1/46. Asymptomatic ureteral varices: detection by Doppler sonography.Retroperitoneal ectatic or varicose veins may cause ureteral extrinsic pressure defects. Doppler sonography may be helpful in the characterization of these vascular lesions. We report the sonographic findings in a case of asymptomatic idiopathic left ureteral varices.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/46. Subepicranial varix mimicking sinus pericranii: usefulness of three-dimensional computed tomography angiography and bone window computed tomography--case report.A 16-year-old female presented with a rare case of subepicranial varix in the left temporal area manifesting as a soft mass in the left temporal area when she laid down in the left lateral position. Bulging of the mass was observed when intracranial venous pressure was raised by the valsalva maneuver, the left lateral position, or the prone position. Bone window computed tomography (CT) revealed a tiny hole, 1 mm in diameter, in the outer bone table. Three-dimensional CT (3D-CT) angiography clearly visualized a mass with a diameter of approximately 10 mm connected to the diploic vein. The mass was totally resected by operation. Venous bleeding was observed from the tiny hole. Histological examination revealed a venous lesion mimicking sinus pericranii and containing endothelial cells. No communication with the intracranial venous sinuses was identified, so the diagnosis was subepicranial varix. Radiological examination by direct injection of contrast medium is usually performed to identify subepicranial varix, but 3D-CT angiography is a non-invasive preoperative examination that can visualize this small venous lesion. Adjustment of the CT acquisition conditions may allow 3D-CT angiography to identify sinus pericranii in the future.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/46. indocyanine green angiographic features of varix of the vortex vein ampulla.Varix of the vortex vein ampulla is a rare, benign, asymptomatic condition, which may be confused with a choroidal naevus or melanoma. A 28-year-old man was referred to a tertiary retinal practice with a diagnosis of choroidal naevus. The lesion was an elevated choroidal mass in the superonasal peripheral retina measuring 2 by 1 disc diameters. It was dark red to burgundy in colour and disappeared under digital pressure applied to the globe. The methods used in diagnosis were colour fundus photography, fluorescein angiography and indocyanine green angiography using a scanning laser ophthalmoscope. On fluorescein angiography the lesion was initially hypofluorescent, becoming isofluorescent 25 s after dye injection. indocyanine green angiography demonstrated the lesion to be two separate dilatations of the vortex vein ampullae.The dilatations collapsed when pressure was applied to the globe. A choroidal mass that collapses under pressure applied to the globe should suggest a varix of the vortex vein ampulla. indocyanine green angiography is useful in demonstrating the outline of the varix of the vortex vein ampulla.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
4/46. association of transjugular intrahepatic portosystemic shunt with embolization in the treatment of bleeding duodenal varix refractory to sclerotherapy.BACKGROUND: Bleeding from duodenal varices are often severe (mortality as high as 40%), and more difficult to sclerose than esophageal varices. We report a patient with a bleeding duodenal varix, refractory to sclerotherapy, successfully treated by the association of portosystemic shunt placement and varix embolization, via the same transjugular intrahepatic route. methods: A 40-year-old Black male underwent emergency TIPS and duodenal varix embolization after failure of endoscopic sclerotherapy. The portosystemic pressure gradient droped from 16 to 9 mm Hg following TIPS. At 5 months from TIPS, the patient is well, with a patent shunt at Doppler ultrasound. CONCLUSION: The present report of successful control of duodenal varix, actively bleeding and refractory to sclerotherapy, by means of combined TIPS and embolization, supports the role of TIPS and suggests that its association to embolization can be valuably considered in the difficult setting of portal hypertension with bleeding duodenal varices.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/46. Non-penetrating deep sclerectomy in unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins.PURPOSE: To investigate the efficacy of non-penetrating deep sclerectomy (NPDS) in a secondary open-angle glaucoma case due to dilated episcleral veins, on intraocular pressure and retrobulbar hemodynamics. methods: NPDS was done on a 32-year-old male unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins. RESULTS: Except for hyphema and shallow anterior chamber on the first post-operative day, no other complications were observed. intraocular pressure was 18-20 mmHg during the first six months, without medication or visual loss. Retrobulbar color Doppler imaging showed normal mean and end-diastolic velocities and pulsatility indices of the posterior ciliary and central retinal arteries at end of the first post-operative year. CONCLUSIONS: NPDS may be an alternative to trabeculectomy in open-angle glaucoma secondary to dilated episcleral veins.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/46. Severe fatty change of the graft liver caused by a portosystemic shunt of mesenteric varices.Portosystemic shunt is a common complication in patients with portal hypertension. Mesenteric varix is one of the collaterals that can cause post-transplant liver dysfunction. In this case report, a 45-year-old woman underwent living relative donor liver transplantation for alcoholic cirrhosis. Although the early postoperative course was uneventful, she was readmitted for treatment of liver hypofunction. Fatty change in the graft liver was confirmed by histopathology of the biopsy specimen. The venous phase of a superior mesenteric angiogram revealed large-caliber mesenteric varices comprising portosystemic venous shunts. Surgery was performed to ligate the shunts. The intraoperative color Doppler ultrasonography showed hepatofugal portal blood flow, which was corrected to hepatopetal blood flow by clamping the shunt vessels. The portal pressure was moderately elevated from 13.6 cm to 21.8 cm H(2)O. Two shunt vessels were ligated and divided. Her liver function returned to nearly normal thereafter. We recommend that descending collaterals be divided during liver transplantation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/46. Massive hemorrhage from ileostomy and colostomy stomas due to mucocutaneous varices in patients with coexisting cirrhosis.Enterostomal varices have been recognized as a cause of serious recurrent hemorrhage in patients with portal hypertension secondary to cirrhosis. Most often the varices at the mucocutaneous junction are the source of the hemorrhage. Three patients--two with hemorrhages from ileostomies and one with hemorrhages from a colostomy--are presented. Local measures have proved successful in controlling hemorrhages. Occasionally direct pressure alone will prove sufficient; more often the bleeding varix will need ligation. Complete revision of the enterostomy under local anesthesia can effect total disruption of the protal-systemic shunt and temporarily can eliminate local hemorrhage. Surgically created portasystemic shunts may be considered in good risk patients in order to eliminate hemorrhage from the stomal varices. Palliative local measures, however, remain the treatment of choice in the high-risk, cirrhotic patient who is unlikely to survive a major operation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/46. Jejunal varix with extrahepatic portal obstruction treated by embolization using interventional radiology: report of a case.We report a case of relapsing jejunal varix with extrahepatic portal obstruction, which was successfully treated by embolization using interventional radiology. A 79-year-old woman suffered repeated episodes of tarry stools 2 years after undergoing jejunal resection for a jejunal varix. The bleeding point was inferred to be in the small intestine, and abdominal angiography revealed extrahepatic portal obstruction and the development of a jejunal varix around the hepaticojejunostomy. Because surgical obliteration of the varices or a shunt operation for portal decompression may have been very invasive due to severe adhesions, the jejunal varix was embolized with anhydrous ethanol and interlocking detachable coils. There were no changes in liver enzymes, the clearance rate of indocyanine green, or portal pressure, and there has been no sign of rebleeding for 13 months. Our experience shows that hemostasis can last, as long as the embolization can be done without aggravating portal hypertension. In conclusion, embolization using interventional radiology is a safe and useful method of treating intestinal varices.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/46. Familial and idiopathic colonic varices: an unusual cause of lower gastrointestinal haemorrhage.A patient is described presenting with an acute lower gastrointestinal haemorrhage as a result of extensive colonic varices. Further investigation revealed that there were no oesophageal varices or splenomegaly. Liver biopsy showed grade II fatty change only, with no other specific or significant pathological features. Transhepatic portography showed a raised portal pressure (20 mm/Hg) but the portal system was patent throughout. There was an abnormal leash of vessels in the caecum thought to represent a variceal plexus. This patient was diagnosed as having idiopathic colonic varices. This case is discussed together with nine other reports of idiopathic colonic varices from the published literature. Four of these reports describe idiopathic colonic varices in more than one member of the same family. Possible modes of inheritance, aetiology of variceal change, natural history, and prognosis are discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/46. Spontaneous orbital hemorrhage in adult females. A report of three cases.Three cases of spontaneous orbital hemorrhages in 3 adult females are reported. All of the patients had acute radiating pain in the orbit, vomiting and proptosis with a limitation of motility and ecchymosis of the eyelids. One was due to a large orbital varix with a preceding history of intermittent exophthalmos; the causes of the other cases could not be determined from their backgrounds. Within a few weeks, all of them had recovered from hematoma and had good prognoses without surgery. Orbital venous bleeding with 40 mm Hg pressure will cause more than 500 g tension on the four rectus muscles. To treat this clinical emergency, hemostasis with compression in the early phase and waiting for its spontaneous absorption are recommended.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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