Choroidal vascular occlusion in a young male patient with sickle cell trait

Dear Editor,Choroidal vascular occlusion is a rare finding. Choroidal perfusion disorders may range from focal infarction of the choriocapillaris to fibrinoid arteriolar necrosis. Vascular occlusion due to microembolism is more common in choroidal than in retinal vasculature. Due to its unique hemodynamic characteristics, which involve one of the highest rates of blood flow in the body and the fact that it is functionally an end artery system, the choroidal circulation is prone to platelet emboli associated with cardiovascular disease and other pathologies with increased risk of microembolismt.

Clinical application of vascular occlusion test based on tissue oxygen saturation monitoring

The vascular occlusion test (VOT) is an experiment that simulates the process of distal ischemia-reperfusion of tissue based on the monitoring of tissue oxygen saturation (StO2) to obtain VOT parameters related to StO2 changes to evaluate microcirculation function of the measured muscle tissue. VOT has the advantages of real-time, noninvasive and continuous, and is widely used to evaluate the functional status of peripheral microcirculation and the relationship between microcirculation changes and prognosis of patients. In clinical work, doctors mainly focus on hemodynamics of patients, while microcirculation function is often neglected due to the lack of real-time monitoring methods, which may lead to severe poor prognosis of patients, especially patients with critical illness. This paper focuses on the clinical application of vascular occlusion test based on tissue oxygen saturation monitoring.

THROMBOLYTIC THERAPY FOR ACUTE CEREBRAL VASCULAR OCCLUSION

Superselective intra-arterial thrombolytic therapy with urokinase infusion was effective in 10 patients with acute cerebral vascular occlusion. PATIENTS AND METHODS In the 10 patients, 8 were men and 2 women. Their age ranged from 34 to 70 years.

Hemihepatic versus total hepatic inflow occlusion during hepatectomy:A systematic review and meta-analysis

AIM： To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion （HHO） compared with total hepatic inflow occlusion （THO）. METHODS： Randomized controlled trials （RCTs） co- mparing hemihepatic vascular occlusion and total he- patic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta- analysis was conducted to estimate blood loss, transfu- sion requirement, and liver injury based on the levels of aspartate aminotransferase （AST） and alanine arni- notransferase （ALT）. Either the fixed effects model or random effects model was used. RESULTS- Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Metaanalysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean dif- ference （WMD） 342.27; 95% confidence intervals （CI） 217.28-467.26; P = 0.00001; I2 = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. CONCLUSION： Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.

Neutrophil-to-lymphocyte ratio in occlusive vascular diseases： the literature review of the past 10 years

BACKGROUND: This study aims to evaluate the results of studies investigating neutrophilto-lymphocyte ratio(NLR) and to identify the prognostic and diagnostic value of NLR in occlusive vascular diseases.METHODS: With the aim of identifying the studies related to NLR, a search was performed on http://www.ncbi.nlm.nih.gov/pubmed by using the key words "neutrophil lymphocyte ratio" between January 2005 and December 2014. All of the original articles were evaluated according to date of publications, countries, clinics and topics. Studies about occlusive vascular diseases were evaluated according to their qualifications, review methods and results. SPSS for Windows 16.0 was used in data analysis and data were expressed as mean, standard deviation and percentage.RESULTS: A total of 735 original research articles were investigated. The number of publications have shown a regular logarithmic increase over the years. Thirty-two percent of all publications were performed by clinics in Turkey and 56.4% were performed by general-oncological surgery and cardiology clinics. A total of 107 publications were identified to be about occlusive vascular diseases, 80.3% of these publications were found to be prognostic and 19.6% to be diagnostic, 82.2% of them were found to be planned as retrospective and 17.7% as prospective. In 95.3% of prognostic publications, there was a positive correlation between high NLR values at admission and poor prognosis. In 95.3% of diagnostic publications high NLR values at admission were identifi ed to be signifi cant diagnostically.CONCLUSION: Elevated neutrophil-to-lymphocyte ratio at admission, could be used as a diagnostic and/or prognostic parameter in occlusive vascular diseases.

Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

Management of centrally located hepatocellular carcinoma:Update 2016

Centrally located hepatocellular carcinoma(HCC)is sited in the central part of the liver and adjacent to main hepatic vascular structures.This special location is associated with an increase in the difficulty of surgery,aggregation of the recurrence disease,and greater challenge in disease management.This review summarizes the evolution of our understanding for centrally located HCC and discusses the development of treatment strategies,surgical approaches and recurrence prevention methods.To improve patient survival,a multi-disciplinary modality is greatly needed throughout the whole treatment period.

Superior mesenteric vein thrombosis induced by influenza infection:A case report

BACKGROUND Among the various types and causes of mesenteric ischemia,superior mesenteric vein(SMV)thrombosis is a rare and ambiguous disease.If a patient presents with SMV thrombosis,past medical history should be reviewed,and the patient should be screened for underlying disease.SMV thrombosis may also occur due to systemic infection.In this report,we describe a case of SMV thrombosis complicated by influenza B infection.CASE SUMMARY A 64-year-old male visited the hospital with general weakness,muscle aches,fever,and abdominal pain.The patient underwent computed tomography(CT)and was diagnosed with SMV thrombosis.Since the patient’s muscle pain and fever could not be explained by the SMV thrombosis,the clinician performed a test for influenza,which produced a positive result for influenza B.The patient had a thrombus in the SMV only,with no invasion of the portal or splenic veins,and was clinically stable.Anticoagulation treatment was prescribed without surgery or other procedures.The follow-up CT scan showed improvement,and the patient was subsequently discharged with continued oral anticoagulant treatment.CONCLUSION This case provides evidence that influenza may be a possible risk factor for SMV thrombosis.If unexplained abdominal pain is accompanied by an influenza infection,examination of an abdominal CT scan may be necessary to screen for possible SMV thrombosis.

Laparoscopic left hemihepatectomy under occlusion of the left inflow and outflow

Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepatectomy, except for resection of the peripheral liver or left lateral segment when porta hepatis dissection is not indicated. Although both inflow and outflow control seems to be ideal in laparoscopic left hepatectomy, there have not been many reports of this. In addition to the high technical demands and the time required, any injury of the main hepatic veins or vena cava during the procedure will cause catastrophic bleeding and air embolism. Recently, we succeeded in achieving inflow and outflow occlusion during laparoscopic left hemihepatectomy in four cases, with satisfactory results.

Management of vascular complications following calcium hydroxylapatite filler injections:a systemic review of cases and experimental studies

Aim:Dermal fillers are increasingly popular procedures.Inadvertent intraarterial injection of fillers,particularly with calcium hydroxylapatite(CaHA),can result in devastating consequences.A systemic review was performed to summarize management strategies to treat CaHA-associated vascular complications.Methods:The methodology of this review was derived from The Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA).In addition,this paper presents a previously unreported case of a CaHA-associated vascular complication.Results:There were 32 articles describing 42 cases,plus our case included in this review.There were 15 cases of vision complications,23 cases of non-vision complications,and 5 experimental studies.The most common injection sites reported were nasal region for vision complications(45%)and nasolabial folds for non-vision complications(40%).Of the 38 human cases,the most prevalent treatment choice was steroids(24 cases,63%).Complete or near complete improvement was reported in 83%of non-vision complications and 40%of vision complications.There was no noticeable homogeneity in the management strategies and outcomes of the patients.Of the 5 experimental studies,no clear consensus on treatments was found.Conclusion:Vascular complications of CaHA are seemingly uncommon,but it is widely suspected that this is due to underreporting.While best management is prevention,preparation for a potential complication is equally important.Derived from CaHA literature,hyaluronic acid filler complication protocols,findings of this review,and personal experiences,this report proposes management strategies for CaHA-associated vascular complications.We hope these strategies provide a much-needed framework for injectors to refer to and utilize as needed.

Effects of Puerarin on Experimental Model of Retinal Vein Occlusion in Rats

Objective To establish a model of retinal vein occlusion（RVO）in rats and to study the effect of puerarin on ischemic retinal disease and the corresponding mechanism.Methods RVO was induced in 10 adult male Sprague-Dawley（SD）rats by laser photothrombosis.Retinal blood flow was examined before and after 1 h of the operation,and model rats with the retinal vein blood flow decreasing by 50%compared to the basic value were chosen and then puerarins（20,40,and 80 mg/kg）were given.The levels of vascular endothelial growth factor（VEGF）,interleukin-1β（IL-1β）,and nitric oxide（NO）were analyzed.In addition,the histopathology of RVO-eyes was performed.Results RVO-eyes displayed the signs of retinal damage and ischemia on Doppler Flowmeter and histopathology.Puerarin（20,40,and 80 mg/kg）increased blood flow by 9.3%（P〈0.05）,33.1%（P〈0.001）,and 41.5%（P〈0.001）,respectively.On the other hand,the histological changes were less severe at different degrees,relieving the symptoms such as edematous and thick neuroretinal layers,lax,edematous,and disorganized optic fibers layers,swollen and confused inner and outer nuclear layer.Besides,dose-dependent decrease of VEGF and IL-1βand increase of NO in vitreous fluid were observed,with respect to the model group.Conclusion A rat model of laser photochemical-induced RVO is established and a decrease in the retinal blood flow and histological damage is detected.The puerarin has therapeutic benefit in the rat model of RVO,through the pathway of neovascularization,anti-inflammation,and increase of NO.

Enterocolic phlebitis:a rare cause of bowel ischemia and review of the literature

Enterocolic phlebitis(EP)is a rare cause of bowel ischemia due to isolated venulitis of the bowel wall and mesentery without arterial involvement.EP is often misdiagnosed as inflammatory bowel disease,carcinoma,or diverticulitis due to non-specific symptoms as well as non-specific clinical and radiologicalfindings.While unresponsive to pharmacotherapy,surgical resection of the affected bowel appears to be the only successful therapy with a very low recurrence rate.Etiology of EP remains unknown.We report a case of EP with rare presentation in the left hemicolon and unusual histologicalfindings emphasizing the heterogeneity of this cause of enterocolic ischemia.The review and comparison of the three enti-ties—EP,mesenteric inflammatory veno-occlusive disease(MIVOD),and idiopathic myointimal hyperplasia of mesenteric veins(IMHMV),all describing patterns of bowel ischemia due to isolated pathology of mesenteric veins—reveal that the current terminology is unclear.EP and MIVOD are very similar and may be considered the same disease.IMHMV,though,differs in localization,symptom duration,and histologicalfindings but also shares features with EP and MIVOD.Further studies and harmonized terminology are inevitable for better understanding of the disease,prevention of unnecessary pharmacotherapy,and reduction in time to diagnosis.