[Symmetrical phlebothrombosis of lower extremities resulting from congenital malformation of vena cava inferior]. / Obojstranná flebotrombóza dolných koncatín zaprícinená vrodenou malformáciou dolnej dutej zily.

Agenesis/atresia ofvena cava inferior is a rare congenital anomaly, caused by an aberrance of embryonal venous system development. This is in most cases asymptomatic, because of well developed collateral venous circulation. However, in some cases, it can be manifested with occurence of deep thrombosis in area of pelvis and lower limbs. In this case report, we repon a 21 year old male with painful swelling of both lower limbs. Ultrasonographic examination revealed a bilateral thrombosis in deep venous system of lower limbs and pelvis. Subsequent CT angiography showed atresia ofinfrarenal segment ofvena cava inferior. According to the CT image thrombotic proces affected also collateral venous system, that joined mostly to vena azygos and hemiazygos. Examination of coagulation system didn't reveal a procuring cause ofthrombotic occurrence. We realized a systemic trombolysis with streptokinase during 5 days. Starting from the fifth day we administered a low molecular weight heparin in anticoagulant dose. This treatment showed a good clinical effect. Pacient was discharged with a long-term oral warfarin therapy in combination with acetylsalicylic acid. In next four months of taking recommended therapy no relapse of thrombotic process nor evolvement of bleeding complication was observed.

Hemosuccus pancreaticus.

In this study, authors describe a rare case of a 40-year old patient with a history of chronic pancreatitis due to ethanol abuse, repeatedly hospitalized for intermittent bleeding into gastrointestinal tract (GIT). The sources of bleeding were pseudoaneurysms of the peripancreatic arteries (gastroduodenal artery, right hepatic artery) bleeding into GIT via pancreatic duct. This type of bleeding is referred as hemosuccus pancreaticus and belongs to a rare form of bleeding into upper GIT. Development of each pseudoaneurysm was monitored with a 6 month time interval. The diagnosis was established using endoscope, Doppler ultrasound and CT angiography. During the therapeutic process, while stopping bleeding, two different radiological interventions were used. In pseudoaneurysm of gastroduodenal artery, hemostasis was achieved using selective transcatheter arterial embolization (TAE) with steel coils. In the second intervention, a stent was inserted into vascular lesion. In the discussion, authors review the problems of hemosuccus pancreaticus, epidemiology, symptoms, diagnostic and possible therapeutic approaches (Fig. 3, Ref. 31). Full Text (Free, PDF) www.bmj.sk.

Behcet's syndrome.

Behcet's syndrome is a systemic illness of unknown etiology characterized by necrotising vasculitis originally described in Turkey. Typical manifestations include urogenital ulcerations, eye inflammation and migratory thrombophlebitis. An unusual course of this disease is described. A 56 year-old man was admitted to the hospital with fever, milk-glass opacities on chest x-ray, mucosal defects on the tongue and penis, hematuria and proteinuria with functional disorder of kidney. Chlamydia pneumoniae, CIK positivity and C 3 complement decrease were found. Antibiotics and antimycotic drugs have shown only slight improvement of pulmonary lesions. An excellent effect in all pathological findings was achieved after prednison administered in dosis of 1 mg/kg and later cyclophosphamide administration (Fig. 7, Ref. 12).