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Varicose veins typically occur in the lower limbs, caused by valvular insufficiency leading to the swelling and tortuosity of subcutaneous veins. Although rare in the upper limbs, they can be successfully diagnosed and treated. Rare causes include congenital vascular anomalies like Klippel-Trenaunay syndrome and Parkes Weber syndrome, characterised by Arteriovenous (AV) fistulae. Subclavian vein thrombosis-induced venous outflow obstruction is another uncommon cause. Diagnosis involves a thorough history taking with clinical examination, often supplemented by investigations. Invasive procedures are rarely necessary but may be used in unique cases to define the pathology further. Treatment for upper limb varicose veins closely mirrors lower limb approaches. The stab-avulsion technique combined with stripping of lengthier sections yields outstanding cosmetic and functional results. Surgical ligation with stripping effectively eliminates varicosities with a low risk of recurrence. Sclerosing agents like Sodium Tetradecyl Sulphate and Polidocanol are substitutes for surgery. In cases of varicosities resulting from upper limb arteriovenous fistulae, surgical intervention involving ligation of the distal venous limb or division of the fistula is the standard approach. In summary, while upper limb varicose veins are exceptionally rare, they can be accurately diagnosed and effectively treated with surgical interventions similar to lower limb varicose veins.

Varicose veins typically occur in the lower limbs, caused by valvular insufficiency leading to the swelling and tortuosity of subcutaneous veins. Although rare in the upper limbs, they can be successfully diagnosed and treated. Rare causes include congenital vascular anomalies like Klippel-Trenaunay syndrome and Parkes Weber syndrome, characterised by Arteriovenous (AV) fistulae. Subclavian vein thrombosis-induced venous outflow obstruction is another uncommon cause. Diagnosis involves a thorough history taking with clinical examination, often supplemented by investigations. Invasive procedures are rarely necessary but may be used in unique cases to define the pathology further. Treatment for upper limb varicose veins closely mirrors lower limb approaches. The stab-avulsion technique combined with stripping of lengthier sections yields outstanding cosmetic and functional results. Surgical ligation with stripping effectively eliminates varicosities with a low risk of recurrence. Sclerosing agents like Sodium Tetradecyl Sulphate and Polidocanol are substitutes for surgery. In cases of varicosities resulting from upper limb arteriovenous fistulae, surgical intervention involving ligation of the distal venous limb or division of the fistula is the standard approach. In summary, while upper limb varicose veins are exceptionally rare, they can be accurately diagnosed and effectively treated with surgical interventions similar to lower limb varicose veins. [ABSTRACT FROM AUTHOR]

Duodenal varices are uncommon complications of portal hypertension. Although duodenal variceal bleeding is infrequent, it is a life-threatening condition with a high mortality rate. Non-surgical methods for duodenal variceal bleeding include endoscopic band ligation, endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and retrograde transvenous obliteration. On the other hand, an optimal treatment strategy for this rare condition has not been established. A 38-year-old male with a history of alcoholic liver cirrhosis presented with hematemesis. An emergency esophagogastroduodenoscopy (EGD) revealed large, multiple varices in the second portion of the duodenum, and plug-assisted retrograde transvenous obliteration (PARTO) was performed accordingly. Gastrointestinal bleeding was resolved after the procedure. Follow-up EGD conducted after 11 weeks revealed complete obliteration of the previously observed duodenal varices. PARTO may be considered a viable option for treating duodenal variceal bleeding.

A 72-year-old male presented to the Department of Shalyatantra with the chief complaint of longstanding swellings in the left forearm (as shown in [Table/Fig-1]) over the last 20 years, which had been progressively increasing in size and number over the last four years. There was no family history of varicose veins. There were no records of previous surgical interventions, and the patient’s medical history was non significant. Occasionally, the patient experienced discomfort, but he denied any precursor trauma or history of weightlifting.

Background and Aim: Portosystemic shunt embolization (PSSE) is a promising treatment for hepatic encephalopathy (HEP) and gastric varix (GV) in cirrhotic patients with a spontaneous portosystemic shunt. However, PSSE may worsen portal hypertension causing hepatorenal syndrome, liver failure, and mortality. This study aimed to develop and validate a prognostic model that helps identify patients with a risk of poor short‐term survival after PSSE. Methods: We included 188 patients who underwent PSSE for recurrent HEP or GV at a tertiary center in Korea. To develop a prediction model for 6‐month survival after PSSE, Cox proportional‐hazard model was used. The developed model was validated in a separate cohort of 184 patients from two other tertiary centers. Results: In multivariable analysis, the 1‐year overall survival after PSSE was significantly associated with baseline levels of serum albumin, total bilirubin, and international normalized ratio (INR). We therefore developed the albumin‐bilirubin‐INR (ABI) score by assigning 1 point each for albumin < 3.0 g/dL, total bilirubin ≥ 1.5 mg/dL, and INR ≥ 1.5. Time‐dependent areas under the curve of the ABI score for predicting 3‐month and 6‐month survival were 0.85 and 0.85 in the development cohort and 0.83 and 0.78 in the validation cohort, indicating good discrimination performance. The ABI score showed a better discrimination and calibration performance than the model for end‐stage liver disease and the Child–Pugh scores, especially in high‐risk patients. Conclusions: The ABI score is a simple prognostic model that helps decide whether to proceed with PSSE for the prevention of HEP or GV bleeding in patients with spontaneous portosystemic shunt. [ABSTRACT FROM AUTHOR]

Orbital venous malformations are low-flow lesions resulting from vascular dysgenesis during development. Patients may present with vision loss, proptosis accentuated by Valsalva, and/or painful spontaneous thrombosis. The preferred treatment for symptomatic lesions is embolization combined with excision. A 34-year-old male presented to our institution from an outside emergency department with a diagnosis of presumed idiopathic orbital inflammation. For the prior month, he had been experiencing left orbital pressure, subjective eye bulging, and both diplopia and blurry vision when in peripheral gaze or when bending over. Despite initial improvement with steroids, his symptoms recurred with tapering. Visual acuity was reduced to 20/25, but pupils and motility remained normal. Biopsy demonstrated a vascular lesion characterized by fibroadipose tissue with histologically unremarkable blood vessels, and cerebral arteriography showed no high-flow components. A diagnosis of orbital venous malformation was made. He then underwent intraoperative angiography and Onyx embolization followed by excision via a transcaruncular approach. Two prior reports have described the use of Onyx in venolymphatic malformations. This report highlights a detailed approach to defining flow characteristics pre- and intraoperatively and expands upon our understanding of the use of Onyx for such cases.

Portal vein aneurysm (PVA) is a rare vascular entity. Here, we describe cases of 2 separate patients who presented with congenital and acquired causes of PVA respectively. The first patient presented with vague abdominal pain and was incidentally diagnosed with PVA, whereas the cause in the second patient was iatrogenic. With a limited number of cases published to date, there is little data on the natural history of the disease. Herein, we will discuss the radiological findings aiding us in reaching our diagnosis and also the probable mimickers of the disease, with a brief overview of its possible causes, complications, and the currently available management options.

Orbital venous malformations are low-flow lesions resulting from vascular dysgenesis during development. Patients may present with vision loss, proptosis accentuated by Valsalva, and/or painful spontaneous thrombosis. The preferred treatment for symptomatic lesions is embolization combined with excision. A 34-year-old male presented to our institution from an outside emergency department with a diagnosis of presumed idiopathic orbital inflammation. For the prior month, he had been experiencing left orbital pressure, subjective eye bulging, and both diplopia and blurry vision when in peripheral gaze or when bending over. Despite initial improvement with steroids, his symptoms recurred with tapering. Visual acuity was reduced to 20/25, but pupils and motility remained normal. Biopsy demonstrated a vascular lesion characterized by fibroadipose tissue with histologically unremarkable blood vessels, and cerebral arteriography showed no high-flow components. A diagnosis of orbital venous malformation was made. He then underwent intraoperative angiography and Onyx embolization followed by excision via a transcaruncular approach. Two prior reports have described the use of Onyx in venolymphatic malformations. This report highlights a detailed approach to defining flow characteristics pre- and intraoperatively and expands upon our understanding of the use of Onyx for such cases. [ABSTRACT FROM AUTHOR]

Background: Orbital varices are rare, accounting for only 0-1.3% of orbital masses. They can be found incidentally or cause mild to serious sequelae, including hemorrhage and optic nerve compression. Case Description: We report a case of a 74-year-old male with progressively painful unilateral proptosis. Imaging revealed the presence of an orbital mass compatible with a thrombosed orbital varix of the inferior ophthalmic vein in the left inferior intraconal space. The patient was medically managed. On a follow-up outpatient clinic visit, he demonstrated remarkable clinical recovery and denied experiencing any symptoms. Follow-up computed tomography scan showed a stable mass with decreased proptosis in the left orbit consistent with the previously diagnosed orbital varix. One-year follow-up orbital magnetic resonance imaging without contrast showed slight increase in the intraconal mass. Conclusion: An orbital varix may present with mild to severe symptoms and management, depending on case severity, ranges from medical treatment to escalated surgical innervation. Our case is one of few progressive unilateral proptosis caused by a thrombosed varix of the inferior ophthalmic vein described in the literature. We encourage further investigation into the causes and epidemiology of orbital varices. [ABSTRACT FROM AUTHOR]

Abstract Background Esophageal varices (EV) are abnormally dilated veins in the esophagus caused by alterations of blood flow or pressure. Esophageal variceal hemorrhage is a major complication of hepatic disease in humans, but a lack of information exists regarding associated adverse events in dogs. Objective To describe the clinical manifestations and associated etiologies and outcomes of dogs with EV. Animals Twenty‐five client‐owned dogs with EV diagnosed via computed tomography (CT), endoscopy, or fluoroscopy. Methods Retrospective case series. Cases were identified by review of the hospital imaging records database between 2010 and 2020. Signalment, clinical signs, and outcomes were documented. When present, additional collateral vasculature was also recorded. Cases were subcategorized into suspected etiology based upon the anatomic location or absence of an attributable underlying disease process, as well as the direction of blood flow. Results Twenty‐four of 25 cases were identified via CT, with a prevalence of 0.012% (24/1950 total studies). Presenting clinical signs were nonspecific, and more likely because of the underlying cause as opposed to complications secondary to EV themselves. Etiologic anatomic locations were similar in occurrence between the abdomen (N = 14) and thorax (N = 11). All cases with an abdominal etiologic location had presumed or confirmed portal hypertension and 9/11 cases with a thoracic etiologic location had pulmonary, caval, or systemic hypertension. No cases died or were euthanized as a direct result of EV or associated hemorrhage. Conclusions and Clinical Importance Esophageal varices are rarely reported in dogs and commonly identified concurrently with portal, pulmonary, and caval hypertension. Hemorrhage is not a common clinical manifestation of EV.

The article presents a case study of a 72-year-old male with longstanding varicose veins in the left forearm, emphasizing the rarity of upper extremity varicose veins and exploring their diagnosis and management, including surgical interventions. Topics discussed include the etiology of upper limb varicose veins, differential diagnosis, and various treatment options, such as surgical procedures and lifestyle modifications.

The levoatriocardinal vein is an uncommon pulmonary venous abnormality that connects the left atrium or pulmonary vein with the systemic vein. It is distinct from partial anomalous pulmonary venous return in that the former forms a connection with the left atrium through the normal pulmonary vein whereas the latter involves pulmonary venous drainage to the systemic vein. Herein, we describe a case of the levoatriocardinal vein initially misdiagnosed as a pulmonary arteriovenous malformation using chest radiography and chest CT. The levoatriocardinal vein combined with pulmonary venous varix was confirmed using pulmonary angiography. To the best of our knowledge, this unusual coexistence of the levoatriocardinal vein and pulmonary venous varix has not been reported in English literature.

Varices are a common cause of gastrointestinal (GI) bleed. When ectopic, there is often a delay in diagnosis as it is difficult to localize these varices. Ectopic small bowel varices usually arise from portal hypertension, which commonly develops in the setting of cirrhosis. This case presents a much rarer cause of bleeding ectopic varices with portal hypertension secondary to chronic superior mesenteric vein (SMV) thrombosis that developed after an episode of hemorrhagic pancreatitis. An 81‐year‐old man with a past medical history of a recent GI bleeds secondary to an arteriovenous malformation presented to the hospital with continued melena after a recent admission at another hospital for the same symptom. Upper endoscopy and colonoscopy showed no evidence of active bleeding. Subsequently computed tomography angiography (CTA) showed bleeding from collaterals in the third part of the duodenum, consistent with ectopic varices. The CTA also showed SMV thrombosis. The patient underwent an ultrasound‐guided transhepatic venogram with coiling and sclerosant embolization of SMV varices and distal SMV balloon angioplasty. Capsule endoscopy after showed no evidence of further bleeding. The patient was discharged 72 h after the intervention with stabilized hemoglobin and resolved melena. Ectopic varices should be on the differential diagnosis for patients presenting with a GI bleed that remains nonlocalized after endoscopy and colonoscopy. EGD or colonoscopy is the first‐line intervention for the treatment of bleeding ectopic varices. If unreachable by these means, percutaneous coil embolization is an alternative way to stabilize the patient. As no general management guidelines exist, treatment of bleeding ectopic varices should continue to be case‐dependent and involve a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic stroke is caused by various vascular abnormalities, such as aneurysms, arteriovenous malformations, and dural arteriovenous fistulas (DAVF). Magnetic resonance angiography (MRA) and threedimensional computed tomography angiography (3DCTA) are used as efficient initial diagnostic modalities in assessing the etiology of hemorrhagic stroke. We describe the unusual case of a false-positive aneurysm on MRA and 3DCTA. Case Description: A 65-year-old nonhypertensive woman was brought to our hospital with a sudden onset of headache and left hemiparesis. She also had chemosis in the right eye. CT and magnetic resonance imaging showed an intracerebral hemorrhage in the right temporal lobe. MRA and 3DCTA showed a rounded mass suggestive of an aneurysm arising from the bifurcation of the middle cerebral artery (MCA) and also demonstrated an abnormal tortuous vessel contacting with a rounded mass. Digital subtraction angiography showed a transversesigmoid sinus DAVF with a varix in contact with the MCA bifurcation. Hematoma evacuation and venous drainage disconnection through the right frontotemporal craniotomy were performed. Conclusion: This case is very instructive and clinicians should keep in mind that detailed neurological and radiological examinations are essential in obtaining an accurate diagnosis, especially if the bleeding source is similar in shape and location to common lesions (such as a cerebral aneurysm). [ABSTRACT FROM AUTHOR]

Background: Esophageal varices (EV) are abnormally dilated veins in the esophagus caused by alterations of blood flow or pressure. Esophageal variceal hemorrhage is a major complication of hepatic disease in humans, but a lack of information exists regarding associated adverse events in dogs. Objective: To describe the clinical manifestations and associated etiologies and outcomes of dogs with EV. Animals: Twenty‐five client‐owned dogs with EV diagnosed via computed tomography (CT), endoscopy, or fluoroscopy. Methods: Retrospective case series. Cases were identified by review of the hospital imaging records database between 2010 and 2020. Signalment, clinical signs, and outcomes were documented. When present, additional collateral vasculature was also recorded. Cases were subcategorized into suspected etiology based upon the anatomic location or absence of an attributable underlying disease process, as well as the direction of blood flow. Results: Twenty‐four of 25 cases were identified via CT, with a prevalence of 0.012% (24/1950 total studies). Presenting clinical signs were nonspecific, and more likely because of the underlying cause as opposed to complications secondary to EV themselves. Etiologic anatomic locations were similar in occurrence between the abdomen (N = 14) and thorax (N = 11). All cases with an abdominal etiologic location had presumed or confirmed portal hypertension and 9/11 cases with a thoracic etiologic location had pulmonary, caval, or systemic hypertension. No cases died or were euthanized as a direct result of EV or associated hemorrhage. Conclusions and Clinical Importance: Esophageal varices are rarely reported in dogs and commonly identified concurrently with portal, pulmonary, and caval hypertension. Hemorrhage is not a common clinical manifestation of EV. [ABSTRACT FROM AUTHOR]

Oral varices are a common acquired vascular malformation that might be associated with several heart diseases. The aim of this study was to investigate whether an association exists between the severity of sublingual varices and stage of hypertension. Oral examinations were conducted, and the sublingual varicosity of 151 patients was categorized as grade 0,1, or 2 based on severity. The blood pressure of the patients was measured and classified as normal, prehypertenslon, stage 1 hypertension, or stage 2 hypertension according to the guidelines of the National Heart, Lung, and Blood Institute. Pearson chi-square test, linear-by-linear association, and logistic regression were used for data analysis. Of 151 patients, 91 (60.3%) had sublingual varices, with 68 (45.0%) having grade 1 varicosity and 23 (15.2%) having grade 2. Sublingual varices were seen most frequently (84.4%) in patients older than 60 years. The frequency of hypertension (stage 1 or 2) among the sample was found to be 24.5%. The Pearson chi-square test showed a positive correlation between hypertension and sublingual varicosity (P < 0.0001; y = 0.499). Logistic regression showed that the risk of hypertension in patients with grades 1 and 2 sublingual varicosity was 2.53 and 7.57 times greater, respectively, than that In patients with grade 0. In addition, sublingual varicosity (grade 1 or 2) was 2.32 times more frequent in men than in women (P = 0.022; 95% CI = 1.12-4.79) and 3.55 times more frequent in smokers than in nonsmokers (P = 0.003; 95% CI = 1.01-1.06). Therefore, sublingual varicosity may be a sign of hypertension. [ABSTRACT FROM AUTHOR]

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

Often discovered only after an extensive work up for hemoptysis and hematemesis, vallecular varices are a rare cause of oral bleeding that increase patient morbidity due to delay of diagnosis.We describe an 89-year-old male who presented with a week of intermittent oral blood production. A vallecular varix was identified on fiberoptic laryngoscopy after studies for hematemesis and hemoptysis had been performed, including negative esophagogastroduodenoscopy and bronchoscopy. Awareness of this pathology and key points in the patient history can direct the clinician toward the correct diagnosis, expediting treatment and limiting invasive diagnostic procedures for pulmonary or gastric etiologies of bleeding.

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objectives of this study were to determine the rate of hemorrhage following type I thyroplasty performed exclusively with Gore-Tex implant and to define whether age, comorbidities, anticoagulation therapy, presence of vocal fold ectasia, and operative technique are associated with increased incidence of hemorrhage. Medical charts of 86 patients who underwent type I thyroplasty with Gore-Tex implant between the years 2013 and 2019 were reviewed retrospectively and divided into two groups based on presence or absence of postoperative vocal fold hemorrhage. Patients were examined on the day following surgery. Hemorrhage was defined as any submucosal erythema on the vocal fold even when isolated to the superior surface. Age, sex, medical comorbidities, preoperative medications with specific attention to anticoagulation therapy, American Society of Anesthesiology score (all procedures were performed under local anesthesia with sedation), operative notes, and pre- and poststroboscopy exams were compared between groups. Statistical analyses were done using Chi-Square (χ 2) Analysis and Student's t test. P values were considered statistically significant at the P < 0.05 level. The rate of hemorrhage was 22.3%. There was a statistically significant difference in incidence of hemorrhage associated with a vocal fold varix on preoperative stroboscopic exam and history of discontinued anticoagulation therapy (1-week preoperatively). No difference was found for the other parameters studied. Presence of vocal fold varix or ectasia and preoperative use of anticoagulation or antiplatelet therapy are associated with an increased risk of hemorrhage following type I Thyroplasty with Gore-Tex implant. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe the clinical characteristics, multimodality imaging findings, and clinical course of iris varices. Methods: Retrospective, noncomparative, observational case series of 28 eyes of 26 patients with iris varices, diagnosed between 2007 and 2017, has been used. Results: The mean (±SD) age was 58.3 ± 12.5 years (median 57.5, range 37–81). Patients were 57.7% male and 27% hypertensive. Varices were bilateral in two patients. The mean and median visual acuities were both 20/20 (range 20/16–20/40). Intraocular pressures were 16 mmHg (10–23 mmHg). Secondary glaucoma did not occur. The inferotemporal iris quadrant was affected in 75%. A single varix was seen in 64% and 36% appeared multiple. Varix orientation was radial in 57% and circumferential in 21%. Combined radial and circumferential varix orientation was noted in 18%. One had independent radial and circumferential varices in separate quadrants. A single episcleral sentinel blood vessel directed to the varix was present in 36%. Ultrasound biomicroscopy (UBM) showed a slightly increased mean iris thickness of 0.8 mm and multiple echolucent iris stromal vascular channels. Iris angiography showed no leakage of dye. Managed by observation over a mean follow-up of 37.7 months (range, 3–129), 96.4% eyes were stable and one (3.6%) regressed. No corectopia, ectropion uveae, hyphema, or metachronous anterior segment benign or malignant tumors occurred. Conclusion: Iris varix is primarily located in the inferotemporal quadrant and not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy. Iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.

Cervical varix is rare and can develop due to various conditions in pregnancy. Most cases of cervical varix during pregnancy are diagnosed in the second or third trimester and are usually associated with abnormal placental location, such as placenta previa or low-lying placenta. A 23-year-old woman with cervical varix bleeding visited our institution at 8 weeks of gestation. This case report describes cervical varix bleeding that developed into a venous thrombus in the first trimester. Ultrasonography with color Doppler and magnetic resonance imaging could be helpful in diagnosis.

Umbilical vein varices are rare umbilical cord anomalies that typically occur intra-abdominally. Extra-abdominal umbilical vein varices are exceedingly rare and usually diagnosed postnatally on gross pathologic examination. Umbilical vein varices have been associated with increased risk of fetal anemia, cardiac abnormalities, and intrauterine fetal demise. This case report discusses a patient who presented with a massive extra-abdominal umbilical vein varix, whose infant was ultimately delivered due to fetal distress and died in the neonatal period. This report also discusses associated fetal conditions and guidelines for antenatal testing and surveillance of known umbilical vein varices. [ABSTRACT FROM AUTHOR]

Investors and collectors hold gold as protection for their savings and wealth at large. Gold does not pay interest like treasure bonds or savings accounts, but current gold prices often reflect increases and decreases of an asset. This research aims to provide a model for the relationship between the exchange rate, which is vital in exporting gold, and gold prices across countries. The Australia, Brazil, and South Africa exchange rates are used as a case study against the gold price. The ARIMA model is used for forecasting gold price as an input for the Transfer Function and VARIX models. The Transfer Function model only considers the relationship between gold prices as input with the exchange rate in each country, whereas the VARIX model also considers the interrelationship between exchange rates in these countries. Daily data is used for the period 1st June 2010 to the 28th February 2018. The RMSE and MAPE are used as criteria for selecting the best model. The results show that VARIX is the best model for forecasting the Australian exchange rate, while the Transfer function is the best model for forecasting South African and Brazilian exchange rates. [ABSTRACT FROM AUTHOR]

A 68-year-old man visited our hospital complaining of painless left scrotal swelling. Stony hard mass was palpable at cephalad side of the testis. MRI showed a solid component mass mimicking epididymal tumor. Thus, exploratory surgery was performed. Since the tumor was firmly adhesive to the spermatic cord, an orchiectomy was unavoidable. The pathological result was hematocele of the spermatic cord.

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

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Background and Aims: Few studies have directly compared the efficacy of sedated‐ and un‐sedated endoscopic variceal ligation (EVL) for acute variceal bleeding. We aimed to determine whether sedation during EVL in patients with variceal bleeding is safe and effective. Methods: We analyzed data from patients who underwent EVL for acute variceal bleeding according to sedation in six hospitals of Hallym University Medical Center. The primary endpoint was treatment failure, defined as a failure to control bleeding, death during EVL, or rebleeding within 5 days. Secondary endpoints included the procedure time, adverse events, and 30‐day mortality. Results: Of 1,300 patients who were included, only 430 (33.1%) received sedation during EVL. Propofol alone was used for sedation in 85% of sedated‐EVLs. The mean procedure time in the sedation group was shorter than that of the non‐sedation group (12.4 ± 9.5 min versus 13.8 ± 9.4 min, P = 0.010). The proportion of treatment failure did not differ between the groups (7.4% versus 9.1%, P = 0.374). In the multivariable analysis, an AIMS65 score ≥2 and blood transfusion within 72 hours were associated with treatment failure of EVL; however, the use of sedation was not (odds ratio [95% confidence interval (CI)] = 0.96 [0.60–1.51]). Adverse events during EVL and hepatic encephalopathy did not differ between the two groups. Sedation also did not affect the 30‐day mortality (hazard ratio [95% CI] = 0.99 [0.66–1.47]). Conclusion: Sedation reduced the procedure time of EVL. Sedation is safe to use during EVL for variceal bleeding in patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration. [ABSTRACT FROM AUTHOR]

Objective: We aimed to review a single-center experience in follow-up and management of fetuses with umbilical vein varix (UVV) and to assess the effect of UVV on fetal Doppler parameters.Methods: We reviewed retrospectively maternal antenatal records, delivery records, and newborn records to identify cases of UVV. Further, we retrospectively compared 25 fetuses with isolated UVV and available cerebroplacental ratio (CPR) analysis with 75 matched controls.Results: We identified 67 cases of UVV. The median gestational age (GA) at diagnosis was 34 weeks (range: 26-41 weeks). The average diameter of UVV at diagnosis was 10.1 mm (range: 9-14 mm). The median GA at delivery was 36 + 6 (range: 33-41 weeks), with an average birth weight of 2918 g (range: 1278-4140 g). There was a single case of intrauterine death at 35 weeks. CPR was 2.13 ± 0.62 in isolated UVV group compared with 1.84 ± 0.61 in the control group (p < .05). Other Doppler parameters did not differ between fetuses with UVV compared with controls.Conclusions: CPR was significantly increased in the UVV group compared with control fetuses. This finding suggests that UVV is not associated with chronic fetal oxygen deprivation; it, therefore, may contribute to our understanding of the pathophysiology explaining abnormal pregnancy outcome in cases with UVV. [ABSTRACT FROM AUTHOR]

Orbital varix (or varicose) is an exceptional pathology with poor clinical sign. The blepharospasm can be a revealing cause. The long-term risk is optic atrophy and blindness. Magnetic resonance imaging is the best diagnostic tools. The rise of lesion dimensions by Valsalva maneuvers and prone position is characteristic. We report the observation of a 42-year-old young man, consulting for a blepharospasm of the left eye evolving for two years. Imaging investigations made the diagnosis of orbital varicose.

Gastropod shells display striking patterns in both color and sculpture, but rather little is known about the developmental mechanisms that produce those patterns. Here, we tested a physical feedback hypothesis for how snails control spatial patterning of shell sculpture. Varices—a form of synchronized, blade‐like axial sculpture—are produced at regular intervals around the shell and often aligned closely between adjacent whorls. Older varices were believed to provide a spatial cue about where to position a new varix. To test this hypothesis, we manipulated physical cues by cutting off varices or attaching new ones to the body whorl of individuals of Ceratostoma foliatum, and then allowing snails to grow a new varix. We found that previous varices on the shell were neither necessary nor sufficient to induce a new varix at a particular location. However, the position of older varices did appear to affect the fine tuning of subsequent varix placement. The results of our experiments therefore suggest that varix synchrony arises mainly from some internal mechanism that yields a standardized amount of spiral growth per growth spurt. We also found that shell damage can induce varix production in unusual or aberrant locations during subsequent shell growth. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe the clinical characteristics, multimodality imaging findings, and clinical course of iris varices.Methods: Retrospective, noncomparative, observational case series of 28 eyes of 26 patients with iris varices, diagnosed between 2007 and 2017, has been used.Results: The mean (±SD) age was 58.3 ± 12.5 years (median 57.5, range 37-81). Patients were 57.7% male and 27% hypertensive. Varices were bilateral in two patients. The mean and median visual acuities were both 20/20 (range 20/16-20/40). Intraocular pressures were 16 mmHg (10-23 mmHg). Secondary glaucoma did not occur. The inferotemporal iris quadrant was affected in 75%. A single varix was seen in 64% and 36% appeared multiple. Varix orientation was radial in 57% and circumferential in 21%. Combined radial and circumferential varix orientation was noted in 18%. One had independent radial and circumferential varices in separate quadrants. A single episcleral sentinel blood vessel directed to the varix was present in 36%. Ultrasound biomicroscopy (UBM) showed a slightly increased mean iris thickness of 0.8 mm and multiple echolucent iris stromal vascular channels. Iris angiography showed no leakage of dye. Managed by observation over a mean follow-up of 37.7 months (range, 3-129), 96.4% eyes were stable and one (3.6%) regressed. No corectopia, ectropion uveae, hyphema, or metachronous anterior segment benign or malignant tumors occurred.Conclusion: Iris varix is primarily located in the inferotemporal quadrant and not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy. Iris varices were benign vasculopathies with no associated ocular or vision-related morbidity. [ABSTRACT FROM AUTHOR]

Background Pial arteriovenous fistulas (PAVFs) are rare, accounting for 1.6%–4.7% of all intracranial vascular malformations. Often diagnosed in childhood, about 30% are associated with hereditary hemorrhagic telangiectasia. A case of PAVF diagnosed soon after birth and given cerebrovascular therapy 4 months after birth is reported. Case Description The patient presented with heart failure immediately after birth. Ultrasonography of the head showed abnormal blood flow in the brain. On digital subtraction angiography performed 4 months after birth, a PAVF with a dural feeder shunt and a giant varix at the posterior temporal part was confirmed. After transarterial embolization (TAE), shunt blood flow disappeared. New shunt flow from the right posterior cerebral artery into the varix was confirmed by magnetic resonance imaging 3 months after the operation. A second TAE procedure using a liquid embolic material was performed and confirmed the complete disappearance of the shunt. Conclusions This report describes a case of infant PAVF with heart failure, a giant varix, hydrocephalus, and intraventricular hemorrhage treated by TAE using platinum coils and liquid embolic material. [ABSTRACT FROM AUTHOR]