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Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema.To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them.This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings.Pregnant women in the intervention group had a significantly smaller increase (p0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again.Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.

Resumo A terapia padrão com varfarina para a trombose venosa profunda (TVP) tem uma série de limitações já estabelecidas. Essa revisão de revisões sistemáticas elenca os principais resultados de eficácia e segurança dos anticoagulantes orais diretos (DOACs), inibidores da trombina e do fator X ativado (Xa), em pacientes com TVP. A pesquisa foi realizada nas bases PubMed e Cochrane Database of Systematic Reviews. Foram recuperados 23 estudos, e uma revisão sistemática foi considerada elegível. Essa revisão atingiu escore máximo no AMSTAR e incluiu 7.596 pacientes para análise dos inibidores da trombina e 16.356 pacientes para a análise dos inibidores do fator Xa. Os resultados da metanálise indicam que os DOACs apresentam eficácia similar à terapia padrão no tratamento da TVP. A incidência de sangramento maior é um pouco menor nos pacientes tratados com os inibidores do fator Xa e similar à terapia padrão no tratamento com inibidores diretos da trombina. Abstract A number of limitations of standard therapy with warfarin for deep vein thrombosis (DVT) have been established. This overview of systematic reviews presents the baseline results for efficacy and safety of the new direct oral anticoagulants (DOACs) thrombin inhibitors, and activated factor X (Xa) inhibitors in patients with DVT. Searches were run on PubMed and the Cochrane Database of Systematic Reviews. Twenty-three studies were retrieved, and one systematic review was judged eligible. This review scored maximum according to AMSTAR criteria and included 7,596 patients for analysis of thrombin inhibitors and 16,356 patients for analysis of factor Xa inhibitors. The results of the meta-analysis indicate that DOACs are similar for DVT treatment when compared to standard treatment with warfarin. The incidence of major bleeding is somewhat lower in patients treated with factor Xa inhibitors and similar to standard therapy when treated with direct thrombin inhibitors.

Made available in DSpace on 2018-12-11T17:21:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-10-01 Jugular thrombophlebitis is a major vascular disease in horses and can lead even to death. Heparin is used to inhibit thrombus growth in humans. The aim of this experiment was to evaluate heparin administration in horses with induced thrombophlebitis. Ten animals were subjected to experimental thrombophlebitis and divided into a control group and heparin group (HG). The HG received heparin (150 IU/kg) for 10 days. Coagulation tests, ultrasound, and venography were performed before and after thrombophlebitis induction. Comparing the HG and control group, a break in the growth of the thrombus after the start of administration of the drug and a decrease in the length of the thrombus with the appearance of flow down the sides of the cranial portion of the thrombus were observed. However, after discontinuation of heparin, fast daily growth of the thrombus and decreased blood flow to the side were observed. Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science São Paulo State University (Unesp) Department of Surgery Medical School São Paulo State University (Unesp) Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science São Paulo State University (Unesp) Department of Surgery Medical School São Paulo State University (Unesp)

Made available in DSpace on 2020-12-12T02:15:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Objectives: To analyze the effect of graduated compression stockings on the venous reflux in the lower limbs of pregnant women. Method: A controlled randomized clinical trial was performed with sixty women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Using duplex-ultrasound, the reflux time and peak reflux velocity in the great saphenous vein and small saphenous vein were analyzed. Results: Great saphenous vein reflux times in the intervention group were 0.13 s at the beginning (initial) and 0.04 s at the end of pregnancy (final) in the right leg and 0.02 s and 0.34 s (p < 0.0001) in the control group. No patient in the intervention group experienced pathological reflux at the end of the pregnancy. There was a significant difference in the reflux time measured from both the great saphenous vein and small saphenous vein and peak reflux velocity between the groups. Conclusion: Compression stockings prevent increased venous reflux in lower limbs of pregnant women. Department of Surgery and Orthopedic Surgery São Paulo State University (UNESP) Medical School School of Dentistry São Paulo State University (UNESP) Department of Surgery and Orthopedic Surgery São Paulo State University (UNESP) Medical School School of Dentistry São Paulo State University (UNESP)

Objectives To evaluate the effectiveness of compression stockings in controlling the varicose veins in pregnant women. Method A prospective controlled randomized clinical trial was performed, including 60 women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Diameters of the great saphenous vein and small saphenous vein in the lower limbs of pregnant women in an orthostatic position were analyzed using Duplex-ultrasound. The symptomatology and CEAP were evaluated. Results Great saphenous vein diameters in the intervention group were 0.37 cm initial and 0.32 cm final (p Conclusions Compression stockings were effective in controlling the varicose veins related to pregnancy.

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01Bitstream added on 2014-10-01T14:03:07Z : No. of bitstreams: 1 S1677-54492014000100018.pdf: 299322 bytes, checksum: 648c645742548d3999490d11d29d5cb5 (MD5) OBJECTIVE:The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT).METHOD:Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups.RESULTS:Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a normal life after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients.CONCLUSION:There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients. Universidade de Marília - UNIMAR Faculdade de Medicina de Marília - FAMEMA Departamento de Clínica Médica Universidade Estadual Paulista - UNESP Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista - UNESP Departamento de Bioestatística Universidade Estadual Paulista - UNESP Universidade Estadual Paulista - UNESP Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista - UNESP Departamento de Bioestatística Universidade Estadual Paulista - UNESP

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-12-01Bitstream added on 2014-10-01T14:03:08Z : No. of bitstreams: 1 S1677-54492013000400296.pdf: 551423 bytes, checksum: 43060d6375107ebe9022450d4126ed50 (MD5) O processo de recanalização das veias dos membros inferiores, após um episódio de trombose venosa profunda aguda em pacientes anticoagulados com heparina e inibidores da vitamina K, faz parte da evolução natural da remodelagem do trombo venoso. Esse complexo processo de remodelagem envolve a adesão do trombo à parede da veia, à resposta inflamatória da parede do vaso, levando à organização e subsequente contração do trombo, à neovascularização e à lise espontânea de áreas no interior do trombo. A presença de fluxo arterial espontâneo em veias com trombose recanalizada tem sido descrita como secundária à neovascularização e se caracteriza pelo desenvolvimento de fluxo com padrão de fístulas arteriovenosas, identificadas por meio de mapeamento dúplex colorido. Nesta revisão, são discutidos alguns aspectos controversos da história natural da trombose venosa profunda, para uma melhor compreensão da sua evolução e do seu impacto sobre a doença venosa. The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease. Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina de Botucatu Department of Surgery and Orthopedics Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina de Botucatu Department of Surgery and Orthopedics

Background Lower limb venous ulceration ranks among the 10 most common medical problems in Western countries and has significant socioeconomic impact. The aim of this study was to identify the risk factors for unhealed, recurrent, and large ulcers and to characterize patients with active or recently healed venous ulcers. Methods We identified 97 patients and assessed 103 ulcerated limbs in 90 patients. All patients underwent clinical examination, arterial and venous system evaluation, ankle-brachial index determination, and ultrasound of the affected limb. Clinical characteristics included age, gender, race, ulcer duration, time since first episode, history of recurrence, localization of ulcer, ulcer area, eczema, ochre dermatitis, lipodermatosclerosis, pain, body mass index, and medical history data. Risk factors were identified by univariate analysis and estimated odds ratios. Results We assessed 90 patients (103 limbs) with active or healed venous leg ulcers, of whom 84.4% were Caucasian and 68.9% were female. Mean age was 56.0 ± 13.3 years. Ulcers had remained unhealed for 60 years (odds ratio [OR] 4.0), extensive lipodermatosclerosis (OR 8.7), and previous history of ulceration (OR 19.9) were risk factors for unhealed ulcers. Time since first ulcer episode ≥2 years (OR 29.2) and incompetence of venous systems (OR 1.6) were risk factors for recurrence. Conclusions Longstanding and large ulcers and recurrences are the main problems encountered by venous ulcer patients. Severe lipodermatosclerosis, previous ulcer history, and time since first ulcer episode ≥2 years are significant risk factors.

0049-3848/$ see front matter D 2006 Elsevier Ltd. All rights reserv doi:10.1016/j.thromres.2006.01.008 Abbreviations: VT, Venous thrombosis; TC, Transcobalamin; MTHFR, Methylenetetrahydrofolate reductase; CBS, Cystathionine-h-synthase; OR, Odds ratio; CI95, 95% confidence interval; FVL, Factor V Leiden; VTE, Venous thromboembolism; BRATROS, Brazilian Thrombosis Study; ARMS, Amplification-refractory mutation system. * Corresponding author. Lauro de Souza Lima Research Institute, Rod. Comte. Joao Ribeiro de Barros, Km 225, 17034-971, Bauru, SP, Brazil. Tel.: +55 11 3103 5864; fax: +55 11 3103 5865. E-mail address: anacarlap@gmail.com (A.C. Pereira).

BACKGROUND: Standard treatment of deep vein thrombosis (DVT) is based on antithrombotic therapy, initially with parenteral administration of unfractionated heparin or low molecular weight heparins (LMWH) for five to seven days, then subsequent long‐term therapy with oral vitamin K antagonists (e.g. warfarin). Pentasaccharides are novel anticoagulants that may be favourable over standard therapy due to their predictable effect, no need for frequent monitoring or re‐dosing, and few known drug interactions. Heparin‐induced thrombocytopenia, a harmful effect of heparins, appears to be rare during treatment with pentasaccharides. OBJECTIVES: To assess the efficacy and harms of pentasaccharides for the treatment of deep vein thrombosis. SEARCH METHODS: The Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (22 March 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2017, Issue 2) (searched 22 March 2017). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles for additional citations. SELECTION CRITERIA: We included randomised controlled trials in which people 18 years of age or older with a DVT confirmed by standard imaging techniques were allocated to receive a pentasaccharide (fondaparinux, idraparinux, or idrabiotaparinux) for the treatment of DVT in comparison with standard therapy or other treatments. DATA COLLECTION AND ANALYSIS: We extracted data characterising the included trials according to the methods, participants, interventions, and outcomes. We assessed risk of bias using Cochrane's 'Risk of bias' tool and employed the GRADE methodology to evaluate the quality of the evidence. The main primary outcome for efficacy was recurrent venous thromboembolism (VTE), and the main primary outcome for harm was major and clinically relevant bleeding. Since our outcomes were dichotomous, we calculated the risk ratio (RR) with a 95% confidence interval (CI). We combined the effects of different comparisons through a meta‐analysis using a fixed‐effect model. MAIN RESULTS: We included five randomised controlled trials of 6981 participants comparing pentasaccharides with standard therapy or other pentasaccharides. The quality of the evidence varied depending on the outcome and was judged as of moderate to very low quality. We downgraded the quality of the evidence due to risk of bias or imprecision, or both. Two studies evaluated fondaparinux, at doses of 5.0 mg, 7.5 mg, and 10.0 mg, plus vitamin K antagonist in comparison with standard therapy. A meta‐analysis of these two studies showed no clear difference in the risk of recurrent VTE (RR 0.80, 95% CI 0.43 to 1.47; 2658 participants); moderate‐quality evidence. The frequencies of major bleeding were similar between interventions in the initial period of treatment (approximately five days) (RR 1.15, 95% CI 0.39 to 3.44; 2645 participants) and at three months' follow‐up (RR 1.05, 95% CI 0.64 to 1.71; 2645 participants). We judged the quality of the evidence as moderate. One study (757 participants) compared idrabiotaparinux (3.0 mg) with idraparinux (2.5 mg) and demonstrated no clear difference in the risk of recurrent VTE at six months' follow‐up (RR 0.72, 95% CI 0.31 to 1.69); low‐quality evidence. Major bleeding during the initial treatment period was not reported. Major bleeding at six‐month follow‐up was less frequent in participants receiving idrabiotaparinux versus participants treated with idraparinux (RR 0.21, 95% CI 0.06 to 0.71); low‐quality evidence. The effect of an initial treatment with LMWH followed by three months of idraparinux (10 mg) showed no clear difference from standard therapy for risk of recurrent VTE (RR 1.51, 95% CI 0.26 to 8.90; 263 participants); very low‐quality evidence; one study. Major bleeding during the initial treatment period was not reported. The frequency of major and other clinically relevant bleeding at three months' follow‐up ranged from 2% to 15% in participants receiving LMWH and increasing doses of idraparinux of 2.5 mg, 5 mg, 7.5 mg, or 10 mg. When dosage groups were combined, there was no clear difference in major plus other clinically relevant bleeding or in major bleeding alone between the idraparinux treatment group and the standard therapy group (RR 1.30, 95% CI 0.70 to 2.40; 659 participants; RR 3.76, 95% CI 0.50 to 28.19; 659 participants, respectively); very low‐quality evidence. One study (2904 participants) compared idraparinux (2.5 mg) to standard therapy. There was no clear difference in the risk of recurrent VTE at three months' follow‐up (RR 0.98, 95% CI 0.64 to 1.48); low‐quality evidence. Major bleeding during the initial treatment period was not reported. Major bleeding at three months of follow‐up appeared to be similar in the idraparinux group and the standard therapy group (RR 0.71, 95% CI 0.34 to 1.47); very low‐quality evidence. AUTHORS' CONCLUSIONS: We found moderate‐quality evidence that the effects of fondaparinux at doses of 5.0 mg, 7.5 mg, and 10.0 mg plus vitamin K antagonist are similar in terms of recurrent VTE and risk of major bleeding compared with standard treatment for DVT. Low‐quality evidence suggests equal efficacy of idraparinux at 2.5 mg and the equimolar dose of 3.0 mg of idrabiotaparinux with regard to recurrent VTE, but a higher frequency of major bleeding was observed in participants treated with idraparinux. We judged evidence on the effectiveness of idraparinux compared with standard therapy, with or without initial treatment with LMWH, and on associated bleeding risk to be low to very low quality, therefore we have very limited confidence in the estimated effects. The observed similar effectiveness in terms of recurrent DVT and harmful effects in terms of bleeding risk with fondaparinux plus vitamin K antagonist compared to standard treatment for DVT suggest that it may be an alternative to conventional anticoagulants for the treatment of DVT in certain circumstances.

Objective The goal of this study was to determine the prevalence of and predictors to indicate bilateral venous duplex ultrasound (DU) to detect contralateral asymptomatic deep venous thrombosis (DVT) in patients with acute symptomatic lower extremity DVT. Methods Venous DU reports along with medical records of the patients were collected from February 2005 to April 2012 in a tertiary university hospital in Botucatu, Brazil. All patients with DVT detected in one lower extremity routinely underwent contralateral limb venous DU examination. Exclusion criteria were previous DVT in the contralateral asymptomatic limb, thrombophlebitis, workup for pulmonary embolism, and bilateral symptomatic lower extremities. Results Scans were done in 579 patients to rule out contralateral lower extremity DVT whenever DVT was confirmed in the ipsilateral lower extremity; of these, 108 patients (18.6%) had an abnormal finding on DU examination for DVT in the contralateral limb, which was proximal DVT in 71.5%. Age >60 years (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.447-7.670), malignant disease (OR, 5.21; 95% CI, 1.943-14.015), and the association of trauma plus malignant disease (OR, 7.11; 95% CI, 1.640-30.863) were the main predictors. Conclusions Age >60 years, malignant disease, lower extremity trauma, inpatient status, and recent hospitalization are risk factors associated with a high incidence of asymptomatic contralateral lower extremity DVT in patients with ipsilateral lower extremity DVT. Therefore, we recommend routine performance of a venous DU examination on the contralateral lower extremity whenever these risk factors are present in patients with ipsilateral lower extremity DVT.

Venous ulcer is the most serious consequence of chronic venous insufficiency and is responsible for almost 70% of chronic leg ulcers. The main purpose of this research was to describe social, demographic and clinical characteristics of patients with venous ulcers and to identify some professional repercussions of this pathology.We evaluated patients with a clinical picture compatible with venous ulcer. The sociodemographic characteristics of the patients, and the clinical characteristics and professional repercussions of the pathology were studied. We used the ankle-brachial index to identify associated arterial disease. The body mass index (BMI) was used for the classification of the nutritional condition of the patients.A total of 120 patients were included in the study (90 females and 30 males; 80.8% White; 44.2%60 years old). Ninety-one per cent of the patients had been in education for less than 4 years, and 89.7% were on the poverty line. Thirty-five per cent were retired, 2.5% were receiving government help due to disease and 4.2% were unemployed. About 16% of patients were out of work due to the disease, and 49.2% presented some degree of disability in terms of work tasks. The ulcer area was less than 30 cm(2) in 69.1% of patients. The first ulcer episode occurred in 13.4 years on average, and 64.2% of patients had recurrent episodes. Females presented on average 5.65 pregnancies, and 75.4% of patients were overweight.Venous ulcer occurred mainly in the low-income population, who presented with little formal education. Generally, the ulcers were present for a long time and were recurrent, with repercussions for the capabilities of patients to work.

Background: Osteochondroma, or osteocartilaginous exostosis, is the most common benign neoplasm of bone, and accounts for 20-50% of all benign tumors. Vascular complications associated with osteochondromas are rare, and include pseudoaneurysm formation, vessel occlusion and vessel displacement. To date, only two cases of popliteal artery entrapment syndrome (PAES) caused by an isolated fibular osteochondroma have been reported. Case Report: This report describes a unique case of PAES. A 33-year-old woman had a history of multiple osteochondroma, including of the proximal tibia and fibula on the left, diagnosed at age two years and monitored clinically by an orthopedist. The patient presented at our facility with a one-year history of a progressive intermittent claudication, left-sided toe pain and pallor in cold weather. After a complete evaluation, we diagnosed an arterial occlusion of the left popliteal artery. We tried several attempts of revascularization, by different forms, without success. The case went to amputation surgery. Conclusion: We consider this an important case because, although the association of osteochondroma and PAES is rare, physicians should consider it early to avoid acute vascular complications. Moreover, to date, we believe this is the first description of a PAES related with multiple osteochondroma.

Made available in DSpace on 2015-12-07T15:30:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2015-12-07T15:52:57Z : No. of bitstreams: 1 PMC4301449.pdf: 250793 bytes, checksum: fd6d64423e5748e0d797dd97a3fc85dd (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be excluded. Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded. Patients will be randomized into two groups, one receiving 75% pure glucose and the other group receiving 0.2% polidocanol diluted in 70% glucose. Just one limb and one session per patient will be performed. The sclerosing agent volume will not exceed 5 mL. Clinical follow-up will include visits on days 7 and 60, always with photographic documentation. This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process. The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point. Forty-eight patients have currently been enrolled. Preliminary results for these patients showed that 25 received treatment, 2 were excluded, and 22 returned after 7 days and showed no greater adverse events. To date, establishing efficacy criteria has not been possible, and no patients have reached the 60-day return point. These data may help doctors choose the best chemical agent for the treatment of reticular veins. ClinicalTrials.gov Identifier: NCT02054325, 3/02/2014. Universidade Estadual Paulista, Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu FAPESP: 2012/11034-0

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:06:10Z No. of bitstreams: 1 S0004-27492001000400007.pdf: 1075651 bytes, checksum: 5e9d2123f5c4fe343b8c92214c1fa03e (MD5) Made available in DSpace on 2013-08-22T19:06:10Z (GMT). No. of bitstreams: 1 S0004-27492001000400007.pdf: 1075651 bytes, checksum: 5e9d2123f5c4fe343b8c92214c1fa03e (MD5) Previous issue date: 2001-08-01 Made available in DSpace on 2013-09-30T20:10:20Z (GMT). No. of bitstreams: 2 S0004-27492001000400007.pdf: 1075651 bytes, checksum: 5e9d2123f5c4fe343b8c92214c1fa03e (MD5) S0004-27492001000400007.pdf.txt: 22784 bytes, checksum: a093b5e0cdc473d857f95b6937493887 (MD5) Previous issue date: 2001-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:36:31Z No. of bitstreams: 2 S0004-27492001000400007.pdf: 1075651 bytes, checksum: 5e9d2123f5c4fe343b8c92214c1fa03e (MD5) S0004-27492001000400007.pdf.txt: 22784 bytes, checksum: a093b5e0cdc473d857f95b6937493887 (MD5) Made available in DSpace on 2014-05-20T13:36:31Z (GMT). No. of bitstreams: 2 S0004-27492001000400007.pdf: 1075651 bytes, checksum: 5e9d2123f5c4fe343b8c92214c1fa03e (MD5) S0004-27492001000400007.pdf.txt: 22784 bytes, checksum: a093b5e0cdc473d857f95b6937493887 (MD5) Previous issue date: 2001-08-01 Objetivo: Avaliar o efeito do tartarato de brimonidina a 0,2% tópico, instilado de 12/12 horas, na circulação retrobulbar em pacientes portadores de glaucoma. Métodos: Foram estudados os 2 olhos de 16 pacientes portadores de glaucoma primário de ângulo aberto e glaucoma crônico de ângulo estreito com iridotomia. Usando o Doppler colorido foram avaliados: velocidade sistólica máxima, velocidade diastólica final e índice de resistência das artéria central da retina, artéria ciliar posterior curta temporal e artéria oftálmica. As avaliações foram feitas antes e depois do uso da brimonidina. Resultados: O tartarato de brimonidina a 0,2% aumentou significativamente a velocidade sistólica máxima (28,24 para 34,23 cm/seg) e velocidade diastólica final (6,62 para 8,10 cm/seg) no olho direito e reduziu o índice de resistência (0,75 para 0,71) no olho esquerdo da artéria oftálmica. Conclusão: O tartarato de brimonidina 0,2% 2x/dia aumentou significativamente a velocidade sistólica máxima e velocidade diastólica final e reduziu índice de resistência da artéria oftálmica de pacientes glaucomatosos. Este efeito sugere que a brimonidina pode beneficiar pacientes glaucomatosos com insuficiência vascular na cabeça do nervo óptico. Purpose: To evaluate a twice daily 0.2% brimonidine tartrate effect on retrobulbar circulation with color Doppler in glaucomatous patients. Methods: Both eyes of sixteen patients with glaucoma were studied. Using a Color Doppler imaging, peak systolic, end diastolic velocity and resistive index was determined in the ophthalmic artery, central retinal artery and temporal short posterior ciliary artery before and after 0.2% brimonidine treatment. Results: 0.2% brimonidine tartrate significantly improved peak systolic (28.24 to 34.23 cm/seg) and end diastolic velocities (6.72 to 8.10 cm/seg) in the right eye and decreased resistive index (0.75 to 0.71) in the ophthalmic artery of the left eye. Conclusions: A twice daily 0.2% brimonidine tartrate treatment significantly increased peak systolic and end diastolic velocity and reduced resistive index in ophthalmic artery in patients with chronic glaucoma. This effect suggests that brimonidine could benefit glaucoma patients with optic nerve head vascular insufficiency. Universidade Estadual Paulista Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Universidade Estadual Paulista Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Universidade Estadual Paulista Departamento de Cirurgia e Ortopedia

Universidade Estadual Paulista, Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Botucatu

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:08Z No. of bitstreams: 1 S0102-86502006000300011.pdf: 31173 bytes, checksum: 2d51349f518f0246d1ab1dfedee07dd2 (MD5) Made available in DSpace on 2013-08-22T18:58:08Z (GMT). No. of bitstreams: 1 S0102-86502006000300011.pdf: 31173 bytes, checksum: 2d51349f518f0246d1ab1dfedee07dd2 (MD5) Previous issue date: 2006-06-01 Made available in DSpace on 2013-09-30T19:53:34Z (GMT). No. of bitstreams: 2 S0102-86502006000300011.pdf: 31173 bytes, checksum: 2d51349f518f0246d1ab1dfedee07dd2 (MD5) S0102-86502006000300011.pdf.txt: 14986 bytes, checksum: dcec74b9b514c6e2430aa1817fa02230 (MD5) Previous issue date: 2006-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:22Z No. of bitstreams: 2 S0102-86502006000300011.pdf: 31173 bytes, checksum: 2d51349f518f0246d1ab1dfedee07dd2 (MD5) S0102-86502006000300011.pdf.txt: 14986 bytes, checksum: dcec74b9b514c6e2430aa1817fa02230 (MD5) Made available in DSpace on 2014-05-20T13:32:22Z (GMT). No. of bitstreams: 2 S0102-86502006000300011.pdf: 31173 bytes, checksum: 2d51349f518f0246d1ab1dfedee07dd2 (MD5) S0102-86502006000300011.pdf.txt: 14986 bytes, checksum: dcec74b9b514c6e2430aa1817fa02230 (MD5) Previous issue date: 2006-06-01 OBJETIVO: Comparar a eficácia e segurança da profilaxia com heparina de baixo peso molecular (enoxaparina) versus heparina não fracionada (HNF). MÉTODOS: Setenta e cinco pacientes (59 homens e 16 mulheres ), submetidos a amputação maior dos membros inferiores (30 acima do joelho e 45 abaixo do joelho ), foram tratados ao acaso com HNF subcutânea (5,000 IU -2x/dia ) ou enoxaparina subcutânea (40mg/dia ) durante a hospitalização . A profilaxia teve início 12 horas antes da cirurgia ou , em casos emergenciais , no primeiro dia de pós-operatório. RESULTADOS: Os dois grupos de tratamento foram comparáveis em termos de características gerais . A avaliação da TVP foi feita por meio de exame clínico diário e pelo mapeamento dúplex antes e 5-8 dias após a cirurgia . A TVP foi documentada no lado operado em 9,75% dos pacientes tratados com enoxaparina e em 11,76% dos pacientes tratados com HNF (p=0,92) e houve um caso de TVP bilateral em cada grupo . Sangramentos não foram verificados nos 2 grupos . CONCLUSÃO: A enoxaparina e HNF foram igualmente eficientes e seguras para a profilaxia da TVP em pacientes submetidos à amputação de membros inferiores . PURPOSE: To compare the efficacy and safety of a low molecular weight heparin (enoxaparin) with unfractionated heparin (UH) in this prophylaxis. METHODS: Seventy five patients (59 men and 16 women), undergoing major lower extremity amputation (30 above-knee and 45 below-knee), were randomized to be treated with subcutaneous UH (5,000 IU t.i.d.) or enoxaparin (40mg/day) during hospitalization. Prophylaxis was started 12 hours before surgery or, in emergency cases, in the first postoperative day. RESULTS: The two groups were comparable with regard to baseline characteristics. Evaluation of DVT was performed by daily clinical examination and by duplex scanning before and 5 to 8 days after surgery. DVT was documented in the operated limb in 9.75% in patients treated with enoxaparin and in 11.76% in patients treated with UH (p=0.92) and there was one bilateral thrombosis in each group . Bleeding complications were not observed in both groups. CONCLUSION: Enoxaparin and UH were both efficient and safe for the prophylaxis of DVT in patients submitted to lower extremity amputation. UNESP SMB Department of Surgery and Orthopedics UNESP SMB Department of Surgery and Orthopedics

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01Bitstream added on 2014-10-01T14:03:07Z : No. of bitstreams: 1 S1677-54492014000100012.pdf: 248004 bytes, checksum: e819fc1c88890380794a365f3efb47f0 (MD5) Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01Bitstream added on 2014-10-01T14:03:07Z : No. of bitstreams: 1 S1677-54492014000100012.pdf: 248004 bytes, checksum: e819fc1c88890380794a365f3efb47f0 (MD5) Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01Bitstream added on 2014-10-01T14:03:07Z : No. of bitstreams: 1 S1677-54492014000100012.pdf: 248004 bytes, checksum: e819fc1c88890380794a365f3efb47f0 (MD5) CONTEXTO:A melhor dose para o início do tratamento anticoagulante com varfarina vem sendo debatida nos últimos dez anos. Em nosso meio, não observamos nenhum estudo comparativo quanto a estas características.OBJETIVO:Comparar segurança e eficácia de dois esquemas de dosagem inicial de varfarina para tratamento anticoagulante.MÉTODOS:Foram estudados prospectivamente 110 pacientes de ambos os sexos, consecutivos, com indicação de anticoagulação por tromboembolismo venoso ou arterial. Durante os três primeiros dias de tratamento, estes pacientes receberam doses adequadas de heparina (RT - razão dos tempos - alvo entre 1,5 e 2,5) e 5 mg de varfarina, cuja dose foi reajustada a partir do quarto dia pelo Razão Normatizada Internacional - RNI (alvo entre 2 e 3). Esse grupo foi comparado com série histórica de 110 pacientes que receberam 10 mg nos dois primeiros dias, 5 mg a partir do terceiro dia, com ajuste posterior de dose baseado no RNI. Os desfechos foram: recorrência do tromboembolismo, sangramentos e tempo para alcançar níveis terapêuticos.RESULTADOS:A eficácia, a segurança e o tempo de internação foram similares entre os grupos. O grupo que recebeu 10 mg atingiu níveis terapêuticos mais precocemente (média de 4,5 dias × 5,8 dias), sendo as doses na alta menores e os níveis terapêuticos mais adequados na primeira visita de retorno.CONCLUSÃO:O esquema de dosagem de 10 mg proporcionou menor tempo para alcançar nível terapêutico, com menores doses de varfarina na alta e RNI mais adequado no retorno. CONTEXT:The question of what is the best loading dosage of warfarin when starting anticoagulant treatment has been under discussion for ten years. We were unable to find any comparative studies of these characteristics conducted here in Brazil.OBJECTIVE:To compare the safety and efficacy of two initial warfarin dosage regimens for anticoagulant treatment.METHODS:One-hundred and ten consecutive patients of both sexes, with indications for anticoagulation because of venous or arterial thromboembolism, were analyzed prospectively. During the first 3 days of treatment, these patients were given adequate heparin to keep aPTT (activated partial thromboplastin time) between 1.5 and 2.5, plus 5 mg of warfarin. From the fourth day onwards, their warfarin doses were adjusted using International Normalized Ratios (INR; target range: 2 to 3). This prospective cohort was compared with a historical series of 110 patients had been given 10 mg of warfarin on the first 2 days and 5 mg on the third day with adjustments based on INR thereafter. Outcomes analyzed were as follows: recurrence of thromboembolism, bleeding events and time taken to enter the therapeutic range.RESULTS:Efficacy, safety and length of hospital stay were similar in both samples. The sample that were given 10 mg entered the therapeutic range earlier (means: 4.5 days vs. 5.8 days), were on lower doses at discharge and had better therapeutic indicators at the first return appointment.CONCLUSIONS:The 10 mg dosage regimen took less time to attain the therapeutic range and was associated with lower warfarin doses at discharge and better INR at first out-patients follow-up visit. Universidade Estadual Paulista - UNESP Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista - UNESP Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Duplex ultrasound scanning (DUS) is the method of choice for diagnosis of deep vein thrombosis (DVT). However, only a few studies have performed prospective serial DUS after an acute episode of DVT to assess its evolution. This study aimed to report our experience using DUS combined with a thrombosis score (TS) and a newly proposed vein diameter variation index (VDVI) to evaluate the rate of resolution of DVT by assessing and quantifying the early stages of vein recanalization in proximal vein segments within 6 months after an episode of acute lower extremity DVT.Twelve patients with first episode of acute lower extremity DVT confirmed by DUS as occurring in ≤10 days after the onset of venous thrombosis symptoms were followed up prospectively for 6 months. TS and VDVI were calculated at 1, 3, and 6 months to assess vein recanalization. Intra-thrombus arteriovenous fistula formation was also investigated and related to the recanalization process.Seven (58%) women were included, with a total cohort median age of 53.5 ± 19 years. The left lower extremity was affected in 7 (58%) patients. DVT was diagnosed in 55 proximal vein segments. All patients had proximal DVT, with involvement of the external iliac, femoral, and popliteal veins. After 6 months, there was a significant decrease in TS and increase in VDVI (P 0.001) in all proximal vein segments assessed, indicating thrombus regression. The more distal the DVT was, the faster was the VDVI increase, with most popliteal veins being recanalized at 3 months (P 0.001). Intra-thrombus arteriovenous fistula was identified in 50% of patients at 1 month while on anticoagulation.The combined use of two different DUS-based assessment tools, TS and the proposed VDVI, provided an effective method to prospectively assess vein recanalization rates after an episode of acute lower extremity DVT in this series of patients and may allow a correct evaluation of DVT and its resolution or progression.

Made available in DSpace on 2014-10-01T13:08:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-01Bitstream added on 2014-10-01T14:03:08Z : No. of bitstreams: 1 S1677-54492013000300226.pdf: 599018 bytes, checksum: 1b7bdda6b166a504c41867589527cf45 (MD5) Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu

Background In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. Objective To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. Methods A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. Results Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. Conclusions NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:28Z No. of bitstreams: 1 S1677-54492011000200009.pdf: 811429 bytes, checksum: 439d94245808eb53e9745dd5e4412ef1 (MD5) Made available in DSpace on 2013-08-22T18:43:28Z (GMT). No. of bitstreams: 1 S1677-54492011000200009.pdf: 811429 bytes, checksum: 439d94245808eb53e9745dd5e4412ef1 (MD5) Previous issue date: 2011-06-01 Made available in DSpace on 2013-09-30T19:31:08Z (GMT). No. of bitstreams: 2 S1677-54492011000200009.pdf: 811429 bytes, checksum: 439d94245808eb53e9745dd5e4412ef1 (MD5) S1677-54492011000200009.pdf.txt: 43746 bytes, checksum: 0bbe01517007fa1eb464f393058e6139 (MD5) Previous issue date: 2011-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:08:32Z No. of bitstreams: 2 S1677-54492011000200009.pdf: 811429 bytes, checksum: 439d94245808eb53e9745dd5e4412ef1 (MD5) S1677-54492011000200009.pdf.txt: 43746 bytes, checksum: 0bbe01517007fa1eb464f393058e6139 (MD5) Made available in DSpace on 2014-05-20T15:08:32Z (GMT). No. of bitstreams: 2 S1677-54492011000200009.pdf: 811429 bytes, checksum: 439d94245808eb53e9745dd5e4412ef1 (MD5) S1677-54492011000200009.pdf.txt: 43746 bytes, checksum: 0bbe01517007fa1eb464f393058e6139 (MD5) Previous issue date: 2011-06-01 Após cerca de 50 anos de experiência com a heparina e antagonistas da vitamina K (AVK), pesquisas e estudos com novos anticoagulantes vêm evoluindo de forma crescente nos últimos anos. Embora consagrados pelo uso, os anticoagulantes tradicionais têm limitações importantes em termos de controle laboratorial, complicações, efeitos colaterais, interações com medicamentos e dieta. A heparina não fracionada (HNF) tem interação com proteínas plasmáticas e parede vascular, pode desencadear trombocitopenia induzida pela heparina (TIH), só pode ser administrada por via parenteral, exige controle laboratorial pelo teste da tromboplastina parcial ativada (TTPa), pode provocar osteoporose e alopecia quando usada por períodos prolongados e sua produção tem origem biológica. A AVK tem a vantagem de poder ser ministrada por via oral, mas o controle (feito pela razão normatizada internacional) pode ser difícil em alguns casos, já que tem início de ação demorado, janela terapêutica estreita, interação com dieta e grande número de medicamentos, pode provocar necrose de pele em portadores de deficiência de antitrombina e de proteínas C e S, e pode induzir alterações fetais quando usada na gravidez. Na década de 1980, surgiram as heparinas de baixo peso molecular, que foram uma evolução da heparina não fracionada, pois apresentaram maior biodisponibilidade, dosagem por peso corporal, sem necessidade de controle laboratorial, administração por via subcutânea, menor risco de trombocitopenia induzida pela heparina, e eficácia e segurança similares à heparina não fracionada. Na última década surgiram, então, uma série de novos anticoagulantes no mercado, os quais têm apresentado resultados promissores em várias situações de profilaxia e tratamento do tromboembolismo venoso. Nesta revisão, são apresentados as novas heparinas de baixo peso molecular, as heparinas de ultrabaixo peso molecular, os pentassacarídeos, os novos inibidores diretos do fator Xa e inibidores do fator IIa. After about 50 years of experience with heparin and vitamin K antagonists (VKA), research and clinical studies of new anticoagulants have recently evolved . Although traditional anticoagulants have proven to be clinically useful, they have important limitations in terms of laboratory control, complications, side effects and interactions with medications and food. .Unfractionated heparin interacts with plasma proteins and the vascular wall, may trigger thrombocytopenia, can only be administered parenterally, requires control by the laboratory test of partial thromboplastin time, may cause osteoporosis and alopecia when used for long periods and it is produced from biological sources. VKA have the advantage of being administered orally, but the control (made by the international normalized ratio) can be difficult in some cases, since they have delayed onset of action and metabolism and a narrow therapeutic window. They also interact with foods and with a large number of medications, can cause skin necrosis in patients with antithrombin and protein C and S deficiencies and may induce fetal changes when prescribed in pregnancy. In the 1980´s the low-molecular-weight heparins were developed and proved to be an evolution over unfractionated heparin, because of their greater bio-availability, fixed dose per body weight, no need for laboratory control, subcutaneous administration, lower risk of heparin-induced thrombocytopenia, and efficacy and safety similar to unfractionated heparin. Over the last decade, a series of new anticoagulants have appeared in the market and shown promising results in several situations of venous thromboembolism prophylaxis and treatment. In the present review, the new low-molecular-weight heparins, ultra-low molecular weight heparin, pentasaccharides and the new direct inhibitors of factor Xa and factor IIa.are addressed. Unesp Faculdade de Medicina de Botucatu Unesp Faculdade de Medicina de Botucatu

This is a case report of a true and dissecting aneurysm of the superior labial artery in a 51-year-old patient without risk factors for vascular pathology. The patient complained of swelling of the upper lip, mostly on the left side. A Doppler ultrasonography was used in the diagnosis. The definitive treatment was surgical resection, and the histopathological analysis confirmed the diagnosis. The progress of the patient was satisfactory, leaving a slight change in sensitivity in the area. This seems to be the first reported case of true and dissecting aneurysm of the superior labial artery in the medical literature.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:27Z No. of bitstreams: 1 S1677-54492010000100012.pdf: 363042 bytes, checksum: ffa257376266c2aaebb37227089d7ed4 (MD5) Made available in DSpace on 2013-08-22T18:43:27Z (GMT). No. of bitstreams: 1 S1677-54492010000100012.pdf: 363042 bytes, checksum: ffa257376266c2aaebb37227089d7ed4 (MD5) Previous issue date: 2010-01-01 Made available in DSpace on 2013-09-30T19:31:07Z (GMT). No. of bitstreams: 2 S1677-54492010000100012.pdf: 363042 bytes, checksum: ffa257376266c2aaebb37227089d7ed4 (MD5) S1677-54492010000100012.pdf.txt: 24053 bytes, checksum: 8adea6389fee42acf2d081c88c6d4b7f (MD5) Previous issue date: 2010-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:21Z No. of bitstreams: 2 S1677-54492010000100012.pdf: 363042 bytes, checksum: ffa257376266c2aaebb37227089d7ed4 (MD5) S1677-54492010000100012.pdf.txt: 24053 bytes, checksum: 8adea6389fee42acf2d081c88c6d4b7f (MD5) Made available in DSpace on 2014-05-20T13:32:21Z (GMT). No. of bitstreams: 2 S1677-54492010000100012.pdf: 363042 bytes, checksum: ffa257376266c2aaebb37227089d7ed4 (MD5) S1677-54492010000100012.pdf.txt: 24053 bytes, checksum: 8adea6389fee42acf2d081c88c6d4b7f (MD5) Previous issue date: 2010-01-01 A cirurgia videolaparoscópica (CVL) vem evoluindo como alternativa cirúrgica menos invasiva para o tratamento da doença aterosclerótica oclusiva aortoilíaca. O objetivo deste relato de caso foi demonstrar os resultados da primeira cirurgia aórtica totalmente laparoscópica relatada no Brasil para o tratamento da doença oclusiva aortoilíaca em paciente com isquemia crítica. Os tempos cirúrgicos totais de dissecção e exposição da aorta antes do clampeamento, exposição retroperitoneal da aorta, clampeamento total e da anastomose proximal com técnica totalmente laparoscópica foram de 220 minutos, 15 e 27 minutos, 42 minutos, 110 minutos e 78 minutos, respectivamente. A técnica videolaparoscópica é mais uma ferramenta minimamente invasiva, viável, segura e eficaz para o tratamento da doença oclusiva aortoilíaca extensa. Ela, que nada mais é do que a cirurgia convencional realizada sob visão laparoscópica, tem bons resultados a longo prazo, que se associam à elegância técnica. Laparoscopic surgery has been increasingly used as a less invasive surgical option for the treatment of aortoiliac occlusive atherosclerotic disease. The objective of this case report was to describe the results of the first total laparoscopic surgery conducted in Brazil for the treatment of the aortoiliac occlusive disease in a patient with critical ischemia. Total time of surgery, time of aortic dissection and exposure before clamping, time of retroperitoneal exposure of the aorta, and time of total clamping and proximal anastomosis using total laparoscopic technique were 220 minutes, 15 and 27 minutes, 42 minutes, 110 minutes, and 78 minutes, respectively. The laparoscopic technique is an additional minimally invasive tool, being feasible, safe, and effective for the treatment of extensive aortoiliac occlusive disease. This technique, which is nothing more than a conventional surgery performed under laparoscopic viewing, brings good long-term results associated with technical elegance. UNESP Faculdade de Medicina de Botucatu UNESP FMB Hospital Augusta, Dusseldorf UNESP Faculdade de Medicina de Botucatu UNESP FMB

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:27Z No. of bitstreams: 1 S1677-54492009000400014.pdf: 221243 bytes, checksum: a766eabce976fbf1737236f8a92da5a4 (MD5) Made available in DSpace on 2013-08-22T18:43:27Z (GMT). No. of bitstreams: 1 S1677-54492009000400014.pdf: 221243 bytes, checksum: a766eabce976fbf1737236f8a92da5a4 (MD5) Previous issue date: 2009-12-01 Made available in DSpace on 2013-09-30T19:31:07Z (GMT). No. of bitstreams: 2 S1677-54492009000400014.pdf: 221243 bytes, checksum: a766eabce976fbf1737236f8a92da5a4 (MD5) S1677-54492009000400014.pdf.txt: 22616 bytes, checksum: a0582c3b45428365df7161ec5d0328c9 (MD5) Previous issue date: 2009-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:08:32Z No. of bitstreams: 2 S1677-54492009000400014.pdf: 221243 bytes, checksum: a766eabce976fbf1737236f8a92da5a4 (MD5) S1677-54492009000400014.pdf.txt: 22616 bytes, checksum: a0582c3b45428365df7161ec5d0328c9 (MD5) Made available in DSpace on 2014-05-20T15:08:32Z (GMT). No. of bitstreams: 2 S1677-54492009000400014.pdf: 221243 bytes, checksum: a766eabce976fbf1737236f8a92da5a4 (MD5) S1677-54492009000400014.pdf.txt: 22616 bytes, checksum: a0582c3b45428365df7161ec5d0328c9 (MD5) Previous issue date: 2009-12-01 A cirurgia videolaparoscópica vem evoluindo como alternativa cirúrgica menos invasiva para o tratamento da doença aterosclerótica oclusiva aorto-ilíaca. O objetivo deste relato é demonstrar os resultados da primeira cirurgia videolaparoscópica realizada no Brasil para o tratamento da doença oclusiva aorto-ilíaca, associada a procedimentos híbridos distais para lesões ateroscleróticas multissegmentares em paciente com isquemia crítica. A técnica videolaparoscópica é mais uma ferramenta minimamente invasiva, viável, segura e eficaz para o tratamento da doença oclusiva aorto-ilíaca extensa. A referida técnica, que nada mais é do que a cirurgia convencional realizada sob visão laparoscópica, tem bons resultados a longo prazo, associados à elegância técnica. Laparoscopic surgery has been increasingly used as a less invasive surgical option for the treatment of aortoiliac occlusive atherosclerotic disease. The objective of this case report is to describe the results of the first laparoscopic surgery conducted in Brazil for the treatment of the aortoiliac occlusive disease associated with distal hybrid procedures to treat multisegmental atherosclerotic lesions in a patient with critical limb ischemia. The laparoscopic technique is an additional minimally invasive tool, being feasible, safe, and effective for the treatment of extensive aortoiliac occlusive disease. This technique, which is nothing more than a conventional surgery performed under laparoscopic viewing, brings good long-term results associated with technical elegance. Universidade Estadual Paulista Faculdade de Medicina de Botucatu UNESP Augusta Hospital and Catholic Clinics Serviço de Cirurgia Vascular e Endovascular Universidade Estadual Paulista Faculdade de Medicina de Botucatu UNESP

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:26Z No. of bitstreams: 1 S1677-54492009000200010.pdf: 104770 bytes, checksum: d7e339dd37329380f39b983dc990040c (MD5) Made available in DSpace on 2013-08-22T18:43:26Z (GMT). No. of bitstreams: 1 S1677-54492009000200010.pdf: 104770 bytes, checksum: d7e339dd37329380f39b983dc990040c (MD5) Previous issue date: 2009-06-01 Made available in DSpace on 2013-09-30T19:31:05Z (GMT). No. of bitstreams: 2 S1677-54492009000200010.pdf: 104770 bytes, checksum: d7e339dd37329380f39b983dc990040c (MD5) S1677-54492009000200010.pdf.txt: 56082 bytes, checksum: aa41f71d295437dc906a4cca57d9255e (MD5) Previous issue date: 2009-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:23Z No. of bitstreams: 2 S1677-54492009000200010.pdf: 104770 bytes, checksum: d7e339dd37329380f39b983dc990040c (MD5) S1677-54492009000200010.pdf.txt: 56082 bytes, checksum: aa41f71d295437dc906a4cca57d9255e (MD5) Made available in DSpace on 2014-05-20T13:32:23Z (GMT). No. of bitstreams: 2 S1677-54492009000200010.pdf: 104770 bytes, checksum: d7e339dd37329380f39b983dc990040c (MD5) S1677-54492009000200010.pdf.txt: 56082 bytes, checksum: aa41f71d295437dc906a4cca57d9255e (MD5) Previous issue date: 2009-06-01 A veia safena magna autóloga é o melhor substituto arterial nas revascularizações dos membros inferiores, importante na revascularização do miocárdio e pode ser utilizada nas cirurgias do sistema venoso e nos traumas das extremidades. A fleboextração aumenta os riscos de lesões linfáticas e neurológicas. Assim, no tratamento das varizes primárias dos membros inferiores por meio da cirurgia ou de outras técnicas, a preservação da safena é recomendável se ela for normal ou apresentar alterações que ainda permitam sua preservação pela correção da causa desencadeante. Tal correção pode ser feita por técnicas cirúrgicas. Entre elas, a cura hemodinâmica da insuficiência venosa em ambulatório (CHIVA) tem mostrado bons resultados. Recentemente, um ensaio clínico randomizado e controlado foi publicado comprovando sua eficácia. Outra técnica bastante utilizada é a da ligadura rasante da junção safenofemoral + crossectomia + ligadura das tributárias de crossa, com a qual se tem obtido resultados contraditórios. Finalmente, as técnicas que corrigem a insuficiência da safena reparando as valvas ostial e pré-ostial (valvoplastia externa) são mais fisiológicas. Um ensaio clínico internacional multicêntrico, randomizado e controlado, testando um novo dispositivo, está sendo realizado, com resultados iniciais favoráveis. Este estudo pretende fazer uma revisão sobre as técnicas utilizadas na preservação da safena magna. The autologous great saphenous vein is the most effective bypass choice for lower limb revascularization, playing an important role in myocardial revascularization, and can be used in venous system surgeries and extremity traumas. Stripping increases the risk of lymphatic lesions and nerve damage. Therefore, when surgery or other techniques are used to treat primary varicose veins in the lower limbs, preservation of the saphenous vein is a desirable objective whenever the vein remains healthy or with alterations that still allow preservation by correcting the cause. Such corrections can be performed surgically. Among the methods currently used, the ambulatory conservative hemodynamic correction of venous insufficiency has yielded good results. A randomized controlled trial confirming the efficacy of this procedure has been recently published. Another largely used technique is flush ligation of the saphenofemoral junction plus saphenous veins stripping and ligation of its tributaries at the groin, which has yielded conflicting results. Finally, there are techniques that correct saphenofemoral reflux by external valvuloplasty of the saphenofemoral junction. An international multicenter, randomized, controlled trial, testing a new device, is currently in progress with favorable preliminary results. This study aimed to review the techniques employed to preserve the great saphenous vein in varicose vein surgery. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Departamento de Cirurgia e Ortopedia

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:26Z No. of bitstreams: 1 S1677-54492008000300008.pdf: 243581 bytes, checksum: cefa0b78d873114e761bc5163787ed51 (MD5) Made available in DSpace on 2013-08-22T18:43:26Z (GMT). No. of bitstreams: 1 S1677-54492008000300008.pdf: 243581 bytes, checksum: cefa0b78d873114e761bc5163787ed51 (MD5) Previous issue date: 2008-09-01 Made available in DSpace on 2013-09-30T18:15:57Z (GMT). No. of bitstreams: 2 S1677-54492008000300008.pdf: 243581 bytes, checksum: cefa0b78d873114e761bc5163787ed51 (MD5) S1677-54492008000300008.pdf.txt: 29209 bytes, checksum: 2b62de4144bec816d997c1a83914ad54 (MD5) Previous issue date: 2008-09-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:16Z No. of bitstreams: 2 S1677-54492008000300008.pdf: 243581 bytes, checksum: cefa0b78d873114e761bc5163787ed51 (MD5) S1677-54492008000300008.pdf.txt: 29209 bytes, checksum: 2b62de4144bec816d997c1a83914ad54 (MD5) Made available in DSpace on 2014-05-20T13:32:16Z (GMT). No. of bitstreams: 2 S1677-54492008000300008.pdf: 243581 bytes, checksum: cefa0b78d873114e761bc5163787ed51 (MD5) S1677-54492008000300008.pdf.txt: 29209 bytes, checksum: 2b62de4144bec816d997c1a83914ad54 (MD5) Previous issue date: 2008-09-01 CONTEXTO: A cirurgia videolaparoscópica (CVL) vem evoluindo como alternativa cirúrgica menos invasiva para o tratamento da doença aterosclerótica oclusiva aorto-ilíaca e do aneurisma da aorta abdominal. Poucos estudos avaliaram objetivamente a curva de aprendizado com essa técnica em cirurgia vascular. OBJETIVO: Avaliar objetivamente os tempos e a evolução de cada passo cirúrgico e demonstrar a exeqüibilidade dessa técnica. MÉTODOS: Entre outubro 2007 e janeiro de 2008, dois cirurgiões vasculares iniciantes na CVL operaram, após cursos e treinamentos, seis porcos consecutivos, com dissecção aórtica e interposição de um enxerto de dácron em um segmento da aorta infra-renal abdominal, com técnica totalmente laparoscópica. RESULTADOS: Todos os tempos cirúrgicos foram decrescentes ao longo do estudo, apresentando redução de 45,9% no tempo total de cirurgia, 85,8% no tempo de dissecção da aorta, 81,2% na exposição da aorta, 55,1% no clampeamento total, 71% na confecção da anastomose proximal e 64,9% na anastomose distal. CONCLUSÃO: O presente estudo mostrou que os resultados técnicos satisfatórios da CVL vascular ocorreram somente após longa curva de aprendizado, que foi decrescente ao longo do tempo, à medida que aumentou a experiência e vivência com os materiais e com a visão não-estereoscópica. Essa técnica pode ser realizada com perfeição por cirurgiões vasculares desde que façam cursos especializados, com treinamento em simuladores e animais, e desde que busquem constante aprimoramento a fim de conseguir resultados similares aos obtidos com a cirurgia convencional. BACKGROUND: Laparoscopic aortic surgery (LAS) is evolving as a minimal invasive alternative technique for the treatment of abdominal aortic aneurysms and peripheral aortoiliac arterial disease. Few articles have objectively evaluated the technique learning curve in vascular surgery. OBJECTIVE: The aim of the present experimental study was to demonstrate surgical feasibility and evaluate each surgical step of LAS. METHODS: Between October 2007 and January 2008, two beginning surgeons attended laparoscopic courses and operated on six consecutive pigs with a total laparoscopic retroperitoneal aortic dissection and interposition of a Dacron tube graft in the infrarenal aortic segment. Both anastomoses were performed under total laparoscopic technique. RESULTS: All surgical time curves decreased along time: 45.9% in total surgical time, 85.8% in dissection time, 81.2% in aortic exposure, 55.1% in total cross-clamping, 71% in proximal anastomosis and 64.9% in distal anastomosis. CONCLUSION:This experimental study showed that satisfactory results with LAS were only reached after a long learning curve. However, this learning curve decreased along time, as experience with the technique, materials and non-stereoscopic vision improved. Vascular surgeons should attend practical courses and should have training opportunities in simulators and animals to achieve results similar to those of conventional surgery. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Disciplina de Angiologia e Cirurgia Vascular UNESP Faculdade de Medicina de Botucatu Hospital Augusta Serviço de Cirurgia Vascular e Endovascular UNESP Faculdade de Medicina Veterinária e Zootecnia Departamento de Cirurgia e Anestesiologia Veterinária Universidade Estadual Paulista Faculdade de Medicina de Botucatu Disciplina de Angiologia e Cirurgia Vascular UNESP Faculdade de Medicina de Botucatu UNESP Faculdade de Medicina Veterinária e Zootecnia Departamento de Cirurgia e Anestesiologia Veterinária

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:25Z No. of bitstreams: 1 S1677-54492007000200017.pdf: 487070 bytes, checksum: fae4b49397640264d53858c99b756719 (MD5) Made available in DSpace on 2013-08-22T18:43:25Z (GMT). No. of bitstreams: 1 S1677-54492007000200017.pdf: 487070 bytes, checksum: fae4b49397640264d53858c99b756719 (MD5) Previous issue date: 2007-06-01 Made available in DSpace on 2013-09-30T18:17:22Z (GMT). No. of bitstreams: 2 S1677-54492007000200017.pdf: 487070 bytes, checksum: fae4b49397640264d53858c99b756719 (MD5) S1677-54492007000200017.pdf.txt: 10637 bytes, checksum: 7a63f28f99c5aa8ac7d177be578f6ad9 (MD5) Previous issue date: 2007-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:29Z No. of bitstreams: 2 S1677-54492007000200017.pdf: 487070 bytes, checksum: fae4b49397640264d53858c99b756719 (MD5) S1677-54492007000200017.pdf.txt: 10637 bytes, checksum: 7a63f28f99c5aa8ac7d177be578f6ad9 (MD5) Made available in DSpace on 2014-05-20T13:33:30Z (GMT). No. of bitstreams: 2 S1677-54492007000200017.pdf: 487070 bytes, checksum: fae4b49397640264d53858c99b756719 (MD5) S1677-54492007000200017.pdf.txt: 10637 bytes, checksum: 7a63f28f99c5aa8ac7d177be578f6ad9 (MD5) Previous issue date: 2007-06-01 O paciente desenvolveu linforragia na região inguinal direita, depois de ponte aorto-bifemoral com enxerto de dácron®. Não respondeu ao tratamento conservador com cuidados locais e compressão. Foi realizado exame de ultra-sonografia Doppler, que evidenciou grande linfocele (6,4 x 3,36 x 6,1 cm), tratada pelo esvaziamento da loja por aspiração e injeção de cola de fibrina (1,6 mL) em seu interior. O paciente se recuperou sem intercorrências e sem recidiva, após 3 meses de seguimento. The patient developed lymphatic drainage in the right groin after an aortobifemoral bypass with Dacron® graft. Conservative treatment with local wound care and compression was unsuccessful. Duplex scan showed a 6.4 x 3.36 x 6.1 cm lymphocele, which was treated by aspiration and injection of fibrin glue (1.6 mL). The patient recovered uneventfully and without recurrence after a 3-month follow-up. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Hospital das Clínicas Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Hospital das Clínicas

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:25Z No. of bitstreams: 1 S1677-54492007000100003.pdf: 263530 bytes, checksum: fde54f30c32bd7d7d9535974a73657a8 (MD5) Made available in DSpace on 2013-08-22T18:43:25Z (GMT). No. of bitstreams: 1 S1677-54492007000100003.pdf: 263530 bytes, checksum: fde54f30c32bd7d7d9535974a73657a8 (MD5) Previous issue date: 2007-03-01 Made available in DSpace on 2013-09-30T18:17:22Z (GMT). No. of bitstreams: 2 S1677-54492007000100003.pdf: 263530 bytes, checksum: fde54f30c32bd7d7d9535974a73657a8 (MD5) S1677-54492007000100003.pdf.txt: 34560 bytes, checksum: 2e18cb2cf0392f39ee3e507d411637c5 (MD5) Previous issue date: 2007-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:29Z No. of bitstreams: 2 S1677-54492007000100003.pdf: 263530 bytes, checksum: fde54f30c32bd7d7d9535974a73657a8 (MD5) S1677-54492007000100003.pdf.txt: 34560 bytes, checksum: 2e18cb2cf0392f39ee3e507d411637c5 (MD5) Made available in DSpace on 2014-05-20T13:33:29Z (GMT). No. of bitstreams: 2 S1677-54492007000100003.pdf: 263530 bytes, checksum: fde54f30c32bd7d7d9535974a73657a8 (MD5) S1677-54492007000100003.pdf.txt: 34560 bytes, checksum: 2e18cb2cf0392f39ee3e507d411637c5 (MD5) Previous issue date: 2007-03-01 CONTEXTO: A aplicação de uma estratégia baseada em um modelo clínico associado ao mapeamento dúplex (MD) pode permitir um diagnóstico da trombose venosa profunda (TVP) mais seguro, eficaz e custo-efetivo. OBJETIVO: Testar o modelo clínico de Wells et al. associado ao MD e verificar a ocorrência de TVP nos pacientes categorizados quanto à probabilidade de apresentar a doença, e determinar se, a partir dos resultados obtidos, seria possível reduzir o número de exames seriados com o MD. MÉTODOS: Os pacientes com suspeita clínica de TVP foram categorizados quanto à apresentação de TVP em baixa, moderada e alta probabilidade (BP, MP, AP) e, em seguida, submetidos ao MD. Pacientes com MD negativo repetiram o exame em 24-48 horas e em 7 dias. Pacientes com exame positivo para TVP foram tratados. Todos os pacientes sem TVP foram convocados para reavaliação clínica em 3 meses. RESULTADOS: A ocorrência de TVP entre os 489 pacientes avaliados foi de 39,1% (191), sendo 35,6% identificados no exame inicial e 3,5% no exame seriado. Os índices de pacientes que apresentaram TVP foram de 6,1% no grupo de BP, 26,9% no grupo de MP e 79,5% no grupo de AP. No exame seriado, o percentual de TVP foi de 2,4, 7,8 e 15,1% nos grupos BP, MP e AP, respectivamente. Dos pacientes com MD negativo, 62,4% compareceram após 3 meses, e piora dos sintomas foi apresentada por apenas um paciente. Neste, o MD mostrou TVP de veia poplítea. CONCLUSÃO: Os resultados obtidos sugerem que, para os pacientes com BP para TVP e MD negativo, seria possível prescindir do exame seriado, devido à baixa ocorrência de TVP neste grupo, tornando, assim, a abordagem diagnóstica mais simples. BACKGROUND: The application of a diagnostic strategy based on a clinical model associated with duplex scanning (DS) may allow for a safer and more effective/cost-effective diagnosis of deep venous thrombosis (DVT). OBJECTIVE: To evaluate the clinical model proposed by Wells et al. associated with DS and verify the occurrence of DVT in patients divided into probability of presenting the disease, and assess the possibility of reducing the number of repeated DS based on the results obtained. METHODS: Suspected DVT patients were accordingly categorized into groups of low, moderate and high DVT probability (LP, MP and HP). The patients were then submitted to DS and those without DVT were rescheduled to repeat the examination in 24-48 hours and in 7 days. Patients positively diagnosed with DVT received proper treatment. All patients without DVT were summoned to return within 3 months. RESULTS: The incidence of DVT among all 489 patients was 39.1% (191); of these, 35.6% were identified in the first examination and 3.5% in the follow-up. Among patients categorized as LP the occurrence was 6.1%, 26.9% in the MP group and 79.5% in the HP group. on the follow-up exams the incidence of DVT in LP, MP and HP groups was 2.4, 7.8 e 13.2%, respectively. Among patients with negative DS, 62.4% attended the reevaluation in 3 months and only one presented worsening of symptoms. This patient was then diagnosed with popliteal DVT using DS. CONCLUSION:The results suggest that for patients with LP for DVT and negative DS, follow-up exams are not needed, since the occurrence of DVT was low in this group. This procedure simplifies the diagnostic process. Universidade Estadual Paulista Faculdade de Medicina de Botucatu UNESP FMB Hospital das Clínicas Universidade Estadual Paulista Faculdade de Medicina de Botucatu UNESP FMB Hospital das Clínicas

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:24Z No. of bitstreams: 1 S1677-54492005000300010.pdf: 439229 bytes, checksum: 4c46ef232745f3f64cb1cb92153a174f (MD5) Made available in DSpace on 2013-08-22T18:43:24Z (GMT). No. of bitstreams: 1 S1677-54492005000300010.pdf: 439229 bytes, checksum: 4c46ef232745f3f64cb1cb92153a174f (MD5) Previous issue date: 2005-09-01 Made available in DSpace on 2013-09-30T18:16:24Z (GMT). No. of bitstreams: 2 S1677-54492005000300010.pdf: 439229 bytes, checksum: 4c46ef232745f3f64cb1cb92153a174f (MD5) S1677-54492005000300010.pdf.txt: 30539 bytes, checksum: 4dd704fd9a4b0c1a135094ecd46233a9 (MD5) Previous issue date: 2005-09-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:43Z No. of bitstreams: 2 S1677-54492005000300010.pdf: 439229 bytes, checksum: 4c46ef232745f3f64cb1cb92153a174f (MD5) S1677-54492005000300010.pdf.txt: 30539 bytes, checksum: 4dd704fd9a4b0c1a135094ecd46233a9 (MD5) Made available in DSpace on 2014-05-20T13:32:43Z (GMT). No. of bitstreams: 2 S1677-54492005000300010.pdf: 439229 bytes, checksum: 4c46ef232745f3f64cb1cb92153a174f (MD5) S1677-54492005000300010.pdf.txt: 30539 bytes, checksum: 4dd704fd9a4b0c1a135094ecd46233a9 (MD5) Previous issue date: 2005-09-01 OBJETIVO: Rever os fatores predisponentes e a evolução em série de casos de trombose venosa profunda dos membros superiores de nossa instituição. MÉTODOS: Cinqüenta e dois pacientes consecutivos, com trombose venosa profunda dos membros superiores (29 homens e 23 mulheres), idade média de 52,3 anos, documentados por mapeamento dúplex (71,1%), flebografia (11,1%) ou clinicamente (15,6%), foram incluídos no presente estudo. RESULTADOS: As manifestações clínicas foram: dor no antebraço (24 casos - 46,1%), dor no braço (27 casos - 51,9%), edema do membro superior (45 casos - 86,5%), dor à compressão do membro superior (36 casos - 70,2%) e dor à movimentação do mesmo (32 casos - 61,7%). Os principais fatores de risco foram: punção ou acesso venoso (20 casos - 39,1%) e câncer (16 casos - 32,6%). As veias envolvidas foram: umeral (n = 18), axilar (n = 27), subclávia (n = 15) e jugular (n = 11). A embolia pulmonar estava inicialmente presente em quatro casos (7,6%). O tratamento inicial foi feito com heparina não-fracionada intravenosa (64,3%), subcutânea (16,7%), ou heparina de baixo peso molecular (17,1%), seguido de varfarina. Doze pacientes morreram antes da alta, em função de causas não relacionadas à embolia pulmonar. Foram acompanhados os 40 pacientes restantes por período de 3 meses a 10 anos, sendo que dois morreram de causas não relacionadas à embolia pulmonar, um paciente desenvolveu seqüelas pós-trombóticas, como edema residual e limitações aos movimentos, e seis ficaram com discretos sintomas residuais (edema e dor). CONCLUSÕES: A trombose venosa profunda dos membros superiores foi mais freqüente em pacientes submetidos a acessos venosos e com neoplasia em atividade. Comparando com dados da literatura, a evolução dos pacientes sob tratamento exclusivo com anticoagulantes foi, no mínimo, similar a outros tratamentos propostos. OBJECTIVE: To review the predisposing factors and the evolution of upper-extremity deep vein thrombosis in a series of cases. METHODS: Fifty-two consecutive patients (29 men and 23 women, mean age of 52.3 years) with upper-extremity deep vein thrombosis documented by duplex scan (71.1%), phlebography (11.1%) or clinically (15.6%) were included in the study. RESULTS: Clinical manifestations were: forearm pain (24 cases - 46.1%), arm pain (27 cases - 51.9%), upper limb edema (45 cases - 86.5%), pain to arm compression (36 cases - 70.2%) and to arm movement (32 cases - 61.7%). Main risk factors were: vein puncture (20 cases - 39.1%), and cancer (16 cases - 32.6%). Deep vein thrombosis involved humeral (n = 18), axillary (n = 27), subclavian (n = 15) and jugular (n = 11) veins. Pulmonary embolism was initially present in four cases (7.6%). Initial therapy included unfractionated heparin, intravenous (64.3%), subcutaneous (16.7%) or low molecular weight heparin (17.1%) administration, followed by warfarin. Twelve patients died before discharge from the hospital, due to causes not related to pulmonary embolism. The remaining 40 patients were followed-up for a period of 3 months to 10 years. Two died of causes not related to pulmonary embolism, one developed post-thrombotic sequels, such as residual edema and limitations to upper limb movement, and six had discrete residual symptoms (edema and pain). CONCLUSIONS: Upper-extremity deep vein thrombosis was more frequent in patients submitted to venous access and with active neoplasia. The outcome of patients exclusively treated with oral anticoagulant was at least similar to other treatments proposed in the literature. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Superficial nerve injuries are very common during varicose vein surgery. In contrast, deep nerve injuries are rare and reported especially when surgery involves the small saphenous vein (SSV). The deep motor nerves most commonly injured are the tibial nerve and the peroneal nerve, which are directly or indirectly affected by extrinsic compression, stretching, or healing process involvement. In this report, two cases of common fibular nerve injury after SSV stripping are described, including treatment used and patient outcomes. Nerve damage mechanisms, anatomy, and prevention strategies are also discussed. In conclusion, fibular nerve damage may occur during SSV stripping. Preventive measures include careful preoperative ultrasonographic investigation of the anatomy of the vein, determining location of the saphenopopliteal joint, and careful dissection far from fibular nerve and restricted to the popliteal fossa.

The prevalence of varicose veins (VV) and of chronic venous insufficiency (CVI) was studied among 1755 adults over 15 years of age (443 men and 1312 women). These people attended the University Health Center in Botucatu, a country town in the State of Sao Paulo, Brazil, for routine examination or for any disease complaints. The prevalence of all grades of VV not including telangiectasis and reticular varices grade I was 47.6% (37.9% in men and 50.9% in non-pregnant women). The prevalence of VV recorded as moderate or severe was 21.2%. The more severe form of CVI with active or healed ulcer was present in 3.6% of the subjects (2.3% of men and 4% of women). For only 5.5% of the patients was VV or CVI the reason for medical consultation. The prevalence of VV increased with age and number of pregnancies and was greater among white than non-white people. Working posture or posture adopted for defaecation did not influence the prevalence of VV. Our data show the prevalence of VV and CVI to be higher or as high as the prevalence found in developed western countries. We therefore propose that studies of these conditions should be included in epidemiological surveys of other developing areas or countries, so that if data similar to ours are verified prophylaxis and early treatment could be included in health planning for these areas with the aim of reducing future morbidity and the related social onus.

Adventitial cystic disease of the popliteal artery is an uncommon condition. Previous reports show a grouping of cases of this disease in Europe and Australasia. With the purpose of widening the knowledge of the geographical distribution of the disease, 3 cases from Brazil are described, and reference is made to 1 previously reported. It is suggested that not recognizing or not reporting the disease could be the cause for this grouping and that the number of diagnosed cases may increase in different parts of the world due to the greater awareness of the disease.