Freemanboesen9414

Objective To measure the pattern and severity of chronic venous insufficiency (CVI) in patients presenting to a vascular surgery clinic in Pakistan. Materials and Methods This cross-sectional study has examined patients presenting with CVI for the first time. Patients were assessed for severity of the disease using clinical, etiological, anatomical and pathological (CEAP) score and venous clinical severity score (VCSS). Patients were then divided into two groups depending on the severity of the disease 'mild/moderate' CVI if the CEAP classification was ≤C3 or VCSS was 3 or VCSS was ≥5. Both groups were then compared to determine the factors associated with the more 'severe' form of CVI. Results During the study duration, 121 patients presented with CVI with mean age of 47.83±12.02 years; 74 (61.2%) were female. Mean body mass index of the patients was 32.49±18.3 kg/m2. Mean VCSS was 5.49±3.84, indicating most patients presented with the severe form of CVI. Field workers were determined to be three to five times more likely to present with severe CVI compared to housewives and office workers. Conclusion Majority of the patients who presented to a tertiary care facility had the severe form of CVI. Thus, there is a need to raise awareness on this disease at community level.Background As a standard treatment for the varicose vein of the great saphenous vein (GSV) type, endovenous ablation (EVA) is the main approach. However, as a background to this, in Europe and the United States, neovascularization (Neo) following high ligation (HL) of the saphenofemoral junction (SFJ) at the time of GSV stripping has been emphasized as one of the reasons for the high rate of recurrence. Selleckchem Bestatin However, in Japan, almost no similar mid- or long-term results of GSV stripping have been reported. Patients and Methods From September 2011 to March 2014 when EVA was not my surgical option, 413 consecutive legs of patients underwent GSV stripping by myself using the same procedure. The patients were contacted by phone 5 years later, and recurrent varices after surgery (REVAS) and reoperation (REDO) were investigated. A total of 270 legs of the 391 living cases (69%) underwent venous ultrasonography (VUS). HL of the SFJ was performed via central flash ligation with towing and pulling out of the peripheral sidResults Of the 391 legs of patients who could be contacted, REDO was performed in 23 (6%), including 15 limbs, immediately after this investigation, and symptomatic REVAS were observed in 29 (7%). In 270 legs examined by VUS, REVAS were diagnosed as follows 29 legs with Level 1 lesion, 40 legs with Level 2 lesion, and 27 legs with Level 3 lesion. Level 1 REVAS that occurred at the SFJ were observed only in 3 legs (1.1%), Level 1 REVAS due to incompetent perforating veins (IPVs) were observed in 14 legs (5%), and Level 1 solitary tributary varices were observed in 9 legs (3%). Conclusion In this study, REVAS at the SFJ were significantly less than those in the past reports. It has been shown that REVAS due to IPVs or solitary tributary varices were more important than those at the SFJ. (This is a translation of Jpn J Phlebol 2019; 30(3) 259-265.).Patients with varicose veins of the lower extremities with osteoarthritis of the knee often experience improvement in knee joint symptoms after endovascular treatment. We considered that it was important to decide the operation indication of lower extremity varices, to know the correlation between the two diseases in the treatment of varicose veins. To investigate the postoperative improvement of knee symptoms related to varicose veins with knee osteoarthritis, we conducted a questionnaire survey for a total of 12 months, from December 2014 to May 2015 and from October 2018 to March 2019. The participants were 35 patients (7 men and 28 women) with varicose veins complicated with knee osteoarthritis. We classified knee osteoarthritis according to a grading scale and compared the improvement of knee symptoms after endovenous thermal ablation. The higher the knee grade, the lower the degree of improvement. However, the improvement was observed in all knee osteoarthritis grades, and as a whole, 25 patients (71.4%) have experienced improvement of subjective symptoms. For patients with knee osteoarthritis, we strongly recommend surgical treatment of the varicose veins regardless of the progression of knee grade. (This is a translation of Jpn J Phlebol 2019; 30(3) 279-283.).Objective In 2017, the Medical Accident Investigation and Support center in Japan released an analysis of acute pulmonary thromboembolism (PTE) related mortality. This recommendation called for maintaining a "team in charge of PTE's risk assessment, prevention, diagnosis and treatment" and preventing PTE through team activities. Therefore, we recommended establishing a deep vein thrombosis (DVT) prevention team. Before this recommendation, a multidisciplinary DVT prevention team was established in our hospital, with excellent outcomes. In the current study, we report the results of the DVT prevention team. Methods Our multidisciplinary team consisted of several departments Cardiovascular Surgery, ward nurses, medical safety managers, and clerks. The following themes were launched 1) preparation of DVT prevention protocol; 2) preparation of DVT preventive manual; 3) regular round for evaluating DVT preventive measures; 4) staff education. The protocol's strong point was that nurses evaluated patients over 16-year-old with Wells' score for DVT on admission. We retrospectively investigated the diagnosis rate of DVT and PTE for 9 months before and after protocol operation. Results The diagnosis rate of DVT was significantly improved after protocol implementation (before 0.06% vs. after 0.56%, p=0.0017). However, no significant difference was observed in the diagnosis rate of PTE before and after the protocol execution (before 0.03% vs. after 0.07%, p=0.98). Conclusion Our DVT prophylactic protocol improved the diagnostic rate of DVT resulting in a decrease of PTE in our hospital. (This is a translation of Jpn J Phlebol 2019; 30(3) 285-293.).A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.Objectives Virtual reality (VR) has been shown to facilitate rehabilitation at hospitals by distracting patients' attention from pain and by providing a virtual environment favorable for motivating the patients to continue rehabilitation. However, the application of VR in a home-visit rehabilitation remains to be validated. Here, we report a case in which home-visit rehabilitation using immersive VR was effective for post-stroke hemiplegic shoulder pain. Case presentation After treatment, at a general hospital, for the hypertensive hemorrhage in the right brain capsule that resulted in the residual attention deficit disorder and left hemiplegia, a 63-year-old woman was cared for with a home-visit rehabilitation in a rural area. The patient had persistent pain in her left shoulder, which increased during activities of daily living and during rehabilitation, and the pain precluded rehabilitation. A VR relaxation program was delivered to the patient to alleviate pain during rehabilitation. Her shoulder pain was successfully alleviated using VR during training for muscle stretching and passive joint mobilization. Conclusion The application of VR to home rehabilitation in rural areas may augment the effectiveness of home rehabilitation by alleviating pain during the procedure and sustaining the motivation for home rehabilitation.Objective We report two cases of atypical femoral fracture (AFF) in patients with cancer. Patients Two patients, a 53-year-old woman with breast cancer and a 77-year-old man with prostate cancer, could not walk after being injured in a fall. They used bone-modifying agents (BMA) for the prevention of bone metastasis for three and four years, respectively. Results Intramedullary nails were placed to fix the femoral fractures in each patient. Neither of them had pathological metastatic femoral fractures based on fracture site specimens; however, severe suppression of bone turnover at the fracture site was suspected. Both patients could ambulate with a T-cane and were free of hip pain after surgery. Radiographs showed no callus formation at the fracture site. Conclusion Based on the two cases of AFF in patients with cancer related to BMA use, we should consider that the incidence of AFF may be associated with long-term BMA use.Objectives Duodenal perforation as a complication of endoscopic ultrasound-guided fine needle aspiration may progress to acute peritonitis and septic shock. Open surgery, the standard treatment, can be avoided by performing closure during endoscopy using endoscopic clips. Patient A 77-year-old woman was referred to our hospital with salivary gland swelling. She had elevated hepatobiliary enzymes and jaundice. Computed tomography (CT) revealed pancreatic head swelling and bile duct dilation. Endoscopic ultrasonography revealed a hypoechoic mass in the pancreatic head. The pancreatic head mass was punctured twice using a 22-gauge Franchine-type puncture needle at the duodenal bulb. The endoscope was advanced to the descending part of the duodenum, and part of the superior duodenal angle was perforated (diameter approximately 15 mm) with the endoscope. The duodenal mucosa around the perforation was immediately closed using endoscopic clips. Results Abdominal CT showed gas in the peritoneal and retroperitoneal spaces. The patient experienced abdominal pain and fever and was treated with fasting and antibiotics. The gas gradually decreased, symptoms improved, and she was discharged 18 days after the perforation. Histopathologically, the pancreatic tissue was consistent as autoimmune pancreatitis. Conclusion Endoscopic closure using endoscopic clips may be a better therapeutic option for duodenal perforation caused by endoscopy.Objective The details regarding the development of fibrocartilage layers in Achilles tendon (AT) enthesis are unknown. Therefore, we evaluated the development of fibrocartilage layers in AT enthesis using a rabbit model. Materials and Methods Forty-eight male Japanese white rabbits were used in this study. Six of them were euthanized at different stages (day 1, and 1, 2, 4, 6, 8, 12, and 24 weeks of age). The proliferation, apoptosis, Sox9-positivity rates, and chondrocyte number were evaluated. Additionally, safranin O-stained glycosaminoglycan (GAG) areas, width of AT enthesis, and calcaneus length were assessed. All parameters were compared to those at 24 weeks of age. Results The level of chondrocyte apoptosis was high from 1 to 8 weeks of age, and high expression level of Sox9 was maintained from day 1 to 6 weeks of age, which decreased gradually. Safranin O-stained GAG areas increased up to 12 weeks, calcaneus length increased up to 6 weeks, and the width of AT enthesis increased up to 1 week of age. Conclusion The changes in chondrocyte and extracellular matrix were completed by 8 and 12 weeks of age, respectively.