Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery.

The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.

A Sociedade Brasileira de Angiologia e de Cirurgia Vascular organizou uma comissão para fornecer novas recomendações baseadas em evidências sobre questões críticas de atendimento ao paciente com insuficiência venosa crônica. São abordados aqui os temas de classificação, diagnóstico, tratamento conservador, tratamento invasivo e tratamento de pequenos vasos. Esta última série está muito relacionada à atividade de angiologistas e cirurgiões vasculares, que possuem forte atuação no tratamento de pequenas veias superficiais. Estas diretrizes destinam-se a auxiliar na tomada de decisões clínicas de médicos assistentes e gestores de saúde. A decisão de seguir uma recomendação de diretriz deve ser feita pelo médico responsável caso a caso, levando em consideração a condição específica do paciente, bem como recursos locais, regulamentos, leis e recomendações de prática clínica.

Treatment of lower limb telangiectasias with Nd: Yag 1064 nm laser with and without tumescent anesthesia - TTL technique.

INTRODUCTION: Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment. OBJECTIVE: The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure. METHODS: 50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05. RESULTS: Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference. CONCLUSION: Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.

Effects of long-pulsed 1064-nm Nd:YAG laser on telangiectasias and reticular veins: a human in-vivo histological study.

BACKGROUND: Telangiectasias and reticular veins are associated with aesthetic disorders. Sclerotherapy is the gold standard treatment, but long-pulsed 1064-nm Nd:YAG laser (LP1064 laser) is also used. No data on the human histological effects of these lasers are reported. The objective was to test different LP1064 laser parameters and their histological effects on the dermis, collagen, telangiectasias, and reticular veins. METHODS: This was a single-center, prospective, single-arm, case-control, human study. During surgery (dermolipectomy), the abdominal section of 10 female patients was irradiated with 6 different transdermal LP1064 laser parameters after anesthesia. Ten pieces with areas of varying irradiation were evaluated according to the characteristics of the vessels identified by area. In each piece, two irradiation areas were performed per group, totaling 12 irradiation areas per piece, with 120 regions later analyzed at the end of the ten samples. After removing the surgical product, histological sections were extracted, and the dermis, telangiectasias, and reticular veins were analyzed. RESULTS: Histological analysis showed that exposition to six different parameters from LP1064 laser led to significant dermal layer separation and collagen alterations. The effects were inconsistent on the loss of endothelial cells, intravascular thrombus formation, and fusion of vascular walls for both telangiectasias and reticular veins. In reticular veins, effects on intravascular thrombus formation and vascular wall fusion were not observed. CONCLUSIONS: The LP1064 laser in monotherapy with fixed settings did not lead to a consistent vascular lesion to promote immediate occlusion in telangiectasias and reticular veins. This strategy may not work as monotherapy for small vein treatment, but the possible late response to the LP1064 laser cannot be ruled out and require further investigation.

The impact of dermatoscopy on the pretreatment assessment of lower limbs telangiectasias: a prospective study.

BACKGROUND: Telangiectasias treatment can lead to skin hyperpigmentation, and pretreatment evaluation with dermoscopy was never performed. This study aimed to evaluate the applicability of dermatoscopy before telangiectasias treatment. METHODS: A prospective study evaluating patients of both sexes (18 to 60 years old), with telangiectasias (venous disease C2-C3 CEAP) of the lower limbs treated at outpatient clinics. Subjects who had never undergone previous interventional treatment for CVI and Fitzpatrick Classification up to phototype III, were included. Patients were submitted to both naked and dermoscopy evaluations of their skin and blindly evaluated by three vascular surgeons and an experienced dermatologist. Agreement by naked eye versus dermoscopy and among examiners was performed using Kappa correlation. Agreement by naked eye among patients and the examiners consensus were performed. RESULTS: There was a more significant agreement between the most experienced examiners in the naked eye assessment. With the dermatoscopic device, the highest agreement was maintained among the more experienced examiners, with a predominance of choice of the purple pigment in 29 of the 38 limbs, which represents a simple agreement of 76.3% (95% CI: 62.8-89.8%) with a Kappa concordance Index of 0.178. There was an agreement between the patient and the consensus of the naked eye examiners in 41.2% (95% CI: 24.7-57.7%). CONCLUSIONS: The dermatoscopy was not decisive for diagnosing skin pigmentation in areas of telangiectasia that had never been treated. The diagnostic accuracy was directly related to the clinical experience of the examiner. Dermatoscopy did not help in aligning expectations with treatment between physicians and patients.

Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery / Diretriz brasileira de doença venosa crônica da Sociedade Brasileira de Angiologia e de Cirurgia Vascular

Abstract The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.

Resumo A Sociedade Brasileira de Angiologia e de Cirurgia Vascular organizou uma comissão para fornecer novas recomendações baseadas em evidências sobre questões críticas de atendimento ao paciente com insuficiência venosa crônica. São abordados aqui os temas de classificação, diagnóstico, tratamento conservador, tratamento invasivo e tratamento de pequenos vasos. Esta última série está muito relacionada à atividade de angiologistas e cirurgiões vasculares, que possuem forte atuação no tratamento de pequenas veias superficiais. Estas diretrizes destinam-se a auxiliar na tomada de decisões clínicas de médicos assistentes e gestores de saúde. A decisão de seguir uma recomendação de diretriz deve ser feita pelo médico responsável caso a caso, levando em consideração a condição específica do paciente, bem como recursos locais, regulamentos, leis e recomendações de prática clínica.

Endovenous laser ablation of the great saphenous vein comparing 1920-nm and 1470-nm diode laser.

BACKGROUND: The aim of this study was to compare venous occlusion rates at a one-year follow-up comparing 1920-nm versus 1470-nm endolaser. METHODS: Randomized prospective study with consecutive patients with varicose veins associated to great saphenous reflux. The 1470-nm laser ablation was performed in continuous mode, with power of 10 W, while for the 1920-nm it was set in 5 W. Follow-up data were collected at the 7-day, 30-day, 3-month, 6-month and 1-year visits, and involved clinical, ultrasound evaluation and measurement of occlusion length. RESULTS: Sixty seven patients were included, with 42 limbs operated in the 1470-nm group and 48 limbs in the 1920-nm group. There were no differences in relation to age, CEAP (Clinical, Etiologic, Anatomical and Pathological Classification), VCSS (Venous Clinical Severity Score) and saphenous diameter. The resulting LEED in 1920-nm group was 17.8±0.6 J/cm and vs. 24.7±0.8 J/cm in 1470-nm group (P<0.01). Closure rates were lower for the 1920-nm group: 90.9% vs. 96.8% (P=0.06) at 30 days, 87.5% vs. 96.3% at 6 months (P=0.03), and 87.5% vs. 94.7% (P=0.05) at one year. The 1920-nm group had less ecchymosis (18.7% vs. 52.4%), induration (12.4% vs. 38.1%) and days of analgesic use (1.4±0.2 vs. 2.4±0.4). CEAP and VCSS were reduced over time in both groups. CONCLUSIONS: Treatment with endolaser 1920-nm was feasible and with reduced complications. The use of low endoluminal energy resulted in lower vein occlusion rates comparing to the 1470-nn laser. Clinical outcome scores were similar between groups.

Vein imaging: a new method of near infrared imaging, where a processed image is projected onto the skin for the enhancement of vein treatment.

BACKGROUND: A new noninvasive vein imaging device initially developed for phlebotomy has been tested for the first time for vein treatment. This unique device captures a near infrared vein image, processes it, and projects it onto the skin using green light. OBJECTIVE: To perform the first clinical tests of the device in phlebology. MATERIALS AND METHODS: A pilot study on 23 subjects with varicose veins and telangiectasias was performed. The VeinViewer prototype (V-V-P; Luminetx Corp., Memphis, TN) was tested in five situations: diagnosing feeder veins with the V-V-P, comparison between the V-V-P and ultrasound, marking varicose veins with or without the device, phlebectomy using the V-V-P, and the use of laser and sclerotherapy guided by the V-V-P. RESULTS: One hundred percent of subjects had feeder veins identified by the V-V-P. The ultrasound machine detected fewer feeder veins than the V-V-P, and the device identified more veins than the naked eye in all subjects. The V-V-P could help in finding feeder veins during phlebectomy and in guiding laser and sclerotherapy treatments. CONCLUSION: The device could identify veins that were invisible to the naked eye and too shallow for ultrasound detection. The V-V-P may help find feeder veins and may also help various types of vein treatments.

A historia familial e a prevalencia de dependencia de alcool e tabaco em area metropolitana na regiao Sul do Brasil / Familial history and prevalence of alcohol and tobacco dependence in a metropolitan area of southern Brasil

No presente estudo, foram analisadas a historia familial e a prevalencia de dependencia de alcool e tabaco nas regioes Norte, Sul e Oeste da cidade de Londrina, estado do Parana, Sul do Brasil, com uma populacao estimada de 277.391 habitantes, por meio de uma amostra aleatoria de 4.280 residencias, totalizando 42.517 pessoas...

Algias de coluna na terceira idade / Spine algia in the third age

Os autores estudaram a incidência de algias de colunaem idosos, baseados em dois questionários aplicados em pessoas de terceira idade na área de abrangência daUnidade Básica de Saúde (UBS) da Vila Casoni, Londrina, Paraná. Foi estudada uma amostra de 83 idosos, envolvendo ambos os sexos. Os resultados comprovaram a alta incidência de problemas de coluna nesse segmento social. Baseando-se em estudos que reforçam a idéia de um tratamento preventivo ou um tratamento paliativopor fisioterapia é mais indicado para os idosos, os autores realizaram um trabalho em grupo que contou coma presença de profissionais especializados. Foram elaborados materiais de fácil leitura sobre algia de coluna para serem distribuídos na própria UBS. O estudo ainda demonstra que a fisioterapia é muito procurada pela populaçäo da regiäo, embora a rede municipal de saúde näo ofereça o serviço desse profissional nas unidades básicas de saúde