The complicated role of venous drainage on the survival of arterialized venous flaps

341 Background: While androgens drive prostate cancer (PCa), studies of systemic levels in eugonadal patients have not shown a relationship with development or progression of PCa. This study characterizes the relationship between systemic, local venous, and tissue androgen levels to understand the regulation and influence of androgens on localized PCa. Methods: Peripheral & periprostatic venous blood & prostate tissue were collected from patients undergoing radical prostatectomy (RP). Androgen levels (testosterone (T) and dihydrotestosterone (DHT)) were assessed by mass spectrometry. PCa grade and stage, PSA, prostate volume, and periprostatic vein diameter (PPVD) on MRI were recorded. A second cohort of patients undergoing just prostate MRI (non-surgical) was assessed to investigate the relationship between PPVD and disease severity. Results: Samples were collected from 176 patients. Analysis identified a subset of patients with elevated periprostatic T (ppT) relative to systemic T (sT) including 25% with ppT/sT > 2, 14% with ppT/sT > 4, and 7% with ppT/sT > 10. Patients with ppT/sT > 4 had supraphysiologic T levels in the periprostatic venous blood (mean 4223ng/mL). These patients also had higher than predicted levels of tissue T and DHT (tT/sT of 0.48 vs 0.24 (p = 0.004) and tDHT/sT of 7.31 vs 4.72 (p = 0.011)). In the surgical cohort, PPVD was increased in patients with elevated ppT/sT levels (5.8mm vs 3.7mm, p = 0.013). In the biopsy cohort (n = 200), increased PPVD was associated with an increased risk of diagnosis of PCa (4.39mm vs 3.43mm p = 0.006) and clinically significant PCa (4.35mm vs 3.43mm p = 0.01). Conclusions: In a subset of patients with PCa, periprostatic venous T levels were highly elevated compared to peripheral levels. Tissue T and DHT were also increased, and MRI demonstrated increased PPVD. We hypothesize that collateralization of venous drainage from the gonadal vein leads to both high local T and dilated veins. In a biopsy cohort, increased PPVD was associated with an increased risk of diagnosis of any and clinically significant PCa, suggesting that high periprostatic androgen levels may play a role in development of PCa.

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The role of extracorporeal membrane oxygenation in an acute basal ventricular septal rupture

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz235 ◽

2019 ◽

Cited By ~ 1

Author(s):

Daniel Matos ◽

Marcio Madeira ◽

Tiago Nolasco ◽

José Pedro Neves

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Life Support ◽

Extracorporeal Life Support ◽

Venous Drainage ◽

Ventricular Septal Rupture ◽

Membrane Oxygenation ◽

The Right ◽

Postinfarction Ventricular Septal Rupture ◽

Mitral Bioprosthesis

Abstract A 74-year-old man was admitted with a post-acute myocardial infarction basal ventricular septal rupture. Onset of cardiogenic shock led to the implantation of a percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) system with an additional venous drainage cannula into the right ventricle. The ventricular septal defect was repaired with concomitant tricuspid valvuloplasty and mitral bioprosthesis implantation after 14 days. ECMO support was temporarily converted into a veno-venous system to wean the patient off cardiopulmonary bypass. The patient was discharged 3 weeks after surgery. This case illustrates the role of this extracorporeal life support system in the setting of postinfarction ventricular septal rupture.

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Endovascular Treatment for Idiopathic Intracranial Hypertension Improves Clinical Symptoms and Signs

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1597820 ◽

2017 ◽

Vol 36 (01) ◽

pp. 01-06

Author(s):

João Silva ◽

Mario Conti ◽

Guilherme Aguiar ◽

Mauricio Jory ◽

Paulo Monzillo ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Clinical Symptoms ◽

Venous Drainage ◽

Transverse Sinus ◽

Pressure Gradients ◽

Sinus Stenosis ◽

Symptoms And Signs

Introduction New physiopathological concepts regarding idiopathic intracranial hypertension (IIH) recommend the endovascular treatment in refractory patients with transverse sinus stenosis. Objectives To assess the role of the transverse sinus stenting treatment in the symptomatology of patients with IIH. Method Clinically refractory patients with impaired venous drainage of the transverse sinus were submitted to cerebral angiographies. Patients with pre and post-stenotic pressure gradients > 8 mmHg were submitted to endovascular treatment. Results Seven patients underwent cerebral angiography with manometry. Stenting was performed in six cases after pressure gradient assessment. All cases showed improvements in headache and resolution of papilledema. Discussion and Conclusion Although the role of endovascular therapy should be further studied, our data suggest it may improve the clinical symptoms and signs of IIH in selected patients.

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