WorldWideScience

Sample records for underwent peripheral venous

  1. Management of Peripheral and Truncal Venous Injuries

    Directory of Open Access Journals (Sweden)

    Triantafillos G. Giannakopoulos

    2017-08-01

    Full Text Available Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.

  2. Inflammation and peripheral venous disease. The San Diego Population Study.

    Science.gov (United States)

    Cushman, M; Callas, P W; Allison, M A; Criqui, M H

    2014-09-02

    The inflammatory response to healing in venous thrombosis might cause vein damage and post-thrombotic syndrome. Inflammation may also be involved in venous insufficiency apart from deep-vein thrombosis. We studied the association of inflammation markers with venous insufficiency in a general population sample. We characterised 2,404 men and women in a general population cohort for peripheral venous disease and its severity using physical exam, symptom assessment, and venous ultrasound. Inflammation markers, C-reactive protein (CRP), fibrinogen, interleukin 1-beta (IL-1-beta), IL-8, IL-10, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, monocyte chemoattractant-1 (MCP-1) and vascular endothelial cell growth factor (VEGF) were compared in 352 case participants with peripheral venous disease and 352 controls with no venous abnormalities frequency matched to cases by age, sex and race. Associations were also evaluated including a subset of 108 cases of severe venous disease, as previously defined. Odds ratios (95% CI), for peripheral venous disease for biomarkers in the top quartile (adjusting for age, race, sex, body mass index and history of venous thrombosis) were 1.8 (1.1-3.0), 1.6 (1.0-2.5) and 1.5 (0.9-2.3) for CRP, fibrinogen and IL-10, respectively. Associations were larger considering cases of severe venous disease, with odds ratios for these three analytes of 2.6 (1.2-5.9), 3.1 (1.3-7.3) and 2.2 (1.1-4.4), and for IL-8: 2.4 (1.1-5.2). There was no association of IL-1-beta, ICAM-1, VCAM-1, E-selectin, MCP-1 or VEGF with overall cases or severe venous disease. In conclusion, a subset of inflammation markers were associated with increased risk of peripheral venous disease, suggesting potential therapeutic targets for treatment.

  3. Microbiological testing of devices used in maintaining peripheral venous catheters

    OpenAIRE

    Rossini, Fernanda de Paula; Andrade, Denise de; Santos, Lissandra Chaves de Sousa; Ferreira, Adriano Menis; Tieppo, Caroline; Watanabe, Evandro

    2017-01-01

    ABSTRACT Objective: to evaluate the use of peripheral venous catheters based on microbiological analysis of devices (dressing and three-way stopcocks) and thus contribute to the prevention and infection control. Methods: this was a prospective study of microbiological analysis of 30 three-way stopcocks (external surfaces and lumens) and 30 dressing used in maintaining the peripheral venous catheters of hospitalized adult patients. Results: all external surfaces, 40% of lumens, and 86.7% of...

  4. Imaging of the complications of peripherally inserted central venous catheters

    International Nuclear Information System (INIS)

    Amerasekera, S.S.H.; Jones, C.M.; Patel, R.; Cleasby, M.J.

    2009-01-01

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  5. Imaging of the complications of peripherally inserted central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Amerasekera, S.S.H. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)], E-mail: steve.amerasekera@nhs.net; Jones, C.M.; Patel, R.; Cleasby, M.J. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)

    2009-08-15

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  6. Peripheral venous distension elicits a blood pressure raising reflex in young and middle-aged adults.

    Science.gov (United States)

    Matthews, Evan L; Brian, Michael S; Coyle, Dana E; Edwards, David G; Stocker, Sean D; Wenner, Megan M; Farquhar, William B

    2016-06-01

    Distension of peripheral veins in humans elicits a pressor and sympathoexcitatory response that is mediated through group III/IV skeletal muscle afferents. There is some evidence that autonomic reflexes mediated by these sensory fibers are blunted with increasing age, yet to date the venous distension reflex has only been studied in young adults. Therefore, we tested the hypothesis that the venous distension reflex would be attenuated in middle-aged compared with young adults. Nineteen young (14 men/5 women, 25 ± 1 yr) and 13 middle-aged (9 men/4 women, 50 ± 2 yr) healthy normotensive participants underwent venous distension via saline infusion through a retrograde intravenous catheter in an antecubital vein during limb occlusion. Beat-by-beat blood pressure, muscle sympathetic nerve activity (MSNA), and model flow-derived cardiac output (Q), and total peripheral resistance (TPR) were recorded throughout the trial. Mean arterial pressure (MAP) increased during the venous distension in both young (baseline 83 ± 2, peak 94 ± 3 mmHg; P blood pressure, MSNA, and TPR were similar between young and middle-aged adults. Additionally, no correlation was found between age and the response to venous distension (all P > 0.05). These findings suggest that peripheral venous distension elicits a pressor and sympathetic response in middle-aged adults similar to the response observed in young adults. Copyright © 2016 the American Physiological Society.

  7. Complications of peripherally inserted central venous catheters in ...

    African Journals Online (AJOL)

    Background: The objective of this study was to assess the complications of peripherally inserted central venous catheters (PICC) in neonates admitted to neonatal surgical intensive care unit (NSICU). Patients and Methods: Retrospective analysis of 237 neonates admitted to NSICU from January 2010 to December 2011 ...

  8. Vascular access in neonatology: peripherally inserted central catheter and peripheral venous catheter

    Directory of Open Access Journals (Sweden)

    Marcia Lienemann

    2014-04-01

    The objective of this paper is to present aspects of peripherally inserted central catheter and peripheral venous catheter, highlighting important points in choosing the type of access. For the passage of peripherally inserted central catheter is previously performing specific course necessary, while the primary indication occurs when it is necessary to access the patient's stay for a long period of time. Whereas peripheral venipuncture is the most appropriate in cases of needing an IV line quickly and safely, for the administration of fluids, blood collection, blood transfusion and other.

  9. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters

    Science.gov (United States)

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

    To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ≥1 risk factor was 10.34% (12/116), in those with ≥2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis. PMID:25664112

  10. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns

    NARCIS (Netherlands)

    Arnts, I.J.J.; Bullens, L.M.; Groenewoud, H.; Liem, K.D.

    2014-01-01

    OBJECTIVE: To compare the complication rates between umbilical central venous catheters and peripherally inserted central venous catheters in newborns and to investigate whether other variables might increase complication rates. DESIGN: A retrospective observational study. SETTING: A Level III

  11. Differences in peripheral arterial and venous hemorheologic parameters

    NARCIS (Netherlands)

    Mokken, F. C.; van der Waart, F. J.; Henny, C. P.; Goedhart, P. T.; Gelb, A. W.

    1996-01-01

    To evaluate the comparability of hemorheologic parameters in arterial and venous blood, we measured hematocrit, whole blood viscosity, plasma viscosity, erythrocyte deformability, erythrocyte aggregation, and erythrocyte indices in both arterial and venous blood from 20 consecutive patients

  12. Inserting epidural patient controlled analgesia into a peripheral venous line.

    Science.gov (United States)

    2016-01-01

    A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management.

    Science.gov (United States)

    Poletti, Fabrizio; Coccino, Claudio; Monolo, Davide; Crespi, Paolo; Ciccioli, Giorgio; Cordio, Giuseppe; Seveso, Giovanni; De Servi, Stefano

    2018-03-01

    Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care. All patients admitted to cardiac intensive care unit with indication for elective central venous access were checked by venous arm ultrasound for peripherally inserted central catheter's implantation. Peripherally inserted central catheters were inserted by ultrasound-guided puncture. After 7 days from the catheter's placement and at the removal, vascular ultrasound examination was performed searching signs of upper extremity deep venous thrombosis. In case of sepsis, blood cultures peripherally from the catheter and direct culture of the tip of the catheter were done to establish a catheter-related blood stream infection. In our cardiac intensive care unit, 137 peripherally inserted central catheters were placed: 80.3% of patients eligible for a peripherally inserted central catheter were implanted. The rate of symptomatic catheter-related peripheral venous thrombosis was 1.4%. Catheter-related blood stream infection was diagnosed in one patient (0.7%; 5.7 × 1000 peripherally inserted central catheter days). All peripherally inserted central catheters were inserted successfully without other major complications. In patients admitted to cardiac intensive care unit, peripherally inserted central catheters' insertion was feasible in a high percentage of patients and was associated with low infective complications and clinical thrombosis rate.

  14. Microbiological testing of devices used in maintaining peripheral venous catheters.

    Science.gov (United States)

    Rossini, Fernanda de Paula; Andrade, Denise de; Santos, Lissandra Chaves de Sousa; Ferreira, Adriano Menis; Tieppo, Caroline; Watanabe, Evandro

    2017-05-15

    to evaluate the use of peripheral venous catheters based on microbiological analysis of devices (dressing and three-way stopcocks) and thus contribute to the prevention and infection control. this was a prospective study of microbiological analysis of 30 three-way stopcocks (external surfaces and lumens) and 30 dressing used in maintaining the peripheral venous catheters of hospitalized adult patients. all external surfaces, 40% of lumens, and 86.7% of dressing presented bacterial growth. The main species isolated in the lumen were 50% coagulase-negative Staphylococcus, 14.3% Staphylococcus aureus, and 14.3% Pseudomonas aeruginosa. Fifty nine percent of multidrug-resistant bacteria were isolated of the three-way stopcocks, 42% of the lumens, and 44% of the dressing with a predominance of coagulase-negative Staphylococcus resistant to methicillin. Besides, 18% gram-negative bacteria with resistance to carbapenems were identified from multidrug-resistant bacteria on the external surfaces of the three-way stopcocks. it is important to emphasize the isolation of coagulase-negative Staphylococcus and gram-negative bacteria resistant to methicillin and carbapenems in samples of devices, respectively, which reinforces the importance of nursing care in the maintenance of the biologically safe environment as well as prevention and infection control practices. avaliar o uso de cateteres venosos periféricos com base em análises microbiológicas de dispositivos (curativos e torneiras de três vias - T3Vs) e assim contribuir para a prevenção e controle de infecção. estudo prospectivo de análise microbiológica de 30 T3Vs (superfícies externas e lúmens) e 30 curativos utilizados na manutenção dos cateteres venosos periféricos de pacientes adultos hospitalizados. todas as superfícies externas, 40% dos lúmens e 86,7% dos curativos apresentaram crescimento bacteriano. As principais espécies isoladas no lúmen foram 50% Staphylococcus coagulase-negativa, 14

  15. The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow

    International Nuclear Information System (INIS)

    Wohlgemuth, Walter A.; Müller-Wille, René; Teusch, Veronika I.; Dudeck, Oliver; Cahill, Anne M.; Alomari, Ahmad I.; Uller, Wibke

    2015-01-01

    PurposeTo evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.Materials and MethodsWe conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.Results11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.ConclusionInitial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate

  16. The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, Walter A., E-mail: walter.wohlgemuth@ukr.de; Müller-Wille, René, E-mail: Rene.Mueller-Wille@ukr.de; Teusch, Veronika I., E-mail: Veronika.Teusch@gmx.de [University Medical Center Regensburg, Department of Radiology (Germany); Dudeck, Oliver, E-mail: Oliver.Dudeck@med.ovgu.de [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Cahill, Anne M., E-mail: Cahill@email.chop.edu [Perelman School of Medicine of the University of Pennsylvania, Division of Interventional Radiology, Department of Radiology, Children’s Hospital of Philadelphia (United States); Alomari, Ahmad I., E-mail: Ahmad.Alomari@childrens.harvard.edu [Boston Children’s Hospital and Harvard Medical School, Division of Vascular and Interventional Radiology (United States); Uller, Wibke, E-mail: Wibke.Uller@ukr.de [University Medical Center Regensburg, Department of Radiology (Germany)

    2015-06-15

    PurposeTo evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.Materials and MethodsWe conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.Results11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.ConclusionInitial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate.

  17. A novel technique of axillary vein puncture involving peripherally inserted central venous catheters for a small basilic vein.

    Science.gov (United States)

    Saijo, Fumito; Odaka, Yoshinobu; Mutoh, Mitsuhisa; Katayose, Yu; Tokumura, Hiromi

    2018-03-01

    Peripherally inserted central venous catheters are some of the most useful devices for vascular access used globally. Peripherally inserted central venous catheters have a low rate of fatal mechanical complications when compared to non-tunnel central venous catheters. However, as peripherally inserted central venous catheter access requires a smaller vein, there is a high risk of thrombosis. The axillary vein (confluence of the basilic and brachial veins) can serve as an access for cannulation. Moreover, as this vein is larger than the basilic or brachial vein, it might be a superior option for preventing thrombosis. The risk of catheter-related bloodstream infection should be considered when the puncture site is at the axillary fossa. The aim of this study was to present our new protocol involving peripherally inserted central venous catheters (non-tunneled/tunneled) and a tunneling technique and assess its feasibility and safety for improving cannulation and preventing thrombosis and infection. The study included 20 patients. The axillary vein in the upper arm was used for peripherally inserted central venous catheters in patients with a small-diameter basilic vein (venous catheter. The observed catheter duration was 645 days (median ± standard deviation, 26 ± 22.22 days). Catheterization was successful in all cases, however, two accidental dislodgements were identified. No fatal or serious complications were observed after catheterization. Our new protocol for axillary peripherally inserted central venous catheters/tunneled axillary peripherally inserted central venous catheters use for a small-diameter basilic vein is safe and feasible.

  18. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis.

    Science.gov (United States)

    Egan, Grace; Healy, Donagh; O'Neill, Heidi; Clarke-Moloney, Mary; Grace, Pierce A; Walsh, Stewart R

    2013-07-01

    Establishing intravenous access is often vital in an acute hospital setting but can be difficult. Ultrasound-guided cannulation increases success rates in prospective studies. However, these studies have often lacked a comparative group. This systematic review and meta-analysis aimed to determine the clinical effectiveness of Ultrasound-guided peripheral intravenous cannulation compared with the standard technique in patients known to have difficult access. Electronic abstract databases, trial registries, article reference lists and internet repositories were searched using the following search terms: 'peripheral venous cannulation', 'peripheral venous access'. Studies meeting the following criteria were included: randomised controlled trial patients of all ages who required peripheral intravenous access; interventions were Ultrasound-guided versus standard cannulation technique; patients were identified as having difficult venous access; inclusion of at least one defined outcome (procedural success time to cannula placement; number of attempts). 7 trials were identified (289 participants). Ultrasound guidance increases the likelihood of successful cannulation (pooled OR 2.42; 95% CI 1.26 to 4.68; p=0.008). There were no differences in time to successful cannulation, or number of percutaneous skin punctures. Ultrasound guidance increases the likelihood of successful peripheral cannulation in difficult access patients. We recommend its use in patients who have difficult venous access, and have failed venous cannulation by standard methods. Further randomised controlled trials (RCTs) with larger sample sizes would be of benefit to investigate if Ultrasound has any additional advantages in terms of reducing the procedure time and the number of skin punctures required for successful venous cannulation.

  19. ABO blood group related venous thrombosis risk in patients with peripherally inserted central catheters.

    Science.gov (United States)

    Koo, Chung Mo; Vissapragada, Ravi; Sharp, Rebecca; Nguyen, Phi; Ung, Thomas; Solanki, Chrismin; Esterman, Adrian

    2018-02-01

    To investigate the association between ABO blood group and upper limb venous thrombosis (VT) risk in patients with peripherally inserted central catheters (PICC). Single centre retrospective cohort study. A cohort of patients who underwent PICC insertion from September 2010 to August 2014 were followed up for symptomatic VT presentations diagnosed by ultrasound. Blood group status was identified from hospital information systems. 2270 participants had 3020 PICCs inserted. There were 124 cases of symptomatic VT, an incident rate of 4% [95% confidence interval, CI (3-5%)]. Univariate analysis adjusting for the clustered sample showed that having chemotherapy, two or more previous PICCs, a larger catheter size, a diagnosis of cancer and having a blood group B were all associated with an increased risk of a VT. In the multivariate analysis, PICC diameter, cancer diagnosis and blood group B were all independently associated with increased risk of VT. Patients undergoing PICC insertion with a blood group B appear to have a higher risk of VT, independent of risks attached to the PICC procedure and cancer diagnosis. Without any existing guidelines for PICC-related VT, this investigation creates a platform for further research to be conducted in order to establish guidelines. Advances in knowledge: Previous studies investigating VT risk associated with blood group status related to large heterogeneous populations. In this article, we look at patients specifically with PICC, which reduces the heterogeneity in the cohort. In addition, due to the substantial number of patients enrolled, we had a chance to perform multivariate analyses with statistical significance.

  20. An unknown complication of peripherally inserted central venous catheter in a patient with ventricular assist device

    Directory of Open Access Journals (Sweden)

    Parikh M

    2011-01-01

    Full Text Available We report an unknown complication of peripherally inserted central venous catheter in a patient with Ventricular Assist Device. This rare complication led to the failure of the right ventricular assist device, which could be detrimental in patients with dilated cardiomyopathy.

  1. Can Peripheral Central Venous Lines be inserted safely and ...

    African Journals Online (AJOL)

    This study was performed to determine whether the placement of a more flexible peripherally inserted catheter, the Arrow PICC (Arrow PS-01651), would result in an improved and acceptable success rate. Method: Twenty-three patients in the casualty unit of the Mamelodi Hospital during 1997 and 1998, who required a ...

  2. Quantitative determination of peripheral arterio-venous shunts by means of radioactively labelled microspheres

    International Nuclear Information System (INIS)

    Friese, K.H.

    1981-01-01

    In the present work a nuclear method of quantitative measurement of peripheral arterio-venous shunts with a whole-body scanner is standardized. This method, developed at the beginning of the 70s at Tuebingen, stands out in contrast with earlier measuring methods by the application of the theory of quantitative scintiscanning. This means that the scintigram obtained after injection of sup(99m)technetium-labelled human albumin microspheres into an artery before the shunt is corrected for the quantitative shunt calculation by several factors using a computer, to avoid systematic mistakes. For the standardization of the method, 182 scintigrams were taken during model experiments and experiments on animals and human beings. This method, having a deviation of 10% at most, is excellently suited for the quantitative determination of peripheral arterio-venous shunts. Already for a pulmonary activity of 3% a peripheral shunt is proved with 97.5% probability. (orig./MG) [de

  3. Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small children.

    Science.gov (United States)

    Hosokawa, K; Kato, H; Kishi, C; Kato, Y; Shime, N

    2010-09-01

    Transillumination facilitates the visualization of peripheral veins in infants and children. The clinical usefulness of light-emitting diode (LED)-powered devices has not been thoroughly studied. We randomly assigned 136 infants and children weighing LED-powered transillumination (TM group, n=67) vs. the usual method (UM group, n=69) of peripheral venous cannulations. Venous puncture was performed following anesthesia induction with sevoflurane and nitrous oxide. The primary and secondary study endpoints were the rate of successful cannulations at initial attempt, and the duration of insertion attempts, respectively. The median score of the estimated cannulation difficulty before attempted puncture was similar in both groups. The success rates at first attempt were 75% and 61% (NS) and mean+/-SD times to successful venous access were 47+/-34 and 68+/-66 s (NS) in the TM and UM groups, respectively. The cannulation procedures were completed significantly earlier in the TM group than in the UM group (hazard ratio, 1.59; 95% confidence interval, 1.03-2.47; P=0.03). In the subgroup of infants and children LED-powered transillumination devices facilitated peripheral venous cannulations in small infants and children.

  4. Does the preference of peripheral versus central venous access in peripheral blood stem cell collection/yield change stem cell kinetics in autologous stem cell transplantation?

    Science.gov (United States)

    Dogu, Mehmet Hilmi; Kaya, Ali Hakan; Berber, Ilhami; Sari, İsmail; Tekgündüz, Emre; Erkurt, Mehmet Ali; Iskender, Dicle; Kayıkçı, Ömur; Kuku, Irfan; Kaya, Emin; Keskin, Ali; Altuntaş, Fevzi

    2016-02-01

    Central venous access is often used during apheresis procedure in stem cell collection. The aim of the present study was to evaluate whether central or peripheral venous access has an effect on stem cell yield and the kinetics of the procedure and the product in patients undergoing ASCT after high dose therapy. A total of 327 patients were retrospectively reviewed. The use of peripheral venous access for stem cell yield was significantly more frequent in males compared to females (p = 0.005). Total volume of the product was significantly lower in central venous access group (p = 0.046). As being a less invasive procedure, peripheral venous access can be used for stem cell yield in eligible selected patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Effect of body temperature on peripheral venous pressure measurements and its agreement with central venous pressure in neurosurgical patients.

    Science.gov (United States)

    Sahin, Altan; Salman, M Alper; Salman, A Ebru; Aypar, Ulka

    2005-04-01

    Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical settings. The effect of body temperature on PVP and its agreement with CVP in patients under general anesthesia are investigated in this study. Fifteen American Society of Anesthesiologists I-II patients undergoing elective craniotomy were included in the study. CVP, PVP, and core (Tc) and peripheral (Tp) temperatures were monitored throughout the study. A total of 950 simultaneous measurements of CVP, PVP, Tc, and Tp from 15 subjects were recorded at 5-minute intervals. The measurements were divided into low- and high-Tc and -Tp groups by medians as cutoff points. Bland-Altman assessment for agreement was used for CVP and PVP in all groups. PVP measurements were within range of +/-2 mm Hg of CVP values in 94% of the measurements. Considering all measurements, mean bias was 0.064 mm Hg (95% confidence interval -0.018-0.146). Corrected bias for repeated measurements was 0.173 +/- 3.567 mm Hg (mean +/- SD(corrected)). All of the measurements were within mean +/- 2 SD of bias, which means that PVP and CVP are interchangeable in our setting. As all the measurements were within 1 SD of bias when Tc was > or = 35.8 degrees C, even a better agreement of PVP and CVP was evident. The effect of peripheral hypothermia was not as prominent as core hypothermia. PVP measurement may be a noninvasive alternative for estimating CVP. Body temperature affects the agreement of CVP and PVP, which deteriorates at lower temperatures.

  6. Effect of Ultrasound-Guided Placement of Difficult-to-Place Peripheral Venous Catheters

    DEFF Research Database (Denmark)

    Partovi-Deilami, Kohyar; Nielsen, Jesper K.; Møller, Ann M.

    2016-01-01

    , discomfort, catheter size, location, and incidence of central venous catheter placement are reported before and after implementation of a training program and a mobile service using ultrasound to place difficult-to-place PVCs. The success rate increased from 0% (0 of 33 patients) to 83% (58 of 70 patients......) with ultrasound. Procedure time was reduced from 20 to 10 minutes, discomfort was unchanged, and the median number of skin punctures decreased from 3 to 2. The incidence of central venous catheter placement dropped from 34% to 7%. Implementation of a training program and a mobile service in which nurse......Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when...

  7. Risk of Venous Thromboembolism Following Peripherally Inserted Central Catheter Exchange: An Analysis of 23,000 Hospitalized Patients.

    Science.gov (United States)

    Chopra, Vineet; Kaatz, Scott; Grant, Paul; Swaminathan, Lakshmi; Boldenow, Tanya; Conlon, Anna; Bernstein, Steven J; Flanders, Scott A

    2018-02-01

    Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known. We performed a retrospective cohort study to assess the association between PICC exchange and risk of thromboembolism. Adult hospitalized patients that received a PICC during clinical care at one of 51 hospitals participating in the Michigan Hospital Medicine Safety consortium were included. The primary outcome was hazard of symptomatic venous thromboembolism (radiographically confirmed upper-extremity deep vein thrombosis and pulmonary embolism) in those that underwent PICC exchange vs those that did not. Of 23,010 patients that underwent PICC insertion in the study, 589 patients (2.6%) experienced a PICC exchange. Almost half of all exchanges were performed for catheter dislodgement or occlusion. A total of 480 patients (2.1%) experienced PICC-associated deep vein thrombosis. The incidence of deep vein thrombosis was greater in those that underwent PICC exchange vs those that did not (3.6% vs 2.0%, P < .001). Median time to thrombosis was shorter among those that underwent exchange vs those that did not (5 vs 11 days, P = .02). Following adjustment, PICC exchange was independently associated with twofold greater risk of thrombosis (hazard ratio [HR] 1.98; 95% confidence interval [CI], 1.37-2.85) vs no exchange. The effect size of PICC exchange on thrombosis was second in magnitude to device lumens (HR 2.06; 95% CI, 1.59-2.66 and HR 2.31; 95% CI, 1.6-3.33 for double- and triple-lumen devices, respectively). Guidewire exchange of PICCs may be associated with increased risk of thrombosis. As some exchanges may be preventable, consideration of risks and benefits of exchanges in clinical practice is needed. Published by Elsevier Inc.

  8. Peripheral and Central Venous Blood Glucose Concentrations in Dogs and Cats with Acute Arterial Thromboembolism

    OpenAIRE

    Klainbart, S.; Kelmer, E.; Vidmayer, B.; Bdolah?Abram, T.; Segev, G.; Aroch, I.

    2014-01-01

    Background Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging. Hypothesis/Objectives Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval. Animals Client?owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 ca...

  9. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.

    Science.gov (United States)

    Ainsworth, S B; Clerihew, L; McGuire, W

    2007-07-18

    Parenteral nutrition for neonates may be delivered via a short peripheral cannula or a central venous catheter. The latter may either be inserted via the umbilicus or percutaneously. Because of the complications associated with umbilical venous catheter use, many neonatal units prefer to use percutaneously inserted catheters following the initial stabilisation period. The method of parenteral nutrition delivery may affect nutrient input and consequently growth and development. Although potentially more difficult to place, percutaneous central venous catheters may be more stable than peripheral cannulae, and need less frequent replacement. These delivery methods may also be associated with different risks of adverse events, including acquired systemic infection and extravasation injury. To determine the effect of infusion via a percutaneous central venous catheter versus a peripheral cannula on nutrient input, growth and development, and complications including systemic infection, or extravasation injuries in newborn infants who require parenteral nutrition. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007), MEDLINE (1966 - February 2007), EMBASE (1980 - February 2007), conference proceedings, and previous reviews. Randomised controlled trials that compared the effect of delivering parenteral nutrition via a percutaneous central venous catheter versus a peripheral cannulae in neonates. Data were extracted the data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author, and synthesis of data using relative risk, risk difference and mean difference. Four trials eligible for inclusion were found. These trials recruited a total of 368 infants and reported a number of different outcomes. One study showed that the use of a percutaneous

  10. Assessing nursing students' knowledge and skills in performing venepuncture and inserting peripheral venous catheters.

    Science.gov (United States)

    Ahlin, C; Klang-Söderkvist, B; Johansson, E; Björkholm, M; Löfmark, A

    2017-03-01

    Venepuncture and the insertion of peripheral venous catheters are common tasks in health care, and training in these procedures is included in nursing programmes. Evidence of nursing students' knowledge and skills in these procedures is limited. The main aim of this study was to assess nursing students' knowledge and skills when performing venepuncture and inserting peripheral venous catheters. Potential associations between level of knowledge and skills, self-training, self-efficacy, and demographic characteristics were also investigated. The assessment was performed by lecturers at a university college in Sweden using the two previously tested instruments "Assess Venepuncture" and "Assess Peripheral Venous Catheter Insertion". Between 81% and 100% of steps were carried out correctly by the students. The step with the highest rating was "Uses gloves", and lowest rating was 'Informs the patients about the possibility of obtaining local anaesthesia'. Significant correlations between degree of self-training and correct performance were found in the group of students who registered their self-training. No associations between demographic characteristics and correct performances were found. Assessing that students have achieved adequate levels of knowledge and skills in these procedures at different levels of the nursing education is of importance to prevent complications and support patient safety. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Optoacoustic monitoring of central and peripheral venous oxygenation during simulated hemorrhage

    Science.gov (United States)

    Petrov, Andrey; Kinsky, Michael; Prough, Donald S.; Petrov, Yuriy; Petrov, Irene Y.; Henkel, S. Nan; Seeton, Roger; Salter, Michael G.; Khan, Muzna N.; Esenaliev, Rinat O.

    2014-03-01

    Circulatory shock may be fatal unless promptly recognized and treated. The most commonly used indicators of shock (hypotension and tachycardia) lack sensitivity and specificity. In the initial stages of shock, the body compensates by reducing blood flow to the peripheral (skin, muscle, etc.) circulation in order to preserve vital organ (brain, heart, liver) perfusion. Characteristically, this can be observed by a greater reduction in peripheral venous oxygenation (for instance, the axillary vein) compared to central venous oxygenation (the internal jugular vein). While invasive measurements of oxygenation are accurate, they lack practicality and are not without complications. We have developed a novel optoacoustic system that noninvasively determines oxygenation in specific veins. In order to test this application, we used lower body negative pressure (LBNP) system, which simulates hemorrhage by exerting a variable amount of suction on the lower body, thereby reducing the volume of blood available for central circulation. Restoration of normal blood flow occurs promptly upon cessation of LBNP. Using two optoacoustic probes, guided by ultrasound imaging, we simultaneously monitored oxygenation in the axillary and internal jugular veins (IJV). LBNP began at -20 mmHg, thereafter was reduced in a step-wise fashion (up to 30 min). The optoacoustically measured axillary oxygenation decreased with LBNP, whereas IJV oxygenation remained relatively constant. These results indicate that our optoacoustic system may provide safe and rapid measurement of peripheral and central venous oxygenation and diagnosis of shock with high specificity and sensitivity.

  12. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

    Directory of Open Access Journals (Sweden)

    Kampf, Günter

    2013-11-01

    Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

  13. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients.

    Science.gov (United States)

    Ugas, Mohamed Ali; Cho, Hyongyu; Trilling, Gregory M; Tahir, Zainab; Raja, Humaera Farrukh; Ramadan, Sami; Jerjes, Waseem; Giannoudis, Peter V

    2012-09-04

    Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

  14. Improving Patient Safety with a Mobile Application for Patients with Peripherally Inserted Central Venous Catheters (PICC).

    Science.gov (United States)

    Nüssli, Stephan; Schnyder, Florian; Zenhäusern, Raphael; Bosshart, Katharina

    2016-01-01

    Peripherally inserted central venous catheters (PICCs) are of growing interest because they allow intravenous therapies up to several months. The appropriate management of the PICCs is crucial to minimize complications and largely depends on the right information for everyone who cares for the patient. To reach this goal we develop the mobile application "PICC App" to provide the necessary information for all involved persons in the outpatient setting. We expect to be able to report about the PICC App and the results of the usability evaluation with pilot users.

  15. Acute Brachial Artery Thrombosis in a Neonate Caused by a Peripheral Venous Catheter

    Directory of Open Access Journals (Sweden)

    Simon Berzel

    2014-01-01

    Full Text Available This case describes the diagnostic testing and management of an acute thrombosis of the brachial artery in a female neonate. On day seven of life, clinical signs of acutely decreased peripheral perfusion indicated an occlusion of the brachial artery, which was confirmed by high-resolution Doppler ultrasound. Imaging also showed early stages of collateralization so that surgical treatment options could be avoided. Unfractionated heparin was used initially and then replaced by low-molecular-weight heparin while coagulation parameters were monitored closely. Within several days, brachial artery perfusion was completely restored. Acetylsalicylic acid was given for additional six weeks to minimize the risk of recurring thrombosis. If inadequately fixated in a high-risk location, a peripheral venous catheter can damage adjacent structures and thus ultimately cause arterial complications.

  16. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility.

    Science.gov (United States)

    Sebbane, Mustapha; Claret, Pierre-Géraud; Lefebvre, Sophie; Mercier, Grégoire; Rubenovitch, Josh; Jreige, Riad; Eledjam, Jean-Jacques; de La Coussaye, Jean-Emmanuel

    2013-02-01

    Peripheral venous (PV) cannulation, one of the most common technical procedures in Emergency Medicine, may prove challenging, even to experienced Emergency Department (ED) staff. Morbid obesity (body mass index [BMI] ≥ 40) has been reported as a risk factor for PV access failure in the operating room. We investigated PV access difficulty in the ED, across BMI categories, focusing on patient-related predicting factors. Prospective, observational study including adult patients requiring PV lines. Operators were skilled nurses and physicians. PV accessibility was clinically evaluated before all cannulation attempts, using vein visibility and palpability. Patient and PV placement characteristics were recorded. Primary outcome was failure at first attempt. Outcome frequency and comparisons between groups were examined. Predictors of difficult cannulation were explored using logistic regression. A p-value underweight, an unfavorable, and a very unfavorable clinical evaluation of PV accessibility are independent risk factors for difficult PV access. Early recognition of patients at risk could help in planning alternative approaches for achieving rapid PV access. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.

    Science.gov (United States)

    Chopra, Vineet; Anand, Sarah; Hickner, Andy; Buist, Michael; Rogers, Mary Am; Saint, Sanjay; Flanders, Scott A

    2013-07-27

    Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs. We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle-Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis. Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68-20·14) and those with cancer (6·67%, 4·69-8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54-4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13-71). PICCs are

  18. CARCINOEMBRYONIC ANTIGEN LEVELS IN THE PERIPHERAL AND MESENTERIC VENOUS BLOOD OF PATIENTS WITH RECTAL CARCINOMA

    Directory of Open Access Journals (Sweden)

    Herminio Cabral de REZENDE JUNIOR

    2013-12-01

    Full Text Available Context The serum carcinoembryonic antigen (CEA is an important prognostic factor in colorectal cancer, however the rectum presents different routes of venous drainage, stating that the level of CEA in peripheral and mesenteric rectal tumors may be different, depending on the location of the tumor in the rectal segment. Objective The goal of this study was to evaluate the relationship between the peripheral and mesenteric venous levels of CEA and the association between these levels and the tumour location in the rectums of patients successfully operated on for rectal carcinoma. Methods Thirty-two patients who were surgically treated for rectal carcinoma were divided into patients with tumours located in the upper rectum (n = 11 or lower rectum (n = 21. The CEA values were assessed by electrochemiluminescence immunoassay. Serum and mesenteric CEA levels were associated with the tumour anatomopathological characteristics: location, histological type, cellular differentiation grade, depth of invasion into the rectal wall, angiolymphatic invasion, tumour, node, and metastasis staging; and the CEA index (≤1.0 or ≥1.0 ng /mL. Results Analysis of the serum CEA values using clinical and anatomopathological parameters revealed no significant association with tumour location, histological type, cellular differentiation grade, depth of invasion into the intestinal wall, and tumour, node, and metastasis staging. The mesenteric CEA levels were significantly associated with the tumour location (P = 0.01. The CEA values in the mesenteric venous blood and the presence of angiolymphatic invasion (P = 0.047 were significantly different. A significant relationship was found between the CEA index value and the rectal tumour location (P = 0.0001. Conclusions The CEA levels were higher in the mesenteric vein in tumours located in the upper rectum and in the presence of angiolymphatic invasion. CEA drainage from lower rectum adenocarcinomas preferentially occurs

  19. Importance of Blood Cultures from Peripheral Veins in Pediatric Patients with Cancer and a Central Venous Line

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Rutkjær, Cecilie

    2015-01-01

    When an infection is suspected in a child with cancer and a central venous line (CVL), cultures are often only obtained from the CVL and not from a peripheral vein (PV). This study was undertaken to evaluate the importance of concomitant blood cultures from the CVL and a PV.......When an infection is suspected in a child with cancer and a central venous line (CVL), cultures are often only obtained from the CVL and not from a peripheral vein (PV). This study was undertaken to evaluate the importance of concomitant blood cultures from the CVL and a PV....

  20. Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study.

    Science.gov (United States)

    Medlej, Kamal; Kazzi, Amin Antoine; El Hajj Chehade, Ahel; Saad Eldine, Mothana; Chami, Ali; Bachir, Rana; Zebian, Dina; Abou Dagher, Gilbert

    2018-01-01

    The placement of a central venous catheter for the administration of vasopressors is still recommended and required by many institutions because of concern about complications associated with peripheral administration of vasopressors. Our aim was to determine the incidence of complications from the administration of vasopressors through peripheral venous catheters (PVC) in patients with circulatory shock, and to identify the factors associated with these complications. This was a prospective, observational study conducted in the emergency department (ED) of a tertiary care medical center. Patients presenting to the ED with circulatory shock and in whom a vasopressor was started through a PVC were included. Research fellows examined the i.v. access site for complications twice daily during the period of peripheral vasopressor administration, then daily up to 48 h after treatment discontinuation or until the patient expired. Of the 55 patients that were recruited, 3 (5.45% overall, 6% of patients receiving norepinephrine) developed complications; none were major. Two developed local extravasation and one developed local thrombophlebitis. All three complications occurred during the vasopressor infusion, none in the 48 h after discontinuation, and none required any medical or surgical intervention. Two of the three complications occurred in the hand, and all occurred in patients receiving norepinephrine and with 20-gauge catheters. The incidence of complications from the administration of vasopressors through a PVC is small and did not result in significant morbidity in this study. Larger prospective studies are needed to better determine the factors that are associated with these complications, and identify patients in whom this practice is safe. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients.

    Science.gov (United States)

    Gnannt, Ralph; Waespe, Nicolas; Temple, Michael; Amirabadi, Afsaneh; Liu, Kuan; Brandão, Leonardo R; Connolly, Bairbre L

    2018-02-27

    Peripherally inserted central catheters (PICCs) are associated with superficial and deep venous thrombosis of the arm. The purpose of this study was to analyze the sequelae of repeated upper limb PICC insertions in children, in terms of the frequency of upper limb thrombosis in this patient group. The study population included all children who underwent their first successful arm PICC insertion between January 2010 and December 2015. We included subsequent ipsilateral arm PICCs in the analysis. Patients were followed until March 2016 or until any alternative central venous line insertion. For each PICC insertion, we collected demographic variables and line characteristics. We correlated all symptomatic deep and superficial thromboses of the arm with the PICC database. Applying inclusion and exclusion criteria, 2,180 PICCs remained for analysis. We identified first, second, third and fourth PICC insertions in the same arm in 1,955, 181, 38 and 6 patients, respectively. In total there were 57 upper body deep symptomatic thrombotic events. An increasing odds ratio was seen with higher numbers of PICC insertions, which was significant when comparing the first with the third and fourth PICC insertions in the same arm (odds ratio [OR] 6.00, 95% confidence interval [CI] 2.25-16.04, P=0.0004). Double-lumen PICCs were associated with a significantly higher risk of thrombosis than single lumen (OR 2.77, 95% CI 1.72-4.47, P=0.0003). Repetitive PICC insertions in the same arm are associated with an increased risk of symptomatic thrombosis. Double-lumen PICCs are associated with a higher risk of thrombosis compared to single-lumen lines.

  2. Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection.

    Science.gov (United States)

    Cooling, Laura; Hoffmann, Sandra; Webb, Dawn; Yamada, Chisa; Davenport, Robertson; Choi, Sung Won

    2017-12-01

    Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A-HPCC. Seven-year, retrospective study of A-HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A-HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC-FE, CD34-FE), bleeding, flow-related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software. A total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34-FE was stable over time whereas MNC-FE decreased after day 4 in 80% of patients. CD34-FE and MNC-FE showed inter- and intra-patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow-related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03-0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20-30 min of pressure. In a 10-year period, there were no instances of product contamination associated with femoral CVC colonization. Femoral CVC are safe and effective for A-HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow-related alarms when compared to thoracic CVCs. © 2017 Wiley Periodicals, Inc.

  3. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature.

    Science.gov (United States)

    Johansson, Eva; Hammarskjöld, Fredrik; Lundberg, Dag; Arnlind, Marianne Heibert

    2013-06-01

    The use of central venous lines carries a significant risk for serious complications and high economic costs. Lately, the peripherally inserted central venous catheter (PICC) has gained in popularity due to presumed advantages over other central venous lines. The aim of this systematic literature review was to identify scientific evidence justifying the use of PICC. The literature review was performed according to the principles of Cochrane Collaboration. The electronic literature search included common databases up to March 2011. Only those studies rated as high or moderate quality were used for grading of evidence and conclusions. The search resulted in 827 abstracts, 48 articles were read in full text, and 11 met the inclusion criteria. None of the articles was classified as high quality and two had moderate quality. The results of these two studies indicate that PICC increases the risk for deep venous thrombosis (DVT), but decreases the risk for catheter occlusion. The quality of scientific evidence behind these conclusions, however, was limited. Due to the lack of studies with sufficiently high quality, questions such as early complications, patient satisfaction and costs could not be answered. We conclude that although PICCs are frequently used in oncology, scientific evidence supporting any advantage or disadvantage of PICC when comparing PICC with traditional central venous lines is limited, apart from a tendency towards increased risk for DVT and a decreased risk for catheter occlusion with PICC.

  4. Development of instruments for assessment of knowledge and skills in performing venepuncture and inserting peripheral venous catheters.

    Science.gov (United States)

    Ahlin, Catharina; Löfmark, Anna; Klang-Söderkvist, Birgitta; Johansson, Eva

    2013-01-01

    Performing venepuncture is one of the most routinely performed invasive procedures in nursing care. The aim of this study was to develop instruments for the assessment of nursing students' knowledge and skills when performing venepuncture and inserting a peripheral venous catheter. 
 Two instruments were developed using the following steps. 1) Assessment items of importance for the procedures (venepuncture 48 items and peripheral venous catheter 51 items) were collected from focus groups including nurses, lecturers and patients. 2) The number of items was reduced using a method based on the Delphi method. Experts (n=51) reviewed the instruments in two rounds. The revised versions included 31 items for venepuncture and 33 items for peripheral venous catheter insertion. 3) Usability tests were conducted by nurses who tested the instruments to confirm that items were possible to assess. 4) Inter-rater reliability was assessed by twelve lecturers who in pairs, but independently of each other, used the instruments to assess 50 nursing students. Proportion of agreement and Cohen's kappa coefficient were calculated for each item to determine inter-rater reliability. Among the tested items for both instruments, the median proportion of agreement was 1 (range 0.66-1) and the median kappa was 0.52 (range 0.22-1). The instruments developed for assessing nursing students' knowledge and skills of venepuncture and peripheral venous catheter insertion showed satisfactory inter-rater reliability.

  5. Correlation of Lactic Acid and Base Deficit Values Obtained From Arterial and Peripheral Venous Samples in a Pediatric Population During Intraoperative Care.

    Science.gov (United States)

    Bordes, Brianne M; Walia, Hina; Sebastian, Roby; Martin, David; Tumin, Dmitry; Tobias, Joseph D

    2017-12-01

    Lactic acid and base deficit (BD) values are frequently monitored in the intensive care unit and operating room setting to evaluate oxygenation, ventilation, cardiac output, and peripheral perfusion. Although generally obtained from an arterial cannula, such access may not always be available. The current study prospectively investigates the correlation of arterial and peripheral venous values of BD and lactic acid. The study cohort included 48 patients. Arterial BD values ranged from -8 to 4 mEq/L and peripheral venous BD values ranged from -8 to 4 mEq/L. Arterial lactic acid values ranged from 0.36 to 2.45 μmol/L and peripheral venous lactic acid values ranged from 0.38 to 4 μmol/L. The arterial BD (-0.4 ± 2.2 mEq/L) was not significantly different from the peripheral venous BD (-0.6 ± 2.2 mEq/L). The arterial lactic acid (1.0 ± 0.5 μmol/L) was not significantly different from the peripheral venous lactic acid (1.1 ± 0.6 μmol/L). Pearson correlation coefficients demonstrated a very high correlation between arterial and peripheral venous BD ( r = .88, P lactic acid ( r = .67, P lactic acid corresponded to a 0.9-unit increase in peripheral venous lactic acid (95% CI: 0.6-1.2; P lactic acid and BD values.

  6. Use of a Peripherally Inserted Central Catheter as a Conduit for Central Venous Access Across Thrombosed Great Veins

    International Nuclear Information System (INIS)

    Guntur Ramkumar, Prasad; Chakraverty, Sam; Zealley, Ian

    2010-01-01

    This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.

  7. Peripheral and central venous blood glucose concentrations in dogs and cats with acute arterial thromboembolism.

    Science.gov (United States)

    Klainbart, S; Kelmer, E; Vidmayer, B; Bdolah-Abram, T; Segev, G; Aroch, I

    2014-01-01

    Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging. Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval. Client-owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 cats and 9 dogs); acute limb paralysis secondary to orthopedic or neurologic conditions (nonambulatory controls; 10 cats and 11 dogs); ambulatory animals presented because of various diseases (ambulatory controls; 10 cats and 9 dogs). Prospective observational, clinical study. Systemic and local (affected limb) blood glucose concentrations were measured. Their absolute and relative differences (ΔGlu and %ΔGlu, respectively) were compared among groups. ΔGlu and %ΔGlu were significantly higher in the ATE cats and dogs groups, compared to both of their respective controls (P cats, respectively, and 1.00 and 1.00, in dogs, respectively. ΔGlu cutoffs of 30 mg/dL and 16 mg/dL, in cats and dogs, respectively, corresponded to sensitivity and specificity of 100% and 90% in cats, respectively, and 100% in dogs. ΔGlu and %ΔGlu are accurate, readily available, diagnostic markers of acute ATE in paralyzed cats and dogs. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  8. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.

    Science.gov (United States)

    Chopra, Vineet; Anand, Sarah; Krein, Sarah L; Chenoweth, Carol; Saint, Sanjay

    2012-08-01

    The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization, PICCs have eliminated the need for such practice. However, PICCs may not be as innocuous as once thought; a growing body of evidence suggests that these devices also have important risks. This review discusses the origin of PICCs and highlights reasons behind their rapid adoption in medical practice. We evaluate the evidence behind 2 important PICC-related complications--venous thrombosis and bloodstream infections--and describe how initial studies may have led to a false sense of security with respect to these outcomes. In this context, we introduce a conceptual model to understand the risk of PICC-related complications and guide the use of these devices. Through this model, we outline recommendations that clinicians may use to prevent PICC-related adverse events. We conclude by highlighting important knowledge gaps and identifying avenues for future research in this area. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Plan to Reduce Improper Care of Peripherally-inserted Central Venous Catheters in Outpatient Chemotherapy Patients

    Directory of Open Access Journals (Sweden)

    Shu-Mei Chen

    2014-09-01

    Full Text Available This project aims at improving peripherally-inserted central venous catheter (PICC care in chemotherapy outpatients. From February to March 2011, 16.8% of PICCs were not cared for properly. The main problems encountered were dermatitis, catheter obstruction and catheter slippage. These problems were caused by lack of wound care guidelines for the PICC, the nursing staff's lack of knowledge and skills for PICC nursing care, and patients and their families’ lack of knowledge regarding PICC home care. Improvement plans included: 1. To establish norms for care of normal and abnormal PICC wounds and produce instructional videos; 2. To design correct flushing and butterfly fixation methods of the PICC. 3. To develop the transparent waterproof protective jacket and to produce a home nursing care manual and instructional video. After implementation of this project, the rate of improper PICC care decreased to 6.1% in September to November 2011, thus achieving the goals of this project. This PICC care project not only enhanced the professional knowledge and skills of nurses, but also the knowledge of patients regarding self-care.

  10. Computer Identification of Symptomatic Deep Venous Thrombosis Associated with Peripherally Inserted Central Catheters

    Science.gov (United States)

    Evans, R. Scott; Linford, Lorraine H.; Sharp, Jamie H.; White, Gayle; Lloyd, James F.; Weaver, Lindell K.

    2007-01-01

    Peripherally inserted central catheters (PICCs) are considered a safe method to provide long-term antibiotic therapy, chemotherapy and nutrition support. Deep venous thrombosis (DVT) is a complication that requires early PICC removal, may extend hospitalization and can result in pulmonary embolism. PICC insertion teams strive to understand risk factors and develop methods to prevent DVTs. However, they can only manage what they can measure. At LDS Hospital, identification of PICC associated DVTs was dependent on verbal notification or manual surveillance of more than a thousand free-text vascular reports. Accurate DVT rates were not known which hindered prevention. We describe the development of a computer application (PICC-DVT monitor) to identify PICC associated DVTs each day. A one-year evaluation of the monitor by the PICC team and a review of 445 random vascular reports found a positive predictive value of 98%, sensitivity of 94%, specificity of 100% and a PICC team associated DVT rate of 2.8%. PMID:18693831

  11. Leukocytic Response and Peripheral Venous Blood Lymphocyte Apoptosis as a Marker of Tissue Ischemia in Acute Massive Blood Loss

    Directory of Open Access Journals (Sweden)

    N. V. Borovkova

    2013-01-01

    Full Text Available Objective: to estimate the level of peripheral venous blood lymphocyte apoptosis and intraoperative hypoxia in victims with acute massive blood loss. Subjects and methods. Twenty-two patients with open and close chest and abdominal traumas complicated by acute massive blood loss were examined. All the patients were emergently operated on to stop bleeding. Tissue metabolism was evaluated from gases, acid-base parameters, and plasma lactate, glucose, potassium, and sodium levels. Apoptosis of mononuclear cells was studied and dead leukocytes were counted using flow cytometry. Results. Preoperatively, the victims were found to have venous hypoxemia, hyperlactatemia, hyperglycemia, moderate leukocytosis, and higher dead leukocyte counts. There were also raised counts of lymphocytes coming into the process of apoptosis. A significant relationship was found between monocyte counts and hypoxia values. At the end of surgery, oxygen balance values became stable and exerted an effect on the count of leukocytes, the relative level of granulocytes, the relative and absolute counts of dead and damaged leukocytes, and the concentration of lymphocytes in the victims’ venous blood during the early stages of apoptosis, as evidenced by nonlinear regression models. Conclusion. The indicators of immunocompetent cell apoptosis and the count of venous blood dead leukocytes along with lactate levels and venous hypoxemia parameters reflect the degree of tissue hypoxia and may be used as specific markers.

  12. Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs).

    Science.gov (United States)

    Kanin, Maralee; Young, Guy

    2013-11-01

    The recent proliferation of deep vein thrombosis in children has been attributed to the increased use of central venous catheters, specifically tunneled lines and peripherally inserted central catheters. A formal comparison of the incidence rate for deep vein thrombosis between tunneled lines and peripherally inserted central catheters has not been undertaken. Children inclusion. Data were extracted from the hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision coding. Patients were excluded if they received more than one central line. Data collected included type of central line, deep vein thrombosis event, and underlying medical illnesses classified according to chronic complex conditions. Over the seven year study period there was an overall rate of 73 deep vein thromboses per 10,000 hospital discharges. Of the 6915 eligible subjects, 181 had a deep vein thrombosis for an overall incidence rate of 2.6%. There were 152 thrombi (2.6%) in subjects with peripherally inserted central catheters and 29 thrombi (3.1%) in subjects with tunneled lines [OR=.83 (0.55, 1.29), p=0.38]. Despite the relative ease and simplicity of use of peripherally inserted central catheters leading to a substantial rise in their use, this study demonstrates that such lines pose a substantial risk for venous thrombosis and no difference in incidence was detected between such lines and tunneled lines. © 2013.

  13. Appropriateness and Complications of Peripheral Venous Catheters Placed in an Emergency Department.

    Science.gov (United States)

    Guihard, Bertrand; Rouyer, Fanny; Serrano, David; Sudrial, Jérôme; Combes, Xavier

    2018-03-01

    The insertion of peripheral venous catheters (PVCs) is the invasive procedure most frequently performed in hospitals, and it could be associated with complications. The appropriateness of PVC placement, however, has not been carefully analyzed. We conducted a study to assess the rate of PVC placement in our Emergency Department (ED), their use, their immediate or potential usefulness, and their complications. In this descriptive prospective study, we recorded every PVC placed in our ED during 1 week and assessed its appropriateness in terms of its use and potential usefulness. We then followed the patients transferred to medical wards to determine the duration of PVC maintenance and any complications. PVCs (n = 210) were placed for 34% (n = 207) of the 605 patients admitted to the ED during the study period. Of these PVCs, 27% (n = 52) were not used and 43% (n = 91) were considered ineffective. Follow-up covered 92 patients with PVCs transferred to medical wards. We recorded seven episodes of phlebitis (8%) and no infections, local or systemic. The mean duration of PVS maintenance in the medical wards was 40 h from insertion. Of the PVCs with complications, 43% were ineffective. The mean duration of maintenance of the PVCs that led to complications was 80 h, compared with 35 h for those without complications (p < 0.02). In accordance with the literature, half of the PVCs inserted in our ED were ineffective; half the PVCs causing complications were avoidable. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Risk Factors for Peripherally Inserted Central Venous Catheter Complications in Children

    Science.gov (United States)

    Jumani, Ketan; Advani, Sonali; Reich, Nicholas G.; Gosey, Leslie; Milstone, Aaron M.

    2012-01-01

    Objective(s) To characterize the epidemiology and identify risk factors for complications necessitating removal of peripherally inserted central venous catheters (PICCs) in children. Design Cohort study Setting The Johns Hopkins Children’s Center, Baltimore, Maryland. Participants Hospitalized children who had a PICC inserted outside of the neonatal ICU between January 1, 2003 and December 1, 2009. Main Exposures Age, PICC dwell time, PICC insertion site, PICC tip location, pediatric ICU exposure, indication for PICC insertion Outcome Measures Complications necessitating PICC removal as recorded by the PICC Team. Results During the study period, 2574 PICCs were placed in 1807 children. Complications necessitating catheter removal occurred in 20.8% of PICCs during 46,021 catheter days (11.6 complications per 1,000 catheter days). These included accidental dislodgement (4.6%), infection (4.3%), occlusion (3.6%), local infiltration (3.0%), leakage (1.5%), breaks (1.4%), phlebitis (1.2%) and thrombosis (0.5%). From 2003 to 2009 complications decreased by 15% per year (IRR 0.85; 95%CI 0.81-0.89). In adjusted analysis, all non-central PICC tip locations - midline (IRR 4.59, 95% CI 3.69-5.69), mid-clavicular (IRR 2.15, 95% CI 1.54-2.98), and other (IRR 3.26 95% CI 1.72-6.15) - compared to central tip location were associated with an increased risk of complications. Pediatric ICU exposure and age less than one year old were independently associated with complications necessitating PICC removal. Conclusion(s) Non-central PICC tip locations, younger age, and pediatric ICU exposure were independent risk factors for complications necessitating PICC removal. Despite reductions in PICC complications, further efforts are needed to prevent PICC-associated complications in children. PMID:23549677

  15. Near-infrared vascular imaging in peripheral venous and arterial access

    NARCIS (Netherlands)

    Cuper, N.J.

    2012-01-01

    Venous and arterial access are among the most widespread medical procedures performed in children. Especially in young children venous and arterial access can be problematic due to tiny blood vessels that are difficult to localize beneath a layer of baby fat. This thesis describes the development

  16. Incidence of ipsilateral postoperative deep venous thrombosis in the amputated lower extremity of patients with peripheral obstructive arterial disease.

    Science.gov (United States)

    Matielo, Marcelo Fernando; Presti, Calógero; Casella, Ivan Benaduce; Netto, Baptista Muraco; Puech-Leão, Pedro

    2008-12-01

    Patients undergoing amputation of the lower limb due to peripheral arterial disease (PAD) are at risk of developing deep venous thrombosis (DVT). Few studies in the research literature report the incidence of DVT during the early postoperative period or the risk factors for the development of DVT in the amputation stump. This prospective study evaluated the incidence of DVT during the first 35 postoperative days in patients who had undergone amputation of the lower extremity due to PAD and its relation to comorbidities and death. Between September 2004 and March 2006, 56 patients (29 men), with a mean age of 67.25 years, underwent 62 amputations, comprising 36 below knee amputations (BKA) and 26 above knee amputations (AKA). Echo-Doppler scanning was performed preoperatively and on postoperative days 7 and 31 (approximately). All patients received acetylsalicylic acid (100 mg daily) preoperatively and postoperatively, but none received prophylactic anticoagulation. DVT occurred in 25.8% of extremities with amputations (10 AKA and 6 BKA). The cumulative incidence in the 35-day postoperative period was 28% (Kaplan-Meier). There was a significant difference (P = .04) in the incidence of DVT between AKA (37.5%) and BKA (21.2%). Age >or=70 years (48.9% vs 16.8%, P = .021) was also a risk factor for DVT in the univariate analysis. Of the 16 cases, 14 (87.5%) were diagnosed during outpatient care. The time to discharge after amputation was averaged 6.11 days in-hospital stay (range, 1-56 days). One symptomatic nonfatal pulmonary embolism occurred in a patient already diagnosed with DVT. There was no relation between other comorbidities and DVT. The multivariate analysis showed no association between risk factors and the occurrence of DVT in the amputated extremity. DVT ipsilateral to the amputation did not influence the mortality rate (9.7%). The incidence of DVT in the early postoperative period (or=70 years and for AKA. Patients with PAD who have recently undergone

  17. Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients

    International Nuclear Information System (INIS)

    Goltz, Jan P.; Scholl, Anne; Ritter, Christian O.; Wittenberg, Guenther; Hahn, Dietbert; Kickuth, Ralph

    2010-01-01

    The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheter-days) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.

  18. Devices and dressings to secure peripheral venous catheters to prevent complications.

    Science.gov (United States)

    Marsh, Nicole; Webster, Joan; Mihala, Gabor; Rickard, Claire M

    2015-06-12

    A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically. To assess the effects of PVC dressings and securement devices on the incidence of PVC failure. We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015). RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained. Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard

  19. [The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC)].

    Science.gov (United States)

    Emoli, Alessandro; Cappuccio, Serena; Marche, Bruno; Musarò, Andrea; Scoppettuolo, Giancarlo; Pittiruti, Mauro

    2014-01-01

    The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC). The insertion of a peripherally inserted central venous catheter (PICC) is not without risks. The Italian Group for the Study of Long-Term Central Venous Access Devices (GAVeCeLT) has developed a protocol (SIP: Safe Implantation of PICCs) with the aim of minimizing the risks which may be associated with the placement of PICCs. The protocol is based on recommendations available in the literature and on the main clinical practice guidelines. The SIP protocol, a bundle of evidence-based recommendations, it is is easy to use, inexpensive, and cost-effective. If routinely used and carefully inplemented, it greatly reduces complications such as failure of venipuncture, accidental arterial puncture, damage of median nerve, infection and catheter related venous thrombosis.

  20. Prospective pilot study on the incidence of infections caused by peripheral venous catheters at a general surgical ward

    Directory of Open Access Journals (Sweden)

    Heinrich, Ines

    2013-04-01

    Full Text Available [english] Device-associated infections comprise a significant proportion of all nosocomial infections. In this prospective, observational pilot study the incidence of infections in 89 peripheral venous catheters (PVCs was documented on a general surgical ward employing an infection data sheet developed by the Institute of Hygiene and Environmental Medicine, Greifswald in adherence to CDC standards for infections. 16 of 20 infections were documented during a four-week time period when medical students in the first four months of their practical year performed their compulsory rotation on the general surgical ward. Insufficient knowledge of adequate hygienic measures as well as non-compliance to aseptical procedural measures prior to and following insertion of a peripheral venous catheter are the assumed instigators of these infections. In order to ensure a uniform hygienic standard in the performance of applied procedures, it is essential that medical students during this practical year receive not only theoretical, but also hands-on schooling prior to initiation of their subsequent official residency.

  1. Valuation of the effectiveness of the nitrous oxide administration to the paediatric patient during channelling a peripheral venous

    Directory of Open Access Journals (Sweden)

    Beatriz Margenta Gutiérrez

    2011-01-01

    Full Text Available Objective: To valuate if the administration of nitrous oxide (Kalinox® during the technique of channelling a peripheral venous level decreases pain, improves the child´s behavior and facilitates the realization of the technique for the nurse. Experimental, randomized clinical trial. Population: children between 6-12 years old with an indication of peripheral venous channeling and medical approbation for administration of Kalinox to the Pediatric ICU unit of the Hospital in Toledo. Sample: 54 subjects in each group (alpha error of 0.05, with a study power of 90% and expecting a mean effect d/s = 0.5 for reducing pain in the experimental group. Main variables: the administration of nitrous oxide (independent variable and level of pain, motor behavior, degree of difficulty in performing the technique, and complications (dependent variables, besides, sociodemographic and clinical variables will be measured. It was used differents validated scales (Oucher, VAS y Frankl and one performed by us. Data will be analyze by SPSS software programme.

  2. Difficult peripheral venous access: clinical evaluation of a catheter inserted with the Seldinger method under ultrasound guidance.

    Science.gov (United States)

    Meyer, Pascal; Cronier, Pierrick; Rousseau, Hélène; Vicaut, Eric; Choukroun, Gerald; Chergui, Karim; Chevrel, Guillaume; Maury, Eric

    2014-10-01

    A preliminary observational study was undertaken to evaluate the risk of failure of ultrasound-guided peripheral intravenous catheterization of a deep arm vein for a maximum of 7 days, after peripheral intravenous (PIV) cannulation failure. This prospective study included patients referred to the intensive care unit for placement of a central line, a polyurethane cannula commercialized for arterial catheterization was used for peripheral venous cannulation. Catheter length and diameter were chosen based on preliminary ultrasound measurements of vein diameter and skin-vein distance. Catheterization was successful for all 29 patients. Mean vein diameter was 0.42 ± 0.39 cm; mean vein depth was 0.94 ± 0.52 cm. Mean catheter duration was 6 (median 7) days. Two occluded catheters were removed prematurely. No thrombophlebitis, catheter infection, or extravasation was observed. Our results suggest that catheters inserted with the Seldinger method are adapted to prolonged peripheral deep-vein infusion. Ultrasound can play a role in catheter monitoring by identifying early thrombosis formation. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy.

    Science.gov (United States)

    Nakamuta, Soshi; Nishizawa, Toshihiro; Matsuhashi, Shiori; Shimizu, Arata; Uraoka, Toshio; Yamamoto, Masato

    2018-03-01

    Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

  4. Use of peripherally inserted central venous catheters (PICCs) in children receiving autologous or allogeneic stem-cell transplantation.

    Science.gov (United States)

    Benvenuti, Stefano; Ceresoli, Rosanna; Boroni, Giovanni; Parolini, Filippo; Porta, Fulvio; Alberti, Daniele

    2018-03-01

    The aim of our study was to present our experience with the use of peripherally inserted central catheters (PICCs) in pediatric patients receiving autologous or allogenic blood stem-cell transplantation. The insertion of the device in older children does not require general anesthesia and does not require a surgical procedure. From January 2014 to January 2017, 13 PICCs were inserted as a central venous device in 11 pediatric patients submitted to 14 autologous or allogeneic stem-cell transplantation, at the Bone Marrow Transplant Unit of the Children's Hospital of Brescia. The mean age of patients at the time of the procedure was 11.3 years (range 3-18 years). PICCs remained in place for an overall period of 4104 days. All PICCs were positioned by the same specifically trained physician and utilized by nurses of our stem-cell transplant unit. No insertion-related complications were observed. Late complications were catheter ruptures and line occlusions (1.2 per 1000 PICC days). No rupture or occlusion required removal of the device. No catheter-related venous thrombosis, catheter-related bloodstream infection (CRBSI), accidental removal or permanent lumen occlusion were observed. Indications for catheter removal were completion of therapy (8 patients) and death (2 patients). Three PICCs are currently being used for blood sampling in follow-up patients after transplantation. Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in pediatric patients with high risk of infectious and hemorrhagic complications such as patients receiving stem-cell transplantation.

  5. Comparative study of peripherally inserted central venous catheter and traditional central catheter assisted with X-ray

    International Nuclear Information System (INIS)

    Yu Jianchun; Wang Xiurong; Jiang Zhuming

    1999-01-01

    Objective: To study the feasibility, complications, mid- and long-term advantages of peripherally inserted central catheters (PICC) compared with central venous access assisted with X-ray. Methods: From Jan 1997 to Dec 1998, the authors conducted a study in 60 patients with placed PICC lines and 60 patients with central lines. Study variables included tip placement and complication rates. Results: Tere were on significant differences between PICC and CVC in the successful placement 95.0% and 88.3%, t = 1.745, P 0.19; the mean duration 13(6-98) days and 14 (7-104) days, F = 0.049, P = 0.83; the total occlusion rate 6.7% (4/60) and 5.0%(3/60), t = 0.152, P = 0.70. In PICC patients, the occlusion rate was slightly higher in 3 Fr (20-gauge) catheter (3/20, 15.0%) than in 4 Fr(18-gauge) catheters (1/20, 5.0%), t = 1.111, P=0.29. Phlebitis occurred in 5.0% of patients (3/60) and one catheter fracture was happened on the catheter hub junction (1.7%). In 3 catheter tips dislocation cases, the catheter tips were moved to the optional position assisted with X-ray image. In CVC group, pneumothorax happened in 1 case (1.7%). In 4 catheter dislocation cases, the catheters were with drawn. No catheter-related sepsis and hemo-pneumothorax happened in both group patients. Conclusions: Both PICC and CVC can be acceptable in clinical use. PICC assisted with X-ray possesses the advantages of less trauma, accurate localization preventing some possible severe complications of central venous access such as pneumothorax. The new method provides a reliable, effective venous access for mid-and long-term usage in patients receiving a variety of solutions, primarily parenteral alimentation, chemotherapy or antibiotic infusion

  6. Evaluating the efficacy of lavender aromatherapy on peripheral venous cannulation pain and anxiety: A prospective, randomized study.

    Science.gov (United States)

    Karaman, Tugba; Karaman, Serkan; Dogru, Serkan; Tapar, Hakan; Sahin, Aynur; Suren, Mustafa; Arici, Semih; Kaya, Ziya

    2016-05-01

    This study was designed to evaluate the effectiveness of lavender aromatherapy on pain, anxiety, and level of satisfaction associated with the peripheral venous cannulation (PVC) in patients undergoing surgery. One hundred and six patients undergoing surgery were randomized to receive aromatherapy with lavender essential oil (the lavender group) or a placebo (the control group) during PVC. The patients' pain, anxiety, and satisfaction scores were measured. There was no statistically significantly difference between the groups in terms of demographic data. After cannulation, the pain and anxiety scores (anxiety 2) of the patients in the lavender group were significantly lower than the control group (for p = 0.01 for pain scores; p aromatherapy had beneficial effects on PVC pain, anxiety, and satisfaction level of patients undergoing surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Maternal intrapartum antibiotic treatment continues to exert a bactericidal effect on the umbilical cord and peripheral venous blood of newborn infants.

    Science.gov (United States)

    Hershkovich-Shporen, C; Bardenstein, R; Blickstein, I; Shinwell, E S; Flidel-Rimon, O

    2017-11-01

    It is unclear whether maternal intrapartum antibiotic treatment (IAT) continues to exert a bactericidal effect on common pathogens in neonates. We studied the in vitro bactericidal effect of IAT on the cord and peripheral venous blood of newborn infants. Umbilical cord and peripheral venous blood from newborn infants born at Kaplan Medical Center, Israel, from April to October 2014 were studied for serum bactericidal titres against Group B Streptococcus (GBS) and Escherichia coli (E. coli) strains. We studied 60 samples of umbilical cord blood and 18 samples of peripheral venous blood from 60 newborn infants whose mothers received IAT. The controls were 10 samples of cord blood from mothers without IAT. Cord blood exerted a bactericidal effect against 98% of GBS isolates but only 8% of E.coli isolates. Peripheral blood exerted a bactericidal effect against GBS in 94% of cases, but not against E. coli. No bactericidal effect was seen in the blood from the controls. We found a continued bactericidal effect of umbilical cord blood and neonatal peripheral blood from newborn infants of IAT-treated mothers, mainly against GBS, but rarely against E. Coli. These findings may assist clinicians treating at-risk infants exposed to IAT. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  8. Immune function of peripheral T cells in patients with venous thromboembolism or coronary artery atherosclerosis.

    Science.gov (United States)

    Zhou, Lin; Song, Haoming; Xu, Wenjun; Xu, Jiahong; Jiang, Jinfa; Gong, Zhu; Liu, Yang; Yan, Wenwen; Wang, Lemin

    2014-06-01

    Recent studies have shown that the major risk factors for arterial thrombotic diseases are closely associated with venous thromboembolism (VTE). This study aimed to investigate the expression of CD3, CD4 and CD8 in T lymphocytes, the CD4/CD8 ratio and high-sensitivity C-reactive protein (hs-CRP) levels in patients with VTE, coronary artery atherosclerosis (CAA) and healthy subjects. A total of 82 healthy subjects, 51 VTE patients and 114 CAA patients were recruited, and the expression of CD3, CD4 and CD8 in T lymphocytes and the CD4/CD8 ratio were determined. Serum hs-CRP was also measured. Compared to healthy subjects, VTE patients had significantly reduced CD3 expression (p=0.019), comparable CD4 expression (p=0.868), significantly reduced CD8 expression (p<0.001) and increased CD4/CD8 ratio (p=0.044). However, VTE patients had comparable expression of CD3, CD4 and CD8 and CD4/CD8 ratio to CAA patients. In addition, among patients with VTE or CAA, the proportion of patients with reduced CD3+ and CD8+ T lymphocytes or increased CD4/CD8 ratio was significantly higher than in healthy subjects. In addition, hs-CRP in both VTE and CAA groups was significantly higher than in healthy subjects. The antigen recognition and signal transduction activation of T cells is significantly reduced in patients with VTE or CAA, and the killing effect of T cells on pathogens, including viruses, is also significantly compromised. In addition, inflammatory and immune mechanisms are involved in the occurrence and development of venous and arterial thrombosis. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.

    Science.gov (United States)

    Loubani, Osama M; Green, Robert S

    2015-06-01

    The aim of this study was to collect and describe all published reports of local tissue injury or extravasation from vasopressor administration via either peripheral intravenous (IV) or central venous catheter. A systematic search of Medline, Embase, and Cochrane databases was performed from inception through January 2014 for reports of adults who received vasopressor intravenously via peripheral IV or central venous catheter for a therapeutic purpose. We included primary studies or case reports of vasopressor administration that resulted in local tissue injury or extravasation of vasopressor solution. Eighty-five articles with 270 patients met all inclusion criteria. A total of 325 separate local tissue injury and extravasation events were identified, with 318 events resulting from peripheral vasopressor administration and 7 events resulting from central administration. There were 204 local tissue injury events from peripheral administration of vasopressors, with an average duration of infusion of 55.9 hours (±68.1), median time of 24 hours, and range of 0.08 to 528 hours. In most of these events (174/204, 85.3%), the infusion site was located distal to the antecubital or popliteal fossae. Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports. Further study is warranted to clarify the safety of vasopressor administration via peripheral IVs. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. [Less pain during puncture by a peripheral venous catheter; a bibliographical review on adults].

    Science.gov (United States)

    Prat González, Irene; Fuentes i Pumarola, Concepció; Bertran Noguer, Carme; Ballester Ferrando, David; Juvinyà Canal, Dolors; Vila Vidal, Dalmau

    2010-06-01

    Canalizing veins is a habitual technique carried out by nurses. Inserting a catheter in a peripheral vein causes pain. The importance of fine quality in nursing treatment implicitly bears on a person's well-being. In daily practice, health professionals do not use any method to reduce pain when inserting a catheter. The authors observations led them to believe in the need to carry out a bibliographical review whose objective was to discover all the methods used to reduce pain caused by puncturing a peripheral vein. Six randomly assigned clinical tests and a meta-analysis evaluate the effectiveness of: The use of Valsalva, an analgesic cream which contains two local amino-amide anesthetics; lidocaine and prylocaine (EMLA) compared to another analgesic cream, Myolaxin; a meta-analysis of twenty studies evaluates the degree by which pain is diminished by one such method: an EMLA cream; an anti-inflammatory skin dressing (diclofenaco), a diclofenaco dressing versus an EMLA anesthetic dressing, 0.25 ml subcutaneous injection of 1% mepivaína, an amida type local anesthetic; and direct photography moments before puncture occurs to use the effects of a flash of light. All these methods studied proved effective in reducing pain. Creams and dressing prove to be unaggressive methods but require some time for application prior to puncture. Using a camera flash, subcutaneous injection of mepivacaine and the application of Valsalva can be effective alternatives to reduce pain when puncturing veins in patients who require emergency care.

  11. PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER SAFETYIN BURN CARE: A SINGLE CENTRE RETROSPECTIVE COHORT REVIEW

    Science.gov (United States)

    Austin, Ryan E.; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G.

    2014-01-01

    Objective PICC line use for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC associated complication rates to existing literature in both the critical care and burn settings. Methods A single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008–2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. Results The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and 3 cases of central line associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days [range 1–49 days]. Conclusions We suggest that PICC line associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to CVC associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant, and potentially fatal risks. PMID:25501778

  12. Massive pleural effusion on the contralateral side of a venous peripherally inserted central catheter.

    Science.gov (United States)

    Sancak, Selim; Tuten, Abdulhamit; Yildirim, Tulin Gokmen; Karatekin, Guner

    2018-02-01

    A preterm newborn infant, delivered at 30 weeks of gestation and 965 g birth weight, developed respiratory distress with resistant hypoxia after a central catheter line was inserted via the right venae brachialis on postnatal day 21. Left-sided massive pleural effusion, collapsed left lung with air bronchograms, and bidirectional shunting through reopened ductus arteriosus were detected by targeted neonatal echocardiography. Hydrothorax was drained under sonographic guidance, producing a milky-white fluid biochemically compatible with parenteral nutrition. We report this case of hydrothorax secondary to a misplaced central catheter on the contralateral side of its peripheral insertion. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:140-144, 2018. © 2017 Wiley Periodicals, Inc.

  13. Instrument validation for peripheral venous puncture with over-the-needle catheter

    Directory of Open Access Journals (Sweden)

    Aminna Kelly Almeida de Oliveira

    2015-05-01

    Full Text Available Objective: to validate an instrument for the assessment of the peripheral venipuncture technique with over-the-needle catheter. Methods: methodological, transversal study developed with 24 judge nurses, professors of the subject semiology and/or physical examination techniques, with at least 1 year of experience in those disciplines in three stages: preparation of checklist; submission to the judges for evaluation; and content validation through the application of the Kappa index. Results: out of the 26 items of the instrument, only 2 did not have Kappa index and content validity index within the established parameters. Out of these 24 items, 7 showed perfect concordance index, 10 great and 7 good. Conclusion: the instrument had representation and extension about the area of ​​interest.

  14. [Peripheral venous catheter use in the emergency department: reducing adverse events in patients and biosafety problems for staff].

    Science.gov (United States)

    Tomás Vecina, Santiago; Mozota Duarte, Julián; Ortega Marcos, Miguel; Gracia Ruiz Navarro, María; Borillo, Vicente; San Juan Gago, Leticia; Roqueta Egea, Fermin; Chanovas Borrás, Manuel

    2016-01-01

    To test a strategy to reduce the rate of adverse events in patients and safety problems for emergency department staff who insert peripheral venous catheters (PVCs). The strategy consisted of training, implementing a protocol, and introducing safety-engineered PVCs. Prospective, multicenter, observational, preauthorization study in patients requiring PVC placement in an emergency department. The study had 2 phases. The first consisted of training, implementing a protocol for using conventional PVCs, and monitoring practice. The second phase introduced safety-engineered PVC sets. The number of adverse events in patients and threats to safety for staff were compared between the 2 phases. A total of 520 patients were included, 180 in the first phase and 340 in the second. We detected breaches in aseptic technique, failure to maintain a sterile field, and improper management of safety equipment and devices. Some practices improved significantly during the second phase. Eighty-six adverse events occurred in the first phase and 52 (15.4%) in the second; the between-phase difference was not statistically significant. The incidence of postinfusion phlebitis was 50% lower in the second phase. Seven splash injuries and 1 accidental puncture occurred with conventional PVCs in the first phase; 2 splash injuries occurred with the safety-engineered PVCs in the second phase (36% decrease, P = .04). Differences were particularly noticeable for short-term PVC placements (P = .02). Combining training, a protocol, and the use of safety-engineered PVC sets offers an effective strategy for improving patient and staff safety.

  15. Impact of Postplacement Adjustment of Peripherally Inserted Central Catheters on the Risk of Bloodstream Infection and Venous Thrombus Formation

    Science.gov (United States)

    Baxi, Sanjiv M.; Shuman, Emily K.; Scipione, Christy A.; Chen, Benrong; Sharma, Aditi; Rasanathan, Jennifer J. K.; Chenoweth, Carol E.

    2014-01-01

    OBJECTIVE Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line–associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment. DESIGN Retrospective cohort study. SETTING University of Michigan Health System, a large referral hospital. PATIENTS Patients who had PICCs placed between February 2007 and August 2007. METHODS The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records. RESULTS There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P = .04), whereas 2 or 3 or more adjustments had no association with CLABSI (P = .58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P = .59, .85, and .78, respectively). Immunosuppression (P PICCs (P = .05), and 3 PICC lumens compared with 1 lumen (P = .02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P = .03). CONCLUSIONS Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT. PMID:23838218

  16. Heparin for clearance of peripherally inserted central venous catheter in newborns: an in vitro study

    Science.gov (United States)

    Balaminut, Talita; Venturini, Danielle; da Silva, Valéria Costa Evangelista; Rossetto, Edilaine Giovanini; Zani, Adriana Valongo

    2015-01-01

    Objective: To compare the efficacy of two concentrations of heparin to clear the lumen of in vitro clotted neonatal peripherally inserted central catheters (PICCs). Methods: This is an in vitro, experimental quantitative study of 76 neonatal 2.0-Fr PICCs coagulated in vitro. The catheters were divided into two groups of 38 PICCs each. In both groups an infusion of low molecular weight heparin was administered with a dose of 25IU/mL for Group 1 and 50IU/mL for Group 2. The negative pressure technique was applied to the catheters of both groups at 5, 15 and 30min and at 4h to test their permeability. Kaplan-Meier survival analysis was used to verify the outcome of the groups according to time intervals. Results: The comparison between both groups in the first 5min showed that more catheters from Group 2 were cleared compared to Group 1 (57.9 vs. 21.1%, respectively). Kaplan-Meier survival analysis showed that less time was needed to clear catheters treated with 50IU/mL of heparin (p<0.001). Conclusions: The use of low molecular weight heparin at a concentration of 50IU/mL was more effective in restoring the permeability of neonatal PICCs occluded in vitro by a clot, and the use of this concentration is within the safety margin indicated by scientific literature. PMID:26116325

  17. Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines Be Placed in the Intensive Care Unit Setting?

    Science.gov (United States)

    Martyak, Michael; Kabir, Ishraq; Britt, Rebecca

    2017-08-01

    Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

  18. Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis.

    Science.gov (United States)

    Sanfilippo, Filippo; Noto, Alberto; Martucci, Gennaro; Farbo, Marco; Burgio, Gaetano; Biasucci, Daniele G

    2017-07-14

    The central venous pressure (CVP) is the most commonly used static marker of preload for guiding fluid therapy in critically ill patients, though its usefulness remains controversial. Centrally inserted central catheters (CICCs) are the gold-standard devices for CVP monitoring but peripherally inserted central catheters (PICCs) may represent a valid alternative. We undertook a systematic review and meta-analysis with the aim to investigate whether the difference between PICC- and CICC-measured CVP is not significant. We searched for clinical studies published in PubMed and EMBASE databases from inception until December 21st 2016. We included studies providing data on paired and simultaneous CVP measurement from PICCs and CICCs. We conducted two analyses on the values of CVP, the first one according to the total number of CVP assessments, the second one considering the number of patients recruited. Four studies matched the inclusion criteria, but only three of them provided data for the meta-analyses. Both analyses showed non-significant differences between PICC-measured and CICC-measured CVP: 1489 paired simultaneous CVP assessments (MD 0.16, 95%CI -0.14, 0.45, p = 0.30) on a total of 57 patients (MD 0.22, 95%CI -1.46, 1.91, p = 0.80). Both analyses showed no heterogeneity (I2 = 0%). Available evidence supports that CVP monitoring with PICCs is accurate and reproduces similar values to those obtained from CICCs. The possibility to monitor CVP should not be used among clinical criteria for preferring a CICC over a PICC line.

  19. Satisfactory reliability among nursing students using the instrument PVC ASSESS to evaluate management of peripheral venous catheters.

    Science.gov (United States)

    Ahlqvist, Margary; Berglund, Britta; Nordström, Gun; Klang, Birgitta; Johansson, Eva

    2014-01-01

    Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n=4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n=3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (κ) were calculated. For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (PVC location." In 81% of the items, κ was between moderate and almost perfect: moderate (n=5), substantial (n=3), almost perfect (n=5). For edema at insertion site and two items on PVC dressing, κ was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the κ ranged between moderate and almost perfect (0.41-1) in 90%-95%. PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.

  20. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis.

    Science.gov (United States)

    Chopra, Vineet; O'Horo, John C; Rogers, Mary A M; Maki, Dennis G; Safdar, Nasia

    2013-09-01

    Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown. To compare risk of CLABSI between PICCs and CVCs. MEDLINE, CinAHL, Scopus, EmBASE, and Cochrane CENTRAL were searched. Full-text studies comparing the risk of CLABSI between PICCs and CVCs were included. Studies involving adults 18 years of age or older who underwent insertion of a PICC or a CVC and reported CLABSI were included in our analysis. Studies were evaluated using the Downs and Black scale for risk of bias. Random effects meta-analyses were used to generate summary estimates of CLABSI risk in patients with PICCs versus CVCs. Of 1,185 studies identified, 23 studies involving 57,250 patients met eligibility criteria. Twenty of 23 eligible studies reported the total number of CLABSI episodes in patients with PICCs and CVCs. Pooled meta-analyses of these studies revealed that PICCs were associated with a lower risk of CLABSI than were CVCs (relative risk [RR], 0.62; 95% confidence interval [CI], 0.40-0.94). Statistical heterogeneity prompted subgroup analysis, which demonstrated that CLABSI reduction was greatest in outpatients (RR [95% CI], 0.22 [0.18-0.27]) compared with hospitalized patients who received PICCs (RR [95% CI], 0.73 [0.54-0.98]). Thirteen of the included 23 studies reported CLABSI per catheter-day. Within these studies, PICC-related CLABSI occurred as frequently as CLABSI from CVCs (incidence rate ratio [95% CI], 0.91 [0.46-1.79]). Only 1 randomized trial met inclusion criteria. CLABSI definition and infection prevention strategies were variably reported. Few studies reported infections by catheter-days. Although PICCs are associated with a lower risk of CLABSI than CVCs in outpatients, hospitalized patients may be just as likely to experience CLABSI with PICCs as with CVCs. Consideration of risks and benefits before PICC use in inpatient

  1. First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis.

    Science.gov (United States)

    Bond, Mary; Crathorne, Louise; Peters, Jaime; Coelho, Helen; Haasova, Marcela; Cooper, Chris; Milner, Quentin; Shawyer, Vicki; Hyde, Christopher; Powell, Roy

    2016-10-01

    Peripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation. These aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale. The systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference -25.42 (95 % CI -32.25, -18.57). Other members of the 'caine' family were also estimated to be more effective than no treatment as were Ametop ® , EMLA ® and Rapydan ® patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be -12.97 (95 % CI -15.71, -10.24) points (100 mm VAS) less painful than unattenuated cannulation

  2. Venous Sampling

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Venous sampling Venous sampling is a diagnostic procedure that uses ... the limitations of venous sampling? What is venous sampling? Venous sampling is a diagnostic procedure that involves ...

  3. Safety and Efficacy of a Needle-free Powder Lidocaine Delivery System in Pediatric Patients Undergoing Venipuncture or Peripheral Venous Cannulation: Randomized Double-blind COMFORT-004 Trial.

    Science.gov (United States)

    Schmitz, Michael L; Zempsky, William T; Meyer, James M

    2015-08-01

    The goal of this study was to determine if a lidocaine hydrochloride monohydrate powder intradermal system designed to provide cutaneous analgesia is efficacious, safe, and tolerable for pediatric subjects compared with a sham placebo system. COMFORT-004, A Phase III, Randomized, Double-Blind, Placebo-Controlled Study to Confirm the Effectiveness and Safety of ALGRX 3268 in Pediatric Subjects, was a single-dose, parallel group study of children undergoing venipuncture or peripheral venous cannulation at the antecubital fossa or back of the hand. Included were subjects (3-18 years) in 3 age groups: 3-7, 8-12, and 13-18 years. Excluded were those with recent similar procedures or with implantable devices or skin pathologies at the anatomical site, insufficient cognitive skills, or allergies to local anesthetics or adhesives. Subjects were randomized to receive the needle-free powder lidocaine delivery system (active system, 0.5 mg of lidocaine/21 ± 1 bar of pressure [n = 269]) or sham placebo (n = 266) 1-3 minutes before venipuncture or peripheral venous cannulation. Analgesic efficacy was assessed patient self-report of venous access pain (Wong-Baker FACES Pain Rating Scale [3-18 years] and visual analog scale [VAS; 8-18 years]) and parental observational VAS. Safety assessments included adverse events (AEs) and relationship to study treatment. Skin signs and symptoms were graded numerically. Wong-Baker FACES scores, VAS, and parental VAS were analyzed by using an ANOVA model. Responder ratings and success rates were compared by using a Cochran-Mantel-Haenszel test stratified according to center, age group, and body site. The active system group had significantly (P = 0.0022) less pain compared with the sham placebo in all age groups combined according to the modified Wong-Baker FACES scale. Secondary efficacy analyses found that the active system resulted in less pain as assessed by subjects' VAS pain assessments aged 8-18 years (P = 0.1856), responder analysis (P

  4. Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies.

    Science.gov (United States)

    Patel, G S; Jain, K; Kumar, R; Strickland, A H; Pellegrini, L; Slavotinek, J; Eaton, M; McLeay, W; Price, T; Ly, M; Ullah, S; Koczwara, B; Kichenadasse, G; Karapetis, C S

    2014-01-01

    Indwelling central venous catheters (CVCs) have been increasingly used to enable delivery of intravenous chemotherapy. We aimed to compare the safety and cost of two commonly used CVCs, peripherally inserted central venous catheter (PICCs) and ports, in the delivery of chemotherapy in patients with non-haematological malignancies. Seventy patients were randomly assigned to receive either a PICC or a port. The primary endpoint was occurrence of major complications, which required removal of the CVC and secondary endpoints included occurrence of any complications. Port devices were associated with fewer complications compared with PICC lines (hazard ratio of 0.25, CI, 0.09-0.86, P = 0.038). Major complication rate was lower in the port arm compared to the PICC arm (0.047 versus 0.193 major complications/100 catheter days, P = 0.034) with 6 versus 20 % of patients experiencing major complications, respectively. Thrombosis, the most common complication, was significantly higher in the PICC arm compared to the port arm (25 versus 0 %, P = 0.013). Quality of life and cost estimates did not differ significantly between the two arms. Port devices are associated with a lower risk of complications, with no difference in cost, compared to PICC lines in patients with non-haematological malignancies receiving intravenous chemotherapy.

  5. Complication of Hemodialysis Access: A Case Report of Venous Hypertension

    Directory of Open Access Journals (Sweden)

    Sadegh Asadi

    2018-03-01

    Full Text Available Vascular access for dialysis is essential for these patients with end-stage renal disease, improvements in hemodialysis managment have lead to extended life expectancy. The creation and maintenance of hemoaccess occupies a significant portion of most vascular and general surgery practices.Venous hypertension due to arteriovenous fistula is usually secondary to venous outlet obstruction. Side to side proximal artery arteriovenous fistula serves as a certain cause of hemodialysis, but it is rarely reported as a peripheral venous hypertension cause. We are reporting a case with developed venous hypertension having dermal injuries in the arm. The patient underwent successful side-to-side radio cephalic fistula creation in the snuffbox a year ago.

  6. Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve.

    Science.gov (United States)

    Rotzinger, Roman; Gebauer, Bernhard; Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Grieser, Christian; Freyhardt, Patrick; Hamm, Bernd; Maurer, Martin H

    2017-12-01

    Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions' durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.

  7. An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission

    Directory of Open Access Journals (Sweden)

    Gregg Bethene L

    2010-10-01

    Full Text Available Abstract Background Early goal directed therapy improves survival in patients with septic shock. Central venous pressure (CVP monitoring is essential to guide adequate resuscitation. Use of peripherally inserted central catheters (PICC is increasing, but little data exists comparing a PICC to a conventional CVP catheter. We studied the accuracy of a novel PICC to transmit static and dynamic pressures in vitro. Methods We designed a device to generate controlled pressures via a column of water allowing simultaneous measurements from a PICC and a standard triple lumen catheter. Digital transducers were used to obtain all pressure readings. Measurements of static pressures over a physiologic range were recorded using 5Fr and 6Fr dual lumen PICCs. Additionally, random repetitive pressure pulses were applied to the column of water to simulate physiologic intravascular pressure variations. The resultant PICC and control waveforms were recorded simultaneously. Results Six-hundred thirty measurements were made using the 5 Fr and 6 Fr PICCs. The average bias determined by Bland-Altman plot was 0.043 mmHg for 5 Fr PICC and 0.023 mmHg for 6 Fr PICC with a difference range of 1.0 to -1.0. The correlation coefficient for both catheters was 1.0 (p-value Conclusion In vitro, no static or dynamic pressure differences were found between the PICC and a conventional CVP catheter. Clinical studies are required to assess whether the novel PICC has bedside equivalence to conventional catheters when measuring central venous pressures.

  8. A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch

    Energy Technology Data Exchange (ETDEWEB)

    Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Tanaka, Norimitsu; Koganemaru, Masamichi; Kugiyama, Tomoko [Kurume University School of Medicine, Department of Radiology (Japan); Kiyokawa, Kensuke [Kurume University School of Medicine, Department of Plastic & Reconstructive Surgery and Maxillofacial Surgery (Japan); Abe, Toshi [Kurume University School of Medicine, Department of Radiology (Japan)

    2017-05-15

    Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.

  9. Venous plethysmography

    International Nuclear Information System (INIS)

    Barnes, R.W.; Middleton, J.; Turley, D.G.

    1984-01-01

    Venous plethysmography provides an objective, versatile, and accurate method of defining those alterations that may result from acute or chronic venous disease, namely venous outflow obstruction and venous reflux through incompetent venous valves. Impedance or strain-gauge plethysmography provides the most accurate means of quantifying abnormal venous outflow in acute deep venous thrombosis. Venous volume plethysmography, using the phleborheograph, provides very sensitive determination of altered venous hemodynamics in acute deep venous thrombosis; it also serves to assess some patients with chronic venous insufficiency. Combinations of strain-gauge and photoplethysmography lead to useful measures of venous reflux in deep, perforating, and superficial veins. This information, along with measurements of maximum venous outflow, may provide the most versatile means of establishing altered hemodynamics in patients with chronic venous insufficiency

  10. Complications of peripherally inserted central venous catheters in neonates: Lesson learned over 2 years in a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    Amit Singh

    2014-01-01

    Full Text Available Background: The objective of this study was to assess the complications of peripherally inserted central venous catheters (PICC in neonates admitted to neonatal surgical intensive care unit (NSICU. Patients and Methods: Retrospective analysis of 237 neonates admitted to NSICU from January 2010 to December 2011 was done. Results: Mean age at presentation was 5.8 days and mean weight was 1.94 kg. Mean number of attempts was 1.14, mean duration of insertion 8.4 min and mean duration of patency of catheter 3.14 days. Most common site of catheter insertion was upper extremity (basilic followed by cephalic. Overall complications were seen in 47 (23% cases. Infectious complications were seen in 22 (10.7% and non-infectious in 25 (12.2% cases. Significant correlation existed between non-infective complications and insertion site (P = 0.03 and duration of PICC (P = 0.04. Conclusion: Precautions should be taken and position must be confirmed during and after PICC insertion to avoid undue complications.

  11. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.

    Science.gov (United States)

    Sharp, Rebecca; Cummings, Melita; Fielder, Andrea; Mikocka-Walus, Antonina; Grech, Carol; Esterman, Adrian

    2015-03-01

    Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research

  12. Central Line–Associated Bloodstream Infection in Hospitalized Children with Peripherally Inserted Central Venous Catheters: Extending Risk Analyses Outside the Intensive Care Unit

    Science.gov (United States)

    Advani, Sonali; Reich, Nicholas G.; Sengupta, Arnab; Gosey, Leslie

    2011-01-01

    Background. Increasingly, peripherally inserted central venous catheters (PICCs) are placed for prolonged intravenous access. Few data exist regarding risk factors for central line–associated bloodstream infection (CLABSI) complicating PICCs in hospitalized children, especially children hospitalized outside the intensive care unit (ICU). Methods. We identified all children with a PICC inserted at The Johns Hopkins Hospital (Baltimore, MD) from 1 January 2003 through 31 December 2009 and used Poisson regression models to identify risk factors for PICC-associated CLABSIs. Results. A total of 2592 PICCs were placed in 1819 children. One hundred sixteen CLABSIs occurred over 44,972 catheter-days (incidence rate [IR], 2.58 cases per 1000 catheter-days; 95% confidence interval [CI], 2.07–3.00 cases per 1000 catheter-days). Independent predictors of CLABSI in the entire cohort included PICC dwell time of ≥21 days (IR ratio [IRR], 1.53; 95% CI, 1.05–2.26), parenteral nutrition as indication for insertion (IRR, 2.24; 95% CI, 1.31–3.84), prior PICC-associated CLABSI (IRR, 2.48; 95% CI, 1.18–5.25), underlying metabolic condition (IRR, 2.07; 95% CI, 1.14–3.74), and pediatric ICU exposure during hospitalization (IRR, 1.80; 95% CI, 1.18–2.75). Risk factors for CLABSI in children without PICU exposure included younger age, underlying malignancy and metabolic conditions, PICCs inserted in the lower extremity, and a prior PICC-associated CLABSI. Conclusions. Prolonged catheter dwell time, pediatric ICU exposure, and administration of parenteral nutrition as the indication for PICC insertion are important predictors of PICC-associated CLABSI in hospitalized children. A careful assessment of these risk factors may be important for future success in preventing CLABSIs in hospitalized children with PICCs. PMID:21454298

  13. A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department.

    Science.gov (United States)

    Lim, Beng Leong; Kelly, Anne-Maree

    2010-10-01

    The objective of this case-based review is to identify and summarize the relevant evidence for the clinical utility of peripheral venous blood gas (pVBG) analyses in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in the emergency department. Relevant studies were identified using the Cochrane Library, Medline, Embase, and CINAHL databases and by hand searching of references of published articles. Included studies were prospective trials comparing arterial and pVBG results in patients with COPD or respiratory distress that reported at least average differences and/or limits of agreement between the two results in English. Outcomes of interest were agreement between arterial and pVBG values for pH, pCO2, pO2, and HCO3. Eighty-nine studies were identified of which six were relevant. The weighted average difference for pCO2 was 5.92 mmHg, whereas those for pH, pO2, and HCO3 were 0.028, 18.65 mmHg, and 1.34 mEq/l, respectively. Using Bland-Altman analysis, the 95% limits of agreement were in the range of -0.10 to 0.08, -17 to 26 mmHg and, -3.5 to 3.5 mEq/l for pH, pCO2, and HCO3, respectively. Reported cutoff pVBG pCO2 values for screening of arterial hypercarbia ranged from 30 to 46 mmHg. No studies investigated the role of pVBG analysis in treatment alteration or clinical outcomes. Available evidence suggests that there is good agreement for pH and HCO3 values between arterial and pVBG results in patients with COPD, but not for pO2 or pCO2. Widespread clinical use is limited because of the lack of validation studies on clinical outcomes.

  14. Avaliação da pressão venosa periférica na esclerose sistêmica Peripheral venous pressure in systemic sclerosis

    Directory of Open Access Journals (Sweden)

    João Potério-Filho

    2004-02-01

    Full Text Available OBJETIVO: Estabelecer a utilidade da medida indireta da pressão venosa periférica (PVP na avaliação de pacientes com esclerose sistêmica (ES, comparando com uma população controle normal. MÉTODOS: Estudo prospectivo avaliando 18 pacientes esclerodérmicas do sexo feminino (sendo oito delas com úlcera cutânea isquêmica submetidas à medida indireta da PVP (por pletismografia. Os dados foram comparados a um grupo controle normal de 18 mulheres hígidas, pareadas para idade. RESULTADOS: Os níveis de pressão arterial foram semelhantes nos dois grupos. Os valores de PVP estavam significativamente diminuídos nos pacientes com ES (58.9 ± 11.6 mmHg no grupo ES e 96.9 ± 7.1 mmHg no grupo controle; p OBJECTIVE: The aim of this prospective study was to establish the usefulness of indirect measurement of peripheral venous pressure (PVP in the evaluation of patients with systemic sclerosis (SSc, comparing them with a normal control population. METHODS: Eighteen female SSc patients (eight patients presenting cutaneous ischemic ulcers were submitted to indirect measurement of the PVP (by plethysmography, and data were compared with a control group of 18 healthy women, paired by age. RESULTS: Arterial pressure levels were similar in both groups. PVP levels were significantly decreased in the SSc patients (58.9 ± 11.6 mmHg in the SSc group and 96.9 ± 7.1 mmHg in the control group; p < 0.0001; in the SSc group, patients with ischemic ulcers presented PVP levels significantly decreased compared with those patients without ulcers (50.6 ± 10.8 mmHg in the ulcer group and 65.5 ± 7.2 mmHg in the group without ulcers; p = 0.006. CONCLUSIONS: It can be concluded that decreased PVP in SSc is associated with a decrease in the blood flow of these patients, predisposing them to cutaneous ischemic ulcers.

  15. Prophylaxis of Venous Thrombosis.

    Science.gov (United States)

    Goldhaber, Samuel Z.

    2001-06-01

    Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior vena cava filters prevent pulmonary embolism, but do not halt the thrombotic process or prevent venous thrombosis. Pharmacologic prophylaxis traditionally has relied upon minidose unfractionated heparin; however, re-examination is warranted in the face of increasingly ill and complex patients. My opinion is that small, fixed doses of once-daily low molecular weight heparin will eventually replace minidose unfractionated heparin as the standard pharmacologic prophylaxis regimen for most surgical and medical patients. Prolongation of prophylaxis after hospital discharge should receive increased emphasis. Most patients being transferred to a skilled nursing facility should receive venous thromboembolism prophylaxis. Similarly, most patients undergoing total hip or knee replacement should receive prolonged preventive regimens, with at least 1 month of anticoagulation. Despite advances, certain aspects of venous thrombosis prophylaxis remain problematic. First, a surprisingly high number of hospitalized patients develop venous thrombosis because of failed (rather than omitted) prophylaxis. Second, many patients in intensive care have a combination of peripheral vascular disease and active bleeding (usually gastrointestinal) that precludes mechanical or pharmacologic prophylaxis. Third, neurosurgical patients undergoing craniotomy for brain tumors suffer a high rate of venous thrombosis and major pulmonary embolism despite the routine use of combined mechanical and pharmacologic prophylaxis. My opinion is that these three areas, in addition to the hospital culture of prophylaxis, should receive

  16. The effectiveness of chlorhexidine-silver sulfadiazine impregnated central venous catheters in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation

    NARCIS (Netherlands)

    Maaskant, J. M.; de Boer, J. P.; Dalesio, O.; Holtkamp, M. J.; Lucas, C.

    2009-01-01

    Immuno-compromised patients are at high risk for all kind of infections. Unfortunately, they need central venous catheters (CVCs), which are associated with infectious complications. In this study we examined the effectiveness of chlorhexidine-silver sulfadiazine impregnated CVCs to prevent

  17. [Venous ulcer].

    Science.gov (United States)

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms.

  18. Radiological placement of peripheral central venous access ports at the forearm. Technical results and long term outcome in 391 patients; Radiologische Implantation zentralvenoeser Portsysteme am Unterarm. Implantationsergebnisse und Langzeit-Follow-up bei 391 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Lenhart, M. [Sozialstiftung Bamberg (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Schaetzler, S. [Klinikum der Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik; Manke, C. [Klinikum Fulda (DE). Klinik fuer Diagnostische und Interventionelle Radiologie] (and others)

    2010-01-15

    To retrospectively analyze the technical result and long term outcome of central venous arm ports placed by radiologists. Over a 5-year period, 399 arm ports were implanted by radiologists in 391 patients. The system consists of a low profile titanium chamber and a silicone catheter. Ports were placed at the forearm after puncture of a vein proximally to the elbow under fluoroscopic guidance. In a retrospective analysis the technical results and the long term outcome were evaluated. Complications were documented according to the standards of the society of interventional radiology. In 391 patients a total of 98 633 catheter days were documented (1 - 1325 days, mean 252 days). Primary technical success was 99.25 % (396 / 399) with a 100 % secondary technical success rate. No severe procedural complications, e. g. pneumothorax or severe hemorrhage, were found. A total of 45 complications occurred (11.28 %, 0.45 / 1000 catheter days), including 8 portal pocket infections (27 - 205 days, mean 115 days). Fifteen ports were explanted because of complications. The complication rate corresponds to the data from subclavian ports and is less than the complication rates published in large surgical trials. Implantation of central-venous arm ports by radiologists is safe and minimally invasive. No severe immediate procedural complications occur due to the peripheral implantation site. Long term complication rates are comparable to other studies of radiological or surgical port implantation at different sites. (orig.)

  19. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults

    Directory of Open Access Journals (Sweden)

    Josep A. Capdevila

    2016-07-01

    Full Text Available The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications.

  20. Venous insufficiency

    Science.gov (United States)

    ... a large vein in the leg called the superficial saphenous vein. Outlook (Prognosis) Chronic venous insufficiency tends ... the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should ...

  1. Venous Ulcers

    Science.gov (United States)

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  2. Venous thromboses

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, A.; Tosch, U.; Rath, M.

    1985-02-01

    The suspicion of the presence of venous thrombosis is supported by Doppler-sonography. The crucial diagnostic procedure, however, is the conventional x-ray-phlebography. The digital subtraction phlebography adds to the conventional technique in the pelvic and thoracic area if parts of the skeleton or soft tissue are overlapping. The radionuclid-phlebography will be applied in contrast medium incompatibility or in suspicion of pulmonary embolism. Factors of increased prevalence of venous thrombosis can be confirmed by CT or sonography.

  3. Peripheral Artery Disease and Diabetes

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with diabetes are ... life. This content was last reviewed January 2016. Diabetes • Home • About Diabetes • Why Diabetes Matters Introduction Cardiovascular ...

  4. THE SUCCESSFUL TREATMENT OF A PERIPHERAL VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION FOR SEVERE ACUTE RESPIRATORY FAILURE IN THE EARLY PERIOD AFTER ADULT LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2014-01-01

    Full Text Available Aim: of our clinical study was to present own experience of veno-venous extracorporeal membrane oxygenation (VV ECMO for the treatment of an adult patient (female, 28 yrs, 150 cm, 35 kg with acute respiratory distress syndrome (ARDS in the early period after liver transplantation against satisfactory liver graft function. Materials and methods. Double-lumen cannula 22 F was placed percutaneously in the right internal jugular vein. The ext- racorporeal contour reduced in length and the polymethylpeptene oxygenator (priming volume 175 ml were also. Results. In 1 hour after the beginning of VV ECMO, we registered the noted improvement of arterial blood gas and acid-base balance (regress of respiratory acidosis, improvement of arterial oxygenation which allowed us to use the «protective» mode of mechanical ventilation. Improvement of gas exchange and regress of clinical and radiological manifestations of ARDS allowed for VV ECMO weaning and decannulation on day 7. The patient was discharged from ICU and then from our Centre to a homestay respectively on the 9th and 16th day after VV ECMO weaning with the satisfactory liver graft and lungs function. Conclusion. VV ECMO can be successfully applied to correct the life-threatening acute respiratory failure in the early period after liver transplantation. 

  5. The association between lactate, mean arterial pressure, central venous oxygen saturation and peripheral temperature and mortality in severe sepsis: a retrospective cohort analysis.

    Science.gov (United States)

    Houwink, Aletta P I; Rijkenberg, Saskia; Bosman, Rob J; van der Voort, Peter H J

    2016-03-12

    During resuscitation in severe sepsis and septic shock, several goals are set. However, usually not all goals are equally met. The aim of this study is to determine the relative importance of the different goals, such as mean arterial pressure (MAP), lactate, central venous oxygen saturation (ScvO2) and central to forefoot temperature (delta-T), and how they relate to intensive care unit (ICU) and hospital mortality. In a retrospective cohort study in a 20-bed mixed medical and surgical ICU of a teaching hospital we studied consecutive critically ill patients who were admitted for confirmed infection and severe sepsis or septic shock between 2008 and 2014. All validated MAP, lactate levels, ScvO2 and delta-T for the first 24 hours of ICU treatment were extracted from a clinical database. Logistic regression analyses were performed on validated measurements in the first hour after admission and on mean values over 24 hours. Patients were categorized by MAP (24-hour mean below or above 65 mmHg) and lactate (24-hour mean below or above 2 mmol/l) for Cox regression analysis. From 837 patients, 821 were eligible for analysis. All had MAP and lactate measurements. The delta-T was available in 812 (99%) and ScvO2 was available for 193 out of these patients (23.5%). Admission lactate (p < 0.001) and admission MAP (p < 0.001) were independent predictors of ICU and hospital mortality. The 24-hour mean values for lactate, MAP and delta-T were all independent predictors of ICU mortality. Hospital mortality was independently predicted by the 24-hour mean lactate (odds ratio (OR) 1.34, 95% confidence interval (CI) 1.30-1.40, p = 0.001) mean MAP (OR 0.96, 95% CI 0.95-0.97, p = 0.001) and mean delta-T (OR 1.09, 95% CI 1.06-1.12, p = 0.001). Patients with a 24-hour mean lactate below 2 mmol/l and a 24-hour mean MAP above 65 mmHg had the best survival, followed by patients with a low lactate and a low MAP. Admission MAP and lactate independently predicted ICU and hospital mortality

  6. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2018-03-01

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  7. Determination of carcinoembryonic antigen levels in peripheral and draining venous blood in patients with colorectal carcinoma Determinação dos níveis do antígeno carcinoembriônico no sangue periférico e no efluente venoso em doentes com carcinoma colorretal

    Directory of Open Access Journals (Sweden)

    Jaques Waisberg

    2004-06-01

    Full Text Available BACKGROUND: The problem of the relationship between blood carcinoembryonic antigen (CEA levels and tissue CEA content in colorectal carcinoma, and the mechanisms for CEA release from tumor cells in tissue adjacent to the neoplasm is important to understanding the biology of colorectal carcinoma. It has not been adequately explained whether CEA in the peripheral blood is drained mainly by portal system blood or by the lymphatic system, or indeed by both systems. AIM: To study the behavior of CEA levels in peripheral blood (CEA-p and venous effluent blood (CEA-d among patients with colorectal tumors, who underwent curative operation. METHOD: A total of 28 patients were studied (12 male [42.9%] and 16 female [57.1%], mean age 66.1 years [range: 43 - 84]. Immediately after laparotomy, peripheral venous blood was extracted by antecubital venous puncture and venous effluent blood was collected from the main drainage vein of the lesions. Values of CEA-p, CEA-d and the gradient between CEA-d and CEA-p that were less than 5.0 ng/mL were considered normal. RESULTS: Eight (28.6% patients were stage A in Duke's classification, nine (32.1% stage B and 11 (39.3% stage C. The neoplasm was located in the rectum of 14 patients (50.0%, in the transverse colon in five (17.9%, in the sigmoid in four (14.3%, in the cecum and/or ascending colon in three (10.7%, and in the descending colon in two (7.1%. The histopathological examination revealed well-differentiated adenocarcinoma in all the patients. Only one patient (3.6%, Duke's classification stage C, presented neoplasm with venous invasion. The gradient between the CEA-p and CEA-d levels were normal in 25 patients (88.3% and high in three (10.7%. The mean value for CEA-p was 3.8 ± 4.1 ng/mL (0.1-21.1 ng/mL and for the drained CEA (CEA-d it was 4.5 ± 4.3 ng/mL (0.3-20.2 ng/mL, without significant difference between these values. There was a significant difference between the mean value for CEA-p and CEA-d levels

  8. Superficial venous disease.

    Science.gov (United States)

    Brown, Kellie R; Rossi, Peter J

    2013-08-01

    Superficial venous disease is a common clinical problem. The concerning disease states of the superficial venous system are venous reflux, varicose veins, and superficial venous thrombosis. Superficial venous reflux can be a significant contributor to chronic venous stasis wounds of the lower extremity, the treatment of which can be costly both in terms of overall health care expenditure and lost working days for affected patients. Although commonly thought of as a benign process, superficial venous thrombosis is associated with several underlying pathologic processes, including malignancy and deep venous thrombosis. Published by Elsevier Inc.

  9. Cerebral sinus venous thrombosis

    Directory of Open Access Journals (Sweden)

    Hernando Raphael Alvis-Miranda

    2013-01-01

    Full Text Available Cerebral sinus venous thrombosis (CSVT is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment.

  10. History of venous leg ulcers.

    Science.gov (United States)

    Gianfaldoni, S; Wollina, U; Lotti, J; Gianfaldoni, R; Lotti, T; Fioranelli, M; Roccia, M G

    To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

  11. Effect of Multi-layer Compression Bandage Systems on Leg Ulcers Associated with Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Hüseyin Kuplay

    2013-03-01

    Full Text Available Introduction: Venous leg ulcer is a major health problem in terms of high prevalence and high cost for treatment. Multi-layer compression bandage systems for venous leg ulcers are supposed to be the gold standard for the treatment of venous ulcers. The aim of the current study is to investigate the effectiveness of multi-layer compression bandage systems for the treatment of venous leg ulcers.Patients and Methods: Nineteen consecutive patients diagnosed to have leg ulcers were evaluated and four patients were excluded from the study due to the peripheral arterial disease. Fifteen patients, enrolled in the study, were classified according to CEAP classification and belonged to the same class. Betaven® multi-layer compression bandage was applied to patients. Patients were followed-up in terms of wound healing and reduction in wound diameter.Results: Twelve male and three female patients underwent multi-layer bandage system. Mean age of patients was 38.2 ± 4.2 years. Ulcer size was measured planimetrically and baseline ulcer size was 4-10 cm². The location of ulcer was on medial malloelus in seven patients, lateral malleolus in three patients, anterior surface of the leg in four patients and lateral side of the leg in one patient. Patients had chronic venous insuuficiency for a mean of 5.1 ± 2.1 years. CEAP classifications were C6, Ep, As2,3-p18, Pr2,3, 18. Each bandage was changed five days after application along with wound care. Mean duration of treatment was 6 ± 2 weeks. Complete healing of the venous ulcers occurred in all patients except for one. This patient was referred to plastic surgery clinic for reconstruction.Conclusion: Multi-layer compression bandage system is an effective method of treatment for venous leg ulcers associated with chronic venous insufficiency by reducing venous return and increasing intertitial tissue pressure. This effect occurred in the shortrun as well as with a low cost and prevented loss of labor.

  12. Peripheral circulation.

    Science.gov (United States)

    Laughlin, M Harold; Davis, Michael J; Secher, Niels H; van Lieshout, Johannes J; Arce-Esquivel, Arturo A; Simmons, Grant H; Bender, Shawn B; Padilla, Jaume; Bache, Robert J; Merkus, Daphne; Duncker, Dirk J

    2012-01-01

    Blood flow (BF) increases with increasing exercise intensity in skeletal, respiratory, and cardiac muscle. In humans during maximal exercise intensities, 85% to 90% of total cardiac output is distributed to skeletal and cardiac muscle. During exercise BF increases modestly and heterogeneously to brain and decreases in gastrointestinal, reproductive, and renal tissues and shows little to no change in skin. If the duration of exercise is sufficient to increase body/core temperature, skin BF is also increased in humans. Because blood pressure changes little during exercise, changes in distribution of BF with incremental exercise result from changes in vascular conductance. These changes in distribution of BF throughout the body contribute to decreases in mixed venous oxygen content, serve to supply adequate oxygen to the active skeletal muscles, and support metabolism of other tissues while maintaining homeostasis. This review discusses the response of the peripheral circulation of humans to acute and chronic dynamic exercise and mechanisms responsible for these responses. This is accomplished in the context of leading the reader on a tour through the peripheral circulation during dynamic exercise. During this tour, we consider what is known about how each vascular bed controls BF during exercise and how these control mechanisms are modified by chronic physical activity/exercise training. The tour ends by comparing responses of the systemic circulation to those of the pulmonary circulation relative to the effects of exercise on the regional distribution of BF and mechanisms responsible for control of resistance/conductance in the systemic and pulmonary circulations. © 2012 American Physiological Society

  13. Risk factors for chronic cerebrospinal venous insufficiency (CCSVI in a large cohort of volunteers.

    Directory of Open Access Journals (Sweden)

    Kresimir Dolic

    Full Text Available BACKGROUND: The role of intra- and extra-cranial venous system impairment in the pathogenesis of various vascular, inflammatory and neurodegenerative neurological disorders, as well as in aging, has not been studied in detail. Nor have risk factors been determined for increased susceptibility of venous pathology in the intra-cranial and extra-cranial veins. The aim of this study was to investigate the association between presence of a newly proposed vascular condition called chronic cerebrospinal venous insufficiency (CCSVI and environmental factors in a large volunteer control group without known central nervous system pathology. METHODS AND FINDINGS: The data were collected in a prospective study from 252 subjects who were screened for medical history as part of the entry criteria and participated in the case-control study of CCSVI prevalence in multiple sclerosis (MS patients, and then were analyzed post-hoc. All participants underwent physical and Doppler sonography examinations, and were assessed with a structured environmental questionnaire. Fullfilment of ≥ 2 positive venous hemodynamic (VH criteria on Doppler sonography was considered indicative of CCSVI diagnosis. Risk and protective factors associated with CCSVI were analyzed using logistic regression analysis. Seventy (27.8% subjects presented with CCSVI diagnosis and 153 (60.7% presented with one or more VH criteria. The presence of heart disease (p = .001, especially heart murmurs (p = .007, a history of infectious mononucleosis (p = .002, and irritable bowel syndrome (p = .005 were associated with more frequent CCSVI diagnosis. Current or previous smoking (p = .029 showed a trend for association with more frequent CCSVI diagnosis, while use of dietary supplements (p = .018 showed a trend for association with less frequent CCSVI diagnosis. CONCLUSIONS: Risk factors for CCSVI differ from established risk factors for peripheral venous diseases. Vascular

  14. Mesenteric venous thrombosis

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001157.htm Mesenteric venous thrombosis To use the sharing features on this page, please enable JavaScript. Mesenteric venous thrombosis (MVT) is a blood clot in one or ...

  15. Venous thromboembolism: Risk profile and management of ...

    African Journals Online (AJOL)

    Objectives. This study aims to describe the venous thromboembolism (VTE) risk profile of women undergoing elective gynaecological surgery in a tertiary hospital and to audit the VTE prophylaxis prescribed. Methods. One hundred and nine women who underwent elective gynaecological surgery at Kalafong Provincial ...

  16. MRI in venous thromboembolic disease

    International Nuclear Information System (INIS)

    Sostman, H.D.; Debatin, J.F.; Spritzer, C.E.; Coleman, R.E.; Grist, T.M.; MacFall, J.R.

    1993-01-01

    We evaluated the ability of magnetic resonance (MR) imaging to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). MR venography was performed on 217 patients suspected of having DVT. Cine-MR imaging of the pulmonary arteries was performed in 14 other patients who were thought to have PE based on other imaging studies. In a third group of 5 patients, MR pulmonary angiograms were performed in the sagittal and coronal planes with a multislice fast gradient recalled echo technique. All but one of the 217 MR venograms were technically adequate. In 72 patients with correlative imaging studies (venography and ultrasound) MR venography was 99% sensitive and 95% specific. On the basis of follow-up (mean 8.3 months), no false-negative MR venograms were detected in an additional 64 patients. In 11 other patients MR revealed a diagnosis other than DVT. Cine-MR showed PE in all 14 patients evaluated. MR pulmonary arteriography demonstrated filling defects consistent with acute PE in 2 of 3 patients with acute PE; in the third patient only a questionable filling defect was seen. Coarctations or webs were found in the pulmonary arteries of both patients with chronic PE. These preliminary data suggest that MR imaging may be able to evaluate both the peripheral venous and the pulmonary arterial component of venous thromboembolic disease. Further technical refinement and more extensive clinical experience will be required to establish the role of this method in diagnosing pulmonary embolism, but MR venography is now used routinely in our hospital for the diagnosis of deep venous thrombosis. (orig.)

  17. Neonatal deep white matter venous infarction and liquefaction: a pseudo-abscess lesion

    Energy Technology Data Exchange (ETDEWEB)

    Ruess, Lynne; Rusin, Jerome A. [Nationwide Children' s Hospital, Department of Radiology, Columbus, OH (United States); The Ohio State University College of Medicine and Public Health, Columbus, OH (United States); Dent, Carly M.; Tiarks, Hailey J.; Yoshida, Michelle A. [Nationwide Children' s Hospital, Department of Radiology, Columbus, OH (United States)

    2014-11-15

    Deep white matter hemorrhagic venous infarction with subsequent cavitation due to necrosis and liquefaction has been described in neonates and may be associated with infection and meningitis. In our experience, the MRI pattern of these lesions is confused with the pattern seen with cerebral abscesses. The purpose of our study was to characterize the MRI findings of post infarction necrosis and liquefaction after hemorrhagic deep white matter venous infarction in infants and to distinguish these lesions from cerebral abscesses. An institutional review board approved a retrospective review of imaging records to identify all patients with cerebral venous infarction at a children's hospital during a 10-year period. Nine infants had deep white matter hemorrhagic venous infarction with white matter fluid signal cavitary lesions. A diagnosis of cerebral abscess was considered in all. The imaging and laboratory findings in these patients are reviewed and compared to descriptions of abscesses found in the literature. There were six female and three male infants. The mean age at presentation was 20 days (range: 0-90 days), while the corrected age at presentation was less than 30 days for all patients. Seven patients presented with seizures and signs of infection; one infant presented with lethargy and later proved to have protein C deficiency. MRI was performed 0-12 days from presentation in these eight patients. Another patient with known protein C deficiency underwent MRI at 30 days for follow-up of screening US abnormalities. There were a total of 38 deep cerebral white matter fluid signal cavitary lesions: 25 frontal, 9 parietal, 2 temporal, 2 occipital. Larger lesions had dependent debris. All lesions had associated hemorrhage and many lesions had evidence of adjacent small vessel venous thrombosis. Lesions imaged after gadolinium showed peripheral enhancement. Three lesions increased in size on follow-up imaging. Three patients, two with meningitis confirmed via

  18. Neonatal deep white matter venous infarction and liquefaction: a pseudo-abscess lesion

    International Nuclear Information System (INIS)

    Ruess, Lynne; Rusin, Jerome A.; Dent, Carly M.; Tiarks, Hailey J.; Yoshida, Michelle A.

    2014-01-01

    Deep white matter hemorrhagic venous infarction with subsequent cavitation due to necrosis and liquefaction has been described in neonates and may be associated with infection and meningitis. In our experience, the MRI pattern of these lesions is confused with the pattern seen with cerebral abscesses. The purpose of our study was to characterize the MRI findings of post infarction necrosis and liquefaction after hemorrhagic deep white matter venous infarction in infants and to distinguish these lesions from cerebral abscesses. An institutional review board approved a retrospective review of imaging records to identify all patients with cerebral venous infarction at a children's hospital during a 10-year period. Nine infants had deep white matter hemorrhagic venous infarction with white matter fluid signal cavitary lesions. A diagnosis of cerebral abscess was considered in all. The imaging and laboratory findings in these patients are reviewed and compared to descriptions of abscesses found in the literature. There were six female and three male infants. The mean age at presentation was 20 days (range: 0-90 days), while the corrected age at presentation was less than 30 days for all patients. Seven patients presented with seizures and signs of infection; one infant presented with lethargy and later proved to have protein C deficiency. MRI was performed 0-12 days from presentation in these eight patients. Another patient with known protein C deficiency underwent MRI at 30 days for follow-up of screening US abnormalities. There were a total of 38 deep cerebral white matter fluid signal cavitary lesions: 25 frontal, 9 parietal, 2 temporal, 2 occipital. Larger lesions had dependent debris. All lesions had associated hemorrhage and many lesions had evidence of adjacent small vessel venous thrombosis. Lesions imaged after gadolinium showed peripheral enhancement. Three lesions increased in size on follow-up imaging. Three patients, two with meningitis confirmed via

  19. [Physiotherapy potentials improve the calf muscle pump function in chronic venous insufficiency].

    Science.gov (United States)

    Dymarek, Robert; Ptaszkowski, Kuba; Słupska, Lucyna; Rajfur, Joanna; Pasternok, Małgorzata; Taradaj, Jakub; Halski, Tomasz

    2014-01-01

    Mechanism of the calf muscle pump plays a major role in venous blood return from peripheral parts of blood vessels of lower extremities. It enables a smooth venous blood movement from the deep venous system segment located below in a direction to the segment lying above which effectively prevents a distal blood stasis and veno-lymphatic edema of lower limbs. Calf muscle pump dysfunction together with disorders in the construction of blood vessels walls and with endurance weakness of valves, leads to venous hypertension and contributes to the development of venous insufficiency. The aim of this paper is to demonstrate the theoretical basis including venous return physiology and the mechanism of lower limbs venous--muscle pump as well as provide practical application of physiotherapy methods to support the properfunction of presented calf muscle pump. Examples in the field of physical medicine, compression therapy and kinesiotherapy for improving the efficiency of lower extremity muscles, providing a physiological venous return.

  20. Infraclavicular brachial plexus block for the management of inadvertent intraarterial drug administration after arterial insertion of a venous cannula during ultrasound-guided venous cannulation.

    Science.gov (United States)

    Leo, Anne-Marie; Mislovic, Branislav

    2014-09-15

    This case report documents the inadvertent placement of an arterial cannula despite using realtime ultrasound to insert a peripheral venous cannula in a child with difficult venous access. The resultant limb ischemia was treated with an infraclavicular ultrasound-guided brachial plexus block as sympatholytic treatment.

  1. Diagnosis of venous disorders

    International Nuclear Information System (INIS)

    Minar, E.

    1993-01-01

    Limited accuracy in the clinic diagnosis of deep vein thrombosis (VT) makes such diagnostic tests such as duplex sonography or venography necessary. Exact information on the age and extent of the thrombus are necessary for the clinician to optimize the therapeutric management. The correct diagnosis of calf vein thrombosis and of recurrent VT in patients with postphlebitis changes also has implications for treatment. After exclusion of thrombosis, the radiologist should evaluate the leg for other possible causes of symptoms besides VT. Investigation of the venous sytem also has a role in the diagnosis in patients with suspected pulmonary embolism. In patients with chronic venous insuffficiency the deep venous system should assessed for patency and venous valve function. The superficial veins should be differentiated in segments with sufficient or insufficient venous valves, and it is also necessary to look for insufficiency of the perforrating veins. In patients with superficial phlebitis there is risk of propagation into the deep venous system. (orig.) [de

  2. [Ultrasound-guided peripheral catheterization].

    Science.gov (United States)

    Salleras-Duran, Laia; Fuentes-Pumarola, Concepció

    2016-01-01

    Peripheral catheterization is a technique that can be difficult in some patients. Some studies have recently described the use of ultrasound to guide the venous catheterization. To describe the success rate, time required, complications of ultrasound-guided peripheral venous catheterization. and patients and professionals satisfaction The search was performed in databases (Medline-PubMed, Cochrane Library, CINAHL and Cuiden Plus) for studies published about ultrasound-guided peripheral venous catheterization performed on patients that provided results on the success of the technique, complications, time used, patient satisfaction and the type of professional who performed the technique. A total of 21 studies were included. Most of them get a higher success rate 80% in the catheterization ecoguide and time it is not higher than the traditional technique. The Technical complications analyzed were arterial puncture rates and lower nerve 10%. In all studies measuring and comparing patient satisfaction in the art ecoguide is greater. Various professional groups perform the technique. The use of ultrasound for peripheral pipes has a high success rate, complications are rare and the time used is similar to that of the traditional technique. The technique of inserting catheters through ultrasound may be learned by any professional group performing venipuncture. Finally, it gets underscores the high patient satisfaction with the use of this technique. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  3. Detection of an embolized central venous catheter fragment with endobronchial ultrasound.

    Science.gov (United States)

    Dhillon, Samjot Singh; Harris, Kassem; Alraiyes, Abdul H; Picone, Anthony L

    2018-01-01

    An 84-year-old woman underwent Convex-probe Endobronchial Ultrasound (CP-EBUS) for 18 F-fluorodeoxyglucose avid subcarinal lymphadenopathy on Positron Emission Tomogram (PET) scan. Endobronchial ultrasound-guided transbronchial needle aspiration of the subcarinal lymph node revealed squamous cell lung carcinoma. A small hyperechoic rounded density was noted inside the lumen of the azygous vein. Based on chest computed tomography findings and her clinical history, this was felt to be a broken fragment of a peripherally inserted central catheter, which was placed for intravenous antibiotics, a few months prior to this presentation. To the best of our knowledge, this is the first ever CP-EBUS description of a broken fragment of central venous catheter. © 2016 John Wiley & Sons Ltd.

  4. Peripheral vascular injuries

    Directory of Open Access Journals (Sweden)

    Celal Yavuz

    2009-01-01

    Full Text Available Aim: To determine etiology and management in patients with peripheral vascular trauma.Materials and Methods: From 2005 to 2006 with a diagnosis of peripheral artery injury, 69 cases admitted to Diyarbakır State Hospital Department of Cardiovascular surgery.Results: These cases have been respectively reviewed. The causes of injuries were; penetrating injuries in 60 cases (87%, blunt trauma in seven cases (10% and gunshot injuries in two cases (3%. In 53 cases (74% upper extremity, in 15 cases (21% lower extremity was involved. As a surgical procedure, in 34 cases (47% end-to-end anastomosis, in 28 cases (39% lateral suture, in five cases (7% venous graft interposition, in five cases (7% ligation was performed.Conclusion: Early intervention, transfusion of fluid and blood, systemic anticoagulation, preoperative and postoperative detailed debridement decreased the morbidity and mortality rates.

  5. Chronic venous disorders

    African Journals Online (AJOL)

    engage in social and occupational activities, reduce QoL, and impose financial constraints. CVD has a significant financial ... 'heaviness or aching' aggravated by prolonged standing and relieved by elevation. Additionally, chronic .... of image acquisition based on venous filling. Abnormalities in venous flow are depicted.

  6. Peripheral Circulatory Features during High-Frequency Jet Ventilation

    Directory of Open Access Journals (Sweden)

    M. B. Kontorovich

    2010-01-01

    Full Text Available The paper gives the results of a study of peripheral circulatory features during high-frequency jet ventilation (HFJV. The main specific features of peripheral circulation and oxygen transport during HFJV are formulated on the basis of a study of cardiac output (impedance cardiography, peripheral vascular resistance, peripheral vascular blood filling (photoplethysmogram analysis, adaptive peripheral blood flow reactions (spectral analysis of peripheral vascular pulsation. HFJV gives rise to the peculiar pattern of peripheral hemodynamics and tissue gas exchange, which is characterized by higher oxygen uptake without a decrease in mixed venous blood saturation, with normal extraction coefficient and preserved low peripheral vascular resistance. During HFJV, unlike traditional ventilation, the main peripheral hemodynamic feature is the increased capillary bed blood volume caused by the blood flow involvement of reserve capillaries under control of volume (parasympathetic regulation of adaptive peripheral hemodynamic reactions. Key words: high-frequency jet ventilation, oxygen transport, peripheral hemodynamics.

  7. Combined Ovarian and Adrenal Venous Sampling in the Localization of Adrenocorticotropic Hormone-Independent Ectopic Cushing Syndrome.

    Science.gov (United States)

    Chen, Shi; Li, Ran; Zhang, Xiaobo; Lu, Lin; Li, Ji; Pan, Hui; Zhu, Huijuan

    2018-03-01

    Cushing syndrome is rarely caused by the secretion of cortisol from ovarian tumors. In clinical decision-making, it is important to determine whether the ovarian tumor is capable of secreting cortisol. Selective ovarian and adrenal venous sampling is scarcely reported in the localization of ACTH-independent ectopic Cushing syndrome. We present a case of 40-year-old Chinese woman who had weight gain, hirsutism, hypertension, and menstrual disorder over 6 months. Her physical examination and biochemical assessment revealed adrenocorticotropic hormone-independent Cushing syndrome. Adrenal computed tomography scan indicated no abnormality. A mass of 5.7 cm × 4.2 cm × 3.4 cm was discovered by pelvic ultrasonography. Somatostatin receptor scintigraphy revealed no abnormal radioactivity intake. Combined ovarian and adrenal venous sampling together with a cortisol assay were conducted. Results revealed cortisol concentration of the right-side ovarian vein, left-side ovarian vein, and peripheral vein of 268.60, 29.00, and 35.18 μg/dL, respectively, suggesting a right-side ovarian origin. A right-side salpingo-oophorectomy was performed and the pathological diagnosis revealed ovarian steroid cell tumor, not otherwise specified. The cortisol level was substantially lower after the patient underwent surgery and symptoms of Cushing syndrome disappeared. At 3-year follow-up, the patient remained disease free, and no tumor was observed on pelvic ultrasonogram. Combined ovarian and adrenal venous sampling is valuable in the localization of adrenocorticotropic hormone-independent ectopic Cushing syndrome.

  8. Venous thrombosis: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  9. [Developmental venous anomaly (DVA)].

    Science.gov (United States)

    Zimmer, A; Hagen, T; Ahlhelm, F; Viera, J; Reith, W; Schulte-Altedorneburg, G

    2007-10-01

    As congenital anatomic variants of venous drainage, developmental venous anomalies (DVA) represent up to 60% of all cerebral vascular malformations. The prior term "venous angioma" is a misnomer implicating an abnormal vascular structure with an increased bleeding risk. They are often found incidentally and are hardly ever symptomatic. Their morphologic characteristics are dilated vessels in the white matter, which converge on a greater collector vein, forming the typical caput medusae. They drain into the superficial or deep venous system. The frequent association with other, potentially bleeding-prone vascular malformations is clinically relevant, in particular cavernous angioma, which might require therapeutic action. Therefore, coincident vascular lesions need to be actively sought by appropriate additional imaging techniques.

  10. Venous thrombosis - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100168.htm Venous thrombosis - series—Normal anatomy To use the sharing features ... Editorial team. Related MedlinePlus Health Topics Deep Vein Thrombosis A.D.A.M., Inc. is accredited by ...

  11. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea; Adderley, Una

    2016-01-15

    Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years. We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations. In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.

  12. Venous ulcer review

    Science.gov (United States)

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

  13. Venous ulcer review

    OpenAIRE

    Bevis, Paul; Earnshaw, Jonothan

    2011-01-01

    Paul Bevis, Jonothan Earnshaw Department of Vascular Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, UKDate of preparation: 3 February 2011Conflict of interest: None declared.Clinical question: What is the best treatment for venous ulcers?Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recu...

  14. Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography.

    Science.gov (United States)

    Struck, Manuel F; Ewens, Sebastian; Schummer, Wolfram; Busch, Thilo; Bernhard, Michael; Fakler, Johannes K M; Stumpp, Patrick; Stehr, Sebastian N; Josten, Christoph; Wrigge, Hermann

    2018-03-01

    Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°. During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005-1.074, p = 0.024). Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.

  15. Lower extremity arterial and venous ulcers.

    Science.gov (United States)

    Sieggreen, Mary

    2005-06-01

    The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found.

  16. Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Fabio Henrique Rossi

    2014-12-01

    Full Text Available Objective:Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT. Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV for these diagnoses is under investigation.Methods:Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed.Results:A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of >80%. The only risk factor that was found to be independently associated with a significantly higher incidence of >50% venous obstruction was a medical history of DVT (p=0.035 (Fisher's exact test. There was a positive relationship between clinical classification (CEAP and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011.Conclusion:Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI.

  17. Brain venous pathologies: MRI findings

    International Nuclear Information System (INIS)

    Salvatico, Rosana; Gonzalez, Alejandro; Yanez, Paulina; Romero, Carlos; Trejo, Mariano; Lambre, Hector

    2006-01-01

    Purpose: To describe MRI findings of the different brain venous pathologies. Material and Methods: Between January 2002 and March 2004, 18 patients were studied 10 males and 8 females between 6 and 63 years old; with different brain venous pathologies. In all cases brain MRI were performed including morphological sequences with and without gadolinium injection and angiographic venous sequences. Results: 10 venous occlusions were found, 6 venous angiomas, and 2 presented varices secondary to arteriovenous dural fistula. Conclusion: Brain venous pathologies can appear in many different clinical contexts, with different prognosis and treatment. In all the cases brain MRI was the best imaging study to disclose typical morphologic abnormalities. (author) [es

  18. Contrast-enhanced peripheral MRA

    DEFF Research Database (Denmark)

    Nielsen, Yousef W; Thomsen, Henrik S

    2012-01-01

    -state MRA. Gadolinium(Gd)-based contrast agents are used for CE-MRA of the peripheral arteries. Extracellular Gd agents have a pharmacokinetic profile similar to iodinated contrast media. Accordingly, these agents are employed for first-pass MRA. Blood-pool Gd-based agents are characterized by prolonged......In the last decade contrast-enhanced magnetic resonance angiography (CE-MRA) has gained wide acceptance as a valuable tool in the diagnostic work-up of patients with peripheral arterial disease. This review presents current concepts in peripheral CE-MRA with emphasis on MRI technique and contrast...... MRI contrast agent is injected intravenously and T1-weighted images are acquired in the subsequent arterial first-pass phase. In order to achieve high quality MR angiograms without interfering venous contamination or artifacts, a number of factors need to be taken into account. This includes magnetic...

  19. Fingertip replantations: importance of venous anastomosis and the clinical results.

    Science.gov (United States)

    Hasuo, Takaaki; Nishi, Genzaburo; Tsuchiya, Daiji; Otsuka, Takanobu

    2009-01-01

    Overall survival rate for 143 digits with complete amputation of the distal phalanx was 78%. Replanted digits that underwent venous anastomosis showed a very high survival rate of 93%. Loss of the distal interphalangeal joint function in subzone IV was significantly inferior to that in subzones II and III. Protective sensation was achieved in 96% of replanted digits. Sensory recovery in the absence of nerve repair was significantly worse for avulsion injury than for crush injury. Nail deformity tended to be increased for replanted digits in subzone III or with crush-type injury. Successful venous anastomosis appears to offer the best way to promote survival of replanted digits. If venous anastomosis is infeasible, a replanted digit can survive with any methods for venous drainage in subzones II and III, but does not survive in subzone IV. To minimise nail deformity, repair of the germinal matrix is necessary.

  20. Placement of an implantable central venous access device

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon; Lee, Young Suk [Dan Kook Univ., Seoul (Korea, Republic of). Hospital

    1998-03-01

    To evaluate the efficacy and safety of placement of a central venous catheter with infusion port into the superior vena cava. Central venous catheters with a infusion port were implanted in 21 patients (M:F=4:17, age range:15-63, mean age: 41) diagnosed as suffering from breast cancer (n=9), lymphoma (n=7), thymoma (n=2) rhabdomyosarcoma(n=2) and rectal cancer (n=1). The per(n=9), lymphoma(n=7), thymoma (n=2) rhabdomyosarcoma (n=2) and rectal cancer (n=1). The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance during injection of contrast media at the site of the ipsilateral peripheral vein (20 cases) and under ultrasonographic guidance (1 case). 9.6F central venous catheters placed in the superior vena cava via the subclavian vein and the connected infusion ports were implanted in the subcutaneous pocket near the puncture site of the right anterosuperior chest wall. Radiologic placement under fluoroscopic guidance of a central venous catheter with a infusion port is easy, safe and useful for patients requiring long-term venous access. (author). 21 refs., 2 figs.

  1. Reduction of venous thrombosis complicating phlebography

    International Nuclear Information System (INIS)

    Bettmann, M.A.; Salzman, E.W.; Rosenthal, D.; Clagett, P.; Davies, G.; Nebesar, R.; Rabinov, K.; Ploetz, J.; Skillman, J.

    1980-01-01

    Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive 125 I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reuction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy

  2. Reduction of venous thrombosis complicating phlebography

    Energy Technology Data Exchange (ETDEWEB)

    Bettmann, M.A. (Peter Bent Brigham Hospital, Boston, MA); Salzman, E.W.; Rosenthal, D.; Clagett, P.; Davies, G.; Nebesar, R.; Rabinov, K.; Ploetz, J.; Skillman, J.

    1980-06-01

    Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive /sup 125/I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reuction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.

  3. Venous hemodynamic changes in lower limb venous disease

    DEFF Research Database (Denmark)

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

    2016-01-01

    aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT...

  4. Direct venous thrombolysis and venous angioplasty in the upper extremity

    International Nuclear Information System (INIS)

    Hollmann, J.P.; Guenther, R.W.

    1987-01-01

    Venous thromboses of stenoses in the upper extremity are often the result of a compression syndrome of the shoulder girdle, the Paget-von Schroetter syndrome, vascular surgery, space-occupying lesions in the mediastinum or the result of catheterisation. Direct venous thrombolysis and venous angioplasty were performed successfully in six patients. (orig.) [de

  5. Ultrasound Guidance as a Rescue Technique for Peripheral Intravenous Cannulation

    Science.gov (United States)

    2006-09-14

    peripheral venous access, subsequently having either a traditional or ultrasound - guided method of JV cannulation used as a means of rescue. Materials...rate of peripheral cannula insertion with ultrasound would elicit less stress with resultant increased patient satisfaction. The attractiveness of... guided catheter placement. Aponte et al. investigated the use of ultrasound - guided cannulation as an aid to peripheral cannulation of veins of the hands

  6. Chronic venous disease.

    Science.gov (United States)

    Wolinsky, Claire D; Waldorf, Heidi

    2009-11-01

    Identifying characteristic cutaneous findings is important in determining the appropriate management of certain venous diseases. The health care provider should be familiar with the classic description of patterns and distributions of skin manifestations, such as varicose veins, stasis dermatitis, palpable cord, petechiae, and telangiectasias. In addition to the gross appearance of the skin, a skin biopsy may help elucidate a diagnosis. General treatment and prevention of the underlying venous pathology is essential. Furthermore, specific management of skin findings should include therapy to ameliorate progression of disease and symptomatology when warranted.

  7. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  8. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

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

  9. Venous access: options, approaches and issues

    Energy Technology Data Exchange (ETDEWEB)

    Asch, M.R. [Univ. of Toronto, Mount Sinai Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada)

    2001-06-01

    Venous access is an essential part of medical practice. It is needed to obtain blood samples to make the diagnosis and to administer fluids or medicines as part of treatment. Although relatively new in the history of medicine, the placement and maintenance of the various venous access devices now occupies a significant portion of many vascular and interventional radiology practices. Thus, it is important to have a thorough understanding of these devices and their uses. The first long-term venous access devices were used in 1973. These were placed via a surgical cut-down on the subclavian vein. In 1982, the first subcutaneous implantable ports were described. These procedures were initially performed by surgeons, but over the last 5-10 years, both the insertion and management of these devices has shifted to interventional radiologists. Peripherally inserted central catheter (PICC) lines have almost completely supplanted the use of standard central lines (Fig. 1). A number of factors have facilitated this - namely, ready and less expensive room access, outpatient procedure and radiologists' accessibility and familiarity with image-guidance procedures and catheters and guide wires. (author)

  10. Venous access: options, approaches and issues

    International Nuclear Information System (INIS)

    Asch, M.R.

    2001-01-01

    Venous access is an essential part of medical practice. It is needed to obtain blood samples to make the diagnosis and to administer fluids or medicines as part of treatment. Although relatively new in the history of medicine, the placement and maintenance of the various venous access devices now occupies a significant portion of many vascular and interventional radiology practices. Thus, it is important to have a thorough understanding of these devices and their uses. The first long-term venous access devices were used in 1973. These were placed via a surgical cut-down on the subclavian vein. In 1982, the first subcutaneous implantable ports were described. These procedures were initially performed by surgeons, but over the last 5-10 years, both the insertion and management of these devices has shifted to interventional radiologists. Peripherally inserted central catheter (PICC) lines have almost completely supplanted the use of standard central lines (Fig. 1). A number of factors have facilitated this - namely, ready and less expensive room access, outpatient procedure and radiologists' accessibility and familiarity with image-guidance procedures and catheters and guide wires. (author)

  11. Cerebral venous thrombosis

    NARCIS (Netherlands)

    Silvis, Suzanne M.; de Sousa, Diana Aguiar; Ferro, José M.; Coutinho, Jonathan M.

    2017-01-01

    Cerebral venous thrombosis (CVT) is an important cause of stroke in young adults. Data from large international registries published in the past two decades have greatly improved our knowledge about the epidemiology, clinical manifestations and prognosis of CVT. The presentation of symptoms is

  12. Venous thromboembolism: The intricacies

    Directory of Open Access Journals (Sweden)

    Dutta T

    2009-01-01

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

  13. A case that underwent bilateral video-assisted thoracoscopic ...

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  14. Arterial versus venous lactate: a measure of sepsis in children.

    Science.gov (United States)

    Samaraweera, Sahan Asela; Gibbons, Berwyck; Gour, Anami; Sedgwick, Philip

    2017-08-01

    This study assessed the agreement between arterial and venous blood lactate and pH levels in children with sepsis. This retrospective, three-year study involved 60 PICU patients, with data collected from electronic or paper patient records. The inclusion criteria comprised of children (≤17 years old) with sepsis and those who had a venous blood gas taken first with an arterial blood gas taken after within one hour. The lactate and pH values measured through each method were analysed. There is close agreement between venous and arterial lactate up to 2 mmol/L. As this value increases, this agreement becomes poor. The limits of agreement (LOA) are too large (±1.90 mmol/L) to allow venous and arterial lactate to be used interchangeably. The mean difference and LOA between both methods would be much smaller if derived using lactate values under 2.0 mmol/L. There is close agreement between arterial and venous pH (MD = -0.056, LOA ± 0.121). However, due to extreme variations in pH readings during sepsis, pH alone is an inadequate marker. A venous lactate ≤2 mmol/L can be used as a surrogate for arterial lactate during early management of sepsis in children. However, if the value exceeds 2 mmol/L, an arterial sample must confirm the venous result. What is known: • In children with septic shock, a blood gas is an important test to show the presence of acidosis and high lactic acid. Hyperlactataemia on admission is an early predictor of outcome and is associated with a greater mortality risk. • An arterial sample is the standard for lactate measurement, however getting a sample may be challenging in the emergency department or a general paediatric ward. Venous samples are quicker and easier to obtain. Adult studies generally advise caution in replacing venous lactate values for the arterial standard, whilst paediatric studies are limited in this area. What is new: • This is the first study assessing the agreement between arterial and peripheral venous

  15. Peripheral Neuropathy

    Science.gov (United States)

    ... arsenic can cause peripheral neuropathy. In addition, certain insecticides and solvents have also been known to cause ... ranges from clinical studies of the genetics and natural history of hereditary neuropathies to basic science investigations ...

  16. Venous ulcer: what is new?

    Science.gov (United States)

    Raffetto, Joseph D; Marston, William A

    2011-01-01

    The pathophysiology of venous dermal abnormality in chronic venous ulcers is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in the microcirculation, cytokine and matrix metalloproteinase activation, and altered cellular function. Red blood cells and macromolecules extravasate into the interstitium and activate endothelial cells. Endothelial expression of specific adhesion molecules recruits leukocytes and causes diapedesis of these cells into the dermal microvasculature, promoting an inflammatory response with activation of cytokines and proteinases. Altered cell function enhances a state of vulnerability in the surrounding tissues, initiating specific changes associated with venous disease. Ultimately, the persistent inflammatory-proteinase activity leads to advanced chronic venous insufficiency and ulcer formation. The mainstay of therapy in venous ulcer abnormality is correction of the underlying venous hypertension through compression therapy and/or surgery. Understanding the science involved in the pathophysiology of venous ulcer formation has led to the development of adjunctive treatment directed at the dysregulated molecular pathways. Randomized clinical trials are critical for determining the most effective evidence-based treatments for venous ulcer, and this review discusses important trials that have had a significant impact on venous ulcer healing. In addition, the authors have included subsections referred to as "Translational Implications for Therapy" in the basic science sections of the review to help bridge the basic science knowledge with clinical applications that may help to modulate the molecular abnormalities in the pathophysiologic cascade leading to venous ulcers.

  17. Prevention of lower extremity venous thrombosis by early mobilization. Confirmation in patients with acute myocardial infarction by 125I-fibrinogen uptake and venography.

    Science.gov (United States)

    Miller, R R; Lies, J E; Carretta, R F; Wampold, D B; DeNardo, G L; Kraus, J F; Amsterdam, E A; Mason, D T

    1976-06-01

    To determine the effects of early ambulation on peripheral venous thrombosis in the coronary care unit, 29 patients with acute myocardial infarction had daily 125I-fibrinogen point counting of both legs using a standard portable technique in the first 3 to 7 days after admission. Twenty-one patients underwent early ambulation during the initial 3 days, while 8 remained at complete bed rest for 5 days. Only 2 of 21 early ambulated patients had positive fibrinogen point counts, in contrast to 5 of 8 nonambulated patients (P less than 0.01). With heart failure, only 2 of 9 ambulated patients had positive point counts, compared with 4 of 5 nonambulated patients (P less than 0.05). In 16 patients undergoing venography, point counts were confirmed in 6 positive and 10 negative findings. These results show that the high frequency of peripheral venous thrombosis in immobilized acute myocardial infarction patients, particularly those with heart failure, can be effectively reduced by early ambulation.

  18. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  19. Distal Superficial Femoral Vein Cannulation for Peripherally Inserted Central Catheter Placement in Infants with Cardiac Disease.

    Science.gov (United States)

    Richter, Robert P; Law, Mark A; Borasino, Santiago; Surd, Jessica A; Alten, Jeffrey A

    2016-12-01

    To describe a novel real-time ultrasound (US)-guided distal superficial femoral vein (DSFV) cannulation technique for insertion of peripherally inserted central catheters (PICC) in critically ill infants with congenital heart disease. Descriptive retrospective cohort study SETTING: Pediatric cardiac intensive care unit in a pediatric tertiary hospital PATIENTS: First 28 critically ill infants that received DSFV PICCs via this new technique. Thirty-seven US-guided DSFV PICCs were attempted on 31 infants from September 2012 to November 2014; 34 PICCs were placed in 28 patients (success rate 92%). Twenty-six of 28 patients underwent cardiac surgery. Median (IQR) age at time of PICC placement 39 days (13, 151); weight 3.4 kg (3.2, 5.3). 25/34 PICCs were placed in patients with STAT 4 or 5 category. Median PICC duration 16 days (11, 29); maximum duration 123 days. Ten infants (36%) had DSFV PICCs placed as the primary central venous access in perioperative period. Ten of 28 patients underwent cardiac catheterization while DSFV PICC was in place, four of which were performed through ipsilateral common femoral vein. Two patients had femoral arterial lines placed in the ipsilateral femoral artery while DSFV PICC was in place. There were no reported inadvertent arterial punctures. The PICC-associated infection rate was 4.6 per 1000 line days. Four of 34 DSFV PICCs (11.8%) were associated with deep venous thrombosis. DSFV is a novel venous access site for PICC placement with high success rate and sufficient longevity and flexibility for critically ill infants with cardiac disease. More experience and larger studies are needed to confirm its potential advantages. © 2016 Wiley Periodicals, Inc.

  20. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  1. Venous thromboembolism and pregnancy

    Directory of Open Access Journals (Sweden)

    Maristella D’Uva

    2010-03-01

    Full Text Available Maristella D’Uva1, Pierpaolo Di Micco2, Ida Strina1, Giuseppe De Placido1Department of Obstetrics and Gynecology and Human Reproduction, “Federico II” University of Naples, Naples, Italy; 2Internal Medicine Division, Buonconsiglio Fatebenefratelli Hospital of Naples, Naples, ItalyAbstract: In recent decades, the association between a hypercoagulable state and its causes and adverse pregnancy outcome, in particular recurrent pregnancy loss (RPL has been studied extensively. Although the first studies were focused only on the association between thrombophilia and RPL, subsequent studies underlined also a potential role of antithrombotic treatment to prevent vascular complication such as venous thromboembolism (VTE during pregnancy. Thromboprophylaxis should be considered also for pregnant subjects carriers of molecular thrombophilia or that previously experienced VTE, in order to prevent VTE during pregnancy, while antithrombotic treatment for VTE should be performed during all pregnant periods.Keywords: thrombophilia, venous thromboembolism, recurrent pregnancy loss, factor V Leiden

  2. Reduction mammoplasty as a treatment for symptomatic central venous stenosis

    Directory of Open Access Journals (Sweden)

    Denise Seok Fun Fok

    2018-03-01

    Full Text Available Central venous stenosis is a rare cause of unilateral breast edema occurring in hemodialysis patients that needs to be differentiated from other differential diagnoses, including, but not limited to, inflammatory breast carcinoma, mastitis, lymphedema, and congestive heart failure. All reports of similar cases in the available literature have described improvement or resolution of the edema after treatment. Herein, we report and discuss the pathophysiology of breast edema formation in a patient who presented with massive left-sided breast edema 7 years after being diagnosed with central venous stenosis. Medical and minimally invasive therapy had not been successful, so she underwent reduction mammoplasty to relieve the symptoms.

  3. Venous leg ulcers.

    Science.gov (United States)

    Nelson, E Andrea

    2011-12-21

    Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide

  4. Dorsalis pedis arterialized venous flap for hand and foot

    Directory of Open Access Journals (Sweden)

    YU Guang

    2012-04-01

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

  5. Medical management of venous ulcers.

    Science.gov (United States)

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  7. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  8. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  9. The complete recanalization of PICC-related venous thrombosis in cancer patients: A series of case reports.

    Science.gov (United States)

    Huang, Zuo-Ping; Liu, Xing-Jing; Zou, Bin-Xin; Wang, Li-Gen; Zhou, Tao

    2013-08-01

    In this study, cancer patients with venous thrombosis associated with the use of peripherally inserted central catheters (PICCs) underwent complete recanalization by the administration of Panax notoginseng saponins (PNS), which vary from heparin or urokinase in that they do not have the same risks associated with thrombolysis, including bleeding. To the best of our knowledge, this is the first study concerning the treatment of cancers with PNS to be reported in the literature. Three cancer patients aged 30-50 years old, two females and one male, were subjected to chemotherapy. On the first day of chemotherapy, a PICC was inserted into the right basilic vein with its tip in the superior vena cava. On the third day of chemotherapy, pain, swelling and skin flushing started. In the following days, particularly days 10-13, a Doppler ultrasound examination confirmed a long thrombus along the PICC line in the axillary vein and brachial veins in each patient. The patients rejected the insertion of an inferior vena cava filter, and neither heparin nor urokinase were administered due to contra-indications. An injection of PNS (200 mg) was administered every day. On days 20-28 of chemotherapy, the thrombus in the axillary and brachial veins disappeared in the three patients. It was concluded that PNS promote blood circulation, which prevents blood stasis and reduces the toxicity of cisplatin. The results suggest that PNS are a feasible and effective treatment option for many types of cancer, but have a broader clinical impact on cancer patients with PICC-related venous thrombosis. Therefore, this study is an original case report of particular interest to cancer patients with PICC-related venous thrombosis.

  10. Correlation of central venous pressure with venous blood gas analysis parameters; a diagnostic study

    Directory of Open Access Journals (Sweden)

    Sima Rahim-Taleghani

    2017-03-01

    Full Text Available Objective: This study was conducted to assess the correlation between central venous pressure (CVP and venous blood gas (VBG analysis parameters, to facilitate management of severe sepsis and septic shock in emergency department. Material and methods: This diagnostic study was conducted from January 2014 until June 2015 in three major educational medical centers, Tehran, Iran. For patients selected with diagnosis of septic shock, peripheral blood sample was taken for testing the VBG parameters and the anion gap (AG was calculated. All the mentioned parameters were measured again after infusion of 500 cc of normal saline 0.9% in about 1 h. Results: Totally, 93 patients with septic shock were enrolled, 63 male and 30 female. The mean age was 72.53 ± 13.03 and the mean Shock Index (SI before fluid therapy was 0.79 ± 0.30. AG and pH showed significant negative correlations with CVP, While HCO3 showed a significant positive correlation with CVP. These relations can be affected by the treatment modalities used in shock management such as fluid therapy, mechanical ventilation and vasopressor treatment. Conclusion: It is likely that there is a significant statistical correlation between VBG parameters and AG with CVP, but further research is needed before implementation of the results of this study. Keywords: Shock, Septic, Central venous pressure, Blood gas analysis, Emergency department, Emergency medicine

  11. Cerebral venous thrombosis.

    Science.gov (United States)

    Ameri, A; Bousser, M G

    1992-02-01

    Neuroimagining facilities allow early recognition of cerebral venous thrombosis (CVT), which now appears far more common than previously assumed. The diagnosis remains difficult because of a wide spectrum of clinical presentation and a highly variable mode of onset. Numerous conditions (presently mostly noninfectious) can cause or predispose to CVT, which therefore requires an extensive etiologic work-up. The functional and vital prognosis is much better than classically thought with, in noninfectious CVT, a fatality rate of less than 10% and a complete recovery in over 70%. Although spontaneous recovery is possible, the efficacy of heparin is now well established.

  12. Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension.

    Science.gov (United States)

    Matloob, Samir A; Toma, Ahmed K; Thompson, Simon D; Gan, Chee L; Robertson, Fergus; Thorne, Lewis; Watkins, Laurence D

    2017-08-01

    Idiopathic intracranial hypertension (IIH) is characterised by an increased intracranial pressure (ICP) in the absence of any central nervous system disease or structural abnormality and by normal CSF composition. Management becomes complicated once surgical intervention is required. Venous sinus stenosis has been suggested as a possible aetiology for IIH. Venous sinus stenting has emerged as a possible interventional option. Evidence for venous sinus stenting is based on elimination of the venous pressure gradient and clinical response. There have been no studies demonstrating the immediate effect of venous stenting on ICP. Patients with a potential or already known diagnosis of IIH were investigated according to departmental protocol. ICP monitoring was performed for 24 h. When high pressures were confirmed, CT venogram and catheter venography were performed to look for venous stenosis to demonstrate a pressure gradient. If positive, venous stenting would be performed and ICP monitoring would continue for a further 24 h after deployment of the venous stent. Ten patients underwent venous sinus stenting with concomitant ICP monitoring. Nine out of ten patients displayed an immediate reduction in their ICP that was maintained at 24 h. The average reduction in mean ICP and pulsatility was significant (p = 0.003). Six out of ten patients reported a symptomatic improvement within the first 2 weeks. Venous sinus stenting results in an immediate reduction in ICP. This physiological response to venous stenting has not previously been reported. Venous stenting could offer an alternative treatment option in correctly selected patients with IIH.

  13. Venous Thromboembolism in Adolescents

    Directory of Open Access Journals (Sweden)

    Aneta Samková

    2012-01-01

    Full Text Available The incidence of venous thromboembolism (VTE during childhood is low with two peaks – neonatal and adolescent age. This retrospective study is focused on clinical characteristics of VTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed – 16 girls (88.9%, 2 boys (11.1%. In 9 patients (50% thrombosis of the lower limb deep veins was diagnosed, six patients (33.3% suffered from symptomatic pulmonary embolism (PE and 3 patients (16.7% from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%. The most frequent acquired risk factor was oral contraception (OC in 12 out of 16 girls (75%. All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6% patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50% in patients with distal lower limb thrombosis, but very high (100% in patients with PE.

  14. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

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

  15. Clinical overview of venous thromboembolism

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) is the result of a venous blood clot formation which may manifest itself as deep vein thrombosis. (DVT) or pulmonary embolism (PE).1,2 DVT and PE are part of the same syndrome. However, important distinguishing factors in terms of epidemiology, diagnosis and treatment exist between.

  16. Frequency of Helicobacter pylori in patients underwent endoscopy

    Directory of Open Access Journals (Sweden)

    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  17. Partial anomalous pulmonary venous return in Turner syndrome.

    Science.gov (United States)

    van den Hoven, Allard T; Chelu, Raluca G; Duijnhouwer, Anthonie L; Demulier, Laurent; Devos, Daniel; Nieman, Koen; Witsenburg, Maarten; van den Bosch, Annemien E; Loeys, Bart L; van Hagen, Iris M; Roos-Hesselink, Jolien W

    2017-10-01

    The aim of this study is to describe the prevalence, anatomy, associations and clinical impact of partial anomalous pulmonary venous return in patients with Turner syndrome. All Turner patients who presented at our Turner clinic, between January 2007 and October 2015 were included in this study and underwent ECG, echocardiography and advanced imaging such as cardiac magnetic resonance or computed tomography as part of their regular clinical workup. All imaging was re-evaluated and detailed anatomy was described. Partial anomalous pulmonary venous return was diagnosed in 24 (25%) out of 96 Turner patients included and 14 (58%) of these 24 partial anomalous pulmonary venous return had not been reported previously. Right atrial or ventricular dilatation was present in 11 (46%) of 24 partial anomalous pulmonary venous return patients. When studied with advanced imaging modalities and looked for with specific attention, PAPVR is found in 1 out of 4 Turner patients. Half of these patients had right atrial and/or ventricular dilatation. Evaluation of pulmonary venous return should be included in the standard protocol in all Turner patients. Copyright © 2017. Published by Elsevier B.V.

  18. Neonatal repair of total anomalous pulmonary venous connection and lung agenesis.

    Science.gov (United States)

    Kaku, Yuji; Nagashima, Mitsugi; Matsumura, Goki; Yamazaki, Kenji

    2015-07-01

    Here we report a neonatal case of total anomalous pulmonary venous connection with left lung agenesis. Diagnostic imaging demonstrated that the left pulmonary veins were totally absent and the right pulmonary veins connected with the common pulmonary chamber. Drainage from the common pulmonary venous chamber entered the persistent left suerior vena cava. In addition, it revealed complete absence of the left main bronchus and left lung vessels. The neonate successfully underwent surgical repair 18 days after birth. © The Author(s) 2014.

  19. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

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

  20. [The PICC line, a new approach for venous access].

    Science.gov (United States)

    Levigoureux, E; Charbonnel, J-F; Latour, J-F; Rosay, H

    2013-03-01

    Peripheral Inserted Central Catheter (PICC) line is a peripherally inserted central catheter. This implantable medical device is placed into a peripheral vein of the arm in order to obtain an intravenous central access. This device can find its use in various applications like intravenous delivery of parenteral nutrition, anticancer agents and antibiotics, as well as for blood sampling. PICC line is not widely used in medical practice because it remains largely unknown. The aim of this review is thus to introduce PICC line to the medical and scientific community. First, we will approach its insertion and maintenance of the dressing. We will then detail the benefits and drawbacks associated with its use, and finally discuss its position with regards to the other central venous access available. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Genotoxic damage in cultured human peripheral blood lymphocytes ...

    African Journals Online (AJOL)

    Falaq Naz

    2012-06-29

    Jun 29, 2012 ... chromatid exchanges and DNA damage as a parameter, in cultured human peripheral blood lym- phocytes. The study was ... Human lymphocyte culture. A sample of heparinized venous blood was obtained from 25 ... The fixative was removed by centrifugation and the procedure was re- peated twice.

  2. Epidemiology of recurrent venous thrombosis

    Science.gov (United States)

    Ribeiro, D.D.; Lijfering, W.M.; Barreto, S.M.; Rosendaal, F.R.; Rezende, S.M.

    2011-01-01

    Venous thrombosis, including deep vein thrombosis and pulmonary embolism, is a common disease that frequently recurs. Recurrence can be prevented by anticoagulants, but this comes at the risk of bleeding. Therefore, assessment of the risk of recurrence is important to balance the risks and benefits of anticoagulant treatment. This review briefly outlines what is currently known about the epidemiology of recurrent venous thrombosis, and focuses in more detail on potential new risk factors for venous recurrence. The general implications of these findings in patient management are discussed. PMID:22183247

  3. Safety and Efficacy of Catheter-Directed Therapies as a Supplement to Surgical Decompression in Venous Thoracic Outlet Syndrome.

    Science.gov (United States)

    Zurkiya, Omar; Donahue, Dean M; Walker, T Gregory; Ganguli, Suvranu

    2018-02-01

    The purpose of this study is to evaluate the role of endovascular therapy in the management of venous thoracic outlet syndrome (TOS), with an emphasis on its role after surgical decompression. This single-center retrospective review identified all patients who underwent conventional contrast-enhanced venography as a component of the imaging evaluation of clinically suspected venous TOS from January 2004 through September 2015. Eighty-one patients were identified, with a mean (± SD) age of 33 ± 12 years, of whom 59% (48/81) were women. After imaging confirmation of venous TOS, a standardized treatment protocol combining surgical and endovascular intervention was used for management. Of the 81 patients included in the study, 73 (90%) had angiographic evidence of venous TOS; 41 of these 73 patients (56%) underwent endovascular venous intervention (e.g., thrombolysis or angioplasty before surgical) decompression. A total of 67 patients (67/73; 92%) with venous TOS underwent surgical decompression, with 56 of these (56/73; 77%) undergoing postoperative venography. Of these 56 patients who underwent postoperative venography, 48 (86%) required venoplasty, four had normal-appearing subclavian veins (7%) and had no intervention, and four of 48 (8%) had chronic total venous occlusions that could not be recanalized. Only four of the 48 of the patients (8%) who underwent postdecompression venoplasty required subsequent repeat venography and intervention for management of persistent or recurrent symptoms, whereas all others (44/48; 92%) remained symptom free on clinical follow-up. No complications were identified that were related to the endovascular interventions. Combining venography and endovascular venous intervention with surgical decompression in managing patients with clinically suspected venous TOS is safe and effective. Postdecompression venoplasty appears to be highly effective, with a low rate of symptom recurrence.

  4. Massive superior mesenteric venous aneurysm with portal venous thrombosis.

    Science.gov (United States)

    Starikov, Anna; Bartolotta, Roger J

    2015-01-01

    Portal venous aneurysm is a rare and sometimes dangerous vascular pathology, which can result in thrombosis or rupture. We present the computed tomography, magnetic resonance, and sonographic imaging of a 27-year-old man with superior mesenteric venous aneurysm and subsequent thrombosis following acute pancreatitis. This multimodality imaging approach can prove useful in the evaluation of these rare aneurysms. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. The diagnosis of deep venous thrombosis using laser Doppler skin perfusion measurements

    NARCIS (Netherlands)

    de Graaff, J. C.; Ubbink, D. T.; Büller, H. R.; Jacobs, M. J.

    2001-01-01

    Compression ultrasonography (CUS) falls short in the diagnosis of deep venous thrombosis in asymptomatic patients and thrombi limited to the calf veins. Alternatively, laser Doppler fluxmetry (LDF) may be useful for this purpose, as it can measure the peripheral vasoconstriction response upon an

  6. Total anomalous pulmonary venous return

    Science.gov (United States)

    ... pulmonary venous return, x-ray References Fraser CD, Kane LC. Congenital heart disease. In: Townsend CM Jr, ... 62. Review Date 10/17/2017 Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, ...

  7. Hydrocephalus in cerebral venous thrombosis

    NARCIS (Netherlands)

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

    2015-01-01

    Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and

  8. Combined oral contraceptives: venous thrombosis.

    Science.gov (United States)

    de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

    2014-03-03

    Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. We selected studies including healthy women taking COC with VT as outcome. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene

  9. Risk of Venous Thromboembolism and Operative Duration in Patients Undergoing Neurosurgical Procedures.

    Science.gov (United States)

    Bekelis, Kimon; Labropoulos, Nicos; Coy, Shannon

    2017-05-01

    The association of operative duration with the risk of venous thromboembolism (VTE) has not been quantified in neurosurgery. To investigate the association of surgical duration for several neurosurgical procedures and the incidence of VTE. We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. In order to control for confounding, we used multivariable regression models, and propensity score conditioning. During the study period, there were 94 747 patients, who underwent neurosurgical procedures, and met the inclusion criteria. Of these, 1358 (1.0%) developed VTE within 30 days postoperatively. Multivariable logistic regression demonstrated an association of longer operative duration with higher 30-day incidence of VTE (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.19-1.25). Compared with procedures of moderate duration (third quintile, 40-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 3.15; 95% CI, 2.49-3.99) of developing VTE. The shortest procedures (<20th percentile) were associated with a decreased incidence of VTE (OR, 0.51; 95% CI, 0.27-0.76) in comparison to those of moderate duration. The same associations were present in propensity score-adjusted models, and models stratified by subgroups of cranial, spinal, peripheral nerve, and carotid procedures. In a cohort of patients from a national prospective surgical registry, increased operative duration was associated with increased incidence of VTE for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management, and to stratify patients with regard to VTE risk. Copyright © 2016 by the Congress of Neurological Surgeons

  10. The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

    Science.gov (United States)

    Leung, Amy; Heal, Clare; Banks, Jennifer; Abraham, Breanna; Capati, Gian; Pretorius, Casper

    2016-01-01

    Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%). The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis. PMID:26904283

  11. Managing Inadvertent Arterial Catheterization During Central Venous Access Procedures

    International Nuclear Information System (INIS)

    Nicholson, Tony; Ettles, Duncan; Robinson, Graham

    2004-01-01

    Purpose: Approximately 200,000 central venous catheterizations are carried out annually in the National Health Service in the United Kingdom. Inadvertent arterial puncture occurs in up to 3.7%. Significant morbidity and death has been reported. We report on our experience in the endovascular treatment of this iatrogenic complication. Methods: Retrospective analysis was carried out of 9 cases referred for endovascular treatment of inadvertent arterial puncture during central venous catheterization over a 5 year period. Results: It was not possible to obtain accurate figures on the numbers of central venous catheterizations carried out during the time period. Five patients were referred with carotid or subclavian pseudoaneurysms and hemothorax following inadvertent arterial catheter insertion and subsequent removal. These patients all underwent percutaneous balloon tamponade and/or stent-graft insertion. More recently 4 patients were referred with the catheter still in situ and were successfully treated with a percutaneous closure device. Conclusion: If inadvertent arterial catheterization during central venous access procedures is recognized and catheters removed, sequelae can be treated percutaneously. However, once the complication is recognized it is better to leave the catheter in situ and seal the artery percutaneously with a closure device

  12. [Duplexsonography investigation in patients with venous ulcer].

    Science.gov (United States)

    Jeanneret-Gris, Christina

    2011-03-01

    Venous hypertension due to venous insufficiency causes venous ulcers. Duplexsonography is a widely accepted non invasive method to assess venous insufficiency with venous reflux measurements. Retrograde venous flow is defined as venous reflux. The testing of venous reflux is reliable if transvalvular pressure is sufficiently high and transvalvular flow velocity exceeds 30 cm/s. Reflux testing in the proximal leg veins (V. femoralis communis, V. femoralis, V. saphena magna) is done using a standardised Valsalva Manoeuvre (exspiration into a tube up to a pressure of 30 mmHg, pressure established within 0.5 seconds, pressure hold for 3 seconds). Distal leg vein testing (V. poplitea, V. tibialis posterior, V. saphena parva) is recommended with a two handed - compression distally to the tested veins. The most important parameter is venous reflux time, a cut off of > 2 seconds is recommended.

  13. Contemporary diagnosis of venous malformation

    Directory of Open Access Journals (Sweden)

    Lee BB

    2013-11-01

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

  14. Venous chest anatomy: clinical implications

    International Nuclear Information System (INIS)

    Chasen, M.H.; Charnsangavej, C.

    1998-01-01

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

  15. Dutch Venous Ulcer guideline update.

    Science.gov (United States)

    Maessen-Visch, M Birgitte; de Roos, Kees-Peter

    2014-05-01

    The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  16. Effects of smoking on venous cannulation pain: a randomized prospective trial

    Directory of Open Access Journals (Sweden)

    Volkan Hanci

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: It has been demonstrated that smoking increases pain perception; however the effect of smoking on perception of pain during venous cannulation is not known. The purpose of this study is to determine whether or not smoking has an effect on pain perception due to peripheral venous cannulation. METHODS: 220 patients scheduled to have elective surgery were enrolled in the study and were divided into two groups (Group S and C, n = 110 for each according to their smoking habits. Numerical rating scale was introduced to the patients and then peripheral venous cannulation at the dorsum of the hand was made with a 20 G intracath. Pain perception of the patients was scored by subsequent numerical rating scale questioning. RESULTS: The demographic characteristics of the groups were identical. Numerical rating scale scores in Group S and C were 3.31 ± 1.56 and 1.65 ± 1.23, respectively (p < 0.001. CONCLUSION: Pain perception due to peripheral venous cannulation is higher in smokers. Future studies on pain treatment should consider the smoking habits of patients.

  17. Optical coherent tomography in diagnoses of peripheral retinal degenarations

    OpenAIRE

    O. G. Pozdeyeva; T. B. Shaimov; A. Yu. Galin; R. B. Shaimov; T. A. Shaimova; A. V. Zolotova; A. V. Fomin

    2014-01-01

    Purpose: Studying the capabilities of optical coherence tomography (RTVue-100, OPTOVUE, USA) in evaluation of peripheral retinal degenerations, vitreoretinal adhesions, adjacent vitreous body as well as measurement of morphometric data.Methods: The study included 189 patients (239 eyes) with peripheral retinal degeneration. 77 men and 112 women aged 18 to 84 underwent an ophthalmologic examination since November 2012 until October 2013. The peripheral retina was visualized with the help of op...

  18. Clinical correlates of chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Weinstock-Guttman Bianca

    2012-05-01

    Full Text Available Abstract Background Chronic cerebrospinal venous insufficiency (CCSVI is a vascular condition characterized by anomalies of the primary veins outside the skull that has been reported to be associated with MS. In the blinded Combined Transcranial (TCD and Extracranial Venous Doppler Evaluation (CTEVD study, we found that prevalence of CCSVI was significantly higher in multiple sclerosis (MS vs. healthy controls (HC (56.1% vs. 22.7%, p  The objective was to evaluate the clinical correlates of venous anomalies indicative of CCSVI in patients with MS. Methods The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other neurological disorders who underwent a clinical examination and a combined Doppler and TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RR-MS: n = 181, SP-MS: n = 80 and PP-MS: n = 12. Disability status was evaluated by using the Kurtzke Expanded Disability Status Scale (EDSS and MS severity scale (MSSS. Results Disability was not associated with the presence (≥2 venous hemodynamic criteria or the severity of CCSVI, as measured with venous hemodynamic insufficiency severity score (VHISS. However, the severity of CCSVI was associated with the increased brainstem functional EDSS sub-score (p = 0.002. In logistic regression analysis, progressive MS (SP-MS or PP-MS vs. non-progressive status (including RR-MS was associated with CCSVI diagnosis (p = 0.004, OR = 2.34, CI = 1.3–4.2. Conclusions The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has no or very limited association with clinical disability.

  19. Venous leg ulcer in the context of chronic venous disease.

    Science.gov (United States)

    Lozano Sánchez, F S; Marinel lo Roura, J; Carrasco Carrasco, E; González-Porras, J R; Escudero Rodríguez, J R; Sánchez Nevarez, I; Díaz Sánchez, S

    2014-05-01

    Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5-C6 and C1 (control) group. Data from a national, multicentre, observational and cross-sectional study (n = 1598) were used to compare three groups of CVD: C1 (n = 243), C5 (n = 136) and C6 (n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers (P ulcers than in those with C1 (P ulcers (C6) had lower QoL scores, but the differences were not statistically significant. Patients with venous leg ulcers (C5-C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.

  20. Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Hansen, Egon G; Holler, Nana G

    2012-01-01

    Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac...

  1. Safety and effectiveness of central venous catheters usage in newborns intensive care unit

    Directory of Open Access Journals (Sweden)

    І. А. Anikin

    2016-10-01

    Full Text Available To date, ensuring long-term venous access in newborns is an actual problem of intensive therapy. Central venous catheters, which implantable peripherally (PICC-line, are widely used as a medium-term vascular access in newborns in the department of intensive care. Objective - To study the incidence of complications associated with the use of central venous access in newborns intensive care department. Materials and methods. Characteristics and safety of various central venous access in newborns were studied. The study is retrospective, with a quantitative analysis of the results. The safe practice PICC-line and CVCSI accesses groups were compared, revealed complications in 361 newborns, who received complex intensive therapy in connection with diseases of the perinatal period, were analyzed. Results. Due to the fact that some babies accessed re-established catheters, the total number of observations was 395. We took the complications of catheter-related infection, taking into account the instructions of the Center for Disease Control and Prevention (theUSA. We searched the number of mechanical and infectious complications, which were associated with venous catheters. The number of catheter occlusion, against the background of infusion therapy was not significantly different in the groups, and the obstruction of the catheter by thrombus was the most frequent complication in the PICC-line group. CVCSIs revealed fairly large number of system thrombosis of the superior vena cava, and a great number of infectious complications. KAI Number of cases in the group of newborns with PICC-line was almost 4 times less than in infants with CVCSI venous access. Cases of death in patients did not associate with venous access, despite the fact that the total amount of complications in CVCSI group were significantly higher. Conclusion. The received results have showen that peripherally implanted catheters have a higher level of security and ease of installation

  2. Central venous oxygen saturation does not correlate with the venous oxygen saturation at the surgical site during abdominal surgery.

    Science.gov (United States)

    Weinrich, Malte; Scheingraber, Stefan; Stephan, Bernhard; Weiss, Christel; Kayser, Anna; Kopp, Berit; Schilling, Martin K

    2008-01-01

    Measurement of central venous oxygen saturation has become a surrogate parameter for fluid administration, blood transfusions and treatment with catecholamines in (early) goal directed therapy in the treatment of acute septic patients. These strategies are not easily transferred to the postoperative management of abdominal surgery due to the different conditions in surgical patients. A study population of 15 patients (8 females/7 males) underwent elective major abdominal surgery: 6 gastrectomies, 5 major liver resections and 4 lower anterior rectum resections. Surgery was performed for primary or secondary malignancy. The patients' age was 65.4+/-12.7 (mean+/-standard deviation, range 44-84, median 62) years. Blood samples were taken intraoperatively from indwelling central venous lines as well as from draining veins at the surgical site. Blood gas analyses to determine the oxygen saturations were performed immediately. All patients were operated in standardized general anesthesia including epidural analgesia and in a balanced volume status. Central venous oxygen saturations and oxygen saturations in blood from the draining veins of the surgical site showed a wide range with high intra- and interindividual differences intraoperatively. Overall, at most time points no correlation between the two oxygen saturations could be detected in three operation types. A significant correlation was only observed at one time point during liver resections. Our results show a lack of correlation between central venous oxygen saturations and oxygen saturations in the draining veins of the surgical site during major abdominal surgery. Measurement of central venous oxygen saturations does not seem to be a good surrogate for the local oxygen supply in the field of interest in major abdominal surgery even under standardized conditions.

  3. Cerebral venous thrombosis after spinal anesthesia: case report

    Directory of Open Access Journals (Sweden)

    Flora Margarida Barra Bisinotto

    Full Text Available Abstract Introduction Cerebral venous thrombosis (CVT is a rare but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia and had postoperative headache complicated with CVT. Case report Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged on the eighth day without sequelae. Discussion Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to CVT in some patients with prothrombotic conditions.

  4. [Cerebral venous thrombosis after spinal anesthesia: case report].

    Science.gov (United States)

    Bisinotto, Flora Margarida Barra; Dezena, Roberto Alexandre; Abud, Tania Mara Vilela; Martins, Laura Bisinotto

    Cerebral venous thrombosis (CVT) is a rare, but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia who had postoperative headache complicated with CVT. Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged eight days without sequelae. Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to TVC in some patients with prothrombotic conditions. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

    Science.gov (United States)

    Friedman, B; Kanter, G; Titus, D

    1994-04-01

    Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

  6. Combination of phlebography and sanguinous measurement of venous blood pressure

    International Nuclear Information System (INIS)

    Weber, J.

    1988-01-01

    Phlebographic visualisation offers the highest spatial resolution of all imaging methods both in respect of veins of the leg and pelvis and of the abdomen. Phlebography offers optimal conditions for assessing morphological changes at the veins and in their direct neighbourhood. No quantitative information is available via phlebography if haemodynamics are disturbed; qualitative information is yielded merely to a restricted extent (by assessing flow velocity and collaterals). Direct sanguinous measurement of venous blood pressure is particularly suitable for the quantitative and qualitative assessment of disturbed haemodynamic conditions; in this respect it stands out among the function tests based on the employment of apparatures. If it is combined with phlebography, it is possible not only to optimise the diagnostic yield in the hands of one investigator, but also to reduce the invasiveness of both methods to one single puncture, since the puncture needle is at the same time also an instrument to measure the pressure. The article points out the possibilities and limitations of combining a) ascending phlebography of the leg and pelvis with peripheral venous pressure measurement (phlebodynamometry) and b) visualisation of the veins of the pelvis and vena cava inferior with central sanguinous venous pressure measurement (CP). Indicatious and technical execution are described. (orig.) [de

  7. Familial Clustering of Venous Thromboembolism

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  8. Prostacyclin Increases Portal Venous Flow.

    Science.gov (United States)

    1984-07-01

    decline in CO. If PCI 2 were administered for an unrelated disease when cirrhosis, portal hypertension, and esophageal varices were present, flow into...the portal system would increase and possibly initiate variceal hemorrhage. The portal venous effects of PGI should be 2realized when considering this

  9. Lower-limb venous thrombosis

    African Journals Online (AJOL)

    muscle strains, tears, or twisting injuries to the leg. • other causes of lower-limb swelling such as cardiac, hepatic and renal pathologies. • lymphoedema. • chronic venous hypertension and its complications. • popliteal (Baker's) cysts. • cellulitis. • other knee pathologies. The objective methods of making a diagnosis of DVT ...

  10. Thyrocervical artery - jugular fistula following internal jugular venous catheterization

    Directory of Open Access Journals (Sweden)

    P P Zachariah

    2014-01-01

    Full Text Available Arteriovenous fistula (AVF is an anomalous communication between an artery and a vein, caused by an iatrogenic or traumatic etiology. Surgically created upper limb AVF remains the preferred vascular access for patients on maintenance hemodialysis. Nonetheless central vein cannulation for hemodialysis is a common procedure done in patients who need hemodialysis. We incidentally detected a thyrocervical artery - jugular fistula in a patient on maintenance hemodialysis. He underwent a successful intra arterial coil embolization of the feeding vessel. Review of literature has shown that, a thyrocervical artery - internal jugular vein arteriovenous fistula following a central venous catheterization has not been reported so far.

  11. Studies on venous chronic obstructions with perfused krypton-81m

    Energy Technology Data Exchange (ETDEWEB)

    Zicot, M.; Guillaume, M. (Universite de Liege, Centre de Recherches du Cyclotron (Belgium))

    1982-01-01

    A perfusion system is used to study the venous return of the lower limbs through an injection of a superficial vein of the foot. Multiple sequential perfusions are possible because there is no building up of the radioactivity (short-life of the Kr-81m and lung elimination). We are therefore able to study the system under different mechanical conditions (tourniquet at different sites and pressures, hyperaemia). The main veins (from popliteal vein to vena cava) are therefore normally vizualised by a peripheral injection. The region below the knee is difficult to study by venoscintigraphy. The transit times from the foot to the groin, and between regions of interest are also studied. We analyse the results obtained with a consecutive series of 31 patients suffering from possible chronic venous problems and sequelae of deep venous thrombosis (lasting for 2 weeks to more than 20 years): 58 limbs are actually examined. Most of these limbs are also assessed by non invasive heamodynamic techniques: Doppler ultrasound and calf plethysmography: 35 limbs are normal, 23 show obliterative sequelae of deep vein thrombosis. The venoscintigraphy displays the level and the degree of obstructions and the pattern of collateral pathways with an accuracy comparable to RX-phlebography. We demonstrate that the Doppler is able to recognize most of the residual obstructions. The resistances to venous outflow measured by plethysmography are also generally increased. We are not able to demonstrate systematic and significant variations of the transit times in the different haemodynamic conditions. These parameters do not seem therefore adequate for functional assessment.

  12. Studies on venous chronic obstructions with perfused krypton-81m

    International Nuclear Information System (INIS)

    Zicot, M.; Guillaume, M.

    1982-01-01

    A perfusion system is used to study the venous return of the lower limbs through an injection of a superficial vein of the foot. Multiple sequential perfusions are possible because there is no building up of the radioactivity (short-life of the Kr-81m and lung elimination). We are therefore able to study the system under different mechanical conditions (tourniquet at different sites and pressures, hyperaemia). The main veins (from popliteal vein to vena cava) are therefore normally vizualised by a peripheral injection. The region below the knee is difficult to study by venoscintigraphy. The transit times from the foot to the groin, and between regions of interest are also studied. We analyse the results obtained with a consecutive serie of 31 patients suffering from possible chronic venous problems and sequelae of deep venous thrombosis (lasting for 2 weeks to more than 20 years): 58 limbs are actually examined. Most of these limbs are also assessed by non invasive heamodynamic techniques: Doppler ultrasound and calf plethysmography: 35 limbs are normal, 23 show obliterative sequelae of deep vein thrombosis. The venoscintigraphy displays the level and the degree of obstructions and the pattern of collateral pathways with an accuracy comparable to RX-phlebography. We demonstrate that the Doppler is able to recognize most of the residual obstructions. The resistances to venous outflow measured by plethysmography are also generally increased. We are not able to demonstrate systematic and significant variations of the transit times in the different haemodynamic conditions. These parameters do not seem therefore adequate for functional assessment [fr

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-02-15

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

  14. Venous sinus stenting for pseudotumour cerebri with venous sinus stenosis

    International Nuclear Information System (INIS)

    Chen Huairui; Bai Rulin; Wu Xiaojun; Qi Xiangqian; Mei Qiyong; Lu Yicheng

    2011-01-01

    Objective: To explore the relation between venous sinus stenosis and pseduotumour cerebri and to discuss the efficacy and strategy of venous sinus stenting for its treatment. Methods: Venous sinus stenting was performed in a total of 9 patients with pseudotumour cerebri accompanied by dural sinus stenosis. The clinical data, including the clinical presentations, intracranial pressure, angiographic findings, pressure of dural sinus,methods of treatment and the therapeutic results, were retrospectively analyzed. Results: Bilateral disc edema was seen in all patients. The pressure gradient in the lateral sinuses was obviously high before stenting (22.67±7.25)mmHg in all patients and a reduction in intra-sinus pressure and pressure gradient was also found (5.78±3.77)mmHg. The symptoms associated with intracranial hypertension were gradually improved or disappeared in two weeks after the placement of the stent in all cases, and the intracranial pressure dropped evidently (12.78±5.97)cm H 2 O. Vision was improved in 7 cases at three months, whereas it remained poor in 2 cases despite normalized intracranial pressure. There was no other permanent procedure-related morbidity. The patients were followed up for 3 months to 5 years, and no recurrence developed. Conclusion: Lateral sinus stenting is an effective method for the treatment of pseudotumour cerebri with dural sinus stenosis. (authors)

  15. Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers.

    Science.gov (United States)

    Lawrence, Peter F; Alktaifi, Ali; Rigberg, David; DeRubertis, Brian; Gelabert, Hugh; Jimenez, Juan Carlos

    2011-09-01

    Endovenous closure of incompetent saphenous veins has been reported to facilitate venous ulcer healing; however, there is little information about the effectiveness of perforator ablation (PA) in healing recalcitrant venous ulcers. We report our experience with PA with venous ulcers unresponsive to prolonged compression therapy. Patients with nonhealing venous ulcers of >3 months' duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Patients who had either no saphenous incompetence or persistent ulcers after saphenous ablation underwent PA of incompetent perforating veins >3 mm that demonstrated reflux; initial treatment was performed on the perforator vein adjacent to the ulcer with additional incompetent veins treated if ulcer healing failed. Seventy-five ulcers with 86 associated incompetent perforating veins were treated with PA in 45 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (61%), calf (37%), and lateral ankle (2%). Initial success of PA, assessed by postprocedure duplex ultrasound, was 58%; repeat ablation was 90% successful and 71% had eventual successful perforator closure. No complications (skin necrosis, infection, or nerve injury) occurred. Failure of ulcer healing with successful perforator closure occurred in 10% and was due to intercurrent illness, patient noncompliance, and patient death due to unrelated causes. Of patients who healed their ulcers, the healing occurred at a mean of 138 days; an average PA of 1.5 incompetent veins per ulcer was required for healing. Ninety percent of ulcers healed when at least one perforator was closed; no ulcer healed without at least one perforator being closed. This experience demonstrates both the feasibility and effectiveness of PA for a selected group of patients with venous ulcers who fail conventional therapy with compression. Copyright

  16. Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access.

    Science.gov (United States)

    Sieverding, Ludger; Busch, Andreas; Gesche, Jens; Blumenstock, Gunnar; Sturm, Ekkehard; Tsiflikas, Ilias; Piersma, Femke; Hauser, Anja; Wiegand, Gesa; Hartleif, Steffen; Hofbeck, Michael; Fuchs, Jörg; Warmann, Steven W

    2018-03-01

    The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access. Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions. Median age at intervention was 47months (interquartile range (IQR),29-74), median time for interventions was 66min (IQR,42-111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm 2 (IQR, 0.2-0.6), no complications occurred during or after interventions. Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients. Treatment Study. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Fingertip Replantation Without and With Palmar Venous Anastomosis: Analysis of the Survival Rates and Vein Distribution.

    Science.gov (United States)

    Aksoy, Alper; Gungor, Melike; Sir, Emin

    2017-01-01

    The purpose of this study was to compare the results of fingertip replantations without (artery anastomosis only replantations) and with venous anastomosis (replantations in which both arterial and palmar venous anastomoses were performed). Also, distribution of the veins used for anastomosis was analyzed retrospectively. First 53 digits (47 patients) received only arterial anastomosis (group 1). For relieving venous congestion, external bleeding method was used. Last 41 digits (38 patients) received both arterial and palmar venous anastomoses without external bleeding (group 2). There was statistical significance of the survival rate between group 1 [77.3% (41/53)] and group 2 [92.6% (38/41)] (P = 0.039). Venous congestion was encountered at 10 digits in group 1 (all underwent necrosis totally) and at 3 digits in group 2 (both were moderate and could be salvaged partially) (P = 0.094, no statistical significance). There was statistical significance of the mean operation time for single-fingertip replantation between group 1 (80 ± 7.8 minutes) and group 2 (105 ± 14.5 minutes) (P replantations with palmar venous anastomosis have simpler postoperative care and lower drawbacks as compared with artery anastomosis-only replantations.

  18. Fingertip Replantation With Palmar Venous Anastomoses in Children.

    Science.gov (United States)

    Wen, Gen; Xu, Jia; Chai, Yi-Min

    2017-06-01

    Fingertip amputation in children is difficult to manage using microsurgical replantation techniques and many salvage procedures have failed owing to the nonavailability of suitable veins for anastomosis in the fingertip. This study reviewed our experience of pediatric fingertip replantation involving palmar venous anastomoses and evaluated the clinical outcomes. From October 2008 to May 2013, 21 pediatric fingertips that had been completely amputated at or distal to the distal interphalangeal joint of the finger, or at or distal to the interphalangeal joint of the thumb were managed using complete replantation. One artery was anastomosed for revascularization with or without nerve repair, and a palmar venous anastomosis was performed to reestablish the outflow system. Twenty (95.2%) of the 21 fingertips survived. One replant involving an avulsion amputation of the left little finger failed, and the patient underwent stump cap-plasty. Excellent restoration of finger motion, pinch strength, and appearance was observed during the mean 39.9-month (range, 18-65 months) follow-up. The mean regained static 2-point discrimination sensation was 3.8 mm (range, 3.2-4.2 mm). All of the children and their families were satisfied with the surgical outcomes. Successful palmar venous anastomosis appears to promote the survival of replanted fingertips in children. Given that the procedure may simplify postoperative care, minimize complications, and achieve a high survival rate, it should be attempted if the technical expertise is available.

  19. Sagittal venous sinus thrombosis after cesarean section: a case report

    Directory of Open Access Journals (Sweden)

    Farideh Keypour

    2013-07-01

    Full Text Available Background: Cerebral venous thrombosis (CVT is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with  premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation.  Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin (LMWs are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

  20. Fate of venous repair after shock and trauma

    Energy Technology Data Exchange (ETDEWEB)

    Barkun, J.S.; Terazza, O.; Daignault, P.; Chiu, R.C.; Mulder, D.S.

    1988-09-01

    To assess the role of shock and trauma in the subsequent thrombosis of a venous repair, the following experiments were performed. Two groups of unsplenectomized dogs were studied: control dogs (Gr.C) underwent replacement of a segment of superficial femoral vein by an autogenous vein graft. Trauma group (Gr.T) dogs were subjected to hypovolemic shock using a modified Wiggers' technique and received standardized hindleg trauma. After resuscitation, venous repairs identical to Gr.C dogs were performed. Gr.T dogs exhibited a 78% thrombosis rate as opposed to 12% in Gr.C animals. To elucidate possible mechanisms, platelets were drawn from another ten animals, divided into similar groups, and labelled with Indium-111-oxine. In Gr.T animals, graft activity increased over time and platelet distribution along the graft was homogeneous. These results contrasted markedly with those of Gr.C animals. We conclude that shock and trauma predispose venous repairs to failure and that altered platelet-endothelium interactions may be implicated.

  1. Fate of venous repair after shock and trauma

    International Nuclear Information System (INIS)

    Barkun, J.S.; Terazza, O.; Daignault, P.; Chiu, R.C.; Mulder, D.S.

    1988-01-01

    To assess the role of shock and trauma in the subsequent thrombosis of a venous repair, the following experiments were performed. Two groups of unsplenectomized dogs were studied: control dogs (Gr.C) underwent replacement of a segment of superficial femoral vein by an autogenous vein graft. Trauma group (Gr.T) dogs were subjected to hypovolemic shock using a modified Wiggers' technique and received standardized hindleg trauma. After resuscitation, venous repairs identical to Gr.C dogs were performed. Gr.T dogs exhibited a 78% thrombosis rate as opposed to 12% in Gr.C animals. To elucidate possible mechanisms, platelets were drawn from another ten animals, divided into similar groups, and labelled with Indium-111-oxine. In Gr.T animals, graft activity increased over time and platelet distribution along the graft was homogeneous. These results contrasted markedly with those of Gr.C animals. We conclude that shock and trauma predispose venous repairs to failure and that altered platelet-endothelium interactions may be implicated

  2. Peripheral Vascular Disease

    Science.gov (United States)

    ... Topics FAQs Peripheral Vascular Disease Peripheral vascular disease (PVD) involves damage to or blockage in the blood ... the organs in and below your stomach area. PVD may also affect the arteries leading to your ...

  3. Significance of venous anastomosis in fingertip replantation.

    Science.gov (United States)

    Hattori, Yasunori; Doi, Kazuteru; Ikeda, Keisuke; Abe, Yukio; Dhawan, Vikas

    2003-03-01

    Adequate venous outflow is the most important factor for successful fingertip replantation. The authors have attempted venous anastomosis in all cases of fingertip replantation to overcome postoperative congestion. In this article, the significance of venous repair for fingertip replantation is described from the authors' results of 64 complete fingertip amputations in 55 consecutive patients, which were replanted from January of 1996 to June of 2001. The overall survival rate was 86 percent. Of the 44 replantations in zone I, 37 survived, and the success rate was 84 percent. Of the 20 replantations in zone II, 18 survived, and the success rate was 90 percent. Venous anastomosis was attempted in all cases, but it was possible in 39 zone I and in all zone II replantations. For arterial repair, vein grafts were necessary in 17 of the 44 zone I and in one of the 20 zone II replantations; for venous repair, they were necessary in six zone I replantations and one zone II replantation. Postoperative vascular complications occurred in 15 replantations. There were five cases of arterial thrombosis and 10 cases of venous congestion. Venous congestion occurred in nine zone I and one zone II replantations. In five of these 10 replantations, venous anastomosis was not possible. In another five replantations, venous outflow was established at the time of surgery, but occlusion occurred subsequently. Except for the five failures resulting from arterial thrombosis, successful venous repair was possible in 49 of 59 replantations (83 percent). Despite the demand for skillful microsurgical technique and longer operation time, the authors' results using venous anastomosis in successful fingertip replantations are encouraging. By performing venous anastomosis, external bleeding can be avoided and a higher survival rate can be achieved. Venous anastomosis for fingertip replantation is a reliable and worthwhile procedure.

  4. Cerebral sino-venous thrombosis

    International Nuclear Information System (INIS)

    Sayama, Ichiro; Kobayashi, Tsunesaburo; Nakajima, Kenji

    1982-01-01

    Three cases of cerebral sino-venous thrombosis were reported. Repeated CT findings were studied and discussed on account of the treatments for those pathologic conditions. Those of studied cases are; a 22-year-old postpartum woman, a 42-year-old woman with irregular vaginal bleeding, and a 26-year-old man with severe reactive emesis after drinking alcohol. They were treated conservatively. Case 1 died in its acute stage. In the remaining ones, each had an uneventful recovery. CT scan findings of them manifested their exact clinical conditions. These findings were devided into two categories, one was direct signs expressed sino-venous occlusion, the other was indirect signs which appeared as a result of these occlusion. Direct signs cannot always get in every cases with sino-venous occlusion, but as for indirect signs, we can get various changes corresponding to the time taken CT photoes, and they are useful to decide appropriate treatments at that time. Considering suitable treatments for this disease, it is necessary to select most suitable ones according to their pathologic conditions, which may be precisely drawn with CT scans. (J.P.N.)

  5. Propylthiouracil and peripheral neuropathy

    Directory of Open Access Journals (Sweden)

    Valentina Van Boekel

    1992-06-01

    Full Text Available Peripheral neuropathy is a rare manifestation in hyperthyroidism. We describe the neurological manifestations of a 38 year old female with Graves' disease who developed peripheral neuropathy in the course of her treatment with propylthiouracil. After the drug was tapered off, the neurological signs disappeared. Therefore, we call attention for a possible toxic effect on peripheral nervous system caused by this drug.

  6. Radioimmunoassay of aldosterone in adrenal venous effluent in a case of Conn's syndrome, ch. 5a

    International Nuclear Information System (INIS)

    Froelich, M.; Bruning, P.F.; Moolenaar, A.J.

    1977-01-01

    In a case of Conn's syndrome samples were obtained from the venous effluent of both adrenals and from peripheral veins during venography. The aldosterone concentration was measured by means of radioimmunoassay. The sensitivty of the aldosterone assay was 27 pg (P<0.05), the parallelism between the standard and the serum dilutions was excellent and there was no cross-reaction with cortisol, cortisone, 21-desoxycortisol, dexamethasone or spironolactone in amounts up to 1 μg per incubation. The aldosterone concentrations measured in peripheral venous blood were 220-250 ng/100 ml serum. In the effluent of the left adrenal, in which an aldosterone producing tumor was localized, an aldosterone level of 8480 ng/100 ml serum was estimated

  7. Classic Peripheral Signs of Subacute Bacterial Endocarditis

    Directory of Open Access Journals (Sweden)

    Yooyoung Chong

    2016-10-01

    Full Text Available A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.

  8. Calculating acid-base and oxygenation status during COPD exacerbation using mathematically arterialised venous blood

    DEFF Research Database (Denmark)

    Rees, Stephen Edward; Rychwicka-Kielek, Beate A; Andersen, Bjarne F

    2012-01-01

    Abstract Background: Repeated arterial puncture is painful. A mathematical method exists for transforming peripheral venous pH, PCO2 and PO2 to arterial eliminating the need for arterial sampling. This study evaluates this method to monitor acid-base and oxygenation during admission...... for exacerbation of chronic obstructive pulmonary disease (COPD). Methods: Simultaneous arterial and peripheral venous blood was analysed. Venous values were used to calculate arterial pH, PCO2 and PO2, with these compared to measured values using Bland-Altman analysis and scatter plots. Calculated values of PO2......H, PCO2 and PO2 were 7.432±0.047, 6.8±1.7 kPa and 9.2±1.5 kPa, respectively. Calculated and measured arterial pH and PCO2 agreed well, differences having small bias and SD (0.000±0.022 pH, -0.06±0.50 kPa PCO2), significantly better than venous blood alone. Calculated PO2 obeyed the clinical rules...

  9. Central Venous Catheter-directed Tissue Plasminogen Activator in Massive Pulmonary Embolism

    OpenAIRE

    Vishal Gulati

    2018-01-01

    We present the case of an 88-year-old female who presented to the emergency department (ED) with suspected massive pulmonary embolism (PE) causing respiratory failure, right heart strain, and shock, who despite early and aggressive resuscitation with vasopressors and continuous peripheral infusion of tissue plasminogen activator (tPA), suffered a cardiac arrest in the ED. We describe the approach of a tPA bolus directed through a central venous catheter, resulting in return of spontaneous cir...

  10. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriëtte; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michaël A.; Spronk, Peter E.

    2012-01-01

    Objective: The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design: Prospective observational controlled study. Setting: Nonacademic university-affiliated

  11. Clinicoroentgenological diagnosis of chronic venous ovarian insufficiency

    International Nuclear Information System (INIS)

    Grakova, L.S.; Galkin, E.V.; Naumova, E.B.

    1989-01-01

    The paper is devoted to clinicoroentgenological correlations of venous renogonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinicolaboratory investigation was followed by visceral and parietal flebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. Clinicoroentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele

  12. Prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: a blinded sonographic evaluation.

    Science.gov (United States)

    Tromba, L; Blasi, S; Vestri, A; Kiltzanidi, D; Tartaglia, F; Redler, A

    2015-02-01

    To verify the prevalence of chronic cerebrospinal venous insufficiency in patients affected by different clinical forms of multiple sclerosis and in healthy subjects using the Zamboni ultrasound protocol combined with M-mode ultrasound examination. We enrolled 112 patients with multiple sclerosis and 67 healthy subjects from 20 to 67 years of age. All the patients underwent Duplex and color-Doppler sonography of the neck vessels, transcranial colour duplex sonography, M-mode study of the valve system and of venous abnormalities. Subjects were positive for chronic cerebrospinal venous insufficiency when at least two of five hemodynamic criteria of the Zamboni protocol were fulfilled. Chronic cerebrospinal venous insufficiency condition was further analyzed by a multivariate analysis including age, sex, disease duration, subtypes of multiple sclerosis and expanded disability status scale score as independent variables. No healthy subjects was positive for chronic cerebrospinal venous insufficiency, while in the sample of patients affected by multiple sclerosis the diagnosis was made in 59.8% of cases (p multiple sclerosis and chronic cerebrospinal venous insufficiency (respectively 54.4% and 76.1%, p present in healthy subjects but were detected in patients with multiple sclerosis. The positivity of the second criterion was associated with diagnosis of chronic cerebrospinal venous insufficiency in 100% of cases. The third criterion had a prevalence of 52.2% in the subgroup of chronic cerebrospinal venous insufficiency patients. It was positive in 36 multiple sclerosis patients and was associated with chronic cerebrospinal venous insufficiency diagnosis in all cases except one. The multivariate analysis showed that age, disease duration, sex, subtypes of multiple sclerosis and expanded disability status scale score were not considered predictors of this haemodynamic condition. Chronic cerebrospinal venous insufficiency is a haemodynamic condition strongly

  13. Venous Thromboembolism: A Comparison of Chronic Spinal Cord Injury and General Surgery Patients in a Metropolitan Veterans Affairs Hospital.

    Science.gov (United States)

    Moore, Ryan M; Rimler, Jonathan; Smith, Brian R; Wirth, Garrett A; Paydar, Keyianoosh Z

    2016-11-01

    Venous thromboembolic events result in significant morbidity, mortality, and costly therapeutic interventions. As medical resource allocation strategies are becoming more pervasive, appropriate risk stratification and prophylactic regimens are essential. Previous studies have shown a decreased incidence of perioperative venous thromboembolism in the chronic spinal cord injury population. The question remains of whether chronic spinal cord injury is protective against venous thromboembolism. A retrospective review of all cases involving chronic spinal cord injury patients who underwent plastic and reconstructive surgery operations (n = 424) and general surgery patients (n = 777) with a primary outcome of deep venous thrombosis or pulmonary embolism within 90 days of surgery was performed. The incidence of postoperative deep venous thrombosis in the control and spinal cord injury groups was 1.7 percent and 0.2 percent, respectively (p = 0.027). However, such significance was not observed with regard to postoperative pulmonary embolism incidence (p = 0.070). Collectively, the incidence of postoperative venous thromboembolism-specifically, deep venous thrombosis or pulmonary embolism-was significantly greater in the general surgery population (p = 0.014). A nearly 10-fold increased risk of venous thromboembolism was seen among the control group (1.9 percent versus 0.2 percent) despite administration of optimal prophylaxis. This study demonstrates a profoundly low incidence of venous thromboembolism among chronic spinal cord injury patients compared with general surgery patients. Future efforts to elucidate how chronic spinal cord injury confers a protective mechanism may potentially influence the evolution of venous thromboembolism prevention guidelines, and spark the development of alternative prophylactic agents or customized application of prevention efforts.

  14. Recalcitrant Venous Leg Ulcers May Heal by Outpatient Treatment of Venous Disease Even in the Presence of Concomitant Arterial Occlusive Disease.

    Science.gov (United States)

    Mosti, G; Cavezzi, A; Massimetti, G; Partsch, H

    2016-09-01

    Peripheral arterial occlusive disease (PAOD) is reported in about 15-20% of patients with venous leg ulcers (VLU). In such cases arterial recanalization is often recommended, and compression therapy is considered a contraindication when the ankle brachial pressure index (ABPI) is venous recalcitrant leg ulcer" [pvRLU]) and with associated PAOD ("mixed arterial and venous recalcitrant leg ulcer" [mavRLU]), by treating only the venous disease. The records of 180 outpatients with recalcitrant ulcers treated between January 2011 and July 2014 were reviewed retrospectively. In total, 109 were affected by pvRLU and 71 by mavRLU, with moderate PAOD defined by an ABPI between 0.5 and 0.8. In addition to the same local wound dressing, the patients received ultrasound guided foam sclerotherapy of the refluxing superficial veins and a modified inelastic compression with a pressure ≤ 40 mmHg. No patient was referred for arterial revascularization. The patients were followed until ulcer healing. Patients with pvRLU and mavRLU showed comparable demographic characteristics. Twenty-five patients were lost to follow up and the outcomes were analyzed in 93 patients with pVLU (85.4%) and in 62 patients with mavRLU (87.4%). The maximum time to complete healing was 48 weeks in the pvRLU group and 52 weeks in the mavRLU group (p = .009), The median healing time was 23 (pvRLU) versus 25.5 weeks (mavRLU) (p = .030). Deep venous incompetence (p ulcer surface area (p ulcer duration (p ulcers by treating venous incompetence by foam sclerotherapy and modified compression is successful, even if underlying moderate PAOD is not actively treated. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Sonographic detection of portal venous gas

    International Nuclear Information System (INIS)

    Lee, Wang Yul; Lee, S. K.; Cho, O. K.

    1989-01-01

    Portal venous gas suggests underlying bowel disease such as strangulating intestinal obstruction and its demonstration carries with it an important implications with respect to patient management. Radiography has been the gold standard for the detection of portal venous gas. We have experienced two cases of portal venous gas diagnosed by ultrasound. Sonographic findings were floating echoes in the main portal vein and highly echogenic linear or patchy echoes within the hepatic parenchyma. Simple abdominal films of those cases failed to demonstrate gas in the portal venous system

  16. Iliac Vein Interrogation Augments Venous Ulcer Healing in Patients Who Have Failed Standard Compression Therapy along with Pathological Venous Closure.

    Science.gov (United States)

    Mousa, Albeir Y; Broce, Mike; Yacoub, Michael; AbuRahma, Ali F

    2016-07-01

    Treatment of venous ulcers is demanding for patients, as well as clinicians, and the investigation of underlying venous hypertension is the cornerstone of therapy. We propose that occult iliac vein stenosis should be ruled out by iliac vein interrogation (IVI) in patients with advanced venous stasis. We conducted a systematic retrospective analysis of a consecutive series of patients who presented with CEAP (clinical, etiological, anatomical, and pathophysiological) 6 venous disease. All patients had great saphenous vein ablation, compressive treatment, wound care (including Unna boot compression), and perforator closure using ablation therapy. Iliac vein stenosis was defined as ≥50% stenosis in cross-sectional surface area on intravascular ultrasound. Primary outcomes include time of venous ulcer healing and/or measurable change in the Venous Clinical Severity Score. Twenty-two patients with CEAP 6 venous disease met the inclusion criteria (active ulcers >1.5 cm in diameter). The average age and body mass index were 62.2 ± 9.2 years and 41.7 ± 16.7, respectively. The majority were female (72.7%) with common comorbidities, such as hyperlipidemia (54.5%), hypertension (36.4%), and diabetes mellitus (27.3%). Twenty-nine ulcers with an average diameter of 3.4 ± 1.9 cm and a depth of 2.2 ± 0.5 mm were treated. The majority of the ulcers occurred on the left limb (n = 17, 58.6%). Average perforator venous reflux was 3.6 ± 0.8 sec, while common femoral reflux was 1.8 ± 1.6. The majority (n = 19, 64.5%) of the perforator veins were located at the base of the ulcer, while the remainder (n = 10, 34.5%) were within 2 cm from the base. Of the 13 patients who underwent IVI, 8 patients (61.5%) had stenosis >50% that was corrected with iliac vein angioplasty and stenting (IVAS). There was a strong trend toward shorter healing time in the IVI group (7.9 ± 9.5 weeks) than for patients in the no iliac vein interrogation (NIVI) group (20.2 ± 15

  17. 7T μMRI of mesenteric venous ischemia in a rat model: timing of the appearance of findings.

    Science.gov (United States)

    Somma, Francesco; Berritto, Daniela; Iacobellis, Francesca; Landi, Nicola; Cavaliere, Carlo; Corona, Marco; Russo, Serena; Di Mizio, Roberto; Rotondo, Antonio; Grassi, Roberto

    2013-04-01

    The aim of this study is to analyze the chronological development of macroscopic, microscopic and magnetic resonance imaging (MRI) findings in a rat model of Superior Mesenteric Venous (SMV) ligation, and to evaluate the role of MRI in the diagnosis of mesenteric venous thrombosis. Thirty adult Sprague-Dawley rats were used and divided in two different groups that underwent a different surgical model and a different monitoring of ischemic damage. Group I underwent macroscopical and histological observation; Group II underwent 7T μMRI evaluation and histological analysis. The first alterations occurred 30 min after SMV ligation and progressively worsened until the eighth hour. The morphological and MRI findings showed the same course. This study provides a systematic evaluation of early anatomopathological and MRI findings following the SMV ligation. MRI allows to identify the early pathological findings of venous mesenteric ischemia and allows to correlate those to the histopathological features. Our data suggest a relevant role of MRI in the diagnostic management of mesenteric venous thrombosis, allowing to non-invasively identify and characterize the histopathologic findings. So, thanks to these skills, its future application in early diagnosis of human mesenteric venous ischemia is supposable. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Validity of colour doppler ultrasonography with d-dimers in clinically suspected deep venous thrombosis of the lower limb

    International Nuclear Information System (INIS)

    Babar, T.H.; Nafees, M.N.; Sarwar, S.; Ashraf, N.

    2010-01-01

    Objective: This study was designed to evaluate the validity of colour Doppler ultrasonography with D-dimers in clinically suspected deep venous thrombosis of the lower limb. Study Design: Validation study Place and Duration of study: Radiology Department CMH/MH Rawalpindi Six months from 15 June 2006 to 31 December 2006. Subjects and Methods: Thirty cases of clinically suspected deep venous thrombosis of the lower limb were included in the study selected on non probability convenience sampling technique. Colour Doppler ultrasonography examination of the affected lower limb was carried out and results compared with D-dimers assays results. Results: Among 30 patients who underwent colour Doppler ultrasonography examination of the affected limb for diagnosis of deep venous thrombosis, 27 (90%) were diagnosed to have deep venous thrombosis, 3 (10%) were diagnosed not to have deep venous thrombosis. Amongst them 2 patients had raised D-dimers levels and repeat Doppler ultrasound advised. On revised ultrasound deep venous thrombosis in these patients was confirmed. This showed that colour Doppler ultrasonography examination has sensitivity of 93.1%, specificity 100%, positive predictive value 100%, negative predictive value 33.33% and overall accuracy of 93.33 %. Conclusion: Colour Doppler ultrasonography has a high diagnostic yield in cases of deep venous thrombosis of lower limb when used in conjunction with D-dimers assays. (author)

  19. Intraoperative digital angiography: Peripheral vascular applications

    International Nuclear Information System (INIS)

    Bell, K.; Reifsteck, J.E.; Binet, E.F.; Fleisher, H.J.

    1986-01-01

    Intraoperative digital angiography is the procedure of choice for the peripheral vascular surgeon who wishes to evaluate his results before terminating anesthesia. Two operating suites at the John L. McClellan Memorial Veterans Hospital are equipped with permanent ceiling-mounted Philips C-arm fluoroscopes and share an ADAC 4100 digital angiographic system. In the last 18 months, 40 peripheral vascular intraoperative digital angiographic procedures have been performed, in all but two cases using direct arterial puncture. In 65% of cases, the intraoperative study showed no significant abnormality. In 12.5%, minor abnormalities not requiring reoperation were seen. In 22.5% of cases, the intraoperative digital angiogram revealed a significant abnormality requiring immediate operative revision. None of the patients who underwent reoperation experienced postoperative sequelae. Intraoperative digital angiography is useful in identifying complications of peripheral vascular operations

  20. Intervenções de enfermagem e flebites decorrentes de cateteres venosos periféricos. Revisão sistemática da literatura. Intervenciones de enfermería y flebitis resultantes de cateteres venosos periféricos. Revisión sistemática de la literatura Nursing interventions and peripheral venous catheter-related phlebitis. Systematic literature review

    Directory of Open Access Journals (Sweden)

    Anabela de Sousa Salgueiro Oliveira

    2010-12-01

    enfermería relacionadas con la inserción del CVP; con la vigilancia de los enfermos y con los conocimientos de los enfermeros. Las tres áreas fueron identificadas como relevantes y con influencia en la aparición de flebitis. Las intervenciones de enfermería realizadas a enfermos portadores de CVP pueden prevenir la aparición de flebitis. La producción científica es, no obstante, reducida, habiendo necesidad de profundizar e investigar sobre el impacto de la formación de los enfermeros en la práctica clínica y sus intervenciones.Nursing care provided to patients using peripheral venous catheters (PVC is a constant need due to the high frequency of catheter use. The aim of this systematic review was to define the scientific evidence on nursing interventions for patients with peripheral venous catheters and their impact on the prevention of phlebitis. Scientific studies published in reference databases, between April 2004 and March 2010, were selected following the PICOD model and previously defined inclusion/exclusion criteria. Nineteen studies were identified and divided into three main areas: nursing interventions related to PVC placement; to patient surveillance; and to nurses’ knowledge. These three areas were identified as relevant and as having an impact on the occurrence of phlebitis. Nursing interventions for patients having PVC can prevent phlebitis. However, the scientific evidence is limited, and so there is a need for further research on the impact of nurses’ training on their clinical practice and interventions.

  1. The use of arteriovenous anastomosis for venous drainage during Tamai zone I fingertip replantation.

    Science.gov (United States)

    Wu, Fei; Shen, Xiaofang; Eberlin, Kyle R; Sun, Zhibo; Zhou, Xiao; Xue, Mingyu

    2018-03-27

    The purpose of this study was to evaluate outcomes for patients sustaining a distal fingertip amputation who underwent replantation witharteriovenous anastomosis for venous drainage over a one year period at our institution. This technique has been utilized when insufficient veins are identified in the amputated part for standard veno-venous anastomosis. A retrospective study was performed on patients presenting from 2013 to 2014. Guillotine, crush, and avulsion/degloving injuries were included if they underwent fingertip (Tamai Zone I) replantation with arterial anastomosis for vascular inflow and arteriovenous anastomosis for venous drainage. The cases were further classified as Ishikawa subzone I and subzone II. Arteriovenous anastomosis for venous drainage during replantation was used in 45 digits in 35 patients. 41 of the 45 digits underwent successful replantation using this technique (91%). The mean active ROM in the DIP joint of the fingers and in the IP joint of thumbs was 65° and 57°, respectively. Sensory evaluation demonstrated a mean of 6.9 mm s2PD in digits where the digital nerves could be repaired. 11 replanted digits without nerve repair regained some sensory recovery with a mean of 9.6 mm s2PD. 91% of patients were highly satisfied with the appearance of the replanted digits based on Tamai criteria. Arteriovenous anastomosis for venous outflow should be considered during zone I fingertip replantation if sufficient veins are not identified in the amputated part. This technique may allow for more routine and successful distal replantation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirin versus warfarin.

    Science.gov (United States)

    Goel, R; Fleischman, A N; Tan, T; Sterbis, E; Huang, R; Higuera, C; Parvizi, J; Rothman, R H

    2018-01-01

    The aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA). A retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk. The adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA. Aspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for

  3. Our Experience on Peripheral Vascular Trauma

    Directory of Open Access Journals (Sweden)

    Funda Tor

    2012-08-01

    Full Text Available Purpose: The aim of this study was to determine etiology and management in patients with peripheral vascular trauma. Method: From May 2010 to May 2012, 48 cases who was admitted Adana Sample Education and Research Hospital Department of cardiovascular surgery with a diagnosis peripheral artery injury have been included in this study. All files of the patients have been reviewed retrospectively. Results: Upper extremity vascular trauma have been seen in 30 patients lower extremitiy vascular trauma in 18 patients too. The causes of injuries were penetrating injuries in 26 patients , gon shot injuries in 3 patients , blunt tarauma in 1 patients. . The causes of lower extremity injuries were; penetrating injuries in 5 patients , blunt trauma in 3 patients. As a surgical procedure simple repair , end to end anastomosis , venous graft or PTFE graft interposition was performed. Conclusions: Early intervention and treatment decreased the morbidity and mortality in patients with peripheral vascular injuries. [Cukurova Med J 2012; 37(4.000: 193-197

  4. Risk Factors for Cerebral Venous Thrombosis

    NARCIS (Netherlands)

    Silvis, Suzanne M.; Middeldorp, Saskia; Zuurbier, Susanna M.; Cannegieter, Suzanne C.; Coutinho, Jonathan M.

    2016-01-01

    Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involving the cerebral veins and dural sinuses. In contrast to more common sites of venous thromboembolism (VTE), such as the legs and lungs, CVT mainly affects young adults and children, and women are affected three times more often

  5. Venous Thromboembolic Events After Cerebral Vein Thrombosis

    NARCIS (Netherlands)

    Miranda, Bruno; Ferro, José M.; Canhão, Patrícia; Stam, Jan; Bousser, Marie-Germaine; Barinagarrementeria, Fernando; Scoditti, Umberto

    2010-01-01

    Background and Purpose-After cerebral vein and dural sinus thrombosis (CVT), there is an increased risk of further venous thromboembolic events (VTEs). Time to a second cerebral or systemic venous thrombotic event and risk factors for recurrence have not been investigated in large prospective

  6. Venous Thromboembolism in Patients With Thrombocytopenia

    DEFF Research Database (Denmark)

    Bælum, Jens Kristian; Ellingsen Moe, Espen; Nybo, Mads

    2017-01-01

    BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. O...

  7. Pulmonary venous abnormalities encountered on pre ...

    African Journals Online (AJOL)

    Multidetector computed tomography (MDCT) elegantly renders pulmonary venous anatomy. With increasing numbers of radiofrequency ablation procedures being performed, there is now a greater emphasis on pre-procedure imaging to delineate this anatomy. Pulmonary venous mapping studies can be performed with or ...

  8. An unusual Complication of Central Venous Cannulation

    Directory of Open Access Journals (Sweden)

    Ashvini Kumar

    2013-04-01

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

  9. Urethro-venous intravasation during urethrography

    African Journals Online (AJOL)

    J.M. Ratkal

    urethrography. Two weeks prior to retrograde urethrography, he had presented with urinary retention. At that time, a suprapubic catheter had been placed after a failed attempt at catheterization. Apart from a proximal urethral stricture, the urethrogram also showed the penile venous anatomy, indicating urethro-venous.

  10. Genetic risk factors of venous thrombosis

    NARCIS (Netherlands)

    Franco, R. F.; Reitsma, P. H.

    2001-01-01

    Venous thrombosis, whose main clinical presentations include deep vein thrombosis and pulmonary embolism, represents a major health problem worldwide. Numerous conditions are known to predispose to venous thrombosis and these conditions are commonly referred to as risk indicators or risk factors.

  11. Venous and arterial thrombosis in dialysis patients

    NARCIS (Netherlands)

    Ocak, Gurbey; Vossen, Carla Y.; Rotmans, Joris I.; Lijfering, Willem M.; Rosendaal, Frits R.; Parlevliet, Karien J.; Krediet, Ray T.; Boeschoten, Els W.; Dekker, Friedo W.; Verduijn, Marion

    2011-01-01

    Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Furthermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis

  12. Sex-specific aspects of venous thrombosis

    NARCIS (Netherlands)

    Roach, Rachel Elizabeth Jo

    2014-01-01

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

  13. A BMPy Road for Venous Development.

    Science.gov (United States)

    Goddard, Lauren M; Kahn, Mark L

    2017-09-11

    Detailed molecular pathways for the specific growth of arteries and lymphatic vessels have been identified, but the mechanisms controlling venous vessel growth have been obscure. Tischfield and colleagues (2017) shed new light on this problem by identifying a role for BMP signaling in development of the cerebral venous system. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Peripheral artery disease - legs

    Science.gov (United States)

    Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of ...

  15. Multiple venous anastomoses decrease the need for intensive postoperative management in tamai zone I replantations

    Directory of Open Access Journals (Sweden)

    Deok Hyeon Ryu

    2018-01-01

    Full Text Available Background Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. Methods A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1, a single vein (group 2, and 2 or more veins (group 3. Survival rates and external bleeding rates were analyzed across the groups. Results The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143. Failures were due equally to venous complications (n=4, 50% and to arterial complications (n=4, 50%. Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689. However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017. Conclusions The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy.

  16. Multiple venous anastomoses decrease the need for intensive postoperative management in tamai zone I replantations

    Science.gov (United States)

    Ryu, Deok Hyeon; Roh, Si Young; Kim, Jin Soo; Lee, Dong Chul; Lee, Kyung Jin

    2018-01-01

    Background Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. Methods A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups. Results The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017). Conclusions The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy. PMID:29076329

  17. Nursing diagnoses in patients with chronic venous ulcer: observational study

    Directory of Open Access Journals (Sweden)

    Glycia de Almeida Nogueira

    2015-06-01

    Full Text Available This study aimed to analyze nursing diagnoses in people with chronic venous ulcer. An observational, descriptive, quantitative research conducted in an ambulatory specialized in wound treatment, with a non-probabilistic sample of 20 patients.  Data collection was performed in an institutional form denominated Assessment Protocol for Clients with Tissue Lesions. Diagnoses were established by consensus among four researchers with experience in nursing diagnoses and wound treatments. From data analysis, 16 diagnoses were identified, with 100% of participants presenting: Impaired tissue integrity, Ineffective peripheral tissue perfusion, Risk of infection, Impaired physical mobility and Ineffective health self-control. These diagnoses are found in Safety/Protection, Activity/Rest and Health promotion domains, which from the clinical practice stand point should be priority focuses in nursing intervention and assessment.

  18. Increased rheumatoid factor and deep venous thrombosis

    DEFF Research Database (Denmark)

    Meyer-Olesen, Christine L; Nielsen, Sune F; Nordestgaard, Børge G

    2015-01-01

    was incident deep venous thrombosis. There were no losses to follow-up. RESULTS: During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs ...BACKGROUND: The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease...... in the general population. METHODS: We included 54628 participants from the Copenhagen City Heart Study (1981-83) and the Copenhagen General Population Study (2004-12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome...

  19. Radiologic placement of hemodialysis central venous catheters: a practical guide

    Energy Technology Data Exchange (ETDEWEB)

    Schemmer, D.; Sadler, D.J.; Gray, R.R.; Saliken, J.C.; So, C.B. [Foothills Hospital, Dept. of Diagnostic Imaging, Calgary, Alberta (Canada)

    2001-04-01

    Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

  20. Radiologic placement of hemodialysis central venous catheters: a practical guide

    International Nuclear Information System (INIS)

    Schemmer, D.; Sadler, D.J.; Gray, R.R.; Saliken, J.C.; So, C.B.

    2001-01-01

    Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

  1. A sonographic quantitative cutoff value of cerebral venous outflow in neurologic diseases: a blinded study of 115 subjects.

    Science.gov (United States)

    Monti, L; Menci, E; Piu, P; Leonini, S; Arrigucci, U; Bellini, M; Zandonella, A; Galluzzi, P; Casasco, A

    2014-07-01

    The autonomic nervous system maintains constant cerebral venous blood outflow in changing positions. Alterations in cerebral autoregulation can be revealed by postural changes at quantitative color Doppler sonography. The aim of this study was to reach an optimal cutoff value of the difference between the cerebral venous blood outflow in the supine and seated positions that can discriminate healthy controls from patients with multiple sclerosis and those with other neurologic diseases and to evaluate its specificity, sensitivity, and diagnostic accuracy. One hundred fifteen subjects (54 with MS, 31 healthy controls, 30 with other neurologic diseases) underwent a blinded quantitative color Doppler sonography evaluation of cerebral venous blood outflow in the supine and sitting positions. An optimal difference value between the supine and sitting positions of the cerebral venous blood outflow cutoff value was sought. The difference value between supine and sitting positions of the cerebral venous blood outflow was ≤ 503.24 in 38/54 (70.37%) patients with MS, 9/31 (29.03%) healthy controls, and 13/30 (43.33%) subjects with other neurological diseases. A difference value between supine and sitting positions of the cerebral venous blood outflow at a 503.24 cutoff reached a sensitivity at 70.37%, a 70.96% specificity, a 80.85% positive predictive value, and a 57.89% negative predictive value; the quantitative color Doppler sonography parameters yielded significant differences. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 assessed the significant difference between MS versus other neurological diseases. Alteration of cerebral venous blood outflow discriminated MS versus other neurologic diseases and MS versus healthy controls. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 was statistically associated with MS. © 2014 by American Journal of Neuroradiology.

  2. Congenital intrahepatic arterioportal and portosystemic venous fistulae with jejunal arteriovenous malformation depicted on multislice spiral CT

    International Nuclear Information System (INIS)

    Chae, Eun Jin; Goo, Hyun Woo; Yoon, Chong Hyun; Kim, Seong-Chul

    2004-01-01

    We report a symptomatic infant with very rare congenital arterioportal and portosystemic venous fistulae in the liver. Multislice CT after partial transcatheter embolisation revealed not only the complicated vascular architecture of the lesion, but also an incidental jejunal arteriovenous malformation which explained the patient's melena. The patient underwent ligation of the hepatic artery and resection of the jejunal arteriovenous malformation. Postoperative multislice CT clearly demonstrated the success of the treatment. (orig.)

  3. Influence of meal composition on postprandial peripheral plasma concentrations of vasoactive peptides in man

    DEFF Research Database (Denmark)

    Pedersen-Bjergaard, U; Høst, U; Kelbaek, H

    1996-01-01

    In a randomized cross-over study healthy non-obese male human subjects received standardized isocaloric, isovolumetric meals consisting of either carbohydrate, protein or fat and a non-caloric control meal consisting of an equal volume of water. Peripheral venous plasma concentrations of calcitonin...... that the postprandial peripheral plasma concentrations of CGRP, VIP and PYY are dependent on the caloric meal composition. The VIP, but not the CGRP and PYY concentrations seem to be influenced by gastric distension. The physiological significance of the postprandial alterations in peripheral concentrations...

  4. Placement peripherally inserted central catheters (PICC): the upper arm approach

    International Nuclear Information System (INIS)

    Choo, In Wook; Choo, Sung Wook; Choi, Dong Il; Yoon, Jung Hwan; Hwang, Jae Woong; Lim, Jae Hoon; Andrews, James C.; Williams, David M.; Cho, Kyung J.

    1995-01-01

    To evaluate a recently developed technique to place a medium-duration (weeks to months) central venous access. Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter (PICC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5-French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients (2.5%), acute thrombosis of the subclavian vein in 3 (0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. The PICC system is an excellent option for medium-duration central venous access. Patients were able to carry on normal activities with the catheters in place

  5. Placement peripherally inserted central catheters (PICC): the upper arm approach

    Energy Technology Data Exchange (ETDEWEB)

    Choo, In Wook; Choo, Sung Wook; Choi, Dong Il; Yoon, Jung Hwan; Hwang, Jae Woong; Lim, Jae Hoon [Samsung Medical Center, Seoul (Korea, Republic of); Andrews, James C. [Mayo Clinic, Lansing (United States); Williams, David M.; Cho, Kyung J. [University of Michigan Hospital, Lansing (United States)

    1995-10-15

    To evaluate a recently developed technique to place a medium-duration (weeks to months) central venous access. Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter (PICC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5-French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients (2.5%), acute thrombosis of the subclavian vein in 3 (0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. The PICC system is an excellent option for medium-duration central venous access. Patients were able to carry on normal activities with the catheters in place.

  6. Vasculitic peripheral neuropathy

    Directory of Open Access Journals (Sweden)

    Mona Amini

    2014-02-01

    Full Text Available Primary systemic vasculitis in pre-capillary arteries is associated with peripheral neuropathy. In some types of systematic vasculitis about 60 % of patients have peripheral nervous system (PNS involvement. In vasculitic peripheral neuropathies (VPN a necrotizing and inflammatory process leads to narrowing of vasa nervorum lumen and eventually the appearance of ischemic lesions in peripheral nerves. Some features might be suggestive of VPN, like: axonal nerve degeneration, wallerian-like degeneration, and diameter irregularity of nerve. Peripheral nervous system (PNS destruction during systemic vasculitides should be considered, due to its frequency and early occurrence in vasculitis progression. The first line treatment of non systematic VPNs is corticosteroid agents, but these drugs might worsen the VPNs or systemic vasculitis.

  7. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  8. [Enterobacterial antigen in human peripheral blood lymphocytes].

    Science.gov (United States)

    Faure-Fontenla, M A; García-Tamayo, F

    1989-11-01

    The following study has as prior history the research reports which have shown the existence of an antigenic tissue deposit in gram-negative enterobacteria. The antigens of the enterobacteria have also been found in the lymphocytic membranes and cytoplasm. Since intestinal lymphoid tissue cells can recirculate by means of the thoracic duct to the peripheral venous system, it was proposed that the circulating lymphocytes in healthy people could also contain small amounts of a common enterobacterial antigen. The study was carried out in 15 human venous blood samples, of which the lymphocytic population was separated to later be used in the preparation of 15 alcohol soluble extracts. This material was used for inhibiting the immuno-hemolysis assay in three occasions in order to show the presence of antigens shared by different enterobacterias, using as reference a fraction separated from the LPS of Escherichia coli 08. The results showed that the human lymphocytes also had antigenic determinants common to gram-negative bacteria.

  9. A Case of Peripheral Ulcerative Keratitis Associated with Autoimmune Hepatitis

    Directory of Open Access Journals (Sweden)

    Hamoon Eshraghi

    2017-01-01

    Full Text Available Purpose. To describe a case of peripheral ulcerative keratitis in the setting of autoimmune hepatitis and possible overlap syndrome with primary sclerosing cholangitis. Case Report. A 48-year-old African American female with autoimmune hepatitis with possible overlap syndrome with primary sclerosing cholangitis presented with tearing, irritation, and injection of the left eye that was determined to be peripheral ulcerative keratitis. The patient was treated with topical and systemic steroids, immunosuppressant drugs (azathioprine and mycophenolate mofetil, a biologic (rituximab, and surgery (conjunctival resection, and the peripheral ulcerative keratitis epithelialized but ultimately led to corneal perforation. Conclusion. In this unique case, a patient with peripheral ulcerative keratitis who underwent treatment ultimately had a corneal perforation. This case may suggest a possible relationship between autoimmune hepatitis and peripheral ulcerative keratitis.

  10. Cerebral Venous Congestion as Indication for Thrombolytic Treatment

    International Nuclear Information System (INIS)

    Tsai, Fong Y.; Kostanian, Varoujan; Rivera, Monica; Lee, Kwo-Whie; Chen, Clayton C.; Nguyen, Thong H.

    2007-01-01

    Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods

  11. Central venous catheters: the role of radiology

    International Nuclear Information System (INIS)

    Tan, P.L.; Gibson, M.

    2006-01-01

    The insertion and management of long-term venous catheters have long been the province of anaesthetists, intensive care physicians and surgeons. Radiologists are taking an increasing role in the insertion of central venous catheters (CVCs) because of their familiarity with the imaging equipment and their ability to manipulate catheters and guide-wires. The radiological management of the complications of CVCs has also expanded as a result. This article reviews the role of radiology in central venous access, covering the detection and management of their complications

  12. Interventional therapy of mesenteric venous thrombosis

    International Nuclear Information System (INIS)

    Li Xuan; Ouyang Qiang; Xiao Xiangsheng

    2006-01-01

    Objective: To evaluate the clinical effect of interventional therapy in treating intestinal ischemia of mesenteric venous thrombosis. Methods: Twelve cases (male 7 cases, female 5 cases; ranging from 33 to 86 years of age) of mesenteric venous thrombosis (MVT) were treated with percutaneous transhepatic mesenteric venous thrombectomy and thrombolysis associated with papaverin perfusion via superior mesenteric artery. Results: Seven of the 12 cases recovered; 3 cases were undertaken laparotomy; 2 died within 30 days respectively. No severe complications occurred in all of the 12 cases. Conclusions: Interventional therapy of MVT is a safe and effective method with reduction of the mortality. (authors)

  13. Doppler diagnosis of deep venous thrombosis

    International Nuclear Information System (INIS)

    Nix, L.

    1984-01-01

    The venous Doppler examination has been shown to be a sensitive test for the diagnosis of deep venous thrombosis. An experienced technologist can perform the examination in about ten minutes at the bedside or in the laboratory. Because the venous Doppler examination is subjective, it requires considerable experience of the examiner to achieve maximal accuracy. Nevertheless, with sufficient practice the technologist may employ this instrument with skill and versatility to detect both obstruction and valvular incompetence in the superficial, communicating, and deep veins of the lower and upper extremities

  14. Peripheral arteriovenous fistula as vascular access for long-term chemotherapy.

    Science.gov (United States)

    Kovalyov, Oleksiy O; Kostyuk, Oleksandr G; Tkachuk, Tetyana V

    To provide long-term vascular access in clinical oncology peripheral forearm veins (up to 95% of patients in Ukraine), central venous access and "complete implanted vascular systems" are used most often. Many oncology patients have contraindications to catheterization of superior vena cava. Besides, exploitation of central veins is associated with potential technical and infectious complications. The aim - to study short-term and long-term results of arteriovenous fistula exploitation as vascular access for continuous anticancer therapy. Peripheral venous bed status in 41 oncology patients taking long-term chemotherapy treatment is analyzed in the article. Doppler sonography, morphologic and immune histochemical analyses were used in the study. Doppler sonography found qualitative and quantitative changes in forearm veins at different time periods after initiation of chemotherapy in the majority of patients. The major morphologic manifestations of venous wall damage were chemical phlebitis, local or extended hardening of venous wall, venous thrombosis and extravasations with necrosis and subsequent paravasal tissue sclerosis. Alternative vascular access created in 12 patients completely met the adequacy criteria (safety, multiple use, longevity, realization of the designed therapy program). The conclusion was made about inapplicability of forearm veins for long-term administration of cytostatic agents. If it is impossible to use central veins, arteriovenous fistula can become an alternative vascular access.

  15. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

    International Nuclear Information System (INIS)

    Catalano, Orlando; Castelguidone, Elisabetta de Lutio di; Granata, Vincenza; D'Errico, Adolfo Gallipoli; Sandomenico, Claudia; Petrillo, Mario; Aprea, Pasquale

    2011-01-01

    Background: Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). Purpose: To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Material and Methods: Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Results: Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. Conclusion: CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi

  16. Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: Usefulness of the portal venous phase

    International Nuclear Information System (INIS)

    Ishigami, Kousei; Tajima, Tsuyoshi; Nishie, Akihiro; Kakihara, Daisuke; Fujita, Nobuhiro; Asayama, Yoshiki; Ushijima, Yasuhiro; Irie, Hiroyuki; Nakamura, Masafumi; Takahata, Shunichi; Ito, Tetsuhide; Honda, Hiroshi

    2010-01-01

    Purpose: To clarify if the portal venous phase is helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis. Materials and methods: MDCT and MRI of groove pancreatic carcinomas (n = 7) and groove pancreatitis (n = 15) were retrospectively reviewed by two radiologists independently. The signal intensity on T2-weighted images was subjectively assessed. The presence or absence of common bile duct (CBD) and main pancreatic duct (MPD) strictures, calcifications, and cystic lesions was evaluated. Additionally, the appearance of groove pancreatic carcinoma and that of groove pancreatitis in the portal venous phase on dynamic MDCT and MRI were compared. Results: There were no significant differences in the signal intensity on T2-weighted images and in the presence or absence of CBD and MPD strictures, calcifications, and cystic lesions between groove pancreatic carcinomas and groove pancreatitis. However, patchy focal enhancement in the portal venous phase was more commonly observed in groove pancreatitis than groove pancreatic carcinoma (Reviewers 1 and 2: 14/15 [93.3%] vs. 1/7 [14.3%], P < 0.0001). In addition, peripheral enhancement was only seen in groove pancreatic carcinomas (Reviewer 1: 4/7 [57.1%] vs. 0/15 [0%], P < 0.005, and Reviewer 2: 3/7 [42.9%] vs. 0/15 [0%], P < 0.05). Conclusion: The portal venous phase may be helpful for the differential diagnosis of groove pancreatic carcinomas and groove pancreatitis.

  17. Venous pooling and drainage affects photoplethysmographic signals at different vertical hand positions

    Science.gov (United States)

    Hickey, Michelle; Phillips, Justin P.; Kyriacou, Panayiotis

    2015-03-01

    The aim of the current work is to investigate the possibility of augmenting pulse oximetry algorithms to enable the estimation of venous parameters in peripheral tissues. In order to further understand the contribution of venous blood to the photoplethysmographic (PPG) signal, recordings were made from six healthy volunteer subjects during an exercise in which the right hand was placed in various positions above and below heart level. The left hand was kept at heart level as a control while the right hand was moved. A custom-made two-channel dual wavelength PPG instrumentation system was used to obtain the red and infrared plethysmographic signals from both the right and left index fingers simultaneously using identical sensors. Laser Doppler flowmetry signals were also recorded from an adjacent fingertip on the right hand. Analysis of all acquired PPG signals indicated changes in both ac and dc amplitude of the right hand when the position was changed, while those obtained from the left (control) hand remained relatively constant. Most clearly, in the change from heart level to 50cm below heart level there is a substantial decrease in both dc and ac amplitudes. This decrease in dc amplitude most likely corresponds to increased venous pooling, and hence increased absorption of light. It is speculated that the decrease in ac PPG amplitude is due to reduced arterial emptying during diastole due to increased downstream resistance due to venous pooling.

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

    International Nuclear Information System (INIS)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-01-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required

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

    Science.gov (United States)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  1. Ammonia concentrations in arterial blood, venous blood, and cerebrospinal fluid of dogs with and without congenital extrahepatic portosystemic shunts.

    Science.gov (United States)

    Or, Matan; Devriendt, Nausikaa; Kitshoff, Adriaan M; Peremans, Kathelijne; Vandermeulen, Eva; Paepe, Dominique; Polis, Ingeborgh; Martlé, Valentine; de Rooster, Hilde

    2017-11-01

    OBJECTIVE To compare ammonia concentrations in arterial blood, venous blood, and CSF samples of dogs with and without extrahepatic portosystemic shunts (EHPSS). ANIMALS 19 dogs with congenital EHPSS and 6 healthy control dogs. PROCEDURES All dogs underwent a physical examination and then were anesthetized for transsplenic portal scintigraphy to confirm the presence or absence of EHPSS. While dogs were anesthetized, arterial and venous blood samples and a CSF sample were simultaneously collected for determination of ammonia concentration, which was measured by use of a portable blood ammonia analyzer (device A) and a nonportable biochemical analyzer (device B). Results were compared between dogs with EHPSS and control dogs. RESULTS Arterial, venous, and CSF ammonia concentrations for dogs with EHPSS were significantly greater than those for control dogs. For dogs with EHPSS, ammonia concentrations in both arterial and venous blood samples were markedly increased from the reference range. There was a strong positive correlation between arterial and venous ammonia concentrations and between blood (arterial or venous) and CSF ammonia concentrations. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that blood and CSF ammonia concentrations in dogs with EHPSS were greater than those for healthy dogs and were strongly and positively correlated, albeit in a nonlinear manner. This suggested that the permeability of the blood-brain barrier to ammonia may be abnormally increased in dogs with EHPSS, but further investigation of the relationship between blood or CSF ammonia concentration and clinical signs of hepatic encephalopathy or the surgical outcome for dogs with EHPSS is warranted.

  2. Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    P Praveen Raj

    2017-01-01

    Full Text Available Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT. Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%. One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

  3. Transorbital Glue Embolization of a Recurrent Venous Varix Using Real-Time Image Guidance in the Neuroangiography Suite.

    Science.gov (United States)

    Shakur, Sophia F; Brunozzi, Denise; Setabutr, Pete; Hussein, Ahmed E; Charbel, Fady T; Alaraj, Ali

    2017-08-01

    Orbital lesions are challenging to access due to their location amid critical anatomic structures. Here, we demonstrate direct transorbital cannulation of an orbital venous varix using image guidance. A 36-year-old male was diagnosed with a left orbital venous varix approximately 5 years ago at an outside institution. He subsequently underwent surgery for direct intraoperative embolization of the venous varix followed by surgical resection. The patient recently presented to us with left eye pain, proptosis, double vision, and conjunctival hemorrhage precipitated by straining or lying flat. Orbital magnetic resonance imaging showed recurrence of the venous varix, which was then confirmed with digital subtraction angiography and intraprocedural computed tomography (DynaCT, Siemens Healthineers, Erlangen, Germany). Due to scarring from the previous surgery, percutaneous transorbital embolization of the venous varix was planned. The needle trajectory was determined and also visualized in real-time using image guidance (Needle Guidance, Siemens Healthineers). Once the needle reached the desired target, n-butyl cyanoacrylate glue (Codman Neuro, San Jose, California) was injected until nearly the entire venous varix was occluded. There were no complications, and at his postoperative visit the patient reported resolution of all symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Spontaneous thrombosis of developmental venous anomaly (DVA) with venous infarct and acute cerebellar ataxia.

    Science.gov (United States)

    Agarwal, Amit; Kanekar, Sangam; Kalapos, Paul; Vijay, Kanupriya

    2014-08-01

    Developmental venous anomaly (DVA), formally known as venous angioma, is a congenital anatomic variant of the venous drainage of the brain. Although they typically have a benign clinical course and a low symptomatic rate, thrombosis of a drainage vein may occur, leading to potentially debilitating complications. We report a unique case of spontaneous thrombosis of a posterior fossa developmental venous anomaly with cerebellar infarct in a 61-year-old man who presented with acute onset cerebellar ataxia. DVA thrombosis was well-depicted on CT and MR studies. Patient was put on anticoagulant therapy and complete recanalization was seen on follow-up imaging.

  5. Venous sacrifice in neurosurgery: new insights from venous indocyanine green videoangiography.

    Science.gov (United States)

    Ferroli, Paolo; Acerbi, Francesco; Tringali, Giovanni; Albanese, Erminia; Broggi, Morgan; Franzini, Angelo; Broggi, Giovanni

    2011-07-01

    The purpose of this paper is to evaluate whether venous indocyanine green (ICG) videoangiography has any potential for predicting the presence of a safe collateral circulation for veins that are at risk for intentional or unintentional damage during surgery. The authors performed venous ICG videoangiography during 153 consecutive neurosurgical procedures. On those occasions in which a venous sacrifice occurred during surgery, whether that sacrifice was preplanned (intended) or unintended, venous ICG videoangiography was repeated so as to allow us to study the effect of venous sacrifice. A specific test to predict the presence of venous collateral circulation was also applied in 8 of these cases. Venous ICG videoangiography allowed for an intraoperative real-time flow assessment of the exposed veins with excellent image quality and resolution in all cases. The veins observed in this study were found to be extremely different with respect to flow dynamics and could be divided in 3 groups: 1) arterialized veins; 2) fast-draining veins with uniform filling and clear flow direction; and 3) slow-draining veins with nonuniform filling. Temporary clipping was found to be a simple and reversible way to test for the presence of potential anastomotic circulation. Venous ICG videoangiography is able to reveal substantial variability in the venous flow dynamics. "Slow veins," when they are tributaries of bridging veins, might hide a potential for anastomotic circulation that deserve further investigation.

  6. Multiple versus single lumen umbilical venous catheters for newborn infants.

    Science.gov (United States)

    Kabra, N S; Kumar, M; Shah, S S

    2005-07-20

    Multiple lumen umbilical venous catheters (ML-UVCs) instead of single lumen UVCs (SL-UVCs) may decrease the need for additional venous lines. Although it seems self-evident that ML-UVCs would reduce the need of additional venous lines, the rates of associated complications might be different. To compare the effectiveness and the safety of ML-UVCs versus SL-UVCs in terms of need of additional vascular access, rates of complications, morbidity and mortality in newborn infants. Randomized and quasi-randomized trials were identified by searching the MEDLINE (1966 - February 2005), EMBASE (1980- February 2005), CINAHL (1982 - February 2005), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004) and Science Direct (subject area: medicine, journal and abstract database; 1967 to February 2005). Literature search also included a manual search of the abstracts of scientific meetings published in Pediatric Research (1990-2004). Additional citations were sought using references in articles retrieved from searches. Subject experts were contacted to identify the unpublished and ongoing studies. Randomized and quasi-randomized controlled clinical trials comparing safety and efficacy of multiple versus single lumen umbilical venous catheter in neonates (both term and preterm) who were in need of umbilical venous catheter insertion for vascular access in first four weeks of life. Each review author performed data extraction independently and differences were resolved by discussion. The following outcomes were determined: total number of additional peripheral intravenous lines per baby in first week and first four weeks of life, total number of additional percutaneously and surgically placed central venous lines per baby in first four weeks of life, and other safety and efficacy measures. The treatment effect estimators used were RR, RD, and WMD when appropriate along with their 95% CI. If RD was statistically significant, then number

  7. Tuberculosis and Venous Thromboembolism: a case series.

    Science.gov (United States)

    Goncalves, Ivone M; Alves, Daniela Costa; Carvalho, Aurora; do Ceu Brito, Maria; Calvario, Fernando; Duarte, Raquel

    2009-12-16

    Tuberculosis remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism is a rare complication of this disease, it may be a potentially life-threatening event. We report two cases of severe pulmonary tuberculosis associated with venous thromboembolism. A 38 year-old caucasian male that had a thromboembolic event as an unsual presentation form of tuberculosis and a 51 year-old caucasian male that developed deep venous thrombosis later in the course of the disease. An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician's awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.

  8. Intracranial developmental venous anomaly: is it asymptomatic?

    Science.gov (United States)

    Puente, A Bolívar; de Asís Bravo Rodríguez, F; Bravo Rey, I; Romero, E Roldán

    2018-03-16

    Intracranial developmental venous anomalies are the most common vascular malformation. In the immense majority of cases, these anomalies are asymptomatic and discovered incidentally, and they are considered benign. Very exceptionally, however, they can cause neurological symptoms. In this article, we present three cases of patients with developmental venous anomalies that presented with different symptoms owing to complications derived from altered venous drainage. These anomalies were located in the left insula, right temporal lobe, and cerebellum. The exceptionality of the cases presented as well as of the images associated, which show the mechanism through which the symptoms developed, lies in the low incidence of symptomatic developmental venous anomalies reported in the literature. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

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

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment......%) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line...

  10. [Emphysematous gastritis with concomitant portal venous air].

    Science.gov (United States)

    Jeong, Min Yeong; Kim, Jin Il; Kim, Jae Young; Kim, Hyun Ho; Jo, Ik Hyun; Seo, Jae Hyun; Kim, Il Kyu; Cheung, Dae Young

    2015-02-01

    Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.

  11. [Venous thromboembolic disease: presentation of a case].

    Science.gov (United States)

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  12. Imaging of cerebral venous complications in patients with infections

    Directory of Open Access Journals (Sweden)

    Xudong Shen

    2017-09-01

    Full Text Available Systemic and local infections can cause cerebrovascular complications in the central nervous system. The involvement of cerebral venous system would result in venous or dural venous sinus thrombophlebitis. Images can help evaluate the venous complications in patients with central nervous system infection and provide information in guiding treatment and prognosis. The main focus of this review is to emphasize the proper utilization of imaging modalities in assessment the complications of cerebral venous system in patients with infection.

  13. Contrast-enhanced ultrasound in portal venous system aneurysms: A multi-center study

    Science.gov (United States)

    Tana, Claudio; Dietrich, Christoph F; Badea, Radu; Chiorean, Liliana; Carrieri, Vincenzo; Schiavone, Cosima

    2014-01-01

    AIM: To investigate contrast-enhanced ultrasound (CEUS) findings in portal venous system aneurysms (PVSAs). METHODS: In this multi-center, retrospective, case series study, we evaluated CEUS features of seven cases of PVSAs that were found incidentally on conventional ultrasound in the period 2007-2013. Three Ultrasound Centers were involved (Chieti, Italy, Bad Mergentheim, Germany, and Cluj-Napoca, Romania). All patients underwent CEUS with Sonovue® (Bracco, Milan, Italy) at a standard dose of 2.4 mL, followed by 10 mL of 0.9% saline solution. The examinations were performed using multifrequency transducers and low mechanical index. We considered aneurysmal a focal dilatation of the portal venous system with a size that was significantly greater than the remaining segments of the same vein, and that was equal or larger than 21 mm for the extrahepatic segments of portal venous system, main portal vein and bifurcation, and 9 mm for the intrahepatic branches. RESULTS: After contrast agent injection, all PVSAs were not enhanced in the arterial phase (starting 8-22 s). All PVSAs were then rapidly enhanced in the early portal venous phase (starting three to five seconds after the arterial phase, 11-30 s), with persistence and slow washout of the contrast agent in the late phase (starting 120 s). In all patients, CEUS confirmed the presence of a “to-and-fro” flow by showing a swirling pattern within the dilatation in the early portal venous phase. CEUS also improved the delineation of the lumen, and was reliable in showing its patency degree and integrity of walls. In one patient, CEUS showed a partial enhancement of the lumen with a uniformly nonenhancing area in the portal venous and late phases, suggesting thrombosis. CONCLUSION: In our case series, we found that CEUS could be useful in the assessment and follow-up of a PVSA. Further studies are needed to validate its diagnostic accuracy. PMID:25561805

  14. Recurrent High-Flow Arterio-Venous Malformation of the Thyroid Gland.

    Science.gov (United States)

    Borchert, D H; Massmann, A; Kim, Y J; Bader, C A; Wolf, G; Eisele, R; Minko, P; Bücker, A; Glanemann, M

    2015-09-01

    Vascular malformations and hemangiomas of the thyroid gland are rare disorders. The first case of a patient with recurrent high-flow arterio-venous malformation of the right thyroid gland involving the right endolarynx is presented. In June 2013, a 42-year-old female patient presented to the surgical department with recurrent hoarseness and a soft, vibrating mass on the right side of her neck. In 1993, she underwent right subtotal hemithyroidectomy with embolization on the day before surgery for a high-flow arterio-venous malformation of the thyroid gland. Diagnostic work-up in 2013 demonstrated a complex recurrent high-flow arterio-venous malformation on the right side of her neck involving the endolarynx. Full function of the right vocal fold could not be ascertained. The lesion was embolized again and excised the following day. Intraoperative gross bleeding and scar tissue prevented visualization and monitoring of the recurrent laryngeal nerve. Gross bleeding was also noted on hemithyroidectomy after embolization in 1993. No therapy was needed for the endolaryngeal part of the lesion. Histology showed large arterio-venous malformations with thyroid tissue. She remains well without signs of recurrence 18 month later but with a definitive voice handicap. This is the first report of a recurrent high-flow arterio-venous malformation originally developing from the right thyroid gland involving the right endolarynx. Counseling, diagnostic, and therapeutic work-up of the patient was possible only with an interdisciplinary team. The endolaryngeal part of the hemangioma dried out after embolization and completion hemithyroidectomy. Her hoarseness has greatly improved but a definitive voice handicap remains. High-flow arterio-venous malformations of the thyroid gland are a rare disease, and recurrent lesions have not been reported. Interdisciplinary management of these patients is mandatory due to the complex nature of the underlying pathology. Recurrence might develop

  15. Outcomes of Foam Sclerotherapy plus Ligation versus Foam Sclerotherapy Alone for Venous Ulcers in Lower Extremities.

    Science.gov (United States)

    Li, Xin; Fan, Lin; Ren, Shiyan; Li, Xianlun

    2017-11-01

    Foam sclerotherapy (FS) is a safe and effective approach for managing patients with varicose veins and venous ulcers in lower extremities. But, recanalization of the ablated varicose veins and phlebitis are common postoperative complications that jeopardize its clinical effects. We hypothesize that ligation of the ablated varicose veins after FS will improve the outcomes of patients with varicose veins and venous ulcer. This study was aimed to evaluate the clinical efficacy of ligation after FS in comparison with FS alone for the management of patients with varicose veins and venous ulcers in lower extremities. Eighteen patients underwent FS plus ligation (FSL) and 15 patients received FS alone. Aberdeen varicose veins questionnaire (AVVQ) and the revised venous clinical severity score (rVCSS), venous disability scores (VDSs), duplex sonography, ulcer healing rate, and ulcer healing time were documented to compare the outcomes in both groups. The ulcer healing time in patients treated with FSL was shorter than that in patients who received FS (P = 0.022; log-rank test). The average healing time was significantly shorter in FSL group than in FS group (35.67 ± 24.62 days vs. 62.86 ± 47.43, P = 0.042). The mean rVCSS, VDS, and AVVQ at 3 months after treatment in both groups decreased significantly in comparison with baseline, respectively. There were no severe complications or side effects in both groups. Ligation of the treated varicose veins after FS can improve the outcomes of patients with venous ulcers in comparison with FS alone. FSL is a safe, effective, and technically feasible procedure and can be used as a day surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Peripheral Ulcerative Keratitis

    Science.gov (United States)

    ... Abbreviations Weights & Measures ENGLISH View Professional English Deutsch Japanese Espaniol Find information on medical topics, symptoms, drugs, ... oval in shape. Diagnosis A doctor's evaluation Sometimes culture The diagnosis of peripheral ulcerative keratitis is suspected ...

  17. [Peripheral ulcerative keratitis].

    Science.gov (United States)

    Stamate, Alina-cristina; Avram, Corina Ioana; Malciolu, R; Oprea, S; Zemba, M

    2014-01-01

    Ulcerative keratitis is frequently associated with collagen vascular diseases and presents a predilection for peripheral corneal localization, due to the distinct morphologic and immunologic features of the limbal conjunctiva, which provides access for the circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates an immune-mediated vasculitis process, with inflammatory cells and mediators involvement by alteration of the vascular permeability. Peripheral ulcerative keratitis generally correlates with exacerbations of the background autoimmune systemic disease. Associated sceritis, specially the necrotizing form, is usually observed in severe cases, which may evolve in corneal perforation and loss of vision. Although the first-line of treatment in acute phases is represented by systemic administration of corticosteroids, immunosuppressive and cytotoxic agents are necessary for the treatment of peripheral ulcerative keratitis associated with systemic diseases.

  18. Peripheral Arterial Disease

    Science.gov (United States)

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  19. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... Lower Your Stroke Risk? Ecstasy May Help Some PTSD Sufferers, but Safety Issues Remain First Death Reported ... of these factors contributes not only to the development of occlusive peripheral arterial disease but also to ...

  20. Fingertip replantation without venous anastomosis.

    Science.gov (United States)

    Chen, Yi-Chieh; Chan, Fuan Chiang; Hsu, Chung-Chen; Lin, Yu-Te; Chen, Chien-Tzung; Lin, Chih-Hung

    2013-03-01

    Replantation of amputated fingertips is a technical challenge, as many salvage procedures fail because no suitable vein in the fingertip is available for anastomosis. In this study, we examined our experience in fingertip replantation in cases without venous anastomosis with our established fingertip replantation treatment protocol. Between August 2002 and August 2010, a retrospective study examined all patients who had undergone fingertip replantation at Chang-Gung Memorial Hospital. All the patients (n = 24) suffered from complete digital amputations at or distal to the interphalangeal joint of the thumb, or distal to distal interphalangeal joint of the fingers. A total of 30 fingertips that were salvaged by microsurgical anastomosis of the digital arteries but not of digital veins were included in this study. On satisfactory arterial anastomosis, a 2-mm incision was made over the fingertip with a number 11 Scalpel blade, and 0.1 to 0.2 mL heparin (5000 IU/mL) was injected subcutaneously around the incision immediately and once per day thereafter to ensure continuous blood drainage from the replanted fingertip. None of the replanted nail plate was removed, and no medical leeches were used. The perfusion of the replanted digits and patient's hemoglobin level were closely monitored. The wound bleeding was maintained until physiologic venous outflow was restored. Of 30 fingertips, 27 (90%) replanted fingertips survived. The average length needed for maintaining external bleeding by chemical leech was 6.8 days (range, 5-10 days). Twelve patients (including a 2-year-old child) received blood transfusions. The average amount of blood transfusion in the 23 adults was 4.0 units (range, 0-16 units) for each patient or 3.29 units (range, 0-14 units) for each digit. A 2-year-old child received 100 mL blood transfusion or 50 mL for each digit. This study showed that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high

  1. Mesenteric angina through superior mesenteric venous thrombosis

    OpenAIRE

    Mohan, Divya; Aijaz, Faisal; Krijgsman, Brandon

    2010-01-01

    We present the case of a 67-year-old male with mesenteric venous thrombosis resulting in mesenteric angina, where early diagnosis made a favourable outcome possible through prompt anticoagulation and bowel rest. Mesenteric venous thrombosis is a relatively rare but important cause of bowel ischaemia, as a delay in diagnosis is associated with high morbidity and mortality. Early diagnosis through computed tomography scanning and subsequent treatment resulted in resolution of the thrombus with ...

  2. Prospects of Jugular Venous Pulse Assessment

    Directory of Open Access Journals (Sweden)

    M D Bhattarai

    2010-09-01

    Full Text Available There is no controversy regarding the current clinical method of examination of waveform of jugular vein pulse. However there are limitations of clinical assessment of central venous pressure by jugular vein pressure measurement from the level of sternal angle. There are variations in the reported distances from sternal angle to right atrium as well as to upper limit of JVP. In erect position, anterior end of fourth intercostal space is at about the level of mid-right atrium. In patients with visible JVP at neck in erect position, measurement of CVP can be done more accurately directly from the anterior end of fourth intercostal space. For others, the position of mid-right atrium can be marked in lateral chest wall first in erect position at the mid-point of an anteroposterior line from anterior end of fourth intercostal space to back. Subsequently in reclining position, the vertical height of venous pressure can be measured from the horizontal plane of the midpoint marked at lateral chest wall to visible upper limit of JVP. Such measurement can be done in a more reliable way with venous pressure (VP manometer with its indicator rod at the horizontal plane of mid-right atrium and with its horizontal surface at upper limit of JVP. The venous pressure manometer can also be used to measure relatively less reliable upper limb venous pressure (ULVP, as indicated by the vertical distance at which veins of upper limb collapse, especially when JVP is not visualized due to subnormal CVP as in hypovolemia. Keywords: CVP, JVP, right atrium, sternal angle, upper limp venous pressure, venous pressure, venous pressure manometer

  3. MR findings of cerebral venous sinus thrombosis

    International Nuclear Information System (INIS)

    Lim, Myung Kwan; Chang, Kee Hyun; Han, Moon Hee; Choi, Choong Gom

    1994-01-01

    To describe MR findings of cerebral venous sinus thrombosis. We reviewed 11 MR images of six patients with cerebral venous sinus thrombosis. The MR images were retrospectively analyzed in terms of location and signal intensity of the thrombi, parenchymal lesions such as hemorrhage and edema, and changes in follow up study obtained in 4 patients. The thrombus in venous sinus was visualized on MRI in all six patients. The most frequently involved sites were superior sagittal sinus(n=4) and left transverse sinus(n=4). Signal intensity of the thrombus was isointense or hyperintense on both T1- and T2-weighted images with loss of normal signal void of the sinus on all sequences in all patients. Parenchymal lesion was patients in five of six cases, manifested as local hemorrhage in three and edema in three cases(one case overlapped). Local edema seen in three patients was completely resolved on follow up study of seven to 29 days intervals. It is concluded that iso- or high signal intensity with loss of signal void in venous sinus is virtually diagnostic of venous sinus thrombosis. If there are local parenchymal lesions such as hemorrhage and/or edema of unknown causes, cerebral venous sinus thrombosis should be included in differential diagnosis

  4. Peripheral moving-table contrast-enhanced magnetic resonance angiography (CE-MRA) using a prototype 18-channel peripheral vascular coil and scanning parameters optimized to the patient's individual hemodynamics.

    Science.gov (United States)

    Potthast, Silke; Wilson, Gregory J; Wang, Maisie S; Maki, Jeffrey H

    2009-05-01

    To demonstrate that with a priori determination of individual patient hemodynamics, peripheral contrast-enhanced magnetic resonance angiography (pCE-MRA) can be customized to maximize signal-to noise ratio (SNR) and avoid venous enhancement. Using a 1.5T MRI scanner and prototype 18-channel peripheral vascular (PV) coil designed for highly accelerated parallel imaging, geometry (g)-factor maps were determined. SNR-maximized protocols considering the two-dimensional sensitivity encoding (2D SENSE) factor, TE, TR, bandwidth (BW), and flip angle (FA) were precalculated and stored. For each exam, a small aortic timing bolus was performed, followed by dynamic three-dimensional (3D)-MRA of the calf. Using this information, the aorta to pedal artery and calf arteriovenous transit times were measured. This enabled estimation of the maximum upper and middle station acquisition duration to allow lower station acquisition to begin prior to venous arrival. The appropriately succinct SNR-optimized protocol for each station was selected and moving-table pCE-MRA was performed using thigh venous compression and high-relaxivity contrast material. The protocol was successfully applied in 15 patients and all imaging demonstrated good SNR without diagnosis-hindering venous enhancement. By knowing each patient's venous enhancement kinetics, scan parameters can be optimized to utilize maximum possible acquisition time. Some time is added for the timing scans, but in return time-resolved calf CE-MRA, maximized SNR, and decreased risk of venous enhancement are gained.

  5. Optimal timing for repair of peripheral nerve injuries.

    Science.gov (United States)

    Wang, Eugene; Inaba, Kenji; Byerly, Saskya; Escamilla, Diandra; Cho, Jayun; Carey, Joseph; Stevanovic, Milan; Ghiassi, Alidad; Demetriades, Demetrios

    2017-11-01

    Data regarding outcomes after peripheral nerve injuries is limited, and the optimal management strategy for an acute injury is unclear. The aim of this study was to examine timing of repair and specific factors that impact motor-sensory outcomes after peripheral nerve injury. This was a single-center, retrospective study. Patients with traumatic peripheral nerve injury from January 2010 to June 2015 were included. Patients who died, required amputation, suffered brachial plexus injury, or had missing motor-sensory examinations were excluded. Motor-sensory examinations were graded 0 to 5 by the Modified British Medical Research Council system. Operative repair of peripheral nerves was analyzed for patient characteristics, anatomic nerve injured, level of injury, associated injuries, days until repair, and repair method. Three hundred eleven patients met inclusion criteria. Two hundred fifty-eight (83%) patients underwent operative management, and 53 (17%) underwent nonoperative management. Those who required operative intervention had significantly more penetrating injuries 85.7% versus 64.2% (p undergoing laparotomy (p = 0.257) and days to nerve repair (p = 0.834) did not influence motor-sensory outcome. Outcomes did not differ significantly in patients who underwent repair 24 hours or longer versus those who were repaired later. Outcomes were primarily influenced by patient characteristics and injury level rather than operative characteristics. Peripheral nerve injuries can be repaired after damage control surgery without detriment to outcomes. Prognostic study, level III.

  6. [Peripheral arterial thromboembolism in Crohn's disease].

    Science.gov (United States)

    Ferrer, Isabel; Benavent, Guillem; Bastida, Guillermo; Arnau, Miguel Ángel; Iborra, Marisa; Beltrán, Belén; Aguas, Mariam; Hinojosa, Joaquín; Nos, Pilar

    2013-01-01

    Inflammatory Bowel Disease (IBD) usually affects the gastrointestinal tract, although some patients can also develop extraintestinal manifestations, such as vascular symptoms both venous and arterial ones. The former being more frequent than the latter. We report the case of a 62-year-old male, diagnosed of Crohńs disease (CD) (A3,L1+L4,B3), admitted to hospital for treatment of a retroperitoneal abscess. He presented a peripheral arterial thromboembolism during his stay, which required urgent embolectomy. After anticoagulation with low-molecular-weight heparin (LMWH), vascular magnetic resonance imaging revealed a large thrombus involving the descent aorta, which was solved with surgery and long-term anticoagulation. Peripheral arterial thrombosis is a rare extraintestinal manifestation of IBD. Nevertheless it is always important to consider it in patients with IBD. Prophylactic treatment should be made with low-molecular-weight heparin (LMWH) and definitive treatment with a combination of LMWH and surgery. Copyright © 2012 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  7. Venous, Arterialized-Venous, or Capillary Glucose Reference Measurements for the Accuracy Assessment of a Continuous Glucose Monitoring System.

    Science.gov (United States)

    Kropff, Jort; van Steen, Sigrid C; deGraaff, Peter; Chan, Man W; van Amstel, Rombout B E; DeVries, J Hans

    2017-11-01

    Different reference methods are used for the accuracy assessment of continuous glucose monitoring (CGM) systems. The effect of using venous, arterialized-venous, or capillary reference measurements on CGM accuracy is unclear. We evaluated 21 individuals with type 1 diabetes using a capillary calibrated CGM system. Venous or arterialized-venous reference glucose samples were taken every 15 min at two separate visits and assessed per YSI 2300 STAT Plus. Arterialization was achieved by heated-hand technique. Capillary samples were collected hourly during the venous reference visit. The investigation sequence (venous or arterialized-venous) was randomized. Effectiveness of arterialization was measured by comparing free venous oxygen pressure (PO2) of both visit days. Primary endpoint was the median absolute relative difference (ARD). Median ARD using arterialized-venous reference samples was not different from venous samples (point estimated difference 0.52%, P = 0.181). When comparing the three reference methods, median ARD was also not different over the full glycemic range (venous 9.0% [n = 681], arterialized-venous 8.3% [n = 684], and capillary 8.1% [n = 205], P = 0.216), nor over the separate glucose ranges. Arterialization was successful (PO2 venous 5.4 kPa vs. arterialized-venous 8.9 kPa, P reference measurements did not significantly impact CGM accuracy. Venous reference seems preferable due to its ease of operation.

  8. High-resolution ultrasound imaging and noninvasive optoacoustic monitoring of blood variables in peripheral blood vessels

    Science.gov (United States)

    Petrov, Irene Y.; Petrov, Yuriy; Prough, Donald S.; Esenaliev, Rinat O.

    2011-03-01

    Ultrasound imaging is being widely used in clinics to obtain diagnostic information non-invasively and in real time. A high-resolution ultrasound imaging platform, Vevo (VisualSonics, Inc.) provides in vivo, real-time images with exceptional resolution (up to 30 microns) using high-frequency transducers (up to 80 MHz). Recently, we built optoacoustic systems for probing radial artery and peripheral veins that can be used for noninvasive monitoring of total hemoglobin concentration, oxyhemoglobin saturation, and concentration of important endogenous and exogenous chromophores (such as ICG). In this work we used the high-resolution ultrasound imaging system Vevo 770 for visualization of the radial artery and peripheral veins and acquired corresponding optoacoustic signals from them using the optoacoustic systems. Analysis of the optoacoustic data with a specially developed algorithm allowed for measurement of blood oxygenation in the blood vessels as well as for continuous, real-time monitoring of arterial and venous blood oxygenation. Our results indicate that: 1) the optoacoustic technique (unlike pure optical approaches and other noninvasive techniques) is capable of accurate peripheral venous oxygenation measurement; and 2) peripheral venous oxygenation is dependent on skin temperature and local hemodynamics. Moreover, we performed for the first time (to the best of our knowledge) a comparative study of optoacoustic arterial oximetry and a standard pulse oximeter in humans and demonstrated superior performance of the optoacoustic arterial oximeter, in particular at low blood flow.

  9. No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin

    NARCIS (Netherlands)

    van Beest, Paul A.; van Ingen, Jan; Boerma, E. Christiaan; Holman, Nicole D.; Groen, Henk; Koopmans, Matty; Spronk, Peter E.; Kuiper, Michael A.

    2010-01-01

    Controversy remains regarding the relationship between central venous saturation (ScvO(2)) and mixed venous saturation (SvO(2)) and their use and interchangeability in patients with sepsis or septic shock. We tested the hypothesis that ScvO(2) does not reliably predict SvO(2) in sepsis. Additionally

  10. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriette; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michael A.; Spronk, Peter E.

    2012-01-01

    Objective:  The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design:  Prospective observational controlled study. Setting:  Nonacademic university-affiliated

  11. Primary correction of total anomalous pulmonary venous return with a modified sutureless technique.

    Science.gov (United States)

    Mueller, Christoph; Dave, Hitendu; Prêtre, René

    2013-03-01

    The objective was to evaluate primary sutureless repair of total anomalous pulmonary venous return (TAPVR) in neonates using a modified technique that minimizes hypothermia and circulatory arrest times. From 2009 to 2011, seven consecutive patients underwent primary sutureless repair for the treatment of TAPVR, by which the prepared posterior pericardium was sutured to an opening in the left atrium. Three patients had the obstructed infracardiac type, and four patients had the unobstructed supracardiac type of TAPVR. Moderate hypothermia was used in all patients with a median temperature of 28°C (26-32). Circulatory arrest was not used except for the opening of the collector, which lasted between 3 and 5 min. The connecting vein was ligated in all seven patients (five during repair and two early postoperatively). The follow-up was 100% complete, with a median duration of 652 (range 370-1023) days. There was no operative mortality and no late death. No patient required reoperation. Postoperative echocardiography showed unobstructed pulmonary venous flow in all patients. Recurrent pulmonary venous stenosis was not seen during the follow-up in any patient. The sutureless technique is an effective technique with potential advantages even for the primary correction of TAPVR. With the described technique, the need for circulatory arrest is substantially reduced. Not handling the pulmonary venous collector by avoiding a direct anastomosis may contribute to better compliance, better growth and the absence of subsequent stenosis.

  12. Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience

    Energy Technology Data Exchange (ETDEWEB)

    Arabi, Mohammad, E-mail: marabi2004@hotmail.com; Ahmed, Ishtiaq; Mat’hami, Abdulaziz [Prince Sultan Military Medical City (PSMMC), Division of Endovascular Interventional Radiology, Department of Medical Imaging (Saudi Arabia); Ahmed, Dildar; Aslam, Naveed [Prince Sultan Military Medical City (PSMMC), Department of Nephrology (Saudi Arabia)

    2016-06-15

    PurposeWe report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.Materials and MethodsSince January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.ResultsTechnical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.ConclusionSharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.

  13. Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute experience

    Directory of Open Access Journals (Sweden)

    Benisvy Danielle

    2009-04-01

    Full Text Available Abstract Background and aims To show the benefits of Ultrasonography in the diagnosis of great vein involvement in the neck and mediastinum in thyroid malignancies (primary or secondary in our experience and to report patient outcomes. Methods Clinical data were collected from the thyroid unit database of the Antoine Lacassagne Institute. Results Of 1171 patients with thyroid cancer treated at our institution over the last 18 years, we retrospectively identified nine patients (0.8%, three women and six men, aged 34–81 years (median age: 70 years presenting with malignant thyroid tumor of median diameter 45 mm (range: 23–87 having venous obstruction of thyroid malignancy origin. Two patients underwent multimodal therapy. All other patients underwent external beam radiation therapy alone ± chemotherapy or palliative care. Ultrasound (US provided particularly useful information on venous involvement characteristics. Median survival was 7 months and median progression-free survival was 6 months. Survival in our series was worse than that of previously reported series despite diagnosis of vein involvement at an early stage in 2/3 cases using US. Conclusion Despite small numbers of patients, it seems that aggressive treatment modalities including surgery are required to improve survival. In our experience, US was a useful non-invasive method to describe tumor extensions to great veins of the neck (invasion versus compression, tumor thrombus versus blood clot and should be recommended to depict early venous invasion in cases of suspected thyroid malignancy.

  14. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

    Science.gov (United States)

    Boyle, Soames; White, Richard H.; Brunson, Ann

    2013-01-01

    Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. PMID:23637127

  15. Cerebral venous thrombosis in Behçet's disease.

    Science.gov (United States)

    Saadoun, D; Wechsler, B; Resche-Rigon, M; Trad, S; Le Thi Huong, D; Sbai, A; Dormont, D; Amoura, Z; Cacoub, P; Piette, J C

    2009-04-15

    To analyze the clinical findings, treatment, outcome, and prevalence of cerebral venous thrombosis (CVT) in a large cohort of patients with Behçet's disease (BD) from a single center. We reported a series of 64 consecutive patients with CVT who fulfilled the international criteria for BD. Multivariate analysis was performed to define factors that affect prognosis. Among a cohort of 820 patients with BD, CVT was present in 64 (7.8%). Compared with BD patients without CVT, those with CVT had lower parenchymal central nervous system involvement (4.7% versus 28.7%; P = 0.0001) and higher extraneurologic vascular lesions (62.5% versus 38.8%; P = 0.03). Up to 90% of patients responded to anticoagulation therapy without severe hemorrhagic complications. Neither steroid nor immunosuppressant use provided better outcome. Severe visual loss due to optic atrophy was the main complication of CVT, being found in 15% of patients. In multivariate analysis, papilledema (odds ratio [OR] 7.1, 95% confidence interval [95% CI] 1.6-31.9) and concurrent prothrombotic risk factors (OR 4.6, 95% CI 1.1-20.2) were independently associated with the occurrence of sequelae. Factors associated with relapse of thrombosis were concurrent prothrombotic risk factors (hazard ratio [HR] 4.9, 95% CI 1.5-15.4) and a peripheral venous thrombosis (HR 2.8, 95% CI 0.7-10.5). After a mean +/- SD followup of 8.2 +/- 6.9 years, 4 deaths unrelated to CVT were noted. CVT in patients with BD may result in serious neurologic outcomes. Anticoagulation represents a safe and effective therapy. Extensive investigation of prothrombotic disorders should be considered.

  16. Measurement of peripheral blood flow in patients with peripheral artery disease: Methods and considerations.

    Science.gov (United States)

    Salisbury, Dereck L; Brown, Rebecca Jl; Bronas, Ulf G; Kirk, Laura N; Treat-Jacobson, Diane

    2018-02-01

    Peripheral artery disease (PAD) is a manifestation of generalized atherosclerosis which results in hemodynamic compromise of oxygen and substrate delivery to the lower extremity skeletal muscles. Hemodynamic assessments are vital in PAD diagnosis and in the evaluation of strategies aimed at treating claudication (i.e. exercise training, revascularization, and pharmacological agents). Venous occlusion plethysmography (VOP) is a century-old, non-invasive technique used to quantify limb blood flow and has been used to evaluate hemodynamic compromise in patients with PAD. However, the literature suggests a wide array of methodological variability in the measurement and analysis of limb blood flow using VOP. In this manuscript, we overview the clinical application of VOP measurement, and secondly we review the methodological variation that occurs during the measurement and analysis of VOP in healthy individuals and in patients with claudication.

  17. Portal venous perfusion steal causing graft dysfunction after orthotopic liver transplantation: serial imaging findings in a successfully treated patient

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Su; Chung, Yong Eun; Choi, Jin Young; Park, Mi Suk; Lim, Joon Seok; Kim, Myeong Jin; Kim, Hon Soul [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Sang Kyun [Dept. of Pathology, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-01-15

    A 53-year-old male with hepatocellular carcinoma underwent orthotopic liver transplantation. Preoperative computed tomography revealed main portal vein luminal narrowing by flat thrombi and the development of cavernous transformation. On post-transplantation day 1, thrombotic portal venous occlusion occurred, and emergency thrombectomy was performed. Subsequent Doppler ultrasonography and contrast-enhanced ultrasonography confirmed the restoration of normal portal venous flow. The next day, however, decreased portal venous velocity was observed via Doppler ultrasonography, and serum liver enzymes and bilirubin levels remained persistently elevated. Direct portography identified massive perfusion steal through prominent splenorenal collateral veins. Stent insertion and balloon angioplasty of the portal vein were performed, and subsequent Doppler ultrasonography demonstrated normalized portal flow parameters. Afterwards, the serum liver enzymes and bilirubin levels rapidly normalized.

  18. Extensive Intracardiac and Deep Venous Thromboses in a Young Woman with Heparin-Induced Thrombocytopenia and May-Thurner Syndrome

    Directory of Open Access Journals (Sweden)

    Yekaterina Kim

    2017-01-01

    Full Text Available A 38-year-old woman with a history of recurrent deep venous thromboses (DVTs on chronic anticoagulation presented with acute left leg swelling. The patient was diagnosed with an acute left lower extremity (LLE DVT in the setting of May-Thurner syndrome for which treatment with unfractionated heparin was started. Her hospital course was complicated by a new diagnosis of heparin-induced thrombocytopenia (HIT, with an incidental discovery of a large tricuspid valve mobile mass on a transthoracic echocardiogram (TTE. Subsequent imaging confirmed multiple right atrial thrombi along with LLE venous stent thrombosis and a new right LE acute DVT. Anticoagulation with argatroban for HIT thrombosis was started. She underwent a right atrial percutaneous thrombectomy and bilateral lower extremity thrombectomy with directed angioplasty and stent placement. This presentation is a rare manifestation of HIT with extensive intracardiac and deep venous thrombi, with successful staged interventions.

  19. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2015-11-15

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  20. Venous injury in abusive head trauma

    International Nuclear Information System (INIS)

    Choudhary, Arabinda K.; Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B.; Dias, Mark S.

    2015-01-01

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  1. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

    Directory of Open Access Journals (Sweden)

    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  2. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

    Directory of Open Access Journals (Sweden)

    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  3. Cerebral Venous Thrombosis Revealing Primary Sjögren Syndrome: Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    A. Mercurio

    2013-01-01

    Full Text Available Sjögren syndrome (SS is an autoimmune disease of the exocrine glands, characterized by focal lymphocytic infiltration and destruction of these glands. Neurologic complications are quite common, mainly involving the peripheral nervous system (PNS. The most common central nervous system (CNS manifestations are myelopathy and microcirculation vasculitis. However, specific diagnostic criteria for CNS SS are still lacking. We report two cases of primary SS in which the revealing symptom was cerebral venous thrombosis (CVT in the absence of genetic or acquired thrombophilias.

  4. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  5. Peripheral vasodilatation determines cardiac output in exercising humans

    DEFF Research Database (Denmark)

    Bada, A A; Svendsen, J H; Secher, N H

    2012-01-01

    In dogs, manipulation of heart rate has no effect on the exercise-induced increase in cardiac output. Whether these findings apply to humans remain uncertain, because of the large differences in cardiovascular anatomy and regulation. To investigate the role of heart rate and peripheral vasodilata...... demonstrate that the elevated cardiac output during steady-state exercise is regulated by the increase in skeletal muscle blood flow and venous return to the heart, whereas the increase in heart rate appears to be secondary to the regulation of cardiac output....... arterial ATP infusion at rest. Exercise and ATP infusion increased cardiac output, leg blood flow and vascular conductance (P ... vasodilatation in the regulation of cardiac output during steady-state exercise, we measured central and peripheral haemodynamics in 10 healthy male subjects, with and without atrial pacing (100–150 beats min(−1)) during: (i) resting conditions, (ii) one-legged knee extensor exercise (24 W) and (iii) femoral...

  6. Comparison of the neutral and retracted shoulder positions for infraclavicular subclavian venous catheterization: a randomized, non-inferiority trial.

    Science.gov (United States)

    Kim, H J; Jung, S H; Min, J; Hong, D M; Jeon, Y; Bahk, J-H

    2013-08-01

    There are controversies regarding the most efficient shoulder position during infraclavicular subclavian venous catheterization. We hypothesized that, regarding the success rate of subclavian venous catheterization, the neutral shoulder position would not be inferior to the retracted shoulder position. A total of 362 patients who underwent elective surgery were randomly assigned to two groups: those who underwent subclavian venous catheterizations in the neutral shoulder position (neutral group, n=181) or in the retracted shoulder position (retracted group, n=181). In the retracted group, a 1 litre saline bag was placed longitudinally beneath the spinal column between the scapulae to allow the shoulders to fall into a 'retracted' position. The incidence of failures to place the central venous catheters and complications such as arterial puncture, pneumothorax, or haemothorax were recorded. The success rates were 95.6% (173/181) in the neutral group and 96.1% (174/181) in the retracted group. The difference of 0.5% was within the prespecified non-inferiority margin of 5% with a P-value of 0.017 [two-sided 95% confidence interval (CI), -0.036 to 0.047; upper limit of the 95% CI, 0.040]. There were four catheterization failures (2.2%) in the neutral group and two failures (1.1%) in the retracted group. Complication rates were not significantly different between the neutral and retracted groups [3/181 (1.7%) vs 4/181 (2.2%) for arterial punctures and 1/181 (0.6%) vs 1/181 (0.6%) for pneumothorax]. The neutral shoulder position was as effective as the retracted shoulder position for infraclavicular subclavian venous catheterization. Shoulder retraction does not appear to be necessary for the infraclavicular subclavian venous catheterization. ClinicalTrials.gov, NCT01368692.

  7. Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations

    DEFF Research Database (Denmark)

    Westergaard, B; Classen, V; Walther-Larsen, S

    2013-01-01

    Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices...... in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search...... of the current literature. Although the literature is heterogeneous with few randomised studies, PICCs emerge as a safe and valuable option for intermediate- to long-term central venous access in children both in and out of hospital. Insertion can often be performed in light or no sedation, with little risk...

  8. Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer.

    Science.gov (United States)

    Moore, Hayley M; Lane, Tristan R A; Franklin, Ian J; Davies, Alun H

    2014-10-01

    We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve.

    Science.gov (United States)

    de Coo, Ilse; van Dijk, J Marc C; Metzemaekers, Jan D M; Haan, Joost

    2017-04-01

    The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. Here, we describe a 41-year-old woman diagnosed with cluster-tic syndrome who underwent microvascular decompression of the trigeminal nerve, primarily aimed at the "trigeminal neuralgia" part of her pain syndrome. After venous decompression of the trigeminal nerve both a decrease in trigeminal neuralgia and cluster headache attacks was seen. However, the headache did not disappear completely. Furthermore, she reported a decrease in pain intensity of the remaining cluster headache attacks. This case description suggests that venous vascular decompression in cluster-tic syndrome can be remarkably effective, both for trigeminal neuralgia and cluster headache. © 2016 American Headache Society.

  10. Paralytic Ileus due to Superior Mesenteric Venous Thrombosis after Transarterial Injection for Hepatocellular Carcinoma.

    Science.gov (United States)

    Nakajima, Yuki; Takahashi, Atsushi; Kanno, Yukiko; Gunji, Naohiko; Imaizumi, Hiromichi; Hayashi, Manabu; Okai, Ken; Abe, Kazumichi; Watanabe, Hiroshi; Ohira, Hiromasa

    2016-01-01

    A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.

  11. A multimodality regimen for deep venous thrombosis prophylaxis in total knee arthroplasty.

    Science.gov (United States)

    Reitman, Richard D; Emerson, Roger H; Higgins, Linda L; Tarbox, Tiffera R

    2003-02-01

    Data indicate that deep venous thrombosis (DVT) occurs at the time of knee arthroplasty. Nevertheless, literature concerning DVT prophylaxis has only recently addressed this contention. This prospective study evaluated the efficacy of a perioperative prophylactic regimen. Between January 1996 and June 2001, 1,308 knees (964 surgeries) underwent total knee arthroplasty. Patients were treated routinely with intraoperative heparin (1000 units intravenous push before inflation of the tourniquet and 500 units at deflation), hypotensive epidural anesthesia (MAP 70-90), external pneumatic compression boots, and aspirin (325 mg, PO, BID for 6 weeks). Duplex venous ultrasonography was performed before discharge. DVT was detected in 4% of cases (1% proximal and 3% distal). Bleeding complications occurred in 1%, and perioperative medical complications occurred in 12%. Copyright 2003, Elsevier Science (USA). All rights reserved.

  12. Accelerated myelination associated with venous congestion

    Energy Technology Data Exchange (ETDEWEB)

    Porto, L.; Yan, B.; Zanella, F.E.; Lanfermann, H. [Klinikum der Johann Wolfgang Goethe-Universitaet, Neuroradiology Department, Institut fuer Neuroradiologie, Frankfurt am Main (Germany); Kieslich, M. [Klinikum der Johann Wolfgang Goethe-Universitaet, Neuroradiology Department, Institut fuer Neuroradiologie, Frankfurt am Main (Germany); Neuropediatric Department, Frankfurt am Main (Germany)

    2006-04-15

    Magnetic resonance imaging is currently the gold standard in the assessment of brain myelination. The normal pattern of brain myelination conforms to a fixed chronological sequence. Focal accelerated myelination is a usual pathological state and previously has only been associated with Sturge-Weber syndrome. The purpose of our study is to describe alternate causes for accelerated myelination. We retrospectively reviewed serial MR scans, MR angiography, conventional angiography and the clinical progress of three children with accelerated myelination. Two patients with accelerated myelination had an underlying cerebral sinovenous thrombosis. The third patient had Sturge-Weber syndrome. Our study strongly suggests that cerebral venous thrombosis with the consequent restriction of venous outflow could be a key factor in the induction of accelerated myelination. We recommend that in patients with accelerated myelination, the search for an underlying etiology should include careful evaluation of the intracranial vascular pathology, especially cerebral venous thrombosis. (orig.)

  13. The Essentials of Parathyroid Hormone Venous Sampling

    Energy Technology Data Exchange (ETDEWEB)

    Taslakian, Bedros, E-mail: btaslakian@gmail.com [NYU Langone Medical Center, Department of Radiology, NYU School of Medicine (United States); Trerotola, Scott O., E-mail: streroto@uphs.upenn.edu [Perelman School of Medicine of the University of Pennsylvania, Department of Radiology (United States); Sacks, Barry, E-mail: bsacks@bidmc.harvard.edu [Beth Israel Deaconess Medical Center, Department of Interventional Radiology (United States); Oklu, Rahmi, E-mail: oklu.rahmi@mayo.edu [Mayo Clinic, Department of Interventional Radiology (United States); Deipolyi, Amy, E-mail: deipolya@mskcc.org [Memorial Sloan Kettering Cancer Center, Department of Radiology (United States)

    2017-01-15

    Hyperparathyroidism is an excess of parathyroid hormone in the blood due to over-activity of one or more parathyroid gland. Localization of abnormal glands with noninvasive imaging modalities, such as technetium sestamibi scan and cross-sectional imaging, has a high success rate. Parathyroid venous sampling is performed for patients with persistent or recurrent disease after previous parathyroid surgery, when repeat noninvasive imaging studies are negative or discordant. The success of invasive localization studies and results interpretation is dependent on the interventional radiologist’s understanding of the normal and ectopic anatomic locations of parathyroid glands, as well as their blood supply and venous drainage. Anatomic and technical considerations for selective parathyroid venous sampling are reviewed.

  14. Central venous obstruction in the thorax

    International Nuclear Information System (INIS)

    Collin, G.; Jones, R.G.; Willis, A.P.

    2015-01-01

    Central venous stenosis and occlusion can occur secondary to a spectrum of conditions ranging from aggressive malignancy to benign extrinsic anatomical compression in otherwise healthy individuals. Irrespective of aetiology, significant morbidity in the acute setting and long term can occur unless prompt accurate diagnosis and appropriate management is initiated, the radiologist being central to both. The present review will provide radiologists with a thorough illustration and explanation of the range of central venous conditions in the thorax (including deep vein thrombosis, thoracic outlet syndrome, haemodialysis, and malignancy related causes), the salient imaging findings and interventional management using case examples from the authors' practice. - Highlights: • We show a range of causes of central venous disease in the thorax. • We provide information about different imaging and management strategies. • We show several cases with successes and complications of endovascular management

  15. Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis.

    Science.gov (United States)

    Rinat, Choni; Ben-Shalom, Efrat; Becker-Cohen, Rachel; Feinstein, Sofia; Frishberg, Yaacov

    2014-11-01

    Central venous catheters are frequently used as access for hemodialysis (HD) in children. One of the known complications is central venous stenosis. Although this complication is not rare, it is often asymptomatic and therefore unacknowledged. Superior vena cava (SVC) stenosis is obviously suspected in the presence of upper body edema, but several other signs and symptoms are often unrecognized as being part of this syndrome. We describe four patients with various manifestations of central venous stenosis and SVC syndrome. These sometimes life- or organ-threatening conditions include obstructive sleep apnea, unresolving stridor, increased intracranial pressure, increased intraocular pressure, right-sided pleural effusion, protein-losing enteropathy and lymphadenopathy. The temporal relationship of these complications associated with the use of central venous catheters and documentation of venous stenosis, together with their resolution after alleviation of high venous pressure, points to a causal role. We suggest pathophysiological mechanisms for the formation of each of these complications. In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.

  16. Clinical features and diagnosis of venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Hirsh, J.; Hull, R.D.; Raskob, G.E.

    1986-12-01

    The clinical diagnosis of venous thrombosis is inaccurate because the clinical findings are both insensitive and nonspecific. The sensitivity of clinical diagnosis is low because many potentially dangerous venous thrombi are clinically silent. The specificity of clinical diagnosis is low because the symptoms or signs of venous thrombosis all can be caused by nonthrombotic disorders. A current approach to the diagnosis of clinically suspected venous thrombosis favors the use of impedance plethysmography over Doppler ultrasonography as the main test for this disorder. This is because impedance plethysmography is precise and objective, whereas the interpretation of Doppler ultrasonography is subjective and requires considerable skill and experience to form reliable diagnoses. The use of serial impedance plethysmography has been evaluated recently in a prospective study. The rationale of repeated impedance plethysmography evaluation is based on the premise that calf vein thrombi are only clinically important when they extend into the proximal veins, at which point detection with impedance plethysmography is possible. Therefore, by performing repeated examinations with impedance plethysmography in patients with clinically suspected venous thrombosis, it is possible to identify patients with extending calf vein thrombosis who can be treated appropriately. Impedance plethysmography is performed immediately on referral; if it is positive in the absence of clinical conditions that are known to produce falsely positive results, the diagnosis of venous thrombosis is established, and the patient is treated accordingly. If the result of the initial impedance plethysmography evaluation is negative, anticoagulant therapy is withheld, and impedance plethysmography is repeated the following day, again on day 5 to 7 and on day 10 to 14. 87 references.

  17. [Superficial venous thrombosis. A state of art].

    Science.gov (United States)

    Sándor, Tamás

    2017-01-01

    For a long time superficial thrombophlebitis has been thought to be a rather benign condition. Recently, when duplex ultrasound technique is used for the diagnosis more and more often, the disease is proved to be more dangerous than anticipated. Thrombosis propagates to the deep veins in 6-44% and pulmonary embolism was observed on the patients in 1,5-33%. We can calculate venous thromboembolic complications on every fourth patient. Diagnosis is clinical, but duplex ultrasound examination is mandatory, for estimation of the thrombus extent, for exclusion of the deep venous thrombosis and for follow up. Both legs should be checked with ultrasound, because simultaneous deep venous thrombosis can develop on the contralateral limb. Two different forms can be distinguished: superficial venous thrombosis with, or without varicose veins. In cases of spontaneous, non varicous form, especially when the process is migrating or recurrent, a careful clinical examination is necessery for exclusion of malignant diseases and thrombophilia. The treatment options are summarised on the basis of recent international consensus statements. The American and German guidelines are similar. Compression and mobilisation are cornerstones of the therapy. For a short segment thrombosis non steroidal antiinflammatory drugs are effective. For longer segments low molecular-weight heparins are preferred. Information on the effect of the novel oral anticoagulants for the therapy is lacking but they may appear to be effective in the future for this indication. When thrombus is close to the sapheno-femoral or sapheno-popliteal junction crossectomy (high ligation), or low molecular-weight heparin in therapeutic doses are indicated. The term superficial thrombophlebitis should be discouraged, because inflammation and infection is not the primary pathology. It should be called correctly superficial venous thrombosis in order to avoid the unnecessary administration of antibiotics and the misconception

  18. Peripherally inserted central catheters and upper extremity deep vein thrombosis

    International Nuclear Information System (INIS)

    Ong, B.; Gibbs, H.; Catchpole, I.; Hetherington, R.; Harper, J.

    2006-01-01

    The purpose of the study was to determine the incidence and risk factors for venous thrombosis in patients with a peripherally inserted central catheter (PICC). A retrospective study of all upper extremity venous duplex scans was carried out in the Vascular Medicine department from year 2000 to 2002 inclusive. A chart review of positive scans was undertaken to identify possible thrombotic risk factors. Of 317 upper extremity venous duplex scans carried out, 115, or 32%, were positive for upper extremity deep vein thrombosis. Three main risk factors were identified - presence of a central line, malignancy and administration of chemotherapy. PICC were the most common central line present. Symptomatic thrombosis occurred in 7% of PICC inserted for chemotherapy compared with 1% of PICC inserted for other reasons. Ten per cent of the patients receiving chemotherapy through a PICC developed a thrombosis. The post-thrombotic syndrome was infrequent following upper extremity deep vein thrombosis. Patients receiving chemotherapy through a PICC are at increased risk of thrombosis. There may be a role for prophylactic low-dose anticoagulation in these high-risk patients

  19. [Lethal portal venous gas after cardiopulmonary arrest].

    Science.gov (United States)

    Thomachot, L; Arnal, J M; Vialet, R; Albanèse, J; Martin, C

    1998-01-01

    We report the case of a 51-year-old patient admitted after a transient cardiorespiratory arrest. The abdominal CT scan revealed the presence of hepatic portal venous gas. At laparotomy, a diffuse mesenteric ischaemia was diagnosed. The patient died from multiple organ failure in the subsequent hours. Necrotic bowel is associated with hepatic portal venous gas in 50% of the cases and the current mortality rate is 85%. Gas originates either through intestinal transmucosal passage, either by intraportal bacterial gas production, or through both mechanisms.

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture...... and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway...

  1. Pressurized Intravenous Fluid Administration in the Professional Football Player: A Unique Setting for Venous Air Embolism.

    Science.gov (United States)

    Fibel, Kenton H; Barnes, Ronnie P; Kinderknecht, James J

    2015-07-01

    Venous air embolism (VAE) is a potentially life-threatening event that is most commonly associated with certain surgical procedures, although this theoretical complication of pressurized rapid infusion of intravenous (IV) fluids has been described. This series of cases describes 4 athletes who presented with continuous coughing and other chest complaints after peripheral IV infusion of normal saline through manual pressurized infusion. Symptoms resolved within 20 minutes, and these incidences did not interfere with resuming athletic competition with no recurrence of symptoms or complications. These cases are most consistent with varying degrees of VAE and reveal the risk of VAE associated with pressurized peripheral IV fluid administration along with the unique clinical presentation of more modest forms of VAE in an awake patient. Becoming more knowledgeable about IV infusion technique and understanding potential pitfalls can be helpful in reducing future incidences of VAE.

  2. Parenchymal abnormalities in cerebral venous thrombosis: findings of magnetic resonance imaging and magnetic resonance angiography

    International Nuclear Information System (INIS)

    Ferreira, Clecia Santos; Pellini, Marcos; Boasquevisque, Edson; Souza, Luis Alberto M. de

    2006-01-01

    Objective: to determine the frequency and localization of parenchymal abnormalities in cerebral venous thrombosis on magnetic resonance imaging and magnetic resonance angiography as well as their correlation with the territory and affected venous drainage. Materials and methods: retrospective analysis (1996 to 2004) of 21 patients (3 male and 18 female) age range between 3 and 82 years (mean 40 years, median 36 years) with clinical and radiological diagnosis of cerebral venous thrombosis on magnetic resonance imaging and magnetic resonance angiography in 2D PC, 3D PC and contrast-enhanced 3D TOF sequences. The statistical analysis was performed with the qui-square test. Four patients had follow-up exams and three patients underwent digital subtraction angiography. Results: main predisposing factors were: infection, use of oral contraceptives, hormone replacement therapy and collagenosis. Predominant symptoms included: focal deficit, headache, alteration of consciousness level and seizures. Most frequent parenchymal manifestations were: cortical/subcortical edema or infarct, venous congestion and collateral circulation, meningeal enhancement and thalamic and basal ganglia edema or infarct. Occlusion occurred mainly in superior sagittal, left transverse, left sigmoid and straight sinuses. Cavernous sinus and cortical veins thrombosis are uncommon events. Conclusion: cerebral venous thrombosis is an uncommon cause of stroke, with favorable prognosis because of its reversibility. Diagnosis is highly dependent on the radiologist capacity to recognize the presentations of this disease, principally in cases where the diagnosis is suggested by parenchymal abnormalities rather than necessarily by visualization of the thrombus itself. An accurate and rapid diagnosis allows an immediate treatment, reducing the morbidity and mortality rates. (author)

  3. Color Doppler US of normal cerebral venous sinuses in neonates: a comparison with MR venography

    International Nuclear Information System (INIS)

    Miller, Elka; Daneman, Alan; Doria, Andrea S.; Blaser, Susan; Traubici, Jeffrey; Jarrin, Jose; Shroff, Manohar; Moineddin, Rahim; Moore, Aideen

    2012-01-01

    Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease. To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV). Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10 h (mean, 3.5 h, range, and 2-7.6 h) of the MRI study using a standard protocol. Fifty consecutive neonates participated in the study (30 males [60%]; 25-41 weeks old; mean, 37 weeks). The mean time interval between the date of birth and the CDUS study was 19.1 days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82-100%), for MRV reading, 99% (range, 96-100%) and for intermodality, 100% (range, 96-100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94-98%) and transverse sinuses (82-86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques. Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease. (orig.)

  4. Ulcer recurrence after in-hospital treatment for recalcitrant venous leg ulceration.

    Science.gov (United States)

    Reeder, S; de Roos, K-P; de Maeseneer, M; Sommer, A; Neumann, H A M

    2013-05-01

    Leg ulceration caused by chronic venous disease occurs in 1% of the adult Western population. A majority of these patients is successfully treated in the outpatient setting. A minority of patients is hospitalized, most frequently because of the lack of healing tendency. The literature provides recurrence rates for ulcer disease, but lacks specific data on recurrence rates after in-hospital treatment of recalcitrant venous leg ulcers. To investigate time to ulcer recurrence after in-hospital treatment of venous leg ulceration. A multicentre, retrospective cohort study of patients admitted for leg ulceration between 1996 and 2007 was conducted. Data could be collected for 107 of the patients. Of these, 27 had conservative treatment (bed rest, local wound care, pain management) and 48 patients underwent surgical ulcer treatment with (n = 19) or without (n = 29) initial vacuum-assisted closure (VAC) treatment. The treatment method was 'miscellaneous' in the remaining 32 patients. Median admission time was 30 days, median percentage of closure at discharge was 95%, and median time to ulcer recurrence 60 days. The Mann-Whitney U-test showed significant differences between the conservative group and the surgery group, the latter having a longer length of hospital stay (P ulcer closure (P ulcer recurrence (P = 0.273). Comparable differences were demonstrated between the conservative group and the VAC plus surgery group. No significant differences could be demonstrated between the surgically treated patients and those treated by VAC and surgery. Hospital stay is significantly shorter in cases of surgical treatment of recalcitrant venous leg ulcers. Most ulcers recur within 2 months after hospital discharge. Recurrence of venous leg ulcers after hospital admission is independent of the method of treatment and cause of ulceration. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

  5. Higher prevalence of thrombophilia in patients with varicose veins and venous ulcers than controls.

    Science.gov (United States)

    Darvall, Katy A L; Sam, Rachel C; Adam, Donald J; Silverman, Stanley H; Fegan, Christopher D; Bradbury, Andrew W

    2009-05-01

    Uncontrolled studies suggest that patients with chronic venous ulceration (CVU) have an increased prevalence of thrombophilia, similar to that observed in patients with deep vein thrombosis. This study compared the nature and prevalence of thrombophilia in patients with varicose veins (VV, CEAP clinical [C] grade C(2) to C(3)) and patients with CVU (C(5) to C(6)) with an age- and sex-matched population without clinical or duplex ultrasound evidence of venous disease. Twenty-seven patients with VV, 27 patients with CVU, and 54 age- and sex-matched case controls with no clinical or duplex evidence of lower limb venous disease, underwent testing for factor V Leiden and prothrombin 20210A mutations, antithrombin deficiencies, and levels of antiphospholipid antibodies, homocysteine, protein C and S, and factor VIII, IX, and XI. The overall prevalences of single and multiple thrombophilias were significantly higher in cases than in controls. Specifically, in VV patients, the prevalences of no, single, and multiple thrombophilias were 33%, 52%, and 15%, respectively, compared with 63%, 26%, and 11% in VV controls. In CVU patients, the prevalences of no, single, and multiple thrombophilias was 26%, 30%, and 44%, respectively, compared with 66%, 22%, and 11% in CVU controls. Compared with controls, only factor XI levels were significantly higher in VV patients, and homocysteine and factor VIII, IX, and XI levels were all significantly higher in CVU patients. Patients with VV, and particularly CVU, have significantly higher prevalences of single and multiple thrombophilias than age- and sex-matched controls without clinical or duplex evidence of lower limb venous disease. These data support the hypothesis that thrombophilia predisposes to the development of superficial and deep lower limb venous reflux, and so VV and CVU, through the increased occurrence of clinical and subclinical thrombosis.

  6. Color Doppler US of normal cerebral venous sinuses in neonates: a comparison with MR venography

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Elka [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Children' s Hospital of Eastern Ontario (CHEO), Diagnostic Imaging Department, Ottawa (Canada); Daneman, Alan; Doria, Andrea S.; Blaser, Susan; Traubici, Jeffrey; Jarrin, Jose; Shroff, Manohar [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Moineddin, Rahim [University of Toronto, Toronto (Canada); Moore, Aideen [Hospital for Sick Children, Department of Neonatology, Toronto (Canada)

    2012-09-15

    Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease. To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV). Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10 h (mean, 3.5 h, range, and 2-7.6 h) of the MRI study using a standard protocol. Fifty consecutive neonates participated in the study (30 males [60%]; 25-41 weeks old; mean, 37 weeks). The mean time interval between the date of birth and the CDUS study was 19.1 days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82-100%), for MRV reading, 99% (range, 96-100%) and for intermodality, 100% (range, 96-100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94-98%) and transverse sinuses (82-86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques. Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease. (orig.)

  7. Novel approach to epicardial pacemaker implantation in patients with limited venous access.

    Science.gov (United States)

    Costa, Roberto; Scanavacca, Mauricio; da Silva, Kátia Regina; Martinelli Filho, Martino; Carrillo, Roger

    2013-11-01

    Limited venous access in certain patients increases the procedural risk and complexity of conventional transvenous pacemaker implantation. The purpose of this study was to determine a minimally invasive epicardial approach using pericardial reflections for dual-chamber pacemaker implantation in patients with limited venous access. Between June 2006 and November 2011, 15 patients underwent epicardial pacemaker implantation. Procedures were performed through a minimally invasive subxiphoid approach and pericardial window with subsequent fluoroscopy-assisted lead placement. Mean patient age was 46.4 ± 15.3 years (9 male [(60.0%], 6 female [40.0%]). The new surgical approach was used in patients determined to have limited venous access due to multiple abandoned leads in 5 (33.3%), venous occlusion in 3 (20.0%), intravascular retention of lead fragments from prior extraction in 3 (20.0%), tricuspid valve vegetation currently under treatment in 2 (13.3%), and unrepaired intracardiac defects in 2 (13.3%). All procedures were successful with no perioperative complications or early deaths. Mean operating time for isolated pacemaker implantation was 231.7 ± 33.5 minutes. Lead placement on the superior aspect of right atrium, through the transverse sinus, was possible in 12 patients. In the remaining 3 patients, the atrial lead was implanted on the left atrium through the oblique sinus, the postcaval recess, or the left pulmonary vein recess. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 36.8 ± 25.1 months. Epicardial pacemaker implantation through pericardial reflections is an effective alternative therapy for those patients requiring physiologic pacing in whom venous access is limited. © 2013 Heart Rhythm Society. All rights reserved.

  8. Evaluation of Hemodynamic Properties of Cerebral Venous Drainage in Patients with Multiple Sclerosis: A Case-Control Study

    International Nuclear Information System (INIS)

    Jandaghi, Ali Babaei; Amanian, Dayan; Roudbari, Seyed Ali; Kanafi, Alireza Rajabzadeh; Pourghorban, Ramin

    2014-01-01

    The purpose of this study was to compare patients with multiple sclerosis and healthy control subjects as regards hemodynamics of cerebral venous drainage. Between December 2012 and May 2013, 44 consecutive patients with multiple sclerosis and 44 age- and sex-matched healthy subjects underwent the B-mode, color Doppler, and duplex Doppler evaluations of the internal jugular vein (IJV) and vertebral vein. The following four parameters were investigated: IJV stenosis, reversal of postural control of the cerebral venous outflow pathways, absence of detectable blood flow in the IJVs and/or vertebral veins, and reflux in the IJVs and/or vertebral veins in the sitting or supine position. In the study group, IJV stenosis, postural control reversal of the cerebral venous outflow pathways, and absence of flow in the IJVs and/or vertebral veins were found in 3 (6.8%), 2 (4.5%), and 3 (6.8%) patients, respectively. In the control group, IJV stenosis (P=0.12), postural control reversal of the cerebral venous outflow pathways (P=0.50), and absence of flow (P=0.12) were not detected. Abnormal reflux was found neither in multiple sclerosis patients nor in healthy subjects. No significant difference in the cerebral venous drainage through the IJV or vertebral vein was found between patients with multiple sclerosis and healthy subjects within any of the investigated ultrasonographic parameters

  9. Comparative diagnosis of venous occlusive diseases of lower extremity through multi-slice CT angiography and DSA

    International Nuclear Information System (INIS)

    Wu Gang; Gu Jianping; Wang Shuzhi; Yin Xinxao; Lu Lingquan

    2008-01-01

    Objective: To assess the clinical application value of multi-slice CT angiography(MSCTA) in the diagnosis of venous occlusive diseases of lower extremity. Methods: Thirty-two suspected patients with venous occlusive diseases of lower extremity underwent 16-slice MSCTA and DSA simultaneously. The MSCTA technique and its diagnostic value were analyzed with clinical data. Results: Thirty-two cases of suspected lower extremity venous occlusive diseases were diagnosed by MSCTA, including 19 cases of iliac vein compression syndrome (left iliac vein in 16 cases, right iliac vein 3 cases). Nine cases of deep vein thrombosis (2 on left side, 5 on right and another 2 bilaterally). The left external iliac vein was compressed by a cyst in left inguinal region in one case and another case showed simple varicosis of superficial veins of the left lower limb. The results were similar demonstrated by DSA and MSCTA in above thirty cases. The right femoral and popliteal venous dilatations were diagnosed by MSCTA in one case and no abnormality in the other. The two cases were found to be valvular functional defect of deep veins of lower limb by DSA. Conclusion: MSCTA possesses rather high application value in the diagnosis of venous occlusive diseases of lower extremity. (authors)

  10. [Assertiveness and peripheral intravenous catheters dwell time with ultrasonography-guided insertion in children and adolescents].

    Science.gov (United States)

    Avelar, Ariane Ferreira Machado; Peterlini, Maria Angélica Sorgini; da Pedreira, Mavilde Luz Gonçalves

    2013-06-01

    Randomized controlled trial which aimed to verify whether the use of vascular ultrasound (VUS) increases assertiveness in the use of peripheral venous catheter in children, and the catheter dwell time, when compared to traditional puncture. Data were collected after approval of theethical merit. Children and adolescents undergoing VUS-guided peripheral intravenous (GVUS) or puncture guided by clinical assessment of the venous conditions(CG) were included in the study. Significance level was set at pAssertiveness was found in 73 (71.6%) GVUS catheters and in 84(71.8%) of the CG (p=0.970), and catheter dwell time presented a median of less than one day in both groups (p=0.121), showing nostatistically significant difference. VUS did not significantly influence the results of the dependent variables investigated. ClinicalTrials.govNCT00930254.

  11. Pregnancy-related venous thromboembolism and risk of occult cancer

    DEFF Research Database (Denmark)

    Hansen, Anette Tarp; Veres, Katalin; Horváth-Puhó, Erzsébet

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected. An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected. An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  12. Peripheral vascular trauma in children: related factors by the logistic regression method

    Directory of Open Access Journals (Sweden)

    Raquel Nogueira Avelar Silva

    2014-03-01

    Full Text Available The objective of the present study was to identify the factors related to “peripheral vascular trauma” in children aged six months to 12 years. This prospective cohort study included children with peripheral vein punctured for the first time per side and excluded those with high/complete healing of trauma signs after removing the catheter. Daily clinical evaluations were performed in intervals shorter than 24 hours. Data were treated according to Pearson’s test and the logistic regression method. Among the 14 variables considered intervenient, four were statistically associated to the occurrence of trauma: dirtiness and humidity in the catheter insertion site, catheter caliber, and age. A causal relationship was found between the intervenient variables and the outcome, “peripheral vascular trauma”, thus, contributing to forming the knowledge of the peripheral venous puncture in children aged six months to 12 years. Descriptors: Child; Nursing Diagnosis; Veins; Injuries.

  13. Congenital absence of infrarenal IVC and iliac venous system : Unusual collateral Pathways

    International Nuclear Information System (INIS)

    Lee, Jin Joo; Lee, Byung Hee; Kim, Kie Hwan; Do, Young Soo; Chin, Soo Yil

    1994-01-01

    We present a case with congenital absence of the infrarenal portion of inferior vena cava and iliac venous system, showing unusual venous collaterals including the left ovarian venous collateral via parametrial venous complex, and a mesenteric-periureteric venous connection. The venous collateral pathways were demonstrated by computed tomography and venography

  14. Self-sustained circadian rhythm in cultured human mononuclear cells isolated from peripheral blood.

    Science.gov (United States)

    Ebisawa, Takashi; Numazawa, Kahori; Shimada, Hiroko; Izutsu, Hiroyuki; Sasaki, Tsukasa; Kato, Nobumasa; Tokunaga, Katsushi; Mori, Akio; Honma, Ken-ichi; Honma, Sato; Shibata, Shigenobu

    2010-02-01

    Disturbed circadian rhythmicity is associated with human diseases such as sleep and mood disorders. However, study of human endogenous circadian rhythm is laborious and time-consuming, which hampers the elucidation of diseases. It has been reported that peripheral tissues exhibit circadian rhythmicity as the suprachiasmatic nucleus-the center of the biological clock. We tried to study human circadian rhythm using cultured peripheral blood mononuclear cells (PBMCs) obtained from a single collection of venous blood. Activated human PBMCs showed self-sustained circadian rhythm of clock gene expression, which indicates that they are useful for investigating human endogenous circadian rhythm.

  15. Severe acute myocardial infarction and peripheral thrombosis in patient with bladder cancer

    Directory of Open Access Journals (Sweden)

    Ahmet Seyfeddin Gürbüz

    2017-12-01

    Full Text Available Cancer-associated thrombosis worsens the lives of patients substantially. Venous manifestations of cancer-associated thrombosis include deep vein thrombosis and pulmonary embolism. Arterial events include stroke and myocardial infarction. In this patient, myocardial infarction and cardiogenic shock are associated with diffuse coronary thrombosis together with peripheral thrombosis. He had surgery because of bladder carcinoma. Severe hypercoagulable condition probably facilitated by cancer itself and surgery caused multivessel coronary and peripheral intense thrombus burden. Intracoronary 10 mcg/kg tirofiban bolus and 15 mg tissue plasminogen activator (tPA were administered respectively before revascularization and thrombectomy operation was performed. Complete revascularization was achieved.

  16. Voiding patterns of adult patients who underwent hypospadias repair in childhood.

    Science.gov (United States)

    Jaber, Jawdat; Kocherov, Stanislav; Chertin, Leonid; Farkas, Amicur; Chertin, Boris

    2017-02-01

    This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  17. [Prognostic Analysis of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy Using QOL-ACD].

    Science.gov (United States)

    Fukui, Yasuhiro; Kashiwagi, Shinichiro; Takada, Koji; Goto, Wataru; Asano, Yuka; Morisaki, Tamami; Noda, Satoru; Takashima, Tsutomu; Onoda, Naoyoshi; Hirakawa, Kosei; Ohira, Masaichi

    2017-11-01

    We investigated into association of quality of life(QOL)and prognosis of breast cancer patients who underwent neoadjuvant chemotherapy(NAC). We retrospectively studied 228 patients with breast cancer who were performed NAC during a period between 2007 and 2015. TheQ OL score was measured with"The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs(QOL-ACD)". We evaluate association between QOL score with antitumor effect and prognosis. Changes in the QOL score between before and after NAC were compared as well. We divided 2 groups by QOL-ACD scoreinto high and low groups. Therapeautic effect of NAC on 75 patients were pathological complete response(pCR). QOL-ACD score was not significantly associated with pCR rate in both high and low groups(p=0.199). High group was significantly associated with higher survival rate in both of disease free survival(p=0.009, logrank)and overall survival(p=0.040, logrank). QOLACD score decreased after NAC in both of pCR and non-pCR patients. In conclusion, QOL evaluation using QOL-ACD could be an indicator of breast cancer patients' prognosis who underwent NAC.

  18. HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

    Science.gov (United States)

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Wowk, Pryscilla Fanini; Mattar, Sibelle Botogosque; Vargas, Rafael Gustavo; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; Bicalho, Maria da Graça

    2012-09-01

    The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART. Copyright © 2012. Published by Elsevier Inc.

  19. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  1. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  2. Misplaced left internal jugular venous catheter with an exceptional ...

    African Journals Online (AJOL)

    Large numbers of central venous catheters (CVCs) are placed each year in the intensive care units and misplacement occurs frequently. Many critically ill patients require central venous catheterization for multiple and varied reasons. Internal jugular vein (IJV) catheter is one of the most frequent central venous catheters in ...

  3. The recalcitrant venous leg ulcer - A never ending story?

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan); M.B. Maessen-Visch (Birgitte); S.I. Langendoen; K.P. de Roos; H.A.M. Neumann (Martino)

    2013-01-01

    textabstractIntroduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is

  4. Venous thrombosis during pregnancy: leg and trimester of presentation

    NARCIS (Netherlands)

    Ginsberg, J. S.; Brill-Edwards, P.; Burrows, R. F.; Bona, R.; Prandoni, P.; Büller, H. R.; Lensing, A.

    1992-01-01

    In order to determine the relative frequencies of left and right leg venous thrombosis during pregnancy and the frequencies of venous thrombosis during the three trimesters, a cohort study of 60 consecutive patients with a first episode of venous thrombosis during pregnancy was performed.

  5. A Novel Stretch Sensor to Measure Venous Hemodynamics

    Directory of Open Access Journals (Sweden)

    Syrpailyne Wankhar

    2018-07-01

    Full Text Available Chronic venous insufficiency is a debilitating condition causing varicose veins and venous ulcers. The pathophysiology includes reflux and venous obstruction. The diagnosis is often made by clinical examination and confirmed by Venous Doppler studies. Plethysmography helps to quantitatively examine the reflux and diagnose the burden of deep venous pathology to better understand venous hemodynamics, which is not elicited by venous duplex examination alone. However, most of these tests are qualitative, expensive, and not easily available. In this paper, we demonstrate the potential use of a novel stretch sensor in the assessment of venous hemodynamics during different maneuvers by measuring the change in calf circumference. We designed the stretch sensor by using semiconductor strain gauges pasted onto a small metal bar to form a load cell. The elastic and Velcro material attached to the load cell form a belt. It converts the change in limb circumference to a proportional tension (force of distension when placed around the calf muscle. We recorded the change in limb circumference from arrays of stretch sensors by using an in-house data acquisition system. We calculated the venous volume (VV, venous filling index (VFI, ejection fraction (EF and residual venous volume (RVV on two normal subjects and on two patients to assess venous hemodynamics. The values (VV > 60 ml, VFI 60%, RVV 2ml/s, EF 35% in patients were comparable to those reported in the literature.

  6. Mechanochemical endovenous ablation and new frontiers in venous intervention

    NARCIS (Netherlands)

    Boersma, D

    2017-01-01

    Venous insufficiency of the lower extremities is a common condition and related to various symptoms, including venous ulcers. The effect of venous insufficiency on patients’ health-related quality of life is substantial and comparable with other chronic diseases such as arthritis, diabetes, and

  7. 21 CFR 870.1140 - Venous blood pressure manometer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section 870.1140 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous...

  8. Metastatic Carcinoma of Unknown Primary Presenting as Jugular Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    Prince Cheriyan Modayil

    2009-01-01

    Full Text Available Jugular venous thrombosis is unusual and is associated with central venous catheterisation, intravenous drug abuse and head and neck sepsis. It is rarely associated with malignancy. We report a case of metastatic carcinoma of unknown primary in a forty year old female which presented with jugular venous thrombosis. The discussion includes investigation and treatment options for this condition.

  9. Diagnostics of defeats of venous collectors of brain

    International Nuclear Information System (INIS)

    Timofeeva, T.V.; Polunina, I.S.; Shcherbakova, E.Ya.; Kuldakova, S.V.

    1997-01-01

    Comparative data of transcranial ultrasonic dopplerography (170 patients) and radionuclidous antroscintigraphy (124), received during diagnostics of defects of venous collectors of brain are analyzed. Five variants of defeats of venous collectors (cross, sigmoid, internal of jugular of jugular vein), but also unpaired sine (direct, confluent) are described. Received results permit to reveal interrelation of infringements of venous outflow and increase of intracranial pressure

  10. The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study

    OpenAIRE

    Piper, Russell; Carr, Peter J.; Kelsey, Lachlan J.; Bulmer, Andrew C.; Keogh, Samantha; Doyle, Barry J.

    2018-01-01

    Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet up to 50% fail. Many pathways to failure are mechanistic and related to fluid mechanics, thus can be investigated using computational fluid dynamics (CFD). Here we used CFD to investigate typical PIVC parameters (infusion rate, catheter size, insertion angle and tip position) and report the hemodynamic environment (wall shear stress (WSS), blood damage, particle residence time and venous stasis vo...

  11. Azygos vein thrombosis secondary to a peripherally inserted central catheter (PICC).

    Science.gov (United States)

    Sherif, Moayid M; Hall, Rebecca; Schauer, Cameron K M W

    2015-07-20

    This case illustrates a rare complication of a peripherally inserted central catheter (PICC). PICCs are associated with a significantly increased risk of upper extremity deep vein thrombosis; however, there are currently no case reports of isolated thrombosis of the azygos vein secondary to a PICC. With the well-documented increase in the use of PICCs for venous access we remind clinicians to consider this rare complication.

  12. Acupuncture for peripheral joint osteoarthritis.

    NARCIS (Netherlands)

    Manheimer, Eric; Cheng, K.; Linde, Klaus; Lao, Lixing; Yoo, Junghee; Wieland, Susan; van der Windt, Daniëlle Awm; Berman, Brian M.; Bouter, Lex M.

    2010-01-01

    BACKGROUND: Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective. OBJECTIVES: To assess the effects of acupuncture for treating peripheral joint osteoarthritis. SEARCH STRATEGY: We searched the Cochrane Central Register of

  13. 'Multi-associations': predisposed to misinterpretation of peripheral tissue oxygenation and circulation in neonates

    International Nuclear Information System (INIS)

    Pichler, Gerhard; Pocivalnik, Mirjam; Pichler-Stachl, Elisabeth; Morris, Nicholas; Zotter, Heinz; Müller, Wilhelm; Urlesberger, Berndt; Riedl, Regina

    2011-01-01

    Interpretation of peripheral circulation in ill neonates is crucial but difficult. The aim was to analyse parameters potentially influencing peripheral oxygenation and circulation. In a prospective observational cohort study in 116 cardio-circulatory stable neonates, peripheral muscle near-infrared spectroscopy (NIRS) with venous occlusion was performed. Tissue oxygenation index (TOI), mixed venous oxygenation (SvO 2 ), fractional oxygen extraction (FOE), fractional tissue oxygen extraction (FTOE), haemoglobin flow (Hbflow), oxygen delivery (DO 2 ), oxygen consumption (VO 2 ), and vascular resistance (VR) were assessed. Correlation coefficients between NIRS parameters and demographic parameters (gestational age, birth weight, age, actual weight, diameter of calf, subcutaneous adipose tissue), monitoring parameters (heart rate, arterial oxygen saturation (SaO 2 ), mean blood pressure (MAP), core/peripheral temperature, central/peripheral capillary refill time) and laboratory parameters (haemoglobin concentration (Hb-blood), pCO 2 ) were calculated. All demographic parameters except for Hbflow and DO 2 correlated with NIRS parameters. Heart rate correlated with TOI, SvO 2 , VO 2 and VR. SaO 2 correlated with FOE/FTOE. MAP correlated with Hbflow, DO 2 , VO 2 and VR. Core temperature correlated with FTOE. Peripheral temperature correlated with all NIRS parameters except VO 2 . Hb-blood correlated with FOE and VR. pCO 2 levels correlated with TOI and SvO 2 . The presence of multiple interdependent factors associated with peripheral oxygenation and circulation highlights the difficulty in interpreting NIRS data. Nevertheless, these findings have to be taken into account when analysing peripheral oxygenation and circulation data

  14. Rare associations of tetralogy of Fallot with anomalous left coronary artery from pulmonary artery and totally anomalous pulmonary venous connection.

    Science.gov (United States)

    Sen, Supratim; Rao, Suresh G; Kulkarni, Snehal

    2016-06-01

    We describe the cases of two patients with tetralogy of Fallot, aged 4 years and 8 months, who were incidentally detected to have concomitant anomalous left coronary artery from pulmonary artery and total anomalous pulmonary venous connection, respectively, on preoperative imaging. They underwent surgical correction with good mid-term outcomes. In this study, we discuss the embryological basis, physiological effects, and review the literature of these two unusual associations. Awareness of these rare associations will avoid missed diagnoses and consequent surgical surprises.

  15. Hyperventilation and finger exercise increase venous-arterial Pco2 and pH differences.

    Science.gov (United States)

    Umeda, Akira; Kawasaki, Kazuteru; Abe, Tadashi; Watanabe, Maki; Ishizaka, Akitoshi; Okada, Yasumasa

    2008-11-01

    Since the invention of the pulse oximeter, physicians often or even routinely perform venous blood gas analysis (VBGA). However, it has not been generally agreed that the application of VBGA is practically meaningful in routine clinical situations such as in an ED. We measured venous-arterial Pco(2) difference ((v-a)Pco(2)) and arterial-venous pH difference ((a-v)pH), and analyzed the physiological factors that affect these differences in healthy volunteers and hyperventilation patients. In healthy volunteers, both (v-a)Pco(2) and (a-v)pH increased during finger exercise or hyperventilation in an intensity-dependent manner. Doppler echography indicated that increases in (v-a)Pco(2) and (a-v)pH during hyperventilation are induced by reduction of peripheral blood flow. Approximately 40% of patients with untreated respiratory alkalosis were found to be incorrectly diagnosed if based only on VBGA. It must be noted that VBGA may lead to overestimation of acidosis and to underestimation of respiratory alkalosis when extremities muscles are active or patients are hyperventilating. Physicians should keep these limitations in mind when conducting VBGA.

  16. Total Anomalous Pulmonary Venous Connection: Preoperative Anatomy, Physiology, Imaging, and Interventional Management of Postoperative Pulmonary Venous Obstruction.

    Science.gov (United States)

    Files, Matthew D; Morray, Brian

    2017-06-01

    Total anomalous pulmonary venous connection refers to a spectrum of cardiac anomalies where the pulmonary veins fail to return to the left atrium and the pulmonary venous blood returns through a systemic vein or directly to the right atrium. There is a wide anatomical variety of venous connections and degrees of pulmonary venous obstruction that affect the presentation, surgical repair, and outcomes. In this review, we explore the preoperative physiology, echocardiographic diagnosis, and approach to postoperative complications.

  17. Small juxtacortical hemorrhages in cerebral venous thrombosis

    NARCIS (Netherlands)

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

    2014-01-01

    Intracerebral hemorrhages (ICHs) are common in patients with cerebral venous thrombosis (CVT). We examined whether small juxtacortical hemorrhages (JCHs) are characteristic for CVT and studied their radiological and pathological properties. We identified all patients with CVT and an ICH at baseline

  18. Clinical overview of venous thromboembolism | Schellack | South ...

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) encompasses two vascular conditions that are of significant importance, namely deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is also the most common cause of PE. Medical and surgical patients, and individuals who are at increased risk of developing VTE through a ...

  19. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    However, the high level of thromboprophylaxis practice appears doubtful because only a few of these physicians carry out VTE risk assessment for their patients as well as follow clinical guidelines on VTE thromboprophylaxis. Key words: Venous thromboembolism, deep vein thrombosis, pulmonary embolism, risk factor, ...

  20. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    MJP

    Report from Centre for Disease Control and. Prevention (CDC) puts VTE related mortality in. ABSTRACT. Background: Venous thromboembolism (VTE) is a major public health challenge globally due to its high morbidity and mortality. The condition is often asymptomatic and under diagnosed due to lack of awareness on ...

  1. Travel and venous thrombosis: a systematic review

    NARCIS (Netherlands)

    Kuipers, S.; Schreijer, A. J. M.; Cannegieter, S. C.; Bueller, H. R.; Rosendaal, F. R.; Middeldorp, S.

    2007-01-01

    In the past decade, numerous publications on the association between venous thrombosis (VT) and travel have been published. Relative and absolute risks of VT after travel, and particularly after travel by air, have been studied in case-control and observational follow-up studies, whereas the effect

  2. Urethro-venous intravasation during urethrography

    African Journals Online (AJOL)

    J.M. Ratkal

    Abstract. Retrograde urethrography is a procedure used to evaluate urethral strictures. Urethro-venous intravasation, rarely seen during retrograde urethrography, can result in bacteremia, adverse reactions to contrast agents, renal failure and even pulmonary embolism. We report one such case of a male patient who ...

  3. Venous function after pharmacomechanical thrombolysis for ...

    African Journals Online (AJOL)

    2017-08-29

    Aug 29, 2017 ... Subsequent chronic venous insufficiency (CVI) because of post-thrombotic syndrome (PTS) is associated with increased morbidity and poses a significant health care burden.1 PTS significantly impacts health-related quality of life (QoL) after DVT. It is characterised by a chronic feeling of limb heaviness ...

  4. Scintiangiographic diagnosis of acute mesenteric venous thrombosis

    International Nuclear Information System (INIS)

    Smith, R.W.; Selby, J.B.

    1979-01-01

    Scintiangiographic findings of prolonged mesenteric activity in a case of acute mesenteric thrombosis is described and 105 cases with abdominal scintiangiography are reviewed. Usual peak mesenteric blush occurred 5 to 15 sec after initial visualization of the aorta. Normal clearance of this activity was 15 to 30 sec. Future cases should confirm the importance of this observation in early diagnosis of mesenteric venous thrombosis

  5. VENOUS THROMBOEMBOLISM PROPHYLAXIS – THE OTHER ...

    African Journals Online (AJOL)

    Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any guidelines, most of the information available has been provided mainly by the pharmaceutical industry which is an interested party. There have been publications in local journals that lean more on ...

  6. Thermodilution-determined Internal Jugular Venous Flow

    DEFF Research Database (Denmark)

    Rasmussen, Peter; Widmer, Mario; Hilty, Matthias P

    2017-01-01

    PURPOSE: Cerebral blood flow (CBF) increases ~20% during whole body exercise although a Kety-Schmidt-determined CBF is reported to remain stable; a discrepancy that could reflect evaluation of arterial vs. internal jugular venous (IJV) flow and/or that CBF is influenced by posture. Here we test...

  7. Knowledge, attitude and practice of venous thromboembolism ...

    African Journals Online (AJOL)

    USER

    We aimed to assess the knowledge, attitude and practice of prophylaxis in venous thromboembolism among medical doctors in Usmanu Danfodiyo University Teaching Hospital,. Sokoto, North-West Nigeria. Methodology: The knowledge, attitude and practice of VTE prophylaxis among medical doctors was assessed using ...

  8. Multiple cerebral venous sinus thrombosis: Case report

    African Journals Online (AJOL)

    (1). Headache was present in our patient. This symptom, in association with vomiting is a feature of intracranial hypertension. Normal cerebro-spinal fluid flow patterns have the final common pathway as the reabsorption by the arachnoid granulations and flow into the venous sinuses (6). Thrombosis within the sinuses block.

  9. Drug-induced peripheral neuropathy

    DEFF Research Database (Denmark)

    Vilholm, Ole Jakob; Christensen, Alex Alban; Zedan, Ahmed

    2014-01-01

    Peripheral neuropathy can be caused by medication, and various descriptions have been applied for this condition. In this MiniReview, the term 'drug-induced peripheral neuropathy' (DIPN) is used with the suggested definition: Damage to nerves of the peripheral nervous system caused by a chemical ...

  10. Venous infraction of developmental venous anomaly: A case report with perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Youn; Kim, Hye Jeong; Hyun, Su Jeong; Kim, Hee Yeong; Kim, Han Myun; Hwang, Ji Young; Hong, Hye Suk; Woo, Ji Young; Yang, Ik [Dept. of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of); Kim, Eun Soo [Dept. of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

    2017-06-15

    Developmental venous anomaly (DVA) is a common congenital venous malformation characterized by dilated medullary veins in caput medusa configuration and a draining vein. Despite the high incidence of DVAs, they are benign anatomic variations and rarely cause symptoms. Here, we report computed tomography and magnetic resonance imaging findings with perfusion images of acute infarction from underlying DVA in a 63-year-old female patient who presented with acute onset of neurologic symptoms and recovered without any neurologic deficit.

  11. Peripheral orbit model

    CERN Document Server

    Hara, Yasuo

    1975-01-01

    Peripheral orbit model, in which an incoming hadron is assumed to revolve in a peripheral orbit around a target hadron, is discussed. The non-diffractive parts of two-body reaction amplitudes of hadrons are expressed in terms of the radius, width an absorptivity of the orbit. The radius of the orbit is about 1 fm and the width of the orbit is determined by the range of the interaction between the hadrons. The model reproduces all available experimental data on differential cross-sections and polarizations of $K^{-}p\\to K^{-}p$ and $\\bar K^{\\circ}n$ reactions for all angles successfully. This contribution is not included in the proceedings since it will appear in Progress of Theoretical Physics Vol. 51 (1974) No 2. Any person interested in the subject may apply for reprints to the author.

  12. Inpatient venous access practices: PICC culture and the kidney patient.

    Science.gov (United States)

    McGill, Rita L; Tsukahara, Tomoki; Bhardwaj, Rahul; Kapetanos, Anastasios T; Marcus, Richard J

    2015-01-01

    Depleted venous access is frequently cited as a reason for low fistula achievement. These quality assurance studies were designed to clarify the interactions between kidney disease, acuity of care and vascular access practices, and define the impact of nephrology intervention. The inpatient population at an urban teaching hospital was surveyed three times between May 2010 and May 2012. Data were collected on limb protection and vascular access practices, as well as level of kidney function and level of care. Peripherally inserted central catheter (PICC) insertion consistently exceeded 30% in patients with chronic kidney disease; reasons for insertion were often poorly defined. More than 50% of patients had devices in the nondominant arm; use of limb protection bracelets was rare. An educational intervention designed to increase nephrologist awareness increased limb protection slightly, but did not affect the distribution of vascular access devices. PICC placement and invasion of the nondominant arm are both frequent in patients with abnormal kidney function, in spite of guidelines discouraging their use. The rate of PICC is higher than that of patients with normal kidney function. Current vascular access practices have substantial potential to affect future fistula rates. Effective vein protection may require participation of the entire medical community.

  13. Bubble generation and venous air filtration by hard-shell venous reservoirs: a comparative study.

    Science.gov (United States)

    Mitchell, S J; Willcox, T; Gorman, D F

    1997-09-01

    We have previously shown significant bubble formation in Medtronic Maxima hard-shell venous reservoirs (HSVRs). In the present study, we not only investigated the mechanism of this bubble formation, but also the extent of bubble clearance by membrane oxygenators and arterial line filters. In addition, we also compared the performance of five HSVRs with respect to bubble formation and venous air filtration. Salvaged clinical CPB circuits containing different HSVRs were studied by downstream Doppler monitoring under fixed flow-decreasing volume, fixed volume-increasing flow, and entrained venous air conditions. Bubbles formed in the Medtronic Maxima top entry HSVR at volumes below 800 ml and flows above 3.5 l min-1, and were incompletely removed by a membrane oxygenator and arterial line filter. Decreased bubbling was seen when the reservoir atmosphere was flushed with CO2, suggesting that these bubbles formed in a fountain at the venous inflow. The Medtronic Maxima Forte HSVR formed significantly fewer bubbles at low volumes, and filtered venous air effectively. Negligible bubble formation occurred in the Sorin, Terumo, or Baxter reservoirs. The minimum recommended operating volume for the Medtronic Maxima top entry reservoir should be reset at 600 ml and this device should always be used with an arterial filter. Bubble formation is substantially reduced in the new Medtronic Maxima Forte HSVR and this device is a good filter for venous air.

  14. Peripheral Opioid Analgesia

    Science.gov (United States)

    1999-07-16

    well. Morphine was isolated in 1806 and as early as 1850 it was used medicinally in conjunction with anesthesia , and it continues to be used for pain...and morphine stimulate POMC expression which is probably mediated through CRH. In the periphery of humans, rats and cows the POMC mRNA is 200-300 base...use of any copyrighted material in the dissenation entitled: "Peripheral Opioid Analgesia" beyond brief excerpts is with the pennission of the

  15. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

    Directory of Open Access Journals (Sweden)

    Fang S

    2017-07-01

    Full Text Available Shirong Fang,1 Jinhong Yang,2 Lei Song,3 Yan Jiang,1 Yuxiu Liu4 1Department of Anesthesiology, 2Department of Oncology, Weifang People’s Hospital, Weifang, 3Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, 4Nursing College, Weifang Medical University, Weifang, People’s Republic of China Background: Central venous catheters (CVCs have been an effective access for chemotherapy instead of peripherally intravenous catheters. There were limited studies on the choices and effects of different types of CVCs for chemotherapy. The aim of this study was to compare the complications, cost, and patients’ quality of life and satisfaction of three commonly used CVCs for chemotherapy, such as implanted venous port, peripherally inserted central catheters (PICCs, and external non-tunneled central venous catheters (NTCs.Methods: A double-center prospective cohort study was carried out from March 2014 to December 2016. Catheterization situation, complications, catheter maintenance, cost, and patients’ quality of life and satisfaction were recorded, investigated, and analyzed. Forty-five ports, 60 PICCs and 40 NTCs were included. All the CVCs were followed up to catheter removal.Results: There was no statistical difference in catheterization success rates between port and PICC. NTC had less success rate by one puncture compared with port. Ports had fewer complications compared with PICCs and NTCs. The complication rates of ports, PICCs and NTCs were 2.2%, 40%, and 27.5%, respectively. If the chemotherapy process was <12 months, NTCs cost least, and the cost of port was much higher than PICC and NTC. When the duration time was longer than 12 months, the cost of port had no difference with the cost of PICC. Quality of life and patients’ satisfaction of port group were significantly higher than the other two groups. Conclusion: Although port catheterization costs more and needs professional medical staff and strict operational

  16. A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Halit Diri

    2014-01-01

    Full Text Available Cushing’s syndrome (CS may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH- independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

  17. Painful peripheral neuropathy

    Directory of Open Access Journals (Sweden)

    SUN Bo

    2013-09-01

    Full Text Available Painful peripheral neuropathy (PPN is characterized by neuropathic pain (NP, which is accompanied by dysfunction of motor, sensory and autonomic nervous system. It always involves small nerve fibers, including A δ and C fibers. PPN can be classified into two types according to etiology: hereditary and acquired. Pain of PPN can manifest as spontaneous pain and stimulus-evoked pain (allodynia, hyperalgesia and hyperpathia. The manifestation of typical cases is length-dependent, which firstly involves the feet, and then progresses proximally and to the hands, presenting a glove-stock pattern. PPN can be either an isolated disease entity or part of other diseases. The former indicates idiopathic small fiber neuropathy (SFN, while the latter contains various diseases involving peripheral nerve fibers, including systemic diseases such as diabetes mellitus and peripheral neuropathy with other causes. The accessory examinations of PPN include quantitative sensory testing (QST, intraepidermal nerve fiber density (IENFD, sympathetic skin response (SSR, etc. Among them, IENFD is the "golden standard" for SFN. The major therapeutic methods are to control primary diseases and relieve pain. Medications alleviating neuropathic pain consist of carbamazepine, pregabalin, gabapentin and amitriptyline, etc.

  18. Risk factors of mesenteric venous thrombosis and current situation of diagnosis and treatment in China

    International Nuclear Information System (INIS)

    Zhuang Zhiwei; Zhu Huanxing; Xu Changsheng

    2010-01-01

    Objective: To investigate risk factors of mesenteric venous thrombosis and current situation of diagnosis and treatment in China. Methods: One hundred and seven case of mesenteric venous thrombosis reported in literature were analyzed. The literature from 2003 to 2007 were retrieved from Chinese Scientific and Technical Periodical Database and Wanfangdata. Results: One hundred and seven papers included 978 MVT patients, male: female = 1. 9:1, the average age was 47. 9. The most common risk factors were portal hypertension (28. 9% ), splenectomy (18. 8%) and thrombophlebitis (11. 5%) in 833 cases with integrated medical history. Final diagnosis was established by medical imageology (40. 0%) and exploratory laparotomy (60. 0%). The achievement ratio of thrombolysis therapy was 83. 9% (73 /87) by peripheral vein and 90. 0% (63 /70) by superior mesenteric artery. 34. 7% patients took warfarin orally after discharge. Conclusions: Portal hypertension, splenectomy and thrombophlebitis may be the most common risk factor for MVT; through peripheral vein or superior mesenteric artery urokinase thrombolytic therapy is an effective means of treatment of early MVT; MVT diagnostic awareness and anticoagulant therapy after surgery awareness of the importance is to be strengthened. (authors)

  19. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  20. [Patients with astigmatism who underwent cataract surgery by phacoemulsification: toric IOL x asferic IOL?].

    Science.gov (United States)

    Torres Netto, Emilio de Almeida; Gulin, Marina Carvalho; Zapparoli, Marcio; Moreira, Hamilton

    2013-01-01

    Compare the visual acuity of patients who underwent cataract surgery by phacoemulsification with IOL AcrySof(®) toric implantation versus AcrySof(®) IQ and evaluate the reduction of cylindrical diopters (CD) in the postoperative period. Analytical and retrospective study of 149 eyes with 1 or more diopters of regular symmetrical keratometric astigmatism, which underwent cataract surgery by phacoemulsification. The eyes were divided into two groups: the toric group with 85 eyes and the non-toric group with 64 eyes. In the pre-operative phase, topographic data and refraction of each eye to be operated were assessed. In the postoperative phase, refraction and visual acuity with and without correction were measured. The preoperative topographic astigmatism ranged from 1.00 to 5.6 DC in both groups. Average reduction of 1.37 CD (p<0.001) and 0.16 CD (p=0.057) was obtained for the toric and non-toric group when compared to the refractive astigmatism, respectively. Considering visual acuity without correction (NCVA), the toric group presented 44 eyes (51.7%) with NCVA of 0 logMAR (20/20) or 0.1 logMAR (20/25) and the toric group presented 7 eyes (10.93%) with these same NCVA values. The results show that patients with a significant keratometric astigmatism presented visual benefits with the toric IOL implantation. The reduction of the use of optical aids may be obtained provided aberrations of the human eye are corrected more accurately. Currently, phacoemulsification surgery has been used not only for functional improvement, but also as a refraction procedure.

  1. Enteral nutrition is superior to total parenteral nutrition for pancreatic cancer patients who underwent pancreaticoduodenectomy.

    Science.gov (United States)

    Liu, Changli; Du, Zhi; Lou, Cheng; Wu, Chenxuan; Yuan, Qiang; Wang, Jun; Shu, Guiming; Wang, Yijun

    2011-01-01

    To determine the effects of total parenteral nutrition (TPN) and enteral nutrition (EN) on biochemical and clinical outcomes in pancreatic cancer patients who underwent pancreaticoduodenectomy. From the year 2006 to 2008, 60 patients who underwent pancreaticoduodenectomy in Tianjin Third Central Hospital were enrolled in this study. They were randomly divided into the EN group and the TPN group. The biochemical and clinical parameters were recorded and analyzed between the two groups. There was no significant difference in the nutritional status, liver and kidney function, and blood glucose levels between the TPN and EN groups on the preoperative day, the 1st and 3 rd postoperative days. However, on the 7th postoperative day, there was significant difference between the two groups in 24 h urinary nitrogen, serum levels of, total protein (TP), transferrin (TF), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transpeptadase (GGT), blood urea nitrogen (BUN) and creatinine (Cr). On the 14th postoperative day, there was a significant difference between the two groups in terms of urinary levels of 24 h nitrogen, TP, TF, retinol binding protein, ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, BUN, Cr, and glucose. The incidence of delayed gastric emptying in the EN and TPN groups was 0% and 20%, respectively. Moreover, the incidence of pancreatic fistulas and hemorrhages in the EN group were 3.6% and 3.6%, versus 26.7% and 30% in the TPN group, respectively. EN is better than TPN for pancreatic cancer patients who received pancreaticoduodenectomy.

  2. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

    Science.gov (United States)

    Fang, Shirong; Yang, Jinhong; Song, Lei; Jiang, Yan; Liu, Yuxiu

    2017-01-01

    Background Central venous catheters (CVCs) have been an effective access for chemotherapy instead of peripherally intravenous catheters. There were limited studies on the choices and effects of different types of CVCs for chemotherapy. The aim of this study was to compare the complications, cost, and patients’ quality of life and satisfaction of three commonly used CVCs for chemotherapy, such as implanted venous port, peripherally inserted central catheters (PICCs), and external non-tunneled central venous catheters (NTCs). Methods A double-center prospective cohort study was carried out from March 2014 to December 2016. Catheterization situation, complications, catheter maintenance, cost, and patients’ quality of life and satisfaction were recorded, investigated, and analyzed. Forty-five ports, 60 PICCs and 40 NTCs were included. All the CVCs were followed up to catheter removal. Results There was no statistical difference in catheterization success rates between port and PICC. NTC had less success rate by one puncture compared with port. Ports had fewer complications compared with PICCs and NTCs. The complication rates of ports, PICCs and NTCs were 2.2%, 40%, and 27.5%, respectively. If the chemotherapy process was PICC and NTC. When the duration time was longer than 12 months, the cost of port had no difference with the cost of PICC. Quality of life and patients’ satisfaction of port group were significantly higher than the other two groups. Conclusion Although port catheterization costs more and needs professional medical staff and strict operational conditions, ports have fewer complications and higher quality of life and patients’ satisfaction than PICCs and NTCs. Therefore, not following consideration of the economic factor, we recommend port as a safe and an effective chemotherapy access for cancer patients, especially for whom needing long chemotherapy process. PMID:28744109

  3. Normal venous anatomy and physiology of the lower extremity.

    Science.gov (United States)

    Notowitz, L B

    1993-06-01

    Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

  4. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-06-15

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

  5. A case-control study of risk factors of chronic venous ulceration in patients with varicose veins.

    Science.gov (United States)

    Abelyan, Gohar; Abrahamyan, Lusine; Yenokyan, Gayane

    2018-02-01

    Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013-2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration. Results There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95-56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08-1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23-10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18-8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08-0.90; p = 0.034). Conclusion We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while

  6. Diffuse Venous Malformation of the Uterus in a Pregnant Woman with Klippel-Trénaunay Syndrome Diagnosed by DCE-MRI

    Directory of Open Access Journals (Sweden)

    Nana Yara

    2016-01-01

    Full Text Available Background. We experienced a rare case of a pregnant woman with Klippel-Trénaunay syndrome complicated with diffuse venous malformation of the uterus. This is the first report on the usefulness of dynamic contrast-enhanced-MRI for the diagnosis of diffuse venous malformation of the uterus. Case Presentation. A 23-year-old woman presented with convulsions and talipes equinus position of both lower limbs at 11 weeks of gestation. At 27 weeks, ultrasonography demonstrated tubular echolucent spaces throughout the myometrium. Dynamic MRI at 37 weeks revealed that the myometrial lesion was enhanced slowly and showed homogeneous enhancement even on a 10 min delayed image. Taken together with unilateral foot hypertrophy, varices, and port-wine stain, the patient was diagnosed as having Klippel-Trénaunay syndrome complicated with diffuse venous malformation of the pregnant uterus. The patient underwent elective cesarean section because of severe dystonia. The lower uterine segment was thickened and heavy venous blood flow was observed at the incision. Histological diagnosis of the myometrial biopsy specimen was venous malformation. Conclusions. Both diffuse venous malformation and Klippel-Trénaunay syndrome during pregnancy can involve considerable complications, in particular, massive bleeding during labor. Women who suffer from this syndrome should be advised about the risk of complications of pregnancy.

  7. Low level laser therapy (GaAlInP 660 nm) in healing of a chronic venous ulcer: a case study

    Science.gov (United States)

    Botaro, C. A.; Faria, L. A.; Oliveira, R. G.; Bruno, R. X.; Rocha, C. A. Q. C.; Paiva-Oliveira, E. L.

    2015-07-01

    The venous ulcer represents approximately 70% to 90% of inferior member ulcers, and the most common etiological factor is venous insufficiency, triggered by venous hypertension. Currently in Brazil there are several types of lasers used in physiotherapy, which benefit biological potential, emitting low power radiation, with anti-inflammatory, analgesic, healing and circulatory effects. This study aimed at the analysis of low level laser therapy effects (LLLT) on the process of tissue repair in chronic venous ulcers. We conducted a case study of a patient with a venous ulcer in the lateral region of the right inferior member. The patient underwent LLLT, which used a GaAlInP diode laser, with a wavelength of 660 nm and energy density of 4 J cm-2 applied punctually at the edges of the wound, with an average distance of 1 cm between the points with a pen-laser perpendicular wrapped in paper and a plastic wrap, keeping contact with the tissue. After four months of therapy and a total of 21 sessions, an improvement was noticeable in the gross appearance of the wound, but after a month and a half without therapy, the dimensions of the wound increased in length and width. Analyzing the results of this case study allows us to conclude that the LLLT GaAlInP (660 nm) with an energy density of 4 J cm-2, was not successful in the healing of venous ulcers.

  8. Low level laser therapy (GaAlInP 660 nm) in healing of a chronic venous ulcer: a case study

    International Nuclear Information System (INIS)

    Botaro, C A; Faria, L A; Oliveira, R G; Bruno, R X; Rocha, C A Q C; Paiva-Oliveira, E L

    2015-01-01

    The venous ulcer represents approximately 70% to 90% of inferior member ulcers, and the most common etiological factor is venous insufficiency, triggered by venous hypertension. Currently in Brazil there are several types of lasers used in physiotherapy, which benefit biological potential, emitting low power radiation, with anti-inflammatory, analgesic, healing and circulatory effects. This study aimed at the analysis of low level laser therapy effects (LLLT) on the process of tissue repair in chronic venous ulcers. We conducted a case study of a patient with a venous ulcer in the lateral region of the right inferior member. The patient underwent LLLT, which used a GaAlInP diode laser, with a wavelength of 660 nm and energy density of 4 J cm −2 applied punctually at the edges of the wound, with an average distance of 1 cm between the points with a pen-laser perpendicular wrapped in paper and a plastic wrap, keeping contact with the tissue. After four months of therapy and a total of 21 sessions, an improvement was noticeable in the gross appearance of the wound, but after a month and a half without therapy, the dimensions of the wound increased in length and width. Analyzing the results of this case study allows us to conclude that the LLLT GaAlInP (660 nm) with an energy density of 4 J cm −2 , was not successful in the healing of venous ulcers. (paper)

  9. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

    International Nuclear Information System (INIS)

    Torres, Carlos; Chakraborty, Santanu; Nguyen, Thanh; Thornhill, Rebecca; Lum, Cheemun; Hogan, Matthew; Freedman, Mark; Patro, Satya; Bussiere, Miguel; Dabirzadeh, Hamid; Schwarz, Betty Anne; Belanger, Stefanie; Legault-Kingstone, Lysa; Schweitzer, Mark

    2017-01-01

    To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. (orig.)

  10. Superficial vein ablation for the treatment of primary chronic venous ulcers.

    Science.gov (United States)

    Sufian, S; Lakhanpal, S; Marquez, J

    2011-10-01

    This retrospective study was undertaken to review our experience with ablation of superficial veins with significant reflux, using VNUS ClosureFAST RF (radiofrequency) or laser 980 nm, in patients with primary chronic venous ulcers, and also determine its effects in ulcer healing and ulcer recurrence. Included were 25 limbs (18 patients with chronic primary venous ulcers (clinical, aetiological, anatomical and pathological elements [CEAP] classification C6), who underwent endovenous ablation with RF for the axial veins or laser for the perforating veins during a two-year period. Of the 18 patients, there were eight men and 10 women. The median age of the group was 68 (range 37-89) years. The number of ablations done in each leg with an ulcer varied from one to eight, with a median of three. During a follow-up period of 6-12 months, one patient failed ulcer healing despite sequential ablations of refluxing veins. There was one case that developed recurrence of a small ulcer after six months and was successfully treated with a perforator ablation. Endovenous ablation of incompetent superficial veins improves the healing of chronic primary venous ulcers and decreases the recurrence rates.

  11. Multidetector Computed Tomography Evaluation of Mesenteric Venous Thrombosis Following Laparoscopic Bariatric Surgery.

    Science.gov (United States)

    Dane, Bari; Clark, Jaclyn; Megibow, Alec

    2017-01-01

    The purpose of this study is to review multidetector computed tomography (CT) imaging findings of mesenteric venous thrombosis occurring following bariatric surgery. To our knowledge, this complication has not been described in the radiologic literature. Multidetector CT examinations of 6 patients known to have developed mesenteric venous thrombosis after laparoscopic bariatric surgery were reviewed. The thrombus was characterized, and associated imaging findings including presence of mesenteric edema, small bowel edema, and thrombotic complications were described. Four patients underwent laparoscopic sleeve gastrectomy approximately 12 days before CT diagnosis of mesenteric thrombosis and 2 patients had a laparoscopic Roux-en-Y gastric bypass approximately 11 years before imaging diagnosis of mesenteric thrombosis.The thrombus occupied the entire length of the superior mesenteric vein in all cases. Extension into jejunal branches was present in 4 cases. The thrombus was completely occlusive in 4 of 6 patients. Mesenteric venous thrombosis is an increasingly recognized complication of laparoscopic bariatric surgery. Awareness demands that postbariatric surgery patients with acute abdominal pain be studied with intravenous contrast material.

  12. Establishment of mesenteric venous thrombosis in a porcine model using a transhepatic endovascular approach.

    Science.gov (United States)

    Kai, Liu; Jiaxiang, Meng; Xinxin, Fan; Baochen, Liu; Weiwei, Ding; Xingjiang, Wu; Shuofei, Yang; Jieshou, Li

    2015-12-01

    By using endovascular techniques, we set up an animal model of mesenteric venous thrombosis to avoid surgical laparotomy. Ten pigs underwent percutaneous transhepatic puncture to create animal model of acute superior mesenteric venous thrombosis. Experimental animals were injected with thrombin via indwelling catheter, while sham-operated animals with receiving physiological saline instead of thrombin. Animals were divided into three groups according to the time of thrombosis: the control (n=3, sham group), group A (n=3, 24h follow up) and group B (n=4, 72 h follow up). Blood samples were collected and tested at the baseline and end of the experiment from the systemic circulation (jugular vein). A pathologist, blinded to the performed interventions, graded the ischemic lesions. Nine pigs were successfully conducted MVT model, while one died of liver rupture during the experiment. White blood cell (WBC) count (group A: 18.77 ± 1.29, group B: 28.93 ± 3.13), D-dimer (group A: 8.30 ± 1.93, group B: 17.30 ± 2.48) and lactate dehydrogenase (LDH) (group A: 452.13 ± 53.14, group B: 753.97 ± 65.29) showed a rapid step-up between the experimental animals and control animals (Pmesenteric ischemia by statistical analysis (Pmesenteric venous thrombosis was feasible. Moreover, further animal studies are underway to evaluate the effectiveness and reproducibility of endovascular technique for MVT model. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  13. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Carlos; Chakraborty, Santanu; Nguyen, Thanh; Thornhill, Rebecca; Lum, Cheemun [University of Ottawa, Department of Radiology, Ottawa, ON (Canada); The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON (Canada); Ottawa Hospital Research Institute OHRI, Ottawa, ON (Canada); Hogan, Matthew; Freedman, Mark [Ottawa Hospital Research Institute OHRI, Ottawa, ON (Canada); University of Ottawa, Department of Medicine, Ottawa, ON (Canada); The Ottawa Hospital, Division of Neurology, Ottawa, ON (Canada); Patro, Satya [University of Ottawa, Department of Radiology, Ottawa, ON (Canada); The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON (Canada); Bussiere, Miguel [University of Alberta, Department of Medicine, Division of Neurology, Edmonton (Canada); Dabirzadeh, Hamid [University of Saskatchewan, Neuroradiologist, Department of Radiology, Saskatoon (Canada); Schwarz, Betty Anne; Belanger, Stefanie; Legault-Kingstone, Lysa [The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON (Canada); Schweitzer, Mark [Stony Brook School of Medicine, Department of Radiology, Stony Brook, NY (United States)

    2017-01-15

    To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. (orig.)

  14. Periodontal disease as a risk factor of recurrence of venous thromboembolic disease: a prospective study.

    Science.gov (United States)

    Sánchez-Siles, Mariano; Rosa-Salazar, Vladimir; Salazar-Sánchez, Noemi; Camacho-Alonso, Fabio

    2015-01-01

    In recent years, periodontal disease has been related to a large number of systemic disorders. To study the possible relationship between periodontal disease and high levels of D-dimer in a group of patients with venous thromboembolic disease. A study was made of 142 patients diagnosed with unprovoked venous thromboembolic disease. All patients underwent oral examination consecutively and randomly. Finally, two groups were obtained: (a) patients with periodontal disease (n = 71); and (b) patients without periodontal disease (n = 71). All patients were subjected to periodontal study, with evaluation of the number of teeth, bleeding index, gingival index, simplified oral hygiene index, community periodontal index of treatment needs, clinical attachment level, probe depth, number of pockets ≥4 mm, number of pockets ≥6 mm. The D-dimer values were evaluated in both groups. D-dimer values were higher in the study group than the control group, with statistically significant differences (p = 0.010). A relationship is observed between the presence of periodontal disease and high D-dimer levels. Patients with venous thromboembolic disease and periodontal disease could have more risk of a new thromboembolism episode.

  15. Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

    Directory of Open Access Journals (Sweden)

    Pooja Binnani

    2012-01-01

    Full Text Available The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete-riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

  16. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  17. Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures.

    Science.gov (United States)

    de Aquino, Marcello Simão; Haddad, Alessandra; Ferreira, Lydia Masako

    2013-06-01

    There are increasingly more patients seeking minimally invasive procedures, which have become more effective and safer in reducing the signs of facial aging. This study included 40 female adult patients who voluntarily underwent selected minimally invasive procedures (filling with hyaluronic acid and botulinum toxin injection) for facial rejuvenation. All patients were followed for a period of 6 months. They were evaluated with the use of questionnaires, a quality-of-life questionnaire (DLQI), the self-esteem scale of Rosenberg (EPM/Rosenberg), and a pain scale. The minimally invasive procedures resulted in improvement in quality of life and self-esteem, which were stronger the first 3 months after the procedures but remained at a higher level than that before treatment, even after 6 months. Hyaluronic acid with lidocaine in the formula is more comfortable for the patient as it makes the injection less painful. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  18. Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision.

    Science.gov (United States)

    Uzun, Hakan; Bitik, Ozan; Kamburoğlu, Haldun Onuralp; Dadaci, Mehmet; Çaliş, Mert; Öcal, Engin

    2015-06-01

    Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction. We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them. There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps. Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

  19. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  20. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

    Directory of Open Access Journals (Sweden)

    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  1. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria.

    Science.gov (United States)

    Osifo, O D; Osaigbovo, E O

    2008-06-01

    To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.

  2. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment.

    Science.gov (United States)

    Cheng, Ching-Yu; Stevenson, Eleanor Lowndes; Yang, Cheng-Ta; Liou, Shwu-Ru

    2018-04-28

    To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Cross-sectional, correlational study. Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants' levels of fertility-related stress and fertility-related quality of life. Descriptive statistics, correlation, and regression analysis were used. Overall, participants reported low levels of fertility-related stress and fertility-related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility-related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility-related quality of life. In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility-related stress. Social support and family consultation might be offered to improve women's fertility-related quality of life. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  3. Peripheral odontogenic myxoma

    Directory of Open Access Journals (Sweden)

    Sanober Tasnime

    2016-01-01

    Full Text Available Odontogenic myxomas are a rare benign odontogenic mesenchymal tumor found exclusively in the tooth-bearing area of the jaw and are usually located centrally in the mandible. Soft tissue localization is rarely seen and is classified as peripheral odontogenic myxoma (POM. POM is slow growing and less aggressive as compared to central myxoma. It has a low recurrence rate, comprises 3-6% of all odontogenic tumors. Only a few cases of POM on maxillary gingiva are reported in the literature. Here, we present an unusual case of primary POM occurring in the gingiva of anterior maxilla in a 14-year-old female patient.

  4. Peripheral odontogenic myxoma.

    Science.gov (United States)

    Tasnime, Sanober; Saxena, Chitrapriya; Bansal, Vishal; Wadhwan, Vijay

    2016-01-01

    Odontogenic myxomas are a rare benign odontogenic mesenchymal tumor found exclusively in the tooth-bearing area of the jaw and are usually located centrally in the mandible. Soft tissue localization is rarely seen and is classified as peripheral odontogenic myxoma (POM). POM is slow growing and less aggressive as compared to central myxoma. It has a low recurrence rate, comprises 3-6% of all odontogenic tumors. Only a few cases of POM on maxillary gingiva are reported in the literature. Here, we present an unusual case of primary POM occurring in the gingiva of anterior maxilla in a 14-year-old female patient.

  5. Daspsone Induced Peripheral Neuropathy

    Directory of Open Access Journals (Sweden)

    P A Sarojini

    1988-01-01

    Full Text Available A 24 year old lady being treated with 300 mg of dapsone daily for dermatitits herpetiformis, developed weakness and wasting of muscles of feet with claw hand deformity and t drop, 2 months tater. Neurological examination and nerve conduction studies conformed the presence of a peripheral motor neuropathy. Dapsone was discontinued and the patient was treated with cotrimatoxazole, gluten-free diet and supportive therapy. This satisfactorily controlled the dermatological lesion without adversely affecting the resolution of her neuropthy. Symptomatic improvement reported by the patient was confirmed by EMG and nerve conduction studies.

  6. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation.

    Science.gov (United States)

    Tzoran, Inna; Papadakis, Manolis; Brenner, Benjamin; Fidalgo, Ángeles; Rivas, Agustina; Wells, Philip S; Gavín, Olga; Adarraga, María Dolores; Moustafa, Farès; Monreal, Manuel

    2017-04-01

    Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism. Copyright © 2017. Published by Elsevier Inc.

  7. Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers.

    Science.gov (United States)

    Seren, Mustafa; Dumantepe, Mert; Fazliogullari, Osman; Kucukaksu, Suha

    2017-06-01

    Objective Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent perforating veins (IPVs) on ulcer recurrence rates in patients with progressive lipodermatosclerosis and impending ulceration. Methods Patients with nonhealing venous ulcers of >2 months' duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Endovenous laser ablation (EVLA) of perforating veins was performed on patients with CEAP 6 disease with increasing hyperpigmentation, lipodermatosclerosis, and/or progressive malleolar pain. A minimum of 2 months of compressive therapy was attempted before endovenous ablation of IPVs. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Results Forty ulcers with 46 associated IPVs were treated with EVLA in 36 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (85.7%), calf (10.7%), and lateral ankle (3.5%). Endovenous laser ablation was successful in 76% (35/46) with the first laser treatment of incompetent perforator veins and 15.2% (7/46) additional ablation procedures were performed. Of the 46 treated IPVs, 42 (91.3%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 162 joule. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. Conclusion Especially in the case of liposclerotic or ulcerated skin in the affected region, PAP of IPVs is highly effective, safe, and appears to be feasible. Patients with active venous ulcers appear to benefit from EVLA of incompetent perforators in order to reduce the risk of ulcer recurrence.

  8. Malposition and complications following venous catheterization

    International Nuclear Information System (INIS)

    Maffesanti, M.; Bortolotto, P.; Kette, F.

    1988-01-01

    Malposition and complications following central venous catheterization largely depend on the site of venous approach. Malpositions are very common after subclavian vein catheterization, and even more common after left jugular vein catheterization. On the contrary, their incidence after right jugular puncture is very low. Among complications, pneumothorax is quate common after subclavian vein catheterization, and migration of the catheter towards the heart after right jugular puncture. Vascular damages may occur in any approach: their early detection on chest radiographs very much depends on a rigorous technique. Radiology plays an important role in the early detection of malposition and complications, which is greatly facilitated by a few ml of contrast medium injected through the catheter

  9. Cerebral Venous Thrombosis Presenting with Subracnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Esra Eruyar

    2015-08-01

    Full Text Available Subarachnoid hemorrhage (SAH associated with cerebral venous thrombosis (CVT is rarely reported. In our case, the initial CT shows with suspected lesions that SAH. After the initial diagnosis of SVT with history and neurological examination findings MRV taken and consistend with thrombus signal change. Dural sinus thrombosis with secondary venous hypertension may lead to SAH into the subarachnoid space due to the rupture of fragile, thin-walled cortical veins. Patients with non-traumatic, non-aneurysmal and non-perimesencephalic subaracnoid hemorrhage tend to have clots circumscribed along the cortical convexity, a condition referred as acute cortical SAH. CVT is a potential cause of cortical SAH. This case; SAH may be the first sign of SVT and especially SVT must do in etiologic research without the involvement of the basal sisterna in cases of SAH.

  10. Endovascular treatment for intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Zhang Qiang; Li Shenmao; Ji Xunming; Miao Zhongrong; Zhu Fengshui; Zhi Xinglong; Ling Feng

    2007-01-01

    Objective: To evaluate the efficacy and risk of endovascular treatment for intracranial venous sinus thrombosis. Methods: Twenty seven patients with intracranial venous sinus thrombosis confirmed by CT, MRI, MRV and/or DSA, from 2004 September to 2006 September, were treated with anticoagulant therapy but without response and then followed by multiple modalities including endovascular treatment. Nineteen of them accepted intravenous thrombolysis and mechanical thrombus maceration, another 5 accepted intravenous thrombolysis, mechanical thrombus maceration and intraarterial thrombolysis and the last 3 with stenting. Results: After thrombolysis, symptoms and signs of 23 patients improved obviously and headache disappeared in 18 of them, but with only mild degree in other 5 and no improvement in 3. Twenty one patients among them achieved recanalization of sinuses completely as confirmed on postprocedural angiography, MRI and MRV studies taken prior to hospital discharge and other 3 achieved recanalization of sinuses partly. Conclusion: Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis. (authors)

  11. VENOUS MALFORMATION OF THE SPONGY BODY OF THE URETHRA

    Directory of Open Access Journals (Sweden)

    O. B. Zhukov

    2017-01-01

    Full Text Available The article presents a rare clinical experience of observation and treatment of 3 patients (2 children and 1 adult with venous malformation (VM of the glans penis. In 2 patients (2 and 15 years this penile disease was asymptomatic, but there was a tendency to increase head formations with age. A 20-year-old boy had episodic bleeding from the urethra during sexual activity and spontaneous erections. All patients underwent a comprehensive clinical urological examination, including ultrasound with dopplerography of the kidneys and bladder, prostate, common iliac veins, scrotum organs, penis, as well as magnetic resonance imaging of the pelvic organs with contrasting, angiography, ureterocystoscopy, and cavernosography. As a method of treatment for all patients, the use of percutaneous sclerosis of VM with a solution of bleomycin was chosen. Patients aged 2 and 15 years were injected with bleomycin twice, a patient at the age of 20 years – single. All patients were discharged home on the 3rd day after sclerosing in a satisfactory condition. At follow-up examination it was found that VM in patients 2 and 15 years was completely eliminated by the results of clinical examination, ultrasound and magnetic resonance imaging. In a patient of 20 years after 3 months of observation recorded a decrease in VM.

  12. Cerebral Venous Thrombosis and Headache--A Case-Series.

    Science.gov (United States)

    Sparaco, Marco; Feleppa, Michele; Bigal, Marcelo E

    2015-06-01

    Headache happens in the majority of patients with Cerebral Venous Thrombosis (CVT) being sometimes the sole manifestation of the disease. Herein we report a case-series of CVT, focusing on headache characteristics. Etiological, clinical, and radiological features of 25 consecutive adult patients with CVT were compiled from August 2005 to December 2013. Diagnosis of CVT was confirmed by brain magnetic resonance imaging and magnetic resonance venography. All patients underwent extensive systematic etiological and genetic work-up at admission. A structured questionnaire about the characteristics of headache was responded by all participants. Headache was reported by 23 out of 25 (92%) of participants, being by far the most frequent symptom. It was the sole manifestation in nearly one third of the patients (8/25, 32.0%). Headache was typically severe (19/23, 82.6%) and throbbing (16/23, 69.5%), with sudden onset (13/23, 56.5%) and non-remitting (20/23, 86.9%) characteristics. The sinus most frequently involved was the transverse sinus (24/25, 96.0%), either alone or in association with other sinuses. Headache is the most frequent symptom and sometimes the sole presentation of CVT. © 2015 American Headache Society.

  13. The venous system of the pelvis: new nomenclature.

    Science.gov (United States)

    Kachlik, D; Pechacek, V; Musil, V; Baca, V

    2010-08-01

    The clinical venous anatomy of the pelvis and its veins featured a break-through during the past few years. Not only the diagnostic and therapeutical methods but also the knowledge of the functional anatomy and nomenclatures of the veins underwent substantial changes. Eleven years ago, the most recent revision of the Latin anatomical nomenclature, Terminologia Anatomica (TA, 1998) was issued. In 2004, during the 21st World Congress of the International Union of Angiology, a consensus document (under the auspices of Federative International Committee on Anatomical Terminology and International Federation of Associations of Anatomists), reflecting phlebologists' requests for new terms and replacing several insufficient ones, was accepted. Six new terms were added in both Latin and English languages in the chapter concerning the veins of the pelvis. Eponyms are not considered equal synonyms and moreover only one of them was recommended for general use. Detailed anatomy of the veins of the pelvis is discussed. This consensus document will be incorporated in the next version of the Teminologia Anatomica.

  14. Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy.

    Science.gov (United States)

    Algattas, Hanna; Kimmell, Kristopher T; Vates, G Edward; Jahromi, Babak S

    2015-11-01

    Craniotomy poses a risk for postoperative venous thromboembolism (VTE), but the utility of anticoagulation in this patient population is unclear. We sought to identify risk factors predictive of VTE in patients undergoing craniotomy. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was reviewed for patients undergoing craniotomy. Clinical factors provided by the database were analyzed for association with VTE. A total of 10,477 adult patients who underwent craniotomy from 2011-2012 were identified. The rate of VTE was 3.2% (pulmonary embolism [PE] was 1.3%; deep vein thrombosis [DVT] was 2.4%). Several factors were significant in univariate analysis, and a subset persisted after multivariate analysis. Patients were assigned a risk score on the basis of the presence of those variables. Higher risk scores were predictive of VTE risk, as well as increasing time from surgery to discharge and mortality. A receiver operating characteristics curve revealed a significant area under the curve (0.719) for scores being predictive of VTE risk. The model was validated against our similar analysis of 2006-2010 NSQIP data and demonstrated comparable findings. The risk of postoperative VTE after craniotomy can be quantified by a simple risk score, with increasing risk factors conferring increased risk of VTE. On the basis of risk scoring, a subset of patients who would benefit from anticoagulation post craniotomy may be identified. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Ultrasound-guided central venous catheterization in prone position

    Directory of Open Access Journals (Sweden)

    Sofi Khalid

    2010-01-01

    Full Text Available Central venous catheterization (CVC is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV, which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique.

  16. The controversy on chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Paolo Zamboni

    2013-08-01

    Full Text Available The objective of this review is to analyze the actual scientific controversy on chronic cerebrospinal venous insufficiency (CCSVI and its association with both neurodegenerative disorders and multiple sclerosis (MS. We revised all published studies on prevalence of CCSVI in MS patients, including ultrasound and catheter venography series. Furthermore, we take into consideration other publications dealing with the pathophysiologic consequences of CCSVI in the brain, as well as ecent data characterizing the pathology of the venous wall in course of CCSVI. Finally, safety and pilot data on effectiveness of endovascular CCSVI treatment were further updated. Studies of prevalence show a big variability in prevalence of CCSVI in MS patients assessed by established ultrasonographic criteria. This could be related to high operator dependency of ultrasound. However, 12 studies, by the means of more objective catheter venography, show a prevalence >90% of CCSVI in MS. Global hypo-hypoperfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies and histology corroborate the 2009 International Union of Phlebology (UIP Consensus decision to insert CCSVI among venous malformations. Finally, safety of balloon angioplasty of the extracranial veins was certainly demonstrated, while prospective data on the potential effectiveness of endovascular treatment of CCSVI support to increase the level of evidence by proceeding with a randomized control trial (RCT. Taking into account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion and cerebro-spinal fluid flow, we conclude that CCSVI can be definitively inserted among the medical entities. Research is still inconclusive in elucidating the CCSVI role in the pathogenesis of neurological disorders. The controversy between the vascular and the

  17. Parenchymal abnormalities associated with developmental venous anomalies

    Energy Technology Data Exchange (ETDEWEB)

    San Millan Ruiz, Diego; Gailloud, Philippe [Johns Hopkins Hospital, Division of Interventional Neuroradiology, Baltimore, MD (United States); Delavelle, Jacqueline [Geneva University Hospital, Neuroradiology Section, Department of Radiology and Medical Informatics, Geneva (Switzerland); Yilmaz, Hasan; Ruefenacht, Daniel A. [Geneva University Hospital, Section of Interventional Neuroradiology, Department of Clinical Neurosciences, Geneva (Switzerland); Piovan, Enrico; Bertramello, Alberto; Pizzini, Francesca [Verona City Hospital, Service of Neuroradiology, Verona (Italy)

    2007-12-15

    To report a retrospective series of 84 cerebral developmental venous anomalies (DVAs), focusing on associated parenchymal abnormalities within the drainage territory of the DVA. DVAs were identified during routine diagnostic radiological work-up based on magnetic resonance imaging (MRI) (60 cases), computed tomography (CT) (62 cases) or both (36 cases). Regional parenchymal modifications within the drainage territory of the DVA, such as cortical or subcortical atrophy, white matter density or signal alterations, dystrophic calcifications, presence of haemorrhage or a cavernous-like vascular malformation (CVM), were noted. A stenosis of the collecting vein of the DVA was also sought for. Brain abnormalities within the drainage territory of a DVA were encountered in 65.4% of the cases. Locoregional brain atrophy occurred in 29.7% of the cases, followed by white matter lesions in 28.3% of MRI investigations and 19.3% of CT investigations, CVMs in 13.3% of MRI investigations and dystrophic calcification in 9.6% of CT investigations. An intracranial haemorrhage possibly related to a DVA occurred in 2.4% cases, and a stenosis on the collecting vein was documented in 13.1% of cases. Parenchymal abnormalities were identified for all DVA sizes. Brain parenchymal abnormalities were associated with DVAs in close to two thirds of the cases evaluated. These abnormalities are thought to occur secondarily, likely during post-natal life, as a result of chronic venous hypertension. Outflow obstruction, progressive thickening of the walls of the DVA and their morphological organization into a venous convergence zone are thought to contribute to the development of venous hypertension in DVA. (orig.)

  18. Congenital pseudoarthrosis associated with venous malformation

    International Nuclear Information System (INIS)

    Al-Hadidy, A.; Haroun, A.; Al-Ryalat, N.; Hamamy, H.; Al-Hadidi, S.

    2007-01-01

    Congenital pseudoarthrosis is a pathologic entity that may be isolated, or may be associated with neurofibromatosis. We report the case of a 3-year-old female with congenital pseudoarthrosis involving the right tibia and fibula. Magnetic resonance imaging (MRI) and complementary magnetic resonance angiogram (MRA) revealed a lobulated mass with vivid enhancement, which led to the diagnosis of venous malformation. This is the first report of congenital pseudoarthrosis caused by the presence of a vascular malformation. (orig.)

  19. Congenital pseudoarthrosis associated with venous malformation

    Energy Technology Data Exchange (ETDEWEB)

    Al-Hadidy, A.; Haroun, A.; Al-Ryalat, N. [Jordan University Hospital, Radiology Department, P.O. Box 340621, Amman (Jordan); Hamamy, H. [Endocrinology and Genetics, National Center for Diabetes, Amman (Jordan); Al-Hadidi, S. [Jordan University Hospital, Departments of Orthopedics, Amman (Jordan)

    2007-06-15

    Congenital pseudoarthrosis is a pathologic entity that may be isolated, or may be associated with neurofibromatosis. We report the case of a 3-year-old female with congenital pseudoarthrosis involving the right tibia and fibula. Magnetic resonance imaging (MRI) and complementary magnetic resonance angiogram (MRA) revealed a lobulated mass with vivid enhancement, which led to the diagnosis of venous malformation. This is the first report of congenital pseudoarthrosis caused by the presence of a vascular malformation. (orig.)

  20. Mesenteric venous thrombosis: multidisciplinary therapeutic approach

    Directory of Open Access Journals (Sweden)

    Stefano Pieri

    2007-08-01

    Full Text Available Mesenteric venous thrombosis is a particular form of intestinal ischemia related to high mortality. The lack of a characteristic clinical picture often leads to a difficult diagnostic and therapeutic classification. We report the case of a young woman, using estrogenic and progestinic oral therapy, affected by a severe form of mesenteric thrombosis and complicated by segmental post ischemic stenosis of small intestine.

  1. Effect of Hypoxia and Bedrest on Peripheral Vasoconstriction

    Science.gov (United States)

    McDonnell, Adam C.; Mekjavic, Igor B.; Dolenc-Groselj, Leja; Jaki Mekjavic, Polona; Eiken, Ola

    2013-02-01

    Future planetary habitats may expose astronauts to both microgravity and hypobaric hypoxia, both inducing a reduction in peripheral perfusion. Peripheral temperature changes have been linked to sleep onset and quality [5]. However, it is still unknown what effect combining hypoxia and bedrest has on this relationship. Eleven male participants underwent three 10-day campaigns in a randomized manner: 1) normobaric hypoxic ambulatory confinement (HAmb); 2) normobaric hypoxic bed rest (HBR); 3) normobaric normoxic bed rest (NBR). There was no change in skin temperature gradient between the calf and toes, an index of peripheral perfusion (Δ Tc-t), over the 10-d period in the HAmb trial. However, there was a significant increase (psleep onset and/or architecture. These data support the theory that circadian changes in temperature are functionally linked to sleepiness [1].

  2. Developmental venous anomaly in the newborn brain

    International Nuclear Information System (INIS)

    Horsch, S.; Govaert, P.; Cowan, F.M.; Benders, M.J.N.L.; Groenendaal, F.; Vries, L.S. de; Lequin, M.H.; Saliou, G.

    2014-01-01

    Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age. (orig.)

  3. Developmental venous anomaly in the newborn brain

    Energy Technology Data Exchange (ETDEWEB)

    Horsch, S. [Erasmus MC-Sophia Children' s Hospital, Department of Neonatology, Rotterdam (Netherlands); Helios Klinikum Berlin-Buch, Department of Neonatology, Berlin (Germany); Govaert, P. [Erasmus MC-Sophia Children' s Hospital, Department of Neonatology, Rotterdam (Netherlands); Cowan, F.M. [Hammersmith Hospital, Department of Paediatrics, Imperial College Healthcare NHS Trust, London (United Kingdom); Benders, M.J.N.L.; Groenendaal, F.; Vries, L.S. de [University Medical Centre Utrecht, Wilhelmina Children' s Hospital, Department of Neonatology, Utrecht (Netherlands); Lequin, M.H. [Erasmus MC/Sophia Children' s Hospital, Department of Paediatric Radiology, Rotterdam (Netherlands); Saliou, G. [University Hospital, Department of Neuroradiology, Le Kremlin-Bicetre (France)

    2014-07-15

    Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age. (orig.)

  4. Developmental venous anomaly in the newborn brain.

    Science.gov (United States)

    Horsch, S; Govaert, P; Cowan, F M; Benders, M J N L; Groenendaal, F; Lequin, M H; Saliou, G; de Vries, L S

    2014-07-01

    Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age.

  5. Can developmental venous anomalies cause seizures?

    Science.gov (United States)

    Dussaule, Claire; Masnou, Pascal; Nasser, Ghaïdaa; Archambaud, Frédérique; Cauquil-Michon, Cécile; Gagnepain, Jean-Paul; Bouilleret, Viviane; Denier, Christian

    2017-12-01

    Developmental venous anomalies (DVAs) are congenital anatomical variants of normal venous drainage of normal brain. Although DVAs are often discovered on the occasion of a seizure, their involvement in epilepsy is poorly studied. Our objective was to determine whether DVA can cause seizures, in the cases where there is no associated lesion, including no cavernoma or dysplasia. Based on clinical history, cerebral MRI, EEG recording, and 18 F-FDG PET, we report 4 patients with DVA revealed by seizures. The first patient had a convulsive seizure caused by a hemorrhagic infarction due to thrombosis of her DVA. The second patient had a left temporo-parietal DVA next to a nonspecific lesion, possibly a sequelae of a venous infarction. The last two patients disclosed an isolated and uncomplicated DVA with a concordant epileptic focus confirmed on ictal video EEG recording. We reviewed literature and identified 21 other published cases of seizures caused by complications of a DVA and 9 patients that may have a direct link between epilepsy and an isolated and uncomplicated DVA. Seizures are linked to a DVA in two main situations: presence of an associated epileptogenic lesion, such as cavernoma or dysplasia, and occurrence of a complication of the DVA. Before concluding that a seizure is caused by a DVA, it is essential to perform full MRI protocols to search them. It remains rare and uncertain that isolated and uncomplicated DVA can cause seizures. In this last situation, physiopathological processes are probably different in each patient.

  6. Venous Thromboembolism Incidence After Craniofacial Surgery.

    Science.gov (United States)

    Omesiete, Wilson I; Walker, James A; Yu, Jack C

    2018-05-01

    Current protocols for venous thromboembolism (VTE) prophylaxis after craniofacial surgery (CFS) vary widely with substantial disagreements in both indications and managements. An evidence-based approach to this issue requires the following: the incidence of postoperative VTE, comorbidities associated with coagulopathy, risk reduction after VTE prophylaxis, and complications attributable to prophylaxis. This study addresses the first two. Retrospective cross-sectional study. Discharge data from 64,170 patients undergoing CFS between 2008 and 2013 extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were analyzed. The outcome measures extracted were: deep venous thrombosis, pulmonary embolism, demographic data, common comorbidities, length of stay, total cost, and discharge outcome. Diagnoses of deep venous thrombosis or pulmonary embolism, collectively classified as VTE, were observed in 355 (0.55%) of 64,170 patients discharged after CFS. Other surgeries exhibited a VTE rate of 1.17%. Men exhibited nearly double the incidence of VTE relative to women (0.69% compared with 0.37% respectively, P use did not exhibit any significant association (odds ratio, 0.94; P = 0.679). Afflicted patients experienced 4.60 times longer hospital stays averaging 23.8 days (95% confidence interval, 21.4-26.2; P use of VTE chemoprophylaxis is appropriate.

  7. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction.

    Science.gov (United States)

    Tazuke, Yuko; Okuyama, Hiroomi; Uehara, Shuichiro; Ueno, Takehisa; Nara, Keigo; Yamanaka, Hiroaki; Kawahara, Hisayoshi; Kubota, Akio; Usui, Noriaki; Soh, Hideki; Nomura, Motonari; Oue, Takaharu; Sasaki, Takashi; Nose, Satoko; Saka, Ryuta

    2015-12-01

    The aim of this study was to evaluate the long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal/alimentary reconstruction. We reviewed the medical records of four long-term survivors of tracheal agenesis and collected the following data: age, sex, type of tracheal agenesis, method of reconstruction, nutritional management, and physical and neurological development. The patients consisted of three boys and one girl, who ranged in age from 77 to 109months. The severity of their condition was classified as Floyd's type I (n=2), II (n=1), or III (n=1). Mechanical respiratory support was not necessary in any of the cases. Esophageal/alimentary reconstruction was performed using the small intestine (n=2), a gastric tube (n=1), and the esophagus (n=1). The age at esophageal reconstruction ranged from 41 to 55months. All of the cases required enteral nutrition via gastrostomy. Three of the patients were able to swallow a small amount of liquid and one was able to take pureed food orally. The physical development of the subjects was moderately delayed-borderline in childhood. Neurological development was normal in two cases and slightly delayed in two cases. None of the long-term survivors of tracheal agenesis required the use of an artificial respirator, and their development was close to normal. Future studies should aim to elucidate the optimal method for performing esophageal reconstruction to allow tracheal agenesis patients to achieve their full oral intake. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis.

    Science.gov (United States)

    de Campos, José Ribas Milanez; Lembrança, Lucas; Fukuda, Juliana Maria; Kauffman, Paulo; Teivelis, Marcelo Passos; Puech-Leão, Pedro; Wolosker, Nelson

    2017-11-01

    Video thoracoscopic sympathectomy is the recommended surgical treatment for primary hyperhidrosis and has a high success rate. Despite this high success rate, some patients are unresponsive and eventually need a resympathectomy. Few studies have previously analysed exclusively the results of these resympathectomies in patients with primary hyperhidrosis. None of the studies have objectively evaluated the degree of response to surgery or the improvement in quality of life after resympathectomies. This is a retrospective study, evaluating 15 patients from an initial group of 2300 patients who underwent resympathectomy after failure of the primary surgical treatment. We evaluated sympathectomy levels of resection, technical difficulties, surgical complications preoperative quality of life, response to treatment and quality-of-life improvement 30 days after each surgery. Regarding gender, 11 (73.3%) patients were women. The average age was 23.2 with SD of 5.17 years, and the mean body mass index was 20.9 (SD 2.12). Ten patients had major complaints about their hands (66%) and 5 (33%) patients about their forearms. A high degree of response to sympathectomy occurred in 73% of patients. In 11 of these patients, the improvement in quality of life was considered high, 3 showed a mild improvement and 1 did not improve. No major complications occurred; the presence of adhesions was reported in 11 patients and pleural drainage was necessary in 4 patients. Resympathectomy is an effective procedure, and it improves the quality of life in patients with primary hyperhidrosis who failed after the first surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  10. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair.

    Science.gov (United States)

    Li, Shoujun; Ma, Kai; Hu, Shengshou; Hua, Zhongdong; Yang, Keming; Yan, Jun; Chen, Qiuming

    2014-09-01

    The study objective was to report the outcomes of biventricular repair in patients with double outlet right ventricle. Patients with double outlet right ventricle who underwent biventricular repair at Fuwai Hospital from January 2005 to December 2012 were included. Patients were excluded if double outlet right ventricle was combined with atrioventricular septal defect, heterotaxy syndrome, atrioventricular discordance, or univentricular physiology. A total of 380 consecutive patients with a mean age of 1.9 ± 2.1 years (range, 1 month to 6 years) were included. Varied types of biventricular repair were customized individually. Follow-up was 90.4% complete, and the mean follow-up time was 3.4 ± 3.9 years. There were 17 (4.5%) early deaths and 7 (2.1%) late deaths. Preoperative pulmonary hypertension was the only risk factor for early mortality. Postoperative significant left ventricular outflow tract obstruction was present in 9 survivors. Patients with noncommitted ventricular septal defect had a longer crossclamp time, longer cardiopulmonary bypass time, and higher incidence of postdischarge left ventricular outflow tract obstruction. There were 4 reoperations, all of which were caused by subaortic left ventricular outflow tract obstruction. All of the pressure gradients were decreased to less than 20 mm Hg after the modified Konno procedure with an uneventful postoperative course. Optimal results of varied types of biventricular repair for double outlet right ventricle have been acquired. Although noncommitted ventricular septal defect is technically difficult, the outcomes of patients are favorable. Late-onset left ventricular outflow tract obstruction is the main reason for reoperation but can be successfully relieved by the modified Konno procedure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  11. Newly Developed Sarcopenia as a Prognostic Factor for Survival in Patients who Underwent Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Ja Young Jeon

    Full Text Available The relationship between a perioperative change in sarcopenic status and clinical outcome of liver transplantation (LT is unknown. We investigated whether post-LT sarcopenia and changes in sarcopenic status were associated with the survival of patients.This retrospective study was based on a cohort of 145 patients from a single transplant center who during a mean of 1 year after LT underwent computed tomography imaging evaluation. The cross-sectional area of the psoas muscle of LT patients was compared with that of age- and sex-matched healthy individuals. The Cox proportional hazards regression model was used to determine whether post-LT sarcopenia and changes in sarcopenic status affect post-LT survival.The mean age at LT of the 116 male and 29 female patients was 50.2 ± 7.9 years; the mean follow-up duration was 51.6 ± 32.9 months. All pre-LT patients with sarcopenia still had sarcopenia 1 year after LT; 14 (15% patients had newly developed sarcopenia. The mean survival duration was 91.8 ± 4.2 months for non-sarcopenic patients and 80.0 ± 5.2 months for sarcopenic patients (log-rank test, p = 0.069. In subgroup analysis, newly developed sarcopenia was an independent negative predictor for post-LT survival (hazard ratio: 10.53, 95% confidence interval: 1.37-80.93, p = 0.024.Sarcopenia in LT recipients did not improve in any of the previously sarcopenic patients and newly developed within 1 year in others. Newly developed sarcopenia was associated with increased mortality. Newly developed sarcopenia can be used to stratify patients with regard to the risk of post-LT mortality.

  12. [Autonomic peripheral neuropathy].

    Science.gov (United States)

    Adams, David; Cauquil, Cecile; Lozeron, Pierre

    2012-11-01

    The mechanisms of dysautonomic disturbances are varied and mostly acquired. They can result from lesions of sympathetic or parasympathetic vegetative fibers located in the peripheral contingent, or in the somatic contingent by demyelination or axonal loss; or more rarely by cellular bodies in the sympathetic or parasympathetic ganglia. Several chronic peripheral neuropathies can be associated with dysautonomia. Only some causes need to be known because they can be clinically significant. Dysautonomia may be seen during chronic acquired neuropathies but also acute or subacute ones. The most frequent cause in the world is the dysautonomia of the diabetes; it affects all the systems; the cardiovascular dysfunction has an impact on the prognosis for survival when it is severe. Hereditary autonomic neuropathies are rare; they can declare themselves very early during the Riley-Day syndrome or very late during amyloid polyneuropathies due to transthyretin gene mutation. The diagnosis can be confirmed by molecular biology. The dysautonomia is frequent and often severe. These neuropathies justify symptomatic treatment to improve quality of life. For some of them, a specific treatment can be proposed to treat the causal affection to try to stop the progression of the disease. Copyright © 2012. Published by Elsevier Masson SAS.

  13. Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

    Science.gov (United States)

    Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

    2016-05-01

    To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

  14. Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia

    Directory of Open Access Journals (Sweden)

    José Luiz Orlando

    2010-01-01

    Full Text Available INTRODUCTION: Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE: To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS: Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty-nine were female (74.4% and 10 were male (25.6%, with ages ranging from 11 to 59 years (median of 24 years. All of the lesions affected limbs, and the main symptom reported was pain (97.4%. Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients; medium, between 3 and 15 cm (27 patients; and large, greater than 15 cm (8 patients. RESULTS: The symptoms completely disappeared in 14 patients (35.9% and improved in 24 (61.5%. The lesion size reduced to zero in 6 patients (15.4% and decreased in 32 (82%. The median number of sessions was 7. There were no complications in 32 patients (82%, while 3 presented local paresthesia (7.7%, 2 superficial trombophlebites (5.1%, 1 skin ulcer (2.6%, and 1 case of hyperpigmentation (2.6%. CONCLUSION: Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate.

  15. Imaging findings and therapeutic alternatives for peripheral vascular malformations

    International Nuclear Information System (INIS)

    Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Santos, Daniela dos; Abud, Thiago Giansante; Abud, Daniel Giansante

    2010-01-01

    Peripheral vascular malformations represent a spectrum of lesions that appear through the lifetime and can be found in the whole body. Such lesions are uncommon and are frequently confounded with infantile hemangioma, a common benign neoplastic lesion. In the presence of such lesions, the correlation between the clinical and radiological findings is extremely important to achieve a correct diagnosis, which will guide the best therapeutic approach. The most recent classifications for peripheral vascular malformations are based on the blood flow (low or high) and on the main vascular components (arterial, capillary, lymphatic or venous). Peripheral vascular malformations represent a diagnostic and therapeutic challenge, and complementary methods such as computed tomography, Doppler ultrasonography and magnetic resonance imaging, in association with clinical findings can provide information regarding blood flow characteristics and lesions extent. Arteriography and venography confirm the diagnosis, evaluate the lesions extent and guide the therapeutic decision making. Generally, low flow vascular malformations are percutaneously treated with sclerosing agents injection, while in high flow lesions the approach is endovascular, with permanent liquid or solid embolization agents. (author)

  16. Compression for preventing recurrence of venous ulcers.

    Science.gov (United States)

    Nelson, E Andrea; Bell-Syer, Sally E M

    2014-09-09

    Up to 1% of adults will have a leg ulcer at some time. The majority of leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or weakness of the valves in the veins of the leg. Prevention and treatment of venous ulcers is aimed at reducing the pressure either by removing/repairing the veins, or by applying compression bandages/stockings to reduce the pressure in the veins.The majority of venous ulcers heal with compression bandages, however ulcers frequently recur. Clinical guidelines therefore recommend that people continue to wear compression, usually in the form of hosiery (tights, stockings, socks) after their ulcer heals, to prevent recurrence. To assess the effects of compression (socks, stockings, tights, bandages) in preventing the recurrence of venous ulcers. If compression does prevent ulceration compared with no compression, then to identify whether there is evidence to recommend particular levels of compression (high, medium or low, for example), types of compression, or brands of compression to prevent ulcer recurrence after healing. For this second update we searched The Cochrane Wounds Group Specialised Register (searched 4 September 2014) which includes the results of regular searches of MEDLINE, EMBASE and CINAHL; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8). Randomised controlled trials (RCTs)evaluating compression bandages or hosiery for preventing the recurrence of venous ulcers. Two review authors undertook data extraction and risk of bias assessment independently. Four trials (979 participants) were eligible for inclusion in this review. One trial in patients with recently healed venous ulcers (n = 153) compared recurrence rates with and without compression and found that compression significantly reduced ulcer recurrence at six months (Risk ratio (RR) 0.46, 95% CI 0.27 to 0.76).Two trials compared high-compression hosiery (equivalent to UK class 3) with

  17. Epidemiology of the contraceptive pill and venous thromboembolism.

    Science.gov (United States)

    Hannaford, Philip C

    2011-02-01

    Current users of combined oral contraceptives have an increased risk of venous thromboembolism. The risk appears to be higher during the first year of use and disappears rapidly once oral contraception is stopped. There is a strong interaction between hereditary defects of coagulation, combined oral contraceptive use and venous thromboembolism. Nevertheless, the routine screening of women before they use combined oral contraception is not recommended. Venous thromboembolism seems to be higher in overweight users, and after air, and possibly other forms of, travel. Both the oestrogen and progestogen content of combined oral contraceptives have been implicated in differences in venous thrombotic risk between products. Even if real, the absolute difference in risk between products is small, because the background incidence of venous thromboembolism in young women is low. All currently available combined oral contraceptives are safe. Progestogen-only oral contraceptives are not associated with an increased risk of venous thromboembolism. © 2011 Elsevier Ltd. All rights reserved.

  18. Complement C3 and High Risk of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Nørgaard, Ina; Nielsen, Sune Fallgaard; Nordestgaard, Børge Grønne

    2016-01-01

    BACKGROUND: Complement activation may contribute to venous thromboembolism, including deep venous thrombosis and pulmonary embolism. We tested the hypothesis that high complement C3 concentrations are associated with high risk of venous thromboembolism in the general population. METHODS: We...... included 80 517 individuals without venous thromboembolism from the Copenhagen General Population Study recruited in 2003-2012. Plasma complement C3 concentrations were measured at baseline, and venous thromboembolism (n = 1176) was ascertained through April 2013 in nationwide registries. No individuals...... were lost to follow-up. RESULTS: Complement C3 concentrations were approximately normally distributed, with a mean value of 1.13 g/L (interquartile range 0.98-1.26; SD 0.21). The cumulative incidence of venous thromboembolism was higher with progressively higher tertiles of complement C3 (log...

  19. Surgical treatment of peripheral artery aneurysms.

    Science.gov (United States)

    Bahcivan, Muzaffer; Keceligil, H Tahsin; Kolbakir, Fersat; Gol, M Kamil

    2010-01-01

    Peripheral arterial aneurysms (PAA) may rupture, cause emboli and ischemia, and local symptoms due to compression. A total of 109 patients who underwent surgery for PAA were analyzed retrospectively, including clinical presentation, surgical procedures used, and postoperative follow-up data obtained 10 days after discharge. True aneurysm was present in 59 (54.1%) patients and pseudoaneurysm in 50 (45.9%). The femoral artery was the most common location. The surgical procedures used were as follows: graft interposition in 31 patients, bypass with synthetic or autologous grafts in 33 patients, aneurysm ligation in 5 patients, primary repair in 41 patients, and patch angioplasty reconstruction in 7 patients. One patient died as a result of massive hemorrhage. In four patients, amputation had to be performed. It is possible to prevent amputation and other complications, including mortality, during the surgical treatment of symptomatic and asymptomatic PAA.

  20. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    Science.gov (United States)

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  1. Combined arterial and venous whole-body MR angiography with cardiac MR imaging in patients with thromboembolic disease - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, Florian M.; Hunold, Peter; Barkhausen, Joerg [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Herborn, Christoph U. [University Hospital Hamburg-Eppendorf, Medical Prevention Center Hamburg (MPCH) at University Hospital Hamburg-Eppendorf, Hamburg (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Kroger, Knut [University Hospital Essen, Department of Angiology, Essen (Germany)

    2008-05-15

    The objective was to assess the feasibility of a combined arterial and venous whole-body three-dimensional magnetic resonance (MR) angiography, together with a cardiac MR examination, in patients with arterial thromboembolism. Ten patients with arterial thromboembolism underwent a contrast-enhanced whole-body MR examination of the arterial and venous vessels, followed by a cardiac MR examination on a separate occasion within 24 h. All examinations were performed on a 1.5-T MR scanner. For both arterial and venous MR angiography only one injection of contrast agent was necessary. The cardiac imaging protocol included dark-blood-prepared half-Fourier acquisition single-shot turbo-spin-echo sequences, fast steady-state free precession cine sequences, T2-weighted turbo-spin-echo sequences and inversion recovery gradient-echo fast low-angle-shot sequences after injection of contrast agent. MR imaging revealed additional clinically unknown arterial thromboembolisms in four patients. The thoracic aorta was depicted as embolic source in four patients, while deep vein thrombosis (DVT) was found in one patient as the underlying disease. Unsuspected infarction of parenchymal organs was detected by MRI in two patients. An unknown additional DVT was found in one patient. Four patients were considered to have arterial emboli of cardiac origin. In conclusion, acquisition of arterial and venous MR angiograms of the entire vascular system combined with cardiac MR imaging is a most comprehensive and valuable strategy in patients with arterial thromboembolism. (orig.)

  2. Peripheral degenerative joint diseases

    Directory of Open Access Journals (Sweden)

    Nilzio Antonio da Silva

    2008-03-01

    Full Text Available Osteoarthritis, a degenerative joint disease, is the most commonrheumatic disorder mainly in a geriatric population. Manifestationsare pain, stiffness and functional loss in the affected joint.According to etiology it is classifi ed as primary (or idiopathicand secondary. Some risk factors for disease development aregenetics, race, age, sex, obesity, occupational activities andarticular biomechanics. Pathogenesis is the same for any cause orlocalization, being catabolic alterations, with synthesis, inhibitionand reparing intent of the cartilage matrix. Metalloproteinases andcytokines (IL-1,IL-6,TNF-α actions promote infl ammatory reactionand cartilage degradation. Pain, the most important symptom,does not correlate with radiologic fi ndings. Peripheral osteoarthritisoccurs predominantly in the knee, hip and hand. Diagnosis is basedon clinical features, laboratorial tests and radiological changes.Rheumatological associations’ guidelines for treatment includenon-pharmacologic (education, physiotherapy, assistive devices,and pharmacologic (analgesics, anti-infl ammatory drugs therapyand surgery. Arthroplasty seems to work better than medicines, butshould be used if other treatments have failed.

  3. An unusual cause of hydrocephalus: aqueductal developmental venous anomaly

    Energy Technology Data Exchange (ETDEWEB)

    Yagmurlu, Banu; Fitoz, Suat; Atasoy, Cetin; Erden, ilhan [Ankara University School of Medicine, Department of Radiology, Ankara (Turkey); Deda, Gulhis; Unal, Ozlem [Ankara University School of Medicine, Division of Pediatric Neurology, Ankara (Turkey)

    2005-06-01

    Vascular malformations are infrequent causes of aqueductal stenoses, developmental venous anomaly (DVA) being the rarest among them. DVAs, also known as venous angiomas, are congenital in origin and characterized by dilatation of vessels in the superficial and deep venous system. Although they are usually clinically silent, they can be complicated by hemorrhage, seizures and neurologic deficits. Herein, we report MR imaging findings of a 7-year-old girl whose hydrocephalus was due to an abnormal vein coursing through the aqueduct. (orig.)

  4. Massive hydrothorax with malpositioned central venous catheter – Ultrasound detection

    Directory of Open Access Journals (Sweden)

    Neha Hasija

    2016-04-01

    Full Text Available Radioimaging is the gold standard for confirmation of the position of central venous catheter as well as its related complications. Use of ultrasound has been proven in guiding central venous cannulations, and it can also be used in detecting related complications. We report a case of a 2 year old child with hydrothorax causing desaturation due to malpositioned central venous catheter diagnosed by ultrasound in the delay for getting a radiograph.

  5. Systematic review of topic treatment for venous ulcers

    OpenAIRE

    Borges, Eline Lima; Caliri, Maria Helena Larcher; Haas, Vanderlei José

    2007-01-01

    Venous ulcer patients can experience this situation for several years without achieving healing if treatment is inadequate. Evidence-based professional practice generates effective results for patients and services. This research aimed to carry out a systematic review to assess the most effective method to improve venous return and the best topic treatment for these ulcers. Studies were collected in eight databases, using the following descriptors: leg ulcer, venous ulcer and similar terms. T...

  6. Factors associated with poor healing and recurrence of venous ulceration.

    Science.gov (United States)

    Labropoulos, Nicos; Wang, Eric D; Lanier, Steven T; Khan, Sami U

    2012-01-01

    Plastic surgeons are often approached for wound management and closure of chronic venous ulcers that fail to heal despite multimodal management. The authors present a retrospective analysis of a large series of venous ulcers to determine factors predicting nonhealing and recurrence. Consecutive patients with chronic venous ulcers (≥ 2-cm diameter) were examined for the presence of superficial, perforating, or deep venous disease, including reflux and/or obstruction. Treatment included compression, venous ligation, stripping, thermal ablation, sclerotherapy, and local wound care. Ulcers refractory to 6 months of treatment were defined as nonhealing ulcers. Data were analyzed for differences in baseline patient and ulcer characteristics and clinical course of nonhealing ulcers. Data were compared using Wilcoxon rank sum, chi-square, and Fisher's exact tests using Sigma Stat and SPSS, with α set at p ulcers in 127 patients. Factors associated with ulcer nonhealing included advanced age, increased body mass index, history of deep venous thrombosis, noncompliance with compression therapy, and large ulcer area. One hundred thirty-one of the ulcers (85.6 percent) healed within 6 months and 147 (96 percent) of the ulcers ultimately healed without the need for operative plastic surgical intervention. A thorough understanding of risks and expected clinical course is required for assessment of the nonhealing venous ulcer. The authors recommend identification and correction of underlying venous abnormality and a minimum of at least 6 months of compression and local wound care followed by reassessment of venous function before operative plastic surgical intervention should be considered. Risk, III.

  7. Venous ulcers of the lower limb: Where do we stand?

    Science.gov (United States)

    Chatterjee, Sasanka S.

    2012-01-01

    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

  8. Pregnancy-related venous thromboembolism and risk of occult cancer

    DEFF Research Database (Denmark)

    Tarp Hansen, Anette; Veres, Katalin; Horváth-Puhó, Erzsébet

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  9. Venous ulcers of the lower limb: Where do we stand?

    Directory of Open Access Journals (Sweden)

    Chatterjee S Sasanka

    2012-01-01

    Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  10. Familial hyperhomocysteinemia, age and peripheral vascular diseases - an Italian study

    Directory of Open Access Journals (Sweden)

    Sandro Michelini

    2013-01-01

    Full Text Available Hyperhomocysteinemia is a widely recognized, although not yet entirely understood, risk factor for cardiovascular disease. Particularly, the complex relationships between age, hyperhomocysteinemia, predisposing genetic factors and peripheral vascular diseases have not been fully evaluated. Our contribution to this issue is a retrospective analysis of a large series of patients with peripheral arterial, venous and lymphatic disease, and of their blood relatives, with special reference to homocysteine plasma levels, age and methylenetetrahydrofolate reductase (MTHFR polymorphisms. Serum homocysteine was measured in 477 patients (286 males, 191 females, age range 19-78 years with various vascular clinical conditions: postphlebitic syndrome (46 recurrent venous ulcers (78, arterial diseases (101 primary lymphoedema (87, secondary lymphoedema (161 and outlet thoracic syndrome (4, and in 50 normal controls. A MTHFR study for polymorphisms was carried on in the subjects with homocysteine values exceeding 15 mol/L. Serum homocysteine determination and MTHFR polymorphism studies were performed also in 1430 healthy blood related relatives (mainly siblings, descendents and sibling descendents of the subjects with hyperhomocysteinemia and MTHFR polymorphisms. We found MTHFR polymorphisms in 20% of controls and in 69.3%, 69.5% and 53.8% of hyperhomocysteinemic subjects with arterial diseases, postphlebitic syndrome and venous ulcers, respectively. As expected, the percentage of hyperhomocysteinemia in patients with secondary lymphoedema and with thoracic outlet syndrome did not show significant differences compared to the control group. A MTHFR polymorphism was found in 116 out of the 214 hyperhomocysteinemic patients, i.e., in the 54% of the overall patient population with hyperhomocysteinemia (214 patients. Interestingly 750 (52% out of the 1430 blood relatives of the 116 patients with hyperhomocysteinemia and MTHFR polymorphisms showed at least one

  11. Peripheral ossifying fibroma. A case report

    Directory of Open Access Journals (Sweden)

    Karen Nair Vallejos Duarte

    2016-12-01

    Full Text Available Introduction: Peripheral ossifying fibroma, a pseudotumoral injury, considered within simple reactive hyperplasia, which in general has a definite cause and is often reversible. Objective: To present a case of an injury to a patient, which manifested as a radiolucent and asymptomatic injury lesion. Its differential diagnosis, which is based on clinical manifestations and conventional radiographic study, is controversial. Case Description: A case is presented in a male patient with 51-year-old with a lesion in the maxillary incisor-canine area, aspects of which were suggestive of granuloma telangiectasico. Previous clinical and radiographic evaluation, the patient underwent surgical resection of the lesion and was sent for histopathological examination, showing compact osteoid material revealing the peripheral final diagnosis, ossifying fibroma. Conclusion: The professional dentist must have knowledge and ability to clinical management of oral pathologies, to make a correct diagnosis and treatment, for it is essential to perform a biopsy, to avoid possible disputes between the clinical and histological diagnosis.

  12. Hyperemic peripheral red marrow in a patient with sickle cell anemia demonstrated on Tc-99m labeled red blood cell venography

    International Nuclear Information System (INIS)

    Heiden, R.A.; Locko, R.C.; Stent, T.R.

    1991-01-01

    A 25-year-old gravid woman, homozygous for sickle cell anemia, with a history of recent deep venous thrombosis, was examined using Tc-99m labeled red blood cell venography for recurrent thrombosis. Although negative for thrombus, the study presented an unusual incidental finding: the patient's peripheral bone marrow was hyperemic in a distribution consistent with peripheral red bone marrow expansion. Such a pattern has not been documented before using this technique. This report supports other literature that has demonstrated hyperemia of peripheral red bone marrow in other hemolytic anemias. This finding may ultimately define an additional role of scintigraphy in assessing the pathophysiologic status of the sickle cell patient

  13. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

    Directory of Open Access Journals (Sweden)

    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  14. Peripheral Neuropathy: Symptoms and Signs

    Science.gov (United States)

    ... the body—in both hands or in both feet. Some types of peripheral neuropathy develop suddenly, while others progress more slowly over many years. The symptoms of peripheral neuropathy often include: ... sleeping because of feet and leg pain Loss of balance and coordination ...

  15. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2016-12-01

    rodents as a function of time after surgery. As predicted, those animals in the negative control group (no repair following nerve deficit injury ...80% of penetrating injuries being associated with peripheral nerve damage, typically involve large segmental nerve deficits. Standard repair uses...technology for repair of peripheral nerve injuries involving significant neural deficit with improved functional outcomes for the wounded warrior. The

  16. Lower limb movement variability in patients with peripheral arterial disease.

    Science.gov (United States)

    Crowther, Robert G; Spinks, Warwick L; Leicht, Anthony S; Quigley, Frank; Golledge, Jonathan

    2008-10-01

    Peripheral arterial disease is a chronic obstructive disease of the arteries of the lower limb caused by atherosclerosis. The resultant decrease in blood flow can result in symptoms of pain in the lower limb on exercise known as intermittent claudication. Exercise induced pain is experienced in the calves, thigh or buttocks restricting activities of daily living and thus reducing quality of life. This study investigated lower limb movement variability in individuals with peripheral arterial disease-intermittent claudication (n=28) compared to individuals without peripheral arterial disease-intermittent claudication (control, n=25). A further aim was to examine the efficacy of various techniques used to describe single joint movement variability. All participants underwent two-dimensional angular kinematics analysis of the lower limb during normal walking. Single joint movement variability was measured using linear (spanning set and coefficient of variation) techniques. Between group differences were examined by one-way ANOVA. The peripheral arterial disease-intermittent claudication participants displayed significantly higher levels of lower limb movement variability in all joints when assessed using the coefficient of variation technique. There were no significant between group differences using the spanning set technique. Individuals with peripheral arterial disease-intermittent claudication have higher levels of lower limb movement variability and reduced walking speed compared to healthy age and mass matched controls. This variability may be an adaptation to the gradual onset of ischaemic pain in this population.

  17. Optical coherent tomography in diagnoses of peripheral retinal degenarations

    Directory of Open Access Journals (Sweden)

    O. G. Pozdeyeva

    2013-01-01

    Full Text Available Purpose: Studying the capabilities of optical coherence tomography (RTVue-100, OPTOVUE, USA in evaluation of peripheral retinal degenerations, vitreoretinal adhesions, adjacent vitreous body as well as measurement of morphometric data.Methods: The study included 189 patients (239 eyes with peripheral retinal degeneration. 77 men and 112 women aged 18 to 84 underwent an ophthalmologic examination since November 2012 until October 2013. The peripheral retina was visualized with the help of optical coherence tomography («RTVue-100,» USA. The fundography was carried out using a Nikon NF505‑AF (Japan fundus camera. All patients were examined with a Goldmann lens.Results: Optical coherence tomography was used to evaluate different kinds of peripheral retinal degenerations, such as lattice and snail track degeneration, isolated retinal tears, cystoid retinal degeneration, pathological hyperpigmentation, retinoschisis and cobblestone degeneration. The following morphometric data were studied: dimensions of the lesion (average length, retinal thickness along the edge of the lesion, retinal thickness at the base of the lesion and the vitreoretinal interface.Conclusion: Optical coherence tomography is a promising in vivo visualization method which is useful in evaluation of peripheral retinal degenerations, vitreoretinal adhesions and tractions. It also provides a comprehensive protocolling system and monitoring. It will enable ophthalmologists to better define laser and surgical treatment indications and evaluate therapy effectiveness.

  18. Optical coherent tomography in diagnoses of peripheral retinal degenarations

    Directory of Open Access Journals (Sweden)

    O. G. Pozdeyeva

    2014-07-01

    Full Text Available Purpose: Studying the capabilities of optical coherence tomography (RTVue-100, OPTOVUE, USA in evaluation of peripheral retinal degenerations, vitreoretinal adhesions, adjacent vitreous body as well as measurement of morphometric data.Methods: The study included 189 patients (239 eyes with peripheral retinal degeneration. 77 men and 112 women aged 18 to 84 underwent an ophthalmologic examination since November 2012 until October 2013. The peripheral retina was visualized with the help of optical coherence tomography («RTVue-100,» USA. The fundography was carried out using a Nikon NF505‑AF (Japan fundus camera. All patients were examined with a Goldmann lens.Results: Optical coherence tomography was used to evaluate different kinds of peripheral retinal degenerations, such as lattice and snail track degeneration, isolated retinal tears, cystoid retinal degeneration, pathological hyperpigmentation, retinoschisis and cobblestone degeneration. The following morphometric data were studied: dimensions of the lesion (average length, retinal thickness along the edge of the lesion, retinal thickness at the base of the lesion and the vitreoretinal interface.Conclusion: Optical coherence tomography is a promising in vivo visualization method which is useful in evaluation of peripheral retinal degenerations, vitreoretinal adhesions and tractions. It also provides a comprehensive protocolling system and monitoring. It will enable ophthalmologists to better define laser and surgical treatment indications and evaluate therapy effectiveness.

  19. Peripheral dentinogenic ghost cell tumor

    Directory of Open Access Journals (Sweden)

    Sushant S Kamat

    2013-01-01

    Full Text Available Dentinogenic ghost cell tumors (DGCT are uncommon lesions mainly with rare peripheral types. This report presents a case of peripheral DGCT on the left side of the mandibular alveolar ridge of a heavy smoker, a 68-year-old man, with main presenting feature as a mild pain. Submandibular lymphadenopathy and radiological "saucerization" were evident. Differential diagnosis included fibroma, neurofibroma, peripheral ameloblastoma, peripheral odontogenic fibroma, and peripheral giant cell granuloma. Histologically, ameloblastoma-like epithelial elements were seen in association with grouped ghost cells. Proliferating polyhedral cells and stellate reticulum-like cells with various densities were spread over a wide range of the field. The lesion was curetted and after 2 years of follow up, it did not recur.

  20. Developmental venous anomaly (DVA) with arterial component: a rare cause of intracranial haemorrhage.

    Science.gov (United States)

    Oran, Ismail; Kiroglu, Yilmaz; Yurt, Alaattin; Ozer, Fisun Demircivi; Acar, Feridun; Dalbasti, Tayfun; Yagci, Baki; Sirikci, Akif; Calli, Cem

    2009-01-01

    To examine the clinical and radiologic findings of patients with developmental venous anomaly (DVA) associated with intracranial haemorrhage but unrelated to cavernoma. Computed tomography (CT) was used to obtain intracranial images from seven patients ranging in age from 6 to 51 years. Magnetic resonance imaging (MRI) was then performed on six patients, and two patients were further examined via CT angiography. Finally, digital subtraction angiography (DSA) was performed to confirm the initial diagnosis. CT showed intraparenchymal supratentorial haemorrhage in all patients. The combined imaging modalities eventually confirmed a diagnosis of arterialized DVA in four patients and arterialized DVA associated with arteriovenus malformation (AVM) in three. Two patients were managed symptomatically, two underwent radiosurgery, one underwent surgery, one underwent combined embolisation plus radiosurgery and the remaining patient underwent combined embolisation plus surgery. Two patients died, one as a result of re-bleeding, and the other due to radiation necrosis. The mean follow-up period was 33 months (6 months to 6 years) for the remaining five patients with favourable outcome. DVA associated with intraparenchymal haemorrhage, but not related to cavernoma, was confirmed. Though very rare, DVA may present with non-cavernoma-related haemorrhage in the form of arterialized DVA or DVA with AVM.

  1. MRA for diagnosis of venous thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Sostman, H. D. [Cornell University, Weill Medical College, Chair of Radiology, New York (United States)

    2001-12-01

    Direct imaging of pulmonary embolism (PE) and deep vein thrombosis (DVT) with CT, and potentially with MR, will continue to replace V/Q scintigraphy. Venous imaging with MR far detecting DVT is used in a few centers, and their published accuracy figures are impressive. Recent studies of MR pulmonary angiography for PE reported that sensitivity of MRA was 85-100%, specificity 95-96%, but this data must be confirmed in other centers and patient populations. MR has advantages compared with CT, which make it worthwhile to continue MR development. Ionizing radiation and iodinated contrast material are not used. Imaging the pulmonary arteries and then imaging whichever venous region is of clinical interest is practical in a single examination. Repeated examinations can be performed safely. New contrast materials will facilitate the practically and accuracy of the MR technique and perfusion imaging may increase sensitivity. MR also has disadvantages compared with CT. It does not image effectively the non-vascular compartment of the lungs. It is more expensive, patient monitoring is more cumbersome, and a routine technique, which embodies all of MR's potential advantages, has not been packaged and tested. Accordingly, helical CT is a realistic option in clinical management of patients with suspected PE in most centers, while clinical application of MR is limited to centers with appropriate MR expertise and technology. However, MR has a number of fundamental characteristics that make it potentially ideal modality for evaluating patients with suspected acute venous thromboembolic disease and further clinical research with MRA is warranted.

  2. Endovenous management of venous leg ulcers.

    Science.gov (United States)

    Raju, Seshadri; Kirk, Orla K; Jones, Tamekia L

    2013-04-01

    Compression is the current "standard" in the treatment of venous leg ulcers, and corrective surgery is ancillary. The emergence of safe and effective minimally invasive corrective techniques prompts a reappraisal of this paradigm. Among 192 consecutive limbs with venous leg ulcers, 189 were treated by (1) endovenous laser ablation (n = 30), (2) iliac vein stent placement (n = 89), or (3) both (n = 69). Residual deep reflux was not treated. No specialized wound care was used, and 38% of patients did not use stockings. Outcome measures were time to heal the ulcer and cumulative long-term healing. Sixty percent of the limbs were post-thrombotic. The median reflux segment score was 3 (range, 0-7). Thirty-seven percent had deep axial reflux. Median intravascular ultrasound-detected stenosis was 70% (range, 0%-100%) in stented patients. Sensitivity of venography to iliac vein obstruction was 52%. Postprocedural mortality was 0%, and 2% had deep venous thrombosis (ulcers approximately ≤1 inch in diameter had healed. Larger ulcers were slower in healing (P pressure). However, long-term ulcer healing was inferior in limbs with reflux segment score of ≥3 (P ulcers in this consecutive series achieved long-term healing with the described minimally invasive algorithm. Uncorrected residual reflux was not an impediment to ulcer healing. Ulcers sized ≤1 inch required no specialized or prolonged wound care. Compression was not necessary to achieve or maintain healing after interventional correction. Copyright © 2013 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  3. Phototherapy improves healing of chronic venous ulcers.

    Science.gov (United States)

    Caetano, Kelly Steinkopf; Frade, Marco Andrey Cipriani; Minatel, Débora Garbin; Santana, Luisiane Avila; Enwemeka, Chukuka S

    2009-02-01

    We tested the hypothesis that LED phototherapy with combined 660-nm and 890-nm light will promote healing of venous ulcers that failed to respond to other forms of treatment. A variety of dressings, growth factors, and adjunct therapies are used to treat venous ulcers, but none seems to yield satisfactory results. We used a randomized placebo-controlled double-blind study to compare a total of 20 patients divided with 32 chronic ulcers into three groups. In group 1 the ulcers were cleaned, dressed with 1% silver sulfadiazine (SDZ) cream, and treated with placebo phototherapy (phototherapy research device. In group 2 the ulcers were treated similarly but received real phototherapy (3 J/cm(-2)) instead of placebo. In group 3 (controls), the ulcers were simply cleaned and dressed with SDZ without phototherapy. The ulcers were evaluated with digital photography and computer image analysis over 90 d or until full healing was attained. Ulcers treated with phototherapy healed significantly faster than controls when compared at day 30 (p +/- 0.01), day 60 (p +/- 0.05), and day 90 (p +/- 0.001), and similarly healed faster than the placebo-treated ulcers at days 30 and 90 (p +/- 0.01), but not at day 60. The beneficial effect of phototherapy was more pronounced when the confounding effect of small-sized ulcers was removed from the analysis. Medium- and large-sized ulcers healed significantly faster with treatment (>or=40% rate of healing per month) than placebo or control ulcers (p +/- 0.05). Phototherapy promotes healing of chronic venous ulcers, particularly large recalcitrant ulcers that do not respond to conventional treatment.

  4. Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Christine Hohl Moinat

    2014-01-01

    Full Text Available Insertion of central venous port (CVP catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE. However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE, or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3% at 3 months, and 11.3% (IC95 9.4–13.2% at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3% at 3 months, and 15.3% (IC95 13.1–17.6% at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

  5. Venous thrombosis and coagulation parameters in patients with pure venous malformations

    NARCIS (Netherlands)

    van Es, J.; Kappelhof, N. A.; Douma, R. A.; Meijers, J. C. M.; Gerdes, V. E. A.; van der Horst, C. M. A. M.

    2017-01-01

    Venous malformations (VMs) are ubiquitous, low-flow vascular anomalies known to be occasionally painful due to thrombotic episodes within the lesion. The prevalence of superficial or deep vein thrombosis is unclear. A cross-sectional study among outpatients aged ≥ 12 years with pure VMs was

  6. Direct oral anticoagulants and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Massimo Franchini

    2016-09-01

    Full Text Available Venous thromboembolism (VTE, consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban and thrombin inhibitors (e.g. dabigatran etexilate. This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.

  7. Pulmonary arterio-venous micro fistulae - Diagnostic

    International Nuclear Information System (INIS)

    Ebram, J.C.

    1989-01-01

    Four patients with pulmonary arterio-venous micro-fistulae - of which two were male (50%) - the ages varying from 10 to 43 (X sup(∼) = 22,7), were studied at the Cardiology Centre of the 6th Ward of Santa Casa da Misericordia Hospital in Rio de Janeiro. They were all basically suffering from Manson's Schistosomiasis, the hepato-splenic form in 3 cases (75%) and the Rendu Osler Weber disease with juvenile cirrhosis in 1 case (25%). All four of them had portal hypertension. The individual cases were clinically evaluate with X-rays, scintillographic and hemodynamic tests. (author)

  8. Venous Thromboembolism Following Major Orthopedic Surgery

    Science.gov (United States)

    CIONAC FLORESCU, Simona; ANASTASE, Denisa-Madalina; MUNTEANU, Ana-Maria; STOICA, Ioan Cristian; ANTONESCU, Dinu

    2013-01-01

    ABSTRACT Venous thromboembolism (VTE) is an important complication of major orthopedic surgery (total hip arthroplasty-THA, total knee arthroplasty-TKA, hip fracture surgery-FHS) and is associated with significant morbidity and mortality. Despite this, not all patients receive an appropriate prophylaxis, often due to a disproportionate fear of bleeding complications. A challenge in the management of VTE prophylaxis is to balance the benefits of the treatment with the risk of bleeding. In this article, we review the latest guidelines recommendations regarding prevention of postoperative VTE in patients undergoing orthopedic surgery. PMID:24371484

  9. Congenital Retinal Macrovessel and the Association of Retinal Venous Malformations With Venous Malformations of the Brain.

    Science.gov (United States)

    Pichi, Francesco; Freund, K Bailey; Ciardella, Antonio; Morara, Mariachiara; Abboud, Emad B; Ghazi, Nicola; Dackiw, Christine; Choudhry, Netan; Souza, Eduardo Cunha; Cunha, Leonardo Provetti; Arevalo, J Fernando; Liu, T Y Alvin; Wenick, Adam; He, Lingmin; Villarreal, Guadalupe; Neri, Piergiorgio; Sarraf, David

    2018-04-01

    Congenital retinal macrovessel (CRM) is a rarely reported venous malformation of the retina that is associated with venous anomalies of the brain. To study the multimodal imaging findings of a series of eyes with congenital retinal macrovessel and describe the systemic associations. In this cross-sectional multicenter study, medical records were retrospectively reviewed from 7 different retina clinics worldwide over a 10-year period (2007-2017). Patients with CRM, defined as an abnormal, large, macular vessel with a vascular distribution above and below the horizontal raphe, were identified. Data were analyzed from December 2016 to August 2017. Clinical information and multimodal retinal imaging findings were collected and studied. Pertinent systemic information, including brain magnetic resonance imaging findings, was also noted if available. Of the 49 included patients, 32 (65%) were female, and the mean (SD) age at onset was 44.0 (20.9) years. A total of 49 eyes from 49 patients were studied. Macrovessel was unilateral in all patients. Color fundus photography illustrated a large aberrant dilated and tortuous retinal vein in all patients. Early-phase frames of fluorescein angiography further confirmed the venous nature of the macrovessel in 40 of 40 eyes. Optical coherence tomography angiography, available in 17 eyes (35%), displayed microvascular capillary abnormalities around the CRM, which were more evident in the deep capillary plexus. Of the 49 patients with CRM, 39 (80%) did not illustrate any evidence of ophthalmic complications. Ten patients (20%) presented with retinal complications, typically an incidental association with CRM. Twelve patients (24%) were noted to have venous malformations of the brain with associated magnetic resonance imaging. Of these, location of the venous anomaly in the brain was ipsilateral to the CRM in 10 patients (83%) and contralateral in 2 patients (17%), mainly located in the frontal lobe in 9 patients (75%). Our study has

  10. 77 FR 24718 - Scientific Information Request on Chronic Venous Ulcers Treatments

    Science.gov (United States)

    2012-04-25

    ... Venous Ulcers Treatments AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Request...) is seeking scientific information submissions from manufacturers of chronic venous ulcer treatment medical devices. Scientific information is being solicited to inform our Chronic Venous Ulcers: A...

  11. Risk factors for development of complication following peripherally inserted central

    Directory of Open Access Journals (Sweden)

    Hakan Aydın

    2014-03-01

    Full Text Available Objectives: Peripherally inserted central venous catheters (PICCs are inserted into central veins through the upper extremity veins. In this retrospective study, we aimed to evaluate PICC procedures, related complications, their causes and factors influencing the success of the procedure during anaesthesia Methods: ‘Central Venous Catheterization Forms’ filled out for 850 patients in whom a PICC was inserted by residents during general anaesthesia between November 2009 and March 2013 in the operating room of Uludag University Medical Faculty Hospital were retrospectively analysed. Results: A total of 1174 procedures were evaluated. The most preferred vein for the first attempt was the right basilic vein (32.7%. Difficulty (more than two attempts with the PICC procedure was correlated with the patient’s age (p30 kg/m² (p<0.05, resident with less than 4 years of training (p=0.001, number of PICC attempts ≥2 (p<0.001, more than one resident involved in the catheterization procedure (p<0.001 and previous failed PICC procedures (p<0.001. Conclusion: We conclude that catheterization should be performed under the surveillance of a staff keeping in mind the risks of complications. In the case of failure following 2 attempts, the procedure should be handed over to a more experienced staff member. J Clin Exp Invest 2014; 5 (1: 29-35

  12. Altered Venous Function during Long-Duration Spaceflights

    Directory of Open Access Journals (Sweden)

    Jacques-Olivier Fortrat

    2017-09-01

    Full Text Available Aims: Venous adaptation to microgravity, associated with cardiovascular deconditioning, may contribute to orthostatic intolerance following spaceflight. The aim of this study was to analyze the main parameters of venous hemodynamics with long-duration spaceflight.Methods: Venous plethysmography was performed on 24 cosmonauts before, during, and after spaceflights aboard the International Space Station. Venous plethysmography assessed venous filling and emptying functions as well as microvascular filtration, in response to different levels of venous occlusion pressure. Calf volume was assessed using calf circumference measurements.Results: Calf volume decreased during spaceflight from 2.3 ± 0.3 to 1.7 ± 0.2 L (p < 0.001, and recovered after it (2.3 ± 0.3 L. Venous compliance, determined as the relationship between occlusion pressure and the change in venous volume, increased during spaceflight from 0.090 ± 0.005 to 0.120 ± 0.007 (p < 0.01 and recovered 8 days after landing (0.071 ± 0.005, arbitrary units. The index of venous emptying rate decreased during spaceflight from −0.004 ± 0.022 to −0.212 ± 0.033 (p < 0.001, arbitrary units. The index of vascular microfiltration increased during spaceflight from 6.1 ± 1.8 to 10.6 ± 7.9 (p < 0.05, arbitrary units.Conclusion: This study demonstrated that overall venous function is changed during spaceflight. In future, venous function should be considered when developing countermeasures to prevent cardiovascular deconditioning and orthostatic intolerance with long-duration spaceflight.

  13. Peripheral Auditory Mechanisms

    CERN Document Server

    Hall, J; Hubbard, A; Neely, S; Tubis, A

    1986-01-01

    How weIl can we model experimental observations of the peripheral auditory system'? What theoretical predictions can we make that might be tested'? It was with these questions in mind that we organized the 1985 Mechanics of Hearing Workshop, to bring together auditory researchers to compare models with experimental observations. Tbe workshop forum was inspired by the very successful 1983 Mechanics of Hearing Workshop in Delft [1]. Boston University was chosen as the site of our meeting because of the Boston area's role as a center for hearing research in this country. We made a special effort at this meeting to attract students from around the world, because without students this field will not progress. Financial support for the workshop was provided in part by grant BNS- 8412878 from the National Science Foundation. Modeling is a traditional strategy in science and plays an important role in the scientific method. Models are the bridge between theory and experiment. Tbey test the assumptions made in experim...

  14. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary

  15. Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis.

    Science.gov (United States)

    Chandrasekaran, Sivashankar; Ariaretnam, Siva Kumar; Tsung, Jason; Dickison, David

    2009-07-01

    Both chemical and mechanical methods of prophylaxis have reduced the incidence of thromboembolic complications following total knee replacement (TKR). Only a few studies have shown that mobilization on the first post-operative day further reduces the incidence of thromboembolic phenomena. We conducted a prospective study to verify not only if early mobilization but also whether the distance mobilized on the first post-operative day after TKR reduced the incidence of thromboembolic complications. The incidence of deep venous thrombosis and pulmonary embolism were compared in 50 consecutive patients who underwent TKR from July 2006 following a change in the mobilization protocol with 50 consecutive patients who underwent TKR before the protocol was instigated. The mobilization protocol changed from strict bed rest the first post-operative day to mobilization on the first post-operative day. Mobilization was defined as sitting out of bed or walking for at least 15-30 min twice a day. The distance mobilized was accurately recorded by the physiotherapists. All patients underwent duplex scans of both lower limbs on the fourth post-operative day. There was a significant reduction in the incidence of thromboembolic complications in the mobilization group (seven in total) compared with the control group (16 in total) (P= 0.03). Furthermore, in the mobilization group the odds of developing a thromboemobloic complication was significantly reduced the greater the distance the patient mobilized (Chi-squared linear trend = 8.009, P= 0.0047). Early mobilization in the first 24 h after TKR is a cheap and effective way to reduce the incidence of post-operative deep venous thrombosis.

  16. MRI and CT in cerebral venous thrombosis

    International Nuclear Information System (INIS)

    Surur, Alberto; Marangoni, Alberto; Devallis, Juan P.; Galvez, Vasco; Marchegiani, Silvio; Galletti, Cayetano; Martin, Juan J.

    2004-01-01

    Purpose: The veno-occlusive encephalic disease is a neurologic disorder of difficult clinic diagnostic almost always. This clinic situation presents a high morbi-mortality range without an early and precise diagnostic. With the use of Helical Computed Tomography (HCT) and Angio Magnetic Resonance Image (AMRI) the diagnosis has became more effective in the encephalic venous thrombosis. Methods: Fourteen patients with clinical suspicion on encephalic venous thrombosis using non-invasive techniques as HCT and AMRI were studied. Results: In all these cases we were able to arrive at the exact etiologic diagnostic using these techniques associated to the clinics findings, without needing the use of another invasive method like Angiography. Conclusion: The results were satisfactory for definitive diagnosis, without Angiography. When a patient has a high suspicion of veno-occlusive disease the neuro radiologic examination in the urgency is a very important fact and using HCT and AMRI as the first examinations techniques it is possible to obtain good results without most aggressive techniques. (author)

  17. Compression Stockings for Treating Venous Leg Ulcers

    Directory of Open Access Journals (Sweden)

    J. P. Benigni

    2013-01-01

    Full Text Available Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle. Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommended pressures whereas Jobst’s Ulcer Care kit does not for treating a venous leg ulcer. Jobst’s Ulcer Care transmits entirely the pressure in relation to a friction index close to 1. Conclusion. This antiulcer kit study underlines that in vivo and in vitro pressures can be different (Jobst’s Ulcer Care kit and Mediven Ulcer kit. In order not to lose pressure, it is important to take into account the friction index when superimposing two stockings.

  18. [Prophylaxis of Recurrent Venous Leg Ulcer].

    Science.gov (United States)

    Kroeger, K; Storck, M; Kujath, P; Rabe, E; Dissemond, J

    2017-06-01

    Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU. Georg Thieme Verlag KG Stuttgart · New York.

  19. Dabigatran versus warfarin in the treatment of acute venous thromboembolism

    NARCIS (Netherlands)

    Schulman, Sam; Kearon, Clive; Kakkar, Ajay K.; Mismetti, Patrick; Schellong, Sebastian; Eriksson, Henry; Baanstra, David; Schnee, Janet; Goldhaber, Samuel Z.; Schulman, S.; Eriksson, H.; Goldhaber, S.; Kakkar, A.; Kearon, C.; Mismetti, P.; Schellong, S.; Minar, E.; Bergqvist, D.; Tijssen, J.; Prins, M. [=Martin H.; Büller, H.; Otten, J.; Peters, R.; Mac Gillavry, M.; Pol, S.; Burroughs, A.; Gilmore, I.; Bluguermann, J.; Carlevaro, O.; Dipaola, L.; Gitelman, P.; Santos, D.; Schygiel, P.; Baker, R.; Blombery, P.; Gallus, A.; Gan, E.; Gibbs, H.; Salem, H.; Baghestanian, M.; Pilger, E.; Sturm, W.; Debing, E.; Gadisseur, A.; Hainaut, P.; Verhamme, P.; Wautrecht, J.-C.; Zicot, M.; Bizzachi, J. M. Annichino; Araujo, G.; de Araujo, J. Dalmo; Panico, F. M. Duarte Brandão; Nagato, Y.; Pereira, A. H.; Leao, P. Puech; Ramaciotti, E.; Moreira, R. C. Rocha; Timi, J.; Anderson, D.; Crowther, M.; Dolan, S.; Eikelboom, J.; Spencer, F.; Game, M.; Kahn, S.; Kassis, J.; Klinke, P.; Kovacs, M.; Milot, A.; Ritchie, B.; Rodger, M.; Solymoss, S.; Villeneuve, J.; Yeo, E.; Cervinka, P.; Homza, M.; Hrdy, P.; Klimsa, Z.; Lang, P.; Maly, R.; Oral, I.; Reichert, P.; Spinar, J.; Varejka, P.; Vladimir, J.; Brønnum-Schou, J.; Jensen, S.; Jensen, S. E.; Kristensen, K. S.; Nielsen, H.; Wiemann, O.; Bost, V.; Buchmuller, A.; Guillot, K.; Laurent, P.; Lecomte, F.; Mottier, D.; Quere, I.; Wahl, D.; Beyer, J.; Dormann, A.; Hoffmann, U.; Maier, M.; Mietaschk, A.; Katsenis, K.; Klonaris, C.; Liappis, C.; Acsady, G.; Berhes, I.; Boda, Z.; Farkas, K.; Jakucs, J.; Kollar, L.; Matyas, L.; Riba, M.; Sereg, M.; Aggarwal, R.; Banker, D.; Bharani, A.; Gadkari, M.; Hiremath, J.; Jain, A.; Kareem, S.; Lyengar, S.; Parakh, R.; Sekar, N.; Srinivas, A.; Suresh, K.; Vujay, T.; Brenner, B.; Efrati, S.; Elias, M.; Gavish, D.; Grossman, E.; Lahav, M.; Lishner, M.; Zeltser, D.; Agnelli, G.; Cimminiello, C.; Palareti, G.; Prandoni, P.; Santonastaso, M.; Silingardi, M.; Lee, E. Aldrett; Andrade, J. M. Fontes; Valles, J. Jaurrieta; Biesma, D.; Dees, A.; Fijnheer, R.; Hamulyak, K.; Kramer, M. H. H.; Leebeek, F. W. G.; Lieverse, L.; Nurmohamed, M. T.; Chunilal, S.; Jackson, S.; Ockelford, P.; Smith, M.; Njaastad, A. M.; Sandseth, P. M.; Tveit, A.; Waage, A.; Barata, J.; Capitao, M.; Fernandes, F. E.; Leitão, A.; Providência, L.; Alohin, D. I.; Belentsov, S.; Chernyatina, M.; Chernyavsky, A.; Fokin, A.; Gubenko, A.; Guz, V. Alexander V.; Katelnitsky, I.; Khamitov, A. A. A.; Khitaryan, A.; Khubulava, G.; Mikhailov, I.; Shkurin, V.; Staroverov, I.; Tchumakov, A.; Zaporozhsky, A.; Duris, T.; Poliacik, P.; Spisak, V.; Szentivanyi, M.; Zubek, V.; Adler, D.; Kelbe, D.; Le Roux, D.; Pieterse, A.; Routier, R.; Siebert, R.; Sloane, B.; Smith, C.; van Rensburg, H.; del Toro, J.; García-Fuster, M. J.; Mateo, J.; Monreal, M.; Nieto, J. A.; Sánchez-Molini, P.; Sedano, C.; Trujillo, J.; Valle, R.; Villalta, J.; Aagesen, J.; Carlsson, A.; Johansson, L.; Lärfars, G.; Lindmarker, P.; Säfvenberg, U.; Själander, A.; Bengisun, U.; Calkavur, T.; Guney, M. R.; Karahan, S.; Kurtoglu, M.; Sakinci, U.; Gubka, A.; Mishalov, V.; Skupyy, O.; Cohen, A.; Keeling, D.; Kesteven, P.; MacCallum, P.; Maclean, R.; Shah, P.; Watson, H.; Bartkowiak, A.; Bolster, E.; Botnick, W. C.; Burnett, B.; Chervu, A.; Comerota, A. J.; Dy, N. M.; Fulco, F. A.; Gossage, J. R.; Kaatz, S.; Lahiri, B.; Lerner, R. G.; Masson, J. A.; Moll, S.; Morganroth, M.; Patel, K.; Paulson, R.; Powell, R.; Samson, R.; Seibert, A.; Spyropoulos, A.; Vrooman, P. S.

    2009-01-01

    BACKGROUND: The direct oral thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative therapy to warfarin for patients who have acute venous thromboembolism. METHODS: In a randomized, double-blind, noninferiority trial involving patients with acute venous

  20. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....