Caliber Of Vein Research Articles

Doppler Ultrasound of Hepatic Vessels in the Diagnosis of Cirrhosis of the Liver in Togo

The aim of this work is to evaluate the role of Ultrasound-Doppler in the hemodynamic study of hepatic vessels during the liver cirrhosis in Togo. Method: This was an analytic cross-sectional study that measured the velocimetric parameters of hepatic vessels in cirrhotic patients and in non-cirrhotic patients. Results: The velocimetric parameters of the hepatic artery, the portal vein, and the hepatic veins were measured in 50 cirrhotic patients and 50 non-cirrhotic The caliber of the portal vein was significantly increased in cirrhotic patients compared to non-cirrhotic patients with 13.11 ± 2.16 mm versus 11.45 ± 1.02 (p < 0.00006). The systolic velocity and the hepatic artery resistance index were significantly raised in the cirrhotic patients compared to the non-cirrhotic with 67.32 ± 22.77 versus 49.97 ± 17.24 (p-value < 0.00004) respectively, and 0.78 ± 0.07 against 0.72 ± 0.08 (p < 0.00006). The caliber of the hepatic veins was significantly decreased in the cirrhotic patients compared to the non-cirrhotic patients (p < 0.0003). There was no correlation between the gender of the patients and the change in the hemodynamics of the hepatic vessels. Conclusion: The hemodynamic study of the hepatic vessels can and must rightly be a diagnostic argument for liver cirrhosis.

Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review

BackgroundUterine leiomyomas represent the gynecological neoplasm with the highest prevalence worldwide. This apparently benign pathological entity may permeate into the venous system causing the so-called intravenous leiomyomatosis of the uterus (IVL). IVL may seldom extend to large caliber veins and reach the right cardiac chambers or pulmonary arteries and cause signs of right sided congestive heart failure and sudden death. Due to its low incidence, however, IVL with intracardiac extension is often misdiagnosed resulting in deferred treatment. No consensus has been obtained regarding the standard surgical approach to be used for this rare condition. We describe the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and provide a review of the literature, analyzing management and surgical outcomes.Case presentationWe present the case of a 46-year-old premenopausal woman presenting with lower-extremity edema, recurrent syncopes and a history of subtotal hysterectomy for multiple uterine fibroids. She was diagnosed with pelvic recurrence of uterine leiomyomatosis and IVL with cardiac involvement. A two-stage surgical excision of the intracardiac-intracaval mass and pelvic leiomyomatosis was performed. The patient had an uneventful recovery and no evidence of recurrence was observed on follow-up.ConclusionsBy virtue of the rarity of the present pathology, awareness is widely scarce and diagnosis is often delayed. Early recognition is difficult due to initial aspecific and subtle clinical manifestations. Nevertheless, suspicion should be held high in premenopausal women with known history of uterine leiomyomata, presenting with cardiovascular symptoms and evidence of a free-floating mass within the right cardiac chambers. In-depth imaging is crucial for defining its anatomical origin and relations. Prompt surgical treatment with radical excision of pelvic and intravenous leiomyomatosis guarantees favorable outcomes and excellent prognosis with low rates of recurrence, whereas delayed diagnosis and treatment exposes to increased risk of congestive heart failure and sudden death.

Atypical use of PICC in infants and small children: a unicentric experience.

The peripherally inserted central catheters (PICCs) are vascular access devices (VAD) that are increasingly being used in the pediatric population. If a small vein caliber prevents positioning the catheter in the arm, the following step is to position the same catheter in the supraclavicular area, which can be defined as an off-label use or "atypical" approach, first described by Pittiruti. We retrospectively reviewed PICC positioning with puncture-site in the supra-clavicular area ("atypical" PICC insertion) and then tunneled on the chest. Nineteen atypical PICCs were positioned in 18 patients. The median age of patients at the day of implant was 14 months (IQR 3-27 months), and weight 7.5 kg (IQR 4-12 kg). Within this population, 74% of cases scheduled for a typical PICC insertion presented vein caliber too small for this procedure. For this reason, the typical PICC insertion was changed in favor of an atypical PICC procedure. Atypical PICCs were successfully used in 100% of cases without immediate complications. Atypical PICC positioning is a safe and useful alternative to the conventional technique when there is need for a central vascular access device (CVAD) for mid- or long-term therapy.

An unusual position of retromandibular vein: a surgical challenge in parotid surgeries

A 44-year-old man presented with swelling in the left parotid region. The swelling was firm and Fine Needle Aspiration Cytology report proved pleomorphic adenoma. In the CT scan, the tumour...

Collagenosis of the Deep Medullary Veins: An Underrecognized Pathologic Correlate of White Matter Hyperintensities and Periventricular Infarction?

White matter hyperintensities (WMH) are prevalent. Although arteriolar disease has been implicated in their pathogenesis, venous pathology warrants consideration. We investigated relationships of WMH with histologic venous, arteriolar and white matter abnormalities and correlated findings with premortem neuroimaging. Three regions of periventricular white matter were sampled from archived autopsy brains of 24 pathologically confirmed Alzheimer disease (AD) and 18 age-matched nonAD patients. Using trichrome staining, venous collagenosis (VC) of periventricular veins (<150 µm in diameter) was scored for severity of wall thickening and occlusion; percent stenosis by collagenosis of large caliber (>200 µm) veins (laVS) was measured. Correlations were made between WMH in premortem neuroimaging and vascular and white matter pathology. We found greater VC (U(114) = 2092.5, p = 0.005 and U(114) = 2121.5, p = 0.002 for small and medium caliber veins, respectively) and greater laVS (t(110) = 3.46, p = 0.001) in patients with higher WMH scores; WMH scores correlated with VC (rs(114) = 0.27, p = 0.004) and laVS (rs(110) = 0.38, p < 0.001). By multiple linear regression analysis, the strongest predictor of WMH score was laVS (β = 0.338, p < 0.0001). VC was frequent in patients with periventricular infarcts identified on imaging. We conclude that periventricular VC is associated with WMH in both AD and nonAD patients and the potential roles of VC in WMH pathogenesis merit further study.

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap.

Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat.This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue.Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.

Vein Patch Closure Using Below the Knee Greater Saphenous Vein for Femoral Endarterectomy Procedures is Not Always a Safe Choice.

BackgroundThe complication of vein patch rupture is well described after carotid patch angioplasty; however, there is a paucity of data about the safety of vein patch closure in the setting of femoral endarterectomy.Methods/resultsFrom May 2012 to May 2015, 115 femoral endarterectomies with patch closure were performed. A patch rupture occurred in three cases (2.6%) with a mortality rate of 66% (2/3). In all cases the greater saphenous vein below the knee was used as patch material.Discussion/conclusionVein patches, particularly from small calibre veins, should be excluded in femoral endarterectomy procedures as they pose a substantial risk of rupture.

BMP-SMAD signalling output is highly regionalized in cardiovascular and lymphatic endothelial networks.

BackgroundBone morphogenetic protein (BMP) signalling has emerged as a fundamental pathway in endothelial cell biology and deregulation of this pathway is implicated in several vascular disorders. BMP signalling output in endothelial cells is highly context- and dose-dependent. Phosphorylation of the BMP intracellular effectors, SMAD1/5/9, is routinely used to monitor BMP signalling activity. To better understand the in vivo context-dependency of BMP-SMAD signalling, we investigated differences in BMP-SMAD transcriptional activity in different vascular beds during mouse embryonic and postnatal stages. For this, we used the BRE::gfp BMP signalling reporter mouse in which the BMP response element (BRE) from the ID1-promotor, a SMAD1/5/9 target gene, drives the expression of GFP.ResultsA mosaic pattern of GFP was present in various angiogenic sprouting plexuses and in endocardium of cardiac cushions and trabeculae in the heart. High calibre veins seemed to be more BRE::gfp transcriptionally active than arteries, and ubiquitous activity was present in embryonic lymphatic vasculature. Postnatal lymphatic vessels showed however only discrete micro-domains of transcriptional activity. Dynamic shifts in transcriptional activity were also observed in the endocardium of the developing heart, with a general decrease in activity over time. Surprisingly, proliferative endothelial cells were almost never GFP-positive. Patches of transcriptional activity seemed to correlate with vasculature undergoing hemodynamic alterations.ConclusionThe BRE::gfp mouse allows to investigate selective context-dependent aspects of BMP-SMAD signalling. Our data reveals the highly dynamic nature of BMP-SMAD mediated transcriptional regulation in time and space throughout the vascular tree, supporting that BMP-SMAD signalling can be a source of phenotypic diversity in some, but not all, healthy endothelium. This knowledge can provide insight in vascular bed or organ-specific diseases and phenotypic heterogeneity within an endothelial cell population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12861-016-0133-x) contains supplementary material, which is available to authorized users.

CADASIL RAPIDLY ACCELERATED BY HYPOTENSION POST-TRAUMA: AUTOPSY REVEALS IMPORTANT CONTRIBUTION OF BOTH ARTERIES AND VEINS IN WHITE MATTER PATHOLOGY

Vascular reactivity of subcortical arteries is impaired in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). This ‘earthen pipe’ state impairs autoregulation with dependency on blood pressure for brain perfusion. Chronic hypoperfusion can cause ischemic damage but less is known about the effects of acute hypotension. Additionally, the contribution of veins has been overlooked in conditions with leukoaraiosis, in general (including Alzheimer’s disease), and in CADASIL specifically. We describe the imaging and pathological findings of a case in whom CADASIL was dramatically accelerated following acute episodes of hypotension. Interestingly, venous collagenosis was demonstrated in the periventricular white matter regions. Case report with neuroimaging and pathological data. A 61-year-old man with genetically confirmed CADASIL was initially lucid following a motor vehicle accident but subsequently became hypotensive (60/40 mm Hg) due to an open femur fracture, and required intubation. Multiple new white matter infarcts appeared on brain imaging. A second hypotensive episode days later was associated with new coin-sized infarcts in the bilateral corona radiata and cerebellar peduncles, and resulted in quadriplegia. No embolic source was found on cardiac or vascular imaging. He expired within 5 weeks of the trauma. Autopsy revealed extensive subcortical and periventricular leukoencephalopathy, and multiple cavitations involving deep subcortical grey and white matter. Small arteries had thickened walls, disruption of the muscularis and intimal PAS-positive material (Fig 1A). Both larger periventricular and small caliber veins had thickened walls that were PAS-negative and trichrome-positive, consistent with venous collagenosis (Fig 1 B,C). There was no pathological evidence of global hypoxia or diffuse axonal injury. The findings suggest rapid acceleration of CADASIL pathology from acute hypotension in the setting of impaired vasoreactivity. Additionally, collagenosis of veins in the affected white matter regions is a novel finding not yet reported in CADASIL, to our knowledge. A few reports have suggested an integral role of collagenized veins in age-related leukoaraiosis and this may also apply to CADASIL. This case underscores the importance of blood pressure regulation in patients with CADASIL and highlights the potential importance of veins in white matter pathology. Cerebral arterial and venous pathology in white matter hyperintensities in CADASIL A. Arteriole containing PAS positive granular material within the media (arrow). B. Collagenosis of periventricular veins (arrows) highlighted by Masson's trichrome. C. The collagenized veins (arrows) do not contain the PAS positive material within their collagenized walls.

Increased Hepatic Arterial Blood Flow Measured by Hepatic Perfusion Index in Hepatosplenic Schistosomiasis: New Concepts for an Old Disease.

Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS). This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS. Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed. It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p=0.0029) and that this increase correlated with splenic length (p=0.038) and diameter of esophageal varices (p=0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices. Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.

Histologic and sonographic features of holmium laser in the treatment of chronic venous disease.

A new holmium laser (HOL) has been introduced to the market. The device is able to reduce the great saphenous vein (GSV) caliber in a tumescence-free procedure, favoring an effective sclerotherapy of large vessels. Aim of the present investigation is to provide the first in vivo data about the effect of HOL on GSV histology. Six chronic venous disease (C2-5, Ep, As, Pr) patients (M:F ratio 1:1; age: 57±8, BMI 24±2 kg/m2) underwent HOL-assisted caliber reduction of the GSV, high-ligation and flush ligation of the incompetent tributaries. Three cm of proximal great saphenous vein not treated by laser and 3 cm of a contiguous segment that was just previously treated by HOL were harvested. Histological assessments were performed. Patent GSV lumen caliber was assessed at the mid-thigh right before, and after the procedure. Periprocedural pain was graded by Visual Analogue Scale. GSV samples after holmium laser therapy showed thickening of the vascular wall with a decreased, yet patent lumen. Immunostaining demonstrated intact endothelial lining in both the treated and not treated segments. Expansion of collagen fibers was observed in the laser-treated segments. Collagen appeared more homogeneous than in controls, with an amorphous appearance. Laser treated veins showed a reduction in elastic fibers with greater fragmentation. Smooth muscle cells appeared swollen. The caliber of the mid-thigh great saphenous vein lumen decreased from 8.1±0.8 mm to 3.9±0.2 mm (P<0.0001). The average periprocedural pain was 1±0.6. HOL significantly reduces the caliber of the GSV. The endothelial lining is spared, while the remaining wall is thickened by a hyalinization-like process.

System for Rapid, Precise Modulation of Intraocular Pressure, toward Minimally-Invasive In Vivo Measurement of Intracranial Pressure

Pathologic changes in intracranial pressure (ICP) are commonly observed in a variety of medical conditions, including traumatic brain injury, stroke, brain tumors, and glaucoma. However, current ICP measurement techniques are invasive, requiring a lumbar puncture or surgical insertion of a cannula into the cerebrospinal fluid (CSF)-filled ventricles of the brain. A potential alternative approach to ICP measurement leverages the unique anatomy of the central retinal vein, which is exposed to both intraocular pressure (IOP) and ICP as it travels inside the eye and through the optic nerve; manipulating IOP while observing changes in the natural pulsations of the central retinal vein could potentially provide an accurate, indirect measure of ICP. As a step toward implementing this technique, we describe the design, fabrication, and characterization of a system that is capable of manipulating IOP in vivo with <0.1 mmHg resolution and settling times less than 2 seconds. In vitro tests were carried out to characterize system performance. Then, as a proof of concept, we used the system to manipulate IOP in tree shrews (Tupaia belangeri) while video of the retinal vessels was recorded and the caliber of a selected vein was quantified. Modulating IOP using our system elicited a rapid change in the appearance of the retinal vein of interest: IOP was lowered from 10 to 3 mmHg, and retinal vein caliber sharply increased as IOP decreased from 7 to 5 mmHg. Another important feature of this technology is its capability to measure ocular compliance and outflow facility in vivo, as demonstrated in tree shrews. Collectively, these proof-of-concept demonstrations support the utility of this system to manipulate IOP for a variety of useful applications in ocular biomechanics, and provide a framework for further study of the mechanisms of retinal venous pulsation.

Study of coronary sinus and its tributaries in pigs

Introduction. Similarities between the bodies of pigs and humans have encouraged studies in comparative anatomy, trying to describe in detail the anatomical variations that could influence in the xenotransplantation, given that advances in genetics, immunology and biotechnology are large, this possibility is not far. The objective of this work was to make contributions to the vascular study of porcine heart. &#x0D; Methodology. 60 porcine hearts, with an average of 5 months old and weighing 85-95kg were obtained from plant Vijagual. After receipt hearts were kept in water for 6 hours, then they were perfused with polyester resin semi-synthetic and mineral blue color, moreover the left coronary artery was perfused with red mineral color. Subsequently, the hearts were subjected to a process of partial corrosion with potassium hydroxide (15%), then the coronary sinus and its tributary branches were dissected from its origin to its distal segments, path, shapes, sizes, anastomosis and presence of registered anatomical variations. Photographic record of the samples was performed.&#x0D; Results. The distal caliber of Great cardiac vein (5.36 +/- 1,04mm), its origin was determined from the apex at 70% of anatomical pieces it studied was determined and the ventricular groove paraconal 30% of the pieces analyzed. The arteriovenous trigone was found in 58 of cardiac structures studied (96.66%).&#x0D; Conclusion. The description of the anatomic variations present in the pig heart structure will contribute to the possibility of xenotransplantation and also provides data for the development of studies on cardiovascular surgery and certain diseases of clinical and epidemiological importance.

Saphenous sparing laser modern options (comment to Gianesini et al., Veins and Lymphatics 2013;2:e21 and Veins and Lymphatics 2015;4:5246)

Not required

The effect of location and configuration on forearm and upper arm hemodialysis arteriovenous grafts

The arteriovenous graft (AVG) is most often used in hemodialysis patients when an autogenous fistula is not feasible. The optimal location (forearm or upper arm) and configuration (loop or straight) of AVGs are not known. To evaluate relationships of AVG location and configuration with patency, we conducted a secondary analysis using data from a randomized, placebo-controlled trial of dipyridamole plus aspirin for newly placed AVG. Participants of the Dialysis Access Consortium (DAC) Graft Study with newly placed upper extremity prosthetic grafts involving the brachial artery were studied. Multivariable analyses adjusting for trial treatment group, center, gender, race, body mass index, diabetes, current treatment with chronic dialysis, and prior arteriovenous vascular access or central venous catheter were performed to compare outcomes of forearm (fAVG) and upper arm (uAVG) grafts, including loss of primary unassisted patency (LPUP) and cumulative primary graft failure (CGF). Subgroup analyses of graft configuration and outflow vein used were also conducted. A total of 508 of the 649 participants (78%) enrolled in the trial had an upper extremity brachial artery graft placed, 255 with fAVG and 253 with uAVG. Participants with fAVG were less often male (33% vs 43%; P= .03), African American (62% vs 78%; P< .001), and receiving dialysis at the time of surgery (62% vs 80%; P< .001). Participants with fAVG had a higher mean body mass index (33 vs 29; P< .001). The LPUP (fAVG 70% vs uAVG 78%; P= .07) and CGF (33% vs 36%; P= .91) were similar between fAVG and uAVG at 1-year follow-up. In multivariable analysis, AVGlocation (uAVG vs fAVG) was not associated with LPUP (hazard ratio, 1.21; 95% confidence interval, 0.90-1.63; P= .20) or CGF (hazard ratio, 1.36; 95% confidence interval, 0.94-1.97; P= .10). LPUP did not differ significantly between fAVG and uAVG among subgroups based on AVG configuration (P= 1.00) or outflow vein used (P= .16). Patency was comparable between fAVG and uAVG despite the larger caliber veins often encountered in the upper arm in carefully selected patients. Our findings support the traditional view that, in order to preserve a maximal number of access sites, the forearm location should be considered first before resorting to an upper arm graft.

Duplication unilateral femoral vein

Background: The purpose of this paper is to describe a case of duplication of unilateral femoral vein, with a complete extension of duplicated veins with similar diameters which is an uncommon condition, noticed in fewer than 10% of lower limb. The venous anatomy is highly variable, only 1/6 patients are exempt of these anomalies. One is the duplicity of the femoral vein. The classic anatomic venous in the lower limb is found in only 16% of subject.Methods: Anatomical variation in the lower limb was found during routine dissection in a 75-year-old male cadaver in the Morphology Laboratory at the University of Pamplona. Result: In the adductor canal femoral vein was divided into two veins: one medial and other lateral, which ascended in parallel until the femoral triangle, at this level 6.5 cms below the inguinal ligament the femoral vein- lateral ramus received to the lateral circumflex femoral vein, and received to the medial circumflex femoral vein, followed the femoral veins lateral ramus binds to the femoral veins medial ramus forming common femoral vein. Both Femoral Veins extend from the adductor canal to the femoral triangle had a length of 18 cms. The caliber of the femoral vein and the caliber of common femoral vein was 30 mm. The caliber of the femoral artery at the femoral triangle was 24 mm. The caliber of the femoral medial and lateral venous component was 20 mm. The common femoral vein received posterolateral to the deep femoral vein; The common femoral vein received anteromedial at the great saphenous. Conclusion: Knowledge of the truncular venous variations is important for the investigation of the venous network. It is also important to recognize and avoid potential errors in diagnosis of deep venous thrombosis of the femoral vein, in the case of an occluded duplicated trunk.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.292-296

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

BACKGROUND Varicosity of lower limb is a common problem in agricultural country like Nepal. Doppler ultrasound is a standard investigation modality for confirmation of diagnosis, evaluation of severity and venous mapping to plan treatment. We aim to find out the epidemiology, common pattern of incompetance, severity assessment by doppler and association of the important doppler variables with skin changes.METHODOLOGY Doppler venous study was done in 56 patients from june 2013 to july 2014. Patients with deep vein thrombosis and peripheral arterial disease were excluded. Altogether 56 patients, 96 limbs were studied. Data was entered in preformed proforma. Doppler study was conducted by senior radiologist with linear probes. Data was entered in SPSS software version 16 and statistical significance was calculated using chi square test.RESULTS Bilateral limb involvement was seen in 40 patients and unilateral in 16 patuents only. Skin related changes were seen in 58 limbs. Saphenofemoral junction incompetance was seen in 79(82.2%) limbs and was most common pattern of incompetance. Overall, superficial veins were involved in 88(91.7%) limbs and deep in 30(31.2%) limbs. Prolonged duration of varicosity (&gt;9 year) (p=0.000), bilateral limb involvement(p=0.024), reflux in deep venous system(p=0.002), larger Greater Saphenous Vein (GSV) size(p=0.003), prolonged duration of reflux(p=0.000) and perforator incompetence (p=0.002) were associated with skin changes. GSV diameter more than 7 mm was associated with reflux significantly (P=0.002).CONCLUSION Superficial vein incompetance is common pattern compared to deep venous system. Sapheno Femoral Junction (SFJ) incompetance is the commonest pattern. Larger caliber of vein, prolonged duration of reflux, reflux in deep venous system and perforator insufficiency are significantly associated with skin changes.Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 1-7

Retinal Vascular Changes are a Marker for Cerebral Vascular Diseases.

The retinal circulation is a potential marker of cerebral vascular disease because it shares origin and drainage with the intracranial circulation and because it can be directly visualized using ophthalmoscopy. Cross-sectional and cohort studies have demonstrated associations between chronic retinal and cerebral vascular disease, acute retinal and cerebral vascular disease, and chronic retinal vascular disease and acute cerebral vascular disease. In particular, certain qualitative features of retinopathy, retinal artery occlusion, and increased retinal vein caliber are associated with concurrent and future cerebrovascular events. These associations persist after accounting for confounding variables known to be disease-causing in both circulations, which supports the potential use of retinal vasculature findings to stratify individuals with regards to cerebral vascular disease risk.

Bevacizumab for the treatment of a complicated posterior melanocytoma

PurposeTo present a case of a complicated posterior melanocytoma that was successfully treated with intravitreal bevacizumab.Case reportA 50-year-old Caucasian man was referred with sudden-onset metamorphopsia and decreased vision in his right eye over the course of the last 2 months. His best-corrected visual acuity was 20/80 and poorer than Jaeger 14 in the right eye, and 20/20 and Jaeger 1 in his left eye. In the right fundus, there was a melanocytic lesion occupying the inferotemporal quadrant of the optic disk, extending to the adjacent choroid inferiorly; optic nerve edema, superotemporal retinal vein dilatation, and subretinal fluid under the macula and nasal half of the posterior pole were observed, and a subretinal choroidal neovascularization complex was observed adjacent to the superotemporal margin of the optic disk, confirmed by fluorescein angiography, surrounded by a dense subretinal hemorrhage. Optical coherence tomography showed retinal edema and detachment of neurosensory retina. The patient was treated with three consecutive doses on a monthly basis of intravitreal 1.25 mg/0.05 mL bevacizumab. Visual acuity recovered rapidly, and at 4 months after treatment, it was 20/20 and Jaeger 1, with complete resolution of macular edema and subretinal fluid and hemorrhage. After 3 years of follow-up, best-corrected visual acuity remained stable, macular area was normal, and there was no evident optic nerve edema, retinal vein caliber and aspect were normal, and there was no significant change of the tumor. Fluorescein angiography only evidenced late staining of choroidal neovascularization scar, and optical coherence tomography showed a normal macular anatomy.ConclusionIntravitreal bevacizumab was effective in the treatment of choroidal neovascularization, optic nerve edema, venous dilatation, and local capillary telangiectasia, complicating an optic disk melanocytoma.