Superior vena caval obstruction: a rare presentation of Behcet's disease.

A 25-year-old Indian man presented with low-grade fever followed by gradually increasing swelling of neck and face. Physical examination showed bilateral neck swelling, facial swelling and dilated veins in the upper chest. Superior vena cava (SVC) obstruction due to an underlying malignancy was suspected. CT thorax showed large saccular aneurysm with thrombosis of bilateral subclavian arteries of which the right one caused external compression of right innominate vein draining into the SVC. A history of recurrent oral and scrotal ulcers was obtained following which skin pathergy test was done, which was suggestive of a diagnosis of Behcet's disease (BD). He responded to treatment with steroids and azathioprine. This report illustrates that rare nonmalignant cause such as BD could also present with SVC obstruction.

Cytokeratin 7 and thyroid transcription factor - 1 levels in patients with lung cancer complicated with superior vena cava syndrome and their correlation with clinicopathological characteristics.

PURPOSE: This study aimed to detect the levels of cytokeratin 7 (CK7) and thyroid transcription factor -1(TTF-1) in serum of patients with non-small cell lung cancer (NSCLC) complicated with superior vena cava syndrome (SVCS), and to explore their prognosis and relationship and correlation with pathological characteristics. METHODS: 68 patients with non-small cell lung cancer (NSCLC) complicated with SVCS treated in Shaoxing Second Hospital from July 2014 to May 2018 were selected as the experimental group, 60 normal healthy persons as the control group, and 60 patients with lung cancer as the lung cancer group. The levels of CK7 and TTF-1 in the three groups were determined by enzyme-linked immunosorbent assay (ELISA), and the differences were compared. The relationship between the expression levels of CK7 and TTF-1 and clinicopathological characteristics of patients, the correlation between CK7 and TTF-1 in lung cancer patients complicated with SVCS, and their 3-year survival rate were analyzed. RESULTS: CK7 and TTF-1 levels in experimental group were significantly higher than those in control group (P<0.05). The levels in lung cancer group were significantly higher than those in control group (P<0.05). In experimental group, the expression of CK7 and TTF-1 was not related to gender, age, weight, histological classification and tumor size (P>0.05)). CK7 expression was positively correlated with TTF-1 expression in lung cancer patients (P<0.001). The 3-year survival rate in CK7 and TTF-1 high expression group was significantly lower than that in low expression group (P<0.05). CONCLUSION: The expressions of CK7 and TTF-1 are increased in patients with lung cancer complicated with SVCS, and are related to TNM stage, lymph node metastasis and differentiation degree. The high expressions of CK7 and TTF-1 in serum of patients are expected to be potential prognostic indicators for lung cancer complicated with SVCS.

Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome?

PURPOSE: To identify whether symptom relief and stent patency vary with use of long-term anticoagulation after stent placement for benign superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Patients with benign SVC syndrome treated with stent placement between January 1999 and July 2017 were retrospectively identified (n = 58). Average age was 49 years (range, 24-80 y); 34 (58%) were women, and 24 (42%) were men. Average follow-up was 2.4 years (range, 0.1-11.1 y, SD 2.6). Of cases, 37 (64%) were due to a long-term line/pacemaker, and 21 (36%) were due to fibrosing mediastinitis. After stent placement, 36 (62%) patients were placed on long-term anticoagulation, and 22 (38%) were not placed on anticoagulation. Percent stenosis was evaluated on follow-up imaging by dividing smallest diameter of the stent by a normal nonstenotic segment of the stent and multiplying by 100. RESULTS: Technical success was achieved in all cases. There was no significant difference in number of patients who reported a return of symptoms characteristic of benign SVC syndrome between the anticoagulated (16 of 36; 44.4%) and nonanticoagulated (11 of 22; 50%) groups (P = .68). There was no significant difference in the mean percent stenosis between the anticoagulated (40.4% ± 34.7% [range, 0-100%]) and nonanticoagulated (32.1% ± 29.2% [range, 1.7%-100%]) groups (P = .36). No significant difference was found in the time (days) between date of procedure and date of return of symptoms (anticoagulated, 735.9 d ± 1,003.1 [range, 23-3,851 d]; nonanticoagulated, 478 d ± 826.6 [range, 28-2,922 d]) (P = .49). There was no difference in primary patency between groups (P = .59). Finally, 1 patient (2.8%) in the anticoagulated group required surgical intervention, whereas none in the nonanticoagulated group required surgical intervention. CONCLUSIONS: No significant difference was observed in clinical and treatment outcomes in patients who did and did not receive anticoagulation after stent placement for benign SVC syndrome. Management of benign SVC syndrome after stent placement may not require anticoagulation if confirmed by additional studies.

Venous obstruction and cerebral perfusion during experimental cardiopulmonary bypass.

To investigate the effects on cerebral perfusion by experimental venous congestion of the superior vena cava (SVC) during bicaval cardiopulmonary bypass (CPB) at 34 °C, pigs were subjected to SVC obstruction at levels of 75%, 50%, 25% and 0% of baseline SVC flow at two arterial flow levels (low, LQ, high, HQ). The cerebral perfusion was examined with near-infrared spectroscopy (NIRS), cerebral microdialysis and blood gas analysis. SVC obstruction caused significant decreases in the NIRS tissue oxygenation index (TOI) and in SVC oxygen saturations (P<0.05, both groups), while the mixed venous saturation was decreased only in the LQ group. Sagittal sinus venous saturations were measured in the HQ group and found significantly reduced in response to venous congestion (P<0.05). No microdialysis changes were seen at the group level, however, individual ischemic patterns in terms of concomitant venous desaturation, decreased TOI and increased lactate/pyruvate occurred in both groups. The total venous drainage remained stabile throughout the experiment, indicating increased flow in the inferior vena cava cannula. The results indicate that SVC congestion may impair cerebral perfusion especially in the case of compromised arterial flow during CPB. Reduced SVC cannula flow may pass undetected during bicaval CPB, if SVC flow is not specifically monitored.

[A case of a papilloferous cystadenoma of boundary malignancy in a 29-year-old female patient with high surgical risk].

A case of papilloferous serous cystadenoma of boundary malignancy in a 29-year old female patient, with VCS syndrome--status post phlebothrombosis ileofemoralis dextra. Thrombosis vena cava superior is presented.

Comparison of laboratory data in dogs with heartworm caval syndrome surviving and nonsurviving after surgical treatment.

Laboratory data in 47 dogs with caval syndrome (CS) surviving after surgical HW removal compared with those in 15 dogs with CS which died after the treatment. The number of HWs removed in surviving dogs was significantly greater than in nonsurviving dogs. The Ht value was significantly higher in nonsurviving dogs than in surviving dogs. Plasma enzyme activities ranged widely from normal to extremely high levels, and there were no significant differences in plasma enzyme activities between the surviving and nonsurviving dogs. Serum total protein, and plasma triglyceride, creatinine, glucose, calcium, sodium (Na) and chloride (Cl) levels were much similar between the HW-free and surviving dogs, but significantly different between the HW-free and nonsurviving dogs. Plasma urea nitrogen, uric acid and potassium levels were higher, and plasma Na and Cl levels were lower in nonsurviving dogs than in surviving dogs.