Anatomical Study of the Cardiac Veins and their Tributaries in Bovines (Bos indicus) in Comparison with Humans and Other Animal Species / Estudio Anatómico de las Venas Cardiacas y sus Tributarias en Bovinos (Bos indicus) en Comparación con Humanos y Otras Especies Animales

SUMMARY: In bovines, anatomical observations of the coronary vascular tree describe qualitative characteristics. The objective of this study was to morphometrically characterize the coronary veins and their tributaries in cattle. An arcuate application with 2.0 silk was performed around the ostium of the coronary sinus of 28 bovine hearts and a number 14 catheter was placed, through which semi- synthetic polyester resin and mineral blue color was perfused. In 22 hearts (78.6 %) the great cardiac vein was originated at the cardiac apex. The configuration of the arteriovenous trigone was mainly closed inferior and superior types (50 %). The caliber of the great cardiac vein at the level of the atrioventricular sulcus was 6.7 +/- 1.2 mm. The origin of the left marginal vein was observed in the lower third of the left cardiac margin (53.6 %), its distal caliber was 4.1 +/- 0.8 mm and its drainage was at the level of the great cardiac vein. The middle cardiac vein originated from the cardiac apex in 78.6 % of the samples, emptied mainly into the coronary sinus (82.1 %) and its distal caliber was 4.7 +/- 0.9 mm. Anastomoses occurred in 28.6 % of the hearts, being found in most cases between the middle cardiac vein and the great cardiac vein (50 %), which was significant compared to other anastomoses (p<0.001). The length of the coronary sinus was 42.2 +/- 5.1 mm, its distal caliber was 13.8 +/- 2 mm, and its shape was cylindrical. Myocardial bridges were found in 3 hearts (10.7 %) mainly in the lower third of the middle cardiac vein (66.6 %). Most of the main coronary veins drained into the coronary sinus, with some cases with atypical outlets and the presence of a high percentage of anastomosis that serves to improve cardiac venous drainage in case of venous compression or obstruction.

En bovinos, las observaciones anatómicas de árbol vascular coronario describen características cualitativas. El objetivo de este estudio fue caracterizar morfométricamente las venas coronarias y sus tributarias en bovinos. Se realizó una aplicatura arciforme con seda 2.0 alrededor del ostium del seno coronario de 28 corazones de bovino y se colocó un catéter número 14, a través del cual se perfundió resina de poliéster semisintética y color azul mineral. La vena cardiaca magna se originó en 22 corazones (78,6 %) en el ápex cardiaco. La configuración del trígono arteriovenoso fue principalmente cerrado inferior y superior (50 %). El calibre de la vena cardiaca magna a nivel del surco atrioventricular fue 6,7 +/- 1,2 mm. El origen de la vena marginal izquierda se observó en el tercio inferior del margen izquierdo cardiaco (53,6 %), su calibre distal fue 4,1 +/- 0,8 mm y su desembocadura fue a nivel de la vena cardiaca magna. La vena cardiaca media se originó en el ápex cardiaco en el 78,6 % de las muestras, desembocó principalmente en el seno coronario (82.1 %) y su calibre distal fue 4,7 +/- 0,9 mm. Se presentó anastomosis en el 28,6 % de los corazones, encontrándose en la mayoría de los casos entre la vena cardiaca media y la vena cardiaca magna (50 %), lo cual fue significativo en comparación con otras anastomosis (p<0,001). La longitud del seno coronario fue 42,2 +/- 5,1 mm, su calibre distal fue 13,8 +/- 2 mm y su forma fue cilíndrica. Se encontró puentes miocárdicos en 3 corazones (10,7 %) y en el tercio inferior de la vena cardiaca media (66,6 %). La mayoría de las venas coronarias principales desembocan en el seno coronario, con algunos casos con desembocaduras atípicas y la presencia de un alto porcentaje de anastomosis que sirve para mejorar el drenaje venoso cardiaco en caso de compresión u obstrucción venosa.

Anatomía clínica-quirúrgica del plexo venoso vertebral del perro: una revisión de la literatura / Clinical and surgical anatomy of the dog vertebral venous plexus: a literature review

El objetivo de la presente monografía, fue actualizar la anatomía del Plexo Venoso Vertebral (PVV) del perro de relevancia clínico-quirúrgica y asimismo evaluar el cumplimiento de la Nómina Anatómica Veterinaria (NAV). Se realizaron búsquedas electrónicas utilizando 9 bases de datos, donde se revisaron un total de 49 fuentes bibliográficas. De éstas, 20 correspondieron a artículos científicos. El criterio de exclusión fue el de publicaciones con más de 10 años de antigüedad, con excepción de libros de anatomía veterinaria de referencia base. Publicaciones que no estuvieran escritas en inglés, español o portugués, fueron también excluidas. En general, en la literatura revisada, existió consenso de cuáles son los componentes del PVV, junto con una escueta descripción de éste. El componente del PVV que es más ampliamente descrito y con mayor dimensión es el Plexo Vertebral Interno Ventral (PVIV). La función de retorno venoso sanguíneo alternativo hacia el corazón es la más nombrada. La no existencia de válvulas en el PVIV, pudiese ser una condición promotora para la metástasis tumoral a través del PVV. A nivel quirúrgico, la hemorragia del PVV, representa un peligro no despreciable para la vida del paciente. Con respecto a lo revisado y discutido, se puede concluir que: i) a pesar de la escasa descripción anatómica del PVV se pudo comprender cómo éste está compuesto ii) el nivel de evidencia que avala las distintas capacidades funcionales del PVV es bajo, no obstante, la información de la presentación de la hemorragia del PVV en las distintas cirugías es mayor iii) las variadas referencias bibliográficas consultadas no respetaron la NAV actual para describir al PVV.

SUMMARY: This monograph aims to provide an update on the anatomy of the Vertebral Venous Plexus (VVP) of the dog with emphasis on its clinical and surgical relevance and to evaluate compliance of terms in the literature with Nomina Anatomica Veterinaria (NAV). Electronic searches were conducted using 9 databases, where a total of 49 bibliographic sources were reviewed. Of these, 20 consisted of scientific articles. Publications with more than 10 years old were excluded from review, except for basic reference veterinary anatomy books. Publications that were not written in English, Spanish or Portuguese were also excluded. In general, in the literature reviewed, there was consensus on what the components of the VVP are, along with a brief description of VVP. The most widely described component of the VVP is the Ven- tral Internal Vertebral Plexus (VIVP). The function of alternative venous blood return to the heart is the most frequently described. The absence of valves in the VIVP could be a promoting condition for tumor metastasis through the VVP. At the surgical level, VVP hemorrhage represents a non-negligible threat to the patient's survival. With respect to what has been reviewed and discussed, it can be concluded that: i) despite the scarce anatomical description of the VVP, it was possible to understand how it is composed ii) the level of evidence that supports the different functional capacities of the VVP is low, however, the information on the ocurrence of VVP hemorrhage in surgical procedures is greater and iii) the various bibliographical references describing the VVP did not comply with the current NAV.

Guia prático de coleta de sangue venoso para obtenção da fibrina rica em plaquetas / Practical guide for collecting venous blood for obtaining platelet rich fibrin

A Fibrina Rica em Plaquetas (PRF) é caracterizada por sua abrangente aplicabilidade na Odontologia. Neste sentido, a venopunção é uma etapa fundamental para sua obtenção. Tal procedimento consiste na identificação das veias superficiais, localizadas na região da fossa antecubital dos membros superiores, para que através da utilização do sistema a vácuo de coleta seja obtido o sangue venoso do paciente. O objetivo deste trabalho é realizar um guia prático abordando cada etapa que compreende a coleta sanguínea para produção do PRF permitindo sua reprodutibilidade de forma segura e eficiente.

Platelet Rich Fibrin (PRF) is characterized by its wide applicability in Dentistry. In this sense, venipuncture is a fundamental step towards obtaining it. Such procedure consists of the identification of superficial veins, located in the region of the antecubital fossa of the upper limbs, so that through the use of the vacuum collection system, the patient's venous blood is obtained. The objective of this work is to carry out a practical guide covering each step that comprises the blood collection for the production of the PRF allowing its reproducibility in a safe and efficient way.

Traumatismo torácico con lesión de grandes vasos del tórax: características, tratamiento y variables asociadas a mortalidad / Thoracic trauma with injury to the great vessels of the chest: characteristics, treatments and variables associated with mortality

Resumen Introducción: Las lesiones de grandes vasos del tórax por traumatismo torácico (TTLGV) son un grupo heterogéneo de lesiones con alta morbimortalidad que constituyen un 0,3-10% de los hallazgos en el traumatismo torácico (TT). Objetivos: Describir características, tratamientos y variables asociadas a mortalidad en pacientes hospitalizados con TTLGV. Material y Métodos: Estudio analítico-observacional. Período enero-1981 y diciembre-2020. Revisión de protocolos de TT prospectivos y fichas clínicas. Se clasificaron los TTLGV según American Association for the Surgery of Trauma (AAST), se calcularon índices de gravedad del traumatismo: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) y Trauma Injury Severity Score (TRISS). Se realizó análisis univariado y multivariado con cálculo de Odds Ratio (OR) para variables asociadas a mortalidad. Se usó SPSS25®, con pruebas UMann Whitney y chi-cuadrado, según corresponda. Resultados: de un total 4.577 TT, 97 (2,1%) cumplieron criterios de inclusión. Hombres: 81 (91,8%), edad promedio: 32,3 ± 14,8 años. TT penetrante: 65 (67,0%). Lesión de arterias axilo-subclavias en 39 (40,2%) y aorta torácica en 31 (32,0%) fueron las más frecuentes. Fueron AAST 5-6: 39 (40,2%). Tratamiento invasivo: 87 (89,7%), de éstos, en 20 (20,6%) reparación endovascular, 14 (14,4%) de aorta torácica. Cirugía abierta en 67 (69,1%). Mortalidad en 13 (13,4%), fueron variables independientes asociadas a mortalidad el shock al ingreso (OR 6,34) e ISS > 25 (OR 6,03). Conclusión: En nuestra serie, los TTLGV fueron más frecuentemente de vasos axilo-subclavios y aorta torácica. El tratamiento fue principalmente invasivo, siendo la cirugía abierta el más frecuente. Se identificaron variables asociadas a mortalidad.

Background: Thoracic great vessel injuries in thoracic trauma (TTGVI) are a heterogeneous group of injuries with high morbimortality that constituting 0.3-10% of the findings in thoracic trauma (TT). Aim: To describe characteristics, treatments and variables associated with mortality in hospitalized patients with TTGVI. Methods: Observational-analytical study. Period January-1981 and December-2020. Review of prospective TT protocols and clinical records. TTGVI were classified according to American Association for the Surgery of Trauma (AAST), trauma severity index were calculated: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) and Trauma Injury Severity Score (TRISS). Univariate and multi- variate analysis was performed with calculation of Odds Ratio (OR) for variables associated with mortality. SPSS25® was used, with U Mann Whitney and chi-squared tests, as appropriate. Results: From a total of 4.577 TT in the period, 97 (2.1%) met the inclusion criteria. Males: 81 (91.8%), mean age: 32.3 ± 14.8 years. Penetrating TT: 65 (67.0%). Axillary-subclavian artery lesions in 39 (40.2%) and thoracic aorta in 31 (32.0%) were more frequent. AAST 5-6: 39 (40.2%). Invasive treatment: 87 (89.7%), of these, in 20 (20.6%) endovascular repair, 14 (14.4%) of thoracic aorta. Open surgery in 67 (69.1%). Mortality in 13 (13.4%), shock on admission was independently associated with mortality (OR 6.34) and ISS > 25 (OR 6.03). Conclusión: In our series, TTGVI were more frequent in axillary-subclavian vessels and thoracic aorta. Treatment was mainly invasive, with open surgery being the most frequent. Variables associated with mortality were identified.

The left gastro-omental vessels are able to maintain the entire spleen blood supply / Os vasos gastromentais esquerdos são capazes de manter o suprimento sanguíneo de todo o baço

Abstract The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.

Resumo O baço é suprido pelo fluxo sanguíneo da artéria e veia esplênicas. O objetivo desta comunicação é apresentar um baço ectópico suprido apenas pelo fluxo sanguíneo reverso proveniente dos vasos gastromentais esquerdos. Um paciente de 14 anos apresentou esplenomegalia pélvica suprida apenas por artéria e veia gastromentais esquerdas, conectadas aos vasos polares inferiores, que eram os únicos presentes nesse baço. Após a distorção do baço e a esplenopexia, o baço voltou às dimensões normais. Não houve intercorrências no acompanhamento do paciente. Em conclusão, os vasos gastromentais esquerdos são capazes de suprir o fluxo sanguíneo de todo o baço.

Aspectos prácticos en la patología venosa del pene / Practical Aspects in Venous Pathology of the Penis

El objetivo del presente artículo es mostrar una serie de alteraciones peneanas que, aunque frecuentes en la consulta de medicina sexual, son minimizadas, la mayoría de las veces por desconocimiento de los terapeutas, aunque para los pacientes que las padecen sean genuinas tragedias personales. Hemos revisado la literatura disponible sobre un grupo de seis patologías venosas especificas del pene que configuran el grupo más representativo. Se incluyen las frecuentes e indolentes venas superficiales tortuosas, los cirsoceles o flebectasias, las fugas venosas dorsales, que suelen ser una patología congénita, las deformantes malformaciones venosas del glande, la desconcertante y enigmática enfermedad de Mondor, y las fístulas arteriovenosas, con su riesgo de priapismo de alto flujo implícito. Todas se consideran alteraciones patológicas que requieren intervenciones menores en su tratamiento, excepto ciertos casos de fugas venosas y de fístulas, cuyo manejo es invasivo, y que, en conjunto, buscan una mejor comprensión de los hallazgos cotidianos en este órgano.

The objective of the present article is to describe a series of penile alterations that, although frequent in the sexual medicine consultation, are minimized, most of the time due to ignorance of the therapists, but, for the patients who suffer them, they are real personal tragedies. We have reviewed the literature available on a group of six specific venous pathologies of the penis that make up the most representative group. They include the frequent and indolent tortuous superficial veins, the cirsoceles or phlebectasias, the dorsal venous leaks, which are usually a congenital pathology, the deforming venous malformations of the glans, the enigmatic Mondor disease, and the arteriovenous fistulas, with their implicit risk of high-flow priapism. All are considered pathological alterations that require minor interventions in their treatment, except for certain cases of venous leaks and fistulas, whose management is invasive, and which together seek a better understanding of the common findings in this organ.

Riesgo de tromboembolismo venoso y uso adecuado de terapia tromboprofiláctica / Risk of venous thromboembolism and adequate use of thromboprophylactic therapy

INTRODUCCIÓN. El tromboembolismo venoso es una complicación prevenible en pacientes hospitalizados y la estratificación del riesgo mejora la seguridad del paciente, su valoración evita su ocurrencia. OBJETIVO. Evaluar el riesgo de tromboembolismo venoso y uso adecuado de terapia tromboprofiláctica en pacientes hospitalizados. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 412 y muestra de 373 pacientes encuestados, distribuidos: 186 en Unidades Clínicas, 163 en Unidades Quirúrgicas y 24 en Obstetricia del Hospital de Especialidades Carlos Andrade Marín, desde el 21 al 23 de febrero del 2019. La tabulación y análisis de datos se realizó en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 21. RESULTADOS. Se categorizó como alto riesgo de tromboembolismo venoso al 76,67% (286; 373) de pacientes; 49,46% (144; 163) postquirúrgicos y 69,40% (129; 286) clínicos de alto riesgo de tromboembolismo venoso, recibiendo tromboprofilaxis farmacológica de forma adecuada el 38,80% (56; 144) de quirúrgicos y 57,40% (74; 129) de clínicos. CONCLUSIÓN. Se determinó que el uso de tromboprofilaxis no farmacológica y farmacológica con heparina de bajo peso molecular en pacientes hospitalizados con riesgo de tromboembolismo venoso, fue bajo.

INTRODUCTION. Venous thromboembolism is a preventable complication in hospitalized patients and risk stratification improves patient safety, its ocurrence is prevented by its assessment. OBJECTIVE. To evaluate the risk of venous thromboembolism and ade-quate use of thromboprophylactic therapy in hospitalized patients. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 412 and sample of 373 patients surveyed, distributed: 186 in clinical wards, 163 in surgical wards and 24 in obstetrics of the Carlos Andrade Marín Specialties Hospital, from february 21 to 23, 2019. Data tabulation and analysis was performed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 21. RESULTS. 76,67% (286; 373) of patients were categorized as high risk of venous thromboembolism; 49,46% (144; 163) post-surgical and 69,40% (129; 286) clinical patients as high risk of venous thromboembo-lism, with 38,80% (56; 144) of surgical and 57,40% (74; 129) of clinical patients receiving adequate pharmacological thromboprophylaxis. CONCLUSIONS. The use of nonpharma-cological and pharmacological thromboprophylaxis with low-molecular-weight heparin in hospitalized patients at risk of venous thromboembolism was low.

Importancia del sitio de terminación de la vena cefálica del antebrazo / Importance of the cephalic antebrachial vein termination site

RESUMEN: Las venas superficiales de la fosa cubital se han estudiado con varios fines, venopunciones, cateterismos, fístulas, entre otros. Se han descrito varios patrones venosos en esta región en diferentes poblaciones. En uno de estos la vena cefálica termina en la vena basílica a nivel del antebrazo generando posibles riesgos de lesiones durante la canalización. En el presente estudio se evaluaron 200 miembros superiores de 100 personas colombianas, 50 mujeres y 50 hombres, 70 de ellas nacidas en la ciudad de Bucaramanga y 30 en la ciudad de Villavicencio. Se registró el número de venas cefálicas y su sitio de terminación, en el brazo o antebrazo. El patrón venoso que predominó en ambos miembros superiores fue el tipo I. El patrón IV en el cual la vena cefálica termina en la vena basílica se presentó en 12 casos (6 %) en el miembro superior derecho y en 17 casos (8,5 %) en el miembro superior izquierdo. Se encontró dos venas cefálicas entre el 13 % y 13,5 % dependiendo del lado y tres venas cefálicas entre el 1 % y 2 %. Conocer esta particularidad de los patrones venosos podría disminuir el riesgo de complicaciones durante la venopunción.

SUMMARY: The superficial veins of the ulnar fossa have been studied for various purposes, venipuncture, catheterization, fistulae, among others. Various venous patterns have been described in this region in different populations. In one of these, the cephalic vein ends in the basilic vein at the level of the forearm, generating possible risks of injury during cannulation. In the present study, 200 upper limbs of 100 Colombians, 50 women and 50 men, were evaluated, 70 of them born in the city of Bucaramanga and 30 in the city of Villavicencio. The number of cephalic veins and their termination site, on the arm or forearm, were recorded. The venous pattern that predominated in both upper limbs was type I. Pattern IV in which the cephalic vein ends in the basilic vein occurred in 12 cases (6 %) in the right upper limb and in 17 cases (8.5 %) in the left upper limb. Two cephalic veins were found between 13 % and 13.5 % depending on the side and three cephalic veins between 1 % and 2 %. Knowing this particularity of venous patterns could reduce the risk of complications during venipuncture.

Enfermedad de Mondor y mamoplastías / Mondor's disease and mammoplasty

Resumen Objetivo: Revisar la incidencia de esta enfermedad en pacientes sometidos a mamoplastías en una clínicaprivada en el período de 11 años, con el fin de describir sus síntomas y signos, diagnóstico, tratamiento y evolución. Materiales y Método: Se estudiaron 355 mujeres que se sometieron a mamoplastías estéticas. Se excluyó aquellas cirugías reconstructivas secundarias a cáncer de mama y aquellas con otros antecedentes oncológicos previos. La información fue recolectada de las fichas clínicas. Resultado: Se analizan 710 mamas operadas en el período 2008-2018, de las cuales seis mamas (6/710) evolucionaron con enfermedad de Mondor (0,8%). El diagnóstico se realizó clínicamente. Todos los casos recibieron terapia antiinflamatoria oral y local, respondiendo favorablemente. Discusión: Existe poca literatura publicada al respecto. Casos bilaterales son menos reportados. Pareciera asociarse con cirugías del surco submamario y no está claro que requiera curación terapéutica. Conclusiones: La enfermedad de Mondor es infrecuente, puede presentarse secundario a mamoplastías, es de diagnóstico clínico y sólo tratamiento sintomático con evolución satisfactoria sin secuelas.

Aim: Review the disease incidence in patients who had mammoplasties in a private clinic on a 11 year-period. The purpose is to describe their symptoms and signs, diagnosis, treatment and evolution. Materials and Method: 355 women who underwent cosmetic mammoplasties were studied. Those reconstructive surgeries secondary to breast cancer and those with other previous oncological history were excluded. The information was collected from clinical files. Results: 710 breasts operated between 2008-2018 are analyzed, six of them (6/710) evolved Mondor disease (0.8%). The diagnosis was made clinically. All cases received oral and local antiinflammatory therapy, responding favorably. Discussion: There is a few published literature about it. Bilateral cases are less reported. It appears to be associated with surgeries of the submammary sulcus and it is not clear that it requires therapeutic cure. Conclusions: Mondor's disease is infrequent, can occur secondary to mammoplasty, diagnosis is clinical, treatment is symptomatic, all cases had satisfactory evolution without sequelae.

Hallazgos por imagen de malformación de Abernethy tipo II en paciente de 12 años / Image finding of Abernethy type II malformation in 12 year old patient

Las malformaciones del sistema venoso abdominal son alteraciones vasculares raras. La incidencia de esta afección se estima en uno de cada 30,000 nacimientos y se asocian con malformaciones gas- trointestinal, genitourinaria, ósea y cardiovascular. En el 2018 se ha registrado en la literatura mundial 39 casos de Abernethy tipo I y 22 casos de Abernethy tipo II. CASO CLÍNICO paciente femenino de 12 años con antecedente de hipertensión portal tratada hace 2 años, con historia de malestar general e ic- tericia, acudió a centro privado para realizarse estudios complementarios. Un ultrasonido Doppler por- tal evidenció una lesión isoecogénica al parénquima hepático en el aspecto inferior del lóbulo derecho. Se continuó la evaluación realizando una tomografía en la cual se observó: configuración anómala del sistema venoso portal; la vena esplénica y mesentérica superior se encuentran dilatadas, además se evidenció confluencia portoesplénica elongada, en la cual derivan dos trayectos portales, uno de ellos drenando la lobulación hepática antes descrita y la segundo se comunica con el sistema venoso portal hepático derecho, demostrando tortuosidad de su trayecto, con estenosis de su porción proximal. Los hallazgos antes descritos sugieren malformación vascular del sistema venoso portal-esplácnico, que causa derivación porto-sistémica en relación a malformación de Abernethy tipo II. En conclusión se recomienda el diagnóstico precoz. El examen preferente es el ecodoppler con posterior confirmación mediante angiotac abdominal. El tratamiento es sumamente importante pues su retraso puede devenir en lesiones irreparables hasta la insuficiencia hepática y muerte...(AU)

Estudio cadavérico del arco de la vena cefálica / Cadaveric study of the cephalic vein arch

RESUMEN: Dentro de las disfunciones de los angioaccesos, la estenosis del arco de la vena cefálica (AVC) juega un papel significativo. Existen características anatómicas del AVC que explican, en parte, este fenómeno. Todo esto obliga a un conocimiento profundo del AVC y sus principales variantes. Se disecaron 43 (n=43) axilas de cadáveres adultos fijados en solución en base a formol. Se registró: longitud del AVC (LAC), angulación del AVC respecto a la vena cefálica (AAC), tipo de terminación (simple o múltiple), presencia de afluentes y su número. LAC promedio 31,6 mm (rango 17-46 mm); AAC promedio 128,95° (rango 65-165°). En cuanto al tipo de terminación 41 (95,3 %) fueron simples, mientras que 2 casos (4,7 %) fueron de forma múltiple. Respecto a los afluentes, se encontraron en 42 de los casos (90,5 %). Se encontraron válvulas en 27 (62,8 %) de los casos. La longitud promedio del AVC fue de 31,6 mm, se dispuso en la mayoría de los casos en ángulo obtuso, presentando en la mayoría de los casos terminación de tipo simple. Además, en el 90,5 % se encontró afluentes que se agotaban en el AVC y en más de la mitad de los casos se encontraron válvulas. Se discuten las implicancias de estos hallazgos en la génesis de la disfunción de angioaccesos.

SUMMARY: Within the angio access dysfunctions, the stenosis of the cephalic vein arch (AC) has a significant role. There are anatomical characteristics of AVC that partially explain this phenomenon. This requires a deep understanding of AVC and its main variants. 43 axillary regions of formalin-fixed adult cadavers were dissected. For this study, the following were registered: length of the AVC (LAC), angulation of the AVC with respect to the cephalic vein (AAC), type of termination (single or multiple), presence and number of tributaries. LAC average 31.6 mm (range 17-46 mm); AAC average 128,95° (range 65-165°). Regarding the type of termination, 41 (95.3 %) were simple, while 2 cases (4.7 %) were multiple. Tributaries were found in 42 of the cases (90.5 %). Valves were found in 27 (62.8 %) of the cases. The average length of the AVC was 31.6mm. Most cases presented an obtuse angle, and simple termination. In addition, in 90.5 % tributaries were found and in more than half of the cases valves were found. Implications of these findings in the genesis of angioaccess dysfunction are discussed.

Atorvastatina Reduz o Acúmulo de Células Musculares Lisas Vasculares para Inibir a Hiperplasia Intimal pela Inibição de Via p38 MAPK em um Modelo de Enxerto de Veia em Ratos / Atorvastatin Reduces Accumulation of Vascular Smooth Muscle Cells to Inhibit Intimal Hyperplasia via p38 MAPK Pathway Inhibition in a Rat Model of Vein Graft

Resumo Fundamento: A taxa de falha de enxerto de veia safena um ano após a cirurgia de revascularização do miocárdio varia de 10% a 25%. O objetivo deste estudo foi de investigar se a atorvastatina pode reduzir o acúmulo de células musculares lisas vasculares para inibir a hiperplasia intimal por meio da inibição da via p38 MAPK. Métodos: Quarenta e cinco ratos Sprague-Dawley foram randomizados em três grupos. Trinta ratos foram submetidos à cirurgia de enxerto de veia e randomizados para tratamento com veículo ou atorvastatina; quinze ratos foram submetidos à cirurgia sham. Detectamos a hiperplasia intimal por meio de coloração com hematoxilina-eosina e a expressão de proteínas relacionadas por meio de análise imuno-histoquímica e Western blot. Foram realizadas as comparações por análise de variância de fator único e pelo teste da diferença mínima significativa de Fisher, com p < 0,05 considerado significativo. Resultados: A íntima analisada pela coloração com hematoxilina-eosina era dramaticamente mais espessa no grupo controle que no grupo atorvastatina e no grupo sham (p < 0,01). Os resultados da coloração imuno-histoquímica de α-SMA demonstraram que a porcentagem de células positivas para α-SMA no grupo controle era mais alta que no grupo atorvastatina (p < 0,01). Nós também avaliamos α-SMA, PCNA, p38 MAPK e fosforilação de p38 MAPK após o tratamento com estatina por meio de análise de Western blot e os resultados indicaram que a atorvastatina não levou à redução de p38 MAPK (p < 0,05); no entanto, resultou na inibição da fosforilação de p38 MAPK (p < 0,01) e reduziu significativamente os níveis de α-SMA e PCNA, em comparação com o grupo controle (p < 0,01). Conclusão: Nós demonstramos que a atorvastatina pode inibir o acúmulo de células musculares lisas vasculares por meio da inibição da via p38 MAPK e é capaz de inibir a hiperplasia intimal em modelos de enxerto de veia em ratos.

Abstract Background: The rate of saphenous vein graft failure one year after coronary artery bypass grafting ranges from 10% to 25%. The aim of this study was to explore whether atorvastatin can reduce accumulation of vascular smooth muscle cells to inhibit intimal hyperplasia via p38 MAPK pathway inhibition. Methods: Forty-five Sprague-Dawley rats were randomized to three groups. Thirty rats received a vein graft operation, and they were randomized to be treated with vehicle or atorvastatin; fifteen rats received a sham operation. We detected intimal hyperplasia by hematoxylin-eosin staining and related protein expression by immunohistochemical and Western blot analysis. Comparisons were analyzed by single-factor analysis of variance and Fisher's least significant difference test, with p < 0.05 considered significant. Results: The intima analyzed by hematoxylin-eosin staining was dramatically thicker in the control group than in the atorvastatin group and sham group (p < 0.01). The outcomes of immunohistochemical staining of α-SMA demonstrated that the percentage of α-SMA-positive cells in the control group was higher than in the atorvastatin group (p < 0.01). We also evaluated α-SMA, PCNA, p38 MAPK, and phosphorylation of p38 MAPK after statin treatment by Western blot analysis, and the results indicated that atorvastatin did not lead to p38 MAPK reduction (p < 0.05); it did, however, result in inhibition of p38 MAPK phosphorylation (p < 0.01), and it significantly reduced α-SMA and PCNA levels, in comparison with the control group (p < 0.01). Conclusion: We have demonstrated that atorvastatin can inhibit accumulation of vascular smooth muscle cells by inhibiting the p38 MAPK pathway, and it is capable of inhibiting intimal hyperplasia in a rat vein graft model.

Anatomía quirúrgica de la vena tiroidea media: prevalencia en 100 tiroidectomías totales consecutivas / Surgical anatomy of the median thyroid vein: prevalence in 100 consecutive total thyroidectomies

El estudio de las venas tiroideas no ha recibido una investigación tan exhaustiva como lo tuvieron las arterias tiroideas y los nervios laríngeos en relación a la cirugía tiroidea.De los tres pedículos venosos de la glándula tiroides, el medio, de lejos es el menos estudiado. La vena tiroidea media es inconstante y es el primer elemento vascular de la glándula tiroides que debe ser seccionado antes de luxar el lóbulo hacia medial para evaluar sus relaciones posteriores. Su lesión puede provocar sangrado intraoperatorio dificultando secundariamente la identificación del nervio laríngeo inferior y las glándulas paratiroides, próximas a la misma. Se realizó un estudio descriptivo de corte transversal evaluando la pesencia, número, simetría y asociación de la vena tiroidea media con variables tales como edad y sexo del paciente, así como la hiperfuncionalidad de la glándula tiroides y la presencia del tubérculo de Zuckerkandl en 100 tiroidectomías totales llevadas a cabo en el Instituto Nacional del Cáncer y en el Servicio de Otorrinolaringología del Hospital Central del Instituto de Previsión Social del Paraguay. La prevalencia global de vena tiroidea media fue del 74 %. En el lóbulo derecho, la vena se presentó en el 60 %, mientras que en el lóbulo izquierdo en el 53 %. En el 38 % se encontró la vena en ambos lóbulos. En 4 pacientes se localizaron venas tiroideas medias dobles, en una de ellas fue bilateral. El mayor porcentaje de las venas tiroideas medias se originó en el tercio medio del lóbulo, el 72 % en el lado derecho y el 70% en el izquierdo. No se encontró asociación entre la presencia de la vena tiroidea media y la edad, sexo, estado de hiperfunción glandular, así como tampoco con la presencia del tubérculo de Zuckerkandl.

The study of the thyroid veins has not received an investigation as extensive as the thyroid arteries and laryngeal nerves did in relation to thyroid surgery. Of the three veins pedicles of the gland the middle is far the least studied. This vein is inconstant and is the first vascular element of the gland that must be sectioned before the medial lobe is dislocated to evaluate ist posterior relationships. His injury can cause intraoperative bleeding, making it difficult to identify the inferior laryngeal nerve and the parathyroid glands, proximal to it. A descriptive crossseccional study was carried aot evaluating the presence, number, symmetricity and association of the middle thyroid vein with variables such as age and sex of the patient, as well as the hyperfunctionality of the gland and the presence of the Zuckerkandl tubercle in 100 total thyroidectomies undergoing at the National Cancer Institute and the ENT Service of the Social Security Institute´s Central Hospital. The overall prevalence of the middle thyroid vein was 74%. In the right lobe the vein appeared in 60% while in the left lobe in 53 %. Double middle thyroid vein was found in 4 patients, in one of them it was bilateral. The highest percentage of the middle thyroid veins originated in the middle third of the lobe, 72 % on the right and 70% on the left side. No association was found between the presence of the vain and age and sex, the state of glandular hyperfunstion, as well as the presence of Zuckerkandl tubercle.

Superinfection / Sobreinfección

Actualmente, en la jerga médica se oyen algunos usos inadecuados de este término, como EPOC sobre infectada, sobreinfección de úlcera venosa, venas varicosas sobre infectadas, enfermedades que en principio no son de origen infeccioso, aunque puedan llegar a complicarse con una infección secundaria. Conocer la etimología ayuda a aclarar la situación.

Proporção entre pressão venosa central menos arterial de dióxido de carbono e conteúdo arterial menos venoso central de oxigênio como indicador de oxigenação tissular: uma revisão narrativa / Central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio as an indicator of tissue oxygenation: a narrative review

RESUMO A proporção entre pressão venosa central menos arterial de dióxido de carbono e conteúdo de oxigênio arterial menos venoso central (Pcv-aCO2/Ca-cvO2) foi proposta como marcador substituto para quociente respiratório e indicador de oxigenação tissular. Alguns pequenos estudos observacionais identificaram que Pcv-aCO2/Ca-cvO2 acima de 1,4 se associa com hiperlactatemia, dependência de suprimento de oxigênio e maior mortalidade. Mais ainda, a Pcv-aCO2/Ca-cvO2 foi incorporada a algoritmos para avaliação da oxigenação tissular e ressuscitação. Contudo, a evidência para estas recomendações é bastante limitada e de baixa qualidade. O objetivo desta revisão narrativa foi analisar as bases metodológicas, os fundamentos fisiopatológicos e a evidência experimental e clínica para dar suporte à utilização da Pcv-aCO2/Ca-cvO2 como marcador substituto para quociente respiratório. De um ponto de vista fisiopatológico, o aumento do quociente respiratório secundariamente a reduções críticas no transporte de oxigênio é um evento dramático e com risco à vida. Entretanto, este evento é facilmente observável e provavelmente não demandaria maiores monitoramentos. Visto que o início do metabolismo anaeróbico é indicado pelo aumento súbito do quociente respiratório e que a faixa normal do quociente respiratório é ampla, o uso do ponto de corte definido como 1,4 para Pcv-aCO2/Ca-cvO2 não faz sentido. Estudos experimentais demonstraram que a Pcv-aCO2/Ca-cvO2 é mais dependente de fatores que modificam a dissociação do dióxido de carbono da hemoglobina do que do quociente respiratório, e o quociente respiratório e Pcv-aCO2/Ca-cvO2 podem ter comportamentos distintos. Estudos conduzidos em pacientes críticos demonstraram resultados controvertidos com relação à capacidade da Pcv-aCO2/Ca-cvO2 para predizer o desfecho, hiperlactatemia, anomalias microvasculares e dependência de suprimento de oxigênio. Um estudo randomizado controlado também demonstrou que a Pcv-aCO2/Ca-cvO2 é inútil como alvo para ressuscitação. A Pcv-aCO2/Ca-cvO2 deve ser interpretada com cautela em pacientes críticos.

ABSTRACT The central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) has been proposed as a surrogate for respiratory quotient and an indicator of tissue oxygenation. Some small observational studies have found that a Pcv-aCO2/Ca-cvO2 > 1.4 was associated with hyperlactatemia, oxygen supply dependency, and increased mortality. Moreover, Pcv-aCO2/Ca-cvO2 has been incorporated into algorithms for tissue oxygenation evaluation and resuscitation. However, the evidence for these recommendations is quite limited and of low quality. The goal of this narrative review was to analyze the methodological bases, the pathophysiologic foundations, and the experimental and clinical evidence supporting the use of Pcv-aCO2/Ca-cvO2 as a surrogate for respiratory quotient. Physiologically, the increase in respiratory quotient secondary to critical reductions in oxygen transport is a life-threatening and dramatic event. Nevertheless, this event is easily noticeable and probably does not require further monitoring. Since the beginning of anaerobic metabolism is indicated by the sudden increase in respiratory quotient and the normal range of respiratory quotient is wide, the use of a defined cutoff of 1.4 for Pcv-aCO2/Ca-cvO2 is meaningless. Experimental studies have shown that Pcv-aCO2/Ca-cvO2 is more dependent on factors that modify the dissociation of carbon dioxide from hemoglobin than on respiratory quotient and that respiratory quotient and Pcv-aCO2/Ca-cvO2 may have distinct behaviors. Studies performed in critically ill patients have shown controversial results regarding the ability of Pcv-aCO2/Ca-cvO2 to predict outcome, hyperlactatemia, microvascular abnormalities, and oxygen supply dependency. A randomized controlled trial also showed that Pcv-aCO2/Ca-cvO2 is useless as a goal of resuscitation. Pcv-aCO2/Ca-cvO2 should be carefully interpreted in critically ill patients.

Descripción anatómica del arco venoso dorsal de la mano en una muestra de población de Bucaramanga, Colombia / Anatomical description of the dorsal venous arch of the hand in a population sample of Bucaramanga, Colombia

Se estudió el arco venoso dorsal de la mano (AVD) en una muestra de la población de Bucaramanga en 54 mujeres y 50 hombres. Las variables estudiadas en el AVD fueron: número de venas que lo forman, número de venas que recorren su interior, presencia de una vena que forme su parte lateral y medial, conformación cerrada o discontinua del AVD, si la vena metacarpiana del primer dedo se unía al AVD y contribuía a la formación de la vena cefálica, si la vena metacarpiana del quinto dedo se unía al AVD y contribuía a la formación de la vena basílica. También se revisó la concordancia entre la vena que escogían dos observadores independientes, como la más adecuada para venopunción. La comparación con los textos clásicos de anatomía evidenció concordancia en que cerca de la cabeza de los metacarpianos se forman venas metacarpianas dorsales, pero, no siempre estas venas se unen de forma completa para formar un "arco venoso cerrado" como lo describen los esquemas de la mayoría de los autores. Sólo un 41,8 % fueron AVD cerrados. Las venas metacarpianas del primer y del quinto dedo se unieron al AVD en un 44,23 % y un 89,42 % respectivamente. Este dato, sumado al hecho de que en el primer y quinto dedos pueden existir más de una vena que drene su sangre, las cuales no siempre se unen al AVD, ayudan a explicar la razón de porqué en otros estudios se describe ausencia de venas cefálica o basílica o presencia de varias venas cefálicas que permiten la formación de ciertos patrones de la fosa cubital. Se encontró concordancia del 78,85 % en cuanto a la vena escogida para posible venopunción y en el análisis bivariado, hubo asociación estadística de esta concordancia al cruzarla con el número de venas que recorren el interior del AVD.

The dorsal venous arch of the hand (AVD) was studied in a sample of the Bucaramanga population of 54 women and 50 men. The variables studied in the AVD were: Number of veins that form it, number of veins that run through its interior, presence of a vein that forms its lateral and medial part, closed or discontinuous conformation of the AVD, if the metacarpal vein of the first finger joined the AVD and contributed to the formation of the cephalic vein, if the metacarpal vein of the fifth finger joined the ADL and contributed to the formation of the basilic vein. The concordance between the vein chosen by two independent observers was also reviewed, as the most suitable for venipuncture. The comparison with the classic anatomy texts showed concordance in which dorsal metacarpal veins are formed near the metacarpal head, but these veins do not always unite completely to form a "closed venous arch" as described in metacarpal diagrams by most authors. Only 41.8 % were closed AVD. The metacarpal veins of the first and fifth toes joined the AVD in 44.23 % and 89.42 % respectively. This fact, in addition that in the first and fifth fingers, there may be more than one vein draining the blood, which do not always bind to the AVD, helps explain the reason other studies describe absence of cephalic veins, basilica or presence of several cephalic veins that allow the formation of certain patterns of the cubital fossa. There was 78.85 % agreement regarding the vein chosen for possible venipuncture and in the bivariate analysis, there was a statistical association of this concordance when crossing it with the number of veins that run through the interior of the AVD.

Conservation of both hematocrit and liver regeneration in hepatectomies: a vascular occlusion approach in rats / Hepatectomia hemoconservadora no rato: preservação do hematócrito e da regeneração hepática

ABSTRACT Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice.

RESUMO Racional: As hepatectomias compreendem considerável perda sanguínea e utilização de hemoderivados, o que diretamente estão relacionados com maior morbimortalidade. A hepatectomia hemoconservadora (HH) é modificação da técnica de oclusão vascular seletiva em hepatectomia. Ela pode ser alternativa cirúrgica para evitar ou diminuir o uso de hemoderivados no perioperatório. Objetivo: Avaliar os efeitos da HH sobre o volume globular (VG), concentração de hemoglobina (HB) e sobre a regeneração hepática em ratos. Métodos: Dois grupos de ratos Wistar foram constituídos: controle (n=6) e intervenção (n=6). Os do grupo controle foram submetidos à hepatectomia parcial de Higgins e Anderson e os do grupo Intervenção à HH. VG e HB foram medidos nos dias D0, D1 e D7. A relação peso do fígado/peso do rato foi calculada em D0 e D7. A regeneração hepática foi analisada qualitativamente e quantitativamente. Resultados: Houve diminuição dos níveis de VG e HB nos ratos do grupo controle a partir de D1, atingindo decréscimo de 18% em D7 (p=0,01 e p=0,008 respectivamente); a HH permitiu a manutenção dos níveis de VG e HB nos ratos do grupo intervenção. A HH não alterou a regeneração hepática. Conclusão: HH resultou em níveis maiores de VG e HB pós-operatórios sem alterar a regeneração hepática. Pode-se considerar estes dados como a prova necessária para a translação à pesquisa clinicocirúrgica.

Variz Intra-Óssea ­ um achado raro diagnosticado pela ressonância magnética / Intraosseous Varicose Vein ­ A rare finding diagnosed by magnetic resonance imaging

Introdução: As varizes são veias que após submetidas a períodos de pressão aumentada no sistema venoso periférico se tornam dilatadas, tortuosas e alongadas. Pacientes acometidos irão referir dor no membro, além de sinais de insuficiência venosa. O exame de imagem comumente utilizado é o ultrassom com Doppler, no entanto, na presença de anomalias de drenagem venosa intraóssea, deve-se preferir a ressonância magnética. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital América, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 46 anos com dor e queimação constantes, além de edema na perna e no pé esquerdos há dois meses Ao exame físico apresenta edema da perna, tornozelo e pé esquerdos, com discreto aumento de temperatura ao toque, sem alteração da coloração da pele. A ressonância magnética demonstra varicosidades das veias tibiais posteriores com comunicação através de veia perfurante com varicosidade da veia intraóssea posterior da tíbia ­ variz intraóssea. Conclusão: Este relato demonstra a dificuldade de diagnosticar a variz intra-óssea que, além de ser uma lesão rara, é diagnosticada apenas pela ressonância magnética.

Introduction: Varicose veins are veins that after being submitted to high pressure on the peripheral venous system become dilated, tortuous and elongated. Patients affected will report pain and venous insufficiency signs in the area. The imaging exam commonly used is the Doppler ultrasound, however, when in front of an intraosseous venous drainage anomaly ­ intraosseous varix, magnetic resonance should be preferred. Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital América, a photographic record of diagnostic methods, and a review from the literature. Results: A 46-year-old man with constant pain and burning, as well as edema in his left leg and foot for two months. On physical examination, he had edema in his left leg, ankle, and foot, with a slight increase in temperature at the touch, without changing the skin color. Magnetic resonance imaging shows varicosities of the posterior tibial veins with communication through a perforating vein with varicosity of the posterior tibial intraosseous vein - intraosseous varicose vein. Conclusion: This report demonstrates the difficulty of diagnosing intraosseous varices, which, in addition to being a rare lesion, are diagnosed only by magnetic resonance imaging.

Angiomiolipoma renal con invasión de vena renal y vena cava inferior. Presentación de un caso y revisión de la literatura / Renal Angiomyolipoma with Extension to Renal and Cava Veins. A Case Report and Revision of the Literature

Introducción El angiomiolipoma es un tumor benigno cuya presentación con invasión del seno renal y formación de trombo venoso tumoral es muy infrecuente, habiéndose descrito aproximadamente 50 casos desde que en 1982 Kutcher describiera el primero. Reporte de caso Presentamos un caso angiomiolipoma renal con afectación venosa diagnosticado mediante TAC a partir del hallazgo de trombo venoso en ecografía y resonancia en una paciente de 43 años embarazada y asintomática que presentó elevación de transminasas en una analítica. Ante la posibilidad de que se tratara de una variante epitelioide y/o clásica con potencial de malignización, se decidió tratamiento mediante nefrectomía y trombectomía abierta, sin incidencias intra ni postoperatorias. La paciente se encuentra asintomática tras 6 meses de seguimiento. La histología fue compatible con angiomiolipoma clásico con trombo venoso. Conclusión La invasión de vena renal por un angiomiolipoma es extremadamente rara. Aunque infrecuente, habría que considerar la posibilidad de malignización para no demorar su tratamiento

Introduction Angiomyolipoma is a benign kidney tumour that rarely affects the renal sinus or the renal or caval vein. Kutcher made the first case report in 1982, and since then there have been described approximately 50 cases. Case Report We present a case of angiomyolipoma with venous thrombus in a 43 years-old asymptomatic pregnant woman who presented elevation of transaminases in a blood test, with an ultrasonography that showed a venous thrombus without any renal mass, being diagnosed after giving birth by scanner. Having in account the possibility of malignancy of the mass, we performed surgical treatment by open radical nephrectomy and thrombectomy, without intraoperative nor postoperative incidences. The patient remains asymptomatic 6 months after surgery. The histology was compatible with classic angiomyolipoma with venous thrombus. Conclussion Angiomyolipoma causing venous invasion is extremely rare, but we should take into consideration its possibility of malignancy in order to treat it as soon as possible