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[Study of the glucose concentration in five vascular regions -- aorta, arteria pulmonalis, vena cava inferior, vena cava superior, vena hepatica -- in childhood (author's transl)].

Using the Beckman glucose analyzer, glucose concentration was determined in the serum of the fasting blood in five vascular regions -- aorta, arteria pulmonalis, vena cava inferior, vena cava superior, vena hepatica -- of 52 children (ages 2,5 months up to 14 years and 3 months, x = 6 years and 3 months, male = 28, female = 24) with a healthy metabolism. The comparison of the average values of the glucose concentrations determined in five vascular regions in childhood showed that the glucose concentration in the vena hepatica was statistically significant higher than in the other vascular regions. Moreover the comparison of the glucose concentrations revealed that the values in the vena cava inferior were statistically significant higher as compared to the values in the vena cava superior. The glucose concentrations in the arteria pulmonalis, the vena cava superior and the aorta were nearly equal. Compared with the older children, the younger children had in all the investigated vascular regions lower glucose concentrations.

Adolescent

Ultrasound diagnosis of masses elevating the inferior vena cava.

The inferior vena cava is frequently involved in diseases of the abdomen and retroperitoneum. Critical evaluation of this vessel's course can greatly help in determining the origin of an adjacent mass. Ultrasound was used to divide the inferior vena cava into three parts. A vector type principle was applied to masses anteriorly displacing the vena cava, and the location of the mass was compared to the particular portion of the cava most affected. With this approach, it was often possible to determine what structures a mass may have originated from.

Abdomen

Nonmalignant venographic abnormalities of the inferior vena cava.

Displacement of the inferior vena cava, impressions made by adjacent structures, or intraluminal filling defects mat indicate retroperitoneal tumor growth. However, similar changes may be caused by nonmalignant normal or pathological conditions. The authors illustrate several such cases seen among 1,428 examinations performed during a three-year period.

Aorta, Abdominal

[New technic of the transjugular cava blocking in the removal of acute pelvic vein and inferior vena cava thrombosis].

Thrombosis of the inferior vena cava rarely occurs. However, it mostly develops by continous growth from thrombosis of the deep leg and pelvic veins. Thrombus formation in the inferior vena cava carries a potentially lethal risk because of possible involvement of the renal veins with consecutive renal failure or development of fulminant pulmonary embolism. Therapy of choice consists in early diagnosis and immediate thrombectomy. Choice of the operative procedure is of the utmost importance for immediate and late results. Our technique consists of inserting a balloon catheter via a side vessel of the internal jugular vein and placing it into an infrarenal position, where it is blocked, thereby preventing blood flow from the area to be cleared. Three cases in which this technique was employed are presented.

Acute Disease

Congenital membranous obstruction of the inferior vena cava.

Congenital membranous obstruction of the inferior vena cava is a rare phenomenon resulting from failure of anastomosis between the right subcardinal vein and the liver. A case is reported in which the presenting symtpom was bleeding from esophageal varices. Cirrhosis was present and other signs of vena caval obstruction were minimal. The diagnosis was made only after an ineffective mesenterico-caval shunt had been performed. Venacavography or pressure measurements in the inferior vena cava are mandatory before attempting a porta-systemic shunt operation.

Budd-Chiari Syndrome

Transposition of the great arteries, primum atrial septal defect, azygos continuation of the inferior vena cava, bilateral superior venae cavae and dextrocardia with centrally placed liver.

Successful surgical correction of transposition of the great arteries in a nine-year-old girl with dextrocardia, primum atrial septal defect, bilateral venae cavae, and azygos continuation of inferior vena cava is reported. The patient was cooled on cardiopulmonary bypass and the operation performed under circulatory arrest at 19 degrees C. nasopharyngeal temperature. The problems of diagnosis and management are discussed.

Abnormalities, Multiple

Interposition mesocaval H shunt associated with a left inferior vena cava.

Variations in the anatomy of the inferior vena cava are important in abdominal surgery. A patient with recurrent bleeding from esophageal varices was noted to have a single left inferior vena cava at the time of panangiography. An interposition mesocaval H shunt subsequently was performed successfully. This represents the first reported case in which a mesocaval H shunt has been performed in a patient with a single left inferior vena cava.

Adult

Ultrasonic diagnosis of hypernephroma extending into the inferior vena cava.

Extension of hypernephroma into the inferior vena cava was demonstrated by ultrasound. When a solid renal lesion is encountered, it is suggested that the inferior vena cava be scanned. The possible significance of gray scale scanning as a more precise diagnostic tool and its use in tumor staging are discussed.

Adenocarcinoma

The endothelial surface of large veins of rabbit: scanning electron microscopic observations.

The following veins of the rabbit were fixed by perfusion and studied systematically by scanning electron microscopy: sagittal sinus, confluence of sinuses, external jugular vein, superior vena cava, inferior vena cava, greater saphenous, and femoral veins. One result is that the shape and arrangement of endothelial cells of the veins are obviously influenced by hemodynamic shear forces. Two types of subendothelial fibres were demonstrated: "cross-fibers" which correspond to the circular inner muscle cells of the media, and "longitudinal fibers" which correspond to the intimal meshwork of connective tissue fibers. Regional differences are demonstrated in the occurrence of these fibres. Moreover, five morphologically different venous valve types are observed. The functional significance of these different valve types is not yet known.

Animals

Computed tomography of a double inferior vena cava: the "double cava" sign.

Right-sided retroperitoneal adenopathy or right adrenal masses demonstrated by CT in cross sectional display may mimic the CT appearance of the inferior- vena cava. This finding has been recently described as the "double cava" sign. The authors report this sign in a patient who actually has a double IVC. "CT angiography" with the technique described herein, will determine that the retroperitoneal structures demonstrated by CT are indeed vessels rather than enlarged nodes or adrenal masses.

Adrenal Gland Neoplasms

Inferior vena cava obstruction. A complication of prostate cancer.

Inferior vena cava (IVC) obstruction, manifested as bilateral, asymmetric, asymptomatic, pitting leg edema and scrotal swelling, developed in two patients with advanced prostatic cancer. Radiological confirmation was obtained in both patients. Inferior vena cava obstruction was the initial manifestation of disease progression and occurred in patients who were ambulatory without evidence of congestive heart failure or concurrent estrogen therapy. Early IVC contrast study is indicated in similar patients in whom asymptomatic bilateral leg edema of obscure origin develops.

Aged

Injuries to the inferior vena cava and their management.

Injuries to the inferior vena cava are being seen with increasing frequency in the civilian population. A review of the experience at UCLA/Harbor General Hospital Medical Center over a ten year period (1966 to 1976) discloses thirty-four patients with major injuries to the inferior vena cava, with an overall mortality of 53%. The factors that appear critical to patient survival are: (1) level of injury (suprarenal versus infrarenal sites); (2) presence or absence of profound shock on admission; and (3) the speed with which diagnosis is made and treatment carried out. Technical considerations regarding identification and handling of inferior vena caval injuries are presented. The mortality rate for major inferior vena caval injuries remains distressingly high and serves as a challenge for future improvement.

Abdominal Injuries

The inferior vena cava: mass effects.

Gray scale ultrasound evaluation of the inferior vena cava is essential for adequate workup of abdominal tumors. Demonstration of perivascular nodal masses and/or invasion of the inferior vena cava is of prognostic significance and of value in planning the surgical approach. In addition, accurate delineation of the extent of such tumor invasion by ultrasonography may preclude additional study by more invasive diagnostic procedures, such as angiography. Results of ultrasonic examination of six patients are reported; all were shown to have significant mass effects on the inferior vena cava.

Abdominal Neoplasms

[Symptomatology and treatment of malformations of the inferior vena cava (author's transl)].

A review of the embryology, pathophysiology semiotics and surgical treatment of malformations of the inferior vena cava is given based on 3 clinical histories. The cases consisted of a typical membrane occlusion, an atresia of the infrarenal segment and of a hitherto not described combination of several malformations of the inferior vena cava: membrane occlusion, aplasia of the infrarenal segment of the vena cava inferior and multiple aneurysms of the iliac vein. The symptomatology of malformations of the vena cava inferior depends on the compensation by the collateral or the persisting embryonic veins, respectively, and on the localization and the degree of the obliteration. The varying hemodynamic reactions are described. The following surgical methods for the treatment of inferior vena cava occlusions in the hepatic segment are available: The so called conservative interventions for the creation of collaterals, the direct or indirect recanalization and the bypass operation. Congenital infrarenal atresias of the vena cava are corrected by homologous or prosthetic interposition. The venous replacement with a bovine heterograft presented here, has not yet been described in the literature.

Adolescent