A severe neurological event during a local anaesthesia phlebectomy

A 58 year old female patient underwent an intervention of phlebectomy below the knee. The patient gradually developed a severe neurological event and the Glasgow Coma Score decreased dramatically. After two and a half hours from onset, general conditions gradually improved and recovered completely. Lidocaine neurotoxicity was excluded. A right side motor deficit strongly suggests a transient ischaemic attack. As to invasivity, phlebectomy can be compared with liquid and foam sclerotherapy so that the simple question arises of also comparing their adverse effects. We have the strong conviction that this case may only be a co-incidental association.</jats:p

Foam sclerotherapy: cardiac and cerebral monitoring

Objectives To investigate and review collected and reported transcutaneous ultrasound, transthoracic echocardiography (TTE) and transcranial Doppler (TCD) data obtained during ultrasound-guided foam sclerotherapy (USGFS) of incompetent saphenous, tributary and perforating veins of the lower extremities. Methods TTE and/or middle cerebral artery TCD were performed during USGFS. Ultrasound (US) findings and adverse events were recorded. Existing literature was reviewed. Results Ultrasound detected emboli circulating in superficial, perforating, communicating and deep veins and into the central circulation. TTE detected bright echoes in the right heart after every injection and in the left heart in up to 65% of selected patients. TCD high-intensity transient signals (HITS) were detected in 14–42% of the patients. Incidence of HITS was higher than patient reports of adverse events. Incidence of HITS was independent of foam volumes injected. Conclusion Echogenic signals were detected in non-treated veins, in heart chambers and in the cerebral circulation by transcutaneous US, TTE and TCD. Pathological consequences of such findings remain to be investigated. </jats:sec

Upper limb secondary lymphedema ultrasound mapping and characterization

Background: Ultrasound investigation potentials in lymphedema are still to be fully used in everyday practice. Aim of the present study was to report the sonographic characterization of the dermo-epidermal complex (DEC) and of the subcutaneous (SUBC) tissue, assessing the feasibility of a related mapping, in upper limb secondary lymphedema. Methods: In this retrospective study 287 patients affected by monolateral upper limb post-mastectomy lymphedema (M5/F282; mean age 64±4.24) were enrolled and scanned by ultrasound, considering the healthy contralateral limb as control. In order to standardize the assessment, the limb was divided in sectors: 4 anterior, 4 posterior below the elbow, 4 anterior and 4 posterior above the elbow, plus the hand. DEC and SUBC regions B-mode appearance were reported, both in the healthy and in the pathological arms. DEC thickness was measured and compared among the same sectors of the healthy and pathological limbs. Results: DEC and SUBC sonographic appearance was differentiated in fluid and sclerotic. DEC included a third category characterized by differentiation loss. The different sectors showed significantly different lymphatic involvement in the affected limb. In the comparison with the contralateral unaffected segments a significantly thicker DEC was reported in the forearm affected by lymphedema (P&lt;0.005), while no significant difference was reported at the arm level. Conclusions: Traditional ultrasonography can provide a secondary upper limb lymphedema characterization with related mapping and useful data for a better lymphatic physiopathology understanding and for a properly addressed therapeutic protocol

Dairy science, 1969

Comparison of straw, shavings, peanut hulls, and shredded bark for bedding for dairy cattle / H. T. Nicholson, V. A. Neuhardt and L. O. Gilmore -- The interrelationship of scientific and practical principles of milking cows / K. L. Smith -- Magnesium deficiency (grass tetany) in cattle / L. A. Muir -- The relationship between rumen fermentation and diet / D. L. Palmquist -- Corn silage as the only forage for dairy cows / R. W. Wallenius -- Adaptation to urea rations / H. R. Conrad and J. W. Hibbs -- Alfalfa as an extender of urea / H. R. Conrad, J. W. Hibbs and V. A. Neuhardt -- Alfalfa and grain packaged in large high density bales as a complete feed for high-producing dairy cows / H. R. Conrad and J. W. Hibbs -- Response of dairy cows to corn and grain sorghum fed as soilage and silage / S. S. Gill, H. R. Conrad, W. H. Newland and W. J. Brakel -- Forage protein for dairy cows / R. W. Van Keuren and J. W. Hibbs -- Early cut forage is worth more for dairy cows / H. R. Conrad and J. W. Hibb

Fake-news-free evidence-based communication for proper vein-lymphatic disease management

Published scientific evidence demonstrate the current spread of healthcare misinformation in the most popular social networks and unofficial communication channels. Up to 40% of the medical websites were identified reporting inappropriate information, moreover being shared more than 450,000 times in a 5-year-time frame. The phenomenon is particularly spread in infective diseases medicine, oncology and cardiovascular medicine. The present document is the result of a scientific and educational endeavor by a worldwide group of top experts who selected and analyzed the major issues and related evidence-based facts on vein and lymphatic management. A section of this work is entirely dedicated to the patients and therefore written in layman terms, with the aim of improving public vein-lymphatic awareness. The part dedicated to the medical professionals includes a revision of the current literature, summing up the statements that are fully evidence-based in venous and lymphatic disease management, and suggesting future lines of research to fulfill the still unmet needs. The document has been written following an intense digital interaction among dedicated working groups, leading to an institutional project presentation during the Universal Expo in Dubai, in the occasion of the v-WINter 2022 meeting