1/50. Local subcutaneous heparin as treatment for venous insufficiency in replanted digits.In the treatment of venous insufficiency unsuitable for surgical correction in replanted digits, a small ungual window was surgically created to infiltrate subcutaneous heparin in the congested digit. The initial heparin dose was 1000 units. This dose made possible a continuous bleeding during 24 to 48 hours, solely through the ungual window. Further doses were applied based on the degree of congestion of the replanted digit, but usually it was necessary to infiltrate up to 500 units of heparin every 24 to 48 hours until vascular stability was achieved. Three patients were treated with this technique. One opted for quitting the treatment. A replanted thumb suffered venous congestion on the seventh postoperative day and was treated with local subcutaneous heparin for 3 days. A replanted fingertip suffered venous thrombosis 24 hours after surgery and was treated likewise for 18 days. In these two patients, success was attained. blood transfusions were carried out in the latter two, and none had any systemic changes in partial thromboplastin or thrombin time. This treatment is based on the mechanism of action of heparin at high doses but applied only to the congested segment. Besides their anticoagulant effect through antithrombin, high doses of heparin slow platelet aggregation, may induce angiogenesis, and have a longer-than-normal half-life. With the above technique, heparin has been applied to the congested segment at an approximate dose of 33,000 to 40,000 units/kg, and continuous bleeding solely through the ungual window for 24 to 48 hours has been achieved, which has allowed us to save two replanted segments with no complications at all. This method may offer another alternative for the medical treatment of venous insufficiency in replanted segments.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
2/50. Reverse venous outflow of a free fibular osteocutaneous flap: a salvage procedure.The authors report 2 patients with a massive bony defect of the tibia due to chronic osteomyelitis. They reconstructed the defect using a free vascularized fibular osteocutaneous flap. Unfortunately, venous insufficiency was diagnosed 24 hours postoperatively. The previous anastomosed veins were promptly explored. The peroneal veins of the vascularized fibular bone graft were noted to be full of thrombi. After thrombectomy, the vessels became very fragile and broke down easily. It was impossible to achieve normal antegrade venous outflow from the previous vein of the donor graft; however, they found that distal runoff of the peroneal vein achieved a reverse venous outflow from the donor graft. The great saphenous vein was dissected and reanastomosed to achieve adequate venous drainage. This procedure may offer an alternative treatment for a flap with venous insufficiency.- - - - - - - - - - ranking = 0.33333333333333keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
3/50. Acute and chronic venous insufficiency in the finger.Venous hypertension with subsequent chronic venous insufficiency and its sequelae in the hand is reported as an uncommon complication of arteriovenous fistulae for hemodialysis.- - - - - - - - - - ranking = 0.83333333333333keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
4/50. Lipodermatosclerosis - report of three cases and review of the literature.We report 3 cases of lipodermatosclerosis (LDS) and discuss the nosology of similar disorders caused by venous insufficiency of the legs. These cases are characterized by (1) occurrence in middle-aged or aged woman, (2) painful, indurated erythema with hyperpigmented scleroderma-like hardening on the lower leg, (3) lobular panniculitis with membranocystic fat necrosis and various degrees of septal fibrosis. Although the designation LDS has been used particularly in the UK and in the USA, this entity is not familiar in other countries including japan. LDS clinically represents a wide spectrum from an acute, inflammatory phase to a chronic, fibrotic state. The clinicopathologic findings of LDS are similar or identical to the disease previously reported as chronic indurated cellulitis, hypodermitis sclerodermiformis, stasis panniculitis or sclerosing panniculitis. These diseases are probably related conditions, which depend upon the various stages.- - - - - - - - - - ranking = 0.16666666666667keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
5/50. Complications of venous insufficiency after neurotologic-skull base surgery.OBJECTIVE: To characterize the incidence and complications resulting from venous insufficiency after neurotologic-skull base surgery. STUDY DESIGN: Retrospective case review of >3,500 cases. SETTING: Tertiary referral center, inpatient surgery. patients: Six patients: four with complications related to chronic venous insufficiency and two with complications related to acute venous insufficiency. INTERVENTION(S): Medical (steroids, acetazolamide, hyperventilation, mannitol) and surgical (lumboperitoneal shunt, optic nerve decompression, embolectomy) interventions were undertaken. MAIN OUTCOME MEASURE(S): Chronic venous insufficiency: nonobstructive hydrocephalus manifested by headache, disequilibrium, and papilledema with resultant visual loss. Acute venous insufficiency: acute nonobstructive hydrocephalus resulting in mental status abnormalities in the postoperative period. CONCLUSIONS: (1) incidence of 1.5 per 1,000 cases. (2) Acute and chronic forms with different pathogenesis. (3) Acute form presents postoperatively with change in consciousness and herniation, and may proceed to death. (4) Chronic form presents months or years postoperatively with headache, disequilibrium, and visual changes from papilledema. (5) Occurs almost solely in patients with preoperative abnormalities of the venous collecting system. (6) Causes mental status changes postoperatively.- - - - - - - - - - ranking = 1.3333629674439keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
6/50. Fluctuating monoplegia due to venous insufficiency by spinal arachnoiditis ossificans.This is the first report of a patient with venous insufficiency following compressive arachnoiditis ossificans (AO). Symptoms of fluctuating monoplegia and sensory disturbance appeared monthly, lasting several weeks each time. Spinal magnetic resonance imaging (MRI) showed high T2-weighted signal intensity in the posterior portion of the column from T11 to T12 and an intradural lesion with low T2-weighted signal intensity. Neurological function and MRI improved markedly following an operation on AO. The symptoms seen in the present case were due to posterior venous insufficiency following compressive AO.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
7/50. Multiple pseudolymphomas caused by hirudo medicinalis therapy.Therapy with medicinal leeches (hirudo medicinalis) is now frequently applied in plastic surgery and in the management of chronic venous insufficiency. We observed a patient in whom firm, brown-red, pea-sized papules developed at each site where leeches had been applied on the lower legs. histology, immunohistology, and molecular analysis of T-cell receptor and immunoglobulin heavy chain gene rearrangement proved these lesions to be follicular pseudolymphomas.- - - - - - - - - - ranking = 0.16666666666667keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
8/50. Persistent leg ulcers in an obese patient with venous insufficiency and elephantiasis.Options in Practice presents different management approaches to the same clinical situation. You are invited to submit a brief case description, including the specialty nursing care provided, and several glossy color photographs of the clinical situation. The case material will then be sent to another wound, ostomy, or continence care nurse, who will also address management concerns. Alternative solutions to difficult wound, ostomy, or incontinence clinical situations will be published.- - - - - - - - - - ranking = 0.66666666666667keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
9/50. Congestive heart failure associated with chronic venous insufficiency and leg ulcers secondary to an arteriovenous fistula caused by a shotgun wound 15 years ago.We present a 65-year-old man who had a significant arteriovenous fistula between the right arteria profunda femoralis and vena profunda femoralis. He had evidence of chronic venous insufficiency and chronic leg ulcers on his right leg, and he had clinical findings of congestive heart failure. An arteriovenous fistula was responsible for all of clinical situation that had been caused by a shotgun wound 15 years ago. Using ultrasonography, after palpating a marked thrill and mass during physical examination, established the diagnosis of arteriovenous fistula. angiography was performed both to delineate the suspected vascular anatomy and to show the coronary arteries. The patient was operated on and no complication was experienced during or after the procedure. Dramatic improvement was seen in the clinical picture just after surgery, and heart size markedly reduced both on chest X-ray and echocardiographic examination.- - - - - - - - - - ranking = 0.83333333333333keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
10/50. Recurrent necrobiosis lipoidica diabeticorum associated with venous insufficiency in an adolescent with poorly controlled type 2 diabetes mellitus.Type 2 diabetes mellitus and associated long-term complications have become a significant health problem in adolescents. We report a 16-year-old girl with poorly controlled type 2 diabetes mellitus who had recurrent necrobiosis lipoidica diabeticorum associated with venous insufficiency.- - - - - - - - - - ranking = 0.83333333333333keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
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