Large diverticulum of the urinary bladder: A rare cause of deep vein thrombosis with consecutive pulmonary embolism.

A 73-year-old man was admitted with progressive dyspnea; he also had benign prostatic hyperplasia (BPH). An angio computed tomography scan showed pulmonary embolism with thrombi in both main pulmonary arteries. By duplex ultrasonography, we detected a thrombus in the right vena femoralis superficialis and vena femoralis communis. Simultaneously, we also noticed a large diverticulum on the right side of the urinary bladder and urinary stasis II of the left kidney. We consider the BPH as the trigger for a secondary diverticulum of the urinary bladder. As a result of its large dimensions, mechanical compression of the deep right pelvic veins resulted in thrombosis which finally caused the pulmonary embolism. With respect to the urinary stasis II, surgical excavation of the diverticulum with infravesical desobstruction was planned. The potentially lethal course of large diverticula may require surgery.

Protective effects of flavonoids contained in the red vine leaf on venular endothelium against the attack of activated blood components in vitro.

New methods are described that allow the selective isolation of venular endothelial cells and their cultivation on porous filters to confluent monolayers. These filters with the attached endothelial cell layer can be mounted in a specially adapted apparatus allowing not only blood filtration studies, but now also the continuous registration of hydraulic conductivity (Lp) of tissue layers. This preparation responds dramatically to certain release products from simultaneously activated blood platelets and polymorphonuclear granulocytes (PMN) with a rise in Lp that, in situ, would lead rapidly to local oedema, arteriolar constriction and venular thrombosis. Selectively activated PMN alone induced only a modest increase in endothelial Lp that could be prevented by uric acid, an antioxidant. ASA prevented the activation of the blood cells, but not the effect of the release products per se, implying that the release products are probably eicosanoids. A standardized extract from red vine leaves (AS 195, active ingredient of Antistax Venenkapseln), containing in particular the flavonoids quercetin-3-O-beta-D-glucuronide and isoquercitrin (quercetin-3-O-beta-D-glucoside), not only prevented the deleterious effect of the release products on the venular endothelial monolayers but, applied promptly to an endothelium damaged by prior exposure to these release products, resulted in the repair of the endothelium. These findings identify for the first time the venular endothelium as a possible important therapeutic target in certain vascular diseases, chronic venous insufficiency being perhaps the most prominent example.