Tortuosity Of Veins Research Articles

A chronic myeloid leukemia presenting as panuveitis combined with retinal and choroidal vascular occlusion: a case report

BackgroundChronic myeloid leukemia (CML) can manifest ocular complications stemming from hematologic irregularities or direct infiltration of neoplastic cells. This article details the case of a patient with newly diagnosed CML exhibiting elevated platelet counts (PLT) who developed panuveitis accompanied by retinal vascular occlusion.Case presentationA 52-year-old woman experienced a notable decline in vision in her left eye over a 2-week period. Classical anterior uveitis, vitreous cavity opacity, optic nerve edema, and retinal vascular obstruction were observed. The right eye exhibited papilledema and retinal vein tortuosity. Despite admission, the condition of both eyes deteriorated, accompanied by a continuous increase in PLT. She was diagnosed with CML based on bone marrow biopsy and chromosomal examination. Following platelet apheresis therapy and chemotherapy, the condition of her right eye significantly improved, but the left eye’s condition remained irreversible.ConclusionsThis is a rare case of newly diagnosed CML presenting with diverse ocular manifestations in both eyes. The disparate outcomes in eyes with varying lesion stages underscore the importance of prompt diagnosis.

Computer-aided detection of retinopathy of prematurity severity assessment via vessel tortuosity measurement in preterm infants' fundus images.

To develop a computer-aided diagnostic system for retinopathy of prematurity (ROP) disease using retinal vessel morphological features. A total of 200 fundus images from 136 preterm infants with stage 1 to 3 ROP were analysed. Two methods were developed to measure vessel tortuosity: the peak-and-valley method and the polynomial curve fitting method. Correlations between temporal artery tortuosity (TAT) and temporal vein tortuosity (TVT) with ROP severity were investigated, and vessel tortuosity relationships with vessel angles (TAA and TVA) and vessel widths (TAW and TVW). A separate dataset from Japan containing 126 images from 97 preterm patients was used for verification. Both methods identified similar tortuosity in images without ROP and mild ROP cases. However, the polynomial curve fit method demonstrated enhanced tortuosity detection in stages 2 and 3 ROP compared to the peak and valley method. A strong positive correlation was revealed between ROP severity and increased arterial and venous tortuosity (P < 0.0001). A significant negative correlation between TAA and TAT (r = -0.485, P < 0.0001) and TVA and TVT (r = -0.281, P < 0.0001), and a significant positive correlation between TAW and TAT (r = 0.204, P value = 0.0040) were identified. Similar results were found in the test dataset from Japan. ROP severity was associated with increased retinal tortuosity and retinal vessel width while displaying a decrease in retinal vascular angle. This quantitative analysis of retinal vessels provides crucial insights for advancing ROP diagnosis and understanding its progression.

Direct ophthalmoscopy as a screening tool to study retinal vascular changes in acute mountain sickness in response to recent ascent to high altitude: A pilot study.

Background Advanced diagnostics are not easily accessible in austere topographical locations. We documented retinal changes in patients with acute mountain sickness (AMS+) and compared these with asymptomatic individuals (AMS-) with recent induction into high altitude using direct ophthalmoscopy as a screening tool. Methods We evaluated 97 individuals (43 AMS- and 54 AMS+) who were inducted to an altitude 3800 m above sea level by direct ophthalmoscopy after pupillary dilatation, on day 2 of arrival. Results Retinal vein dilatation was seen in 36 (66.7%) AMS+ v. 14 (32.6%) AMS- (p<0.01), hyperaemia of the optic disc in 30 (55.6%) AMS+ v. 14 (32.6%) AMS- (p<0.05), hyperaemia of the optic disc along with retinal vein dilatation in 27 (50%) AMS+ v. 9 (20.9%) AMS- (p<0.01), retinal vein tortuosity in 12 (22.2%) AMS+ v. 3 (7%) AMS- (p<0.02). In AMS+ with retinal vein dilatation 17 (50%) had SpO2 >91% and 19 (79.2%) had SpO2 <91% (p<0.01). An AMS score of >5 was recorded in 25 (69.4%; p<0.001) with venular dilatation and in 19 (52.8%; p<0.001) who were AMS+ with an induction number ≥3 had retinal dilatation. Conclusion Acute hypobaric hypoxia causes retinal venous dilatation, tortuosity and hyperaemia of the optic disc in those with AMS and correlates directly with SpO2 levels. The incidence of retinal vein dilatation increases with frequent re-entry into high altitude and more severe symptoms of AMS. Hence, all those being inducted to high altitude should be screened for retinal vascular changes.

Application of 4D flow MRI for exploring factors affecting haemodynamics of iliac veins in asymptomatic population.

Haemodynamics plays an important role in the development of vascular disease. There is currently a lack of studies evaluating the characteristics and affecting factors of the iliac vein haemodynamics in clinical practice. The goal of this study was to use 4D flow MRI to explore the haemodynamic characteristics of iliac veins and its affecting factors in an asymptomatic population. Thirty consecutive volunteers without venous-related symptoms or signs underwent four-dimensional postprocessing of their MRI images. Relevant parameters, the demographic data, common iliac vein-inferior vena cava angle, iliac vein area, tortuosity, iliac vein mean flow, mean velocity was computed and analysed. T tests and Spearman's tests were used for analysing. A P value of 0.05 or less was considered significant. Height and iliac vein area were positively correlated with flow, while degree of stenosis, and common iliac-inferior vena cava angle were negatively correlated with that. Degree of stenosis was positively correlated with velocity, but the common iliac-inferior vena cava angle and iliac vein tortuosity were negatively correlated with that. The mean flow and velocity of iliac veins in females were lower than males. The mean flow and velocity of the left iliac veins were lower than those of the right. The height, gender, tortuosity, degree of stenosis, common iliac vein-inferior vena cava angle of the iliac vein are important factors that affect flow and velocity of the iliac veins. There were differences in haemodynamic parameters of the bilateral iliac veins.

Use of the Buddy Judkins Catheter and Stiff Wire Technique to Deliver Sheaths for Catheter Ablation Through Iliac Vein Tortuosity

Use of the Buddy Judkins Catheter and Stiff Wire Technique to Deliver Sheaths for Catheter Ablation Through Iliac Vein Tortuosity

A Comparison of the Tortuosity Phenomenon in Retinal Arteries and Veins Using Digital Image Processing and Statistical Methods

The tortuosity of retinal blood vessels is an important phenomenon, and it can act as a biomarker in the diagnosis of several eye diseases. The study of abnormalities in the tortuosity of retinal arteries and veins provides ophthalmologists with important information for disease diagnosis. Our study aims to compare the tortuosity relation between retinal arteries and veins by quantifying the vessels’ tortuosity in the retina using 14 tortuosity measures applied to the AV-classification retinal dataset. Two feature sets are created, one for arteries and the other for veins. The comparison between the tortuosity of arteries and veins is based on a two-sample T-test statistical method, a regression analysis between the quantified tortuosity features, principal component analysis at the dataset level, and the introduction of the arteriovenous length ratios concept to compare the variations in these new ratios to see the tortuosity behavior in each image. The methods’ results have shown that the tortuosity of retinal arteries and veins is similar. The result of the two-sample T-test supports the research hypothesis, as the P-value obtained was greater than 0.05. Furthermore, the regression analysis between arteries and veins features showed a high correlation (r2 = 89.39% and 89.11%) for arteries and veins, respectively. The study concludes that the retinal vessel type has no statistical significance in the tortuosity calculation results.

Ocular manifestations of COVID-19: systematic review and meta-analysis

ObjectifLa présente étude a pour objectif d'accroître nos connaissances sur la maladie à coronavirus 2019 (COVID-19) en proposant un examen exhaustif de la prévalence des différentes manifestations oculaires en lien avec la COVID-19. NatureRevue de synthèse systématique et méta-analyse. MéthodesLes études admissibles publiées entre le 20 juin 2021 et le 11 mai 2023 ont été extraites de 3 bases de données (MEDLINE, EMBASE et CINAHL) et de la documentation parallèle. Le logiciel Covidence a servi à réaliser la revue de synthèse systématique. Les doublons ont été éliminés, et 2 examinateurs indépendants se sont assurés de la pertinence des études ainsi extraites. Par la suite, on a évalué le risque de biais. Après l'extraction des données, c'est le logiciel STATA, version 14.0, qui a été utilisé pour procéder à la méta-analyse. Des modèles à effets fixes et à effets aléatoires ont été calculés en tenant compte de l'hétérogénéité. RésultatsNotre méta-analyse regroupait 43 articles, pour un total de 10 572 patients. Les résultats ont permis de constater une prévalence significativement plus élevée de conjonctivite (ampleur de l'effet [AE] = 0,11; intervalle de confiance [IC] à 95 % : 0,07–0,15), de ptosis (AE = 0,22; IC à 95 % : 0,15–0,30) et d'ophtalmoplégie (AE = 0,40; IC à 95 % : 0,06–0,74) chez les patients atteints de la COVID-19. Nos résultats font également ressortir une prévalence plus élevée d'exsudats cotonneux (AE = 0,06; IC à 95 % : 0,03–0,09), d'hémorragie rétinienne (AE = 0,12; IC à 95 % : 0,06–0,18) et de tortuosité veineuse rétinienne (AE = 0,19; IC à 95 % : 0,09–0,35) en présence de COVID-19. ConclusionLa COVID-19 peut entraîner des effets extrapulmonaires pouvant toucher les segments antérieur et postérieur de l’œil. La conjonctivite compte au nombre des effets fréquents sur le segment antérieur, tandis que les exsudats cotonneux, les hémorragies rétiniennes et la tortuosité veineuse rétinienne font partie des effets sur le segment postérieur. L'amélioration de nos connaissances en ce qui a trait aux manifestations oculaires de la COVID-19 peut accélérer le diagnostic et la mise en route du traitement.

Genome-wide Association Studies of Retinal Vessel Tortuosity Identify Numerous Novel Loci Revealing Genes and Pathways Associated With Ocular and Cardiometabolic Diseases.

To identify novel susceptibility loci for retinal vascular tortuosity, to better understand the molecular mechanisms modulating this trait, and reveal causal relationships with diseases and their risk factors. Genome-wide Association Studies (GWAS) of vascular tortuosity of retinal arteries and veins followed by replication meta-analysis and Mendelian randomization (MR). We analyzed 116 639 fundus images of suitable quality from 63 662 participants from 3 cohorts, namely the UK Biobank (n=62 751), the Swiss Kidney Project on Genes in Hypertension (n=397), and OphtalmoLaus (n=512). Using a fully automated retina image processing pipeline to annotate vessels and a deep learning algorithm to determine the vessel type, we computed the median arterial, venous and combined vessel tortuosity measured by the distance factor (the length of a vessel segment over its chord length), as well as by 6 alternative measures that integrate over vessel curvature. We then performed the largest GWAS of these traits to date and assessed gene set enrichment using the novel high-precision statistical method PascalX. We evaluated the genetic association of retinal tortuosity, measured by the distance factor. Higher retinal tortuosity was significantly associated with higher incidence of angina, myocardial infarction, stroke, deep vein thrombosis, and hypertension. We identified 175 significantly associated genetic loci in the UK Biobank; 173 of these were novel and 4 replicated in our second, much smaller, metacohort. We estimated heritability at ∼25% using linkage disequilibrium score regression. Vessel type specific GWAS revealed 116 loci for arteries and 63 for veins. Genes with significant association signals included COL4A2, ACTN4, LGALS4, LGALS7, LGALS7B, TNS1, MAP4K1, EIF3K, CAPN12, ECH1, and SYNPO2. These tortuosity genes were overexpressed in arteries and heart muscle and linked to pathways related to the structural properties of the vasculature. We demonstrated that retinal tortuosity loci served pleiotropic functions as cardiometabolic disease variants and risk factors. Concordantly, MR revealed causal effects between tortuosity, body mass index, and low-density lipoprotein. Several alleles associated with retinal vessel tortuosity suggest a common genetic architecture of this trait with ocular diseases (glaucoma, myopia), cardiovascular diseases, and metabolic syndrome. Our results shed new light on the genetics of vascular diseases and their pathomechanisms and highlight how GWASs and heritability can be used to improve phenotype extraction from high-dimensional data, such as images. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Relationship between the features of venous drainage of supratentorial arteriovenous malformations and the risk of intracranial hemorrhage

Intracranial hemorrhage is the most common complication of cerebral arteriovenous malformations (AVM). In recent years, most studies devoted to the features of AVM functioning consider venous drainage as important factor influencing the rupture of malformation. To review the literature data on the relationship between the features of venous drainage of cerebral arteriovenous malformations and intracranial hemorrhage. We found 43 studies discussing the features of AVM venous drainage for the period from 1982 to 2020. Most of reports were published between 2005 and 2020. Deep venous drainage and a single drainage vein were the most significant factors influencing the risk of hemorrhage. Venous ectasia, reflux, stenosis, number, length and tortuosity of drainage veins were less important for the risk of AVM rupture. Analysis of the features of AVM venous drainage can make it possible to predict the natural course of disease and risk of intracranial hemorrhage. These aspects are essential for neurosurgical treatment.

Retinal Vein Changes as a Biomarker to Guide Diagnosis and Management of Elevated Intracranial Pressure.

Retinal vein changes, which can be observed on clinical exam or ophthalmic imaging, are promising non-invasive biomarkers for elevated intracranial pressure (ICP) as a complement to other markers of high ICP including optic nerve head swelling. Animal and human studies have demonstrated increase in retinal vein pressure associated with elevated ICP mediated by increase in cerebral venous pressure, compression of venous outflow by elevated cerebral spinal fluid pressure in the optic nerve sheath, and compression of venous outflow by optic nerve head swelling. Retinal vein pressure can be estimated using ophthalmodynamometry. Correlates of retinal vein pressure include spontaneous retinal venous pulsations, retinal vein diameter, and retinal vein tortuosity. All of these have potential for clinical use to diagnose and monitor elevated ICP. Challenges include diagnostic prediction based on single clinical measurements and accurate assessment of retinal vein parameters in cases where optic nerve head swelling limits visualization of the retinal veins.

Прогрессирование начальной диабетической ретинопатии: связь с состоянием углеводного обмена

Актуальность. Распознавание ранних стадий диабетической ретинопатии (ДР) у пациентов с сахарным диабетом 2-го типа (СД2) и прогнозирование их прогрессии имеет важное значение и является актуальной задачей современной офтальмологии. Цель исследования — изучить особенности возникновения и прогрессирования начальных стадий ДР и установить связь со степенью нарушения углеводного обмена у пациентов с СД2. Материалы и методы. Был обследован 91 пациент (182 глаза) с СД2. Согласно ETDRS по системе клинических признаков Airlie House определяли микроаневризмы (МА), микрогеморрагии (МГ), интраретинальные микрососудистые аномалии (ИРМА), ретинальные венозные аномалии, неперфузию сетчатки и связь их развития со степенью нарушения углеводного обмена у больных СД2. Результаты. У большинства пациентов (72,5 %) на начало исследования ДР не было (уровень ETDRS составил 0–10 на обоих глазах). У остальных (27,5 %) на одном глазу уровень ETDRS был 10, а на другом отмечены единичные изменения калибра сосудов, расширение и извитость вен, ИРМА или МГ, что соответствовало уровню ETDRS 14/15. У этих пациентов давность СД2 была больше (в среднем на 3 года), а нарушения углеводного обмена были более выраженными. В течение 1 года наблюдения глазные изменения прогрессировали по-разному: при отсутствии ДР в начале исследования прогрессия была отмечена в 50 % случаев, тогда как при их наличии — в 92 %. Пациенты с прогрессией имели больший стаж диабета и худшие показатели углеводного обмена. Выводы. Установлено, что диабетические изменения сетчатки начинаются с одиночных сосудистых изменений, при наличии которых в течение 1 года ДР развивается в большинстве случаев.

The role of choroidal optical coherence tomography for follow-up of carotid cavernous fistula with anterior drainage.

To evaluate the role of the choroidal vascularity index (CVI) and the tortuosity index (TI), along with choroidal thickness measurements, in follow-up for anteriorly draining carotid cavernous fistulas (CCF) that would otherwise necessitate an invasive carotid angiogram. In this longitudinal observational study, analysis of enhanced depth imaging spectral domain optical coherence tomography (SD-EDI-OCT) images of 22 patients with angiographically proven unilateral CCF with anterior drainage was performed for subfoveal choroidal thickness (SFCT), central foveal thickness (CFT), CVI and TI. Baseline measurements were compared with those taken at the last visit after occlusion of the fistula. Both in the clinically affected and unaffected eyes, there was a significant decrease in CFT (p = 0.015 and p = 0.005, respectively), SFCT (p = 0.000 for both eyes), CVI (p = 0.002 and 0.001, respectively) and all three TI parameters, including inferior (p < 0.001 and p = 0.01, respectively) and superior temporal vein tortuosity index (p = 0.005 and p = 0.02, respectively) as well as total venular tortuosity index (p < 0.001 and p = 0.002, respectively) after successful closure of the fistula compared to first presentation. Changes in all parameters were similar between the D-CCF and I-CCF groups except for CVI. In this first study concerning follow-up of anteriorly draining unilateral CCFs by SD-EDI-OCT, we not only demonstrated involvement of the clinically unaffected eye but also showed that, this modality, utilizing CVI and TI together with choroidal thickness measurements, can be used as a readily available, noninvasive first-line followup method for evaluating occlusion of fistulas by endovascular treatment or spontaneous resolution.

Comorbidity of hypertension and chronic venous disease in men

Aim. To study the clinical manifestations and characteristics of lower extremity chronic venous disorders (CVD) in working-age men with hypertension (HTN).Material and methods. The study included 74 men with HTN at the age of 30-50 years and 41 men without HTN. HTN duration and regularity of antihypertensive medication intake were studied. We analyzed complaints and objective signs associated with CVD, their severity, structural and functional parameters of superficial, deep and perforator veins of the lower extremities using the triplex ultrasound. The prevalence and severity of cardiovascular risk factors among patients with HTN and CVD and patients with HTN and without CVD were analyzed.Results. Men aged 30-50 with HTN showed a high prevalence of complaints (68%) associated with CVD: evening heaviness and fullness in the legs; pain decrease at rest; a combination of pain, spasm and swelling in long-time standing. Objective signs of CVD were recorded in 83,8% of men with HTN (most often — telangiectasia (38%) and swelling (24%)). Men with HTN were diagnosed with more severe manifestations of CVD than men without HTN. In patients with HTN, episodic pain and evening perimalleolar swelling were 1,8 and 4 times more likely, respectively, than in men without HTN. The presence of CVD and HTN was not associated with cardiovascular risk factors. HTN in men was characterized by a large-diameter veins, pathological reflux, vein tortuosity, the presence of thrombotic masses and postthrombotic lesions. In patients with HTN, along with an increased blood flow velocity in the deep and perforator veins of the lower leg, a low velocity in the deep femoral veins was observed. This is the evidence of venous insufficiency even at rest. Orthostasis in men with HTN increased the frequency of reflux in superficial veins by 2-4 times, which proves latent venous insufficiency.Conclusion. HTN is characterized by an increase in the frequency and severity of symptoms and signs of CVD, which indicates their comorbidity.

Visual Function and Fundus Morphology in Relation to Growth and Cardiovascular Status in 10-Year-Old Moderate-to-Late Preterm Children

To study visual function and ocular fundus morphology in relation to growth, metabolic status, and blood pressure in moderate-to-late preterm (MLP) children at 10 years of age. Prospective cohort study. In this population-based observational study, nonsyndromic MLP children born in Gothenburg, Sweden, were examined neonatally in the years 2002-2003 concerning length, weight, head circumference, and insulin-like growth factor I (IGF-I). At 10 years of age, 33 children (10 girls) were examined regarding previously mentioned variables, and regarding visual acuity, refraction, fundus morphology, IGF binding protein 3, leptin, adiponectin, and blood pressure. An age- and sex-matched control group consisted of 28 children (9girls). Myopia was more commonly found in MLP children than in controls (P= .004, 95% CI 1.8to49.8). The MLP group had smaller optic disc area (P= .01, 95% CI -0.5 to -0.1), smaller rim area (P= .001, 95% CI -0.5 to -0.2), fewer branching points (P= .0001, 95% CI -5.7 to -2.1), and higher index of tortuosity of arteries (P= .03, 95% CI 0.002 to 0.03) and veins (P= .02, 95% CI 0.003 to 0.02). Refraction correlated with IGF-I (P= .0005, rs= 0.60 in right eye, and P= .002, rs= 0.55 in left eye) at 10 years of age. Tortuosity of arteries at assessment correlated with neonatal IGF-I levels (P= .03, rs= -0.39). Tortuosity of veins correlated with a leptin/adiponectin ratio at assessment (P= .04, rs= 0.37). The findings suggest that being born MLP is associated with myopia, smaller optic disc and rim areas, and abnormal retinal vascularization. Furthermore, metabolic status and growth factors seem to have an impact on ocular development.

Minimization of skin incisions at stripping by Mayo of large-diameter veins.

The aim of the present study was to analyze the possibility to minimize of the skin incisions up to a puncture size at stripping by Mayo with the use of the stripper with an oval-ring head for large-diameter veins. The problem is solved due to the geometrical changing of the stripper head from a round to an oval one. The laboratory experiment showed that with a vein diameter of 10-20 mm the total cross-sectional area of its walls constituted 13.61 mm2, with a diameter of more than 20 mm it was 19.98 mm2. There were designed three types of the external dimensions for the stripper: 3.0×6.0 mm; 3.5×7.0 mm and 4.0×8.0 mm. From 1997 to 2017, the stripper with an oval-ring head was used in 1274 patients (421 males, 853 females) to treat 1832 lower limbs. Average age was 46.4±12.3 years (range, 29 to 73). GSV and SSV stripping was performed in 1165 and 137 cases, respectively, in patients with the trunk diameter of more than 10 mm, severe vein tortuosity, for a vein located immediately under the skin, as well as for patients with the history of thrombophlebitis. The pain level in the first evening after the operation was 1.59, on day 7, it decreased to 0.12 according to VAS-10. The motion activity level in the first evening after the operation was 7.24; on day 7, it decreased to 9.96 according to VAS-10. All patients had primary wound healing. Hematomas along the location of the eliminated veins were of a moderate nature and resolved, on average, within 17 days. With the GSV diameter of 10-20 mm the skin scars were of 2.93 mm (95% CI: 3.09-4.47 mm), with the GSV diameter of more than 20 mm the skin scars were of 4.10 mm (95% CI: 4.01-5.07 mm). After 3 months, 1102 patients (86.5%) were very satisfied and 172 (13.5%) were just satisfied with the performed operation. The use of the proposed stripper with an oval-ring head in patients with large-diameter subcutaneous trunks leads to the minimization of the skin incisions up to the punctures and, in general, makes the surgery significantly less traumatic, providing a quick recovery and minimization of the skin scars.

High Intensity Circuit Training and Progressive Resistance Training improve functional performance but not the Gait Profile Score

To study visual function and ocular fundus morphology in relation to growth, metabolic status, and blood pressure in moderate-to-late preterm (MLP) children at 10 years of age.Prospective cohort study.In this population-based observational study, nonsyndromic MLP children born in Gothenburg, Sweden, were examined neonatally in the years 2002-2003 concerning length, weight, head circumference, and insulin-like growth factor I (IGF-I). At 10 years of age, 33 children (10 girls) were examined regarding previously mentioned variables, and regarding visual acuity, refraction, fundus morphology, IGF binding protein 3, leptin, adiponectin, and blood pressure. An age- and sex-matched control group consisted of 28 children (9 girls).Myopia was more commonly found in MLP children than in controls (P = .004, 95% CI 1.8 to 49.8). The MLP group had smaller optic disc area (P = .01, 95% CI −0.5 to −0.1), smaller rim area (P = .001, 95% CI −0.5 to −0.2), fewer branching points (P = .0001, 95% CI −5.7 to −2.1), and higher index of tortuosity of arteries (P = .03, 95% CI 0.002 to 0.03) and veins (P = .02, 95% CI 0.003 to 0.02). Refraction correlated with IGF-I (P = .0005, rs = 0.60 in right eye, and P = .002, rs = 0.55 in left eye) at 10 years of age. Tortuosity of arteries at assessment correlated with neonatal IGF-I levels (P = .03, rs = −0.39). Tortuosity of veins correlated with a leptin/adiponectin ratio at assessment (P = .04, rs = 0.37).The findings suggest that being born MLP is associated with myopia, smaller optic disc and rim areas, and abnormal retinal vascularization. Furthermore, metabolic status and growth factors seem to have an impact on ocular development.

Outcome of Injection Sclerotherapy for First Degree and Second Degree Haemorrhoids– A Study of 50 Cases

Introduction: Haemorrhoid is the frequent problem in clinical practice of general surgery. Haemorrhoids are dilatation and tortuosity of rectal veins affecting almost 4.5% of the population. Various operative and non operative therapeutic options are in practice to treat haemorrhoids, yet none has been proven cent percent effective. Sclerotherapy is a simple, safe and cost effective procedure that is widely practiced globally to treat haemorrhoids. Many sclerosants are being used with variable efficacies.&#x0D; Objective: To evaluate the outcome of injection Sclerotherapy in first degree and second degree haemorrhoids.&#x0D; Materials and Methods: Fifty patients of both gender having haemorrhoids who attended Outpatient Department (OPD) at BNS Patenga from September 2013 to August 2014 were included in this study. On the basis of history, patients were selected for Digital Rectal Examination (DRE) and proctoscopic examination to confirm the diagnosis. Sclerotherapy was repeated at interval of 6 weeks till symptomatic relief was achieved. Maximum 3 sittings of sclerotherapy were given. Patients were followed up at 3 months interval for 1 year.&#x0D; Results: This prospective study was conducted on 50 cases of first degree and second degree Haemorrhoids. The highest number of patients 21(42%) were in the age group of 21-30 years with majority 38(76%) being male. Male female ratio was 3.16: 1. All the patients presented with painless per-rectal bleeding. Satisfactory results were observed in 29(58%) patients of whom 20(40%) patients were having first degree haemorrhoids and 9(18%) patients were having second degree haemorrhoids. Sclerotherapy was more effective in first degree compared to second degree haemorrhoids patients.&#x0D; Conclusion: Injecting Sclerotherapy is a suitable office procedure for treatment of haemorrhoids. The method is easy, convenient, cheap, well accepted and comfortable for patient. More or less there are no complications and the result is also satisfactory.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 98-101

A Clinical study of Retinal vein occlusions and Management

episodes of unilateral RVO in 50 patients were studied in this series giving special consideration to high risk factors and manifestations, results of various modalities of management and eventual complications. Aims and objectives of the study : 1. To study the prevalence of disease 2. To assess risk factors for RVO 3. To study the results of various modalitiesof treatment Inclusion criteria : Criteria For Crvo : flame shaped ,dot or punctuate retinal hemorrhages or both in all four quadrants of the retina ,dilatation and increased tortuosity of retinal veins and optic disc swelling with or without macular edema. Hcrvo : same as CRVO but involving either superior or inferior half of the retina only Brvo : Initially : either flame shaped,dot or punctuate retinal hemorrhagesin the distribution of occluded branch dilataion and tortuisity of the occluded vein. Later : Criteria expanded to include cases in whom retinal hemorrhages had resolved and new vessels or collaterals have developed. Investigations related to various risk factors were done in accordance with our proforma.The course of the disease was monitored through out study period and appropriate intervention in individual cases was done based on its necessity; Exclusion criteria : Those with associated diabetic retinopathy changes on fundus examination.

Expert Diagnosis of Plus Disease in Retinopathy of Prematurity From Computer-Based Image Analysis.

Published definitions of plus disease in retinopathy of prematurity (ROP) reference arterial tortuosity and venous dilation within the posterior pole based on a standard published photograph. One possible explanation for limited interexpert reliability for a diagnosis of plus disease is that experts deviate from the published definitions. To identify vascular features used by experts for diagnosis of plus disease through quantitative image analysis. A computer-based image analysis system (Imaging and Informatics in ROP [i-ROP]) was developed using a set of 77 digital fundus images, and the system was designed to classify images compared with a reference standard diagnosis (RSD). System performance was analyzed as a function of the field of view (circular crops with a radius of 1-6 disc diameters) and vessel subtype (arteries only, veins only, or all vessels). Routine ROP screening was conducted from June 29, 2011, to October 14, 2014, in neonatal intensive care units at 8 academic institutions, with a subset of 73 images independently classified by 11 ROP experts for validation. The RSD was compared with the majority diagnosis of experts. The primary outcome measure was the percentage of accuracy of the i-ROP system classification of plus disease, with the RSD as a function of the field of view and vessel type. Secondary outcome measures included the accuracy of the 11 experts compared with the RSD. Accuracy of plus disease diagnosis by the i-ROP computer-based system was highest (95%; 95% CI, 94%-95%) when it incorporated vascular tortuosity from both arteries and veins and with the widest field of view (6-disc diameter radius). Accuracy was 90% or less when using only arterial tortuosity and 85% or less using a 2- to 3-disc diameter view similar to the standard published photograph. Diagnostic accuracy of the i-ROP system (95%) was comparable to that of 11 expert physicians (mean 87%, range 79%-99%). Experts in ROP appear to consider findings from beyond the posterior retina when diagnosing plus disease and consider tortuosity of both arteries and veins, in contrast with published definitions. It is feasible for a computer-based image analysis system to perform comparably with ROP experts, using manually segmented images.

A case of pacemaker implantation in the patient with duplication of the left innominate vein: a case report.

Introduction Duplication of the left innominate vein is a rare systemic venous anomaly defined as the coexistence of a retroaortic innominate vein and a normally positioned left innominate vein. We describe a successful case of pacemaker implantation in a patient with duplication of the left innominate vein via a retroaortic innominate vein.Case descriptionA 70-year-old mentally challenged man was admitted to our hospital because of bradycardia and an altered state of consciousness. Electrocardiogram indicated sinus arrest and junctional escape rhythm with a heart rate of 40 beats/min; hence, a pacemaker was implanted. Left subclavian venography showed two vessels that were connected to the superior vena cava: a narrow, normal positioned left innominate vein and a tortuous vein. The normally positioned left innominate vein was too narrow to pass through with a guide wire. Therefore, we chose the tortuous vein for implantation. However, the procedure was difficult because of the vein’s tortuosity. Finally, leads at the right atrium and ventricle were successfully implanted using a steerable stylet. After the procedure, computed tomography showed two innominate veins: a retroaortic innominate vein and narrow left innominate vein that was a duplication of the left innominate vein.Discussion and evaluationThe exact embryogenesis of retroaortic innominate vein remains unknown and incidence of retroaortic innominate vein is very rare. But for cardiologists performing transvenous pacemaker insertion, the anomalous brachiocephalic vein may cause technical difficulty during a left arm approach.ConclusionsIn cases in which subclavian venography shows a tortuous vein, cardiologists should consider the presence of a retroaortic innominate vein.