Asymmetry of the anterior ethmoidal artery in relation to the anterior skull base: a population-based study of 500 arteries.

OBJECTIVE: To analyze variability in the distance between the Anterior Ethmoidal Artery (AEA) and the anterior Skull Base (SB), as well as the frequency of lateral asymmetry in a Latin American population using computed tomography. METHODS: A total of 250 computed tomography scans of paranasal sinuses in coronal reconstruction (500 AEAs) were analyzed. After determining the image with the best anatomical view of the artery, the distance between its midpoint and the ethmoidal roof was measured, and the images were independently interpreted by 2 physicians. RESULTS: Of the 500 AEAs, 279 (55.8%) adhered to or passed through the SB at a distance of 0mm. A total of 221 AEAs (44.2%) were at some distance from the SB, of which 107 (48.4%) were on the right side, ranging from 1.18 to 6.75mm, and 114 (51.5%) were on the left side, ranging from 1.15 to 6.04mm. The overall mean distance between the AEA and SB was 1.22 (SD=1.57) mm, increasing to 2.77 (SD=1.14) when the arteries adhered to the SB were excluded. Seventy-six individuals (30.4%) had a lateral distance variation > 1mm. CONCLUSION: Our study includes the largest sample of AEA analyzed with computed tomography scans of paranasal sinuses. There was some distance between the AEA and SB in almost half the patients, and we found a high rate of lateral variability >1mm. LEVEL OF EVIDENCE: Level 3.

Morphometry, topography and arterial supply of the thyroid gland in rhesus monkeys (Macaca mulatta Zimmermann, 1780).

The purpose of this research was to investigate the measures, topography, and vascularization of the thyroid gland in Macaca mulatta, a non-human primate. The study involved the dissection of ten male adult cadavers of Macaca mulatta. The length, width, and thickness of the right lobe of the thyroid were 2.552 ± 0.341, 1.019 ± 0.137, and 0.729 ± 0.137 cm. These measures in the left thyroid lobe were 2.406 ± 0.299, 1.013. ± 0.087, and 0.769 ± 0.083 cm. The study found no significant differences in the measures of the left and right lobes of the thyroid gland in rhesus monkeys. Regarding topography, the thyroid gland was located ventrolateral to the trachea, similar to its position in other mammal species. The cranial pole of the gland was closely related to the cricoid or thyroid cartilage, while the caudal pole showed variable positioning to the tracheal rings. The isthmus, a thin band of tissue connecting the lobes, was present in all specimens. The cranial thyroid artery was found to originate from the external carotid artery in most specimens. It supplied the thyroid gland and sent branches to muscles in the neck region. The caudal thyroid artery, originating from the common carotid artery, provides additional blood supply to the gland and sends a branch to the esophagus. This research contributes to knowledge about the thyroid gland in non-human primates, specifically Macaca mulatta. The findings provide critical information for comparative studies and understanding the thyroid gland's role in health and disease.

Eradicating Atherosclerotic Events by Targeting Early Subclinical Disease: It Is Time to Retire the Therapeutic Paradigm of Too Much, Too Late.

Recent decades have seen spectacular advances in understanding and managing atherosclerotic cardiovascular disease, but paradoxically, clinical progress has stalled. Residual risk of atherosclerotic cardiovascular disease events is particularly vexing, given recognized lifestyle interventions and powerful modern medications. Why? Atherosclerosis begins early in life, yet clinical trials and mechanistic studies often emphasize terminal, end-stage plaques, meaning on the verge of causing heart attacks and strokes. Thus, current clinical evidence drives us to emphasize aggressive treatments that are delayed until patients already have advanced arterial disease. I call this paradigm "too much, too late." This brief review covers exciting efforts that focus on preventing, or finding and treating, arterial disease before its end-stage. Also included are specific proposals to establish a new evidence base that could justify intensive short-term interventions (induction-phase therapy) to treat subclinical plaques that are early enough perhaps to heal. If we can establish that such plaques are actionable, then broad screening to find them in early midlife individuals would become imperative-and achievable. You have a lump in your coronaries! can motivate patients and clinicians. We must stop thinking of a heart attack as a disease. The real disease is atherosclerosis. In my opinion, an atherosclerotic heart attack is a medical failure. It is a manifestation of longstanding arterial disease that we had allowed to progress to its end-stage, despite knowing that atherosclerosis begins early in life and despite the availability of remarkably safe and highly effective therapies. The field needs a transformational advance to shift the paradigm out of end-stage management and into early interventions that hold the possibility of eradicating the clinical burden of atherosclerotic cardiovascular disease, currently the biggest killer in the world. We urgently need a new evidence base to redirect our main focus from terminal, end-stage atherosclerosis to earlier, and likely reversible, human arterial disease.

Venovenous Extracorporeal Membrane Oxygenation Initiation for Pediatric Acute Respiratory Distress Syndrome With Cardiovascular Instability is Associated With an Immediate and Sustained Decrease in Vasoactive-Inotropic Scores.

OBJECTIVE: To determine the association of venovenous extracorporeal membrane oxygenation (VV-ECMO) initiation with changes in vasoactive-inotropic scores (VISs) in children with pediatric acute respiratory distress syndrome (PARDS) and cardiovascular instability. DESIGN: Retrospective cohort study. SETTING: Single academic pediatric ECMO center. PATIENTS: Children (1 mo to 18 yr) treated with VV-ECMO (2009-2019) for PARDS with need for vasopressor or inotropic support at ECMO initiation. MEASUREMENTS AND MAIN RESULTS: Arterial blood gas values, VIS, mean airway pressure (mPaw), and oxygen saturation (Sp o2 ) values were recorded hourly relative to the start of ECMO flow for 24 hours pre-VV-ECMO and post-VV-ECMO cannulation. A sharp kink discontinuity regression analysis clustered by patient tested the difference in VISs and regression line slopes immediately surrounding cannulation. Thirty-two patients met inclusion criteria: median age 6.6 years (interquartile range [IQR] 1.5-11.7), 22% immunocompromised, and 75% had pneumonia or sepsis as the cause of PARDS. Pre-ECMO characteristics included: median oxygenation index 45 (IQR 35-58), mPaw 32 cm H 2o (IQR 30-34), 97% on inhaled nitric oxide, and 81% on an advanced mode of ventilation. Median VIS immediately before VV-ECMO cannulation was 13 (IQR 8-25) with an overall increasing VIS trajectory over the hours before cannulation. VISs decreased and the slope of the regression line reversed immediately surrounding the time of cannulation (robust p < 0.0001). There were pre-ECMO to post-ECMO cannulation decreases in mPaw (32 vs 20 cm H 2o , p < 0.001) and arterial P co2 (64.1 vs 50.1 mm Hg, p = 0.007) and increases in arterial pH (7.26 vs 7.38, p = 0.001), arterial base excess (2.5 vs 5.2, p = 0.013), and SpO 2 (91% vs 95%, p = 0.013). CONCLUSIONS: Initiation of VV-ECMO was associated with an immediate and sustained reduction in VIS in PARDS patients with cardiovascular instability. This VIS reduction was associated with decreased mPaw and reduced respiratory and/or metabolic acidosis as well as improved oxygenation.

Anatomical and physiological adaptation of the scrotal artery with muscular reinforcement in the middle layer and connective reinforcement of the adventitia.

The histology of blood vessels shows they are structured in three layers or tunics: tunica intima, which includes the internal limiting lamina with high elastin content; tunica media of smooth muscles fibers of circular disposition, which includes the external limiting lamina; and tunica adventitia of connective tissue. The vascular system is essential in regulating body temperature, especially in the scrotum and testis. This study aimed to analyze the histology of the scrotal arteries and their possible relationship to testicular temperature homeostasis. This study used scrotal samples from human adults, anonymized and obtained from the University of Chile's teaching bank. The control group corresponds to an arteriole of muscle tissue. The results show that the middle layer of the scrotal artery is made up of smooth muscle fibers distributed in two layers: a longitudinal inner sublayer and a circular outer sublayer, different from the findings in muscle tissue arteries, with a single, circularly arranged muscle layer. This arrangement could be related to testicular temperature homeostasis by reducing the temperature of the testis and seminiferous tubules. The results described in this work suggest that these anatomical adaptations may be very significant in the face of the constant increase in global temperature. Further and better research is required to understand the mechanisms of thermoregulation in human reproduction and the histological particularities of the tissues that form the scrotum. RESEARCH HIGHLIGHTS: The human scrotal artery has a histological composition adapted for regulation of testicular temperature. The muscular double middle layer of the scrotal artery retains intravascular temperature.

Surveillance and risk factors for early restenosis following transcarotid artery revascularization.

OBJECTIVE: Restenosis after transcarotid artery revascularization (TCAR) is a known complication. When identified in the early postoperative period, it may be related to technique. We evaluated our TCAR experience to identify potentially modifiable factors impacting restenosis. METHODS: This is a single-institution, retrospective review of patients undergoing TCAR from November 2017 to July 2022. Restenosis was defined as >50% stenosis on duplex ultrasound (DUS) examination or computed tomographic angiography (CTA). Continuous variables were compared using Kruskal-Wallis's test. Categorical variables were compared using the Fisher's exact test. RESULTS: Of 61 interventions, 11 (18%) developed restenosis within the median follow-up of 345 days (interquartile range, 103-623 days). Among these patients, 82% (9/11) had >50% stenosis, and 18% (2/11) had >80% stenosis. Both patients with high-grade restenosis were symptomatic and underwent revascularization. Diagnosis of post-TCAR restenosis was via DUS examination in 45% (5/11), CTA in 18% (2/11), or both CTA/DUS examination in 36% (4/11). Restenosis occurred within 1 month in 54% (6/11) and 6 months in 72% (8/11) of patients. However, three of the six patients with restenosis within 1 month had discordant findings on CTA vs DUS imaging. Patient comorbidities, degree of preoperative stenosis, medical management, balloon size, stent size, lesion characteristics, and predilatation angioplasty did not differ. Patients with restenosis were younger (P = .02), had prior ipsilateral endarterectomy (odds ratio [OR], 6.5; P = .02), had history of neck radiation (OR, 18.3; P = .01), and lower rate of postdilatation angioplasty (OR, 0.11; P = .04), without an increased risk of neurological events. CONCLUSIONS: Although post-TCAR restenosis occurred in 18% of patients, only 3% of patients had critical restenosis and required reintervention. Patient factors associated with restenosis were younger age, prior endarterectomy, and history of neck radiation. Although early restenosis may be mitigated by improved technique, the only technical factor associated with restenosis was less use of postdilatation angioplasty. Balancing neurological risk, this factor may have increased application in appropriate patients. Diagnosis of restenosis was inconsistent between imaging modalities; current surveillance paradigms and diagnostic thresholds may warrant reconsideration.

[Digital artery pseudoaneurysm. Case report and systematic review of the literature]. / Pseudoaneurisma de arteria digital. Reporte de un caso y revisión sistemática de la bibliografía.

INTRODUCTION: aneurysms are focal and permanent dilations of an artery; in pseudoaneurysms, the normal layers of the blood vessel are replaced by fibrous tissue. Due to their low incidence, as well as the diagnostic and therapeutic challenge they represent; our objective is to present the clinical case of a pseudoaneurysm of a digital artery of the hand and to carry out a systematic review of this pathology. MATERIAL AND METHODS: literature search in Medline, using the terms "digital artery" and "aneurysm." Studies of vascular dilation pathology affecting the hand and fingers were incorporated. Studies with pathology of proximal involvement of the hand were excluded. CASE PRESENTATION: a 79-year-old female patient who, after a sharp force trauma to the fifth finger of the left hand, develops a rapidly growing necrotic tumor. She had ultrasound and angiography that suggested hematoma. Surgical management was decided, during which it was observed that the tumor involved ulnar collateral digital artery of the fifth finger. The lesion and the arterial segment involved were resected. Post-surgical course without complications. The histopathological diagnosis of pseudoaneurysm of the lesion was confirmed. DISCUSSION: traumatic etiology is the most frequent cause of digital aneurysms. Risk factors for pseudoaneurysms include sharp force trauma and alterations of the coagulation pathways, as in the case presented. CONCLUSION: the pseudoaneurysm of a digital artery is a rare pathology with great variability of therapeutic management. Surgical resection of the lesion with vascular flow reconstruction is the recommended treatment.

INTRODUCCIÓN: los aneurismas son dilataciones vasculares localizadas y permanentes de una arteria; en los pseudoaneurismas, las capas normales del vaso sanguíneo son reemplazadas por tejido fibroso. Debido a su baja incidencia, así como el desafío diagnóstico y terapéutico que representan; nuestro objetivo es presentar el caso clínico de un pseudoaneurisma de una arteria digital de la mano y realizar una revisión sistemática sobre dicha patología. MATERIAL Y MÉTODOS: búsqueda bibliográfica en Medline, utilizando los términos "arteria digital" y "aneurisma". Se incorporaron estudios de patología de dilatación vascular que afecte la mano y los dedos. Se excluyeron trabajos con patología de afección proximal de la mano. PRESENTACIÓN DE CASO: paciente femenino de 79 años de edad, que posterior a herida cortante de quinto dedo de mano izquierda, desarrolla tumoración necrótica de rápido crecimiento. Contaba con ecografía y angiografía que sugerían hematoma. Se decidió manejo quirúrgico, durante el cual se observó que la tumoración involucraba arteria digital colateral cubital del quinto dedo. Se resecó lesión y segmento arterial involucrado. Cursó postquirúrgico sin complicaciones. Se confirmó el diagnóstico histopatológico de pseudoaneurisma de la lesión. DISCUSIÓN: la etiología traumática es la causa más frecuente de los aneurismas digitales. Los factores de riesgo para los pseudoaneurismas incluyen lesiones penetrantes y alteraciones de la cascada de coagulación, como en el caso presentado. CONCLUSIÓN: el pseudoaneurisma de una arteria digital es una patología rara y con gran variabilidad de manejo terapéutico. La resección quirúrgica de la lesión con la reconstrucción del flujo vascular, es el tratamiento recomendado.

¿Existe correlación metabólica hipoglucémica y el síndrome de Percheron? Reporte de caso / Is there a metabolic correlation between hypoglycemia and Percheron syndrome? Case report

Introducción: El síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: Presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatologia inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: Los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome.

Review of surgical treatment of iatrogenic iliofemoral artery injury in the pediatric population after catheterization.

Trauma is the leading cause of death in the pediatric population. Although vascular trauma has an incidence of 6% in civilian population, iatrogenic injuries are the leading cause, and the most frequent injured vessel is the iliofemoral sector. However, little information is available and there are no guidelines about its treatment. Therefore, this review aimed to describe the information available concerning pediatric iatrogenic arterial trauma, focusing on the iliofemoral segment and present 3 cases. We described 11 articles with 171 patients, of whom 61% underwent surgery to treat iatrogenic trauma. Mean age was 3.28 years (standard deviation of 3.5 years), and 54% were female. Most iliofemoral injuries occurred after arterial catheterization for hemodynamic monitorization and therapeutic or diagnostic cardiac catheterization (due to congenital heart diseases, including septal defects, tetralogy of Fallot, aortic coarctation, and patent ductus arteriosus). For acute complications, arterial thrombosis was the leading injury, followed by pseudoaneurysm, hematoma, dissection, transection, avulsion, eversion, and combined lesions.

[Arterial ischemic stroke in childhood]. / Accidente cerebrovascular isquémico arterial pediátrico.

Despite advances in the identification and recognition of risk factors for pediatric arterial ischemic stroke, little progress has been made in hyperacute treatment. The most frequent risk factors are arteriopathies, cardiopathies, and thrombophilia. Early confirmation with neuroradiological studies is key to consider reperfusion therapies, which have limited evidence in pediatrics but a good safety profile. There is consensus on the use of anticoagulation in cardio-embolic and prothrombotic diseases, and antiplatelet therapy in arteriopathies. The future challenge is to improve coordination between prehospital services and specialized stroke centers to improve therapeutic management in the hyperacute stage and reduce morbidity and mortality.

A pesar de los avances en la identificación y reconocimiento de factores de riesgo del accidente cerebrovascular (ACV) isquémico arterial pediátrico hay escasos avances en el tratamiento hiperagudo. Los factores de riesgo más frecuentes son las arteriopatías, cardiopatías y trombofilias. La confirmación temprana con estudios neurorradiológicos es clave para considerar las terapias de reperfusión, que tienen evidencia limitada en pediatría con buen perfil de seguridad. Existe consenso en la utilización de anticoagulación en patología cardioembólica, enfermedades protrombóticas y antiagregación en arteriopatías. El desafío futuro será lograr una coordinación entre servicios prehospitalarios y centros especializados en ACV, para mejor manejo terapéutico en etapa hiperaguda disminuyendo su morbimortalidad.

Evaluation of konjac noodle as a microsurgery training model: learning curve analysis.

BACKGROUND: classical models of microsurgical anastomosis training are expensive and have ethical implications. Some alternatives join low cost and easiness to store. However, the translation of knowledge acquired by training in these methods into the traditional ones is not clear. This project aims to assess the feasibility of konjac noodles as a reliable microsurgery-training model. METHODS: 10 neurosurgery residents performed an end-to-end anastomosis in a 2-3mm placenta artery. The anastomoses were evaluated quantitatively, recording time; and qualitatively, applying a validated score (Anastomosis Lapse Index - ALI) by three experienced neurosurgeons and verifying the presence of gross leakage through the infusion of fluorescein. Subsequently, they performed 10 non-consecutive sessions of anastomosis training in the konjac noodle. Eventually, a final anastomosis in the placenta model was performed and the same parameters were scored. RESULTS: we observed a 17min reduction in the mean time to perform the anastomosis in the placenta model after the training in the konjac (p<0.05). There was a non-significant 20% reduction in gross leakage, but the training sessions were not able to consistently improve the ALI score. CONCLUSIONS: we demonstrate a reduction in anastomosis performing time in placental arteries after training sessions in the konjac noodle model, which can be regarded as a feasible low-cost method, particularly useful in centers with surgical microscopes only in the operation room.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g?

BACKGROUND: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. METHODS: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. RESULTS: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). CONCLUSIONS: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

INTRODUCCIÓN: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. MÉTODOS: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. RESULTADOS: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. CONCLUSIONES: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Study of digital palmar and plantar arteries of horses and mules by B-mode and Doppler ultrasonography / Estudo das artérias digitais palmares e plantares de equinos e muares por ultrassonografia modo-B e Doppler

The present study aimed to evaluate and compare the palmar and plantar digital arteries of 10 horses and 10 mules through B-mode and spectral Doppler ultrasound. Likewise, compare the plantar arteries of the pelvic limbs with the palmar arteries of the thoracic limbs, in addition to verifying the differences of the digital arteries in the contralateral limbs (right and left) in horses and mules using B-mode and spectral Doppler ultrasonography. The evaluated parameters were the diameter and the intima-media thickness (IMT), resistivity index (RI), pulsatility index (PI), peak of systolic velocity (pSV), final diastolic velocity (fDV) and mean velocity (MV) of the lateral and medial palmar and plantar arteries digital in healthy horses and mules. The horses presented higher diameters values, IMT, pSV, fDV and MV in comparison to the mules. The variables RI and PI also presented differences between horses and mules. Also, both species showed higher values in the variables of B-mode and Doppler ultrasonography in the thoracic limbs. Differences were also detected in the comparison between the limb sides (right and left) in the two modalities. The B-Mode and spectral Doppler ultrasound techniques are viable tools to identify differences in the palmar and plantar digital arteries in healthy horses and mules, highlight the differences between the thoracic and pelvic limbs and their respective sides (right and left) as well.

O presente estudo teve como objetivo avaliar e comparar as artérias digitais palmares e plantares de 10 equinos e 10 muares, por meio de ultrassom modo B e Doppler espectral. Da mesma forma, buscou-se comparar as artérias plantares dos membros pélvicos com as artérias palmares dos membros torácicos, além de se verificarem as diferenças das artérias digitais nos membros contralaterais (direito e esquerdo) em equinos e mulas, por meio de ultrassonografia modo B e Doppler espectral. Os parâmetros avaliados foram o diâmetro e a espessura médio-intimal (EMI), o índice de resistividade (IR), o índice de pulsatilidade (IP), o pico de velocidade sistólica (pVS), a velocidade diastólica final (VDf) e a velocidade média (VM) das artérias palmares e plantares lateral e medial digitais em equinos e muares sadios. Os equinos apresentaram maiores valores de diâmetros, EMI, pVS, VDf e VM em comparação aos muares. As variáveis IR e IP também apresentaram diferenças entre equinos e muares. Cavalos e mulas apresentaram maiores valores nas variáveis de ultrassonografia modo B e Doppler nos membros torácicos. Também foram detectadas diferenças na comparação entre os lados dos membros (direito e esquerdo) nas duas modalidades. As técnicas de ultrassom modo-B e Doppler espectral são ferramentas viáveis para identificar diferenças nas artérias digitais palmares e plantares em equinos e muares saudáveis, bem como para destacar as diferenças entre os membros torácicos e pélvicos e seus respectivos lados (direito e esquerdo).

The Diastolic Oscillation Amplitude Used as an Arterial Aging Indicator.

Introduction: The compliance of the distal arteries depends on their vasoconstrictor tone and distensibility and is sensitive to endothelial function and aging. C2, a component of the Windkessel model, is a measure of distal arterial compliance, and establishes the magnitude of the pressure rise during early diastole. It is calculated from the diastolic portion of the radial pulse wave using sophisticated analyses. C2 is used as a cardiovascular risk indicator since it decreases with aging, high blood pressure, and diabetes. Here, we propose an alternative method to assess the distal arteries distensibility by measuring the amplitude of the oscillation that occurs at the beginning of diastole. Methods: Peripheral pulse wave was evaluated noninvasively by applanation tonometry in 511 individuals (264 women) aged between 13 and 70 years. Diastolic amplitude (DA) was measured as the peak-to-peak amplitude of the diastolic oscillation. Radial augmentation index (RAIx) and pulse wave velocity (PWV) were also calculated. Results: DA decreased approximately 2% per decade of life between 16 and 70 years from 19% to 7%, and was higher in men than in women (p<0.0001). Linear regression analysis identified RAIx as the strongest predictor of AD (p<0.0001), followed by age and height. Sex modified the age-related decrease in DA (p< 0.001). By applying the method to measure DA from previously published data, we found a strong linear correlation with C2. Conclusion: DA decreased linearly with age in a reciprocal manner to the increase in radial augmentation index, was greater in men than women, and was independent of blood pressure and heart rate, as previously reported for C2. We propose that measuring DA could provide an alternative index to evaluate distal arterial compliance and aging.

Acute Carpal Tunnel Syndrome due to Persistent Median Artery thrombosis: Case report / Síndrome do túnel do carpo aguda por trombose da artéria mediana: Relato de caso

Abstract Carpal tunnel syndrome is the most common compressive neuropathy of the upper limb, affecting ~ 4% of the general population. The clinical picture is characterized by pain and, mainly, paresthesia in the median nerve territory, of insidious onset and, in the most severe cases, loss of strength and atrophy of the thenar musculature is observed. It is an extremely common pathology in the daily practice of hand surgery, and in most cases, it can be treated with conservative methods. We present here an atypical case of carpal tunnel syndrome, of acute onset, triggered by persistent median artery (PMA) thrombosis, condition associated with distal embolization and hypoper-fusion of the limb.

Resumo A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior, afetando ~ 4% da população geral. O quadro clínico caracteriza-se por dor e, principalmente, parestesia no território do nervo mediano, de início insidioso e, nos casos mais graves, observa-se perda de força e atrofia da musculatura tenar. Trata-se de patologia extremamente comum na prática diária de cirurgia da mão, e na maior parte dos casos pode ser tratada com métodos conservadores. Apresentamos aqui um caso atípico de síndrome do túnel do carpo, de surgimento agudo, desencadeado pela trombose da artéria mediana persistente, quadro associado com embolização distal e hipoperfusão do membro.

Genicular Artery Embolization Technique.

Genicular artery embolization (GAE) is a safe and effective treatment for knee pain related to osteoarthritis, however there are several aspects of the procedure technique which may be unique. Familiarity with procedural steps, arterial anatomy, embolic endpoints, technical challenges, and potential complications is imperative for good clinical practice and outcomes. The success of GAE depends on correctly interpreting angiographic findings and variable anatomy, navigating small and acutely angled arteries, recognizing collateral supply, and avoiding non-target embolization. The procedure can potentially be performed for a wide range of patients with knee osteoarthritis. When effective, pain relief can be durable for many years. When done meticulously, adverse events from GAE are uncommon.