Dystrophic calcinosis cutis in chronic venous disease of the lower limbs.

Lower limb ulcers secondary to chronic venous disease (CVD) are a significant public health problem in Brazil and account for about 70% of these ulcers. Despite recent technological advances and the various therapeutic options for treatment of these chronic injuries, several factors may be involved in resistance to treatment. Dystrophic calcinosis cutis (DCC) is a rare and often underdiagnosed condition that, when in conjunction with CVD, may be associated with a refractory healing process. In this article, we report a case of DCC in a patient with CVD and discuss its etiology, pathophysiology and possible treatment options.

Calcinose distrófica cutânea na doença venosa crônica de membros inferiores / Dystrophic calcinosis cutis in chronic venous disease of the lower limbs

Resumo As úlceras de membros inferiores, secundárias à doença venosa crônica (DVC), constituem um problema significativo de saúde pública no Brasil e representam cerca de 70% do total dessas úlceras. Apesar dos recentes avanços tecnológicos e das diversas opções terapêuticas utilizadas para essas lesões crônicas, existem diversos fatores que podem estar implicados na resistência ao tratamento. A calcificação distrófica cutânea (CDC) é uma condição rara e frequentemente subdiagnosticada, que, quando associada à DVC, pode estar associada à refratariedade no processo cicatricial. Neste artigo, relatamos um caso de CDC em paciente portador de DVC e discutimos a sua etiologia, fisiopatologia e possíveis opções de tratamento.

Abstract Lower limb ulcers secondary to chronic venous disease (CVD) are a significant public health problem in Brazil and account for about 70% of these ulcers. Despite recent technological advances and the various therapeutic options for treatment of these chronic injuries, several factors may be involved in resistance to treatment. Dystrophic calcinosis cutis (DCC) is a rare and often underdiagnosed condition that, when in conjunction with CVD, may be associated with a refractory healing process. In this article, we report a case of DCC in a patient with CVD and discuss its etiology, pathophysiology and possible treatment options.

Alopecia in anticoagulated patients.

Alopecia is a common complication of anticoagulant therapy that may have important psychological repercussions for patients, especially female patients, and can interfere with the decision to extend anticoagulation. This review aims to describe the mechanisms potentially involved in the genesis of alopecia during anticoagulant therapy, since these are not yet fully understood, and discusses the existing therapies for the most appropriate management.

Posicionamento de ultrassonografia vascular do departamento de imagem cardiovascular da Sociedade Brasileira de Cardiologia ­ 2019 / Vascular Ultrasound Positioning of the Department of Cardiovascular Imaging of the Society Brazilian Cardiology - 2019

Posicionamento de Ultrassonografia Vascular do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia ­ 2019. (AU)

Profilaxia do tromboembolismo venoso em viagens aéreas / Venous thromboembolism prophylaxis on flights

A aviação civil vem apresentando aumento progressivo do número de voos regulares nos últimos 10 anos e, em função disso, mais passageiros estão sendo transportados em viagens aéreas (VAs). Associado a isso, há um aumento das doenças relacionadas às VAs, especialmente naquelas de longa duração. Uma das complicações mais temidas dos voos é o tromboembolismo venoso (TEV), mas a sua real incidência é de difícil mensuração devido à falta de consenso sobre, por exemplo, quanto tempo após o pouso podemos considerar que o TEV possa estar relacionado à VA realizada ou mesmo quanto tempo de voo pode ser considerado como de longa duração. Muito tem se discutido sobre os mecanismos fisiopatológicos do TEV relacionado às VAs, quais passageiros são os de maior risco e quais medidas profiláticas podemos adotar com segurança e eficácia. O objetivo desta revisão é esclarecer esses pontos e as condutas consensuais atuais

Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. There has been much discussion of the pathophysiological mechanisms of flight-related VTE, of which passengers are at greatest risk, and of what prophylactic measures can be adopted safely and effectively. The purpose of this review is to clarify these points and describe current consensual conduct

Venous thromboembolism prophylaxis on flights.

Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. There has been much discussion of the pathophysiological mechanisms of flight-related VTE, of which passengers are at greatest risk, and of what prophylactic measures can be adopted safely and effectively. The purpose of this review is to clarify these points and describe current consensual conduct.

Uso de parâmetros microcirculatórios para a avaliação de tratamento clínico da desordem venosa crônica (DVC) / Use of microcirculatory parameters to evaluation of clinical treatment in chronic venous disorder

Objetivos: Avaliar mudanças na microangiopatia cutânea em estágio iniciais de pacientes com desordem venosa crônica depois do uso de Cirkan® [droga venotônica contendo Ruscus aculeatus (extrato de planta), hesperidina methylchacone (flavonóide) e vitamina C], meio elástica de média compressão ou nenhum tratamento durante quatro semanas. Pacientes e Métodos: Cinquenta e cinco pacientes do sexo feminino, (85 pernas), entre 25 e 57 anos, com pelo menos um membro classificado como C2,s o C2,3,s (da classificação CEAP), foram alocadas consecutivamente, de acordo com a ordem de entrada nesses três grupos. Cinco mulheres sem doença venosa, com idades semelhantes foram também investigadas. Utilizando-se a técnica de luz polarizada ortogonal (método não-invasivo), medidas da densidade capilar funcional (DCF, número de capilares com fluxo sanguíneo/mm2), morfologia capilar (MC, % de capilares anormais/mm2) e diâmetros (um) da papila dérmica (DPD), no novelo capilar (DNC) e do capilar da perna (DC) foram obtidos na região peri-maleolar medial e mais tarde analisada utilizando-se o Sofware CapImage. Resultados e conclusão: Pacientes com DVC mostraram mudanças significativas no diâmetro e na morfologia capilar comparada com mulheres saudáveis, em concordância com nossos achados prévios (J Vasc Surg 43:1037-1044, 2006). Em pacientes tratados com Cirkan® durante quatro semanas, houve diminuição do diâmetro capilar em ambas as pernas e melhora da morfologia na perna esquerda, sugerindo melhora da hipertensão venosa crônica. Nenhuma mudança significativa pôde ser detectada nos outros grupos de pacientes. Esses resultados confirmam a existência de disfunção microcirculatória nos estágios iniciais da DVC, provavelmente devido à hipertensão pós-capilar e apóiam a ação do venotônico Cirkan®.

Objetives: To evaluate changes on cutaneous microangiopathy in chronic venous disorder (CVD) after use of Cirkan® [venotonic drug containing Ruscus aculeatus (plant extract), hesperidine methilchacone (flavonoid) and vitamin C], elastic compression stockings (ECS) or no treatment for four weeks. Patients and Methods: Fifty-five female patients (85 legs), 25 to 57 years, with at least one limb classified as C2,s of C2,3,s (CEAP classification), were allocated consecutively, according to entrance order, in these three groups. Ten healthy women age-matched were also investigated. Using orthogonal polarization spectral technique (noninvasive method), measurements of functional capillary density (FCD, number of capillaries with flowing red blood cells/mm2), capillary morphology (CM, 5 of abnormal capillaries/mm2) and diameters (um) of dermal papilla (DDP), capillary bulk (DCB) and capillary limb (CD) were obtained on the medial perimalleolar region and later analyzed using CapImage software. Results and conclusions: CVD patients showed significant changes on CD and CM compared to healthy subjects in agreement with our previous findings (J Vasc Surg 43:1037-1044, 2006). On Cirkan®-treated patients, after 4 weeks, CD decreased on both limbs and CM improved on the left one, suggesting an amelioration of the chronic venous hypertension. No significant changes could be detected on other patient groups. These results confirm the exixtence of microcirculatory dysfunction in early stages of CVD, probably due to post-capillary hypertension, and further support the venotonic action of Cirkan®.