Measurements between the hepatic veins and portal venous system, in human cirrhotic liver: a cast study.

PURPOSE: To measure the distance between the right and middle hepatic veins and portal vein branches, in human cirrhotic liver casts. Was this measure actually smaller in the cirrhotic liver than in normal one? MATERIALS AND METHODS: This study was authorized by an area Research Ethics Committee, and each study subject or legal representative granted signed informed consent. Acrylic corrosion casts of 21 resected cirrhotic livers were generated. Diameters of hepatic veins and portal branches and pertinent intervening distances were measured. To assess differences in estimated average (relative to reference values), Student's t test for one sample was applied. RESULTS: Mean distances from right hepatic vein to the right portal branch and to portal vein bifurcation were 33 ± 6.4 and 36 ± 7.4 mm, respectively, both significantly less than published reference values in healthy human livers (p < 0.0001 and p < 0.0002, respectively). Mean distances from middle hepatic vein to right and left branches of portal vein were 36 ± 6.8 and 26 ± 8.8 mm, respectively. CONCLUSION: Distances separating right hepatic vein and portal vein (right branch and bifurcation) are diminished in cirrhotic livers compared to healthy ones. Given its caliber and proximity to portal branches, the middle hepatic vein remains as a reasonable alternative for TIPS procedures.

Nd:Yag laser combined with injection sclerotherapy in the treatment of reticular veins and telangiectasias (CLaCS method): A triple-blind randomized clinical trial comparing two sclerosing agents associated with same laser patterns.

BACKGROUND: Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows -20°C air onto the skin and needle in a pre-, parallel-, and post-fashion. OBJECTIVE: Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities. METHODS: Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%. RESULTS: The results were evaluated 30 days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found. CONCLUSION: The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear.

Aerobic exercise and telomere length in patients with systolic heart failure: protocol study for a randomized controlled trial.

BACKGROUND: Heart failure (HF) with reduced ejection fraction (HFrEF) is a syndrome that leads to fatigue and reduced functional capacity due to disease-related pathophysiological mechanisms. Aerobic exercise (AERO) plays a key role in improving HF outcomes, such as an increase in peak oxygen uptake (VO2peak). In addition, HF promotes cell senescence, which involves reducing telomere length. Several studies have shown that patients with a worse prognosis (i.e., reduced VO2 peak) also have shorter telomeres. However, the effects of AERO on telomere length in patients with HFrEF are still unknown. In an attempt to fill this gap, we designed a study to determine the effects of 16 weeks of aerobic training (32 sessions) on telomere length in HFrEF patients. METHODS: In this single-center randomized controlled trial, men and women between 50 and 80 years old will be allocated into two different groups: a moderate-intensity aerobic training and a control grouTelomere length, functional capacity, echocardiographic variables, endothelial function, and walking ability will be assessed before and after the 16-week intervention period. DISCUSSION: Understanding the role of physical exercise in biological aging in HFrEF patients is relevant. Due to cell senescence, these individuals have shown a shorter telomere length. AERO can delay biological aging according to a balance in oxidative stress through antioxidant action. Positive telomere length results are expected for the aerobic training group. TRIAL REGISTRATION: ClinicalTrials.gov NCT03856736 . Registered on February 27, 2019.

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants.

AIMS: Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. METHODS: Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. RESULTS: In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. CONCLUSION: The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients.Cite this article: Bone Jt Open 2022;3(11):859-866.

Efficacy of zoniporide, an Na/H exchange ion inhibitor, for reducing perioperative cardiovascular events in vascular surgery patients.

OBJECTIVES: To determine whether a novel Na+/H+ exchange ion inhibitor, zoniporide, is associated with reduced perioperative myocardial ischemic injury in high-risk surgery patients. DESIGN: Randomized double-blind placebo-controlled multidose trial. SETTING: Multicenter worldwide (105 centers) trial. PARTICIPANTS: Patients with known or multiple risk factors for coronary artery disease undergoing noncardiac vascular surgery. INTERVENTIONS: Four parallel groups received 1 of 3 doses of zoniporide or placebo, delivered as a 60-minute loading dose immediately before surgery, and followed by a continuous intravenous infusion for up to 7 days. MEASUREMENTS AND MAIN RESULTS: A total of 824 subjects were randomized into the study from 105 centers worldwide. Of these, 784 subjects received study drug infusion in the 3-mg/kg/d, 6-mg/kg/d, and 12-mg/kg/d groups and the placebo group, and 769 satisfied the criteria for the primary efficacy analysis population. This is 68% of the planned sample size of 1125 subjects. Anesthetic management and perioperative cardiac medications were at the discretion of the attending anesthesiologists, surgeons, and cardiologists. The proportion of subjects who experienced the composite endpoint event (death, myocardial infarction, congestive heart failure, arrhythmia) by postsurgical day 30 was 18.5% in the 12-mg/kg/d group, compared with 15.7% in the placebo group, resulting in a relative risk (RR) of 1.17% (95% confidence interval [CI], 0.80-1.72; p = NS) favoring placebo. The proportions in the lower 2 zoniporide dose groups were slightly lower than in the placebo group, although the sample size is inadequate to reach any firm conclusions. CONCLUSIONS: The results fail to demonstrate the efficacy of zoniporide in reducing the proportion of patients at high risk undergoing noncardiac vascular surgery who experience a composite cardiovascular endpoint, which led the corporate sponsor to stop enrollment early on the basis of a futility analysis of the chance of demonstrating efficacy with a larger sample size.

O ecodopller carotideovertebral / Carotid-vertebral ecodoppler

O ecodoppler e exame nao invasivo recentemente introduzido no arsenal diagnostico. A aplicacao, em nosso meio, e a difusao dde suas indicacoes prendem-se basicamente a sua elevada acuracia (91% em relacao a arteriografia). Estes resultados sao obtidos gracas a analise da dados hemodinamicos e morfologicos. Os autores chamam atencao para a validade do metodo e propoem protocolos para o manejo dos pacientes sintomaticos e assintomaticos utilizando o ecodoppler como metodo de triagem

Colocaçäo do filtro de veia cava inferior na profilaxia da embolia pulmonar: relato de três casos / Use of vena cava filter in the prophylaxis of pulmonary embolism: three cases reports

A utilizaçäo de filtros de veia cava inferior para prevenir o deslocamento de êmbolos para a circulaçäo pulmonar é a principal alternativa terapêutica nos pacientes com contra-indicaçäo para a anticoagulaçäo plena ou na ineficácia desta. Relatam-se os três primeiros casos de colocaçäo de filtro (Kimray-Greenfield) em veia cava inferior no Hospital de Clínicas de Porto Alegre, devido a recidiva de embolia pulmonar sob anticoagulaçäo. Tanto a colocaçäo por dissecçäo de veia jugular (um caso) quanto por via femoral com técnica transcutânea (dois casos) foram bem sucedidas. Os pacientes tiveram boa evoluçäo do quadro clínico e mantiveram-se assintomáticos após a alta