Clinical results after coil embolization of the ovarian vein in patients with primary and recurrent lower-limb varices with respect to vulval varices.

OBJECTIVE: To study the effect of coil embolization of the insufficient ovarian vein (IOV) on varices of the lower limb (VLL). METHOD: From December 2005 until May 2008, we selected all patients with phlebograms that were performed in our hospital to confirm the diagnosis of insufficiency of the ovarian vein. The CEAP (clinical, aetiological, anatomical and pathological elements) classification was used to classify the lower-limb venous disease in each patient. All patients with suspected IOV in combination with VLL underwent a phlebography. If IOV was found, coil embolization of the ovarian vein(s) was performed. RESULTS: IOV was found in 43 of 44 patients (98%). After coil embolization of the ovarian vein(s), VLL disappeared in five patients (12%) without any further treatment. Improvement in CEAP classification was measured in 13 patients (31%). In 21 (88%) of 24 patients with vulval varices, coil embolization of the ovarian vein(s) resulted in disappearance of vulval varices. CONCLUSIONS: In only 31% of the patients with IOV in combination with VLL, phlebography and coil embolization of the ovarian vein(s) did improve CEAP classification. However, coil embolization of the ovarian vein resulted in disappearance of the vulval varices in 88% of the patients.

Spondylolisthesis with sciatica. Magnetic resonance findings and chemonucleolysis.

Fifteen patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica were examined with magnetic resonance imaging. All patients had a disc protrusion at the level of the spondylolisthesis. Nine patients had a central herniated disc that caused dural sac deformation; in 6 of these patients there was extension to the disc tissue into the foramen. In 5 patients there was no clear dural sac deformation, but there was a foraminal disc protrusion that caused nerve root compression. In 1 patient there was a hernia lateral to the foramen. In none of the patients was there evidence of compression by bony elements. No abnormalities on adjacent levels were found. All 15 patients were treated with chemonucleolysis. There were no complications. A followup study was done after 19 months (range, 10-42 months). The result was rated as good or excellent in 10 of 12 patients with a spondylolisthesis of L5 and in 1 of 3 patients with a spondylolisthesis of L4. Magnetic resonance imaging showed a decrease in dural sac deformation in 4 patients, no clear decrease in 3, and a slight increase in 2. There were no distinct foraminal changes in 9 of 11 patients.

Isthmic lumbar spondylolisthesis with sciatica: the role of the disc.

Thirty-one patients with isthmic spondylolisthesis were investigated using MR imaging. Twenty-one of these patients had selectively unilateral sciatica and no abnormalities on adjacent discs. In 18 patients there was a clear correlation between the degree of foraminal stenosis and the symptomatic side. In 20 patients there was evidence of root compression by disc tissue.

[Endovascular embolization in gastrointestinal hemorrhage]. / Endovasculaire embolisatie bij gastro-intestinale bloedingen.

The indications, the technique and the choice of materials for transcatheter embolisation in three patients are described. A 73-year-old woman with Henoch-Schönlein vasculitis was admitted with haematemesis and melaena. Angiography showed active haemorrhage in a branch of the pancreaticoduodenal artery. The common hepatic artery was catheterised up to the pancreaticoduodenal artery and superselective transcatheter embolisation was accomplished using polyvinyl alcohol (PVA) particles of 0.3-0.5 mm diameter. A 82-year-old woman with chronic cardiac decompensation developed serious haematemesis after a papillotomy. With the help of PVA particles the bleeding A. pancreaticoduodenalis inferior ramus posterior was embolised. Several days after a pancreaticoduodenectomy for a carcinoma of the papilla of Vater a 75-year-old man went into shock. The angiogram revealed haemorrhage of the right hepatic artery. With the combination of microcoils and a coaxial balloon catheter proximal of the bifurcation of the hepatic artery haemorrhage could be arrested. Haemorrhage did not recur and all patients could be discharged in good condition. When local anatomy has been changed by earlier surgery or when patients in bad general condition are concerned, transcatheter embolisation can offer the solution in active haemorrhage.

Deep venous thrombosis of the leg: US findings.

In a prospective study, 121 consecutive patients with a clinical diagnosis of deep venous thrombosis of the leg were examined with real-time ultrasonography. The findings were correlated with the results of venography. The common femoral vein and the popliteal vein were evaluated for intraluminal echoes and compressibility, and the common femoral vein was also evaluated for an increase in diameter in response to the Valsalva maneuver. The superficial femoral vein and the calf veins were not evaluated. The results indicate that compressibility of the common femoral and popliteal veins is the best indication of deep venous thrombosis, with a sensitivity of 96% and a specificity of 97%. The accuracy of detection was not improved by including data from thrombus visualization or the response of the common femoral vein to the Valsalva maneuver.

Subtraction pitfalls in venous DSA of the renal arteries.

Venous DSA of the renal arteries was performed in 32 patients for suspected renovascular hypertension who were considered for percutaneous transluminal angioplasty (PTA). To trace the causes of contradictory or divergent findings in our material, v-DSA and conventional angiography prior to PTA were compared. Superimposition of dense bone structures on the origins of the renal arteries was the most common cause of different findings. In 22 arteries with superimposition, 11 were not the same (50%). In 42 arteries without superimposition 7 were not comparable (16.5%). The difference between both groups is statistically significant (chi square test: p less than 0.05). Other possible factors of influence such as motion artifacts, superimposition of vessels and calcifications in the region of the renal arteries, had no measurable effect. The importance and the origin of subtraction artifacts caused by dense bone structures are discussed.

Povidone-iodine irrigation of the subcutaneous tissue to prevent surgical wound infections.

In a prospective randomized trial, the influence of irrigation of the subcutaneous tissue using povidone-iodine solution upon the development of postoperative wound infection was examined in 592 patients undergoing general surgical operative procedures. No beneficial effect of irrigation with povidone-iodine solution could be demonstrated, nor could it be demonstrated in the group as a whole or in the subgroups according to bacterial contamination.