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admin | Category: What Cause Ed | 11.03.2014
A branch retinal vein occlusion, or BRVO, is an occlusion of one of the retinal veins serving the retina.  This is different than a central retinal vein occlusion which involves the entire retina.
Acute painless loss of vision is common, but some patients, as this one, have minimal or no vision loss. The degree of vision loss is related to the degree in which the macula is involved.  In this picture, the macula is barely involved as you can see by the small amount of blood located just above the macula. Again, the degree of vision loss with a BRVO directly correlates to the amount of macular edema caused by the BRVO.   Yes, that is to say, sometimes, if the macula is uninvolved, or spared, the vision remains perfect and patients are unaware of the occlusion. In general, treatment for a branch retinal vein occlusion (BRVO) is aimed at treating macular edema caused by the branch vein occlusion. If the macula is normal and has no swelling (edema), usually no treatment is required.  If macular edema is present (and vision is decreased), then treatment to improve the macular edema may be necessary. Most of the time, I need a combination of treatments to maximally reduce the macular edema.  Improvement in vision occurs quite often when treating BRVO and less often with central retinal vein occlusions (CRVO). Contrary to what one might imagine, our blood vessels are not waterproof and have pores that allow the input and output of cells, bacteria, proteins and water. When inflammation occurs, the blood vessels become more permeable to facilitate the arrival of the defense cells to the site of infection or trauma. The process of edema formation in a trauma or infection is easy to understand and is thoroughly explained in the link above. The increase in venous pressure occurs when there is some kind of obstruction, even partial, of the venous blood flow. Similar mechanism occurs in case of heart failure, where a weak heart cannot pump blood efficiently, again favoring the same situation in the lower limbs. Both heart failure and venous insufficiency in the lower limb, edema appears and worsens when the patient stands for a long time and tends to disappear after a few hours in bed, when gravity does not exert opposing force. One of the typical signs of swelling in the legs or locker is the Godet signal, which is the presence of a small sinking digital pressure to the skin. In some diseases, especially of renal origin, there is an accumulation of sodium (salt) in the body. The two mechanisms described above (vascular permeability and increased venous pressure) causes located edema, in the legs or the affected site of trauma or inflammation.
Another mechanism for the formation of lumps is decreased blood viscosity, called the oncotic pressure, and is mainly caused by the protein concentration in blood.
While the increase in pressure within the veins favors the leakage of liquids, the oncotic pressure acts the opposite way.
When one has a condition which reduces the blood proteins (albumin is the major), the patient tends to form edema, even though the pressure within the veins is normal.
A type of swelling characteristic of cirrhosis, and that is part of anasarca, is ascites, which occurs by leakage of fluid into the abdominal cavity. Another disease that can cause diffuse edema and ascites is the nephrotic syndrome, which is nothing more than a kidney disease where there is loss of protein in the urine. There is a kind of swelling that occurs mainly in young and healthy people, normally associated with the menstrual period.
Edema is often cyclical and many women take diuretics before the menstrual period for symptom relief. The diuretic wrongly indicated increases sodium retention, especially in the intervals between shots. So healthy people should not use diuretics for small edemas in lower limbs, especially if associated with menstrual periods. A type of edema is common in clinical practice that occurs in a patient with long hospitalization, especially in the ICU. Swelling of the feet, ankles and legs, also known as edema, is often caused by an abnormal build-up of fluids in ankle and leg tissues. Exercising the legs causes the fluid to work back into the veins and lymphatic channels so that the swelling goes down.


Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation.
The focus of the rest of this article is on pitting edema, as it is by far the most common form of edema. Edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities. The most common local conditions that cause edema are varicose veins and thrombophlebitis (inflammation of the veins) of the deep veins of the legs. In some cases, however, edema may be a sign of a more serious underlying medical condition.
This disease causes scarring of your liver, which interferes with liver function, causing changes in the hormones and chemicals that regulate fluids in your body, as well as increasing pressure within the large blood vessel (portal vein) that carries blood from your intestine, spleen and pancreas into your liver. When you have kidney disease, your kidneys may not be able to eliminate enough fluid and sodium from your blood.
Damage to the tiny blood vessels in your kidneys (glomeruli) that filter waste and excess water from your blood can result in nephrotic syndrome. In fact, the excessive water flows to the interstitial space, the space between the tissue cells. With the enlargement of pores, there is a greater fluid extravasation into the surrounding tissues. This increase has nothing to do with hypertension, which is the elevation of blood pressure.
This excess of salt increases the amount of body water, which consequently increases not only the blood pressure but also the venous pressure, favoring the appearance of bumps. Therefore, the formation of edema is a balance between the hydrostatic pressure and oncotic pressure. In this case the swelling is widespread, since the lack of protein occurs throughout the body. In fact, any serious chronic disease may inhibit the production of albumin by the liver and cause edema. The patient ends up being dependent on medication and cannot establish a causal link with the diuretic. It is best to reduce salt intake, stop taking drugs that may cause edema as nifedipine, amlodipine, anti-inflammatory rosiglitazone and minoxidil.
In case of severe brain swelling especially caused by trauma or other operative manipulation (tumor ablation), decompressive craniectomy with durotomy has not resulted in significant chances of recovery. Painless swelling of the feet and ankles is a common problem, particularly in older people. Mild pressure applied by elastic bandages or support stockings can help reduce ankle swelling.
Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. An accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in a disorder called pulmonary edema. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally.
The most common systemic diseases associated with edema involve the heart, liver, and kidneys. These conditions can cause inadequate pumping of the blood by the veins (venous insufficiency). This swelling (edema) is the result of excessive fluid in your tissues — often caused by congestive heart failure or blockage in a leg vein.


These problems can result in fluid accumulating in your legs and your abdominal cavity (ascites).
One result of nephrotic syndrome is low levels of protein (albumin) in your blood, which can lead to fluid accumulation and edema. Chronic venous insufficiency (CVI) is a condition in which the veins in your legs are weakened or damaged and can't pump enough blood back to your heart. There are three mechanisms for the formation of edema in addition to increased permeability of vessels. It is worth remembering that the arteries carry the blood from the heart to organs and tissues while the veins the other way bring back blood from the tissues to the heart. It is worth remarking that the veins of the legs must act against gravity, and when there is a defect in this system, there is a damming of blood in the lower limbs. Ascites has two mechanisms: caused both by the absence of albumin and by increased pressure in the veins of the liver common in cirrhosis. It occurs in elephantiasis, in cancers, in the morbidly obese and upper limbs of patients who do mastectomy and have their axillary lymph nodes removed. Avoid putting anything directly under the knees when lying down, and don't wear constricting clothing or garters on the upper legs.
The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema.
Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. In these diseases, edema occurs primarily because of the body's retention of too much salt (sodium chloride).
The resulting increased back-pressure in the veins forces fluid stay in the extremities (especially the ankles and feet). The accumulated blood in the veins increases the pressure within them and causes fluid extravasation into the subcutaneous tissue. When it stops working properly, reduced protein synthesis occurs and consequently it leads to the oncotic pressure.
When suspending the diuretic, there is a worsening of edema, which frightens and causes it to return the product. All tissues of the body are made up of cells and connective tissues that hold the cells together.
Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time. Swelling in the legs and feet may also be a symptom of other, more serious health issues, such as heart failure, renal failure, or liver failure.
Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling. With an increase in intracranial pressure (ICP) threatening with brainstem herniation, wide bilateral craniectomy was carried out, followed by dura opening and subsequent formation of a vascular tunnel in a simple way a€“using hemostatic sponge cushions a€“ around the main cortical veins at the entering points of the herniated area.
In various diseases, excess fluid can accumulate in either one or both of these compartments. Twenty operations with traumatic brain edema were performed using this vascular tunnel method. The results were promising in comparison with the well-known surgical or conservative treatment. Applying very strict selection criteria (Glasgow coma scale <6, signs of severe edema on CT, or intracranial pressure permanently a‰?30A mmHg) in this small series of patients with severe brain injury, good results were achieved using the new operative technique.



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