Enterocolic granulomatous phlebitis associated with epidermal growth factor-containing fibulin-like extracellular matrix protein 1 deposition and focal amyloid properties: A case report

A woman in her 60s with rheumatoid arthritis was admitted with fever and abdominal pain. Laparoscopic examination with the differential diagnosis of peritoneal neoplasm and infection revealed granulomatous phlebitis in the resected greater omentum. Amorphous eosinophilic deposits observed in the resected tissue exhibited focal, weak positivity for Congo red but were strongly positive for thioflavin S, confirming their focal amyloid properties. Marked degeneration of elastic fibers was also evident. Electron microscopy revealed deposits around the affected elastic fibers. Immunohistochemistry revealed the deposition of epidermal growth factor-containing fibulin-like extracellular matrix protein 1 (EFEMP1) along with T-cell-predominant lymphocytic inflammation. The definitive diagnosis was granulomatous enterocolic lymphocytic phlebitis (ELP) associated with EFEMP1 deposition exhibiting focal amyloid properties (EFEMP1/AEFEMP1), supported by proteomics analysis. This type of vasculitis is similar to amyloid-β-related angiitis of the central nervous system. Thus, we speculate that granulomatous ELP also results from an immune response that recognizes EFEMP1/AEFEMP1 deposits as foreign material and attempts to remove them. Confirmation of EFEMP1/AEFEMP1 deposition with Congo red staining is challenging, particularly in the presence of inflammation, and warrants comprehensive evaluation.

Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial

BACKGROUND

Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion.

OBJECTIVE

To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters.

DESIGN

This was a prospective, randomized, controlled, open-label trial.

SETTING

Patients were recruited from 14 medical institutions in China between February and June 2023.

PARTICIPANTS

In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group.

METHODS

Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups.

RESULTS

After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449-0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039-0.142) in the intervention group and 23.8 % (30/126, 0.167-0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858-0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748-0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622).

CONCLUSION

The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety.

REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311.

Protective effect of isoliquiritigenin in amiodarone-induced damage of human umbilical vein endothelial cells

OBJECTIVE

Amiodarone (AM) is a drug commonly used in patients with ventricular arrhythmias. It can damage vascular endothelial cells and easily cause phlebitis. At present, the prevention and treatment of phlebitis induced by the use of AM is not clear due to the lack of corresponding primary research. Isoliquiritigenin (ISL) has an anti-inflammatory effect, but until now, has not been explored much in the field of research in primary care nursing. The purpose of this study is to investigate the efficacy and mechanism of action of ISL in treating phlebitis induced by AM.

METHODS

In our study, we used human umbilical vein endothelial cells (HUVECs) that were divided into three groups: the NC group (normal), the AM group (AM 30 μmol/L for 24 h), and the ISL pretreatment group (isoliquiritigenin 10 μmol/L after 1 h of pretreatment with amiodarone for 24 h). We used CCK-8 to detect cell proliferation, cell scratch assay to detect the migration capability of cells, flow cytometry to measure apoptosis, angiogenesis assay to check the total length and total branches of angiogenesis, and PCR and WB to detect the expression of PCNA, casepase-3, and VEGFA. WB was used to detect NF-κBp65 and p-NF-κBp65 expression.

RESULTS

Compared with the AM group, the ISL pretreatment promoted cell proliferation and migration, inhibited cell apoptosis, increased the total length and total branches of angiogenesis, and downregulated p-NF-κBp65 expression.

CONCLUSION

ISL shows promise in the prevention and treatment of clinical phlebitis and can be used as a potential therapeutic drug to prevent phlebitis.

Identification of potentially irritating intravenous medications

AIMS

To identify commonly used intravenous drugs that may produce endothelial damage.

METHODS

An experimental research study was performed using a sample of 62 intravenous drugs commonly used in emergency care, pH and osmolarity were measured. Subsequently, based on these values, the theoretical capacity to cause irritation or endovascular damage was determined and classified as high, moderate, and low.

RESULTS

Samples from 19 drugs for fluid therapy, 21 antibiotics and 22 drugs for intravenous use were studied. Glucose solutions, sodium bicarbonate 1M and mannitol 10% showed a high capacity to cause venous irritation. Vancomycin, ciprofloxacin, amiodarone, haloperidol, and labetalol solution presented a high capacity for irritation based on their acidic pH. The antibiotics, dexketoprofen, diazepam, digoxin, etomidate, phenytoin, levetiracetam and metamizole also showed high osmotic values in their reconstituted or undiluted presentations. Moreover, osmolarity of diazepam, digoxin and phenytoin remained high despite being diluted in 100 ml of saline.

CONCLUSIONS

Knowing the pH and osmolarity of intravenous drugs allows their capacity to cause endothelial damage to be assessed. The use of comprehensive tables based on the chemical properties of the drugs can be a useful tool to help prevent chemically-induced phlebitis.

[Functional venous insufficiency: diagnosis and treatment (literature review) (Part I)]

Reviewed herein are the available literature data concerning functional venous insufficiency (phlebopathies). Part I analyses the data on terminology, epidemiology, effect on quality of life, aetiology and pathogenesis, risk factors, as well as possible methods of diagnosis of this pathological condition.

METHOD

search in the MEDLINE database by means of the PubMed system.

[Study on the risk factors regarding deep venous thrombosis in acute pulmonary thromboembolism]

OBJECTIVE

To identify the risk factors of deep venous thrombosis(DVT) in patients with acute pulmonary thromboembolism (PTE).

METHODS

Post hoc analysis on data from a prospective multicenter through a randomized control trial on thrombolysis and anticoagulant among 454 patients with acute symptomatic PTE from June 2002 to December 2004. All patients were confirmed PTE by CT pulmonary angiography (CTPA) and/or ventilation perfusion scan or by magnetic resonance pulmonary angiography. Data of PTE patients with DVT was compared with those without DVT to identify the DVT risk factors. The effect of other variable on DVT was assessed by logistic regression analysis.

RESULTS

When comparing the age, sex body weight index and underlying diseases including hypertension, coronary heart disease, chronic obstructive pulmonary disease, cerebral accident and malignant tumor between groups of DVT and no DVT,data showed that there was no statistically significant difference except for diabetes (chi2 = 4.481, P = 0.034) among them.However,results from multi-analysis showed that edema of lower-limb [odd ratio (OR), 2.255; 95% CI, 1.493 to 3.408], phlebitis (OR, 2.380; 95% CI, 1.426 to 3.973) and the entire swollen (calf swelling > or =1 cm) larger than asymptomatic side (OR, 3.834; 95% CI, 2.561 to 5.738) were independent risk factors for DVT.

CONCLUSION

Edema of lower-limb, phlebitis and calf swelling > or =1 cm seemed to be risk factors for DVT.

Traitement chirurgical d'une thrombose de la veine mésentérique

INTRODUCTION

Mesenteric venous thrombosis is a rare form of mesenteric ischemia that can be lethal when appropriate treatment is delayed.

CASE

A 61-year-old woman consulted with nonirradiating epigastric and left upper abdominal pain, nausea and vomiting, all of which had been increasing for 4 days. Two years earlier, she had had phlebitis and a pulmonary embolism. Her white blood cell count was 15,300/mm3. Abdominal computed tomography (CT) showed thrombosis of the superior mesenteric vein with no evidence of intestinal parietal ischemia. The patient received a full dose of heparin promptly and underwent selective intra-arterial thrombolysis. As her clinical condition deteriorated, an emergency laparotomy was performed to resect 1.5 meters of gangrenous jejunum. Full anticoagulation with heparin was resumed postoperatively, and she was discharged 15 days after surgery. She continued taking oral anticoagulants. All results of a thorough laboratory work-up were negative.

DISCUSSION

The clinic presentation of acute mesenteric venous thrombosis is generally insidious. CT scanning is a reliable diagnostic method. The goal of initial treatment is to define the underlying cause of the patient's hypercoagulable state and to treat it appropriately. After achieving appropriate anticoagulation, patients should start long-term warfarin. Indications for surgery include signs of peritonitis, possible bowel infarction, and hemodynamic instability. Once treated, patients with this condition have a fairly good prognosis.

Symptomatic combined homozygous factor XII deficiency and heterozygous factor V Leiden. luscaber@tin.it

A family with a combined deficiency of factor XII and factor V Leiden is presented. The proposita is a 72-year-old who showed a mild to moderate thrombotic tendency characterized by two episodes of deep venous thrombosis and superficial phlebitis between the age of 50 and 71. She was shown to be carrier of homozygous factor XII deficiency and heterozygous FV Leiden mutation. A sister of the proposita showed the same pattern but remained asymptomatic. Other family members showed either isolated heterozygous factor XII deficiency or combined heterozygous factor XII deficiency and heterozygous FV Leiden mutation but were all asymptomatic. These data lend support to those who maintain that FV Leiden is a mild genetic determinant for thrombosis. The role of FXII deficiency as an additional risk factor remains questionable.

[Eales disease with neurologic manifestation: differential diagnosis of multiple sclerosis. Report of two cases]

BACKGROUND

Eales disease is a condition associating recurrent vitreous and retinal hemorrhage related to retinal periphlebitis. This ophthalmological disease is sometimes associated with central nervous system manifestations.

CASE REPORT

Two patients with Eales disease of the retina developed a progressively worsening neurological deficit several years later.

DISCUSSION

Evidence of multifocal anomalies of the white matter initially suggested a possible association of Earles disease with multiple sclerosis. Pathology findings enable formal differentiation of these two entities. Earles disease with neurological manifestations remains an uncommon condition and constitutes a differential diagnosis of multiple sclerosis.

Studies in phlebitis. VII: In vitro and in vivo evaluation of pH-solubilized levemopamil

We describe a computational model and an in vitro experiment for assessing whether or not a pH-solubilized drug has the potential to precipitate upon dilution with blood. The computational model enables an efficient means of selecting buffer concentration and pH, and the in vitro test provides a simple experimental validation. Both means of screening are applied to the formulation of the weakly basic drug levemopamil-HCI. A buffered formulation of levemopamil is chosen from the computational model and shown to be free of precipitation upon dilution in vitro and to not produce phlebitis in the rabbit ear model. In comparison, an unbuffered formulation at the same pH and drug concentration precipitates in vitro and causes significant phlebitis in vivo. The results of this study reinforce the importance of buffering parenteral formulations instead of simply adjusting the pH of the formulation.

[Venous pain, 30 years after the 1st International Congress of Phlebology in Chambéry]

In 1960, the first International Conference of Phlebology, organised at Chambéry by Jean Marmasse under the egis of R. Tournay included only three subjects in its programme, one of which was: "venous pain". What is the status of venous pain thirty years on? Can we compare our current concepts with work from past years? Have we advanced in knowledge and in its clinical and therapeutic applications? All these questions are even more worthy of consideration bearing in mind world-wide increased interest in Phlebology and its even richer future. The Chambéry Conference established a clear pattern with: two basic reports: "pain due to essential varicose veins and to trophic disorders" (C. Huriez, F. Desmons, M. Thoreux) and "pain in phlebitis" (R. Fontaine); three analytical and differential reports "pain due to interlinked arterial and venous disorders" (F. Piulachs), "pain in the lower limbs due to interlinked gynecological and venous disorders" (A. Bret, R. Legros) and "pain due to the association of osteoarticular and rheumatic disorders or of neuralgia in venous disease patients" (J. Forestier); and nine other studies, the following being worthy of particular attention: a very interesting report by R. Tournay: "Pain in venous disorders of the lower limbs related to their treatment"; and two papers: "pain of "cellulite" type and the metameric disposition of the lower limbs in relation to functional disorders of the ovary" (S. Bourgeois), and "exercise pain and rest pain in varicose vein sufferers" (J. Marmasse); three German reports (F. Jaeger, F. Maid-Fischer and D. Gross) on the pathogenesis and mechanisms of venous pain; and the report of M. Comel "epiesthesia and histoangeological correlations". Since that time, venous pain has no longer figured in the same format on the programme of any international conference, nor at meetings of the French Society of Phlebology. Progress has thus occurred insidiously... Mention may be made of the following with regard to essential varicose veins: some progress in knowledge of cramps, phlebalgia and venous paresthesiae; attribution to venous syndromes of "restless legs", which have been such a source of intrigue for the past hundred years, and interest in inflammatory pain of the superficial venous system and of subcutaneous cellular tissue in relation with venous insufficiency, as well as ulcer pain. However, it is in the area of acute deep venous thrombosis that everything has been disrupted. Firstly, with the established certainty that the clinical picture leads to errors in more than 50 p. cent of cases, both by excess and default.(ABSTRACT TRUNCATED AT 400 WORDS)

[Mondor's disease. Considerations on 5 cases]

The clinical, anatomical, topographical and pathological features of Mondor's disease are described, and five personal cases are presented. Their aetiopathogenetic characteristics reflect the doubts expressed in the literature. Stress is laid on the benign nature of the disease, the possibility of treating it at the out-patient level, and the complete remission of both subjective and objective symptoms obtainable in the space of a few weeks.

30-year observation of patients with Eale's disease

Of 135 patients with Eale's disease, two thirds of the patients were men around 20 years of age at the onset, while the women were older. The disease continued from six months to 51 years. Several patients were followed for 40 years. The prognosis for useful vision was good as only one patient became blind in both eyes.