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Report on a 28-year-old man with acute impairment of vision (blurring) who was subsequently found to have extensive bilateral retinal edema with hemorrhages at posterior pole. A striking feature was the periphlebitic sheathing in this area. After systemic corticosteroid application visual acuity improved rapidly as the exudations regressed. Apart from the finding of circulating immunocomplexes non of the serological tests showed any pathologic changes. It is reasonable to assume that the appearance of the acute generalized periphlebitis was related to a past or still active viral process.

Among 15,000 neuroophthalmological patients examined in the years 1963 to 1977, 51 showed periphlebitic changes of the retinal veins. 46 of these patients were known to suffer from multiple sclerosis (MS). From his results that changes of the fundus of the eye are associated with a high degree of probability (about 90 per cent) with multiple sclerosis. In the same period of time, 422 patients were found to suffer from MS. From this one can calculate the relative frequency of periphlebitic changes of the retinal veins in MS cases to be about 10.9 per cent. Apart from their diagnostic importance, the findings are also interesting because they may indicate the significance of periphlebitic changes in the etiopathogenesis of MS.

A case history of a young man with recurrent papillophlebitis. The fluorescein angiogram showed an extensive hyperfluorescence of the disk and surrounding retinal veins in the venous and late phase. The electro-ophthalmological findings were normal in both eyes, while computerized perimetry demonstrated an enlarged blind spot in the bad eye but was normal in the other. The paper concludes with a description of the differential diagnosis of papillophlebitis, papillitis and papilledema caused by vascular occlusive disease or increased intracranial pressure.

Primary phlebitis or sprain phlebitis in the upper member are caused by a compressive mechanism in the thoraco-brachial passage. Thrombosis most often originates in the area of the cost-clavicular hinge, and spreads towards the extremity of the member. In this series, 19 cases were treated: 8 recent cases of phlebitis, in which results were all too often imperfect (5 failures), 11 post-phlebitic syndromes, in which there were 9 good results. The surgical procedure which we therefore recommend aims at the decompression of the collateral circulation flowing around the thrombosed area: this should be enough to improve results in a large proportion of cases.

We have described a patient who had Candida albicans suppurative thrombophlebitis at the site of an indwelling intravenous catheter. The microbial etiology was established by needle aspiration of the venipuncture site, affording rapid and accurate identification of the infecting organism and providing prompt institution of therapy. Phlebectomy and a brief course of amphotericin B prevented further dissemination of the infection.

Many neurological affections of the middle and posterior sections of base of skull may simulate tumors. Vascular disorders include diabetic lesions, diffuse cerebral vascularitis, vascular malformations, posterior fossa angioma, telangiectasis or cavernous hemangioma, and basilar artery aneurysms. Degenerative or deficiency nervous system affections may also simulate tumors, as well as bone or nerve malformations, such as erosions due to basilar artery compression. Arnold-Chiaris malformation, aqueduct stenosis, or an empty sella turcica.

From a 3,000 patients study, estimation of venous system by B-mode Imaging coupled with directional Doppler velocimetry is reported. Concordance in 85% of correlations between ultrasonic venography and conventional phlebography for deep vein calf thrombosis is promising. Real time venous echography provides reliable diagnosis with simple, repetitive and non-invasive control of deep veins system. Significant visualization of superficial veins system provides for non-occlusive disease or thrombotic lesions a new approach and eventual enlargement of surgical indications.

Lower extremity venography is essential to confirm the diagnosis of phlebitis when the clinical situation is not completely typical. 8 patients are presented, 6 of whom had been given prolonged prior anticoagulant therapy for phlebitis and pulmonary embolus. Normal venograms and reassurance led to resolution of symptoms in all cases.

Mondor's disease is described on the basis of 4 patients of our hospital. The typical finding is a subcuttaneous cord of about 5 min in diameter along the chest wall. The lenght varies from 10 to 40 cm. There is no significant preference of one sex. Often there are no symptoms like pain or tension of the skin. The clinical and histological examinations show in most cases a thrombosed vein at the junction of the subcutaneous tissue. Treatment does not result in a significant change of the natural course. Our study confirms, that Mondor's disease is benign and does not connote systemic disease or cancer.

Thirty-two patients with documented Eales' disease who have been followed-up at Johns Hopkins Hospital for periods of as long as 37 years were investigated. The previously reported association of Eales' disease with tuberculoprotein hypersensitivity was confirmed in 10 of 21 patients tested. For the first time, associated vestibuloauditory dysfunction is described. The previously reported association with multiple sclerosis was not confirmed. Eales' disease is a specific vasculopathy that can affect both the retinal and vestibuloauditory circulations. Patients with suspected Eales' disease should also be examined to rule out other diseases such as diabetes, sarcoidosis, and connective tissue diseases including systemic lupus erythematosus. This can be done by obtaining such tests as fasting blood glucose, chest radiograph, erythrocyte sedimentation rate, antinuclear antibody, rheumatoid factor, and LE cell preparation. Tuberculoprotein sensitivity status should be ascertained and active tuberculosis should be ruled out. The patient should be questioned regarding hearing or balance problems, and if a history suggestive of abnormalities is elicited, referral for vestibuloauditory function testing should be made.

Under observation there were 11 patients with destructive appendicitis complicated by pylephlebitis. Early antibiotic treatment using antibiotics of reserve under control of antibioticogram, introduction of metronidazole++, heparin and adequate desintoxicating therapy allows to anticipate successful results. The best results in shorter terms can be achieved by the intraportal administration of antibiotics, heparin and other drugs after recanalization and catheterization of the umbilical vein.

Venous lesions in Behçet's disease (BD) were defined by Adamantiades and represent one of the most suggestive signs of the disease. They are occasionally the first sign of the disease and are frequently the basis for the diagnosis in a case of recurrent thrombosis in a young subject, the preferential context of BD. Involvement of superficial vessels is virtually constant. Venous vasculitis is responsible for non-specific hypersensitivity and erythema nodosa, which constitute some of the major diagnostic criteria. Ocular periphlebitis is one of the elements responsible for posterior uveitis. The originality of the venous involvement is due to the involvement of deep territories. Any vein may be affected, but the remarkable features are the size of the thrombosed vessels: superior and inferior vena cava, iliofemoral veins and the unusual site of the involvement: supra-hepatic veins, cerebral vessels, etc. Inferior vena cava thrombosis may be associated with aneurysms of the pulmonary arteries in the context of Hughes-Stovin syndrome. Cerebral phlebitis, which can now be identified more easily by means of digital angiography, is responsible for a typical picture: headaches, bilateral papilloedema and raised CSF pressure. The classical pictures of optic chiasmatic arachnoiditis and so-called benign intracranial hypertension actually correspond to unrecognised phlebitis. They may also be associated with other neurological lesions. In one half of cases, phlebitis cutaneous manifestations. However, they may precede the diagnostic signs or may occur very late in the course of the disease. They are recurrent and affect a number of different territories.(ABSTRACT TRUNCATED AT 250 WORDS)

This report is based on eight patients with Mondor's syndrome. Its main clinical findings is linear retraction of breast skin probably due to thrombophlebitis or lymphangitis. The final diagnosis of Mondor's syndrome implies exclusion of breast cancer by mammography. A differential diagnosis of this entity is discussed.

Mercury gauge plethysmography with venous occlusion (PJC) is an atraumatic procedure for the diagnosis of deep venous thrombosis (TVP) of the lower limbs: 103 patients were studied both by plethysmography and phlebography (the reference examination). 54 were hospitalised for a suspicion of pulmonary emboli (EP), 21 for clinical phlebitis and finally 28 subjects had the studies as part of a systematic work-up. 60 cases of TVP of the lower limbs were discovered: 47 were recent, 34 were proximal and 13 sural. The clinical examination failed to reveal these in 36% of cases; the phlebographic and PJC results were concordant for 75% of cases: PJC seemed particularly to be the technique of high sensibility for the early diagnosis of proximal TVP but of a lesser interest for the early diagnosis of peripheral TVP (sensibility 69%). This examination makes an important contribution: for the early diagnosis of hidden proximal TVP; for the diagnosis of EP in its deceptive forms where the presence of a peripheral embolic focus constitutes one weighing factor towards the diagnosis of peripheral thrombo-embolic disease (MIE); for the control of anti-coagulant therapy in the clinic where the local inflammatory process and the biology controlling the consumption of heparin are jointly observed and the study of venous drainage allows an appropriate decision to be made as to the cessation of anticoagulant therapy and minimises the risk of recurrence or avoiding postphlebitis disease by a prolonged treatment.

In current phlebological practice nodular vasculitic lesions are described as being characterised by hypodermal perivascular inflammation. The aetiology is diverse: in this article hypodermatitis of varicose and postphlebitic origin, both of which are due to basic vein disorders and which are certainly the most often encountered phlebopathies in daily practice, are studied and then there is a further study of acute and sub-acute nodular hypodermatitis which in practice represents a differential diagnosis to the former but are less frequently encountered. Finally, other cases of hypodematitis due to yet more rare causes are recalled. Rare though these may be, the practicing physician must not fail to consider them when a patient who has come to see him presents with suspect nodular lesions of the lower limbs.

This article deals with a case of pleural metastases of an adenocarcinoma starting at an unknown point in a 59-year-old patient without notable circulatory antecedents, shown by a recurrent phlebitis having several sites over two months and a hemothorax.

Retinal periphlebitis appeared as an early sign of bacterial endophthalmitis in three patients, a 36-year-old man with bilateral Terson's syndrome who underwent vitrectomy for dense vitreous hemorrhage, a 78-year-old woman who had had intracapsular cataract extraction and penetrating keratoplasty after repair of a wound leak and pars plana anterior membranectomy, and an 18-year-old man who suffered an accidental penetrating ocular injury. Staphylococcus organisms were recovered from vitreous samples in all three cases. Although recovery of useful vision is rare after postvitrectomy endophthalmitis, the first patient attained a final visual acuity of 20/50. The visual acuities of the second and third patients returned to 20/25 and 20/20 respectively. In an experimental primate (cynomolgus monkey) model of bacterial endophthalmitis, retinal periphlebitis developed early and closely resembled the clinical findings in humans. Histopathologic studies confirmed the presence of inflammatory cells that infiltrated the retinal venules.

According to the author's data among 23 patients an etiological factor of the Mondor disease was trauma in 19 cases and infection -- in 4. A complete cure was gained in 2 weeks if a patient addressed for medical help during the period of thrombformation, whereas in the second stage -- in 3--4 weeks. A recurrence of the disease in a form of fibrous bands was observed among these patients in 3.2%. The treatment is accomplished under out-patient conditions.

The diagnosis of varicose veins is based on historical details pertaining to risk factors such as familial preponderance, advanced age, overweight, multiple births, professional activities carried out mainly in the standing or sitting position, use of oral contraceptives, diuretics or drugs which lower venous tone. Swelling of the legs on prolonged recumbancy, during pregnancy, fractures or cast treatment may be associated with thrombosis (Table 1). In addition to inspection and palpation in the standing and lying positions, the status of the pulses and the joints are of importance. The diagnostic measures must clarify the stage of the chronic venous insufficiency and provide adequate information on the various forms of venous functional disturbances (Table 2). Classification of varicose veins is carried out according to etiology--primary or secondary--or according to anatomical and functional derangement: with varicosities of the great saphenous vein and the lesser saphenous vein, in addition to valve incompetence at the proximal confluence of the saphenous-femoral junction, there may be segmental or global valve incompetence frequently in combination with a perforating vein incompetence. Varicosities of the great saphenous vein are classified with respect to whether the venous valves involved are those only in the region of the proximal confluence or from the inguinal region to above or below the knee or to the ankle, respectively, in four degrees of severity (Figure 1). For varicosities of the lesser saphenous vein, three degrees of severity are differentiated, the confluence incompetence, incompetence of the venous valves from the knee to the middle of the lower leg or from the knee to the ankle.4+ as the postthrombotic syndrome. Chronic venous insufficiency is characterized by venous hypertension and subdivided into three degrees of severity: grade I in the presence of corona phlebectatica paraplantaris and stasis edema; grade II in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of healed or florid ulceration. The two most important diagnostic measures are Doppler ultrasonography and ascending pressure phlebography which complement each other (Table 3)...

In this study the case is reported of a patient aged thirty in good general health who presented with oedema of the left lower limb, attributed to a deep phlebitis sustained in 1977. Clinical examination showed an old scar in Scarpa's triangle and a mycosis of the toes, and questioning revealed the precise circumstances of the "Phlebitis"; from this and with the aid of a dye test it was possible to rectify the diagnosis. Phlebography confirmed that the problem was one of lymphangitis and that the correct diagnosis was that of lymphoedema, secondary to an infection arising from the feet in a patient with a mechanical defect in the lymphatic circulation.

Occlusive rheoplethysmography (RPO) constitutes a new method of quantitative tetrapolar rheography. It enables us to assess peripheral venous function by measuring distensibility (symbol of influx = IR greater than 0.6, and of drainage = IV greater than 0.7), and flow (symbol of the drainage flow = IDV greater than 0.5). Deep venous thrombosis in the receptor trunk of the popliteal vein and vena cava reduces the IDB (obstructive syndrome). Isolated thrombosis of the tibial vein modifies only the distensibility (restrictive syndrome). RPO is extremely reliable in the diagnosis of acute venous thrombosis of the receptor trunk, as well as in the diagnoses of tibial thromboses, and so it facilitates the recognition of indicants for phlebography. RPO constitutes a simple, portable, rapid, economical and totally objective examination; its use in the observation of the efficiency of treatments as well as in the quantitative assessment of phlebitic after-effects means that it makes a valuable contribution to the management of venous disorders.

A 29-year-old patient suffering from Mondor's disease is described. This case is remarkable for the presence of two fragments of subcutaneous cords in the thoracic and abdominal area. Administration of indomethacin for 2 weeks has been fairly effective.

The blue test is designed to reveal oedema of total or partial lymphatic origin. It consists of the subcutaneous or intradermal injection in oedematous areas of a very small amount of violet patent blue and study of its resorption. The diagnosis is immediate and although reliability is not absolute it is nevertheless highly constant. Intolerance to the dye injected is rare, though sometimes severe, and users should be aware of the possibility. The Blue test remains of great interest in angeiology.

Within 3 years 2546 nosocomial infections were registered among 18 897 hospitalised patients of a gynaecological-obstetric university hospital, Results were obtained in a prospective study on the use of nurses specially trained in hygiene. The incidence of nosocomial infections was 13.5% including predominantly asymptomatic bacteriurias and 3.9% without bacteriurias. It was higher after major surgical intervention and lowest in pregnant women, postnatal patients, vaginal deliveries and minor operations. Bacteriurias were the most common infection in all patient groups. They made up 71% of the total, followed by postoperative pelvic infections (7.3%), phlebitis at the site of infusion (6.5%) and abdominal wound infection (4.2%). During the control programme, introduction and reinforcement of various hygienic measures and continuous instruction and control of the wards and treatment rooms by the specially trained nurses the incidence of all nosocomial infections decreased by 48.1% and of urinary tract infections by 42.7%.