Vein Thrombophlebitis Research Articles

Comparison of endovenous laser ablation and conservative treatment in acute thrombophlebitis of the varicose great saphenous vein: rationale, design and first results of clinical trial

Thrombophlebitis of the superficial lower limb veins is one of the most common complications of chronic vein disease. Nowadays a long-term (at least 45 days) subcutaneous injection of fondaparinux sodium or heparin in combination with elastic compression of the limb is recommended for treatment of superficial vein thrombosis with a moderate risk of thrombus propagation to deep venous system. However, long-term use of anticoagulants is not always possible and sometimes contraindicated. Endovenous laser ablation (EVLA) around thrombus-free junction of great or small saphenous veins without subsequent long-term use of anticoagulants seems to be a promising intervention for treatment of acute thrombophlebitis of varicose superficial veins.The prospective single-center randomized open-label clinical trial was dedicated for comparison the efficacy and safety of three following treatments options for patients with acute thrombosis of the varicose great saphenous vein and location of thrombi in the trunk and/ or its large inflows: EVLA close to saphenous vein junction without anticoagulation, EVLA and 7 days of anticoagulation and noninvasive treatment with anticoagulation for 45 days (subcutaneous injections of the fondaparinux 2,5 mg). Class 2 compression stockings are used in all patients. Adverse outcomes are recorded at 7, 45 and 90 days after randomization. These include the progression of superficial vein thrombosis, recurrent superficial vein thrombosis, thrombosis involvement of the superficial segment of the perforating vein up to the fascia, deep vein thrombosis according to compression ultrasound, and pulmonary embolism with symptoms. Bleedings according to the World Society of Thrombosis and Hemostasis and the Academic Research Consortium classification as well other complications are also recorded. The first 30 patients included in the study have a low incidence of venous thrombosis risk factors and localization of the thrombus relatively far from the saphenofemoral junction. EVLA resulted in persistent cessation of venous blood flow at the intervention site. New episodes of venous thrombosis were noted only in the group of medical treatment — deep vein thrombosis of the contralateral tibia 5 days after stopping of 45-day treatment with fondaparinux and thrombus in the recanalized inflow of the great saphenous vein without involving its trunk at the 21st day after stopping of 45-day injection of fondaparinux. There were no complications in the area of intervention and bleedings.

Two cases of aseptic internal jugular vein thrombophlebitis associated with hemodialysis catheter, presenting as sore throat: case report and literature review

BackgroundNon-cuffed hemodialysis (HD) catheters are often used for emergency or temporary vascular access. Its complications include thrombosis and catheter-related bloodstream infection (CRBSI); however, thrombophlebitis can also occur. Thrombophlebitis of the internal jugular vein (IJV) may present with symptoms, such as fever, lateral neck pain, and swelling, regardless of the presence or absence of infection; however, symptoms may be minor and easily overlooked. Sore throat is a well-known symptom of Lemierre's syndrome, but has not been reported in cases of thrombophlebitis without infection. We report two cases of HD catheter-associated IJV thrombophlebitis in patients that were diagnosed with sore throat.Case presentationCase 1 included a 58-year-old woman with diabetic nephropathy on HD. She was admitted to our hospital due to the occlusion of an arteriovenous fistula (AVF) for dialysis. A temporary HD catheter was placed in the right IJV until an arteriovenous graft (AVG) was fabricated. After admission, CRBSI was suspected because she developed fever; however, bacteremia was ruled out and a sore throat gradually developed. Contrast-enhanced computed tomography (CT) revealed thrombophlebitis of the right IJV. Anticoagulation therapy was initiated and she was discharged due to an improvement of symptoms. Case 2 included an 83-year-old man with end-stage renal disease due to hypertensive nephrosclerosis. He was admitted to our hospital because of AVF occlusion. A temporary HD catheter was inserted into the right IJV and an AVG was created. He had elevated C-reactive protein levels after catheter placement but was asymptomatic. When removing the catheter, he complained of throat discomfort. Ultrasonography of the neck revealed thrombotic obstruction of the right IJV, and contrast-enhanced CT revealed thrombophlebitis of the right IJV. Blood culture results were negative. He was discharged after anticoagulation therapy was started and symptoms improved.ConclusionsThe presence of sore throat leads to the diagnosis of IJV thrombophlebitis. Pharyngeal symptoms that develop after central venous catheter (CVC) placement should be differentiated from thrombophlebitis using a minimally invasive vascular ultrasound.

Тромбоз яичниковых вен при беременности

Ovarian vein thrombosis (OVT) is a rare but potentially serious complication associated with a variety of conditions, including past childbirth, inflammatory diseases, malignant processes, and pelvic surgery. The aim of this study is to summarize the literature on this problem and to analyze the frequency, differential diagnosis, and management of OVT. The article highlights three observations of ovarian vein thrombosis and thrombophlebitis diagnosed after spontaneous and operative vaginal deliveries. Key words: pregnancy complications, postpartum period, thrombosis, thrombophlebitis, ovarian vein

Современное состояние проблемы лечения тромбофлебита поверхностных вен нижних конечностей

INTRODUCTION: The article is devoted to such an urgent problem as the choice of the most effective and safe method of treatment of thrombophlebitis of the saphenous veins of the lower extremities. This pathology is one of the most common in vascular surgery. Left untreated, saphenous vein thrombophlebitis can lead to a life-threatening complication such as pulmonary embolism. The main tasks that a vascular surgeon faces during treatment are to prevent the progression of the disease, relieve symptoms and reduce the likelihood of recurrence of thrombophlebitis of superficial veins. Approaches to the management of patients with this pathology have been changing over a long period of time — from active surgical tactics to conservative therapy and large studies on the effectiveness and safety of drugs. Due to development of modern methods of treating varicose veins, it has become possible to use endovascular methods of surgical intervention for saphenous veins thrombophlebitis of the lower extremities. The article presents the review of the largest and most significant studies devoted to the results of treatment of patients with saphenous vein thrombophlebitis of the lower extremities. CONCLUSION: Despite numerous studies and opinions of reputable experts in the field of vascular surgery, some issues of choosing the most safe and effective treatment method remain debatable at the present time. Thus, for example, it is not clear what is more effective — active surgical tactics with the existing indications or 45-day conservative therapy under continuous US control. There is no consensus in the opinions on the terms of phlebectomy for prevention of recurrence of venous thromboembolic events. These and other issues concerning the choice of tactics for the treatment of patients with thrombophlebitis of the saphenous veins require further study.

Risk assessment and preventive strategies of Deep Vein Thrombosis among patients admitted in Intensive Care Units of a selected hospital in Mangaluru

Deep Vein thrombosis (DVT) is thrombophlebitis of deep veins and is known to be associated with fatal complications. Use of appropriate measures through risk assessment are of vital importance in preventing DVT related complications. Well’s criteria is a beneficial tool in categorizing the patients, therefore may guide in using appropriate preventive strategies and promoting wellbeing of immobilized patients. The present study aimed at assessing the risk and preventive strategies of Deep Vein Thrombosis among patients admitted in Intensive Care Units (ICU) of a selected hospital in Mangaluru. The study was conducted by a descriptive cross sectional design. The study was conducted among 120 ICU admitted patients of Father Muller Medical College Hospital. Purposive sampling technique was used to select sample. The tools used were Well’s criteria for risk assessment of deep vein thrombosis (DVT) and checklist for preventive strategies used. The patients were assessed after 48 hours of admission to ICU. The findings of the study revealed that there is a significant association between age above 55years (p=0.02) and diagnosis related to medical conditions of the subjects (p=0.02). Out of total 120 subjects assessed, 26 subjects had high DVT risk and 94 subjects had moderate DVT risk. Further assessment on use of preventive measures revealed that among subjects with high DVT risk, 3 subjects were on pneumatic compression devices, 18 on crepe bandages and 1 with LMWH. And out of 94 subjects with moderate DVT risk, 3 were on pneumatic compression devices, 7 on crepe bandages and 2 with LMWH. It is found that mechanical devices for prevention of DVT even though advised are seldom considered due to lack of awareness among the health care personnel towards its positive effect.

Cannula provoked upper extremity superficial vein thrombophlebitis: are we overtreating?

Cannula provoked upper extremity superficial vein thrombophlebitis (UESVT) is common. Retrospective audit of 93 consecutive patients, 51% male, median age 57 years (range 20-91), with symptomatic UESVT revealed varied management including symptomatic management (37%), prophylactic (37%) and higher dose anticoagulation (27%). There was 2% (95% confidence interval (CI) 0-7.6) thrombus extension and 1% (95% CI 0-5.9) major bleeding, both limited to cancer. We argue anticoagulation is unnecessary in most UESVT patients.

Surgical Management of Peripheral Vein Thrombophlebitis in the Upper Extremity

Peripheral vein thrombophlebitis has a reported overall incidence ranging from 20% to 80%. Thrombophlebitis can progress despite antibiotic therapy to become a challenging clinical problem requiring surgical intervention. There is currently no consensus on its optimal management. We reviewed our experience of surgical intervention with analyses of the indications for intervention, descriptions of the surgical procedures, and outcomes. We aimed to provide guidance on the management of this potentially serious complication. This is a retrospective review of 51 patients with thrombophlebitis refractory to conservative management between January 2017 and August2020. Analyses revealed a high prevalence of comorbidities, including diabetes mellitus, malignancy, and chronic kidney disease. A total of 60% of patients had concurrent bacteremia, and the decision to operate had a low threshold in the presence of these factors. On exploration, 80% of patients had intraluminal thrombus, 47% had intraluminal pus, and 29% had pus beyond the veins or extending proximally. The surgical approach employed in 98% of patients involved an extensile incision in those with several morbidity factors (diabetes mellitus, chronic kidney disease, or bacteremia). One patient presented with severe clinical signs of local infection, and on exploration, there was intraluminal pus and thrombus up to 10 cm. A novel technique of a minimally invasive approach of intermittent stab incisions was employed in a young and healthy patient without comorbidities. We developed an algorithm to guide the indications for intervention and surgical approach to thrombophlebitis. The threshold for intervening surgically should be lowered by the presence of comorbidities. The failure of antibiotics to resolve the clinical signs of infection or the suspicion of abscess formation should mandate intervention. Thrombosed sections of the vein should be ligated proximally and distally and excised and surrounding collections of pus drained. Delayed secondary wound closure is usual. Stab incisions may limit surgical dissection and subsequent scarring in less severe cases. Prognostic IV.

Superficial Vein Thrombophlebitis of Lower Limb Caused by an Intra-vascular Foreign Metallic Body

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Endoscopic transversus abdominis release in the treatment of midline incisional hernias: a prospective single-center observational study on 100 patients.

For W2-3 incisional hernias of the midline, a component separation is often needed to achieve closure of the fascia during repair with a mesh. Posterior component separation has been initially performed via open surgical approach, but more recently interest in minimally invasive reconstruction has grown. The aim of this work is to describe the technical aspects of endoscopic hernia repair with posterior component separation and to assess its feasibility in midline incisional hernias, based on the analysis of the results. We prospectively evaluated and analyzed patients with midline incisional hernias who underwent endoscopic posterior component separation by transversus abdominis release (TAR). A group of 100 patients was operated between April 2017 and September 2021. The median follow-up was 27 ± 13.5months, mean age 59 ± 10.2years, ASA 2.5 ± 0.7; 94% of patients had comorbidity. There were 7 (7%) complications observed in the early postoperative period-retromuscular hematoma (1), infection of the retromuscular space (4), and thrombophlebitis of superficial veins (2). In 4 (4%) patients, late complications were observed-persistent seroma (3) and chronic pain (1). There were no hernia recurrences in the follow-up period. The use of TAR endoscopic separation can reduce the number of unfavorable surgical site events, compared to the published data on a similar open surgery, while maintaining a low recurrence rate.

Acute Venous Disease Anomalies in Critically Ill COVID-19 Patients

Introduction: Other entities besides deep vein thrombosis (DVT) affecting the venous system, such as superficial vein phlebitis (SVP) and superficial vein thrombophlebitis (SVT), receive poor attention in the literature. However, both entities may propagate proximally into the deep venous system and progress to a DVT. To our knowledge, the relevance of other venous findings such as SVP or SVT in coronavirus disease 2019 (COVID-19) patients has not been evaluated. This work aimed to assess the clinical, biochemical, and hematological variables associated with the incidence of acute venous diseases, such as DVT, SVP, and SVT, in a cohort of 74 critically ill COVID-19 patients and their association with mortality.Methods: Given the high thrombotic risk, all patients underwent venous imaging with bedside ultrasound. Clinical variables were obtained from medical records. Comparisons were made by the chi-square test or Fisher’s exact test. We constructed Kaplan-Meier curves and used Cox proportional hazard models to calculate hazard ratios for dichotomized risk factors to identify predictors of mortality. SPSS version 21.0 (IBM Corp., Armonk, NY) was used for statistical analysis.Results: SVP occurred in 28 patients (37.8%), DVT in 22 patients (29.7%), and 28 patients died (37.8%). Elevated D-dimer was associated with DVT but not with SVP. Neither SVP nor DVT was associated with mortality. After adjusting for age, elevated troponins (OR: 2.4, 95% CI: 1.1-5.4), platelets < 244 cell/mm3 (2.4, 1.1-5.6), and IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding score > 7 (2.8, 1.3-6.3) were predictors of mortality.Conclusions: Acute venous findings such as SVP and DVT are highly prevalent and independent of mortality in critically ill COVID-19 patients. These entities are not related, although they may occur synchronically. DVT is frequently presented as an asymptomatic distal bilateral finding associated with elevated D-dimer, decreased ferritin, and higher vasoactive drug use but independent from chronic venous disease. Interestingly, elevated troponins, decreased platelets, and a prognostic value > 7 of the IMPROVE bleeding score were predictors of mortality in this group of critically ill COVID-19 patients.

Surgical Specifics of Lower Limb Superficial Thrombophlebitis Combined with Undifferentiated Connective Tissue Disease

Background. Superficial thrombophlebitis of lower extremities is among the most frequent acute vascular pathologies. Concomitant undifferentiated connective tissue dysplasia exerts specific changes in its clinical course.Aim: A study of the specific dynamics of acute lower limb superficial thrombophlebitis (ST) and its surgical treatment in patients with undifferentiated connective tissue dysplasia (UCTD).Materials and methods. The case histories, surgery reports and follow-up examinations of patients treated at the Vascular Surgery Unit during 2012–2020 were analysed. A total of 86 patients had signs of UCTD and underwent classical crossectomy of the great saphenous vein (Troyanov operation).Results and discussion. Duplex ultrasound of lower limb veins in 34 (39.53 %) patients revealed a discrepancy between the upper localisation of thrombotic masses in the great saphenous lumen and the external boundary registered for clinical manifestations, hyperaemia and tissue thickening. In 69 (80.23 %) patients, four or more phenotypic UCTD markers were exposed. In 74 (86.05 %) cases, a classical Babcock phlebectomy was performed as a next stage within one year after an acute thrombophlebitis attack had subsided. Of 12 (13.95 %) patients not having had a second-stage phlebectomy within one year: 4 people had UCTD signs — they refused surgery due to absent significant complaints or marked saphenous reflux; 3 had a deep vein thrombosis episode; 5 had no saphenous reflux of lower extremities in ultrasound examination.Conclusion. The registration of phenotypic signs of undifferentiated connective tissue dysplasia is recommended in choosing a surgical tactic to treat acute ascending thrombophlebitis of lower limb saphenous veins.

Gurltia paralysans: A Neglected Angio-Neurotropic Parasite of Domestic Cats (Felis catus) and Free-Ranging Wild Felids (Leopardus spp.) in South America.

Gurltia paralysans is a neglected and re-emerging metastrongyloid angio-neurotropic nematode causing severe chronic meningomyelitis in domestic cats (Felis catus) as well as in free-ranging small wild felids such as kodkods (Leopardus guigna), margays (Leopardus wiedii) and the northern tiger cat (Leopardus triginus) in South America. Within these definitive hosts (DH), adult males and females of G. paralysans parasitize the leptomeningeal veins of the subarachnoid space and/or the meningeal veins of spinal cord parenchyma, inducing vascular alterations. Feline gurltiosis has been associated with progressive thrombophlebitis of the meningeal veins, resulting in ambulatory paraparesis, paraplegia, ataxia, hindlimb proprioceptive deficit, uni- or bilateral hyperactive patellar reflexes, faecal and urinary incontinence, and tail paralysis. The complete life cycle of G. paralysans has not been elucidated yet, but most probably involves gastropods as obligate intermediate hosts (IH). In terms of epidemiology, G. paralysans infections in domestic and wild felids are scattered around various South American countries, with hyperendemic areas in southern parts of Chile. Etiological diagnosis of G. paralysans still represents a challenge for clinicians due to a lack of evidence of the excretion of either eggs or larvae in faeces or in other body fluids. Diagnosis is based on clinical neurological signs, imaging findings through computed tomography (CT), myelography, magnetic resonance imaging (MRI), and post mortem examination. Nonetheless, novel diagnostic tools have been developed, including semi-nested PCR for detecting circulating G. paralysans DNA in the cerebrospinal fluid, serum and blood samples as well as in serological diagnostic kits detecting parasite-derived antigens, but these need validation for routine usage. The hypothetical life cycle of G. paralysans is addressed in this article, including the exogenous stages (i.e., eggs, and first- (L1), second- (L2) and third-stage (L3) larvae) and obligate gastropod IH and/or paratenic hosts (PH), and we propose possible anatomical migration routes of infective L3 that reach the leptomeningeal veins in vivo. Finally, the pro-inflammatory endothelium- and leukocyte-derived innate immune reactions of the host against G. paralysans, which most likely result in thrombophlebitis and meningomyelitis, are briefly touched on.

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Introduction: Lemierre’s syndrome (LS) is a rare and serious condition that often affects school-aged children, adolescents, and healthy young adults. It is defined as an oropharyngeal infection with secondary septicemia, internal jugular vein thrombosis, and septic emboli. Rare cases of atypical LS in which thrombosis occurs in other locations have been reported. Case Presentation: We presented a case of an adolescent with fever, sore throat, and neck tenderness. Physical examination revealed acute pharyngitis and bilateral small cervical lymph nodes. Rapid antigen group A Streptococcus and viral serologic tests were negative. Complete hemogram and blood biochemical analysis showed leukocytosis and elevated serum C-reactive protein (CRP). Cervical computerized tomography (CT) scan revealed a heterogeneous right tonsil and small cervical lymph nodes. The chest radiograph was normal. After admission, the adolescent started complaining of dyspnea and thoracic pain and had a painful small cervical right mass. In the thoracic CT angiography (CTA), several pulmonary septic emboli were apparent throughout the pulmonary parenchyma. Cervical Doppler ultrasound showed right facial vein thrombophlebitis, later confirmed in a CTA. Thromboses in other locations, including the internal jugular vein, were excluded, as well as cervical abscesses. The patient was successfully treated with intravenous antibiotic therapy and anticoagulation. Discussion: To this date, no reports of LS presenting with isolated thrombosis of the facial vein have been described in pediatric patients. We highlighted the importance of early recognition of LS and its atypical variants. Pediatric international guidelines regarding its management and treatment would also greatly affect the outcome of these patients.

Hemostasiological aspects after the planned and urgent laparoscopic operations on the appendages of uterus

Postoperative period was complicated in three supervisions (6,0%) by development of thrombophlebitis of muscular veins of right shin, in one (2,0%) – thromboembolism of pulmonary artery, unconnected with development of sharp thrombophlebitis. In all supervisions after the leadthrough of conservative treatment postoperative complications were with sleeping compartments. Before an operation the indexes of coagulative hemostasis of women, gettings traditional treatment, for certain did not differ from the indexes of healthy women of genital age. At the analysis of platelet link of hemostasis it is set by us, that in preoperative period an amount of thrombocytes was on 47,8% higher as compared to healthy women. In addition, for certain the indexes of number of small aggregation appeared more high – in 2,2 time, number of large aggregation – in 2,9 time, number of aggregation – in 2,3 time higher. Other indexes of platelet hemostasis for certain did not differ from a control group. The results of the conducted researches testify to the high risk of thromohemorrhagic complications for patients after laparoscopic operations on the appendages of uterus. It dictates the necessity of improvement of algorithm of diagnostic and treatment-and-prophylactic measures.

Effect of undifferentiated connective tissue dysplasia on clinical course of varicose disease and thrombophlebitis of varicose veins after crossectomy

Objective: to analyze the features of clinical course of lower limb varicose vein disease and acute thrombophlebitis of varicose veins for the patients with undifferentiated connective tissue dysplasia (UCTD) after crossectomy. Materials and Methods. The prospective clinical cohort study involved 132 female patients with varicose disease who underwent crossectomy, of which 67 patients with dysplasia were included into the main group, whereas patients without dysplasia were included into the control group. Examination of patients and ultrasound scanning of leg veins were conducted in 3, 6, 12, and 36 months. The Cox regression analysis was used to assess the effect of dysplasia on the risk of developing thrombophlebitis of varicose veins. Results. The progress of varicose disease clinical manifestations of after crossectomy was detected in 57 (85.1%) female patients with dysplasia and in 14 (21.5%) without it (р=0.002), which resulted in phlebectomy. The recurrent thrombophlebitis of varicose veins was found in 22 (32.8%) female patients with dysplasia vs. 5 (7.7%) without it (р=0.002). Cox regression model Exp (B), which characterizes the predicted change of risks for dysplasia, was 4.216 (95% CI 1.595-11.147). Conclusion. The clinical course of varicose disease in patients with UCTD is characterized by the progression of clinical manifestations of chronic venous insufficiency of a lower limb. UCTD results in over 4.2-fold risk of developing the recurrent thrombophlebitis of varicose veins after crossectomy.

Standardized use of a combined topical preparation in the complex treatment of thrombophlebitis of the superficial veins of the lower extremities

Introduction. Treatment of thrombophlebitis should be complex and, along with mandatory compression, include both systemic and local use of drugs.Aim. To evaluate the efficacy and safety of the standardized use of the combined drug indomethacin/troxerutin in gel in real clinical practice in the treatment of superficial vein thrombophlebitis.Materials and methods. The study included 71 patients with varicose veins complicated by superficial vein thrombophlebitis. In group I patients (n = 35), topical drugs were not used. In group II patients (n = 36), combined drug indomethacin/troxerutin in gel was used daily. The drug was applied to the skin of the lower extremities three times a day, 4–5 cm of gel. Its total daily amount did not exceed 20 cm of gel. The observation period was 10 days. A dynamic scoring of clinical symptoms was performed using a linear analog scale and thermometry of the skin of the lower extremities.Results. On day 10, patients of the main group showed a statistically significant decrease in thermographic parameters in the area of thrombophlebitis: Tmin – 33.23 ± 0.12 °C, Tmax – 39.86 ± 0.24 °C, Tmean – 40.01 ± 0.16 °C (p ≤ 0.05). When assessing the symptoms of thrombophlebitis using a linear analog scale after 10 days of treatment, there was a general decrease in the number of points in the control group to 16.4 ± 0.12 and in the main group to 12.3 ± 0.16 points (p ≤ 0.05).Conclusion. Combined drug indomethacin/troxerutin in gel is an effective and safe combined drug for the treatment of patients with thrombophlebitis of the superficial veins of the lower extremities.

Сlinical case of treatment of superficial thrombophlebitis (unique in its originality)

Among patients with varicose veins, superficial vein thrombophlebitis occurs in 4–59% of patients. Unfortunately, despite the large number of published official sources with recommendations for the treatment of vein thrombophlebitis in our daily clinical practice, we continue to meet not just with casuistic cases, but because of their absurdity, which are beyond reasonable understanding (the appointment of leeches, c auterization of veins with celandine, alcohol compresses and lotions with dimexide). This clinical case report describes the case of a 65-year-old patient who initially sought medical help from a local therapist due to the appearance of a single seal and hyperemia in the upper third of the lower leg. For two weeks, the patient tried to independently stop the inflammation with alcohol compresses. Due to the lack of a positive effect, the district therapist prescribed antibiotics and warming compresses with combined nonivamide/nicoboxil ointment. Two weeks later, with the progression of inflammation and multiple purulent wounds on the background of necrosis foci throughout the inner surface of the entire lower limb, the patient turned to our medical center. As a result, it took us more than two months to stop the inflammation and heal extensive purulent wounds with secondary tension. Treatment of vein thrombophlebitis in varicose veins has been developed in detail for a long time and in detail. The tactics of using conservative means and operational benefits depend on the localization, prevalence, acute or chronic course of the disease. The purpose of this publication is to focus the attention of specialists of a wide profile on a specific example from practice on the choice of methods of treatment of vein thrombophlebitis.

Septic Cavernous Sinus Thrombosis Caused by Dental Infection

Purpose: We report a case of bilateral septic cavernous thrombosis caused by a dental infection.Case summary: A 58-year-old male was transferred to our hospital because of left-sided proptosis and eyelid swelling. The patient had fever and left temporal headache, which did not respond to oral and intravenous antibiotics. After experiencing a tooth injury while chewing hard food 3 months ago, the patient developed toothache and swelling around the tooth for which he did not take any treatment. The patient had left eyelid edema, ptosis, chemosis, and conjunctival congestion. The left eye movements were limited in all directions. Brain magnetic resonance imaging showed dilatation and thrombosis of the left superior ophthalmic vein and thrombosis of bilateral cavernous sinuses. The patient was treated with systemic antibiotics and anticoagulants. The blood culture showed growth of Parvimonas micra and Dialister Pneumosintes, which are common causes of dental infection.Conclusions: Septic thrombosis of the cavernous sinus and superior ophthalmic vein thrombophlebitis can occur due to the spread of dental infection. Prompt diagnosis and treatment are important for rapid resolution of symptoms and good prognosis.

MP56-14 UTILIZING THE MODIFIED FRAILTY INDEX TO PREDICT OUTCOMES AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP56-14 UTILIZING THE MODIFIED FRAILTY INDEX TO PREDICT OUTCOMES AFTER RADICAL CYSTECTOMY Hannah Jarvis, and Andrew Harris Hannah JarvisHannah Jarvis More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002639.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For patients with muscle invasive bladder cancer radical cystectomy remains the gold standard. There is significant risk associated with this procedure and we aim to evaluate patient characteristics that may predict outcomes following surgery. The modified frailty index (MFI) is used as a tool for predicting morbidity. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) public use files (PUF) between 2012 and 2018 were reviewed for cases of radical cystectomy, with 10,338 total observations. Morbidity was defined by the following 30-day complications: mortality, superficial incisional surgical site infection (SSI), deep incisional SSI, organ/space SSI, wound dehiscence, pneumonia, bleeding requiring transfusion, urinary tract infection (UTI), unplanned intubation, ventilator for more than 48 hours, sepsis, acute renal failure, progressive renal insufficiency, pulmonary embolism, deep vein thrombosis (DVT) or thrombophlebitis, cardiac arrest requiring CPR, myocardial infarction, and stroke with neurological deficit or cerebrovascular accident (CVA). The modified frailty index score is defined on a scale of 1 to 5, with each patient receiving one point per each of their existing comorbidities: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension that requires medication, or a functional status that was not dependent. RESULTS: Variables found to have significant differences when compared to MFI scores include patient age, gender, race, BMI, ASA class, and smoking history. Post-operative variables with statistical significance in relation to MFI scores include LOS, surgical site infection, sepsis, pneumonia, unplanned intubations, need for transfusion, readmission, and returns to the operating room. Under multivariate analysis of morbidity by frailty score, adjusting for all significant patient characteristics and operation duration, significance was found for MFI >2, age >80, male sex, minority race, smoking history, disseminated cancer, and operation duration greater than 320 minutes. CONCLUSIONS: We believe mFI score is an effective pre-operative tool for evaluating potential morbidity in patients with MIBC who are under consideration for radical cystectomy. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e978 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Jarvis More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF DownloadLoading ...

Presence of neutrophil extracellular traps in superficial venous thrombosis of Behçet's disease.

Behçet's disease (BD) has a heterogeneous spectrum of disease manifestations featuring the involvement of different organs and can be characterized with different symptoms depending on the clinical department in charge. We retrospectively reviewed BD patients seen at our hospital and investigated the presence of neutrophils producing neutrophil extracellular traps (NET) in those patients. Immunolabeling of myeloperoxidase and histone citrullination proteins was performed on skin biopsies from three BD patients who had skin biopsy-proven superficial vein thrombophlebitis in their erythema nodosum-like lesions. We observed a higher proportion of female patients and a higher incidence of acne-like eruptions among BD patients seen at our dermatology department, while there was a higher incidence of ocular and gastrointestinal involvement among BD patients treated in other departments. We suggest that sex statistical trends could lead to the co-development of different manifestations and may help clinicians choose the best therapeutic approaches, tailoring them to the specific phenotype of the patient rather than one based on single disease manifestations. NET were found in neutrophils of panniculitis concurrent with superficial vein thrombophlebitis. We suggest that the pathogenesis of BD-related thrombosis could be associated with neutrophil activation and NET are released in the panniculitis of affected skin lesions, erythema nodosum-like lesions.