End Of Vein Research Articles

Abstract P5-22-05: Evaluation of simplified lymphatic microsurgical preventing healing approach (SLYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection

Abstract Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure however requires microsurgical techniques. The aim of this study was to assess the efficiency of Simplified-LYMPHA (SLYMPHA) in preventing LE in a prospective cohort of patients. Methods: All patients, undergoing ALND with or without SLYMPHA between January 2014 and December 2016 were included in the study. SLYMPHA is a slightly modified and simplified version of LYMPHA. It is performed by the operating surgeon performing the ALND. One or more lymphatic channels identified by reverse arm mapping are inserted using a sleeve technique into the cut end of a neighboring vein. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. Demographic, clinical, surgical and pathologic factors were recorded. The incidence of clinical LE was compared between ALND with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE. Results: 406 patients were included in the study. SLYMPHA procedure was attempted in 81 patients and was completed successfully in 90% of patients. Early complication rates were similar between patients who underwent SLYMPHA and who did not (4% vs. 4.13%; p = 0.948). Median follow-up time was 15±13.73 [1-32] months. Patients, who underwent SLYMPHA, had a significantly lower rate of clinical LE both in univariate and multivariate analysis (3% vs 19%; p = 0.001; OR 0.12 [0.03-0.5]). Excising > 22 lymph nodes and a co-diagnosis of diabetes were also correlated with higher clinical LE rates on univariate analysis, but only excising > 22 lymph nodes remained to be significant on multivariate analysis. Conclusions: SLYMPHA is a safe and relatively simple method, which decreases incidence of clinical LE dramatically. It should be considered as an adjunct procedure to ALND for all patients during initial surgery. Citation Format: Ozmen T, Lazaro M, Zhou Y, Vinyard A, Avisar E. Evaluation of simplified lymphatic microsurgical preventing healing approach (SLYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-05.

Операція Whipple з резекцією ворітної/верхньої брижової вени без реконструкції судин з приводу пухлинного тромбозу судин системи ворітної вени

Вступ. Наведений досвід виконання панкреатодуоденальної резекції (ПДР) з резекцією та повним перев’язуванням верхньої брижової (ВБВ) чи ворітної (ВВ) вени у 4 хворих з приводу повної оклюзії пухлиною головки та гачкоподібного відростка підшлункової залози (ПЗ) судин системи ВВ.
 Матеріали і методи. За період з 2015 по 2017 р. оперовані 4 пацієнта з приводу пухлини правого анатомо-хірургічного сегмента ПЗ з інвазією пухлини у ВВ/ВБВ з повним (відсутність кровотоку) або субкомпенсованим (понад 80%) тромбозом цих судин.
 Результати. У 3 хворих під час ПДР не виконували реконструкцію судин, дистальний кінець ВБВ зашитий наглухо. В одного хворого сформований циркулярний венозний анастомоз кінець у кінець між ВВ та розширеною колатеральною веною, що відходила від ВБВ. Тривалість операції становила в середньому (390 ± 47) хв, післяопераційного періоду (18 ± 4,2) дня, летальність - 25% (померла одна хвора).
 Висновки. ПДР з повним перев’язуванням ВБВ без формування судинного анастомозу за її оклюзії пухлиною безпечна і можлива у ретельно відібраних пацієнтів.

Analysis on the Curative Effect of Improved Radial Artery and Cephalic Vein Anastomosis in the Fistulation for the Hemodialysis in Patients

To investigate the application of improved radial arteryand cephalic vein anastomosis in the fistulation for the hemodialysis in patients, 80 cases of patients with chronic renal failure were randomly divided into two groups, a control group and an improved group. The procedure for the wrist radial arteryand cephalic vein anastomosis was improved, in which in a way of continuously everted full-thickness suture, the distal end of radial artery and the proximal end of cephalic vein were anastomosed. The patients were examined by the different methods before the surgery to evaluate the patients’conditions. Patients in the improved group underwent the anastomosis of the wrist radial artery and cephalic vein in a way of continuously everted full-thickness suture, and those in the control group underwent the anastomosis in the conventional way. The improved procedure showed some advantages, such as reduced anastomotic blood leakage, good alignment of the arteryand veinwalls, shortened vascular suture time, and less knot of sutures at the anastomotic junction. The improved procedure should be appropriated for the patients whose Allen's test is negative and cephalic vein is good in the blood flow and filling. However, the weak blood reflux of the distal end of radial artery should bethe contraindication for the improved procedure.

Evaluation of simplified lymphatic microsurgical preventing healing approach (SLYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection.

563 Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure however requires microsurgical techniques. The aim of this study was to assess the efficiency of Simplified-LYMPHA (SLYMPHA) in preventing LE in a prospective cohort of patients. Methods: All patients, undergoing ALND with or without SLYMPHA between January 2014 and December 2016 were included in the study. SLYMPHA is a slightly modified and simplified version of LYMPHA. It is performed by the operating surgeon performing the ALND. One or more lymphatic channels identified by reverse arm mapping are inserted using a sleeve technique into the cut end of a neighboring vein. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. Demographic, clinical, surgical and pathologic factors were recorded. The incidence of clinical LE was compared between ALND with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE. Results: 406 patients were included in the study. SLYMPHA procedure was attempted in 81 patients and was completed successfully in 90% of patients. Early complication rates were similar between patients who underwent SLYMPHA and who did not (4% vs. 4.13%; p = 0.948). Median follow-up time was 15±13.73 [1-32] months. Patients, who underwent SLYMPHA, had a significantly lower rate of clinical LE both in univariate and multivariate analysis (3% vs 19%; p = 0.001; OR 0.12 [0.03-0.5]). Excising > 22 lymph nodes and a co-diagnosis of diabetes were also correlated with higher clinical LE rates on univariate analysis, but only excising > 22 lymph nodes remained to be significant on multivariate analysis. Conclusions: SLYMPHA is a safe and relatively simple method, which decreases incidence of clinical LE dramatically. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.

Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma.

Western studies have suggested two distinct etiologies of esophagogastric junction (EGJ) cancer: Helicobacter pylori-associated atrophic gastritis and non-atrophic gastric mucosa resembling esophageal adenocarcinoma. The present study investigated whether endoscopic gastric mucosal atrophy can distinguish between these two types of EGJ adenocarcinoma. Data were collected from patients with Siewert type II, T1 EGJ adenocarcinoma who underwent endoscopic or surgical resection at eight Japanese institutions in 2010-2015. Clinicopathological characteristics of EGJ cancers with and without endoscopic gastric mucosal atrophy were compared. EGJ was defined as the lower end of the palisade vein and/or the top of the gastric folds. Of the 229 patients identified, 161 had endoscopic gastric mucosal atrophy and 68 did not. The latter group was younger (64 vs 70years, P=0.000); had a higher proportion of patients negative for H.pylori (90% vs 47%, P<0.0001); and had higher rates of gastroesophageal reflux disease symptoms (43% vs 12%, P=0.017), mucosal breaks (25% vs 15%, P=0.009), Barrett's esophagus (BE, 78% vs 42%, P<0.0001), and tumors above the EGJ (81% vs 19%, P<0.0001) and on the upper-right side (74% vs 38%, P<0.0001) than the former group. Multivariate analysis showed that H.pylori positivity (odds ratio [OR]=13.0, P<0.001), long-segment BE (OR=0.025, P=0.033), and longitudinal (OR=8.6, P=0.001) and circumferential (OR=4.7, P=0.006) tumor locations were independently associated with gastric mucosal atrophy. Two distinct types of EGJ cancer were identified, with and without endoscopic gastric mucosal atrophy. These types were associated with different tumor locations.

Cadaveric study of mode of termination of gonadal veins: Implications for procedures utilizing terminal ends of gonadal veins as entry portals

Context:The terminal ends of gonadal veins act as an entry portal in gonadal embolization procedures used for treating varicocele in males and pelvic congestion disease in females. Here, we studied the modes of termination of gonadal veins in adult cadavers.Materials and Methods:Thirty-five adult formalin-fixed cadavers (seventy sides) were studied over a period of 4 years. The modes of termination of gonadal veins were observed under the following study variables: (a) number, (b) locale of termination, and (c) termination angle.Results:Variations in study parameters were observed in eight sides of seven cadavers (seven unilateral and one bilateral). Double veins at termination were observed in six cadavers; anomalous termination was observed in three cadavers. Angle of termination differed from normal in 3 cadavers. In one of these cadavers, the left ovarian vein drained into the left suprarenal vein.Conclusion:Duplication of terminal ends, anomalous drainage site, and varied angles of termination call for caution to ensure the success of procedures, which use terminal ends of gonadal veins as entry portals.

Prevention of propofol injection-related pain using pretreatment transcutaneous electrical acupoint stimulation

Background/aim: This study aimed to study the effect of pretreatment transcutaneous electrical acupoint stimulation (TEAS) in preventing propofol injection-related pain. Materials and methods: A total of 360 patients who were to undergo elective hysteroscopy surgery were randomly divided into the following three groups of 120 patients each: control (Group C), sham TEAS (Group F), and TEAS (Group T). Patients in Group C did not undergo any treatment before surgery; 30 min before the induction of anesthesia, patients in Groups F and T underwent electrical stimulation of the bilateral LI4-PC6 acupoint. Patients in Group F were subjected to 'feeling flow', while those in Group T were subjected to 'tolerance flow.' The stimulation frequency was 2/100 Hz and the duration of stimulation was 30 min. After the induction of anesthesia, propofol injection-related pain scores, hemodynamic parameters, and adverse reactions were recorded. Results: Of the 360 patients, 324 completed the study. There were significant differences among the groups in terms of the incidence of moderate-to-severe pain. In terms of the four-point scaling method, the end of the radial vein, the cubital vein, and the 'back of the hand' vein differed significantly among the three groups (P = 0.05). Finally, using a numerical rating scale, a significant difference was observed among the three groups in terms of the pain scores in the different veins. Conclusions: Pretreatment TEAS effectively reduces the incidence and severity of propofol injection-related pain, the incidence of postoperative nausea and vomiting, and patient postoperative pain scores.

Anatomical Variations of the Venous Drainage from the Left Adrenal Gland: An Anatomical Study.

For radiologists, the venous drainage of adrenal glands is a key to the technique of selective adrenal venous sampling. For endocrine surgeons, it is key to adrenalectomy for carcinoma and pheochromocytoma. This study aims to demonstrate direct anastomosis between the left adrenal vein, the diaphragmatic circulation and the azygos system. Anatomical textbooks only offer very little information concerning the left adrenal vein (LAV) and its potential anastomosis with the reno-lumbo-azygo trunk (RLAT) and the diaphragmatic circulation. Between November 2014 and October 2015 in the LADAF (French Alps Anatomy Laboratory), we dissected 44 formalin-fixed adult cadavers. We found no direct anastomosis between the left adrenal vein and the reno-azygo-lumbar trunk and two anastomoses (4.5%) between the adrenal capsular vein and azygos system. A lumbo-azygo trunk has been found 38 times (86.3%), drained 35 times (79.5%) into the left renal vein and 3 times (6.8%) into the left genital vein. An inferior phrenic vein ending into an adrenal vein was highlighted in all cases, 6 times (13.7%) in a double adrenal vein and 38 times (86.3%) in a single one. No connections have been found between left adrenal vein and the RLAT, and frequency of the IPV is discordant with the literature. However, our findings concerning the capsular vessels' anastomosis with the azygos system, inferior diaphragmatic flow and double adrenal vein could have two clinical applications: Firstly, the ligation of the adrenal vein solely is not enough to entirely interrupt the adrenal vein drainage, and secondly, sampling of hormones in the LAV could be underestimated because of the risk of dilution.

Revision of Ilfeldia and establishment of Ovulepteris gen. nov. from the Pennsylvanian of Europe, with a discussion on their concepts

This paper presents a taxonomic revision of the fossil-genus Ilfeldia Remy and establishes the fossil-genus Ovulepteris nov. Three species of Ilfeldia (Ilfeldia jejunata, Ilfeldia gregoriensis nov. sp. and Ilfeldia polysporangiata comb. nov.) have been identified in Europe from localities in the Douro Basin (Portugal), Ilfeld Basin (Germany) and at Manebach (Germany). The stratigraphic distribution of the fossil-genus varies from Gzhelian (Carboniferous) (I. jejunata and I. gregoriensis sp. nov.) to lower Asselian (Permian) (I. polysporangiata comb. nov.). All species of Ilfeldia are associated with larger taeniopterid leaves that could potentially be sterile equivalents due to dimorphism, and sterile and fertile leaves have been found in organic connection in I. gregoriensis sp. nov. Ilfeldia may be affiliated with the ferns or pteridosperms, but the systematic position is unclear. Ovulepteris gen. nov., which is established for leaves that bear ovule-type reproductive organs, has oblong leaves with a partly reduced leaf lamina, with reproductive organs situated on the leaf margin. The concept of Ovulepteris gen. nov. is based on material originally described by Obrhel (1957, 1965) under the names Ilfeldia robusta Obrhel and Ilfeldia lobecensis Obrhel from the Pennsylvanian of the Czech Republic. The new combinations Ovulepteris robusta (Obrhel) comb. nov. and Ovulepteris lobecensis (Obrhel) comb. nov. are established herein. Ovulepteris gen. nov. differs from Sobernheimia in the style of placement of the seeds. In Ovulepteris gen. nov., seeds are situated at the end of veins in protruding segments, whereas their attachment in Sobernheimia is uncertain but appear to be attached to the “midrib”. The diagnosis of Ovulepteris gen. nov. is not identical with the diagnoses of existing genera that have leaves with ovules, necessitating establishment of this new fossil-genus. The systematic position of all fossil-genera studied herein is uncertain, although they appear to be a member of the pteridosperms.

Co-ordination in Morphological Leaf Traits of Early Diverging Angiosperms Is Maintained Following Exposure to Experimental Palaeo-atmospheric Conditions of Sub-ambient O2 and Elevated CO2.

In order to be successful in a given environment a plant should invest in a vein network and stomatal distribution that ensures balance between both water supply and demand. Vein density (Dv) and stomatal density (SD) have been shown to be strongly positively correlated in response to a range of environmental variables in more recently evolved plant species, but the extent of this relationship has not been confirmed in earlier diverging plant lineages. In order to examine the effect of a changing atmosphere on the relationship between Dv and SD, five early-diverging plant species representing two different reproductive plant grades were grown for 7 months in a palaeo-treatment comprising an O2:CO2 ratio that has occurred multiple times throughout plant evolutionary history. Results show a range of species-specific Dv and SD responses to the palaeo-treatment, however, we show that the strong relationship between Dv and SD under modern ambient atmospheric composition is maintained following exposure to the palaeo-treatment. This suggests strong inter-specific co-ordination between vein and stomatal traits for our study species even under relatively extreme environmental change. This co-ordination supports existing plant function proxies that use the distance between vein endings and stomata (Dm) to infer plant palaeo-physiology.

Starling resistors, autoregulation of cerebral perfusion and the pathogenesis of idiopathic intracranial hypertension.

Two critical functions for the control of intracranial fluids dynamics are carried on the venous side of the perfusion circuit: the first is the avoidance of cortical veins collapse during the physiological increases of cerebrospinal fluid (CSF) pressure in which they are immersed. The second, is the generation of an abrupt venous pressure drop at the confluence of the cortical veins with the dural sinuses that is required to allow a CSF outflow rate balanced with its production. There is evidence that both of these effects are ensured by a Starling resistor mechanism (a fluid dynamic construct that governs the flow in collapsible tubes exposed to variable external pressure) acting at the confluence of cortical veins in the dural sinus. This implies that, in normal circumstances of perfusion balance, a certain degree of venous collapse physiologically occurs at the distal end of the cortical vein. This is passively modulated by the transmural pressure of the venous wall (i.e. the difference between internal blood pressure and external CSF pressure). The mechanism provides that the blood pressure of the cortical vein upstream the collapsed segment is dynamically maintained a few mmHg higher than the CSF pressure, so as to prevent their collapse during the large physiological fluctuations of the intracranial pressure. Moreover, the partial collapse of the vein confluence also generates a sharp pressure drop of the blood entering into the sinus. The CSF is drained in dural sinus through arachnoid villi proportionally to its pressure gradient with the sinus blood. The venous pressure drop between cortical veins and dural sinus is therefore needed to ensure that the CSF can leave the cranio-spinal space with the same speed with which it is produced, without having to reach a too high pressure, which would compress the cortical veins. Notably, the mechanism requires that the walls of the dural sinuses are rigid enough to avoid the collapse under the external cerebrospinal fluid pressure, and predicts that in the presence of excessively flexible dural sinuses, the system admits a second point of balance between cerebral fluid pressure and dural sinus pressure, at higher values. The second balance state is due to the triggering of a self-limiting venous collapse feedback loop between the CSF pressure, that compresses the sinus, and the subsequent increase of the dural sinus pressure, that further raises the intracranial pressure. The loop may stabilize only when the maximum stretching allowed by the venous wall is reached. Then, a new relatively stable and self-sustaining balance state is achieved, at the price of a higher CSF and dural sinus pressure values. We propose that this model is crucially involved in Idiopatic Intracranial Hypertension pathogenesis with and without papilledema, a condition that could be described as a pathological new balance state, relatively stable, between intracranial and dural venous pressure, at higher absolute values.

Laparoscopic anatomic liver resections for hepatocellular carcinoma

Aims: Liver resection is the most important treatment for patients with hepatocellular carcinoma (HCC), offering a possibility of cure. Because of the risk of portal metastases through microscopic vascular invasion, anatomic liver resection is generally assumed to be superior to non-anatomic resection. Aim of the video is to demonstrate how anatomic resections for HCC can be effectively performed laparoscopically thanks to laparoscopic ultrasound (LUS) guidance. Methods: Our technique of LUS guided liver resection is showed. A first scan is performed to complete staging and defining the relationships of the tumor and intrahepatic vasculo-biliary pedicles. To be always aware of the liver anatomy, both in planning the resection and during transection, the planes where main vascular structures run are marked with the electrocautery on the liver surface. When all the vessels are identified and marked, the resection lines are designed on the liver surface with the electrocautery. Results: The first case is a segmentectomy of Sg3. Sg3 pedicle and left hepatic vein are marked. The resection is carried with ultrasound dissector. At the end of the resection left hepatic vein (LHV) is exposed on the liver surface. Segment 2 is spared without any remnant ischemic parenchyma.The second case is a resection of Sg4b. LUS shows the tumor infiltrating a Sg4b main pedicle while superior pedicles are free. Segment 4 superior and inferior pedicles and right hepatic vein (RHV) are marked on liver surface. The resection is completed sparing the superior pedicle of Sg4 and exposing the RHV on the liver surface. The last case is a Sg5 segmentectomy. Two Sg5 pedicles are marked as well as right and middle hepatic vein. The section line is traced along the lines of the structure that will be spared and across the ones that will be cut and the resection is completed. Conclusions: LUS guided laparoscopic anatomic liver resections are feasible and safe.

Interventional revision method on shunt dysfunction after transjugular intrahepatic portosystemic shunt using covered stents

Objective To explore the interventional revision method on shunt dysfunction after transjugular intrahepatic portosystemic shunt (TIPS) using covered stents. Method Twenty-four patients with shunt dysfunction who underwent TIPS using covered stents between October 2009 and January 2013 were enrolled. Seventeen patients were males and 7 were females, with age ranging from 31 to 63, average 51±8. All the enrolled patients were characterized by recurrence of preoperative symptoms after first TIPS. All cases were treated by in-situ recanalization firstly, and when the guide wire and catheter was difficult to get through from the liver vein end to portal vein end, retrograde wire guiding technique was introduced through percutaneous transhepatic puncture. If all the attempts failed, parallel TIPS was employed. Oral administration of aspirin (0.1 g, 1/d) was conducted for antiplatelet therapy after surgery. Pair t-test was used to compare the portal venous pressure before and after the interventional revision. The therapeutic effect was evaluated by ultrasonic Doppler and the symptoms, such as upper gastrointestinal hemorrhage or intractable ascites. Follow up time was 27-66 months, and median time was 41 months. Results All the 24 cases were confirmed to be shunt stenosis by angiography, including 21 cases of stents-liver vein end stenosis and 3 cases of portal vein end stenosis. All the patients were examined by color Doppler ultrasound and 20 cases prompted shunt stenosis. The positive rate was 83.3%. Twenty patients were revised by in-situ recanalization and 4 patients were revised by parallel TIPS. Portal venous pressure decreased from (3.5 ± 0.4) kPa to (1.4 ± 0.4) kPa after interventional revision (t=18.3, P=0.001). Except one case of portal cavernoma rebleeding one month after the revision and missing follow up, all patients had no symptom recurrence and shunt restenosis by color doppler ultrasound. The second patency was 95.8% (23/24). Conclusions Stents-liver vein end stenosis was common among the shunt stenosis after TIPS. The interventional revision can improve the shunt dysfunction significantly. Key words: Restenosis,revise; Covered stents; Interventional radiology; Portasystemic shunt, transjugular intrahepatic

Morphological analysis of the 6b oncogene-induced enation syndrome.

The T-DNA 6b oncogene induces complex and partly unprecedented phenotypic changes in tobacco stems and leaves, which result from hypertrophy and hyperplasia with ectopic spot-like, ridge-like and sheet-like meristems. The Agrobacterium T-DNA oncogene 6b causes complex growth changes in tobacco including enations; this unusual phenotype has been called "6b enation syndrome". A detailed morphological and anatomical analysis of the aerial part of Nicotiana tabacum plants transformed with a dexamethasone-inducible dex-T-6b gene revealed several striking growth phenomena. Among these were: uniform growth of ectopic photosynthetic cells on the abaxial leaf side, gutter-like petioles with multiple parallel secondary veins, ectopic leaf primordia emerging behind large glandular trichomes, corniculate structures emerging from distal ends of secondary veins, pin-like structures with remarkable branching patterns, ectopic vascular strands in midveins and petioles extending down along the stem, epiascidia and hypoascidia, double enations and complete inhibition of leaf outgrowth. Ectopic stipule-like leaves and inverted leaves were found at the base of the petioles. Epinastic and hyponastic growth of petioles and midveins yielded complex but predictable leaf folding patterns. Detailed anatomical analysis of over sixty different 6b-induced morphological changes showed that the different modifications are derived from hypertrophy and abaxial hyperplasia, with ectopic photosynthetic cells forming spot-like, ridge-like and sheet-like meristems and ectopic vascular strands forming regular patterns in midveins, petioles and stems. Part of the enation syndrome is due to an unknown phloem-mobile enation factor. Graft experiments showed that the 6b mRNA is mobile and could be the enation factor. Our work provides a better insight in the basic effects of the 6b oncogene.

Biometric measurements involving the terminal portion of the thoracic duct on left cervical level IV: an anatomic study.

To determine the point of entrance of the thoracic duct in the venous system, as well as to evaluate some biometric measurements concerning its terminal portion, we conducted an anatomic study on 25 non-preserved cadavers. The termination of the thoracic duct occurred on the confluence between the left internal jugular vein and the left subclavian vein in 60% of the individuals. The average results for the biometric measurements were: distance between the end of left internal jugular vein and omohyoid muscle 31.2±2.7mm; distance between the end of thoracic duct and the left internal jugular vein 0.0±0.0mm; distance between the end of thoracic duct and the left subclavian vein 3.6±1.0mm; distance between the end of thoracic duct and the left brachiocephalic vein 10.7±3.1mm. Moreover, it was identified that the left internal jugular vein length in level IV, measured between its entrance in the left subclavian vein and the omohyoid muscle, was able to predict the termination of the thoracic duct on the junction between the left internal jugular vein and the left subclavian vein (OR=2.99) with high accuracy (79.3%). In addition, the left internal jugular vein length at level IV was able to predict the localization of thoracic duct termination. Thus, this finding has practical value in minimizing the risk for a potential chyle leak during or after a left-sided neck dissection.

Considerations on the caliber of the internal iliac vein

Abstract The diameter at the origin of the internal iliac vein was found between 4.7 to 9.9 mm; for the right internal iliac vein between 4.7 to 9.7 mm; the statistical distribution groups value in ascending order being as follows: 4.7 to 5.5 mm: 4 cases (22.22% of cases); 6.9 to 7.8 mm: 6 cases (33.33% of cases); 8.4-8.8 mm: 4 cases (22.22% of cases); 9.1 to 9.7 mm: 4 cases (22.22% of cases). The diameter at the origin of the left internal iliac vein was between 4.8 to 9.9 mm, while the distribution statistics on groups of values, in ascending order, being as follows: 4.8-5.2 mm: 4 cases (22.22 % of cases); 6.8-7.1 mm: 8 cases (44.44% of cases); 8.3 to 9.9 mm: 6 cases (33.33% of cases). The diameter at the end of the internal iliac vein was between 5.9 to 10.2 mm; the diameter at the end of the right internal iliac vein was between 6.1 to 10.2 mm, the statistical distribution of values groups in ascending order being follows: 6.1 to 7.5 mm: 6 cases (33.33% of cases); 8.4 to 8.7 mm: 8 cases (44.44% of cases); 9.3 to 10.2 mm: 4 cases (22.22% of cases). The diameter at the end of the left internal iliac vein was between 5.9 to 9.9 mm, while the distribution statistics on groups of values in ascending order being as follows: 5.9 to 6.2 mm: 4 cases (22.22 % of cases); 7 to 7.6 mm: 3 cases (16.67% of cases); 8.3-8.4 mm: 5 cases (27.28% of cases); 9.1 to 9.9 mm: 6 cases (33.33% of cases). Comparing the common iliac vein caliber of the two, right and left, we found that in 10 cases (55.56% of cases), the right internal iliac vein has a greater diameter than the left one by 0.3 mm. In 8 cases (44.44% of cases), the left internal iliac vein has a larger diameter than the right one with 0.1-0.6 mm; between the two values there is a difference of 0.5 mm

Direct Open Venous Drainage: An Alternative Choice for Flap Congestion Salvage.

In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this 8×6 cm defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.

Innovative technique: Distal venous cannulation for salvaging free flap venous thrombosis by heparinised saline irrigation.

Introduction:Successful free tissue transfer depends on a multitude of factors, and adequate drainage of venous blood is one of the most critical part of successful free tissue transfers.Material and Methods:We report 6 cases of microvascular free flaps used for covering various defects, which developed venous congestion, that were salvaged with heparinised saline irrigation through the distal end of the congested vein by the help of an intravenous cannula. The irrigation was continued for 5 days.Results:All the flaps were successfully salvaged.Conclusion:This method has potential applications in situations for successful salvage of free tissue transfer particularly due to venous thrombosis.

Lipid Profile of Cord Blood in Term Newborns

Background: Hyperlipidemia is an important risk factor for coronary artery disease. Detection of lipid profile in umbilical cord blood of term newborns could identify neonates with a higher risk of coronary artery disease. Objectives: The aim of the present study was to improve the existing information about cord blood lipid profile of Iranian term newborns. Patients and Methods: This cross-sectional study was conducted on healthy term neonates born from healthy mothers between August and October 2009 in Zanjan, Iran. Ten milliliters of cord blood was collected from the placental end of umbilical vein immediately after the cord clamping. Total cholesterol (TC) and triglyceride (TG) were measured by enzymatic GOD-PAP method with Pars Azmoon kits. High-density lipoprotein-cholesterol (HDL-C) was measured after precipitation of Apo lipoproteins with phosphotungstic acid (PTA). Low-density lipoprotein-cholesterol (LDL-C) was calculated by Friedewald’s formula. Statistical Analysis was performed by the SPSS statistical package version 16.0 for windows. Results: Of the 174 neonates, 97 were female. Vaginal delivery was recorded in 79.8%. There were no significant differences regarding demographic findings between male and female neonates. The mean values of TC, LDL-C, HDL-C and TG were 73.1 ± 26.5, 28.7 ± 11.1, 27.6 ± 10, and 81.4 ± 37.1mg/dL respectively, with no difference between the two sexes. Conclusions: We found a relatively high value of TC and TG in our study. Considering the relationship between high levels of lipids in the neonatal period and coronary artery disease in the adult population, we recommend future cohort studies for this statistical society.

The soybean mycorrhiza-inducible phosphate transporter gene, GmPT7, also shows localized expression at the tips of vein endings of senescent leaves.

GmPT7 was originally identified as an arbuscular mycorrhiza-inducible gene of soybean that encodes a member of subfamily I in the PHOSPHATE TRANSPORTER 1 family. In the present study, we established conditions under which a number of dwarf soybean plants complete their life cycles in a growth chamber. Using this system, we grew transgenic soybean with a GmPT7 promoter-β-glucuronidase fusion gene and evaluated GmPT7 expression in detail. GmPT7 was highly expressed in mature, but not in collapsed, arbuscule-containing cortical cells, suggesting its importance in the absorption of fungus-derived phosphate and/or arbuscule development. GmPT7 was also expressed in the columella cells of root caps and in the lateral root primordia of non-mycorrhizal roots. The expression of GmPT7 occurred only in the late stage of phosphorus translocation from leaves to seeds, after water evaporation from the leaves ceased, and later than the expression of GmUPS1-2, GmNRT1.7a and GmNRT1.7b, which are possibly involved in nitrogen export. GmPT7 expression was localized in a pair of tracheid elements at the tips of vein endings of senescent leaves. Transmission electron microscopy revealed that the tip tracheid elements in yellow leaves were still viable and had intact plasma membranes. Thus, we think that GmPT7 on the plasma membranes transports phosphate from the apoplast into the tip elements. GmPT7 knockdown resulted in no significant effects, the function of GmPT7 remaining to be clarified. We propose a working model in which phosphate incorporated in vein endings moves to seeds via xylem to phloem transfer.