Interruption Of Veins Research Articles

Pelvic Congestion Syndrome: Surgical Treatment

Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.

Uterine viability in the baboon after ligation of uterine vasculature: a pilot study to assess alternative perfusion and venous return for uterine transplantation

To assess, in two separate groups of baboons, uterine viability after ligation of the uterine veins and uterine viability after ligation of both the uterine arteries and veins, respectively. Prospective, observational study. Baboon breeding colony. Six naïve female Papio hamadryas baboons with indicators of normal reproductive function. Three baboons underwent surgical interruption of the uterine veins bilaterally, and three baboons underwent surgical interruption of the uterine arteries and the uterine veins bilaterally. All baboons also underwent colpotomy, cervico-vaginal reanastomosis, and intraoperative near-infrared fluorescence imaging after vessel ligation. In the postoperative period, transabdominal sonography, vaginoscopy, and endocervical biopsy were performed on all animals. Postoperative uterine and ovarian viability. Near-infrared imaging confirmed intraoperative perfusion of the uterus and cervico-vaginal anastomosis in all cases. In all subjects, sonography revealed normal uteri, and vaginoscopy revealed well-healed anastomoses. Endocervical biopsies (five of six) demonstrated pathologically normal endocervical tissue without evidence of necrosis. Cyclical sex skin turgescence and menstruation were unanimously observed. Disruption of bilateral uterine vessels does not affect uterine or ovarian viability in the baboon. Bilateral uterine artery and vein ligation furthers development of a minimally invasive approach to donor hysterectomy.

Impact of optimal anticoagulation therapy on chronic venous ulcer healing in thrombophilic patients with post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is the long-term sequelae of deep venous thrombosis (DVT). PTS clinical manifestations include chronic leg pain, oedema, lipodermatosclerosis and ulcers. The objective of this study is to determine in patients with documented history of thrombophilias and DVT whether the number of previous thrombotic events and optimal anticoagulation therapy are associated with the time to venous ulcer healing following the start of compression therapy. Retrospective analysis performed in thrombophilic patients under the age of 50 years old with chronic venous ulcers secondary to DVT at the wound clinic in the National Institute of Medical Sciences and Nutrition 'Salvador Zubirán ' in Mexico City. Variables such as the number or episodes of thrombotic events, type of hypercoagulable disorder, optimal anticoagulation therapy with Warfarin monitored by therapeutic International Normalised Ratio (INR) (2-3) and compliance to compression therapy were examined. Patients that underwent superficial or perforator vein interruption or endovascular recanalisation of deep veins were excluded from the study. From a database of 29 patients with chronic venous ulcers followed in our clinic from January 1992 to September 2012, only 13 patients (61% female) met the inclusion criteria. Mean age±standard deviation (SD) was 32±12 years old. Of these, seven (54%) patients with suboptimal INR presented with an average of two previous thrombotic events and the remaining six (46%) patients with optimal INR only one event (p=0.28), the mean time to the clinical manifestation of a venous ulcer after the first episode of DVT was 39 months (range: 12-72) for patients with suboptimal INR and 82 months (range: 12-216) for those with optimal anticoagulation therapy (p=0.11). During the mean follow-up period of 52 months, all patients in optimal anticoagulation healed their ulcer; their mean time for wound healing was 44 months (range: 4-102). In the suboptimal INR group, only four healed the ulcers with an mean of 72 months (range: 2-204) (p=0.94). There seems to be an association between an optimal anticoagulation therapy with Warfarin monitored by INR and wound healing rates in thrombophilic patients with chronic venous ulcers. Further research is warranted. The authors have no conflict of interest.

A Prospective Study in Comparison of Ambulatory Phlebectomy and Duplex Guided Foam Sclerotherapy in the Management of Varicosities with Isolated Perforator Incompetence.

Perforators are those which connect the superficial and deep venous system either directly to main veins or indirectly through the muscular and soleal venous plexus. The emergence of minimally invasive techniques like ambulatory phlebectomy (AP) and foam sclerotherapy (FS) has led to increasing interest about the appropriate therapy for the treatment of isolated perforator incompetence. There have been no studies which have compared the effectiveness of these in-office procedures in isolated perforator incompetence due to the low prevalence of cases. The primary goal of this study is to compare the clinical parameters (return to normal activity, primary symptom relief), functional parameters (procedure time, change in disease severity, course of venous ulcer), and duplex parameters (recurrence in treated veins, complete occlusion of treated veins) in the management of leg varicosities having isolated primary perforator incompetence by ambulatory phlebectomy and duplex guided foam sclerotherapy. Though the procedure time was shorter with FS than AP, the other parameters of primary symptom relief such as change in disease severity, faster healing of venous ulcer, complete occlusion of treated veins in follow-up duplex examination, and lower recurrence of treated veins are better with AP than FS. In conclusion, the interruption of perforators is effective in decreasing the symptoms of chronic venous insufficiency and for the rapid healing of ulcers. The interruption of the incompetent perforating veins appears to be essential to decrease ambulatory venous hypertension. It is apparent from this study that ambulatory phlebectomy stands distinct with enormous benefits and serves as a superior alternative to foam sclerotherapy in treating patients with isolated perforator incompetence.

Conduit Puncture for Electrophysiological Procedures in Patients with Fontan Circulation

Background: Electrophysiological procedures are challenging in pa- tients who have undergone lateral tunnel or extracardiac conduit Fontan operation because the caval veins are not connected to the cardiac atria and ventricles. This study describes our experience in managing a series of patients with Fontan circulation requiring cath- eter ablation for arrhythmias. Methods: This study included eight consecutive patients with Fontan circulation who underwent catheter ablation or pacemaker implan- tation via Fontan conduit puncture (median age (interquartile range), 21.5 (16.0-25.8) years; 5 men). Lateral tunnel and extracardiac con- duit were equally distributed among the eight patients. A standard technique for conduit puncture and subsequent electrophysiologic procedure was used. The time taken for conduit puncture was com- pared for different types of conduits. Results: The median age of patients in this series was 21.5 years (interquartile range: 16.0-25.8 years). Fontan conduit puncture via right femoral vein under intracardiac echocardiographic guidance was successfully performed without complications in seven of the eight patients. Conduit puncture failed in one patient with extracardiac conduit made of the pericardium due to interruption of both femoral veins. In three patients with Fontan conduit made of pericardium, a Bronckenbrough transseptal needle or a radiofrequency transseptal needle with a snare was used. In four patients with Fontan conduit made of Gore-tex, a radiofrequency transseptal needle with a snare, and percutaneous transluminal angioplasty balloon were used. Fontan conduit puncture time was significantly longer in patients with conduit made of Gore-tex (median time, 91 min; interquartile range, 59.8-130.5 min) than in patients with conduit made of the pericardium (median time, 11.5 min; interquartile range, 10.0-18.3 min), respectively (p=0.020). Conclusions: Conduit puncture is feasible and safe in patients with lateral tunnel and extracardiac Fontan circulation. Puncture of the Gore-tex conduit is more difficult and time consuming than punc- ture of the pericardium conduit.

The Management of Chronic Venous Insufficiency With Ulceration: The Role of Minimally Invasive Perforator Interruption

The purpose of this study was to analyze the long-term outcomes associated with interruption of incompetent perforator veins (IPV) using minimally invasive techniques as adjunctive therapies in the management of patients with chronic venous insufficiency (CVI). This is a retrospective review of a prospectively maintained venous database collected over 6 years (2005-2011). The study cohort included 64 patients with CVI stage C5 or C6 who underwent minimally invasive perforator interruption with subfascial endoscopic perforator surgery (SEPS) or radiofrequency ablation of IPV (RFA-IPV) as part of the management of their CVI. All patients were referred for evaluation after having failed conservative treatment with compression dressings. Relevant patient characteristics and comorbidities were recorded along with symptom resolution, venous ulcer healing, recurrence, and surgical complications. In addition to clinic follow-up examination by a surgical provider, chart notes from other subspecialties were also reviewed. We also conducted telephone assessments in patients who had been lost to clinic follow-up in order to provide complete outcome data. In this subset (n = 64) of patients with CVI who had adjunctive IPV treatment, 41(64%) underwent SEPS and 23 (36%) patients underwent RFA-IPV along with ablation of the greater saphenous vein for C5 or C6 disease. The mean patient follow-up was 37 months. There were no differences in patient demographics or risk factors. Twenty-three (88%) SEPS and 12 (100%) RFA-IPV patients (P=NS) with C6 disease went on to completely heal their venous ulcers after the procedure with an average healing time of 5.2 (SEPS) and 4.4 (RFA-IPV) months (P=NS). Overall, 7 (17%) SEPS and 6 (23%) RFA-IPV patients (P=NS) developed a recurrent ulcer after surgical treatment. Procedural complications were seen in 14 (34%) SEPS and 2 (9%) RFA-IPV patients (P=NS), mostly minor. Major complications only occurred in the SEPS group consisting of 2 major amputations caused by pain from nonhealing ulcers and 1 deep venous thrombosis. This study supports the premise that in patients with advanced venous disease, there may be a demonstrable benefit directly attributable to perforator interruption. Our recurrent ulceration rates are acceptable, with low complication rates in patients undergoing RFA-IPV, thereby making this procedure more attractive in patients with multiple comorbidities. We support an aggressive approach to patients with C5/C6 disease that includes perforator elimination when appropriate.

Laparoscopic Surgery of Deferential Reflux in Pediatric and Adolescent Varicocele

This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically. Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively,all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS)to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of refluxing deferential veins. Reflux in both the ISV and the deferential vein was observed in 21 (14.1%) out 148 boys with varicocele.Only one case (0.6%) of varicocele was caused by an isolated deferential reflux. No reflux in the cremasteric vein was observed. After a median follow up period of 2 years (range, 6 months-5 years), none of our patients with deferential reflux experienced varicocele recurrence either clinically or according to CDUS scanning.No testicular atrophy was observed. Our diagnostic approach is a rigorous standard for identifying all the venous systems concurring with the varicocele. Our proposed technique with laparoscopic interruption or coagulation of deferential veins when proved by CDUS to be refluxing may allow successful treatment for most varicoceles. This method allows reduction in recurrence of varicocele due to a missed deferential reflux.

Laparoscopic Incisional and Umbilical Hernia Repair in Cirrhotic Patients

Traditional approach to incisional hernias (IHs) in cirrhotic patients is plagued by a significant recurrence rate and frequent wound infections. The laparoscopic repair of IHs was designed to offer a minimally invasive and tension-free technique that yields less morbidity and fewer recurrences than the standard open repair. In cirrhotic patients there are additional reasons for the benefits of laparoscopy. First, preservation of the abdominal wall avoids interruption of large collateral veins. Second, nonexposure of viscera restricts electrolytic and protein losses, and improves absorption of ascites. Finally, the laparoscopic approach is associated with a lower perioperative blood loss (smaller abdominal incision). A retrospective review was performed for 14 consecutive patients with ventral hernias and affected by chronic hepatitis or cirrhosis related to hepatitis C-B virus, who underwent laparoscopic repair at our institution between September 2002 and October 2004. All patients were in class A of Child-Pugh classification. There was no conversion to open operation. The mean size of the defects was 87 cm (range 1 to 480); incarceration was present in 2 patients and multiple (Swiss-cheese) defects in 1. In all cases, the mesh (average, 287 cm) was secured with transabdominal sutures and metal tacks or staples leaving the sac in situ. Operative time and estimated blood loss averaged 88 min (range 18 to 270) and 30 mL (range 10 to 150). Length of hospital stay averaged 2.6 days (range 1 to 6). There were 11 minor complications: seroma lasting >4 weeks (5), postoperative ileus (2), suture site pain >2 weeks (2), urinary retention (1), and skin breakdown (1). We experienced no recurrences with an average follow-up of 8 months (range 3 to 24). Laparoscopic IH repair is technically feasible and safe even in cirrhotic patients with fascial defects. This operation decreases postoperative pain, shortens the recovery period, and seems to reduce postoperative morbidity and recurrence. To the best of our knowledge, this is the first report in which a series of cirrhotic patients affected by incisional and umbilical hernias is treated with a laparoscopic approach.

Preoperative and intraoperative evaluation of diameter-reflux relationship of calf perforating veins in patients with primary varicose vein.

Interruption of incompetent perforating veins (PVs) is important for varicose vein surgery. The purpose of this study was to evaluate the preoperative and intraoperative diameter-reflux relationship of PVs and to evaluate the accuracy of preoperative duplex scanning in patients with varicose vein. Patients with primary varicose veins were retrospectively investigated. Diameters and reflux of PVs were evaluated before surgery with color flow duplex ultrasound scan (US). During operation, the incompetent PVs were defined as those that showed an outward spurt of blood flow from the stump of the PVs. The sensitivity and specificity of US in the detection of reflux of PVs were calculated. Competent versus incompetent vein diameters were compared with the Student t test and one-way analysis of variance. Three hundred twenty-four calf PVs were detected in 304 legs of 175 patients with varicose vein. Diameters of competent and incompetent PVs confirmed with intraoperative finding averaged 2.67 +/- 1.10 mm (n = 28) and 3.28 +/- 1.01 mm (n = 58), respectively, at the upper calf (P =.012), 2.85 +/- 0.85 mm (n = 53) and 3.68 +/- 0.94 mm (n = 137), respectively, at the lower calf (p <.001), and 2.67 +/- 0.99 mm (n = 14) and 3.27 +/- 0.66 mm (n = 22), respectively, at the posterior calf (P =.036). The overall sensitivity of detection of reflux with US was 87.7%, and the specificity was 75.3%. Diameters of true-incompetent PVs and false-incompetent PVs were 3.59 +/- 0.94 mm (n = 199) and 3.31 +/- 0.84 mm (n = 24), respectively (P =.157). Diameters of true-competent PVs and false-competent PVs were 2.61 +/- 0.91 mm (n = 73) and 2.89 +/- 0.82 mm (n = 28), respectively (P =.158). Although the diameter of incompetent PVs was larger than that of competent PVs in both US and intraoperative findings, diameter measurement alone can not completely distinguish competent and incompetent PVs. The sensitivity and specificity of reflux obtained with US showed that the accuracy of preoperative duplex scanning to evaluate PV competency was not sufficient.

Development of perforator vein surgery from the Linton and Cockett procedure to endoscopic dissection

Interruption of incompetent perforator veins (PV) is regarded as one of the principles of therapy in cases of severe stages of chronic venous insufficiency. This paper is to demonstrate the development of PV surgery from the original procedure (termed the radical Linton's operation after its originator) to minimal invasive approaches as the subfascial endoscopic perforator vein surgery (SEPS). Subfascial or epifascial interruption is frequently complicated by poor postoperative wound healing (sometimes more than 50%) even in cases with smaller incisions as the former Linton's procedure. PV interruption by hooks and special knives has been in wide use, however, the procedure is not as precise as a direct subfascial approach. The blind subfascial perforator interruption and fasciotomy by Hach has been advocated in severe forms of chronic venous insufficiency. It was Hauer at the beginning of the eighties who introduced a video-controlled surgical approach using a scope with fiberoptic lighting and video camera. At this time, a variety of instruments and modified techniques exists, but the effect of SEPS on venous hemodynamics and clinical outcome is not totally proven due to an additional reflux or obstruction in the deep or saphenous veins and concurrent epifascial surgery. A lower rate of complications of the endoscopic procedures is described, however, there is still a rate of about 5% hematoma and about 7% delayed wound healing. SEPS is an important adjunct in severe cases of PV insufficiency with chronic venous ulcers and lipodermatosclerosis. SEPS will fail in circular crural ulceration where the lesion should be totally excised and covered with skin transplantation. Up to now there is no study to demonstrate the efficacy of SEPS in patients with primary saphenous vein incompetence without deep reflux.

A new technique for resecting ‘unresectable’ liver tumors

Background/Purpose: Liver tumors that surround the three major hepatic veins traditionally have been considered unresectable. This report describes an extended atypical left hepatectomy technique for tumors around the major hepatic veins. Methods: Three children with tumors surrounding the 3 hepatic veins underwent intraoperative evaluation for extended atypical left hepatectomy. The left hepatic artery, left branch of the portal vein, and the 3 hepatic veins are occluded with vascular clamps. Perfusion of the remaining liver is through the right hepatic artery and portal vein into the retrohepatic vena cava via the retro hepatic veins. If the liver remains soft and does not become mottled, division of the 3 hepatic veins and resection of the tumor are carried out. Results: Extended atypical left hepatectomy was successful in 2 children. Bile leak occurred in 1 instance and healed spontaneously. Both patients had transiently elevated serum bilirubin and transaminase levels and an elevated prothrombin time for 2 weeks. Both survived after treatment with chemotherapy. In the third child the liver became tense and mottled, and the procedure was abandoned. Conclusions: Successful extended atypical left hepatectomy depends on the ability of the retro hepatic veins to adequately drain blood into the vena cava after interruption (clamping) of the main hepatic veins. If the liver becomes mottled and tense the procedure must be abandoned and the patient should be considered for hepatic transplantation. J Pediatr Surg 35:1294-1299. Copyright © 2000 by W.B. Saunders Company.

Hemorrhagic infarction of hilar lymph nodes associated with combined heart-lung transplantation

The histologic changes in lymph nodes transplanted during combined heart-lung transplantation were examined. We studied at autopsy nine patients who had received a total of 10 heart-lung transplants. Hemorrhagic infarction of hilar nodes was found in eight of the 10 transplanted lungs. Pulmonary parenchymal pathologic changes associated with lymph node infarction included acute rejection (two cases), chronic rejection with bronchiolitis obliterans (two cases), and pneumonia (four cases). In one of the transplants without lymph node infarction there was chronic rejection with bronchiolitis obliterans and in another there was evidence of bronchopneumonia. The hemorrhagic lymph node infarction seen in the recipients of combined heart-lung transplant's may be directly attributable to the interruption of bronchial arteries and veins by the surgical procedure. At present the possible contribution of node infarction to postoperative morbidity or mortality is unknown.

The pattern of intramural veins of the left ventricle of the human heart.

A detailed injection, microradiographic, and histological necropsy study of 18 hearts showed that the pattern of myocardial veins differed from the arterial pattern. In "normal" hearts, large drainage veins began in the subendocardial zone and coursed fairly directly towards the epicardium, maintaining a comparatively even calibre throughout. Smaller, but similar, drainage veins also begain in the middle of the myocardial wall. In the outer myocardium small groups of these vessels converged to form a single vein which then entered, almost at right angles, the pericardial veins. In general, small veins within the myocardium entered directly into the large drainage veins without any extensive intermediate sized venous network. In "abnormal" hearts with left ventricular hypertrophy the myocardial veins appeared basically normal but were more widely separated and consequently overall less dense on microradiography. Interruption of main drainage veins and loss of normal pattern were seen in areas of myocardial fibrosis associated with coronary artery disease. In a heart with severe generalized coronary artery atheroma the normal pattern in the inner half of the wall was replaced by a "plexus" of small veins in which the majority of vessels coursed circumferentially. The possible significance of both the normal and abnormal vein pattern is discussed.

Intracarotid coomassie blue eye as an aid in the surgery of intracranial vascular lesions.

T RANSIENT coloring of the vessels of the retina or of the face by intracarotid Coomassie Blue, t a deepcolored, nontoxic dye, provides a means of confirming the correct placement of a polyethylene catheter in ei ther the external or internal carotid ar tery . This technique has been developed in conjunction with circulation studies requiring selective internal carotid injection of radioisotopes for direct recording from the surface of the brain during operation. 6-s The dye injection also displays the a n a t o m y of the pial and cortical circulation of the surgically exposed brain. This has supplied useful quali tat ive information to supplement quant i ta t ive radioisotopic flow curves obtained during operation on various lesions, including cerebral neoplasms, angiomas, aneurysms, and epilel)togenie scars. 7,s The combination of these techniques provides the neurosurgeon with a means for examining the cerebral circulation directly during craniotomy. Thus, it has been possible to distinguish arterial and venous vessels in the pial circulation, to define differences in regional blood flow in the distribution of the major cerebral arteries, and to assess changes in local blood flow after excisions which have necessitated surgical interruption of arteries or veins. ~,1~ Intra-arterial dye injection has been found useful as a means of confirming catheter placement in radioisotopic circulation studies, with external monitoring over the head. I t has also made possible controlled injection of amy ta l and metrazol into the internal carotid a r t e ry in epileptic patients when electroencephalographic localization

Fatal pulmonary emboli: A study of 130 autopsy-proven fatal emboli

1. 1. One hundred thirty cases of autopsy-proven fatal pulmonary emboli have been studied at the Boston City Hospital. 2. 2. Ninety-one per cent of these came from leg veins and the majority of these had positive leg signs for phlebitis. 3. 3. Hemiplegia was the third most frequent predisposing disease. 4. 4. Eight cases had some form of surgical interruption of the deep veins to prevent embolization. The reasons for the failure of these interruptions have been examined.

Venous circulation in lower extremities following femoral vein interruption.

D URINC: the past fifteen years the operation of femoral vein interruption, originally introduced by Homans, 1 has been used with varying frequency by different clinics for the prevention of pulmonary embolism. Since a broad program of femoral vein interruption a.~ a prophrlactic measure necessarily entails, in many instances, the interruption of veins which are normal, it has been of some interest to evaluate the effect, of this procedure on the venous return frorn limbs which, prior to the procedure, were ostensibly normal. Clinical evaluations of such patients have been rnade.‘MG These evaluations have shown little evidence of damage to t,he venous drainage of the limb provided the interruption had been performed distal to the larger collateral venous trunks in the femoral triangle. The activity of the paGent may, however, decrease greatly following the primary illness for which he was treated, and for this reason reports of such clinical evaluations may not be entirely tenable. Furthermore, bandaging of t,he extremity may be used to forestall edema and thus mask sequelae. The introduction of the walking venous pressure test as a method for the objective evaluation of the efficiency of the venous return is o has prompted us to study, by means of this test, the extremities of a group of patients in whom the operation of superficial femoral vein interruption was performed. The results of the walking venous pressure test in ext,remities in which diseased femoral veins had been interrupted have been reported before.’ The patients presented below had normal veins prior to superficial femoral vein interruption, and did not develop postinterruption thrombosis.

Postthrombotic Sequelae of the Lower Extremity. Treatment by Superficial Femoral Vein Interruption and Stripping of the Saphenous Veins: (A Preliminary Report)

Postthrombotic Sequelae of the Lower Extremity. Treatment by Superficial Femoral Vein Interruption and Stripping of the Saphenous Veins: (A Preliminary Report)

VENOUS THROMBOSIS AND PULMONARY EMBOLISM

This communication will present the experience at the Massachusetts General Hospital with thrombosis and embolism up to June 1946. Previous reports have stressed the importance of this syndrome and have called attention to the diagnostic criteria.1The safety of interruption of the femoral veins in the treatment of this disorder has been demonstrated. We wish now to record our present views on the subject including a controlled study on the use of Dicumarol. PROPHYLAXIS Prevention of thrombus formation in the deep veins of the legs is, in fact, the basic principle on which investigators in this field have been working for many decades. Progress has been slow, yet through a coordination of ideas much has been accomplished along these lines. Inasmuch as thrombosis within the veins is most apt to occur as a complication of illness or operative intervention, the opportunity for prophylaxis against this additional hazard to the

The syndrome of the rolandic vein: Hemiplegia of venous origin

T HE disturbances, resuIting from interference with the cerebra1 venous circuIation, because of their reIative infrequency have not received the concentrated attention of cIinica1 investigators. Even so most of the Iiterature concerned with the cerebra1 venous system is IargeIy based on the great venous channeIs, the cavernous, superior sagitta1, Iateral and straight sinuses, whiIe the changes incident to interruption of the cerebra1 veins have received scant mention. There has been a tendency to treat the cerebra1 veins as more or Iess useIess structures devoid of physioIogica1 importance. l In the meager reports there have been few cIinica1 descriptions of the motor and sensory changes to be expected from obstruction of the cerebra1 veins, of a nature suffrcientIy definitive so that the diagnosis of such occIusions can be made with the same confident certainty manifested in evaIuating arteria1 Iesions. However, there has been sIowIy accumuIating information with respect to the physica symptoms resuIting from interruption of the drainage of the roIandic vein, so that the suspicion of such interference can be entertained with increasing conIidence. The idea1 basic situation for such a suspicion occurs when a prior disease exists in or near the superior sagitta1 sinus, such as infection, a tumor invoIving or adjacent to the sinus, or trauma to the sinus. This paper is concerned with a further eIaboration of the syndrome of the roIandic vein.