RESUMO
Several external and internal factors can affect the performance and variability of Hemoglobin concentration [Hb] measurements using HemoCue, and documentation on the contribution of different sources of [Hb] variation is limited. We used an experimental repeated measurements design with nine randomly selected participants, three HemoCue devices, and three trained field workers. HemoCue measurements for all samples were repeated three times. The [Hb] measurement system considers four sources of error: 1) HemoCue devices, 2) field workers, 3) between individuals, and 4) within individuals. A concordance analysis was used to assess accuracy and precision, and a linear mixed model was used to estimate mean differences (bias) from blood specimens, anticoagulants, and to estimate the contribution of the 4 sources of error to [Hb] measurements. Positive mean [Hb] differences were found: 1.34 g/dL for capillary drops, 0.81 g/dL for pooled capillary blood samples, 0.756 g/dL for venous blood stored with EDTA, and 0.911 g/dL for venous blood stored with heparin. The mean [Hb] difference for venous blood with EDTA was used as a correction factor for all results measured using a HemoCue. After adjustment, capillary drops showed a mean difference of 0.585 g/dL, and pooled capillary samples were not significantly different. The individual variability was 95.8% of total variance, HemoCue devices contributed 2.1% of measurement error, field staff contributed 0.4%, and the residual was 1.7%. The HemoCue [Hb] measurement system is reliable in controlled environments, with a small measurement error of 4.2%.
Assuntos
Capilares , Hemoglobinas , Humanos , Hemoglobinas/análise , Feminino , Masculino , Adulto , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/instrumentação , Veias , Reprodutibilidade dos Testes , Teste em Amostras de Sangue Seco/métodos , Teste em Amostras de Sangue Seco/instrumentaçãoRESUMO
INTRODUCTION: Pulp stones (PS) are calcifications commonly found in the pulp tissue that may be associated with systemic diseases. OBJECTIVE: To evaluate the association between PS and systemic diseases. METHODS: A case-control study with the inclusion of individuals from 18 to 65 years of age, of both sexes. Analysis was made of 1047 digital panoramic radiographs. The controls could not have any teeth with PS; the cases were the contrary. A questionnaire comprising demographic, habit, and general health (diabetes, problems with blood vessels, altered cholesterol level, heart attack, kidney or gallbladder stone, arthritis, or autoimmune disease, and for women, endometriosis, and ovarian cyst). Data were submitted to the Student's t-test to identify differences between groups about sex and age. The Chi-square test was applied to the cross-tabulation. The analyses were performed using SPSS®, version 25.0, with a 5% significance level. RESULTS: 490 patients participated (242 cases and 248 controls). There was no difference between groups for the sex (p=0.966) and age (p=0.186). Only "kidney stone" was associated with the case group (p=0.001), being almost three times higher when compared to the control group. No significant differences were found in females about the presence or absence of PS (p>0.05). CONCLUSÃO: In this research, it is suggested the existence of an association between kidney stones and the presence of pulp stones.
INTRODUÇÃO: Nódulos pulpares (NP) são calcificações comumente encontradas no tecido pulpar que podem estar associadas a doenças sistêmicas. OBJETIVO: Avaliar a associação entre NP e doenças sistêmicas. MÉTODOS: Estudo caso-controle com inclusão de indivíduos de 18 a 65 anos de idade, de ambos os sexos. Foram analisadas 1047 radiografias panorâmicas digitais. Os controles não poderiam ter dentes com NP; os casos foram o contrário. Foi aplicado um questionário aos participantes, contendo variáveis demográficas, de hábitos e de saúde geral (diabetes, problemas com vasos sanguíneos, nível de colesterol alterado, ataque cardíaco, cálculo renal ou biliar, artrite ou doença autoimune, e para as mulheres, endometrioses e cisto no ovário). Os dados foram submetidos ao teste t de Student para identificar diferenças entre os grupos em relação ao sexo e à idade. O teste Qui-quadrado foi aplicado para a tabulação cruzada. As análises foram realizadas no SPSS®, versão 25.0, com nível de significância de 5%. RESULTADOS: Participaram 490 pacientes (242 casos e 248 controles). Não houve diferença entre os grupos para sexo (p=0,966) e idade (p=0,186). Apenas "cálculo renal" associou-se ao grupo caso (p=0,001), sendo quase três vezes maior quando comparado ao grupo controle. Não foram encontradas diferenças significativas no sexo feminino em relação à presença ou ausência de PS (p>0,05). CONCLUSÃO: Nesta pesquisa, sugere-se a existência de uma associação entre cálculos renais e presença de Nódulos pulpares.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Calcificações da Polpa Dentária , Cistos Ovarianos , Artrite , Tabagismo , Veias , Consumo de Bebidas Alcoólicas , Cálculos Biliares , Cálculos Renais , Diabetes Mellitus , Endometriose , Hipercolesterolemia , Infarto do MiocárdioRESUMO
CONTEXT: The role of hormone parameters at adrenal venous sampling (AVS) in predicting clinical and biochemical outcomes remains controversial. OBJECTIVE: To investigate the impact of hormone parameters at AVS under cosyntropin stimulation on lateralization and on complete biochemical and clinical outcomes. METHODS: We retrospectively evaluated 150 sequential AVS under cosyntropin infusion. The bilateral successful cannulation rate was 83.3% (n = 140), 47.9% bilateral and 52.1% unilateral. The lateralization index, aldosterone/cortisol ratio (A/C) in the dominant adrenal vein (AV), and relative aldosterone secretion index (RASI = A/C in AV divided by A/C in inferior vena cava) were assessed. The contralateral suppression (CS) percentage was defined by (1 - nondominant RASI) * 100. RESULTS: A nondominant RASI <0.5 (CS >50%) had 86.84% sensitivity and 92.96% specificity to predict contralateral lateralization. An A/C ratio in dominant AV >5.9 (74.67% sensitivity and 80% specificity) and dominant RASI >4.7 (35.21% sensitivity and 88.06% specificity) had the worst performance to predict ipsilateral lateralization. Complete biochemical and clinical cure was significantly more frequent in the patients with CS >50% [98.41% vs 42.86% (P < .001) and 41.94% vs 0% (P < .001)]. CS correlated with high aldosterone at diagnosis (P < .001) and low postoperative aldosterone levels at 1 month (P = .019). Postoperative biochemical hypoaldosteronism was more frequent in patients with CS >50% (70% vs 16.67%, P = .014). In multivariable analysis, a CS >50% was associated with complete biochemical cure [odds ratio (OR) 125, 95% confidence interval (CI) 11.904-5000; P = .001] and hypertension remission (OR 12.19, 95% CI 2.074-250; P = .023). CONCLUSION: A CS >50% was an independent predictor of complete clinical and biochemical cure. Moreover, it can predict unilateral primary aldosteronism and postoperative biochemical hypoaldosteronism. Our findings underscore the usefulness of CS for clinical decision-making.
Assuntos
Glândulas Suprarrenais , Aldosterona , Cosintropina , Hidrocortisona , Hiperaldosteronismo , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/metabolismo , Aldosterona/sangue , Cosintropina/administração & dosagem , Adulto , Hidrocortisona/sangue , Prognóstico , Veias , Coleta de Amostras Sanguíneas/métodos , IdosoRESUMO
BACKGROUND: The presence of a vascular, blue linear discoloration on the nasal root of infants and young children is a frequent incidental feature, rarely reported in the medical literature. It is related to the trajectory of the transverse nasal root vein (TNRV). OBJECTIVE: To study the frequency and clinical characteristics of the vascular discoloration of the nasal root in children. METHODS: A prospective study was performed to address the presence or absence of vascular discoloration of the nasal root in all children under 6 years of age attending a pediatric dermatology clinic from November 2022 to November 2023. Data on age and skin phototype (Fitzpatrick classification I-VI) were also collected. RESULTS: Of 701 patients examined, 345 (49.2%) presented with a vascular discoloration of the nasal root. This was present in 97 of 193 (50.3%), 127 of 261 (48.7%), and 121 of 247 (49.0%) patients for the age groups 0-1, 1-3, and 3-6 years, respectively. The presence of vascular discoloration of the nasal root was more frequent in patients with lighter Fitzpatrick skin phototypes: 49 of 69 (71.0%) phototype II, 157 of 290 (54.1%) phototype III, and 137 of 337 (40.7%) phototype IV. CONCLUSIONS: A vascular discoloration of the nasal root is a frequent skin feature in infants and children, persisting at least until the age of 6. It does not constitute any medical problem aside from cosmetic concern and parents can be reassured of its benign nature. We propose the medical term "prominent TNRV" to describe this condition.
Assuntos
Nariz , Humanos , Pré-Escolar , Lactente , Estudos Prospectivos , Masculino , Feminino , Criança , Nariz/irrigação sanguínea , Veias/anormalidades , Veias/anatomia & histologia , Recém-Nascido , Pigmentação da PeleRESUMO
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.
Assuntos
Animais , Bovinos , Bovinos/anatomia & histologia , Vasos Coronários/anatomia & histologia , Veias , Estudos Transversais , Seio Coronário/anatomia & histologiaRESUMO
Introduction: central vein stenosis (CVS) is a common complication in chronic kidney disease (CKD) patients, leading to vascular complications and higher mortality. Exposure to catheters is an important risk factor, and there is a wide spectrum of clinical presentation, including edema of the upper arm, neck, upper chest, and face, impairment of dialysis efficiency, and reduction of vascular accesses. Case report: a 41-year-old woman with CKD on dialysis and a history of multiple vascular accesses was admitted with a 3-month history of cervical and left hemiface edema. An angiotomography revealed marked stenosis in the proximal segment of the left brachiocephalic vein, and a venography confirmed the diagnosis of CVS, with subocclusive stenosis of the venous trunk and significant collateral veins. An endovascular treatment was performed with balloon angioplasty. She presented considerable improvement in the edema after the procedure. Conclusion: to avoid the development of central vein obstruction, it is important to enhance our knowledge about the main risk factors associated with this pathology. Although it is a treatable condition, recurrence of symptoms may occur, and subsequent vascular interventions may be needed. Therefore, prevention strategies are the most efficient approach.
Introdução: a estenose venosa central é uma complicação comum em pacientes com doença renal crônica (DRC), levando a complicações vasculares e maior mortalidade. A exposição a cateteres é um importante fator de risco, e a sua apresentação clínica envolve um amplo espectro de sinais e sintomas, incluindo edema em membros superiores, região cervical, tórax e face, comprometimento da eficiência da diálise e redução de sítios viáveis para confecção de acessos vasculares. Relato de caso: paciente do sexo feminino, 41 anos, com DRC dialítica e história prévia de múltiplos acessos vasculares, foi admitida com história de edema em região cervical e hemiface esquerda há três meses. A angiotomografia revelou estenose acentuada no segmento proximal da veia braquiocefálica esquerda, e a flebografia confirmou o diagnóstico de estenose venosa central, com estenose suboclusiva do tronco venoso e veias colaterais significativas. Foi realizado tratamento endovascular com angioplastia com balão, apresentando melhora considerável do edema após o procedimento. Conclusão: para evitar o desenvolvimento de obstrução venosa central, é importante aprofundar o conhecimento a respeito dos principais fatores de risco associados a esta patologia. Embora corresponda a uma condição tratável, o paciente pode evoluir com recorrência dos sintomas, e intervenções vasculares subsequentes podem ser necessárias. Portanto, as estratégias de prevenção são a abordagem mais eficiente.
Assuntos
Humanos , Feminino , Adulto , Constrição Patológica , Veias , Flebografia , Veias Braquiocefálicas , Diálise Renal , Angioplastia com Balão , Diálise , Prevenção de Doenças , Insuficiência Renal Crônica , CatéteresRESUMO
BACKGROUND: Intimal hyperplasia is the response to endothelial injury. Platelet-derived growth factor is released early and favors the formation of intimal hyperplasia. Although multiple treatments, from open surgery to endovascular techniques, have been used they remain controversial. There is currently interest in developing pharmacological strategies to address this pathology. Local vascular inflammation induced by vessel barotrauma generates intimal hyperplasia due to mechanical stress over the venous endothelium. Cilostazol is a selective phosphodiesterase type 3 (PDE3) selective inhibitor with a regulatory effect over intimal hyperplasia. The objective was to investigate cilostazol's role in inhibiting smooth muscle cell proliferation due to changes in the expression and release of PDGF-BB isoform and the effect on developing IH using an experimental model of vascular barotrauma (balloon-induced injury model). METHODS: We included 12 New Zealand rabbits. The balloon-induced injury model (BIIM) and experimental group cilostazol (20 mg/kg/day) included 6 rabbits each. Contralateral veins from 6 rabbits used in BIIM model has been taken as control group. We measured and compared the expression of PDGF-BB and the development of IH. A pathologist board chooses a PDGFRα antibody to localized its expression by immunohistochemistry analysis. Subsequently, using an automated immunohistochemical staining machine, the PDGFR expression was evaluated using a Zeiss Primo Star 4 light microscope. RESULTS: The measurement obtained in the intimal layer was: 126.12 µm2 in the CG, 232 µm2 in the BIIM group, and 178 µm2 in the EG. A statistically significant difference was observed. Baseline serum concentrations of PDGF-BB in the BIIM group were 0.22 pg/mL. At 12 h 0.42 pg/mL, and 0.17 pg/mL at seven days. In the experimental group, the basal levels were 0.33 pg/mL. With the use of cilostazol, a lower peak was obtained at 12 h (0.08 pg/mL). This difference was statistically significant. CONCLUSIONS: Cilostazol induced a significant reduction of IH caused by barotrauma in the venous endothelium, which correlates with decrease in the PDGF-BB in serum. This could be attributed to the pharmacologic effect on PDGFR expression.
Assuntos
Becaplermina , Proliferação de Células , Cilostazol , Modelos Animais de Doenças , Hiperplasia , Neointima , Lesões do Sistema Vascular , Cilostazol/farmacologia , Animais , Coelhos , Lesões do Sistema Vascular/patologia , Lesões do Sistema Vascular/metabolismo , Lesões do Sistema Vascular/tratamento farmacológico , Becaplermina/farmacologia , Proliferação de Células/efeitos dos fármacos , Inibidores da Fosfodiesterase 3/farmacologia , Músculo Liso Vascular/efeitos dos fármacos , Músculo Liso Vascular/patologia , Músculo Liso Vascular/metabolismo , Masculino , Veias/efeitos dos fármacos , Veias/metabolismo , Veias/patologia , Regulação para Baixo , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/patologia , Miócitos de Músculo Liso/metabolismo , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Isoformas de Proteínas/metabolismoRESUMO
OBJECTIVE: To comparatively evaluate performances of tablet-based versus paper-based Venous Insufficiency Epidemiologic and Economic Study-Quality of Life/Symptom (VEINES-QOL/Sym) questionnaire. METHODS: We prospectively evaluated 78 consecutive patients who completed tablet-based and paper-based VEINES-QOL/Sym questionnaires and compared their scores, completion time, data entry time, and ease of use. We used Student's t-test and Wilcoxon test for quantitative variables, Bland-Altman test and kappa coefficient for agreement between questionnaires and patients, respectively. Spearman's correlation coefficient was used to assess correlations. RESULTS: Most participants (83.3%) found it easier to use the tablet device. Less time was needed to complete the tablet-based (median, 4.75; IQR, 3-7 min) than the paper-based (median, 8.3; IQR, 6.3-11.3 min) questionnaire (p < .001). Better educated patients took less time to complete paper-based (p = .003) and tablet-based (p = .001) questionnaires and considered the latter easier to use (p = .010). CONCLUSIONS: The tablet-based VEINES-QOL/Sym proved to be an easy-to-use and time-saving tool.
Assuntos
Qualidade de Vida , Insuficiência Venosa , Humanos , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/epidemiologia , Veias , Inquéritos e Questionários , Doença CrônicaRESUMO
Introducción: La cirugía del seno cavernoso se consideró durante mucho tiempo inviable (no accesible para el hombre) (5,31) debido al riesgo de sangrado o lesión de estructuras neurovasculares críticas, como la ACI, el nervio oculomotor, troclear y abducens (5.31). Desde entonces, numerosos estudios han contribuido a comprender la anatomía microquirúrgica del seno cavernoso. En 1965, Parkinson (25) realizó el primer abordaje del seno cavernoso para el tratamiento de la fístula carótida-cavernosa. Fue el comienzo de la era moderna en la cirugía del seno cavernoso y abrió la puerta a muchas publicaciones que detallan los abordajes quirúrgicos de diversas lesiones dentro y alrededor del seno cavernoso. Junto al desarrollo y la mejora de la neuroimagen y la anatomía microquirúrgica, permitieron acceder con éxito al seno cavernoso. Nuestro objetivo es presentar una revisión narrativa de vanguardia de la anatomía microquirúrgica del seno cavernoso y el manejo interdisciplinario. Para lograr este propósito, se realizó la disección cadavérica de 2 cabezas (cuatro senos cavernosos) reflejada en 2 casos quirúrgicos, además de una revisión bibliográfica exhaustiva que orienta el manejo multimodal de los tumores que se encuentran dentro o alrededor del seno cavernoso. Objetivo: Describir la anatomía quirúrgica del seno cavernoso a través de disecciones cadavéricas y su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 4 senos cavernosos cadavéricos humanos fijados en formol. Las arterias y venas fueron inyectadas con silicona coloreada, las imágenes fueron tomadas con una cámara DSLR Nikon 3400 profesional de 24,2 megapíxeles. Resultados: El seno cavernoso es un compartimento dural que contiene estructuras neurovasculares críticas, cuya disección debe ser realizada de forma cuidadosa y prolija por el inminente riesgo de lesión de las mismas. Es así que lesiones confinadas por ejemplo a la pared lateral (caso clínico 2) tienen mayor probabilidad de remoción total, por lo tanto mejor pronóstico, no así las lesiones que invaden el seno cavernoso (caso clínico 1) donde la probabilidad de remoción total disminuye y el riesgo de lesión neurovascular aumenta. Conclusiones: El conocimiento preciso de la anatomía microquirúrgica del seno cavernoso y el manejo multimodal son cruciales en el manejo y pronóstico del paciente(AU)
Background: Cavernous sinus surgery was long considered unfeasible (not accessible to humans) (5.31) due to the risk of bleeding or injury to critical neurovascular structures, such as the ICA, oculomotor, trochlear and abducens nerves (5.31). Since then, numerous studies have contributed to understanding the microsurgical anatomy of the cavernous sinus. In 1965, Parkinson (25) performed the first approach to the cavernous sinus for the treatment of carotid-cavernous fistula. This was the beginning of the modern era in cavernous sinus surgery and opens the door to many publications detailing surgical approaches to various injuries in and around the cavernous sinus. Together with the development and improvement of neuroimaging and microsurgical anatomy, they allowed successful access to the cavernous sinus. Our goal is to present a state-of-the-art narrative review of cavernous sinus microsurgical anatomy and interdisciplinary management. To achieve this purpose, cadaveric dissection of 2 heads (four cavernous sinuses) was performed, reflected in 2 surgical cases, in addition to an exhaustive literature review that guides the multimodal management of tumors found within or around the cavernous sinus. Objective: The aim of this study is to describe the surgical anatomy of the cavernous sinus through cadaveric dissections and its microsurgical application. Methods: 4 human cadaveric cavernous sinuses fixed in formalin were studied, the arteries and veins were injected with colored silicone, the images were taken with a 24.2-megapixel Nikon 3400 professional DSLR camera. Results: The cavernous sinus is a dural compartment that contains critical neurovascular structures, whose dissection must be performed carefully and neatly due to the imminent risk of injury to them, so lesions confined, for example, to the lateral wall (clinical case 2 ) have a higher probability of total removal and therefore a better prognosis, but not lesions that invade the cavernous sinus (clinical case 1) itself, where the probability of total removal decreases and the risk of neurovascular injury increases. Conclusions: Precise knowledge of the microsurgical anatomy of the cavernous sinus and multimodal management are crucial in the management and prognosis of the patient
Assuntos
Seio Cavernoso , Artérias , Veias , Base do Crânio , Anatomia , MicrocirurgiaRESUMO
BACKGROUND: Chronic venous insufficiency (CVI) is a condition related to chronic venous disease that may progress to venous leg ulceration and impair quality of life of those affected. Treatments such as physical exercise may be useful to reduce CVI symptoms. This is an update of an earlier Cochrane Review. OBJECTIVES: To evaluate the benefits and harms of physical exercise programmes for the treatment of individuals with non-ulcerated CVI. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 28 March 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing exercise programmes with no exercise in people with non-ulcerated CVI. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were intensity of disease signs and symptoms, ejection fraction, venous refilling time, and incidence of venous leg ulcer. Our secondary outcomes were quality of life, exercise capacity, muscle strength, incidence of surgical intervention, and ankle joint mobility. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included five RCTs involving 146 participants. The studies compared a physical exercise group with a control group that did not perform a structured exercise programme. The exercise protocols differed between studies. We assessed three studies to be at an overall unclear risk of bias, one study at overall high risk of bias, and one study at overall low risk of bias. We were not able to combine data in meta-analysis as studies did not report all outcomes, and different methods were used to measure and report outcomes. Two studies reported intensity of CVI disease signs and symptoms using a validated scale. There was no clear difference in signs and symptoms between groups in baseline to six months after treatment (Venous Clinical Severity Score mean difference (MD) -0.38, 95% confidence interval (CI) -3.02 to 2.26; 28 participants, 1 study; very low-certainty evidence), and we are uncertain if exercise alters the intensity of signs and symptoms eight weeks after treatment (MD -4.07, 95% CI -6.53 to -1.61; 21 participants, 1 study; very low-certainty evidence). There was no clear difference in ejection fraction between groups from baseline to six months follow-up (MD 4.88, 95% CI -1.82 to 11.58; 28 participants, 1 study; very low-certainty evidence). Three studies reported on venous refilling time. We are uncertain if there is an improvement in venous refilling time between groups for baseline to six-month changes (MD 10.70 seconds, 95% CI 8.86 to 12.54; 23 participants, 1 study; very low-certainty evidence) or baseline to eight-week change (MD 9.15 seconds, 95% CI 5.53 to 12.77 for right side; MD 7.25 seconds, 95% CI 5.23 to 9.27 for left side; 21 participants, 1 study; very low-certainty evidence). There was no clear difference in venous refilling index for baseline to six-month changes (MD 0.57 mL/min, 95% CI -0.96 to 2.10; 28 participants, 1 study; very low-certainty evidence). No included studies reported the incidence of venous leg ulcers. One study reported health-related quality of life using validated instruments (Venous Insufficiency Epidemiological and Economic Study (VEINES) and 36-item Short Form Health Survey (SF-36), physical component score (PCS) and mental component score (MCS)). We are uncertain if exercise alters baseline to six-month changes in health-related quality of life between groups (VEINES-QOL: MD 4.60, 95% CI 0.78 to 8.42; SF-36 PCS: MD 5.40, 95% CI 0.63 to 10.17; SF-36 MCS: MD 0.40, 95% CI -3.85 to 4.65; 40 participants, 1 study; all very low-certainty evidence). Another study used the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20), and we are uncertain if exercise alters baseline to eight-week changes in health-related quality of life between groups (MD 39.36, 95% CI 30.18 to 48.54; 21 participants, 1 study; very low-certainty evidence). One study reported no differences between groups without presenting data. There was no clear difference between groups in exercise capacity measured as time on treadmill (baseline to six-month changes) (MD -0.53 minutes, 95% CI -5.25 to 4.19; 35 participants, 1 study; very low-certainty evidence). We are uncertain if exercise improves exercise capacity as assessed by the 6-minute walking test (MD 77.74 metres, 95% CI 58.93 to 96.55; 21 participants, 1 study; very low-certainty evidence). Muscle strength was measured using dynamometry or using heel lifts counts. We are uncertain if exercise increases peak torque/body weight (120 revolutions per minute) (changes from baseline to six months MD 3.10 ft-lb, 95% CI 0.98 to 5.22; 29 participants, 1 study; very low-certainty evidence). There was no clear difference between groups in baseline to eight-week change in strength measured by a hand dynamometer (MD 12.24 lb, 95% CI -7.61 to 32.09 for the right side; MD 11.25, 95% CI -14.10 to 36.60 for the left side; 21 participants, 1 study; very low-certainty evidence). We are uncertain if there is an increase in heel lifts (n) (baseline to six-month changes) between groups (MD 7.70, 95% CI 0.94 to 14.46; 39 participants, 1 study; very low-certainty evidence). There was no clear difference between groups in ankle mobility measured during dynamometry (baseline to six-month change MD -1.40 degrees, 95% CI -4.77 to 1.97; 29 participants, 1 study; very low-certainty evidence). We are uncertain if exercise increases plantar flexion measured by a goniometer (baseline to eight-week change MD 12.13 degrees, 95% CI 8.28 to 15.98 for right leg; MD 10.95 degrees, 95% CI 7.93 to 13.97 for left leg; 21 participants, 1 study; very low-certainty evidence). In all cases, we downgraded the certainty of evidence due to risk of bias and imprecision. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to assess the benefits and harms of physical exercise in people with chronic venous disease. Future research into the effect of physical exercise should consider types of exercise protocols (intensity, frequency, and time), sample size, blinding, and homogeneity according to the severity of disease.
Assuntos
Insuficiência Venosa , Humanos , Peso Corporal , Lacunas de Evidências , Exercício Físico , Veias , Insuficiência Venosa/terapiaRESUMO
OBJECTIVE: To evaluate the role of cyanoacrylate glue in reducing dislodgement of umbilical venous catheters (UVCs). STUDY DESIGN: This was a single-center, randomized, controlled, nonblinded trial. All infants requiring an UVC according to our local policy were included in the study. Infants with a UVC with a centrally located tip as verified by real-time ultrasound examination were eligible for the study. Primary outcome was the safety and efficacy of securement by cyanoacrylate glue plus cord-anchored suture (SG group) vs securement by suture alone (S group), as measured by reduction in dislodgment of the external tract of the catheter. Secondary outcomes were tip migration, catheter-related bloodstream infection, and catheter-related thrombosis. RESULTS: In the first 48 hours after UVC insertion, dislodgement was significantly higher in the S group than in the SG group (23.1% vs 1.5%; P < .001). The overall dislodgement rate was 24.6% in the S group vs 7.7% in the SG group (P = .016). No differences were found in catheter-related bloodstream infection and catheter-related thrombosis. The incidence of tip migration was similar in both groups (S group 12.2% vs SG group 11.7%). CONCLUSIONS: In our single-center study, cyanoacrylate glue was safe and effective for securement of UVCs, and particularly effective in decreasing early catheter dislodgments. TRIAL REGISTRATION: UMIN-CTR Clinical Trial; Registration number: R000045844.
Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Sepse , Trombose , Doenças Vasculares , Lactente , Humanos , Cianoacrilatos/uso terapêutico , Catéteres , Veias , Veias UmbilicaisRESUMO
OBJECTIVE: To assess the extent and resolution of pulmonary hypertension (PH), cardiovascular factors, and echocardiographic findings associated with mortality in infants and children with vein of Galen malformation (VOGM). STUDY DESIGN: We performed a retrospective review of 49 consecutive children with VOGM admitted to Boston Children's Hospital from 2007 to 2020. Patient characteristics, echocardiographic data, and hospital course were analyzed for 2 cohorts based on age at presentation to Boston Children's Hospital: group 1 (age ≤60 days) or group 2 (age >60 days). RESULTS: Overall hospital survival was 35 of 49 (71.4%); 13 of 26 (50%) in group 1 and 22 of 23 (96%) in group 2 (P < .001). High-output PH (P = .01), cardiomegaly (P = .011), intubation (P = .019), and dopamine use (P = .01) were significantly more common in group 1 than group 2. Among patients in group 1, congestive heart failure (P = .015), intubation (P < .001), use of inhaled nitric oxide (P = .015) or prostaglandin E1 (P = .030), suprasystemic PH (P = .003), and right-sided dilation were significantly associated with mortality; in contrast, left ventricular volume and function, structural congenital heart disease, and supraventricular tachycardia were not associated. Inhaled nitric oxide achieved no clinical benefit in 9 of 11 treated patients. Resolution of PH was associated with overall survival (P < .001). CONCLUSIONS: VOGM remains associated with substantial mortality among infants presenting at ≤60 days of life owing to factors associated with high output PH. Resolution of PH is an indicator associated with survival and a surrogate end point for benchmarking outcomes.
Assuntos
Hipertensão Pulmonar , Malformações da Veia de Galeno , Humanos , Lactente , Criança , Recém-Nascido , Hipertensão Pulmonar/complicações , Malformações da Veia de Galeno/complicações , Malformações da Veia de Galeno/diagnóstico por imagem , Malformações da Veia de Galeno/terapia , Óxido Nítrico , VeiasRESUMO
The present research aims to present and describe an unusual and rare anatomical variation in relation to the drainage of the right gonadal vein. This anatomical knowledge is crucial as it assists in the work of surgeons and health professionals in general. The dissection occurred in the anterior wall of the abdomen and, through observational analysis, an anatomical variation was found in the drainage of the right gonadal vein in a human cadaver, obtained by anonymous donation, male gender and without predetermined clinical characteristics, ethnicity, and age, belonging to the Padre Albino University Center collection. This research was approved by the Research Ethics Committee under protocol 12923919.8.0000.5430. The drainage of right gonadal vein is this variant occurs anastomosed with an innominate venous trunk that empties into the inferior vena cava. Furthermore, the presence of an accessory right renal vein is also noticed, which anastomoses with the innominate venous trunk and with the right renal vein, through a vein suggestively called interrenal, differing from the anatomical normality described in the literature. This variation is supposed to occur due to flaws in the development of the embryo, which generate venous changes in the origins of the right gonadal vein. Acknowledging the existence of it is relevant when performing surgical procedures in the region, as it differs from the most frequent anatomy found in the human population. The rare drainage of the right gonadal vein through an innominate trunk to the inferior vena cava and its importance is highlighted in this article.
Assuntos
Veias , Veia Cava Inferior , Masculino , Humanos , Veias/anatomia & histologia , Veia Cava Inferior/anormalidades , Veias Renais/anatomia & histologia , Drenagem , DissecaçãoRESUMO
Treatment of peripheral nerve injury is not always satisfactory. To improve results, specific adjuvant methods have been used, such as platelet-rich fibrin (PRF) and vein conduits. The goal of this study was to assess whether use of PRF and vein conduits after nerve suture improves nerve regeneration as measured by a functional score and histomorphometry analysis. Ten isogenic spontaneously hypertensive rats were randomly assigned to 4 experimental procedures: 1) Sham group (n = 10); 2) Nerve graft (NG) group (n = 10); 3) Nerve graft covered with a vein conduit (NGVC) (n = 10); and 4) Nerve graft covered with a vein conduit pre-filled with PRF (NGVCP) (n = 10). Nerve repair results were evaluated on: sciatic functional index (SFI) at 0, 30, 60 and 90 days; morphometric and morphologic analysis of the distal nerve; and histological analysis of Fluoro-Gold® stained motor neurons in the anterior horn of the spinal cord. Compared to the Sham control group, the NGVC and NGVCP groups exhibited lower SFI on all measures. The NGVC group showed improvement in SFI at day 90, which was significant compared to the NG group. Fiber and axon diameters were comparable in the NGVC and NGVCP groups, which were both significantly lower than in the Sham and NG groups. Significant improvement was expected with PRF, but in fact the release of factors from this substance was not as effective as hoped.
Assuntos
Traumatismos dos Nervos Periféricos , Fibrina Rica em Plaquetas , Ratos , Animais , Nervo Isquiático/cirurgia , Nervo Isquiático/lesões , Nervo Isquiático/fisiologia , Veias/transplante , Traumatismos dos Nervos Periféricos/cirurgia , Regeneração Nervosa/fisiologiaRESUMO
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.
Assuntos
Animais , Coluna Vertebral/irrigação sanguínea , Veias/anatomia & histologia , Cães/anatomia & histologiaRESUMO
Bradypus variegatus, the common sloth, belongs to the Bradypodidae family, being considered a biological model to be applied in multidisciplinary research. This study was developed with the aim of being applied to clinical medicine and to the adequate management of the common sloth. Ten sloths were utilized, obtained post-natural death. The animals were fixed and to obtain the results, they were submitted to the dissection technique. For 80% of the animals, the portal vein originated from five tributaries, which were: the resulting vein from the anastomosis of the cardia vein, fundic vein, and the pyloric branches; the mesenteric trunk; the vein formed by the confluence of the stomach body branches and the cranial portion of the cavity of the cardia; the pyloric vein and splenic vein. While in 20% of the animals, the portal vein was comprised of six tributaries, because the fundic vein and cardia vein form two direct anastomoses, arriving at the portal vein two tributary vessels. This pattern differs in number and arrangement of branches when compared to the main domestic species. Therefore, the hepatic portal system is responsible for the drainage of the stomach, spleen, pancreas and intestines.
Bradypus variegatus, a preguiça-comum, pertence à família Bradypodidae, sendo considerada um modelo biológico a ser aplicado em pesquisas multidisciplinares. Este estudo foi desenvolvido a fim de ser aplicado à clínica médica e ao manejo adequado da preguiça-comum. Foram utilizadas 10 preguiças, obtidas após morte natural. Os animais foram fixados e, para a obtenção dos resultados, submeteram-se à técnica de dissecação. Em 80% das observações, a veia porta originou-se a partir de cinco tributárias, são elas: a veia resultante da anastomose da veia cárdia, da veia fúndica e dos ramos pilóricos; o tronco mesentérico; a veia formada a partir da confluência de ramos do corpo estomacal e da porção cranial da cavidade cárdica; a veia pilórica e a veia esplênica. Enquanto em 20% dos animais a veia porta é constituída por seis tributárias, a veia fúndica e a veia cárdica formam duas anastomoses diretas, chegando à veia porta dois vasos tributários. Esse padrão difere em número e em disposição dos ramos, quando comparado ao das principais espécies domésticas. Portanto, o sistema porta hepático é responsável pela drenagem do estômago, do baço, do pâncreas e dos intestinos.
Assuntos
Animais , Feminino , Sistema Porta/anatomia & histologia , Bichos-Preguiça/anatomia & histologia , Veias/anatomia & histologia , Circulação HepáticaRESUMO
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.
Assuntos
Veias , Coleta de Amostras Sanguíneas , Odontologia , Fibrina Rica em PlaquetasRESUMO
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.