Occlusion of subclavian-innominate veins: the increasing problem of receiving improper care

Acute upper vein obstruction necessitates emergency treatment and always requires surgery. However, it is not treated appropriately most of the time. Leaving this condition untreated, or treating it incorrectly, can result in permanent disability of the patient, as well as malpractice and negligence lawsuits against the treating physicians. Thus, all physicians must be familiar with the proper care of acute upper vein obstruction. We provide in this article an easy-to-follow algorithm and an outline of steps for successful treatment. We also discuss two situations that should not be confused: 1) the acute event involving the axillary-subclavian-innominate vein, which is called effort thrombosis or Paget-Schroetter syndrome, and 2) the chronic, more extensive obstruction caused by the intravenous placement of intraluminal devices.     

Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis

Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.     

Müller-Weiss disease: clinical and biomechanical features

Müller-Weiss disease is a rare condition that is characterized by an odd deformation of the tarsal navicular, which may appears queezed and eventually fragmented between the talar head and the lateral cuneiforms. Because the head of the talus protrudes laterally, the subtalar joint remains in an inverted position. The plantar arch may correspond to that of a normal, cavus, or flat foot.The disease is not the consequence of a osteonecrotic process but results from impaired development of the bone, in most instances because of stressing environmental factors during childhood.Isolated cases that are due to individual predisposing factors are rare, although most of the patients can be grouped together as late collateral damage of war or poverty.     

Polyoxygenated eudesmanes and trans-chrysanthemanes from the aerial parts of Santolina insularis

The eudesmane sesquiterpenoids 1-3 and the trans-chrysanthemyl monoterpenoid 4 have been isolated from the aerial parts of Santolina insularis, a bush endemic to Sardinia. The absolute stereostructures of these novel compounds and of two known but incompletely characterized chrysanthemanes (5, 6) were established by spectroscopic techniques and by application of the modified Mosher method. The presence of the p-menthane aldehyde eucamalol (7) gives credit to the widespread use of S. insularis to fend off mosquitoes.     

Implantation of cryopreserved allograft pulmonary monocusp patch to treat nonthrombotic femoral vein incompetence

We implanted cryopreserved allograft monocusp patches made from cadaveric pulmonary arteries to correct nonthrombotic valvular insufficiency of the common femoral vein in patients with chronic venous ulcers. Thirty-eight patients with 40 ulcers of longer than 3 years' duration underwent valvular repair of the common femoral vein from September 1995 through November 2001. We studied ulcer healing and competence of the monocusp patches using duplex ultrasonography Three patients with a total of 4 ulcers were lost to follow-up; therefore, 35 patients with 36 ulcers were available for examination. Twenty-four ulcers healed, and 12 did not. Of the 24 healed ulcers, 5 recurred. Four of the 5 ulcers were treated, 3 by monocusp patch replacement and 1 by iliac vein dilation and stenting. All such recurrent ulcers healed. The 5th recurrent ulcer was not treated, because the patient refused therapy Therefore, of the 24 ulcers that healed initially, 23 were healed at the end of the study Of the 12 unhealed ulcers, 4 were treated: 2 by ligation of incompetent perforating veins, 1 by saphenous vein ligation and partial stripping, and 1 by monocusp replacement. All 4 ulcers healed. The other 8 patients, all of whom had severe monocusp insufficiency, refused therapy. Therefore, of the 12 ulcers that did not heal initially, 4 were healed after additional treatment. No implanted monocusp patch developed clots. The ulcers remained healed when the prostheses remained competent. We conclude that monocusp patches can restore valvular competence to the femoral vein in patients who have primary valve insufficiency. In such patients, venous ulcers heal rapidly after prosthesis implantation if the monocusp remains competent and if there is no severe incompetence of the superficial venous system or of perforating veins.     

Randomised,double blind,multicentre, placebo controlled study of sulodexide in the treatment of venous leg ulcers

Sulodexide, a highly purified glycosaminoglycan, was investigated for treatment of venous leg ulcers. Patients (n = 235) undergoing local treatment including wound care and compression bandaging, were randomised to receive either sulodexide or matching placebo for three months. Primary study endpoint was complete ulcer healing after 2 months; secondary endpoints were ulcer healing at 3 months and the time-course changes of ulcer areas. The proportion of patients with complete ulcer healing was higher with sulodexide at 2 months (p = 0.018) and 3 months. The "number needed to treat" to obtain one additional patient healed with sulodexide was 7 at 2 months and 5 at 3 months. The changes in ulcer surface area with time were significant for sulodexide only (p = 0.004). Fibrinogen significantly decreased in sulodexide patients (p = 0.006). In conclusion, sulodexide associated with local treatment proved to be effective and well tolerated in the management of venous leg ulcers.     

Central nervous system myelination in mice with deficient expression of Notch1 receptor

Activity of the Notch1 gene is known to inhibit oligodendrocyte (OL) differentiation in vitro. We tested the hypothesis that the Notch1 pathway regulates in vivo myelin formation, by examining brain myelination of Notch1 receptor null heterozygotes mutant animals (Notch1(+/-)). We show that a deficiency in Notch1 expression leads to increased abundance of products of specific myelin genes in myelinated areas of the brain during the first 2 weeks of postnatal life. We observed increased numbers of myelinated axons in optic nerves and the presence of myelinated fibers in the molecular layer (ML) of the Notch1(+/-) cerebella. These findings were accompanied by up-regulation of Mash1 and down-regulation of Hes5 proteins. In addition, we found expression of Jagged1, one of the Notch1 activators, in unmyelinated axons of the cerebellar ML during normal development. Our findings indicate that the Jagged/Notch signaling pathway might actively participate in the regulation of myelination during central nervous system development and suggest that certain neuronal populations might regulate whether their axons are myelinated by the expression of inhibitory signals such as Jagged1.     

Measurement of spleen volume by ultrasound scanning in patients with thrombocytosis: a prospective study

Spleen size was assessed in 73 patients with thrombocytosis and in 15 healthy subjects, comparing palpation with ultrasonography (US) measurement of longitudinal diameter and volume. Intraobserver and interobserver variability for volume on US, checked in 12 patients, was very low. Correlation between spleen volume measured by US and that measured by computed tomography was excellent. Splenomegaly was detected by palpation in 25% of patients, by US assessment of longitudinal diameter in 33%, and by US assessment of volume in 52%. After diagnostic work-up, 54 patients had a diagnosis of essential thrombocythemia (ET), 4 of idiopathic myelofibrosis (IMF), and 15 of secondary thrombocytosis (ST). Spleen volume in patients with ST was in the normal range (138 +/- 47 mL) and was significantly lower than that in patients with ET or IMF (370 +/- 210 mL; P <.001). Thus, US-measured volume was the most sensitive method for identifying nonpalpable splenomegaly in patients with primary myeloproliferative diseases, and it may help in distinguishing these diseases from reactive disorders.