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ABSTRACT: INTRODUCTION: Recent clinical studies have suggested a relationship between multiple sclerosis (MS) and the occurrence of pathological changes in the jugular, vertebral and azygous veins that result in abnormal blood outflow from the brain and the spinal cord. Together, these pathological changes have been designated chronic cerebrospinal venous insufficiency (CCSVI). The aim of the present study was to evaluate the usefulness of duplex Doppler ultrasound in the evaluation of central nervous system venous outflow disturbances in patients suffering from MS. METHODS: We examined 181 patients with MS, diagnosed on the basis of the McDonald criteria, and 50 healthy volunteer controls. All patients underwent Doppler ultrasound examination of the internal jugular veins (IJV) and vertebral veins (VVs). The presence of outflow disturbances and morphological abnormalities were evaluated. RESULTS: Pathological changes in the extracranial jugular veins were diagnosed in 148/181 MS patients (82%) and 7/50 control group volunteers (14%). The following abnormalities in the MS group were revealed: the presence of a reflux in the IJVs and/or VVs (54%), narrowing (54%), a complete block in the flow through the IJV (10%) and an abnormal postural control of the cerebral outflow route (25%). These particular pathologies were of statistical significance in the MS group compared with the control group. This study also revealed a correlation between the occurrence of inverted flow in patients in a sitting position and chronic progressive MS (P = 0.0033). CONCLUSIONS: The examinations undertaken indicate a possible connection between MS and CCSVI. The widely accessible and highly sensitive and specific Doppler ultrasound test may be useful for revealing, and preliminary analysis of, CCSVI pathologies.
Phlebology 02/2012; · 2.07 Impact Factor
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ABSTRACT: The aim of this open-label study was to assess extracranial Doppler criteria of chronic cerebrospinal venous insufficiency in multiple sclerosis patients.
Seventy patients were assessed: 49 with relapsing-remitting, 5 with primary progressive and 16 with secondary progressive multiple sclerosis. The patients were aged 15-58 years and they suffered from multiple sclerosis for 0.5-40 years. Sonographic signs of abnormal venous outflow were detected in 64 patients (91.4%).
We found at least two of four extracranial criteria in 63 patients (90.0%), confirming that multiple sclerosis is stronghly associated with chronic cerebrospinal venous insufficiency. Additional transcranial investigations may increase the rate of patients found positive in our survey. Reflux in internal jugular and/or vertebral veins was present in 31 cases (42.8%), stenosis of internal jugular veins in 61 cases (87.1%), not detectable flow in internal jugular and/or vertebral veins in 37 cases (52.9%) and negative difference in cross-sectional area of the internal jugular vein assessed in the supine vs. sitting position in 28 cases (40.0%). Flow abnormalities in the vertebral veins were found in 8 patients (11.4%). Pathologic structures (membranaceous or netlike septa, or inverted valves) in the junction of internal jugular vein with brachiocephalic vein were found in 41 patients (58.6%), in 15 patients (21.4%) on one side only and in 26 patients (37.1%) bilaterally.
Multiple sclerosis is highly correlated with chronic cerebrospinal venous insufficiency. These abnormalities in the extracranial veins draining the central nervous system can exist in various combinations. The most common pathology in our patients was the presence of an inverted valve or another pathologic structure (like membranaceous or netlike septum) in the area of junction of the IJV with the brachiocephalic vein.
International angiology: a journal of the International Union of Angiology 04/2010; 29(2):109-14. · 1.65 Impact Factor
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ABSTRACT: Eventration is a serious complication in the abdominal surgery. Despite the surgical suture technique improvement the frequency of this complication is still increasing. In the paper the cases of the patients operated for the diseases requiring laparotomy from November 1991 to December 1997 were retrospectively analysed. There were 4030 laparotomies done because of vascular or other surgical diseases. In 23 cases eventrations were postoperatively observed (0.57%). Mean age was 58.7 years. 11 patients were qualified for the emergency surgery (6 patients with acute abdominal diseases and 5 with vascular diseases). 12 patients were operated electively (6 patients--general surgery, 5--vascular reasons). Among 23 patients with eventrations--16 patients were qualified for the relaparotomy with abdominal cavity suture. In 7 cases because of bad general condition of the patient only the skin suture above the eventration in the intensive care station was performed and abdomen was wrapped with the bandage. There were 8 deaths: 2 patients (8.7%) after skin suture and 6 patients (26.1%) after reoperation. Respiratory or respiratory and circulatory insufficiency was observed in 13 patients (56.5%). In 60.8% of cases (14 patients) wound infection was recognized and in 3 cases sepsis occurred in the postoperative period. The disease that was the reason for the surgery did not play a significant part in the eventration occurrence frequency. The condition of the patient before the surgery was the most important prognostic factor of the eventration. In patients with bad condition it is more convenient to perform the suture of the skin above the abdominal viscera first and later the reoperation.
Wiadomości lekarskie (Warsaw, Poland: 1960) 02/1999; 52(9-10):448-55.
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ABSTRACT: The paper presents authors experience and indications for an elective relaparotomy performed as the second-look laparotomy after primary operation. 12 patients with vascular or surgical diseases were operated on for: abdominal neoplastic tumors (2 patients), elective abdominal aneurysm (2 patients), ruptured abdominal aneurysm (2), abdominal aneurysm ruptured into the inferior caval vein (1), ruptured aneurysm of the iliac artery (1), abdominal aortic coarctation with visceral arteries abnormality (1), thrombosis of the superior mesenteric artery (1) and peritonitis because of intestinal ischaemia and necrosis (2 patients). In all cases an elective relaparotomy was done on the 1st or 2nd postoperative day. 5 patients died, in 4 cases complications found during second look relaparotomy required surgical treatment (2 of this patients died, two other were successfully treated). The authors discuss indications and advantages of elective second-look laparotomy in abdominal surgery according to the anticipated risk factors and patients condition.
Wiadomości lekarskie (Warsaw, Poland: 1960) 02/1997; 50 Suppl 1 Pt 2:241-6.
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ABSTRACT: History of 71-year-old woman with sudden upper digestive tract hemorrhage is presented. Endoscopic attempt to control the hemorrhage was unsuccessful-patient died during endoscopy. On autopsy it was found that hemorrhage was caused by neoplastic ulceration of the stomach penetrating to the spleen.
Polskie archiwum medycyny wewnȩtrznej 11/1996; 96(4):367-8. · 1.37 Impact Factor
