Venous Circulation Research Articles

Choroidal Changes in Eyes With Polypoidal Choroidal Vasculopathy After Anti-VEGF Therapy Imaged With Swept-Source OCT Angiography.

PurposeSwept-source optical coherence tomography angiography was used to investigate choroidal changes and their association with pigment epithelial detachments (PEDs) in eyes with polypoidal choroidal vasculopathy (PCV) after treatment with vascular endothelial growth factor (VEGF) inhibitors.MethodsPatients with treatment-naïve PCV were included and underwent anti-VEGF therapy. Mean choroidal thickness (MCT), choroidal vascularity index (CVI), and PED volume measurements were obtained before and after treatment.ResultsThirty-four treatment-naïve PCV eyes from 33 patients were included. The PED volume decreased after treatment (P < 0.05). The MCT decreased from 223.0 ± 79.6 µm at baseline to 210.9 ± 76.2 µm after treatment (P < 0.001). The CVI at baseline was 0.599 ± 0.024, and the CVI after treatment was 0.602 ± 0.023 (P = 0.16). There was a correlation between the decreased PED volumes and the decreased MCT measurements (r = 0.47; P = 0.006). Also, there was a correlation between the decreased PED volumes and the increased CVI measurements (r = −0.63; P < 0.001).ConclusionsIn treatment-naïve eyes with PCV, the decreases in PED volumes were correlated with the decrease in MCT and the increase in CVI measurements. We propose that, at baseline, the PCV lesions serve as high-volume arteriovenous shunts between choroidal arterial and venous circulation, causing transudation into the choroidal stroma. We propose that, after treatment, the blood flow through the vascular shunt is reduced, the excess stromal transudation is resorbed, and the exudation from the neovascular lesion is reduced, resulting in thinning of the choroid, resolution of the PEDs, and an increase in the CVI due to the resorption of excess choroidal transudation.

Abstract 13781: Megakaryocytes Participating in Thrombosis Under Inflammatory Stress and Sepsis: Direct Pathological Evidence in Two Cases

Introduction: Megakarycytes (MKs) produce platelets (PLTs) which enter the circulation and play its roles in hemostasis and thrombosis. However, direct pathological evidence that MKs participate in thrombosis has not been reported in clinical practice. We describe here direct observations in two cases where MKs were found in thrombosis in coronary artery and in the right atrium under open-heart surgery. Hypothesis: MKs might be mobilized into circulation and directly participate in and magnify thrombosis under sepsis, inflammatory stress and full heparinization. Methods: Case one was a 51-year-old male with ischemic cardiomyopathy, coronary stenoses and severe mitral insufficiency who underwent coronary artery bypass grafting (CABG) and mitral annuloplasty under cardiopulmonary bypass (CPB). A thrombus was pulled out from the right atrium when an atrial cannula was removed under full heparinization. Case two was a 53-year-old male with known mitral endocarditis and acute anterior myocardial infarction. Acute coronary angiogram after admission showed thrombosis in the left anterior descending (LAD) branch. The patient underwent emergency thrombectomy, CABG and mitral valve replacement with CPB. The thrombus was completely removed from the LAD through a small incision. Both thrombi, valve tissue and vegetation were sent for pathological examination with HE and CD41-IHC staining on paraffin sections. Results: Large number of giant polyploidy MKs surrounded by PLTs were seen in different areas in the thrombi of MKs-PLTs-fibrin networks from the right atrium and LAD. The coronary thrombus was consisted of MKs, PLTs and red cells in fibrin networks while the infected vegetation was consisted dominantly of inflammatory cells, bacterial legions and fibrin. Conclusions: MKs may enter both venous and arterial circulation, actively participate in thrombosis under inflammatory stress and sepsis, and be capable of escaping from inhibition of full heparinization.

Хроническая церебральная венозная дисфункция: взгляд на проблему

В статье представлен аналитический обзор результатов отечественных и зарубежных исследований по проблеме хронических нарушений мозгового венозного кровообращения, которым уделяют меньше внимания в сравнении с патологией артериальной системы из-за нечеткости проявлений, особенно ранних, анатомической изменчивости венозного русла даже у здоровых, сложности верификации диагноза и т.д. Когда баланс артериального притока и венозного оттока нарушается и это нарушение прогрессирует, развиваются необратимые изменения в других структурах полости черепа — в первую очередь страдает головной мозг (что согласуется с концепцией Монро — Келли). Хронические нарушения церебрального венозного кровообращения могут иметь разные причины и разную степень выраженности. Синдром хронической церебральной венозной дисфункции, терминологически принятый у нас, в некоторых странах рассматривается как хроническая венозная цереброспинальная недостаточность, что подчеркивает патогенетическую связь нарушений церебрального венозного кровотока с внечерепными венами, что, на наш взгляд, является логичным и обоснованным. Признание хронической цереброспинальной венозной недостаточности вызвало значительный интерес к изучению роли внечерепной венозной патологии и вариантов ее развития. Несмотря на то, что диагноз изначально был основан на допплерографической сонографии, пока не установлено диагностических способов визуализации, неинвазивных или инвазивных, которые могут служить золотым стандартом для выявления венозных отклонений, свидетельствующих о хронической цереброспинальной венозной недостаточности. Обсуждаются результаты ряда исследований, в частности, гипотезы о роли хронической цереброспинальной венозной недостаточности в патогенезе рассеянного склероза и многих сопутствующих клинических проявлений. Анализируется общность по патогенезу идиопатической внутричерепной гипертензии, болезни Меньера, синдрома спондилогенной вертебрально-базилярной недостаточности. Акцентируется внимание и на другом мнении ученых, которые повышение венозного кровенаполнения головного мозга и других образований полости головы при определенных условиях рассматривают как компенсаторную реакцию. Рассматриваются анатомо-физиологические особенности венозной системы черепной полости, обосновывающие клинические проявления венозной дисфункции, способы диагностики и лечения патологии. Обобщая вышесказанное отметим, что хроническое нарушение циркуляции венозной крови в полости черепа в значительной степени связано с проблемами внечерепного венозного кровотока и не только само по себе является достаточно характерным синдромокомплексом, который негативно влияет не только на неврологические функции за счет гипоксии мозга и метаболических изменений, ухудшает качество жизни, но и на течение или имеет патогенетическую связь с другими заболеваниями, в частности, может сопровождаться различным уровнем артериального давления.

Хроническая головная боль как проявление венозного тромбоза дурального синуса

Пациентам с мозговым венозным тромбозом (МВТ) присущ широкий спектр клинических проявлений — от головной боли до комы. Хроническая окклюзия венозных синусов твердой мозговой оболочки приводит к формированию ряда компенсаторных явлений, таких как сосудистая коллатерализация, реканализация организованного тромба, эффективность которых и определяет тяжесть состояния и течение заболевания. Целью нашего исследования стало освещение клинической проблемы диагностирования хронического субкомпенсированного МВТ. С учетом того, что такое течение процесса наблюдается в 20 % случаев, около четверти пациентов, у которых заболевание проявляется головной болью неясной этиологии, остаются незамеченными и с низким качеством жизни. Для анализа течения и прогноза заболевания нашей задачей стало тщательное изучение механизмов адаптации организма при хроническом тромбозе дурального синуса в виде формирования системы венозных коллатералей и реканализации. Однако весомым подводным камнем хронической окклюзии венозных синусов твердой мозговой оболочки при отсутствии соответствующего лечения является то, что гемодинамические компенсаторные явления также определяют и высокий риск развития цереброваскулярных катастроф, которые приводят к летальному исходу или инвалидизации. В представленном нами клиническом случае имел место хронический венозный тромбоз поперечного и сигмовидного синусов, который манифестировал мигренеподобным цефалгическим синдромом с вегетативным компонентом и постепенным нарастанием синдрома внутричерепной гипертензии. Без антикоагулянтной терапии венозный дренаж через коллатеральные пути, отсроченная реканализация тромбированных синусов осуществлялись у пациента неэффективно, что привело к формированию диффузного отека, вторичному повреждению мозговой ткани. После проведения тщательного обследования, установления диагноза, назначения индивидуализированного лечения и длительного наблюдения с коррекцией терапии у пациента имел место регресс симптомов МВТ. Церебральная МР-венография — это важный инструмент в диагностике и прогнозе данного заболевания. Таким образом, пациентам с длительным анамнезом головной боли, которая не поддается лечению и имеет признаки внутричерепной гипертензии, нужно проводить МР-венографию. Тем не менее в случаях геморрагических инсультов неясного генеза, которые не соответствуют артериальным территориям, часто возникает необходимость исследовать состояние вен головного мозга и твердомозговых синусов. С целью индивидуального анализа течения и прогноза заболевания необходимо изучать формирование венозных коллатералей и процессов реканализации тромбов дурального синуса пациента.

Cyanosis in a Previously Well Child.

Cyanosis in a Previously Well Child.

Endothelial progenitor cells overexpressing platelet derived growth factor-D facilitate deep vein thrombosis resolution.

To assess the therapeutic efficacy of PDGF-D-overexpressing endothelial progenitor cells (EPCs) in deep vein thrombosis. Inferior vena cava thrombosis was induced in female Sprague Dawley (SD) rats. Animals were injected via the distal vena cava with EPCs overexpressing PDGF-D after transfection with a lentiviral vector containing the PDGF-D gene. The effect on thrombosis in animals who received EPCs was evaluated using MSB staining, immunohistochemistry, immunofluorescence, and venography; the steady-state mRNA and protein levels of PDGF-D and its receptor (PDGF-Rβ) were determined by RT-PCR and Western blotting, respectively; and the PDGF-D-induced mobilization of circulating EPCs was estimated by flow cytology. Compared with controls, injection of EPCs overexpressing PDGF-D was associated with increased thrombosis resolution; recanalization; PDGF-D and PDGF-Rβ expression; induction of monocyte homing; and mobilization of EPCs to the venous circulation. In a rat model, transplantation of PDGF-D-overexpressing EPCs facilitated the resolution of deep vein thrombosis.

Hemodynamic effects of combined antihypertensive therapy during exercise in men with arterial hypertension and chronic venous diseases

Introduction. Currently, there is insufficient data on the effect of modern antihypertensive therapy (AHT) on venous circulation, especially during physiological stress.Aim of the study – the investigation was to study the hemodynamic effects of a combination of a calcium channel blocker (CCB) and an angiotensin-converting enzyme (ACE) inhibitor during exercise in men with arterial hypertension (AH) and chronic venous diseases (CVD).Material and methods. In 46 men 30–50 years old with AH on the background of AHT, a comparative assessment of the dynamics of SBP, DBP, peripheral venous pressure (PVP), ultrasound parameters of venous blood flow of the left leg in response to physical activity (Ruffier’s test) was performed. The parameters were assessed in 23 patients with hypertension without CVD and 23 patients with hypertension and CVD. We studied the reaction before and after 14 days of combined AHT with the use of CCB (Amlodipine) and an ACE inhibitor (Lisinopril).Results. Before treatment, the response to exercise in patients of both groups was the same and was manifested by a twofold increase in the area of the lumen of the veins and a drop in blood flow velocity. Patients with CVD before treatment with exercise were characterized by an altered systemic hemodynamic response, more frequent cases of venous dilatation and decreased blood flow velocity. After AHT with exercise, both groups showed normalization and identity of SBP. DBP, PVP, a decrease in the severity of venous dilatation and a decrease in blood flow velocity. Patients with CVD after AHT in response to exercise are characterized by more pronounced venous dilatation and higher blood flow velocity.Conclusion. After 14 days of antihypertensive therapy in patients with hypertension without chronic venous disease and in patients with hypertension and chronic venous disease during exercise normalization of systolic blood pressure, diastolic blood pressure, PVP, a decrease in venous dilatation and a decrease in blood flow velocity are noted. Patients with CVD after AHT under load are characterized by varicose veins and accelerated venous blood flow.

HeRO® graft: technical application and clinical experience in 73cases

Zunehmendes Alter, Komorbiditäten und die Dauer der chronischen Dialysepflichtigkeit erschweren die Anlage und den Erhalt eines funktionierenden Gefäßzugangs bei Patienten mit terminaler Niereninsuffizienz. Dabei steigt durch zentralvenöse Katheter und kardiologische bzw. onkologische Eingriffe das Risiko einer zentralen Stenose bzw. Okklusion. Die Implantation des Hemodialysis-Reliable-Outflow(HeRO®)-Grafts (Merit Medical Systems Inc., South Jordan, UT, USA) ist ein inzwischen etabliertes kombiniert chirurgisch/interventionelles Verfahren zur Wiederherstellung des stenosierten oder okkludierten venösen Abstroms. Hierdurch kann der Gefäßzugang an der oberen Extremität erhalten bleiben und die wichtige Gefäßressource der unteren Extremität geschont werden. In unserem Zentrum wurden seit 2013 insgesamt 73 Grafts erfolgreich mit steigendem Bedarf implantiert. Der operative Eingriff ist bei uns ein etabliertes und risikoarmes Verfahren geworden. Nach der Implantation ist bei akuter Thrombosierung jedoch 2‑ bis 3‑mal jährlich eine Reintervention erforderlich. Entsprechende Erfahrung vorausgesetzt, sind diese Revisionseingriffe technisch einfach durchzuführen. Bei vollständiger Okklusion der zentralvenösen Strombahn im Bereich der V. cava superior, die nicht durch den HeRO®-Graft passiert werden kann, ist ein Kombinationseingriff mit dem Surfacer®-Sytem (Inside-out-Verfahren) möglich und sinnvoll. Der HeRO®-Graft kann bei Bedarf an eine früh punktierbare Prothese angeschlossen werden. Hierdurch können passagere Dialysekatheter vollständig umgangen werden. Trotz steigender Zahl der HeRO®-Graft-Implantationen bleibt diese Option in unserem Zentrum ein Reserveverfahren. Die interventionellen Verfahren ohne Implantation von Fremdmaterial sollten zunächst ausgeschöpft und etablierte gefäßchirurgische Alternativen (wie beispielsweise der V.-jugularis-Anschluss) vorrangig durchgeführt werden.

Features of venous blood circulation and valve function in the lower extremities according to duplex scanning data and morphofunctional studies

Aim. To study the mechanisms of venous return and the functioning features of lower extremity venous valves in horizontal and vertical positions.&#x0D; Methods. The study, conducted from April 2019 to December 2020, included 100 people. The study participants were divided into 2 groups. The first group was represented by 44 patients (88 limbs) with varicose veins, whose venous system was examined by duplex ultrasound scanning during inpatient rehabilitation. The second (control) group consisted of 56 healthy individuals (92 limbs) without visible signs of venous pathology who underwent an outpatient examination of the venous system. The average age of the patients in the two groups was 49.22.4 and 51.11 years, respectively; women predominated in both groups. The qualitative and quantitative parameters of venous blood flow were studied in the study. Venous valvular insufficiency was assessed by using reflux duration and the Psatakis index. A morphometric study was conducted on 140 limbs of 48 human corpses, from which venous fragments were taken for biomechanical studies of the valves. The clinical characteristics of patients are presented by descriptive statistics, quantitative parameters are reported as the mean value (M) and standard deviation (SD). The differences were tested for significance by using the Student's t-test.&#x0D; Results. In the study, we introduced the concept of the valve index, the aspect ratio of the ellipse, the shape of which has a venous valve in cross-section. Duplex ultrasound scanning, as well as a morphofunctional examination of the valves, made it possible to establish that the valve index is significantly higher in the presence of signs of varicose veins, which indicates dilation and incipient varicose vein, which leads to valvular insufficiency. The elasticity index defined by us, as the indicator of change in the venous lumen size, measured by the ratio of its diameters, also significantly (p=0.034) differed in the studied groups: the elasticity index in the group of healthy people was 1.370.11, in the group of patients with varicose veins 1.560.17. The studied factors allowed us to develop a test that has an important prognostic value for the early diagnosis of varicose veins as well as the implementation of preventive health measures.&#x0D; Conclusion. The features of venous blood circulation and valve function studied in the study not only have prognostic value for the early diagnosis of varicose veins but are also of practical interest for developing methods of surgical correction of venous valvular insufficiency.

Thrombosis in pre- and post-vaccination phase of COVID-19.

Acute infections may be complicated by thrombosis occurring in the venous and arterial circulation. This may be observed in patients with community-acquired pneumonia (CAP) and also in patients with coronavirus 2019 (COVID-19), that is a pandemic characterized by severe acute respiratory syndrome (SARS-CoV-2) needing mechanical ventilation and intensive care unit treatment. However, the type and rate of thrombosis can vary according to the cause of pneumonia as is more frequently complicated by arterial thrombosis in CAP, while an equal incidence of venous and arterial thrombosis occurs in SARS-CoV-2. The mechanisms of disease are overall platelet-related in CAP while activation of both platelets and clotting system is implicated in the pathogenesis of thrombosis in SARS-CoV-2; this finding could imply a different therapeutic approach of the two settings. Thrombosis may also occur in subjects vaccinated against SARS-CoV-2 even if its incidence is not so high (1/100 000); this rare effect occurs more prevalently in young women, is independent from known risk factors of thrombosis, is caused by antibodies against platelet PF4 and is counteracted by treatment with immunoglobulin and glucocorticoids.

Systems analysis of the mechanisms governing the cardiovascular response to changes in posture and in peripheral demand during exercise

Blood flows and pressures throughout the human cardiovascular system are regulated in response to various dynamic perturbations, such as changes to peripheral demands in exercise, rapid changes in posture, or loss of blood from hemorrhage, via the coordinated action of the heart, the vasculature, and autonomic reflexes. To assess how the systemic and pulmonary arterial and venous circulation, the heart, and the baroreflex work together to effect the whole-body responses to these perturbations, we integrated an anatomically-based large-vessel arterial tree model with the TriSeg heart model, models capturing nonlinear characteristics of the large and small veins, and baroreflex-mediated regulation of vascular tone and cardiac chronotropy and inotropy. The model was identified by matching data from the Valsalva maneuver (VM), exercise, and head-up tilt (HUT). Thirty-one parameters were optimized using a custom parameter-fitting tool chain, resulting in an unique, high-fidelity whole-body human cardiovascular systems model. Because the model captures the effects of exercise and posture changes, it can be used to simulate numerous clinical assessments, such as HUT, the VM, and cardiopulmonary exercise stress testing. The model can also be applied as a framework for representing and simulating individual patients and pathologies. Moreover, it can serve as a framework for integrating multi-scale organ-level models, such as for the heart or the kidneys, into a whole-body model. Here, the model is used to analyze the relative importance of chronotropic, inotropic, and peripheral vascular contributions to the whole-body cardiovascular response to exercise. It is predicted that in normal physiological conditions chronotropy and inotropy make roughly equal contributions to increasing cardiac output and cardiac power output during exercise. Under upright exercise conditions, the nonlinear pressure-volume relationship of the large veins and sympathetic-mediated venous vasoconstriction are both required to maintain preload to achieve physiological exercise levels. The developed modeling framework is built using the open Modelica modeling language and is freely distributed.

Coronary venous therapy to improve microvascular dysfunction

The coronary circulation is a complex system in which vascular resistances are determined by an interplay of forces in at least three compartments: the epicardial, the microvascular, and the venous district. Cardiologists, and particularly interventional cardiologists, normallly place the focus of their attention on diseases of the epicardial coronary circulation as possible causes of coronary syndromes and neglect the importance of the other two compartments of coronary circulation. The study of the coronary microcirculation, an increasingly recognized source of ischemia, has long been disregarded, but is witnessing a revival since the (re-)introduction of diagnostic tools in the better equipped catheterization laboratories. Unfortunately, to date our understanding of coronary microvascular disease remains incomplete and the numerous proposed classifications fail to reflect its complexity. Further, no specific therapy for these disorders is available. The coronary venous circulation is an even more neglected third vascular district. Its role in regulating coronary resistances is almost completely unexplored, but inital evidence suggests that the modulation of venous pressure might help improve coronary perfusion. Coronary sinus interventions are a group of invasive techniques (both surgical and catheter-based) that are designed to treat ischaemic heart disease by increasing coronary venous pressure and therefore redistributing coronary blood flow towards the endocardium. In this review paper, we revise the role of these interventions with particular focus on acute and chronic coronary microvascular disease.

Invasive hemodynamic monitoring by Swan-Ganz pulmonary artery catheter: concepts and utility

Since its beginnings in the last century, pulmonary artery catheterization (PAC) has evolved into an invasive hemodynamic evaluation technique that can be performed at the patient's bedside through a Swan-Ganz catheter; this procedure has maintained an intermittent course in terms of its use; however, it has currently demonstrated relevance in specific scenarios. The PAC allows access to the central venous circulation, the right heart and the pulmonary artery; it performs the calculation of hemodynamic variables directly or indirectly by means of established formulas and methods. This makes possible to perform an adequate hemodynamic evaluation and classification, perform specific tests (e.g. vasoreactivity test), which help to define the diagnosis, therapeutic , monitor the response to treatment, evaluation prior to advanced therapies (e.g. cardiac transplantation or mechanical circulatory assistance devices), and prognosis in our patients. In this article we discuss the concepts and usefulness of pulmonary artery catheterization.

S3648 Pyogenic Liver Abscess: Where Did It Come From, How Did It Grow?

Introduction: Liver abscesses are suppurative space occupying lesions resulting from the invasion of the liver tissue by insult/injury, intraabdominal infection disseminated from the portal venous circulation, or originate in the biliary system. Three different etiologies consist of pyogenic, amebic and fungal abscesses. The common cause of liver abscess in the United States is bacterial intraabdominal source. Additionally, the right lobe of liver is mostly an affected region as it’s predominately supplied by superior mesenteric vein. We describe an unusual case of right hepatic lobe abscess with unidentifiable source. Case Description/Methods: We present a 79-year-old woman with a medical history of diabetes and hypertension who presented with complaint of fatigue. She otherwise denied recent illness, travel, hospitalizations or intestinal infections. On presentation, she was hypotensive and admission labs significant for neutrophil predominant leukocytosis. The patient exhibited right upper quadrant tenderness. Blood cultures were obtained. Broad spectrum antibiotics were started. Pertinent imaging revealed a hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver. Interventional radiology performed a biopsy and aspiration of 60 mL purulent fluid. Blood cultures grew Bacteriodes fragilis. Surgical liver pathology was predominately fragments of necrotic hepatic tissue with acute inflammation. Liver abscess cultures speciated Escherichia coli, Klebsiella pneumonia, and Streptococcus intermedius. Antibiotics were tailored accordingly. This prompted an echocardiogram which was negative for valvular vegetations. The patient opted for outpatient colonoscopy for further evaluation. Repeat liver imaging showed enlarging abscess, therefore drain was placed. Patient was sent home on 6 week course of antibiotics. Discussion: While the incidence of liver abscess is low, it is essential to have a complete understanding of the disease activity and harm potential because the severity of these abscesses have a high mortality if left untreated. The physiology of disease is so delicate in these patients that an abscess located in the liver parenchyma close to the diaphragm can cause referred pain to the right shoulder or potentially a cough caused by diaphragmatic irritation. Although imaging was negative for etiology of the abscess, the workup is still in progress. This case highlights the importance of antibiotic therapy with drain placement to achieve source control and clinical and bacteriologic cure.Figure 1.: CT imaging demonstrating hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver.

Особливості стану венозної гемодинаміки головного мозку в дітей, хворих на бронхіальну астму

Актуальність. Дані щодо кількості хворих із хронічною ішемією головного мозку серед дітей та підлітків поодинокі й нечисленні. Отже, актуальність дослідження стану та змін мозкової гемодинаміки, зокрема венозної циркуляції, у дітей, хворих на бронхіальну астму, не викликає сумніву й є вкрай гострим питанням. Мета. Вивчення особливостeй стану венозної гемодинаміки головного мозку у дітей, хворих на бронхіальнy астмy. Матеріали та методи. Проведено ультразвукове допплерографічне дослідження 101 хворих на бронхіальну астму та 30 здорових дітей віком 10–17 років. Хворих дітей було розподілено за гендерною приналежністю, ступенем контролю та тривалістю захворювання. Ультразвукова допплерографія здійснювалась з визначенням максимальної лінійної швидкості кровоплину в руслі базальної вени Розенталя. Результати. Встановлено явища персистуючої венозної дисгемії та веностазу у хворих дітей, особливо хлопчиків, незалежно від ступеня контролю бронхіальної астми. На показники венозної гемодинаміки також негативно впливала тривалість захворювання понад 5 років. Висновки. Oсобливості венозної циркуляції y дітей, хворих на бронхіальнy астмy, є ранніми доклінічними ознакaми цереброваскулярних порушень. Запропоновано віднести їх до групи ризику щодо виникнення цереброваскулярної патології в майбутньому. Доцільно доповнити диспансернe спостереження дітей, хворих на бронхіальнy астмy, дослідженням стану венозної гемодинаміки з використанням транскраніальної допплерографії та дуплексного сканування магістральних судин головного мозку, що забезпечить ранню діагностику цереброваскулярних порушень.

Lars Edvinsson: bench-to-bedside discovery

Lars Edvinsson: bench-to-bedside discovery

Adipose Tissue and Biological Factors. Possible Link between Lymphatic System Dysfunction and Obesity.

The World Health Organization (WHO) has recognised obesity as one of the top ten threats to human health. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of an increased release of biologically active metabolites. Moreover, obesity predisposes the development of metabolic syndrome and increases the incidence of type 2 diabetes (T2DM), increases the risk of developing insulin resistance, atherosclerosis, ischemic heart disease, polycystic ovary syndrome, hypertension and cancer. The lymphatic system is a one-directional network of thin-walled capillaries and larger vessels covered by a continuous layer of endothelial cells that provides a unidirectional conduit to return filtered arterial and tissue metabolites towards the venous circulation. Recent studies have shown that obesity can markedly impair lymphatic function. Conversely, dysfunction in the lymphatic system may also be involved in the pathogenesis of obesity. This review highlights the important findings regarding obesity related to lymphatic system dysfunction, including clinical implications and experimental studies. Moreover, we present the role of biological factors in the pathophysiology of the lymphatic system and we propose the possibility of a therapy supporting the function of the lymphatic system in the course of obesity.

Pelvic congestion syndrome as a cause of chronic pelvic pain

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

Incremental value of compression ultrasound sonography in the emergency department.

The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.

Biphasic Effect of Curcuminoids on Oxidation of Postprandial Chylomicrons.

Chylomicrons are large, triglyceride-rich lipoproteins that transport dietary lipids and lipophilic micronutrients through the lymphatic system and into the venous circulation. They therefore represent a valuable means of investigating the bioavailability of a range of bioactive molecules. Curcuminoids have a complex reputation, with most in vitro studies suggesting a beneficial effect (e.g., as an antioxidant), while in vivo work is often, at best, equivocal. We have prepared a curcuminoid extract from fresh turmeric and investigated the transfer of curcuminoids to chylomicrons by rapid ultracentrifugation. We subsequently characterized the chylomicrons in terms of their susceptibility to oxidation. There was a dose-dependent relationship between the curcuminoid level in chylomicrons and decreased levels of preformed lipid hydroperoxides (P < .05), which was broadly mirrored by paraoxonase arylesterase activity. At lower dosages (1000-3000 mg), curcuminoids protected chylomicrons against copper(II)-mediated oxidation, but at higher levels (4000-5000 mg), a pro-oxidant effect was observed. In conclusion, we report a clear biphasic (hormetic) effect of curcuminoids on lipid oxidation, which supports the theory that low dosages of bioactive compounds can have beneficial effects, while higher dosages may have an equivocal or negative impact on the disease.