Vein Diameter Research Articles

Risk Factors of Portal Vein Thrombosis in Patients with Different Child-Pugh Classes Liver Cirrhosis

Aim: to evaluate the frequency of portal vein thrombosis (PVT) and build predictive models of the development of PVT for patients with liver cirrhosis (LC) of A and B/C classes by Child-Pugh.Materials and methods. Research design is a case-control. The Case group included 130 patients with newly diagnosed PVT not caused by invasive hepatocellular carcinoma (HCC); 29 patients were assigned to class A, 101 patients were assigned to class B/C. From the database of cirrhotic patients without PVT 60 Controls for class A and 205 for B/C were selected using sratified randomization by sex, age and etiology of cirrhosis. The Mann-Whitney U-test and Pearson's chi-squared test were used to compare the groups. Odds ratios (OR) and 95 % confidence intervals (95 % CI) were calculated. Logistic regression models are constructed with the separation of the sample into training and test (0.7; 0.3). The operational characteristics of the models were calculated on the test sample; ROC analysis was carried out, the area under the ROC curve (AUC) was calculated.Results. The overall frequency of PVT was 4.1 % (95 % CI 2.7-5.8 %) in class A and 10.4 % (95 % CI 8.5-12.5 %) class B/C. Patients with class A and B/C PVT differed from the corresponding controls by more severe portal hypertension: the frequency of bleeding / number of interventions on varices compared with the control were 41/45 % vs. 7/8 % (p < 0.001) for class A and 25.7/30.7 % vs. 16.1/16.1 % (p < 0.05) for class B/C, ascites frequency was 24 % vs. 8 % (p < 0.05) for class A and 89.1 % vs. 68.3 % (p < 0.001) for class B/C. The cutoff by the portal vein diameter was the same for both classes — 13.4 mm; the spleen length was similar and amounted 17.5 mm for class A, 17.1 mm for class B/C. Patients with PVT differed from the corresponding controls by neutrophil-to-lymphocyte ratio: class A 2.33 (1.82; 3.61) vs. 1.76 (1.37; 2.20), p < 0.01, class B/C 2.49 (1.93; 3.34) vs. 2.15 (1.49; 3.26), p < 0.05. Patients of class B/C had a higher incidence of newly diagnosed malignant tumors - 23.8% (primarily HCC that does not invade the portal vein), compared with control and cases of class A - 6.3 % and 3 % (p < 0.05), respectively. The best model for class A included variceal bleeding, ascites, portal vein diameter, absolute number of neutrophils, for class B — ascites, spleen length, portal vein diameter, malignant tumors / local factors; sensitivity, specificity, accuracy and AUC were 79.3 %, 90 %, 86.5 %, 0.897 and 73.3 %, 68.3 %, 69.9 %, 0.789, respectively.Conclusion. Independently of the Child-Pugh class of LC, the main risk factor for PVT is severe portal hypertension.

Predictive Value of Spectral Computed Tomography Parameters in Esophageal Variceal Rupture and Bleeding in Cirrhosis.

To evaluate the value of the spectral CT parameters in predicting the risk of esophageal variceal bleeding in cirrhosis with portal hypertension and to provide a reference for clinical diagnosis and treatment. Seventy-eight patients were divided into an esophageal variceal bleeding group and a non- esophageal variceal bleeding group. A comparison of variables including age, gender, platelet count, Child-Pugh classification, and spectral parameters between the 2 groups was done. Baseline model and spectral model were constructed with conventional parameters and conventional parameters coupled with spectral parameters, respectively. The 2 models were analyzed by the Receiver Operating Characteristic (ROC) curve. The baseline model was established based on 4 conventional parameters and evaluated by ROC curve analysis. The spectral model was constructed based on the variables in the baseline combined with normalized iodine density in the liver parenchyma for the arterial phase, normalized iodine density in the liver parenchyma for the portal phase, normalized iodine density in the splenic parenchyma for the portal phase, diameter of the main portal vein, diameter of the splenic vein, and normalized iodine density of the left gastric vein. Normalized iodine density of the left gastric vein, normalized iodine density in the liver parenchyma for the portal phase, and Child-Pugh classification were the influencing factors of esophageal variceal bleeding in cirrhosis patients. The Area Under Curve (AUC) for the baseline and spectral models were compared (0.664 vs. 0.860) and the difference was found to be statistically significant (P < .001). The use of spectral CT parameters in consort with the conventional parameters can improve the diagnostic effectiveness of esophageal variceal bleeding in cirrhosis cases and screen for high-risk esophageal variceal bleeding patients. It may also provide an objective basis for the clinical prevention and treatment of esophageal variceal bleeding.

Manipulation of ploidy for blueberry breeding: in vitro chromosome doubling of diploid Vaccinium duclouxii (Lévl.) Hand.-Mazz by trifluralin

The diversification, evolution, domestication, and breeding of many plant species have all been greatly aided by polyploidization. In this study, we reported a successful induction of autotetraploids of Vaccinium duclouxii (Lévl.) Hand.-Mazz, which was an important germplasm for developing highbush blueberry cultivars. The isolated stems of V. duclouxii were soaked in different concentrations of trifluralin solution, and then the ploidy of the seedlings sprouted from stems were identified by flow cytometry and chromosome counting analyses. The optimal condition for inducing tetraploid of V. duclouxii leaf bud was 0.002 % trifluralin for 48 h, which the induction rate reached 8.33 %. The morphological and anatomical characteristics of induced tetraploid seedlings were significantly different from those of the original diploid plants. The average stem diameter, leaf length, leaf width, and leaf thickness of the tetraploid plants showed significantly larger and thicker compared with the diploid progenitor plants. The stomata number of lower epidermis on the tetraploid seedling leaves only was 64.20 % of the diploid progenitors’, while the average stomatal area was increased by 166.67 %. In addition, the length and width of guard cells were 128.57 % and 141.18 % of its diploid progenitor, separatively, and the chloroplast numbers were in guard cells increased by 157.36 %. The main leaf vein diameter, the upper epidermal thickness, palisade tissue and sponge tissue of induced tetraploid leaves were all significantly increased in comparison to its diploid progenitor, indicating that these indexes can be used for screening tetraploid seedlings during breeding program.

Is Femoral Vein Diameter a Reliable Marker of Central Venous Pressure?

Objective: To determine the correlation of femoral vein diameter with central venous pressure.Study Design: Cross-sectional analytical study.Place and Duration of Study: The study was carried out at the Intensive Care Unit (ICU) of Combined Military Hospital (CMH), Peshawar, Pakistan from March 2021 to July 2021.Materials and Methods: This study was done on patients aged ≥18 years who were admitted to the intensive care unit and had a central venous line passed. Patients with lower extremity deep vein thrombosis, conditions associated with raised intra-abdominal pressure like pregnancy or recent laparotomy and those unable to lie supine were excluded. Central venous pressure was measured by a manual manometer. Femoral vein diameter was also measured in horizontal and vertical dimensions at the bedside and the mean was calculated. Results: There were 150 patients, including 109 (72.7%) males and 41 (27.3%) females, with a mean age of 36.53 ± 13.83 years. Mechanical ventilation was given to 17 (11.33%) patients. The mean central venous pressure and femoral vein diameter were 8.82 ±3.87 cm and 9.36 ± 3.14 cm, respectively. The overall regression was statistically significant (r=0.407, p&lt;0.001). Femoral vein diameter significantly predicted central venous pressure (0.502, p&lt;0.001).Conclusion: Femoral vein diameter can be used as a bedside non-invasive method to determine central venous pressure.

Liver Histopathology of Mice Induced by Paracetamol on Administration of Methanol Extract of Laban Tree Bark (Vitex pubescens Vahl.)

Paracetamol metabolism takes place in the liver mediated by CYP450 enzymes and generates NAPQI radicals. The NAPQI radical is highly electrophilic to hepatocyte biomolecules and is therefore capable of inducing liver damage. Laban tree bark (V. pubescens) methanol extract is known to contain antioxidant compounds of flavonoids, saponins, and tannins with an IC50 value of 19.83 g/ml. This study aims to determine the optimal dose of extract that can improve the liver microanatomy of mice induced by toxic dose of paracetamol (TDP). This study used 30 male Swiss strain mice with a body weight of 20-30 g. The treatments given consisted of negative control (paracetamol 105 mg kg-1), positive control (vitamin E 46.8 mg kg-1), and laban extract at a dose of 75; 150; 300; 600 mg kg-1 BW. Liver microanatomy parameters measured included hepatocyte diameter (19.50±0.21 µm), sinusoids (4.39±0.23 µm), and central vein (36.84 ± 1.79 µm). Data were analyzed using one-way ANOVA and Duncan's Multiple Range Test further test was then presented in the form of mean ± standard deviation. The results showed that extract at a dose of 600 mg kg-1 had hepatocyte, sinusoid, and central vein diameters that were not significantly different (p&gt;0.05) with vitamin E.

Relationship of the Presence of the Inferior Right Hepatic Vein with the Right Hepatic Vein Diameter and CT Liver Volumetry.

Background Right hepatic venous anatomy, right lobe volume, and percentage of remnant liver are issues to be considered in preoperative planning especially transplantation. Objectives The aim of this study was to investigate the relationship of the presence of the inferior right hepatic vein (IRHV) with the right hepatic vein (RHV) diameter, right lobe volume, and percentage of remnant liver. Materials and Methods In t his cross-sectional study, the computed tomography (CT) images of 90 patients who underwent triphasic CT for being living liver donation were evaluated retrospectively. The number and diameter of IRHVs and the diameter of main RHV were recorded. For the liver volume analysis, a deep learning-based automatic liver segmentation (Hepatic VCAR) program was used. A virtual hepatectomy plane was drawn, where the right and left liver volumes were found and the percentage of the left lobe to the total liver volume was calculated. Pearson's correlation analysis was used for correlation analysis and Student's t -test was used to compare parameters. Results A total of 74 IRHVs were detected in 53 (58.88%) of 90 patients. There were no differences in the percentage of remnant left lobe volume, right lobe volume, and RHV diameter between the IRHV (+) and (-) groups. The RHV diameter had a weak negative correlation with the IRHV diameter, and a weak positive correlation with the right lobe volume. Conclusions The percentage of remnant left lobe volume, right lobe volume, and RHV diameter did not differ in liver donors with and without an IRHV. The RHV diameter had a weak negative correlation with the IRHV diameter and a weak positive correlation with the right lobe volume.

Computed tomography predictors of gastroesophageal varices in cirrhotic patients: the added value of portosystemic collaterals

BackgroundDetection of ‘spontaneous’ portosystemic collateral veins (PSCV) serves as an important tool in diagnosing portal hypertension (PTHN) and predicting prognosis. Multidetector computed tomography (MDCT) imaging is noninvasive and allows accurate assessment of variceal site and size. So, this study was conducted to assess the role of MDCT in predicting, detecting and grading gastroesophageal varices in correlation with endoscopy in cirrhotic patients in relation to other portosystemic collaterals.MethodsAnalytical cross-sectional prospective study was conducted on 100 cirrhotic patients. All patients were subjected to history taking, upper gastrointestinal endoscopic assessment, and triphasic CT or contrast-enhanced CT assessment of abdomen and pelvis.ResultsPatients who had esophageal varices in MDCT show a statistically significant difference (p = 0.016) with its endoscopic grading. There was good agreement between endoscopy and MDCT in diagnosing grade of esophageal varices as k = 0.882. The presence of ascites, splenic size, and esophageal vein diameter serve as clinically significant predictors of esophageal varices. Splenic size showed a significant difference according to endoscopic grades of EV (esophageal varices) as p = 0.031 as patients with no varices had splenic size of (15.9 ± 1.4) cm, patients with grade I had a mean splenic size of (15.2 ± 8.7) cm, patients with grade II had mean splenic size of (16.9 ± 1.8) cm and patients with grade III had mean splenic size of (18 ± 4.2) cm, while other veins diameters showed increase with advanced grades of EV but with statistically insignificant differences as p > 0.05.ConclusionsMultidetector CT features of the presence of PSCVs, splenic size, and ascites are accurate predictors of PTHN in either EVs presence or absence. MDCT can be an excellent alternative for patients who are contraindicated for endoscopy. Moreover, it can be potential screening tool for early detection of esophageal varices in very early stage of chronic liver disease and in the early care of patient with varices. MDCT remains the most applicable noninvasive diagnostic tool for patients with portosystemic collaterals.

Early results following comparison of radiofrequency and microfoam ablation of large diameter truncal veins demonstrate high closure rates and symptomatic relief

ObjectiveEndovenous closure of truncal veins with a large diameter (LD) (≥8 mm) has been associated with higher risk of post ablation thrombus propagation into the deep venous system. Similar findings after Varithena microfoam ablation (MFA) have not been characterized. The study objective was to analyze outcomes after both radiofrequency ablation (RFA) and MFA and of LD truncal veins. MethodsA retrospective review of a prospectively maintained database was performed. All patients who underwent MFA and RFA for LD symptomatic truncal vein reflux (≥8 mm) were identified. All patients had postoperative duplex (48-72 hours) scanning. Patients underwent subsequent clinical follow-up at 3 to 6 weeks. Demographic data, CEAP Classification, Venous Clinical Severity Score, procedure details, adverse thrombotic events, and follow-up data were abstracted. ResultsBetween June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent truncal vein (great, accessory, and small saphenous) closure for symptomatic reflux. Sixty-six limbs in the MFA group met inclusion criteria. Sixty-six consecutive limbs treated with RFA during the same time period were included as a comparison group. The mean truncal vein diameter treated was 10.5 mm (RFA, 10.0 mm; MFA, 10.9 mm). Twenty-nine limbs (44%) in the RFA group underwent concomitant phlebectomy. Tributary veins were concomitantly sclerosed in 34 MFA limbs (52%). Total procedural times were shorter in the MFA group (MFA, 31.6 minutes vs RFA, 55.7 minutes) (P < .001). Immediate closure rates were 100% and 95% in the RFA and MFA groups, respectively. Venous Clinical Severity Scores improved after treatment in both groups (RFA, from 9.5 to 7.8; P ≤ .001) (MFA, from 11.3 to 9.0; P ≤ .001). In the RFA and MFA groups, 83% and 79% of venous ulcers healed during the study period, respectively. Symptomatic superficial phlebitis occurred after RFA in 11% and 17% MFA. The incidence of postablation proximal deep venous thrombus extension was 3.0% in the RFA group and 6.1% in the MFA group, which was not statistically significant. All resolved with short-term oral anticoagulant therapy. No remote deep venous thromboses or pulmonary emboli occurred in either group. ConclusionsHigh early closure rates, symptom relief and ulcer healing rates can be achieved after RFA and MFA of LD saphenous veins. Both techniques can be used safely across a wide array of CEAP classes. Longer term studies are required to characterize the durability of MFA closure and sustained symptom relief in LD truncal veins.

Small Caliber Distal Cephalic Veins Undergo Significant Dilation under Anesthesia and Can Successfully Be Used for Arteriovenous Fistula Creation

Successful arteriovenous fistula (AVF) maturation and use for dialysis is highly dependent on preoperative diameter. Small veins (<2mm) exhibit high failure rates and are typically avoided. This study investigates the effects of anesthesia on the distal cephalic vein diameter as compared to preoperative outpatient vein mapping for the purpose of hemodialysis access creation. One hundred eight consecutive procedures for dialysis access placement met inclusion criteria and were reviewed. All patients received preoperative venous mapping and postanesthesia ultrasound mapping (PAUS). All patients received either regional and/or general anesthesia. A multiple regression was conducted to determine predictors of venous dilatation. The independent variables included both demographical and operative-specific variables such as the type of anesthesia. Outcomes of fistula maturation (successful cannulation and dialysis) were analyzed. In this cohort, the mean preoperative vein diameter was 1.85mm and the mean PAUS diameter was 3.45mm, a 2.21× increase, with only 2 patient veins failing to increase in diameter. Smaller veins (<2mm) exhibited significantly more dilation than larger veins after anesthesia (2.73 vs. 1.47×, P<0.001). In the multiple regression analysis, smaller vein diameter was correlated with a significantly greater degree of dilation (P<0.001). The degree of venous dilation was not affected by patient demographic-specific factors or by the type of anesthesia (regional block versus general) in the multiple regression analysis. 6month follow-up data for fistula maturation was available for 75 of 108 patients. Small veins (<2mm) on preoperative ultrasound matured at a similar rate as larger veins (90% vs. 91.4%, P=0.833). Small caliber distal cephalic veins experience a significant degree of dilation under regional and general anesthesia and can successfully be used for AVF creation. Consideration should be made to perform a postanesthesia vein mapping for all patients undergoing access placement despite preoperative venous mapping results.

Combination of Ultrasound and Molecular Markers in Evaluating Isolated Distal Deep Vein Thrombosis in Lower Limbs: A Prospective Cohort Study.

To evaluate the risk factors of isolated distal deep vein thrombosis (IDDVT) in the lower limbs by using a combination of Doppler ultrasound and thrombus molecular markers. A prospective cohort study was used. We selected 145 patients with deep vein thrombosis of the lower limbs. They were divided into the IDDVT group and the non-IDDVT group. We compared the differences in Doppler ultrasound and biochemical indexes between the two groups. The independent influencing factors of IDDVT were analyzed using logistic regression, and we plotted the receiver operating characteristic (ROC) curve. We compared 47 IDDVT cases diagnosed by DSA with 47 non-IDDVT cases selected at random. The diameter of the common femoral vein (CFV) of the affected side, deep femoral vein, and the great saphenous vein, thickness of subcutaneous tissue, and serum D-dimer (D-D) and thrombin-antithrombin III complexes (TAT) were significantly higher in the IDDVT group than the non-IDDVT group (P < .05). Logistic regression analysis showed that CFV diameter, subcutaneous tissue thickening, D-D, and TAT were all independent risk factors for IDDVT (P < .05). The combined predictor had higher predictive sensitivity, specificity, and Youden's index (93.6, 87.2, and 0.808, respectively) than using thrombus molecular markers alone or Doppler ultrasound alone. D-D and TAT, the thrombosis molecular markers, CFV diameter, and thickening of subcutaneous tissue, as well as the Doppler ultrasound, all have their own independent effects on IDDVT. When Thrombosis molecular markers and Doppler ultrasound are used in combination, they can predict which patients are at high risk of IDDVT and help doctors in making clinical decisions pertaining to prevention and treatment.

The safest power to be applied in relation to diameter of the vein to give maximal benefit with least complications in endovenous laser ablation of varicose veins

Background Over the years, there have been significant advancements in the treatment of varicose veins. In most surgical settings, the open procedure is still the primary approach. Yet, the popularity of less invasive procedures like EVLA and RFA has produced fantastic outcomes. Objective to assess the safest power of laser which gives maximal effect and least complications in ablation of varicose veins. Methodology A prospective observational study inducing EVLA of different laser power settings (7W &amp; 10W) with preoperative assessment then follow up by CEAP &amp; VCSS and duplex ultrasound measuring great saphenous vein (GSV) diameter and also post-operative complications and time to return to work. Results This study included 50 patients (52 limbs). The Patients were distributed as regard laser power used into two groups (7W, 10W) of 26 limbs for each one. As regard GSV measures changes, there was highly statistically significant decrease in GSV diameter after 1 m and after 3 m compared to preoperative, with P value P&lt;0.001, among patients group. Also, there is higher number of cases with GSV&gt;10 mm in power of laser ‘10w’ group compared to ‘7w; group, with P value (P&lt;0.001); while there is no statistically significant difference between power of laser 7w versus 10w, because all patients ≤10 mm after 1 month and after 3 months, with P value &gt;0.05.Statistically there was no significant difference between 7W &amp; 10W groups as regards time to return to work, CEAP scores and postoperative complications except the significant difference in Pain over the treated vein being less in 7W laser power group. Conclusion For endovenous laser ablation of varicose veins, both 7W and 10W laser power are indicated. They are risk-free and provide the greatest impact with the fewest difficulties for the chosen vein diameter. In our investigation, we came to the conclusion that patients with small GSV diameter required low laser power (7W), while those with large GSV diameter required high laser power (10W).

An Observational Study on Transposed Brachial Artery ‒ Basilic Vein AV Fistula in Vascular Access for Hemodialysis

Background: Dialysis access in patients of chronic kidney disease (CKD) on long-term hemodialysis is a problem area. Patients with poor caliber veins distally on initial evaluation or with multiple fistula failures, basilic vein transposition is a good alternative. We present our experience with basilic vein transposition at our center. Methods: This study was a single-center observational study. A retrospective review of prospectively collected data from December 2013 to June 2019 was done. Qualitative variables were expressed as frequencies/percentages and compared between groups using the Chi-square test. Quantitative variables were expressed as mean ± standard deviation and compared between groups using unpaired t-test between groups and paired t-test within groups across follow-ups. Multiple linear regression analysis using a stepwise model selection tool was used to assess factors affecting the first cannulation. The best model was arrived in four steps where explanatory power (R 2) increased from 66.6% to 79.3% (P &lt; 0.001). Results: One hundred and eighty-eight patients formed a part of the study. One hundred and sixty-four patients underwent single stage, whereas 24 underwent two-stage transposition. Ninety-four each were male and female. The mean age was 51.38 ± 14.74 years. About 96.27% of fistulas underwent successful cannulation. The overall mean maturation time was 44.46 ± 7.21 days. It was 42.28 ± 3.71 for single and 60.27 ± 6.66 days for two-stage procedures. Primary patency at 6 months and 1 year were 92.82% and 85.67%, whereas primary-assisted patency rates were 94.6% and 91%. The secondary patency rate at 1 year was 60.77%. Salvage procedures included thrombolysis in 2, thrombectomy in 18, and thrombectomy with venoplasty in four cases. There were 28 failures. Fistula thrombosis was the most common cause. Complications included transient arm edema in 36.7%, late thrombosis in 7.7%, wound infection in 4.4%, and lymphorrhea in 6.9% of patients. Conclusion: The smallest basilic vein diameter for successful transposition is 2.5 mm. Factors used to predict successful maturation are initial vein diameter ≥2.5 mm, preoperative Peak systolic velocity (PSV) in brachial artery &gt;70 cm/s, fistula flow rate of &gt;400 ml/min at 6 weeks, and fistula diameter &gt;4.5 mm at 06 weeks.

Effect of electric function training instrument for arteriovenous fistula on vascular index of fistula and puncture success rate in patients with autogenous arteriovenous fistulization

ABSTRACT Objective. To explore the effect of electric function training instrument for arteriovenous fistula on vascular index of fistula and puncture success rate in patients with autogenous arteriovenous fistulization (AVF). Methods. 60 patients received AVF in the Fourth Hospital of Hebei Medical University from June 2020 to June 2021 were selected as the study subjects, and they were divided into the treatment group (TG, n = 30) and the reference group (RG, n = 30) according to the random number table method. The patients in the RG received routine pressure training by clench fist and tourniquet after surgery, and the TG used electric function training instrument for arteriovenous fistula on the basis of routine clench fist, then comprehensively evaluating the clinical application value of this study protocol by comparing the vascular index of fistula and puncture success rate of the two groups. Results. The depth of cephalic vein to skin at T2 and T3 in the TG was notably lower than the RG (P < 0.05), and the vessel diameter of cephalic vein at T3 in the TG was visibly higher than the RG (P < 0.05), with no overt difference in the rate of fistula complication, one-time puncture success rate and the incidence of puncture injury in both groups (P > 0.05). The score of functional exercise compliance of fistula in the TG was clearly higher than the RG (P < 0.001). Conclusion. The study results suggest that the use of electric function training instrument for arteriovenous fistula after AVF is more effective, so it has certain clinical application value.

A Comparison of the Human Umbilical Cord's Histomorphometric and Histological Structure in Pregnant Diabetic and Non-Diabetic Women

This study aimed to explore the histomorphometrical and histopathological alterations of umbilical cord (UC) vessels caused by gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM). A total of thirty UC samples were obtained from full term pregnant women without any complications. Ten out of thirty UCs were obtained from non-diabetic pregnant women (normal group), 10 from GDM and 10 from PGDM pregnant women. Segments from the placental attachment, center and fetal side of UCs were taken for each group. These segments were processed for paraffin blocks, sectioned, and stained with H&amp;E, Masson trichrome (MT) and Periodic Acid Shift (PAS). The results of the histomorphometric study showed no significant differences in the UC mean weight among these three groups. In three different segments, GDM resulted in a significant decrease in artery and vein wall thickness compared to the control group. GDM and PGDM resulted in a non-significant difference in the diameter of artery and vein in fetal segment, the vein in placental segment, and artery in the central segment compared with normal. All the UCs in the three groups contained two arteries and one vein but only one cord recorded in the GDM group contained one artery and one vein. Histological study of diabetic UC segments showed extravasation of blood, artery discordance, degeneration of Warton’s jelly (WJ) fibers with formation of honeycomb like empty spaces, formation of multiple spaces between smooth muscle cells of tunica media and detachment of the umbilical arteries from surrounding WJ. In both diabetic groups, there was a marked decrease in collagen fibers in tunica intima and media with their irregular arrangement in both arteries and vein especially in placental segment. The results also showed there was a rich carbohydrate content in the intima and media in all three groups. In conclusion, the current results proved that GDM and PGDM have an adverse effect on the structure of UC and its vessels. Keywords: Umbilical cord; Diabetes mellitus; Histological study; Special stains; Blood vessels DOI: 10.7176/JBAH/13-6-04 Publication date: April 30 th 2023

MP43-18 ADOLESCENT VARICOCELE: EFFECTS OF VEIN SIZE AND ARTERIAL FLOW RATE ON SEMINAL PARAMETERS

You have accessJournal of UrologyCME1 Apr 2023MP43-18 ADOLESCENT VARICOCELE: EFFECTS OF VEIN SIZE AND ARTERIAL FLOW RATE ON SEMINAL PARAMETERS Selin Ocal, Alina Sheikh, Joseph Pizzuti, Alexander Fang, Joseph Boroda, Steven Friedman, Ronnie Fine, Mark Horowitz, Ronnie Fine, Richard Sclussel, Lori Dyer, Paul Zelkovic, Jaime Freyle, Israel Franco, and Jordan Gitlin Selin OcalSelin Ocal More articles by this author , Alina SheikhAlina Sheikh More articles by this author , Joseph PizzutiJoseph Pizzuti More articles by this author , Alexander FangAlexander Fang More articles by this author , Joseph BorodaJoseph Boroda More articles by this author , Steven FriedmanSteven Friedman More articles by this author , Ronnie FineRonnie Fine More articles by this author , Mark HorowitzMark Horowitz More articles by this author , Ronnie FineRonnie Fine More articles by this author , Richard SclusselRichard Sclussel More articles by this author , Lori DyerLori Dyer More articles by this author , Paul ZelkovicPaul Zelkovic More articles by this author , Jaime FreyleJaime Freyle More articles by this author , Israel FrancoIsrael Franco More articles by this author , and Jordan GitlinJordan Gitlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Varicocele severity has been associated with larger testicular vein size but the relationship to decreased fertility remains debatable. In clinical practice, largest vein diameter is used to screen for surgical intervention, yet more recent studies have found venous reflux patterns and total testicular volume (TTV) to be associated with total motile sperm count (TMSC). This study compares largest testicular vein size and arterial flow rates to identify patients at risk for reduced seminal parameters. METHODS: We conducted a retrospective single institution chart review over 14 years of 487 Tanner V adolescents. 148 met inclusion criteria of palpable, non-operated left sided varicoceles who underwent at least one SA and color doppler ultrasonography. Abnormal TMSC was defined by WHO 2010 criteria. Descriptive statistics, ROC analysis, univariate and multivariate logistic regression were performed using SPSS. RESULTS: Data on 148 Tanner V adolescent males with mean age 18.24±1.38 years were evaluated. Median diameter of largest left testicular vein was 3.5 mm (IQR 3.1-4.6), median peak systolic velocity (PSV) of left testicular artery was 10.4 cm/s (IQR 9.1-12.5), median end diastolic velocity (EDV) of left testicular artery was 5.1 cm/s (IQR 4.3-5.9), median value of PSV/EDV was 2.1 (IQR 1.8-2.3) and median TMSC was 37.4 million sperm/ejaculate (IQR 15.8-84.2). On ROC analysis regarding prediction of abnormal TMSC (<9 million sperm/ejaculate), left testicular PSV was found to have the greatest AUC at 0.73 (95% CI 0.62-0.85) with Youden index analysis determining cutoff of 10.22 cm/s while largest vein diameter was found to have an AUC of 0.48. On univariate logistic regression, PSV<10.22 cm/s resulted in a significantly greater likelihood of abnormal TMSC (OR: 5.51 [1.84-16.46], p=0.002), which persisted on multivariate logistic regression with adjustment for age (OR: 5.49 [1.83-16.43], p=0.002). CONCLUSIONS: Left testicular PSV was most significantly correlated to TMSC. PSV <10.22 cm/s was predictive of an abnormal TMSC. No significant association was found between larger veins and greater risk for abnormal TMSC. When assessing varicocele, left testicular artery PSV may help stratify future fertility risk, allowing for improved surveillance regarding surgical intervention. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e608 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Selin Ocal More articles by this author Alina Sheikh More articles by this author Joseph Pizzuti More articles by this author Alexander Fang More articles by this author Joseph Boroda More articles by this author Steven Friedman More articles by this author Ronnie Fine More articles by this author Mark Horowitz More articles by this author Ronnie Fine More articles by this author Richard Sclussel More articles by this author Lori Dyer More articles by this author Paul Zelkovic More articles by this author Jaime Freyle More articles by this author Israel Franco More articles by this author Jordan Gitlin More articles by this author Expand All Advertisement PDF downloadLoading ...

Pelvic pain and venous congestion revisited: examining relationship between chronic pelvic pain and uterine venous size and blood flow.

To investigate the relationship between increased uterine venous plexus diameter and chronic pelvic pain in women attending a gynecology clinic. This was a retrospective study of patients attending a tertiary university hospital in London, UK. Women presenting to the gynecology clinic undergoing transvaginal ultrasound examination were recruited into the study. The largest trunk of the uterine venous plexus was measured on each side. Blood flow within the uterine veins was categorized into continuous or interrupted flow and evaluated using color and spectral Doppler ultrasound during normal respiration and on Valsalva maneuver to demonstrate the presence of venous reflux. The largest uterine vein diameter and its blood flow were used for the analysis. The main variables of interest were chronic pelvic pain, uterine vein diameter and type of blood flow. We included 1500 women in the study, of whom 584 (38.9% (95% CI, 36.5-41.5%)) reported chronic pelvic pain. Dysmenorrhea was the most common type of pelvic pain. Age (P < 0.001), menopausal status (P = 0.02), varicose veins (P = 0.01), adenomyosis (P < 0.001) and endometriosis (P < 0.001) were found to be independently associated with the occurrence of pain on multiple logistic regression analysis. There was no difference in uterine vein diameter between women with and those without pain (P = 0.10). Neither uterine vein diameter (P = 0.47) nor type of blood flow (P = 0.07) was significantly associated with the occurrence of pelvic pain on multiple logistic regression. Our findings show that uterine vein diameter is not associated with pelvic pain. However, we found other important clinical and demographic factors that are associated with chronic pelvic pain. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

The effect of immediate postoperative increase in blood flow velocity in predicting maturation of arteriovenous fistula for dialysis

Background Doppler ultrasonography is the main imaging modality for hemodialysis arteriovenous fistula (AVF) as it is safe, accurate, and noninvasive. Published literature related to the utility of early postoperative ultrasound in predicting AVF maturation is scarce. With the KDOQI guidelines recommending an AVF first catheter last approach, the quest to increase AVF maturation is of utmost importance. This study aims at measuring blood flow immediately postoperatively and assessing its predictive role in AVF maturation. Methods We correlated the ultrasound parameters with maturation in newly created AVFs measured preoperatively, immediately postoperatively, 6 weeks, and 3, 6, and12 months postoperatively. Both demographics and vascular parameters were compared between the group of patients whose AVFs successfully maturated and those whose AVFs did not. Primary endpoint was AVF maturation; secondary endpoints included patency, functional success, and predictive value of increased vein blood flow on fistula patency. Results A total of 50 procedures were performed; the mean age was 52.12 years (±6.58). The overall technical success rate was 86% (43) and 39 (90.7%) of them were functionally mature according to KDOQI guidelines for maturation. Primary patency was 93.02%, 92.7%, and 88.89%; and the primary-assisted patency was 97.7%, 95.12%, and 91.67% at 3, 6, and 12 months, respectively. Receiver-operated curve (ROC) showed a cutoff value of 322.8 ml/min increase in blood flow above which the AVF is more likely to become mature. Binary logistic regression showed that arterial depth greater than 3.92 mm, arterial flow velocity greater than 88 ml/min, preoperative average vein diameter of greater than 2.5 mm, arterial flow velocity of greater than 73 ml/min immediately postoperatively, and average vein diameter of greater than 3.94 mm immediately postoperatively were significant predictors of successful maturation at 6 weeks postoperatively (P values 0.001, &lt;0.0001, &lt;0.0001, &lt;0.0001, and &lt;0.0001, respectively). Conclusion Immediately postoperative flow measurement is a reliable parameter that can be used to predict successful fistula maturation, especially if flow velocities exceed 326.15 ml/min.

The gallbladder wall thickness in correlation with portal hemodynamic changes in cirrhotic patients

Background The gallbladder wall thickness (GBWT) is affected by portal hypertension, so GBWT can predict portal hemodynamic changes. Aim To determine whether noninflammatory GBWT correlates with portal hemodynamic changes and esophageal varices (EV) in cirrhotic patients. Patients and methods A total of 80 patients were enrolled in this cross-sectional study. Patients consisted of 30 cirrhotic patients with EV, 30 cirrhotic patients without EV, and 20 noncirrhotic individuals as a control group. Complete blood count, liver function tests, hepatitis C virus antibody, and HBsAg were assessed. Child–Pugh score was calculated in cirrhotic patients. Moreover, abdominal ultrasonography was performed for measuring wall thickness of the gallbladder, spleen length, and portal vein diameter. Moreover, portal vein Doppler was done for portal blood mean flow velocity measurement. Upper gastrointestinal tract endoscopy was done. Results GBWT was significantly increased in cirrhotic patients with EV compared with cirrhotic patients with without EV and noncirrhotic individuals (P&lt;0.001). Moreover, GBWT was significantly correlated with spleen length, portal vein diameter, and portal velocity in cirrhotic patients with EV (P&lt;0.001). Conclusion The GBWT could be one of the simple noninvasive predictors of portal hypertension and EV as it was positively correlated with portal hemodynamic changes that accompany cirrhotic portal hypertension.

Correlation Between Portal Venous Dimensions And Liver Stiffness In Patients Of Child Pugh A Cirrhosis

BACKGROUND: Liver cirrhosis is an end-stage liver disease characterized by pathologic fibrosis and regenerative nodules with resultant liver dysfunction. The diagnostic hallmark of portal hypertension is slow flow velocities in addition to the increased caliber of the mean portal vein. That is, the diagnosis of portal hypertension requires the measurement of mean portal velocity and portal diameter, and the correlation between cirrhosis and mean portal velocity and port diameter is the correlation between liver cirrhosis and its complications.OBJECTIVE: To analyze the correlation between portal vein dimensions and liver stiffness in patients of Child-Pugh A cirrhosis.METHOD: This study was a cross-sectional study on 30 subjects with Child-Pugh A liver cirrhosis. The subjects of this research are patients who come to the Radiology Department of the Dr. Kariadi Hospital in Semarang for point shear wave elastography and abdominal ultrasound examination from January to December 2022. Spearman test correlation was used for the analysis.RESULT: Spearman test showed no correlation between liver stiffness and portal vein diameter (p=0.250, r= -0.217), liver stiffness and mean portal vein velocity (p=0.883, r= -0.028), and portal vein diameter with mean venous velocity in Child-Pugh A liver cirrhosis (p = 0.979, r = 0.005)

Особенности и закономерности течения фотоиндуцированного тромбоза ретинальных вен в эксперименте

Central retinal vein occlusion (CRVO) was first described in the 19th century, but some aspects of the pathogenesis of the disease remain controversial to this day [1]. In the development of retinal vein obturation hemorheological, coagulation, hemodynamic and immune-inflammatory factors are important [2, 3]. Creation of an experimental model of CRVO and its branches (BRVO) as close as possible to the natural course of the disease, will provide new knowledge about the pathogenesis of retinal vein obturation, which may help in the development of a new method for treating this pathology. Purpose. To study patterns of the course of photoinduced retinal vein occlusion in an in vivo experiment. Materials and methods. The experiment was carried out on 40 rabbits, which reproduced photoinduced CRVO and BRVO by introducing «Photoditazine» and laser irradiation of the retinal vessels of the right eye. The left eye of the animals remained intact and constituted the comparison group. On days 1, 3, 7, and 14 after the intervention, ophthalmoscopy, optical coherence tomography of the retina was performed, and 10 rabbits were taken out of the experiment, followed by enucleation, hematoxylin-eosin staining, and light microscopy of the structures of the posterior segment of the eyeball. Fluorescein angiography retinal vessels was performed on days 3 and 7 after modeling thrombosis of the retinal vein. Statistical processing of the obtained results was carried out using the IBM SPSS Statistics 27 program. Differences were considered statistically significant at p &lt; 0.05. Results. With experimental photoinduced CRVO and BRVO, a mixed thrombus is formed in the vessel, occupying more than half of the retinal vein diameter, which causes an increase in the time of venous perfusion by 2.0 times (p = 0.047) compared with the intact eyes of rabbits, as well as pronounced microcirculation disorders, leading to the development of cystic macular edema and the appearance of non-perfused areas of the retina. Conclusions. An experimental study of photoinduced thrombosis of the retinal veins confirmed the feasibility of early treatment before the occurrence of complications of occlusion of the CRVO and BRVO, since changes in chorioretinal structures and hemodynamic disturbances in the retinal vessels microvasculature appear as early as 1-3 days after the formation of a thrombus in the retinal vessel lumen. Keywords: experimental model, central retinal vein occlusion, branch retinal vein occlusion, pathogenesis, microcirculation