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2.
Forensic Sci Int ; 307: 110115, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31918164

RESUMO

INTRODUCTION: In a case of child pornography, only the dorsum of the offender's hand was clearly visible. After identification of a suspect, the question arose of whether and how it is possible to identify or exclude the suspect as perpetrator according to the morphology of the hand vein pattern. MATERIAL AND METHODS: A simple approach to use the hand vein pattern in crime suspects as a tool for identification was tested. In this study, the hand vein patterns of 30 study participants were analysed from conventional frames on videography. A standardised grid system consisting of six lines and four sectors was applied on the dorsum of the hands. Vein branchings within the sectors and line crossings of the veins were counted, leading to a total of 11 variables for each hand. RESULTS: A positive identification of each of the 30 test participants was possible for each hand when taking only the first five variables into account. A random overlapping prediction was obtained by statistically simulating hand vein patterns of different numbers of persons using this sample. Considering the hand vein frequencies in this sample, the results indicate that the chance for two persons having the same pattern is smaller than 1:1000. CONCLUSIONS: It can be concluded that the introduced grid system approach can be an appropriate simple and non-costly tool for the analysis of the pattern of hand veins for identification purposes.


Assuntos
Mãos/irrigação sanguínea , Processamento de Imagem Assistida por Computador , Reconhecimento Automatizado de Padrão , Veias/anatomia & histologia , Gravação em Vídeo , Adulto , Idoso , Criança , Bem-Estar da Criança/legislação & jurisprudência , Literatura Erótica/legislação & jurisprudência , Feminino , Ciências Forenses/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31791089

RESUMO

This study evaluated the morphological changes of the lower limb and associated hemodynamic responses to different lower-body compression pressures (COMPs) in physically active, healthy individuals at rest. Each of the 32 participants underwent three trials with three different degrees of lower-body compression applied: "Low" (2.2±1.4 mmHg), "Medium" (12.9±3.9 mmHg), and "High" (28.8±8.3 mmHg). In each COMP, a cross-sectional area of leg muscles (CSAmuscle), subcutaneous fat (CSAfat), superficial vessels (SupV), deep arteries (DA), and deep veins (DV) at the calf, knee, and thigh levels were measured using magnetic resonance imaging (MRI). Additionally, blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were measured using Doppler ultrasound (USCOM®). With High COMP, calf CSAmuscle and SupV were smaller (p<0.01), whereas DA and DV were larger (p<0.05). Calf CSAfat, however, was similar among all COMPs. There were no major changes in CSAmuscle and CSAfat at knee and thigh levels. CO (3.2±0.9 L/min) and SV (51.9±16.4 mL) were higher (p<0.05) only with High COMP, but other hemodynamic variables showed no significant changes across different COMPs. The High COMP at the lower limb induces leg morphological changes and increases associated hemodynamic responses of physically active healthy individuals at rest.


Assuntos
Hemodinâmica/fisiologia , Extremidade Inferior/fisiologia , Meias de Compressão , Artérias/diagnóstico por imagem , Artérias/fisiologia , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Volume Sistólico/fisiologia , Gordura Subcutânea/irrigação sanguínea , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiologia , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Veias/diagnóstico por imagem , Veias/fisiologia , Adulto Jovem
4.
World Neurosurg ; 133: e479-e486, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541756

RESUMO

BACKGROUND: Cavernous carotid fistulas (CCF) are anatomically complex vascular lesions. Treatment via the venous approach has been previously described and is highly dependent on the patency of the drainage pathways. The use of a unilateral approach to contralateral or bilateral shunts is technically challenging and not commonly described. We present our experience with the unilateral across-the-midline approach to both cavernous sinuses to treat shunts according to anatomic compartments to achieve anatomic cure. METHODS: Patients included in this study presented with either bilateral or unilateral shunts with unilateral venous drainage. We used a transarterial guiding catheter for road mapping and control angiography. A venous triaxial system was used to achieve support for distal navigation across the midline via the coronary sinus to the contralateral cavernous sinus. Coils were favored for embolization, with occasional complementary liquid embolic material. RESULTS: Five patients underwent complete occlusion in a single session. One patient required additional complementary transarterial embolization. Despite a successful unilateral approach to bilateral cavernous sinuses, 1 patient needed an additional ipsilateral transophthalmic venous approach to obliterate the anterior compartment of the cavernous sinus. No complications were encountered. Complete angiographic cure was observed in all patients by the end of the final procedures, with persistent occlusion in their follow-up imaging. CONCLUSIONS: Careful inspection of the venous anatomy and fistulization sites is critical when treating unilateral or bilateral carotid cavernous shunts. The contralateral venous route can serve as a safe approach when visualized. Crossing the midline via the anterior or posterior coronary sinuses is feasible and efficacious.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Cateterismo , Seio Cavernoso , Angiografia Cerebral , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Veias
5.
J Vasc Access ; 21(1): 105-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328635

RESUMO

Non-maturation of arteriovenous fistulas is a frequent problem after dialysis access creation, especially in the forearm. The presence of accessory veins may play an important role in the non-maturing fistula. Several surgical and endovascular techniques are described to deal with this problem. We describe a new surgical technique in which we perform a rejoining of the arm veins to create a single large run-off vessel with greater diameter and flow for haemodialysis.


Assuntos
Braço/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veias/cirurgia , Adulto , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem
8.
Khirurgiia (Mosk) ; (12): 54-59, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825343

RESUMO

OBJECTIVE: To analyze the causes and develop methods for the treatment of extensive purulent processes after combined phlebectomy in patients with lower limb varicose veins. MATERIAL AND METHODS: The authors reported 3 cases of extensive phlegmon after phlebectomy for the period from 2014 to 2018. It is shown that comprehensive debridement of purulent-inflammatory lesion with application of additional methods including high-energy exposure by the air-plasma flow is essential for effective treatment of this complication. In addition, literature review showed only few observations of severe septic complications after traditional varicose vein surgery. RESULTS: Radical debridement of purulent wounds with wide excision of necrotic subcutaneous tissue and fascia, combination of standard surgical technique and plasma scalpel, as well as subsequent plasmodynamic staged wound repair in a therapeutic mode prevented severe purulent-inflammatory process, stopped systemic inflammatory syndrome and resulted fast wound healing. CONCLUSION: Active surgical approach combined with air-plasma technology was followed by high-quality correction of extensive suppurative process. Minimally invasive management of varicose disease with improvement of surgical techniques will minimize the likelihood of these complications.


Assuntos
Celulite (Flegmão)/cirurgia , Supuração/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Celulite (Flegmão)/etiologia , Desbridamento , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Supuração/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Veias/cirurgia
9.
Magy Seb ; 72(4): 167-171, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31813239

RESUMO

Introduction: Artificial arterio-venous fistula-induced steal syndrome and subsequent distal ischemia are one of the most serious complications of arterial-venous fistula (AVF) surgery, ranging from 1 to 8% of cases. Traditionally, the complication is difficult to treat without losing the fistula. Treatment options include ligature of the fistula, fistula banding, distal revascularization with interval ligation (DRIL), proximalisation of the arterial inflow (PAI), and revision using distal inflow (RUDI). We would like to present a case of a 45-year-old woman who has developed dialysis associated steal syndrome with necrosis on the left arm 5 months after a cubital AVF was created. In order to maintain her arterio-venous fistula, RUDI procedure was performed to eliminate ischemia. We used basilic vein graft for distal revision of the astomosis. As a result of the procedure, ischemic complaints ceased, dialysis did not need to be interrupted, no further vascular access was necessary. Distalization of arterial inflow (RUDI) is an easy-to-implement, good-performing method for which the use of vena basilica graft is a very obvious solution.


Assuntos
Derivação Arteriovenosa Cirúrgica , Oclusão de Enxerto Vascular , Transplantes , Feminino , Humanos , Ligadura , Pessoa de Meia-Idade , Diálise Renal , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Veias
10.
Vet J ; 254: 105397, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31836171

RESUMO

In the pig industry, labour efficiency and animal welfare have become two of the most important factors for achieving technical goals and farming competitiveness. Blood sampling is one of the most common sample-collecting techniques, but routine on-field blood collection can be very demanding for farm operators and the welfare of the animals, in particular for lactating sows. The aim of this study was to describe and investigate the mammary vein as a novel means of blood access in lactating sows that does not require coercive restraint. The study involved a total of 68 sows: 34 animals were sampled from the jugular vein (Group J) and the other 34 sows from the mammary vein (Group M). Labour time and indicators of the sow welfare (vocalizations during collection and serum cortisol concentration in the 30min after the procedure) were collected from the two groups. The total amount of labour required, calculated as the time employed to perform blood collection multiplied by the number of operators involved in performing the technique (one for Group M and two for Group J, one for restraint and one for sampling), was significantly lower in Group M than Group J (Group M, 39.83±29.45s; Group J, 82.73±55.34s; P<0.001). Mean blood volume collected at T0 was 4.81±2.00mL and 4.84±1.73mL in Group J and Group M, respectively (P>0.05). The percentage of sows that vocalized in Group M was less than in Group J (2.94% vs. 94.12%; P<0.001). Serum cortisol concentrations were not statistically different between the two groups (P>0.05). The present study suggests greater efficiency in terms of saving labour time and reducing sow vocalization during blood collection with the use of mammary vein access compared with jugular vein access.


Assuntos
Coleta de Amostras Sanguíneas/veterinária , Suínos/sangue , Bem-Estar do Animal , Animais , Coleta de Amostras Sanguíneas/métodos , Feminino , Veias Jugulares , Lactação , Glândulas Mamárias Animais/irrigação sanguínea , Veias
11.
Artigo em Russo | MEDLINE | ID: mdl-31851176

RESUMO

Mechanisms of the development of pain in chronic venous diseases (CVD), including pelvic congestion syndrome (PCS), are understudied. The existing hypotheses of the occurrence of venous pelvic pain (VVP) do not allow to answer the question why some patients have no pain syndrome while others have very pronounced pain despite the same morphofunctional changes in the pelvic veins. This review presents current hypotheses of the VPP development, data on some vasoactive neuropeptides (endothelin, calcitonin gene-related peptide, and substance P), their role in the modulation of vascular tone and sensation of pain, possible association between neurogenic inflammation and VPP and provides a rationale for studying the activity of these neurotransmitters in the treatment of PCS and pelvic pain.


Assuntos
Dor Pélvica , Varizes , Doenças Vasculares , Doença Crônica , Humanos , Dor Pélvica/complicações , Pelve , Varizes/complicações , Doenças Vasculares/complicações , Veias
12.
Tech Vasc Interv Radiol ; 22(4): 100630, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864535

RESUMO

Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.


Assuntos
Procedimentos Endovasculares , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Malformações Vasculares/terapia , Veias/anormalidades , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Fatores de Risco , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veias/diagnóstico por imagem , Veias/fisiopatologia
13.
Angiol Sosud Khir ; 25(4): 116-122, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855208

RESUMO

The purpose of the study was to work out a Russian-made, simple-to-manufacture, safe, inexpensive and efficient device for performing endovasal laser obliteration (EVLO) of varicose veins, with the underlying principle of endoluminal distribution of the total laser energy into several flows. The development of this device was based on the principle of dividing the total laser radiation into two energy flows. One flow has a shape of circularly formed, continuous field of laser radiation of specified width within the angular range from 50 to 90°, which ensures the main energetic contribution to thermal impact on the vascular wall. The second energetic flow is formed in the part of the tip having a shape of a truncated cone, along the axis of the optical fibre within the angular range from 10 to 50°, which ensures additional thermal effect of radiation on the narrowing walls of the venous channel. Starting from 2016, EVLO with the use of the developed device was performed in a total of 50 patients with class C2-C3 varicose veins. The morphogenesis of the occurring restructuring of the venous wall was studied intraoperatively and in various time periods. Tissue specimens obtained intraoperatively demonstrated in the majority of cases complete or partial intimal detachment, swelling, disorganization of the middle membrane, adventitial loosening with thrombosis of the elements of the vasa vasorum in the majority of portions. The histological specimens harvested at 10 to 14 days were found to contain in the venous wall clear-cut distinct evidence of actively commensing connective-tissue proliferation. At 1 month of follow up the specimens of the veins treated with EVLO using the developed device showed the beginning of collagenisation of the wall, with finally fibrous restructuring and wall hyalinosis by month 3 after EVLO. The proposed device for EVLO of varicose veins makes it possible to act upon the venous wall simultaneously with two energy flows which excludes negative thermal action of excess energy of laser radiation on the vascular wall while using unidirectional radiation in the form of one or even two, but thin rings and, thus, dramatically decreasing reducing the risk for the development of complications. Implementation of the new device into the phlebological practice in Russia in conditions of complete import substitution has significant economic benefit.


Assuntos
Terapia a Laser/instrumentação , Varizes/cirurgia , Veias/cirurgia , Humanos , Varizes/patologia , Veias/patologia
14.
Undersea Hyperb Med ; 46(5): 673-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683367

RESUMO

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.


Assuntos
Embolia Aérea/terapia , Oxigenação Hiperbárica/métodos , Algoritmos , Altitude , Artérias , Pressão Atmosférica , Descompressão/efeitos adversos , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Forame Oval Patente/complicações , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Posicionamento do Paciente/métodos , Veias
15.
Tex Heart Inst J ; 46(3): 175-178, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708698

RESUMO

In 1708, Adam Christian Thebesius, a 22-year-old student at Leiden University, presented his graduate thesis, Disputatio medica inauguralis de circulo sanguinis in corde. More than a doctoral dissertation, this groundbreaking work opened new channels into the study of the human coronary venous system. Thebesius' theory about the vascular communication between the coronary arteries and the chambers of the heart helped to advance understanding of hemodynamic principles and to clarify the physiologic pathways of the coronary circulation. The following article-the third in a trilogy about Lower Silesian scientists-provides an overview of the life story and achievements of this Silesian physician and innovator, whose name was immortalized in 2 cardiac eponyms: the Thebesian veins and the Thebesian valve.


Assuntos
Anatomia/história , Cardiologia/história , Circulação Coronária , Vasos Coronários/anatomia & histologia , Veias/anatomia & histologia , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , Humanos , Polônia
16.
Plast Reconstr Surg ; 144(5): 751e-759e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688749

RESUMO

BACKGROUND: The objective of this study was to compare the economic impact of complete decongestive therapy and lymphovenous bypass in the management of upper extremity lymphedema. METHODS: Economics were modeled for a patient with breast cancer-related lymphedema undergoing three different clinical pathways: (1) complete decongestive therapy alone; (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy; or (3) lymphovenous bypass requiring ongoing complete decongestive therapy. Activity-based cost analysis identified costs incurred with complete decongestive therapy and lymphovenous bypass. Costs were retrieved from supplier price lists, physician fee schedules, lymphedema therapists, and literature reviews. The net present value of all costs incurred for each clinical pathway were calculated. RESULTS: The estimated net present value of all costs for a patient with breast cancer-related lymphedema undergoing treatment were as follows: (1) complete decongestive therapy alone ($30,400); (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy ($15,000); or (3) lymphovenous bypass requiring ongoing complete decongestive therapy ($42,100). The expected net present value of all costs for lymphovenous bypass was $26,800, which was comparable to that of complete decongestive therapy alone. Sensitivity analysis demonstrated that the expected net present value of lymphovenous bypass was dependent on the patient's life expectancy, number of bypass anastomoses, and likelihood of discontinuing complete decongestive therapy. CONCLUSIONS: Lymphedema has substantial ongoing costs irrespective of the treatment modality. The cost of lymphovenous bypass appears comparable to that of complete decongestive therapy alone-the surgical costs of lymphovenous bypass are offset by the savings from discontinued ongoing therapy. Despite its limitations as a theoretical economic model, this study provides insight into the potential economic impact of lymphovenous bypass.


Assuntos
Linfedema Relacionado a Câncer de Mama/economia , Linfedema Relacionado a Câncer de Mama/cirurgia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Excisão de Linfonodo/economia , Mastectomia/efeitos adversos , Anastomose Cirúrgica/economia , Anastomose Cirúrgica/métodos , Linfedema Relacionado a Câncer de Mama/fisiopatologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Canadá , Estudos de Coortes , Drenagem/economia , Drenagem/métodos , Feminino , Humanos , Excisão de Linfonodo/métodos , Vasos Linfáticos/cirurgia , Mastectomia/métodos , Estudos Prospectivos , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia
17.
Plast Reconstr Surg ; 144(5): 1214-1224, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688769

RESUMO

BACKGROUND: Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive. METHODS: From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors' hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post-lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded. RESULTS: No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green-enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent). CONCLUSION: With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Microcirurgia/métodos , Veias/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/métodos , China , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Extremidade Inferior/cirurgia , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento
18.
BMC Surg ; 19(1): 160, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690302

RESUMO

BACKGROUND: Electrosurgical vessel sealers are gradually replacing conventional techniques such as ligation and clipping. Algorithms that control electrosurgical units (ESU), known as modes, are important for applications in different surgical disciplines. This chronic porcine animal study aimed to evaluate the safety and effectiveness of the novel thermoSEAL electrosurgical vessel sealing mode (TSM). The BiClamp® mode (BCM) of the renowned VIO® 300 D ESU served as control. BCM has been widely available since 2002 and has since been successfully used in many surgical disciplines. The TSM, for the novel VIO® 3 ESU, was developed to reduce sealing time and/or thermal lateral spread adjacent to the seal while maintaining clinical success rates. The primary aim of this study was to investigate the long-term and intraoperative seal quality of TSM. METHODS: The BiCision® device was used for vessel sealing with TSM and BCM in ten German Landrace pigs which underwent splenectomy and unilateral nephrectomy during the first intervention of the study. The seals were cut with the BiCision® knife. Ninety-nine arteries, veins and vascular bundles were chronically sealed for 5 or 21 days. Thereafter, during the second and terminal intervention of the study, 97 additional arteries and veins were sealed. The carotid arteries were used for histological evaluation of thermal spread. RESULTS: After each survival period, no long-term complications occurred with either mode. The intraoperative seal failure rates, i.e. vessel leaking or residual blood flow after the first sealing activation, were 2% with TSM versus 6% with BCM (p = 0.28). The sealing time was significantly shorter with TSM (3.5 ± 0.69 s vs. 7.3 ± 1.3 s, p < 0.0001). The thermal spread and burst pressure of arteries sealed with both modes were similar (p = 0.18 and p = 0.61) and corresponded to the histological evaluation. The measured tissue sticking parameter was rare with both modes (p = 0.33). Tissue charring did not occur. Regarding the cut quality, 97% of the seals were severed in the first and 3% in the second attempt (both with TSM and BCM). CONCLUSIONS: The novel TSM seals blood vessels twice as fast as the BCM while maintaining excellent tissue effect and clinical success rates. TRIAL REGISTRATION: Not applicable.


Assuntos
Algoritmos , Eletrocirurgia/métodos , Nefrectomia/métodos , Esplenectomia/métodos , Animais , Artérias/cirurgia , Eletrocoagulação , Feminino , Ligadura , Suínos , Veias
19.
Khirurgiia (Mosk) ; (11): 24-28, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714526

RESUMO

OBJECTIVE: To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS: There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS: In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION: Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Constrição Patológica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Fluxo Sanguíneo Regional , Síndrome , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/patologia
20.
Khirurgiia (Mosk) ; (10): 69-74, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626242

RESUMO

Varicose veins of lower extremities, varicocele and varicose dilation of pelvic veins including ovaricovaricocele are the most common non-inflammatory diseases of venous system. The same mechanisms determined varicose dilatation regardless localization of the vein. First of all, these are wall weakness and valvular insufficiency combined with hereditary collagen fiber defectiveness in case of undifferentiated connective tissue syndrome. Imbalance between different types of collagen in vascular wall (especially types I and III) also results wall weakness. Other important mechanisms are smooth muscle cells dysfunction followed by excessive intracellular synthesis and intramuscular fibrosis and imbalance of protease system due to overproduction of metalloproteinases. We consider that different forms of varicose veins (varicose veins of lower extremities, varicocele, ovaricovaricocele) may be unified within one pathology (varicose vein disease).


Assuntos
Varizes/fisiopatologia , Veias/fisiopatologia , Colágeno/fisiologia , Dilatação Patológica , Humanos , Extremidade Inferior , Masculino , Varizes/etiologia
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