Venous Congestion Research Articles

Neuroimaging of Neonatal Stroke: Venous Focus.

Perinatal venous infarcts are underrecognized clinically and at imaging. Neonates may be susceptible to venous infarcts because of hypercoagulable state, compressibility of the dural sinuses and superficial veins due to patent sutures, immature cerebral venous drainage pathways, and drastic physiologic changes of the brain circulation in the perinatal period. About 43% of cases of pediatric cerebral sinovenous thrombosis occur in the neonatal period. Venous infarcts can be recognized by ischemia or hemorrhage that does not respect an arterial territory. Knowledge of venous drainage pathways and territories can help radiologists recognize characteristic venous infarct patterns. Intraventricular hemorrhage in a term neonate with thalamocaudate hemorrhage should raise concern for internal cerebral vein thrombosis. A striato-hippocampal pattern of hemorrhage indicates basal vein of Rosenthal thrombosis. Choroid plexus hemorrhage may be due to obstruction of choroidal veins that drain the internal cerebral vein or basal vein of Rosenthal. Fan-shaped deep medullary venous congestion or thrombosis is due to impaired venous drainage into the subependymal veins, most commonly caused by germinal matrix hemorrhage in the premature infant and impeded flow in the deep venous system in the term infant. Subpial hemorrhage, an underrecognized hemorrhage stroke type, is often observed in the superficial temporal region, and its cause is probably multifactorial. The treatment of cerebral sinovenous thrombosis is anticoagulation, which should be considered even in the presence of intracranial hemorrhage. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Acute Mesenteric Ischemia: Imaging Findings and Mimics

Acute mesenteric ischemia is a rapidly life-threatening condition in which the radiologist may play a crucial role in early diagnosis and thus improve patient outcomes. Acute mesenteric ischemia can occur from arterial embolism or thrombosis, venous occlusive, or nonocclusive etiologies. Key findings for acute arterial occlusion include hypoenhancing bowel, which is usually not thickened or dilated. Venous occlusion often results in a hyperenhancing, thickened, and dilated bowel. Nonocclusive mesenteric ischemia should be considered in the appropriate clinical context, when there is no vascular occlusion on CT, and when there is involvement of watershed regions without specific vascular territory abnormalities. Venous congestion and increased vascular permeability can result in mesenteric edema and ascites; however, it is not predictive of mesenteric ischemia severity. Pneumatosis alone may not indicate presence of nonviable bowel; however, pneumatosis with portal venous gas or pneumoperitoneum has high sensitivity for nonviable bowel. Clinical history and laboratory results can often help differentiate between acute mesenteric ischemia and its mimics, such as inflammatory bowel disease, enteritis, and radiation injury.

Biomechanical properties measured with dynamic Scheimpflug analyzer in central serous chorioretinopathy.

Recent evidence suggests that venous congestion at the vortex vein significantly contributes to the development of central serous chorioretinopathy (CSCR), and sclera is observed to be thicker in affected eyes. This study aims to investigate whether eyes with CSCR exhibit stiff corneas, measured using Corneal Visualization Scheimflug Technology (Corvis ST), which may serve as an indicator of scleral stiffness. This retrospective case-control study comprises 52 eyes from 33 patients diagnosed with CSCR and 52 eyes from 32 normal controls without CSCR. We compared biomechanical parameters measured with Corvis ST and anterior scleral thickness measured using anterior segment swept-source optical coherence tomography between the two groups. Age, sex, axial length, intraocular pressure, and central corneal thickness showed no significant differences between the two groups (p > 0.05, linear mixed model). Three biomechanical parameters-peak distance, maximum deflection amplitude, and integrated inverse radius-indicated less deformability in CSCR eyes compared to control eyes. The stress-strain index (SSI), a measure of stiffness, and anterior scleral thickness (AST) at temporal and nasal points were significantly higher in the CSCR eyes. SSI and AST were not correlated, yet both were significantly and independently associated with CSCR in a multivariate logistic regression model. Eyes affected by CSCR have stiffer corneas, irrespective of thicker scleral thickness. This suggests that stiffer sclera may play a role in the pathogenesis of CSCR.

Transesophageal echocardiographic acquisition of the venous excess ultrasound exam—a case series and technical description

PurposeObtaining an objective, reproducible, and accurate assessment of volume status is one of the more difficult tasks in the perioperative arena. Since its advent in 2020, the Venous Excess Ultrasound (VExUS) score has gained popularity in the minimally invasive assessment of venous congestion. The VExUS exam has been well described as an additional series of images (hepatic vein, portal vein, and intrarenal vein) obtained with a phased-array probe during a transthoracic echocardiogram. Nevertheless, there are no descriptions of comprehensive VExUS exams performed using transesophageal echocardiography (TEE)—a modality that is routinely employed in patients undergoing cardiac surgery. Clinical featuresWe describe techniques to acquire and interpret a comprehensive TEE-supported VexUS exam, which may be used to optimize the perioperative care of cardiac surgical patients.ConclusionGiven the risks of fluid overload in critically ill cardiac surgery patients, TEE-supported VExUS examination may be a way to reduce morbidity in this population.

Mechanism of IL-17 Signaling Pathway in Spleen Inflammatory Response Induced by Altitude Hypoxia in Mice

To explore the mechanism of spleen tissue inflammatory response induced by altitude hypoxia in mice. C57BL/6 mice were randomly assigned to a plain, i.e., low-altitude, normoxia group and an altitude hypoxia group, with 5 mice in each group. In the plain normoxia group, the mice were kept in a normoxic environment at the altitude of 400 m above sea level (with an oxygen concentration of 19.88%). The mice in the altitude hypoxia group were kept in an environment at the altitude of 4200 m above sea level (with an oxygen concentration of 14.23%) to establish the animal model of altitude hypoxia. On day 30, spleen tissues were collected to determine the splenic index. HE staining was performed to observe the histopathological changes in the spleen tissues of the mice. Real time fluorogenic quantitative PCR (RT-qPCR) and Western blot were conducted to determine the mRNA and protein expressions of interleukin (IL)-6, IL-12, and IL-1β in the spleen tissue of the mice. High-throughput transcriptome sequencing was performed with RNA sequencing (RNA-seq). KEGG enrichment analysis was performed for the differentially expressed genes (DEGs). The DEGs in the key pathways were verified by RT-qPCR. Compared with the plain normoxia group, the mice exposed to high-altitude hypoxic environment had decreased spleen index (P<0.05) and exhibited such pathological changes as decreased white pulp, enlarged germinal center, blurred edge, and venous congestion. The mRNA and protein expression levels of IL-6, IL-12, and IL-1β in the spleen tissue of mice in the altitude hypoxia group were up-regulated (P<0.05). According to the results of transcriptome sequencing and KEGG pathway enrichment analysis, 4218 DEGs were enriched in 178 enrichment pathways (P<0.05). DEGs were significantly enriched in multiple pathways associated with immunity and inflammation, such as T cell receptor signaling pathway, TNF signaling pathway, and IL-17 signaling pathway (P<0.05) in the spleen of mice exposed to high-altitude hypoxic environment. Among them, IL-17 signaling pathway and the downstream inflammatory factors were highly up-regulated (P<0.05). Compared with the plain normoxia group, the mRNA expression levels of key genes in the IL-17 signaling pathway, including IL-17, IL-17R, and mitogen-activated protein kinase genes (MAPKs), and the downstream inflammatory factors, including matrix metallopeptidase 9 (MMP9), S100 calcium binding protein A8 gene (S100A8), S100 calcium binding protein A9 gene (S100A9), and tumor necrosis factor α (TNF-α), were up-regulated or down-regulated (P<0.05) in the altitude hypoxia group. According to the validation of RT-qPCR results, the mRNA expression levels of DEGs were consistent with the RNA-seq results. Altitude hypoxia can induce inflammatory response in the mouse spleen tissue by activating IL-17 signaling pathway and promoting the release of downstream inflammatory factors.

Inhaled Pulmonary Vasodilators for the Treatment of Right Ventricular Failure in Cardio-Thoracic Surgery: Is One Better than the Others?

Right ventricular failure (RFV) is a potential complication following cardio-thoracic surgery, with an incidence ranging from 0.1% to 30%. The increase in pulmonary vascular resistance (PVR) is one of the main triggers of perioperative RVF. Inhaled pulmonary vasodilators (IPVs) can reduce PVR and improve right ventricular function with minimal systemic effects. This narrative review aims to assess the efficacy of inhaled nitric oxide and inhaled prostacyclins for the treatment of perioperative RVF. The literature, although statistically limited, supports the clinical similarity between them. However, it failed to demonstrate a clear benefit from the pre-emptive use of inhaled nitric oxide in patients undergoing left ventricular assist device implantation or early administration during heart-lung transplants. Additional concerns are related to cost safety and IPV use in pathologies associated with pulmonary venous congestion. The largest ongoing randomized controlled trial on adults (INSPIRE-FLO) is addressing whether inhaled Epoprostenol and inhaled nitric oxide are similar in preventing RVF after heart transplants and left ventricular assist device placement, and whether they are similar in preventing primary graft dysfunction after lung transplants. The preliminary analysis supports their equivalence. Several key points may be achieved by the present narrative review. When RVF occurs in the setting of elevated PVR, IPV should be the preferred initial treatment and they should be preventively used in patients at high risk of postoperative RVF. If severe refractory postoperative RVF occurs, IPVs should be combined with complementary pharmacology (inotropes and inodilators). If unsuccessful, right ventricular mechanical support should be established.

Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study.

Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.

Death due to sickle cell crisis: a case report.

Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy worldwide. It results in characteristic acute and chronic findings on postmortem computed tomography (PMCT), macroscopic and microscopic examinations. While the diagnostic imaging and macroscopic features are not specific for SCD on their own, when coupled with microscopic features such as sickled erythrocytes and evidence of chronic venous congestion (i.e., Gamna-Gandy bodies), these clues can help alert forensic pathologists to the presence of SCD. Despite the prevalence of the disease and the constellation of findings alluded to above, SCD is not often explored in forensic pathology literature. This case demonstrates classic acute and chronic features of SCD on PMCT, macroscopic and microscopic examinations. It explores the pathophysiology leading to sudden and unexpected death in a person with SCD and possible pitfalls in attribution of cause of death.

Characterizing a new clinical phenotype: the co-existence of cerebral venous outflow and connective tissue disorders.

There is increasing recognition of connective tissue disorders and their influence on disease in the general population. A conserved clinical phenotype involving connective tissue disorders and idiopathic intracranial hypertension (IIH) and associated cerebral venous outflow disorders (CVD) has not been previously described. A single-institution retrospective review of a prospectively maintained database of patients with connective tissue disorders and CVD was performed. A total of 86 patients were identified. The majority of these patients carried a diagnosis of Ehlers-Danlos syndrome (55%) and most were non-obese (mean body mass index 29.7 kg/m2), Caucasian (90%) females (87%). Most prevalent presenting symptoms included pressure headache (98%), dizziness (90%), tinnitus (92%), and cognitive dysfunction (69%). Aside from CVD and IIH, the most common associated conditions were postural orthostatic tachycardia syndrome (POTS; 55.8%), cerebrospinal fluid (CSF) leaks (51.2%), dysautonomia (45.3%), cranio-cervical instability (37.2%), mast cell activation syndrome (25.6%), and tethered cord syndrome (23.3%). Allergies to medications (87.2%) and surgical tape (19.8%) were also frequent. Despite significantly lower opening pressures on lumbar puncture, headache severity and quality of life scores were reported with the same severity of classic IIH patients, suggesting an underlying hypersensitivity to intracranial pressures and cerebral venous congestion. There is a rare but conserved clinical phenotype that has not been described previously that presents with severe IIH symptoms in predominantly young, non-obese Caucasian women with a high associated incidence of dysautonomia, POTS, craniocervical instability, and CSF leaks, among others.

Prevention of venous thromboembolism in surgical patients: A proposal for a protocol based on the reality of a university hospital

Introduction: Venous thromboembolism (VTE) results from the formation of thrombi in the endothelial space, following factors related to endothelial injury, venous stasis and coagulation disorders. This scenario can result in deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), which is the third leading cause of cardiovascular death worldwide. Given the possibility of preventing VTE in the majority of in-hospital cases, it is recommended that every hospital has a formal strategy for VTE prevention, including in patients undergoing elective surgery. To this end, it is possible to use risk stratification scales, both for the development of VTE and the baseline risk of bleeding in post-operative patients. Objective: To provide an institutional protocol that is systematized and updated according to the main national and international literature on the prevention of venous thromboembolism in elective surgeries at the Júlio Muller University Hospital (HUJM/ UFMT). Materials and Methods: A protocol was drawn up based on a systematic analysis of up-to-date scientific evidence on thromboprophylaxis in elective surgeries, adapted to the routine of the Júlio Muller University Hospital (HUJM/UFMT), using the UpToDate, Pubmed and Cochrane Library platforms, as well as the Guidelines of the Brazilian Society of Angiology and Vascular Surgery (SBACV) and the American College of Chest Physicians (ACCP). Conclusion: The patient's risk of developing VTE is largely due to avoidable or predictable risk factors, depending on the type of surgery, mobilization time and risk of bleeding. The use of a protocol for the prevention of venous thromboembolism through risk stratification will allow greater individualization of the patient in relation to established prophylaxis, based on scientific evidence. Further studies on the subject are still needed, especially in the setting of elective surgery.

How to diagnose and treat venous congestion in heart failure.

How to diagnose and treat venous congestion in heart failure.

Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy.

After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (- 40, - 125, and - 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with - 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at - 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with - 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with - 200 mmHg but not with - 40 and - 125 mmHg. EndoVAC therapy with a pressure of - 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion.

Revisit to Phlebolymphedema as Ultimate Outcome of Dual Outflow System Failure

Venous and lymphatic systems are one interdependent, "inseparable" dual-outflow system of the circulation. Both systems are "mutually complimentary"; the insufficiency or overload to one of two systems allows the other to play an auxiliary role of fluid return through micro- &amp; macro-anastomosis. But both systems are "mutually complimentary" only when they are with normal function; when the venous stasis exceeds this maximum lymphatic compensatory capacity, the insufficiency becomes "phlebo-lymphatic". When one of the two systems should fail to provide sufficient compensation to the other system, it would become a combined condition of chronic venous insufficiency (CVI)/chronic venous hypertension and chronic lymphatic insufficiency (CLI)/chronic lymphedema, known as “phlebo-lymphedema” (PLE). Hence, the ulcer of PLE origin represents an unavoidable outcome of the joint failure of this “inseparable” venous-lymphatic circulation system, presenting as a combined condition of veno-lymphatic edema caused by CVI and CLI. When the lymphatic system becomes damaged (mechanical insufficiency) or the ultrafiltrate load becomes greater than the ability of the lymphatic system to drain it (dynamic insufficiency), the lymphatic system would fail to handle the interstitial fluid load, and the proteins and macromolecules start to accumulate in the interstitium. This "presence of proteins in the interstitial space" further induces an inflammatory cascade to create a proinflammatory state leading to the irreversible changes. These proteins may serve further as a substrate for microorganisms to facilitate extending and intensifying infections. Increased scarring and trauma by these infections cause further damage to the vulnerable lymphatic collectors. Therefore, lymphatic system can be easily damaged not only by drainage overload but also by the inflammatory environment created by the fluid stasis so that this vicious circle created by the impairment of the venous and lymphatic system would cause the ulcer management more seriously complicating. Hence, a precise understanding of the nature of all the chronic "indolent" venous stasis ulcers as a combined condition of veno-lymphatic edema caused by CVI and CLI of various origins is mandated based on simultaneous evaluation of these two closely linked conditions/systems.

Novel closed-loop control system of dual rotary blood pumps in total artificial heart based on the circulatory equilibrium framework: a proof-of-concept in vivo study.

Total artificial heart (TAH) using dual rotary blood pumps (RBPs) is a potential treatment for end-stage heart failure. A well-noted challenge with RBPs is their low sensitivity to preload, which can lead to venous congestion and ventricular suction. To address this issue, we have developed an innovative closed-loop control system of dual RBPs in TAH. This system emulates the Frank-Starling law of the heart in controlling RBPs while monitoring stressed blood volume (V) based on the circulatory equilibrium framework. We validated the system in in-vivo experiments. In 9 anesthetized dogs, we prepared a TAH circuit using 2 centrifugal-type RBPs. We first investigated whether the flow and inlet atrial pressure in each RBP adhered to a logarithmic Frank-Starling curve. We then examined whether the RBP flows and atrial pressures were maintained stably during aortic occlusion (AO) and pulmonary cannula stenosis (PS), whether averaged flow of dual RBPs and bilateral atrial pressures were controlled to their predefined target values for a specific V, and whether this system could maintain the atrial pressures within predefined control ranges under significant changes in V. This system effectively emulated the logarithmic Frank-Starling curve. It robustly stabilized the flow and atrial pressures during AO and PS without venous congestion or ventricular suction, accurately achieved target values in averaged flow and atrial pressures, and efficaciously maintained these pressures within the control ranges. This system controls dual RBPs in TAH accurately and stably. This system may accelerate clinical application of TAH with dual RBPs.

Effect of Ethanol Extract of Moringa Leaf on Liver Histopathology of White Rat (Rattus norvegicus) Induced by Meloxicam

The aim of this study was to find out the effects of ethanol extract of moringa leaf on liver histopathology white rats (Rattus norvegicus) induced by meloxicam. The experimental design used in this study was a Completely Randomized Design (CRD) with 5 treatments where K- was given only aquadest, K+ was given 8.4 mg/kg BW of meloxicam, P1 was given 8.4 mg/kgbw of meloxicam and 200 mg of moringa leaf extract, P2 was given 8.4mg/kg bw of meloxicam and 400 mg of moringa leaf extract and P3 was given 8.4 mg/kg BW of meloxicam and 600 mg of moringa leaf extract, and each treatment consisted of 5 replications. The treatment was carried out for 35 days. The parameters observed were hydropic degeneration, sinusoidal dilatation, venous congestion, fatty degeneration, necrosis, and inflammatory cell infiltration. The data obtained were analyzed by One Way ANOVA analysis and continued with Duncan’s test. The results showed a significant effect (P&lt;0.05) of the ethanol extract of moringa leaves on liver histopathology white rats induced by meloxicam. It can be concluded that the ethanol extract of moringa leaves in this study can prevent liver cell damage in white rat caused by meloxicam.

VExUS Score at Discharge as a Predictor of Readmission in Patients with Acute Decompensated Heart Failure: A Cohort Study.

Residual venous congestion is a major contributor to readmission of patients with heart failure, and the venous excess ultrasound (VExUS) score is a potentially useful tool to evaluate systemic congestion. To investigate the association between VExUS score before hospital discharge among patients with heart failure and the risk of readmission due to acute decompensated heart failure (ADHF) within 90 days after discharge. This prospective cohort study enrolled adults with signs and symptoms of ADHF, left ventricular ejection fraction of 40% or below (heart failure with reduced ejection fraction), New York Heart Association functional class II to IV symptoms, and clinical evidence of venous congestion necessitating intravenous diuretics. Just prior to discharge, we conducted VExUS score evaluation. The primary outcome was a composite endpoint of readmission or emergency visits due to ADHF within 90 days following hospital discharge. Statistical significance was set at p < 0.05. The cohort comprised 49 individuals, 11 (22.4%) of whom experienced the primary outcome. At discharge, 34.7% of participants had VExUS score 2 or 3. Patients with VExUS 2 and 3 had a higher proportion of the primary outcome when compared with patients with VExUS of 0 (35.3% versus 9%, p = 0.044). A significant proportion of patients with heart failure with reduced ejection fraction admitted for ADHF presented clinical and ultrasound signs of residual congestion at discharge. Patients with VExUS score of 2 or 3 at the time of hospital discharge were found to be at higher risk of readmissions or emergency visits due to ADHF after 90 days.

Retinal haemorrhage after cardiopulmonary resuscitation of a patient

Aims/Purpose: We present a rare case of a patient who presented with bilateral retinal haemorrhage after cardiopulmonary resuscitation (CPR).Methods: A 37‐year‐old man, with a medical history of allergic bronchial asthma and a BMI &gt;35, was referred to our emergency department from the cardiology clinic. He complained of sudden, painless, monocular visual acuity reduction after cardiac arrest and CPR because of an acute myocardial infarction (right coronary). He underwent a complete ophthalmic examination, as well as multimodal imaging and he was under close monitoring for the following months.Results: In his initial ophthalmic examination, best corrected visual acuity was 0.1 in his right eye and 1.0 in his left eye (Snellen's chart). Intraocular pressure was 14 mmHg and 15 mmHg in his right and left eye, respectively. Dilated fundus examination showed bilaterally scattered sub‐retinal, intraretinal and pre‐retinal haemorrhages in the posterior pole, with involvement of the right fovea. After the resolution of the haemorrhages, a fluoroangiography was performed which revealed delayed central retinal vein filling in the right eye. 2 months later, during follow‐up examination, visual acuity in the right eye was 0.7 and in the left eye 1.0. The haemorrhages have been absorbed bilaterally, leaving in the right eye a sub‐foveal photoreceptor and RPE disruption.Conclusions: Retinal haemorrhages can be observed after CPR. According to the literature, there have been reports of retinal haemorrhages in infants after CPR. Meanwhile, there is only one published case of an adult with associated comorbidities with this clinical presentation. The underlying pathophysiology of this clinical entity is still unclear, although a potential relationship between the increase in central venous pressure during CPR, and sequential retinal venous stasis is suspected.

ХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ВЕН КАК МУЛЬТИДИСЦИПЛИНАРНАЯ ПРОБЛЕМА: ОТ ЕДИНОГО ПАТОГЕНЕЗА К СИСТЕМНОМУ ПОДХОДУ

Chronic venous diseases (CVD) are examined in this review from the perspective of the continuity of the venous system of the lower extremities and pelvis. The review emphasizes the most clinically significant manifestations of venous insufficiency in the lower extremities, pelvic veins, and varicose veins of the scrotum and hemorrhoids. Due to the unity of pathogenesis and similarity of symptoms of venous stasis in different locations, the review stresses the need for a multidisciplinary approach in managing this category of patients. Assessing venous symptoms in the presence of comorbidities such as osteoarthritis, diabetes mellitus, and arteriosclerosis obliterans of the lower extremities is one of the most essential clinical tasks facing a phlebologist. At the same time, the modern trend in the treatment of CVD, regardless of the anatomical location, is endovenous and minimally invasive technologies that combine surgical radicalism with minimally invasive interventions. This review is based on analyzing published materials in the three most common electronic databases: PubMed, Web of Science, and EMBASE. The primary search query strategy included the following keywords: chronic venous disease, venous insufficiency, pelvic venous disorders, hemorrhoidal disease, and varicocele. Keywords: Chronic venous diseases, varicose veins of the lower extremities, pelvic vein diseases, varicocele, hemorrhoids.

Effect of Carbon Dioxide Pneumo-peritoneum in Coagulation Profile of Patients undergoing Laparoscopic Cholecystectomy: A Prospective Cohort Study

Introduction: Laparoscopic Cholecystectomy (LC) is done under general anaesthesia with the patient in a reverse Trendelenburg position and with pressurised carbon dioxide in the peritoneum. This can induce venous stasis in the lower extremities and may affect the balance in the coagulation and fibrinolysis system, thereby thrombo-embolic complications. Aim: To investigate the effects of carbon dioxide pneumoperitoneum on the coagulation system of patients undergoing LC. Materials and Methods: A prospective longitudinal study was carried out from January 2021 to June 2021 among patients aged 18 to 60 years who attended the Surgery Department at Regional Institute of Medical Sciences, Imphal, Manipur, India and were diagnosed with gallstone disease and subsequently underwent LC. Independent variables like age, sex, religion, pre-operative prothrombin time, platelet count, activated Partial Thromboplastin Time (aPTT), and International Normalised Ratio (INR). Outcome variables comprised complications, postoperative prothrombin time, platelet count, aPTT, and INR. Data collected were analysed using Statistical Package for Social Sciences(SPSS) version 21.0. Paired t-tests were employed to test the association between mean values of post-operative and pre-operative PT, aPTT, INR, etc. A p-value of less than 0.05 was considered statistically significant. Results: The study enrolled 71 patients who encountered LC with carbon dioxide pneumo-peritoneum, including 18 male and 54 female patients. Maximum number of patients (28, 38.9%) fell into the 41 to 50 years age group. There was no significant difference in the mean value of prothrombin time (p=0.150) and INR (p=0.437) measured between the pre-operative and postoperative periods. Conclusion: LC is a safe procedure without clinically significant changes in the coagulation profile.

Histopathological Profile of Lung Lesions- An Autopsy Study at a Tertiary Care Centre, Kerala, India

Introduction: Autopsy plays a crucial role in understanding and identifying pulmonary pathology, encompassing non neoplastic lesions, neoplastic conditions and the secondary implications of the lungs in terminal events of cardiovascular diseases. Pathological analysis confirms diagnosis and identifies the prevalence of lesions, contributing significantly to medical understanding and patient care. Aim: To estimate the prevalence of lung pathology in autopsy specimens through Histopathological Examination (HPE). Materials and Methods: A cross-sectional one-year study was conducted to determine the histopathological alterations in 132 lung autopsy specimens from Medicolegal autopsies received in the Department of Pathology at a tertiary care centre in Government Medical College, Cochin, Kerala, India from January 2021 to December 2021. Autopsy specimens of the lung were fixed in 10% formalin. Following gross examination, tissue sections were processed with paraffin and subjected to staining, with microscopy findings recorded. The data was numerically coded and entered into a Microsoft Excel spreadsheet. Statistical Package for Social Sciences (SPSS) version 21.0 was used for descriptive statistics and graphical representations of findings. Results: The mean age of the study population, comprising 132 autopsy cases, was 49.41±52.12 years and the male-to- female ratio was 3.71:1. Most cases 97/132 (73.50%) involved sudden deaths where the cause remained unknown. Significant microscopic findings found in 117 (88.63%) cases were as follows: Pulmonary oedema and congestion: 61 (46.21%), Pneumonia: 17 (12.87%), Diffuse Alveolar Damage (DAD): 12 (9.09%), Chronic venous congestion: 8 (6.06%), Tuberculosis: 7 (5.30%), Emphysema: 7 (5.30%), Pulmonary fibrosis: 1 (0.75%), Fat embolism: 1 (0.75%) and Pulmonary arterial hypertension: 1 (0.75%). Neoplastic lesions were identified in 7 (5.30%) cases, with primary lung cancers accounting for 3 (2.27%) cases. There were 10 cases of Real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), positive Coronavirus Disease 2019 (COVID-19) autopsies, of which 6 (60%) exhibited DAD, while 4 (40%) showed changes of bronchopneumonia. Conclusion: Non neoplastic lesions such as pulmonary oedema, DAD and infections contributed to mortality in most cases. DAD was the most common lung finding in more than half of COVID- 19 deaths. The prevalence of pulmonary neoplastic lesions in autopsies underscores their epidemiological significance in a particular geographical area.