RESUMEN
PURPOSE: Venous aneurysms have been reported to occur in most major veins. These aneurysms may be misdiagnosed as soft tissue masses or as inguinal or femoral hernias. Venous aneurysms of the deep system have been associated with deep venous thrombosis (DVT) and pulmonary embolism (PE). To more precisely characterize these lesions, we reviewed our experience with the disease. METHODS: A retrospective analysis of our experience over 22 years was performed. The presentation and management of these lesions were reviewed and compared with the literature. RESULTS: Thirty-nine venous aneurysms were reported in 30 patients. There were 14 men and 16 women. The patients' ages ranged from 3 to 75 years. Thirty aneurysms were located in the lower extremities, four in the upper extremity, and five in the internal jugular vein. Fifty-seven percent of lower extremity aneurysms occurred in the deep system. Patients' symptoms were a mass (75%) associated with pain (67%) and swelling (42%). Thromboembolism occurred in six patients, DVT in three, and PE in three. Eight of nine patients (89%) who had aneurysms of the superficial venous system had their condition misdiagnosed. Diagnosis was made by phlebography (60%), color flow duplex scanning (27%), continuous-wave Doppler scanning (10%), or magnetic resonance imaging (10%). The aneurysm size ranged from 1.7 to 6.0 cm. Management consisted of tangential excision in five (17%), total excision in 23 (77%), and observation in seven (6%). CONCLUSIONS: Venous aneurysms are unusual vascular malformations that occur equally between the sexes and are seen at any age. Most patients have a painful mass of the extremity, and diagnosis is achieved by radiologic examination. Superficial venous aneurysms of the inguinal region are often misdiagnosed. Thromboembolism is more common in aneurysms involving the deep venous system. Because of their potential morbidity, management should be surgical in the majority of cases.
Asunto(s)
Aneurisma/diagnóstico , Venas , Adolescente , Adulto , Anciano , Aneurisma/complicaciones , Aneurisma/terapia , Niño , Preescolar , Diagnóstico Diferencial , Extremidades/irrigación sanguínea , Femenino , Humanos , Venas Yugulares , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Surgeons are often faced with the evaluation and management of groin masses. In most cases, an accurate history and physical examination will establish a diagnosis. Ultrasonography is being increasingly used in the evaluation of surgical problems. A case is presented in which bedside ultrasound was utilized in the evaluation of a large, symptomatic left inguinal mass found to be a synovial cyst on exploration. The differential diagnosis of cystic groin lesions and the impact of ultrasonography on diagnosis is reviewed with emphasis on synovial cysts. Surgeon-directed ultrasonography is an asset in the diagnosis of some patients with groin masses and may assist in the identification of those lesions requiring prompt operative intervention.
Asunto(s)
Ingle/diagnóstico por imagen , Quiste Sinovial/diagnóstico por imagen , Anciano , Femenino , Humanos , Quiste Sinovial/cirugía , UltrasonografíaRESUMEN
PURPOSE: Hirulog, a thrombin-specific inhibitor, has shown efficacy in reducing arterial thrombosis in patients treated with aspirin who require angioplasty or have unstable angina. In this study, the effect of hirulog on reducing deposition of indium 111-labeled platelets was assessed in a surgical model of aspirin-treated rats undergoing carotid endarterectomy. METHODS: Animals were randomly assigned to one of five groups: control (no aspirin or hirulog); aspirin alone (10 mg/kg); aspirin plus low-dose hirulog (0.2 mg/kg bolus followed by 0.5 mg/kg/hr); aspirin plus medium-dose hirulog (0.4 mg/kg bolus followed by 1.0 mg/kg/hr); or aspirin plus high-dose hirulog (0.6 mg/kg bolus followed by 1.5 mg/kg/hr). Hirulog was infused before surgery and continued until termination of the experiment 30 minutes after endarterectomy. RESULTS: Platelet deposition in rats receiving aspirin alone was reduced by 19% +/- 23% SE (p = 0.26) compared with controls. Deposition in aspirin-treated groups receiving low-, medium-, and high-dose hirulog decreased in a dose-dependent manner by 37% +/- 20% (p = 0.048), 44% +/- 19% (p = 0.061), and 56% +/- 13% (p = 0.022), respectively. As the dose of hirulog was increased, the plasma hirulog levels and activated partial thromboplastin time ratios (final:initial) also increased in a dose-dependent manner. The mean plasma hirulog levels ranged from 0.74 +/- 0.08 micrograms/ml in the low-dose hirulog group to 2.55 +/- 0.08 micrograms/ml in the high-dose hirulog group, and the corresponding activated partial thromboplastin time ratios were 1.5 +/- 0.12 (p = 0.001) and 3.3 +/- 0.63 (p = 0.001). Bleeding was easily controlled by local hemostatic measures for all experimental groups. CONCLUSION: Hirulog causes significant decrease in 111In-labeled platelet deposition in aspirin-treated rats subjected to microsurgical endarterectomy at doses that allow surgical hemostasis to be easily established.
Asunto(s)
Aspirina/uso terapéutico , Endarterectomía Carotidea , Hirudinas/análogos & derivados , Fragmentos de Péptidos/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Trombina/antagonistas & inhibidores , Trombosis/prevención & control , Animales , Aspirina/farmacología , Plaquetas/efectos de los fármacos , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Terapia con Hirudina , Hirudinas/farmacología , Masculino , Fragmentos de Péptidos/farmacología , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes/farmacología , Proteínas Recombinantes/uso terapéuticoRESUMEN
Frostbite injuries are a common problem associated with military operations in cold environments. Long-term disability can result. A follow-up study of 40 patients with documented frostbite injuries reveals that 65% are still having symptoms attributable to their initial injuries. This appears to be a higher percentage than most studies would suggest.
Asunto(s)
Congelación de Extremidades/complicaciones , Personal Militar , Enfermedad Aguda , Estudios de Seguimiento , Humanos , Estados Unidos , Tiempo (Meteorología)RESUMEN
In a retrospective study, 26 patients underwent 34 episodes of selective intraarterial streptokinase infusion for peripheral arterial thromboembolic occlusive disease. Thrombolytic therapy was beneficial in 23 instances (67 percent), caused no change in 7 instances, and caused deterioration in 4 instances. Nine patients (26 percent) had a major complication and 15 (44 percent) had a minor complication. Puncture site hematoma, which occurred in 11 cases (32 percent), was the most frequent complication. Local thrombolytic therapy is an effective primary or adjuvant method of treatment for thromboembolic occlusive disease in properly selected patients. Protocols for the safe use of streptokinase therapy are necessary. Enthusiasm for thrombolytic therapy must be tempered by the recognition of its potential for serious complications, the requirement for intensive care monitoring, and the availability of dedicated radiologists and vascular surgeons.