Large Venous Channels Research Articles

Does diploic venous flow drain extracranially in the pterional area? A magnetic resonance imaging study.

To the best of our knowledge, no study using neuroimaging modalities has documented calvarial diploic veins (DVs) connected to the extracranial sites. This study aimed to characterize them using magnetic resonance imaging (MRI). A total of 88 patients underwent thin-sliced contrast MRI. In addition, the DVs coursing through the pterional area were observed on three injected cadaver heads. On postcontrast MRI, the DVs of the pterional area directly drained into the temporalis muscle or supplied branches coursing into the muscle in 43% on the right side and 40% on the left. The DVs and their branches were highly variable in diameter and number. In 9% of cases, the DV of the pterional area was found to drain into an extracranial site and connected to large venous channels distributed in the temporalis muscle. Furthermore, in 17% of cases, the DVs drained into the extracranial sites in the frontal skull region, followed by 9% in the parietal, 2% in the occipital, and 1% in the temporal regions. The DVs coursed superficially in the pterional area on both sides of all three cadaver heads. On one side, the DV in the area was open to an extracranial site. Part of the diploic venous flow drains extracranially in the pterional area. This area may provide an important interface between the calvarial DVs and the extracranial venous system.

4:10 PM Abstract No. 388 Ethylene vinyl alcohol copolymer (Onyx) for treatment of large venous vascular malformations: long-term results

To describe the long-term results and advantages of ethylene vinyl alcohol polymer for treatment of venous vascular malformations. Since 2005, we have used Ethylene vinyl alcohol copolymer (Onyx 18 & 34) in the treatment of 62 patients with large, low-flow venous vascular malformations. There were 34 females and 28 males with ages ranging from 7–59 years (mean 25 years). Fifty-one of the malformations involved the extremities and 11 involved the chest, abdominal wall or pelvis. All patients were evaluated with MRI/MRA pretreatment. Onyx was delivered by direct injection with ultrasound and fluoroscopic guidance under tourniquet control. In a few cases Onyx was also delivered via a transarterial micro catheter positioned in large feeding vessels. Sodium tetradecyl (3%) foam was used also in conjunction with Onyx in six patients where there were associated smaller foci of malformation. Histologic examination of tissues from patients whose embolized lesions were subsequently explanted was performed. Ethylene vinyl alcohol copolymer (Onyx) was found to be useful for occlusion of large venous channels in venous malformations. Unlike sclerosing agents, its visibility allowed direct observation of filling of the venous malformation during injection. When used alone, there was minimal post procedure discomfort. There were two complications: one extrusion of Onyx from a lesion on the sole of the foot, which healed without sequelae and one instance of embolization of a small Onyx fragment to the lung, also without sequelae. On H & E stains, the Onyx was noted to be distributed in the intraluminal spaces with associated mild foreign body type giant cell reaction. Permanency of the copolymer was demonstrated on long-term imaging follow-up. Ethylene vinyl alcohol copolymer (Onyx) is a safe, durable agent for treatment of venous vascular malformations. It is of particular value in malformations with large venous channels. Unlike standard sclerosing agents, Onyx behaves as a filler, and is not dependent upon generation of an inflammatory reaction for occlusion. Its opacity allows visualization of filled channels. It can be used alone or in conjunction with sclerosing agents.

What is Important in The Diagnose of Orbital Varix?

Orbital venous varices are large tubular venous channels which generally have direct connection with the systemic venous system. Orbital venous varices are rare entity (less than 1, 3% of all orbital tumors) of orbital tumors, which often located in the intraconal area of orbital apex In suspicion of orbital venous varices, performing prone position with Valsalva maneuver during MRI examination will be helpful to the radiologist to diagnose the orbital venous varices.

On the pathogenesis of penile venous leakage: role of the tunica albuginea

BackgroundEtiology of venogenic erectile dysfunction is not exactly known. Various pathologic processes were accused but none proved entirely satisfactory. These include presence of large venous channels draining corpora cavernosa, Peyronie's disease, diabetes and structural alterations in fibroblastic components of trabeculae and cavernous smooth muscles. We investigated hypothesis that tunica albuginea atrophy with a resulting subluxation and redundancy effects venous leakage during erection.Methods18 patients (mean age 33.6 ± 2.8 SD years) with venogenic erectile dysfunction and 17 volunteers for control (mean age 31.7 ± 2.2 SD years) were studied. Intracorporal pressure was recorded in all subjects; tunica albuginea biopsies were taken from 18 patients and 9 controls and stained with hematoxylin and eosin and Masson's trichrome stains.ResultsIn flaccid phase intracorporal pressure recorded a mean of 11.8 ± 0.8 cm H2O for control subjects and for patients of 5.2 ± 0.6 cm, while during induced erection recorded 98.4 ± 6.2 and 5.9 ± 0.7 cmH2O, respectively. Microscopically, tunica albuginea of controls consisted of circularly-oriented collagen impregnated with elastic fibers. Tunica albuginea of patients showed degenerative and atrophic changes of collagen fibers; elastic fibers were scarce or absent.ConclusionStudy has shown that during erection intracorporal pressure of patients with venogenic erectile dysfunction was significantly lower than that of controls. Tunica albuginea collagen fibers exhibited degenerative and atrophic changes which presumably lead to tunica albuginea subluxation and floppiness. These tunica albuginea changes seem to explain cause of lowered intracorporal pressure which apparently results from loss of tunica albuginea veno-occlusive mechanism. Causes of tunica albuginea atrophic changes and subluxation need to be studied.

Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study

Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described. The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases. We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3 mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed. Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.

Facial “glomangiomas”: Large facial venous malformations with glomus cells

Background: “Glomangiomas” are benign cutaneous vascular lesions consisting of convoluted, abnormally formed venous channels lined by cuboidal and oval epithelioid, α-actin-positive, glomus cells. Three different clinical variants of glomangioma have been recognized: solitary, multiple, and nodular, or plaquelike. Inheritable forms are common. Objective: We describe in 7 patients (2 of them having a familial glomangiomatosis) the rare facial location of glomangiomas to differentiate this type from common facial venous malformation (VM). Methods: We analyzed clinical data (photographs), course, investigations (computed tomographic scans in 4 patients, magnetic resonance imaging in 6, arteriography in 2, direct puncture phlebography in 4, and pathologic examinations in all 7), and outcome with treatment. Results: Lesions were soft, composed of multiple nodules, confluent and plaquelike, deep blue or blue-to-purple, sometimes sagging, one-sided in a cheek, extending to the lips in 5 patients, to the chin in 4, and to the lower eyelid in 4. They were poorly compressible, a finding different from common facial VMs. In a young man extensive back involvement was associated. Among radiologic investigations, only magnetic resonance imaging after gadolinium enhancement offered some differential features with common VMs. However, histopathologic examination clarified the differential diagnosis: although the large tortuous venous channels were reminiscent of capillary-venous malformation, in many vessels the walls contained one or several rows of glomus cells. Conclusion: Multiple plaquelike facial “glomangiomas” mimic a common venous malformation because of their blue hue. However, with experience, one can clinically recognize them, and their pathologic aspect is distinctive. Management should differ slightly from that for common facial VM because sclerotherapy has proven to be less effective. Therefore surgical treatment is the only helpful therapeutic option. (J Am Acad Dermatol 2001;45:239-45.)

Cardiac arrest and resuscitation of a 6‐month old achondroplastic baby undergoing neurosurgery in the prone position

We describe the case of a 6-month-old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position. Haemorrhage remained difficult to control and a second episode of air embolism occurred 5 min later leading to a profound bradycardia and hypotension again requiring full cardiorespiratory resuscitation in the prone position. In total, 11 min elapsed before an adequate spontaneous cardiac output was re-established. The procedure was abandoned and the patient transferred to the intensive care unit for postoperative management. An electroencephalogram performed after 24 h was reported as normal, and clinically the child made a full neurological recovery.

Vascularisation of the placenta in some bats

Vascularisation of the placenta of several species of bats representing 8 families is reported. Maternal vascularisation in all these bats is effected by a few large vessels which pass through the entire thickness of the placenta and give rise to numerous radial branches on reaching the foetal surface of the placenta. Maternal blood is returned through placental tubules which empty into large venous channels at the utero-placental junction. Foetal vascularisation is brought about by two allantoic arteries which capillarise over the placental tubules, and a large allantoic vein. In the exchange areas there is mostly crosscurrent circulation of the maternal and foetal bloods. Only in emballonurid bats is there an haematoma from which maternal blood is not drained back but is absorbed by cells of the trophoblast of chorionic villi.

The role of sclerotherapy as an adjunct to Unna's boot for treating venous ulcers: A prospective study

Ankle ulcers associated with venous disease have been traditionally treated by Unna's compressive bandages. However, successful healing of an ulcer with this therapeutic modality is slow and tedious. The purpose of this study is to investigate whether adjunctive sclerotherapy of large venous channels near the ulcers enhances healing. Twenty-eight patients with perimalleolar venous ucleration were entered into this study. Ulcer size ranged from 6.0 to 25 cm2. All were examined for the presence of large venous channels adjacent to the ulcer bed. A portable continuous-wave Doppler supplemented digital examination of the area. Twenty-five out of 28 patients had easily detectable venous channels, and these were randomized into two groups: group I, treated by weekly changes of Unna's compressive boots; group II, treated by weekly change of Unna's compressive boots and sclerotherapy with 3% sodium tetradecyl sulfate (Sotradecol). All patients had the size of the ulcer measured during their weekly visits. Patients in group II took a mean of 2.1 weeks to exhibit 50% healing and 4.3 weeks to fully heal. Conversely patients in group I took a mean of 3.2 weeks to achieve 50% healing and 6.1 weeks to fully heal. Thus, healing was significantly faster (p < 0.05) in group II. In conclusion, the therapeutic efficiency of Unna's compressive bandaging is significantly enhanced by the adjunctive sclerotherapy of adjacent venous channels

Bacteremia and Injection Sclerotherapy

The incidence of bacteremia following injection sclerotherapy for esophageal varices has been a subject of interest since its resurrection in the early 1980s. Multiple invasions of large venous channels through a needle contaminated with salivary microflora might be expected to be associated with a high frequency of bacteremia, especially in cirrhotic patients with "compromised" immune system. Injection of saliva into peripheral veins has been shown to produce fever and polymicrobial bacteremia.¹In this issue of theArchives, Low and colleagues²studied 38 patients subjected to 104 sessions of sclerotherapy and compared blood cultures obtained before and after the procedure. Only 4.3% of the postsclerotherapy blood cultures yielded bacteria. My colleagues and I³previously showed that the incidence of bacteremia following sclerotherapy (5%) is not higher than after routine diagnostic endoscopy (1.8% to 8%).^4-6However, other investigators have reported a higher frequency of bacteremia^7,8and attributed their findings to the length

Calcification in sclerosing adenosis simulating malignant breast calcification.

Egan (1964) describing the calcifications found on mammography in breast carcinoma, states that “The typical calcifications are pathognomonic of carcinoma. They are so specific that in their presence a histologic diagnosis of benign disease usually indicates that either the surgeon has selected the wrong tissue for biopsy or that the pathologist is in error.” We here present a patient who, on mammography had a lesion with the features of malignant calcification. Extensive and detailed histological examination demonstrated only a benign lesion. A 54-year-old married female presented to the Breast Clinic at Hammersmith Hospital with a one month history of retraction of the left nipple. She had breast fed two children and was one year post-menopausal. In 1936, at the age of 19, she was diagnosed as having “chronic interstitial mastitis” of the left breast, and for this was given a course of radiotherapy extending over a two-month period. The estimated dose was 1,200 rads. On examination at the present time the left breast was smaller than the right, with retraction of the nipple. No discrete mass was felt and there were no lymph nodes palpable. Skeletal survey and bone scan were normal. Mammography demonstrated a localized zone of numerous irregular fine punctate calcifications deep to the nipple. There was no associated mass, skin thickening, or evidence of large venous channels. This appearance was considered to be pathognomonic of malignant calcification.

Endocranial drainage of spinal cord veins.

Enlarged draining veins of spinal cord arteriovenous malformations and tumors often ascend to the foramen magnum and beyond. Serial skull filming in concomitance with spinal cord angiography shows considerable endocranial extent of these draining veins, with various patterns and final discharge into cranial sinuses. This vascular connection between spinal and cranial structures represents accentuation of a normal condition—endocranial drainage of cord veins. The endocranial drainage of cord arteriovenous malformations is a factor in treatment choice. These large venous channels in the posterior fossa may create diagnostic angiographic problems and may explain papilledema sometimes associated with cord arteriovenous malformations and tumors.

Endocranial Drainage of Spinal Cord Veins

Abstract Enlarged draining veins of spinal cord arteriovenous malformations and tumors often ascend to the foramen magnum and beyond. Serial skull filming in concomitance with spinal cord angiography shows considerable endocranial extent of these draining veins, with various patterns and final discharge into cranial sinuses. This vascular connection between spinal and cranial structures represents accentuation of a normal condition—endocranial drainage of cord veins. The endocranial drainage of cord arteriovenous malformations is a factor in treatment choice. These large venous channels in the posterior fossa may create diagnostic angiographic problems and may explain papilledema sometimes associated with cord arteriovenous malformations and tumors.

Air Embolism From Exposure Of Posterior Cranial Fossa In Prone Position

<h3>To the Editor:—</h3> Air embolism as a complication of exploration of the posterior fossa or cervical portion of the spine is usually associated with these procedures when carried out with the patient in the upright position. Michenfelder et al reported 39 instances of air embolism in 751 patients operated upon for lesions in the posterior cranial fossa.¹ The case reported below points out that precautions against air embolism are indicated even if the patient is in the prone position, especially in view of the recent widespread adoption of hyperventilation using a negative pressure phase in the respiratory cycle. Should the structures involved at operation include large venous channels, the possibilities for air embolism are obviously enhanced. <h3>Report of a Case:—</h3> A 47-year-old right-handed man was admitted to the neurosurgical service at the Episcopal Hospital in Philadelphia on March 30, 1968, with a six-week history of vertigo and syncopal episodes,

Foreign body of embolic origin in right ventricle of heart removed with successful result.

A FOREIGN body brought to the heart through the major vessels is a rare condition, encountered, as a rule, only under wartime conditions, when multiple small foreign bodies have opportunity to penetrate the human body. It would be impossible to estimate the number of foreign bodies which have penetrated large venous channels and, at the same time, closed over this wound of entrance. Later, if the foreign body is unattached at the point of entrance, the missile is transported through the vena cavae into the right auricle and through the tricuspid valve into the right ventricle. It is because of this rare condition that this case is presented. Harkins demonstrated in the last war the feasibility of the removal of these foreign bodies and the dangers encountered in leaving themin situ. Since that time, there have been many intracardiac procedures evolved for various acquired and congenital anomalies to make

Further experience with the hypoxia tolerance test of the heart in children: Mannheimer, E., Carlgren, L. E., and Graf, W.: J. Pediat. 2:58 (July), 1948

Ankle ulcers associated with venous disease have been traditionally treated by Unna's compressive bandages. However, successful healing of an ulcer with this therapeutic modality is slow and tedious. The purpose of this study is to investigate whether adjunctive sclerotherapy of large venous channels near the ulcers enhances healing. Twenty-eight patients with perimalleolar venous ucleration were entered into this study. Ulcer size ranged from 6.0 to 25 cm2. All were examined for the presence of large venous channels adjacent to the ulcer bed. A portable continuous-wave Doppler supplemented digital examination of the area. Twenty-five out of 28 patients had easily detectable venous channels, and these were randomized into two groups: group I, treated by weekly changes of Unna's compressive boots; group II, treated by weekly change of Unna's compressive boots and sclerotherapy with 3% sodium tetradecyl sulfate (Sotradecol). All patients had the size of the ulcer measured during their weekly visits. Patients in group II took a mean of 2.1 weeks to exhibit 50% healing and 4.3 weeks to fully heal. Conversely patients in group I took a mean of 3.2 weeks to achieve 50% healing and 6.1 weeks to fully heal. Thus, healing was significantly faster (p < 0.05) in group II. In conclusion, the therapeutic efficiency of Unna's compressive bandaging is significantly enhanced by the adjunctive sclerotherapy of adjacent venous channels (J VASC SURG 1990;11:572-5.)

The Distribution and Complications of Amebic Lesions Found in 186 Post-Mortem Examinations 1

The Distribution and Complications of Amebic Lesions Found in 186 Post-Mortem Examinations 1