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World Neurosurgery Sep 2022The mastoid emissary vein (MEV) describes a transosseous connection between the sigmoid dural venous sinus and the suboccipital venous plexus. In cases of outflow... (Review)
Review
INTRODUCTION
The mastoid emissary vein (MEV) describes a transosseous connection between the sigmoid dural venous sinus and the suboccipital venous plexus. In cases of outflow stenosis or malformation, the MEV may become dilated and a source of pulsatile tinnitus (PT) amenable to treatment. We describe a case of PT secondary to MEV treated successfully via endovascular coil embolization and conduct a systematic review of the literature.
METHODS
We performed a systematic review without meta-analysis of studies involving management of dilated MEV on January 14, 2022, and describe a case of PT secondary to an enlarged MEV treated via coil embolization.
RESULTS
A total of 13 studies were selected for full review. Reports identified MEV presenting as PT in 60% (12 of 20) of cases, intraoperative hemorrhage in mastoid surgery in 15% (3 of 20), a compressive scalp mass in 10% (2 of 20), and thrombophlebitis, facial swelling, or an incidental finding in 5% (1 of 20) each. Forty-five percent (9 of 20) underwent treatment, with all experiencing symptom resolution or improvement. Surgery included transvenous coil embolization in 33.3% (3 of 9), flap reconstruction in 22.2% (2 of 9), and surgical packing, ligation, and thrombectomy in 11.1% (1 of 9) each. Dilated MEV was reported concurrently with impeded drainage pathways in 35% (7 of 20) of reports.
CONCLUSIONS
Dilated MEV has been reported as an etiology of pulsatile tinnitus and appears amenable to treatment via open and endovascular means. Endovascular coil embolization appears to offer effective symptom resolution, however, available literature exists only in case reports and small series. Further investigation is highly warranted.
Topics: Blood Vessel Prosthesis; Cranial Sinuses; Dilatation, Pathologic; Humans; Jugular Veins; Mastoid; Tinnitus
PubMed: 35772705
DOI: 10.1016/j.wneu.2022.06.106 -
NPJ Microgravity Feb 2024The validity of venous ultrasound (V-US) for the diagnosis of deep vein thrombosis (DVT) during spaceflight is unknown and difficult to establish in diagnostic accuracy...
The validity of venous ultrasound (V-US) for the diagnosis of deep vein thrombosis (DVT) during spaceflight is unknown and difficult to establish in diagnostic accuracy and diagnostic management studies in this context. We performed a systematic review of the use of V-US in the upper-body venous system in spaceflight to identify microgravity-related changes and the effect of venous interventions to reverse them, and to assess appropriateness of spaceflight V-US with terrestrial standards. An appropriateness tool was developed following expert panel discussions and review of terrestrial diagnostic studies, including criteria relevant to crew experience, in-flight equipment, assessment sites, ultrasound modalities, and DVT diagnosis. Microgravity-related findings reported as an increase in internal jugular vein (IJV) cross-sectional area and pressure were associated with reduced, stagnant, and retrograde flow. Changes were on average responsive to venous interventions using lower body negative pressure, Bracelets, Valsalva and Mueller manoeuvres, and contralateral IJV compression. In comparison with terrestrial standards, spaceflight V-US did not meet all appropriateness criteria. In DVT studies (n = 3), a single thrombosis was reported and only ultrasound modality criterion met the standards. In the other studies (n = 15), all the criteria were appropriate except crew experience criterion, which was appropriate in only four studies. Future practice and research should account for microgravity-related changes, evaluate individual effect of venous interventions, and adopt Earth-based V-US standards.
PubMed: 38316814
DOI: 10.1038/s41526-024-00356-w -
The American Journal of Emergency... Apr 2024Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein.
OBJECTIVE
This review aimed to compare the first-pass success rate and arterial puncture rate for different approaches to ultrasound-guided CVC above the diaphragm.
METHODS
In May 2023, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform were searched for randomized controlled trials (RCTs) comparing the 5 CVC approaches. The Confidence in Network Meta-Analysis tool was used to assess confidence. Thirteen RCTs (4418 participants and 13 comparisons) were included in this review.
RESULTS
The SupraSCV approach likely increased the proportion of first-attempt successes compared to the other 4 approaches. The SupraSCV first-attempt success demonstrated risk ratios (RRs) > 1.21 with a lower 95% confidence interval (CI) exceeding 1. Compared to the IJV, the SupraSCV approach likely increased the first-attempt success proportion (RR 1.22; 95% confidence interval [CI] 1.06-1.40, moderate confidence), whereas the DistalAV approach reduced it (RR 0.72; 95% CI 0.59-0.87, high confidence). Artery puncture had little to no difference across all approaches (low to high confidence).
CONCLUSION
Considering first-attempt success and mechanical complications, the SupraSCV may emerge as the preferred approach, while DistalAV might be the least preferable approach. Nevertheless, head-to-head studies comparing the approaches with the greatest first attempt success should be undertaken.
Topics: Humans; Catheterization, Central Venous; Network Meta-Analysis; Ultrasonography, Interventional; Subclavian Vein; Brachiocephalic Veins; Jugular Veins
PubMed: 38330835
DOI: 10.1016/j.ajem.2024.01.043 -
Acta Clinica Belgica Aug 2021: Lemierre's syndrome is a septic thromboembolic complication of an oropharyngeal or neck infection, primarily caused by Fusobacterium species. Although it usually...
: Lemierre's syndrome is a septic thromboembolic complication of an oropharyngeal or neck infection, primarily caused by Fusobacterium species. Although it usually affects young healthy patients, some case reports describe this syndrome in older population.: A case report and a systematic review of the literature were conducted to investigate the late onset of Lemierre's syndrome. Forty-one articles were selected for the qualitative analysis, 39 for the quantitative analysis.: The average age of the study population was 52 years old. Diabetes mellitus and upper gastro-intestinal malignancy, common comorbidities in the study population, might play a role in the development of late-onset Lemierre's syndrome. Empiric antibiotic treatment should cover Fusobacterium and Streptococcus species both, which may cooperate to induce purulent disease. Reported unfavourable outcome was more than expected.: Lemierre's syndrome in adulthood may differ from the usual version. This disease may further pass unrecognized, if presented out of the expected age range. Nevertheless, early diagnosis and prompt treatment are a requisite to prevent morbidity and mortality, which may be higher in this older population.
Topics: Adult; Aged; Anti-Bacterial Agents; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Middle Aged
PubMed: 32116143
DOI: 10.1080/17843286.2020.1731661 -
Frontiers in Oncology 2020Gross strap muscle invasion (gSMI) in patients with differentiated thyroid cancer (DTC) was defined as high-risk recurrent group in the 2015 American Thyroid...
Gross strap muscle invasion (gSMI) in patients with differentiated thyroid cancer (DTC) was defined as high-risk recurrent group in the 2015 American Thyroid Association guidelines. However, controversy persists because several studies suggested gSMI had little effect on disease outcome. Herein, a systematic review and meta-analysis was conducted to investigate impact of gSMI on outcome of DTC. A systematic search of electronic databases (PubMed, EMBASE, Cochrane Library, and MEDLINE) for studies published until February 2020 was performed. Case-control studies and randomized controlled trials that studied the impact of gSMI on outcome of DTC were included. Six studies (all retrospective studies) involving 13,639 patients met final inclusion criteria. Compared with no extrathyroidal extension (ETE), patients with gSMI were associated with increased risk of recurrence ( = 0.0004, OR, 1.46; 95% CI: 1.18-1.80) and lymph node metastasis (LNM) ( < 0.00001, OR 4.19; 95% CI: 2.53-6.96). For mortality ( = 0.34, OR 1.47; 95% CI: 0.67-3.25), 10 year disease-specific survival ( = 0.80, OR 0.91; 95% CI: 0.44-1.88), and distant metastasis (DM) ( = 0.21, OR 2.94; 95% CI: 0.54-15.93), there was no significant difference between gSMI and no ETE group. In contrast with maximal ETE(extension of the primary tumor to the trachea, esophagus, recurrent laryngeal nerve, larynx, subcutaneous soft tissue, skin, internal jugular vein, or carotid artery), patients with gSMI were associated with decreased risk of recurrence ( < 0.0001, OR, 0.58; 95% CI: 0.44-0.76), mortality ( = 0.0003, OR 0.20; 95% CI: 0.08-0.48), LNM ( = 0.0003, OR 0.64; 95% CI: 0.50-0.81), and DM ( = 0.0009, OR 0.28; 95% CI: 0.13-0.59). DTC patients with gSMI had a higher risk of recurrence and LNM than those without ETE. However, in contrast with maximal ETE, a much better prognosis was observed in DTC patients with only gSMI.
PubMed: 33102203
DOI: 10.3389/fonc.2020.01687 -
Pediatric Ectopic Cushing Syndrome Caused by Hepatic Neoplasms: A Case Report and Systematic Review.Cureus Mar 2023Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is rare in children, and localizing the source of EAS is often challenging. Here, we report EAS in an...
Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is rare in children, and localizing the source of EAS is often challenging. Here, we report EAS in an adolescent boy who presented with Cushingoid features and had endogenous ACTH-dependent hypercortisolism on hormonal evaluation. Abdominal ultrasound and CT revealed a hepatic lesion with characteristics suggestive of hemangioma, whereas the lesion was tracer non-avid on Ga-DOTANOC positron emission tomography/CT. A regional sampling of ACTH was done to confirm the hepatic lesion as the source of EAS, and a definitive ACTH gradient was observed between the hepatic vein and the right internal jugular vein. Further, a preoperative biopsy of the lesion revealed a small round cell tumor with positive immunostaining for ACTH and synaptophysin, suggestive of a neuroendocrine tumor. The patient was managed with partial hepatectomy, resulting in hormonal and clinical remission of Cushing syndrome. In a systematic review of pediatric EAS due to primary hepatic tumors (n = 11), calcifying nested stromal epithelial cell tumors were the most common. EAS-associated hepatic tumors were larger (≥10 cm) except benign primary hepatic neuroendocrine tumors (PHNET). The latter were misdiagnosed as hemangioma in two cases by anatomical imaging but correctly diagnosed by somatostatin receptor scintigraphy. Hepatic tumors causing EAS in children required extensive resection, except benign PHNET. Nevertheless, all benign tumors with an uncomplicated perioperative course demonstrated disease-free survival over a median follow-up period of two years.
PubMed: 37123777
DOI: 10.7759/cureus.36852 -
The Annals of Pharmacotherapy May 2021To determine the optimal anticoagulation strategy in patients diagnosed with Lemierre Syndrome (LS).
OBJECTIVE
To determine the optimal anticoagulation strategy in patients diagnosed with Lemierre Syndrome (LS).
DATA SOURCES
A systematic review in accordance with PRISMA guidelines was conducted using PubMed, MEDLINE, Scopus, ProQuest, and CINAHL from January to April 2020. Search terms included "Lemierre Syndrome" AND "anticoagulation" NOT "prophylaxis" OR "atrial fibrillation," in addition to a list of parenteral and oral anticoagulants. Adult patients who developed a clot and required systemic anticoagulation as a result of LS were included in this review.
STUDY SELECTION AND DATA EXTRACTION
A total of 4180 records were initially identified, though following the removal of duplicates and nonrelevant entries, 216 full-text articles were reviewed for inclusion; 13 articles were ultimately included.
DATA SYNTHESIS
The majority (11/14) of patients developed thromboses of the internal jugular veins, which corresponds to the pathophysiology of LS. Anticoagulation strategies were varied in the included literature, though 12/14 patients initially received a parenteral product. Two patients received a direct-acting oral anticoagulant (DOAC) following either intravenous heparin or subcutaneous enoxaparin and had outcomes similar to patients transitioned to warfarin.
RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE
Anticoagulation in LS is a clinical controversy because the thromboembolic events have rarely led to significant complications; thrombi typically resolve independently, and concerns for bleeding risks are well founded; however, this review indicates both the efficacy and safety of anticoagulation.
CONCLUSIONS
Anticoagulation is both efficacious and safe in LS, including treatment using a DOAC. Although further studies are needed, clinicians should consider a duration of anticoagulation of 6 to 12 weeks.
Topics: Anticoagulants; Atrial Fibrillation; Disease Management; Drug Administration Schedule; Enoxaparin; Heparin; Humans; Jugular Veins; Lemierre Syndrome; Randomized Controlled Trials as Topic; Thromboembolism; Warfarin
PubMed: 32909436
DOI: 10.1177/1060028020957620 -
The Neurologist May 2021Cerebral venous sinus thrombosis (CVST) can rarely present with cranial neuropathies other than abducent nerve palsy. The authors report a case and review the literature...
INTRODUCTION
Cerebral venous sinus thrombosis (CVST) can rarely present with cranial neuropathies other than abducent nerve palsy. The authors report a case and review the literature for nonabducent cranial neuropathies in CVST.
CASE REPORT
A 22-year-old woman with a history of oral contraceptive use developed right-sided headache, blurred vision, and dizziness for 4 days. Magnetic resonance venogram showed complete thrombosis of the right transverse sinus, sigmoid sinus, and internal jugular vein, and partial thrombosis of the superior sagittal sinus, left transverse sinus, and superior part of the left internal jugular vein. Hypercoagulable workup revealed heterozygous factor V Leiden mutation. About 2 weeks after symptom onset, she developed right facial droop and left eye ptosis. Examination revealed bilateral papilledema, partial left ptosis, complete right abducent, and right peripheral facial palsies. Acetazolamide 250 mg 2 times per day was initiated for the treatment of headache. Three days after starting acetazolamide left ptosis, right facial and abducent palsies improved that continued to get better with only slight deficits at discharge 4 weeks from symptom onset. Follow-up computed tomography venogram on day 24 showed partial recanalization of CVST.
CONCLUSION
A systematic review identified 26 patients from 21 articles with nonabducent cranial neuropathies. Seven patients had lower motor neuron facial palsy, 13 patients had hearing loss or vertigo with vestibulocochlear involvement, and 6 patients had other mixed cranial nerve palsies with CVST. They are usually associated with transverse sinus and/or sigmoid sinus thrombosis. They have a good prognosis with improvement and complete resolution of cranial neuropathies in most cases usually in 1 month.
Topics: Adult; Female; Humans; Papilledema; Sinus Thrombosis, Intracranial; Superior Sagittal Sinus; Tomography, X-Ray Computed; Transverse Sinuses; Young Adult
PubMed: 33942790
DOI: 10.1097/NRL.0000000000000310 -
Frontiers in Physiology 2022The recent discovery of a venous thrombosis in the internal jugular vein of an astronaut has highlighted the need to predict the risk of venous thromboembolism in...
The recent discovery of a venous thrombosis in the internal jugular vein of an astronaut has highlighted the need to predict the risk of venous thromboembolism in otherwise healthy individuals (VTE) in space. Virchow's triad defines the three classic risk factors for VTE: blood stasis, hypercoagulability, and endothelial disruption/dysfunction. Among these risk factors, venous endothelial disruption/dysfunction remains incompletely understood, making it difficult to accurately predict risk, set up relevant prophylactic measures and initiate timely treatment of VTE, especially in an extreme environment. A qualitative systematic review focused on endothelial disruption/dysfunction was conducted following the guidelines produced by the Space Biomedicine Systematic Review Group, which are based on Cochrane review guidelines. We aimed to assess the venous endothelial biochemical and imaging markers that may predict increased risk of VTE during spaceflight by surveying the existing knowledge base surrounding these markers in analogous populations to astronauts on the ground. Limited imaging markers related to endothelial dysfunction that were outside the bounds of routine clinical practice were identified. While multiple potential biomarkers were identified that may provide insight into the etiology of endothelial dysfunction and its link to future VTE, insufficient prospective evidence is available to formally recommend screening potential astronauts or healthy patients with any currently available novel biomarker. Our review highlights a critical knowledge gap regarding the role biomarkers of venous endothelial disruption have in predicting and identifying VTE. Future population-based prospective studies are required to link potential risk factors and biomarkers for venous endothelial dysfunction to occurrence of VTE.
PubMed: 35574486
DOI: 10.3389/fphys.2022.885183 -
Cureus Sep 2023Lemierre's syndrome refers to septic thrombophlebitis caused by bacteremia. The incidence of Lemierre's syndrome has risen over the past two decades. This report...
Lemierre's syndrome refers to septic thrombophlebitis caused by bacteremia. The incidence of Lemierre's syndrome has risen over the past two decades. This report describes a case of a 31-year-old woman presenting with multifocal pneumonia and uncomplicated parapneumonic effusion, considered as COVID-19 pneumonia initially, then found to have Lemierre's syndrome with bacteremia and right internal jugular vein thrombophlebitis. Her condition improved after four weeks of antibiotics without anticoagulation. The article summarized the history, epidemiology, clinical presentation, differential diagnosis, and treatment of Lemierre's syndrome, the rare but severe complication of bacterial infection. The article also summarized six reported Lemierre's syndrome cases during the COVID-19 pandemic to emphasize the significance of having a broad differential diagnosis for respiratory symptoms, especially in the COVID-19 era.
PubMed: 37876396
DOI: 10.7759/cureus.45827