Mondor’s disease of the penis due to asymptomatic infective prostatitis provoking episodes of secondary sclerotizing lymphangitis

Mondor’s disease of the penis is an under-reported condition caused by superficial thrombophlebitis of the dorsal vein or thrombosis of the deep venous network of the penis. This is a benign, self-limiting condition, characterized by a sudden, indurated swelling of the aforementioned veins. The possible causes comprise traumatism, neoplasms, excessive sexual activity, or coagulation inherited deficit. An accompanied lymphangitis is discussed, eventually as a distinct variety. The differential diagnosis must be established by the means of ultrasound, which is the imaging diagnostic technique of choice. We describe the case of Mondor’s sclerotizing lymphangitis secondary to recurrent episodes of genitourinary infection previously diagnosed as recurrent superficial Mondor thrombophlebitis of the penis.

What are the ideal characteristics of a venous stent?

Historically, the stents used in the venous system were not dedicated scaffolds. They were largely adapted arterial stents. An essential feature of a venous stent is compliance, in order to adapt its crosssectional area to the vein. It should also be crush resistant, corrosion resistant and fatigue resistant. The material should be radiopaque, for follow-up. Another characteristic of the ideal venous stent is flexibility, to adapt its shape to the vein, not vice versa. The scaffold should be uncovered too, in order to avoid the occlusion of collaterals. The ideal venous stent should not migrate, so it is necessary a large diameter and a long length. The radial force is important to prevent migration. However, current stents derived from arterial use display high radial force, which could affect the patency of the thin venous wall. Alternatively, if the stent has an anchor point, that permits a passive anchoring, the radial force required to avoid migration will be lower. Dedicated venous stents were not available until very recently. Furthermore, there is a preclinical study about a new compliant nitinol stent, denominated Petalo CVS. Out of the commonest causes of large veins obstruction, dedicated venous stent could also treat other diseases described more recently, such as the jugular variant of the Eagle syndrome, JEDI syndrome and jugular lesions of the chronic cerebrospinal venous insufficiency that result unfavorable for angioplasty according to Giaquinta classification.

Ointment therapy and prevention of cannulation-induced superficial phlebitis

The primary aim of this prospective randomized trial is to determine the effect of clobetasol ointment with nitroglycerin ointment on the prevention of phlebitis caused by cannulation. The target sample is 144 patients admitted to surgical ward, randomized to 3 groups. the data collection tools included demographic information, information about intravenous treatment and phlebitis measurement scale. In the intervention groups, after venipuncture, 1.5 cm of ointments (clobetasol and nitroglycerin) was applied n three time periods of 24, 48 and 72 hours from the time of venipuncture. In the first 24 hours after cannulation, there was no significant difference between the three groups. But at 48 and 72 hours after placement, the difference between intervention and control groups was significant (P<0.0001). It is recommended to use clobetasol ointment and nitroglycerin ointment to prevent the occurrence of phlebitis in patients who need long-term use of cannula (more than 48 hours).

Spectral characteristics of the internal jugular vein and central venous pressure pulses: a proof of concept study

In this proof-of-concept study the impact of central venous pressure (CVP) on internal jugular veins cross-sectional area (CSA) and blood flow time-average velocity (TAV) was evaluated in eight subjects, with the aim of understanding the drivers of the jugular venous pulse. CVP was measured using a central venous catheter while CSA variation and TAV along a cardiac cycle were acquired using ultrasound. Analysis of CVP, CSA and TAV time-series signals revealed TAV and CSA to lag behind CVP by on average 0.129 s and 0.138 s, with an inverse correlation between CSA and TAV (r= –0.316). The respective autocorrelation signals were strongly correlated (mean r=0.729-0.764), with mean CSA periodicity being 1.062 Hz. Fourier analysis revealed the frequency spectrums of CVP, TAV and CSA signals to be dominated by frequencies at approximately 1 and 2 Hz, with those >1 Hz greatly attenuated in the CSA signal. Because the autocorrelograms and periodograms of the respective signals were aligned and dominated by the same underlying frequencies, this suggested that they are more easily interpreted in the frequency domain rather than the time domain.

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. The etiology of CIEP is still a matter of debate. We present a rare occurrence of CIEP in a known hypertensive and type 2 diabetic patient after endovascular coiling of cerebral aneurysm with oculomotor nerve palsy. A 68-year old female presented with seven days history of headache and left ptosis or blepharoptosis with mild mydriasis. The headaches were localized mainly at the left side of the nose, orbit, and upper forehead while the left ptosis was associated with blurred vision. Computed tomography angiography revealed an aneurysm in between the C4 segment of the left internal carotid artery (ICA) and the bifurcation of the left posterior communicating artery. Digital subtraction angiography further confirmed the aneurysm. We used the transarterial approach to assess the aneurysm and subsequent coiling. Iohexol (Omnipaque) contrast agent was used during the endovascular procedure. The patient’s condition deteriorated into acute confusion state with cardinal symptomology of CIEP immediately after the operation. Computed tomography scan revealed cortical contrast enhancement in the vascular territory of the ICA as well as edema. Her symptomatology resolved 48 hours after treated with anticonvulsants, intracranial pressure reduction and hydration. Chronic hypertension as well as type 2 diabetics may be critical predisposing factors to CIEP. CIEP should be suspected in patients presenting with acute confusion state after endovascular therapy. Massive edema with ischemic brain changes in white matter of the brain before endovascular procedure should rise suspicion of CIEP.

In memory of Prof. Waldemar L. Olszewski

This is Waldemar as we know him: incorruptibly believing on his own experience; which revolutionized conventional ideas concerning basic facts on physiology and pathology of tissue function. He was the first who described the contractility of normal lymphatics, and was a scientific pioneer in many other subjects, e.g. the long-term treatment of recurrent erysipelas with antibiotics, or the implantation of silicone tubing for treatment of advanced lymphedema, his broad and brilliant knowledge of bacteriology and immunology and his open mind for social problems in the whole world made him to a unique personality, far beyond the well-known lymphologist.1In spite of his interest in basic biology he was always open for problems of the basis, promoting courses how to treat lymphedema in the community and performed some important studies concerning the conservative treatment of lymphedema patients, together with his female partner, Dr. Zaleska. When the International Compression Club (ICC) invited him to support one of their educational meetings he never refused to give a presentation and to provide us with a manuscript which were all accepted a printed in Veins and Lymphatics.2,3 I had the privilege being invited to write a chapter in one of his books and, working in Vienna, to see his grandson in my practice; since Waldemar’s daughter was married to an Austrian also living there. I may express my deep condolences to his family and to Dr Zaleska and promise that we will never forget Waldemar. Prof. Hugo Partsch, M.D. Past President of the International Compression Club (ICC) [email protected]

The pioneers of modern lymphology in the early 20th century

We can state that modern lymphology was born from the pioneering work of the physicians of the first quarter of the 20th century. The turning point was definitely linked to the huge and precise work of the anatomists of the previous centuries and above all to the fine anatomical studies that resulted from the works of the second half of the 19th century. In the following decades, the possibility of specifically highlighting and studying lymphatic vessels and their physiology allowed the foundational step towards their clinical application and therefore the real understanding of pathologies and the first rudimentary therapeutic approaches. After the work of Von Recklingausen (1863) and Sappey (1876), after the technical completion of the then modern Gerota staining (1896) and the postulates on the physiology of the microcirculation put forward by Starling (1894), three centuries after the intuitions of Aselli (1626), we saw the definitive emancipation of Lymphology as an independent medical subject.

Effects of inhibition of lymphangiogenesis by the vascular endothelial growth factor receptor 3 (VEGFR-3) inhibitor, MAZ51 on full thickness wounds in mice

We herein used MAZ51 to inhibit lymphangiogenesis and aimed to clarify the effect of inhibition of lymphangiogenesis on wound healing. BALB/c male mice were divided into two groups: the control group which was injected the dimethyl sulfoxide (DMSO), the experiment group was injected MAZ51 in the DMSO. All wounds were observed for 15 days and the wound areas were measured. Tissue samples were harvested on day 3, 7, 9, 11, 13 and 15, and subjected to immunostaining of blood vessels and lymphatic vessels. There are no significant differences between two groups in the wound area, the number of blood vessels and lymphatic vessels. The number of blood vessels peaked on day 7 in both groups as with previous studies, while the number of lymphatic vessels peaked on 13 or 15 in both groups. This result revealed delayed lymphangiogenesis in comparison with previous studies. The wound healing process in the control and experiment groups were similar, but both groups seemed delayed lymphangiogenesis comparing with previous studies. Injections of MAZ51 or/and DMSO did not affect angiogenesis, while they may affect lymphangiogenesis.

Editorial

Not required.

Pending questions in venous ulcers management. Report from a Symposium of the World Union of Wound Healing Societies International Congress

Venous ulcers represent the most frequent ulcers and have a high clinical and socioeconomic significance. Nevertheless, pending questions remain on epidemiology, genetic and biomolecular mechanisms, contraindications and risk factors of compression therapy, role of pharmacological therapy. Overall prevalence in the range of 1-2% and point prevalence of 0.08-0.6% can be reduced if risk factors are identified and treated early. In this context, analysis of factor XIII and hemocromatosis gene polymorphisms, with the C282Y and H63D variants, may be of great importance. Also MMP12 gene polymorphism and the imbalance between matrix metalloproteinases and their tissue inhibitors are able to impair wound healing via deleterious degradation process of extra-cellular matrix. From a therapeutic point of view, conflicting recommendations exist on relative contraindications, risks and adverse events of compression therapy. Some studies showed that the administration of pentoxyphilline, Micronized purified flavonoid fraction (MPFF) and sulodexide was effective in accelerating ulcer healing, but there is no data on the duration of treatment, recurrence rates and cost-effectiveness relationship.