Skull base trauma: Masking, stimulating or neutral factor for the insidious development of angiosarcoma in a 19-year-old.

Angiosarcoma is a malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas, uncommonly found in the head and neck region. The etiology is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Presented here is a case of a patient treated due to the skull base trauma and diagnosed with this type of tumor.

Prevalence of Non-thrombotic Iliac Vein Lesions in Patients with Unilateral Primary Varicose Veins.

OBJECTIVES: A role of non-thrombotic iliac vein lesions (NIVLs) in the development of primary varicose veins (PVVs) has not been studied. It seems that intravascular ultrasound (IVUS) is the most accurate method to diagnose these lesions. The aim of the study was to investigate the association between the presence of NIVLs and PVVs and the frequency of NIVLs in asymptomatic and PVV limbs. DESIGN: This was an observational study. MATERIALS: Thirty-three patients with unilateral PVV and great saphenous vein incompetence who were qualified for surgical treatment were analyzed. Nineteen patients (57%) presented with varicose veins on the right side. METHODS: During varicose vein surgery, IVUS of the iliac veins and the inferior vena cava was performed. In all patients the iliocaval outflow was interrogated by IVUS in both the limb with and without PVVs. The PVV side was accessed through the surgically exposed sapheno-femoral junction and the non-PVV side was accessed by an ultrasound guided percutaneous puncture of the common femoral vein. In both the common iliac (CIVs) and the external iliac veins (EIVs) the minimal and reference lumen area were measured and the percentage stenosis calculated. RESULTS: There were no intra- or post-procedural complications. The minimal lumen area (MLA) was smaller and the stenosis of the CIV was greater on the left side than the right: median 57 and 108 mm(2) (p = 0.001) and 69 and 34% (p < 0.001), respectively. However when the PVV and non-PVV sides were compared, no statistically significant differences of MLA or stenosis of the CIV were found: 88 and 67 mm(2) (p = 0.38) and 44% and 51% (p = 0.40), respectively. With regard to EIVs, no statistically significant differences in either MLA or stenosis between the left and right and PVV and non-PVV sides were found. The frequency of ≥50% stenosis of CIV and EIV in the PVV limbs and the non-PVV limbs was 42% and 48% and 51% and 39%, respectively. CONCLUSIONS: NIVLs are common in patients with PVV but do not seem to be associated with the presence of ipsilateral PVV.

The value of extended preoperative thromboprophylaxis with dalteparin in patients with ovarian cancer qualified to surgical treatment.

AIM: Ovarian cancer (OC) is associated with a high risk of venous thromboembolism (VTE) in both, pre- and postoperative period. The aim of the study was to analyse the efficacy and the safety of an early prophylaxis with dalteparin in patients with OC qualified to surgery. METHODS: The prospective, non-randomized study was performed in the group of OC patients qualified to surgical treatment. The study group (SG) consisted of 37 patients with OC in whom thromboprophylaxis was started at the moment of qualification to the surgery (mean 16,1 days ± 11,32 SD before procedure). The control group (CG) consisted of 61 patients with OC qualified to surgery in whom thromboprophylaxis was started 12 hour before surgical treatment. The duration of postoperative prophylaxis was 4 weeks in both groups. Dalteparin 5000 U/day was used in both groups. The primary end points were occurrence of VTE and major bleeding. The patients underwent color Doppler US and D-dimer (DD) assessment at the moment of qualification for surgery, 1 day before and 7, 14, 28 days and 3 months after procedure. RESULTS: The total duration of thromboprophylaxis was 45.3 ± 10.7 days in SG and 27.9 ± 3.7 days in CG (P < 0.0001). The deep venous thrombosis rate was 2,7% in SG and 16.4% in CG (P = 0.042). Neither pulmonary embolism, nor major bleeding were observed. Median preoperative DD concentration in all patients was 1700 ng/ml and was significantly higher in patients who developed postoperative DVT when compared to those who did not, 2556.8 and 1691.0 ng/mL respectively (P = 0.0009). CONCLUSION: Prolonged preoperative thromboprophylaxis with dalteparin in patients with ovarian cancer qualified to the surgical treatment is safe, decreases the risk of thromboembolic complications. To determine indication, dosage and timing of such thromboprophylaxis in this group of patients further studies are required.

Morphological and mechanical changes in juxtarenal aortic segment and aneurysm before and after open surgical repair of abdominal aortic aneurysms.

OBJECTIVE: The aim of study was to assess how the ultrastructure of the wall of aortic aneurysms, sac and neck influences aortic wall distensibility and proximal dilatation 2 years after open repair. METHODS: Biopsies for electron microscopy were taken from aneurysmal sac and neck of 30 patients. Patients were assessed by computed tomography (CT) and ultrasound for aneurysm diameter and distensibility (M-mode ultrasonography). RESULTS: Postoperative CT of the aortic stump distinguished two groups. Group I (n = 11) with little enlargement, median 1 mm (1-3 mm) and group II (n = 19) with significant aortic enlargement, median 5.2 mm (4-12 mm). In group II, changes in elastic fibres in the aneurysm neck were comparable to, but as extreme as in the aneurysm sac. For group I, the distensibility of the aneurysmal sac was significantly lower than in the neck or at the renal arteries. For group II, the distensibility in both the neck and sac was significantly lower than at the juxtarenal segment (p = 0.01). The biopsies of group II patients showed the extensive degeneration of normal architecture, which was associated with altered wall distensibility in both the aneurysmal neck and sac. CONCLUSIONS: Disorganisation and destruction of normal aortic architecture at the ultrastructural level are associated with decreasing aortic distensibility. Low aortic neck distensibility is associated with proximal aortic dilatation at 2 years postoperatively.

The influence of elastic components of the venous wall on the biomechanical properties of different veins used for arterial reconstruction.

OBJECTIVE: To evaluate the relationship between the biomechanical properties and the structure of elastic components in different veins used for vascular reconstruction. DESIGN: In vitro experimental study. MATERIAL AND METHODS: Groups of 30 samples of incompetent saphenous veins (rSV), competent saphenous veins (cSV) and femoral veins (FVs) were compared following immunohistochemical staining for the presence of collagen types I, III and IV and elastin. The percentage area of transverse section of veins occupied by each type of collagen and elastin was measured using a computer-image-analysis system connected to a microscope. For all three groups of veins, the storage modulus, E', and the loss modulus, E'', were measured with a mechanical analyser, DMA-242, and changes in the function of temperature and frequency, and duration of exposure to the applied force were determined. RESULTS: The rSV showed the highest percentage share of collagen I and the lowest percentage share of collagen IV. These samples also showed the greatest expression of elastin and the highest elastin to collagen ratio. The rSV were also found to have the highest E' and E'', and during the long-term exposure achieved maximum stiffness in the least time as compared to cSV and FV. CONCLUSION: The histological structure directly influences the biomechanical properties of venous wall with rSV showing least compliance and cSV the greatest compliance.

Restenosis after carotid endarterectomy: incidence and endovascular management.

SUMMARY: Surgical procedures designed to restore vascular patency for a recurrent stenosis following carotid endarterectomy (CEA) are burdened with technical difficulties as well as with the possibility of serious neurological complications. An endovascular approach employing transluminal percutaneous angioplasty and stenting (PTAS) is a promising solution to these problems. We aimed to evaluate the incidence of carotid artery restenosis following CEA, and to evaluate the safety and efficacy of treating post-CEA restenosis with an endovascular technique (PTAS). One hundred and two patients who underwent CEA for symptomatic and asymptomatic stenosis were included in the analysis. Clinical and sonographic follow-up examinations identified carotid artery restenosis in 16 patients, who fulfilled our criteria for endovascular treatment. Carotid PTAS was performed on symptomatic patients with a stenosis over 60% of the artery lumen (n=7) and in asymptomatic patients with a stenosis over 80% (n=9). The post-PTAS patients were evaluated by duplex sonography every three months over a 24 month follow-up period for evidence of restenosis. The cumulative incidence of post-CEA carotid restenosis qualifying for PTAS was 9.3% during an average 12-month follow-up interval. The average time from CEA to carotid PTAS was 11 months. All 16 endovascular procedures were technically successful. All of the carotid arteries were widely patent following PTAS. There were no immediate perioperative complications. One patient died two days after carotid PTAS from a cerebral hemorrhage. Thirteen of the 16 patients remained asymptomatic and had no sonographic evidence of significant restenosis during the 24- month post-PTAS follow-up period. One patient developed a symptomatic 80% restenosis proximal to the stent six months after carotid PTAS. Another patient developed an asymptomatic 60% restenosis proximal to the stent at 24 months. One patient was lost to follow-up. Following CEA, there is a significant risk of developing a symptomatic or high-grade carotid artery restenosis requiring correction. Endovascular treatment (PTAS) of a recurrent stenosis after CEA is a safe and effective alternative to repeat carotid surgery.

The influence of cryopreservation on changes in diameter and compliance of allografts in an animal experimental model.

OBJECTIVE: The purpose of this study was to analyze the influence of cryopreservation on changes in diameter and compliance of allografts. METHODS: Sixty aortic allografts implanted in situ in rats were analyzed. The animals were divided into four groups that received fresh or cryopreserved isogenic (Lewis to Lewis) grafts, or fresh or cryopreserved allogenic (Lewis to DA) grafts, respectively. The diameter and compliance of the grafts were then visually evaluated with the digital video camera recorder after 15, 30, 60, 90 and 120 days. RESULTS: Gradual increase in diameter and decrease in compliance in case of all allogenic and cryopreserved isogenic grafts were observed. The observed changes in cryopreserved grafts were smaller when compared with fresh grafts, however, the differences did not reach statistical significance. CONCLUSION: Cryo preservation does not protect allografts from stiffening and dilatation.

The mechanical properties of fresh and cryopreserved arterial homografts.

OBJECTIVES: To assess the effect of cryopreservation on the elasticity and compliance of arterial allografts. MATERIALS AND METHODS: Iliofemoral segments of arteries and veins harvested from multiorgan donors were divided into two groups: fresh-control, tested for 24 hours after harvesting, and cryopreserved in liquid nitrogen after pretreatment with 20% dimethylsulphoxide and stored for an average time of 22 days. Vessel wall elastic properties were evaluated from the stress-strain relationship in a specially designed test cell fixed to the Instron Universal Testing Machine. RESULTS: The elastic modulus of the artery control group (1.54+/-0.33 MPa, n=20) was not significantly different from the cryopreserved group (1.69+/-0.61 MPa, n=15). Similarly, values for unfrozen veins (3.11+/-0.65 MPa, n=47) were not significantly different from those of frozen samples (2.71+/-0.85 MPa, n=38). Control compliance (6. 86+/-1.79x10(-5)%/Pa, for arteries; 3.84+/-0.81x10(-5)%/Pa, for veins) was similar to that of the cryopreserved group (6.66+/-1. 80x10(-5)%/Pa, for arteries; 4.16+/-1.21x10(-5)%/Pa, for veins). CONCLUSIONS: Cryopreservation maintains the important elastic properties of arterial and venous allografts during average storage time of 22 days.

[The importance of excision of the first thoracic rib and accessory cervical rib in the treatment of deep venous thrombosis of the upper extremities]. / Znaczenie usuniecia pierwszego zebra piersiowego i dodatkowego zebra szyjnego w leczeniu zakrzepicy zyl glebokich konczyny górnej.

This paper presents 15 cases of deep venous thrombosis of the upper extremity as a complication of previously asymptomatic thoracic outlet syndrome. The diagnosis was based on clinical examination and phlebography. To achieve prompt recanalisation of the vein streptokinase was used. Fibrinolytic treatment was followed by surgical treatment carried out 6 to 8 weeks after resolution of acute symptoms. The surgery consisted of excision of first rib and accessory cervical rib when present through the axillary approach. In 73% of cases complete lysis of the thrombus was achieved which was confirmed by phlebography and resolution of symptoms of venous hypertension.

[Investigations on the pathogenesis of primary varicose veins]. / Badania nad patogeneza pierwotnych zylaków konczyn dolnych.

The data from the clinical course and epidemiology of primary varicose veins of lower limb suggest that sex hormones can directly influence the development of the disease through their intracellular receptor localised in cells of venous wall. The purpose of this study was to determine the stereometric differences in the structure of healthy and varicose veins of lower limb and to determine the presence and localisation of oestrogen and progesterone receptors in the cells of vein. The segments of greater saphenous vein obtained from the 8 women operated for varicose vein were used for the study. The segments of the greater saphenous vein obtained from 8 women that underwent femoro-popliteal venous bypass procedure were used as control group. The vein samples for stereometric analysis were preserved in Buin's solution, embedded in paraffin and then evaluated with automatic analyser MagiCal. To determine the presence of oestrogen and progesterone receptors the immunohistochemic analysis LAB with monoclonal antibodies produced by DAKO was used. The decreased smooth muscle fraction in venous wall, thickening of adventitia, the change of the smooth muscle cells to stroma cells ratio in the muscular layer of venous wall and change of muscular layer to adventitia ratio were observed in varicose veins in comparison with control group. The oestrogen receptors were found in the nuclei of the smooth muscle cells and endothelium. The progesterone receptors were localised in nuclei of smooth muscle cells and cells of subendothelial layer. It seems that quantitative analysis of sex hormones receptor in the venous wall could be useful in the determination of patients with increased risk of the development of primary varicose veins.