静脉支架临床研究及应用进展

慢性静脉疾病（CVD）是常见的血管疾病,约占我国血管外科疾病的60%,而静脉流出梗阻是慢性静脉疾病的主要原因,如深静脉血栓（DVT）,血栓后综合征（PTS）以及非血栓性髂静脉病变（NIVLs）等导致静脉压力过高而出现严重的临床症状。经皮腔内血管成形术和支架植入术的微创介入已成为公认静脉流出道梗阻的治疗方法,然而静脉疾病的血管内支架技术局限于使用动脉支架,而非使用静脉系统专用支架。由于动脉狭窄和髂静脉阻塞的病理生理学以及解剖位置不同,因此理想的静脉支架必须在静脉疾病的病理生理条件下提供灵活性,径向支撑力,精准释放等特点。目前,欧美市场兴起多款静脉专用支架,在临床研究以及应用中取得了一定的进展,而国内的静脉支架也逐一进入临床研究阶段。     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

Pressure-induced cellular senescence: a mechanism linking venous hypertension to venous ulcers

INTRODUCTION: Slow healing of ulcers in chronic venous insufficiency (CVI) has long been thought secondary to venous hypertension. Dermal fibroblasts isolated from venous ulcers have morphologies and protein production suggestive of premature aging. In this study, we hypothesized that neonatal fibroblasts (NNF) cultured under elevated pressure will demonstrate premature aging and that this effect will be augmented by an inflammatory mediator, transforming growth factor beta (TGF-beta). MATERIALS AND METHODS: A unique pressure incubator was used to culture NNF at atmospheric pressure (ATM), ATM + 30 mmHg, ATM + 60 mmHg, and ATM +120 mmHg. Some pressure-exposed NNF were also cultured with TGF- beta (1 ng/ml). Growth rates were determined by flow cytometry. Senescent cells were identified by staining with a marker for cellular senescence, beta-galactosidase (SA-beta-Gal). Light microscopy and digital imaging were used to evaluate cell morphology. Paired linear models and comparison of the slopes were used for statistical analysis of growth. chi2 analysis was used to compare senescence rates. RESULTS: NNF cultured at ATM + 60 mmHg and ATM + 120 mmHg showed increased SA-beta-Gal activity (P <0.05), and reduced growth rates (P <0.05) at 11 days. These effects were not seen at ATM + 30 mmHg. NNF grown with TGF-beta did not show augmented SA-beta-Gal staining. CONCLUSIONS: Pressure-exposed NNF demonstrated an accelerated aging phenomenon similar to fibroblasts isolated from venous ulcers. This aging effect was directly related to the level of pressure. TGF-beta did not augment the aging effect. This study suggests that pressure elevations result in altered cell function and accelerated aging that may contribute to the slowed healing seen in patients with venous insufficiency.     

Is chronic venous ulcer curable? A sample survey of a plastic surgeon

Introduction:

Venous ulcers of lower limbs are often chronic and non-healing, many a time neglected by patients and their treating physicians as these ulcers mostly do not lead to amputation as in gangrenous arterial ulcer and also cost much to complete the course of treatment and prevention of recurrence.

Materials and Methods:

One hundred and twenty two lower limb venous ulcers came up for treatment between May 2006 and April 2009. Only twenty nine cases completed the treatment. The main tool of investigation was the non invasive Duplex scan venography. Biopsy of the ulcer was done for staging the disease. Patients′ choice of treatment was always conservative and as out-patient instead of hospitalisation and surgery, which required a lot of motivation by the treating unit.

Results:

Out of twenty nine cases, ten cases were treated conservatively and seven (24.13%) healed well. Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful. Only seven cases (24.13%) failed to heal. Compression stockings were advised to control oedema, varices and pain. Foot care, regular exercises and follow-up were stressed effectively.     

Developmental venous anomalies (DVA): The so-called venous angioma

Summary Following a review of the literature it is possible to demonstrate the normality of the so called venous angiomas. They should be named Developmental Venous Anomaly (DVA). They illustrate in their two extreme types (superfical and deep) the hemodynamic equilibrium of the transcortical venous drainage in the periependymal zones. Venous ectasias and varices which can be encountered, associated with DVA constitute an acquired feature in relation to a venous outlet obstacle.The sinus pericranii represents an extracerebral DVA, but also corresponds to a normal variation. As any extreme anatomical variant, each DVA corresponds to a weak situation which may express itself clinically; only rare situations justify a radical treatment.     

Preventing venous thrombosis in critically ill children: what is the right approach?

Background: The incidence of venous thromboembolic (VTE) events in children has increased in recent years (J Neurosurg, 101, 2004, 32; J Thromb Haemost, 1, 2003, 1443) yet there is currently no consensus as to what VTE prophylaxis, if any, should be applied to the pediatric population. Objectives/Aims: Our aim was to audit current practice in pediatric VTE prophylaxis across England and Wales and to advocate simple measures for prevention. We illustrate the importance of the condition with a series of cases from the South West Paediatric Burns and Neurosurgical Services based in Bristol. Methods: Every pediatric intensive care unit (PICU) and burns center admitting children in England and Wales was invited to participate in a structured telephone questionnaire designed to find out how VTE in children were being prevented. We performed a literature review of specific risk factors and management of these factors. Results: Only one of the 24 units surveyed had written guidelines specific for children. Four other units used modified adult guidelines in older children. In the remaining 19 units that had no written guidelines, decisions regarding prophylaxis were based on individual cases and consultant‐led. Conclusion: There is no consensus in England and Wales as to which VTE prophylactic measures should be applied in patients <18 years of age. The National Institute for Health and Clinical Excellence (NICE) guidelines apply to adults only. Given the rarity of VTE events in children, it is unlikely that randomized controlled trials will provide the answer. We therefore propose that simple empirical measures be formally implemented in critically ill children to reduce the risk of developing this important but under‐recognized condition.     

980‐nm laser therapy versus varicose vein surgery in racially diverse Penang,Malaysia

Background: Chronic venous disorders are conditions of increasing prevalence in the developing world, and venous ulceration is the terminal sequel. Currently there are only limited data on all aspects of this from Southeast Asia. The aim of the present study was to assess differences in the demography and outcome between varicose vein surgery (VVS) and the relatively new endovenous laser therapy (EVT) in patients from Penang, Malaysia. Methods: A retrospective study was performed. Patients who presented to the outpatient clinic of the surgical department with saphenofemoral junction and/or saphenopopliteal junction incompetence associated with reflux of the great saphenous vein or small saphenous vein, respectively, underwent either surgery (1999–2004) or laser therapy (2004–2006). A single surgeon at a single institution performed all procedures. Results: A total of 350 limbs were treated from 292 patients. Demographics, symptoms, outcomes and complications that arose in both groups were compared. There were significant improvements in pains, swelling, cramps and heaviness postoperatively (P < 0.001) in both groups. Deep venous thrombosis was present as a complication in the VVS group at 3.0%, but was absent altogether in the EVT group. Conclusions: Although both are highly effective procedures, laser therapy has become popular as an elective procedure with its minimally invasive nature, cosmesis, rapid recovery and other advantages. Surgery remains an important and very cost‐effective procedure, especially in a developing society such as Penang.     

Percutaneous central access in patients younger than 5 years: size does matter

Purpose

The purpose of this study was to determine, in a pediatric population less than 5 years of age, which size catheter is ideal for central venous access via the subclavian and internal jugular vein based on the children’s age, weight, and height.

Methods

This was a retrospective chart review of children less than 5 years of age at The Children’s Hospital in Denver, Colorado who underwent subclavian or internal jugular central venous catheter placement from January 1, 1998 through December 31, 2001. Age, height, weight, primary disease, access site, type of central venous catheter, size of central venous catheter, and complications were recorded. Age, weight, and height were stratified and compared with catheter size to determine any correlation between age, weight, height, and complications.

Results

There were 430 central venous catheters placed via the subclavian or internal jugular vein in 331 patients less than 5 years old. One hundred ninety-five catheters (45.4%) were less than 6F in size, and 235 (54.6%) catheters were ≥6F in size. Children, who were between 0.5 and 0.99 years old, 5 to 7.49 kg in weight, 7.5 to 9.99 kg in weight, and 60 to 74.9 cm in height had higher complication rates (P < .05) when catheters ≥6F were inserted. Children who were greater than 1 year of age, greater than 10 kg in weight, and longer than 75 cm in height did not experience a significant difference (P > .05) in complications versus catheter size.

Conclusions

The choice of central venous catheter size should be predicated, not only on the primary disease, but also on the child’s age, weight, and height. Insertion of central venous catheters larger than 6F in children less than 1 year of age, less than 10 kg in weight, or less than 75 cm in height, was associated with higher complications compared with other settings.     

DUPLEX ULTRASOUND ASSESSMENT OF THE VENOUS STATUS OF THE SWOLLEN LEG

Between January 1991 and December 1993, duplex ultrasound characterization of venous disease in leg swelling was studied in 214 patients (261 limbs; 167 unilateral and 47 bilateral). All patients were examined with a duplex scanner, the superficial and deep venous systems were evaluated for the presence of thrombus and valvular incompetence. Of the 261 limbs, 29 (11.1%) had deep venous thrombosis, 14 (5.4%) had superficial venous thrombosis, 66 (25.3%) had deep venous incompetence (31/66 limbs also had superficial venous incompetence), 65 (24.9%) had incompetence in the superficial veins only. and five (1.9%) had deep venous obstruction resulting from a popliteal cyst or a popliteal vein ligation. Eighty-two limbs (31.4%) had no evidence of venous obstruction or incompetence at the areas evaluated. This study showed that venous obstruction and valvular incompetence had occurred in two-thirds of swollen legs examined. Some of the venous obstructions resulted from surgically treatable diseases such as a popliteal cyst, and some of the venous disorders involved the superficial venous system only. Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of the swelling.     

Ruptured supratentorial arteriovenous malformations associated with venous aneurysms

Summary Six patients with ruptured supratentorial arteriovenous malformation (AVM) and an associated venous aneurysm (ectasia, dilatation, varix, pouch) are described.At presentation, patients ranged in age from 16 to 61 years and were equally distributed according to sex. Maximal AVM diameter was between 2.5 and 5.0 cm at presentation while the maximal size of the venous aneurysm ranged between 0.75 and 3.0 cm. One patient had multiple venous pouches while 5 patients had a single venous aneurysm. Three patients had a single bleed; 1 patient had 2 bleeds; and 2 patients had 3 bleeds. Hemorrhage around the venous aneurysm was seen in 4 of 5 patients who underwent magnetic resonance imaging of the brain. One patient, who suffered 3 bleeds over a several year period, had both an increase in the size of the venous aneurysm as well as enlargement of the AVM. The following features did not appear to influence hemorrhage: AVM size or location; venous aneurysm size or location; age; sex; pattern; location or number of draining veins; or external circulation feeders.These observations suggest that a venous aneurysm may increase the risk of hemorrhage from a supratentorial AVM and may be an ominous feature.     

Microbubble generation and transmission of medtronic's affinity hardshell venous reservoir and collapsible venous reservoir bag: an in-vitro comparison

Microemboli are implicated in neurological injury; therefore, the extracorporeal circuit (ECC) should not generate microbubbles or transmit introduced air. The venous reservoir is the first component in the ECC designed to remove introduced air. The purpose of this study was to investigate the relative safety of two kinds of adult venous reservoirs--the closed soft-shell venous reservoir (SSVR [Medtronic CBMVR 1600]) and the open hard-shell venous reservoir (HSVR [Affinity NT CVR])--in terms of microbubble generation and introduced air transmission. A recirculating in-vitro circuit was used to compare the two reservoirs with the SSVR further assessed in a fully closed or partially open state. Microbubbles were counted using a Hatteland CMD-10 Doppler in the outflow of the reservoirs before (microbubble generation) and after infusing 20 mL/min of air into the venous line (microbubble transmission) while altering pump flow rates (3 L/min; 5 L/min) and reservoir prime (200 mL; 700 mL). Negligible bubble generation was noted in the SSVRs at both flow rates and either reservoir volume. However, microbubble generation was significant in the HSVR at the higher flow rate of 5 L/min and lower reservoir volume of 200 mL. When infusing air, a flow of 3 L/min was associated with insignificant to small increases in microbubble transmission for all reservoirs. Conversely, infusing air while flowing at 5 L/min was associated with significantly more microbubble transmission for all reservoirs at both low and high reservoir volumes.The SSVR is as safe as the HSVR in microbubble handling as the generation and transmission of microbubbles by the SSVR is not more than the HSVR over a range of prime volumes and flow rates. As both reservoirs transmitted microbubbles at higher pump flow rates regardless of reservoir volumes, it is important to eliminate venous air entrainment during cardiopulmonary bypass.