(1/725) Aetiologies and prognosis of Chinese patients with deep vein thrombosis of the lower extremities.
Deep vein thrombosis (DVT) of the lower extremities is not frequently encountered in Oriental patients. We investigated its aetiology and prognosis in 143 patients (65 males, 78 females), presenting to the National Taiwan University Hospital over 4.3 years, diagnosed by colour Doppler ultrasonography. Swelling and pain of the lower extremities were the most frequent presenting symptoms. The left femoropopliteal veins were more frequently involved than other parts of the lower extremities. In these patients, malignancy with or without intravenous catheterization was the most frequent cause (39 patients, 27%). Other common aetiologies included coagulopathy (29 patients, 20%), immobilization (24 patients, 17%) and catheter-related (13 patients, 9%). No definite aetiology could be determined in 37 patients (26%). During follow-up, 27 patients (19%) died, mostly with malignancy. Pulmonary embolism was noted in 16 patients and was not significantly directly related to death. Compared to similar studies in Caucasian patients, there were significant differences in the aetiology of DVT, with malignancy and coagulopathy more common in these Chinese patients. (+info)
(2/725) Endovascular repair of a descending thoracic aortic aneurysm: a tip for systemic pressure reduction.
A proposed technique for systemic pressure reduction during deployment of a stent graft was studied. A 67-year-old man, who had a descending thoracic aneurysm, was successfully treated with an endovascular procedure. An occluding balloon was introduced into the inferior vena cava (IVC) through the femoral vein. The balloon volume was manipulated with carbon dioxide gas to reduce the venous return, resulting in a transient and well-controlled hypotension. This IVC-occluding technique for systemic pressure reduction may be safe and convenient to minimize distal migration of stent grafts. (+info)
(3/725) Signal-enhanced color Doppler sonography of deep venous thrombosis in the lower limbs and pelvis.
Detection of Doppler signal tends to be more difficult in peripheral veins owing to low flow velocity. This can be caused by nonoccluding thrombosis, post-thrombotic wall changes, or a deep anatomic location of pelvic veins. The last-mentioned frequently is accompanied by interference by bowel gas. In addition, inappropriate insonation angles adversely affect the outcome of color-coded Doppler interrogation. The purpose of the present study was to evaluate the effectiveness of signal-enhanced color Doppler sonography on peripheral veins in 31 patients clinically suspected of having deep vein thrombosis. As a result of diagnostic uncertainty, additional enhanced studies were performed on 43 venous segments. The enhancement led to a decrease in false-positive results (from four patients to one patient) and false-negative results (from four patients to two patients) compared to unenhanced studies. Evaluation of the deeply located pelvic veins profited the most through signal enhanced Doppler sonography. (+info)
(4/725) Transport of colloidal particles in lymphatics and vasculature after subcutaneous injection.
This study was designed to determine the transport of subcutaneously injected viral-size colloid particles into the lymph and the vascular system in the hind leg of the dog. Transport of two colloid particles, with average size approximately 1 and 0.41 microm, respectively, and with and without leg rotation, was tested. Leg rotation serves to enhance the lymph flow rates. The right femoral vein, lymph vessel, and left femoral artery were cannulated while the animal was under anesthesia, and samples were collected at regular intervals after subcutaneous injection of the particles at the right knee level. The number of particles in the samples were counted under fluorescence microscopy by using a hemocytometer. With and without leg rotation, both particle sets were rapidly taken up into the venous blood and into the lymph fluid. The number of particles carried away from the injection site within the first 5 min was <5% of the injected pool. Particles were also seen in arterial blood samples; this suggests reflow and a prolonged residence time in the blood. These results show that particles the size of viruses are rapidly taken up into the lymphatics and blood vessels after subcutaneous deposition. (+info)
(5/725) High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics in healthy volunteers and patients who are post-thrombotic.
PURPOSE: Deep vein thrombosis (DVT) is a preventable cause of morbidity and mortality in patients who are hospitalized. An important part of the mechanism of DVT prophylaxis with intermittent pneumatic compression (IPC) is reduced venous stasis with increased velocity of venous return. The conventional methods of IPC use low pressure and slow inflation of the air bladder on the leg to augment venous return. Recently, compression devices have been designed that produce high pressure and rapid inflation of air cuffs on the plantar plexus of the foot and the calf. The purpose of this study is to evaluate the venous velocity response to high-pressure, rapid-inflation compression devices versus standard, low-pressure, slow-inflation compression devices in healthy volunteers and patients with severe post-thrombotic venous disease. METHOD: Twenty-two lower extremities from healthy volunteers and 11 lower extremities from patients with class 4 to class 6 post-thrombotic chronic venous insufficiency were studied. With duplex ultrasound scanning (ATL-Ultramark 9, Advanced Tech Laboratory, Bothell, Wash), acute DVT was excluded before subject evaluation. Venous velocities were monitored after the application of each of five IPC devices, with all the patients in the supine position. Three high-pressure, rapid-compression devices and two standard, low-pressure, slow-inflation compression devices were applied in a random sequence. Maximal venous velocities were obtained at the common femoral vein and the popliteal vein for all the devices and were recorded as the mean peak velocity of three compression cycles and compared with baseline velocities. RESULTS: The baseline venous velocities were higher in the femoral veins than in the popliteal veins in both the volunteers and the post-thrombotic subjects. Standard and high-pressure, rapid-inflation compression significantly increased the popliteal and femoral vein velocities in healthy and post-thrombotic subjects. High-pressure, rapid-inflation compression produced significantly higher maximal venous velocities in the popliteal and femoral veins in both healthy volunteers and patients who were post-thrombotic as compared with standard compression. Compared with the healthy volunteers, the patients who were post-thrombotic had a significantly attenuated velocity response at both the popliteal and the femoral vein levels. CONCLUSION: High-pressure, rapid-inflation pneumatic compression increases popliteal and femoral vein velocity as compared with standard, low-pressure, slow-inflation pneumatic compression. Patients with post-thrombotic venous disease have a compromised hemodynamic response to all IPC devices. However, an increased velocity response to the high-pressure, rapid-inflation compression device is preserved. High-pressure, rapid-inflation pneumatic compression may offer additional protection from thrombotic complications on the basis of an improved hemodynamic response, both in healthy volunteers and in patients who were post-thrombotic. (+info)
(6/725) Regional glycerol and free fatty acid metabolism before and after meal ingestion.
We measured splanchnic and leg glycerol [and free fatty acid (FFA)] uptake and release in 11 healthy volunteers before and after meal ingestion to assess whether regional FFA-to-glycerol release ratios mirror systemic release ratios. Basal splanchnic triglyceride release was also assessed. Although basal splanchnic glycerol uptake (111 +/- 18 micromol/min) accounted for most of systemic glycerol rate of appearance (156 +/- 20 micromol/min), leg glycerol uptake was also noted. The basal, systemic FFA-to-glycerol release ratio was less (2.6 +/- 0.2, P < 0.05) than the splanchnic ratio of 6.1 +/- 1.3, and the leg FFA-to-glycerol release ratio under fed conditions was less than the systemic ratio (0.9 +/- 0.1 vs. 1.6 +/- 0.2, respectively, P < 0.05). Basal splanchnic triglyceride production rates were 74 +/- 20 micromol/min, which could produce equimolar amounts of glycerol in the peripheral circulation via lipoprotein lipase action. In summary, 1) regional FFA-to-glycerol release ratios do not mirror systemic ratios, 2) leg glycerol uptake occurs in humans, and 3) splanchnic triglyceride production rates are substantial relative to systemic glycerol appearance. Glycerol appearance rates may not be a quantitative index of whole body lipolysis. (+info)
(7/725) Splanchnic and leg substrate exchange after ingestion of a natural mixed meal in humans.
The disposal of a mixed meal was examined in 11 male subjects by multiple (splanchnic and femoral) catheterization combined with double-isotope technique (intravenous [2-3H]glucose plus oral U-[14C]starch). Glucose kinetics and organ substrate balance were measured basally and for 5 h after eating pizza (600 kcal) containing carbohydrates 75 g as starch, proteins 37 g, and lipids 17 g. The portal appearance of ingested carbohydrate was maximal (1.0 mmol/min) between 30 and 60 min after the meal and gradually declined thereafter, but was still incomplete at 300 min (0.46+/-0.08 mmol/min). The total amount of glucose absorbed by the gut over the 5 h of the study was 247+/-26 mmol (45+/-6 g), corresponding to 60+/-6% of the ingested starch. Net splanchnic glucose balance (-6.7+/-0.5 micromol x kg(-1) x min(-1), basal) rose by 250-300% between 30 and 60 min and then returned to baseline. Hepatic glucose production (HGP) was suppressed slightly and only tardily in response to meal ingestion (approximately 30% between 120 and 300 min). Splanchnic glucose uptake (3.7+/-0.6 micromol x kg(-1) x min(-1), basal) peaked to 9.8+/-2.0 micromol x kg(-1) x min(-1) (P<0.001) at 120 min and then returned slowly to baseline. Leg glucose uptake (34+/-5 micromol x leg(-1) x min(-1), basal) rose to 151+/-29 micromol x leg(-1) x min(-1) at 30 min (P<0.001) and remained above baseline until the end of the study, despite no increase in leg blood flow. The total amount of glucose taken up by the splanchnic area and total muscle mass was 161+/-16 mmol (29+/-3 g) and 128 mmol (23 g), respectively, which represent 39 and 30% of the ingested starch. Arterial blood lactate increased by 30% after meal ingestion. Net splanchnic lactate balance switched from a basal net uptake (3.2+/-0.6 micromol kg(-1) x min(-1) to a net output between 60 and 120 min and tended to zero thereafter. Leg lactate release (25+/-11 micromol x leg(-1) x min(-1), basal) drastically decreased postprandially. Arterial concentration of both branched-chain amino acids (BCAA) and non-branched-chain amino acids (N-BCAA) increased significantly after meal ingestion (P<0.001). The splanchnic area switched from a basal net amino acid uptake (31+/-16 and 92+/-48 micromol/min for BCAA and N-BCAA, respectively) to a net amino acid release postprandially. The net splanchnic amino acid release over 5 h was 11.3+/-4.2 mmol for BCAA and 37.8+/-9.7 mmol for N-BCAA. Basally, the net leg balance of BCAA was neutral (-3+/-5 micromol x leg(-1) x min(-1)), whereas that of N-BCAA indicated a net release (54+/-14 micromol x leg(-1) x min(-1)). After meal ingestion, there was a net leg uptake of BCAA (20+/-6 micromol x leg(-1) x min(-1)), whereas leg release of N-BCAA decreased by 50%. It is concluded that in human subjects, 1) the absorption of a natural mixed meal is still incomplete at 5 h after ingestion; 2) HGP is only marginally and tardily inhibited; 3) splanchnic and peripheral tissues contribute to the disposal of meal carbohydrate to approximately the same extent; 4) the splanchnic area transfers >30% of the ingested proteins to the systemic circulation; and 5) after meal ingestion, skeletal muscle takes up BCAA to replenish muscle protein stores. (+info)
(8/725) Elevated plasma levels of adrenomedullin in congenital cyanotic heart disease.
Adrenomedullin is a novel hypotensive peptide originally isolated from human pheochromocytoma. Accumulating evidence suggests the possible involvement of adrenomedullin in the physiology of the pulmonary circulation and the pathophysiology of hypoxaemia. The aim of the present study was to investigate the pathophysiological significance of adrenomedullin in hypoxaemia caused by congenital cyanotic heart disease. Subjects were 16 patients with congenital cyanotic heart disease aged 0.8-10 years (Group C) and 12 age-matched control subjects (patients with coronary artery dilatation after Kawasaki disease; Group N). Plasma adrenomedullin concentrations were measured, using radioimmunoassay, in femoral venous, pulmonary arterial and pulmonary venous blood obtained during cardiac catheterization. Plasma adrenomedullin concentrations in Group C were significantly (3-fold) higher than those in Group N at all sampling sites. In Group C, plasma adrenomedullin concentrations in pulmonary venous blood were significantly lower than those in pulmonary arterial blood. Pulmonary uptake of adrenomedullin in Group C was significantly greater than that in Group N. Patients with congenital cyanotic heart disease showed elevated plasma adrenomedullin concentrations and an increased uptake of adrenomedullin in the pulmonary circulation, which may act to dilate pulmonary vessels and increase pulmonary blood flow to alleviate hypoxaemia. Intrinsically increased adrenomedullin levels may function as a compensatory mechanism for hypoxaemia in congenital cyanotic heart disease. (+info)