Cases reported "Varicose Veins"

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1/66. Ileal varices associated with recurrent bleeding in a patient with liver cirrhosis.

    We report a rare case of massive and recurrent bleeding from ileal varices in a patient with hepatitis c virus-positive liver cirrhosis. A 66-year old woman, who had undergone laparotomy and blood transfusion 36 years before (because of an extrauterine pregnancy) and endoscopic sclerotherapy for esophageal varices 1 year previously, was admitted to our hospital with loss of bright red blood per rectum. The bleeding was massive and recurrent, and frequent blood transfusions were required. Endoscopic studies failed to find the bleeding site. In the venous phase of selective superior mesenteric angiography, mesenteric varices in the lower part of the abdominal cavity were observed. laparotomy was performed to control the repeated bleeding which had lasted for more than 1 month. Varices communicating with the right ovarian vein were found on the ileal wall and segmental resection of the ileum was performed. Histological examination demonstrated a massive varicose vein and several dilated veins in the submucosa. The patient's postoperative course was favorable, with no hemorrhagic events during a follow-up of more than 6 months after surgery. Ileal varices should be considered in the diagnosis of a patient who presents with lower gastrointestinal bleeding and portal hypertension.
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2/66. Temporary arterio-venous shunts to dilate saphenous crossover graft and maintain graft patency.

    A modification of the Palma operation is described in a 25-year-old man with impaired venous outflow of the right leg. After a phlebitic occlusion of the right superficial femoral and external iliac veins he had been operated on twice for varicose veins. The result of these operations was a serious outflow stasis of the right leg during exercise. A saphenous cross-over graft to the right popliteal vein was constructed. Preoperatively a temporary arterio-venous shunt between the left posterior tibial artery and the great saphenous vein had been made in order to increase the diameter of the saphenous vein. Three months later the dilated saphenous vein was resected at the level of the sapheno-tibial artery shunt and anastomosed to the popliteal vein of the right leg. The cross-over graft occluded several times during this operation. A temporary popliteo-popliteal arterio-venous shunt was established distally to the sapheno-popliteal anastomosis to keep the vein graft patent. This second arterio-venous shunt was resected after three months. Venography one month later showed that the vein graft was patent. The patient's complaints had disappeared one month after the operation and a normalization of his venous outflow was recorded plethysmographically. The graft has remained patent during an observation time of eighteen months.
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3/66. angiography in the diagnosis and therapy of hemorrhage from the large bowel.

    angiography has added a new dimension to the management of hemorrhage from the large bowel. In patients with diverticular hemorrhage, mesenteric angiography not only localizes the bleeding site but, in addition, the bleeding can be acutely controlled with intraarterial infusion of vasopressin, making an emergency colectomy unnecessary. Similarly in patients bleeding from inflammatory bowel disease or in patients with post-operative hemorrhage, angiography provides information about the nature of the lesion and selective arterial infusions of vasopressin can control the bleeding. At times intestinal varices have angiographically been demonstrated as a potential source of rectal hemorrhage while in patients with unexplained lower gastrointestinal bleeding and repeatedly negative barium and endoscopic examinations, angiography has been valuable for the diagnosis of angiodysplasia of the colon.
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4/66. Spinal intradural perimedullary arteriovenous fistula with varix in infant.

    A rare occurrence of type IV spinal arteriovenous malformation (intradural perimedullary arteriovenous fistula) is described in an 18-month-old boy initially misdiagnosed with guillain-barre syndrome. An intramedullary mixed-intensity mass lesion at Th1 was demonstrated by magnetic resonance imaging together with flow voids over the dorsal aspect of the swollen spinal cord. angiography demonstrated an intradural perimedullary arteriovenous fistula including an intraparenchymal vascular pocket. After partial embolisation of the posterior spinal arteries through the left intercostal-radicular artery, the arteriovenous fistula was removed completely together with an organised haematoma. The fistula directly opened into a vascular pocket, which was confirmed pathologically to be a varix. The postoperative course was uneventful, and the patient resumed ambulation within 4 months. The case, subclassifiable as a type IVb spinal perimedullary AVF, was unique given its location and the patient's age at presentation.
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5/66. Intrarenal varix mimicking a cystic renal tumor.

    BACKGROUND: A case of intrarenal varix in a 60-year-old woman is reported. methods/RESULTS: The preoperative diagnosis was cystic tumor in the central part of the left kidney. Retrospectively, gadolinium-enhanced magnetic resonance (MR) imaging demonstrated a layered gadolinium sign, indicating the vascular nature of the mass. CONCLUSIONS: Our experience shows that urologists should be aware of the possible presence of a renal cystic mass of vascular origin and of the usefulness of gadolinium-enhanced MR examination for making an identification.
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6/66. Subepicranial varix mimicking sinus pericranii: usefulness of three-dimensional computed tomography angiography and bone window computed tomography--case report.

    A 16-year-old female presented with a rare case of subepicranial varix in the left temporal area manifesting as a soft mass in the left temporal area when she laid down in the left lateral position. Bulging of the mass was observed when intracranial venous pressure was raised by the valsalva maneuver, the left lateral position, or the prone position. Bone window computed tomography (CT) revealed a tiny hole, 1 mm in diameter, in the outer bone table. Three-dimensional CT (3D-CT) angiography clearly visualized a mass with a diameter of approximately 10 mm connected to the diploic vein. The mass was totally resected by operation. Venous bleeding was observed from the tiny hole. Histological examination revealed a venous lesion mimicking sinus pericranii and containing endothelial cells. No communication with the intracranial venous sinuses was identified, so the diagnosis was subepicranial varix. Radiological examination by direct injection of contrast medium is usually performed to identify subepicranial varix, but 3D-CT angiography is a non-invasive preoperative examination that can visualize this small venous lesion. Adjustment of the CT acquisition conditions may allow 3D-CT angiography to identify sinus pericranii in the future.
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7/66. Postoperative minocycline pigmentation.

    This paper describes an unusual case of florid postoperative pigmentation caused by minocycline which was not diagnosed for some 8 months, causing anxiety and distress to both patient and surgeon.
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8/66. Successful reconstruction of stripped superficial femoral vein.

    A 69-year-old man who had hemorrhagic shock after inadvertent stripping of the right superficial femoral-popliteal vein during surgery for greater saphenous vein varicosis in another hospital was referred to us. phlebography revealed a ruptured popliteal vein with intact profunda femoris and common femoral veins. The stripped superficial femoral-popliteal vein brought in a jar was reimplanted. phlebography performed during the patient's follow-up visits in our outpatient clinic 11 months postoperatively showed a patent femoral vein.
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9/66. Varix of the heart.

    A 76-year-old patient was operated on for an asymptomatic primary tumor of the heart located in the right atrium. The tumor was detected during a preanesthetic check-up for a transurethral resection of a prostate adenoma, showing a 3/6 systolic murmur. The mass was resected. The postoperative course was uneventful but the histologic result was surprising: varix of the heart.
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10/66. Portal venous dilatation and stenting for bleeding jejunal varices: report of two cases.

    We present two patients who underwent a portal stent placement for bleeding jejunal varices of the afferent loop caused by extrahepatic portal venous stenosis. Case 1 involved a 66-year-old woman who developed bleeding jejunal varices due to extrahepatic portal venous stenosis 1 year after a pancreaticoduodenectomy with intraoperative radiation therapy. Percutaneous transhepatic balloon dilatation and stent placement were performed. Since undergoing the procedure, no bleeding has occurred. Case 2 concerned a 44-year-old woman who had a rupture and bleeding of jejunal varices 16 years after a choledocojejunostomy. Stenosis was observed from the right and left branches of the portal vein to its intrahepatic branches. Both balloon dilatation and stent placement were attempted. However, the stent could not be fully inserted into the intrahepatic portal vein. Portal stent placement is less invasive and radical, and therefore should be attempted for the treatment of extrahepatic portal venous stenosis. However, there are limits to its application if the stenosis extends to the intrahepatic branches of the portal vein.
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