Neck duplex Doppler ultrasound evaluation for assessing chronic cerebrospinal venous insufficiency in multiple sclerosis patients.

INTRODUCTION: Recent clinical studies have suggested a relationship between multiple sclerosis (MS) and the occurrence of pathological changes in the jugular, vertebral and azygous veins that result in abnormal blood outflow from the brain and the spinal cord. Together, these pathological changes have been designated chronic cerebrospinal venous insufficiency (CCSVI). The aim of the present study was to evaluate the usefulness of duplex Doppler ultrasound in the evaluation of central nervous system venous outflow disturbances in patients suffering from MS. METHODS: We examined 181 patients with MS, diagnosed on the basis of the McDonald criteria, and 50 healthy volunteer controls. All patients underwent Doppler ultrasound examination of the internal jugular veins (IJV) and vertebral veins (VVs). The presence of outflow disturbances and morphological abnormalities were evaluated. RESULTS: Pathological changes in the extracranial jugular veins were diagnosed in 148/181 MS patients (82%) and 7/50 control group volunteers (14%). The following abnormalities in the MS group were revealed: the presence of a reflux in the IJVs and/or VVs (54%), narrowing (54%), a complete block in the flow through the IJV (10%) and an abnormal postural control of the cerebral outflow route (25%). These particular pathologies were of statistical significance in the MS group compared with the control group. This study also revealed a correlation between the occurrence of inverted flow in patients in a sitting position and chronic progressive MS (P = 0.0033). CONCLUSIONS: The examinations undertaken indicate a possible connection between MS and CCSVI. The widely accessible and highly sensitive and specific Doppler ultrasound test may be useful for revealing, and preliminary analysis of, CCSVI pathologies.

Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula.

Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators.

Popliteal vein aneurysm.

The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented.

Septal branches of right coronary artery as a source of blood supply to interventricular septum in morphological and clinical studies.

The aim of this article was to investigate septal branches of the right coronary artery in order to create both their typologies and to evaluate the usefulness of the vessels mentioned above for revascularisation procedures on the interventricular heart septum. The clinical studies were performed on 58 human hearts aged 28-80. Technical method of direct preparation, corrosive preparation and coronarographic picture assessment. The tests showed that the number of septal branches ranged from 5 to 11, their diameter from 0.7 to 1.2 mm. There were no main trunk or vessels with different dimensions than other arteries. Creation of septal vascularisation model was not possible because of rapid changes in studied vessels, their distribution and small diameters (about 1 mm) disqualifying them for direct revascularised operations on interventricular heart septum.

Types of interventricular septal branches of the anterior interventricular branch of the left coronary artery in human hearts.

The study aimed at determining types of interventricular septal branches stemming from the anterior interventricular branch of the left coronary artery. The studies were performed on 28 preparations of human heart aging 29 to 88 years. The technique of direct preparation was applied using a dissecting microscope. The conducted observations indicate that septal vessels of the anterior interventricular branch follow one of the three main patterns. Type I involves a dominant septal trunk, exhibiting its own branching and few fine septal branches, type II exhibits a single dominant unbranched ramus and multiple fine branches, while type III includes two dominant, unbranched septal rami of the septum and small number of fine septal branches. In the cases examined by us type III pattern was most frequent. No relationship was detected between the type of coronary vessels of the heart and the type of septal vessels of the anterior interventricular branch.