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Kitkarncharoensin N, Catithammanit S, Chavanachinda N, Phruttinarakorn B, Cherntanomwong P, Kitiyakara T. Downhill Varices and Apical Lung Cancer Without Superior Vena Cava Syndrome. ACG Case Rep J 2024; 11:e01236. [PMID: 38162006 PMCID: PMC10754591 DOI: 10.14309/crj.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
A 75-year-old woman with hypertension, dyslipidemia, thalassemia trait, osteoarthritis of the knees, and hyperthyroidism presented with bloating, abdominal discomfort, and change in stool caliber underwent an esophagogastroduodenoscopy. The esophagogastroduodenoscopy revealed varices at the middle of esophagus, which were diagnosed to be downhill esophageal varices (DEVs). DEVs occur mainly from the superior vena cava (SVC) obstruction; however, in the absence of obstruction, angiogenesis and thrombosis could be the etiology. In our patient, computed tomography showed a pulmonary nodule located at periphery of the right upper lung without SVC contact nor obstruction. The nodule was later proven to be an adenocarcinoma. Thus, our patient showed the possibility that adenocarcinoma of the lung might associated with the DEV through a mechanism other than SVC obstruction. Recognition and differentiation of DEV from other benign venous blebs of the esophagus are important, and once detected, further investigation with computed tomography of the chest is recommended.
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Affiliation(s)
| | - Sarin Catithammanit
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Bantita Phruttinarakorn
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piya Cherntanomwong
- Cardiothoracic Surgical Unit, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taya Kitiyakara
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Choi WM, Yoo SY, Chang JI, Han S, Kim YS, Sinn DH, Choi SH, Gwon DI, Lim YS. A model for predicting poor survival in patients with cirrhosis undergoing portosystemic shunt embolization. J Gastroenterol Hepatol 2023; 38:1629-1636. [PMID: 37417652 DOI: 10.1111/jgh.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND AIM Portosystemic shunt embolization (PSSE) is a promising treatment for hepatic encephalopathy (HEP) and gastric varix (GV) in cirrhotic patients with a spontaneous portosystemic shunt. However, PSSE may worsen portal hypertension causing hepatorenal syndrome, liver failure, and mortality. This study aimed to develop and validate a prognostic model that helps identify patients with a risk of poor short-term survival after PSSE. METHODS We included 188 patients who underwent PSSE for recurrent HEP or GV at a tertiary center in Korea. To develop a prediction model for 6-month survival after PSSE, Cox proportional-hazard model was used. The developed model was validated in a separate cohort of 184 patients from two other tertiary centers. RESULTS In multivariable analysis, the 1-year overall survival after PSSE was significantly associated with baseline levels of serum albumin, total bilirubin, and international normalized ratio (INR). We therefore developed the albumin-bilirubin-INR (ABI) score by assigning 1 point each for albumin < 3.0 g/dL, total bilirubin ≥ 1.5 mg/dL, and INR ≥ 1.5. Time-dependent areas under the curve of the ABI score for predicting 3-month and 6-month survival were 0.85 and 0.85 in the development cohort and 0.83 and 0.78 in the validation cohort, indicating good discrimination performance. The ABI score showed a better discrimination and calibration performance than the model for end-stage liver disease and the Child-Pugh scores, especially in high-risk patients. CONCLUSIONS The ABI score is a simple prognostic model that helps decide whether to proceed with PSSE for the prevention of HEP or GV bleeding in patients with spontaneous portosystemic shunt.
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Affiliation(s)
- Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seo Yeon Yoo
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-In Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Gastroenterology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Seungbong Han
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Baharvand M, Mortazavi H, Eshaghian M, Mirzaei H. Sublingual varicosity as a possible indicator of hypertension. Gen Dent 2022; 70:46-49. [PMID: 35225804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Oral varices are a common acquired vascular malformation that might be associated with several heart diseases. The aim of this study was to investigate whether an association exists between the severity of sublingual varices and stage of hypertension. Oral examinations were conducted, and the sublingual varicosity of 151 patients was categorized as grade 0, 1, or 2 based on severity. The blood pressure of the patients was measured and classified as normal, prehypertension, stage 1 hypertension, or stage 2 hypertension according to the guidelines of the National Heart, Lung, and Blood Institute. Pearson chi-square test, linear-by-linear association, and logistic regression were used for data analysis. Of 151 patients, 91 (60.3%) had sublingual varices, with 68 (45.0%) having grade 1 varicosity and 23 (15.2%) having grade 2. Sublingual varices were seen most frequently (84.4%) in patients older than 60 years. The frequency of hypertension (stage 1 or 2) among the sample was found to be 24.5%. The Pearson chi-square test showed a positive correlation between hypertension and sublingual varicosity (P < 0.0001; γ = 0.499). Logistic regression showed that the risk of hypertension in patients with grades 1 and 2 sublingual varicosity was 2.53 and 7.57 times greater, respectively, than that in patients with grade 0. In addition, sublingual varicosity (grade 1 or 2) was 2.32 times more frequent in men than in women (P = 0.022; 95% CI = 1.12-4.79) and 3.55 times more frequent in smokers than in nonsmokers (P = 0.003; 95% CI = 1.01-1.06). Therefore, sublingual varicosity may be a sign of hypertension.
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Kushi Y, Satow T, Ikedo T, Ohta T, Hara T, Takahashi JC, Iihara K, Kataoka H. Transvenous Coil-plugging Technique for a Symptomatic Giant Varix Associated with Arteriovenous Malformation. NMC Case Rep J 2022; 8:479-483. [PMID: 35079507 PMCID: PMC8769487 DOI: 10.2176/nmccrj.cr.2020-0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
In case of symptomatic varix associated with cerebral arteriovenous malformations (AVM), nidus is usually treated with transarterial embolization (TAE). However, TAE is not always possible due to inaccessible nidus. A man in his 40s presented with numbness and clumsiness in the right hand. Magnetic resonance imaging (MRI) and cerebral angiography revealed a giant varix associated with an AVM nidus in the left parietal lobe. The varix severely compressed the postcentral gyrus with edema. The main feeder was occluded, and tiny collateral vessels fed the nidus. After admission, his symptoms deteriorated rapidly due to the enlarging varix. To extirpate the varix, selective transvenous embolization (TVE) of a small compartment, the varix neck, between the varix and the main cortical drainer with coils was performed. After treatment, the thrombosed varix gradually shrank, and his symptoms improved. The transvenous coil-plugging technique is a potential strategy for symptomatic varix with a varix neck.
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Affiliation(s)
- Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Hara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Slead TS, Gremillion CL, Cohen EB, Tolbert MK. Esophageal varices in dogs: A retrospective case series. J Vet Intern Med 2022; 36:493-499. [PMID: 35001429 PMCID: PMC8965243 DOI: 10.1111/jvim.16355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Esophageal varices (EV) are abnormally dilated veins in the esophagus caused by alterations of blood flow or pressure. Esophageal variceal hemorrhage is a major complication of hepatic disease in humans, but a lack of information exists regarding associated adverse events in dogs. Objective To describe the clinical manifestations and associated etiologies and outcomes of dogs with EV. Animals Twenty‐five client‐owned dogs with EV diagnosed via computed tomography (CT), endoscopy, or fluoroscopy. Methods Retrospective case series. Cases were identified by review of the hospital imaging records database between 2010 and 2020. Signalment, clinical signs, and outcomes were documented. When present, additional collateral vasculature was also recorded. Cases were subcategorized into suspected etiology based upon the anatomic location or absence of an attributable underlying disease process, as well as the direction of blood flow. Results Twenty‐four of 25 cases were identified via CT, with a prevalence of 0.012% (24/1950 total studies). Presenting clinical signs were nonspecific, and more likely because of the underlying cause as opposed to complications secondary to EV themselves. Etiologic anatomic locations were similar in occurrence between the abdomen (N = 14) and thorax (N = 11). All cases with an abdominal etiologic location had presumed or confirmed portal hypertension and 9/11 cases with a thoracic etiologic location had pulmonary, caval, or systemic hypertension. No cases died or were euthanized as a direct result of EV or associated hemorrhage. Conclusions and Clinical Importance Esophageal varices are rarely reported in dogs and commonly identified concurrently with portal, pulmonary, and caval hypertension. Hemorrhage is not a common clinical manifestation of EV.
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Affiliation(s)
- Tanner S Slead
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Christine L Gremillion
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA.,Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Eli B Cohen
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - M Katherine Tolbert
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.,Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Suetov AA, Boiko EV, Izmaylov AS, Molodkina NA. [Vortex vein varix (clinical observations)]. Vestn Oftalmol 2022; 138:81-86. [PMID: 36004595 DOI: 10.17116/oftalma202213804181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Varix of the vortex vein ampulla is a rare benign condition that has clinical similarities to more concerning choroidal lesions that pose a threat to vision, in particular choroidal melanoma. The article describes two clinical cases, one of which is unique due to the combination of bilateral lesion and the presence of multiple varices in one eye. A brief review of the literature on this condition is also provided.
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Affiliation(s)
- A A Suetov
- Saint Petersburg Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Saint Petersburg, Russia
| | - E V Boiko
- Saint Petersburg Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Saint Petersburg, Russia
| | - A S Izmaylov
- Saint Petersburg Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Saint Petersburg, Russia
| | - N A Molodkina
- Saint Petersburg Branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Saint Petersburg, Russia
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You Y, Heo JS, Han IW, Shin SH, Shin SW, Park KB, Cho SK, Hyun D. Long term clinical outcomes of portal vein stenting for symptomatic portal vein stenosis after pancreaticoduodenectomy. Medicine (Baltimore) 2021; 100:e27264. [PMID: 34596122 PMCID: PMC8483817 DOI: 10.1097/md.0000000000027264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
Gastrointestinal bleeding caused by portal vein (PV) stenosis is serious complication after pancreaticoduodenectomy (PD) The purpose of this study is to reveal the long-term clinical outcomes of PV stenting for symptomatic PV stenosis and risk factors of stent related complication.Fifteen patients who underwent portal vein stenting for symptomatic PV stenosis after PD between 2000 and 2018 were retrospectively reviewed. The whole cohort was divided into 9 patients with benign stenosis group (Group-B) and 6 patients with recurrence group (Group-R).The median follow up period was 17.0 (interquartile range 12.0-38.0) months. The technical success rate and clinical success rate was revealed at 93.3% and 86.7%. The primary patency rate of stents was 79.4% and mean patency period was 14.0 (4.0-28.0) months. There was significant difference in time to stenosis and proportion of anticoagulation treatment between 2 groups [2.0 (1.0-4.0) months vs 18.5 (2.5-50.3) months, P = .035 and 100% vs 50%, P = .044. In univariable analysis, stent diameter was found to have a significant correlation with stent occlusion (P = .036).PV stenting was found to be feasible and safe in the treatment of symptomatic PV stenosis from a long term point of view.
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Affiliation(s)
- Yunghun You
- Department of Surgery, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, South Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - In Woong Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sang Hyun Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
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Lakatos L, Gönczi L, Izbéki F, Patai Á, Rácz I, Gasztonyi B, Varga-Szabó L, Barnabás Á, Iliás Á, Lakatos PL. Outcomes of variceal upper gastrointestinal bleeding: A prospective, multicenter, population-based study from West Hungary. Orv Hetil 2021; 162:1252-1259. [PMID: 34333456 DOI: 10.1556/650.2021.32166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Az akut varixeredetű gastrointestinalis vérzés napjainkban is jelentős morbiditással és mortalitással jár. Célkitűzés: Célunk az akut varixeredetű felső gastrointestinalis vérzések incidenciájának, ellátási folyamatainak és kimeneteli tényezőinek átfogó felmérése volt. Módszer: Prospektív, multicentrikus vizsgálatunk keretében hat nyugat-magyarországi gasztroenterológiai centrum bevonásával elemeztük az ott diagnosztizált és kezelt, varixvérző betegek adatait. Rögzítettük a demográfiai, az anamnesztikus, a diagnosztikus, valamint a terápiát és a betegség kimenetelét érintő adatokat. Minden beteg esetében kockázat- és predikcióbecslést végeztünk a Glasgow-Blatchford Score (GBS), a pre- és posztendoszkópos Rockall Score (RS) és az American Society of Anesthesiologists (ASA) Score alapján. Eredmények: A vizsgált egyéves periódusban (2016. 01. 01. és 2016. 12. 31. között) 108, akut varixeredetű gastrointestinalis vérzést találtunk (átlagéletkor: 59,6 év). Endoszkópos terápiára 57,4%-ban került sor, 39,8% sclerotherapiában, 18,5% ligatióban részesült. Transzfúziót a betegek 76,9%-a igényelt. A teljes halálozás 24,1% volt. A transzfúziós igény vonatkozásában a legmagasabb prediktív értékű a GBS volt (AUC: 0,793; cut-off: GBS >8 pont). Az ASA-pontszám szignifikáns összefüggést mutatott a transzfúzió-szükséglettel (OR 7,6 [CI 95% 2,7-21,6]; p<0,001), az endoszkópos intervencióval (OR 12,6 [CI 95% 3,4-46,5]; p = 0,033) és trendszerű kapcsolatot a mortalitással (OR 3,6 [0,8-16,7]; p = 0,095). Emellett a nemzetközi normalizált ráta (INR) értéke (p = 0,001) és a szérumkreatinin-szint (p = 0,002) állt kapcsolatban a mortalitással. Az endoszkópos intervenció aránya szignifikáns összefüggésben volt a varix Paquet-stádiumával (p<0,001) és az ASA-pontszámmal (OR = 12,6 [3,4-46,5]; p = 0,033). Következtetés: Nyugat-Magyarországon magas az akut varixeredetű vérzés előfordulási gyakorisága. Az ASA-pontszám és a GBS jó prediktív faktor a betegségkimenetel és a transzfúziós igény vonatkozásában. A megfigyelt magas mortalitás és az endoszkópos ligatio alacsony aránya indokolja a kezelési stratégiák optimalizálását akut varixeredetű gastrointestinalis vérzés esetén. Orv Hetil. 2021; 162(31): 1252-1259. SUMMARY INTRODUCTION Acute variceal gastrointestinal bleeding is associated with significant morbidity and mortality. OBJECTIVE Our aim was to evaluate the characteristics and prognostic factors in the management of acute upper gastrointestinal bleeding in a large multi-center study from Hungary. METHOD This prospective one-year study (between January 1, 2016 and December 31, 2016) involved six community hospitals in Western Hungary. Data collection included demographic characteristics, vital signs at admission, comorbidities, medications, time to hospital admission and endoscopy, laboratory results, endoscopic management, risk assessment using Glasgow-Blatchford Score (GBS), Rockall Score (RS) and the American Society of Anesthesiologists (ASA) Physical Status Score, transfusion requirements, length of hospital stay and mortality. RESULTS 108 cases (male: 69.4%) of acute variceal gastrointestinal bleeding were registered during the 1-year period. Endoscopic therapeutic intervention was performed in 57.4%. On initial endoscopy, 39.8% of the patients were treated with sclerotherapy and 18.5% had ligation. 76.9% of the patients required blood transfusion. The overall mortality (including in-hospital bleedings) was 24.1%. The GBS predicted transfusions (AUC: 0.793; cut-off: GBS >8 points). The ASA Score was associated with transfusion (OR 7.6 [CI 95% 2.7-21.6]; p<0.001), endoscopic intervention (OR 12.6 [CI 95% 3.4-46.5]; p = 0.033), and showed similar trend with mortality (OR 3.6 [0.8-16.7]; p = 0.095). The increased international normalized ratio (INR) and creatinine levels were associated with mortality (p = 0.001 and p = 0.002). CONCLUSION Incidence rates of acute variceal gastrointestinal bleeding in Western Hungary are high. The ASA Score, GBS predicted outcomes and transfusion requirements. The observed high mortality rates, coupled with relatively low rates of endoscopic ligation, warrant optimization of management strategies in acute variceal gastrointestinal bleeding. Orv Hetil. 2021; 162(31): 1252-1259.
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Affiliation(s)
- László Lakatos
- 1 Csolnoky Ferenc Kórház, I. Belgyógyászati Osztály, Veszprém
| | - Lóránt Gönczi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest
| | - Ferenc Izbéki
- 3 Fejér Megyei Szent György Egyetemi Oktató Kórház, I. Belgyógyászati Osztály, Székesfehérvár
| | - Árpád Patai
- 4 Markusovszky Egyetemi Oktatókórház, Gasztroenterológiai és Belgyógyászati Osztály, Szombathely
| | - István Rácz
- 5 Petz Aladár Egyetemi Oktató Kórház, I. Belgyógyászat-Gasztroenterológia, Győr
| | - Beáta Gasztonyi
- 6 Zala Megyei Szent Rafael Kórház, Belgyógyászati Osztály, Zalaegerszeg
| | - Lajos Varga-Szabó
- 7 Szent Pantaleon Kórház-Rendelőintézet, Gasztroenterológiai Osztály, Dunaújváros
| | - Ádám Barnabás
- 8 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest
| | - Ákos Iliás
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest
| | - Péter László Lakatos
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika, Budapest.,9 McGill University Health Centre (MUHC), Montreal General Hospital, Montreal, Kanada
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9
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Park CH, Park SW, Jung JH, Kim GG, Choi SY, Kim ES, In DH, Kim HD. Clinical outcomes of sedation during emergency endoscopic band ligation for variceal bleeding: Multicenter cohort study. Dig Endosc 2020; 32:894-903. [PMID: 31858649 DOI: 10.1111/den.13610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Few studies have directly compared the efficacy of sedated- and un-sedated endoscopic variceal ligation (EVL) for acute variceal bleeding. We aimed to determine whether sedation during EVL in patients with variceal bleeding is safe and effective. METHODS We analyzed data from patients who underwent EVL for acute variceal bleeding according to sedation in six hospitals of Hallym University Medical Center. The primary endpoint was treatment failure, defined as a failure to control bleeding, death during EVL, or rebleeding within 5 days. Secondary endpoints included the procedure time, adverse events, and 30-day mortality. RESULTS Of 1,300 patients who were included, only 430 (33.1%) received sedation during EVL. Propofol alone was used for sedation in 85% of sedated-EVLs. The mean procedure time in the sedation group was shorter than that of the non-sedation group (12.4 ± 9.5 min versus 13.8 ± 9.4 min, P = 0.010). The proportion of treatment failure did not differ between the groups (7.4% versus 9.1%, P = 0.374). In the multivariable analysis, an AIMS65 score ≥2 and blood transfusion within 72 hours were associated with treatment failure of EVL; however, the use of sedation was not (odds ratio [95% confidence interval (CI)] = 0.96 [0.60-1.51]). Adverse events during EVL and hepatic encephalopathy did not differ between the two groups. Sedation also did not affect the 30-day mortality (hazard ratio [95% CI] = 0.99 [0.66-1.47]). CONCLUSION Sedation reduced the procedure time of EVL. Sedation is safe to use during EVL for variceal bleeding in patients with cirrhosis.
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Affiliation(s)
- Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Jang Han Jung
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Gyeong Guk Kim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Se Young Choi
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Eun Sun Kim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Dong Hyun In
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Hong Deok Kim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
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10
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Li G, Wang G, Yu J, Hou K, Yu J. Regression of a symptomatic varix after transarterial embolization of a brain arteriovenous malformation: A case report and literature review. Medicine (Baltimore) 2019; 98:e18418. [PMID: 31876715 PMCID: PMC6946530 DOI: 10.1097/md.0000000000018418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Brain arteriovenous malformation (BAVM)-associated varix is always asymptomatic, and no special treatment is needed. However, there is no consensus regarding how to address a varix that has led to clinical manifestation. PATIENT CONCERNS An 11-year-old girl was admitted complaining of left hemiparesis for 4 days. She was previously healthy and denied any history of similar ictus. She was alert, and a physical examination performed upon admission was unremarkable except for the left hemiparesis. DIAGNOSES Head magnetic resonance imaging (MRI) showed a linear and round flow void and perilesional edema in the region of the right basal ganglia, indicating a BAVM. Gadolinium-enhanced MRI showed peripheral enhancement of the round lesion. Computed tomography angiography (CTA) showed that the BAVM was fed by the ipsilateral posterior cerebral artery and anterior choroidal artery and drained into the vein of Galen. A large varix was also noted at the top of the BAVM and was consistent with the round flow void observed at the right basal ganglia on MRI. The Spetzler-Martin grading scale was grade IV INTERVENTIONS:: The patient experienced a TAE of the BAVM nidus with liquid embolic agent. OUTCOMES A follow-up investigation showed regression of the varix, although there was still some residual BAVM. The patient experienced a favorable recovery. LESSONS In the case of a BAVM-associated symptomatic varix, if surgical resection cannot readily be performed, initial TAE of the BAVM nidus can be attempted.
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Affiliation(s)
| | | | - Jing Yu
- Department of Operation Room, The First Hospital of Jilin University, Changchun, China
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Kim YM, Kim JW, Park IS, Choi JS. Tongue base varix as a source of oral bleeding: A case report. Medicine (Baltimore) 2019; 98:e16987. [PMID: 31626079 PMCID: PMC6824825 DOI: 10.1097/md.0000000000016987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Oral bleeding is usually diagnosed after by referral to other department for the differential diagnosis of hematemesis or hemoptysis. If a patient presents with blood in the oral cavity with no obvious source, generally upper airway, pulmonary, or gastroesophageal lesions are considered likely bleeding foci. The tongue base is an unusual site for laryngopharyngeal varices and only a few cases have been reported. PATIENT CONCERNS Although varix at the tongue base in patients with liver cirrhosis has been rarely described, physicians must consider variceal bleeding from the tongue base when presented with oral bleeding. In such cases, bleeding foci can be identified and controlled by laryngoscopy. We describe the case of a 42-year-old woman complaining of small amount of hemoptysis with variceal bleeding at the tongue base controlled by laryngoscopic excision and cauterization. DIAGNOSIS A diagnosis of tongue base varix was made based on medical history, clinical manifestations, laryngoscopic findings and pathologic features for the patient. INTERVENTIONS The successful laryngoscopic procedures were performed. OUTCOMES The patient has shown no recurrent oral bleeding during follow-up. LESSONS Variceal bleeding in the tongue base is likely to cause serious massive hemorrhage. We need to consider this possibility when presented with a patient with intraoral bleeding but no evidence of hemoptysis or hematemesis.
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Affiliation(s)
- Young-Mo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Ji Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - In Suh Park
- Department of Pathology, Inha University School of Medicine, Incheon, Republic of Korea
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12
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Abstract
Acute upper gastrointestinal (GI) bleeding is a commonly encountered condition that can potentially be life-threatening. Endoscopy is the diagnostic modality of choice, but it is important to recognize it's shortcomings. We introduce a 61-year-old female who presented with hematemesis and syncope. She had a history of recurrent episodes of hematemesis and hospitalizations for the preceding 18 months, for which multiple endoscopies had been performed but had failed to demonstrate a source. A repeat esophagogastroduodenoscopy (EGD) performed at our facility was unremarkable. A CT scan demonstrated a lobulated mass-like filling defect in the gastric cardia consistent with solitary varix with an abnormal fold pattern. An upper GI follow-through series was performed to better characterize this varix. The patient subsequently underwent balloon-occluded retrograde transvenous obliteration with successful control of the source of bleeding. It is important to keep in mind that EGD while being the gold standard for the diagnosis of varices, has its limitations, and should be augmented with the use of non-traditional diagnostic modalities such as CT scans or radionuclide imaging.
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Affiliation(s)
- Divya Ravi
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Fouzia Oza
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Nishant Sharma
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Bojana Milekic
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Mahmoud Khalaf
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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13
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Hmida B, Mnari W, Maatouk M, Zrig A, Golli M. Orbital varix: rare cause of blepharospasm. Pan Afr Med J 2019; 32:147. [PMID: 31303918 PMCID: PMC6607264 DOI: 10.11604/pamj.2019.32.147.14958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022] Open
Abstract
Orbital varix (or varicose) is an exceptional pathology with poor clinical sign. The blepharospasm can be a revealing cause. The long-term risk is optic atrophy and blindness. Magnetic resonance imaging is the best diagnostic tools. The rise of lesion dimensions by Valsalva maneuvers and prone position is characteristic. We report the observation of a 42-year-old young man, consulting for a blepharospasm of the left eye evolving for two years. Imaging investigations made the diagnosis of orbital varicose.
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Affiliation(s)
- Badii Hmida
- Imaging Department, FB University, Hospital Monastir, Tunisia
| | - Walid Mnari
- Imaging Department, FB University, Hospital Monastir, Tunisia
| | - Mezri Maatouk
- Imaging Department, FB University, Hospital Monastir, Tunisia
| | - Ahmed Zrig
- Imaging Department, FB University, Hospital Monastir, Tunisia
| | - Mondher Golli
- Imaging Department, FB University, Hospital Monastir, Tunisia
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14
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Abstract
Purpose: The purpose of this study is to describe the clinical characteristics, multimodality imaging findings, and clinical course of iris varices. Methods: Retrospective, noncomparative, observational case series of 28 eyes of 26 patients with iris varices, diagnosed between 2007 and 2017, has been used. Results: The mean (±SD) age was 58.3 ± 12.5 years (median 57.5, range 37–81). Patients were 57.7% male and 27% hypertensive. Varices were bilateral in two patients. The mean and median visual acuities were both 20/20 (range 20/16–20/40). Intraocular pressures were 16 mmHg (10–23 mmHg). Secondary glaucoma did not occur. The inferotemporal iris quadrant was affected in 75%. A single varix was seen in 64% and 36% appeared multiple. Varix orientation was radial in 57% and circumferential in 21%. Combined radial and circumferential varix orientation was noted in 18%. One had independent radial and circumferential varices in separate quadrants. A single episcleral sentinel blood vessel directed to the varix was present in 36%. Ultrasound biomicroscopy (UBM) showed a slightly increased mean iris thickness of 0.8 mm and multiple echolucent iris stromal vascular channels. Iris angiography showed no leakage of dye. Managed by observation over a mean follow-up of 37.7 months (range, 3–129), 96.4% eyes were stable and one (3.6%) regressed. No corectopia, ectropion uveae, hyphema, or metachronous anterior segment benign or malignant tumors occurred. Conclusion: Iris varix is primarily located in the inferotemporal quadrant and not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy. Iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.
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Affiliation(s)
- Puneet Jain
- Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York City, New York, USA
| | - Paul T Finger
- Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York City, New York, USA
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15
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Grin L, Shenhav S, Elasbah A, Rabinovich M, Sofer H, Anteby EY, Zohav E. Is umbilical vein varix associated with changes in cerebroplacental ratio? J Matern Fetal Neonatal Med 2018; 33:162-166. [PMID: 29888988 DOI: 10.1080/14767058.2018.1487943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: We aimed to review a single-center experience in follow-up and management of fetuses with umbilical vein varix (UVV) and to assess the effect of UVV on fetal Doppler parameters.Methods: We reviewed retrospectively maternal antenatal records, delivery records, and newborn records to identify cases of UVV. Further, we retrospectively compared 25 fetuses with isolated UVV and available cerebroplacental ratio (CPR) analysis with 75 matched controls.Results: We identified 67 cases of UVV. The median gestational age (GA) at diagnosis was 34 weeks (range: 26-41 weeks). The average diameter of UVV at diagnosis was 10.1 mm (range: 9-14 mm). The median GA at delivery was 36 + 6 (range: 33-41 weeks), with an average birth weight of 2918 g (range: 1278-4140 g). There was a single case of intrauterine death at 35 weeks. CPR was 2.13 ± 0.62 in isolated UVV group compared with 1.84 ± 0.61 in the control group (p < .05). Other Doppler parameters did not differ between fetuses with UVV compared with controls.Conclusions: CPR was significantly increased in the UVV group compared with control fetuses. This finding suggests that UVV is not associated with chronic fetal oxygen deprivation; it, therefore, may contribute to our understanding of the pathophysiology explaining abnormal pregnancy outcome in cases with UVV.
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Affiliation(s)
- Leonti Grin
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
| | - Simon Shenhav
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
| | - Ahmed Elasbah
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
| | - Mark Rabinovich
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
| | - Hadar Sofer
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
| | - Eyal Y Anteby
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
| | - Efraim Zohav
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkeon, Israel
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16
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di Pasquo E, Kuleva M, O'Gorman N, Ville Y, Salomon LJ. Fetal intra-abdominal umbilical vein varix: retrospective cohort study and systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51:580-585. [PMID: 28876490 DOI: 10.1002/uog.18895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the ultrasound characteristics and outcome of pregnancies with fetal intra-abdominal umbilical vein varix (FIUVV). METHODS Cases of FIUVV managed at our tertiary university hospital over an 8-year period were reviewed. Information retrieved included gestational age and diameter of the umbilical varix at diagnosis, increase in varix diameter, associated ultrasound or chromosomal anomalies and pregnancy outcome. Furthermore, a systematic review and meta-analysis of series of FIUVV in the literature was performed to assess the incidence of chromosomal anomalies, small-for-gestational age infants and intrauterine fetal demise (IUFD), and to pool odds ratio (OR) estimates on the relationship between the incidence of these outcomes and the presence of additional associated ultrasound anomalies. RESULTS Thirteen cases of FIUVV were included in the cohort study. Additional ultrasound anomalies were found in two (15.4%) of 13 cases. One case of IUFD was observed and no case of chromosomal anomaly or thrombosis of varix was recorded. A total of five studies comprising 254 cases met the inclusion criteria of the systematic review. FIUVV was associated with additional ultrasound anomalies (non-isolated FIUVV) in 19% (95% CI, 10.9-29.1%) of cases. No case of chromosomal abnormality or IUFD was reported in fetuses with isolated FIUVV. In contrast, in the group of non-isolated FIUVV, the incidence of chromosomal anomalies was 19.6% and that of IUFD was 7.3%, with ORs of 14.8 (95% CI, 2.9-73.0) and 8.2 (95% CI, 1.05-63.1), respectively, when compared with the group of isolated FIUVV. CONCLUSION When isolated, the outcome of cases affected by FIUVV is usually favorable. In about 20% of cases, additional ultrasound anomalies are found, which are associated with an increased risk for chromosomal abnormalities and IUFD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E di Pasquo
- Maternité Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - M Kuleva
- Maternité Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - N O'Gorman
- Maternité Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Y Ville
- Maternité Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France
| | - L J Salomon
- Maternité Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France
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17
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Ocak PE, Dinc C, Cikla U, Başkaya MK. Resection of complex occipital arteriovenous malformation with giant varix: demonstration of microsurgical technique. Neurosurg Focus 2017; 43:V5. [PMID: 28669274 DOI: 10.3171/2017.7.focusvid.17125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The complexity of arteriovenous malformations (AVMs) does not necessarily preclude surgical resection. In this video the authors present a 72-year-old male who was known to have an occipital AVM with a large draining varix for the previous 10 years. The patient had progressively worsening visual and cognitive deficits over several years. Total surgical resection was achieved following single stage preoperative embolization. Although resection of the AVMs is challenging, even in experienced hands, it offers a cure and may improve patient clinical outcome. The video can be found here: https://youtu.be/YI1AwGjJdvo .
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Affiliation(s)
- Pinar Eser Ocak
- Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Cem Dinc
- Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Ulaş Cikla
- Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Mustafa K Başkaya
- Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin
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18
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Jimbo K, Suzuki M, Fujii T, Ohtsuka Y, Sugo H, Kawasaki S, Shimizu T. Usefulness of magnetic resonance angiography for the evaluation of varices at hepaticojejunostomy after liver transplantation. Acta Radiol Open 2015; 4:2058460115578600. [PMID: 26034644 PMCID: PMC4447635 DOI: 10.1177/2058460115578600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/16/2015] [Indexed: 01/08/2023] Open
Abstract
A 7-year-old Japanese girl who had undergone living-donor liver transplantation (LT) at the age of 10 months for decompensated liver cirrhosis caused by biliary atresia presented with recurrent episodes of obscure gastrointestinal bleeding (GIB) with anemia. Over the following 6 years, she experienced five episodes of GIB requiring hospitalization. Subsequent evaluations including repeat esophagogastroduodenoscopy (EGD), colonoscopy (CS), contrast-enhanced computed tomography (CT), and Meckel's scan all failed to reveal a bleeding source. However, varices at the site of hepaticojejunostomy were detected on abdominal ultrasonography and magnetic resonance angiography (MRA) at the age of 7 years. MRA might be more helpful than contrast-enhanced CT for identifying such bleeding.
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Affiliation(s)
- Keisuke Jimbo
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Fujii
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshikazu Ohtsuka
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Sugo
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seiji Kawasaki
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
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19
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Hikichi T, Obara K, Nakamura SI, Irisawa A, Ohira H. Potential application of interventional endoscopic ultrasonography for the treatment of esophageal and gastric varices. Dig Endosc 2015; 27 Suppl 1:17-22. [PMID: 25594429 DOI: 10.1111/den.12436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/13/2015] [Indexed: 12/14/2022]
Abstract
Interventional endoscopic ultrasonography (EUS) has been developed mainly for the treatment of pancreaticobiliary disorders (e.g. cyst drainage for pancreatic pseudocysts, biliary drainage for malignant biliary obstruction, and celiac plexus neurolysis). Recently, the application of interventional EUS has been expanded to a new field, the treatment of gastrointestinal varices. There have been several studies examining this new technique for the treatment of esophageal and gastric varices. In the present review, we have summarized the current status of interventional EUS for the treatment of esophageal and gastric varices (e.g. EUS-guided coil deployment for gastric varices) and clarified the clinical feasibility of this procedure.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
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20
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Sugimoto T, Park YS, Nakagawa I, Nishimura F, Motoyama Y, Nakase H. Effectiveness of intraoperative indocyanine green videoangiography in direct surgical treatment of pediatric intracranial pial arteriovenous fistula. J Neurosurg Pediatr 2015; 15:55-9. [PMID: 25343732 DOI: 10.3171/2014.9.peds13683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions. The authors report a rare case of pediatric pial AVF treated by direct disconnection with the aid of indocyanine green (ICG) videoangiography. A 3-year-old girl presented with developmental problems. Magnetic resonance imaging revealed brain atrophy and an anomalous left temporal vascular mass. Angiography showed a high-flow pial AVF in the early arterial phase fed by the M1 portion of the left middle cerebral artery and draining into the superficial sylvian vein and the vein of Trolard with a large varix. Given that her fistula was located in a superficial region that was easily accessible by craniotomy, the authors successfully disconnected her pial AVF by direct surgery aided by ICG videoangiography, which clearly confirmed the shunting point. In this report, the authors discuss the existing literature and compare the relative merits of endovascular versus surgical options for the treatment of pial AVF.
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Affiliation(s)
- Tadashi Sugimoto
- Department of Neurosurgery, Higashiosaka City General Hospital, Osaka; and
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21
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Inoue T, Shima A, Hirai H, Suzuki F, Matsuda M. Trigeminal Neuralgia due to an Isolated Cerebral Varix: Case Report. J Neurol Surg Rep 2014; 75:e206-9. [PMID: 25485214 PMCID: PMC4242819 DOI: 10.1055/s-0034-1383861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/13/2014] [Indexed: 11/01/2022] Open
Abstract
Intracranial isolated varix is a very rare entity. Although it is usually asymptomatic, there are reports on symptomatic cases with hemorrhage or mass effect that mostly relate to arteriovenous fistulas or arteriovenous malformations. We present an extremely rare case of trigeminal neuralgia caused by an isolated varix. A 55-year-old woman had been experiencing right trigeminal neuralgia for 3 years. Computed tomography and magnetic resonance imaging revealed an enhanced mass lesion on the root entry zone of the right trigeminal nerve. Angiograms confirmed the mass was a varix arising on the vein connecting the basal vein of Rosenthal and the superior petrosal vein. Preoperative three-dimensional (3D) imaging clearly depicted the anatomical relation of the varix, adjacent vessels, and trigeminal nerve, which helped plan operative procedures. The varix with its parent vein was successfully transposed from the nerve without sacrificing any veins. Her pain disappeared immediately after the surgery and did not recur during a 30-month follow-up period. The 3D image contributed to making an accurate and safer operative plan especially for this rare case.
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Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Ayako Shima
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Hisao Hirai
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Fumio Suzuki
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
| | - Masayuki Matsuda
- Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, Higashiohmi, Shiga, Japan
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Won JW, Lee HW, Yoon KH, Yang SY, Moon IS, Lee TJ. Extended hemangioma from pharynx to esophagus that could be misdiagnosed as an esophageal varix on endoscopy. Dig Endosc 2013; 25:626-9. [PMID: 24164602 DOI: 10.1111/j.1443-1661.2012.01405.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/21/2012] [Indexed: 12/21/2022]
Abstract
Giant hemangioma in the neck and head is an uncommon vascular neoplasm and has an unpredictable clinical behavior. We report a hemangioma that extended from the pharynx to the esophagus that could have been misdiagnosed as an esophageal varix. A 42-year-old man with dilated varices-like vessels on his esophagus that were incidentally detected by endoscopy was referred to our hospital for further evaluation. On re-examined endoscopy, multiple vascular dilatations were noted in the pharynx, expanding into the esophagogastric junction. These dilatations looked like esophageal varices that are found in patients with liver cirrhosis. There was no significant abnormality, including liver cirrhosis, on the abdomino-pelvic computed tomography scan. On the endoscopic esophageal biopsy, dilatedsubmucosal blood vessels were diagnosed as hemangioma. In consultation with an otorhinolaryngologist for evaluation of the risk of hemangioma, it was determined that the hemangioma was not dangerous to the patient as long as it did not cause hoarseness, dyspnea or dysphagia. We planned regular 6-month follow ups. We report a case of extended hemangioma that could possibly have been misdiagnosed as an esophageal varix on endoscopy. Even if head and neck hemangioma is uncommon, careful consideration during endoscopy is required to avoid the misdiagnosis of varices or hemangioma.
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Affiliation(s)
- Jong Won Won
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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23
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Berecova Z, Neuschl V, Boruta P, Masura J, Ghersin E. A complex pulmonary vein varix -- diagnosis with ECG gated MDCT, MRI and invasive pulmonary angiography. J Radiol Case Rep 2013; 6:9-16. [PMID: 23365698 DOI: 10.3941/jrcr.v6i12.1017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A case of an asymptomatic 32-year-old male with a complex congenital pulmonary vein varix is reported herein. Chest X-ray incidentally revealed a tubular opacity passing from the periphery of the left lingula to the mediastinum. ECG gated multidetector computed tomography showed the opacity to be a vessel emptying into the left atrium via the left superior pulmonary vein. In addition, a second vascular structure was noted within the posterior mediastinum that was emptying into the same pulmonary vein. These findings were also confirmed by magnetic resonance imaging, 4D magnetic resonance angiography and invasive arterial angiography. Based on multimodality imaging findings the diagnosis of complex congenital pulmonary venous varix with posterior mediastinal extension was established.
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Affiliation(s)
- Zuzana Berecova
- Department of Radiology, Slovak Medical University, Bratislava, Slovakia.
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Ismail H, Chang YL, Chang SD, Nusee Z. Fetal Intra-Abdominal Umbilical Vein Varix in Monochorionic Twins: Is it Significant? Malays J Med Sci 2012; 19:69-73. [PMID: 23785250 PMCID: PMC3684235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 11/25/2011] [Indexed: 06/02/2023] Open
Abstract
A 30-years-old Taiwanese female in her second pregnancy spontaneously conceived a monochorionic twin pregnancy. A routine ultrasound at 27 weeks of gestation revealed a selective intrauterine growth restriction (sIUGR) fetus and an appropriate gestational age (AGA) fetus. The AGA fetus was found to have a fetal intra-abdominal umbilical vein (FIUV) varix. Serial ultrasounds showed no changes in the FIUV varix. 2 weeks later, the pregnancy progressed to twin-twin transfusion syndrome (TTTS). Repeated amnioreductions were required at 29 and 30 weeks gestation. The babies were delivered by caesarean section at 31 weeks due to fetal distress in the sIUGR fetus. Both fetuses survived the neonatal period with problems of prematurity. The FIUV varix disappeared a few days after delivery.
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Affiliation(s)
- Hamizah Ismail
- Department of Obstetrics and Gynaecology, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital Campus, 25100, Kuantan, Pahang, Malaysia
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan Hsien, 333, Taiwan, Republic of China
- College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan, Republic of China
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan Hsien, 333, Taiwan, Republic of China
- College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan, Republic of China
| | - Zalina Nusee
- Department of Obstetrics and Gynaecology, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital Campus, 25100, Kuantan, Pahang, Malaysia
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Cheon JH, Song HJ, Kim JS, Park KJ, Kim WH, Jung HC, Song IS. Recurrent lower gastrointestinal bleeding from congenital arteriovenous malformation in the terminal ileum mimicking intestinal varicosis: a case report. J Korean Med Sci 2007; 22:746-9. [PMID: 17728522 PMCID: PMC2693832 DOI: 10.3346/jkms.2007.22.4.746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report on an exceptional vascular cause of gastrointestinal hemorrhage. A 30-yr-old man was admitted because of recurrent hematochezia. Colonoscopy showed circumferential, erythematous, and nodular vascular distensions with hematocystic spots in the terminal ileum resembling varicosis and subsequent computed tomography with 3-dimensional angiographic reconstruction revealed a vascular architecture around the terminal ileum. No other potential source of bleeding was identified. The patient was treated by ileocecectomy and the final diagnosis was of an arteriovenous malformation confined to the terminal ileum. He has been followed up without a further hemorrhagic episode.
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Affiliation(s)
- Jae Hee Cheon
- Department of Internal Medicine, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Internal Medicine, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
| | - Woo Ho Kim
- Department of Pathology, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Chae Jung
- Department of Internal Medicine, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
| | - In Sung Song
- Department of Internal Medicine, Liver Research Institute Seoul National University College of Medicine, Seoul, Korea
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Chung JM, Lee HS, Lim CJ, Kim KS, Choi BH, Choe HJ. Prognostic evaluation of endoscopic sclerotherapy on bleeding esophageal varices. Korean J Intern Med 1986; 1:92-7. [PMID: 15759383 PMCID: PMC4534896 DOI: 10.3904/kjim.1986.1.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
From November 1981 to March 1984, 100 patients with esophageal varices bleeding were treated by endoscopic sclerotherapy. The combined peri and intravasal method was applied, using Äthoxysclerol as a sclerosant. The 79 cases were followed after sclerotherapy over a period ranging from 3 months to 26 months. The amount of transfused blood on presclerotherapy was 4–5 pints and in 2/3 cases 1–2 pints were needed on postsclerotherapy. Seven cases (8.1 per cent) had complications; 2 cases developed esophageal stenosis, 3 cases aspiration pneumonia, and 2 cases mediastinitis. Fortunately, all 7 cases recovered. Rebleeding occurred in 15 cases (19.0 per cent); namely 3 cases (3.8 per cent) within 6 months, 5 cases (6.3 per cent) in the period from 6 months to 12 months and 7 cases (8.9 per cent) after 12 months. During the follow up period, 14 cases died. Their causes of death were as follows: 6 cases died of hepatic failure, 5 cases died of hepatoma, and 3 cases expired from uncontrollable bleeding. Based on data, it appears to be possible to control the bleeding in 97 per cent of the esophageal varices bleeding on their (first) bleeding.
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