Modern approaches in the treatment of patients with Paget-Schretter syndrome

Goal. Consider the management of patients with effort thrombosis (Paget-Schretter syndrome).The article presents the modern vision of the problem of effort thrombosis. This review is aimed at describing the epidemiology, pathophysiology, diagnosis and treatment of patients with Paget-Schretter syndrome. SPS occurs spontaneously, as a rule, in young, healthy and active patients aged 20-30 years after strenuous physical activity. The ratio of men and women is 2:1, recently there has been a growing trend among women. The main complaints of patients with SPS include swelling of the affected limb, discomfort when moving the affected arm, pain and heaviness when trying to raise the arm up. When examining these patients, attention is paid to hyperemia of the skin or their cyanotic nature, pasty limbs, as well as an enhanced venous pattern on the shoulder, the so-called Arshel sign. The diagnosis is based on the data of anamnesis, physical examination, the “gold standard of diagnostics” – ultrasound examination of veins, the sensitivity and specificity of which is 70-100%. The first step in the diagnosis can be the evaluation of the D-dimer, with its negative values, the SPSH is rejected. With an obvious clinic and controversial results of serial ultrasound examinations, other imaging methods are used, such as computed contrast tomography, magnetic resonance imaging, the diagnostic value of which is especially significant in occlusive venous thrombosis.SPS differs not only from DVT of the lower extremities, but also from secondary DVT of the upper extremities, which determines the peculiarities of management of this category of patients, including surgical treatment aimed at preventing subclavian vein compression in the future. The article summarizes the experience in the management of patients with blood thrombosis.

Study of the human liver by ultrasound examination to search for variations of venous anatomy.

Introduction: Knowledge about venous patterns (especially portal and hepatic venous) and their variations are extremely crucial for liver transplantation and other surgical procedures on liver. Studies have been done at national or international level on variations of hepatic venous patterns by CT or MRI or by dissection on cadaveric liver. No definitive or authentic study on this topic could be noted in electronic and print media, as well as in standard textbook. Considering low cost and noninvasive nature, we utilized ultrasonography to bridge this lacuna. Aim: To estimate prevalence and types of anatomical variations of hepatic venous system and to determine association of among variations. Materials and methods: It is an observational cross-sectional study where ultrasonographic evaluation of hepatic venous pattern on adult population of either sex (consecutive sampling) without any major liver disorders was done in RG Kar Medical College and data were analyzed with appropriate statistical procedures. Results: Normal hepatic venous pattern along with normal portal venous pattern is much higher in our study, which is a unique finding. The proportion of normal portal venous pattern is more in extra hepatic bifurcation group. Variations of portal vein and normal hepatic venous pattern are more in case of intrahepatic bifurcation of portal venous branching group. Overall presence of intrahepatic bifurcation of portal vein is significantly higher than extrahepatic bifurcation. Conclusions: This study provides an updated database for the prevalence and distribution of anatomic variations of the hepatic venous and portal venous system.

Analysis of bronchial and vascular patterns in left upper lobes to explore the genesis of mediastinal lingular artery and its influence on pulmonary anatomical variation

Background For thoracic surgeons, three-dimensional computed tomography bronchography and angiography (3-DCTBA) is a convenient way to analyze pulmonary variations before segmentectomy. Mediastinal lingular artery (MLA) is one of the representative variations. Methods The 3-DCTBA data of left upper lobe (LUL) were collected from patients who underwent pulmonary surgery from January 2018 to December 2019. We reviewed the patterns of bronchi and pulmonary vessels and grouped them according to different classifications. Results Among all the 404 cases of 3-DCTBA, mediastinal lingular artery (MLA) was found in 107 cases (26.49%). The patterns of B3 and the vein in left upper division (LUD) are distinct between mediastinal (M-type) group and interlobar (IL-type) group. The patterns of bronchi and veins in lingular division, as well as the pattern of pulmonary artery in LUD, have no differences between M-type and IL-type groups. Conclusions Mediastinal lingular artery is speculated to originate from the variation of B3, and the MLA independently influences the venous pattern in LUD in turn.

Severe Congenital Neutropenia Due To G6PC3 Deficiency Case Series of Five Patients and Literature Review

Glucose-6-phosphate catalytic subunit 3 (G6PC3) deficiency is characterized by severe congenital neutropenia with recurrent pyogenic infections, a prominent superficial venous pattern, and cardiovascular and urogenital malformations, caused by an alteration of glucose homeostasis, with increased endoplasmic reticulum stress and cell apoptosis. We describe five new cases from Mexico, and review 89 more patients reported in the past decade, to delineate the most frequent laboratory and genetic features, their treatment, and outcomes, and to expand the knowledge of syndromic and non-syndromic phenotypes in these patients.

Type A Cubital Venous Pattern among Students of a Dental College: A Descriptive Cross-sectional Study

Introduction: Superficial veins in cubital fossa vary frequently in their anatomical pattern. The knowledge of variation of the cubital venous pattern is very essential for medical professionals for venous access during different medical procedures. This study aims to find the prevalence of Type A cubital venous pattern among students of a dental college. Methods: This descriptive cross-sectional study was conducted among 133 dental students of age 18 to 25 years in the department of anatomy of a dental college from November 2020 to February 2021. This study was conducted after obtaining ethical clearance from the Institutional Review Committee. Convenience sampling used and data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 133 dental students, Type A cubital venous pattern was found in 96 (72.18%) (64.56-79.79 at 95% Confidence Interval). Type A cubital venous pattern was seen in the left arm in 116 (43.61%) and in the right arm of 76 (28.57%) students. This pattern was noticed in 30 (22.55%) male and 103 (77.44%) female students respectively. Conclusions: This study showed higher Type A cubital venous pattern among dental students than other international studies.

Severe congenital neutropenia due to G6PC3 deficiency. Case series of five patients and literature review

Glucose-6-phosphate catalytic subunit 3 (G6PC3) deficiency is characterized by severe congenital neutropenia with recurrent pyogenic infections, a prominent superficial venous pattern, and cardiovascular and urogenital malformations, caused by an alteration of glucose homeostasis, with increased endoplasmic reticulum stress and cell apoptosis. We describe five new cases from Mexico, and review 89 more patients reported in the past decade, to delineate the most frequent laboratory and genetic features, their treatment, and outcomes, and to expand the knowledge of syndromic and non-syndromic phenotypes in these patients.

Complications in AVM Surgery

In AVM surgery perioperative complications can arise and can have serious perioperative consequences. Surgically related complications in AVM treatment, in many cases, can be avoided by paying attention to details:1. Careful selection of the patient: - addressing a patient with eloquent AVM to Gamma Knife treatment - preoperative treatment with selective embolization of the accessible deep feeders - preoperative gamma knife or embolize those patient with an over-expressed venous pattern2. Meticulous coagulation of deep medullary feeders: - Using dirty coagulation - Using dry non-stick coagulation - Using micro clips - Using laser - Reaching the choroidal vessel in the ventricle when possible - Avoiding occlusive coagulation with hemostatic agents3. Check and avoiding any residual of the AVM4. Keep the patient under pressure control during postoperative periodFulfilling these steps contributes to reduce complications in this difficult surgery, leading to a safer treatment that compares favorably with natural history of brain arteriovenous malformations.

Subpial Hemorrhage of the Neonate

Background and Purpose— Subpial hemorrhage of the neonate is a rare stroke subtype reported in few case series. Birth trauma and coagulopathy are commonly proposed etiologies. We evaluated our subpial hemorrhage of the neonate patient cohort to expand current understanding Methods— Cases of subpial hemorrhage of the neonate were identified by keyword searches of the institutional database. The medical records and magnetic resonance imagings were reviewed. Results— Seventeen cases were identified. Assisted delivery occurred in 12% of cases, and acute coagulation abnormalities occurred in 77%. Subpial hemorrhage of the neonate was located in the temporal lobe in 82%, with cytotoxic edema and medullary vein congestion and thrombosis subjacent to the hemorrhages in 100% and 76% of cases, respectively. Neurological disability was present in 44% of survivors. Three patients had chronic coagulation abnormalities. Conclusions— In our cohort, clinical findings supporting a potential relationship with birth trauma were infrequent. The imaging findings suggest a nonarterial, deep venous pattern of hemorrhagic ischemia.

Dry needling of the gastrocnemius muscle. Overlap between trigger point area and the presence of blood vessels

Aims To evaluate the anatomic variability of the gastrocnemius venous system using ultrasound and the overlap of the same with myofascial trigger points (MTrPs 1 and 2) clinically located in this muscle. Material and Methods In total, 82 legs of 41 healthy adults were studied, belonging to 26 men and 15 women aged between 22 and 50 years. The blood vessels located below MTrP1 and MTrP2, described by Travell and Simons were observed, and each image was analyzed by sectors (medial, central and lateral) to quantify the number of blood vessels, their distribution and overlap with the MTrPs described at this level. Results Examination of the 164 heads of 82 gastrocnemius muscles revealed that at least one vessel exists for each section analyzed. The number of veins per head varied between 1 and 8. The most common pattern in the medial gastrocnemius was three vessels (41.5%) and two vessels (49%) in the lateral gastrocnemius. In 100% of the cases the localization of the veins coincided with the clinical localization of the MTrPs. Conclusions The venous pattern of the proximal gastrocnemius is highly variable among subjects regarding the number of blood vessels and their distribution. There is a complete overlap between the clinical localization of the gastrocnemius MTrPs and the presence of blood vessels.