Search

Pediatric venous disease is increasing in incidence in both inpatient and outpatient populations. The widespread use of central venous access devices as well as the rising incidence of thromboembolic events in pediatrics is leading to more systemic venous occlusions in both the central and peripheral veins. This review focuses on the etiology, presentation, workup, and general technical considerations of recanalization as well as procedural complications related to pediatric systemic venous occlusive disease. The potential role for pediatric interventional radiology guided treatments will be discussed in detail.

The aim of this study was to compare flucloxacillin concentrations between two specimens collected simultaneously during continuous infusion. One specimen was collected from a peripherally inserted central catheter (PICC) and the other collected simultaneously by peripheral venepuncture. We conducted a prospective study in seven patients who were enrolled in our outpatient parenteral antibiotic therapy (OPAT) service at John Hunter Hospital, Australia, and who were receiving continuous flucloxacillin infusions from an elastomeric device. Blood samples were drawn simultaneously from a PICC and a peripheral vein in each patient. Plasma drug concentrations were measured and compared by paired t test. Flucloxacillin concentrations from the patient’s PICC sample were disproportionately higher than the peripheral sample with a mean difference of 28.4 mg/L (95%CI 2.48 to 54.4; p = 0.037). Plasma flucloxacillin concentrations taken from central catheters are falsely elevated as compared with those from peripheral veins.

Fur die bildgebende Darstellung der Bein- und Beckenvenen gibt es mehrere Verfahren. Bei Verdacht auf Beinvenenthrombose wird eine reine B‑Bild-Kompressionssonographie durchgefuhrt, deren Genauigkeit heute ausreicht, um den Verdacht ohne zusatzliche Bildgebung zu bestatigen bzw. auszuraumen. Die Untersuchung der Beckenstrombahn erfordert allerdings die Hinzunahme der Flussinformation aus dem Pulsed-wave-Doppler bzw. Farbdoppler. Bei Verdacht auf eine Armvenenthrombose genugt in den meisten Fallen ebenfalls die Sonographie. Fur die Darstellung der zentralen Abschnitte des Venensystems, das heist der V. brachiocephalica beidseits sowie der V. cava superior und inferior, stehen Schnittbildverfahren zur Verfugung. Die genauere Ortsauflosung der Gefasdurchgangigkeit besitzt die computertomographische Angiographie, in Bezug auf das umgebende Gewebe ist dagegen die Magnetresonanztomographie uberlegen. Die klassische Kontrastmittelphlebographie kommt heute nur noch im Zusammenhang mit Interventionen bei proximalen oder zentralen Venenverschlussen zur Anwendung. Eine weitere Indikation fur die Bildgebung ist die chronische venose Insuffizienz. Sowohl die differenzialdiagnostische Abklarung als auch die Behandlungsplanung bei Varikose kann sich vollstandig auf die Sonographie stutzen.

There is some evidence that children born post-term (≥42 weeks of gestation) have metabolic abnormalities that may be associated with an increased risk of adverse health outcomes in adulthood. However, there are no data as to whether adolescents born post-term display alterations in aerobic capacity or cardiovascular function. We studied 48 adolescents (56% males) in Auckland (New Zealand) with a mean age of 14.3 years (SD = 1.7): 25 born post-term and 23 born at term (37–41 weeks of gestation). Assessments included metabolic markers in blood, whole body DXA scans, 24-hour ambulatory blood pressure monitoring, maximal exercise capacity, as well as cardiac MRI scan at rest and during submaximal exercise. Exercise capacity was lower in the post-term than in control participants (44.5 vs 47.8 ml/kgffm/min; p = 0.04). There were no differences in left ventricular volumes at rest and during exercise between groups. The 24-hour ambulatory blood pressure monitoring also showed no differences between the two groups. Being born post-term was associated with reduced exercise capacity, but with no observed differences in central cardiac function. We speculate that the reduction in exercise capacity may be due to changes in the peripheral vascular system.

Flussigembolisate konnen kleinste Gefase bis auf die kapillare Ebene vollstandig verschliesen. Den meisten klassischen Flussigembolisaten fehlen allerdings optimale Applikationseigenschaften. Ethanol oder Histoacryl, als Beispiele fur klassische Flussigembolisate, verfugen uber Nachteile, die Steuerbarkeit, fluoroskopische Sichtbarkeit, Dauer der Okklusion und die Toxizitat betreffend. Das Flussigembolisat Onyx besteht aus einem Kopolymer (Ethylen-Vinyl-Alkohol), dem Losungsmittel Dimethylsulfoxid (DMSO) und Tantalpulver. Onyx ist gut steuerbar, fluoroskopisch sichtbar und ermoglicht eine permanente Okklusion. Als nachteilig erweisen sich die hohen Kosten und die Eigenschaften des Losungsmittels DMSO (Schmerzen bei der Applikation; DMSO-kompatible Katheter). Auf Grund seiner speziellen Eigenschaften wird Onyx neben den neuroradiologischen Indikationen zunehmend auch im peripheren Gefassystem eingesetzt. Onyx kann bei der interventionellen Therapie von Typ-II-Endoleaks nach abdominellen Aortenstents sowie der Behandlung akuter Blutungen und arteriovenoser Malformationen eingesetzt werden.

WOS: 000307957500014, PubMed ID: 22454038, Nitric oxide synthesized from L-arginine via the nitric oxide synthase enzyme family is the main regulatory molecule in many physiological systems. The level of nitric oxide can now be measured in tissues by a direct real-time amperometric method. The effect of electrical stimulation of the upper cervical spine on the arteries that supply the brain and upper extremities has been established by experimental studies, and thus it has begun to be used in clinical practice to increase blood flow in the brain and the peripheral vascular system. The mechanism of this effect is still a subject of research. This is the first report of real-time nitric oxide measurement in living brain and dermal tissue during electrical stimulation of the upper cervical spine. Using the amperometric method, nitric oxide levels in frontal subcortical and front foot skin were measured before, during and after electrical stimulation of the upper cervical spine in three groups of rabbits that received infusions of saline solution, 7-aminoguanidine or atropine. By electrical stimulation, tissue nitric oxide levels increased significantly and remained increased during stimulation in the brain and skin. The nitric oxide levels dropped back to normal value 1 min after stimulation was turned off. The results we obtained have showed that real-time nitric oxide could also be measured by an amperometric method in living tissues like brain. The effect of stimulation on nitric oxide levels of living tissues disappears immediately when the stimulation is turned off., Scientific Research Project Fund of Cumhuriyet University [T275], This work is supported by the Scientific Research Project Fund of Cumhuriyet University under the project number T275. We thank Mrs. Ziynet Cinar for her assistance in the statistical analysis.

Scleroderma sine scleroderma (ssSSc) is an occult form of systemic sclerosis that may cause diagnostic difficulties due to the absence of skin involvement. Delays in the diagnosis of ssSSc means lost opportunites to address and treat the often lethal involvement of internal organs such as the lungs and heart. In this systemic review we collected all published cases of ssSSc using EMBASE, MEDLINE, PubMed, and Web of Science from 1950 to present. Our purpose was to describe the range and frequency of the clinical manifestations of ssSSc. A total of 108 published cases of ssSSc were analyzed. Lung involvement was present in 66% of cases. Peripheral vascular system involvement was present in all patients whereas gastrointestinal manifestations were present in 82% of the cases. Overall the clinical presentation is subtle and heightened clinical awareness is required to facilitate prompt recognition and treatment.

The arteriovenous anastomoses (AVAs) in distal body parts (especially hands and feet) and the peripheral veins draining them constitute the "AVA organ" that may provide around one third of the total skin surface area for heat exchange [1]. The temperatures over AVA-regulated skin sites are seldom taken into account and therefore actual heat loss may be underestimated, especially in studies employing mild whole-body cooling. The aim of this test was to study the response pattern of finger skin temperature (rich in AVAs) with non-AVA sites during transient whole-body cooling in an elderly and a young man.

This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.

A total of 224 chronic pain somatoform disorder patients without obvious pathophysiology or psychopathology were found to have colder hands than nonpatients. A paradoxical temperature increase (PTI) in response to a cognitive stressor (mental arithmetic) was noted in a subset of these chronic pain patients. Patients were defined as “PTI” responders if, during cognitive stress, an increase in digital temperature occurred over a prior eyes closed resting condition. It was found that 49.4% of males and 42.6% of females in a total sample of 224 patients demonstrated PTI. The PTI patients had significantly colder hands than non-PTI patients prior to stress. A concurrent SCL measure of sympathetic activation found no difference between the PTI and non-PTI groups either at baseline or during cognitive stress. It appears from this data that PTI is specific to the peripheral vascular system of these patients and may be a marker of psychophysiological dissociation or trauma blocked from consciousness.

Summary statement: Processed digitized Doppler signals abstracted from recordings during continuous air infusion in dogs were used to train a neural network to estimate air embolism infusion rates. Background: Precordial Doppler is a sensitive technique for detecting venous air embolism during anesthesia, but it requires constant attentive listening. Since neural networks are particularly well suited to the task of pattern recognition, we sought to investigate this technology for detection and grading of air embolism. Methods: Air was infused into peripheral veins of four anesthetized dogs at rates of 0.025, 0.05, 0.10, 0.25, 0.50 and 1.0 ml−1·kg−1·min−1 while digital recordings of the precordial Doppler ultrasound signal were collected. The frequency content of the recordings was determined by Fourier analysis. The output of the Fourier transform was the input to a neural network. The network was then trained to estimate the air infusion rate. Results: The correlation coefficient between the size of the air embolism and the air infusion rate was greater than r2 = 0.93 for each of the four animals in the study when the network was trained using the data for all four dogs. When the data from a dog was withheld from the training set and used only for testing the correlation coefficients ranged from r2 = 0.75 to r2 = 0.27. For frequencies below 250 Hz, the acoustic energy tended to fall as the air infusion rate increased. The opposite occurred at frequencies above 325 Hz. Conclusions: Neural network processing of the precordial Doppler signal provides a quantitative estimate of the size of an air embolism.

The relevant literature on the long-term effects of whole-body vibration (wbv) was analyzed in order to obtain condensed information concerning a possibly higher health risk due to long-term exposure, the relationships between the quality of exposure (intensity, duration, frequency) and pathological effects, the significance of individual factors, conclusions for standard setting, and medical health care of workers exposed to wbv. Vibration exposure was characterized by measured values in one third of papers, whereas more than 30% of the publications selected did not contain any exposure data. Health data of about 43 000 workers exposed to wbv and 24 000 persons in control groups were reported. The results indicate an increased health risk of the spine and of the peripheral nervous system after intense long-term wbv. With a lower probability, the digestive system, the peripheral veins, the female reproductive organs, and the vestibular system were also affected. Long-term effects on other organs cannot be precluded. Wbv can worsen certain endogenous conditions. Specific diagnostic features of pathological changes induced by wbv with frequencies below 20 Hz do not exist. On average, the health risk increases with higher intensity or duration of exposure, however, quantitative exposure-effect relationships cannot be derived at present. Since wbv near the Exposure Limit of the International Standard IS 2631 is not completely safe, this survey provides arguments in favour of a lower limit. Contra-indications for professional exposure to wbv and further research needs are discussed.

Comparison of glucose tolerance tests carried out with or without cortisone showed the advantage of the former when testing the internal secretory function of the pancreas. With the aid of this test the insulin secretion during glucose loading was found to be biphasic. The dynamics of the blood insulin level in the pancreatico-duodenal vein reflects insulin secretion by the pancreas better than the dynamics of its concentration in the blood of the peripheral veins.

A review of the literature of aortic elasticity data leads to the conclusion that the pressure-volume curves of the human aorta can be reasonably well approximated by parabolas, while a straight line approximation proves inadequate. By using the above relationship and assuming flow through the peripheral vascular system to be directly proportional to the pressure difference across it, two equations are derived which relate systolic and diastolic blood pressures, cardiac output, pulse rate, peripheral resistance, and two constants of aortic elasticity. Pulsewave transmission phenomena are ignored. These two equations can be solved simultaneously for any two variables in terms of the others. When values computed from these equations are compared with experiment, the errors are usually less than 5 per cent, provided errors due to inaccurate measurements of the aortic elasticity constants are avoided.

1. Mit der Methode der innervierten, isoliert durchstromten Organe wird die Beeinflussung der Reizung Acetylcholin-empfindlicher Receptoren durch 16 verschiedene Phenylalkylamine untersucht. 2. Es lassen sich Beziehungen zwischen der Struktur der Phenylalkylamine und ihrer Wirkung auf die Receptoren feststellen. 3. Derivate des 3,4-Dioxyphenyl mit einer alkoholischen OH-Gruppe am C-1-Atom der Seitenkette fuhren eine Sensibilisierung der Acetylcholin-empfindlichen Receptoren herbei. 4. Phenylalkylamine ohne OH-Gruppen am Ring und an der Seitenkette setzen die Empfindlichkeit der Receptoren fur Acetylcholin herab oder heben sie vollstandig auf. 5. Die Befunde werden zu den Ergebnissen in Beziehung gesetzt, die bei Untersuchungen an anderen synaptischen Strukturen erhalten wurden. Ihre Bedeutung fur einige Probleme der Pharmakologie der Sympathomimetica wird diskutiert.