated copper wires located within the stent electrode introducer. Initially, to optimize the power setting, ablation of 6 saphenous veins in 3 goats was performed with power settings of 10, 20 and 30 W. Pull back rate of the electrode was 2 and 4 cm/min for each power level, respectively. The goats were sacrificed 4-6 weeks later and histologic examinations of the saphenous veins were done. For the second part of the experiment, RF ablation of 4 saphenous veins from 2 goats was done by applying the optimal power, based upon the first examination; these procedure was performed with variable pull back rates. Again, the goats were sacrificed 1-6 weeks later and histologic examinations were done. Endovenous ablation of the goat saphenous veins at 20 W caused complete obliteration without complication. There was incomplete occlusion at 10 W, and there were vessel perforation, extravasation, and adjacent tissue injury at 30 W. In second part of the study, the complete circumferential obliteration of the vein was demonstrated at a pull back rate of 1 cm/min and 3 cm/min with the power of 20 W. The stent-type electrode may be useful in endovenous RF ablation for treatment of varicose veins. For stents with a diameter of 6 mm, the optional combination of 20 W of power with a pull back rate of 1-3 cm/min produced the most favorable results. Further study and clinical investigations are warranted.

  20. [Treatment of lower limb varicose veins in 2015: The present and the future].

    Science.gov (United States)

    Jacquet, R

    2015-01-01

    The introduction of intravenous therapy (ultrasound-guided foam sclerotherapy, laser, radiofrequency) has considerably changed radical treatment of superficial venous insufficiency. The recent granting of reimbursable status for radio frequency thermal ablation has led us to propose radical synthetic treatment for varicose veins. The treatment is based on Doppler ultrasound exploration with detailed varicose cartography, taking into account the affected area (large or small saphenous vein), the site of the point or points of leakage, the diameter of the incontinent saphenous vein, whether the saphenous vein and tributaries are rectilinear or sinuous, and the depth of the varicose network in relation to the skin surface. The decision to implement radical therapy is based on the stage of the disease, particularly in the event of trophic lesions, and takes into consideration both the functional and aesthetic impairment caused by the varicose disorder. All of the foregoing factors affect the choice of treatment, which is also based upon the availability of the various technical approaches mentioned, upon full control of the benefits and limitations of each of the various methods, and upon informed patient consent with regard to the various options proposed: surgery, essentially involving stripping and phlebectomy or endovenous treatments: chemical ablation via ultrasound-guided foam sclerotherapy, and laser or radiofrequency thermal ablation.

  1. Gastroesophageal reflux disease in children.

    Science.gov (United States)

    Barnhart, Douglas C

    2016-08-01

    Despite the frequency with which antireflux procedures are performed, decisions about gastroesophageal reflux disease treatment remain challenging. Several factors contribute to the difficulties in managing gastroesophageal reflux. First, the distinction between physiologic and pathologic gastroesophageal reflux (gastroesophageal reflux disease-GERD) is not always clear. Second, measures of the extent of gastroesophageal reflux often poorly correlate to symptoms or other complications attributed to reflux in infants and children. A third challenge is that the outcome of antireflux procedures, predominately fundoplications, are relatively poorly characterized. All of these factors contribute to difficulty in knowing when to recommend antireflux surgery. One of the manifestations of the uncertainties surrounding GERD is the high degree of variability in the utilization of pediatric antireflux procedures throughout the United States. Pediatric surgeons are frequently consulted for GERD and fundoplication, uncertainties notwithstanding. Although retrospective series and anecdotal observations support fundoplication in some patients, there are many important questions for which sufficient high-quality data to provide a clear answer is lacking. In spite of this, surgeons need to provide guidance to patients and families while awaiting the development of improved evidence to aid in these recommendations. The purpose of this article is to define what is known and what is uncertain, with an emphasis on the most recent evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Varicose vein - noninvasive treatment

    Science.gov (United States)

    Sclerotherapy; Laser therapy - varicose veins; Radiofrequency vein ablation; Endovenous thermal ablation; Ambulatory phlebectomy; Transilluminated power phlebotomy; Endovenous laser ablation; Varicose vein ...

  3. Endovascular vein harvest: systemic carbon dioxide absorption.

    Science.gov (United States)

    Maslow, Andrew M; Schwartz, Carl S; Bert, Arthur; Hurlburt, Peter; Gough, Jeffrey; Stearns, Gary; Singh, Arun K

    2006-06-01

    Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. Prospective observational study. Single tertiary care hospital. Sixty patients (30 EDVH and 30 open-vein harvest) undergoing isolated coronary artery bypass graft surgery. Hemodynamic, procedural, and laboratory data were collected prior to (baseline), during, and at it the conclusion (final) of vein harvesting. Data were also collected during cardiopulmonary bypass (CPB). Data were compared by using t tests, analysis of variance, and correlation statistics when needed. There were significant increases in arterial CO(2) (PaCO(2), 35%) and decreases in pH (1.35%) during EDVH. These were associated with increases in heart rate, mean blood pressure, and cardiac output. Within the EDVH group, greater elevations (>10 mmHg) in PaCO2 were more likely during difficult harvest procedures, and these patients exhibited greater increase in heart rate. Elevated CO(2) persisted during CPB, requiring higher systemic gas flows and greater use of phenylephrine to maintain desired hemodynamics. EDVH was associated with systemic absorption of CO(2). Greater absorption was more likely in difficult procedures and was associated with greater hemodynamic changes requiring medical therapy.

  4. Endovascular radiofrequency ablation. Effect on the vein diameter using the ClosureFast(®) catheter.

    Science.gov (United States)

    Bauzá Moreno, Hernán; Dotta, Mariana; Katsini, Roxana; Marquez Fosser, Carolina; Rochet, Sofía; Pared, Carlos; Martinez, Hugo

    2016-01-01

    Endovascular radiofrequency with first generation catheters was not successful due to its technical difficulty and restrictions in veins with diameters larger than 12mm. However, using the new catheter there is not enough scientific evidence to affirm that the diameter represents a technical limitation. The aim of this study was to evaluate and compare pre and post-operative venous trunks diameter, aiming at the reduction of size after 6 months with last generation catheters. Retrospective observational and descriptive study on a cohort of patients with insufficiency of the great saphenous vein, small saphenous vein and anterior accessory vein operated on with last generation radiofrequency catheters. The diameters were evaluated in the pre and post-operative period with ultrasound. Between 2007 and 2014 a total of 365 ablations were performed in veins with an average diameter of 9±3.1mm showing a reduction of it after 6 months with a mean value of 5.2±0.8mm (P<.0001). Total occlusion was also observed in 100% of cases and complications such as deep vein thrombosis in 0.5% and heat-induced thrombosis in 1.1%. A significant reduction in venous diameter after endovascular treatment with the new ClosureFast(®) catheters was checked, even in veins with diameters greater than 12mm. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Correcting Reflux Laparoscopically

    Directory of Open Access Journals (Sweden)

    Eric C Poulin

    1998-01-01

    Full Text Available Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.

  6. Deep Vein Thrombosis

    Science.gov (United States)

    Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein ... the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem ...

  7. Traumatic lesions of internal saphenous nerve and branches.

    Science.gov (United States)

    Rodrigues, Flávio Freinkel; Skartz, Issac; Dozza, Diego Cassol; Moscovici, Maurício; Suchmacher, Mendel

    2009-09-01

    To show a rare lesion that sometimes simulates vascular disorder of the lower extremities. Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches. In two cases there were almost total pain resolution, and in other case improvement only. Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

  8. miRNA-21 is dysregulated in response to vein grafting in multiple models and genetic ablation in mice attenuates neointima formation

    NARCIS (Netherlands)

    McDonald, Robert A; White, Katie M; Wu, Junxi; Cooley, Brian C; Robertson, Keith E; Halliday, Crawford A; McClure, John D; Francis, Sheila; Lu, Ruifaug; Kennedy, Simon; George, Sarah J; Wan, Song; van Rooij, Eva; Baker, Andrew H

    2013-01-01

    AIMS: The long-term failure of autologous saphenous vein bypass grafts due to neointimal thickening is a major clinical burden. Identifying novel strategies to prevent neointimal thickening is important. Thus, this study aimed to identify microRNAs (miRNAs) that are dysregulated during neointimal fo

  9. miRNA-21 is dysregulated in response to vein grafting in multiple models and genetic ablation in mice attenuates neointima formation

    NARCIS (Netherlands)

    McDonald, Robert A.; White, Katie M.; Wu, Junxi; Cooley, Brian C.; Robertson, Keith E.; Halliday, Crawford A.; McClure, John D.; Francis, Sheila; Lu, Ruifaug; Kennedy, Simon; George, Sarah J.; Wan, Song; van Rooij, Eva; Baker, Andrew H.

    2013-01-01

    Aims The long-term failure of autologous saphenous vein bypass grafts due to neointimal thickening is a major clinical burden. Identifying novel strategies to prevent neointimal thickening is important. Thus, this study aimed to identify microRNAs (miRNAs) that are dysregulated during neointimal for

  10. Relationship between reflux and laryngeal cancer

    NARCIS (Netherlands)

    Coca-Pelaz, A.; Rodrigo, J.P.; Takes, R.P.; Silver, C.E.; Paccagnella, D.; Rinaldo, A.; Hinni, M.L.; Ferlito, A.

    2013-01-01

    Gastroesophageal reflux disease (GERD), or its variation known as laryngopharyngeal reflux (LPR), has been recognized as a potential cause of several laryngeal disorders. Patients with laryngeal cancer have lifestyle risk factors, especially tobacco and alcohol consumption, that play an etiological

  11. [Therapeutic principles in gastroesophageal reflux].

    Science.gov (United States)

    Chassany, O; Elkharrat, D; Bergmann, J F; Segrestaa, J M

    1995-01-01

    Gastroesophageal reflux is a common disease. Its chronic course, even if mild, is sometimes complicated by erosive oesophagitis. Drug therapy acts against gastric acidity and motility disorders. Treatment of gastroesophageal reflux disease has three aims: improvement of symptoms and quality of life, healing erosive lesions and prevention of symptomatic and endoscopic relapses. Non-drug measures are always useful, even if their efficacy is not well established. Initial therapy of a symptomatic reflux or mild oesophagitis is most of the time effective (antacids, prokinetics, H2 receptor antagonists). Proton-pump inhibitors are also effective in healing and preventing severe oesophagitis. Questions about long-term treatment adverse events with powerful acid inhibitors, such as hypergastrinemia and the risk of gastric carcinoid tumours seem to be resolved. Studies are requested to define the optimal long-term maintenance treatment with cisapride, H2 receptor antagonists or proton-pump inhibitors at low doses in prevention of symptomatic and mild oesophagitis relapses.

  12. Morphine-augmented cholescintigraphy enhances duodenogastric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Shih, Wei-Jen; Magoun, S.; Wierzbinski, B.; Ryo, U-Yun [Kentucky Univ., Lexington, KY (United States). Medical Center; Lee, Jong-Kang

    1995-11-01

    Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients` duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: occurrence of duodenogastric reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p<0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients. (author).

  13. Surgery for acquired cardiovascular disease: antiseptic treatment of contaminated vein grafts.

    Science.gov (United States)

    Schmidt, F P; Peivandi, A A; Kohnen, W; Jansen, B

    2014-04-01

    Saphenous vein grafts harvested for use as bypass conduits can be contaminated intraoperatively, e.g. by being inadvertently dropped to the floor of the operating room (OR). This study was performed to investigate microorganisms most likely contaminating vein grafts and to assess the possible efficacy of measures to treat potentially contaminated vein grafts antiseptically for further use. In a first step we determined the microbiological flora of the OR using surface cultures and cultures from intentionally dropped vein grafts. Several antiseptic agents (PVP-iodine 10%, octenidinhydrochloride 0.1%, polyhexanide 1%) were evaluated for their in vitro efficacy to disinfect artificially contaminated vein segments. The most promising antiseptic regimen was tested on veins contaminated in a real OR setting. Finally, we tested for possible alterations in mechanical properties of the veins caused by antiseptic treatment. Coagulase-negative staphylococci where the predominant bacteria recovered from the OR with 59.9%. Antiseptic treatment with a combination of octenidine and PVP-iodine resulted in a higher rate of negative cultures than any single agent. Treatment of 50 saphenous vein grafts contaminated in the OR with the combination regimen resulted in only 3 positive cultural results within 7 days. Mechanical tear-stress testing comparing antiseptically treated vein grafts with controls showed no difference in their resistance to tear stress. Antiseptic treatment of contaminated vein grafts was shown to be effective in a high percentage of cases without altering mechanical properties of grafts and may be an option for the surgeon in case of a contamination.

  14. Vesicoureteral reflux: A historical perspective

    African Journals Online (AJOL)

    K.N. DeCotiis

    2016-12-28

    Dec 28, 2016 ... has evolved considerably throughout the years due to a dynamic ... 3. Grading of reflux is not important. 4. Bladder outlet obstruction ... ureteral reimplantation became the gold standard therapy for treat- ... In order to standardize terminology ... sified by Nguyen, et al. proposed imaging studies for patients.

  15. Treatment of uncomplicated reflux disease

    Institute of Scientific and Technical Information of China (English)

    Joachim Labenz; Peter Malfertheiner

    2005-01-01

    Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always recommended.Long-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle).In selected patients requiring long-term PPI treatment,antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.

  16. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob

    2012-05-01

    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  17. Radiologic diagnosis of gastro-oesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, S.G.; Soekjer, H.; Johansson, K.E.; Tibbling, L.

    In 149 patients, a standardized radiologic method for the detection of gastro-oesophageal reflux was applied and compared with the results obtained at endoscopy and by a manometric reflux test. Radiologic reflux was recorded in 53 patients, of whom 25 had reflux without abdominal compression and 51 with compression. At least one of the other two types of examination disclosed pathologic conditions in all but 2 of 53 patients. Oesophagitis was significantly more severe among the patients with reflux observed at radiography. The presence of hiatal incompetence with reflux only to the hiatal hernia but not to the oesophagus was not a strong indicator of gastro-oesophageal reflux disease. Hiatal hernia was present in a significantly larger number of the patients with reflux at radiography than in those without reflux. Increased width of the hiatus gave stronger evidence for reflux disease than in patients with a normal hiatus. Thus, the width of the hiatus also had a bearing on the diagnosis of gastro-oesophageal reflux disease.

  18. Portal Vein Thrombosis

    OpenAIRE

    Hakan Demirci

    2016-01-01

    Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low...

  19. Focus on Varicose Veins

    Science.gov (United States)

    ... veins, which are the visible purple or greenish-blue veins that appear in our legs. Spider veins or teleangiectesias are tiny veins that you ... reduce leg swelling and decrease the risk of blood clots. Prescription ... sclerosing solution into spider, reticular or varicose veins. This is a minimally ...

  20. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, Anthony James, E-mail: consultant@radiologist.co.uk [The Imaging Clinic (United Kingdom)

    2015-08-15

    Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.

  1. Spider Vein Removal

    Science.gov (United States)

    Spider veins: How are they removed? I have spider veins on my legs. What options are available ... M.D. Several options are available to remove spider veins — thin red lines or weblike networks of ...

  2. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.

    Science.gov (United States)

    Gloviczki, Peter; Comerota, Anthony J; Dalsing, Michael C; Eklof, Bo G; Gillespie, David L; Gloviczki, Monika L; Lohr, Joann M; McLafferty, Robert B; Meissner, Mark H; Murad, M Hassan; Padberg, Frank T; Pappas, Peter J; Passman, Marc A; Raffetto, Joseph D; Vasquez, Michael A; Wakefield, Thomas W

    2011-05-01

    The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping

  3. Phenazines and natural products; Novel synthesis of saphenic acid

    DEFF Research Database (Denmark)

    Petersen, Lars; Jensen, Knud Jørgen; Nielsen, John

    1999-01-01

    The natural product saphenic acid (6-(1-hydroxyethyl)1-phenazinecarboxylic acid) was synthesized from readily accessible starting materials. The desired product was obtained in an overall yield of 22% for four steps with the key steps being formation of a diphenylamine, followed by cyclization un...... under alkaline and reducing conditions. Assignments of H-1 NMR spectra were achieved by homo- and heteronuclear 1D and 2D correlations. Double pulsed field gradient spin-echo one-dimensional NOESY proved especially valuable for assignment of aromatic protons....

  4. Phenazines and natural products; novel synthesis of saphenic acid

    DEFF Research Database (Denmark)

    Petersen, Lars; Jensen, Knud J.; Nielsen, John

    1999-01-01

    The natural product saphenic acid (6-(1-hydroxyethyl)1- phenazinecarboxylic acid) was synthesized from readily accessible starting materials. The desired product was obtained in an overall yield of 22% for four steps with the key steps being formation of a diphenylamine, followed by cyclization u...... under alkaline and reducing conditions. Assignments of 1H NMR spectra were achieved by homo- and heteronuclear 1D and 2D correlations. Double pulsed field gradient spin-echo one-dimensional NOESY proved especially valuable for assignment of aromatic protons....

  5. Subsartorial Entrapment of the Saphenous Nerve of a Competitive.

    Science.gov (United States)

    Dumitru, D; Windsor, R E

    1989-01-01

    In brief: A 40-year-old bodybuilder had a six- week history of progressively worsening pain of the medial part of her right knee that did not respond to rest and a nonsteroidal anti-inflammatory drug (NSAID). Somatosensory evoked potential readings suggested that both branches of the right saphenous nerve were entrapped. Management consisting of two intramuscular injections of bupivacaine, administrations of two different NSAIDs, and application of knee wraps around the subsartorial region resolved the patient's symptoms within five weeks. She then resumed an intensive lower-extremity exercise regimen without discomfort, in preparation for a bodybuilding competition.

  6. Sclerotherapy of Varicose Veins and Spider Veins

    Science.gov (United States)

    ... you as to whether the procedure was a technical success when it is completed. Your interventional radiologist ... Varicose Veins) Phlebectomy of Varicose Veins Contrast Materials Anesthesia Safety Sponsored by Please note RadiologyInfo.org is ...

  7. Vein Problems Related to Varicose Veins

    Science.gov (United States)

    ... telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body. Spider veins often appear on the legs and face. They're red or blue and usually look like a spider web or ...

  8. The effect of decaffeination of coffee on gastro-oesophageal reflux in patients with reflux disease.

    Science.gov (United States)

    Pehl, C; Pfeiffer, A; Wendl, B; Kaess, H

    1997-06-01

    Patients with reflux disease often complain of heartburn after ingestion of coffee. Induction of gastro-oesophageal reflux has been demonstrated by pH-metry following the intake of coffee in healthy volunteers. The reflux was reduced when the coffee had undergone a decaffeination process. The aim of this study was to investigate the effect of decaffeination of coffee on reflux in patients with reflux disease. Seventeen reflux patients underwent two osesophageal 3-h pH measurements. The patients received, in a double-blind study design in a randomized order, 300 mL of either regular or decaffeinated coffee together with a standardized breakfast. The fraction time oesophageal pH decaffeinated coffee. The amount of gastro-oesophageal reflux induced by the intake of regular coffee in patients with reflux disease can be reduce by the decaffeination of coffee.

  9. Esophageal motility abnormalities in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Irene; Martinucci; Nicola; de; Bortoli; Maria; Giacchino; Giorgia; Bodini; Elisa; Marabotto; Santino; Marchi; Vincenzo; Savarino; Edoardo; Savarino

    2014-01-01

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  10. Esophageal motility abnormalities in gastroesophageal reflux disease.

    Science.gov (United States)

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

    2014-05-06

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  11. Interplay between vesicoureteric reflux and kidney infection in the development of reflux nephropathy in mice.

    Science.gov (United States)

    Bowen, Samantha E; Watt, Christine L; Murawski, Inga J; Gupta, Indra R; Abraham, Soman N

    2013-07-01

    Vesicoureteric reflux (VUR) is a common congenital defect of the urinary tract that is usually discovered after a child develops a urinary tract infection. It is associated with reflux nephropathy, a renal lesion characterized by the presence of chronic tubulointersitial inflammation and fibrosis. Most patients are diagnosed with reflux nephropathy after one or more febrile urinary tract infections, suggesting a potential role for infection in its development. We have recently shown that the C3H mouse has a 100% incidence of VUR. Here, we evaluate the roles of VUR and uropathogenic Escherichia coli infection in the development of reflux nephropathy in the C3H mouse. We find that VUR in combination with sustained kidney infection is crucial to the development of reflux nephropathy, whereas sterile reflux alone fails to induce reflux nephropathy. A single bout of kidney infection without reflux fails to induce reflux nephropathy. The host immune response to infection was examined in two refluxing C3H substrains, HeN and HeJ. HeJ mice, which have a defect in innate immunity and bacterial clearance, demonstrate more significant renal inflammation and reflux nephropathy compared with HeN mice. These studies demonstrate the crucial synergy between VUR, sustained kidney infection and the host immune response in the development of reflux nephropathy in a mouse model of VUR.

  12. Reflux perception and the esophageal mucosal barrier in gastroesophageal reflux disease

    NARCIS (Netherlands)

    P.W. Weijenborg

    2016-01-01

    Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. Heartburn, regurgitation and chest pain are the key symptoms. Patients with reflux symptoms often have more than average reflux of acidic contents in the esophagus. However, frequently there is

  13. Personal Experience in TCM Treatment of Reflux Esophagitis

    Institute of Scientific and Technical Information of China (English)

    洪流

    2003-01-01

    @@ Reflux esophagitis falls into the category of reflux gastroesophagopathy. It is characterized by inflammation, erosion, ulcer formation and fibrosis of the esophageal mucous membrane due to reflux of the content of the stomach and duodenum into the esophagus.

  14. Treatment of vesicoureteric reflux by endoscopic injection of Teflon.

    OpenAIRE

    1984-01-01

    Thirteen girls with grade III-V vesicoureteric reflux were treated by endoscopic injection of Teflon paste behind the intravesical ureter. Fourteen of the 18 treated ureters showed complete absence of reflux after one injection of Teflon. Three ureters required a second injection of Teflon for successful treatment of the reflux. One ureter with grade IV reflux was converted to grade II reflux. Properly carried out, this procedure corrects reflux. It takes less than 15 minutes, may be done as ...

  15. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  16. Cough in asthma triggered by reflux episodes.

    Science.gov (United States)

    Mehta, Devendra; He, Zhaoping; Padman, Raj

    2014-05-01

    With combined pH and impedance monitoring, non-acid, as well as acid reflux episodes, are more commonly detected immediately prior to cough in asthma in children. Gastroesophageal reflux should be evaluated as a trigger for cough in difficult childhood asthma.

  17. Recurrent varicose veins of the legs. Analysis of a social problem.

    Science.gov (United States)

    Cardia, G; Catalano, G; Rosafio, I; Granatiero, M; De Fazio, M

    2012-01-01

    The present study was aimed at assessing the experience of a single referral center with recurrent varicose veins of the legs (RVL) over the period 1993-2008. Among a total of 846 procedures for Leg Varices (LV), 74 procedures were for RVL (8.7%). The causes of recurrence were classified as classic: insufficient crossectomy (13); incompetent perforating veins (13); reticular phlebectasia (22); small saphenous vein insufficiency (9); accessory saphenous veins (4); and particular: post-hemodynamic treatment (5); incomplete stripping (1); Sapheno-Femoral Junction (SFJ) vascularization (5); post-thermal ablation (2). For the "classic" RVL the treatment consisted essentially of completing the previous treatment, both if the problem was linked to an insufficient earlier treatment and if it was due to a later onset. The most common cause in our series was reticular phlebectasia; when the simple sclerosing injections are not sufficient, this was treated by phlebectomy according to Mueller. The "particular" cases classified as 1, 2 and 4 were also treated by completing the traditional stripping procedure (+ crossectomy if this had not been done previously), considered to be the gold standard. In the presence of a SFJ neo-vascularization, with or without cavernoma, approximately 5 cm of femoral vein were explored, the afferent vessels ligated and, if cavernoma was present, it was removed. Although inguinal neo-angiogenesis is a possible mechanism, some doubt can be raised as to its importance as a primary factor in causing recurrent varicose veins, rather than their being due to a preexisting vein left in situ because it was ignored, regarded as insignificant, or poorly evident. In conclusion, we stress that LV is a progressive disease, so the treatment is unlikely to be confined to a single procedure. It is important to plan adequate monitoring during follow-up, and to be ready to reoperate when new problems present that, if left, could lead the patient to doubt the

  18. Reflux Revisited: Advancing the Role of Pepsin

    Directory of Open Access Journals (Sweden)

    Karna Dev Bardhan

    2012-01-01

    Full Text Available Gastroesophageal reflux disease is mediated principally by acid. Today, we recognise reflux reaches beyond the esophagus, where pepsin, not acid, causes damage. Extraesophageal reflux occurs both as liquid and probably aerosol, the latter with a further reach. Pepsin is stable up to pH 7 and regains activity after reacidification. The enzyme adheres to laryngeal cells, depletes its defences, and causes further damage internally after its endocytosis. Extraesophageal reflux can today be detected by recognising pharyngeal acidification using a miniaturised pH probe and by the identification of pepsin in saliva and in exhaled breath condensate by a rapid, sensitive, and specific immunoassay. Proton pump inhibitors do not help the majority with extraesophageal reflux but specifically formulated alginates, which sieve pepsin, give benefit. These new insights may lead to the development of novel drugs that dramatically reduce pepsinogen secretion, block the effects of adherent pepsin, and give corresponding clinical benefit.

  19. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Ronny Cohen

    2015-01-01

    Full Text Available Portal vein thrombosis (PVT is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

  20. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    Science.gov (United States)

    Watson, David I; Immanuel, Arul

    2010-04-01

    Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

  1. The Auscultation of a Carbon Dioxide Embolization Event during Endoscopic Vein Harvest

    Directory of Open Access Journals (Sweden)

    Erik Strauss

    2016-01-01

    Full Text Available Endoscopic vein harvest in preparation for coronary artery bypass surgery has become a preferred method of procuring saphenous vein. Several case reports have documented carbon dioxide (CO2 embolization with this procedure as well as CO2 embolization during other laparoscopic surgeries (Markar et al., 2010. Although uncommon, the potential for CO2 entrainment through an open vein or through absorption by vascular structures exists and should be recognized (Lin et al., 2003. We report a case of CO2 embolization during EVH for a 77-year-old patient who underwent CABG that was identified early by the cardiac surgeon through the indirect auscultation of a mill-wheel murmur after the pericardium was opened. This may be the first reported case of a murmur related to air emboli identified without the use of a precordial Doppler probe or a stethoscope. This diagnosis was further supported by TEE before systemic hypotension or cardiovascular collapse occurred.

  2. Discussion related to the vein of toe in toe free flap transplantation%(足母)甲瓣游离移植术中趾静脉相关问题探讨

    Institute of Scientific and Technical Information of China (English)

    谭海涛; 许林; 江建中; 杨克勤; 韦平欧; 罗翔; 林汉

    2014-01-01

    Objective To explore the clinical value of applying digital technology to make the course of toe vein clear before toe free flap transplantation for thumb reconstruction.Methods Before operation,scan the donor and recipient site by CT,and apply digital three-dimensional CT angiography reconstruction technology to got threedimensional images of the arteries and veins in the donor site for 22 various defected thumbs which were going to have toe free flap transplantation operation,thus indentifyed the types of FDMA and the distribution and course of the toe vein from June,2012 to March,2013.Used computer assisted anatomical modeling to analyze three-dimensional images of blood supply of the donor site and degree of defect of the recipient site and guide the operative design in the donor site according to the digital three-dimensional reconstruction technology.Conducted toe free flap transplantation for thumb reconstruction in accordance with the design.Results It shows that 64-slice dual-source spiral CT could well display the size,distribution and course of toe vein.The toe veins were clarified to two groups,deep one and superficial one whose diameter was larger and was the main reflux vein of the toe.Dorsal vein of the toe origind from venous plexus in the nail bed and it travels along the back of the toe to reach to the near side of metatarsophalangeal joint.And then it beeomes three to four dorsal metatarsal veins to infused dorsal venous arch of foot.The rule of its course was:centralize-decentralize-connect-decentralize again.The great saphenous vein origins from the inner side of dorsal venous arch of foot,rises along the crus before malleolus medialis and collect three larger tributaries:medial malleolar branches-anterior crural branch-outside crural branch.The small saphenous vein derives from the outside of dorsal venous arch of foot and winds behind lateral malleolus up to the back of the curs and infuses to the vein.Conclusion It is useful for venous

  3. Chronic venous insufficiency patterns in lower extremity veins detected by Doppler Ultrasound

    Directory of Open Access Journals (Sweden)

    Özhan Özgür

    2013-12-01

    Full Text Available Objective: The aim of this study was to reveal patterns ofchronic venous insufficiency of lower extremity detectedby color Doppler ultrasound and clarify its clinical implicationsin the patients with varicose veins symptoms.Methods: Between 2006 to 2011, a total of 2006 patientspresented with symptoms of venous insufficiency wereincluded in study. A total of 3938 lower extremity venoussystems were examined using color Doppler US. Weclassified four patterns considering combinations of superficialand deep venous insufficiency.Results: Of 2006 patients, 966 had either single venousinsufficiency (790, 82% or combined insufficiency (176,18%. Superficial venous insufficiency was observedat the saphenoefemoral junction (SFJ in 25.5%, at theGreat Saphenous Vein (GSV in 57.6%, at the GiacominiVein in 2.4%, at the saphenopopliteal junction in 1.8% andfinally at the Small Saphenous Vein (SSV in 9.1% of thepatients. We found multilevel venous insufficiency showingconnections at the rate of 51%. We described fourpatterns as Pattern 1: SFJ insufficiency combined withGSV (97.9%, GSV branching (7.1%, and perforatingvein (20.8% insufficiency, Pattern 2: Deep venous insufficiencycombined with SFJ (63.6%, GSV (76.4%, andSSV (16.4% insufficiency, Pattern 3: SPJ insufficiencycombined with SSV insufficiency (95.5% and Pattern 4:Giacomini Vein insufficiency combined with GSV (67.9%and SSV (75% insufficiency.Conclusion: Chronic venous insufficiency may show fourdifferent patterns. Our results revealed that SFJ and GSVinsufficiency combination and deep venous insufficiencyand GSV insufficiency combinations are the most commoninsufficiency patterns seen in lower extremity.Key words: Doppler ultrasound, varicose veins, venous insufficiency

  4. Nicht-operative invasive Therapie der Perforansinsuffizienz // Nonoperative Therapy in the Treatment of Varicose Vein Disease

    Directory of Open Access Journals (Sweden)

    Zerweck C

    2016-01-01

    Full Text Available Nonoperative therapy options in the treatment of varicose vein disease have gained more in importance over the last decade. A profound, catheter- based varicose vein therapy must accomplish powerful therapy solutions for all kinds of varicose vein anatomies, such as saphenous veins, side branches and incompetent perforating veins. This overview, focused on thermal ablation techniques such as laser-, radiofrequencyor steamablation and other chemical sclerotherapy options provides also step-by-step guidance and tricks on perforating vein ablation. The enormous quantity of incompetent perforating vein ablation studies shows great interest in this method and occupies an important place in the field of chronic venous disease therapy. p bKurzfassung: /bNicht-operative Therapieverfahren gewinnen in der modernen Varizentherapie zunehmend an Bedeutung. Um eine uneingeschränkte Varizensanierung mit kathetergestützten Therapieverfahren durchführen zu können, sind analog zur operativen Sanierung für sämtliche Varizenformen potente Okklusionsverfahren notwendig. Diese Arbeit soll einen Überblick zum derzeitigen Stand der Ablationserfolge von inkompetenten Perforansvenen geben. Neben den thermischen Ablationsverfahren wie Laser-, Radiowellen- und Dampfablation sowie sonstigen chemischen Sklerosierungsarten gibt die Arbeit praktische Anleitung und Tipps zur Durchführung einer Perforansvenenablation. Die große Anzahl von Studien zur Perforansvenen ablation zeigt, dass die Behandlung mit Kathetersystemen einen bedeutenden und festen Platz in der Therapie der Perforansvarikosis hat.

  5. Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group

    Directory of Open Access Journals (Sweden)

    Flora Filho Rowilson

    1999-01-01

    Full Text Available The purpose of this study was to explore the relationship between the intensity of acid reflux and severity of esophageal tissue damage in a cross-sectional study of patients with gastroesophageal reflux disease (GERD. Seventy-eight patients with were selected in accordance with the strict 24-hour ambulatory esophageal pHmetry (24h-pHM criteria and distributed into three age groups: Group A: 14 - 24 years of age. Group B: 25 - 54; and Group C: 55 - 64. The 24h-pHM was carried out in accordance with DeMeester standardization, and the Savary-Miller classification for the diagnosis of reflux esophagitis was used. The groups were similar in 24h-pHM parameters (p > 0.05, having above normal values. For the study group as a whole, there was no correlation between age group and intensity of acid reflux, and there was no correlation between intensity of acid reflux and severity of esophageal tissue damage. However, when the same patients were sub-grouped in accordance with the depth of their epithelial injury and then distributed into age groups, there was a significant difference in esophagitis without epithelial discontinuity. Younger patients had less epithelial damage than older patients. Additionally, although there was a significant progression from the least severe to the moderate stages of epithelial damage among the age groups, there was no apparent difference among the age groups in the distribution between the moderate stages and most severe stages. The findings support the conclusion that the protective response of individuals to acid reflux varies widely. Continued aggression by acid reflux appears to lead to the exhaustion of individual mechanisms of epithelial protection in some patients, but not others, regardless of age or duration of the disease. Therefore, the diagnosis and follow-up of GERD should include both measurements of the quantity of refluxed acid and an assessment of the damage to the esophageal epithelium.

  6. Intraosseous anomalous drainage: a rare case of pretibial varicose vein.

    Science.gov (United States)

    Moraes, Frederico Barra de; Camelo, Carolina Parreira Ribeiro; Brandão, Marcelo Luiz; Fávaro, Pedro Ivo; Barbosa, Tercília Almeida; Barbosa, Raul Carlos

    2016-01-01

    Valve failure with reflux and post-thrombotic syndrome are the factors most commonly correlated with varicose disease. Other rare etiologies can be put forward when these two main causes are ruled out. We report a case in which a young man presented chronic pain in the left tibia, varicose veins in the lower limbs and frequent occurrences of erysipelas. During investigation of the etiology of the varicose veins, radiographs and magnetic resonance imaging of the left leg were requested. These showed images suggestive of an osteolytic lesion in the tibia, but led us to the diagnosis of an intraosseous vein with anomalous drainage. This was confirmed through vascular examinations comprising Doppler venous flow measurement and phlebography. Recognition of this rare intraosseous anomaly is fundamental for proper patient management, but an intraosseous surgical approach is unnecessary.

  7. Pediatric GERD (Gastro-Esophageal Reflux Disease)

    Science.gov (United States)

    ... in Toggle navigation b Join Now Donate Now Disclosure Form News About Us Our Campaigns Foundation Governance ... the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas ...

  8. Laparoscopic Anti-Reflux (GERD) Surgery

    Science.gov (United States)

    ... Sponsorship Opportunities Log In Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  9. [Severe laryngitis associated to gastroesophageal reflux].

    Science.gov (United States)

    Botto, Hugo; Antonioli, Cintia; Nieto, Mary; Cocciaglia, Alejandro; Cuestas, Giselle; Roques Revol, Magdalena; López Marti, Jessica; Rodríguez, Hugo

    2014-02-01

    There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

  10. Veias linfonodais: uma causa pouco conhecida de varizes Lymph node veins: a little-known cause of varicose veins

    Directory of Open Access Journals (Sweden)

    André Paciello Romualdo

    2008-12-01

    Full Text Available As veias linfonodais fazem parte de uma rede venosa no triângulo de Scarpa, que liga em vários pontos o sistema venoso superficial às veias profundas, e podem tanto ser causa de incompetência do sistema venoso superficial quanto estar envolvidas na recorrência pós-safenectomia. Na rotina diária dos exames de Doppler venoso de membros inferiores, temos notado de maneira cada vez mais freqüente a associação das veias linfonodais com varizes primárias e recorrentes. A adequada caracterização dessas veias pode ajudar na compreensão do mecanismo fisiopatológico do aparecimento das varizes e permitir um controle e tratamento mais dirigidos. Este artigo lança luz sobre os aspectos anatômicos e fisiológicos das veias linfonodais, objetivando chamar a atenção dos profissionais envolvidos no diagnóstico de doenças venosas dos membros inferiores para uma causa pouco difundida de varizes.Lymph node veins are part of a venous network in Scarpa"s triangle, communicating in many points the superficial venous system and the deep veins, and may either be the cause of incompetence of the superficial venous system, or be involved in recurrent varicose veins after saphenous vein stripping. In the daily routine of venous Doppler examination of the lower extremities, an increasingly frequent association of lymph node veins with primary and/or recurrent varicose veins has been noticed. Appropriate characterization of these veins may help to understand the pathophysiological mechanism of varicose vein appearance and provide a more focused approach to follow-up and treatment. This article sheds some light on the anatomical and physiological aspects of lymph node veins, drawing the attention of professionals involved in the diagnosis of venous disorders of the lower extremities to a little-known cause of varicose veins.

  11. Surgical management of vesicoureteral reflux in children.

    Science.gov (United States)

    Sung, Jennifer; Skoog, Steven

    2012-04-01

    Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0-21%, new renal damage in 9-12%, and recurrent reflux in 17-47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

  12. Is obesity associated with gastropharyngeal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Cheol Woong Choi; Gwang Ha Kim; Chul Soo Song; Soo Geun Wang; Byung Joo Lee; Hoseok I; Dae Hwan Kang; Geun Am Song

    2008-01-01

    AIM: To examine the association between obesity and gastropharyngeal reflux disease (GPRD) as well as gastroesophageal reflux disease (GERD)METHODS: We conducted a cross-sectional study of consecutive patients undergoing ambulatory 24-h dual-probe pH monitoring from July 2003 to December 2006.The association between body mass index (BMI) and parameters about gastroesophageal or gastropharyngeal reflux was examined in univariate and multivariate analyses.RESULTS: A total of 769 patients (307 men and 462 women; mean age 50.7 years) were finally enrolled. Most variables showing gastroesophageal reflux was higher in the obese patients than the patients with normal BMI.There was no difference in all the variables showing gastropharyngeal reflux according to the BMI. After adjustment for age, sex, alcohol intake and smoking,obese patients demonstrated an about 2-fold increase in risk of GERD compared with patients with normal BMI (OR, 1.9; 95 CI, 1.3-2.9), but overweight patients did not demonstrate increased risk of GERD (OR, 1.2; 95 CI,0.8-1.7). Both obese patients and overweight patients did not demonstrated increased risk of GPRD compared with patients with normal BM[ (OR, 1.1; 95 CI, 0.8-1.7;and OR, 0.9; 95 CI, 0.6-1.3, respectively).CONCLUSION: Obesity is not associated with GPRD reflux while it is associated with GERD.

  13. Diagnosis and clinical implications of pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Hajime Anjiki; Naoto Egawa; Masanao Kurata; Goro Honda; Kouji Tsuruta

    2008-01-01

    The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice.A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall,as occurs in pancreaticobiliary maljunction (PBM);in such cases,sphincter action does not functionally affect the junction.As the hydropressure within the pancreatic duct is usually greater than in the bile duct,pancreatic juice frequently refluxes into the biliary duct (pancreatobiliary reflux) in PBM,resulting in carcinogenetic conditions in the biliary tract.Pancreatobiliary reflux can be diagnosed from elevated amylase level in the bile,secretinstimulated dynamic magnetic resonance cholangiop ancreatography,and pancreatography via the minor duodenal papilla.Recently,it has become obvious that pancreatobiliary reflux can occur in individuals without PBM.Pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without PBM.Since few systemic studies exist with respect to clinical relevance and implications of the pancreatobiliary reflux in individuals with normal pancreaticobiliary junction,further prospective clinical studies including appropriate management should be performed.

  14. The rat saphenous flap: a fasciocutaneous free flap model without panniculus carnosus.

    Science.gov (United States)

    Mutaf, M; Tasaki, Y; Tanaka, K; Fujii, T

    1995-10-01

    The rat saphenous flap is described as a new experimental model for free flap studies. This is a fasciocutaneous free flap based on the saphenofemoral vascular pedicle. The flap may include the entire medial aspect of the lower leg between the knee and ankle. Thirty flaps were harvested from 15 inbred rats. Each flap was transferred to the anterior neck of a recipient rat of the same inbred strain so that 15 flaps were vascularized free flaps using the standard end-to-end microvascular technique and the other 15 flaps were nonvascularized free grafts. All but two (technical failure) of the vascularized flaps showed complete survival, whereas all nonvascularized flaps completely necrosed 2 weeks after transfer. It was concluded that the rat saphenous flap has several advantages such as a long and consistent vascular pedicle, ease of harvest, and an all-or-none survival pattern. Furthermore, as a unique feature of this flap, histological analysis revealed that the rat saphenous flap is composed of the skin and underlying fascia without panniculus carnosus. We therefore suggest that the rat saphenous flap is the first true fasciocutaneous free flap model in the rat. In this paper, in addition to illustrating the anatomy of the saphenous vessels and describing a new fasciocutaneous free flap model based on these vessels, we have documented some anatomical details of the rat leg that have never been described in the literature related to the rat anatomy.

  15. [Recommended diet for reflux spectrophotometry].

    Science.gov (United States)

    Felix, Valter Nilton; Viebig, Ricardo Guilherme

    2003-01-01

    The spectrophotometric probe, which uses bilirubin as a marker for the detection of duodenoesophagic reflux is subject to interference from strongly colored foods, which can cause erroneously high bilirubin absorbance readings. To overcome this problem it is necessary to ingest a diet that is free from such substances. To test the absorbance of 48 different food substances in an in vitro environment. Dry foods were blended with water or milk and non-dry solid foods were blended undiluted. It was utilized the proper calibration recipient to test them. The absorbance of weakly colored foods was usually lesser than the commonly accepted threshold of 0.14, and the absorbance of strongly colored foods was usually above this. Thirty-two from the 48 substances tested are suitable when the absorbance threshold is set at 0.14, but scrambled eggs, lacteous flour mush, green beans, beetroot, carrot, chayote, squash, "baroa" potato, boiled corn, orange, cashew, purple grape, avocado, mango, papaya and peach can alter the results and must be avoided. From the foods evaluated, enough are suitable at the 0.14 threshold to enable a suitable diet to be constructed for most patients during Bilitec studies.

  16. Bladder Dysfunction and Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Ulla Sillén

    2008-01-01

    Full Text Available In this overview the influence of functional bladder disturbances and of its treatment on the resolution of vesicoureteral reflux (VUR in children is discussed. Historically both bladder dysfunction entities, the overactive bladder (OAB and the dysfunctional voiding (DV, have been described in conjunction with VUR. Treatment of the dysfunction was also considered to influence spontaneous resolution in a positive way. During the last decades, however, papers have been published which could not support these results. Regarding the OAB, a prospective study with treatment of the bladder overactivity with anticholinergics, did not influence spontaneous resolution rate in children with a dysfunction including also the voiding phase, DV and DES (dysfunctional elimination syndrome, most studies indicate a negative influence on the resolution rate of VUR in children, both before and after the age for bladder control, both with and without treatment. However, a couple of uncontrolled studies indicate that there is a high short-term resolution rate after treatment with flow biofeedback. It should be emphasized that the voiding phase dysfunctions (DV and DES are more severe than the genuine filling phase dysfunction (OAB, with an increased frequency of UTI and renal damage in the former groups. To be able to answer the question if treatment of bladder dysfunction influence the resolution rate of VUR in children, randomized controlled studies must be performed.

  17. Management of gastroesophageal reflux disease.

    Science.gov (United States)

    Tutuian, Radu; Castell, Donald O

    2003-11-01

    Gastroesophageal reflux disease (GERD) is a chronic condition requiring long-term treatment. Simple lifestyle modifications are the first methods employed by patients and, because of their low cost and simplicity, should be continued even when more potent therapies are initiated. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Whereas healing of the esophageal mucosa is achieved with a single dose of any proton pump inhibitor (PPI) in more than 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (preferably with combined multichannel intraluminal impedance and pH) for association of symptoms with acid, nonacid, or no GER. Long-term follow-up studies indicate that PPIs are efficacious, tolerable, and safe medication. So far, promotility agents have shown limited efficacy, and their side-effect profile outweighs their benefits. Antireflux surgery in carefully selected patients (ie, young, typical GERD symptoms, abnormal pH study, and good response to PPI) is as effective as PPI therapy and should be offered to these patients as an alternative to medication. Still, patients should be informed about the risks of antireflux surgery (ie, risk of postoperative dysphagia; decreased ability to belch, possibly leading to bloating; increased flatulence). Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program.

  18. Relationship between acid pocket and acid reflux in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    姚东英

    2014-01-01

    Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease(GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory

  19. Effect of coffee on gastro-oesophageal reflux in patients with reflux disease and healthy controls

    NARCIS (Netherlands)

    Boekema, PJ; Samsom, M; Smout, AJP

    1999-01-01

    Background Many patients with gastro-oesophageal reflux disease (GORD) report that coffee aggravates their symptoms and doctors tend to discourage its use in GORD. Objective To assess the effect of coffee ingestion on gastro-oesophageaI acid reflux. Design A randomized, controlled, crossover study.

  20. [Right ovarian vein syndrome].

    Science.gov (United States)

    Arvis, G

    1985-01-01

    Right ovarian vein syndrome is revealed in pregnancy by right lumbar pains, and even by nephritic colics. It results from a congenital malposition of the right ovarian vein, which presses the right ureter on the external iliac artery. Diagnosis is by intravenous urography and retrograde ureteral pyelography. If pain persists despite treatment by analgesics, it may be necessary to place a double-J catheter, and to operate after delivery to ligate the ovarian vein.

  1. Use of Brilliant Blue FCF during vein graft preparation inhibits intimal hyperplasia.

    Science.gov (United States)

    Osgood, Michael J; Sexton, Kevin; Voskresensky, Igor; Hocking, Kyle; Song, Jun; Komalavilas, Padmini; Brophy, Colleen; Cheung-Flynn, Joyce

    2016-08-01

    Intimal hyperplasia remains the primary cause of vein graft failure for the 1 million yearly bypass procedures performed using human saphenous vein (HSV) grafts. This response to injury is caused in part by the harvest and preparation of the conduit. The use of Brilliant Blue FCF (FCF) restores injury-induced loss of function in vascular tissues possibly via inhibition of purinergic receptor signaling. This study investigated whether pretreatment of the vein graft with FCF prevents intimal hyperplasia. Cultured rat aortic smooth muscle cells (A7r5) were used to determine the effect of FCF on platelet-derived growth factor-mediated migration and proliferation, cellular processes that contribute to intimal hyperplasia. The effectiveness of FCF treatment during the time of explantation on preventing intimal hyperplasia was evaluated in a rabbit jugular-carotid interposition model and in an organ culture model using HSV. FCF inhibited platelet-derived growth factor-induced migration and proliferation of A7r5 cells. Treatment with FCF at the time of vein graft explantation inhibited the subsequent development of intimal thickening in the rabbit model. Pretreatment with FCF also prevented intimal thickening of HSV in organ culture. Incorporation of FCF as a component of vein graft preparation at the time of explantation represents a potential therapeutic approach to mitigate intimal hyperplasia, reduce vein graft failure, and improve outcome of the autologous transplantation of HSV. Copyright © 2016. Published by Elsevier Inc.

  2. Postpartum renal vein thrombosis.

    Science.gov (United States)

    Rubens, D; Sterns, R H; Segal, A J

    1985-01-01

    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  3. Association of left renal vein variations and pelvic varices in abdominal MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Koc, Zafer [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey); Baskent Universitesi Adana Hastanesi, Adana (Turkey); Ulusan, Serife; Oguzkurt, Levent [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey)

    2007-05-15

    The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. (orig.)

  4. Gastro-oesophageal Reflux Disease: An Update

    Directory of Open Access Journals (Sweden)

    T Murphy

    2015-09-01

    Full Text Available Gastro-oesophageal reflux disease (GERD is a disorder in which reflux of stomach contents causes troublesome symptoms and/or complications and which affects health-related quality of life. It is one of the commonest disorders and appears to be increasing in incidence. The mechanisms leading to reflux are complex and multifactorial. The lower oesophageal sphincter (LES is an important part of the gastro-oesophageal barrier. Transient LES relaxations (TLESRs lead to reflux as these vagally mediated motor patterns cause relaxation of the LES and also result in oesophageal shortening and inhibition of the crural diaphragm. Heartburn and regurgitation are the characteristic symptoms of GERD. A clinical diagnosis of GERD can be made with typical symptoms. Oesophagitis is seen in a minority of patients with GERD. Lifestyle modification is widely advocated for patients with GERD. For short-term relief of symptoms of mild GERD, antacids/alginates are frequently used but they do not heal oesophagitis. Both histamine 2 receptor antagonists (H2RA and proton pump inhibitors (PPI have been shown to heal and prevent relapse of oesophagitis, although PPIs have been shown to be superior. The PPIs are the recommended first-line therapy for erosive oesophagitis and initial management of non-erosive reflux disease. Maintenance PPI therapy should be given to patients with oesophagitis, those who have recurrence of symptoms after discontinuation of medication and for those with complications of GERD.

  5. Gene expression in Barrett's esophagus and reflux esophagitis induced by gastroduodenoesophageal reflux in rats

    Institute of Scientific and Technical Information of China (English)

    Peng Cheng; Jun Gong; Tao Wang; Chen Jie; Gui-Sheng Liu; Ru Zhang

    2005-01-01

    AIM: To investigate the difference of gene expression profiles between Barrett's esophagus and reflux esophagitis induced by gastroduodenoesophageal reflux in rats.METHODS: Eight-week-old Sprague-Dawley rats were treated esophagoduodenostomy to produce gastroduodenoesophageal reflux, and another group received sham operation as control. Esophageal epithelial tissues were dissected and frozen in liquid nitrogen immediately for pathology 40 wk after surgery. The expression profiles of 4 096 genes in reflux esophagitis and Barrett's esophagus tissues were compared with normal esophageal epithelium by cDNA microarray.RESULTS: Four hundred and forty-eight genes in Barrett'sesophagus were more than three times different from those in normal esophageal epithelium, including 312 up regulated and 136 down-regulated genes. Two hundred and thirty-twogenes in RE were more than three times different from those in normal esophageal epithelium, 90up-regulated and 142 down-regulated genes. Compared to reflux esophagitis, there were 214 up-regulated and 142 down-regulated genes in Barrett's esophagus. CONCLUSION: Esophageal epithelium exposed excessively to harmful ingredients of duodenal and gastric reflux can develop esophagitis and Barrett's esophagus gradually.The gene expression level is different between reflux esophagitis and Barrett's esophagus and the differentially expressed genes might be related to the occurrence and development of Barrett's esophagus and the promotion or progression in adenocarcinoma.

  6. What Causes Varicose Veins?

    Science.gov (United States)

    ... blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg. Figure A shows ... blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg. Older age or ...

  7. Gastroesophageal Reflux Disease and Sleep Quality in a Chinese Population

    Directory of Open Access Journals (Sweden)

    Mei-Jyh Chen

    2009-01-01

    Conclusion: The present study highlights the adverse effect of gastroesophageal reflux on sleep, even in the absence of reflux symptoms. This finding has therapeutic implications in patients with silent erosive disease, and future trials are warranted.

  8. Gastroesophageal reflux diagnosed by occlusal splint tintion.

    Science.gov (United States)

    Cebrián-Carretero, José Luis; López-Arcas-Calleja, José María

    2006-01-01

    The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

  9. Nursing Experience in the Treatment of Lower Extremity Varicose Veins%下肢静脉曲张腔内激光治疗的护理

    Institute of Scientific and Technical Information of China (English)

    邹燕慧

    2015-01-01

    大隐静脉曲张是外科常见病,近年来下肢静脉曲张微创外科治疗技术得到了飞速发展。静脉曲张腔内激光治疗术具有美观,手术创伤、创口和并发症少,术后恢复快,住院时间短等优点。我科于2013年引进激光静脉曲张治疗系统治疗大隐静脉曲张23例,与传统的手术方法相比较,具有微创、美观、彻底三大特点。%Varicosis of great saphenous vein is a common surgical disease,in recent years,varicose veins of lower extremity treated with minimal y invasive surgery technology has been rapid development.Has the advantages of beautiful appearance,varicose veins endovenous laser treatment,surgical trauma,the wound and few complications,postoperative quick recovery,short hospitalization time and other advantages.In our department in 2013 the introduction of laser system for treating varicose vein treatment of varicosis of great saphenous vein in 23 cases,compared with the traditional surgical method,with minimal y invasive,beautiful,completely three characteristics.

  10. Helicobacter pylori and gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Nigro Casimiro

    2008-07-01

    Full Text Available Abstract Background The nature of the relationship between Helicobacter pylori and reflux oesophagitis is still not clear. To investigate the correlation between Helicobacter pylori infection and GERD taking into account endoscopic, pH-metric and histopathological data. Methods Between January 2001 and January 2003 a prospective study was performed in 146 patients with GERD in order to determine the prevalence of Helicobacter pylori infection at gastric mucosa; further the value of the De Meester score endoscopic, manometric and pH-metric parameters, i.e. reflux episodes, pathological reflux episodes and extent of oesophageal acid exposure, of the patients with and without Helicobacter pylori infection were studied and statistically compared. Finally, univariate analysis of the above mentioned data were performed in order to evaluate the statistical correlation with reflux esophagitis. Results There were no statistically significant differences between the two groups, HP infected and HP negative patients, regarding age, gender and type of symptoms. There was no statistical difference between the two groups regarding severity of symptoms and manometric parameters. The value of the De Meester score and the ph-metric parameters were similar in both groups. On univariate analysis, we observed that hiatal hernia (p = 0,01, LES size (p = 0,05, oesophageal wave length (p = 0,01 and pathological reflux number (p = 0,05 were significantly related to the presence of reflux oesophagitis. Conclusion Based on these findings, it seems that there is no significant evidence for an important role for H. pylori infection in the development of GERD and erosive esophagitis. Nevertheless, current data do not provide sufficient evidence to define the relationship between HP and GERD. Further assessments in prospective large studies are warranted.

  11. 术前诱导化疗对实验犬隐皮瓣的影响%Effects of neoadjuvant chemotherapy on saphenous flap in a dog model

    Institute of Scientific and Technical Information of China (English)

    王伟; 周晓; 戴捷; 陈森林; 肖腾飞; 汪安兰; 李俊军

    2011-01-01

    目的:观察术前化疗药物直接注射对隐皮瓣存活的影响.方法:将健康成年杂种雄性犬14只,随机分为对照组和化疗组,均从右后肢内侧隐静脉予以静脉穿刺输液,左后肢不予任何静脉穿刺以自身左右对照.化疗组予以顺铂(DDP)50 mg/m2加氟尿嘧啶(5-FU)150 mg/m2化疗,分别于第1、3和5天经隐静脉给予,每21 d为1个周期,共2个周期;对照组予以等量的生理盐水及糖水注射.于第42~49天进行隐皮瓣手术,术后每天观察皮瓣变化,术后第7天用坐标贴纸法测量皮瓣存活面积后,将整个带蒂皮瓣取下,对皮瓣及隐静脉、隐动脉进行病理形态分析.结果:对照组6只,化疗组5只,共计11只试验犬存活.术后2~3 d内,各组皮瓣均有不同程度的肿胀.术后7 d,对照组非直接注射侧(A组)、对照组直接注射侧(B组)、化疗组非直接注射侧(C组)、化疗组直接注射组(D组)的皮瓣存活率相近,分别为(89.26±9.97)%、(90.25±7.55)%、(88.11±9.38)%和(88.64±11.25)%(F=0.051,P=0.984).镜下各组均显示表皮及皮下组织生长良好.A组及C组可见少量炎性细胞浸润,未发现明显血栓形成,而B组及D组有较多的血栓形成和炎性细胞浸润.各组隐动脉内均未发现血栓形成.结论:术前化疗对直接注射静脉存在影响,其影响可能与穿刺部位的机械刺激和损伤有关,化疗药物对直接注射静脉的伴行动脉无明显影响.术前诱导化疗对隐皮瓣存活影响不明显,静脉直接注射部位仍可以作为皮瓣供区.%OBJECTIVE: To investigate the effects of preoperative chemotherapeutic drugs on flap in a dog model. METHODS: Fourteen healthy and male mongrel dogs were divided randomly into control groups and chemotherapy groups. Every dog was introvenous transfusion in the right hind medial saphenous vein, while the left hind leg was not given any vein ptncture for self-control. The dogs in chemotherapy groups were treated with cisplatin (DDP

  12. The Mystery and Misery of Acid Reflux in Children

    Science.gov (United States)

    Davenport, Mike; Davenport, Tracy

    2006-01-01

    When a child is sick, parents want answers. They want to know what is wrong, what they can do, and how to get their child healthy--pronto. Regrettably, there are some puzzling illnesses affecting children that are surrounded by mystery. One of them is gastroesophageal reflux (GER), otherwise known as acid reflux--or "reflux" for short. Reflux…

  13. Endoscopic Vein Harvesting for Coronary Bypass Grafting: A Blessing or a Trojan Horse?

    Directory of Open Access Journals (Sweden)

    Ryan Accord

    2011-01-01

    Full Text Available Conventional open harvest of the great saphenous vein (GSV during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.

  14. Rapid elongation of arteries and veins in rats with a tissue expander.

    Science.gov (United States)

    Stark, G B; Hong, C; Futrell, J W

    1987-10-01

    The saphenous arteries and veins of 40 rats were elongated with 20-cc tissue expanders underlying the leg adductor muscles. The mean rate of successful elongation of the vessels was 84 +/- 47 percent SD, with a maximum gain of 140 percent. The fastest mean elongation velocity reached 45 percent per day. Thrombosis occurred only with stretching velocities of more than 10 percent per day, which seemed to be a safe margin. Distribution of the volume into many intervals was safer than infrequent high-volume injections. Histology showed no reduction in vessel wall diameter or loss intimal integrity. Subendothelial cellular proliferation was an indicator of this rapid regeneration. Microvascular anastomoses performed in elongated arteries and veins had the same patency rate (90 percent) as in controls.

  15. [Forensic medical implications in the course of sclerotherapy of varicose veins].

    Science.gov (United States)

    Natali, J; Farman, T

    1996-11-01

    Complications are exceptional compared to the number of sclerosis treatments performed. We report 58 case-files with medico-legal implications. Intraarterial injections are by far the most severe complications: we observed 40 such cases with the following consequences: 7 major amputations including 2 above the knee and 5 below the knee, 6 minor peripheral amputations of one or more toes, 27 severe sequelae, mainly due to retraction of the triceps sural muscle. This type of accident occurs more readily after attempted sclerosis of the lesser saphenous vein "crosse", although other localizations can be involved: inguinal area by sclerosis of the greater saphenous vein "crosse", the lower third of the leg with direct injection into the anterior or posterior tibial artery or its branches. Subcutaneous injections of the sclerosis agent produce either simple inflammatory reactions or skin necrosis. Neurological disorders can be observed by direct damage to the nerve. Sensorial complications may occur by lesion of a cutaneous branch of the popliteal sciatic nerve. Other cases involve motor disorders. Pulmonary thromboembolic events (4 cases) appear to be exception when modern criteria for the diagnosis of phlebitis are used. General allergic and anaphylactic reactions are very rare and often related to overdose. The same is true for toxic reactions. One case of septicemia occurred after incision of post-sclerosis clots. From a medicolegal point of view, the responsibility of the practician is usually confirmed for severe accidents (intraarterial injections) leading to trophic disorders. For necrosis or limited eschars, the question is debated.

  16. Congenital preduodenal portal vein

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Jin; Hwang, Mi Soo; Huh, Young Soo; Park, Bok Hwan [College of Medicine, Youngnam University, Gyeongsan (Korea, Republic of)

    1991-03-15

    Congenital preduodenal portal vein, first reported by Knight in 1921, is an extremely rare congenital anomaly in which the portal vein passes anteriorly to the duodenum rather than posteriorly in its normal location. It is of surgical significance because it may cause difficulties in operations involving the gall bladder, biliary duct, or duodenum. Recently, we experienced 2 cases of preduodenal portal vein. One was found during surgical exploration for the diagnosis and correction of malrotation of the bowels and the other in a 3 day-old male newborn associated with dextrocardia, situs inversus, and duodenal obstruction by diaphragm. We report these 2 cases with a review of the literature.

  17. Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation

    Institute of Scientific and Technical Information of China (English)

    Samuel; C; Lüthold; Mascha; K; Rochat; Peter; Bhler

    2010-01-01

    AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP...

  18. Umbilical and portal vein calcification following umbilical vein catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, K.; Fendel, H.; Hartl, M.

    1989-07-01

    Calcifications of the umbilical vein and intrahepatic branches of the portal vein developed in a newborn who had inserted an umbilical vein catheter for 11 days postnatally. The calcified intrahepatic portal veins can still be demonstrated sonographically at the age of three years, whereby these calcifications were no longer detectable radiologically. (orig.).

  19. [Alginates in therapy for gastroesophageal reflux disease].

    Science.gov (United States)

    Avdeev, V G

    2015-01-01

    This article presents evidence of the prevalence of gastroesophageal reflux disease (GERD) and highlights its main treatment options. Among its medications, particular emphasis is laid on alginates and their main mechanisms of action are described. There is information on the efficacy of alginates, including the alginate-antacid Gaviscon Double Action, in treating GERD. Recommendations for how to administer these drugs are given.

  20. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy.

    Science.gov (United States)

    Silva, Carlos Eduardo Dilen da; Niedermeier, Bruno Taccola; Portinho, Fernando

    2015-07-01

    Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux.

  1. Experimental and theoretical study of reflux condensation

    Energy Technology Data Exchange (ETDEWEB)

    Bakke, Knut

    1997-12-31

    This thesis studies the separation of gas mixtures in a reflux condenser. also called a dephlegmator. Reflux condensation is separation of a gas mixture, in reflux flow with condensing liquid, under continuous heat removal. A numerical model of a dephlegmator for binary mixtures was developed. The model may readily be extended to multi-component mixtures, as the solution method is based on a matrix solver. Separation of a binary mixture in a reflux condenser test rig is demonstrated. The test facility contains a single-tube test section that was designed and built as part of the project. Test mixtures of propane and n-butane were used, and a total of 15 experiments are reported. Limited degree of separation was achieved due to limited heat transfer area and narrow boiling point range of the test mixture. The numerical model reproduces the experimental data within reasonable accuracy. Deviation between calculated and measured properties is less than 6% of the measured temperature and less than 5% of the measured flow rate. The model is based on mechanistic models of physical processes and is not calibrated or tuned to fit the experimental data. The numerical model is applied to a number of separation processes. These case studies show that the required heat transfer area increases rapidly with increments in top product composition (light component). Flooding limits the amount of reflux liquid. The dephlegmator is suitable for separation of feed mixtures that are rich in light components. The gliding temperature in the dephlegmation process enables utilization of top product as refrigerant, with subsequent energy saving as a result. 61 refs., 50 figs., 34 tabs.

  2. Vesicoureteral reflux in adults studied by computerized radionuclide cystography

    Energy Technology Data Exchange (ETDEWEB)

    Kinn, A.C.; Jacobsson, H.; Schnell, P.O. (Depts. of Urology Diagnostic Radiology and Hospital Physics, Karolinska Sjukhuset, Stockholm (Sweden))

    1991-01-01

    Direct radionuclide cystography in a computerized method as described by Willi and Treves was used in adults with recurrent pyelites but without evidence of obstruction. Reflux was observed in 15 out of 38 patients. In patients with neurogenic bladder dysfunction or megaureters, reflux began early during the bladder filling and attained higher volumes than in those with uncomplicated pyelitis, who has minor reflux appearing mainly during voiding. Bladder capacity and detrusor compliance were lower in patients with reflux than in those without reflux. The low radiation exposure in radionuclide cystography permits observation of the urodynamic course of urinary reflux and correlation to the intravesical volume and pressure. The method is sensitive, and minorl refluxed volumes can be detected. Radionuclide cystrography can therefore be recommended for checking or surgical results and for follow-up of patients with neurogenic bladder dysfunction. (au).

  3. Alterations in serotonin receptor-induced contractility of bovine lateral saphenous vein in cattle grazing endophyte-infected tall fescue

    Science.gov (United States)

    As part of a large 2-year study documenting the physiologic impact of grazing endophyte-infected tall fescue on growing cattle, 2 experiments were conducted to characterize and evaluate the effects of grazing 2 levels of toxic endophyte-infected tall fescue pastures on vascular contractility and ser...

  4. Deep vein thrombosis.

    Science.gov (United States)

    Bandyopadhyay, Gargi; Roy, Subesha Basu; Haldar, Swaraj; Bhattacharya, Rabindra

    2010-12-01

    Occlusive clot formation in the veins causes venous thrombosis, the site most common in the deep veins of leg, called deep vein thrombosis. The clot can block blood flow and when it breaks off, called an embolism which in turn can damage the vital organs. Venous thrombosis occurs via three mechanisms ie, Virchow's triad. The mechanisms are decreased flow rate of blood, damage to the blood vessel wall and an increased tendency of the blood to clot. There are several factors which can increase a person's risk for deep vein thrombosis. The symptoms of deep vein thrombosis in the legs are pain, swelling and redness of the part. One variety of venous thrombosis is phlegmasia alba dolens where the leg becomes pale and cool. Investigations include Doppler ultrasound examination of the limb, D-dimer blood test, plethysmography of the legs, x-rays to show vein in the affected area (venography). Hospitalisation is necessary in some cases with some risk factors. The mainstream of treatment is with anticoagulants, mostly low molecular weight heparin for 6 months. Deep venous thrombosis is a rising problem. Early diagnosis and treatment is associated with a good prognosis.

  5. Gastric Reflux on Routine Tc-99m DISIDA hepatobiliary Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Wook; Lee, Heon Young [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1995-06-15

    Reflux of bile and digestive enzymes from the small bowel and duodenum into stomach has been observed in patients with various gastroduodenal diseases. Tc-99m iminodiacetic acid derivatives hepatobiliary scan has been used as a noninvasive method to detect duodenogastric reflux. Sometimes, gastric reflux can be observed incidentally on routine Tc-99m DISA hepatobiliary scintigraphy. To evaluate the clinical meaning of gastric reflux on routine Tc-99m DISIDA hepatobiliary scan, we analyzed 36 patients showed gastric reflux incidentally on the routine Tc-99m-DISIDA hepatobiliary scintigraphy from December 1991 to June 1995 in Chungnam National University Hospital. The results were as follows: 1) The gastric reflux was observed in 2.3% of 1,553 cases of routine Tc-99m DISIDA Hepatobiliary scintigraphy for 43 months. 2) Nineteen percent of patients with gastric reflux had the past medical history of operations on stomach or biliary system. And that history was more prevalent in patients with reflux than those without reflux, significantly (p<0.01). 3) On fiberoptic gastroduodenpscopic examination, 87% of the patients with gastric reflux had the gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, duodenal cancer and ampullary diverticulosis. We thought that the gastric reflux can be observed considerably in patients without any operation history on stomach or duodenum, although the operation history is more prevalent in patients with gastric reflux than those without reflux, significantly and most of patients with gastric reflux on routine Tc-99m DISIDA scan has various gastroduodenal diseases.

  6. Mesenteric vein thrombosis: CT identification

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, A.; Korobkin, M.; Silverman, P.M.; Dunnick, N.R.; Kelvin, F.M.

    1984-07-01

    Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filling defect. Four fo the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis.

  7. Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors

    Institute of Scientific and Technical Information of China (English)

    Luigi Monaco; Antonio Brillantino; Francesco Torelli; Michele Schettino; Giuseppe Izzo; Angelo Cosenza; Natale Di Martino

    2009-01-01

    AIM: To determine the prevalence and characteristics of bile reflux in gastroesophageal reflux disease (GERD) patients with persistent symptoms who are nonresponsive to medical therapy.METHODS: Sixty-five patients (40 male, 25 female;mean age, 50 ± 7.8 years) who continued to report symptoms after 8 wk of high-dose proton pump inhibitor (PPI) therapy, as well as 18 patients with Barrett's esophagus, were studied. All patients filled out symptom questionnaires and underwent endoscopy,manometry and combined pH-metry and bilimetry.RESULTS: There were 4 groups of patients: 22 (26.5%)without esophagitis, 24 (28.9%) grade A-B esophagitis,19 (22.8%) grade C-D and 18 (21.6%) Barrett's esophagus. Heartburn was present in 71 patients (85.5%) and regurgitation in 55 (66.2%), with 44 (53%)reporting simultaneous heartburn and regurgitation. The prevalence of pathologic acid reflux in the groups without esophagitis and with grades A-B and C-D esophagitis was 45.4%, 66.6% and 73.6%, respectively. The prevalence of pathologic bilirubin exposure in these 3 groups was 53.3%, 75% and 78.9%, respectively. The overall prevalence of bile reflux in non-responsive patients was 68.7%. Pathologic acid and bile reflux was observed in 22.7% and 58.1% of non-esophagitic patients and esophagitic patients, respectively.CONCLUSION: The high percentage of patients poorly responsive to PPI therapy may result from poor control of duodenogastroesophageal reflux. Many patients without esophagitis have simultaneous acid and bile reflux, which increases with increasing esophagitis grade.

  8. Different risk factors between reflux symptoms and mucosal injury in gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Chung-Hsien Li

    2015-06-01

    Full Text Available Gastroesophageal reflux disease (GERD is diagnosed based on typical symptoms in clinical practice. It can be divided into two groups using endoscopy: erosive and nonerosive reflux disease (NERD. This study aims to determine the risk factors of reflux symptoms and mucosal injury. This was a two-step case-control study derived from a cohort of 998 individuals having the data of reflux disease questionnaire (RDQ and endoscopic findings. Those with minor reflux symptoms were excluded. The first step compared symptomatic GERD patients with healthy controls. The 2nd step compared patients with erosive esophagitis with healthy controls. In this study, the prevalence of symptomatic GERD and erosive esophagitis were 163 (16.3% and 166 (16.6%, respectively. A total of 507 asymptomatic individuals without mucosal injury of the esophagus on endoscopy were selected as healthy controls. Compared with healthy controls, multivariate analyses showed that symptomatic GERD patients had a higher prevalence of hypertriglyceridemia [odds ratio (OR, 1.83; 95% confidence interval (CI 1.13–2.96] and obesity (OR, 1.85; 95% CI 1.08–3.02. By contrast, male sex (OR, 2.24; 95% CI 1.42–3.52, positive Campylo-like organism (CLO test (OR, 0.56; 95% CI 0.37–0.84, and hiatus hernia (OR, 14.36; 95% CI 3.05–67.6 were associated with erosive esophagitis. In conclusion, obesity and hypertriglyceridemia were associated with reflux symptoms. By contrast, male sex, negative infection of Helicobacter pylori, and hiatus hernia were associated with mucosal injury. Our results suggested that risk factors of reflux symptoms or mucosal injury might be different in GERD patients. The underlying mechanism awaits further studies to clarify.

  9. The Histological and Immunohistochemical Aspects of Bile Reflux in Patients with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Andreas Nakos

    2011-01-01

    Full Text Available Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI. The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53 of patients with GERD and in 13% (2/15 of controls (=0.02. Severe esophageal lesions were significantly more common in BRI (+ patients (14/25 compared to BRI (− ones (=0.0049. Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.

  10. The histological and immunohistochemical aspects of bile reflux in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Nakos, Andreas; Kouklakis, Georgios; Pitiakoudis, Michail; Zezos, Petros; Efraimidou, Eleni; Giatromanolaki, Alexandra; Polychronidis, Alexandros; Liratzopoulos, Nikolaos; Sivridis, Efthimios; Simopoulos, Konstantinos

    2011-01-01

    Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI). The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53) of patients with GERD and in 13% (2/15) of controls (P = 0.02). Severe esophageal lesions were significantly more common in BRI (+) patients (14/25) compared to BRI (-) ones (P = 0.0049). Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.

  11. Clinical course and effective treatment of varicose vein of lower limb in diabetic patients

    Directory of Open Access Journals (Sweden)

    Yu.O. Syniachenko

    2017-04-01

    Full Text Available Background. Type 2 diabetes mellitus (DM2 is a risk factor for arteriosclerosis of the lower extremities, and the relationship with the state of the feet venous vascular territory remains insufficiently studied, the effectiveness of surgical treatment of patients with varicose veins is not defined. Objective: to analyze the clinical course of foot varicose veins and the effectiveness of medical measures on the background of DM2. Materials and methods. The study included 302 patients (227 men and 75 women aged 29–72 years old, 16 % of which had previous phlebothrombosis and the prevalece of II, III, IV, V and VI class of venous insufficiency was 10, 14, 37 16 and 23 %, respectively. 263 patients underwent endovenous laser coagulation, and 39 — the traditional phlebectomy and ligation of perforating veins. Results. Among the examined patients with varicose veins of lower extremities DM2 was diagnosed in 9 % of cases, more often in males and elderly patients on the background of atherosclerosis of the foot vessels (iliac, femoral, tibial, popliteal artery, which was accompanied by more frequent involvement of the great saphenous vein in the process and its gate extension, the prevalence of severe grades of venous insufficiency, significantly worse the results of surgical treatment of varicose veins and greater frequency of complications, despite more frequent using of rivaroxaban and low molecular weight heparins, and the effectiveness of endovenous laser ablation after four weeks of its implementation is inferior to that in the group without DM2, while glycemic index inversely correlated with the surface tension of the venous blood, which has prognostic significance in the context of future medical interventions. Conclusions. The presence of DM2 is a risk factor for more severe feet varicose veins, is a negative predictive factor in the effectiveness of surgical treatment of the disease and the complications number.

  12. Diagnostic Approach to Reflux in 2007

    Directory of Open Access Journals (Sweden)

    Sumit Dave

    2008-01-01

    Full Text Available There is ongoing controversy regarding the association between vesicoureteric reflux (VUR, recurrent urinary tract infections (UTI, and renal damage. Despite this, routine work up for VUR is still recommended after febrile UTI in most children. The present article reviews the indications and imaging modalities available for VUR diagnosis. Alternative newer techniques like MR cystography and voiding urosonography are discussed. The increasing evidence of the role of DMSA scans in managing children with VUR is highlighted.

  13. Esophageal sphincter device for gastroesophageal reflux disease.

    Science.gov (United States)

    Ganz, Robert A; Peters, Jeffrey H; Horgan, Santiago; Bemelman, Willem A; Dunst, Christy M; Edmundowicz, Steven A; Lipham, John C; Luketich, James D; Melvin, W Scott; Oelschlager, Brant K; Schlack-Haerer, Steven C; Smith, C Daniel; Smith, Christopher C; Dunn, Dan; Taiganides, Paul A

    2013-02-21

    Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. We prospectively assessed 100 patients with gastroesophageal reflux disease before and after sphincter augmentation. The study did not include a concurrent control group. The primary outcome measure was normalization of esophageal acid exposure or a 50% or greater reduction in exposure at 1 year. Secondary outcomes were 50% or greater improvement in quality of life related to gastroesophageal reflux disease and a 50% or greater reduction in the use of proton-pump inhibitors at 1 year. For each outcome, the prespecified definition of successful treatment was achievement of the outcome in at least 60% of the patients. The 3-year results of a 5-year study are reported. The primary outcome was achieved in 64% of patients (95% confidence interval [CI], 54 to 73). For the secondary outcomes, a reduction of 50% or more in the use of proton-pump inhibitors occurred in 93% of patients, and there was improvement of 50% or more in quality-of-life scores in 92%, as compared with scores for patients assessed at baseline while they were not taking proton-pump inhibitors. The most frequent adverse event was dysphagia (in 68% of patients postoperatively, in 11% at 1 year, and in 4% at 3 years). Serious adverse events occurred in six patients, and in six patients the device was removed. In this single-group evaluation of 100 patients before and after sphincter augmentation with a magnetic device, exposure to esophageal acid decreased, reflux symptoms improved, and use of proton-pump inhibitors decreased. Follow-up studies are needed to assess long-term safety. (Funded by Torax Medical; ClinicalTrials.gov number, NCT00776997.).

  14. Gastroesophageal reflux disease and asthma in children.

    Science.gov (United States)

    Khoshoo, Vikram; Haydel, Robert; Saturno, Emilio

    2006-06-01

    Gastroesophageal reflux disease (GERD) occurs in about two thirds of children with asthma. It may simply represent a concomitant unrelated finding or it may be responsible for provoking or worsening asthma. GERD could also be a byproduct of asthma itself. In any case, aggressive treatment of GERD seems to improve asthma outcomes. GERD should be suspected in asthma patients who do not have any known risk factors or those who are becoming difficult to treat.

  15. Prevalence of saphenous nerve injury after adductor-canal-blockade in patients receiving total knee arthroplasty

    DEFF Research Database (Denmark)

    Henningsen, Maja; Jæger, Pia; Hilsted, K L;

    2013-01-01

    BACKGROUND: Adductor-canal-blockade is a new technique for pain relief after knee surgery. This block could cause nerve injury and the aim of this follow-up study was to determine the prevalence of saphenous nerve injury in patients receiving adductor-canal-blockade for pain treatment after total...... knee arthroplasty. METHODS: All patients included in two former studies of adductor-canal-blockade following total knee arthroplasty were invited to participate in this follow-up study 3-6 months after surgery. We examined the cutaneous area on the medial aspect of the lower leg (medial crural branch......, 76 patients could not discriminate between blunt and sharp stimulation with a needle, 81 patients could not discriminate between cold and warmth, and 82 patients displayed an altered sensation to light brush. CONCLUSION: We found no indications of saphenous nerve injury caused by the adductor-canal...

  16. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria

    2014-01-01

    Full Text Available Introduction Laryngopharyngeal reflux (LPR is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

  17. Radionuclide voiding cystography in intrarenal reflux detection

    Energy Technology Data Exchange (ETDEWEB)

    Rizzoni, G.; Perale, R.; Bui, F.; Pitter, M.; Pavanello, L.; Boscolo, R.; Passerini Glazel, G.; Macri, C.

    1986-01-01

    In order to evaluate the possibility of detecting intra-renal reflux (IRR) with a more sensitive procedure, 48 children with recurrent urinary tract infections underwent intravenous urography (IVU) and voiding cystourethrogram (VCU) using a solution containing contrast medium and sup(99m)Tc-sulfur colloid particles which are known to persist in the renal parenchyma for a long time. Scintigraphic images were taken at 5 and 20 hours after VCU. 18 children had no vesico-ureteral reflux, 11 showed unilateral and 19 bilateral VUR, which was therefore present in 49 renal units. Among the 49 renal refluxing units (RRUs) IRR was detected radiologically in 8; of these isotopic activity in the renal area was present in all 6 RRUs who were examined at 20 hours. Of the remaining 41 RRUs with no radiologically detectable IRR 24 were evaluated at 20 hours and 5 (21%) showed renal radioactivity. Renal scars were significantly more frequent in kidneys with radioisotopic activity at 20 hours. The results of this study indicate that radionuclide cystography using sup(99m)Tc-sulfur colloid is a reliable procedure for demonstrating IRR, and to this end is more sensitive than X-ray VCU. Radionuclide cystography with sulfur colloid particles should therefore be considered a simple and useful complementary procedure, which is more sensitive than X-ray VCU in the diagnosis and follow-up of IRR.

  18. Diagnosis and treatment of gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Raul; Badillo; Dawn; Francis

    2014-01-01

    Gastroesophageal reflux disease(GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical,atypi-cal and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms,these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations,further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis,peptic stricture,Barrett’s esophagus,esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification,medical therapy and surgical therapy. Life-style modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids,histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy,others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gas-troesophageal reflux disease.

  19. Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis: A Review

    Directory of Open Access Journals (Sweden)

    Ahmed Fahim

    2011-01-01

    Full Text Available The histological counterpart of idiopathic pulmonary fibrosis is usual interstitial pneumonia, in which areas of fibrosis of various ages are interspersed with normal lung. This pattern could be explained by repeated episodes of lung injury followed by abnormal wound healing responses. The cause of the initiating alveolar epithelial injury is unknown, but postulated mechanisms include immunological, microbial, or chemical injury, including aspirated gastric refluxate. Reflux is promoted by low basal pressure in the lower oesophageal sphincter and frequent relaxations, potentiated by hiatus hernia or oesophageal dysmotility. In susceptible individuals, repeated microaspiration of gastric refluxate may contribute to the pathogenesis of IPF. Microaspiration of nonacid or gaseous refluxate is poorly detected by current tests for gastroesophageal reflux which were developed for investigating oesophageal symptoms. Further studies using pharyngeal pH probes, high-resolution impedance manometry, and measurement of pepsin in the lung should clarify the impact of reflux and microaspiration in the pathogenesis of IPF.

  20. Vesical-ureteral reflux in children; Reflux vesico-ureteral chez l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Desvignes, V.; Palcoux, J.B. [Hotel-Dieu, 63 - Clermont-Ferrand (France); Cochat, P. [Hopital Edouard-Herriot, 69 - Lyon (France)

    1995-12-31

    The vesical-ureteral reflux is the most frequent uropathy in children. The diagnosis is made by uretero-cystography, often after pyelonephritis, sometimes after ante-natal diagnosis from echographic abnormalities. Spontaneous recovery is possible in 50 to 80% of cases. This is especially true in grade 1, 2 and 3, however complications may occur. They are more frequent in the case of reflux nephropathy with a resulting risk of hypertension and chronic renal failure. The therapeutic choice is between the conservative management with urinary antiseptics ad the surgical treatment with ureters re-implantation or endoscopic treatment. The therapeutic indications take into account vesical-ureteral reflux grades, the child`s age, the associated diseases and the child`s and parents` compliance. (authors). 22 refs., 2 figs.

  1. Above-knee vein harvest for coronary revascularization increases ASEPSIS score.

    Science.gov (United States)

    Akowuah, Enoch; Shrivastava, Vivek; Ponniah, Alan; Jamnadas, Binal; Chilton, Gary; Cooper, Graham

    2006-02-01

    The long saphenous vein may be harvested from the thigh or the lower leg, depending on the operating surgeon's preference. This prospective study compared the incidence of altered wound healing between these two sites in 175 patients undergoing routine coronary artery bypass grafting over a 3-month period. The patients were divided into 3 groups. In group A, the vein harvest site was restricted to above the upper border of the patella. Group B included harvest sites that started at the ankle but extended above the level of the upper border of the patella. In group C, the vein harvest site was restricted to below the upper border of the patella. The wounds were assessed daily using the ASEPSIS scoring system. In group A, significantly more patients (24%) had an ASEPSIS score > 10, compared to group B (3%) and group C (2%). The mean ASEPSIS score was significantly lower in group C than groups A or B, 1.5 +/- 2.4 vs. 6.5 +/- 3.2 or 3.7 +/- 1.7, respectively. The ASEPSIS score is reduced when vein harvest is restricted to below the level of the knee.

  2. Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology.

    Science.gov (United States)

    Nunes, Heloisa Sobreira; Pinto, José Antonio; Zavanela, Adma Roberta; Cavallini, André Freitas; Freitas, Gabriel Santos; Garcia, Fabiola Esteves

    2016-07-01

    The Gastroesophageal Reflux Disease has a prevalence of ∼12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR. We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). The RSI and RFS can easily be included in ENT routines as objective parameters, with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests.

  3. Renal Agenesis with Full Length Ipsilateral Refluxing Ureter

    Directory of Open Access Journals (Sweden)

    DilipKumar Pal

    2016-04-01

    Full Text Available Unilateral renal agenesis with vesicoureteral reflux in the ipsilateral full length ureter is a rare phenomenon. Herein we report a case of 10-year old boy who presented with recurrent urinary tract infections. No renal tissue was identified on left side in various imaging studies. Micturating cystourethrogram (MCUG showed left sided refluxing and blind ending ureter. Left ureterectomy was done because of recurrent UTI in the refluxing system.

  4. A review of a new Dutch guideline for management of recurrent varicose veins.

    Science.gov (United States)

    Lawson, James A; Toonder, Irwin M

    2016-03-01

    In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.

  5. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

    Institute of Scientific and Technical Information of China (English)

    Nicola de Bortoli; Andrea Nacci; Edoardo Savarino; Irene Martinucci; Massimo Bellini; Bruno Fattori; Linda Ceccarelli

    2012-01-01

    AIM:To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale,GIS; visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD),pathological acid exposure time (AET) in the absence of esophageal erosions (NERD),and a positive correlation between symptoms and refluxes (hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52 (14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41),linear indentation in the medial edge of the vocal fold (31/41),vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P < 0.05); conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients

  6. Deep Vein Thrombosis

    Centers for Disease Control (CDC) Podcasts

    2012-04-05

    This podcast discusses the risk for deep vein thrombosis in long-distance travelers and ways to minimize that risk.  Created: 4/5/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/5/2012.

  7. Retinal vein occlusion

    Science.gov (United States)

    ... decrease the risk of retinal vein occlusion. These measures include: Eating a low-fat diet Getting regular exercise Maintaining an ideal weight Not smoking Aspirin or other blood thinners may help prevent blockages in the other eye. Controlling diabetes may ...

  8. The vein collar

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect...

  9. Deep Vein Thrombosis

    African Journals Online (AJOL)

    OWNER

    Il s'agissait de la main et les recherches en ligne. Des termes ..... Cerrato D, Ariano G, and Fiacchino F : Deep vein ... Surg 1988; 75: 1053–7. 19. Salzman ... Alikhan R, Cohen AT, Combe S, Samama .... Kakkar AK, Williamson RCN. Thrombo.

  10. [Ovarian vein syndrome].

    Science.gov (United States)

    Ferrero Doria, R; Guzmán Valls, P; López Alba, J; Tomás Ros, M; Rico Galiano, J L; Fontana Compiano, L O

    1996-04-01

    The Ovarian Vein Syndrome has been the subject of controversy ever since first described as such by Clark in 1964. This is an uncommon entity within urologic sings and symptoms which appears as a recurrent nephritic colic coinciding with menstruation or during the immediately preceding days. The authors review a clinical case from our Urology Service, including some considerations on the case.

  11. Cucumber vein yellowing virus

    Science.gov (United States)

    Cucurbits are an important crop of temperate, subtropical and tropical regions of the world. Cucumber vein yellowing virus (CVYV) is a major viral pathogen of cucurbits. This chapter provides an overview of the biology of CVYV and the disease it causes....

  12. Squash vein yellowing virus

    Science.gov (United States)

    Cucurbits are an important crop of temperate, subtropical and tropical regions of the world. Squash vein yellowing virus (SqVYV) is a major viral pathogen of cucurbits. This chapter provides an overview of the biology of SqVYV and the disease it causes....

  13. Endovenous treatments for varicose veins

    NARCIS (Netherlands)

    R.R. van den Bos (Renate)

    2011-01-01

    textabstractEndovenous treatment is currently one of the most frequently used methods for treating varicose veins in the Netherlands. Varicose veins are tortuous and enlarged veins due to weakening in the vein’s wall or valves. They are manifestations of chronic venous disease (CVD), which may lead

  14. 膝上主干内翻剥脱联合泡沫硬化剂治疗下肢静脉曲张%Theinvaginated vein striping upper knee and foam sclerotherapy in the treatment of varicose vein

    Institute of Scientific and Technical Information of China (English)

    王小凯; 冯苏; 袁福康; 高新宝; 田志龙; 贾高磊

    2016-01-01

    Objective To evaluate the invaginated vein striping upper knee and foam sclerotherapy in the treatment of varicose vein.Methods From Feb 2012 to Feb 2014, 124 patients with varicose veins were received limited invaginated vein striping and foam sclerotherapy. Primary end points were postoperative limb symptoms,petechiae, saphenous nerve injury, superficial thrombophlebitis, deep venous thrombosis and recurrence rate.Results All patients’ varicose veins disappeared, and all clinical symptoms remission. No remained varicose veins, no serious complications, and the satisifed cosmetic effects achieved.Conclusion Treatment of varicose veins of the lower limbs by the invaginated vein striping upper knee and foam sclerotherapy has the beneift of mini-invasion, fast recovery, and good curative-effect.%目的:探讨膝上主干内翻剥脱联合泡沫硬化剂治疗下肢静脉曲张(great saphenous varicose veins,GSVV)的手术方法及技巧,寻求微创性与有效性兼顾的外科治疗方法。方法回顾性分析2012-02—2014-02徐州市中心医院血管外科124例下肢静脉曲张患者应用膝上主干内翻剥脱联合泡沫硬化剂治疗的临床资料。内翻剥脱大隐静脉主干至膝关节水平。小腿曲张静脉应用泡沫硬化剂(foam sclerotherapy)治疗。主要观察指标为术后患肢症状改善情况、血栓性浅静脉炎、深静脉血栓形成、隐神经损伤及术后复发的发生率。结果所有患者术后患肢下肢静脉曲张消失,症状缓解,无隐神经损伤,未出现严重并发症。结论在血管外科治疗下肢静脉曲张的方法中膝上主干内翻剥脱联合泡沫硬化剂治疗是简单、微创、有效的治疗方法。

  15. 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.

  16. Gastroesophageal reflux. Reflujo gastroesofágico.

    Directory of Open Access Journals (Sweden)

    Lauro A. Melo Aguilera

    2005-12-01

    Full Text Available Although many infants has smaller degrees of gastroesophageal reflux, it is recognized that 1:3,000 at 1:10,000 of they have a pathological or symptomatic reflux. Near 90% of children vomits during the first 6 weeks of life, due primarily to the physiologic immaturity of antireflux mechanism. However, in 60% of cases, reflux disappears before 18 months, even without treatment. 30% maintains the symptoms, becoming in pathological, and of them, 10% develops serious problems, around 5% esophagitis with stenosis and between the 1 to 5% the death related with aspiration. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005

    Aunque muchos lactantes tienen grados menores de reflujo gastroesofágico, se reconoce que entre 1:3,000 a 1:10,000 tiene un reflujo patológico o sintomático. Cerca del 90 % de los niños vomita durante las primeras 6 semanas de vida, debido primariamente a la inmadurez fisiológica del mecanismo antirreflujo. Sin embargo, en el 60 % de los casos el reflujo desaparece antes de los 18 meses, incluso sin tratamiento. Un 30 % mantiene la sintomatología convirtiéndose en patológico, y de ellos, el 10 % desarrolla problemas serios, alrededor de un 5 % esofagitis con estenosis y entre el 1 y el 5 % la muerte relacionada con aspiración. Se presenta la Guía de Buenas Prácticas Clínicas para reflujo gastroesofágico, aprobada por consenso en el 4º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Las Tunas, marzo de 2005.

  17. Dietary guideline adherence for gastroesophageal reflux disease

    Science.gov (United States)

    2014-01-01

    Background Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms. Methods We conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education. Results GERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors. Conclusions GERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients. PMID:25125219

  18. Vesicoureteral reflux: From prophylaxis to surgery

    Science.gov (United States)

    Blais, Anne-Sophie; Bolduc, Stéphane; Moore, Katherine

    2017-01-01

    Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.

  19. Efficacy of noofen use in the treatment of gastroesophageal reflux disease in schoolchildren

    Directory of Open Access Journals (Sweden)

    S.L. Nyankovskyy

    2017-05-01

    Full Text Available We examined 40 children aged 10–18 years, who were diagnosed with gastroesophageal reflux disease (GERD. According to a survey by O.M. Vein, all patients had manifestations of autonomic dysfunction. The children were divided into 2 groups. The control group consisted of 20 patients, who received standard antisecretory therapy. The main group consisted of 20 children, who received standard antisecretory therapy and phenibut (Noofen®, OlainFarm, Latvia at a dose of 250 mg 2 times a day for 21 days. After 1 month of starting the treatment, an evaluation of its efficacy was conducted. Clinical evaluation of the dynamics of autonomic nervous system status in schoolchildren with GERD suggests that inclusion of Noofen into the complex of therapy for this disease provides good stabilizing effect, which manifests by a restoration of autonomic nervous system balance in schoolchildren.

  20. Varicosity of the pulmonary veins

    Energy Technology Data Exchange (ETDEWEB)

    Leicher-Dueber, A.; Lindner, P.; Schild, H.; Plewe, G.

    1986-04-01

    Varicosity of the pulmonary veins is a rare anomaly of the pulmonary vascular system. The varices do not usually change in size over years, do not cause symptoms and need no therapy. However, raised left atrial pressure can cause increase in the diameter of pulmonary vein varices. A case of lung vein varicosity in the right middle and upper lobe associated with coarctation of the aorta and an anomalous upper-middle lobe vein was observed over a period of 10 years. Increase in left atrial pressure (aortic and relative mitral regurgitation) led to enlargement of the pulmonary veins.

  1. OUR EXPERIENCE IN THE MANAGEMENT OF VARICOSE VEINS OF THE LOWER LIMB

    Directory of Open Access Journals (Sweden)

    Ravikumar

    2014-04-01

    Full Text Available Varicose veins of the lower limb are a common problem .It is known as the ‘penalty against gravity’. The prevalence has been variously reported from as little as 2% to over 20% in population studies. This enormous variation results from the different populations studied, different definitions applied and the different assessment or examination techniques used. Western studies have shown that 20% population suffers from varicose vein and 1% has skin changes proceeding to venous ulceration. In India incidence of varicose veins seems to be far less common because in India most patients present late with complications of varicose veins such as pain, edema, pigmentation and ulceration. We present our experience in the management of varicose veins of the lower limb over 2 years at our institution. AIMS AND OBJECTIVES: 1. To study the incidence of varicose veins according to age, sex and occupation.2.To study spectrum of clinical presentation in varicose veins. 3. To study effect of surgery in healing of varicose ulcers if present. MATERIALS AND METHODS: A total of 50 patients admitted to our institution between 2010 and 2012 were included in this study. It is found that varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. The incidence is on rise. It is more common in middle-aged group. The majority of the patients were males in the study. Patients presented with spectrum of symptoms and signs, with pain being more common presenting symptom with or without venous ulcer. The study revealed increased incidence of varicosity in the left lower limb as compared to the right lower limb. Most of the patients presented to the hospital for one of the other complications, not for the cosmetic purpose. Long saphenous system is the most common venous system affected. CONCLUSION: Operative line of treatment is the primary procedure in the management of varicose veins

  2. Posterior urethral valves: relationship between vesicoureteral reflux and renal function.

    Science.gov (United States)

    Cozzi, Denis A; Morgante, Debora; Frediani, Simone; Iaconelli, Romina; Ceccanti, Silvia; Mele, Ermelinda; Cozzi, Francesco

    2011-05-01

    To investigate the relationship between renal function and vesicoureteral reflux before and after valve ablation in patients with posterior urethral valves. In these patients, back pressure may not be the only cause of renal damage. We conducted a retrospective review of 37 patients with valves consecutively treated between 1970 and 2002. Data were available for 31 patients, 19 of whom presented reflux at presentation. Grade of reflux was ascertained by voiding cystourethrography. Overall renal function was measured by serum creatinine, and split renal function was estimated by dimercaptosuccinic acid scan available for all patients but two. Before relief of obstruction, there was no correlation between split renal function and grade of reflux into 25 kidneys of the 17 patients (r = -.13; 95% CI, -.50 to .27; P = .51). High-grade reflux (grade IV-V) affected 6 of the 11 renal units, with split renal function >40% vs 11 of the 14 units with split renal function 40% vs 4 of the 14 units with split renal function <40% (P = .0005). The good renal function of more than half of the renal units with high-grade reflux at presentation, and the persistence of reflux mainly in nonfunctioning or poorly functioning kidneys after valve ablation, support the concept that in some patients with valves, reflux and renal damage are associated anomalies. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. New insights into aerophagia, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Hemmink, G.J.M.

    2009-01-01

    Gastro-oesophageal reflux is a physiological phenomenon and occurs in every healthy subject approximately 40 times every day. Twenty percent of the general western population experiences reflux symptoms such as heartburn, regurgitation, and retrosternal pain at least once a week. Gastro-oesophageal

  4. Quantitative Evaluation of Therapeutic Efficacy of Endovenous Laser Treatment for Distal Varicose Veins by Tc-99m RBC Venography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Do Young; Song, Ki Hoon; Sim, Seung Joo; Kim, Ki Ho [College of Medicine, Univ. of Donga, Busan (Korea, Republic of)

    2003-07-01

    Endovenous laser treatment (EVLT) has been shown to be effective for elimination of greater saphenous (GSV) incompetence. While the result of GSV closure has been studied in detail, the effects in distal GSV and its tributaries following EVLT are still not completely understood. In addition, the optimal time for treatment of remaining varicose veins is not established. We evaluated the clinical and radiological changes of distal varicose veins after EVLT and determined the optimal time for additional treatment of distal varicose veins following EVLT by Tc-99m RBC. Forty GSV (30 patients) were treated with 940 nm or 810 nm diode laser at usual energy setting. Clinical and Duplex evaluation were performed at I week, and at various monthly intervals (2-6 months) following the initial treatment. Tc-99m venography was performed as usual protocol at I month and at every 3 months after EVLT. The distal varicose veins were quantified by determining the ratio of mean counts per pixel in the target and background areas and then comparing the pre-EVLT and post-EVLT values. Thirty-eight (95.0%) GSV were closed following EVLT and remained closed at 1-21 months follow-up examination. The reduction rate of distal varicose veins measured by Tc-99m venography was 22.8% at l month, 42.7% at 3 months, 61.5% at 6 months, and 72.4% at 9 months after EVLT. Fifteen legs (37.5%) required additional phlebectomy at 1 to 3 months after EVLT, while the others (62.5%) showed spontaneous regression of distal veins from one month during follow-up period. Therapeutic efficacy of EVLT for distal varicose vein can be well-evaluated quantitatively by Tc-99m RBC venography. Theses results suggest that after EVLT for GSV, the 'wait' policy would be necessary, rather than the 'wasting' of distal veins concurrently with EVLT.

  5. Gastroesophageal reflux in children with recurrent abdominal pain.

    Science.gov (United States)

    van der Meer, S B; Forget, P P; Kuijten, R H; Arends, J W

    1992-02-01

    In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.

  6. Diagnosis of deep vein thrombosis, and prevention of deep vein thrombosis recurrence and the post-thrombotic syndrome in the primary care medicine setting anno 2014.

    Science.gov (United States)

    Michiels, Jan Jacques; Michiels, Janneke Maria; Moossdorff, Wim; Lao, Mildred; Maasland, Hanny; Palareti, Gualtiero

    2015-02-04

    The requirement for a safe diagnostic strategy of deep vein thrombosis (DVT) should be based on an overall objective post incidence of venous thromboembolism (VTE) of less than 1% during 3 mo follow-up. Compression ultrasonography (CUS) of the leg veins has a negative predictive value (NPV) of 97%-98% indicating the need of repeated CUS testing within one week. A negative ELISA VIDAS safely excludes DVT and VTE with a NPV between 99% and 100% at a low clinical score of zero. The combination of low clinical score and a less sensitive D-dimer test (Simplify) is not sensitive enough to exclude DVT and VTE in routine daily practice. From prospective clinical research studies it may be concluded that complete recanalization within 3 mo and no reflux is associated with a low or no risk of PTS obviating the need of MECS 6 mo after DVT. Partial and complete recanalization after 3 to more than 6 mo is usually complicated by reflux due to valve destruction and symptomatic PTS. Reflux seems to be a main determinant for PTS and DVT recurrence, the latter as a main contributing factor in worsening PTS. This hypothesis is supported by the relation between the persistent residual vein thrombosis (RVT = partial recanalization) and the risk of VTE recurrence in prospective studies. Absence of RVT at 3 mo post-DVT and no reflux is predicted to be associated with no recurrence of DVT (1.2%) during follow-up obviating the need of wearing medical elastic stockings and anticoagulation at 6 mo post-DVT. The presence or absence of RVT but with reflux at 3 to 6 mo post-DVT is associated with both symptomatic PTS and an increased risk of VTE recurrence in about one third in the post-DVT period after regular discontinuation of anticoagulant treatment. To test this hypothesis we designed a prospective DVT and postthrombotic syndrome (PTS) Bridging the Gap Study by addressing at least four unanswered questions in the treatment of DVT and PTS. Which DVT patient has a clear indication for long

  7. Current Pharmacological Management of Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Yao-Kuang Wang

    2013-01-01

    Full Text Available Gastroesophageal reflux disease (GERD, a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment.

  8. Analytical Investigation of a Reflux Boiler

    Science.gov (United States)

    Simon, William E.; Young, Fred M.; Chambers, Terrence L.

    1996-01-01

    A thermal model of a single Ultralight Fabric Reflux Tube (UFRT) was constructed and tested against data for an array of such tubes tested in the NASA-JSC facility. Modifications to the single fin model were necessary to accommodate the change in radiation shape factors due to adjacent tubes. There was good agreement between the test data and data generated for the same cases by the thermal model. The thermal model was also used to generate single and linear array data for the lunar environment (the primary difference between the test and lunar data was due to lunar gravity). The model was also used to optimize the linear spacing of the reflux tubes in an array. The optimal spacing of the tubes was recommended to be about 5 tube diameters based on maximizing the heat transfer per unit mass. The model also showed that the thermal conductivity of the Nextel fabric was the major limitation to the heat transfer. This led to a suggestion that the feasibility of jacketing the Nextel fiber bundles with copper strands be investigated. This jacketing arrangement was estimated to be able to double the thermal conductivity of the fabric at a volume concentration of about 12-14%. Doubling the thermal conductivity of the fabric would double the amount of heat transferred at the same steam saturation temperature.

  9. Gallbladder carcinoma associated with pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Jin Kan Sai; Masafumi Suyama; Yoshihiro Kubokawa; Bunsei Nobukawa

    2006-01-01

    AIM: To detect the patients with and without pancreaticobiliary maljunction who had pancreatobiliary reflux with extremely high biliary amylase levels.METHODS: Ninety-six patients, who had diffuse thickness (>3 mm) of the gallbladder wall and were suspected of having a pancreaticobiliary maljunction on ultrasonography, were prospectively subjected to endoscopic retrograde cholangiopancreatography, and bile in the common bile duct was sampled. Among them,patients, who had extremely high biliary amylase levels (>10000 IU/L), underwent cholecystectomy, and the clinicopathological findings of those patients with and without pancreaticobiliary maljunction were examined.RESULTS: Seventeen patients had biliary amylase levels in the common bile duct above 10000 IU/L, including 11 with pancreaticobiliary maljunction and 6 without pancreaticobiliary maljunction. The occurrence of gallbladder carcinoma was 45.5% (5/11) in patients with pancreaticobiliary maljunction, and 50% (3/6) in those without pancreaticobiliary maljunction.CONCLUSION: Pancreatobiliary reflux with extremely high biliary amylase levels and associated gallbladder carcinoma could be identified in patients with and without pancreaticobiliary maljunction, and those patients might be detected by ultrasonography and bile sampling.

  10. Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation.

    Science.gov (United States)

    Casian, D; Gutsu, E; Culiuc, V

    2009-04-01

    A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery.

  11. 头颈部CT增强中造影剂静脉返流征象及预防%Venous Reflux Signs of Contrast Agent and the Prevention in Head and Neck CT Enhancement

    Institute of Scientific and Technical Information of China (English)

    陈丹; 瞿中威; 张亚林; 雷胜; 贺素军

    2012-01-01

    目的 探讨头颈部CT增强中造影剂返流征象和预防措施.方法 选择的42例均采取平静吸气,从肘静脉高压团注造影剂扫描,左肘3 4例,右肘8例.结果 静脉返流表现为大量对比剂返流至颈部深、浅静脉及颅内静脉窦,右侧返流占多数,包括颈前静脉及颈静脉弓返流12例、颈外静脉1 9例、甲状腺上静脉7例、耳后静脉2例,颈内静脉24例,项部静脉6例、椎静脉1 2例、椎旁静脉丛16例,髁前静脉6例,返流造影剂表现为静脉显影早于伴行动脉,密度极高,有线束硬化伪影、分布不均且有典型分层改变.结论 在头颈部CT增强过程中,由于各种客观因素影响,虽不可避免产生一定程度造影剂返流,但是我们针对性采取一些措施后仍然能将其控制在可接受范围,获得良好的增强图像,提高检查质量.%Objective To explore venous reflux signs of contrast agent and the prevention in Head and neck CT enhancement. Methods 42 cases took resting aspiration and hypertension bolus of contrast agent by ulnar vein (34 cases in left elbow, 8 cases in right elbow). Results Venous reflux performed as mass of contrast agent reflux into deep cervical vein, superficial cervical vein and intracranial venous sinus, which majoy happenned in the right side, including 12 cases of anterior jugular vein and jugular venous arch reflux, 19 cases of external jugular vein, 7 cases of superior thyriod vein, 2 cases of posterior auricular vein, 24 cases of internal jugular vein, 6 cases of napex vein, 12 cases of vertebral vein, 16 cases of paravertebral venous plexus, and 6 cases of anterior condylar vein. Contrast agent reflux showed that veins developed earlier than the accompanying arteries, and veins showed very high density, wire harness sclerosis artifact, uneven distribution and a typical layered change. Conclusion In the head and neck CT enhancement process, it inebitably produce a certain degree of contrast agents reflux

  12. Composite score of reflux symptoms in diagnosis of gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Jin-Hai Wang; Jin-Yan Luo; Lei Dong; Jun Gong; Ai-Li Zuo

    2004-01-01

    AIM: To evaluate the significance of the composite score of reflux symptoms in the diagnosis of gastroesophageal reflux disease (GERD), and to determine the relationship of the composite score with reflux esophagitis (RE) and pathological gastroesophageal reflux (PGER).METHODS: Upper digestive endoscopy and /or 24-h esophageal pH monitoring were performed in 244 subjects.Of these, 54 were consecutive patients attending our clinic with symptoms suggestive of GERD, and 190 were randomly selected from 2532 respondents who participated in our previous general population-based study on GERD. A standardized questionnaire was used to classify both the frequency and severity of typical symptoms of GERD(heartburn, acid and food regurgitation) using a 4-score scale, and the composite score of main reflux symptoms(score index: SI, range from 0 to 18) were calculated for every subject. RE was diagnosed according to the SavaryMiller criteria. Subjects with abnormal pH-metry (DeMeester score more than 14.7) were considered to have PGER.GERD patients were defined as the subjects with RE and/or PGER.RESULTS: The sensitivity of SI in the diagnosis of GERD was inversely associated with SI, but the specificity tended to increase with increased SI. With the cut-off of 8, the SI achieved the highest accuracy of 70.0%, with a sensitivity of 78.6% and a specificity of 69.2% in diagnosing GERD,followed by the cut-off of 3, which had an accuracy of 62.1%,a sensitivity of 96.4% and a specificity of 34.6%. The prevalence of RE, PGER and GERD was strongly associated with increased SI (P<0.01), but there was no significant association between the severity of RE and SI (P>0.05).Among patients with RE, 69.2% had PGER, and 30.8%were confirmed to have negative findings of pH monitoring.Among patients with PGER, 52.9% were identified to have RE and 47.1% had negative endscopic findings in esophagus.CONCLUSION: According to the composite score of main reflux symptoms, the diagnosis of GERD can

  13. A new HIFU probe for the treatment of the superficial venous insufficiency and varicose veins

    Science.gov (United States)

    Pichardo, Samuel; Curiel, Laura; Milleret, René; Pichot, Olivier; Lacoste, François; Chapelon, Jean-Yves

    2006-05-01

    A previous work showed the feasibility of inducing a localized partial shrinkage of venous tissues with High Intensity Focused Ultrasound (HIFU). A partial shrinkage of the vein wall is proposed to correct the valvular dysfunction on the saphenous vein that is responsible of the superficial venous insufficiency and varicose veins. In the present study, a new real-time imaging HIFU probe is presented which is suited for this type of treatment. The probe is composed of two HIFU elements that focus sound uniformly over a line of 7 mm-length. Geometry of the HIFU elements was calculated by numerical optimization and allows positioning of the focal line 15 mm in-depth from the skin. The probe is compatible with commercial imaging devices used currently in vascular medicine. Once coupled with an imaging probe, the imaging system shows the central perpendicular plan to the focal line. A validation of the compatibility with a commercial ultrasound imaging system was achieved using a precise model fabricated by stereo-lithography. Construction of the probe is underway.

  14. SURGICAL TREATMENT OF POSTPARTUM ILIOFEMORAL DEEP VEIN THROMBOSIS--CASE REPORTS.

    Science.gov (United States)

    Cazan, I; Strobescu, Cristina; Baroi, Genoveva; Cazan, Simona; Lefter, G; Popa, R F

    2016-01-01

    The writing committee for Antithrombotic Therapy for Venous Thromboembolic Disease of the 2008 ACCP guidelines made the following recommendations for thrombus removal strategies in patients with deep vein thrombosis (DVT): open surgical thrombectomy is recommended in patients with acute iliofemoral DVT to reduce symptoms and post-thrombotic morbidity; whenever available, catheter-directed thrombolysis is preferred to surgical venous thrombectomy, the risk of hemorrhage being diminished; surgical venous thrombectomy is recognized to be efficient in cases where catheter-directed thrombolysis is unavailable or the patients are not suitable candidates for such a procedure. Randomized studies comparing surgical thrombectomy and anticoagulant therapy in patients with iliofemoral DVT (IFDVT) showed that at 6 months, 5 years, and 10 years the patients in the thrombectomy group presented increased permeability, lower venous pressure, less edema, and fewer postthrombotic symptoms compared to the patients receiving anticoagulant therapy. In this article we present 3 cases of IFDVT in postpartum patients diagnosed by Doppler ultrasound of the deep venous system. The 3 patients received anticoagulant therapy prior to surgery. Surgery consisted in thrombectomy of the common, superficial and deep femoral veins, external and internal iliac veins, and femoral-saphenous arteriovenous fistula. The patients received postoperative antithrombotic therapy and were followed-up at 3, 6 and 9 months by Doppler ultrasound of the deep venous system.

  15. Retroaortic left renal vein joining the left common iliac vein

    Energy Technology Data Exchange (ETDEWEB)

    Brancatelli, G.; Galia, M.; Finazzo, M.; Sparacia, G.; Pardo, S.; Lagalla, R. [Dept. of Radiology ' ' P. Cignolini' ' , Univ. of Palermo (Italy)

    2000-11-01

    Retroaortic left renal vein joining the left common iliac vein is a rare congenital anomaly in the development of the inferior vena cava. To our knowledge, only one case has been reported in the literature; however, its imaging features have never been described. A 27-year-old male presented with a 1-year history of recurrent right flank pain, dysuria, hematuria, and fever (39 C). Computed tomography and MR venography showed a retroaortic left renal vein joining the left common iliac vein. We present the CT and MR venography findings and discuss their feasibility in showing this congenital anomaly. (orig.)

  16. Surgical treatment of varicose vein using the tumescent technique of local anesthesia

    Directory of Open Access Journals (Sweden)

    Bjelanović Zoran

    2011-01-01

    Full Text Available Background/Aim. Tumescent local anesthesia (TLA is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventional treatment for varicose vein. Methods. Seventy-two patients with varicose vein were enrolled in the study. All of them were operated on applying TLA, from April 2008 to November 2009. TLA solution consisted of local anesthetics was used. TLA solutions used were: 1% prilocaine-chloride with adrenaline supplement, and 2% lidocaine-chloride and adrenaline in concentration of 0.1%-0.4%. Results. Out of 72 patients, we stripped great saphenous vein from 60 patient and did varicectomy as well as ligation of insufficiently perforating veins. In 12 patients we did partial varicectomy and ligation of perforating veins. There were not any patients with the need for continued surgery, as well as bringing patient to the general anesthesia due to pain during the surgery. One patient came for postoperative opening wound in the groin, one for infection of the wound and one for the formation of seroma in the groin. There were not any allergic reactions or systemic complications in the operations as well as postoperative period. Postoperatively, all the patients were treated with compressive elastic bandage during the period of 6 weeks as well as anticoagulation prophylaxis in the duration of 5 days. Conclusion. Surgery of varicose veins with implementation of TLA is easy and safe method with very low percentage of complications and unwanted effects. It is a good alternative method to classic surgery of varicose veins. The economic aspect is a very important component

  17. A RARE CASE OF EXTENSIVE THROMBOSIS OF INFERIOR VENA CAVA, PORTAL VEIN, SPLENIC VEIN AND SUPERIOR MESENTRIC VEIN

    Directory of Open Access Journals (Sweden)

    Giridhar

    2015-03-01

    Full Text Available While the most common presentation of venous thromboembolic disease is deep vein thrombosis (DVT or pulmonary thromboembolism, rarer manifestations are thrombosis of jugular vein, cerebral sinus and inferior vena cava. Here we are presenting a rare case of inferior vena caval thrombosis with multiple thrombus in portal vein, splenic vein and superior mesenteric vein

  18. LINX(™) Reflux Management System: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease.

    Science.gov (United States)

    Bonavina, Luigi; DeMeester, Tom R; Ganz, Robert A

    2012-12-01

    Gastroesophageal reflux disease (GERD), commonly manifested by heartburn or regurgitation, is a chronic, progressive condition in which failed sphincter function allows the contents of the stomach to reflux into the esophagus, the airways and the mouth. Chronic GERD affects 10% of Western society. The majority of patients receive adequate relief from proton pump inhibitors, but up to 40% have incomplete relief of symptoms that cannot be addressed by increasing the dose of medications. The laparoscopic Nissen fundoplication is the surgical gold standard; however, the level of technical difficulty and its side effects have limited its use to less than 1% of the GERD population. These factors have contributed to the propensity of patients to persist with medical therapy, even when inadequate to control symptoms and complications of the disease. Consequently, a significant gap in the treatment continuum for GERD remains evident in current clinical practice. The LINX(™) Reflux Management System (Torax Medical) is designed to provide a permanent solution to GERD by augmenting the physiologic function of the sphincter barrier with a simple and reproducible laparoscopic procedure that does not alter gastric anatomy and can be easily reversed if necessary.

  19. Diagnosis of intrarenal reflux and its role in pathogenesis of reflux nephropathy in children

    Energy Technology Data Exchange (ETDEWEB)

    Fujimatsu, Akiko [Kurume Univ., Fukuoka (Japan). School of Medicine

    2000-06-01

    We compared newly developed radionuclide cystography with conventional contrast voiding cystography (VCG) with regard to their diagnostic usefulness of intrarenal reflux (IRR) in children. Based on the imaging findings, we assessed the role of IRR in the pathogenesis of reflux nephropathy (RN). Among the ureters which revealed IRR diagnosed by radionuclide cystography, 38.9% (7 out of 18 ureters) of the cases examined by VCG had IRR. In the case of VCG, the sensitivity and specificity of IRR detection were 33.3% and 100%, respectively. There was a statistical correlation between the presence/absence of IRR and vesicoureteral reflux (VUR). RN was significantly correlated with advanced grade of VUR associated with IRR. Among 9 kidneys of the subjects who had suffered from urinary tract infection (UTI) only once, IRR was detected in 33.3% (3/9) and RN in 66.7% (2/3). From these findings, conventional contrast VCG is considered not effective for the diagnosis of IRR. Moreover, it is suggested that VUR complicated with IRR is deeply associated with the development of RN. In addition, it is suggested that UTI might be related to the onset of IRR. (author)

  20. Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions

    Directory of Open Access Journals (Sweden)

    Deokkyu Kim

    2017-02-01

    Full Text Available Background Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 μg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]. Methods Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany was used to assess cardiac output (CO and systemic vascular resistance (SVR. Six minutes after intubation, baseline heart rate (HR, systolic blood pressure (BP, diastolic BP, mean arterial pressure (MAP, CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 μg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. Results No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. Conclusions For patients under general anesthesia receiving dopamine at 10 μg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

  1. Cephalic vein aneurysm.

    Science.gov (United States)

    Faraj, Walid; Selmo, Francesca; Hindi, Mia; Haddad, Fadi; Khalil, Ismail

    2007-11-01

    Cephalic vein aneurysms are rare malformations that may develop in any part of the vascular system, and their history, presentation, and management vary depending on their site. The etiology of venous aneurysms remains unclear, although several theories have been elaborated. Venous aneurysms are unusual vascular malformations that occur equally between the sexes and are seen at any age; they can present as either a painful or a painless subcutaneous mass. No serious complications have been reported from upper extremity venous aneurysms. Surgical excision is the definitive management for most of these. The case reported here presented with a painless and mobile, soft, subcutaneous mass that caused only cosmetic concern.

  2. [Gastroesophageal reflux disease and respiratory disease].

    Science.gov (United States)

    Mattioli, G; Caffarena, P E; Battistini, E; Fregonese, B; Barabino, A; Jasonni, V

    1995-01-01

    The patients treated for oesophageal atresia present a correlation between the clinical sintomatology after recanalization characterized by disfagia, dispnea, recurrent cough, chronic pneumopaties and oesophageal anomalies. Where morphological alterations accounting for the presence of gastro-oesophageal reflux (GOR) were not evident, possible functional alterations of the motility were considered. The incidence of GOR was considerably high and, expression of a congenital alteration of the lower oesophageal sphincter and of oesophageal peristalsis, becomes even more severe due to further stretching of the gastro-esophageal junction. The authors underline that the early demonstration of histological changes, even before recanalization, and the motility disorders of the oesophagus have to be well studied, while the LES is normalized, in order to prevent and treat the possible appearance of the well-known complications of GOR.

  3. [Roxatidine acetate in therapy of reflux esophagitis].

    Science.gov (United States)

    Friedrich, P; Botzler, R; Mayershofer, R; Kriech, W

    1996-06-10

    A total of 3409 patients with gastro-oesophageal reflux disease were treated with roxatidine acetate. 60.7% of the patients received a daily dose of 2 x 75 mg roxatidine acetate, and the median duration of treatment was 5 weeks. Symptoms improved in about 90% of patients. For 1687 patients, endoscopic findings were available at the beginning and end of the treatment period. The overall endoscopic healing rate was 65.3%, and, depending on the initial finding (if), decreased from 92.9% (if: Savary-Miller stage I) to 67.5% (if: stage II), 40.7% (if: stage III), and to 22.5% (if: stage IV). Twenty-one patients experienced adverse events during the course of treatment, which, however, were either only minor or not related to the use of roxatidine acetate.

  4. Gastroesophageal Reflux in Children with Refractory Asthma

    Directory of Open Access Journals (Sweden)

    Alaa S. Deeb

    2010-07-01

    Full Text Available Objectives: To investigate the association between clinical and macroscopic findings of GER and severity of refractory asthma (statistical study.Methods: A prospective study in a university-based practice of 75 children who were diagnosed with refractory asthma because they exhibited no satisfactory response for at least three months of treatment. Medical history, physical examination, spirometrical measurements and prick skin test were conducted on all patients. Endoscopic and macroscopic evaluations for esophagitis were performed on all patients regardless of the presence of GER symptoms.Results: Endoscopy was done for 75 children with refractory asthma. GER was symptomatic in 65% of all patients with no statistical significance (p>0.05 and the most frequent symptom was abdominal pain (67%. The frequency of these symptoms was 50% in mild asthma, 58% in moderate asthma and 72% in severe asthma with no statistical significance (p>0.05. The frequency of macroscopic esophagitis was 71%, distributed in three asthmatic groups as in order of 75% in mild asthma, 58.3% in moderate asthma and 76.6% in severe asthma (p>0.05. Regarding the relationship between GER and nocturnal attacks or spasmodic cough, the frequency of the latest was 66.7%. The differences have no statistical significance regarding GER symptoms (p>0.05, but they are statistically significant regarding the reflux esophagitis (p<0.05. Also endoscopic reflux was as frequent as76.3% in non allergic patients, and this result is statistically significant (p<0.05.Conclusion: In spite of the fact that there was no relationship between the severity of asthma and the symptoms of GER, or its endoscopic findings, the frequency of GER in asthmatic children was higher than its frequency in other children.

  5. Historical Overview of Varicose Vein Surgery

    NARCIS (Netherlands)

    van den Bremer, Jephta; Moll, Frans L.

    2010-01-01

    Varicose veins are as old as Hippocrates. Varicose vein treatments come and go. Surgery for varicose vein disease is one of the commonest elective general surgical procedures. The history of varicose vein surgery has been traced. We note the first descriptions of varicose veins, and we particularly

  6. Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux - radiological and pathoanatomical analysis

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, J.; Thysell, H.; Tencer, J. [Univ. Hospital, Lund (Sweden). Dept. of Nephrology; Forsberg, L.; Hellstroem, M. [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Diagnostic Radiology

    2001-03-01

    Purpose: To study the long-term development of urographic renal morphology in adults with vesicoureteral reflux, to investigate the relationship between renal damage and reflux grade, and to analyse the association between the long-term urographic outcome and the occurrence of acute pyelonephritis and reflux during follow-up. The purpose was also to try to distinguish between acquired and developmental renal damage, based on analyses of renal histological specimens and urographic features, and to analyse associated congenital urogenital abnormalities and family history of reflux, reflux nephropathy, urological malformation or death from end-stage renal disease. Material and Methods: Renal damage was identified in 100 (83 women) of 115 adults, selected because of documented reflux. Eighty-seven patients had two urographies done (median interval 14.3 years). The extent and progression of renal damage were assessed and features of developmental renal damage were determined. Histological renal specimens were available in 23 patients with renal damage. Results and Conclusions: The extent of renal damage correlated positively with the severity of reflux. No renal damage developed during the follow-up in 45 previously undamaged kidneys and progression of renal damage was rare (4 of 120 previously damaged kidneys), despite persisting reflux in half of the cases and episodes of acute pyelonephritis during follow-up. Thus, repeated renal imaging is rarely justified in adults with reflux nephropathy. Histological examination showed 'chronic pyelonephritis' in all 23 cases and co-existing renal dysplasia in 1 case. The detailed urographic analysis did not reveal support for developmental renal damage. High frequencies of associated congenital urogenital abnormalities and of a positive family history were found. Thus, congenital and/or hereditary factors cannot be discarded as background factors for the development of renal damage.

  7. phenoVein - A software tool for leaf vein segmentation and analysis

    OpenAIRE

    Bühler, Jonas; Rishmawi, Louai; Pflugfelder, Daniel; Huber, Gregor; Scharr, Hanno; Hülskamp, Martin; Koornneef, Maarten; SCHURR, ULRICH; Jahnke, Siegfried

    2015-01-01

    phenoVein is a software tool dedicated to automated segmenting and analyzing images of leaf veins. It includes comfortable manual correction features. Advanced image filtering automatically emphasizes veins from background and compensates for local brightness inhomogeneities. Phenotypical leaf vein traits being calculated are total vein density, vein lengths and widths and skeleton graph statistics. For determination of vein widths, a model based vein edge estimation approach has been impleme...

  8. Synthesis of todorokite by refluxing process and its primary characteristics

    Institute of Scientific and Technical Information of China (English)

    FENG Xionghan; LIU Fan; TAN Wenfeng; LIU Xiangwen; HU Hongqing

    2004-01-01

    Single phase and well-crystallined todorokite were synthesized by heating and refluxing process from birnessite as a precursor. The average chemical composition of the synthesized todorokites by refluxing for 8 h and for 24 h was Mg0.19MnO2.11(H2O)1.15 and Mg0. 17-MnO2.10(H2O)0.88, respectively. The crystallinity of the todorokite increased and no other phase was produced with increasing refluxing period. The synthesized todorokites have the same morphologies and the similar structural characteristics with the natural todorokites and hydrothermally synthesized samples. The chemical compositions of the synthetic tordorokites by refluxing process are close to those of todorokites synthesized by hydrothermal process, except a higher average oxidation state of Mn for the former.

  9. Retrocaval ureter with vesicoureteric reflux, a very rare entity

    African Journals Online (AJOL)

    M.C. Arya

    2016-12-26

    Dec 26, 2016 ... The prob- lem is similar to pelviureteric junction obstruction and ipsilateral reflux. .... VUR is retrograde flow of urine from bladder into the ureter or pelvicalyceal ... MR urogram confirmed type 1 right retrocaval ureter on T-2.

  10. How to Approach Laryngopharyngeal Reflux: An Otolaryngology Perspective.

    Science.gov (United States)

    Dhillon, Vaninder K; Akst, Lee M

    2016-08-01

    In the otolaryngology practice, there is a rising concern with the current diagnosis and management of laryngopharyngeal reflux (LPR). The implication of LPR in many common head and neck symptoms, along with the rising cost of empiric therapy and no overall improvement in patient symptoms, has established a need to review what are indeed laryngopharyngeal complaints secondary to reflux and what are not. This article reviews the otolaryngologist's approach to LPR, the various ways diagnosis is made, and the guidelines that inform the current trends in otolaryngology management of LPR. The goal of this article is to recognize that reflux can be the cause of a variety of laryngopharyngeal complaints seen within an otolaryngology practice, but when empiric therapy does not improve symptoms, consideration should be given to other non-reflux causes.

  11. Hot-electron refluxing enhanced relativistic transparency of overdense plasmas

    CERN Document Server

    Yu, Yong; Chen, Zi-Yu; Wang, Jia-Xiang; Zhu, Wen-Jun

    2013-01-01

    A new phenomenon of enhancing the relativistic transparency of overdense plasmas by the influence of hot-electron refluxing has been found via particle-in-cell simulations. When a p-polarized laser pulse, with intensity below the self-induced-transparency (SIT) threshold, obliquely irradiates a thin overdense plasma, the initially opaque plasma would become transparent after a time interval which linearly relies on the thickness of the plasma. This phenomenon can be interpreted by the influence of hot-electron refluxing. As the laser intensity is higher than the SIT threshold, the penetration velocity of the laser in the plasma is enhanced when the refluxing is presented. Simulation data with ion motion considered is also consistent with the assumption that hot-electron refluxing enhances transparency. These results have potential applications in laser shaping.

  12. Leiomyosarcoma of the renal vein

    Directory of Open Access Journals (Sweden)

    Lemos Gustavo C.

    2003-01-01

    Full Text Available Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.

  13. Agenesis of the iliac veins.

    Science.gov (United States)

    Thomas, M L; Posniak, H V

    1984-01-01

    Three case reports of patients with the rare anomaly of agenesis of the iliac veins are presented. It is emphasised that full phlebographic investigation should be carried out in such patients before surgical treatment is considered. It is pointed out that surgical ablation may exacerbate the symptoms of leg swelling and varicose veins for which the patients seek advice.

  14. Infrared imaging of varicose veins

    Science.gov (United States)

    Noordmans, Herke Jan; de Zeeuw, Raymond; Verdaasdonk, Ruud M.; Wittens, Cees H. A.

    2004-06-01

    It has been established that varicose veins are better visualized with infrared photography. As near-infrared films are nowadays hard to get and to develop in the digital world, we investigated the use of digital photography of varicose veins. Topics that are discussed are illumination setup, photography and digital image enhancement and analysis.

  15. 10-Minute Conultation Varicose veins

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    A 55 year old woman presents with a history of tortuous veins on both legs and a related ache towards the end of the day.She finds these veins unsightly and would like to know whether she can have them treated.

  16. Gastroesophageal Reflux Disease in Children with Interstitial Lung Disease.

    Science.gov (United States)

    Dziekiewicz, M A; Karolewska-Bochenek, K; Dembiński, Ł; Gawronska, A; Krenke, K; Lange, J; Banasiuk, M; Kuchar, E; Kulus, M; Albrecht, P; Banaszkiewicz, A

    2016-01-01

    Gastroesophageal reflux disease is common in adult patients with interstitial lung disease. However, no data currently exist regarding the prevalence and characteristics of the disease in pediatric patients with interstitial lung disease. The aim of the present study was to prospectively assess the incidence of gastroesophageal reflux disease and characterize its features in children with interstitial lung disease. Gastroesophageal reflux disease was established based on 24 h pH-impedance monitoring (MII-pH). Gastroesophageal reflux episodes (GERs) were classified according to widely recognized criteria as acid, weakly acid, weakly alkaline, or proximal. Eighteen consecutive patients (15 boys, aged 0.2-11.6 years) were enrolled in the study. Gastroesophageal reflux disease was diagnosed in a half (9/18) of children. A thousand GERs were detected by MII-pH (median 53.5; IQR 39.0-75.5). Of these, 585 (58.5 %) episodes were acidic, 407 (40.7 %) were weakly acidic, and eight (0.8 %) were weakly alkaline. There were 637 (63.7 %) proximal GERs. The patients in whom gastroesophageal reflux disease was diagnosed had a significantly higher number of proximal and total GERs. We conclude that the prevalence of gastroesophageal reflux disease in children with interstitial lung disease is high; thus, the disease should be considered regardless of presenting clinical symptoms. A high frequency of non-acid and proximal GERs makes the MII-pH method a preferable choice for the detection of reflux episodes in this patient population.

  17. Quantitative assay for the detection of vesicoureteral reflux in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Linden, A.; Schnippering, H.G.; Ritzl, F.

    1984-04-01

    Using a method in which the camera computer system is adjusted for the individual patient, a quantitative isotopic micturition cystourethrogram (Nuclear Cystogram) can be obtained with less radiation exposure for the patient and more sensitively compared to the equivalent X-ray micturition cysto-urethrogram. Less than 0,1 ml reflux urine can be measured and it can be determined whether reflux occurs during bladder filling or emptying.

  18. Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram

    OpenAIRE

    Agrawal Vikesh; Rangarajan Venkatesh; Kamath Tejaswini; Borwankar S

    2009-01-01

    Aim : Evaluation of vesicoureteric reflux (VUR) in children by bladder volume graded direct radionuclide cystogram (BVG DRC). This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units) with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG) and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two...

  19. Dental erosion caused by gastroesophageal reflux disease: a case report

    OpenAIRE

    Cengiz,Seda; Cengiz, M ?nan?; Sara?, Y ?inasi

    2009-01-01

    Introduction Chronic regurgitation of gastric acids in patients with gastroesophageal reflux disease may cause dental erosion, which can lead in combination with attrition or bruxism to extensive loss of coronal tooth tissue. Case presentation This clinical report describes treatment of severe tooth wear of a gastroesophageal reflux disease patient who is 54-year-old Turkish male patient. After his medical treatment, severe tooth wear, bruxism and decreased vertical dimensions were determined...

  20. A PROPOSITION FOR THE DIAGNOSIS AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN - A REPORT FROM A WORKING GROUP ON GASTROESOPHAGEAL REFLUX DISEASE

    NARCIS (Netherlands)

    VANDENPLAS, Y; ASHKENAZI, A; BELLI, D; BOIGE, N; BOUQUET, J; CADRANEL, S; CEZARD, JP; CUCCHIARA, S; DUPONT, C; GEBOES, K; GOTTRAND, F; HEYMANS, HSA; JASINSKI, C; KNEEPKENS, CMF; KOLETZKO, S; MILLA, P; MOUGENOT, JF; NUSSLE, D; NAVARRO, J; NEWELL, SJ; OLAFSDOTTIR, E; PEETERS, S; RAVELLI, A; POLANCO, [No Value; SANDHU, BK; TOLBOOM, J

    1993-01-01

    In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux

  1. Persistência da veia ciática Persistent sciatic vein

    Directory of Open Access Journals (Sweden)

    Bárbara Borges Cardoso

    2010-09-01

    and expansion. Consequently, anomalies may occur during this process. When there is persistence of the sciatic vein, it may communicate with the small saphenous vein or with the popliteal vein during its route, being anastomosed to the superior perforating vein and to the medial circumflex femoral vein. OBJECTIVE: To report a case of bilateral persistent sciatic vein on the lower limbs in comparison to the literature. METHODS: Thirty-two lower limbs from 16 corpses preserved in formaldehyde were dissected at the Laboratory of Anatomy of the discipline of Topographic Anatomy of the Medical School of Universidade Santo Amaro (Unisa, during 2006 and 2007, and the sciatic vein was observed in 2 lower limbs of one single corpse. RESULTS: On the left lower limb of a corpse that presented bilateral anomaly, the vein had 37 cm, emerging on the popliteal vein, accompanying the sciatic nerve, perforating the long adductor muscle and leading into the deep femoral vein. On the right lower limb, it measured 36 cm, emerged receiving the veins of the anterior tibial compartment, accompanied the sciatic nerve, perforated the long adductor muscle and led into the internal iliac vein. CONCLUSION: The anatomical variations of the lower limb venous system are the most common ones. The persistent sciatic vein may cause chronic venous failure in the lower limbs and, in this manner, must be investigated aiming at a better clinical or surgical management.

  2. A STUDY ON CLINICAL ASSESSMENT OF VARICOSE VEINS BY CLINICAL SCORES AND VALIDATING THE OUTCOME OF TRENDELENBURG PROCEDURE IN VARICOSE VEINS OF LOWER LIMBS

    Directory of Open Access Journals (Sweden)

    Nilavi

    2016-06-01

    Full Text Available cose veins of Lower Limbs. This study was conducted in the Department of General Surgery, ESIC Hospital, over a period of 12 months. METHODS AND MATERIALS This analytical study group consisted of 92 patients between 20 to 80 yrs., inclusive of both males (n=78 and females (n=14. They were assessed for severity of varicose veins by documenting a detailed history, clinical examination findings, imaging studies on a pre-structured case sheet and the result of surgery. It was found that majority of the patients were ≤60 yrs. and the left lower limb was predominantly affected in both sexes. RESULTS Using the VCSS system, 19.57% (n=18 cases had mild disease, 67.39% (n=62 cases had moderate disease and 13.04% (n=12 had severe disease. In the present study as per the VDS system, majority of the patients (n=51 55.43% had grade III disability and 40.22% (n=37 of the patients had moderate grade of venous reflux, i.e. venous reflux duration <1 second. All 92 patients had surgery with majority had uneventful postoperative periods 58.17% (n=52, whereas a few had complications 44.44% (n=40. CONCLUSION A statistically significant result was found for the clinical assessment scores and also for the surgical outcome.

  3. [Use of laser technologies in treatment of chronic venous insufficiency in patients with a wide ostial segment of the main trunks of subcutaneous veins].

    Science.gov (United States)

    Luk'ianenko, M Iu; Starodubtsev, V B; Karpenko, A A; Sergeevichev, D S

    2014-01-01

    Presented herein is the authors' experience in endovascular laser obliteration of the major trunks of the grate saphenous vein (GSV) with a wide ostial segment (measuring from 15 to 34 mm) in patients presenting with chronic venous insufficiency. Group One patients (n=32) underwent crossectomy followed by endovasal laser obliteration (EVLO) of the GSV's trunk on the femur. Group Two patients (n=46) were not subjected to crossectomy, whereas obliteration of the GSV's trunk was carried out immediately from the ostium. In Group One we managed to achieve obliteration of the GSV's trunk in 32 patients (100%) with no additional interventions, and in Group Two this was achieved in 42 (91.3%) patients. Four patients (8.7%) required performing a secondary procedure of EVLO after which obliteration of the trunk was achieved in all patients of Group Two. There was no evidence of deep-vein thrombosis.

  4. Sagittal vein thrombosis caused by central vein catheter.

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-03-01

    Full Text Available Cerebral venous thrombosis, including thrombosis of cerebral veins and major dural sinuses, is an uncommon disorder in the general population. However, it has a higher frequency among patients younger than 40 years of age, patients with thrombophilia, pregnant patients or those receiving hormonal contraceptive therapy or has foreign body such as catheter in their veins or arterial system. In this case report, we described clinical and radiological findings in a patient with protein C-S deficiency and malposition of central vein catheter.

  5. Pulmonary manifestations of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Gaude Gajanan

    2009-01-01

    Full Text Available Gastroesophageal reflux disease (GERD may cause, trigger or exacerbate many pulmonary diseases. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. A primary care physician often encounters patients with extra esophageal manifestations of GERD in the absence of heartburn. Patients may present with symptoms involving the pulmonary system; noncardiac chest pain; and ear, nose and throat disorders. Local irritation in the esophagus can cause symptoms that vary from indigestion, like chest discomfort and abdominal pain, to coughing and wheezing. If the gastric acid reaches the back of the throat, it may cause a bitter taste in the mouth and/or aspiration of the gastric acid into the lungs. The acid can cause throat irritation, postnasal drip and hoarseness, as well as recurrent cough, chest congestion and lung inflammation leading to asthma and/or bronchitis/ pneumonia. This clinical review examines the potential pathophysiological mechanisms of pulmonary manifestations of GERD. It also reviews relevant clinical information concerning GERD-related chronic cough and asthma. Finally, a potential management strategy for GERD in pulmonary patients is discussed.

  6. Health economics of gastroesophageal reflux disease.

    Science.gov (United States)

    Sadowski, D; Champion, M; Goeree, R; Leddin, D; Otten, N; Morris, G; Beck, I; Faloon, T; Fedorak, R N

    1997-09-01

    The present study provides an overview of the current state of health economics studies of gastroesophageal reflux disease (GERD). It indicates the strengths and weaknesses of individual studies, and the state of health economics analysis in general as they apply to GERD. Specifically, this study adopts a pharmacoeconomic perspective, which is a subsection of health economics analytical methods, to provide a comparative analysis of alternative courses of action based on cost and consequence. The pharmacoeconomic outlook is most effective when it considers a comprehensive societal perspective, with special consideration given to other relevant viewpoints, such as the payer, the primary provider and, most important, the patient. Pharmacoeconomics provides several specific analytical techniques for GERD-related health economics analysis. The Canadian Association of Gastroenterology consensus conference on GERD in 1996 thought that a cost effective analysis was the most appropriate technique to assess the pharmacoeconomics of GERD. Six previous studies on GERD health economics have been performed comparing omeprazole with H2 receptor antagonists. These studies vary in cost data collected and in analytical techniques. In general, the existing outcome measurements of these previous health economics studies are not ideal. Namely, they combine various GERD grades, use randomized controls, are endoscopically based, assess pharmaceutical therapy only and are short term. More appropriate health economic trials in GERD, which focus on GERD management strategies and therapeutic treatment of GERD, need to be designed and conducted. These economic assessments, however, should not replace detailed thinking, careful observation, good judgement and common sense.

  7. Gastroesophageal reflux disease correlation with posterior laryngitis

    Directory of Open Access Journals (Sweden)

    Dimitrijević Milovan

    2009-01-01

    Full Text Available Background/Aim. Over the last years numerous studies have been performed dealing with mutual relations among gastroesophageal reflux disease (GERD and numerous diseases of the upper airways. The aim of the present study was to establish possible causal relationship between GERD and posterior laryngitis (PL. Methods. The study included 103 patients with gastrointestinal complaints. Diagnostic procedure included a medical history, gastroscopy and laryngeal directoscopy. The obtained data processed using classic methods of the descriptive statistics, as well as Pearson's chi-square test, Student's t test, rank sum test and Fisher's parametric analysis of variance. Results. Out of the total number of 103 examined patients, 33 (32% were diagnosed with PL, while GERD was diagnosed in five of the examined patients all belonging to the PL group (15% of the patients with PL. In the remaining patients, PL was caused by other factors. All the patients with GERD had PL and globus sensation while 80% of GERD patients had prominent symptom of pain. Conclusion. The results of the study are indicative of the causal relationship between GERD and PL.

  8. Biomarkers for Gastroesophageal Reflux in Respiratory Diseases

    Directory of Open Access Journals (Sweden)

    Össur Ingi Emilsson

    2013-01-01

    Full Text Available Gastroesophageal reflux (GER is commonly associated with respiratory symptoms, either through a vagal bronchoconstrictive reflex or through microaspiration of gastric contents. No diagnostic test is available, however, to diagnose when respiratory illnesses are caused by GER and when not, but research in this field has been moving forward. Various biomarkers in different types of biosamples have been studied in this context. The aim of this review is to summarize the present knowledge in this field. GER patients with respiratory diseases seem to have a different biochemical profile from similar patients without GER. Inflammatory biomarkers differ in asthmatics based on GER status, tachykinins are elevated in patients with GER-related cough, and bile acids are elevated in lung transplant patients with GER. However, studies on these biomarkers are often limited by their small size, methods of analysis, and case selections. The two pathogenesis mechanisms are associated with different respiratory illnesses and biochemical profiles. A reliable test to identify GER-induced respiratory disorders needs to be developed. Bronchoalveolar lavage is too invasive to be of use in most patients. Exhaled breath condensate samples need further evaluation and standardization. The newly developed particles in exhaled air measurements remain to be studied further.

  9. Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

    Directory of Open Access Journals (Sweden)

    Theodore Liakakos

    2009-01-01

    Full Text Available Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases.

  10. Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

    Institute of Scientific and Technical Information of China (English)

    SU Li-ya; GUO Fa-jin; XU Guang; HAN Xiu-jie; SUN Chang-kun; ZHANG Zheng; JING Qing-hong

    2013-01-01

    Background Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT).This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT (M∶F,21∶14; mean age (64.5±10.6) years) and 23 gastrocnemius hematoma (M∶F,16∶7; mean age (75.4±11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

  11. Vein matching using artificial neural network in vein authentication systems

    Science.gov (United States)

    Noori Hoshyar, Azadeh; Sulaiman, Riza

    2011-10-01

    Personal identification technology as security systems is developing rapidly. Traditional authentication modes like key; password; card are not safe enough because they could be stolen or easily forgotten. Biometric as developed technology has been applied to a wide range of systems. According to different researchers, vein biometric is a good candidate among other biometric traits such as fingerprint, hand geometry, voice, DNA and etc for authentication systems. Vein authentication systems can be designed by different methodologies. All the methodologies consist of matching stage which is too important for final verification of the system. Neural Network is an effective methodology for matching and recognizing individuals in authentication systems. Therefore, this paper explains and implements the Neural Network methodology for finger vein authentication system. Neural Network is trained in Matlab to match the vein features of authentication system. The Network simulation shows the quality of matching as 95% which is a good performance for authentication system matching.

  12. Neonatal renal vein thrombosis.

    Science.gov (United States)

    Brandão, Leonardo R; Simpson, Ewurabena A; Lau, Keith K

    2011-12-01

    Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent antithrombotic therapy guidelines for the management of childhood thrombosis do not provide a risk-based algorithm for the acute management of RVT among newborns with hereditary prothrombotic disorders. Whereas neonatal RVT is not a condition associated with a high mortality rate, it is associated with significant morbidity due to renal impairment. Recent evidence to evaluate the effects of heparin-based anticoagulation and thrombolytic therapy on the long term renal function of these patients has yielded conflicting results. Long term cohort studies and randomized trials may be helpful to clarify the impact of acute versus prolonged antithrombotic therapy for reducing the morbidity that is associated with neonatal RVT.

  13. LINX(®) Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux.

    Science.gov (United States)

    Bonavina, Luigi; Saino, Greta; Lipham, John C; Demeester, Tom R

    2013-07-01

    Gastroesophageal reflux disease (GERD) results from incompetency of the lower esophageal sphincter that allows the contents of the stomach to reflux into the esophagus, the airways, and the mouth. The disease affects about 10% of the western population and has a profound negative impact on quality of life. The majority of patients are successfully treated with proton-pump inhibitors, but up to 40% have incomplete relief of symptoms even after dose adjustment. The laparoscopic Nissen fundoplication represents the surgical gold standard, but is largely underused because of the level of technical difficulty and the prevalence of side effects. These factors have contributed to the propensity of patients to continue with medical therapy despite inadequate symptom control and complications of the disease. As a consequence, a significant 'therapy gap' in the treatment of GERD remains evident in current clinical practice. The LINX(®) Reflux Management System (Torax Medical, St. Paul, MN, USA) is designed to provide a permanent solution to GERD by augmenting the sphincter barrier with a standardized, reproducible laparoscopic procedure that does not alter gastric anatomy and is easily reversible. Two single-group trials confirmed that a magnetic device designed to augment the lower esophageal sphincter can be safely and effectively implanted using a standard laparoscopic approach. The device decreased esophageal acid exposure, improved reflux symptoms and quality of life, and allowed cessation of proton-pump inhibitors in the majority of patients.

  14. A Vein Map Biometric System

    Directory of Open Access Journals (Sweden)

    Felix Fuentes

    2013-08-01

    Full Text Available There is increasing demand world-wide, from government agencies and the private sector for cutting-edge biometric security technology that is difficult to breach but userfriendly at the same time. Some of the older tools, such as fingerprint, retina and iris scanning, and facial recognition software have all been found to have flaws and often viewed negatively because of many cultural and hygienic issues associated with them. Comparatively, mapping veins as a human barcode, a new technology, has many advantages over older technologies. Specifically, reproducing a three-dimensional model of a human vein system is impossible to replicate. Vein map technology is distinctive because of its state-of-the-art sensors are only able to recognize vein patterns if hemoglobin is actively flowing through the person

  15. [Surgery of essential varicose veins].

    Science.gov (United States)

    Maraval, M

    1994-03-15

    Idiopathic varicose veins of the lower limbs are a frequent but benign disorder. Surgery is only a moment in the course of the disease. Although not the only treatment of essential varicose veins, surgery by an experienced team performing crossectomy, stripping by intussusception using a stripper, and phlebectomy gives fully satisfactory results, both to patient and to physician, in over 80% of cases. New techniques were recently developed that, at present, have not confirmed early hopes.

  16. Portal Vein Thrombosis in non cirrhotic patients

    NARCIS (Netherlands)

    M.C.W. Spaander (Manon)

    2010-01-01

    textabstractExtrahepatic portal vein thrombosis (EPVT) is the most common cause of portal hypertension in non- cirrhotic patients. EPVT has been defined as an obstruction of the extrahepatic portal vein with or without involvement of the intrahepatic portal veins. Although the portal vein accounts f

  17. Clinical pathology of primary bile reflux gastritis

    Directory of Open Access Journals (Sweden)

    Ping YAO

    2011-05-01

    Full Text Available Objective To analyze the clinical and pathological features of primary bile reflux gastritis(BRG.Methods Endoscopy,Helicobacter pylori(H.pylori detection,and histopathologic examination were performed in 218 patients with primary BRG(observed group and 236 patients with simple chronic gastritis(SCG,control group as identified by gastroscope in order to analyze the endoscopic abnormalities,the frequency of H.pylori infection,pathological features and scores of inflammation.Results The frequency of H.pylori infection was 39.0%(85/218 in the observed group,which was significantly lower than that in the control group [52.1%(123/236].The topographic abnormalities of the antral mucosa as detected by gastroscopy,i.e.,congestion,hemorrhagic spots,erosion were not significantly different between BRG and SCG patients(P > 0.05.The scores of chronic and active inflammation were higher in patients when H.pylori infection was present than in patients without H.pylori infection in both groups(P < 0.05.The scores of inflammation,the detection rates of the antral intestinal metaplasia,antral atrophy and atypical hyperplasia were all higher in observed group than in control group(P < 0.05.The incidence of lengthening of gastric pits,telangiectasis or interstitial edema in BRG patients was also significantly higher than those in SCG patients(P < 0.05.Conclusions Primary BRG shows features of chemical gastritis with a higher tendency toward mucosal atrophy,intestinal metaplasia and atypical hyperplasia.Gastropic examination and biopsy should be emphasized.

  18. The evaluation of gastroesophageal reflux before and after medical therapies

    Energy Technology Data Exchange (ETDEWEB)

    Malmud, L.S.; Fisher, R.S.

    1981-07-01

    Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy.

  19. Gastroesophageal reflux disease: A review of surgicaldecision making

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Gastroesophageal reflux disease (GERD) is a verycommon disorder with increasing prevalence. It isestimated that up to 20%-25% of Americans experiencesymptoms of GERD weekly. Excessive reflux ofacidic often with alkaline bile salt gastric and duodenalcontents results in a multitude of symptoms for thepatient including heartburn, regurgitation, cough, anddysphagia. There are also associated complications ofGERD including erosive esophagitis, Barrett's esophagus,stricture and adenocarcinoma of the esophagus. Whilefirst line treatments for GERD involve mainly lifestyleand non-surgical therapies, surgical interventions haveproven to be effective in appropriate circumstances.Anti-reflux operations are aimed at creating an effectivebarrier to reflux at the gastroesophageal junction andthus attempt to improve physiologic and mechanicalissues that may be involved in the pathogenesis ofGERD. The decision for surgical intervention in thetreatment of GERD, moreover, requires an objectiveconfirmation of the diagnosis. Confirmation is achievedusing various preoperative evaluations includingambulatory pH monitoring, esophageal manometry,upper endoscopy (esophagogastroduodenoscopy) andbarium swallow. Upon confirmation of the diagnosisand with appropriate patient criteria met, an antirefluxoperation is a good alternative to prolongedmedical therapy. Currently, minimally invasive gastroesophagealfundoplication is the gold standard forsurgical intervention of GERD. Our review outlines themany factors that are involved in surgical decisionmaking.We will review the prominent features thatreflect appropriate anti-reflux surgery and presentsuggestions that are pertinent to surgical practices,based on evidence-based studies.

  20. A Study on the Relationship between Reflux Esophagitis and Periodontitis.

    Science.gov (United States)

    Adachi, Kyoichi; Mishiro, Tomoko; Tanaka, Shino; Yoshikawa, Hiroo; Kinoshita, Yoshikazu

    2016-01-01

    Objective Metabolic syndrome and dental erosion have been demonstrated to correlate with gastroesophageal acid reflux disease (GERD), while periodontitis has been reported to have a positive relationship with metabolic syndrome. However, no correlation between periodontitis and GERD has yet been reported. We therefore investigated the relationship between periodontitis and GERD. Methods The subjects consisted of 280 individuals who visited the Health Center for a detailed medical checkup examination. Each underwent upper endoscopy and periodontitis examinations, with the latter performed by measuring the concentrations of lactate dehydrogenase and hemoglobin in saliva. The subjects were divided into those with positive and negative periodontitis findings, and the prevalence rates of endoscopically proven reflux esophagitis, dyslipidemia, hypertension, and hyperglycemia were compared. Results The number of subjects positive for periodontitis was 93, while 187 had negative findings. The prevalence of reflux esophagitis was not different between the positive and negative groups (8.6% vs. 8.0%). In addition, a multiple logistic regression analysis did not identify a positive relationship between the presence of periodontitis and reflux esophagitis. On the other hand, dyslipidemia and hypertension were more frequently observed in the subjects that were positive for periodontitis. Conclusion We did not find an association between periodontitis and reflux esophagitis in the present study. On the other hand, the presence of periodontitis was found to correlate with hypertension and dyslipidemia.

  1. Is ineffective esophageal motility associated with gastropharyngeal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Kyung Yup Kim; Gwang Ha Kim; Dong Uk Kim; Soo Geun Wang; Byung Joo Lee; Jin Choon Lee; Do Youn Park; Geun Am Song

    2008-01-01

    AIM: To evaluate the association between IEM and gastropharyngeal reflux disease (GPRD) in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms.METHODS: A total of 632 patients who underwent endoscopy, esophageal manometry and ambulatory 24-h dual-pH monitoring due to supraesophageal symptoms (e.g. globus, hoarseness, or cough) were enrolled. Of them, we selected the patients who had normal esophageal motility and IEM. The endoscopy and ambulatory pH monitoring findings were compared between the two groups.RESULTS: A total of 264 patients with normal esophageal motility and 195 patients with the diagnosis of IEM were included in this study. There was no difference in the frequency of reflux esophagitis and hiatal hernia between the two groups. All the variables showing gastroesophageal reflux and gastropharyngeal reflux were not different between the two groups. The frequency of GERD and GPRD, as defined by ambulatory pH monitoring, was not different between the two groups.CONCLUSION: There was no association between IEM and GPRD as well as between IEM and GERD. IEM alone cannot be considered as a definitive marker for reflux disease.

  2. Comparison of Endoscopic Findings with Gastroesophageal Reflux Disease Questionnaires (GerdQ and Reflux Disease Questionnaire (RDQ for Gastroesophageal Reflux Disease in Medan

    Directory of Open Access Journals (Sweden)

    Gontar Alamsyah Siregar

    2015-12-01

    Full Text Available ABSTRACT Background: There are many questionnaires that have been developed to diagnose gastroesophageal reflux disease (GERD, i.e. reflux disease questionnaire (RDQ, and the recently developed, gastroesophageal reflux disease questionnaires (GerdQ. In this study, we tried to compare GerdQ and RDQ in terms of sensitivity and specificity to diagnose GERD and its relationship with endoscopic findings. Method: This study was a cross sectional analytical study. Subsequently, all the subjects were evaluated using the GerdQ and RDQ, then underwent esophagogastroduodenoscopy examination. The severity of endoscopically observed reflux esophagitis was graded with the Los Angeles classification. All endoscopy was performed by well-trained doctor. Results: A total of 85 patients were examined, 34 (40% patients had reflux esophagitis at endoscopy examination, including 15 (44.1% cases of grade A, 11 (32.3% cases of grade B, 4 (11.8% cases of grade C, and 4 (11.8% cases of grade D. Analysis study using sensitivity, specificity, and receiver operating characteristic (ROC test showed that GerdQ had sensitivity (49%, specificity (91%, and an area under the ROC of 0.701 (p value = 0.002. RDQ had sensitivity (24%, specificity (91%, and an area under the ROC of 0.574 (p value = 0.253. Taking 11 as the cut off point for GerdQ, a maximal sensitivity of 73.5%, specificity of 82.4%, and an area under the ROC of 0.779 was achieved. Conclusion: GerdQ and RDQ can be used to help diagnose GERD, but GerdQ is more superior than RDQ in diagnosing GERD. A multi-center study with larger samples is needed to determine the best GerdQ’s cut off point in Indonesia.

  3. Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To analyze the spectrum and risk factors of gastroesophageal reflux disease (GERD) based on presenting symptoms and endoscopic findings. METHODS: A cross-sectional survey in a cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version Reflux Disease Questionnaire (RDQ) and other items recording the demographic characteristics and potential risk factors for GERD. Subjects were defined as having GERD symptoms according to the RDQ score (>12). All subjects were endoscopied and the definition and severity of erosive esephagitis were evaluated by Los Angeles classification.The statistical analysis was performed with SPSS13.0 programs. RESULTS: Of 2231 recruited participants, 701 (31.40%) patients were diagnosed as having GFRD while 464 (20.80%) patients had objective findings of reflux esophagitis (RE). Of those 464 patients, only 291 (13.00%) were reported as subjects with GERD symptoms. A total of 528 (23.70%) patients were found to have GERD symptoms, including 19.50% patients with grade A or B reflux esophagitis, 0.90% with grade C and 0.40% with grade D. On multivariate analysis, old age,male, moderate working burden, divorced/widowed and strong tea drinking remained as significant independent risk factors for erosive esophagitis. Meanwhile, routine usage of greasy food and constipation were considered as significant independent risk factors for non-erosive reflux disease (NERD).CONCLUSION: GERD is one of the common GI diseases with a high occurrence rate in China and its main associated factors include sex, anthropometrical variables and sociopsychological characteristics.

  4. Features of Motor and Secretory Disorders in Gastroesophageal Reflux Disease in Young Patients with Concomitant Obesity

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    O.A. Oparin

    2015-09-01

    Materials and Results of the Study. The study included 50 patients with gastroesophageal reflux disease, they we divided into 2 groups, depending on the presence of concomitant obesity. The first group included patients with gastroesophageal reflux disease and concomitant obesity, the second one — patients with gastroesophageal reflux disease without comorbidity. Control group consisted of 20 apparently healthy individuals. The study found that patients with gastroesophageal reflux disease and concomitant obesity had severe motor disturbances which were evaluated using ultrasound study (there were evaluated the diameter of esophageal hiatus, the thickness of esophageal wall, esophageal lumen width in the lower third, as well as the presence or absence of reflux, and were in close correlation with specific clinical manifestations of gastroesophageal reflux disease, measured by GERDQ questionnaires (international questionnaires for the diagnosis of gastroesophageal reflux disease compared with the group of patients with gastroesophageal reflux disease without comorbidity.

  5. Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Johansson, K.E.; Ask, P.; Boeryd, B.; Fransson, S.G.; Tibbling, L.

    1986-01-01

    In a study comprising 100 patients referred to a surgical clinic with symptons suggestive of gastro-oesophageal reflux disease, the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly corelated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux, and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensivity for radiologic, manometric and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

  6. [Gastro-esophageal reflux and chronic respiratory diseases].

    Science.gov (United States)

    Dirou, S; Germaud, P; Bruley des Varannes, S; Magnan, A; Blanc, F-X

    2015-12-01

    Gastroesophageal reflux disease (GERD) frequently occurs in association with chronic respiratory diseases although the casual link is not always clear. Several pathophysiological and experimental factors are considered to support a role for GERD in respiratory disease. Conversely, respiratory diseases and bronchodilator treatment can themselves exacerbate GERD. When cough or severe asthma is being investigated, GERD does not need to be systematically looked for and a therapeutic test with proton pump inhibitors is not always recommended. pH impedance monitoring is now the reference diagnostic tool to detect non acid reflux, a form of reflux for which proton pump inhibitor treatment is ineffective. Recent data have shown a potential role of GERD in idiopathic pulmonary fibrosis and bronchiolitis obliterans following lung transplantation, leading to discussions about the place of surgery in this context. However, studies using pH impedance monitoring are still needed to better understand and manage the association between GERD and chronic respiratory diseases.

  7. Applying the ALARA concept to the evaluation of vesicoureteric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Richard S.; Diamond, David A. [Children' s Hospital Boston, Department of Urology, Boston, MA (United States); Chow, Jeanne S. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States)

    2006-09-15

    The voiding cystourethrogram (VCUG) is a widely used study to define lower urinary tract anatomy and to diagnose vesicoureteric reflux (VUR) in children. We examine the technical advances in the VCUG and other examinations for reflux that have reduced radiation exposure of children, and we give recommendations for the use of imaging studies in four groups of children: (1) children with urinary tract infection, (2) siblings of patients with VUR, (3) infants with antenatal hydronephrosis (ANH), and (4) children with a solitary functioning kidney. By performing examinations with little to no radiation, carefully selecting only the children who need imaging studies and judiciously timing follow-up examinations, we can reduce the radiation exposure of children being studied for reflux. (orig.)

  8. Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease (GERD

    Directory of Open Access Journals (Sweden)

    Selfie

    2015-12-01

    Full Text Available Gastroesophageal reflux disease (GERD was a damage in mucosal layer caused by gastric acid reflux. GERD was found about 10-20% in Western Countries and less in Asia, about 2,6-6,7%. Among different type of GERD, refractory GERD was a problem found in daily clinical practice. This terminology was used in patients with regurgitation and heartburn symptoms which is not responsive to 8 weeks proton pump inhibitor (PPI therapy. There were several mechanisms underlying the etiology and pathophysiology of refractory GERD. In general, refractory GERD diagnosis was based on clinical findings, objective endoscopic examination, ambulatory reflux monitoring, and response to antiacid-secretion therapy. Reevaluation of patients compliance should be the first step in refractory GERD management. A further treatment strategies could be started, consist of medical and surgical therapies. A basic clinical knowledge of refractory GERD would help clinician in deciding the best approach for diagnosis and therapy.

  9. Omeprazole for Refractory Gastroesophageal Reflux Disease during Pregnancy and Lactation

    Directory of Open Access Journals (Sweden)

    John K Marshall

    1998-01-01

    Full Text Available Symptomatic gastroesophageal reflux is a common complication of pregnancy and lactation. However, the safety of many effective medical therapies, including oral proton pump inhibitors, has not been well defined. The administration of oral omeprazole to a 41-year-old female during the third trimester of pregnancy, after ranitidine and cisapride failed to control her refractory gastroesophageal reflux, is reported. No adverse fetal effects were apparent, and the patient elected to continue omeprazole therapy (20 mg/day while breastfeeding. Peak omeprazole concentrations in breast milk (58 nM, 3 h after ingestion were less than 7% of the peak serum concentration (950 nM at 4 h, indicating minimal secretion. Although omeprazole is a potentially useful therapy for refractory gastroesophageal reflux during pregnancy and lactation, further data are needed to define better its safety and efficacy.

  10. Bethanechol versus antiacids in the treatment of gastroesophageal reflux.

    Science.gov (United States)

    Levi, P; Marmo, F; Saluzzo, C; Dell'Olio, D; Ansaldi, N; Giuliani, L; Guardamagna, O; Mostert, M; Ponzone, A

    1985-12-01

    To compare the efficacy of bethanechol in the treatment of gastroesophageal reflux with that of antiacids, a prospective, cross-over study was undertaken, in which 20 affected infants and children were randomized into two groups on 6-week alternate bethanechol and antiacids oral medication. Patients were evaluated clinically and by esophageal pH-metry before and after each treatment. Clinical score amelioration was achieved earlier than reflux number reduction and with similar incidence in both groups of patients, irrespectively to the initial medication; moreover, the differences in the degree of improvement between the two groups after either treatment were not found to be significant. These results fail to show that bethanechol is more effective than antiacids in controlling gastroesophageal reflux; moreover, bethanechol is more difficult to administer and offers a higher rate of undesired side effects.

  11. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Grattan-Smith, J.D. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Jones, Richard A. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)

    2008-01-15

    MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

  12. Chronic laryngitis as a result of gastro esophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Trajković Rada

    2014-01-01

    Full Text Available Reflux of gastric contents to the level of the pharynx and larynx is called laryngopharyngeal reflux, which can exist as such or laryngeal and pharyngeal reflux as separate entities, and in such form may lead to other diseases such as rhinitis, sinusitis, otitis media, and precancerous cancerous condition. To determine the relationship and impact of gastroesophageal reflux disease on the occurrence, frequency and duration of inflammatory processes and mucosal damage to the larynx. All patients were obtained anamnesticly, lab test done in all patients, indirect hipofaringo and laryngoscopy was performed in all patients. Based on the feedback reports gastroenterologists, we obtained data of gastroscopy. Results: 120 subjects were processed with dyspeptic symptoms. Based on history, all patients had some symptoms of upper respiratory tract disease.62 (51.66% male respondents and 58 (48.33% females. The average age of 54 years. In 82 (68.33% patients was increased salivation (one of the leading symptoms, of that number in 61 (74.39% participants laryngitis was present. In 68 (56.66% cases where the predominant symptom was cough, laryngitis was present in 26 (38.23%. In 70 (58.33% of patients with globus sensation, laryngitis was present in 38 (54.28% patients. Smoking has been represented with 65.83% (70 respondents, the percentage of patients with chronic laryngitis in this group was 69.62% (55 respondents. Been held after gastroscopy and otorinolaryngological examination in 62 (51.66% patients were diagnosed gastroesophageal reflux disease (GERD, of which, in 43 (69.35% patients laryngitis was present. After a three-month follow-up of patients with therapy (H2 blockers, proton pump inhibitors and antacids 28 (65.11% subjects (total treated, showed an improvement. The results of this study indicate a significant correlation between gastroesophageal reflux disease and chronic laryngitis, as well as the favorable impact and effect of antacid therapy

  13. Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

    Science.gov (United States)

    Dziekiewicz, Marcin A; Banaszkiewicz, Aleksandra; Urzykowska, Agnieszka; Lisowska, Aleksandra; Rachel, Marta; Sands, Dorota; Walkowiak, Jaroslaw; Radzikowski, Andrzej; Albrecht, Piotr

    2015-01-01

    Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

  14. The Association between Childhood Overweight and Reflux Esophagitis

    Directory of Open Access Journals (Sweden)

    Nirav R. Patel

    2010-01-01

    Full Text Available Background. In adults, it has been shown that obesity is associated with gastroesophageal reflux disease (GERD and GERD-related complications. There are sparse pediatric data demonstrating associations between childhood overweight and GERD. Objective. To investigate the association between childhood overweight and RE. Methods. We performed a retrospective chart review of 230 children (M : F=114 : 116 who underwent esophagogastroduodenoscopy (EGD with biopsies between January 2000 and April 2006. Patient demographics, weight, height, clinical indications for the procedure, the prevalence of BMI classification groups, the prevalence of RE and usage of anti-reflux medications were reviewed. For these analyses, the overweight group was defined to include subjects with BMI≥ 85th percentile. The normal weight group was defined to include subjects with BMI 5th to 85th percentile. Results. Among the 230 subjects, 67 (29.1% had BMI percentiles above the 85th percentile for age and gender. The prevalence of RE in the overweight group did not differ significantly from that in the normal weight group (23.9% versus 24.5%, resp.. Overweight subjects taking anti-reflux medications clearly demonstrated a higher prevalence of biopsy-proven RE compared to overweight subjects not taking anti-reflux medications (34.1% versus 7.7%, =.009. Conclusions. There was no significant difference in the prevalence of biopsy-proven RE in the overweight group compared to the normal weight group. However, the prevalence of RE was significantly higher in overweight subjects on anti-reflux medications compared to overweight subjects not taking anti-reflux medications. This finding emphasizes the importance of early recognition and treatment of GERD for the overweight pediatric patients with symptoms in conjunction with weight loss program for this population to reduce long-term morbidities associated with GERD.

  15. Unmet Needs in the Treatment of Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Dickman, Ram; Maradey-Romero, Carla; Gingold-Belfer, Rachel; Fass, Ronnie

    2015-07-30

    Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the ther-apeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, main-tenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett's esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any fu-ture development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the afore-mentioned areas of unmet need.

  16. Reflux and acid peptic diseases in the elderly.

    Science.gov (United States)

    Soumekh, Amir; Schnoll-Sussman, Felice H; Katz, Philip O

    2014-02-01

    Gastroesophageal reflux disease (GERD) is a common disorder among elderly patients seeking medical care. Diagnosis and management of GERD in the older patient is a unique challenge for both the primary care provider and the gastroenterologist. Such patients may have atypical symptoms, more severe disease, and a higher rate of complications such as erosive esophagitis, Barrett esophagus, and esophageal cancer. Moreover, the elderly may be more sensitive to the morbidity and mortality of the available treatments for GERD. A careful and vigilant approach to the diagnosis, monitoring, and treatment of reflux disease in the elderly is warranted.

  17. [Dyspepsia, Ulcer Disease – Helicobacter pylori, Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Wirth, Hans-Peter

    2016-06-01

    Prevalence of H. pylori (HP) is declining, whereas reflux disease and the proportion of non-steroidal antiinflammatory drugs (NSAR) to HP-induced ulcers increase. Eradication heals HP-ulcer disease, interrupts cancerous progression and can improve dyspeptic symptoms. NSAR-ulcers heal under proton pump inhibitor (PPI) therapy but tend to recur after reexposition. Anticoagulants and antiplatlet agents increase the risk additionally. PPI reduces NSAR-ulcer recurrence. Reflux patients with severe inflammation and complications often need long-term therapy. Barrett’s esophagus patients are at risk of esophageal adenocarcinoma.

  18. Is vein damage the only cause of clinical signs of lower limb chronic venous insufficiency?

    Directory of Open Access Journals (Sweden)

    Amélia Cristina Seidel

    2014-09-01

    Full Text Available Background:Venous insufficiency is a very prevalent disease. Some decades ago a group of patients was identified that had symptoms of venous insufficiency, but no visible anatomic abnormalities. Studies showed that this subset had reduced venous tone, and their condition became known as hypotonic phlebopathy.Objective:To investigate prevalence, age group and variations in body mass index (BMI among patients with hypotonic phlebopathy.Methodology:A total of 1,960 limbs were examined in 1,017 patients who had been referred for complaints compatible with venous insufficiency. Patients with BMI ≥ 30 were defined as obese. The patients were examined using color Doppler ultrasonography to detect presence or absence of reflux in veins of the lower limbs and were then distributed into two groups as follows: patients with CEAP ≤ 1 and no reflux, diagnosed with hypotonic phlebopathy; or patients with CEAP ≥ 2 and reflux.Results:The study sample comprised 89.7% women and 10.3% men with a mean age of 44.9 years. Hypotonic phlebopathy was more common among the women (p = 0.0001. Obese women were more likely than women who were not obese to have venous symptom etiology involving trunk lesions (p = 0.0017. Among the men, obesity was unrelated to etiology of symptoms (p = 0.5991. Symptomology was more likely to be related to trunk vein damage among older age groups than among younger age groups (p-valor <0.0001.Conclusions:Hypotonic phlebopathy was very prevalent, particularly among young women who were not obese.

  19. Accuracy of Venous Filling Index on Standing (VFIst) and Pure Regurgitation Index (PRI), a Novel Index Obtained by Air Plethysmography, for Detecting Venous Reflux.

    Science.gov (United States)

    Shiraishi, Yasushi

    2015-01-01

    To evaluate the accuracy of venous filling index on standing (VFIst) and a new index named pure regurgitation index (PRI), obtained by air plethysmography, for detecting venous reflux. One hundred and sixty-one healthy subjects (161 limbs) and 180 varicose vein patients (180 limbs) were investigated. All subjects underwent duplex ultrasonography for verifying venous reflux and air plethysmography to obtain hemodynamic parameters such as VFIst, VFI in the supine position (VFIsu), and the maximum arterial inflow rate. To evaluate the accuracy of VFIst and PRI (= (VFIst - VFIsu)/body mass index), receiver operating characteristics curves were created. The optimal cut-off value, sensitivity, specificity, and area under the curve, obtained from analyzing the receiver operating characteristics curves, of VFIst vs. PRI were 2.058 mL/s vs. 0.059 mL · m(2)/s · kg, 93.3% vs. 90.3%, 88.8% vs. 91.3%, and 0.954 vs. 0.964, respectively. This study indicates that while both VFIst and PRI are highly accurate indicators of venous reflux, PRI, which is not affected by the arterial inflow rate and body mass index, is slightly superior to VFIst, especially in subjects with greater body mass index.

  20. Use of acid-suppressive therapy before anti-reflux surgery in 2922 patients

    DEFF Research Database (Denmark)

    Lødrup, A; Pottegård, A; Hallas, J

    2015-01-01

    BACKGROUND: Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery. AIM: To determine the use of proton pump...

  1. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Weusten, Bas L. A. M.; Timmer, Robin; Smout, Andre J. P. M.

    2006-01-01

    OBJECTIVE: In some patients with a physiological esophageal acid exposure, an association between reflux episodes and symptoms can be demonstrated. Besides acidity, other factors such as proximal extent may determine whether a reflux episode is perceived or not. We aimed to investigate the reflux pr

  2. [Varicose vein recurrence after surgery of the sapheno-femoral junction: color Doppler ultrasonography study].

    Science.gov (United States)

    Roscitano, Giuseppe; Mirenda, Francesco; Mandolfino, Tommaso; De Caridi, Giovanni; Stilo, Francesco; Benedetto, Filippo; Spinelli, Francesco

    2003-01-01

    The aim of this study was to evaluate the accuracy and sensitivity of colour Doppler ultrasonography for the diagnosis of postoperative recurrent varicose veins in patients submitted to surgical ligation of the saphenofemoral junction with a view to classifying the recurrences according to the causes. We studied 401 lower limbs in the orthostatic position with colour Doppler ultrasonography in 318 patients (64 M and 254 F) presenting postoperative varicose vein recurrence during the follow-up (12-60 months). We evaluated the type of reflux at the inguinal level under the Valsalva manoeuvre and divided them into 5 types. We observed an incomplete crossectomy (type 1) in 23.2% of the cases; an incontinent saphenofemoral junction, intact and in an anatomical site in 12.5% (type 2); a major tributary (double saphena) originating from the common femoral vein near to the crossectomy site in 10.2% (type 3); neovascularization in 9.7% (type 4) and the presence of a number of major tributaries from the veins of the perineal and pudendal region or from the abdominal parietal veins in 44.4% (type 5). In all cases it was possible to note and classify the type of recurrence. Colour Doppler ultrasonography is an accurate, reliable tool for the diagnosis and classification of postoperative varicose vein recurrences in patients submitted to surgical obliteration of the saphenofemoral junction. It is decisive in the preoperative evaluation and follow-up of patients. In our experience, more than one half of the cases of recurrence were not due to an error of surgical technique.

  3. Gastric reflux: association with aspiration and oral secretion pH as marker of reflux: a descriptive correlational study.

    Science.gov (United States)

    Schallom, Marilyn; Orr, James A; Metheny, Norma; Kirby, John; Pierce, Janet

    2015-01-01

    Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia. The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions. A descriptive correlational study was conducted in mechanically ventilated surgical or medical patients receiving gastric tube feedings. Oral secretions were suctioned hourly and tracheal secretions every 2 to 3 hours for 12-hour periods over 1 to 2 days in 15 patients. There were 142 paired samples of oral tracheal secretions. A majority of samples (60%) had the same results, with 32% both pepsin-positive and 27% both pepsin-negative. The range of pH measurements was 4 to 8, with a mean of 6.3 ± 0.05. Ninety oral specimens had a pH of 4 to 6. Forty-seven of the oral specimens with pH measures between 4 and 6 (52%) were pepsin-positive. The correlation of pH percent pepsin-positive oral secretions was not significant. Aspiration events were more frequent than reflux events. Measurement of actual pepsin concentration to detect new reflux and aspiration events is recommended in future studies. Bedside pH measures of oral secretions are not a valid marker of gastric reflux.

  4. Does the Compliance of the Bladder Affect the Grade of Vesicoureteral Reflux?

    Directory of Open Access Journals (Sweden)

    Ferhat Kilinc

    2013-10-01

    Full Text Available Aim: We retrospectively reviewed videourodynamic outcomes in children with primary vesicoureteral reflux. The aim of this study to evaluate the relationship between vesicoureteral reflux grade and bladder compliance. Material and Method: Videourodynamic traces of 53 children with primary vesicoureteral reflux investigated between January 2004 and January 2012 were reviewed. The detrusor pressures of the point when the reflux started were recorded. The detrusor pressures 10 cmH2O or less at that point was accepted as normal compliance (Group 1, the detrusor pressures more than10 cm H2O was accepted as hipocompliance (Group 2. The reflux grades were divided into two grades, low-grade reflux (grades 1 and 2, high-grade reflux (grades 3, 4 and 5. Data were analyzed using the chi-square test. Results: Patients’ ages ranged between 5 and 11 years (mean 7.09±1.81 years. Of the 53 patients, 29 (54.7% had normal compliance (Group 1, 24 (45.3% had hipocompliance (Group 2. Twenty-four (82.8% patients in-group 1 had a low-grade reflux, 5 (17.2% patients had a high-grade reflux. In group 2, 8 (33.3% patients had a low-grade reflux, 16 (66.7% patients had a high-grade reflux. The detected high-grade reflux in-group 2 was significantly higher than in-group 1 (p<0.001. Discussion: The physicians should be considering the bladder compliance at the point when the reflux started in primary vesicoureteral reflux cases. The bladder hipocompliance may play a secondary role in reflux grade.

  5. Microdissection of distal artery perforator of the medial leg and design of skin flap pedicled with nutrient vessels of the saphenous nerve%小腿内侧远端动脉穿支显微解剖与隐神经营养血管皮瓣设计

    Institute of Scientific and Technical Information of China (English)

    张发惠; 郑和平; 张国栋

    2007-01-01

    以胫后动脉肌间隙支、内踝前动脉穿支和以踝管区动脉穿支血管蒂的3种隐神经-大隐静脉营养血管远端蒂皮瓣或复合瓣,旋转轴点在内踝平面,适宜小腿远段、踝足部及其远侧的组织缺损修复.%BACKGROUND: The distally based skin flap pedicled with nutrient vessels of saphenous nerve has provided a method with higher achievement ratio to repair the tissue defect of ankle and foot, due to its high rotation point, lacking of distributive characteristics of distally pedicled vessels description for the specific operations, so it is still difficult in clinical application.OBJECTIVE: To investigate the distal artery perforators of medial leg, so as to suggest an anatomical theory for the reasonable design of the distally based compound flap pedicled with nutrient vessels of saphenous nerve-great saphenous vein.DESIGN: A single sample experiment.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out in the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004.Thirty-four adult specimens perfused with red emulsion at lateral arteries of upper lower limbs were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: Specimens of the distal medial legs were dissected with microscope taking the most prominent point of medial malleolus as the pivot point.MAIN OUTCOME MEASURES: ① Distal artery perforators of medial leg; ② Distal nutrient vessels of saphenous nerve-great saphenous vein; ③ Blood supply correlation of nutrient vessel with neighboring muscle, bone and skin.RESULTS: ① The distal artery perforators of medial leg derived from 9 main

  6. Measurement of the circumferential mechanical properties of the umbilical vein: experimental and numerical analyses.

    Science.gov (United States)

    Karimi, Alireza; Navidbakhsh, Mahdi; Rezaee, Taraneh; Hassani, Kamran

    2015-01-01

    Coronary artery disease is responsible for almost 30% of all deaths worldwide. The saphenous vein and umbilical vein (UV) are the most common veins using for treatment as a coronary artery bypass graft (CABG). The mechanical properties of UV belonging to its long-term patency for CABG are very important. However, there is a lack of knowledge on the linear elastic and nonlinear hyperelastic mechanical properties of the UV. In this study, three stress definitions (second Piola-Kichhoff stress, engineering stress and true stress) and four strain definitions (Almansi-Hamel strain, Green-St Venant strain, engineering strain and true strain) are used to determine the elastic modulus, maximum stress and strain of eight human UVs under circumferential loading. The nonlinear mechanical behaviour of the UV is computationally investigated using Mooney-Rivlin hyperelastic model. A numerical finite element analysis is also carried out to simulate the constitutive modelling versus its numerical results. The results show that the Almansi-Hamel strain definition overestimates the elastic modulus while Green-St Venant strain definition underestimates the elastic modulus at different stress definitions. The true stress-true strain definition, which gives more accurate measurements of the tissue's response using the instantaneous values, reveals the Young's modulus and maximum stress of 2.18 and 6.01 MPa, respectively. The Mooney-Rivlin material model is well represented by the nonlinear mechanical behaviour of the UV. The findings of this study could have implications not only for understanding the extension and rupture mechanism of UV but also for interventions and surgeries, including balloon angioplasty, bypass and stenting.

  7. [Lower limb varicose veins as a manifestation of undifferentiated connective tissue dysplasia].

    Science.gov (United States)

    Potapov, M P; Potapov, P P; Staver, E V; Mazepina, L S

    2016-01-01

    Analysed herein are the data of 737 patients (a total of 745 lower limbs) suffering from lower-limb varicose veins (LLVV) and subjected to treatment at the Surgical Department consisting of crossectomy, truncal and tributary phlebectomy, dissection of perforant veins exclusively in the basin of the great saphenous vein. Relapses during five-year follow up occurred in 13.8% (102/745) of cases. Based on clinical signs and laboratory findings we studied the effect of the factor of undifferentiated connective tissue dysplasia (UDCTD) on the development of lower-limb varicosity. We carried out comparative analysis in the groups with relapsing LLVV (n=43), without relapses (n=39) and control group comprising volunteers not suffering from LLVV (n=37). The median of blood serum total oxiprolin concentration in LLVV patients both with and without relapses was elevated and amounted to 18.4 (IR 14.9-19.65) and 14.3 (IR 13.1-16.5) versus 8.35 (5.75-9.75) μmol/l, respectively. The mode of the clinical parameter of UDCTD degree in accordance with the rating scale of Smolnova T.Yu. (2003) in the group of patients with LLVV relapses turned out to be higher (Mo=19) than in the group of patients without relapses (Mo=10, p=0.003). The lowest score was in the control group. In patients having immediate relatives with LLVV the level of blood serum total oxiprolin and clinical scores of LLVV turned out to be statistically significantly higher. Hence, based on the obtained during the study clinical and laboratory findings it may be supposed that undifferentiated connective tissue dysplasia plays an important part in the development of both lower limb varicosity and relapses thereof.

  8. Urodynamics in boys after prenatally diagnosed vesicoureteric reflux

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens

    1996-01-01

    Over the years, several theories have been presented regarding the pathogenesis of vesicoureteral reflux (VUR) in children without neurological disease or posterior urethral valves. Primary VUR is one of many fetal uropathies detectable by prenatal sonography. Thirteen boys with a prenatal...

  9. Associations between peripheral vertigo and gastroesophageal reflux disease.

    Science.gov (United States)

    Viliušytė, Edita; Macaitytė, Raminta; Vaitkus, Antanas; Rastenytė, Daiva

    2015-09-01

    We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered – gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram

    Directory of Open Access Journals (Sweden)

    Agrawal Vikesh

    2009-01-01

    Full Text Available Aim : Evaluation of vesicoureteric reflux (VUR in children by bladder volume graded direct radionuclide cystogram (BVG DRC. This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two patients and 36 renal units were found to have VUR in either of the reflux studies. A VCUG was able to detect 20 units (55.50% and a BVG DRC was able to detect 35 units (97.2%. A VCUG had a test accuracy of 77.8% and a BVG DRC had a test accuracy of 98.6%. There was a positive correlation between bladder volume grades and scarring on a DMSA scan. Conclusions : Like a conventional DRC, BVG DRC is a sensitive and an accurate test. It gives additional information on the reflux phenomenon with respect to bladder filling. The bladder volume graded technique is better than conventional DRC for grading of VUR.

  11. Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

    Institute of Scientific and Technical Information of China (English)

    Mike Thomson; Prithviraj Rao; David Rawat; Tobias G Wenzl

    2011-01-01

    AIM: To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII).METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement.METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were nonacidic.The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058).Median number of non-acid GOR, average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant.CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children.

  12. [Severe interstitial lung disease from pathologic gastroesophageal reflux in children].

    Science.gov (United States)

    Ahrens, P; Weimer, B; Hofmann, D

    1999-07-01

    Interstitial lung diseases comprise a heterogeneous group of pulmonary conditions that cause restrictive lung disease of poor prognosis, especially if growth failure, pulmonary hypertension and fibrosis appears. We report on the case of a girl of 11 years of age who suffered from severe nonallergic asthma in early childhood and who developed severe interstitial pulmonary disease caused by gastro-oesophageal reflux at the age of 8 years. This diagnosis was established by lung biopsy, bronchoalveolar lavage and a high amount of lipid-laden alveolar macrophages, 2-level pH measurement and oesophageal biopsy. Because therapy with oral and inhaled steroids failed and Omeprazol showed benificial effects, hemifundoplication according to THAL was performed. At present the lung function is clearly normal and there is no need of any medicaments. Following the history, we can assume the pathological gastro-oesophageal reflux to be the cause of the disease. It is important to state that there were no typical symptoms at any time pointing to gastro-oesophageal reflux disease. The development of pulmonary disease by pathological reflux is very often caused by "silent aspiration". Very typically there are no symptoms such as vomiting, heartburn and pain but only signs of chronic lung disease.

  13. The human laryngeal microbiome: effects of cigarette smoke and reflux

    Science.gov (United States)

    Jetté, Marie E.; Dill-McFarland, Kimberly A.; Hanshew, Alissa S.; Suen, Garret; Thibeault, Susan L.

    2016-01-01

    Prolonged diffuse laryngeal inflammation from smoking and/or reflux is commonly diagnosed as chronic laryngitis and treated empirically with expensive drugs that have not proven effective. Shifts in microbiota have been associated with many inflammatory diseases, though little is known about how resident microbes may contribute to chronic laryngitis. We sought to characterize the core microbiota of disease-free human laryngeal tissue and to investigate shifts in microbial community membership associated with exposure to cigarette smoke and reflux. Using 454 pyrosequencing of the 16S rRNA gene, we compared bacterial communities of laryngeal tissue biopsies collected from 97 non-treatment-seeking volunteers based on reflux and smoking status. The core community was characterized by a highly abundant OTU within the family Comamonadaceae found in all laryngeal tissues. Smokers demonstrated less microbial diversity than nonsmokers, with differences in relative abundances of OTUs classified as Streptococcus, unclassified Comamonadaceae, Cloacibacterium, and Helicobacter. Reflux status did not affect microbial diversity nor community structure nor composition. Comparison of healthy laryngeal microbial communities to benign vocal fold disease samples revealed greater abundance of Streptococcus in benign vocal fold disease suggesting that mucosal dominance by Streptococcus may be a factor in disease etiology. PMID:27775059

  14. The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux

    NARCIS (Netherlands)

    de Jong, [No Value; van Ramshorst, B; Timmer, R; Gooszen, HG; Smout, AJPM

    2004-01-01

    Background: Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. Methods: 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after

  15. Heartburn, gastro-oesophageal reflux disease and non-erosive ...

    African Journals Online (AJOL)

    2010-01-31

    Jan 31, 2010 ... stomach acid causes troublesome reflux-associated symptoms and/or .... Magnesium salts, however, can lead to diarrhoea, and aluminium salts can cause ... relieve symptoms for longer periods.12 Although some proton ... 15 mg and pantoprazole 20 mg.13 Higher dosage PPIs and other. PPIs are ...

  16. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    OpenAIRE

    Thomas Lendvay

    2008-01-01

    Robotic-assisted laparoscopy (RAL) has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are traine...

  17. Inducing and Aggravating Factors of Gastroesophageal Reflux Symptoms

    Directory of Open Access Journals (Sweden)

    Radhiyatam Mardhiyah

    2016-12-01

    Full Text Available Gastroesophageal reflux disease (subsequently abbreviated as GERD is a disease commonly found in the community. Several factors have been recognized as inducing and aggravating factors of GERD symptoms such as older age, female gender, obesity, smoking habit, alcohol consumption, certain diet and poor eating habit like eating fatty, spicy, and acid food.

  18. Erroneous Diagnosis of Gastroesophageal Reflux Disease in Achalasia

    NARCIS (Netherlands)

    B.F. Kessing; A.J. Bredenoord; A.J.P.M. Smout

    2011-01-01

    BACKGROUND & AIMS: Most experienced gastroenterologists have seen one or several cases of achalasia patients who have been erroneously diagnosed with gastroesophageal reflux disease (GERD) or even underwent antireflux surgery. We aim to describe the current knowledge about the diagnostic features of

  19. Gastroesophageal reflux disease: exaggerations, evidence and clinical practice

    Directory of Open Access Journals (Sweden)

    Cristina Targa Ferreira

    2014-04-01

    Full Text Available OBJECTIVE: there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD in children. The association between GERD and cow's milk protein allergy (CMPA, overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children. DATA SOURCE: a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013. DATA SYNTHESIS: abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER. Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects. CONCLUSIONS: there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.

  20. Role of the Renin–Angiotensin System in the Pathogenesis of Intimal Hyperplasia: Therapeutic Potential for Prevention of Vein Graft Failure?

    Science.gov (United States)

    Osgood, Michael J.; Harrison, David G.; Sexton, Kevin W.; Hocking, Kyle M.; Voskresensky, Igor V.; Komalavilas, Padmini; Cheung-Flynn, Joyce; Guzman, Raul J.; Brophy, Colleen M.

    2014-01-01

    The saphenous vein remains the most widely used conduit for peripheral and coronary revascularization despite a high rate of vein graft failure. The most common cause of vein graft failure is intimal hyperplasia. No agents have been proven to be successful for the prevention of intimal hyperplasia in human subjects. The rennin–angiotensin system is essential in the regulation of vascular tone and blood pressure in physiologic conditions. However, this system mediates cardiovascular remodeling in pathophysiologic states. Angiotensin II is becoming increasingly recognized as a potential mediator of intimal hyperplasia. Drugs modulating the renin–angiotensin system include angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These drugs are powerful inhibitors of atherosclerosis and cardiovascular remodeling, and they are first-line agents for management of several medical conditions based on class I evidence that they delay progression of cardiovascular disease and improve survival. Several experimental models have demonstrated that these agents are capable of inhibiting intimal hyperplasia. However, there are no data supporting their role in prevention of intimal hyperplasia in patients with vein grafts. This review summarizes the physiology of the rennin–angiotensin system, the role of angiotensin II in the pathogenesis of cardiovascular remodeling, the medical indications for these agents, and the experimental data supporting an important role of the rennin–angiotensin system in the pathogenesis of intimal hyperplasia. PMID:22445245

  1. Modulation of action potential trains in rabbit saphenous nerve unmyelinated fibers.

    Science.gov (United States)

    Zhu, Zhi-Ru; Liu, Yi-Hui; Ji, Wei-Gang; Duan, Jian-Hong; Hu, San-Jue

    2013-01-01

    Usually, the main axon is assumed to faithfully conduct action potentials (APs). Recent data have indicated that neural processing can occur along the axonal path. However, the patterns and mechanisms of temporal coding are not clear. In the present study, single fiber recording was used to analyze activity-dependent modulation of AP trains in the main axons of C fibers in the rabbit saphenous nerve. Trains of 5 superthreshold electrical pulses at interstimulus intervals of 20 or 50 ms were applied to the nerve trunk for 200 s. The interspike intervals (ISIs) for these trains were compared to the input interstimulus intervals. Three basic types of C fibers were observed in response to repeated stimuli: first, the ISI between the first and second AP (ISI1-2) of type 1 was longer than the interstimulus interval; second, the ISI1-2 of type 2 showed wavelike fluctuations around the interstimulus interval, and third, the ISI1-2 of type 3 exhibited shorter intervals for a long period. Furthermore, both 4-aminopyridine-sensitive potassium and hyperpolarization-activated cation currents were involved in the modulation of ISI1-2 of train pulses. These data provide new evidence that multiple modes of neural conduction can occur along the main axons of C fibers.

  2. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

    BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted elect