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Infecção de corrente sanguínea relacionada a cateter venoso central (ICSRC) em enfermarias: estudo prospectivo comparativo entre veia subclávia e veia jugular interna/ Catheter-associated bloodstream infections (CA-BSI) in wards: a prospective comparative study between subclavian and jugular access  

Abstract in portuguese CONTEXTO: Hemocultura positiva associada a cateter venoso central tem sido estudada em unidades de terapia intensiva (UTI), mas ainda é controverso se o acesso jugular tem maior incidência de complicações infecciosas que o acesso na veia subclávia. OBJETIVO: Comparar índice de infecção entre os acessos na jugular interna e os na veia subclávia em pacientes internados nas enfermarias de cirurgia. MÉTODOS: Estudo prospectivo, descritivo e comparativo com 114 catet (more) eres em 96 pacientes admitidos nas enfermarias de cirurgia de um Hospital Quaternário, tendo como variáveis o local de inserção, número de lumens, tempo de uso, comparando-os com o índice de complicações infecciosas. RESULTADOS: O índice de infecção foi de 9,64% (11 cateteres), sem significância estatística quando comparados o número de lumens (mono versus duplo) e infecção (p=0,274); também sem significância estatística a comparação entre o tempo de uso (>14 dias) e infecção (p=0,156). Comparando os acessos jugular e subclávia, encontramos significância estatística tendo infecção em 17,2% na subclávia e 1,8% na jugular, com p=0,005. Índice de Hemocultura positivo associado a cateter venoso central foi maior no acesso subclávia quando comparado com jugular interna, com OR 11,2, IC95% (1,4-90,9; p=0,023). CONCLUSÕES: O acesso venoso central na jugular interna tem menor risco de infecção se comparado com subclávia em enfermarias. Abstract in english BACKGROUND: Positive hemoculture associated with central venous catheters has been studied in intensive care units (ICU), but is still controversial if the internal jugular vein access has a higher incidence of infection than subclavian or femoral vein access. OBJECTIVE: To compare catheter-related bloodstream infection (CABSI) rates between internal jugular and subclavian vein access in patients admitted to surgical wards. METHODS: This is a prospective, descriptive and (more) comparative study of 114 central venous catheters placed in 96 patients admitted to the surgical wards of a tertiary-care hospital. The following parameters were studied: local of insertion of the catheter (internal jugular versus subclavian), number of lumens (single versus double) and duration of use (longer or shorter than 14 days), in order to determine their influence in CABSI rates. RESULTS: The CABSI rate was 9,64% (11 catheters), with no significant statistical differences regarding the number of lumens (p=0.274), and duration of use (p=0.156). The CABSI rate was higher in the subclavian vein than in the internal jugular vein access (OR 11.2, 95%CI 1.4-90.8; p=0.023). CONCLUSIONS: The internal jugular vein access has a lesser incidence of CABSI than subclavian vein access in patients admitted to surgical wards.

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Trombose séptica de seios cavernosos, transverso e sigmóide e de veia jugular, associada à meningite, secundária a furúnculo nasal: Relato de Caso/ Septic thrombosis of cavernous, transverse, sigmoid sinuses and jugular vein, associated with meningitis, secondary to nasal furuncle: Case report  

Abstract in portuguese Os autores descrevem um caso de furúnculo nasal que evoluiu com trombose séptica de seio cavernoso, bilateral e assimétrica, e de seios transverso e sigmóide e de veia jugular interna a esquerda, associada à meningite bacteriana, em um paciente previamente hígido. Apesar da trombose séptica extensa de seios venosos, o paciente apresentou boa evolução, após tratamento clínico agressivo com antibióticos, corticosteróides e anticoagulantes. Porém, manteve como seqüela: paresia de VI nervo à esquerda e lesão parcial de nervo óptico homolateral. Abstract in english The authors report a case of nasal furuncle that progressed to septic bilateral and asymmetric thrombosis of cavernous, transverse, sigmoid sinus and internal jugular vein, associated with bacterial meningitis, in a previously healthy patient. In spite of the extensive thrombosis, the patient presented a good evolution, after an aggressive clinical treatment with antibiotics, corticosteroids and anticoagulants. However, there remained paresis of the VI nerve on the left and partial lesion of the homolateral optic nerve.

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Safety of a training program for ultrasound-guided internal jugular vein catheterization in critically ill patients/ Segurança de um programa de treinamento para punção de veia jugular interna guiada por ultrassom em pacientes críticos  

Abstract in portuguese OBJETIVO: Avaliar a segurança e efetividade de um programa de treinamento para cateterização da veia jugular interna guiada por ultrassom em pacientes críticos. MÉTODOS: Estudo de coorte prospectivo, avaliando pacientes adultos internados em uma unidade de terapia intensiva com programa de ensino. Os médicos residentes do serviço realizaram as punções de veia jugular interna guiadas por ultrassom. Foram avaliadas as características de base dos pacientes, sintopi (more) a dos vasos e experiência dos operadores. Os desfechos primários foram a taxa de sucesso da cateterização e a incidência de complicações graves. RESULTADOS: No período entre maio de 2008 e novembro de 2009 foram avaliados 118 pacientes. A taxa de sucesso da punção guiada por ultrassom foi 90% (106/118), 77% dessas na primeira tentativa. Complicações graves ocorreram em 4% dos casos (n = 5) e não foram associadas às variáveis analisadas. Incapacidade de progredir o fio-guia foi a razão de 58% (7/12) das falhas. Operadores com mais de 15 punções guiadas por ultrassom obtiveram uma maior taxa de sucesso (95% vs. 79%, p = 0,01) e pacientes com cateterização prévia apresentaram um maior número de falhas (26% vs. 7%, p = 0,02). CONCLUSÃO: O aprendizado da técnica de punção de veia jugular interna guiada por ultrasssom é seguro e efetivo em pacientes críticos. Este processo não esteve associado a um aumento da taxa de complicações e melhores resultados são obtidos à medida que aumenta a experiência do operador Abstract in english OBJECTIVES: Evaluate the safety and effectiveness of a training program for performing ultrasound-guided internal jugular vein cannulation in critically ill patients. METHODS: Cohort prospective study, evaluating adult patients admitted in a teaching intensive care unit (ICU). Catheter placement was performed by an ICU medical resident. The patient's baseline characteristics, vessel's position and operator experience were the evaluated variables. The main outcomes were ca (more) nnulation success rate and incidence of major complications. RESULTS: A total of 118 consecutive patients were enrolled between May 2008 and November 2009. The success rate of ultrasound guided catheter placement was 90% (106/118), 77% in the first attempt. Major complications occurred in 4% of the cases (n = 5) and were not associated with the analyzed variables. Inability to place the guide wire was the reason for 58% (7/12) of the failures. Operators with more than 15 previous ultrasound guided cannulations had an increased success rate (95% vs. 79%, p = 0.01) and increased failure was related to previous catheterization (26% vs. 7%, p = 0.02). CONCLUSION: Learning ultrasound guidance for IJV vein cannulation was safe and feasible in ICU patients. This process was not associated to complications and better results were achieved across the spectrum of operator experience

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Síndrome de Lemierre: relato de caso/ Lemierre syndrome: case report  

Abstract in portuguese A síndrome de Lemierre é uma doença rara, mais comum em jovens, causada frequentemente pelo Fusobacterium necrophorum. Inicia-se com faringite e propaga-se até a veia jugular interna, promovendo uma fonte de bacteremia contínua e êmbolos sépticos pulmonares. Manifestações clínicas incluem febre, alterações respiratórias e massa cervical. O diagnóstico é realizado por tomografia computadorizada e duplex scan, além de hemocultura ou cultura direta. O tratame (more) nto é realizado com antibióticos beta-lactâmicos resistentes a beta-lactamases, sendo a cirurgia raramente necessária. Paciente do sexo feminino, 34 anos, com quadro de orofaringite, evoluiu em 48 horas com queda do estado geral, febre, aumento de volume e dor em região cervical esquerda. Radiografia e tomografia de tórax evidenciaram múltiplas lesões pulmonares. A tomografia cervical e o duplex scan confirmaram a trombose da veia jugular interna, compatível com tromboflebite supurativa aguda, a síndrome de Lemierre. Após antibioticoterapia, o paciente apresentou melhora do quadro clínico. O duplex scan de controle evidenciou recanalização venosa. Abstract in english Lemierre syndrome is a rare disease. It often affects young adults and is most frequently caused by Fusobacterium necrophorum. The initial event is pharyngitis, which extends to the internal jugular vein, serving as source of continuous bacteremia and septic pulmonary emboli. Clinical manifestations include fever, respiratory distress, and swollen cervical lymph nodes. Diagnosis is established based on blood culture or direct blood culture and confirmed by computed tomogr (more) aphy and/or duplex scan. Treatment consists of administration of beta-lactamase resistant beta-lactam antibiotics. Surgical exploration is rarely required. A 34-year-old woman with acute oropharyngeal infection presented 48 hours later with prostration, fever, and swollen and painful cervical lymph nodes on the left side of the neck. Chest radiography and tomography demonstrated multiple lung lesions. Computed tomography and duplex scan demonstrated thrombosis of the internal jugular vein, compatible with acute suppurative thrombophlebitis, also known as Lemierre syndrome. The patient received antibiotics and had clinical recovery. A control duplex scan demonstrated partial recanalization of the internal jugular vein.

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Internal thoracic vein draining into the extrapericardial part of the superior vena cava: a case report  

Abstract in portuguese As veias torácicas internas são veias comitantes de cada artéria torácica interna drenando o território suprido por ela e geralmente se unem em frente à terceira cartilagem costal. Esta única veia entra na veia braquicefálica correspondente. Apresentamos uma variação da veia mamária interna direita drenando para a veia cava superior em um cadáver masculino de 45 anos. O provável desenvolvimento e a significância clínica da veia são discutidos. Abstract in english The internal thoracic veins are venae comitantes of each internal thoracic artery draining the territory supplied by it and usually unite opposite the third costal cartilage. This single vein enters the corresponding brachiocephalic vein. We present a variation of right internal mammary vein draining into superior vena cava in a 45-year-old male cadaver. Likely development and clinical significance of the vein are discussed.

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Morfologia dos vasos da base do encéfalo do quati (Nasua nasua)/ Morphology of the main vessels of the coati brain (Nasua nasua)  

Abstract in portuguese Estudou-se a morfologia do encéfalo de Nasua nasua - quati, buscando comparar estes achados com outras espécies já descritos. Foram utilizados cinco encéfalos de quatis, provenientes do Criatório Científico (Cecrimpas), Unifeob. Os animais foram eutanásiados de acordo com a legislação (Cobea). Canulou-se a artéria carótida comum e a veia jugular externa sentido cranial, injetou-se solução de látex/bário corado de vermelho na artéria carótida, e solução (more) de látex corado de azul na veia jugular. Em seguida os animais fixados em solução de formaldeído a 10%. O encéfalo tem sua nutrição dependente de quatro artérias, as artérias carótidas internas e as artérias vertebrais direitas e esquerdas. Esses vasos compuseram o circuito basilar e carotídeo que se anastomosam através das artérias cerebrais caudais. Correm na base do encéfalo sob a meninge pia mater. Abstract in english The morphology of the brain of coati, Nasua nasua, was studied, to compare the findings with other species described. The brains of five coatis were used, proceeding from the Scientific Breeding School (Cecrimpas), Unifeob. The animals were sacrificed in accordance with the legislation (Cobea). With a needle, the common carotid artery and the external jugular vein was cannulated to cranial direction, injected latex solution stained with colored red barium respectively. Af (more) terwards the animals were fixed in 10% formaldehyde solution. Brain has its dependent nutrition of four arteries, the internal carotid arteries and the right and left vertebral arteries. These vessels had composed the basal and carotid circuits that anastomose through the cerebral arteries volumes. They run in the base of the brain under piamater meninges.

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Quilopericárdio isolado após cirurgia cardíaca/ Isolated chylopericardium after cardiac surgery  

Abstract in portuguese Quilopericárdio como complicação de cirurgia cardíaca é raro. Pode ser causado por lesão no ducto torácico, de tributárias do ducto ou pela trombose da confluência das veias jugular e subclávia esquerda, obstruindo a drenagem do ducto torácico. O tratamento pode ser conservador ou cirúrgico, dependendo da duração e do volume drenado. Apresentamos o caso de uma mulher de 24 anos que no pós-operatório tardio de troca da valva mitral (bioprótese) foi interna (more) da com quadro de tamponamento cardíaco devido à presença de quilopericárdio. São comentados os aspectos clínicos e o tratamento instituído. Abstract in english Chylopericardium is a rare complication of cardiac surgery. It may be caused by a lesion in the thoracic duct or its tributaries or by thrombosis in the confluence of the jugular and left subclavian veins, obstructing the drainage of the thoracic duct. The treatment may be conservative or surgical, depending on the duration and on the volume of the effusion. We report the case of a 24-year-old female, who, in the late postoperative period of mitral valve replacement (biop (more) rosthesis), was hospitalized with cardiac tamponade due to the presence of chylopericardium. The clinical findings and treatment performed are discussed.

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Uso do ultra-som para punção venosa central em paciente obeso com adenomegalia cervical/ Ultrasound-guided central venous puncture in an obese patient with cervical adenomegaly/ Uso del ultrasonido para punción venosa central en paciente obeso con adenomegalia cervical  

Abstract in portuguese JUSTIFICATICA E OBJETIVOS: As técnicas clássicas para punção venosa central são realizadas com base em referências anatômicas de superfície e conhecimento da anatomia vascular da região em que se realizará a punção. O uso do ultra-som permite a realização da punção sob visão direta das estruturas vasculares, peri-vasculares e da agulha de punção. O objetivo deste relato foi descrever o uso do ultra-som no auxílio de acesso venoso central em paciente ob (more) eso e com adenomegalias. RELATO DO CASO: Paciente do sexo masculino, branco, 28 anos, 1,70 m, 120 kg, com diagnóstico de linfoma de Hodgkin esclerose nodular. Solicitado ao Serviço de Anestesiologia do Hospital Governador Celso Ramos, punção de veia jugular interna direita guiada por ultra-som devido à presença de gânglio supraclavicular que prejudicava a referência anatômica de punção e à obesidade do paciente. Após a obtenção da melhor imagem a veia jugular interna esquerda foi puncionada e colocado um cateter venoso de triplo lúmen. A punção foi única, com progressão fácil do cateter e realizada sem complicações. CONCLUSÕES: O uso da ultra-sonografia para punção venosa central pode evitar complicações tornando o procedimento mais seguro para o paciente. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Las técnicas clásicas para la punción venosa central se realizan con base en referencias anatómicas de superficie y con conocimiento de la anatomía vascular de la región en que se realizará la punción. El uso del Ultrasonido permite la realización de la punción bajo la visión directa de las estructuras vasculares, peri-vasculares y de la aguja de punción. El objetivo de este relato fue el de describir el uso del Ultrasonido en el aux (more) ilio de acceso venoso central en paciente obeso y con adenomegalias. RELATO DEL CASO: Paciente del sexo masculino, blanco, de 28 años, 1,70 m, 120 kg, con diagnóstico de linfoma de Hodgkin esclerosis nodular. Solicitado al Servicio de Anestesiología del Hospital Governador Celso Ramos, punción de vena yugular interna derecha guiada por Ultrasonido debido a la presencia de ganglio supraclavicular que le perjudicaba la referencia anatómica de punción y obesidad del paciente. Después de la obtención de la mejor imagen, la vena yugular interna izquierda se puncionó y se le puso un catéter venoso de triple lumen. La punción fue única, con progresión fácil del catéter y realizado sin complicaciones. CONCLUSIONES: El uso del ultrasonido para la punción venosa central puede evitar complicaciones haciendo el procedimiento más seguro para el paciente. Abstract in english BACKGROUND AND OBJECTIVES: Classical central venous techniques are based on superficial anatomical references and the knowledge of the vascular anatomy of the area to be punctured. The ultrasound allows direct vision of vascular and perivascular structures, and the needle during the procedure. The objective of this report was to describe an ultrasound-guided central venous catheter placement in an obese patient with adenomegaly. CASE REPORT: This is a 28 years old white m (more) ale patient, with 1.70 m, weighing 120 kg, with the diagnosis of nodular sclerosis Hodgkin's lymphoma. An ultrasound-guided internal jugular vein catheter placement was requested to the Anesthesiology Department of the Hospital Governador Celso Ramos due to the presence of a supraclavicular node that would hinder the anatomical reference for the puncture in an obese patient. After obtaining the best image, the left internal jugular vein was punctured and a triple lumen catheter was introduced. It was necessary only a single puncture and the catheter was easily introduced; no complications developed during the procedure. CONCLUSIONS: Ultrasound-guided central venous puncture can prevent complications, increasing the safety of the procedure.

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Carotid reconstruction in patients operated for malignant head and neck neoplasia  

Abstract in portuguese CONTEXTO: Os pacientes portadores de neoplasia maligna de cabeça e pescoço podem apresentar acometimento simultâneo de grandes vasos devido ao crescimento da massa tumoral. As opções terapêuticas são a quimioterapia, radioterapia, cirurgia ou tratamento combinado. Quando o tratamento cirúrgico é indicado e a veia jugular interna é acometida, normalmente é ressecada sem reconstrução, pois geralmente não há repercussões clínicas importantes. Porém, quando (more) a artéria carótida interna e/ou comum são acometidas, a ressecção sem revascularização normalmente leva a índices de complicações neurológicas elevadas, motivo pelo qual deve ser realizado enxerto arterial. OBJETIVO: Analisar o resultado do tratamento cirúrgico com reconstrução carotídea dos pacientes portadores de neoplasia maligna avançada de cabeça e pescoço. TIPO DE ESTUDO: Prospectivo. LOCAL: Hospital do Câncer A.C. Camargo, São Paulo, SP, Brasil. PARTICIPANTES: 11 pacientes operados por neoplasia maligna avançada de cabeça e pescoço acometendo artéria carótida interna e/ou comum. PRINCIPAIS VARIÁVEIS: Por meio de exame clínico, seguimento ambulatorial e mapeamento dúplex, analisamos a perviedade dos enxertos carotídeos, as complicações vasculares e não-vasculares, recorrência da doença e sobrevida dos pacientes. RESULTADOS: Seis pacientes (54,5%) não apresentaram nenhum tipo de complicação. Houve uma complicação vascular representada por oclusão do enxerto carotídeo com acidente vascular cerebral hemisférico. As complicações não-vasculares ocorreram em cinco pacientes (45,5%). Durante o seguimento, oito pacientes faleceram (72,7%), sendo sete com recidiva tumoral loco-regional e um com metástases pulmonares e hepáticas (média de nove meses após a operação). Sete desses pacientes apresentavam enxerto funcionante. Os três pacientes vivos encontram-se sem recidiva tumoral e com enxertos funcionantes (média de nove meses). CONCLUSÕES: Os pacientes com neoplasia maligna avançada de cabeça e pescoço acometendo artéria carótida tratados cirurgicamente apresentam prognóstico reservado. Quando a artéria carótida interna e/ou comum é ressecada em bloco com o tumor, a reconstrução arterial deve ser realizada, sendo a veia safena magna um substituto vascular adequado. Abstract in english CONTEXT: Patients with malignant head and neck neoplasia may present simultaneous involvement of large vessels due to the growth of the tumoral mass. The therapeutic options are chemotherapy, radiotherapy, surgery or combined treatments. OBJECTIVE: To analyze the result of surgical treatment with carotid reconstruction in patients with advanced malignant head and neck neoplasia. DESIGN: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. PARTICIPAN (more) TS: Eleven patients operated because of advanced malignant head and neck neoplasia that was involving the internal and/or common carotid artery. MAIN MEASUREMENTS: By means of clinical examination, outpatient follow-up and duplex scanning, we analyzed the patency of the carotid grafts, vascular and non-vascular complications, disease recurrence and survival of the patients. RESULTS: Six patients (54.5%) did not present any type of complication. There was one vascular complication represented by an occlusion of the carotid graft with a cerebrovascular stroke in one hemisphere. Non-vascular complications occurred in five patients (45.5%). During the follow-up, eight patients died (72.7%), of whom seven had loco-regional tumor recurrence and one had pulmonary and hepatic metastases (at an average of 9 months after the operation). Seven of these patients presented functioning grafts. The three patients still alive have no tumor recurrence and their grafts are functioning (an average of 9 months has passed since the operation). CONCLUSIONS: Patients with advanced malignant head and neck neoplasia involving the carotid artery that are treated surgically present a prognosis with reservations. When the internal and/or common carotid artery is resected en-bloc with the tumor, arterial reconstruction must be performed. The long saphenous vein is a suitable vascular substitute.

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Pacientes miológicos com defeitos extensos: opções de reconstrução. Relato de caso/ Cancer patients with large defects. Reconstructional options: a case study  

Abstract in portuguese Referimo-nos ao caso de um paciente masculino de setenta e cinco anos de idade, com um carcinoma espinocelular (SCC), que se originou na parte exterior da orelha direita há quatro anos. Sofreu uma remoção cirúrgica da parte lesionada combinada com dissecção modificada do pescoço e reconstrução com o uso de retalho peitoral maior. Além disso, teve radioterapia com 6000 rads na região temporal direita. Há dois meses o paciente mostrou urna recorrência expansiva (more) no que diz respeito ao músculo temporal e ao osso, o osso litóide, os músculos masseter e os músculos pterigóideos, a parte direita da mandíbula, a glândula da parótida com o nervo facial, e o bulbo superior da veia jugular interna. Sofreu uma remoção cirúrgica da lesão afetada até as extremidades saudáveis e reconstrução estética e funcional com a utilização combinada de uma prótese de metal fixa do côndilo e da mandíbula direita e o uso de músculo-cutâneo trapezious flap. Apresentamos o relato de um caso sobre as opções de reconstrução que nós temos em nossos dias para proporcionar qualidade de vida a doentes que sofrem de cancro. Abstract in english We report a case of a seventy-five years old male patient with a squamous cell carcinoma (SCC) originated from the right external ear four years ago. He was undergone surgical removal of the lesion with a combination of modified neck dissection and reconstruction with the use of pectoralis major flap. Furthermore, he had radiotherapy with 6000 rads of the right temporal region. Two months ago the patient showed an extended recurrence concerning the temporal muscle and bon (more) e, the lithoid bone, the maseter and the pterygoids muscles, the right part of the mandible, the parotid gland with the facial nerve, and the superior bulb of the internal jugular vein. He had a surgical removal of the lesion in extended healthy margins and functional and esthetic reconstruction of the defect with a combination of metal fixed prosthesis of the condyle and the right mandible and the use of myocutaneous trapezious flap. This is a case report of the reconstruction options we have nowadays to provide quality of life in cancer patients.

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Peculiaridades da terapia trombolítica na síndrome nefrótica pediátrica: monitorização do fator anti-Xa/ Particularities of thrombolytic therapy in pediatric nephrotic syndrome: anti-factor Xa monitoring  

Abstract in portuguese OBJETIVO: Descrever a importância do tromboembolismo pulmonar (TEP) na síndrome nefrótica pediátrica e o uso da heparina de baixo peso molecular como opção terapêutica segura e eficaz. DESCRIÇÃO DO CASO: Menino de 5,7 anos com síndrome nefrótica córtico-resistente e glomérulo-esclerose segmentar e focal foi internado devido à diarréia, distúrbios eletrolíticos e anasarca. No 11º dia de internação, evoluiu com desconforto respiratório súbito, cuja inv (more) estigação mostrou área de alta probabilidade de TEP na cintilografia pulmonar ventilação/perfusão e obstrução em veia jugular interna esquerda ao ultra-som doppler. Iniciado suporte ventilatório com nebulização de oxigênio e anticoagulação com enoxaparina (2mg/kg/dia). Após seis dias, evoluiu com sintomas neurológicos compatíveis com episódio isquêmico transitório, sem alteração na tomografia computadorizada de crânio. A monitorização do fator anti-Xa no soro demonstrou nível subterapêutico e a dose de enoxaparina foi ajustada para 3mg/kg/dia. O edema e os sintomas pulmonares melhoraram e o paciente recebeu alta hospitalar após 33 dias. COMENTÁRIOS: Embora o TEP seja raro em crianças, a síndrome nefrótica é uma condição pró-trombótica que favorece a complicação. A heparina de baixo peso molecular pode ser considerada no tratamento e na profilaxia secundária do TEP, sendo importante monitorizar o nível sérico do fator anti-Xa para ajustar sua dose e promover tratamento seguro e eficaz. Abstract in english OBJECTIVE: Report the importance of pulmonary thromboembolism (PTE) in pediatric nephrotic syndrome and the use of low molecular weight heparin (LMWH) as an effective and secure therapeutic option. CASE DESCRIPTION: A 5.7 year-old boy with steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis was admitted to the pediatric unit with diarrhea, electrolyte disturbances and anasarca. On the 11th day of hospital stay, he developed a sudden respiratory dis (more) comfort. Pulmonary ventilation/perfusion cintilography scan demonstrated high probability of PTE and the doppler ultrasonography showed obstruction of the left internal jugular vein. Oxygen support as well as enoxaparin, at a dose of 2mg/kg/day, were prescribed. Six days later, the patient developed transitory cerebrovascular symptoms without alterations in the cranial CT. The serum anti-Xa factor level was lower than the therapeutic range and enoxaparin was increased to 3mg/kg/day. The edema and the pulmonary symptoms improved and the boy was discharged at the 33rd day of stay. COMMENTS: Although PTE is rare in children, nephrotic syndrome is a prothrombotic condition amenable to this complication. LMWH can be considered for treatment and for secondary prophylaxis of PTE. Anti-factor Xa serum level monitoring is necessary to adjust LMWH dosage and to promote an effective and safe treatment.

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Enxertos vasculares homólogos e heterólogos conservados em glicerina na fleboplastia da jugular em eqüinos/ Arterial homograft and venous heterograft conserved in glycerin in the phleboplasty of the jugular in equines  

Abstract in portuguese Doze eqüinos foram divididos aleatoriamente em dois grupos de seis animais (grupos I e II), com a finalidade de estudar a compatibilidade tecidual e a propriedade de indução de trombos de dois tecidos biológicos conservados em glicerina a 98%. Esses tecidos foram usados na restauração da jugular externa e se constituíram de artéria carótida comum homóloga (ACCHo), no grupo I, e veia jugular externa heteróloga (VJEHe), no grupo II. Para a restauração, utilizar (more) am-se duas técnicas de anastomose da jugular, sendo, no grupo I, a técnica de bypass e, no grupo II, a substituição de um segmento da jugular esquerda por meio de anastomose vascular término-terminal. Para avaliar a trombogênese local e a histocompatibilidade, foram realizados exames clínicos, hematológicos, ecoDopplercardiográficos e histológicos dos segmentos vasculares enxertados. Os segmentos foram colhidos após 45 dias da avaliação pós-operatória, tendo a jugular direita como testemunha para os exames histológicos. Ambos os tecidos foram compatíveis quando implantados nos eqüinos, sem processo inflamatório acentuado, indicativo de rejeição. A técnica de bypass não foi eficiente na restauração da jugular, ocorrendo trombose obliterante dos enxertos de ACCHo. A substituição completa do segmento da jugular por VJEHe pode ser viável para o restabelecimento do fluxo sangüíneo da jugular de eqüinos, desde que se mantenha a igualdade dos diâmetros entre o enxerto e o vaso receptor. Abstract in english Twelve horses were randomly divided into two groups of six animals each (groups I and II) in order to study the compatibility and trombogenicity of two biological tissues conserved in glycerin at 98% which were used to restore the external jugular. The tissues consisted of arterial homograft - ACCHo (group I) and venous heterograft - VJEHe (group II). Two different techniques for jugular anastomosis were performed - bypass in group I and replacement of a segment of the le (more) ft jugular by means of end to end vascular anastomosis in group II. Clinical, hematological, Doppler ultrasonography, and histological examinations of the grafted vascular segments were conducted to evaluate local trombogenicity and tissue compatibility. All animals had the segments collected after 45 days, being the right jugular used as standard for the histopathological exams. Both tissues were compatible since no serious inflammatory process indicative of rejection took place. The bypass technique was not efficient for jugular restoration because of the occurrence of obliterant trombosys of the ACCHo. The full replacement of a jugular segment by the VJEHe can be feasible in reestablishing blood flow through the jugular of horses as long as the diameters of the grafted tissue and the original blood vessel are kept the same.

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Análise do comportamento do hemometabolismo cerebral durante endarterectomia carotídea com pinçamento transitório/ Analysis of brain hemometabolism behavior during carotid endarterectomy with temporary clamping/ Análisis del comportamiento del hemometabolismo cerebral durante endarterectomia carotídea con pinzamiento transitorio  

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A endarterectomia carotídea com pinçamento transitório altera a relação entre o fluxo sangüíneo cerebral e a demanda metabólica cerebral de oxigênio, com conseqüente geração de uma tendência a hipóxia oliguêmica ou desacoplamento hemometabólico. O objetivo do presente estudo foi identificar as alterações do hemometabolismo cerebral, avaliados através das alterações da saturação da oxihemoglobina no bulbo da veia jugular in (more) terna (SjO2), durante endarterectomia carotídea com pinçamento, correlacionando essas alterações com fatores com potencialidade de interferir com as mesmas, principalmente a pressão de CO2 expirada (P ET CO2) e a pressão de perfusão cerebral (PPC). MÉTODO: Participaram do estudo 16 pacientes com doença estenosante unilateral e submetidos a pinçamento arterial transitório durante endarterectomia carotídea. Os parâmetros monitorizados (saturação da oxihemoglobina no bulbo da veia jugular interna, stump pressure e a pressão de CO2 expirado) foram analisados nos seguintes momentos: M1 - pré-pinçamento; M2 - 3 minutos pós-pinçamento; M3 - pré- despinçamento; M4 - pós-despinçamento. RESULTADOS: A comparação entre a SjO2 (%, Média ± DP) nos períodos estudados evidenciou uma diferença entre a registrada nos momentos M1 (52,25 ± 7,87) e M2 (47,43 ± 9,19). Essa redução inicial estabilizou-se durante o pinçamento transitório, com diminuição na comparação entre M2 e M3 (46,56 ± 9,25), sem significado estatístico (p = ns). Na fase pós-despinçamento, M4 (47,68 ± 9,12), a média da SjO2 apresentou uma elevação, quando comparada com os momentos de pinçamento M2 e M3, ainda inferior ao momento pré-pinçamento M1 (M4 x M1 - p Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La endarterectomia carotídea con pinzamiento transitorio altera la relación entre el flujo sanguíneo cerebral y la demanda metabólica cerebral de oxígeno, con consecuente generación de una tendencia a hipóxia oliguemica o desacoplamiento hemometabólico. El objetivo del presente estudio fue identificar las alteraciones del hemometabolismo cerebral, evaluados por medio de las alteraciones de la saturación de la oxihemoglobina en el bulbo (more) de la vena yugular interna (SjO2), durante endarterectomia carotídea con pinzamiento, correlacionando esas alteraciones con factores con potencialidad de interferir con las mismas, principalmente la presión de CO2 expirada (P ET CO2) y la presión de perfusión cerebral (PPC). MÉTODO: Participaron del estudio 16 pacientes con enfermedad estenosante unilateral y sometidos al pinzamiento arterial transitorio durante endarterectomia carotídea. Los parámetros monitorizados (saturación de la oxihemoglobina en el bulbo de la vena yugular interna, stump pressure y la presión de CO2 expirado) fueron analizados en los siguientes momentos: M1 - pre-pinzamiento; M2 - 3 minutos pos-pinzamiento; M3 - pre-despinzamiento; M4 - pos-despinzamiento. RESULTADOS: La comparación entre la SjO2 (%, Media ± DP) en los períodos estudiados evidenció una diferencia entre la registrada en los momentos M1 (52,25 ± 7,87) y M2 (47,43 ± 9,19). Esa reducción inicial estabilizó durante el pinzamiento transitorio, con disminución en la comparación entre M2 y M3 (46,56 ± 9,25), sin significado estadístico (p = ns). En la fase pos despinzamiento, M4 (47,68 ± 9,12), la media de la SjO2 presentó una elevación, cuando comparada con los momentos de pinzamiento M2 e M3, más inferior al momento pre-pinzamiento M1 (M4 x M1 - p Abstract in english BACKGROUND AND OBJECTIVES: Carotid endarterectomy with temporary clamping changes cerebral blood flow and cerebral metabolic oxygen demand ratio with consequent oligemic hypoxia or hemometabolic uncoupling. This study aimed at identifying changes in brain hemometabolism, evaluated through changes in oxyhemoglobin saturation in internal jugular vein bulb (SvjO2) during carotid endarterectomy with clamping, and at correlating these changes with potentially interfering facto (more) rs, mainly end tidal CO2 pressure (P ET CO2) and cerebral perfusion pressure (CPP). METHODS: Sixteen patients with unilateral carotid stenotic disease scheduled to carotid endarterectomy with carotid arterial clamping were enrolled in this study. Parameters including internal jugular bulb oxyhemoglobin saturation, stump pressure and end tidal CO2 pressure were measured at the following moments: M1 - pre-clamping; M2 - 3 minutes after clamping; M3 - pre-unclamping; M4 - post-unclamping). RESULTS: The comparison among SvjO2 (%, mean ± SD) in all studied periods has shown differences between those recorded in moments M1 (52.25 ± 7.87) and M2 (47.43 ± 9.19). This initial decrease stabilized during temporary clamping, showing decrease in the comparison between M2 and M3 (46.56 ± 9.25), without statistical significance (p = ns). At post-unclamping, M4 (47.68 ± 9.12), SvjO2 was increased as compared to M2 and M3 clamping stages, however it was still lower than that of pre-clamping stage M1.(M4 x M1 - p

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Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study/ Variação anatômica de vasos obturatórios e seu risco prático: relato de caso de um estudo anatômico  

Abstract in portuguese A artéria obturatória é muitas vezes um ramo da divisão anterior da artéria ilíaca interna. Ela tem chamado atenção de cirurgiões pélvicos, anatomistas e radiologistas devido à alta freqüência de variações em seu trajeto e origem. A veia obturatória é geralmente descrita como uma tributária de veia ilíaca interna. Durante aulas de dissecação para estudantes de medicina, observamos a artéria obturatória surgindo a partir da artéria ilíaca externa, (more) veia obturatória drenando para a veia ilíaca externa, veia comunicante entre a veia obturatória e a veia ilíaca externa e artéria epigástrica inferior surgindo a partir da artéria obturatória. Os vasos obturatórios anômalos e a artéria epigástrica inferior no presente caso podem se encontrar em situação perigosa em cirurgias pélvicas que exigem dissecação ou suturas ao longo da borda pélvica. Discutem-se as causas de desenvolvimento e a significância clínica das variações. Abstract in english Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining (more) into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.

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Vestibulopatia por lesão endovascular em cateterismo de urgência/ Vestibular system paresis due to emergency endovascular catheterization  

Abstract in portuguese OBJETIVO: O objetivo deste relato de caso é descrever uma causa incomum de vestibulopatia periférica associada à perda auditiva unilateral em paciente idoso pós- cateterismo de urgência. RELATO DE CASO: Paciente do gênero masculino, 82 anos, submetido à correção de aneurisma roto de aorta abdominal, no intra-operatório sofreu infarto agudo do miocárdio necessitando de angioplastia primária. Após alta hospitalar refere queixa de hipoacusia acentuada à direita (more) e vertigem incapacitante, sem sinais neurológicos focais. Ao exame clínico otorrinolaringológico apresentava: Teste de Weber lateralizado para a esquerda, nistagmo espontâneo para a esquerda , marcha oscilante, leve disbasia e ataxia, índexnariz e diadococinesia normais, Teste de Romberg com oscilação sem queda e Fukuda com desvio lateral para a direita. O exame audiométrico evidenciava anacusia à direita e perda neurossensorial à esquerda em agudos, arreflexia vestibular à direita na prova calórica e, na tomografia computadorizada dos ossos temporais e tronco-encefálico, presença de haste metálica atravessando o osso temporal direito, a partir da veia jugular interna e bulbo jugular, atravessando os canais semicirculares posterior, superior e vestíbulo, projetando-se em lobo temporal. O diagnóstico radiológico foi lesão traumática por guia endovascular metálico durante cateterismo de urgência e a conduta, considerando que o paciente não havia compensado o equilíbrio, foi reabilitação vestibular. CONCLUSÃO: Queixas de tontura no paciente idoso devem ser criteriosamente avaliadas diante do seu histórico clínico patológico pois os antecedentes de doenças e tratamentos prévios, em geral, direcionam as hipóteses diagnósticas porém podem trazer alterações inesperadas. Abstract in english OBJECTIVE: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. STORY OF CASE: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of acce (more) nted hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. CONCLUSION: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

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TIPS - anastomose portossistêmica intra-hepática transjugular. Revisão/ TIPS - transjugular intrahepatic portosystemic shunt. A review  

Abstract in portuguese Diversas alternativas terapêuticas têm sido usadas, atualmente, na tentativa de reduzir a mortalidade de pacientes com hipertensão portal que desenvolvem varizes esofagianas. Abordagem de uma dessas alternativas que ainda é de exceção e pouco utilizada em nosso meio - o "shunt" (desvio) portossistêmico intra-hepático transjugular - TIPS ("transjugular intrahepatic portasystemic shunt"). O TIPS possibilita redução significativa do gradiente de pressão portohepá (more) tico, uma vez que funciona como um "shunt" portocava látero-lateral, promovendo, dessa forma, descompressão eficiente do sistema portal, reduzindo significativamente o risco de sangramentos. A técnica consiste na inserção percutânea, através da veia jugular interna, de malha metálica através do parênquima hepático, sob controle angiográfico, criando verdadeira comunicação portocava. Bons resultados na utilização do TIPS têm sido atestados em diversos estudos, muito embora bem poucos deles tenham sido controlados e randomizados de modo a concluir que esse procedimento é seguro, eficaz e com boa relação custo-benefício. Dessa forma, buscou-se, nesta revisão, uma análise do estado atual da utilização do TIPS, sua técnica, principais indicações e complicações. O TIPS vem sendo utilizado nos casos de hemorragia digestiva refratária ao tratamento farmacológico e/ou endoscópico, principalmente em pacientes Child-Pugh B e C ou ainda como opção de controle do quadro, servindo como "ponte" para um futuro transplante hepático. Pode-se considerar ainda o tratamento da ascite refratária, da síndrome hepatorrenal e do hidrotórax hepático como promissoras indicações definitivas para a colocação do TIPS. As complicações dessa técnica estão relacionadas, sobretudo, a sua colocação, às conseqüências hemodinâmicas imediatas, como a encefalopatia hepática, e às complicações tardias envolvendo principalmente a oclusão do "stent" (prótese auto-expansiva). Abstract in english At the present time several therapeutic options are used for the treatment of bleeding esophageal varices in patients with portal hypertension. We will review the main medical publications on transjugular intrahepatic portosystemic shunt (TIPS), a procedure seldom used among us. TIPS works as a portocaval side-to-side shunt and decreases the risk of esophageal bleeding through lowering of the portal system pressure and a decrease of the portal hepatic pressure gradient. T (more) IPS consists in the percutaneous insertion, through the internal jugular vein, of a metallic stent under fluoroscopic control in the hepatic parenchyma creating a true porta caval communication. There are several studies demonstrating the efficacy of TIPS, although only a few of them are randomized and control-matched to allow us to conclude that this procedure is safe, efficient and with a good cost benefit ratio. In this review, we search for the analysis of the TIPS utilization, its techniques, its major indications and complications. TIPS has been used in cases of gastroesophageal bleeding that has failed with pharmacologic or endoscopic treatment in patients Child-Pugh B and C. It can be used also as a bridge for liver transplantation. Others indications for TIPS are uncontrolled ascites, hepatic renal syndrome, and hepatic hydrotorax. The main early complications of TIPS using are related to the insertion site and hepatic encephalopathy and the stent occlusion is the chief late complication.

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Systematization, description and territory of the caudal cerebral artery of the brain in broad-snouted Caiman (Caiman latirostris)/ Sistematização, descrição e território da artéria cerebral caudal no cérebro do jacaré do papo-amarelo (Caiman latirostris)  

Abstract in portuguese Foram utilizadas trinta cabeças com o segmento de pescoço de Caiman latirostris. Os animais eram provenientes do Criatório Mister Caiman sob a autorização do Instituto Brasileiro de Meio Ambiente e dos Recursos Naturais Renováveis (Ibama). Os animais foram sacrificados de acordo com as normas de rotina de abate do frigorífico e as cabeças foram seccionadas na altura da terceira vértebra cervical. O sistema arterial foi lavado com solução salina 0.9% resfriada, (more) com drenagem pelas veias jugulares. Em seguida, o sistema foi preenchido com injeção de látex, corado em vermelho As peças foram então fixadas em formaldeído a 20.0% por sete dias. O cérebro foi removido, com um segmento de medula espinhal, a dura-máter retirada e as artérias dissecadas. Na altura da hipófise, a artéria carótida interna emitiu um ramo rostral e, um curto ramo caudal, continuando-se naturalmente, como artéria cerebral caudal. Esta se projetou látero-dorsalmente e ao sobrepassar o trato óptico, emitiu seu I (primeiro) ramo central. Penetrou na fissura transversa do cérebro, lançando a artéria diencefálica e a seguir seu II (segundo) ramo central. Ainda dentro da fissura originou ramos hemisféricos occipitais, e um ramo pineal. Emergiu da fissura transversa do cérebro, no pólo occipital do hemisfério cerebral. Projetou-se rostralmente, sagital a fissura longitudinal do cérebro, como artéria interhemisférica. Esta artéria lançou ramos hemisféricos convexos e mediais para as respectivas faces dos hemisférios cerebrais, anastomosou-se com sua homóloga contralateral, formando uma artéria etmoidal comum. Esta mergulhou na fissura entre os pedúnculos olfatórios emergindo ventralmente e, dividindo-se em artérias etmoidais, direita e esquerda, as quais progrediram para as cavidades nasais, vascularizando-as. O território da artéria cerebral caudal compreendeu a área mais caudal da base do hemisfério cerebral, sua face convexa, os pendúculos e bulbos olfatórios, plexo corióides e o diencéfalo com seus órgãos parietais. Abstract in english Thirty heads with the neck segment of Caiman latirostris were used. The animals were provided from a creation center called Mister Caiman, under the authorization of the Brazilian Institute of Environment and Renewable Natural Resources (Ibama). Animals were sacrificed according to the slaughtering routine of the abattoir, and the heads were sectioned at the level of the third cervical vertebra. The arterial system was washed with cold saline solution, with drainage throu (more) gh jugular veins. Subsequently, the system was filled with red colored latex injection. Pieces were than fixed in 20% formaldehyde, for seven days. The brains were removed, with a spinal cord segment, the duramater removed and the arteries dissected. At the level of the hypophysis, the internal carotid artery gave off a rostral branch, and a short caudal branch, continuing, naturally, as the caudal cerebral artery. This artery projected laterodorsalwards and, as it overpassed the optic tract, gave off its I (the first) central branch. Penetrated in the cerebral transverse fissure, emitting the diencephalic artery and next its II (second) central branch. Still inside the fissure, originated occipital hemispheric branches and a pineal branch. Emerged from the cerebral transverse fissure, over the occipital pole of the cerebral hemisphere. Projected rostralwards, sagital to the cerebral longitudinal fissure, as interhemispheric artery. This artery gave off medial and convex hemispheric branches to the respective surfaces of the cerebral hemispheres, anastomosed with its contralateral homologous, forming the common ethmoidal artery. This artery entered the fissure between the olfactory peduncles, emerging ventrally and dividing into ethmoidal arteries, right and left, which progressed towards the nasal cavities, vascularizing them. The territory of the caudal cerebral artery included the most caudal area of the base of the cerebral hemisphere, its convex surface, the olfactory peduncles and bulbs, the choroid plexuses and the diencephalus with its parietal organs.

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Mensuração de pressão venosa central por meio de cateteres venosos central e periférico: comparação entre os valores obtidos em cães e elaboração de índice de correção/ Measurement of central venous Pressure by mean of central and peripheric catheters: comparison among the obtained vallues in dogs and elaboration of a correction index  

Abstract in portuguese A Pressão Venosa Central (PVC) é a pressão de retorno do sangue ao lado direito do coração e é um importante parâmetro a ser aferido em numerosas situações clínicas, cirúrgicas e experimentais. Para sua realização, utiliza-se um Cateter Venoso Central (CVC) aplicado na veia jugular. Em virtude de este ser um aparato intravenoso de alto custo, optou-se por testar a validade de se aferir a PVC com um Cateter Venoso Periférico (CVP) aplicado à mesma veia, o qu (more) al apresenta custo reduzido. Como resultado, a medida da PVC, tomada com o CVC, deve sofrer um índice de redução, chegando-se, assim, ao valor da PVC que seria obtido com o uso do CVC. Os resultados deste estudo permitem concluir que o CVP é apropriado para a aferição da PVC em cães. Abstract in english The Central Venous Pressure (CVP) is a very important pattern for monitorization in many clinical, surgical and experimental procedures, and it reflects the blood pressure that returns to the right heart side. For its measurement a Central Venous Catheter (CVC) must be used inside the jugular vein. Because of the high cost of the CVC, an option was taken to measure the CVP with a Peripheric Venous Catheter (PVC) inside the jugular vein, with low cost. The CVP measure obta (more) ined with the PVC must be subtracted to a reduction index, in this way the measure would correspond to the ones done with the CVC. This study alouds to conclude that the PVC is adequate for CVP measurement in dogs.

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Aspectos microscópicos do funículo umbilical em eqüinos (Equus caballus -- Linnaeus, 1758)/ Microscopic features of the umbilical cord in equine (Equus caballus ¾ Linnaeus, 1758)  

Abstract in portuguese Estudaram-se a disposição e a ramificação das artérias e veias do funículo umbilical de eqüinos sem raça definida, em diferentes fases da prenhez. Utilizaram-se funículos umbilicais de 8 fetos com idade variando de 73 a 249 dias. Para o estudo histológico, foram usadas as técnicas de hematoxilina-eosina, Verhoeff, Gordon, pricrossírius e tricrômio de Masson. Tanto as artérias quanto as veias umbilicais apresentam na constituição de suas paredes uma túnica (more) interna que mostra um repregueamento característico, principalmente nas artérias, uma túnica média que contém uma musculatura bem desenvolvida e uma túnica adventícia. As fibras reticulares são características da parede dos vasos umbilicais, embora sejam mais evidentes na parede das veias umbilicais. Por outro lado, as fibras elásticas aparecem em menor quantidade na túnica média e adventícia. Finalmente, a disposição das fibras colágenas pode ser evidenciada pela técnica histológica de picrossírius, e elas são similares nas artérias e veias umbilicais. Abstract in english Microscopy of the umbilical cord vein and arteries from cross-bred equine in different pregnancy stages was studied. Umbilical cords from 8 fetuses were collected with age varying from 73 to 249 days. For histological study several staining techniques were used, such as hematoxilin-eosin, Verhoeff, Gordon, picrossirius and Masson's Tricrome. Both the arteries and the veins presented a tunic intern in the constitution of their walls that showed a characteristic plaiting ma (more) inly in the arteries, a tunic media that contained a well developed musculature, and a tunic adventitia. Reticular fibers were common characteristics in the wall of the umbilical vessels, even so more numerous in the walls of the umbilical veins. On the other hand, the elastic fibers appeared in small amount mainly in the tunic media and adventitia. Finally, the disposition of the collagen fibers could be evidenced by the picrossirius staining technique, and they were very similar in both the vein and the umbilical arteries.

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Estudo da regeneração de nervos tibiais de ratos Wistar em sutura primária com "gap" e sem "gap", cobertos por segmentos de veia/ Study of tibial nerve regenration in Wistar rats in primary neurorrhaphy with and without gap, wrapped in vein segments  

Abstract in portuguese OBJETIVO: O presente estudo comparou, em ratos da raça Wistar, a regeneração nervosa nas suturas epineurais com espaçamento de 1,0mm (com "gap") e sem espaçamento (sem "gap"), ambos cobertos com tubo de veia jugular externa, através da contagem de motoneurônios no nível da medula espinhal entre L3 e S1, marcados por meio de exposição do nervo tibial ao Fluoro - Goldâ (FG). MÉTODO: Os nervos tibias de ambos os lados foram seccionados e foram realizadas suturas (more) epineurais com "gap" e, no lado contralateral, sem "gap" sendo que as suturas foram cobertas com tubo de veia. Após quatro meses do procedimento cirúrgico, os nervos tibias foram expostos ao FG, perfundidos e realizada a contagem dos motoneurônios na medula espinhal. RESULTADOS: Para a análise estatística foi utilizado o teste de Wilcoxon pareado, onde obtivemos um resultado estatisticamente significante entre o número de motoneurônios do grupo com "gap" em relação ao sem "gap" (p= 0,013). CONCLUSÃO: Obtivemos melhores resultados na contagem de motoneurônios daqueles nervos onde haviam sido realizadas as suturas primárias sem "gap", quando comparados com as suturas com "gap". Nível de Evidência: Estudo Experimental. Abstract in english OBJECTIVE: This study compared nerve regeneration in Wistar rats, using epineural neurorrhaphy with a gap of 1.0 mm and without a gap, both wrapped with jugular vein tubes. Motor neurons in the spinal cord between L3 and S1 were used for the count, marked by exposure of the tibial nerve to Fluoro-Gold (FG). METHOD: The tibial nerves on both sides were cut and sutured, with a gap on one side and no gap in the other. The sutures were wrapped with a jugular vein. Four months (more) after surgery the tibial nerves were exposed to Fluoro-Gold and the motor neuron count performed in the spinal cord. RESULTS: The results were statistically analyzed by the paired Wilcoxon test. There was a statistical difference between the groups with and without gap in relation to the motor neuron count (p=0.013). CONCLUSION: The epineural neurorraphy without gap wrapped with jugular vein showed better results for nerve regeneration than the same procedure with gap. Level of Evidence: Experimental Study.

 
 
 
 
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Acesso vascular para hemodiálise com cateter temporário de duplo lúmen em cães com insuficiência renal aguda/ Hemodialysis vascular access with temporary double-lumen catheter in dogs with acute renal failure  

Abstract in portuguese A hemodiálise é uma modalidade terapêutica que pode sustentar a vida do paciente com insuficiência renal aguda (IRA), enquanto este recupera a função renal. Para sua realização, é necessário estabelecer circulação extracorpórea, para que seja realizada a filtração do sangue, impondo a necessidade de um acesso vascular viável e eficiente. O objetivo deste estudo foi avaliar a eficiência e as complicações do acesso vascular para hemodiálise (HD), com cat (more) eter temporário de duplo lúmen inserido na veia jugular externa. Foram estudados 10 cães com IRA induzida por gentamicina, submetidos a sessões diárias de HD, com duração de uma hora, até a recuperação da função renal ou óbito. Foram realizadas 104 sessões de HD nos animais estudados, observando-se necessidade de troca do cateter em sete sessões (6,7%), devido à obstrução do lúmen do cateter em seis sessões (5,8%) ou por saída acidental do mesmo em uma sessão (1,0%). Não se observou migração do cateter, infecção, hemorragia ou hematoma no local de entrada do cateter na pele, obtendo-se fluxo sanguíneo patente em 90,4% das sessões. Concluiu-se que o acesso vascular na veia jugular externa com cateter temporário de duplo-lúmen mostrou-se viável, com ocorrência de poucas complicações, sendo, portanto, indicado como forma de acesso para a circulação extracorpórea para HD em cães com IRA. Abstract in english Hemodialysis is a therapeutic procedure that can sustain the patient's life in acute renal failure (ARF), during the renal function recover. To perform hemodialysis (HD), an extracorporeal circulation is established to blood filtration, imposing the need of a viable and efficient vascular access. The aim of this study was to evaluate the effectiveness and complications of the HD vascular access with temporary double-lumen catheter inserted into the external jugular vein. (more) Ten mongrel dogs with ARF, induced by gentamicin administration, were submitted to daily hemodialysis for one hour, until renal function recover or death. A total of 104 HD sessions were performed. Catheter replacement was accomplished in seven sessions (6.7%), due to catheter lumen mechanical obstruction in six sessions (5.8%) or accidental catheter output in one session (1.0%). No catheter migration, infection, bleeding or haematoma around the catheter insertion site was found. Effective blood flow rates were observed in 90.4% HD sessions. In conclusion, the vascular access in jugular external vein with temporary double-lumen catheter was valuable, with few complications, and should be indicated to vascular access in extracorporeal circulation to HD in ARF dogs.

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Estudo comparativo entre enxerto autógeno e enxerto muscular coberto com tubo de veia autógeno em nervos tibiais de ratos wistar, utilizando o fluoro-gold® como marcador neuronal/ Comparative study between autogenous graft and muscular graft covered with autogenous vein tube in wistar rats' tibial nerves using the fluoro-gold® as a neuronal marker  

Abstract in portuguese Este trabalho teve como objetivo o estudo da regeneração nervosa através da contagem de neurônios comparando duas técnicas cirúrgicas no tratamento da perda de substância nervosa nos membros inferiores em 15 ratos. Inicialmente obteve-se tubo de veia de 12mm de comprimento retirado da jugular externa esquerda. A seguir, opera-se os dois membros inferiores, expondo o nervo tibial de cada lado e ressecando um segmento de 8 mm do nervo, simulando, ao mesmo tempo, a pe (more) rda de substância e a obtenção do enxerto nervoso autógeno. A reparação da perda de substância do lado esquerdo consistiu numa enxertia convencional simples para a reparação de lesão nervosa por meio de sutura microcirúrgica. A do membro inferior direito foi pela tubulização com 8 mm de enxerto de músculo quadríceps denaturado com nitrogênio líquido coberto com veia jugular. Após quatro meses, os animais foram submetidos à nova cirurgia para exposição dos nervos tibiais ao marcador neuronal Fluoro Gold®. Após 48 horas, foram perfundidos e o segmento medular entre L3 e S1 foi removido e posteriormente cortado em secções de 40 µm. Houve contagem neuronal de todos os cortes e não foram verificadas diferenças estatísticas entre as duas técnicas cirúrgicas. Abstract in english The purpose of this work was to study nervous regeneration through neurons counts by comparing two surgical techniques for addressing nervous gaps on 15 rats' lower limbs. Initially, a 12-mm long vein tube from the left outer jugular was obtained, and then both lower limbs are operated, exposing the tibial nerve at each side and performing a resection of an 8-mm nerve segment, at the same time simulating a gap and an autogenous nerve graft. Left gap repair consisted of a (more) usual conventional graft for nervous injury repair by means of microsurgical suture. The gap repair on right lower limbs was made through quadriceps muscle, treated with liquid nitrogen, covered with an 8-mm tube of jugular vein. After four months, the animals were submitted to a new surgery for exposing tibial nerves to the Fluoro-Gold® neuronal marker. After 48 hours, the rats were perfused and medullar segment between L3 and S1 was removed and subsequently cut into 40µm sections. Neurons on all sections were counted, and no statistical differences were found between both surgical techniques.

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Padronização de modelo experimental para estimulação elétrica artificial atrial em coelhos/ Standadization of an experimental model for artificial atrial pacing in rabbits  

Abstract in portuguese O presente estudo teve por objetivo padronizar modelo experimental de estimulação cardíaca artificial atrial em coelhos. Foram utilizados 20 coelhos raça Norfolk-2000 de ambos os sexos com peso mínimo de 2200g. Após anestesia endovenosa com pentobarbital(30mg/Kg), foi dissecada a veia jugular externa esquerda e introduzido eletrodo EthiconÒ especialmente preparado, até átrio direito via veia cava esquerda. Foram realizadas leituras dos (more) parâmetros elétricos(ondaP, resistência e limiar de comando) no ato cirúrgico e com 7, 14 e 21 dias denominados M1,M2, M3 e M4 respectivamente. Observamos diferença significativa em todos as variáveis analisadas entre M1 e demais momentos. Os resultados são compatíveis com o que se conhece de estimulação cardíaca artificial em outras espécies animais e no homem. O presente modelo mostrou ser viável para estudos de estimulação cardíaca artificial. Abstract in english The aim of the present study was to standardize an experimental model for artificial atrial heart pacing in rabbits. Twenty rabbits(Norfolk-2000, both sexes with minimum weigth of 2200g) were studied. After endovenous anesthesia with pentobarbital sodium(30mg/Kg) the external jugular vein was dissected and a pacemaker lead(Ethiconâ ) was introduced through left cava vein until the rigth atriun. The eletric parameters(P wave, resistance and thre (more) shold) were accomplished at surgical time and at 7, 14 and 21 post-operative day. These experimental moments were denominated M1, M2, M3 and M4 respectively. The statistical analisys showed significant difference between M1 and all others experimental moments. The results are compatible with the actual knowlodge of artificial heart pacing in others animal species and in human beings. The present model showed to be viable for artificial pacing studies.

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Fístula arteriovenosa postraumática: tratamiento endovascular. Revisión de la literatura y presentación de un caso clínico/ Endovascular treatment of a post-traumatic arterio-venous fistula: Presentation of a clinical case and literature review  

Abstract in spanish Las fístulas arteriovenosas en la cabeza y el cuello son entidades poco frecuentes. La mayoría es secundaria a heridas penetrantes por arma blanca. Se describe el tratamiento exitoso mediante cirugía endovascular de una fístula postraumática tras una herida penetrante entre la arteria maxilar interna izquierda y la vena yugular externa. A través de este caso clínico y la revisión de la literatura se ilustran las causas, manifestaciones, estudio radiológico y trat (more) amiento de una fístula postraumática entre la arteria maxilar interna y la vena yugular externa. A través de este caso clínico se demuestra la utilidad de los procedimientos endovasculares en el tratamiento de estas complicaciones. Abstract in english Traumatic arteriovenous fistulas of the head and neck region are uncommon. The majority are due to penetration of blunt injury. We describe a successful endovascular treatment of a posttraumatic fistula between the left maxillary artery and the external jugular vein due to a penetration injury. This case and a review of the literature illustrate the causes, manifestations, image studies and treatment for a posttraumatic fistula between the maxillary artery and the externa (more) l jugular vein. This case demonstrate the utility of endovascular treatment of head and neck injuries complications.

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Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions/ Reimplante de artéria coronaria direita: uma técnica cirúrgica para o tratamento da lesão ostial  

Abstract in portuguese O tratamento cirúrgico da obstrução de óstio da artéria coronária direita é realizado mediante a utilização de enxertos venosos ou arteriais, endarterectomia ou, ainda, por meio da reconstrução ostial com retalhos de pericárdio bovino, veia safena ou artéria torácica interna. Os autores propõem uma técnica cirúrgica que consiste no reimplante da artéria coronária na aorta. Esta técnica foi utilizada em quatro pacientes multiarteriais, porém com lesão única ostial na artéria coronária direita. Abstract in english Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

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Myocardial revascularization in patient with situs inversus totalis: case report/ Revascularização do miocárdio em paciente com situs inversus totalis: relato de caso  

Abstract in portuguese Este é um relato de caso infreqüente de uma paciente com dextrocardia associada a "situs inversus totalis" que apresentou dor precordial típica ao teste ergométrico. A cineangiocoronariografia revelou lesão coronariana crítica de tronco de artéria coronária esquerda. Foi levada à operação de revascularização do miocárdio. Não foram encontrados relatos de casos semelhantes na literatura médica nacional. A revascularização do miocárdio foi realizada com a (more) artéria mamária interna direita (torácica interna direita) para artéria descendente anterior e enxerto de veia safena para o primeiro ramo diagonal e primeiro ramo marginal. Abstract in english This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

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Pressão venosa central em bezerros neonatos hígidos/ Central venous pressure in healthy newborn calves  

Abstract in portuguese Com o propósito de estabelecer valores-padrão da pressão venosa central (PVC), utilizaram-se 24 bezerros sadios, da raça Holandesa, com idade entre oito e 30 dias, e peso entre 37 e 50kg. A PVC foi medida, no átrio direito, com uso de cateter intravenoso e equipo próprio usando-se como via de acesso a veia jugular esquerda. O átrio direito foi considerado o ponto zero de referência para as leituras, estando topograficamente em correspondência externa à articula? (more) ?ão escapuloumeral no animal em estação e à região do esterno, quando em decúbito lateral direito. Estabeleceram-se os valores médios da PVC, em centímetros de água, de 0,81±1,40 e 0,88±1,76, respectivamente, nos animais em estação e em decúbito lateral, e não houve diferença estatística entre os valores. A metodologia empregada para mensurar a PVC de bezerros revelou-se segura e exeqüível, não necessitando de aparelhagem sofisticada para a sua determinação. Abstract in english With the aim of determining the central venous pressure (CVP) standard values, twenty-four healthy Holstein calves, aging 8-to-30 days and weighing from 37 to 50kg, were studied. To measure CVP, a specific intravenous catheter was inserted in the right atrium through the left jugular vein. The right atrium was the reference mark (zero) for the measurements, topographically in external correspondence to the scapulohumeral joint, when the animal was standing; and to the ste (more) rnum region, when the animal was in right lateral recumbency. It was measured a mean CVP, in centimetres of H2O - 0.81±1.40 for animals in standing position, and 0.88±1.76 for animals in lateral recumbency - with no statistical difference between those values. The technique used for measuring CVP in calves was determined to be feasible and do not require sophisticated devices.

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Efeitos agudos da aplicação endovenosa do cogumelo-do-sol (Agaricus blazei Murill) sobre a pressão arterial média e a freqüência cardíaca de ratos anestesiados/ Acute effects of the endovenous application of the royal mushroom (Agaricus blazei Murill) on mean arterial pressure and heart rate of anesthetized rats  

Abstract in portuguese Este trabalho objetivou verificar os efeitos agudos da aplicação endovenosa do extrato aquoso do Agaricus blazei Murill sobre a pressão arterial média (PAM) e a freqüência cardíaca (FC) de ratos anestesiados. Foram usados Rattus novergicus albinus, n = 6, anestesiados com tiopental sódico, traqueostomizados e canulados através da veia jugular e da artéria carótida. Foram injetadas as concentrações de 1,25 mg/kg, 2,50 mg/kg e 5,00 mg/kg do extrato aquoso em vo (more) lume de 0,2 mL. A PAM foi registrada com um sistema Biopac, modelo MP100, e a FC com um eletrocardiógrafo ECG-4 Funbec. Os resultados foram obtidos no controle e nos tempos 15, 30, 45, 60 e 120s após a aplicação dos extratos. Os valores foram expressos em média ± EPM e analisados estatisticamente pelos testes "t" de Student-Newman-Keuls e Tukey (p Abstract in english The aim of this paper was to verify the acute effects of the endovenous application of the aqueous extract of Agaricus blazei Murill on mean arterial pressure and heart rate of the anesthetized rats. The injected concentrations were: 1.25 mg/kg, 2.50 mg/kg and 5.00 mg/kg, in volume of 0.2 mL. The rats were anesthetized with sodium thiopental and, after tracheotomy, both jugular vein and carotid artery were cannulated. The MAP was recorded with a Biopac System, model MP100 (more) . The HR was obtained with an electrocardiograph model ECG-4 (Funbec). The records were made in the control and 15, 30, 45, 60 and 120s after the application of the different concentrations of the extracts. The values were expressed by mean ± SEM and by paired "t"-Student-Newman-Keuls and Tukey tests (p

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Influência da ordem e estádios da lactação no perfil bioquímico sangüíneo de cabras da raça Saanen/ Influence of parity and stage of lactation on the blood biochemical profile of Saanen goats  

Abstract in portuguese O perfil bioquímico sérico de cabras da raça Saanen lactantes foi investigado com o objetivo de analisar as variações fisiológicas e a influência da ordem e estádio da lactação, em função de possíveis biomarcadores, para monitorar o balanço energético, adequação metabólica durante a lactação. Foram analisadas amostras de sangue de cabras lactantes de primeira, segunda e terceira lactação, colhidas da veia jugular em tubo vacutainer com gel separador (more) para obtenção de soro e determinação das concentrações de proteínas, metabólitos, minerais e enzimas. Observou-se influência da ordem de lactação nos valores das proteínas totais, glicose, triglicérides, cálcio total e ionizado, aspartato aminotransferase (AST), fosfatase alcalina e dos estádios da lactação nas concentrações séricas das proteínas totais, glicose, triglicérides, magnésio, AST e fosfatase alcalina. Conclui-se que glicose, triglicérides, cálcio total, cálcio ionizado, magnésio, AST e fosfatase alcalina são biomarcadores eficazes para detecção de desbalanço energético e mineral em cabras lactantes. Abstract in english The serum biochemical profile of Saanen dairy goat was investigated with the purpose of analyzing the physiological variations and the influence of lactation order and stage in terms of possible biomarkers to monitor the energetic balance and the metabolic adequacy during lactation. Blood samples were taken from lactating goats at first, second and third lactation. They were collected from the jugular vein in a vacutainer tube with separator gel to obtain sera and to dete (more) rmine protein, metabolite, mineral and enzyme concentrations. The lactation order influence was observed on total protein, glucose, triglycerides, total and ionized calcium, aspartate aminotransferase (AST) and alkaline phosphatase values and the lactation stages on serum concentrations of total proteins, glucose, triglycerides and magnesium, AST and alkaline phosphatase. It was inferred that glucose, triglycerides, total calcium, ionized calcium, magnesium, AST and alkaline phosphatase are effective biomarkers to detect the energetic and mineral imbalance in Saanen dairy goats.

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Arterialização seletiva da veia interventricular anterior: opção de revascularização miocárdica/ Selective arterialization of the anterior interventricular vein: a choice for myocardial revascularization  

Abstract in portuguese O objetivo deste trabalho é referir dois casos cirúrgicos, onde, após ressecção de aneurisma de ventrículo esquerdo, a revascularização do miocárdio através da artéria interventricular anterior (AIA) não foi possível. Utilizando-se a artéria torácica interna (ATI) esquerda, optou-se pela anatomose com a veia interventricular anterior (VIA) com ligadura próxima, para estabelecimento do fluxo retrógrado e evitar a formação de fístula artenovenosa. Não h (more) ouve mortalidade e os resultados a curto prazo são encorajadores. Testes de perfusão miocárdica com radioisótopos no pré e no pós-operatório, assim como angiografia do sistema coronário e da artéria torácica interna esquerda pré e pós-operatória são apresentados e discutidos. O objetivo da cirurgia de aneurisma ventricular é a recomposição geométrica do ventrículo esquerdo e revascularização de possíveis áreas isquémicas. Na impossibilidade de revascularização direta da artéria interventricular anterior, a técnica citada demonstra ser facilmente exeqüível e, a curto prazo, com bons resultados. Abstract in english The purpose of this study is to report two surgical cases, whereby after the repair of the left ventricular aneurysm, the myocardial revascularization of the interventricular anterior artery (IAA) was not possible. Using the left internal thoracic artery it was decided to perform anastomosis with the interventricular anterior (IAA) and its cephalad ligation, in order to obtain a retrograde flow and to avoid an arteriovenous fistula formation. There was no mortality and th (more) e results are optimistic in a short follow-up of these two patients. Myocardial perfusion tests and pre and post-operative angiography of the coronary system and the left internal thoracic artery are assessed and discussed. The geometrical reconstruction of the left ventricle and the revascularization of the ischemic areas play major role in the repair of postinfarction ventricular aneurysm. When it is not possible to access diretly the revascularization of the IAV this technique is safely and easily perfomed and shows satisfactory results in a short period of time.

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Morphological aspects of the spermatic cord of mice (Mus musculus)/ Aspectos morfológicos dos componentes do funículo espermático do camundongo (Mus musculus)  

Abstract in portuguese Estudando os aspectos morfológicos de 33 pares dos funículos espermáticos do camundongo (Mus musculus), adultos, observa-se histologicamente, em 3 pares, que os seus componentes acham-se envolvidos por delgada cápsula de mesotélio. Sob esta cápsula, contornando completamente o funículo, encontra-se densa camada de tecido adiposo. Seus componentes estão rodeados por tecido conjuntivo frouxo, predominando fibras colágenas entre reticulares e elásticas. A artéria (more) testicular mostra calibre variável rodeada pelas veias testiculares, possuindo: túnica interna constituída por endotélio e membrana elástica limitante interna; túnica média formada por espessa camada de musculatura lisa sustentada por uma rede de fibras reticulares; túnica externa constituída por tecido conjuntivo denso, que se encontra contínuo com o tecido conjuntivo intervascular e as adventícias das veias. As veias testiculares formam o plexo pampiniforme, que cerca parcialmente a artéria, apresentando lumens amplos e irregulares, delgadas paredes, constituídas quase que exclusivamente de endotélio, desprovidas de válvulas e apresentando íntima relação com a artéria testicular. O ducto deferente encontra-se na periferia do tecido adiposo subcapsular, que o envolve parcialmente, e está acompanhado de arteríolas, vênulas, linfáticos e nervos. O modelo do segmento da artéria testicular obtido com Neoprene látex "450", em 60 moldes, exibe trajeto sinuoso e como comprimentos médio, máximo e mínimo em cm, respectivamente, 1,35, 1,80 e 0,80 à direita e 1,32, 1,85 e 0,70 à esquerda; valores estes que não apresentam diferenças estatisticamente significantes, ao nível de 5%. Abstract in english A histological study of the morphological aspects of 33 spermatic cord pairs of adult mice (Mus musculus) showed that its their components were ensheated by a thin mesothelium capsule in 3 pairs. Under this capsule, completely surrounding the cord, there was a dense layer of adipose tissue. Its components were surrounded by loose connective tissue with a predominance of collagen fibers among reticular and elastic fibers. The testicular artery varied in diameter and was in (more) volved by the testicular veins, consisting of an inner layer formed by endothelium and an inner limiting elastic membrane, a middle layer formed by a thick smooth muscle layer supported by a network of reticular fibers, and an outer layer consisting of dense connective tissue close to the intervascular connective tissue and the adventitia layers of the veins. The testicular veins form the pampiniform plexus which partially surrounds the artery, presenting wide and irregular lumens, thin walls consisting almost exclusively of endothelium, with no valves and intimately related to the testicular artery. The vas deferens is located at the periphery of the subcapsular adipose tissue which partially surrounds it and is accompanied by arterioles, venules, lymphatic vessels and nerves. The cast of the segment of testicular artery obtained with Neoprene 450 latex in 60 molds exhibited a sinuous trajectory and the length (cm): was mean, maximum and minimum, 1.35. 1.80 and 0.80 on the right and 1.32. 1.85 and 0.70 on the left, respectively. These values showed no significance at 5%.

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Enxerto composto de artéria torácica interna esquerda e veia safena magna: estudo angiográfico após oito anos/ Left internal thoracic artery and saphenous vein as a composite graft: 8-year angiographic follow-up study  

Abstract in portuguese O uso de enxerto composto de artéria torácica interna esquerda (ATIE) com segmentos arteriais ou segmentos de veia safena magna (VSM) pode permitir a revascularização completa do sistema coronariano esquerdo (SCE) sem circulação extracorpórea (CEC) e sem manuseio da aorta ascendente (MAA), como forma de tentar reduzir alguns riscos e complicações no pós-operatório imediato. Neste trabalho, relatamos os resultados angiográficos, após oito anos, de dois pacient (more) es submetidos à cirurgia de revascularização do SCE com enxerto composto de ATIE e VSM, sem CEC e sem MAA. Abstract in english The use of a composite graft with left internal thoracic artery (LITA) and arterial or saphenous vein (SV) grafts can allow the complete revascularization of the left coronary system (LCS) without cardiopulmonary bypass (CPB) and without ascending aorta manipulation (AAM), in order to reduce some complications in the immediate postoperative. This study shows 8-year angiographic follow-up results of two patients underwent no-touch aorta off-pump coronary artery bypass grafting (CABG) using LITA and SV as a composite graft to supply LCS.

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Excess fluid volume: clinical validation in patients with decompensated heart failure/ Volume de líquidos excessivo: validação clínica em pacientes com insuficiência cardíaca descompensada/ Volumen de líquidos excesivo: validación clínica del diagnóstico en pacientes con insuficiencia cardíaca descompensada  

Abstract in portuguese Estudo transversal que teve como objetivo validar clinicamente as características definidoras do diagnóstico de enfermagem volume de líquidos excessivo, em pacientes com insuficiência cardíaca descompensada. Para a validação, utilizou-se o modelo de Fehring. Participaram 32 pacientes de um hospital universitário do Rio Grande do Sul. A média de idade foi de 60,5±14,3 anos. As características definidoras maiores com taxa de fidedignidade(R): R ?0,80 foram: (more) dispneia, ortopneia, edema, refluxo hepatojugular positivo, dispneia paroxística noturna, congestão pulmonar e pressão venosa central elevada; e menores, ou secundárias, R >0,50 a 0,79: ganho de peso, hepatomegalia, distenção da veia jugular, crepitações, oligúria, hematócrito e hemoglobina diminuídos. Demonstrou-se, neste estudo, que as características definidoras com R >0,50 e 1 foram validadas para o diagnóstico volume de líquidos excessivo na amostra em estudo. Abstract in spanish Estudio transversal que tuvo como objetivo validar clínicamente las características definidoras del Diagnóstico de Enfermería Volumen de Líquidos Excesivo en pacientes con insuficiencia cardíaca descompensada. Para la validación se utilizó el modelo de Fehring. Participaron 32 pacientes de un hospital universitario en Rio Grande del Sur. El promedio de edad fue de 60,5±14,3 años. Las características definidoras mayores que tuvieron tasa de fiabilidad (R): R  (more) 805; 0,80 fueron: disnea, orto-disnea, edema, reflujo hepatoyugular positivo, disnea paroxística nocturna, congestión pulmonar y presión venosa central elevada; y las menores o secundarias con R > 0,50 a 0,79, fueron: aumento de peso, hepatomegalia, distención de la vena yugular, crepitaciones, oliguria, hematocrito y hemoglobina disminuidos. Se demostró en este estudio que las características definidoras con R > 0,50 y 1 fueron validadas para el diagnóstico Volumen de Líquidos Excesivo en la muestra en estudio. Abstract in english This cross-sectional study aimed to clinically validate the defining characteristics of the Nursing Diagnosis Excess Fluid Volume in patients with decompensated heart failure. The validation model used follows the model of Fehring. The subjects were 32 patients at a university hospital in Rio Grande do Sul. The average age was 60.5 ± 14.3 years old. The defining characteristics with higher reliability index (R): R ? 0.80 were: dyspnea, orthopnea, edema, positive he (more) patojugular reflex, paroxysmal nocturnal dyspnea, pulmonary congestion and elevated central venous pressure, and minor or secondary, R> 0.50 to 0.79: weight gain, hepatomegaly, jugular vein distention, crackles, oliguria, decreased hematocrit and hemoglobin. This study indicates that the defining characteristics with R> 0.50 and 1 were validated for the diagnosis Excess Fluid Volume.

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Effect of N-acetylcysteine on lung injury induced by skeletal muscle ischemia-reperfusion: histopathological study in rat model/ Efeito de N-acetilcisteína em dano pulmonar induzido por isquemia-reperfusão de músculo esquelético: estudo histopatólogico em modelo de rato  

Abstract in portuguese OBJETIVO: Investigar se N-acetilcisteína, neutralizador de radicais livres, tem efeito protetor contra dano pulmonar como um órgão remoto após isquemia-reperfusão de músculo esquelético. MÉTODOS: Vinte ratos machos Wistar, foram aleatóriamente distribuídos em dois grupos: grupo isquemia-reperfusão (grupo I) e grupo isquemia-reperfusão +N-acetilcisteína (grupo II). Todos os animais foram submetidos a duas horas de ischemia pela oclusão artéria femoral e 24 h (more) oras de reperfusão. Antes de ocluir a artéria femoral, foi administrado 250 IU de heparina pela veia jugular para prevenir coagulação. A N-acetilcisteína foi administrada por via intravenosa, na uma dose de 150 mgkg-1, imediatamente antes de reperfusão. Após 24 horas de reperfusão, os animais foram eutanasiados e o pulmão esquerdo foi removido para análise histológica em microscopia óptica. RESULTADOS: No grupo I, os tecidos mostraram alterações histológicas com edema e hemorragia intra-alveolar e infiltração neutrofílica. Houve diferença histopatológica significante (P = 0.005) entre os dois grupos. CONCLUSÃO: O tratamento com a N-acetilcisteína diminuiu significantemente o dano pulmonar induzido por isquemia-reperfusão de músculo esquelético. Abstract in english PURPOSE: To investigate whether N-acetylcysteine, a free radicals scavenger has a protective effect against lung injury as a remote organ after skeletal muscle ischemia-reperfusion. METHODS: Twenty Wistar male rats were divided randomly into two experimental groups: group ischemia-reperfusion (group I) and group ischemia-reperfusion + N-acetylcysteine (group II). All animals were undergone two hours of ischemia by occlusion femoral artery and 24h of reperfusion. Before cl (more) amped the femoral artery, 250 IU heparin was administered via the jugular vein to prevent clotting. Rats that were treated with N-acetylcysteine given IV at a dose of 150 mgkg-¹, immediately before reperfusion. After 24h of reperfusion, animals were euthanized and left lung harvested for histopathological analysis under light microscopy. RESULTS: In the group I, tissues showed histological changes with intra-alveolar edema, intra-alveolar hemorrhage and neutrophilic infiltration. Histopathologically, there was a significant difference (P = 0.005) between two groups. CONCLUSION: Administration of N-acetylcysteine treatment significantly decreased lung injury induced by skeletal muscle ischemia reperfusion according to histological findings.

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Efeitos agudos dos extratos hidroalcoólicos do alho (Allium sativum L.) e do capim-limão (Cymbopogon citratus (DC) Stapf) sobre a pressão arterial média de ratos anestesiados/ Acute effects of Allium sativum L. and Cympobongon citratus (DC) Stapf hydroalcoholic extracts on arterial blood pressure of anesthetized rats  

Abstract in portuguese Este trabalho objetivou verificar os efeitos da aplicação aguda endovenosa dos extratos hidroalcoólicos de Allium sativum e de Cymbopogon citratus sobre a pressão arterial de ratos. Foram usados Rattus novergicus albinus, n=7, anestesiados, traqueostomizados e canulados através da veia jugular e da artéria carótida. Foram injetadas doses de 1 mg dos extratos separadamente e em associação (1mg + 1mg), em volumes de 0,2mL. A pressão arterial média (PAM) foi regis (more) trada com um sistema Biopac, modelo MP100. O Allium sativum diminuiu a PAM de 124±2 mmHg, no controle, para 108±2 mmHg aos 15s. Da mesma forma, o Cymbopogon citratus diminuiu a PAM de 122±2 mmHg, no controle, para 106± 2 mmHg aos 15s. A associação de ambos também diminuiu a PAM de 126±3 mmHg, no controle, para 113±3 mmHg aos 15s. Os efeitos das duas plantas foram iguais e não foram incrementados quando associadas. Abstract in english This work aimed to verify the effects of acute intravenous applications of Allium sativum and Cymbopogon citratus hydroalcoholic extracts on arterial blood pressure of anesthetized rats. Adult male rats (Rattus novergicus albinus), n=7, were used. The rats were anesthetized, tracheotomy and cannulation of both jugular and carotid were carried out. The injected doses were 1 mg separately as well as the association of both extracts, in volumes of 0,2 mL. The mean arterial b (more) lood pressure (MAP) was recorded with a Biopac System, model MP100. The Allium sativum decreased the MAP only from 124±2 mmHg (control) to 108±2 mmHg at 15s. The Cymbopogon citratus also decreased the MAP from 122±2 mmHg (control) to 106±2 mmHg after 15s. The 1mg of Allium sativum + 1mg of Cymbopogon citratus also decreased the MAP from 126±3 mmHg (control) to 113±3 mmHg after 15s. The effects of the two plants were the same and were not increased when in association.

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Bispectral index in dogs with high intracranial pressure, anesthetized with propofol and submitted to two levels of FiO2/ Índice biespectral em cães com pressão intracraniana elevada, anestesiados com propofol e submetidos a dois níveis de FiO2  

Abstract in portuguese Avaliaram-se os efeitos das frações inspiradas de oxigênio (FiO2) de 1 e 0,6 sobre o índice biespectral (BIS) em cães com pressão intracraniana elevada e submetidos a infusão contínua de propofol. Oito animais foram anestesiados em duas ocasiões, recebendo durante a ventilação controlada FiO2 = 1(G100) ou FiO2 = 0,6 (G60). Propofol foi usado para indução (10mg.kg-1) e seguido por infusão contínua (0,6mg.kg-1minuto-1). Após vinte minutos da implantação do (more) cateter de fibra óptica do monitor de pressão intracraniana, na superfície do córtex cerebral direito, realizaram-se as mensurações basais de BIS, índice de qualidade de sinal, taxa de supressão, eletromiografia, pressão parcial de dióxido de carbono ao final da expiração, pressão arterial média, pressão intracraniana e pressão de perfusão cerebral. Em seguida, interrompeu-se o fluxo sanguíneo da veia jugular direita, para o aumento da pressão intracraniana e depois de 20 minutos, novas mensurações foram realizadas em intervalos de 15 minutos (T0, T15, T30, T45 e T60). A pressão parcial de oxigênio no sangue arterial variou conforme a FiO2. Para os outros parâmetros não foram registradas diferenças significativas. Conclui-se que o monitoramento pelo BIS não foi afetado pelo emprego de diferentes FiO2. Abstract in english The effects of inspired oxygen fractions (FiO2) of 1 and 0.6 on bispectral index (BIS) in dogs with high intracranial pressure, submitted to a continuous rate infusion of propofol were evaluated. Eight dogs were anesthetized on two occasions, receiving, during controlled ventilation, an FiO2 = 1 (G100) or an FiO2 = 0.6 (G60). Propofol was used for induction (10mg.kg-1, IV), followed by a continuous rate infusion (0.6mg.kg-1.minute-1). After 20 minutes, a fiber-optic cathe (more) ter was implanted on the surface of the right cerebral cortex to monitor the intracranial pressure, the baseline measurements of BIS values, signal quality index, suppression ratio number, electromyogram indicator, end-tidal carbon dioxide partial pressure, mean arterial pressure, intracranial pressure and cerebral perfusion pressure were taken. Then, the blood flow from the right jugular vein was interrupted in order to increase intracranial pressure and after 20 minutes additional recordings were performed at 15-minute intervals (T0, T15, T30, T45 and T60). The arterial oxygen partial pressure varied according to the changes in oxygen. For the other parameters, no significant differences were recorded. The BIS monitoring was not influenced by different FiO2.

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Effect of exercise on occurrence of diurnal rhythms of plasma ions and metabolites in Thoroughbred racehorses/ Efeito do exercício na ocorrência de ritmos diários de íons e metabólitos plasmáticos em cavalos de corrida Puro Sangue Inglês  

Abstract in portuguese Mensuraram-se as concentrações plasmáticas de cálcio (Ca++), fósforo (Pi), potássio (K+), sódio (Na+), cloreto (Cl-), magnésio (Mg++), ferro (Fe++), glicose, colesterol, triglicerídeos e proteínas totais para determinar os efeitos do exercício sobre a ocorrência dos ritmos diários em cavalos de corrida da raça Puro Sangue Inglês (n=7), em treinamento. A atividade física consistiu de galope na raia e passo. Amostras de sangue foram coletadas da veia jugular (more) a cada 4h durante um período de 48h. As concentrações plasmáticas de Ca++, K+, Mg++ e Na+ foram obtidas por espectrofotometria de absorção atômica com chama, e as concentrações de Pi, Cl-, Fe++, glicose, colesterol, triglicerídeos e proteína total foram mensuradas por testes colorimétricos utilizando-se a espectrometria de luz UV visível. Os dados foram analisados utilizando-se um período de 24h para cada tipo de exercício desenvolvido. Ritmo diário de Pi foi observado quando o passo foi a atividade física desenvolvida, apresentando sua acrofase no período diurno. A concentração plasmática de triglicerídeos mostrou significante ritmo diário com a acrofase ocorrendo no período noturno, independente se foi desenvolvido o galope ou passo. O exercício de alta intensidade (galope) diminuiu a amplitude dos triglicerídeos. Nenhum ritmo diurno foi achado nas outras variáveis. Estes resultados mostram que o galope como atividade física, mascara o ritmo diário do fósforo. Entretanto, o treinamento físico não apresentou nenhum efeito na ocorrência do ritmo diário de triglicerídeos, somente na sua amplitude. Abstract in english Records of plasma calcium (Ca++), phosphorus (Pi), potassium (K+), sodium (Na+), chloride (Cl-), magnesium (Mg++), iron (Fe++), glucose, cholesterol, triglycerides and total protein levels were measured to determine the effects of exercise on occurrence of diurnal rhythms in Throughbred racehorses (n=7) under physical training. Physical activities consisted of gallop on the track and walking. Blood samples were collected from jugular vein every 4h over a 48h period. Plasm (more) a Ca++, K+, Mg++ and Na+ levels were obtained by flame photometry; and, Pi, Cl-, Fe++, glucose, cholesterol, triglycerides and total protein levels were measured by colorimetric tests using visible UV spectrophotometry. The data were analyzed using a 24h period to each exercise performed. Diurnal rhythm of Pi was observed when walking was the physical activity performed, and its acrophase occurred at the light period. Plasma triclycerides showed significant diurnal rhythms, with their acrophases occurring at the dark period, even when walking or gallop were performed. High intensity exercise (gallop) decreased triglycerides amplitude. No significant diurnal rhythms of other variables were found. Gallop, as physical activity, masked phosphorus diurnal rhythm. However, physical training did not influence triglycerides diurnal rhythm occurrence. High intensity exercise (gallop) just declined triglycerides amplitude.

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Desenvolvimento de um modelo experimental de hemodiálise em cães/ Development of a dog model of hemodialysis  

Abstract in portuguese Com o objetivo de desenvolver um modelo de hemodiálise (HD) em cães, foram estudados 18 animais, sem raça definida, machos, clinicamente sadios, com peso corporal variando entre sete e 14 kg. O acesso vascular foi obtido através de implantação do cateter de duplo lúmen em veia jugular externa. As sessões de HD, em número de cinco por animal, com até três horas de duração, foram realizadas em hemodialisadora de sistema proporcional com ultrafiltração (UF) co (more) ntrolada, com solução dialisante padrão e tampão bicarbonato. A UF foi ajustada para HD isovolêmica, utilizou-se perfil de sódio, e para anticoagulação heparina sódica. Os animais foram mantidos anestesiados com cloridrato de levomepromazina e propofol. Foram avaliados dados hematológicos, bioquímicos, hemogasometria, pressão arterial sistêmica e tempo de coagulação ativado. Foi observada diminuição do número global de hemácias, volume globular, hemoglobina e leucócitos. Em relação aos exames bioquímicos, houve manutenção nos níveis de sódio sérico, e quanto à hemogasometria, a manutenção da SO2. A pressão arterial sistêmica manteve-se constante. Os resultados obtidos no presente trabalho permitiram concluir que foi possível o desenvolvimento do modelo proposto e mostrou que a HD em cães é um método viável e seguro, que poderá contribuir para o tratamento clínico da insuficiência renal nesta espécie. Abstract in english To develop a model of hemodialysis (HD), 18 healthy dogs, without a defined breed, males, weighing 7-14 kg, were studied. A double lumen catheter was inserted into the jugular vein for vascular access. HD sessions, totalizing 5 for each dog, were performed with a proportional HD machine, controlled isovolemic ultrafiltration, standard dialysis solution and bicarbonate buffer. Sodium profile and sodium heparin were used. During HD sessions the dogs were kept anesthetized ( (more) levomepromazine and propofol). Hematological and biochemistry data, blood gas analysis, systemic arterial blood pressure, and activated clotting time were evaluated. Serum biochemistry e blood gas analysis showed, respectively, sodium and SO2 maintenance. Systemic blood pressure kept sustained during HD sessions. It could be concluded that it was possible to develop a HD dog model that is a safe and viable technique to be used in chronic renal failure patients.

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Anatomía quirúrgica del drenaje venoso en la región del triángulo carotídeo/ Surgical anatomy of jugular vein tributaries  

Abstract in spanish Los principales afl uentes de la vena yugular interna se incorporan a nivel cervical por medio del tronco venoso tirolinguofacial. Clásicamente se ha descrito su formación por la unión de la vena facial, lingual y tiroidea superior. El objetivo de este estudio fue determinar las variaciones en la presentación del tronco tirolinguofacial en cadáveres humanos de la región del Maule, Chile. Se disecaron 30 hemicuellos pertenecientes a 15 cadáveres humanos de ambos sex (more) os, con un rango de edad entre 29 y 50 años, y se analizaron mediante observación directa. Se observó la formación de tronco venoso en la totalidad de los casos, siendo 53,3% correspondiente al tronco de tipo tirolinguofacial, 23,3% linguofacial, 20% tirolingual y sólo un 3,3% el tronco tirolinguofaringofacial. No se encontró la formación del tronco venoso de tipo tirofacial. Además se encontró una correlación significativa entre el diámetro de la vena yugular interna y el tronco venoso conformado por estas venas. Por lo tanto, existen variaciones morfológicas en los patrones de conformación de las venas facial, lingual y tiroidea superior, siendo estos datos de importancia para áreas de cirugía oncológica, cirugía plástica, cirugía de cabeza y cuello y radiología. Abstract in english Background: The main tributaries of the internal jugular vein join at cervical level through the venous thyrolinguofacial trunk. This trunk is classically described as formed by the union of the facial, superior thyroid and lingual veins. Aim: To evaluate variations in the formation of the thyrolinguofacial trunk in human cadavers. Material and Methods: Thirty hemi-necks were dissected in human cadavers of nine men and six women, with ages ranging between 29 and 50 years, (more) and analyzed by direct observation. Results: In 16 hemi-necks (53.3%), the trunk was thyrolinguofacial; in seven (23.3%), it was linguofacial; in six (20%), it was thyrolingual and in one case (3.3%) it was thyrolinguo pharyngofacial. No thyrofacial trunk formation was found. There was a correlation between the diameter of the internal jugular vein and of the venous trunk formed by these veins. Conclusions: There are morphological changes in the formation patterns of facial, lingual and superior thyroid veins. This information is useful for surgical oncology, plastic surgery, head and neck surgery and radiology.

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Estudo morfológico do funículo espermático em ovinos da raça Corriedale (Ovis aries, L. 1758)/ Morfology study of the spermatic cord in Corriedale sheeps (Ovis aries, L. 1758)  

Abstract in portuguese Estudamos em 40 ovinos adultos da raça Corriedale os aspectos histológicos do funículo espermático. Observamos que este se acha envolvido por uma cápsula de tecido conjuntivo fibroelástico denso, de espessura variável, pregueada em alguns pontos, e revestida por mesotélio que circunda todo o conjunto vásculo-nervoso, e projeta-se para formar o mesoducto deferente. Em posição subcapsular, verifica-se uma camada de tecido conjuntivo fibroelástico frouxo, de espe (more) ssura variável, que circunda parcialmente o funículo espermático, isolando nas regiões deferencial e abdeferencial conjuntos vásculo-nervosos, responsáveis pela nutrição do epidídimo. Na região do mesoducto deferente, o tecido subcapsular acompanhado de tecido adiposo constitui a camada interna deste meso, formando a sua adventícia e abrigando vasos e nervos deferenciais. Na região abdeferencial, pequenos acúmulos de tecido adiposo são vistos de permeio aos vasos e nervos desta região. Entre as artérias, veias e nervos testiculares, bem como entre os vasos das regiões deferencial e abdeferencial, observa-se o tecido conjuntivo denso, intervascular, rico em fibras elásticas, que constitui as adventícias contínuas destes vasos. O arranjo vascular mostra que o segmento da artéria testicular, contido no funículo espermático, apresenta trajeto sinuoso. Estando envolvido pelo plexo venoso pampiniforme, formado por veias testiculares desprovidas de válvulas de calibres variados, apresentando amplas comunicações entre si. As veias responsáveis pela drenagem do epidídimo e ducto deferente estão localizadas em posição subcapsular deferencial e abdeferencial e mostram-se providas de válvulas. O trato das artérias testiculares no funículo espermático apresenta como comprimento médio, máximo e mínimo, respectivamente, 150,4 cm, 198,0 cm e 73,3 cm, à direita, e 149,6 cm, 189,2 cm e 90,0 cm, à esquerda, não existindo diferenças estatisticamente significantes ao nível de 5%, quando comparamos a média do segmento da artéria testicular contida no funículo espermático direito em relação ao esquerdo. Abstract in english We have been studied histological aspect of 40 pairs of spermatic cord in adults Corriedale sheep. It was observed that structures were wrapped up a thin layer of dense fibroelastic connective tissue with variable thickness and folding, recovered by mesotelium, which involves all the neurovascular cord, and forms the mesoductus deferents. Under this arrangement there was a layer of loose fibroelastic tissue involving partially the cord and insulating in the deferential an (more) d abdeferential regions the vessels and nerves of the epididimus. Around the mesoductus deferents the subcapsular tissue forms with the internal layer of the meso, which protects vessels and nerves. In the abdeferential region we can see a little fatty tissue between vessels and nerves. A dense connective tissue with elastic fibers occurs between vessels and nerves of the testis and vessels of the deferential an abdeferential regions. The vascular arrangement shows in the cord the sinuous trajectory of the testicular artery recovered by the plexus pampiniformis, whose veins shows connections and have no valves. The veins of the epididimus and ductus deferents are subcapsular. The length of the intra spermatic cord segment of the testicular artery has a medium, maximum and minimal ranges, respectively 150.4 cm, 198.0 cm and 73.3 cm, on the right, and 149.6 cm, 189.2 cm and 90.0 cm, on the left. There were no statistical differences between the right and left medium ranges.

 
 
 
 
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Morfologia do funículo espermático em caprinos da raça Bhuj Brasileira/ Morphology of the spermatic cord in Brazilian Bhuj goats  

Abstract in portuguese Estudamos em 40 caprinos adultos da raça Bhuj Brasileira os aspectos histológicos do funículo espermático. Observamos que este se acha envolvido por uma cápsula de tecido conjuntivo fibroelástico denso, de espessura variável, pregueada em alguns pontos, e revestida por mesotélio que circunda todo o conjunto vásculo-nervoso, e projeta-se para formar o mesoducto deferente. Em posição subcapsular, verifica-se uma camada de tecido conjuntivo fibroelástico frouxo, (more) de espessura variável, que circunda parcialmente o funículo espermático, isolando nas regiões deferencial e abdeferencial, conjuntos vásculo-nervosos, responsáveis pela nutrição do epidídimo. Na região do mesoducto deferente, o tecido subcapsular acompanhado de tecido adiposo constitui a camada interna deste meso, formando a sua adventícia e abrigando vasos e nervos deferenciais. Na região abdeferencial, pequenos acúmulos de tecido adiposo são vistos de permeio aos vasos e nervos desta região. Entre as artérias, veias e nervos testiculares, bem como entre os vasos das regiões deferencial e abdeferencial, observa-se o tecido conjuntivo denso, intervascular, rico em fibras elásticas, que constitui as adventícias contínuas destes vasos. O arranjo vascular mostra que o segmento da artéria testicular, contido no funículo espermático, apresenta trajeto sinuoso. Estando envolvido pelo plexo venoso pampiniforme, formado por veias testiculares desprovidas de válvulas de calibres variados, apresentando amplas comunicações entre si. As veias responsáveis pela drenagem do epidídimo e ducto deferente estão localizadas em posição subcapsular deferencial e abdeferencial e mostram-se providas de válvulas. O trato das artérias testiculares no funículo espermático apresenta como média e desvio padrão 134,6±38,1cm à direita, e 137,0±33,9cm à esquerda, não existindo diferenças estatisticamente significantes ao nível de 5%, quando comparamos a média do segmento da artéria testicular contida no funículo espermático direito em relação ao esquerdo. Abstract in english Histological aspects of the spermatic cord were studied in 40 Brazilian Bhuj goats. It was seen that the spermatic cord is involved by a thin capsule of compact connective tissue recovered by mesothelium which forms an expansion, the mesodeferens. Under this capsule is a subcapsular layer of variable thickness, formed by loose elastic fiber connective tissue that mixes with deep layer of the mesodeferens and with the adventitia of ductus deferens. Between the testicular a (more) rtery and testicular veins exists an intervascular compact elastic fiber connective tissue in continuity with the adventitia of spermatic cord vessels. In the abdeferential region of the spermatic cord exists a neurovascular contingent, the vessels of which generally have inferior calibers and similar constitution and arrangement as the testicular artery and veins; the described contingent is related to nutrition of the initial portion of ductus deferens and part of the epididymis head and body. The vascular arrangement shows that the segment of the testicular artery in the spermatic cord has a sinuous disposition and is totally involved by the venous plexus formed by testicular vein valves with irregular outlines, diverse calibers and large connections. The length of the intra spermatic cord segment of the testicular artery has a medium and standard deviation of 134.6±38.1cm on the right and 137±33.9cm on the left. There were no statistical differences between the right and left medium ranges.

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Clinical Perspectives: 7-Year-Old Girl Has 6 Organs Removed and Retransplanted  

... jugular vein. The jugular vein really has good quality and size, very nice size match, makes a perfect size match for the portal vein. And I'm putting a little growth factor and tying the knot after the artery- the ...

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Anatomical landmark for internal jugular vein catheterization for detection of jugular venous O2 saturation (SjvO2) in Thai people.  

Thirty-two (32) cadavers were dissected to find the anatomical landmark for puncturing the internal jugular vein. The point for the right internal jugular vein was 2 cm above and 2.17 cm lateral to the right clavicular head, and that for the left internal jugular vein was 2 cm above and 2.08 cm lateral to the left clavicular head. The right internal jugular vein was found to dominate eighty-eight per cent (88%) of the cadavers. The anatomical point 2 cm above and 2 cm lateral to the head of the clavicle was appropriate for puncturing the internal jugular vein. After puncturing the internal jugular vein, a catheter was inserted ascending to the jugular bulb where jugular venous O2 saturation (Sjv O2) related to the cerebral metabolism was detected. PMID:10087728

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Aspectos morfológicos do funículo espermático de jumentos (Equus asinus -- Linnaeus, 1758) da raça Pêga/ Morphological aspects study of spermatic cord in Pêga donkey  

Abstract in portuguese Estudando aspectos morfológicos de 38 pares de funículos espermáticos de jumentos da raça Pêga, observamos histologicamente que seus componentes encontram-se envolvidos por delgada cápsula de tecido conjuntivo denso, revestido pelo mesotélio, sob a qual se encontra o músculo cremáster interno, apresentando camadas distintas ou septado por tecido conjuntivo denso. Cápsula funicular e tecido muscular formam inúmeras pregas e algumas expansões, por vezes acompanh (more) adas pelo tecido conjuntivo frouxo intervascular. Envolvendo a artéria e as veias funiculares, identificamos tecido conjuntivo frouxo rico em fibras elásticas e reticulares, com arteríolas, vênulas, nervos e linfáticos. O segmento da artéria testicular estudado possui trajeto sinuoso, túnica interna formada pelo endotélio e tecido conjuntivo, com destacada lâmina limitante elástica interna. A túnica média é formada por espessa camada de musculatura lisa, sustentada por rica e ordenada rede de fibras reticulares e escassas fibras elásticas, e a túnica externa, constituída por tecido conjuntivo denso, contendo fibras colágenas e elásticas, apresenta continuidade com tecido conjuntivo frouxo intervascular. Veias testiculares que envolvem a artéria testicular para formar o plexo venoso pampiniforme mostram calibre variável, túnica média desenvolvida, constituída por fibras musculares lisas, sustentadas por irregular rede de fibras reticulares e poucas fibras elásticas. Os segmentos das artérias testiculares dos funículos espermáticos possuem como comprimento médio, máximo e mínimo, respectivamente, 71,34 , 108,9 e 41,6 cm à direita e 68,78, 110,4 e 41,6 cm à esquerda, não apresentando diferenças estatisticamente significantes ao nível de 5%. O funículo espermático possui forma cônica, achatado látero-lateralmente, com base assentada sobre a margem epididimária do testículo. Abstract in english We have studied morphologic aspects of 38 pairs of spermatic cord in Pêga donkey, and histologically observed that their components are involved for a slim capsule of dense connective tissue. Bellow this capsule we find internal cremaster muscle that shows distinct layer or arises septate by dense connective tissue invasion. Funicular capsule and muscular tissue form disordered plicae and also some expansions that sometimes are followed for intervascular loose connective (more) tissue. Involving funicular arteries and veins, we identified loose connective tissue with elastic and reticular fibbers, with arteriolae, venulae, nerves and lymphatic. Testicular artery studied has sinuous course, internal tunica formed by endothelium and connective tissue, with outstanding internal elastic limiting lamina. Tunica media shows to be formed for smooth musculature, supported by a rich and orderly net of reticular fibbers and few elastic fibbers, while external tunica, constituted of dense connective tissue, with collagenous and elastic fibbers, has continuity with intervascular loose connective tissue. Testicular veins, involving testicular artery, to form venous pampiniform plexus and show variable caliber, a developed tunica media, constituted of smooth muscular fibbers supported by a irregular net of reticular fibbers and few elastic fibbers. Testicular arteries segments of spermatic cord have mean, maximum and minimum lengths, respectively, of 71.34 cm, 108.9 cm and 41.6 cm at the right, and 68.78 cm, 110.4 cm and 41.6 cm at the left, and do not have statiscally significant differences, at level of 5%. Spermatic cord has a conical shape, latero-laterally flattened, with basis settled over orchis epididymal edge.

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Pseudoaneurysms of large arteries associated with AIDS  

Abstract in portuguese CONTEXTO: São conhecidas várias complicações vasculares associadas à Síndrome de Imunodeficiência Adquirida (AIDS). Publicações recentes chamam à atenção sobre o desenvolvimento de aneurismas em grandes artérias em pacientes aidéticos. RELATO DE CASO: Neste relato são apresentados dois casos de pacientes (23 e 31 anos de idade) portadores de AIDS com pseudoaneurismas da aorta abdominal e artérias ilíacas comuns. Após a avaliação clínica e radiológic (more) a (arteriografia e tomografia computadorizadas), foram operados e submetidos à aneurismectomia com colocação de selo de dacron no primeiro caso e interposição de prótese aorto-ilíaca direito e femoral esquerdo no segundo. Este último desenvolveu novos aneurismas de subclávia direita e poplítea esquerda, dois meses após a operação, optando-se pela ligadura proximal do seu colo para tratar o primeiro e ressecção e interposição de veia safena interna invertida para tratar o pseudo-aneurisma de artéria poplítea. O estudo histopatológico da artéria poplítea revelou arterite necrotizante. Abstract in english BACKGROUND: Several vascular complications are known to occur in association with the acquired immunodeficiency syndrome (AIDS) and recent publications have called attention to the development of pseudoaneurysms of large arteries in patients with AIDS. CASE REPORT: We report on 2 patients with AIDS aged 23 and 31 years with pseudoaneurysms of the abdominal aorta and common iliac arteries. After clinical and radiological evaluation by arteriography and computed tomography, (more) the patients were submitted to aneurysmectomy, with the placement of a patch of dacron in the first case and the interposition of a right aorto-iliac and left femoral prosthesis in the second. The second patient developed new aneurysms of the right subclavian and left popliteal arteries 2 months after surgery. Proximal ligation of the right subclavian artery was performed to treat the first aneurysm and resection and interposition of a reversed saphenous vein was carried out to treat the pseudoaneurysm of the popliteal artery. Histopathological examination of the popliteal artery revealed necrotizing arteritis.

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Importancia do conjugado arteria carotida interna-seio cavernoso/ Physiological importance of the internal carotid artery-cavernous sinus conjugate  

Abstract in portuguese O autor considera necessário o conjugado anatômico artério-venoso representado pela artéria carótida interna e seio cavernoso, bem como o plexo venoso carotídeo que reveste a carótida interna dentro do canal carotídeo da porção petrosa do osso temporal. Julga que, além de proteger a parede vascular arterial nas hipertensões arteriais súbitas, possa contribuir no mecanismo de controle e regulação do fluxo sanguíneo carotídeo, por considerar diferentes as c (more) ondições fisiológicas do seio cavernoso em relação aos demais seios venosos durais e o sistema venoso endocraniano; consequente de sua constituição cavernosa, diferente dos demais canais sanguíneos venosos, com fisiollogia venosa própria e funções diferentes. Procura assemelhá-los aos demais distritos do organismo em que existem plexos cavernosos nos quais a tensão venosa chega a grandes proporções, comparada às demais regiões em que não existe esta constituição morfológica. Estabelece a correlação resultante ao mecanismo de resistência cérebro-vascular do qual considera participar, diferindo dos demais seios durais conjugado artéria carotida-beio cavernoso e veias encefálicas. Ainda valoriza o sifão carotídeo fisiologicamente e julga que o mesmo participa da hemodinâmica quando o paciente se encontra caído (em plano horizontal) com hipotensão arterial, favorecendo a chegada sanguínea ao cérebro, evitando a anóxia e descerebração consequente dentro de determinados limites, sendo mais um meio de defesa do organismo. Abstract in english The author considers of atmost importance the anatomical arterial-venous conjugate, represented by the internal carotid artery and the cavernous sinus, as well as the carotid venous plexus which covers the internal carotid artery within the petrous portion of the temporal bone. He believes that besides protecting the vascular arterial wall in acute episodes of hypertension, it can also contribute to the mechanism of the carotid blood flow. This is due to the fact that he (more) considers the physiological conditions of the cavernous sinus in relation to the others dural venous sinuses and the endocranial venous system and its cavernous constitution, which differs from other venous blood canals with their own venous physiology and different functions. He attempts to compare it to the rest of the body areas where cavernous plexuses are localized and where venous pressure reachs high proportions, in comparison with the other regions without this morphologic constitution. He establishes a correlation resulting form the cerebro-vascular resistence mechanism, the participation of which he considers as differing from others dural sinuses and encephalic veins. He also emphasizes physiologically the carotid siphon and believes that it participates in the hemodynamics, when the patient is lying down (in a horizontal position) with hypotension, facilitating the blood access to the brain, thus avoiding consequent anoxia and decerebration, within certain limits, and constituting an additional mean of body defense.

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Analysis of Jugular Foramen Exposure in the Fallopian Bridge Technique  

Objective: To analyze the exposure of the jugular foramen afforded by the fallopian bridge technique. Method: The jugular foramen exposure was obtained using the jugular foramen approach combined with the fallopian bridge technique. We applied this technique using 10 temporal bone specimens at a ter...

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Aborto em bovinos devido à intoxicação por Tetrapterys acutifolia (Malpighiaceae)/ Abortion in cattle due to Tetrapterys acutifolia poisoning  

Abstract in portuguese Esse estudo teve por objetivo demonstrar experimentalmente que Tetrapterys acutifolia Cav. (fam. Malpighiaceae) é capaz de provocar aborto em bovinos e caracterizar as alterações clínico-patológicas nas vacas e nos fetos. Estas plantas são responsáveis por significativo número de mortes em bovinos com mais de um ano de idade, especialmente nos Estados de Rio de Janeiro e São Paulo, mas até agora não havia sido comprovado experimentalmente seu efeito abortivo em (more) bovinos. Os experimentos foram realizados no município de Barra do Piraí, RJ. Quatro vacas de descarte receberam brotos e folhas novas frescas de T. acutifolia, coletadas em propriedades vizinhas, nas doses de 2,5g/kg/dia, 5,0g/kg/dia (2 vacas) e 10g/kg/dia, até ocorrer o abortamento. O quadro clínico nas vacas caracterizou-se por arritmia cardíaca, tremores musculares, anorexia, ascite, jugular ingurgitada, edema de peito e barbela e aborto (23-76 dias após o início da ingestão da planta); todas as vacas abortaram. Das quatro vacas apenas uma (a que recebeu 10g/kg/dia) morreu 36 dias após o abortamento, com sintomas de insuficiência cardíaca. O exame necroscópico dos fetos/natimortos revelou hidrotórax, hidropericárdio, hidroperitônio e congestão hepática; ao corte do miocárdio, verificaram-se áreas pálidas. No exame histológico havia edema intersticial com fibrose incipiente. Na vaca que recebeu a maior dose e foi a óbito, bem como em outra intoxicada naturalmente, os achados de necropsia foram similares aos observados nos fetos, exceto pela dilatação dos vasos da base do coração e mais acentuada palidez do miocárdio. Observaram-se ainda edema subcutâneo nas regiões cervical e esternal, bem como veias jugulares ingurgitadas. Os achados histopatológicos foram necrose e edema intersticial com acentuada fibrose no miocárdio, espongiose da substância branca do encéfalo e, no fígado, congestão e leve fibrose. Adicionalmente, observou-se na vaca intoxicada espontaneamente, 17 dias após o aborto, arritmia cardíaca, jugular ingurgitada, edema de peito e barbela, anorexia com morte 43 dias após o aborto. Este estudo demonstra que Tetrapterys acutifolia é capaz de induzir aborto e, dependendo da dose, ainda causar a morte das vacas que abortarem. Abstract in english Tetrapterys acutifolia Cav. (fam. Malpighiacae) stands out among the most important toxic plants of the Brazilian Southeast Region. These plants are responsible for a significant number of deaths in over 1-year-old cattle, especially in the states of Rio de Janeiro and São Paulo. This study aims to demonstrate that T. acutifolia is also able to induce abortion in cattle and to characterize the clinic-pathological alterations in cows and fetuses. Four cows, kept on pastur (more) e were used in the experiments which were performed on a farm in the county of Barra do Piraí, RJ, Brazil. The sprouts and young leaves of T. acutifolia were collected from the vicinity shortly before disposed in a trough. The experimental cows ingested the plant material at doses of 2.5g/kg/day (one cow), 5g/kg/day (two cows) and 10g/kg/day (one cow) until abortion occurred. All four cows aborted. The cows showed cardiac arrhythmia, muscular tremors, anorexia, ascites, distended jugular veins, edema of the sternal region and dewlap, and abortion (23 to 76 days after the beginning of ingestion of the plasnt) from the 5th to the 28th day of the experiment. Only one cow which received 10g/kg/day died with characteristic signs of heart failure, 36 days after she had aborted. Gross examination of the fetuses revealed hydrothorax, hydropericardium, hydroperitoneum, nutmeg appearance of the liver, few petechiae and ecchymoses in the epicardium, and pale areas in cross sections of the myocardium. The main postmortem findings in the cow that died were hydrothorax, hydropericardium and hydroperitoneum, engorged vessels at the heart base, exceedingly pale heart muscle with marked spots and stripes in cross sections. Distended jugular veins and severe edema in the sternal region and the abdominal wall were also observed. Histological examination of the fetal hearts revealed interstitial edema with incipient fibrosis and degenerative/necrotic changes of the myocytes. In the succumbed cow was found interstitial fibrosis, as well as necrotic areas and/or necrosis of individual myocytes in extensive portions of the heart, besides passive congestion of the liver. This study shows that Tetrapterys acutifolia can induce abortion in cattle and, depending on the dosage, can cause death.

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A veia ázigos direita na cutia (Dasyprocta aguti, rodentia)/ The right azygos vein in agouti (Dasyprocta aguti, rodentia)  

Abstract in portuguese O comportamento da veia ázigos, sua formação e topografia foram estudados em 10 cutias (Dasyprocta aguti, rodentia) adultas (6 machos e 4 fêmeas, capturadas no estado do Piauí, Brasil). Este trabalho tem por objetivo constituir a base de outras investigações, particularmente aquelas referentes à exploração zootécnica desta espécie. O sistema de veia ázigos foi injetado com látex - Neoprene 671, e os animais foram colocados em solução aquosa de formol a 10% (more) , e dissecados. Em todas as espécies foi observado que a veia ázigos sempre chega na veia cava cranial em nível do quarto espaço intercostal. A veia ázigos recebe em (50%) dos casos as veias intercostais à direita e (50%) à esquerda. As tributárias da veia ázigos são: as veias frênicas (100%) e a veia bronco esofágica (30%). A veia hemiázigos aparece em todos os casos à esquerda e em 60% dos casos à direita. A veia ázigos comunica-se com a veia hemiázigos esquerda (90%), e com a direita (100%), com a veia cava caudal e veias intervertebrais, com igual freqüência (30%). Abstract in english The behaviour of the azygos vein, its formation and topography were studied in 10 cutias (Dasyprocta aguti, rodentia) adults (6 males and 4 females) captured in the State of Piauí, Brazil. This research intends to be a base for other investigations, particularly those with reference to zootechnical exploration of this species. The azygos venous system was injected with latex (Neoprene 671), then the animals were put in watery solution of formol 10%, and dissected. In all (more) specimens it was observed that the azygos vein always arrives in the cranial vena cava on a level with fourth intercostal space. The azygos vein receives more frequently (50%), the intercostal veins on the right side and 5 (50%) on the left one. The tributaries of the azygos vein are the phrenic veins (l00%), and the broncoesophagea vein (30%). The hemiazygos vein is in all cases on the left side and in 60% of the cases on the right side. The azygos vein communicates with the left hemiazygos vein (90%), with the right one (100%), and with the vena cava caudal and intervertebral veins, with equal frequency (30%).

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Prevention of renal ischemia/reperfusion injury in rats using acetylcysteine after anesthesia with isoflurane/ Prevenção de lesão de isquemia/reperfusão em ratos com acetilcisteína após anestesia com isoflurano  

Abstract in portuguese OBJETIVO: Avaliar o efeito da N-acetilcisteína na proteção renal contra lesão de isquemia/reperfusão, quando administrada logo após a indução anestésica, em ratos anestesiados com isoflurano. MÉTODOS: Dezoito ratos Wistar machos pesando mais que 300g foram anestesiados com isoflurano. A jugular interna direita e a carótida esquerda foram dissecadas e canuladas. Os animais foram distribuídos aleatoriamente em GAcetil, recebendo N-acetilcisteína por via intrave (more) nosa, 300mg/kg, e GIsot, solução salina. Foi realizada nefrectomia direita e clampeamento da artéria renal esquerda por 45 min. Os animais foram sacrificados após 48h, sendo colhidas amostras sanguíneas após a indução anestésica e ao sacrifício dos mesmos para avaliar a creatinina sérica. Realizou-se histologia renal. RESULTADOS: A variação da creatinina foi 2,33mg/dL ± 2,21 no GAcetil e 4,38mg/dL ± 2,13 no GIsot (p=0,074). Dois animais apresentaram necrose tubular intensa no GAcetil, comparados a cinco no GIsot. Apenas GAcetil apresentou animais livres de necrose tubular (dois) e degeneração tubular (um). CONCLUSÃO: Após isquemia/reperfusão renais, os ratos aos quais se administrou N-acetilcisteína apresentaram menor variação na creatinina sérica e lesões renais mais leves que o grupo controle. Abstract in english PURPOSE: To evaluate the effect of N-acetylcysteine, as a renoprotective agent, when administered early after anesthesia induction, against ischemia/reperfusion injury in rats anesthetized with isoflurane. METHODS: Eighteen male Wistar rats weighing > 300g were anesthetized with isoflurane. The internal jugular vein and the left carotid artery were dissected and cannulated. The animals were randomly divided into GAcetyl, receiving intravenous N-acetylcysteine, 300mg/kg, a (more) nd GIsot, isotonic saline. After 30 minutes, right nephrectomy was performed and the left renal artery was clamped during 45 minutes. The animals were sacrificed after 48 hours and blood samples were taken after anesthetic induction and upon sacrificing of the animals to evaluate blood creatinine. The kidneys were sent for histological analysis. RESULTS: The variation in serum creatinine was 2.33mg/dL ± 2.21 in GAcetyl and 4.38mg/dL ± 2.13 in GIsot (p=0.074). Two animals presented intense tubular necrosis in GAcetyl, compared to 5 in GIsot. Only GAcetyl presented animals free of tubular necrosis (two) and tubular degeneration (one). CONCLUSION: After renal ischemia/reperfusion, the rats which were given N-acetylcysteine presented less variation in serum creatinine and milder kidney injuries than the control group.

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Perfil hematológico de equinos submetidos à prova de Team Penning/ Hematologic profile of horses subjected to Team Penning  

Abstract in portuguese As variações nos parâmetros hematológicos são utilizadas com intuito de avaliar o grau de treinamento ou estado clínico do animal. A avaliação hematológica de eqüinos em repouso tem sido objeto de estudo, a fim de estabelecer uma relação com treinamento ou capacidade atlética. Objetivou-se avaliar o perfil hematológico de eqüinos submetidos à prova de Team Penning, correlacionando o sexo e freqüência da atividade física. Mediante punção da veia jugula (more) r externa coletaram-se dois mL de sangue de 29 eqüinos, 18 machos e 11 fêmeas, em repouso (Momento I) e após o exercício (Momento II). As amostras de sangue foram processadas em analisador hematológico automático veterinário (ABC VET - Horiba ABX Diagnostics). Os animais foram divididos em Grupos A, B, C e D, de acordo com o número de participações na prova. Observou-se que os valores de volume globular, hemoglobina, hemácias, leucócitos, neutrófilos em bastonetes e segmentados, e monócitos aumentaram após o exercício físico, ao contrário do número de linfócitos e eosinófilos, que reduziram. Não existiram diferenças significativas (p Abstract in english Variations in hematologic parameters are used to assess the degree of training or clinical state of the animal. The hematologic evaluation of horses at rest has been an object of study in order to establish a correlation with training or athletic capacity. The purpose of this study was to evaluate the hematologic profile of horses subjected to Team Penning competitions, correlating sex and frequency of physical activity. Two milliliters of blood were drawn through a punct (more) ure made in the external jugular vein from 29 horses, 18 males and 11 females, at rest (Moment I) and after exercising (Moment II). The blood samples were processed in an ABC VET automated veterinary hematology analyzer (Horiba ABX Diagnostics). The animals were divided into Group A, B, C and D according to the number of times they participated in the competition. The values of globular volume, hemoglobin, erythrocytes, rod-shaped segmented neutrophils and monocytes increased after the physical exercise, unlike the number of lymphocytes and eosinophils, which decreased. A comparison of the before/after exercise correlations showed no significant differences (p

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Glucose utilisation during status epilepticus in an epilepsy model induced by pilocarpine: a qualitative study/ Utilização de glicose durante o estado de mal epiléptico no modelo de epilepsia induzido pela pilocarpina: um estudo qualitativo  

Abstract in portuguese O estado de mal epiléptico (SE) é uma emergência médica e está associado a lesão cerebral. O procedimento da [14C] desoxiglicose tem sido utilizado para avaliar as alterações da atividade funcional cerebral induzidas por agentes farmacológicos e toxicológicos. O objetivo deste estudo foi verificar as alterações metabólicas do cérebro de ratos durante o SE induzido pela pilocarpina, para tanto, utilizamos a técnica de mapeamento funcional da [14C] desoxiglic (more) ose. Ratos machos da raça Wistar foram submetidos ao SE induzido pela pilocarpina durante período de 6 horas; 45 minutos antes de se completar 6 horas de SE, tais animais receberam uma injeção de [14C] desoxiglicose por via venosa (veia jugular). Os animais pertencentes ao grupo controle foram submetidos aos mesmos procedimentos, no entanto, receberam solução salina e não pilocarpina. As fatias cerebrais foram preparadas e expostas em filme de raioX por um período de sete dias. A análise da densidade óptica de cada região foi obtida por analisador digital de estado sólido. Tal análise revelou aumento no consumo de glicose durante o SE nas seguintes regiões: formação hipocampal (+50,6%), núcleo caudado-putamen (+30,6%), córtex frontoparietal (+32,2%), amigdala (+31,7%), córtex entorrinal (+28,2%), complexo talâmico (+93,5%), área pré-tectal (+50,1%) e substância negra (+50,3%), quando comparadas com os animais pertencentes ao grupo controle. Nossos resultados sugerem que a ativação dessas estruturas deve ser particularmente importante nos mecanismos de desencadeamento e alastramento da atividade epiléptica durante o estado de mal epiléptico. Abstract in english Status epilepticus (SE) is a medical emergency and it is associated to brain damage. 2-deoxy-[14C] glucose (2-DG) procedure has been used to measure the alterations in the functional activity of the brain induced by various pharmacological and toxicological agents. The aim of this study was to determine which changes occur in the seizure anatomic substrates during the SE induced by pilocarpine (PILO) using [14C]-2 deoxyglucose functional mapping technique. Wistar male adu (more) lt rats were submitted to SE PILO-induced for 6h and received [14C] 2-deoxyglucose injection via jugular vein 45 min before the 6th hour of SE. The control animals were submitted to all procedures but received saline and not pilocarpine. Brain sections were prepared and exposed X-ray film about seven days. The optical density of each region was obtained using a solid state digital analyser. The analysis revealed that 14C-2DG utilisation was pronounced in the SE rats on the areas corresponding to the hippocampal formation (+50.6%), caudate-putamen (+30.6%), frontoparietal cortex (+32.2%), amygdala (+31.7%), entorrinal cortex (+28.2%), thalamic nucleus (+93.5%), pre-tectal area (+50.1%) and substantia nigra (+50.3%) when compared to control. Our results suggest that the different activation levels of the distinct structures may be particularly important for understanding triggering and spreading mechanisms underlying epileptic activity during status epilepticus.

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Aspectos clínico-patológicos da intoxicação experimental pelas sementes de Crotalaria mucronata (Fabaceae) em bovinos/ Experimental poisoning by Crotalaria mucronata (Fabaceae) seeds in cattle  

Abstract in portuguese Sementes moídas de Crotalaria mucronata Desv. (=Crotalaria striata DC., Crotalaria pallida Ait., Crotalaria saltiana), com nomes populares de "xique-xique" ou "guizo-de-cascavel", foram administradas por via oral a 9 bovinos. As doses diárias de 1g/kg, 2g/kg, 3g/kg cada uma a um bovino, e 5g/kg em dois de três bovinos, dadas durante 61 a 63 dias, não causaram intoxicação. A dose de 5g/kg em um bovino, 7,5g/kg em dois bovinos e 10g/kg em um bovino, dadas durante 47-6 (more) 1 dias, causaram sintomas entre 47 e 80 dias após o início da administração e a morte entre 3 horas e 5 dias após o início dos sintomas. Os principais sintomas foram pulso venoso positivo da veia jugular, respiração abdominal, taquicardia, inapetência, fezes ressequidas, edema sub-mandibular e fraqueza. Os achados de necropsia foram palidez pulmonar, hidropericárdio, hidrotórax, hidroperitôneo, edema de mesentério, aumento da consistência hepática, alterações de cor do fígado, dilatação de ventrículo cardíaco direito e edema da parede ruminal. As principais alterações histológicas concentraram-se nos pulmões, sob forma de espessamento das paredes alveolares e da parede das arteríolas com diminuição da luz e fibrose periarteriolar; havia também lesões hepáticas e cardíacas de menor importância. Pode-se concluir que as principais lesões causadas pela ingestão das sementes de C. mucronata durante períodos prolongados, devem-se à dificuldade de passagem do sangue pelos vasos pulmonares em função da hipertensão arterial decorrente de fibrose e espessamento arteriolar determinada pela ação pneumotóxica da planta. Abstract in english Experiments were performed to define the clinical and pathological picture of prolonged administration of the seeds of Crotalaria mucronata Desv. to cattle, in order to obtain additional information about this toxicosis. The ground seeds were administered orally to 9 bovines. Doses of 1g/kg/day, 2g/kg/day, 3g/kg/day each in one bovine, and 5g/kg/day in two of three bovines, given for 61- 63 days, did not cause poisoning. Doses of 5g/kg, in one bovine, 7.5g/kg in two bovin (more) es and 10g/kg in one bovine, given for 47-61 days, caused symptoms between 47 and 80 days after the first administration and caused death between 3 hours and 5 days after the onset of symptoms. The main clinical signs were positive venous pulse of the jugular vein, abdominal breath, tachycardia, loss of appetite, dry feces, sub-mandibular edema and weakness. Bovines that did not die, were slaughtered 8 or 9 months after first administration. At necropsy pulmonary paleness, hydropericardium, hydrothorax, hydroperitoneum, mesenteric edema, augmented hepatic consistency, discoloration of the liver, right cardiac ventricle dilatation and ruminal wall edema were seen. The main histological lesions were thickening of the alveolar walls and of the arterioles with narrowing of their lumen, and periarteriolar fibrosis, besides hepatic and cardiac lesions of minor importance. It is concluded, that the lesions caused by ingestion of the seeds of C. mucronata over a long period are caused by the difficulties of blood passage through the pulmonar vessels due to fibrosis and thickening of the arteriolar walls through the pneumotoxic action of the plant.

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Veias soleares: bases anatômicas e seu papel na origem da trombose venosa profunda em membro inferior/ Soleus veins: anatomic basis and their role in the origin of deep venous lower limb thrombosis  

Abstract in portuguese OBJETIVO: Estudar o número, a setorização e a terminação das veias soleares. MÉTODOS: Em 100 pernas de 50 cadáveres, excluídos aqueles com alterações congênitas ou adquiridas dos membros inferiores, foram realizadas, a fresco, na região crural posterior, dissecções anatômicas minuciosas, estratigráficas. Após o rebatimento da pele, foram realizadas a individualização das veias superficiais e perfurantes, rebatimento da tela subcutânea e da fáscia, ind (more) ividualização e rebatimento dos músculos gastrocnêmio e plantar, desinserção tibial do músculo sóleo, individualização das veias soleares e o estudo morfométrico. A região foi dividida em seis setores: súpero-medial, súpero-lateral, médio-medial, médio-lateral, ínfero-medial e ínfero-lateral. No estudo estatístico utilizaram-se os testes não-paramétricos Wilcoxon e Friedman. RESULTADOS: Foram encontradas 4.679 veias soleares. O setor com maior número de veias soleares foi o súpero-lateral com 1.529 veias (32,7%), seguido do médio-medial com 1.256 veias (26,8%) e do médio-lateral com 975 veias (20,8%). As terminações ocorreram em veias comunicantes (1.207 veias - 25,8%), veias tibiais posteriores (964 veias - 20,6%), veias fibulares (709 veias - 15,2%) e em mais 32 tipos (1799 veias - 38,4%). CONCLUSÃO: A drenagem venosa do músculo sóleo é realizada por um grande número de veias soleares, freqüentemente localizadas nos setores súpero-lateral, médio-medial e médio-lateral, terminando comumente em veias tibiais posteriores e fibulares e, em veias comunicantes. Abstract in english OBJECTIVE: Study of the number, sectorization and termination of the soleus veins. METHODS: Meticulous, stratigraphical, anatomical dissections were carried out in the posterior crural region of 100 legs of 50 fresh cadavers. Those belonging to subjects with congenital or acquired pathologies in the lower limbs were disregarded. After the skin was reflected on both sides, dissection of superficial and perforating veins, was performed. Then reflection of the subcutaneous t (more) issue and fascia, detachment and reflection of the gastrocnemius and plantaris muscles, detachment of the tibial origin of the soleus muscle, differentiation of the soleus veins and study of morphometric parameters were carried out. The region was divided into six sectors: superior-medial, superior-lateral, medio-medial, medio-lateral, inferior-medial and inferior-lateral. Data obtained from Wilcoxon and Friedman nonparametric tests were utilized for statistical analysis. RESULTS: In the dissected legs 4679 soleus veins were found. The sector with the greatest number of soleus veins was the superior-lateral (1529 veins - 32.7%), followed by the mediomedial (1.256 veins - 26.8%) and the mediolateral sectors (975 veins - 20.8%). The extremities drained into communicant veins (1.207 veins - 25.8%), posterior tibial veins (964 veins - 20.6%), peroneal veins (709 veins - 15.2%) and into 32 other types (1.799 veins 38.4%). CONCLUSION: The venous drainage of the soleus muscle is carried out by a great number of soleus veins which are frequently located in the superior-lateral, mediomedial and mediolateral sectors, more often going into the posterior tibial, peroneal and communicant veins.

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MONITORIZACIÓN DE LA OXIMETRÍA DEL BULBO DE LA YUGULAR/ Oximetry monitoring of the jugular vein bulb  

Abstract in spanish La monitorización de sangre de la yugular interna para determinar la oxigenación cerebral ha recobrado interés, pues permite una estimación global del balance entre aporte y demanda de oxígeno del cerebro. La medida directa de la presión arterial se considera como una necesidad. Sin embargo, no siempre es posible lograr un acceso arterial o incluso monitorizar la presión arterial no invasiva. La importancia clínico fisiológica y las técnicas descritas en este tr (more) abajo, así como las experiencias nacionales e internacionales al respecto, nos permiten conocer que la mayor utilidad de la monitorización de la SvyO2 es la detección de isquemia cerebral y la implementación de un tratamiento adecuado y temprano. La introducción de la oximetría del bulbo yugular permite la estimación del balance entre el aporte y la demanda de O2 del cerebro. Esta monitorización en tiempo real posibilita la mejoría del entorno fisiológico del cerebro y puede mejorar el resultado final del paciente; sin embargo, deben considerarse sus limitaciones. Abstract in english Monitoring internal jugular vein blood to determine cerebral oxygenation has regained interest because it allows a global assessment of the balance between demand and supply resources of oxygen in the brain. The direct measurement of arterial pressure is considered as a necessity. However it's not always possible to neither achieve an arterial access nor even monitor the arterial pressure with a non invasive technique. The clinical and physiological importance of the tech (more) niques described in this review, as well as the national and international experiences in the topic, allow us to know that the main utility of the SvyO 2 is the detection of cerebral ischemia and the implementation of an adequate and early treatment. This monitoring in real time makes possible the brain's fisological environment and it can also improve the final clinical results however, its limitations must be known and assessed.

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Cirurgia de revascularização do miocárdio com enxertos compostos/ Myocardial revascularization using composite grafts  

Abstract in portuguese Existem evidências das vantagens e influência na sobrevida dos pacientes revascularizados com a artéria torácica interna (ATI). Entretanto, outros enxertos foram introduzidos. O objetivo do presente estudo é mostrar as vantagens da revascularização completa do miocárdio com enxertos arteriais compostos e análise dos resultados a curto e médio prazos. Entre junho de 1992 e dezembro de 1997, 50 pacientes foram submetidos à cirurgia de revascularização completa (more) do miocárdio com enxertos arteriais compostos. A idade variou de 41 a 88 anos, com média de 56 anos. Todos os pacientes foram avaliados segundo o protocolo de exames clínicos, ECG, raios X de tórax, ecocardiograma e cateterismo cardíaco. Apresentaram fatores de risco para doença arterial coronária: HAS em 28% diabete melito em 26%, tabagismo em 38% e dislipidemia em 50%. Neste grupo 44% tinham IAM prévio e 20% angina instável. Todos foram classificados segundo o grau de angina da Canadian Cardiology Society (CCS) e classe funcional segundo a New York Heart Association (NYHA). As lesões coronárias eram triarteriais em 46%, biarteriais em 38%, uniarteriais em 16% e lesão de tronco de coronária esquerda em 16%. Em 80% dos pacientes foi utilizada a circulação extracorpórea (CEC), hipotermia moderada e proteção intermitente do miocárdio. Em média foram 2,9 pontes por paciente. Em todos os casos a ATI foi utilizada com prolongamento de veia safena, em 6% veia safena em "Y", em 24% artéria radial em "Y" em 40%, e em 80% dos casos com "Y" da própria ATI. O acompanhamento pós-operatório incluiu exame clínico, prova de esforço e/ou cintilografia miocárdica. Em 14% foi realizada a coronariografia. As complicações mais freqüentes no pós-operatório foram atelectasia pulmonar em 16%, mediastinite em 4%, IAM transoperatório em 4%, SARA 4%, AVCI 2%, sendo a morbidade maior no grupo de pacientes do sexo feminino e com diabete melito. A mortalidade hospitalar foi de 2%. Apenas um paciente apresenta quadro de angina grau II da CCS. Podemos concluir com este estudo que a cirurgia de revascularização do miocárdio com o uso de enxertos compostos pode ser realizada com baixa mortalidade, permite maior número de anastomoses e proporciona excelente evolução pós-operatória a curto e médio prazos. Abstract in english There is evidence of the advantage and impact on the prolongation of life in revascularized patients using the internal thoracic artery. Other grafts have been introduced. The scope of the present report is to show the advantages of myocardial revascularization using composite grafts and to analyze the results over the short and medium term. Between June 1992 and December 1997 fifty patients were submitted to complete myocardial revascularization surgery with composite ar (more) terial grafts. Age ranged from 41 to 88 years (average 56). In this group 44% of the patients had previous MAI and 20% unstable angina. In all cases ITA was used with prolongation of saphenous vein in 6%, saphenous vein in "Y" in 24%, radial artery in "Y" in 40% and in 30% with "Y" of the ITA itself. Post-operative follow-up included clinical exam, exercise tests proves and/or myocardial scintigraphy. In 14% coronary arteriography was accomplished. Postoperatively the highest mortality was in females with diabetes mellitus. Hospital mortality was 2%. Only one patient demonstrates class II angina (CCS - Canadian Cardiology Society). This study demonstrates that myocardial revascularization with composite grafts is possible with low mortality, it permits a greater number of anastomoses and provides excellent postoperative progress over the short and medium term.

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Nova abordagem técnica e eletrofisiológica para tratamento da fibrilação atrial/ New technical and eletrophysiological approach for atrial fibrillation treatment  

Abstract in portuguese A cirurgia do "Labirinto" para tratamento da fibrilação atrial primária, inicialmente proposta por Cox, é relativamente complexa e aumenta o risco de morbidade próprio da cirurgia da valva mitral isoladamente. OBJETIVO: Apresentar o detalhamento técnico, os conceitos de eletrofisiologia adotados e os resultados iniciais de nova abordagem cirúrgica e eletrofisiológica, incluindo o bloqueio de macrocircuitos atriais específicos definidos por Frame, e otimizando a t (more) ática cirúrgica de tratamento da fibrilação atrial. MÉTODO: Foram operados oito pacientes portadores de fibrilação atrial crônica e disfunção de valva mitral, associada à disfunção de valva tricúspide em um paciente, empregando-se as seguintes modificações principais da cirurgia de Cox: 1- Exclusão da aurícula esquerda por sutura interna, na junção com o átrio esquerdo; 2- Exclusão de aurícula direita por sutura em bolsa de fixação da cânula de drenagem venosa para a veia cava superior; 3- Incisão biatrial única; 4- Eletrocauterização transendocárdica no tecido atrial esquerdo circunjacente aos óstios das veias pulmonares; 5- Substituição das incisões e suturas no átrio esquerdo por eletrocauterização transendocárdica. RESULTADOS: O tempo de circulação extracorpórea variou de 64 a 133 min (média de 107,5 min) e o tempo de cardioplegia de 40 a 105 min (média de 76,7 min). Ao final da cirurgia, todos os pacientes estavam em ritmo atrial regular. O pós-operatório transcorreu sem complicações cirúrgicas e todos os pacientes receberam alta hospitalar em ritmo atrial regular. Em nenhum paciente foi necessário o implante de marcapasso definitivo. No seguimento ambulatorial, seis meses após a cirurgia, seis (75%) pacientes mantiveram o ritmo atrial com as contrações atriais regulares, e dois apresentaram fibrilação atrial, clinicamente controlada (NYHA II). Também não ocorreram complicações embólicas nem evidência de trombose no controle ecocardiográfico. CONCLUSÃO: Pode-se concluir, como experiência inicial, que a abordagem eletrofisiológica e a técnica empregada otimizaram o tratamento cirúrgico da fibrilação atrial, possibilitando a correção de lesões valvares mitrais e tricúspide sem morbidade adicional. Abstract in english INTRODUCTION: The maze procedure for primary atrial fibrillation treatment, initially proposed by Cox, is somewhat complex and increases the morbidity risk originating from the isolated mitral valve surgery itself. OBJECTIVE: To describe the surgical technique, the concepts of electrophysiology considered and the initial results of a new surgical and electrophysiological approach. Also the blocking of main atrial circuits as defined by Frame and optimization of the surgic (more) al tactic for atrial fibrillation treatment are considered. METHOD: Eight patients with chronic atrial fibrillation and mitral valve dysfunction and with tricuspid valve regurgitation in one case were operated on. The following modifications of the classic Cox procedure were employed: 1. - Exclusion of the left atrium appendage by internal suturing to close its left atrial ostium; 2. - Exclusion of the right atrium appendage by one purse string suture used for the fixation of the superior vena cava draining cannula; 3. - Single atrial incision; 4. - Transendocardial electrocauterization of the left atrium wall around all the pulmonary vein ostia; 5. - Substitution of the incisions and sutures in the left atrium by transendocardial electrocauterization. RESULTS: The cardiopulmonary bypass time varied from 64 to 133 min (mean 107.5 min) and the cardioplegia time was from 40 to 105 min. (mean 76.7 min). At the end of the surgery all patients were in regular atrial rhythm. The postoperative period was uneventful with all patients discharged from hospital showing regular atrial rhythm, without definitive pacemaker implantation. Six months after surgery, six patients were in regular atrial rhythm (75%) with preserved atrial contractions, and two (25%) with atrial fibrillation, clinically controlled (NYHA II). There was no evidence of embolic complications or thrombosis seen by Doppler echocardiography. CONCLUSION: It is concluded that in this initial series of cases, the electrophysiolgical approach and the surgical technique employed improved the surgical treatment of atrial fibrillation enabling the correction of mitral and tricuspid valve lesions without additional morbidity.

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Internal jugular vein valve morphology in the patients with chronic cerebrospinal venous insufficiency (CCSVI); angiographic findings and schematic demonstrations.  

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome recently described in multiple sclerosis patients. It is characterized by abnormal venous hemodynamics resulting from numerous obstacles in the main veins draining the central nervous system, usually: the internal jugular veins and the azygous vein. Internal jugular vein is the most commonly vein affected. Most of the abnormalities in this vein are located at the level of jugular valve. The aim of this review is to give venographic and schematic descriptions of the most common valvular and perivalvular anomalies found in the lower part of internal jugular vein. PMID:22338622

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Raised Jugular Venous Pressure Intensifies Release of Brain Injury Biomarkers in Patients Undergoing Cardiac Surgery  

Objectives Neurologic damage after cardiac surgery with extracorporeal circulation is multifactorial. Despite several studies, its pathophysiology is poorly understood. The purpose of this study was to determine the changes in jugular venous pressure and to analyze their effect on perioperative brain injury measured by biomarkers in patients undergoing coronary artery bypass grafting. Design Observational study. Setting Department of cardiac surgery in a medical university hospital. Participants Adult patients undergoing elective coronary artery bypass grafting with extracorporeal circulation under general anesthesia. Interventions The right jugular vein was cannulated in retrograde fashion. Jugular venous pressure was measured in the jugular vein bulb (JVBP). Concentrations of plasma glia...

60

Anatomical study of the renal veins observed during 342 living-donor nephrectomies  

Abstract in portuguese OBJETIVO: é demonstrar as variações anatômicas das veias renais encontradas em 342 nefrectomias realizadas em doadores-vivos. MATERIAL E MÉTODO: de maio de 1990 a maio de 1996 realizamos 342 nefrectomias em doadores-vivos para transplante sendo 331 à esquerda e 31 à direita RESULTADOS: encontramos a seguinte anatomia das veias renais: no lado esquerdo a veia renal era sempre única (311/311), tinha duas tributárias (veias suprarenal e gonadal) em 100% e uma ou mai (more) s veias renolumbares em 65,27%, circundava a aorta (circumaorta venous ring) em 0,96% e era retroaortica em 1,28%, cava dupla 0.64%; no lado direito a veia renal era dupla em 29% (9/31) e somente uma vez (3,22%) tinha uma veia tributária ( veia gonadal), três ou mais veias em 9,7%. CONCLUSÃO: a veia renal esquerda é sempre única, apresenta variação principalmente no seu trajeto e em suas tributárias, enquanto a veia renal direita é dupla ou tripla em 38,7%. Abstract in english The anatomical variations of renal veins observed during 342 nephrectomies in living donors are described, 311 cases on the left side and 31 on the right. The following anatomy of the renocava veins was observed: 1. On the left side the renal vein was always unique (311/311) and had two tributaries (suprarenal and gonadal veins) in 100 per cent and one or more renolumbar veins in 65.27 per cent, encircling the aorta in 1.07 per cent, was retroaortic in 1.4 per cent; and t (more) he inferior vena cava was double in 0.64 per cent; B- on the right side the renal vein was double in 29 per cent (9/31) and had only one tributary (gonadal vein) in one case, for 3.22 per cent (1/ 31); three or more renal veins in 9.7 per cent (3/31). We concluded that the left renal vein is always unique, presenting variations principally in its tributaries and trajectory. On the right side, the renal vein was double or triple in 38.79 per cent

 
 
 
 
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Revascularização miocárdica com enxerto composto de artéria torácica interna esquerda em Y: análise de fluxo sangüíneo/ Myocardial revascularization surgery using composite Y-graft of the left internal thoracic artery: blood flow analysis  

Abstract in portuguese OBJETIVO: Verificar o comportamento do fluxo sangüíneo na artéria torácica interna esquerda (ATIE), quando utilizada para revascularizar a artéria interventricular anterior (AIA) e mais um ramo do sistema coronariano esquerdo (SCE). MÉTODO: No presente estudo, compara-se o fluxo obtido pela ecocardiografia Doppler na ATIE, em repouso e sob estresse com dobutamina, em dois grupos de 20 pacientes cada. No grupo A, foi utilizado enxerto pediculado de ATIE anastomosada (more) unicamente à AIA. No grupo B, a ATIE revasculariza a AIA, e um enxerto de veia safena magna, anastomosado em "Y" à ATIE, revasculariza outro ramo do SCE. O estudo angiográfico demonstrou patência de todos os enxertos em ambos os grupos. Na avaliação pela ecocardiografia Doppler foram realizadas as seguintes medidas: débitos sistólico (DS), diastólico e total, razão entre o débito total em estresse pelo débito total em repouso (DTE/DTR), velocidades de pico sistólico (VPS) e diastólico e razão entre essas velocidades. RESULTADOS: Todos os parâmetros analisados apresentaram diferença estatisticamente significativa, com exceção do DS, DTE/DTR e VPS. CONCLUSÃO: Nas condições e métodos usados neste estudo, pode-se inferir que o fluxo sangüíneo na ATIE no enxerto composto (Grupo B) é maior que no enxerto simples (Grupo A), o que demonstra a grande capacidade da ATIE em adaptar-se à demanda de fluxo. Abstract in english OBJECTIVE: To assess the left internal thoracic artery (LITA) flow pattern, when it was used to supply the left anterior descending artery (LADA) and another branch from the left coronary artery system (LCAS). METHODS: In the following study, the left internal thoracic artery flow was investigated by echocardiography Doppler, at rest and under dobutamine stress, in two twenty-patient groups. Group A consisted of patients who received only a pedicled LITA graft to the LADA (more) . Group B consisted of patients who received a pedicled LITA graft associated with a vein graft to supply the LADA and another artery from the LCAS. The angiographic study showed graft patency in all patients from both groups. The following parameters were used: systolic flow (SF), diastolic flow, total flow, total flow in stress/total flow at rest ratio (TFS/TFR), systolic peak velocities (SPV), diastolic peak velocities and systolic peak velocity/diastolic peak velocity ratio. RESULTS: All analysed parameters were considered statistically significant, except SF, TFS/TFR and SPV. CONCLUSIONS: We concluded that in the same conditions and methodology, the LITA flow in the composite graft (group B) is higher than in the free graft (group A), which shows the great flow adaptability of LITA to respond to flow demand.

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Aspectos morfológicos da placenta da preguiça, Bradypus variegatus Shinz, 1825/ Morphological aspects of placenta of the Bradypus variegatus Shinz, 1825  

Abstract in portuguese Estudaram-se os aspectos morfológicos da placenta e das membranas fetais de 03 placentas de bichos-preguiça (Bradypus variegatus), adultas e prenhes, originárias da Zona da Mata do Estado de Pernambuco. Essas estruturas foram obtidas de 03 fêmeas doadas pela Universidade Federal de Pernambuco, das quais duas encontravam-se congeladas e a terceira foi colhida mediante realização de cirurgia cesariana, onde mãe e feto foram preservados. Depois de descongeladas, as pl (more) acentas foram fixadas em solução aquosa de formol 10,00%. Da placenta obtida da cesariana colheram-se pequenos fragmentos da região placentária e do funículo umbilical, os quais foram fixados em paraformoldeido 4,00%, tampão fosfato pH 7,4. Os fragmentos passaram pela rotina histológica, onde foram coradas em Hematoxilina e Eosina e Tricrômio de Masson. A placenta da preguiça é corioamniótica, com o cório viloso constituindo os lobos placentários, que se localizam na região fúndica do útero, e o cório liso relacionando-se com a face interna do útero. Nas placentas de final de prenhez os lobos aglomeram-se e fundem-se aumentando de tamanho, formando uma massa principal discóide, caracterizando uma placenta zonária discoidal, que se une ao feto pelo funículo umbilical, constituído por duas artérias e uma veia umbilical. Os resultados histológicos demonstraram que a placenta desses animais é labiríntica e endoteliocorial. Assim, a placenta da preguiça pode ser classificada como labiríntica, endoteliocorial, múltipla, discóide (a termo) e corioamniótica. Abstract in english The morphological aspects of the placenta and fetal membranes were investigated in 03 sloth originated from the forestal zone in the state of Pernambuco, Brazil. These structures were obtained in 03 pregnant females from Universidade Federal de Pernambuco, two of them were frozen and the third placenta was collected by caesarian, and mother and fetus were preserved. After defrost the placenta were fixed in formaldehyde 10,00% water solution. The small fragments were colle (more) cted in the placenta and umbilical cord from caesarian. These fragments were fixed in 4,00% paraformoldehyde and processed, as usual, for light microscopy; the specimens were embedded in paraplast. HE and Masson stained 5 mm thick sections. The sloth placenta is chorioamniotic, with villous chorion composing the placental lobes, localized in the fundic uterus region. The smooth chorion has relationship with intern face of the uterus. In late gestation the lobes of placenta fused and increase the size in a unique discoid mass, characterizing the placenta discoid. The umbilical cord connect the fetus with placenta, two arteries and one umbilical vein compose it. The histological result suggests a labirinthic and endotheliochorial placenta in these animals. Therefore, the sloth placenta may be classified as labyrinth, endotheliochorial, multiple, discoid (at term) and chorioamniotic.

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Características morfológicas do funículo espermático do burro (Equus asinus x Equus caballus)/ Morphological aspects of the spermatic cord in mules (Equus asinus x Equus caballus)  

Abstract in portuguese Estudando 15 pares de funículos espermáticos de burros (Equus asinus x Equus caballus), observamos em 5 pares que seus componentes acham-se envolvidos por delgada cápsula de tecido conjuntivo denso, revestido por mesotélio. Sob esta cápsula e em estreita relação com ela encontra-se espessa camada de musculatura lisa (músculo cremáster interno) que acompanha também o mesoducto deferente. A cápsula funicular e o músculo cremáster interno aparecem em alguns pont (more) os levemente pregueados. Os componentes vásculo-nervosos estão envolvidos por tecido conjuntivo frouxo integrado predominantemente por fibras colágenas. A artéria testicular no funículo mostra trajeto sinuoso, túnica interna constituída por endotélio acompanhado de delicada camada de tecido conjuntivo e lâmina elástica limitante interna. Sua espessa túnica média é composta por fibras musculares lisas sustentadas por rede de fibras reticulares, e a túnica externa, por tecido conjuntivo que se confunde com o tecido conjuntivo intervascular. As veias testiculares aparecem em grande número, possuem túnica média formada por fibras elásticas e reticulares, com poucas fibras musculares e são desprovidas de válvulas, envolvem as artérias testiculares formando os plexos pampiniformes. O modelo do segmento da artéria testicular obtido com Neoprene látex 450 em 20 preparações, correspondentes a 10 pares de funículos espermáticos, apresentaram, respectivamente como comprimentos médio, máximo e mínimo, 58,2 cm, 81,0 cm e 44,0 cm à direita e 66,3 cm, 96,0 cm e 51,0 cm à esquerda. Abstract in english In a morphologic study of 15 spermatic cord pairs of male mules (Equus asinus x Equus caballus), histology showed in 5 pairs that its components are involved in a thin capsule of a dense connective tissue, covered by a mesothelium. Underneath the capsule, in a close relation, we identified the internal cremaster muscle. This muscle goes with mesoductus. The funicular capsule and muscular tissue form a few small plicae. The funicular vessels (testicular artery and veins) a (more) re wrapped up in loose conjunctive tissue prevailing collagen fibers. The funicular part of the testicular artery is convoluted. It shows a thick tunica média vasorum supported by a net of reticular fibers; tunica intima vasorum is build up endothelium, thin connective tissue and a well defined internal elastic layer; tunica externa vasorum with the connective tissue becoming part of intervascular connective tissue. The testicular veins constituted a very elaborated close-meshed pampiniform plexus in which contortions of the artery are embedded. These veins have a medial tunic formed by elastic and reticular fibers, with a few muscular fibers without valves. The part of testicular artery model obtained with Neoprene latex 450 in 20 preparations, corresponding to 10 pairs of spermatic cords, have mean, maximum, and minimum lengths, respectively, of 58,2 cm, 81 cm, and 44 cm to the right side and 66,5 cm, 96 cm, and 51 cm to the left side.

64

[Jugular venous and arterial concentrations of serum S100B protein in patients with severe head injury].  

It is important for physicians in intensive care units to be able to predict the presence and severity of central nervous system injury in patients with severe head injury (SHI). The extent of S100B elevation has been found to be useful in predicting clinical outcome after brain injury. However, only two studies were realized with jugular venous blood samples. The purpose of our study is to compare the interest between jugular venous and arterial concentrations evaluation of serum S100B protein in patients with SHI. We recruited 17 patients with a SHI, admitted to the intensive care unit. Paired arterial and jugular venous samples were taken at kinetically after injury. S100B median was 0.16 ?g/L in arterial and 0.25 ?g/L in jugular. This arterio-jugular difference is significant. However, there was any significant arterio-jugular difference in the patients group showing an unfavourable outcome or for the earlier samples (earlier than 24h). We observed there was no significant decrease of S100B in jugular, unlike in arterial, 24h after the head injury in the patients group showing an unfavourable outcome. Determination of S100B concentration in jugular samples appears to be better than in arterial to predict clinical outcome after brain injury. PMID:22565174

65

Functional Deficits of Cranial Nerves in Patients with Jugular Foramen Lesions  

Lower cranial neuropathies are a leading presenting symptom in patients with tumors involving the jugular foramen. The purpose of this study is to assess acute and chronic functional deficits along with neurologic findings in 31 patients who underwent resection of a tumor involving the jugular foram...

66

High-Flow Traumatic Carotico-Jugular Fistula Manifesting as Venous Hypertensive Encephalopathy: A Case Report  

We report the clinical and angiographic findings in a patient who presented with venous hypertensive encephalopathy secondary to a traumatic carotico-jugular fistula. Endovascular entrapment of the fistula by occluding the common carotid artery and internal jugular vein at the base of the skull resu...

67

Isoflurano em emulsão lipídica por via venosa promove estabilidade cardiovascular respiratória em modelo experimental/ Intravenous isoflurane in lipid emulsion promotes cardiovascular and respiratory stability. Experimental model/ Isoflurano en emulsión lipídica por vía venosa promueve estabilidad cardiovascular respiratoria en modelo experimental  

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A administração venosa de anestésico inalatório pode causar lesão pulmonar. Halotano em solução lipídica por via venosa promove anestesia com estabilidade hemodinâmica e respiratória. Esta pesquisa procurou estabelecer a dose de indução para emulsão lipídica de isoflurano a 10% e observar as condições cardiovasculares e respiratórias, em anestesia experimental. MÉTODO: Sete porcos machos foram selecionados. Os animais receberam (more) infusão de propofol para as preparações cirúrgicas invasivas: dissecção de artéria femoral e veia jugular, sensor de ecodopplercardiografia no esôfago. Foram registrados freqüência cardíaca (FC), eletrocardiograma (ECG), pressão arterial sistólica (PAS), diastólica (PAD), média (PAM), venosa central (PVC), índice cardíaco (IC), débito cardíaco (DC) e índice bispectral (BIS). As frações inspirada e expirada dos gases respiratórios foram analisadas continuamente. Iniciada infusão da emulsão lipídica de isoflurano até o índice bispectral atingir valor de 40 ± 5 (BIS40). Os animais foram mantidos anestesiados e submetidos a laparotomia exploradora para sutura gástrica. RESULTADOS: O volume total infundido para atingir BIS40 foi 25,6 ± 11,2 ml (2,56 ml de isoflurano). O tempo médio para atingir BIS40 foi 15,6 ± 6,9 minutos. Maior velocidade de infusão reduziu o tempo para os animais atingirem BIS40. Condições cardiovasculares e respiratórias mostraram-se estáveis durante a experimentação. A freqüência cardíaca aumentou com a elevação da fração expirada do isoflurano. CONCLUSÕES: A infusão venosa do isoflurano em solução emulsificada promoveu diminuição do índice bispectral, estabilidades hemodinâmica e respiratória e correlação direta com sua fração expirada. O uso do isoflurano em emulsão lipídica pode se constituir em modalidade segura de aplicação deste anestésico. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La administración venosa de anestésico inhalatorio pode causar lesión pulmonar. Halotano en solución lipídica por vía venosa promueve anestesia con estabilidad hemodinámica y respiratoria. Esta pesquisa buscó establecer la dosis de inducción para emulsión lipídica de isoflurano a 10% y observar las condiciones cardiovasculares y respiratorias, en anestesia experimental. MÉTODO: Siete cerdos machos fueron seleccionados. Los animales r (more) ecibieron infusión de propofol para las preparaciones quirúrgicas invasivas: disección de arteria femoral y vena yugular, sensor de ecodopplercardiografia en el esófago. Fueron registrados frecuencia cardíaca (FC), eletrocardiograma (ECG), presión arterial sistólica (PAS), diastólica (PAD), media (PAM), venosa central (PVC), índice cardíaco (IC), débito cardíaco (DC) e índice bispectral (BIS). Las fracciones inspirada e expirada de los gases respiratorios fueron analizadas continuamente. Iniciada infusión de la emulsión lipídica de isoflurano hasta el índice bispectral obtener valor de 40 ± 5 (BIS40). Los animales fueron mantenidos anestesiados y sometidos a laparotomía exploradora para sutura gástrica. RESULTADOS: El volumen total infundido para obtener BIS40 fue 25,6 ± 11,2 ml (2,56 ml de isoflurano). El tiempo medio para alcanzar BIS40 fue 15,6 ± 6,9 minutos. Mayor velocidad de infusión redució el tiempo para los animales alcanzar BIS40. Condiciones cardiovasculares e respiratorias se mostraron estables durante la experimentación. La frecuencia cardíaca aumentó con la elevación de la fracción expirada del isoflurano. CONCLUSIONES: La infusión venosa del isoflurano en solución emulsificada promovió disminución del índice bispectral, estabilidades hemodinámica y respiratoria y correlación directa con su fracción expirada. El uso del isoflurano en emulsión lipídica se puede constituir en modalidad segura de aplicación de este anestésico. Abstract in english BACKGROUND AND OBJECTIVES: Intravenous infusion of inhalation anesthetics may promote lung injury. Intravenous halothane in lipid emulsion induces anesthesia with hemodynamic and respiratory stability. This investigation aimed at establishing the induction dose of isoflurane in 10% lipid emulsion and at observing cardiovascular and respiratory effects in experimental anesthesia. METHODS: This study involved 7 male piglets. Animals received intravenous propofol for invasiv (more) e surgical preparations: femoral artery and jugular vein dissection and esophageal ecodopplercardiographic sensor. Heart rate (HR), electrocardiography (ECG), systolic (SBP), diastolic (DBP), mean (MBP) blood pressure and central venous pressure (CVP), cardiac index (CI) and bispectral index (BIS) were recorded. Inspired and expired gases fractions were continuously evaluated. Isoflurane lipid emulsion was injected until bispectral index had decreased to 40 ± 5 (BIS40). Animals were kept anesthetized and submitted to laparotomy for gastric suture. RESULTS: Total volume to reach BIS40 was 25.6 ± 11.2 mL (2.56 mL isoflurane). Mean time to reach BIS40 was 15.6 ± 6.9 minutes. The higher the infusion rate the shorter the time to reach BIS40. Cardiovascular and respiratory conditions were stable throughout the experiment. Heart rate has increased with increased end tidal isoflurane. CONCLUSIONS: Intravenous isoflurane in lipid emulsion has promoted bispectral index decrease, hemodynamic and respiratory stability and direct correlation with its expired fraction. Intravenous isoflurane in lipid emulsion may be a safe modality for this anesthetic delivery.

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Caracterização anestésica da nanoemulsão não lipídica de propofol/ Anesthetic profile of a non-lipid propofol nanoemulsion/ Caracterización anestésica de la nanoemulsión no lipídica de propofol  

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: Uso clínico de formulação lipídica de propofol causa dor durante injeção, reação alérgica e crescimento microbiano. Propofol tem sido reformulado em diferentes apresentações não lipídicas para reduzir os efeitos adversos, mas essas mudanças podem modificar sua farmacocinética e farmacodinâmica. Neste trabalho, investigamos a farmacologia e a toxicologia do propofol lipídico (CLP) e da nanoemulsão não lipídica (NLP). MÉTODO: (more) CLP and NLP foram infundidos na veia jugular de ratos sob medida da pressão arterial (PA), frequência cardíaca (FC) e frequência respiratória (FR). Ambas as formulações (1%) foram infundidas (40 µL.min-1) durante 1 hora. Doses hipnóticas e anestésicas, assim como recuperações, foram determinadas. A dor induzida pelo veículo do CLP e NLP foi comparada por meio da contagem do número de contorções abdominais ("writhing test") após injeção intraperitonial (i.p.) em camundongos. Ácido acético (0,6%) foi usado como controle positivo. RESULTADOS: As doses hipnóticas e anestésicas com 1% CLP (6,0 ± 1,3 e 17,8 ± 2,6 mg.kg-1, respectivamente) e 1% NLP (5,4 ± 1,0 e 16,0 ± 1,4 mg.kg-1, respectivamente) não foram significativamente diferentes. A recuperação da hipnose e da anestesia foi mais rápida com NLP do que com CLP. As alterações de FC, PA e FR causadas pelo NLP não foram significativamente diferentes das do CLP. Ácido acético e veículo do CLP provocaram 46,0 ± 2,0 e 12,5 ± 0,6 contorções em 20 min após injeção i.p., respectivamente. Observou-se ausência de contorções abdominais com veículo de NLP. Nenhuma resposta inflamatória abdominal foi notada com a injeção i.p. de ambos os veículos de propofol. CONCLUSÕES: O NLP pode representar melhor alternativa do que o CLP para anestesia venosa com menores efeitos adversos Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El uso clínico de la formulación lipídica del propofol, causa dolor durante la inyección, reacción alérgica y crecimiento microbiano. El propofol ha sido reformulado en diferentes presentaciones no lipídicas para reducir los efectos adversos, pero esos cambios pueden modificar su farmacocinética y farmacodinámica. En este trabajo, investigamos la farmacología y la toxicología del propofol lipídico (CLP) y de la nanoemulsión no lipí (more) dica (NLP). MÉTODO: El CLP y el NLP fueron infundidos en la vena yugular de ratones midiendo la presión arterial (PA), frecuencia cardíaca (FC) y frecuencia respiratoria (FR). Las dos formulaciones (1%) fueron infundidas (40 µL.min-1) durante 1 hora. Dosis hipnóticas y anestésicas y recuperaciones, fueron determinadas. El dolor inducido por el vehículo del CLP y NLP se comparó por medio del conteo del número de contorciones abdominales ("writhing test") después de la inyección intraperitoneal en ratones. El ácido acético (0,6%) fue usado como control positivo. RESULTADOS: Las dosis hipnóticas y anestésicas con 1% CLP (6,0 ± 1,3 y 17,8 ± 2,6 mg.kg-1, respectivamente) y 1% NLP (5,4 ± 1,0 y 16,0 ± 1,4 mg.kg-1, respectivamente), no fueron significativamente diferentes. La recuperación de la hipnosis y de la anestesia fue más rápida con NLP que con CLP. Las alteraciones de FC, PA y FR causadas por el NLP no fueron significativamente diferentes de las del CLP. El ácido acético y el vehículo del CLP provocaron 46,0 ± 2,0 y 12,5 ± 0,6 contorciones en 20 minutos después de la inyección i.p., respectivamente. No se observaron contorciones abdominales con vehículo de NLP. Ninguna respuesta inflamatoria abdominal fue notada con la inyección i.p. de los dos vehículos de propofol. CONCLUSIONES: El NLP puede representar una mejor alternativa que el CLP para la anestesia venosa, con menores efectos adversos Abstract in english BACKGROUND AND OBJECTIVES: The clinical use of a lipid propofol formulation causes pain during injection, allergic reactions, and bacterial growth. Propofol has been reformulated in different non-lipid presentations to reduce the incidence of adverse effects, but those changes can modify its pharmacokinetics and pharmacodynamics. In the present study, we investigate the pharmacology and toxicology of lipid propofol (CLP) and the non-lipid nanoemulsion (NLP). METHODS: Conv (more) entional lipid formulation of propofol and NLP were infused in the jugular veins of rats and blood pressure (BP), heart rate (HR), and respiratory rate (RR) were measured. Both formulations (1%) were infused (40 µL.min-1) over 1 hour. Hypnotic and anesthetic doses as well as recoveries were determined. The pain induced by the CLP and NLP vehicles was compared by counting the number of abdominal contortions ("writhing test") after the intraperitoneal (i.p.) injection in mice. Acetic acid (0.6%) was used as positive control. RESULTS: Hypnotic and anesthetic doses of 1% CLP (6.0 ± 1.3 and 17.8 ± 2.6 mg.kg-1, respectively) and 1% NLP (5.4 ± 1.0 and 16.0 ± 1.4 mg.kg-1, respectively) were not significantly different. Recovery from hypnosis and anesthesia was faster with NLP than with CLP. Changes in HR, BP, and RR caused by NLP were not significantly different from those caused by CLP. Acetic acid and the vehicle of CLP caused 46.0 ± 2.0 and 12.5 ± 0.6 abdominal contortions 20 min after i.p. injection, respectively. The absence of abdominal contractions was observed with the vehicle of NLP. Abdominal inflammatory response was not observed after the i.p. injection of both propofol vehicles. CONCLUSIONS: Non-lipid formulation of propofol can be a better alternative to CPL for intravenous anesthesia with fewer adverse effects

69

A Case of Jugular Foramen Meningioma Mimicking Paraganglioma (Glomus Jugulare)  

Meningioma, which usually occurs in the intracranial fossa, occurs only extremely rarely in temporal bone. Tumors extending to the mesotympani are so similar that differentiating between meningioma and paraganglioma is very difficult. We report a case preoperatively diagnosed as glomus jugulare involving radical dissection, but determined postoperatively to be jugular foramen meningioma. Although the subject’s postoperative condition remains satisfactory, follow up must include collaboration with the neurosurgeon. It cannot be emphasized enough that jugular foramen meningioma must be diagnosed from characteristic radiological findings and differentiated from paraganglioma.   

70

Jugular foramen: anatomic and computed tomographic study  

The computed tomographic (CT) appearance of the jugular foramen was examined in detail, and anatomic and CT sections were correlated. The pars nervosa and pars vascularis were identified, and, with intravenous contrast enhancement, a rapid sequence of scans at a gantry angle of +30/sup 0/ to the canthomeatal line demonstrated cranial nerves IX, X, and XI. The osseous margins of the jugular foramen were best shown by CT at planes of sections parallel and positive (0/sup 0/-30/sup 0/) to the canthomeatal line. CT can be used to evaluate osseous anatomy and the jugular foramen with precision sufficient to confidently exclude an intracanalicular mass.

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Tratamento cirúrgico da conexão anômala parcial das veias pulmonares em veia cava superior/ Surgical treatment of partial anomalous pulmonary venous connection to the superior vena cava  

Abstract in portuguese OBJETIVO: O tratamento cirúrgico da conexão anômala das veias pulmonares em veia cava superior, associada ao defeito septal atrial tipo seio venoso, é bem estabelecido e transcorre com baixa mortalidade e morbidade. Com a finalidade de diminuir a incidência de estenose ou oclusão da veia cava superior direita, especialmente quando associada à presença de veia cava superior esquerda, o apêndice atrial direito foi utilizado para ampliar a veia cava superior direita (more) , após o desvio das veias pulmonares para o átrio esquerdo. MÉTODOS: No período entre junho de 1986 e setembro de 2008, foram operados 95 pacientes, consecutivos, portadores desta anomalia com drenagem em veia cava superior direita e porção alta do átrio direito. A idade variou de 6 meses a 68 anos e o sexo feminino predominou com 50 casos. RESULTADOS: No material apresentado, não ocorreu nenhum óbito na fase de pós-operatório imediato ou tardio. O ritmo cardíaco permaneceu sempre sinusal e não ocorreram complicações na evolução. CONCLUSÃO: O presente trabalho demonstra a aplicabilidade da técnica descrita, com resultados favoráveis em relação a mortalidade, distúrbios de ritmo e complicações na região da veia cava superior direita. Abstract in english OBJECTIVE: Surgical treatment of anomalous pulmonary venous connection to the superior vena cava, associated with sinus venous atrial septal defect, is well established and correlates with low mortality and morbidity. In order to reduce the incidence of stenosis or occlusion of the right superior vena cava, especially when associated with the presence of left superior vena cava, the right atrial appendage was used to enlarge the right superior vena cava, after the diversi (more) on of the anomalous pulmonary veins for the left atrium. METHODS: Between June 1986 and September 2008, 95 consecutive patients were operated with anomalous drainage in the superior right vena cava and high right atrium. Ages ranged from 6 months to 68 years and females predominated with 50 cases. RESULTS: There was no death in the immediate or late post operative care. The sinus cardiac rhythm was preserved in all cases and there was no complications in the late follow up. CONCLUSION: This paper demonstrates the applicability of the technique described, with favorable results on mortality, rhythm disturbances and complications in the right superior vena cava.

72

Veia cava superior esquerda anômala com ausência de veia cava superior direita: achados de imagem/ Persistent left superior vena cava with absent right superior vena cava: image findings  

Abstract in portuguese A persistência da veia cava superior esquerda com ausência da veia cava superior direita é uma anomalia rara, com menos de 150 casos descritos na literatura. A não-obliteração e regressão da veia cardinal anterior esquerda durante o desenvolvimento embriológico promove uma variação sistêmica de retorno venoso ao coração, com persistência da veia cava superior esquerda. Sua incidência varia de 0,3% em pacientes sem alterações cardíacas congênitas concomi (more) tantes a 4,3% naqueles com cardiopatias. Na maioria das vezes coexiste a veia cava superior direita, porém se houver regressão e degeneração da veia cardinal anterior direita, implicará a sua ausência e a drenagem venosa para o coração será feita pela veia cava superior esquerda ao átrio direito, através do seio coronariano. Mostramos um caso de um paciente submetido a radiografia de tórax e tomografia computadorizada para avaliação de doença pulmonar obstrutiva crônica, tendo como achado a persistência da veia cava superior esquerda com ausência da direita, sem qualquer cardiopatia associada e com a drenagem cardíaca sendo feita, através do seio coronariano, para o átrio direito. Abstract in english Persistent left superior vena cava with absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease (more) . In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the coronary sinus. We report the case of a patient with a persistent left superior vena cava and absence of right superior vena cava identified by chance during a chest radiograph and computed tomography examination for investigation of chronic pulmonary obstructive disease. The patient had no congenital heart disease and the blood from the right side was drained by the persistent left superior vena cava into the right atrium through the coronary sinus.

73

Aneurisma venoso gigante de veia ilíaca externa secundário a fístula arteriovenosa traumática: relato de caso/ Giant external-iliac-vein aneurysm secondary to traumatic arteriovenous fistula: a case report  

Abstract in portuguese Aneurismas venosos abdominais são raros. Os localizados nas veias ilíacas externas estão entre os mais infrequentes aneurismas venosos publicados na literatura. Relatamos o caso de um paciente jovem com aneurisma venoso gigante de veia ilíaca externa secundário a uma fístula arteriovenosa adquirida há 20 anos, tratado pelos métodos convencional e endovascular com sucesso. Abstract in english Venous abdominal aneurysms are rare entities, especially at the external iliac vein. We report the case of a young male patient who presented with a giant external-iliac-vein aneurysm secondary to an arteriovenous fistula acquired 20 years earlier, and treated successfully by conventional and endovascular methods in our service.

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Hemorragia adrenal bilateral com trombose da veia renal direita e veia cava inferior em um recém-nascido/ Bilateral adrenal hemorrhage associated with right renal vein and inferior vena cava thrombosis in a newborn  

Abstract in portuguese Os autores apresentam um caso de um recém-nascido com um tipo raro de associação de hemorragia adrenal bilateral com trombose de veia renal direita e de veia cava inferior, em que os exames de ultra-sonografia e tomografia computadorizada exerceram papel crucial no estabelecimento do diagnóstico, orientação da conduta e seguimento do paciente. Abstract in english We report a rare case of coexisting bilateral adrenal hemorrhage, right renal vein and inferior vena cava thrombosis in a neonate. Imaging studies played an important role in the diagnosis, management, and follow-up of this patient.

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Usefulness of Groshong Catheters for Central Venous Access via the External Jugular Vein  

This study was designed to evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Central venous access was achieved by insertion of a single-lumen 4.0 Fr Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVC-RBSI) were evaluated from the database. Two hundred and twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugu...

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Ultrasonographic finding of internal jugular vein during anti-G straining maneuver: is it associated with gravity-induced loss of consciousness?  

Gravity-induced loss of consciousness (G-LOC) is caused by loss of cerebral blood flow during high +Gz (head-to-foot inertial forces). The resistance of the jugular vein is a significant factor in decrease in cerebral blood flow. Ultrasonography of thoracic inlet veins, including internal jugular vein, is feasible to visualize the internal jugular vein and hemodynamic information. Anti-gravity straining maneuver (AGSM) was widely recognized as one of the important factors in preventing G-LOC. The purpose of this study was to evaluate the relationship between the ultrasonographic shape and size of internal jugular vein during AGSM and G-LOC. 47 trainee pilots who participated in human centrifuge education program were enrolled. They were all men, and their mean age was 23.9???1.38?years. Qu...

77

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20-day HU treatment increased the protein mass of nitric oxide synthase in both carotid and femoral ... The factors modulated by HU treatment are complex and nonuniform in the ... receptor mechanisms in ... of jugular vein to isoproterenol, ...

78

Risk of Cardiac Rhythm Problems during Spaceflight  

Description: Heart rhythm disturbances have been seen among astronauts. ... It is hoped that advanced screening for coronary ... mediated via catecholamines (2). ..... heart, cerebral and femoral arteries, and jugular and femoral veins during ...

79

Nimodipine can improve cerebral metabolism and outcome in patients with severe head trauma  

In the present study, the effect of nimodipine was investigated in a patient with severe head trauma. Nimodipine was administered into the peripheral vein to prevent secondary neuronal damages in patients. The five patients in control group were treated according to the standard procedures without nimodipine. Other five patients in nimodipine group were treated with standard procedures plus nimodipine. Cerebral perfusion pressure (CPP), intracranial pressure (ICP), jugular venous oxygen saturation (SjvO2), jugular lactate and glucose levels were measured. Additionally, all patients were evaluated with Glascow outcome score (GOS) before discharge. It was found that CPP (p<0.05) and SjvO2 (p<0.05) were significantly higher; but, ICP (p<0.001), jugular lactate (p<0.05) and jugular glucose (p<...

80

Revascularização do miocárdio no paciente octogenário: 15 anos de observação/ Myocardial revascularization in the octogenarian: fifteen years of observation  

Abstract in portuguese Com o objetivo de avaliar a mortalidade hospitalar atual e comparar a evolução da revascularização convencional do miocárdio nos pacientes octogenários, tratados evolutivamente de Janeiro/1978 a Janeiro/ 1993, no InCór, foram analisados, retrospectivamente, todos os pacientes operados no período. Dos 47 pacientes, 35 (74,46%) eram do sexo masculino e 12 (25,53%) do sexo feminino. A média de idade foi igual a 81,85 (80 a 88) anos. A indicação operatória ocorreu (more) devido ao quadro de angina instável em 29 (61,70%) pacientes, angina estável em 17 (36,17%) pacientes e em 1 (2,12%) paciente devido a dissecção de placa de ateroma quando da realização de angioplastia. As operações foram realizadas em caráter eletivo em 33 (70,21%) pacientes, em caráter de urgência em 10 (21,27%) paciéntese em caráter emergencial nos outros 4 (8,51 %). Os condutos utilizados foram a veia safena autógena em 41 (87,23%) pacientes e a artéria torácica interna pediculada em 6 (12,76%). A mortalidade hospitalar foi de 8,5% e as causas de óbito foram: encefalopatia anóxica, insuficiência respiratória, hemorragia digestiva e choque cardiogênico secundário a infarto agudo do miocárdio. O tempo médio de seguimento foi de 17,6 (1 a 75) meses. As causas de óbito tempo-relacionadas foram: neoplasias em 3 (27,27%) pacientes, infecção em 3 (27,27%) pacientes, acidente vascular cerebral em 2 (18,18%) pacientes, trombose mesentérica em 1 (9,09%) paciente, síndrome depressiva em 1 (9,09%) paciente e choque cardiogênico em 1 (9,09%). Analisando a sobrevida tempo-relacionada, observamos que nos 3 últimos períodos: 91,92 e Janeiro/93 a mortalidade caiu para zero. A grande maioria dos pacientes estava livre de angina e de sinais e/ou sintomas de insuficiência cardíaca. Concluímos que a revascularização convencional do miocárdio representa boa alternativa terapêutica para o paciente octogenário portador de doença arterial coronária, não só devido ao risco operatório decrescente, como também à redução/abolição dos sintomas, melhorando a qualidade e/ou a expectativa de vida. Abstract in english This is a retrospective study where 47 patients submitted to the conventional revascularization of the myocardium were analysed at InCór in a period covering January/78 to January/93; 47 patients were analysed. Thirty-tive (74.46%) were male and 12 (25.33%) female. The mean age was 81.85 (80-80) years. The operatory indication was due to unstable angina in 29 (61.70%), stable angina in 17 (36.17%) and dissection of the atheromatous plaque during angioplasty in 1 (2.12%). (more) The operation was carried out eletively in 33 (70.21 %), in caracter of urgency in 10 (21.27%) and in emergency in 4 (8.51 %). All of them were operated on through median thoracotomy with extracorporeal circulation and moderate hypotermia. The saphenous vein was used as a graft in 41 (87.23%) patients and the internal thoracic artery in 6 (12.76%). Hospital mortality was 8.5% and the mean follow-up time was 17,6 months. From among the early and late deaths only one of each group was related to cardiopathy. Analysis of the cases revealed that in the period of 1991, 1992 and January/1993, hospital mortality fell down to zero. Surgical conventional revascularization of the myocardium represents a good alternative for the octogenarian patient, not only due to the present operative low risk, but as well as the reduction or elimination of the symptoms during the late follow-up.

 
 
 
 
81

Opções técnicas utilizadas no transplante pancreático em centros brasileiros/ Technical options used in pancreatic transplants in brazilian centers  

Abstract in portuguese OBJETIVO: Analisar o perfil dos principais centros de transplantes do Brasil, quanto às opções técnicas no transplante de pâncreas. MÉTODO: Foi encaminhado um questionário por correio eletrônico (email) para um membro de cada equipe de 12 centros de transplante do Brasil, com casuística mínima de um transplante de pâncreas. O questionário continha 10 perguntas, abordando aspectos controversos e não padronizados. RESULTADOS: A maioria dos centros (90,9%) utili (more) za incisão mediana. O órgão de escolha a ser implantado primeiro foi principalmente o rim, em 63% dos centros. Em relação à drenagem venosa, 90,9% utilizam a drenagem sistêmica. A ligadura da veia ilíaca interna é realizada em 54,5% dos centros. A maioria dos centros (90,9%) utiliza a drenagem entérica para transplante combinado pâncreas-rim. Para o transplante de pâncreas isolado, apenas cinco centros responderam, sendo que dois utilizam a drenagem entérica e três a vesical. A utilização de dreno na cavidade abdominal ocorre em 63% dos centros. Em 72,7% dos centros é realizada algum tipo de indução na imunossupressão para o transplante combinado pâncreas-rim, sendo a imunossupressão básica a associação de tacrolimus (FK506), micofenolato mofetil (MMF) e corticóide. A antibioticoprofilaxia é realizada por todos os centros e profilaxia para fungos é realizada por seis centros (54,5%). Oito centros (72,7%) utilizam algum tipo de profilaxia para trombose vascular, em esquemas diversos. CONCLUSÃO: Existem diversos caminhos técnicos na condução do transplante pancreático. A falta de padronização dificulta a análise e a comparação dos resultados. Apesar dessa heterogeneidade das equipes, observamos uma tendência para a realização de incisão mediana, drenagem venosa sistêmica e exócrina entérica, com a utilização de algum tipo de profilaxia para trombose vascular nos transplantes combinados pâncreas-rim. Abstract in english BACKGROUND: To analyze the profile of the most important Brazilian Transplant Centers regarding technical options in the pancreas transplant. METHODS: A query was sent by electronic mail for the 12 Brazilian Transplant Centers with at least one pancreas transplant performed. The query included ten questions approaching controversial and non-standard technical aspects. RESULTS: Midline abdominal incision is used in 90.9% of the Centers. The first organ to be implanted is t (more) he kidney in 63% of the Centers. Regarding the venous drainage, 90.9% perform systemic drainage. In 54.5% of the Centers the internal iliac vein is ligated. For combined pancreas-kidney transplant 90.9% of the teams perform enteric drainage. Five Centers answered about isolated pancreas transplant, two of them use enteric drainage and the other three prefer to utilize the bladder. 63% of the surgical teams use abdominal drain. 72.7% of the Centers adopt immunosupression induction for the combined pancreas-kidney transplant. The basic immunosuppression was an association between tacrolimus (FK506), and mofetil microfenolato (MMF), and corticoids. While antibiotic prophylaxis is performed in all the 12 Centers, fungus prophylaxis is routinely made in six of them. Eight Centers (72.7%) adopt vascular thrombosis prophylaxis by several different protocols. CONCLUSION: There are various technical medical protocols on how to conduct a pancreas transplant patient. The lack of homogeneity in the protocols makes it more difficult to analyze and compare the results. Nevertheless we can conclude that in combined pancreas-kidney transplant there is a preference towards midline abdominal incision, and vein systemic and enteric drainage, and vascular thrombosis prophylaxis.

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Artéria femoral profunda: uma opção como origem de fluxo para derivações infrageniculares/ Deep femoral artery: an option as inflow site in infragenicular bypasses  

Abstract in portuguese CONTEXTO: Na isquemia crítica, a artéria femoral profunda pode tornar-se a opção mais distal como origem de fluxo para derivações distais em casos de oclusão da origem da artéria femoral superficial associada a prega inguinal hostil. OBJETIVO:Avaliar, retrospectivamente, a artéria femoral profunda como doadora de fluxo para derivações infrageniculares. MÉTODOS: De 2000 a 2005, 129 derivações infrageniculares apresentaram anastomose proximal nas artérias fem (more) orais, comum (40), superficial (72) e profunda (17). O presente estudo teve como foco a artéria femoral profunda, e suas indicações foram: prega inguinal hostil (seis casos), limite da extensão do substituto (seis casos) e ambos os fatores (outros cinco casos). Foram abordadas a primeira e a segunda porção em 12 casos e a terceira porção em cinco casos. As cirurgias foram secundárias em 47% dos casos, e os substitutos utilizados foram veias do membro superior em 11 casos, safena interna em cinco e safena externa em um caso. RESULTADOS: No total dos enxertos (129), as estimativas de perviedade primária e salvamento do membro foram: 68,0% e 84,7%, respectivamente, com erro padrão (EP) aceitável (0,1) em 36 meses. Quando o grupo foi estratificado, as artérias femorais comum, superficial e profunda apresentaram resultados comparáveis de perviedade primária (63,3, 70,2 e 64,7%; p = 0,63) e salvamento do membro (83,1, 82,4 e 92,3%; p = 0,78). A perviedade dos enxertos com origem nas porções proximal e distal da artéria femoral profunda, bem como das cirurgias primárias e secundárias, foram comparáveis, sem diferença estatística significante (p = 0,89 e p = 0,77, respectivamente). CONCLUSÃO: A artéria femoral profunda mostrou ser acessível e efetiva como origem de fluxo de enxertos infrageniculares, com resultados satisfatórios de perviedade e salvamento do membro. Abstract in english BACKGROUND: Deep femoral artery can be the most distal technical option as donor site in patients with critical limb ischemia presenting superficial artery occlusion and hostile groins. OBJECTIVE: To retrospectively assess the deep femoral artery as an inflow site for infragenicular bypass grafts. METHODS: From 2000 to 2005, 129 infragenicular bypass grafts with proximal anastomosis located in femoral arteries were performed. Forty were located in the common femoral arter (more) y (CFA), 72 in the superficial femoral artery (SFA) and 17 in the deep femoral artery (DFA). Indications for using the DFA as inflow were hostile groin (six cases), limited arterial substitute length (six cases) or both (five cases). Anastomosis site was located in the first or second portion in 12 cases, and in the third in five cases. The surgery was secondary in 47% of the cases, and the arterial substitutes used were arm veins (11), greater saphenous vein (five) and lesser saphenous vein (one). RESULTS: Primary patency and limb salvage rates were 68.0 and 84.7%, respectively, with acceptable standard error (0.1) in 36 months. The results of patency divided by inflow artery were similar (CFA, 63.3%; SFA, 70.2%; DFA 64.7%; p = 0.63), as well as limb salvage rates (CFA, 83.1%; SFA, 82.4%; DFA 92.3%; p = 0.78). Analyzing the deep femoral group, no difference of patency rates was observed when the anastomotic site was compared (proximal vs. distal portions of the DFA) or between patients with or without previous grafts. (p = 0.89 and 0.77, respectively). CONCLUSION: Deep femoral artery is a feasible and effective option as donor site for infragenicular bypass grafts, with satisfactory patency and limb salvage rates.

83

Artéria gastroepiplóica direita na cirurgia de revascularização do miocárdio/ Gastroepiploic artery in coronary artery bypass grafting  

Abstract in portuguese CASUÍSTICA E MÉTODOS: Entre janeiro de 1996 e julho de 1999, a artéria gastroepiplóica direita (AGED) foi usada como enxerto na revascularização do miocárdio (RM) de 26 pacientes, sendo 25 do sexo masculino, com média de idade de 55,2 anos. Indicamos a operação em pacientes que apresentavam obstruções críticas e/ou totais nas artérias coronárias direita, interventricular anterior e ramos da artéria coronária circunflexa. Angina estável foi diagnosticada (more) em 15 (57,8%) pacientes e angina instável em 10 (38,4%); 1 paciente apresentou isquemia silenciosa. Cinco (19,2%) pacientes foram submetidos à reoperação, sendo em 2 a segunda reoperação. A circulação extracorpórea (CEC) foi usada em 24 pacientes, normotérmica em 18 (75%) e hipotérmica em 6 (25%). Dois, 5 e 19 pacientes apresentavam obstruções em um, dois e três vasos coronários, respectivamente. A AGED foi usada na forma pediculada em 24 pacientes, servindo de enxerto para o ramo interventricular anterior (3), artéria coronária direita (8) e seus ramos descendente (11) e ventricular posteriores (1) e ramo descendente posterior da artéria circunflexa (1). Como enxerto livre, a AGED revascularizou o ramo diagonal em 2 pacientes. Utilizamos, concomitantemente as artérias torácicas internas esquerda e direita, radial esquerda e a veia safena magna para a total RM. RESULTADOS: Angiografia seletiva de controle pós-operatório foi realizada em 12 (46,7%) pacientes. Em 10 (83,4%) visibilizou-se que a AGED estava pérvia, em 1 não foi possível cateterizar o tronco celíaco e no outro o enxerto estava ocluído. Não houve óbito hospitalar/30 dias e todos os pacientes tiveram alta hospitalar assintomáticos. CONCLUSÃO: Concluímos que a AGED, neste estudo, mostrou ser um enxerto seguro para ser utilizado na operação de RM. Abstract in english MATERIAL AND METHODS: From January 1996 to July 1999, the right gastroepiploic artery (RGA) has been used for coronary artery bypass grafting (CABG) in 26 patients (25 male, average age 55.2 years). The surgery was indicated in patients with occlusion or critical coronary disease in the right coronary artery, in the anterior descending coronary artery and in branches of the circumflex coronary artery. Some 15 (57.8%) patients had stable angina, 10 (38.4%) had unstable ang (more) ina and one of them had no clinical signs. There were 5 (19.2%) reoperations, 2 of them were second reoperations. CABG was used in 24 patients; normothermic in 18 and hypothermic in six. Two, 5 and 19 patients had coronary artery disease in one, two and three vessels respectively. RGA was used "in situ" in 24 patients and as a graft in 3 to the anterior descending coronary artery, 11 to the right posterior descending coronary artery, 8 to the right coronary artery, 1 to the right posterior ventricular coronary artery and 1 to the descending posterior vessel of the circumflex coronary artery and as a free graft revascularized the coronary diagonal in 2. The left and the right internal thoracic artery, the left radial artery and the saphenous vein graft were used concomitantly. RESULTS: Postoperative angiography was performed in 12 (46.7%) patients, in 10 (83.4%) of them the RGA was patent, in 1 it was impossible to catheterize the celiac trunk, hence the flow could not be evaluated and in the other patient the graft was occluded. There were no deaths and all patients had an excellent outcome. CONCLUSION: The RGA is a safe graft for CABG.

84

Case of huge neurofibroma expanding extra- and intracranially through the enlarged jugular foramen. CT scan findings and surgical approach  

The surgical approach to the jugular foramen has been considered to be very difficult and troublesome, because of the location in which important structures, such as the internal jugular vein, internal carotid artery and lower cranial nerves, converge in the narrow deep space. A case of huge neurofibroma, which extended from the tentorium cerebelli through the dilated jugular foramen to the level of the vertebral body of C/sub 3/ was presented. A 12-year-old girl was admitted with complaints of visual disturbance and palsy of the V-XII cranial nerves of the left side. Plain skull film showed prominent widening of the cranial sutures and enlargement of the sella turcica. Horizontal CT scan with contrast showed symmetrical ventricular dilatation and a heterogeneously enhanced mass, which was situated mainly in the left CP angle. Coronal CT scan with contrast revealed a huge mass and enlarged jugular foramen, through which the tumor extended to the level of the vertebral body of C/sub 3/. Occlusion of the sigmoid sinus and the internal jugular vein of the left side was noticed in the vertebral angiography. Two-stage approach, the first one for removal of the intracranial tumor and the second one for extracranial tumor, was performed for its huge tumor. Several authors have reported excellent surgical approaches for the tumors situated in the jugular foramen. By our approach, modifying Gardner's original one, a wide operative field was obtained to remove the tumor around the jugular foramen with success. Our approach for the jugular foramen was described with illustrations.

85

Prevalence of jugular bulb abnormalities and resultant inner ear dehiscence: a histopathologic and radiologic study.  

Objective Jugular bulb abnormalities (JBA), including high-riding jugular bulb (HRJB) and jugular bulb diverticulum (JBD), can erode into the inner ear. In this study, the authors investigate the prevalence and consequences of JBA and their erosion into inner ear structures using temporal bone histopathology and computed tomography (CT). Study Design Cross-sectional study of temporal bone histopathology and radiology. Setting Academic medical center. Subjects and Methods In total, 1579 temporal bone specimens and 100 CT of the temporal bones (200 ears) were examined for JBA and any associated dehiscence of inner ear structures. Temporal bone specimens were examined for histological consequences of inner ear erosion. Jugular bulb dimensions were measured on axial CT scans and compared across groups. Accompanying demographic and clinical information were reviewed. Results High jugular bulbs were noted in 8.2% (130/1579) of temporal bone specimens and in 8.5% (17/200) of temporal bone CT. The prevalence of JBA increases during the first 4 decades of life and stabilizes thereafter. High-riding jugular bulbs eroded inner ear structures such as the vestibular aqueduct, vertical facial nerve, or posterior semicircular canal in 2.8% (44/1579) of cases histologically and 1.5% (3/200) radiologically. In most, jugular bulb-mediated inner ear dehiscence was clinically and radiologically silent. Conclusion Jugular bulb abnormalities are common. They are present in 10% to 15% individuals and are primarily acquired by the fourth decade of life. In 1% to 3% of cases, the HRJB erodes into the inner ear and most frequently involves the vestibular aqueduct. PMID:22619257

86

Migration of a Distal Ventriculoperitoneal Shunt Catheter Into the Internal Jugular Vein and Heart Through the External Jugular Vein  

A 6-year-old boy had undergone ventriculoperitoneal (VP) shunt for acute hydrocephalus because of a brain tumor at the age of 11 months, and presented with vomiting and somnolence after the shunt malfunctioned 6 days after VP shunt reconstruction, during which the right external jugular vein was injured during the tunneling process and the peritoneal catheter was not fixed to the peritoneum with a purse string suture. Radiography revealed an abnormal route of the peritoneal catheter, suggesting that the distal VP shunt catheter had migrated into venous vasculature through the right external jugular vein. Computed tomography revealed that the peritoneal catheter had migrated into the internal jugular vein and the right atrium. At surgery, the peritoneal catheter was exposed through a small incision on the subclavicular region, was easily extracted from the internal jugular vein and the heart as there was no coiling or adhesion of the distal catheter to the vascular tissues, and was repositioned into the peritoneum with weak fixing between the subcutaneous tissues of the right subclavicular region and the right abdominal rectus muscle fascia as a temporary emergency measure. Peritoneal shunt migration into the internal jugular vein and the heart through the external jugular vein can be lethal because of pulmonary infarction or arrhythmia, and must be detected as soon as possible. Periodic follow-up radiography should be scheduled after VP shunt placement, even in the absence of symptoms.   

87

Model of septic arthritis by intravenous inoculation of Staphylococcus aureus in Wistar rats/ Modelo de artrite séptica por inoculação de Staphylococcus aureus em ratos Wistar  

Abstract in portuguese Descrição de um modelo experimental de artrite séptica por inoculação monobacteriana de Staphylococcus aureus na veia dorsal do pênis de ratos Wistar. Abstract in english An experimental model of septic arthritis by monobacterial inoculation of Staphylococcus aureus 10.9 in Wistar rats dorsal penis vein is describred.

88

Modelling overlapping functionality  

The reference process for the development of automotive product lines developed in the project VEIA introduces different kinds of models for the representation of architectural views of the system family under development. So far we described the different models for these views and guidelines on ho...

89

Implante de filtro de veia cava com uso de dióxido de carbono como meio de contraste: série de casos/ Carbon dioxide use as contrast for vena cava filter implantation: case series  

Abstract in portuguese OBJETIVO: Avaliar o resultado do implante de filtro em veia cava inferior empregando angiografia digital por subtração com dioxide de carbono (CO2) como meio de contraste. MÉTODOS: No período de abril de 2010 a fevereiro de 2011, sete pacientes foram submetidos ao implante de filtro na veia cava inferior, utilizando-se CO2 como meio de contraste em subtração digital. Os pacientes apresentaram como critério de inclusão trombose venosa profunda no setor ilíaco-femo (more) ral e contraindicação à anticoagulação. RESULTADOS: Foi obtido sucesso técnico em todos os casos, com adequada visualização da veia cava e veias renais, não havendo complicações relacionadas ao uso do CO2 ou ao procedimento. CONCLUSÃO: O implante de filtro de veia cava utilizando o CO2 como meio de contraste é segura e efetiva em pacientes portadores de alergia ao contraste iodado ou com insuficiência renal não dialítica. Abstract in english OBJECTIVE: To assess the use of digital subtraction with carbon dioxide (CO2 ) for vena cava filter implant. METHODS: From April (2)010 to February (2)011, seven patients underwent inferior vena cava filter placement with digital subtraction angiography with the use of CO2 as contrast media. All patients had iliac and femoral deep venous thrombosis and contraindications for anticoagulation. RESULTS: Technical success was achieved in all cases. Inferior vena cava e renal v (more) eins were identified in all cases. There were no evidences of complications related to the use of CO2 during or after the procedure. CONCLUSION: The placement of inferior vena cava filter with CO2 and digital subtraction angiography is safe and effective with good results in patients with renal insufficiency and allergy to iodine.

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[Regional transcranial oximetry with near infrared spectroscopy (NIRS) in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation].  

Using a dual channel near infrared (NIR) in vivo optical spectroscopy (INVOS) system (INVOS 3100A, Somanetics Corp. Troy, MI, USA) we investigated the relationship between jugular venous oxygen saturation (SjvO2) and regional cerebral oxygen saturation (rSO2) in 30 infants and children (mean age 4.5 years) with congenital heart disease undergoing cardiac catheterisation. The NIRS-SomaSensor (emitter and dual receiver probe) was applied at a standardised right fronto-temporal location (over the right frontal cortex) on the infant's head and covered with an adhesive flexible bandage. Using NIR light (730 and 810 nm) and two source-detector spacings (3 and 4 cm from the transmitter), percentage values of rSO2 were calculated from detected haemoglobin saturations. Simultaneously, jugular venous oxygen saturation (SjvO2) monitoring was performed via a catheter placed in the right internal jugular vein with its tip positioned in the jugular bulb, as verified by fluoroscopy. To compare the reliability of NIRS measurement characteristics, jugular venous blood was analysed for SjvO2 as a reference measure of global cerebral oxygenation, by co-oximetry (OSM3-Hemoximeter, Radiometer Copenhagen, Denmark). Other measured variables included pulse oximetry, arterial blood pressure, and venous and arterial oxygen saturations. Over a jugular venous oxygen saturation range of 31-83%, a significant positive linear correlation was found between rSO2 (NIRS measurement) and SjvO2 (jugular bulb oximetry) (r = 0.93, p SjvO2 measurement (method for monitoring global cerebral oxygenation) suggests that NIRS measurement with subtraction algorithm should identify predominantly intracranial saturation in the pediatric age group, and will tend to reflect global oxygenation under physiological conditions. Transcranial oximetry using dual receiving channel NIRS offers a noninvasive, real-time, reliable and practicable means of monitoring cerebral haemoglobin oxygenation changes infants and children with cyanotic and noncyanotic congenital heart disease. PMID:11155535

91

Revascularização do miocárdio com a artéria radial/ Radial artery for coronary artery bypass grafting  

Abstract in portuguese Os enxertos com a artéria radial foram utilizados há mais de 20 anos e praticamente abandonados após constatação de elevadas taxas de oclusão ou estenose em estudos pós-operatórios. Mais recentemente, seu emprego foi reiniciado associado ao uso dos bloqueadores dos canais de cálcio. Nos últimos 6 meses, em 30 pacientes realizamos 31 enxertos aorto-coronários com a artéria radial. Concomitantemente, a artéria torácica interna esquerda foi empregada em todos ( (more) 100%) os pacientes, a artéria torácica interna direita em 9 (30%) pacientes e em 24 (80%) também foram realizadas pontes de veia safena. A média de enxertos por paciente foi de 3,5.0 enxerto de artéria radial foi realizado para a artéria diagonal em 10 (33,3%) pacientes, artéria circunflexa em 8 (26,6%), artéria coronária direita em 8 (26,6%), artéria diagonalis em 4 (13,3%) e artéria interventricular anterior em 1 (3,3%). Quatorze (46,6%) pacientes tinham antecedentes de infarto do miocárdio e em 2 (6,6%) tratava-se de reoperação. Em 3 pacientes realizou-se a endarterectomia coronária e uma dessas artérias recebeu enxerto com artéria radial. A artéria radial esquerda foi utilizada em 28 (93,4%) pacientes e a direita em 2 (6,6%). A artéria radial foi anastomosada à aorta ascendente como enxerto livre, diretamente com sutura contínua de Polipropileno 7-0. Completada a anastomose, a pinça da aorta era removida, para avaliação do fluxo sangüíneo através da artéria radial. Todos os pacientes receberam nifedipina no intra e no pós-operatório, quando se associou o AAS. O calibre da artéria radial variou de 2,5 mm a 3,75 mm e nenhum paciente apresentou sinais de isquemia ou outras alterações na mão. Não houve mortalidade nesta série, nem complicações per-operatórias conseqüentes ao uso do enxerto. O cateterismo precoce, antes da alta hospitalar, foi realizado em 7 (23,3%) pacientes e em todos o enxerto encontrava-se pérvio e sem espasmo (um deles para a artéria submetida a endarterectomia). A artéria radial parece constituir uma alternativa de grande importância na revascularização do miocárdio, especialmente após o advento dos bloqueadores dos canais de cálcio. Entretanto, é necessário maior número de estudos e o seguimento a longo prazo dos pacientes, para conclusões definitivas. Abstract in english The radial artery (RA) was used as a conduit for coronary artery bypass many years ago. Some years later, the graft was abandoned due to of a high incidence of narrowing or occlusion. The advent of new antispastic drugs led us to reinvestigate the use of the RA for coronary artery bypass grafting. Since May 1994,30 patients underwent myocardial revascularization using 31 RA grafts (1 patient received 2 grafts) at our Service. The left internal thoracic artery (LITA) was c (more) oncomitantly used in all (100%) patients, the right internal thoracic artery (RITA) in 9 (30%) patients and a saphenous vein graft in 24 (80%) cases. A mean of 3.5 graft per patient was performed. The RA was anastomosed to the diagonal (n=10/33,3%), circunflex (n=8/26.6%), right coronary (n=8/26.6%), diagonalis (n=4/13.3%) and anterior interventricular artery (n=1/3.3%). Two (6.6%) patients presented for redo coronary surgery and 14 (46%) had prior myocardial infarction. Two patients underwent associated ventricular aneurismectomy and 3 coronary endarterectomy. The left RA was used in 28 (93.4%) patients, and the right RA in the 2 (6.6%) remaining. The RA was used as a free graft. The proximal end of the RA was directly anastomosed to the ascending aorta using a 7-0 Polypropylene suture. After complete, the aortic clamp was removed and the blood flow throught the RA was tested. The distal anastomosis was then performed using a running 7-0 Polypropylene suture. All patientes received diltiazem started intraoperatively and continued at the follow-up period, when the AAS was associated. There was no mortality in this series. Angiographic controls were obtained in 7 (23.3%) patients before the Hospital discharge, with all patent grafts without any abnormality. We have not observed any ischemic symptoms of the hand in this series. We believe that the RA is a valuable alternative procedure to the myocardial revascularization, specially after the advent of new antispastic drugs. However, a larger study including late control angiograms is still required to establish definitive conclusions.

92

Vascular anomalies, sutures and small canals of the temporal bone on axial CT  

Purpose: Subtle bony structures, small canals and fine sutures cause sometimes problems in the analysis of CTs of the temporal bone. The aim of this study was: to analyze the visibility of subtle structures and to estimate the incidence of vascular anomalies. Patients and method: We retrospectively analyzed axial scans of 223 high-resolution CTs of the temporal bone obtained as single slice or spiral CT with 1 mm slice thickness. All CTs had clinical indications. Two experienced radiologists studied CTs regarding the visibility of the fine sutures, fissures and small canals and the occurrence of vascular anomalies. Results: The following structures were seen commonly: sphenosquamosal suture (76%), arcuate artery canal (93%), vestibular aqueduct (89%), mastoid emissary vein (82%), singular canal (56%). Not so commonly were observed: tympanosquamosal suture (31%), mastoid canaliculus (28%), lateral sigmoid sinus (28%), petrotympanic fissure (24%), tympanomastoid suture (10%). Seldom we identified: the inferior tympanic canaliculus (6%), high jugular bulb (6%), anterior sigmoid sinus (5%), dehiscent internal carotid artery canal (2%), persistent petrosquamosal sinus (1%), dehiscent jugular bulb (1%). Persistent stapedial artery, aberrant internal carotid artery, dehiscent jugular bulb, high jugular bulb with diverticulum, anterior and dehiscent sigmoid sinus were detected in below 1% of the analyzed temporal bones. The frequency of asymmetry of the jugular foramen, which varied between 3% and 42%, depended on different criterions of size. Conclusion: A profound knowledge of normal anatomy and anomalies of the temporal bone avoids misinterpretation as pathological lesions and iatrogenic bleedings.

93

Rifampicin-miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy.  

Antimicrobial-impregnated catheters are more expensive than standard catheters (S-C). A higher incidence of catheter-related bloodstream infection (CRBSI) has been found in jugular venous access with tracheostomy than without tracheostomy. The objective of this study was to determine central venous catheter (CVC)-related costs (considering only the cost of the CVC, diagnosis of CRBSI, and antimicrobial agents used to treat CRBSI) using rifampicin-miconazole-impregnated catheters (RM-C) or S-C in jugular venous access with tracheostomy. We performed a retrospective cohort study of patients admitted to the intensive care unit (ICU) with tracheostomy who received one or more jugular venous catheters. RM-C showed a lower incidence of CRBSI compared with S-C (0 vs. 20.16 CRBSI episodes/1,000 catheter-days; odds ratio=0.05; 95% confidence interval=0.001-0.32; p11.46 ± 6.25 vs. 38.11 ± 77.25; p<0.001) in jugular venous access with tracheostomy. The use of RM-C could reduce CVC-related costs in jugular venous access with tracheostomy. The results of our study may contribute to clinical decision-making and selection of those patients who could benefit from the use of antimicrobial-impregnated catheters. PMID:22187350

94

Successful endovascular therapy of a penetrating zone III jugular bulb injury. A case report.  

Penetrating venous injuries via Zone III of the neck extended over jugular bulb are rare. The optimal strategies for these venous injuries are currently unknown because many of the vital structures in this region are poorly accessible to the surgeon and therefore it is difficult to control bleeding. A 76-year-old man got drunk and fell down onto a paper door. The wooden framework of the paper door was broken and got stuck deep in the right side of his neck. Enhanced computed tomography showed the wood stick had penetrated through the right jugular foramen and injured the jugular bulb. We successfully performed right sigmoid and jugular vein occlusion via an endovascular approach using Guglielmi detachable coils at first and then to draw out the wood stick in order to avoid venous bleeding. To our best knowledge, these venous injuries have reported in only four cases. Only one case was performed by endovascular approach using n-butyl cyanoacrylate (NBCA). Coil embolization is much better than NBCA in the light of reducing complications due to adhesion to the inserted wood stick and embolization of unintended vessels. Venous occlusion using coil embolization is the best way to treat a penetrating jugular bulb injury via zone III because of reducing the hemorrhage and air embolism. PMID:22681736

95

Necesidad de radiografía de tórax después del abordaje venoso profundo en pacientes pediátricos cardiópatas/ Need of thorax X-ray film after deep venous approach in children presenting with heart disease  

Abstract in spanish Introducción: La radiografía de tórax puede ser potencialmente omitida en ciertos casos luego de la inserción de un catéter venoso central cuando los médicos aplican una técnica correcta, buen juicio clínico y discriminan bien los casos. Objetivo: Determinar si se puede prescindir de la radiografía de tórax después del abordaje venoso central. Método: Se incluyó en un estudio prospectivo, analítico, descriptivo y observacional 72 pacientes pediátricos progr (more) amados para cirugía cardiaca electiva previo consentimiento informado y aprobación del Comité de Ética. Posterior a la inducción de la anestesia general se colocó un calzo interescapular de 3-5 cm. La cabeza se situó en posición central y extendida, Trendelemburg 15 grados. A nivel del cartílago cricoideo se localizó el pulso carotideo derecho y lateral a este se procedió a puncionar la vena yugular interna. El trocar se dirigió con un ángulo de 45º hacia la mama ipsilateral. Se introdujo el catéter mediante técnica de Seldinger clásica. Se confirmó la posición en la unión atriocava del catéter durante la apertura de la aurícula derecha. En la sala de terapia intensiva se realizó Rx tórax anteroposterior y se recogieron las complicaciones hasta su llegada a esta. Resultados: En todos los casos el catéter quedó colocado de forma correcta y sin complicaciones relacionadas con la posición. Conclusiones: No es necesario el uso rutinario de la radiografía de tórax de control después del abordaje venoso central según la técnica descrita en este trabajo Abstract in english Introduction: Thorax X-ray film may be potentially missed in some cases after insertion of a central venous catheter when physicians apply an appropriate technique, a good clinical criterion and a deep discrimination of cases. Objective: To determine if it possible to omit of thorax X-ray film after the central venous approach. Method: In a observational, descriptive, analytical and prospective study authors included 72 children candidates to elective cardiac surgery prev (more) ious informed consent and the approval of the Ethics Committee. After anesthesia induction a 3-5 cm intercapsular wedge was placed. Head was placed in central and extended position, Trendelemburg 15º. At level of cricoid cartilage the right and carotid pulse was localized and lateral to it the puncture of internal jugular vein was made. Trocar was directed in a 45º angle towards the ipsilateral breast. The catheter was introduced by the classic Seldinger technique. The location in the atriocaval junction during the opening of right atrium was confirmed. In the intensive therapy service the anteroposterior thorax X-ray film was made signaling the complications until its arrival. Results: In all the cases the catheter remains placed in a proper way and without complications related to position. Conclusions: The systematic use of a control thorax X-ray film it is not necessary after the central venous approach according the technique described in present paper.

96

Pig liver sectorization and segmentation and virtual reality depiction/ Setorização e segmentação hepática do suíno e sua representação em realidade virtual  

Abstract in portuguese OBJETIVO: Determinar a setorização e a segmentação do fígado do suíno da raça Landrace, apresentando a sua relação com a veia porta e com as veias hepáticas, e desenvolver uma animação em realidade virtual. MÉTODOS: Foram obtidos 20 moldes por meio de injeção de uma solução de metil metacrílico nas veias hepáticas e porta, e corrosão do parênquima hepático com ácido clorídrico a 35%. Um desses moldes serviu como base para se desenvolver uma animaç (more) ão em realidade virtual do órgão utilizando-se o programa de computação gráfica 3D Studio Max. RESULTADOS: Observou-se a presença constante de oito segmentos e seis setores de drenagem venosa. Não se constatou uma bifurcação na veia porta do suíno. As veias hepáticas foram nomeadas com base na origem embriológica. Por meio da animação obtida, estabeleceu-se a relação entre o sistema venoso e o parênquima hepático. CONCLUSÕES: Os moldes permitiram o estudo dos setores e dos segmentos hepáticos do suíno, com a proposição de uma nomenclatura das veias hepáticas. Além disso, possibilitaram o desenvolvimento de um molde em realidade virtual, cuja animação mostra a relação do parênquima hepático com o sistema venoso do fígado do suíno e a sua observação por vários ângulos. Abstract in english OBJECTIVE: To determine pig liver sectorization and segmentation through the representation of their correlation to portal and hepatic veins, and through the development of virtual reality (VR) animation. METHODS: Twenty models were obtained by injection of portal and hepatic veins from Landrace pig livers with a methyl methacrylate solution, and by corrosion of the hepatic parenchyma with chloride acid 35%. VR animation of one of these models was conducted through graphi (more) c software (3D Studio Max 3.0). RESULTS: Constant presence of eight segments and six venous drainage sectors was observed. Pig portal vein bifurcation was not noticed. Hepatic veins were named according to their embryological origin. Correlation between venous system and hepatic parenchyma was established by means of VR animation. CONCLUSION: These models facilitated both the study of pig hepatic sectors and segments, and the proposal of hepatic veins nomenclature. These models have also been used for the development of VR animated models which show the correlation between the hepatic parenchyma and the pig liver venous system as well as the observation of them from several points of view.

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Experiência clínica com a utilização de plugs vasculares Amplatzer®/ Clinical experience with Amplatzer® vascular plugs  

Abstract in portuguese INTRODUÇÃO: Os plugs vasculares Amplatzer® I e II (PVAs I e II) são dispositivos de nitinol autoexpansíveis e de baixo perfil desenvolvidos para oclusão de estruturas vasculares. Relatamos nossa experiência com esses dispositivos em dois centros brasileiros de referência. MÉTODOS: Estudo retrospectivo dos pacientes que se submeteram a procedimentos de oclusão de estruturas vasculares diversas com PVAs desde 2005. Foram utilizadas próteses 30% a 50% maio (more) res que o vaso-alvo, implantadas sob anestesia geral por via venosa femoral e jugular interna ou arterial femoral e braquial por cateteres terapêuticos ou bainhas longas 5 F a 8 F. RESULTADOS: Foram identificados 14 pacientes (50% do sexo masculino) com mediana de idade de 5 anos (11 meses a 70 anos) e mediana de peso de 15 kg (8 kg a 67 kg). Foram utilizados 17 plugs vasculares, sendo 2 PVAs II e 15 PVAs I, com diâmetros de 4 mm a 16 mm. Em 3 pacientes existiam dois vasos para oclusão, sendo utilizados 2 PVAs em vasos diferentes. Em 3 pacientes com fístulas coronárias houve oclusão completa dos vasos após 24 horas. Em 2 pacientes com anastomose de Blalock-Taussig houve oclusão completa da anastomose, em um deles com auxílio de molas adicionais. Em 3 pacientes com fístulas venovenosas no pós-operatório de Glenn ou Fontan houve oclusão completa dos vasos e melhora da saturação, em um deles com auxílio de molas adicionais. Outro caso de fístula venovenosa apresentava fluxo residual discreto no laboratório, com oclusão na monitorização ecocardiográfica em 24 horas. Em 2 pacientes com fístula arteriovenosa pulmonar foram utilizados, além dos PVAs, outras próteses Amplatzer e molas de Gianturco, permanecendo mínimo fluxo residual em ambos os casos. Em 2 pacientes com colaterais sistêmicopulmonares no pós-operatório de atresia pulmonar com comunicação interventricular, houve oclusão completa com auxílio de molas, sendo um imediato e outro em 24 horas. Em um paciente com síndrome da cimitarra a colateral sistêmica foi ocluída totalmente. Não houve episódios de embolização ou mortalidade. CONCLUSÕES: Os PVAs mostraram-se adequados e versáteis para oclusão de diferentes estruturas vasculares, com facilidade de implante e bons índices de oclusão. Em alguns casos, houve necessidade de uso de outros dispositivos. Nesses casos, os PVAs funcionam bem para ancorar os dispositivos adicionais. Abstract in english BACKGROUND: The Amplatzer® vascular plugs I and II (AVPs I and II) are low profile self-expandable devices made of nitinol, designed for vascular occlusions. We report our experience with these devices in two tertiary referral hospitals. METHODS: Retrospective study of patients undergoing vascular occlusion procedures with AVPs since 2005. The devices were 30%-50% larger than the target vessel, deployed under general anesthesia via femoral and internal jugular ve (more) in or femoral and brachial artery, and delivered through guiding catheters or 5 F to 8 F long sheaths. RESULTS: Fourteen patients (50% male) at a median age of 5 years (11 months to 70 years) and a median weight of 15 kg (8 kg to 67 kg) were identified. Seventeen AVPs were used: 2 AVPs II and 15 AVPs I, with a diameter ranging from 4 mm to 16 mm. In 3 patients with more than one vessel to occlude, 2 AVPs were implanted in each vessel. In 3 patients with coronary fistula total occlusion of the vessels occurred after 24 hours. In 2 patients with modified Blalock-Taussig shunts, there was total occlusion of the anastomosis, with the use of additional coils in one. In 3 patients with venovenous fistulas after Glenn or Fontan operations, there was complete occlusion of the vessels and improved saturation, with the use of additional coils in one. Another patient with venovenous fistula had mild residual shunt in the lab and total occlusion observed at echocardiographic monitoring within 24 hours. Two patients with multiple pulmonary arteriovenous malformations underwent closure using the AVP, other Amplatzer devices and Gianturco's coils, with minimal residual shunts in all cases. In 2 patients with systemic-pulmonary collaterals in the postoperative period of pulmonary atresia and VSD repair, there was complete occlusion with the aid of additional coils, one immediately after the procedure and the other within 24 hours. In one patient with scimitar syndrome the systemic collateral vessel was totally occluded. There was no embolization or death. CONCLUSIONS: The AVPs were appropriate and flexible devices for occlusion of different vascular sites, with easy deployment and good occlusion rates. Additional coils were required in some cases. In these cases, AVPs worked well to anchor the coils.

98

Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature  

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The T...

99

Hemomediastinum resulting from subclavian artery laceration during internal jugular catheterization.  

The complications associated with internal jugular vein catheterization are inadvertent arterial puncture, pleural and mediastinal injuries, pneumothorax, hemothorax, and hemomediastinum. Complications caused by laceration of a subclavian artery are rare. We present a case of hemomediastinum resulting from laceration of the subclavian artery during central venous catheterization. After right internal jugular vein catheterization, the left lateral decubitus position was maintained for 6 h during surgery. The severe hypotension was first noted in the supine position after transfer to the postanesthesia care unit. Chest radiograph showed a bulging of the right upper mediastinum. During the upper half sternotomy, a 5-mm long laceration was found at the posteroinferior side of the right subclavian artery near its origin from the innominate artery. IMPLICATIONS: The authors describe the delayed presentation of hemomediastinum resulting from subclavian artery laceration after internal jugular vein catheterization. PMID:14570633

100

Internal jugular vein cannulation: an ultrasound-guided technique versus a landmark-guided technique  

Abstract in english OBJECTIVES: To compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients. METHODS: A total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter plac (more) ement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded. RESULTS: The overall complication rate was higher in the landmark group than in the ultrasound-guided group (p

 
 
 
 
101

Early and Late Retrieval of the ALN Removable Vena Cava Filter: Results from a Multicenter Study  

Retrieval of removable inferior vena cava (IVC) filters in selected patients is widely practiced. The purpose of this multicenter study was to evaluate the feasibility and results of percutaneous removal of the ALN removable filter in a large patient cohort. Between November 2003 and June 2006, 123 consecutive patients were referred for percutaneous extraction of the ALN filter at three centers. The ALN filter is a removable filter that can be implanted through a femoral/jugular vein approach and extracted by the jugular vein approach. Filter removal was attempted after an implantation period of 93???15 days (range, 6?722 days) through the right internal jugular vein approach using the dedicated extraction kit after control inferior vena cavography. Following filter removal, vena cavograms...

102

Transverse Sinus Thrombosis After Internal Jugular Vein Ligation  

Background: Cerebral vein and dural sinus thrombosis is a rare condition with a wide range of causes and a highly variable presentation. It can lead to significant morbidity, but scant literature is available describing diagnosis and treatment when this occurs after ligation of the internal jugular vein. Objectives: To discuss potential risk factors for cerebral vein and dural sinus thrombosis after ligation of the internal jugular vein, and present current options for diagnosis and treatment. Case Report: A 23-year-old male construction worker was brought to the Emergency Department by Emergency Medical Services after sustaining a severe neck laceration from a hand-held grinder. He was treated with ligation of the left internal jugular vein, but subsequently developed severe headaches and...

103

Migration of Ventriculoperitoneal Shunt into the Heart  

A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. Three-dimensional computed tomography demonstrated penetration of the catheter into the internal jugular vein. Under local anesthesia, part of the peritoneal catheter was pulled out through the cervical incision and cut off. The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity.   

104

Cerebral Oxygenation Impairment and S-100? Protein Release During Off-Pump Coronary Artery Revascularization.  

OBJECTIVE: To elucidate the magnitude of global cerebral oxygenation impairment, using cerebral oxygenation indices and S-100? protein as potential markers, during off-pump coronary artery bypass grafting (OPCAB). DESIGN: Prospective cohort study. SETTING: Tertiary cardiac center. PARTICIPANTS: Thirty-five patients undergoing OPCAB. INTERVENTIONS: Jugular bulb and arterial blood samples for cerebral oxygenation indices (arterial oxygen and carbon dioxide partial pressures, jugular bulb oxygen saturation, arterial-jugular bulb oxygen content, arterial-jugular carbon dioxide partial pressure, brain oxygen extraction ratio, and estimated respiratory quotient) and S-100? protein determination were collected at anesthesia induction; anterior, inferior, and posterior wall anastomoses; after sternal closure; and 6 hours postoperatively. Concomitant hemodynamic data were obtained. The S-100? determination was extended to 12 and 24 hours postoperatively. MEASUREMENTS AND MAIN RESULTS: Heart positioning for the target vessel exposure induced significant hemodynamic deterioration (p dislocation (p < 0.001), they remained within normal limits. Hemodynamic and cerebral oxygenation statuses reverted to baseline within 6 hours postoperatively. Similarly, S-100? jugular bulb and arterial protein levels presented a gradual increase, which peaked by the end of surgery (means, 0.54 and 0.62 ?g/L, respectively; p < 0.001) and then decreased by the first postoperative day. Jugular bulb-arterial S-100? levels were maximized during posterior wall anastomosis (0.098 ?g/L; p < 0.01). CONCLUSION: Although exposure of the 3 main coronary arteries during OPCAB promotes derangement of the cerebral oxygen indices and S-100? release, this seems to be transient, remains within the near-normal range, and is reversible almost completely 6 hours postoperatively. PMID:22818497

105

Right Atriotomy Using Total Venous Inflow Occlusion for Removal of Heartworms in a Cat  

Heartworm infection with caval syndrome was detected in a thirteen-year-old male cat. However, removal of the heartworms via a jugular venotomy was infeasible because the size of the jugular vein limited our ability to use flexible alligator forceps. Therefore, a right atriotomy using total venous inflow occlusion was performed to remove the heartworms. The procedure was accomplished successfully, and the cat recovered from its symptoms. The present case suggests that right atriotomy using venous inflow occlusion is practical for removal and prevention of rupture of heartworms.   

106

Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach  

Background Infraclavicular approach of the subclavian veins is commonly used for central venous access. However, aberrant catheter tip locations are frequently quoted for this approach. It was hypothesized that with the shoulder pulled downwards, the angle between the internal jugular and subclavian veins may increase, directing subclavian catheters into the internal jugular vein. This prospective study assessed the influence of the shoulder position on proper placement of right infraclavicular subclavian catheters. Methods Patients who required subclavian central venous catheterization for major neurosurgical and thoracic procedures were randomly divided into two groups: neutral (n=180) vs lowered (n=181) shoulder position. The right shoulder was placed and maintained in the...

107

Radiological features of Lemierre's syndrome: A case report; Manifestaciones radiologicas del sindrome de Lemierre: a proposito de un caso  

Lemierre's syndrome is a type of sepsis caused by anaerobes that is secondary to a pharyngotonsillar infection complicated by suppurative thrombophlebitis of ipsilateral jugular vein and septic emboli. Imaging studies are valuable tools for confirming the diagnosis. Chest x-ray reveals poorly defined cavitated, peripheral, nodular lesions. computed tomography (CT) is useful in confirming the pulmonary lesions, which are suggestive of septic emboli. Doppler ultrasound of the neck plays and indispensable role in demonstrating the internal jugular vein thrombosis. We report the case of patient who presented the characteristic clinical and radiological features of Lemierre's syndrome. (Author) 17 refs.

108

No increase of calcitonin gene-related peptide in jugular blood during migraine  

Increased calcitonin gene-related peptide (CGRP) in external jugular venous blood during migraine attack is one of the most cited findings in the headache literature. The finding has not been convincingly reproduced and is based on comparison with historic control subjects. The validity of this finding is important for the understanding of migraine. We therefore investigated the issue using an intrapatient comparison design and two different CGRP assays. We sampled blood from the external jugular and cubital vein during, as well as outside of, an attack of migraine without aura. We succeeded in 17 patients, whereas only cubital fossa blood could be sampled in an additional 4 patients. CGRP was measured with the same assay as most previous studies (assay I) and furthermore with a more sensitive and validated assay (assay II). For assay I, mean CGRP concentration in external jugular venous blood during attack was 17.18 pmol/L compared with 15.88 pmol/L outside of attack. Mean difference was 1.81 pmol/L (95% confidence interval [CI]: -2.88, 6.41; p = 0.44). In peripheral blood during attack, CGRP was 16.86 pmol/L compared with 17.57 pmol/L outside of attack. Mean difference was -0.79 pmol/L (95% CI: -4.64, 3.06; p = 0.69). For assay II, external jugular venous blood concentration of CGRP during attack was 32.59 pmol/L compared with 30.59 pmol/L outside of attack; mean difference was 2.00 pmol/L (standard error, 2.39; 95% CI: -3.07, 7.07; p = 0.416). In peripheral blood during attack, CGRP was 33.37 pmol/L compared with 31.84 pmol/L outside of attack; mean difference was 1.53 pmol/L (standard error, 1.90; 95% CI: -2.46, 5.51; p = 0.431). Thus, no difference between CGRP level in external jugular or cubital fossa blood during and outside of attack was found. No difference was found between external jugular and peripheral venous blood. Thus, previous findings of increased CGRP level in external jugular or cubital fossa venous blood could not be confirmed. Our finding strongly suggests that CGRP is not increased in jugular venous blood during migraine without aura. CGRP cannot be used as a biomarker to validate human or animal models of migraine.

109

Review of Venous Anatomy for Venographic Interpretation in Chronic Cerebrospinal Venous Insufficiency  

Chronic cerebrospinal venous insufficiency (CCSVI) represents a recently described condition that may potentially contribute to the symptoms experienced by patients with multiple sclerosis. The evaluation of a prospective patient for CCSVI often involves an invasive evaluation with venography of the internal jugular and azygos veins. The purpose of this article is to review the normal anatomy of the internal jugular, vertebral, and azygos veins, as an understanding of these veins is necessary for appropriate interpretation of the venograms obtained to evaluate patients for CCSVI.

110

Review of venous anatomy for venographic interpretation in chronic cerebrospinal venous insufficiency.  

Chronic cerebrospinal venous insufficiency (CCSVI) represents a recently described condition that may potentially contribute to the symptoms experienced by patients with multiple sclerosis. The evaluation of a prospective patient for CCSVI often involves an invasive evaluation with venography of the internal jugular and azygos veins. The purpose of this article is to review the normal anatomy of the internal jugular, vertebral, and azygos veins, as an understanding of these veins is necessary for appropriate interpretation of the venograms obtained to evaluate patients for CCSVI. PMID:21975259

111

Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency.  

Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units. PMID:21803799

112

Cholinesterase modulations in patients with acute bacterial meningitis  

Abstract Background. The circulating cholinesterases acetyl- and butyrylcholinesterase may be suppressed and subsequently released from the brain in acute bacterial meningitis. Methods. We report serum activities of acetylcholinesterase and butyrylcholinesterase in paired arterial and jugular venous samples from seven patients with acute bacterial meningitis and eight healthy controls. Paraoxonase 1, which protects these enzymes from oxidative inactivation, was also measured. Findings and conclusion. Acetyl- and butyrylcholinesterase activities were lower in patients, independently of changes in paraoxonase 1. Arterial and jugular venous enzyme activities were similar both in patients and controls, suggesting that no cerebral release was present.

113

Is a Neutral Head Position as Effective as Head Rotation During Landmark-Guided Internal Jugular Vein Cannulation? Results of a Randomized Controlled Clinical Trial  

Objective Central venous access remains a cornerstone procedure for a variety of clinical conditions. Ultrasound studies suggest that rotation of the head increases the magnitude of the overlap of the internal jugular vein with the carotid artery. The authors assessed whether a neutral position of the head during anatomic landmark-guided cannulation of the internal jugular vein (IJV) was an attractive alternative to rotating the neck to a >45° head turn. Design A prospective, randomized, controlled study. Setting An education and research hospital and a university-affiliated hospital. Participants Eighty patients requiring central venous catheterization in the right IJV. Interventions Under general anesthesia, patients were positioned in the Trendelenburg position with extens...

114

Use of transcranial Doppler ultrasonography and jugular oximetry to optimize hemodynamics during pediatric posterior fossa craniotomy  

We describe a 13-year-old child who developed inadvertent intraoperative cerebral oxygen desaturation attributed to empiric hyperventilation during posterior fossa craniotomy, diagnosed by jugular venous oximetry. Although restoration of normocapnia at age-appropriate mean arterial blood pressure improved jugular venous saturation (SjvO2), it remained below acceptable values. Transcranial-Doppler (TCD) ultrasonography-guided stepwise increase in mean arterial pressure led to a linear increase in the mean flow velocity of the middle cerebral artery and SjvO2 to desirable values. Intraoperative SjvO2 monitoring and TCD ultrasonography may be utilized together to individualize hemodynamic targets and ventilation parameters and maintain adequate cerebral oxygenation during paediatric craniotom...

115

Nova técnica cirúrgica de preparo da veia safena para revascularização do miocárdio sem manipulação direta - no-touch/ Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting  

Abstract in portuguese FUNDAMENTO: Otimização da veia safena na revascularização miocárdica. OBJETIVO: Apresentar a técnica no-touch de preparo da veia safena. Essa técnica consiste na retirada da veia safena do seu leito, com um pedículo de tecido adiposo, protegendo-a contra espasmos, sendo desnecessário distendê-la. MÉTODOS: Estudo prospectivo e randomizado, incluindo 156 pacientes submetidos a cirurgia de revascularização miocárdica. Comparação da técnica no-touch com duas (more) outras técnicas: convencional e intermediária. Procedeu-se à avaliação da morfologia endotelial, utilizando a microscopia. A perviabilidade das pontes foi determinada com exame angiográfico num período médio de 18 meses após a operação. A enzima óxido nítrico sintetase endotelial (eNOS) foi identificada por meio do estudo imunohistoquímico. RESULTADOS: A avaliação morfológica mostrou integridade endotelial de 97% nas veias do grupo no-touch; enquanto quase metade da superfície endotelial das veias tratadas pelas outras técnicas exibiu ausência de células endoteliais. A angiografia revelou perviabilidade de 95,4% para as pontes do grupo no-touch, 88,9 e 86,2% para as pontes do grupo convencional e intermediária, respectivamente. O estudo imunohistoquímico revelou a presença da eNOS nas três camadas que compõem a parede da veia no grupo no-touch e redução dessa enzima no grupo convencional. CONCLUSÃO: A integridade endotelial e a atividade da eNOS foram melhor preservadas com o uso da técnica no-touch. A proteção mecânica fornecida pelo tecido gorduroso circundante à veia e a atividade vasodilatadora e bloqueadora da agregação plaquetária causada pelo óxido nítrico podem ser responsáveis pela proteção da veia contra o espasmo, como também por sua alta perviabilidade imediata. Abstract in english BACKGROUND: Optimization of the saphenous vein for myocardial revascularization. OBJECTIVE: To present the no-touch technique of the saphenous vein preparation. This technique consists of harvesting the vein with a pedicle of surrounding tissue, which protects the vein from spasms, obviating the need for distension. METHODS: A prospective, randomized study with 156 patients who underwent artery bypass grafting was performed comparing three saphenous vein harvesting techni (more) ques: conventional, intermediate, and no-touch. A morphological study of the endothelium was carried out using scanning microscopy. An angiographic assessment of the vein graft patency was performed at a mean follow-up time of 18 months. Also, an immunohistochemical assessment was carried out to identify the endothelial enzyme nitric oxide synthase (eNOS) in the vein wall RESULTS: The preservation of the endothelial cell integrity was greater in the no-touch technique than in the other procedures. At angiographic follow-up, the patency for the no-touch group was 95.4%, 88.9% for the grafts of the conventional technique group, and 86.2% for the grafts performed in the intermediate technique group. The immunohistochemical assessment revealed eNOS in all three layers of the vein wall in the no-touch group and reduction of this enzyme in the conventional group. CONCLUSION: The endothelial integrity and eNOS activity were better preserved when using the no-touch technique for vein graft harvesting. The mechanical protection provided by the cushion of surrounding tissue in the no-touch group, the vasorelaxation and thromboresistant activities of nitric oxide may be responsible for the reduction of vasospasms and improved patency rate.

116

Vein of Galen aneurysm in an adult: case report/ Aneurisma da veia de Galeno em adulto: relato de caso  

Abstract in portuguese Aneurisma da veia de Galeno é patologia rara, representando menos de 1% das malformações vasculares intracranianas. Apresentamos o caso de um homem de 65 anos que teve episódio de crise convulsiva tônico-clônica generalizada. Exames de imagem evidenciaram grande processo expansivo calcificado na região pineal, confirmando o diagnóstico de aneurisma trombosado de veia de Galeno. Devido à trombose espontânea da malformação, foi excluída a possibilidade de tratamento endovascular bem como microcirúrgico, mantendo-se o acompanhamento clínico. Abstract in english Vein of Galen aneurysm is a rare pathology, representing less than 1% of intracranial vascular malformations. We report on a 65 years-old man who experienced a generalized tonic-clonic seizure. Brain imaging showed a large calcified expanding mass in the pineal region, confirming the diagnosis of a vein of Galen aneurysm. Because of the spontaneous thrombosis of the malformation, there was no need for microsurgical or endovascular treatment and he is been regularly followed since that.

117

Agenesia de veia cava inferior associada à trombose venosa profunda/ Agenesis of inferior vena cava associated with deep venous thrombosis  

Abstract in portuguese A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior. Abstract in english The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

118

Método trigonométrico para o acesso à veia basílica no terço distal do braço/ Trigonometric method to the anatomo-surgical approach of the basilic vein in the arm distal third  

Abstract in portuguese OBJETIVO: Determinar parâmetros anátomo-cirúrgicos para o acesso rápido, seguro e preciso da veia basílica no terço distal do braço e avaliar os aspectos anatômicos relacionados à presença, número e sintopia neural na região. MÉTODO: Foram utilizados 30 membros superiores de cadáveres adultos, brasileiros, do sexo masculino (27 a 58 anos), fixados em solução de formalina a 10%. Foi criado um método trigonométrico utilizando-se parâmetros anatômicos, de (more) terminando-se um triângulo cujo ápice foi o ponto de referência para a localização da veia basílica no terço distal do braço. A região foi dissecada e a veia exposta. O método foi também utilizado na dissecação venosa de 15 pacientes. RESULTADOS: A veia basílica foi encontrada na face medial do terço distal do braço de todos os cadáveres, localizando-se no ápice do trígono em 70% dos casos e em situação medial em relação ao mesmo em 30%. Em 83,33% havia ramos dos nervos cutâneos mediais do braço e antebraço junto à adventícia da veia basílica. Foram encontrados dois ramos dos nervos cutâneos mediais do braço e antebraço relacionados a cada veia basílica em 90% dos membros superiores e apenas um ramo no restante. Em 30% dos casos existiam ramos posteriores à veia basílica, o que deve ser considerado ao se realizar a dissecação da mesma. CONCLUSÕES: O método proposto para a localização da veia basílica mostrou-se eficaz, rápido, seguro e preciso, indicando ser uma boa opção de acesso venoso no paciente em estado crítico que necessite de tal procedimento. Abstract in english BACKGROUND: To determine anatomo-surgical parameters to fast, safe and precise approach to the basilic vein in the arm distal third and to assess anatomic features related to the presence, and nerve sintopy in the region. MATERIAL AND METHODS: The study was made in 15 human corpses, from male adults aged 27 up to 58 years old, summing up 30 upper limbs, fixed in 10% formalin. It was created a trigonometric method using anatomic parameters to determine a triangle which ape (more) x was the reference point to locate the basilic vein in the arm distal third. The region was dissected, the vein exposed, its diameter assessed with a caliper. The method was utilized to perform the basilic vein dissection in 15 patients that required the venous approach. RESULTS AND CONCLUSION: The basilic vein was found in the medial surface of arm distal third in all studied cadavers. The vein was located on the triagle apex in 70% of the cases (87% of the right and 53% of the left upper limbs). In 30% of the specimens the vein was placed medially to the triangle apex, the distance did not exceeded 5mm. In 83,33% of the specimens there were branches of the medial cutaneous nerves of arm and forearm against the vein adventitia. It was found two branches of the medial cutaneous nerves of arm and forearm related to each basilic vein in the majority of the upper limbs (90% - 27 limbs) and only one branch in the remaining (10 % - 3 limbs). In 30% of the cases there were branches located behind the basilic vein, this fact must be considered when the basilic vein dissection is made. The proposed method to the basilic vein location showed to be fast, safe and precise, indicating that the method is a good option to the vascular approach in patients in critical conditions that demand this procedure.

119

Anomalous sub aortic left brachiocephalic vein: a case report/ Veia braquiocefálica esquerda subaórtica anômala: relato de caso  

Abstract in portuguese A veia braquiocefálica esquerda, ocasionalmente, segue curso aberrante. Esta variação freqüentemente está associada com anomalias congênitas do coração. Neste trabalho é apresentado um caso de veia braquiocefálica esquerda anômala, com trajeto subaórtico, sem anormalidade cardíaca. A tomografia computadorizada com multidetectores é muito útil no correto diagnóstico dessa condição e permite a conclusão diagnóstica, sem quaisquer outras investigações. Abstract in english The left brachiocephalic vein occasionally follows an aberrant course. It is usually associated with congenital cardiac anomaly. We present a case of anomalous left brachiocephalic vein which followed a sub aortic course, with no cardiac abnormality. Multi detector computed tomography is very useful in accurate diagnosis of this condition and prevents any further investigation in cases of isolated abnormalities.

120

Trauma da Veia Porta/ Portal vein injury  

Abstract in portuguese OBJETIVO: O trauma da veia porta é raro e freqüentemente fatal por causa de exsanguinação e alta incidência de lesões de estruturas adjacentes. Devido às pecualiaridades desta lesão e diferentes condutas propostas na literatura, o objetivo dos autores é relatar a experiência neste tipo de lesão. MÉTODO: Estudo retrospectivo, de janeiro de 1994 e dezembro de 2001, de 1370 pacientes submetidos à laparotomia devido trauma abdominal. Entre esses, 15 pacientes apr (more) esentavam lesão da veia porta. As lesões foram classificadas conforme a sua extensão e localização. RESULTADOS: O mecanismo de trauma predominante foi o penetrante. O diagnóstico da lesão foi realizado no intraoperatório. Os procedimentos executados foram: sutura, anastomose término-terminal e ligadura da veia porta. A mortalidade foi de 53,3%. CONCLUSÃO: A lesão da veia porta possui alta taxa de mortalidade e o atendimento adequado está diretamente relacionado à sobrevida. Abstract in english BACKGROUND: Portal vein injury is rare and frequently lethal because of exsanguination and high incidence of injuries to the adjacent structures. Due the peculiarity of this lesion and different conducts proposed in the literature, the authors' objetive is to report their experience in the treatment of this lesion. METHODS: This study, is a retrospective analysis between January 1994 and December 2001, during which 1370 patients were treated with laparotomy for isolated a (more) bdominal trauma. Among these patients 15 had injury to the portal vein. The injuries were classified according to extension and location. RESULTS: The predominant mechanism of trauma was penetrating. The diagnosis was made intraoperatively. The procedures were: suture, end-to-end anastomosis and ligation of the portal vein. The mortality rate was 53,3%. CONCLUSION: Portal vein lesion had high mortality and advanced assistance is essential to increase survivors.

 
 
 
 
121

Fístula arteriovenosa dural intracraniana com drenagem perimedular: relato de caso/ Intracranial dural arteriovenous fistula draining into spinal cord veins: case report  

Abstract in portuguese Apresentamos um caso típico de fístula arteriovenosa dural intracraniana com drenagem para o plexo venoso peribulbar e veias perimedulares. Discutimos seus aspectos etiológicos e fisiopatológicos, bem como os critérios de diagnóstico e tratamento deste tipo de lesão. Abstract in english We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its ethiological, physiopathological, diagnostic and therapeutic aspects.

122

Glycol methacrylate-embedding medium to study morphological alterations of saphenous vein under brief and crescent pressurizations/ Inclusão em glicol metacrilato para estudar alterações morfológicas de veias safenas humanas submetidas a pressurizações breves e crescentes  

Abstract in portuguese OBJETIVO: Avaliar a inclusão em glicol metacrilato para estudar alterações morfológicas de veias safenas humanas submetidas a pressurizações breves e crescentes. MÉTODOS: Veias safena de 20 pacientes submetidos a cirurgia de revascularização do miocárdio foram distribuídas ao acaso em quatro grupos experimentais (controle, pressões de 100, 200 e 300 mmHg durante 15 segundos). Para quantificar a percentagem da superfície venosa recoberta por endotélio utilizo (more) u-se o aumento de 100x. A análise morfométrica foi realizada utilizando-se videomicroscopia com auxílio do software Leica Qwin em conjunto com um microscópio Leica e videocâmera, acoplados a um computador. RESULTADOS: Observou-se uma leve tendência de aumento quantitativo de todos os parâmetros avaliados, incluindo a percentagem de superfície recoberta por endotélio e a espessura das paredes das veias safenas. CONCLUSÕES: A inclusão em glicol metracrilato permitiu secções com adequada resolução dos detalhes estruturais, revelando-se um método extremamente útil para o estudo de veias safenas humanas pressurizadas. Abstract in english PURPOSE: This study sought to evaluate the efficiency of glycol methacrylate-embedding medium to detect morphological alterations of human saphenous vein submitted to brief and crescent pressurizations. METHODS: Saphenous veins of 20 CABG patients were randomly distributed into four experimental groups (control, 100, 200 and 300 mmHg pressures during 15 seconds). To quantify the percentage of endothelium spread over vein surface a microscope magnification of 100x was used (more) for measurements. Morphometric analysis was performed using videomicroscopy with the Leica Qwin software in conjunction with a Leica microscope, videocamera, and an on-line computer. RESULTS: A slight tendency of quantitative increase was observed in all parameters including percentage of endothelium spread over vein surface and thickness of saphenous vein walls (intima and media layers). CONCLUSIONS: The glycol methacrylate-embedding allowed sections with adequate resolution of structural details and revealed to be an extremely useful method to study pressurized human saphenous veins.

123

A veia gástrica esquerda como alternativa de revascularização portal no transplante hepático/ Left gastric vein as an alternative of portal revascularization in liver transplant  

Abstract in portuguese Trombose ou hipoplasia da veia porta não tem sido, ainda, considerados contra-indicações para o transplante ortotópico de fígado. Contudo, permanecem com obstáculos associados com aumento da freqüência de falha primária e a longo prazo do transplante de fígado. Existem alguns fatores de risco tais como: sexo masculino, cirrose avançada, doença hepática alcoólica e cirurgia prévia para hipertensão portal. Os autores relatam o caso de uma criança de 4 anos, (more) do sexo feminino, que sofria de doença terminal do fígado resultante de atresia de vias biliares e que tinha submetido, sem sucesso, a uma operação de Kasai. Ela se submeteu a um transplante ortotópico de fígado por cirrose biliar secundária. Durante a cirurgia uma hipoplasia portal severa do receptor foi encontrada. Uma anastomose entre a veia gástrica esquerda do receptor e a veia porta do doador foi feita. Reperfusão hepática e subseqüente função do fígado foram excelentes. A paciente recebeu alta hospitalar no trigésimo dia. A veia gástrica esquerda pode ser uma alternativa para revascularização portal no transplante hepático. Abstract in english Portal vein thrombosis or hipoplasia have not been, anymore, a contraindication for orthotopic liver transplantation. Nevertheless, it remains an obstacle associated with increased incidence of primary and long-term liver failure. There are some risk factors like being male, advanced cirrhosis, alcoholic liver disease and previos surgery for portal hypertension. The authors report a case of a 4-yr-old female patient who suffered from end-stage liver disease resulting from (more) biliary atresia with failed Kasai´s operation. She underwent orthotopic liver transplantation for secondary biliary cirrhosis. During surgery a severe recipient portal vein hipoplasia was found. An anastomosis between the recipient left gastric vein and the graft portal vein was performed. Hepatic reperfusion and subsequent liver function were excellent. The patient left hospital on the 30th postoperative day. The left gastric vein can be an alternative of portal revascularization in liver transplant.

124

Drenagem anômala parcial de quatro veias pulmonares com septo interatrial íntegro: relato de um caso raro/ Partial anomalous return of four pulmonary veins with intact interatrial septum defect: a rare case report  

Abstract in portuguese É relatado caso raro de drenagem anômala parcial de quatro veias pulmonares no átrio direito e veia cava superior, com septo interatrial íntegro em criança de cinco anos de idade. Havia poucos sintomas, em contraste com débito ventricular esquerdo dependente do fluxo da veia lobar superior esquerda e da língula. Complacência diminuída à esquerda motivou quadro acentuado de hipertensão venocapilar pulmonar no pós-operatório imediato, aliviado por feitura de comunicação interatrial de 8 mm. A evolução posterior foi boa. Abstract in english We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.

125

Relato de caso: implante transparietohepático de cateter de longa permanência para diálise/ Case report: transhepatic insertion of long-term dialysis catheter  

Abstract in portuguese O implante transhepático de cateteres de diálise de longa permanência é um procedimento de exceção, utilizado para obter um acesso em pacientes com oclusão de veias centrais de membros superiores e inferiores. O caso descrito relata um paciente jovem, com história de 15 anos de diálise, que foi submetido no passado a um transplante renal sem sucesso. Esse paciente encontrava-se em urgência dialítica e oclusão comprovada de veias centrais de membros superiores (more) e de veias ilíacas. Foi realizado o implante do cateter de longa permanência pelo acesso transparietohepático sob anestesia geral. A ponta do cateter foi posicionada ao nível do átrio direito. A diálise foi realizada satisfatoriamente no mesmo dia. Abstract in english Transhepatic insertion of long-term dialysis catheter is an exception procedure used to obtain access in patients with central vein occlusion of lower and upper limbs. We report on a case of a young patient with history of dialysis for 15 years, who was submitted to an unsuccessful renal transplantation. This patient was in dialytic emergency and had confirmed occlusion of upper limb central veins and iliac veins. Transhepatic insertion of a long-term catheter was perform (more) ed under general anesthesia. The catheter tip was placed at the level of the right atrium. Dialysis was satisfactorily performed on the same day.

126

Aneurisma da veia femoral simulando uma hérnia inguinal/ Femoral vein aneurysm simulating an inguinal hernia  

Abstract in portuguese INTRODUÇÃO: Somente seis casos de aneurismas da veia femoral simulando hérnia inguinal foram descritos na literatura. RELATO DO CASO: Um caso de aneurisma da veia femoral comum direita que simulava uma hérnia inguinal é descrito em jovem de 19 anos de idade com uma massa dolorosa de consistência mole na região inguinal direita de seis meses de duração. Durante a consulta médica, o paciente morreu durante em episódio de convulsão generalizada. Na necropsia, tromboembolismo pulmonar maciço e um aneurisma da veia femoral comum de 8x8x7 cm com trombos foram diagnosticados. Abstract in english BACKGROUND: Only six cases of femoral vein aneurysm are related on medical literature. CASE REPORT: A case of a right common femoral vein aneurysm simulating an inguinal hernia in a 19 year-old male. He had a soft and painful mass in the right inguinal area of six months of duration. At medical consultation, the patient died during a generalized convulsive episode. At necropsy, massive pulmonary thromboembolism and an 8x8x7 cm common femoral vein aneurysm with thrombus were recognized.

127

Central retinal vein thrombosis as an initial manifestation of heterozygous protein C deficiency: case report/ Trombose da veia central da retina como manifestação inicial da deficiência de proteína C na forma heterozigótica: relato de caso  

Abstract in portuguese O objetivo deste estudo é relatar um caso de trombose da veia central da retina associada à deficiência isolada de proteína C na forma heterozigótica. Oclusão aguda da veia central da retina é um dos mais dramáticos quadros oftalmológicos. Geralmente resulta tanto de fatores locais como sistêmicos. Uma causa sistêmica rara é a deficiência de proteína C na forma heterozigótica, ocorrendo usualmente associada a outras trombofilias. Este caso mostra que defici (more) ência isolada de proteína C na forma heterozigótica pode ser a causa da trombose da veia central da retina e reforça a importância de sua investigação em pacientes jovens com esta doença ocular. Abstract in english The purpose of this paper is to report a case of central retinal vein thrombosis associated with isolated heterozygous protein C deficiency. Acute occlusion of the central retinal vein presents as one of the most dramatic pictures in ophthalmology. It is often a result of both local and systemic causes. A rare systemic cause is heterozygous protein C deficiency, and it usually occurs in combination with other thrombophilic conditions. This case highlights that isolated he (more) terozygous protein C deficiency may be the cause of central retinal vein thrombosis and underscores the importance of its screening in young patients with this ophthalmologic disease.

128

Ligation of the left renal vein in epm1-wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands  

Abstract in portuguese OBJETIVO: A ligadura da veia renal esquerda é conduta discutida na literatura pelos riscos de lesão do perênquima renal. Com o objetivo de estudar morfológica e funcionalmente essas lesões, realizamos trabalho experimental em ratos. MATERIAL E MÉTODO: foram utilizados 64 ratos machos adultos da linhagem EPM1-WISTAR, divididos em oito grupos. Em quatro grupos efetuou-se a ligadura da veia renal esquerda enquanto os outros quatro serviram de "grupo controle". Cada gru (more) po com veia ligada e respectivo "grupo controle" foram sacrificados sucessivamente no sétimo, 15º. 30º, e 60º dia após a operação inicial. RESULTADOS: encontramos alterações morfo-funcionais apenas nos ratos submetidos a ligadura e em todos períodos de sacrifício. Os resultados de proteinúria e as dosagens plasmáticas de creatina, testoterona e corticosterona pouco se alteraram em relação aos valores normais, Lesões histológicas graves e estatisticamente significante apareceram nos rins e testículo nos grupos submetidos à "ligadura da veia renal esquerda", embora fossem observados também nas glândulas supra-renais, porém sem significado estatístico. CONCLUSÃO: com base nestes resultados, concluímos que a ligadura da veia renal esquerda nestes animais é de alto risco. Abstract in english OBJECTIVE: The ligation of the left renal vein (LLVR) in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. MATERIAL AND METHODS: 64 male adult EPM1-WISTAR rats were used, divided into 8 groups - 4 for LLRV and four for control. Each LLRV group and corresponding control group were sacrificed (more) progressively on the 7th, 15th, 30th and 60th day after the initial surgery. RESULTS: We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice.The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance CONCLUSION: Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.

129

Isolamento das veias pulmonares em pacientes com fibrilação atrial permanente secundária a valvopatia mitral/ Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease  

Abstract in portuguese OBJETIVO: Analisar a eficácia do isolamento cirúrgico das veias pulmonares para restabelecer ritmo sinusal em pacientes com fibrilação atrial secundária à doença mitral. MÉTODOS: 33 pacientes com indicação de correção cirúrgica da valva mitral e com fibrilação atrial permanente, foram submetidos ao isolamento cirúrgico das veias pulmonares, sendo 67% mulheres. Média de idade de 56,3±10 anos, classe funcional NYHA pré-operatória de 3,2±0,6, tamanho de (more) átrio esquerdo de 5,5± 0,9 cm, fração de ejeção de 61,3±13%. A técnica cirúrgica consistiu de incisão circunferencial ao redor das 4 veias pulmonares, excisão do apêndice atrial esquerdo e de incisão perpendicular desde a borda inferior da incisão, isolando as veias pulmonares, até o ânulo da valva mitral. Arritmias precoces foram tratadas, agressivamente, com cardioversão. RESULTADOS: O seguimento médio foi de 23,9±17 meses e ocorreram 3 óbitos no pós-operatório. Dez pacientes necessitaram de cardioversão elétrica no pós-operatório; 87% apresentavam ritmo sinusal na última consulta e 33% estavam em uso de amiodarona. CONCLUSÃO: Isolamento das veias pulmonares associado à cirurgia da valva mitral é uma técnica efetiva e segura na manutenção de ritmo sinusal em pacientes com fribilação atrial permanente. Abstract in english OBJECTIVE: To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease. METHODS: Thirty-three (67% were women) patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3±10 years, preoperative NYHA functional class was 3.2±0.6, left atrial s (more) ize was 5.5±0.9 cm, and ejection fraction was 61.3±13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left atrial appendage, and a perpendicular incision originating in the inferior margin of the circumferential incision isolating the pulmonary veins down to the mitral valve. Early arrhythmias were aggressively treated with cardioversion. RESULTS: The mean follow-up was 23.9±17 months, and 3 patients died in the postoperative period. Ten patients required electrical cardioversion in the postoperative period; 87% had sinus rhythm in the last medical visit, and 33% were using amiodarone. CONCLUSION: Isolation of the pulmonary veins associated with mitral valve surgery is an effective and safe technique for maintaining sinus rhythm in patients with permanent atrial fibrillation.

130

Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study/ Pulsatilidade venosa pulmonar em fetos de mães diabéticas: estudo doppler-ecocardiográfico pré-natal  

Abstract in portuguese OBJETIVO: Testar a hipótese de que o índice de pulsatilidade da veia pulmonar é maior em fetos de mães diabéticas do que em fetos normais. MÉTODOS: Examinados 24 fetos de mães com diabetes prévio ou gestacional (casos) e 25 fetos normais de mães sem doença sistêmica (controles). Os fetos foram examinados pela ecocardiografia pré-natal com Doppler e mapeamento de fluxo em cores. O índice de pulsatilidade da veia pulmonar foi obtido colocando-se a amostra volum (more) e do Doppler pulsado sobre a veia pulmonar superior direita e aplicando-se a fórmula (velocidade sistólica-velocidade pré-sistólica)/velocidade média. RESULTADOS: Os casos apresentaram idade gestacional média de 30,3 ± 2,7 semanas, e os controles, de 29, ± 3,3 semanas, sem diferença significativa entre as idades gestacionais nos dois grupos (p = 0,14). Os fetos de mães diabéticas apresentaram índice de pulsatilidade da veia pulmonar médio de 1,6 ± 1 e os fetos do grupo controle 0,86 ± 0,27. CONCLUSÃO: Fetos de mães diabéticas apresentam índice de pulsatilidade da veia pulmonar (parâmetro Doppler-ecocardiográfico de fácil obtenção, que pode estar relacionado com a função diastólica fetal) maior do que os de mães com glicemia normal. Abstract in english OBJECTIVE: To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. METHODS: Twenty-four fetuses of mothers with either gestational or previous diabetes (cases), and 25 normal fetuses of mothers without systemic disease (control) were examined. Fetuses were examined through prenatal Doppler and color flow mapping. The pulmonary vein pulsatility index was obtained by pla (more) cing the pulsed Doppler sample volume over the right superior pulmonary vein and applying the formula (systolic velocity - presystolic velocity)/mean velocity. RESULTS: The mean gestational age of the study fetuses was 30.3±2.7 weeks, and gestational age of the controls was 29±3.3 weeks, with no significant difference in gestational age between groups (p=0.14). Fetuses of diabetic mothers had a mean pulmonary vein pulsatility index of 1.6±1, and those of the control group had an index of 0.86±0.27. CONCLUSION: Fetuses of diabetic mothers had pulmonary vein pulsatility indexes (parameter easily obtained through Doppler echocardiography that may be related to fetal diastolic function) higher than those in fetuses of mothers with normal glycemia.

131

Four year survival after trans-jugular intrahepatic porto-systemic shunt for veno-occlusive disease following autologous bone marrow transplantation  

Severe hepatic veno-occlusive disease is still a potentially lethal complication after bone marrow transplantation. We here report the case of a patient who developed liver veno-occlusive disease with severe hemodynamic dysfunction and was successfully treated by means of a trans-jugular intrahepati...

132

Internal jugular catheterisation. Case report of a potentially fatal hazard.  

A case is presented of acute life-threatening haemorrhage caused by laceration of the subclavian artery as a result of attempted cannulation of the internal jugular vein. This sequence of events has not been reported previously, and probably resulted from use of a cannula-over-needle system. PMID:2091628

133

A complication of percutaneous cannulation of the internal jugular vein  

Reviews of the use of the technique of percutaneous cannulation of the internal jugular vein for central venous pressure monitoring have indicated that it is free from serious complications. A patient is reported here in whom the ascending cervical artery was damaged during attempted cannulation of ...

134

[An unusual suicidal attempt (author's transl)].  

Report on an unusual suicidal attempt by a separating disc (grinding disc). The patient inflicted himself incisions on both wrists, the occiput and the throat between the hyoid-bone and the thyroid cartilage. The hypopharynx was severed up to the posterior wall and the left jugular vein was cut completely. Due to the immediate care by the physician, the patient survived. PMID:524898

135

Removal of Selected Infralabyrinthine Lesions Without Facial Nerve Mobilization  

The infralabyrinthine approach can be modified for the removal of certain lesions without facial nerve mobilization. This procedure is to be used for lesions falling under the three following categories: glomus jugulare tumors, infralabyrinthine cholesteatomas, and cholesterol cysts of the temporal ...

136

Posterior semicircular canal dehiscence following endolymphatic sac surgery.  

Posterior semicircular canal dehiscence is a rare otologic entity that presents with third window signs and symptoms. Petrous apex cholesteatoma, fibrous dysplasia, high riding jugular bulb, and eosinophilic granuloma have been reported to be associated with posterior semicircular canal dehiscence. Here we report a case of development of posterior semicircular canal dehiscence following an endolymphatic sac surgery for the first time. PMID:22689472

137

Posterior semicircular canal dehiscence following endolymphatic sac surgery  

Abstract Posterior semicircular canal dehiscence is a rare otologic entity that presents with third window signs and symptoms. Petrous apex cholesteatoma, fibrous dysplasia, high riding jugular bulb, and eosinophilic granuloma have been reported to be associated with posterior semicircular canal dehiscence. Here we report a case of development of posterior semicircular canal dehiscence following an endolymphatic sac surgery for the first time. Laryngoscope, 2012

138

Peripheral 5-HT2-like receptors. Can they be classified with the available antagonists?  

Interactions between 5-hydroxytryptamine (5-HT) and the so-called 5-HT2 receptor antagonists ketanserin, spiperone, trazodone and methysergide were studied in isolated preparations of the rabbit aorta, rat jugular vein, and rat caudal artery. Trazodone and spiperone were apparently simple competitiv...

139

Pituitary adenylate cyclase activating polypeptide is expressed in autonomic neurons.  

Pituitary adenylate cyclase activating polypeptide (PACAP) is a novel vasoactive intestinal peptide (VIP)-like peptide, which is present in neuronal elements of several peripheral organs, and thus a putative neurotransmitter/modulator. In the present study, the expression of PACAP in two parasympathetic ganglia (otic, sphenopalatine) and one mixed parasympathetic/sensory ganglion (jugular-nodose) in rat was characterized by use of in situ hybridization and immunocytochemistry and compared to that of VIP and calcitonin gene-related peptide (CGRP). PACAP and VIP were expressed in virtually all nerve cell bodies in the otic and sphenopalatine ganglia; PACAP and VIP were also expressed in subpopulations of nerve cell bodies in the jugular-nodose ganglion. CGRP was expressed in numerous nerve cell bodies in the jugular-nodose ganglion and in a few, scattered, nerve cell bodies in the sphenopalatine ganglion. In the otic and sphenopalatine ganglia, PACAP- and VIP-like immunoreactivities were frequently co-localized; in the jugular-nodose ganglion, PACAP-like immunoreactivity was frequently co-localized with CGRP-like immunoreactivity in presumably sensory neurons and to a lesser extent with VIP in parasympathetic neurons. Thus, PACAP is synthesized and stored in autonomic parasympathetic neurons as well as in vagal sensory neurons, which provides an anatomical basis for the diverse effects of PACAP previously described. PMID:12506422

140

Stereotactic Radiation Therapy for Brain Tumors  

... determine the actual dose delivered to these critical structures when treating any target in the brain. Would you like to talk about the actual ... email questions, "What is the prognosis of different brain tumors ... the vascular structures around the carotid, pharynx, and jugular, and we ...

 
 
 
 
141

Space obstructive syndrome: intracranial hypertension, intraocular pressure, and papilledema in space.  

Humans undergo several consistent and measurable changes of fluid distribution and regulation in the course of adapting to microgravity. Recently, a syndrome of objective findings has been described by Mader et al. associated with long-duration missions, including hyperopic shifts, mildly elevated intracranial pressure, papilledema, globe flattening, choroidal folds, and other anatomic findings. Experience with venous obstructive lesions leads the author to propose a primary obstructive process, unique to or exacerbated by microgravity, acting at the level of the proximal internal jugular veins, termed Space Obstructive Syndrome (SOS). Literature, anatomy, and ultrasound observations revealed four major potential compression zones of the internal jugular vein, with Zone I between the sternocleidomastoid muscle and the carotid artery as the primary area of compression, both in 1 G in an upright position and in microgravity. Internal jugular vein compression, along with loss of gravitationally induced cranial outflow of blood in the vertebral veins and collaterals, may lead to intracranial venous hypertension with resultant facial/head and upper airway swelling, increased intraocular pressure, intracranial hypertension, and papilledema. Further study and proof of concept will necessitate ultrasound, Doppler flow study, and internal jugular vein pressure measurements on orbit in the International Space Station. If proven, SOS will give researchers opportunity for study and development of mitigation strategies such as artificial gravity systems. PMID:22272520

142

Common Carotid Artery to Internal Jugular Vein Shunt for Managing Hypoxemia After a Cavopulmonary Shunt  

In the present report, we discuss a patient who developed persistent hypoxemia after an attempt at Fontan completion failed. As a bail-out procedure, a left common carotid artery to left internal jugular vein shunt was constructed, after which the hypoxemia was relieved.

143

Persistence and effects of sinus rhythm after Fontan procedure for tricuspid atresia.  

Four patients who had had a Fontan type of procedure for tricuspid atresia 23, 6, 6, and 11 months previously were investigated by ambulatory electrocardiographic recording and simultaneous recording of the jugular venous pressure and echocardiogram of the conduit or pulmonary valve. All had been co...

144

Common carotid artery to internal jugular vein shunt for managing hypoxemia after a cavopulmonary shunt.  

In the present report, we discuss a patient who developed persistent hypoxemia after an attempt at Fontan completion failed. As a bail-out procedure, a left common carotid artery to left internal jugular vein shunt was constructed, after which the hypoxemia was relieved. PMID:22916756

145

Monitoring of cerebral hemodynamics with jugular bulb catheters.  

Jugular venous oxygen saturation (SjvO2) monitoring is useful for detecting episodes of cerebral hypoxia/ischemia in patients with head injury, patients undergoing neurosurgical procedures, and patients undergoing cardiopulmonary bypass. The use of SjvO2 monitoring can direct the treatment of ischemic episodes and identify the optimal level of cerebral perfusion pressure and PCO2 for the individual patient. PMID:9012576

146

Nimodipine can improve cerebral metabolism and outcome in patients with severe head trauma.  

In the present study, the effect of nimodipine was investigated in a patient with severe head trauma. Nimodipine was administered into the peripheral vein to prevent secondary neuronal damages in patients. The five patients in control group were treated according to the standard procedures without nimodipine. Other five patients in nimodipine group were treated with standard procedures plus nimodipine. Cerebral perfusion pressure (CPP), intracranial pressure (ICP), jugular venous oxygen saturation (SjvO2), jugular lactate and glucose levels were measured. Additionally, all patients were evaluated with Glascow outcome score (GOS) before discharge. It was found that CPP (pSjvO2 (p<0.05) were significantly higher; but, ICP (p<0.001), jugular lactate (p<0.05) and jugular glucose (p<0.05) were lower in nimodipine than that of control groups. Again, GOS values were significantly higher in nimodipine than that of control groups (p<0.05). Results of this study revealed that nimodipine can improve cerebral metabolism and outcome in patient with severe head trauma. Thus, nimodipine may be considered as a protective agent against severe head trauma related neuronal injuries. PMID:18996202

147

Jugular venous desaturation and outcome after head injury.  

Early experience with continuous monitoring of jugular venous oxygen saturation (SjvO2) suggested that this technology might allow early identification of global cerebral ischaemia in patients with severe head injury. The purpose of the present study was to examine the relationship between episodes of jugular venous desaturation and neurological outcome. One hundred and sixteen severely head-injured patients had continuous monitoring of SjvO2 during days 1-5 after injury. Episodes of jugular venous desaturation (SjvO2 SjvO2. Episodes of desaturation were most common on day 1 after injury, and were twice as common in patients with a reduced cerebral blood flow as in patients with a normal or elevated cerebral blood flow. The occurrence of jugular venous desaturation was strongly associated with a poor neurological outcome. The percentage of patients with a poor neurological outcome was 90% with multiple episodes of desaturation and 74% in patients with one desaturation, compared to 55% in patients with no episodes of desaturation. When adjusted for all co-variates that were found to be significant, including age, Glasgow coma score, papillary reactivity, type of injury, lowest recorded cerebral perfusion pressure, and highest recorded temperature, the incidence of desaturation remained significantly associated with a poor outcome. Although a cause and effect relationship with outcome cannot be established in this study, the data suggest that monitoring SvO2 might allow early identification and therefore treatment of many types of secondary injury to the brain.

148

Jugular venous desaturation and outcome after head injury.  

Early experience with continuous monitoring of jugular venous oxygen saturation (SjvO2) suggested that this technology might allow early identification of global cerebral ischaemia in patients with severe head injury. The purpose of the present study was to examine the relationship between episodes ...

149

SjvO2 monitoring in head-injured patients.  

Jugular venous oxygen saturation (SjvO2) measures the balance between cerebral oxygen delivery and cerebral oxygen consumption. Abnormalities that increase oxygen consumption (e.g., fever or seizures) or that decrease oxygen delivery (e.g., increased ICP, hypotension, hypoxia, hypocapnia, or anemia) can decrease SjvO2. Measuring SjvO2 continuously in the ICU in 177 patients with severe head injury, jugular venous desaturation (SjvO2 SjvO2 monitoring contributed to the neurological injury. In the operating room, jugular venous desaturation was identified in 6 of 8 patients who were monitored during emergency evacuation of a traumatic intracranial hematoma. The lowest SjvO2 observed was 28%. In all 8 cases, the SjvO2 increased, from 47 +/- 10% to 63 +/- 5% after evacuation of the hematoma. Additional data supporting the hypothesis that these secondary insults identified with the SjvO2 monitoring contribute to the patient's neurological injury come from measurement of the extracellular concentrations of lactate and excitatory amino acids in the brain using microdialysis. Lactate concentration increased from 0.9 +/- 0.3 to 2.4 +/- 0.5 mumol/L and glutamate increased from 11.5 +/- 8.5 to 55.0 +/- 10.4 mumol/L during 8 episodes of jugular venous desaturation in 7 of 22 patients monitored with microdialysis. SjvO2 identifies global reductions in cerebral oxygenation due to a variety of causes, and is useful as a monitor for secondary insults in patients with severe head injury. PMID:8594216

150

Jugular venous oxygen saturation thresholds in trauma patients may not extrapolate to ischemic stroke patients: lessons from a preliminary study.  

The authors' first examinations of 10 patients with severe hemispheric stroke indicate that bedside monitoring of cerebral blood flow (CBF) is of clinical value as a prognostic tool for outcome and as therapy of elevated intracranial pressure (ICP). Jugular venous oximetry, which is easier to handle and provides on-line data, may also be of prognostic value in patients with ischemic stroke. No clinical studies are available on patients with hemispheric infarctions. Therefore, in a second data analysis from the same patient population, the authors' objective was to estimate the clinical value of monitoring cerebral hemodynamics and metabolism with jugular bulb catheters in treatment of severe postischemic brain edema. In 10 patients with severe hemispheric infarctions, ICP, jugular venous oxygen saturation (SjvO2), CBF, and cerebral metabolic rate of oxygen (CMRO2) were measured prospectively. A total of 101 ICP, SjvO2, and 92 CBF measurements were obtained. Only two SjvO2 values were below the critical thresholds to detect secondary ischemic events defined in trauma patients (SjvO2 SjvO2 did not reflect changes in CBF. Jugular bulb oximetry should interpreted with caution in patients with severe hemispheric infarction. Critical thresholds defined in trauma patients may not be extrapolated to ischemic stroke. PMID:11907393

151

Blood-oxygen binding in healthy Standardbred horses  

The purpose of this study was to determine the effect of regulating factors on the oxygen equilibrium curve (OEC) under standard conditions and then to calculate the oxygen extraction between arterial and jugular venous blood in healthy Standardbred horses. The results were compared to those previou...

152

The effect of colic on oxygen extraction in horses  

Blood oxygen transport and oxygen extraction were assessed in horses with colic. A gravity score (GS) ranging from I to 3 was attributed to each colic case with healthy horses used as controls. Jugular venous and carotid arterial blood samples were collected and concentrations of 2,3-diphosphoglycer...

153

Hibernating kidney – a case report  

A 75-year-old woman presented with a two-month history of progressive dyspnea on exertion. On physical examination, her blood pressure was 148/90 mmHg, jugular venous pressure was 10 cmH2O with a prominent V wave, right ventricular heave was present and she had a systolic murmur at the right upper s...

154

Chondrosarcoma of the temporal bone: a case report  

Chondrosarcoma of the temporal bone is a rare lesion. Clinically it has been confused with chordoma, glomus jugulare tumor and meningioma, among other conditions, and due to its anatomic location, cranial nerve palsy is frequently observed. We report a case involving a 50-year-old woman with chondrosarcoma of the temporal bone.

155

Differential response to lipopolysaccharide (LPS) and corticotrophin-releasing hormone (CRH) on immune parameters  

The ability of LPS and CRH to elicit immune responses was compared. Brahman heifers were transported from Overton, TX, to Lubbock, TX, were fitted with jugular catheters and separated into 2 treatments groups, LPS (0.25 microgram/kg BW; n=6; 194±11 kg) or CRH (0.5 microgram/kg BW; n=6; 202±9 kg). Bl...

156

Microsurgical Management of Jugular Foramen Schwannomas.  

BACKGROUND:: Jugular foramen schwannomas are uncommon and surgically challenging lesions. OBJECTIVE:: To determine the importance of surgical technique on morbidity and recurrence of jugular foramen schwannomas. METHODS:: A retrospective review and case-control analysis of a single senior-surgeon series of 81 patients with surgically treated jugular foramen schwannomas was performed focusing on operative technique. Patients undergoing an aggressive, total tumor resection ("Series 1") were compared with those undergoing more conservative resection focusing on preserving the pars nervosa ("Series 2"). RESULTS:: There was a statistically significant decrease (p=0.04) in permanent deficits of the cranial nerve 9/10 complex with a conservative technique. Recurrence was seen in three patients (5.7%) in Series 1 and in three patients (10.7%) in Series 2 (p=0.36). Recurrence was treated with re-operation in one patient, radiation in one patient, and observation in the others. CONCLUSION:: Though radical gross total resection is desirable, it is not optimal for cranial nerve preservation in patients with jugular foramen schwannomas. A more conservative approach resulted in a statistically significant decrease in lower cranial nerve deficits. There was a non-statistically significant trend toward increasing recurrence, which may be treated with multiple modality therapy in the modern era. PMID:23096422

157

A new strategy for the treatment of jugular foramen tumors using radiosurgery  

A new treatment strategy for jugular foramen tumors using radiosurgery is reported. Six jugular foramen tumors, including 2 glomus tumors and 4 lower cranial neurinomas, were involved. Among them only one tumor was confined to the jugular foramen, but the others extended into the posterior fossa, the upper cervical portion or both. As an initial treatment, 3 cases underwent operative resection from suboccipital or transcervical route. The tumor sizes at radiosurgery ranged from 14.3 to 36.1 mm with a mean of 22.4 mm in diameter. They were treated with a marginal dose between 13 to 16.5 Gy (mean 15.6 Gy). Follow-up MRI showed an apparent tumor shrinkage in 4 and no change in 2. Central tumor necrosis was found in 4 cases, but tumor progression was never observed in the mean follow-up period of 19 months. No complication occurred during and after the radiosurgery. These results indicate that radiosurgery is effective for the control of jugular foramen tumors with acceptable risk. Large tumors extending to the upper cervical portion and posterior fossa can be treated by operative resection combined with radiosurgery. (author).

158

Duplication of the superior vena cava  

The authors report three cases of duplication of the superior vena cava which were demonstrated by radionuclide angiography. Nuclear imaging was performed in order to demonstrate a left-to-right intracardiac shunt. Injection into the left external jugular vein demonstrated the presence of a duplication of the superior vena cava in addition to the presence of a shunt.

159

Válvula mecânica em carbono, de disco basculante, com revestimento de material biológico: princípios e desenvolvimento/ Pivoting disc carbon mechanical valve covered with biological material: principles and development  

Abstract in portuguese INTRODUÇÃO: após estudo experimental de implante de material biológico e carbono em átrio esquerdo e aorta, foi desenvolvida uma nova prótese, primeira válvula de carbono feita inteiramente no País. A finalidade foi conseguir uma válvula de sistema mecânico durável, de boa aceitação orgânica para facilitar a cicatrização a partir do anel e isolar o máximo de material sintético da corrente sangüínea; o objetivo é conseguir menores índices de morbidade (more) e mortalidade, alterando a história natural da prótese mecânica em relação a trombose, tromboembolismo, reoperações e menor uso de anticoagulante. MATERIAL E MÉTODOS: a válvula é do tipo disco basculante perfurado, fabricada em Carbolite (carbono polimérico endurecido). O anel apresenta haste com pino central para guiar e reter a movimentação do disco, batente e dois pinos para limitação do grau de abertura. O anel tem perfurações para fixação do material biológico (pericárdio e veia). O conjunto é colocado entre dois anéis lisos acoplados revestidos de Poliéster com aba de sutura externa. O batente tem aspecto denteado, formando plataformas onde se apoia o disco e entre os dentes existe continuidade do revestimento biológico. A prótese é toda revestida, exceto o pino, o disco, as plataformas do batente e a face interna do orifício menor. A prótese foi testada em duplicador de pulso em teste equivalente a dez anos, sem desgaste aparente com disco de carbono e poliacetal. Cada prótese, antes do implante, é testada individualmente durante cinco dias a 1.000 pulsações por minuto com pressão média de 12 cmHg. Então, é feita limpeza, esterilização, revestimento de material biológico processado em glicerina, montagem e esterilização final em formol ou gás ETO (conservação em glicerina). Existem 7 pacientes mitrais em observação com tempo médio de 7,8 meses (mínimo de 4 meses e máximo de 13 meses), sendo mantidos com anticoagulação oral. RESULTADOS INICIAIS: como o número de pacientes é pequeno, destacam-se apenas algumas observações iniciais: ausência de tromboembolismo, ausência de disfunção mecânica primária, ocorrência de dois acidentes hemorrágicos maiores e um episódio de trombose em paciente com dois meses de evolução, por anticoagulação inadequada, com reoperação e mantendo a mesma prótese com achado de depósito difuso de fibrina e boa evolução após dez meses. CONCLUSÕES: os resultados dos testes mecânicos do material e da válvula e os aspectos clínicos iniciais são favoráveis, devendo-se ampliar a casuística, com proteção anticoagulante mais efetiva e uniforme nos três primeiros meses. Após três meses, a presença do material biológico e as baixas doses de anticoagulante parecem ser eficientes no controle das complicações pós-operatórias da válvula mecânica, contra a trombose, o tromboembolismo e os acidentes hemorrágicos. Abstract in english INTRODUCTION: a hybrid valve was developed for improving a durable mechanic disc valve with good biocompatibility, by promoting easy healing around the ring valve and making the maximum isolation of the synthetic material in the blood stream. Lining the mechanical valve with porcine biologic tissue (pericardium and vein) is a tentative to reduce the morbidity and mortality on respect of thrombosis, thromboembolism, reoperations and minor use of anticoagulants to reduce th (more) e hemorrhagic events. Some principles were established on hybrid valve: durable mechanical system, points of contact without biologic material, use of biological material with minor organic reaction, movable parts without biologic material outside its perimeter, preferential closing system with superposition on a track seat and loose joints for accept biologic material limited growth. MATERIAL AND METHOD: the valve is the type of perforated tilting disc and all made of Carbolite (hardened polymeric carbon). The prosthesis is all covered except the central pivot, the disc and the internal part of the minor orifice, with 65% amount of surface recovered. The disc extends over thetnajor orifice with a track seat. The valve is processed in glycerol and sterilized in ETO and preserved in glycerol preferentially. There are seven mitral patients in observation with a mean time of 7,8 months (4 to 13 months) with oral anticoagulation. INITIAL RESULTS: in the first three months the mean Prothrombin Value (PV) was 60% and a case of valvular thrombosis occurred after two months with a PV of 70%, history of tachycardia and dyspnea. The patient was reoperated and was seen a good healing on Polyester ring and diffuse fibrin deposit. The fibrin was removed and the valve is going well after ten months. Two majors of hemorrhagic episodes occurred in two patients with a PV of 10% and 20% with good evolution. After three months the group has the mean PV of 51 % with no cases of hemolysis, thromboembolism, dysfunction or hemorrhagic events. CONCLUSIONS: the mechanical tests of the valve and the initial clinical aspects are favorables. It is necessary to augment the number of cases with more effective and uniform anticoagulant protection in the first three months to avoid thrombosis and hemorrhagic events. After three months the biolization of the valve with low anticoagulant doses seems to be efficient.

160

Renewable sources in national energy policies; Le fonti rinnovabili nelle politiche energetiche nazionali  

How renewable sources help meet national energy requirements, and their share of total generation and consumption. [Italian] Il contributo delle fonti energetiche rinnovabili al bilancio energetico nazionale e la loro incidenza sul consumo e sulla produzione interna.

 
 
 
 
161

JPL Robotics: People: Publications  

... Strategy to Land Precisely on the Northern Plains Of Mars," ISAIRAS_2010, 2010. ... Tree Traversability Analysis for Autonomous Off-Road Navifgation," Proc. ... "Automatic Registration of Color Separation Films," Interna¬tional Journal of ...

162

Impaired Recruitment of Grk6 and ?-Arrestin2 Causes Delayed Internalization and Desensitization of a WHIM Syndrome-Associated CXCR4 Mutant Receptor  

WHIM (warts, hypogammaglobulinemia, infections, and myelokatexis) syndrome is a rare immunodeficiency syndrome linked to heterozygous mutations of the chemokine receptor CXCR4 resulting in truncations of its cytoplasmic tail. Leukocytes from patients with WHIM syndrome display impaired CXCR4 interna...

163

Meeting Summary  

meeting/workshop summaries. 4th Global Precipitation Measurement (GPM) Interna- .... drift and wind-induced gauge errors are most signifi- cant. He also discussed ... to determine solutions for DSD estimates and identify precipitation phase ...

164

The relationship between home and work in an enlarged Europe : a quantitative analysis Die Beziehung zwischen Privatleben und Arbeit in einem erweiterten Europa : eine quantitative Analyse  

'Das vorliegende Projekt untersucht die komplexe Beziehungsstruktur zwischen Erwerbsarbeit und Privatleben in acht west- und osteuropäischen Ländern. Zunächst werden die Determinanten geschlechtsspezifischer Arbeitszeitmuster in den ausgewählten Ländern analysiert. Als Datenquelle dient eine interna...

165

Usefulness of Groshong catheters for central venous access via the external jugular vein.  

This study was designed to evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Central venous access was achieved by insertion of a single-lumen 4.0 Fr Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVC-RBSI) were evaluated from the database. Two hundred and twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (p parenteral nutrition (TPN) (p < .01) and less frequent use of chemotherapy (p < .01) than for IJV-C. However, there were no significant differences (NS) in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C. There were no significant differences such complications as malposition, oozing or hematoma formation of insertion site, arterial bleeding, nerve damage, pneumothorax, and phlebitis between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding, and nerve damage. Thus the study concluded that EJV-C using Groshong catheters has no severe complications and has the same rates of CVC-RBSI as conventional IJV-C for central venous access. PMID:18197529

166

Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury.  

Jugular bulb oximetry is the most widely used method of monitoring cerebral oxygenation. More recently, measurement of brain tissue oxygenation has been reported in head-injured patients. We compared the changes in brain tissue oxygen partial pressure (PbO2) with changes in jugular venous oxygen saturation (SjVO2) in response to hyperventilation in areas of brain with and without focal pathology. Thirteen patients with severe head injuries were studied. A multiparameter sensor was inserted into areas of brain with focal pathology in five patients and outside areas of focal pathology in eight patients. A fiberoptic catheter was inserted into the right jugular bulb. Patients were hyperventilated in a stepwise manner from a PaCO2 of approximately 35 mm Hg to a PaCO2 of 22 mm Hg. There was no significant change in cerebral perfusion pressure or arterial partial pressure of oxygen with hyperventilation. In areas without focal pathology, there was a good correlation between changes in SjVO2 and PbO2 (deltaSjVO2 and deltaPbO2; r2 = 0.69, P SjVO2. Thus, monitoring of PbO2 is a useful addition to multimodal monitoring of patients with traumatic head injury. IMPLICATIONS: Brain oxygenation is currently monitored by using jugular bulb oximetry, which attracts a number of potential artifacts and may not reflect regional changes in oxygenation. We compared this method with measurement of brain tissue oxygenation using a multiparameter sensor inserted into brain tissue. The brain tissue monitor seemed to reflect regional brain oxygenation better than jugular bulb oximetry. PMID:10072004

167

Phosphotidylinositol turnover in vascular, uterine, fundal, and tracheal smooth muscle: effect of serotonin (5HT)  

In brain, platelets, and aorta, 5HT has been reported to increase phosphotidylinositol turnover, an effect linked to 5HT/sub 2/ receptors. The authors examined the effect of 5HT on /sup 3/H-inositol-1-phosphate (/sup 3/H-I-P) in tissues possessing 5HT/sub 2/ receptors that mediate contraction to 5HT (rat jugular vein, aorta, uterus and guinea pig trachea) and in a tissue in which contraction to 5HT is not mediated by 5HT/sub 2/ receptors (rat stomach fundus). Tissues were incubated (37/sup 0/C, 95% O/sub 2/, 5% CO/sub 2/) with /sup 3/H-inositol (90 min), washed, LiCl/sub 2/ (10 mM) and 5HT added for 90 min, extracted, and /sup 3/H-I-P eluted from a Dowex-1 column. Basal /sup 3/H-I-P was 10-fold higher in the uterus than in the other tissues. 5HT (10/sup -6/-10/sup -4/M) increased /sup 3/H-I-P in the jugular vein, aorta, and uterus but not in the trachea or fundus. Maximum increase was greatest in the jugular vein (8-fold) with an ED/sub 50/ of 0.4 ..mu..M 5HT. The selective 5HT/sub 2/ receptor blocker, LY53857 (10/sup -8/M) antagonized the increase in /sup 3/H-I-P by 5HT in the jugular vein, aorta and uterus. Pargyline (10/sup -5/M) added to the trachea and fundus did not unmask an effect of 5HT (10/sup -4/M). These data suggest that (1) the jugular vein produced the most sensitive response to 5HT-induced increases in /sup 3/H-I-P, (2) increases in /sup 3/H-I-P by 5HT in smooth muscle may be linked to 5HT/sub 2/ receptors and (3) activation of 5HT/sub 2/ receptors as occurred in the trachea will not always increase /sup 3/H-I-P.

168

Obtenção da veia safena magna através de acesso minimamente invasivo para revascularizações miocárdicas/ Minimally invasive greater saphenous vein access as a conduit for coronary artery bypass surgery  

Abstract in portuguese Objetivo: Avaliar a possibilidade de obtenção da veia safena magna através de miniincisões de pele, a sua qualidade e a ocorrência de complicações precoces da ferida operatória. Casuística e Métodos: Foram estudados 46 pacientes, admitidos entre julho e novembro de 1999. Após miniincisões longitudinais de pele a veia safena magna foi identificada e, com auxílio de afastador de lâmina longa e estreita, delicadamente dissecada. Os pacientes foram divididos em (more) 2 grupos na dependência da presença dos fatores de risco: anemia, aterosclerose periférica, obesidade e diabete melito. As feridas operatórias foram observadas quanto às complicações maiores e menores. Amostras da veia foram enviadas para estudo histológico. Resultados: O número médio de incisões foi 2,3, com tamanho médio de 3,5 cm e de todas incisões somadas de 7,3 cm. O tamanho médio da veia foi 34,1 cm, com tempo médio de retirada de 28,7 minutos. Foram observadas complicações menores em 5 (10,8%) pacientes; sendo hematoma local a mais comum (6,5%). Não foram observadas complicações maiores e a ressecção foi sempre possível. Em 2 casos houve lesão macroscópica da veia, sendo possível a sua correção e utilização. O estudo histológico demonstrou preservação da arquitetura tecidual e não evidenciou lesão endotelial significativa. Conclusões: A obtenção da veia safena magna através de miniincisões é possível e resulta em adequado enxerto venoso. A incidência de complicações da ferida é baixa e independente dos fatores de risco. Estes resultados preliminares sugerem que a técnica pode ser aplicada com segurança em pacientes submetidos à revascularização miocárdica, embora os resultados a longo prazo ainda necessitem ser determinados. Abstract in english Objective: The aim of this study was to evaluate the possibility of excision of the greater saphenous vein through the minimal invasive technique, assessing its morphologic quality and the early complications in the leg wound. Material And Methods: From July to November/1999, 46 patients received aortocoronary saphenous vein bypass graft. A miniincision was made, the vein was identified and gently dissected out with a special retractor, with a long and narrow blade. The s (more) amples of the vein were sent to histological analysis. Taking into accounts the presence or absence of the risk factors (female sex, anemia, obesity, peripheral vascular disease and diabetes mellitus) the patients were divided into two groups. The wounds were inspected, looking for majors and minor wound complications. Results: The average number of incisions was 2.3, the average length was 3.5 cm, and the average of all incision length was 7.3 cm. The average length of vein harvested was 34.1 cm. The mean duration of the procedure was 28.7 minutes. Minor leg wound complications occurred in 5 (10.8%) patients and the most common problem was local hematoma (6.5%). There were no major complications. The macroscopically evaluation showed two tears but the correction was possible. Histological study showed that vascular integrity was maintained and there was no significant endothelial damage. Conclusions: It was possible to harvesting satisfactory length of the vein through minimally invasive technique. This technique does not compromise the morphological quality of the vein graft. A low incidence of leg wound complications was observed, independently of the risk factors. These initial results suggest that this technique can be satisfactorily used for harvesting the greater saphenous vein. However, the long-term results still remain to be determined.

169

Superficial peripheral vein type classification of adolescents, adults and elderly according to the Delphi technique/ Clasificación de las venas periféricas superficiales en adolescentes, adultos y ancianos mediante la técnica Delphi/ Classificação de veias superficiais periféricas de adolescentes, adultos e idosos pela técnica Delphi  

Abstract in portuguese Esta pesquisa descritiva visa colaborar com a padronização da comunicação sobre os tipos de veias na prática de enfermagem. Utilizou a técnica "Delphi" e teve como objetivo elaborar e validar uma classificação sobre os tipos de veias superficiais periféricas de adolescentes/adultos/idosos, segundo características dos vasos. Inicialmente foram identificados pelos autores na literatura os diferentes tipos de veias, que constituíram a classificação, contendo tí (more) tulos e definições que foram complementadas durante o processo de validação por peritos (enfermeiros, angiologistas, anestesistas e bioquímicos). Foram validados 12 critérios e 27 tipos de veias (ind. concordância > 90%). Complementarmente foi constituído um conjunto de fotos, representacional na população, dos diferentes tipos de veias. Destas, 144 foram usadas; 35 peritos escolheram uma foto para exemplificar cada título da classificação. Foram identificadas fotos representativas de 21 tipos de veia. Esta classificação contribui para a avaliação clínica do vaso sanguíneo, podendo ser empregada no ensino, na pesquisa e na gestão do cuidado ao paciente. Abstract in spanish Esta investigación descriptiva tiene por objetivo colaborar en la estandarización de los tipos de venas para la práctica de enfermería. Se utilizó la técnica "Delphi", para elaborar y validar una clasificación sobre los tipos de venas periféricas superficiales en adolescentes/adultos/ancianos, para ello se tuvo en consideración las características de los vasos. Inicialmente se identificó a través de la bibliografía los diferentes tipos de venas, los cuales co (more) nformaron la clasificación, usando títulos y definiciones que fueron complementados durante el proceso de validación por expertos (enfermeros, angiólogos, anestesiólogos y bioquímicos). Se validaron 12 criterios y 27 tipos de venas (nivel de concordancia > 90%). Además, se elaboró un conjunto de fotos representativas para la población sobre los diferentes tipos de venas, de las cuales fueron usadas 144. De esta forma, 35 peritos escogieron una foto como ejemplo de cada título de clasificación, siendo identificadas las fotos representativas de 21 tipos de venas. Esta clasificación contribuyó en la evaluación clínica de los vasos sanguíneos, pudiendo ser utilizada para la enseñanza, investigación y gestión en el cuidado del paciente. Abstract in english This descriptive research attempts to cooperate with the standardization of communication about vein types in Nursing. Authors utilized the "Delphi" technique and aimed at elaborating and validating a peripheral vein type classification of adolescents/adults/elderly according to their vein characteristics. Initially, authors identified different vein types in literature. This was a preliminary classification that contained the titles and definitions, which were complement (more) ed during the expert (nurses, angiologists, anesthetists and biochemists) validation process. Twelve criteria and 27 vein types were validated (agreement level > 90%). In addition, authors organized a set of pictures representing the different vein types. From these, 144 were used; 35 experts chose one picture to exemplify each classification title. The pictures representing 21 vein types were identified. This classification contributes to the clinical assessment of blood vessels and can be used in teaching, research and patient care management.

170

Extensive deep vein thrombosis as a complication of testicular cancer treated with the BEP protocol (bleomycin, etoposide and cisplatin): case report/ Trombose venosa profunda extensa como complicação de um tumor do testículo tratado com o protocolo BEP (cisplatina, bleomicina e etoposide): relato de caso  

Abstract in portuguese CONTEXTO: Não há relatos na literatura de trombose venosa profunda (TVP) extensa associada ao protocolo de quimioterapia cisplatina, bleomicina e etoposite (BEP). RELATO DO CASO: O paciente era um adolescente de 18 anos com um tumor germinativo não-seminomatoso no testículo direito, com metástases pulmonares, hepáticas e retroperitoneais. Após orquiectomia radical, o paciente começou a receber quimioterapia de acordo com o protocolo BEP (sem profilaxia rotineira p (more) ara TVP). No quarto dia do ciclo, TVP massiva foi diagnosticada, estendendo-se das veias poplíteas até o segmento inferior da veia cava torácica. Tratamento trombolítico foi iniciado imediatamente com estreptoquinase. No segundo dia da terapia trombolítica, o paciente desenvolveu insuficiência renal aguda, devido ao acometimento das veias renais pela trombose. Estroptoquinase foi mantida por seis dias e o paciente teve evolução surpreendentemente favorável. Abstract in english CONTEXT: There are no reports in the literature of massive deep venous thrombosis (DVT) associated with cisplatin, bleomycin and etoposide (BEP) cancer treatment. CASE REPORT: The patient was a 18-year-old adolescent with a nonseminomatous germ cell tumor of the right testicle, with the presence of pulmonary, liver, and massive retroperitoneal metastases. Following radical orchiectomy, the patient started chemotherapy according to the BEP protocol (without routine prophyl (more) axis for DVT). On day 4 of the first cycle, massive DVT was diagnosed, extending from both popliteal veins up to the thoracic segment of the inferior vena cava. Thrombolytic therapy with streptokinase was immediately started. On day 2 of thrombolytic therapy, the patient developed acute renal failure, due to extension of the thrombosis to the renal veins. Streptokinase was continued for six days and the outcome was remarkably favorable.

171

Mixoma de átrio direito com origem na veia cava inferior: uma localização rara com implicações diagnósticas e terapêuticas/ Right atrium myxoma originating from the inferior vena cava: an unusual location with therapeutic and diagnostic implications  

Abstract in portuguese Os mixomas são os tumores cardíacos primários mais freqüentes. Sua localização habitual é o átrio esquerdo, sendo encontrados também em outros locais. É relatado o caso de paciente de 71 anos que, com diagnóstico de tumor em átrio direito, foi submetido a operação para retirada do tumor. A operação foi realizada, sendo confirmado o diagnóstico e procedida a ressecção do tumor com sucesso e sem intercorrência. Em estudo ecocardiográfico de controle no (more) 4º mês de pós-operatório, evidenciou-se presença de massa residual que parecia originar-se na veia cava inferior. Foi submetida a nova operação, em que foi realizada a ressecção do mixoma, que se originava na veia cava inferior e se projetava para o interior do átrio direito. Com o tumor, foi ressecada, na sua implantação, uma porção da veia cava inferior. O presente relato mostra uma localização rara de origem do mixoma, bem como as complicações quanto ao diagnóstico e à abordagem no tratamento cirúrgico. Abstract in english The myxomas are the most frequent primary cardiac tumors. They are usually located in the left atrium but can be found in other places. This is a case report of a 71 year old patient with diagnosis of a tumor arising from the right atrium, submitted to a surgical resection of the tumor. The operation was realized and the diagnosis confirmed. Resection was successful and the procedure uneventful. Four months postoperatively a standard two-dimensional echocardiogram reveale (more) d a residual mass that seemed to arise from the inferior vena cava. He was reoperated and the myxoma originating from the inferior vena cava and extending to the interior of the right atrium was resected. At the basis of the tumor implantation, a portion of the inferior vena cave was resected. The present report shows an unusual location of the myxoma as well as the complications regarding the diagnosis and the approach to surgical treatment.

172

O papel da oxigenação hiperbárica na estrutura do fígado e baço após ligadura das veias hepáticas: estudo em ratos/ The role of hyperbaric oxygenation in the liver and spleen structure after hepatic vein ligation: study in rats  

Abstract in portuguese OBJETIVO: Avaliação morfológica do fígado e baço de ratos submetidos à oxigenoterapia hiperbárica após a ligadura das veias hepáticas. MÉTODO: Foram utilizados 30 animais machos adultos da espécie Holtzman, distribuídos aleatoriamente em dois grupos de 15 animais cada, assim designados: grupo 1 - ligadura das veias hepáticas; grupo 2 - ligadura das veias hepáticas associada à oxigenoterapia hiperbárica. Todos os animais foram submetidos à anestesia geral (more) por meio de solução contendo cloridrato de cetamina (40 mg/ml) e cloridrato de meperidina (10 mg/ml) na dose de 50 mg/kg/peso, laparotomia mediana e ligadura das veias hepáticas. A oxigenoterapia hiperbárica foi aplicada nos animais do grupo 2, a partir da oitava hora do pós-operatório, por 120 minutos, sendo 90 minutos sob pressão de 2,5 atmosferas e 15 minutos no início e final da terapêutica, para promover a compressão e descompressão gradativa no período de 20 dias consecutivos. No 21° dia de pós-operatório, os animais foram mortos por inalação de éter e submetidos à laparotomia e extirpação dos fígados e baços para exame histológico. Foram comparados os resultados da histologia hepática e esplênica aplicando-se o teste exato de Fisher, considerando-se a diferença significante de P Abstract in english OBJECTIVE: Liver and spleen morphologic evaluation of rats submitted to hyperbaric oxygen therapy after hepatic vein ligation. METHOD: Thirty Holtzman adult male rats were used, distributed into two groups of 15 animals: group 1 - hepatic vein ligation; group 2 - hepatic vein ligation associated with hyperbaric oxygen therapy. All animals received general anesthesia by a solution composed of ketamine chloride (40 mg/ml) and meperidine chloride (10 mg/ml) in a dose of 50/m (more) g/weight, and were submitted to median laparotomy and hepatic vein ligation. Group 2 animals were submitted to hyperbaric oxygen therapy, 8 hours after the operation, 90 minutes at 2.5 atmosphere pressure and 15 minutes at the onset and end of the therapy, in a total of 120 minutes, in order to promote the gradual compression and decompression in 20 consecutive days. On the 21st preoperative day, the animals were sacrificed by ether inhalation and submitted to laparotomy and stripping of liver and spleen for histological study. The results of the histological study of livers and spleens were compared using Fisher's exact test. Statistically significant difference was considered when P

173

Efeitos da oxigenoterapia hiperbárica em ratos submetidos à ligadura das veias hepáticas: avaliação da mortalidade e da histologia do fígado e baço/ Hyperbaric oxygen therapy in rats submitted to hepatic veins ligation: mortality valuation and histological study of liver and spleen  

Abstract in portuguese OBJETIVO: Avaliar os efeitos da oxigenoterapia hiperbárica em ratos submetidos a ligadura das veias hepáticas quanto a mortalidade dos animais e alterações na histologia do fígado e baço. MÉTODOS: Foram utilizados 30 animais machos adultos da espécie Holtzman, distribuídos aleatoriamente, em dois grupos de 15 animais cada, assim designados: grupo 1 - ligadura das veias hepáticas; grupo 2 - ligadura das veias hepáticas associada à oxigenoterapia hiperbárica. T (more) odos os animais foram submetidos à anestesia geral por meio de solução contendo cloridrato de cetamina (40 mg/ml) e cloridrato de meperidina (10 mg/ml) na dose de 50 mg/Kg/peso, laparotomia mediana e ligadura das veias hepáticas. A oxigenoterapia hiperbárica foi aplicada nos animais do grupo 2, a partir da oitava hora do pós-operatório, por 120 minutos, sendo 90 minutos sob pressão de 2,5 atmosferas e 15 minutos no início e final da terapêutica, para promover a compressão e descompressão gradativa no período de 20 dias consecutivos. No 21° dia de pós-operatório, os animais foram mortos por inalação de éter, submetidos à laparotomia e extirpação dos fígados e baços para exame histológico. Foi comparada a evolução dos animais dos dois grupos quanto à mortalidade e histologia do fígado e do baço, aplicando-se o teste exato de Fisher, considerando-se a diferença significante o valor de p Abstract in english PURPOSE: To evaluate the effects of hyperbaric oxygen therapy in rats submitted to instantaneously hepatic vein obstruction. METHODS: 30 Holtzman adult male rats were utilised, distributed into two groups: 1) hepatic vein obstruction; 2) hepatic vein obstruction associated with hyperbaric oxygen therapy. General anaesthesia was utilized by a solution composed of ketamine chloride (40 mg/ml) and meperidine chloride (10 mg/ml) in a dose of 50/mg/weight, applied into the rig (more) ht gluteus muscle. The animals belonged to group 2 were submitted to hyperbaric oxygen therapy, 8 hours after the operations, in a 2,5 atmosphere, which lasts 120 minutes per day, in consecutive 20 days. The statistical analysis was made in relation to mortality and histological study of livers and spleens utilizing the Fisher test, and the results were considered statistically significant when p

174

Quilotórax/ Chylothorax  

Abstract in portuguese O quilotórax, normalmente secundário a doenças malignas, trauma, doenças congênitas, infecções e trombose da veia cava superior, é uma causa pouco freqüente de derrame pleural. O diagnóstico e tratamento precoces são importantes no sentido de prevenir a mais temida conseqüência do quilotórax, a má nutrição e conseqüente comprometimento do estado imunológico. Abstract in english Chylothorax, an uncommon cause of pleural effusion, is usually secondary to malignancy, trauma, congenital diseases, infections and superior vena cava thrombosis. The early diagnosis and treatment are important to prevent the most fearful consequence of chylothorax, the malnutrition with a compromised immunological status.

175

Vertebral artery thrombosis and subsequent stroke following attempted internal jugular central venous catheterization.  

Complications arising from internal jugular venous catheterization are uncommon. Injury to the carotid artery is reported as one of the more common injuries. Vertebral artery injuries are rare and include pseudoaneurysm formation, arteriovenous fistulas, lacerations, and dissection with thrombus formation. Occasionally, such injuries initially go unnoticed and have the potential to cause catastrophic outcomes, leaving clinicians and families wondering what transpired. A thorough autopsy can not only help discern the cause of death, but also help to bring closure to the family. Here we present a case of an unexpected death 3 days following surgery for idiopathic scoliosis in a 17-year-old male. During the surgical procedure, a right internal jugular venous catheterization was attempted but aborted after several failed tries. Twenty-four hours after the procedure, the patient became obtunded and progressed to brain death. At autopsy, he was found to have a right transmural vertebral artery puncture wound with thrombosis leading to a massive posterior circulatory stroke. PMID:22754124

176

Late-Onset Congestive Heart Failure in a Patient With a 58-Year-Old Huge Traumatic Carotid-Jugular Fistula and Pseudoaneurysm: Endovascular Treatment With a Stent-Graft  

We report a case of successful stent-graft endovascular treatment of a huge traumatic carotid-jugular fistula with a pseudoaneurysm that had resulted from a bullet injury. A 77-year-old man with a pulsatile neck mass came to our hospital complaining of dyspnea and chest pain at rest; about 58 years ago, a gunshot accident had inflicted a penetrating bullet wound on the right side of his neck. Computerized tomography angiogram had demonstrated a huge vascular mass protruding into the right anterior neck with a pseudoaneurysm. The calcified pseudoaneurysm had an oval-shaped opening in the right common carotid artery, with a large base into the right internal jugular vein. Echocardiography showed deteriorating congestive heart failure, wherein left ventricular (LV) enlargement with a LV end-d...

177

Removal of Selected Infralabyrinthine Lesions Without Facial Nerve Mobilization  

The infralabyrinthine approach can be modified for the removal of certain lesions without facial nerve mobilization. This procedure is to be used for lesions falling under the three following categories: glomus jugulare tumors, infralabyrinthine cholesteatomas, and cholesterol cysts of the temporal bone. This report includes three glomus jugulare tumors (C1 Fisch type) and five infralabyrinthine cholesteatomas operated on with such a technique. Some anatomic data concerning access to the infralabyrinthine area are analyzed. This technique requires very good preoperative imaging screening and is made easier by intraoperative facial nerve monitoring. It can be combined with the translabyrinthine and transcochlear approaches and, if necessary, be modified into an infratemporal approach at any time. ImagesFigure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12Figure 13

178

More severe white matter changes in the elderly with jugular venous reflux  

AbstractObjective The etiology of age-related white matter changes is unclear. Cerebral white matter changes on magnetic resonance imaging (MRI) and progressive dementia have been reported in patients with dural arteriovenous fistulas of the sigmoid sinus. The frequency of jugular venous reflux, which mimics a dural arteriovenous fistula, significantly increases with age. We investigated whether jugular venous reflux was associated with the severity of age-related white matter changes in 97 persons (aged 55-90 years, mean [standard deviation]: 75.77 [8.19] years; 55 men) from a medical center memory clinic. Methods MRI (1.5T) and the semiquantitative Scheltens scale were used to investigate the severity of white matter changes. Subjects were classified into 3 groups (no, mild, and severe j...

179

Peritoneal Shunt Migration into the Pulmonary Artery  

A 48-year-old man underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to left vertebral artery dissection, which had been successfully treated by trapping. The peritoneal catheter was correctly positioned via a right upper abdominal incision, and symptoms related to the hydrocephalus disappeared. One month later, the patient began to complain of pain on the right side of the neck. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. The catheter route was explored through a small neck incision, and was found to enter the external jugular vein. The catheter was extracted and repositioned into the peritoneum. This type of shunt migration is quite unusual, but could be lethal by causing pulmonary infarction or arrhythmia. The catheter had probably entered the external jugular vein through a perforation caused by the shunt guide during the ventriculoperitoneal shunt operation. Follow-up radiography should be scheduled to detect such a complication.   

180

Assessment of cervical venous blood flow and the craniocervical venus valve using ultrasound sonography  

Severe congestion with petechiae and/or small hemorrhages over a wide area consisting of the subcutaneous and mucous level of the head and neck is observed in most cases of strangulation and positional asphyxial death. Congestion present above the strangulation mark is accepted as a vital reaction. Although the congestion results from a disturbance of cervical venous flow, only a few reports concerning a relationship between venous flow and posture were found in the literature. We assessed the physiological situation of cervical venous return and movement of the craniocervical venous valve for many types of valve with respect to posture using color-duplex ultrasound sonography (US). We measured the Doppler wave of cervical veins consisting of internal jugular vein (IJV), external jugular v...

 
 
 
 
181

[Microsurgical anatomy of the transoval percutaneous route to the trigeminal cave and the trigeminal ganglion].  

The percutaneous Hartel transoval route goes through an inverted pyramid, with an inferior summit and a superior base that includes three compartments. The danger of the inferior compartment is the parotid duct. The middle compartment contains many branches of the mandibular nerve. The superior compartment is crossed by the internal maxillary artery and its branches, as well as the auditory tube. The base of the pyramid presents not only the foramen ovale, but also the foramen lacerum, where the trocar may injure the internal carotid, and the foramen jugulare, where the trocar may meet the internal jugular vein and nerves of the pars nervosa (IX, X, XI). The trigeminal cave contains, within the trigeminal cistern, the trigeminal ganglion, extended backward by the triangular plexus (the target for thermocoagulation). These structures are undercrossed by the masticatory motor branch of the trigeminal nerve. PMID:19327797

182

Gamma knife radiosurgery for the treatment of glomus jugulare tumors  

The treatment of glomus jugulare tumors represents a challenge for the neurosurgeon, since they invade major vessels and compress critical cranial nerves, resulting in significant morbidity from tumor resection. Among alternative and complementary treatment options, gamma knife radiosurgery is a less invasive procedure and may provide better protection of vital structures. This study aimed to evaluate the efficacy and long-term outcomes of gamma knife surgery in the treatment of these tumors in a large series with the longest follow-up period compared with previous reports. A total of 18 patients with glomus jugulare tumors that underwent gamma knife radiosurgery (GKS) were included. Eleven patients had a history of previous microsurgical treatment. The mean marginal radiation dose was 15....

183

Paragangliomas of the temporal bone: high-resolution CT studies  

Seventeen patients with 15 surgically proved paragangliomas involving the temporal bone and parapharyngeal spaces were examined with high-resolution computed tomography(CT). Scans were obtained in multiple axial (0/sup 0/,30/sup 0/) and coronal (70/sup 0/,105/sup 0/) section planes using 1.5-mm collimation and table incrementation. The purpose of this study was to demonstrate the utility of HRCT in assessing tumor extent and size, with particular emphasis on intrinsic temporal bone invasion. The most characteristic HRCT signs of paraganglioma include: jugular fossa expansion, soft-tissue mass in the hypotympanum and sinus tympani, permeation of the infracochlear surface, dural ballooning adjacent to the jugular fossa (indicative of epidural tumor), anterior displacement of parapharyngeal fat planes, and extension into the proximal aspect of the eustachian canal. It is concluded that HRCT is the single most efficacious examination to determine tumor extent, especially when intratemporal invasion has occurred, and to define other additional clinically unsuspected lesions.

184

Gamma Knife Radiosurgery for Glomus Jugulare and Tympanicum  

Abstract Objective: To establish the role of gamma knife radiosurgery (GKS) as a treatment strategy for glomus jugulare and tympanicum. Method: A retrospective review of 14 glomus tumors, including 11 glomus jugulare and 3 glomus tympanicum tumors, which were treated by GKS in Taipei Veterans General Hospital from 1993 to 2009, was conducted. Two of these cases had undergone prior surgery with partial tumor resection, and the other 12 cases received primary treatment with GKS after a thorough neuroimaging and cerebral angiography. The tumor volume ranged from 6.5 to 22.1 ml. The maximum dose at the tumor center ranged from 21.6 to 26.3 Gy. All 14 patients were regularly followed up by clinical and radiological evaluations. The median follow-up time was 40.3 months. Results: All 14 patients...

185

The carotid space: anatomical review, main diseases and imaging diagnosis methods; O espaco carotideo: revisao anatomica, principais doencas e metodos de diagnostico por imagem  

The carotid space is situated at the lateral aspect of the neck and extends from the base of the skull to the upper mediastinum, traversing the supra and the infrahyoid neck. This space contains the internal and common carotid arteries, the internal jugular vein, the lymph nodes of the internal jugular chain, the vagus nerve and in its upper portion the glossopharyngeal (IX), accessory (XI) and hypoglossal (XII) nerves. These structures may be the site of several diseases such as vascular anomalies, inflammatory and infectious diseases, the neoplasms. The authors reviewed the literature and performed an ionographic study in order to review the anatomy of the carotid space, its relationship to the contiguous spaces and most frequent diseases, and the imaging methods for its assessment, particularly computed tomography and magnetic resonance imaging. (author)

186

Deficiência de tiamina como causa de cor pulmonale reversível/ Thiamin deficiency as a cause of reversible cor pulmonale  

Abstract in portuguese A deficiência de tiamina pode apresentar quatro formas clássicas de apresentação clínica: polineuropatia periférica, anorexia e fraqueza muscular (beribéri seco); insuficiência cardíaca de alto débito com sinais congestivos (beribéri úmido); beribéri associado ao choque (Shoshin beribéri) e encefalopatia de Wernicke. Neste relato, descrevemos quadro sugestivo de hipertensão pulmonar grave e cor pulmonale, com estase jugular, hepatite congestiva e edema generalizado, que apresentou reversão completa após administração de tiamina. Abstract in english Thiamine deficiency may present four classic clinical forms: peripheral polyneuropathy, anorexia and muscular weakness (dry beriberi); high output heart failure with signs of congestion (wet beriberi); beriberi associated with shock (Shoshin beriberi) and Wernicke's encephalopathy. In this report we describe a picture that is suggestive of severe pulmonary hypertension and cor pulmonale, with jugular stasis, congestive hepatitis and generalized edema that reversed completely after the administration of thiamine.

187

Craniocervical Paraganglioma With Numerous Pulmonary Metastases  

A 28-year-old man presented with a rare craniocervical paraganglioma with multiple pulmonary metastases manifesting as hearing disturbance, hoarseness, and dysphagia in February 2003. Magnetic resonance imaging depicted a large jugular foramen tumor extending to the deep cervical region. Chest computed tomography revealed numerous small pulmonary nodules. The jugular tumor was totally resected immediately after preoperative embolization. Histological examination revealed paraganglioma. Localized irradiation (54 Gy) and two courses of combination chemotherapy consisting of paclitaxel (80 mg/m2) and gemcitabine (1000 mg/m2) were given. The patient remained well during follow up for 48 months and the number of pulmonary metastases did not increase. Local control of primary craniocervical paraganglioma by palliative surgical resection may be effective for control of metastatic lesions.   

188

Complications of central venous catheterization.  

The complications of central venous catheterization are discussed in a review of experience and of the literature. The anatomy surrounding the subclavian and internal jugular veins is described. Indications and contraindications of catheterization are reported. Common and unusual complications are discussed and illustrated. Laceration of pleura, subclavian artery puncture, hematoma, catheter malposition, fragment embolization, air embolism, venous thrombosis, and infection are included. The radiologist is responsible for recognizing immediate, as well as delayed, complications of central venous catheterization. PMID:111506

189

The effect of breath physiotherapeutic maneuvers on cerebral hemodynamics: a clinical trial/ Efeitos das manobras de fisioterapia respiratória na hemodinâmica cerebral: um ensaio clínico  

Abstract in portuguese OBJETIVO: Observar a repercussão das técnicas de fisioterapia respiratória na pressão arterial média (PAM), pressão intracraniana (PIC), pressão de perfusão cerebral (PPC), pressão venosa jugular de oxigênio (PjO2) e saturação venosa jugular de oxigênio (SjO2). MÉTODO: Foram incluídos no estudo 20 pacientes com traumatismo cranioencefálico. O protocolo consistiu na aplicação das manobras fisioterapêuticas de vibrocompressão (VBC), aumento de fluxo expi (more) ratório (AFE) e aspiração (ASP). RESULTADOS: Os resultados mostraram a manutenção das variáveis da hemodinâmica cerebral durante as manobras de VBC e AFE. Porém, em relação à ASP, houve uma elevação da PAM e PIC, com manutenção da PPC, PjO2 e SjO2 e retorno aos valores basais da PAM e PIC dez minutos após o final da aspiração. CONCLUSÃO: As manobras de fisioterapia respiratória (VBC, AFE) não promovem alterações sobre a hemodinâmica cerebral, ao contrário da ASP traqueal, em pacientes com traumatismo cranioencefálico grave, em ventilação mecânica, sedados e curarizados. Abstract in english OBJECTIVE: To observe the repercussion of respiratory physiotherapy techniques on the mean arterial pressure (MBP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), jugular venous oxygen pressure (PjvO2) and jugular venous oxygen saturation (SjvO2). METHOD: The sample consisted of 20 patients with head trauma. The protocol consisted of physiotherapy techniques application of vibrocompression (VBC), expiratory flow increase (EFI) and suction. RESULTS: The re (more) sults show the maintenance on variables of cerebral hemodynamics during the techniques of VBC and EFI. However, in relation to suction, there was an increase of MBP, ICP, with maintenance of CPP, PjvO2 and SjvO2 and return to baseline of MBP and ICP 10 minutes after the end of suction. CONCLUSION: The respiratory physiotherapy techniques (VBC, EFI) do not promote cerebral hemodynamic repercussion, unlike suction, in severe head injury patients, mechanically ventilated, sedated and paralyzed.

190

High-resolution CT in the evaluation of glomus tumors of the temporal bone  

High-resolution computed tomography (HRCT) was performed in 33 cases of other tumors in and around the jugular foramen. HRCT helped to differentiate glomus tumors from vascular anomalies and from other benign or malignant lesions, and to determine the extent of deep involvement. It provided essential information for planning the surgical approach. When a lesion is large or appears atypical, complementary angiography is helpful. Otherwised, angiography may not be necessary.

191

Bacteriemia por Ochrobactrum anthropi en paciente en hemodiálisis por catéter tunelizado permanente: Caso clínico/ Catheter associated bacteremia caused by Ochrobactrum anthropi in a patient on hemodialysis: Report of one case  

Abstract in english Ochrobactrum anthropi is a rare pathogen in humans that is usually related to infections in inmunocompromised patients or people with indwelling medical devices. There are very few reported cases of O. anthropi bacteremia in patients on hemodialysis. We report a 19-year-old female on hemodialysis through a jugular catheter, with fever and malaise lasting one month. The catheter was withdrawn and Ochrobactrum anthropi was isolated from it and from blood cultures. The patient was successfully treated with levofloxacin.

192

[Malfunctioning of cerebral function monitors in three cases of carotid endarterectomy].  

In three patients, EEG, jugular venous oxygen saturation (Sjvo2) and near infrared spectroscopy (NIRS) were monitored to detect cerebral ischemia during carotid endarterectomy. In all cases, no changes in Sjvo2 and NIRS were observed during carotid artery occlusion, but in two patients EEG showed changes when carotid artery was clamped. It is important to know the precise mechanism of cerebral monitors to assess the cerebral ischemia in patients with preexisting neurological disorder during carotid endarterectomy. PMID:10689842

193

Increasing mean arterial blood pressure has no effect on jugular venous oxygen saturation in insulin-dependent patients during tepid cardiopulmonary bypass.  

Preexisting diabetes mellitus is one of the major factors related to adverse postoperative neurological disorders after cardiac surgery. In previous reports, we found that diabetic patients more often experienced cerebral desaturation than nondiabetic patients during normothermic cardiopulmonary bypass (CPB). The purpose of this study was to examine the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen hemoglobin saturation (SjvO2) during tepid CPB in diabetic patients. We studied 20 diabetic patients scheduled for elective coronary artery bypass graft surgery and, as a control, 20 age-matched nondiabetic patients. After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO2. After measuring the baseline partial pressure of the arterial and jugular venous blood gases and cardiovascular hemodynamic values, MAP was increased by the repeated administration of a 10-microg bolus of phenylephrine until it reached 100% of baseline values. There was a significant difference in SjvO2 value between the Diabetic and Control groups after the administration of phenylephrine (Diabetic group, 56% +/- 6%; Control group: 60% +/- 4%) (P SjvO2 versus cerebral perfusion pressure for increasing cerebral perfusion pressure between the Insulin-Dependent group and the other groups (Dunnett test: P = 0.04). Increasing MAP had no effects on the SjvO2 value in insulin-dependent patients during tepid CPB. IMPLICATIONS: We examined the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen saturation (SjvO2) during tepid cardiopulmonary bypass in diabetic patients and found that increasing MAP had no effect on the SjvO2 value in insulin-dependent patients. PMID:12145032

194

X-ray diagnosis of the posterior skull-base  

Since the cranial nerves and the base of the skull are spatially close to each other, certain complexes of symptoms and signs give a very accurate indication of the possible location of the lesion. Basing on such neurologic-topical structuralisation, lesions of the cerebrellopontine angle, the foramen jugulare, the clivus and of the foramen magnum are discussed systematically. The various techniques of radiological imaging or examination are assessed in accordance with their diagnostic ranking, and characteristic constellations of findings are described.

195

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases.  

Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension.In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected. PMID:22673549

196

Oversized vein grafts develop advanced atherosclerosis in hypercholesterolemic minipigs  

ABSTRACT: BACKGROUND: Accelerated atherosclerosis is the main cause of late aortocoronary vein graft failure. We aimed to develop a large animal model for the study of pathogenesis and treatment of vein graft atherosclerosis. METHODS: An autologous reversed jugular vein graft was inserted end-to-end into the transected common carotid artery of ten hypercholesteroemic minipigs. The vein grafts were investigated 12-14 weeks later with ultrasound and angiograpy in vivo and microscopy post mortem. RESULTS: One minipig died during follow up (patent vein graft at autopsy), and one vein graft thrombosed early. In the remaining eight patent vein grafts, the mean (standard deviation) intima-media thickness was 712 mum (276 mum) versus 204 mum (74 mum) in the contralateral control internal jugular veins (P diameter of artery). No plaques were found in four non-oversized vein grafts (P <.05). CONCLUSIONS: Our model of jugular vein graft in the common carotid artery of hypercholesterolemic minipigs displayed the components of human vein graft disease, i.e. thrombosis, intimal hyperplasia, and atherosclerosis. Advanced atherosclerosis, the main cause of late failure of human aortocoronary vein grafts was only seen in oversized grafts. This finding suggests that oversized vein grafts may have detrimental effects on patient outcome.

197

[Evaluation of blood flow and the cross-sectional area of internal jugular vein in Japanese multiple sclerosis and neuromyelitis optica patients].  

Zamboni et al proposed a new hypothesis for the pathomechanisms of multiple sclerosis (MS): chronic cerebrospinal venous insufficiency (CCSVI). Using Doppler ultrasound and venograms, they found severe extracranial venous stenosis in MS patients. They suggested that a venous obstruction in the neck caused a reflux back into the brain, which led to edema and demyelination. We examined the blood flow and the cross-sectional area of the internal jugular veins using Doppler ultrasound (Vivid 7 PRO, GE Health Japan, Tokyo) in 17 MS (8 males and 9 females; 20-58 years of age, median 38 years) and 11 neuromyelitis optica (NMO) Japanese patients (1 male and 10 females; 23-60 years of age, median 44 years). Nine of the 11 NMO patients were seropositive for anti-aquaporin4 antibodies. We did not find any obstruction or stenosis of the internal jugular veins in any patient. Other disorders such as bilateral internal and external jugular venous ligation or radical neck dissection, which result in venous stasis, are not known causes of demyelination in the central nervous system. Our data also does not support the hypothesis of CCSVI theory, despite the fact that our study was limited to a small group of patients and the examination was performed only using Doppler ultrasound. PMID:21735737

198

Pull-Through Technique for Recanalization of Occluded Portosystemic Shunts (TIPS): Technical Note and Review of the Literature  

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is an important problem after creation of shunts. Most commonly, TIPS recanalization is performed via the jugular vein approach. Occasionally it is difficult to cross the occlusion. We describe a hybrid technique for TIPS revision via a direct transhepatic access combined with a transjugular approach. In two cases, bare metal stents or polytetrafluoroethylene (PTFE)-covered stent grafts had been placed in TIPS tract previously, and they were completely obstructed. The tracts were inaccessible via the jugular vein route alone. In each case, after fluoroscopy or computed tomography-guided transhepatic puncture of the stented segment of the TIPS, a wire was threaded through the shunt and snared into the right jugular vein. The TIPS was revised by balloon angioplasty and additional in-stent placement of PTFE-covered stent grafts. The patients were discharged without any complications. Doppler sonography 6 weeks after TIPS revision confirmed patency in the TIPS tract and the disappearance of ascites. We conclude that this technique is feasible and useful, even in patients with previous PTFE-covered stent graft placement.

199

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases  

Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3–4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension.In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.   

200

Early and Late Retrieval of the ALN Removable Vena Cava Filter: Results from a Multicenter Study  

Retrieval of removable inferior vena cava (IVC) filters in selected patients is widely practiced. The purpose of this multicenter study was to evaluate the feasibility and results of percutaneous removal of the ALN removable filter in a large patient cohort. Between November 2003 and June 2006, 123 consecutive patients were referred for percutaneous extraction of the ALN filter at three centers. The ALN filter is a removable filter that can be implanted through a femoral/jugular vein approach and extracted by the jugular vein approach. Filter removal was attempted after an implantation period of 93 {+-} 15 days (range, 6-722 days) through the right internal jugular vein approach using the dedicated extraction kit after control inferior vena cavography. Following filter removal, vena cavograms were obtained in all patients. Successful extraction was achieved in all but one case. Among these successful retrievals, additional manipulation using a femoral approach was needed when the apex of the filter was close to the IVC wall in two patients. No immediate IVC complications were observed according to the postimplantation cavography. Neither technical nor clinical differences between early and late filter retrieval were noticed. Our data confirm the safety of ALN filter retrieval up to 722 days after implantation. In infrequent cases, additional endovenous filter manipulation is needed to facilitate extraction.

 
 
 
 
201

The effect of hyperventilation and hyperoxia on cerebral venous oxygen saturation in patients with traumatic brain injury.  

Eighteen head-injured patients undergoing hyperventilation were studied for changes in jugular venous oxygen saturation (SjvO2) and arteriovenous oxygen content difference (AVDO2) in response to changes in PaO2 and PaCO2. SjvO2 decreased significantly from 66% +/- 3% to 56% +/- 3% (mean +/- SD) when PaCO2 decreased from 30 to 25 mm Hg at a PaO2 of 100-150 mm Hg. SjvO2 values returned to baseline (66% +/- 2%) when PaCO2 was restored to 30 mm Hg. Repetition of the study at a PaO2 of 200-250 mm Hg produced a similar pattern. However, SjvO2 values were significantly greater with PaO2 within the range of 200-250 mm Hg (77% +/- 4% and 64% +/- 3%) than SjvO2 measured at a PaO2 of 100-150 mm Hg at PaCO2 values of both 30 and 25 mm Hg. AVDO2 also improved with a PaO2 of 200-250 mm Hg at each PaCO2 (P SjvO2 associated with decreases in PaCO2 may be offset by increasing PaO2. IMPLICATIONS: The adequacy of cerebral oxygenation can be estimated in head-injured patients by monitoring jugular bulb oxygen saturation and the arteriovenous oxygenation content difference. Increasing the partial pressure of arterial oxygen above normal offset deleterious effects of hyperventilation on jugular bulb oxygen saturation and arteriovenous oxygenation content difference in head-injured patients. PMID:9768781

202

[What will jugular bulb oxygen saturation monitoring tell?].  

Global cerebral oxygenation can be measured by means of a catheter introduced in the internal jugular vein and placed retrograde in the jugular bulb. The measure of oxygen saturation sampled from the jugular vein (SjvO2) depends on cerebral metabolism and blood flow. This parameter describes the relative balance between oxygen delivery to the brain and oxygen consumption by the brain. SjvO2 remains normal until cerebral blood flow is proportional to cerebral metabolic demands. Any disturbances that increase cerebral metabolism and/or diminishes cerebral oxygen supply determines a reduction of SjvO2. Correspondingly, a decrease of oxygen consumption and/or an increase of oxygen supply may induce an increase of SjvO2. Therefore, SjvO2 is a useful monitor to assess the adequacy of cerebral circulation in patients with neurologic illness, allowing detection of state of hypoperfusion. Monitoring cerebral oximetry in comatose patients is of great importance in order to prevent, detect, control and understand secondary brain insults and damage which are mainly ischemic/hypoxic in nature. Although SjvO2 was shown to be highly sensitive in the presence of global hypoxia or ischemia, the occurrence of focal ischemia may still go undetected. Besides this, elevated SjvO2 should not be universally interpreted as hyperaemia. Instead, the presence of an elevated SjvO2 is a heterogeneous condition. Increased SjvO2 may be alarming prognostic indicators that carry important implications for comatose patients management. PMID:10389412

203

Preferential activation of the vagal nodose nociceptive subtype by TRPA1 agonists in the guinea pig esophagus  

Background The TRPA1 receptor is directly activated by a wide range of chemicals including many endogenous molecules relevant for esophageal pathophysiology. We addressed the hypothesis that the TRPA1 agonists differentially activate esophageal nociceptive subtypes depending on their embryological source (neural crest or epibranchial placodes). Methods Single cell RT-PCR and whole cell patch clamp recordings were performed on the vagal neurons retrogradely labeled from the guinea pig esophagus. Extracellular recordings were made in the isolated innervated esophagus preparation ex vivo. Key results Single cell RT-PCR revealed that the majority of the nodose (placodes-derived) and jugular (neural crest-derived) TRPV1-positive esophageal nociceptors express TRPA1. Single fiber recording showed that the TRPA1 agonists allyl-isothiocyanate (AITC) and cinnamaldehyde were effective in inducing robust action potential discharge in the nerve terminals of nodose nociceptors, but had far less effect in jugular nociceptors (approximately fivefold less). Higher efficacy of the TRPA1 agonists to activate nodose nociceptors was confirmed in the isolated esophagus-labeled vagal neurons in the whole cell patch clamp studies. Similarly to neural crest-derived vagal jugular nociceptors, the spinal DRG nociceptors that are also neural crest-derived were only modestly activated by allyl-isothiocyanate. Conclusions & Inferences We conclude that the TRPA1 agonists are substantially more effective activators of the placodes-derived than the neural crest-derived esophageal nociceptors. Our data predict that in esophageal diseases the presence of endogenous TRPA1 activators will be preferentially signaled by the vagal nodose nociceptors.

204

Changes in Plasma Progesterone Levels in the Caudal Vena Cava and the Jugular Vein and Luteinizing Hormone Secretion Pattern After Feeding in Lactating and Non-lactating Dairy Cows  

The present study was designed to assess progesterone profiles at the secreted (caudal vena cava) and circulating levels (jugular vein) and luteinizing hormone (LH) secretion pattern in lactating and non-lactating cows with reference to feeding. Four lactating and four non-lactating cycling Holstein cows were examined. Blood samples were collected simultaneously from the caudal vena cava (via a catheter inserted from the coccygeal vein) and the jugular vein every 15 min for 12 h (0500–1700 h) during the functional luteal phase. Cows were fed 50% of the daily diet 6 h after the start of blood sampling. During the 12-h sampling period, mean progesterone concentrations in the caudal vena cava did not differ between lactating and non-lactating cows (49.0 ± 2.9 and 53.3 ± 3.7 ng/ml; mean ± SE), whereas mean progesterone concentrations in the jugular vein in lactating cows were higher than those in non-lactating cows (6.4 ± 0.1 and 5.6 ± 0.1 ng/ml, P   

205

Hepatectomia total com preservação da veia cava inferior: "piggy-back" experimental em cães/ Total hepatectomy with preservation of the inferior vena cava: piggyback technique in the dog  

Abstract in portuguese No transplante de fígado, a preservação do segmento retro-hepático da veia cava durante a hepatectomia do receptor apresenta uma série de vantagens: diminuição do tempo de isquemia quente por eliminar a anastomose da veia cava infra-hepática, redução da necessidade da utilização de derivações veno-venosas e simplificação da cirurgia do re-transplante hepático. Em cães, os lobos hepáticos lateral direito e caudado são caprichosamente atravessados pela v (more) eia cava inferior, dificultando a completa "esqueletização" do vaso. No presente trabalho, os autores revisam a singular história do método do "piggy-back" experimental e clínico, e discutem a técnica da cirurgia em cães. Abstract in english During the recipient hepatectomy in liver transplantation, preservation of the retrohepatic segment of the inferior vena cava has several advantages: it decreases warm ischemia time by eliminating the infrahepatic caval anastomosis, eliminates the need for venovenous bypass and eases retransplantation. Removal of the liver of the dog without sacrificing the inferior vena cava has been considered impossible because of the intrahepatic course of the vena cava at the sites o (more) f entry of the hepatic veins. The following report reviews the history of the piggyback method, and discuss about the feasibility of the total removal of the liver without injury to the vena cava in the dog.

206

Surgical treatment of lone atrial fibrillation/ Tratamento cirúrgico da fibrilação atrial solitário  

Abstract in portuguese Atualmente, isolamento epicárdico da veia pulmonar com cirurgia torácica vídeo-assistida sem circulação extracorpórea oferece uma alternativa atraente para procedimento de Maze com circulação extracorpórea no tratamento cirúrgico da fibrilação atrial solitária. No entanto, procedimento de Maze com circulação extracorpórea através de uma meio-esternotomia ainda desempenha papel importante em pacientes com fibrilação atrial isolada em várias ocasiões, e (more) specialmente em pacientes com falha da veia pulmonar percutânea isoladamente. O objetivo do artigo é fazer uma breve revisão de estratégias para o tratamento cirúrgico fibrilação atrial isolado e apresentar as possíveis indicações de procedimento de Maze com extracorpórea, através de uma abordagem meio-esternotomia. Abstract in english Currently, off-pump video-assisted thoracoscopic epicardial pulmonary vein isolation offers an attractive alternative to on-pump Maze procedures for surgical treatment of lone atrial fibrillation. Nevertheless, on-pump Maze procedures through a mid-sternotomy approach still play an important role in patients with lone atrial fibrillation on many occasions, especially in patients with failed percutaneous pulmonary vein alone. The aim of this article was to give a brief rev (more) iew of the surgical strategies for treating lone atrial fibrillation, and present the possible indications for on-pump Maze procedures through a mid-sternotomy approach.

207

Effects of electrocautery to provoke endovascular thermal injury/ Efeitos do eletrocautério para provocar lesão térmica endovascular  

Abstract in portuguese OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressivas de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto (more) maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular. Abstract in english PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy ap (more) plied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.

208

Prevalência de hipertensão arterial em pacientes com oclusão do ramo da veia central da retina/ Prevalence of arterial hypertension in branch retinal vein occlusion patients  

Abstract in portuguese OBJETIVOS: Identificar em pacientes com oclusão do ramo da veia central da retina utilizando a monitorização ambulatorial da pressão arterial e medidas clínicas da pressão arterial: prevalência de hipertensão e o perfil noturno da pressão arterial. MÉTODOS: Prospectivamente, 93 olhos de 83 pacientes com oclusão do ramo da veia central da retina foram submetidos à avaliação oftalmológica. Após, os pacientes foram encaminhados para avaliação clínica e mon (more) itorização da pressão arterial. Pacientes sem descenso da pressão durante o sono ("non-dipper") foram definidos como um declínio na pressão arterial sistólica Abstract in english PURPOSE: To identify in patients with branch retinal vein occlusion using ambulatory blood pressure monitoring and clinical blood pressure measures: hypertension prevalence, and nocturnal profile of blood pressure. METHODS: Prospectively, 93 eyes of 83 patients with branch retinal vein occlusion were submitted to ophthalmological examination. Afterwards the patients were submitted to clinical evaluation and blood pressure monitoring. Non-dipper was defined as a fall in sy (more) stolic blood pressure

209

Utilização da técnica do varal para angioplastia de estenose de veia central com stent-graft/ Utilization of the through-and-through technique for central vein angioplasty using stent-graft  

Abstract in portuguese A estenose de veia central é uma das situações mais frequentes em pacientes com insuficiência renal crônica em hemodiálise. A angioplastia com o uso de stent-graft tem obtido bons resultados nestes casos. O sistema de liberação dos stents é de calibre maior, podendo dificultar sua navegabilidade em áreas de estenose ou tortuosidade acentuadas. A técnica do varal é comumente utilizada para o tratamento endovascular do aneurisma de aorta, permitindo atingir bom (more) mecanismo de estiramento e facilitando a navegação do sistema de entrega da endoprótese. Descrevemos o caso de uma angioplastia de veia central com stent-graft na qual foi utilizada a técnica do varal para permitir a transposição da área de estenose. Abstract in english The central vein stenosis is one of the most common conditions in patients with chronic kidney failure in a hemodialysis program. In these cases, angioplasty using stent-grafts has obtained good results. The stent-graft delivery system is generally of large diameter what can hinder its navigability in very severe stenosis or tortuosities. The through-and-through technique is commonly used for endovascular treatment of aortic aneurysms, making possible to achieve a good me (more) chanism of stretch and easy navigation of the endograft delivery system. We report a case of a central venous stenosis in wich a stent-graft was inserted using the through-and-through technique in order to cross the lesion.

210

Subclavian vein angioplasty during arteriovenous fistula surgery: case report and literature review/ Angioplastia de veia subclávia no intraoperatório de fístula arteriovenosa: relato de caso e revisão de literatura  

Abstract in portuguese Pacientes portadores de Insuficiência Renal Crônica (IRC) estágio V são geralmente tratados por hemodiálise (HD), preferencialmente por fístula arteriovenosa (FAV). Descrevemos um relato de caso de um paciente de 58 anos, masculino, portador de diabetes mellitus, hipertensão arterial sistêmica e IRC terminal. Seus antecedentes demonstram múltiplos acessos para implante de cateter de hemodiálise, assim como tentativas prévias de realização de FAV. Esse pacient (more) e desenvolveu estenose subclínica da veia subclávia, limitando a HD pelo membro superior. O propósito deste relato foi descrever o tratamento endovascular de estenose de veia subclávia, concomitante à realização de uma nova FAV. Abstract in english Patients with chronic kidney disease stage 5 are generally treated by hemodialysis, preferentially performed via an arteriovenous fistula (AVF). We report the case of a 58-year-old male patient with diabetes mellitus, hypertension and end-stage renal disease in whom hemodialysis was conducted via a long-term catheter. His medical record described numerous central venous cannulations and several AVF creations. The patient developed subclinical subclavian stenosis that requ (more) ired creation of a new vascular access route. The purpose of this case report is to describe treatment of subclavian vein stenosis during AVF creation.

211

Trombose de veia central da retina bilateral associada à síndrome de hiperviscosidade sanguínea: relato de caso/ Bilateral central retinal vein occlusion associated with blood hyperviscosity syndrome: case report  

Abstract in portuguese Relato de caso de um paciente masculino de 16 anos de idade com queixa inicial de baixa da acuidade visual e que no exame oftalmológico foi encontrado edema de papila bilateral, que evoluiu para trombose da veia central da retina em ambos os olhos. Na investigação laboratorial, foi feito diagnóstico de um mieloma múltiplo tipo IgA que cursava com síndrome de hiperviscosidade sanguínea, o que explicava o quadro oftalmológico. Após tratamento específico, o pacient (more) e apresentou melhora tanto da acuidade visual quanto do aspecto fundoscópico. O achado de oclusão de veia central da retina bilateral pode levar ao diagnóstico de importantes doenças sistêmicas. os achados fundoscópicos podem servir de parâmetro na avaliação do tratamento. Abstract in english The authors report the case of a 16-year-old male patient who presented with blurred vision and bilateral optic disc edema, then developing bilateral central retinal vein occlusion. On laboratory work-up, he was found to have multiple myeloma IgA along with hyperviscosity syndrome, which led to the ophthalmological features. After proper treatment, the patient recovered visual acuity and normalized his eye fundus changes. Bilateral central retinal vein occlusion finding m (more) ay yield the diagnosis of major systemic diseases. Fundoscopic features may serve as parameters on treatment evaluation.

212

Regeneração do fígado de ratos após oclusão parcial da drenagem venosa hepática/ Hepatic regeneration after parcial oclusion of hepatic vein drainage in rats  

Abstract in portuguese INTRODUÇÃO: A regeneração hepática é um mecanismo para superar a perda de tecido funcional do fígado. Este processo é estudado através de diferentes métodos. OBJETIVO: Avaliar o efeito da oclusão parcial da drenagem venosa hepática sobre a regeneração do fígado remanescente de ratos submetidos à hepatectomia parcial. MÉTODO: Foram colhidas biópsias de fígado em 30 ratos Wistar machos, e a seguir realizada hepatectomia a dois terços. Os animais foram di (more) vididos em três grupos: um grupo controle e dois grupos de estudo, submetidos a diferentes graus de estenose da veia hepática direita. Após 96 horas do estímulo para regeneração hepática, todos submeteram-se à outra biópsia hepática. Analisaram-se os fragmentos por imunoistoquímica para os marcadores Ki-67 e fator de von Willebrand. Para a leitura das amostras utilizou-se o sistema SAMBA 4000. A deposição de colágeno foi avaliada pela coloração tricrômico de Masson. RESULTADOS: A proliferação celular dos animais submetidos à hepatectomia parcial e estenose moderada ou severa da veia hepática direita persistiu mais elevada quando comparada ao grupo controle. O Índice de Marcação para o Ki-67 foi significativamente mais elevado após a hepatectomia nos grupos submetidos à oclusão parcial da veia hepática, tanto moderada quanto severa. A expressão de fator de von Willebrand estava diminuída após a hepatectomia parcial nos três grupos. Houve pouco depósito de colágeno no tecido hepático nos animais dos dois grupos com estenose da veia hepática direita. CONCLUSÃO: A oclusão parcial da drenagem venosa hepática em ratos submetidos à hepatectomia parcial prolonga o tempo de proliferação de células hepáticas quando comparado aos animais com veias de calibre normal. Como consequência, também houve atraso na restauração da matriz extracelular e na formação de novos vasos sinusoidais. Abstract in english BACKGROUND: Hepatic regeneration is a mechanism to overcome the loss of liver functional tissue. This process has been studied through different methods. AIM: To evaluate the effect of the partial occlusion of the hepatic venous drainage on the regeneration of the remainder livers in rats submitted to partial hepatectomy. METHOD: Liver biopsies from 30 male Wistar rats were collected, and after they were submitted two-third hepatectomy. The animals were divided in three g (more) roups: a control group and two study groups, which were submitted to different degrees of the right hepatic vein stenosis. After 96 hours of the stimulation for regeneration all rats were submitted to another hepatic biopsy. The analysis of the fragments was performed by immunohistochemistry for the Ki-67 and von Willebrand factor markers. The reading of the samples was done using the SAMBA 4000 system. Collagen deposition was evaluated by the trichromic Masson's staining. RESULT: The cellular proliferation of the animals submitted to partial hepatectomy and stenosis of the right hepatic vein persists higher when compared to control group. The Label Index for Ki-67 was significantly higher post-hepatectomy in groups submitted to hepatic vein partial occlusion. The expression of von Willebrand factor was strongly decreased after the hepatectomy in all groups. There was little deposit of collagen in the hepatic tissue of animals with hepatic vein stenosis. CONCLUSION: Partial occlusion of the hepatic venous drainage in rats submitted to partial hepatectomy prolongs the time of hepatic cells proliferation when compared to the animals with vein of normal caliber. Consequently, there will be also a delay in the restoration of the extracellular matrix and in the formation of new sinusoidal vessels.

213

Contributions to the knowledge of Banasa Stål (Hemiptera, Heteroptera, Pentatomidae): Banasa chaca Thomas  

Abstract in portuguese Contribuições ao conhecimento de Banasa Stål (Hemiptera: Heteroptera: Pentatomidae: Pentatominae): Banasa chaca Thomas. O macho de Banasa chaca Thomas é descrito com ênfase na genitália externa e interna, também é descrita a genitália interna da fêmea. Banasa chaca é registrada pela primeira vez na província de Buenos Aires (Argentina). Abstract in english Contributions to the knowledge of Banasa Stål (Hemiptera, Heteroptera, Pentatomidae): Banasa chaca Thomas. The male of Banasa chaca Thomas is described with emphasis on external and internal genitalia and the female internal genitalia is described. Banasa chaca is newly recorded from Buenos Aires Province (Argentina).

214

Epistaxe tardia secundária a pseudoaneurisma intracavernoso de carótida interna/ Delayed epistaxis secondary to intracavernous pseudoaneurysm of internal carotid artery  

Abstract in portuguese Pseudoaneurisma traumático da artéria carótida interna é uma causa rara de epistaxe, porém potencialmente fatal. O diagnóstico precoce é essencial para um adequado manejo da patologia. Os autores relatam um caso de pseudoaneurisma da carótida interna que se apresentou como epistaxe maciça após seis meses de trauma craniano prévio. Abstract in english Post-traumatic pseudoaneurysm of the internal carotid artery is a very rare but potentially fatal cause of epistaxis. Early diagnosis is essential for an adequate management of this entity. The authors present a case of pseudoaneurysm of the internal carotid artery that developed massive epistaxis six months after skull base trauma.

215

Bindweeds or random walks in random environments on multiplexed trees and their asympotics  

We report on the asymptotic behaviour ofa new model of random walk, we term the bindweed model, evolving in a random environmenton an infinite multiplexed tree.The term \\textit{multiplexed} means that the model can beviewed as a nearest neighbours random walk on a tree whosevertices carry an interna...

216

Ecosystem-based adaptation to climate change: What role for policy-makers, society and scientists?  

In developing countries where economies and livelihoods depend largely on ecosystem services, policies for adaptation to climate change should take into account the role of these services in increasing the resilience of society. This ecosystem-based approach to adaptation was the focus of an interna...

217

Knowledge transfer within multinational corporations : how well does it flow?  

O conhecimento é considerado um dos mais importantes, se não o mais importante, recurso estratégico das empresas. Particularmente, no âmbito das empresas multinacionais (MNCs), a transferência interna de conhecimento coloca-se como o mais importante desafio estratégico. Contudo, a literatura com foc...

218

IFRS 3 - Enlightening the world of Acquisitions : A study of IFRS 3, IAS 36 & IAS 38's impact on companies financial statements and their acquisition process IFRS 3 - Sätter företagsförvärv i nytt ljus : En studie av IFRS 3, IAS 36 & IAS 38s påverkan på företags finansiella rapportering och deras förvärvsprocess  

Purpose: The purpose with this thesis is to describe and analyze how the new interna-tionally harmonized accounting standards IFRS 3, IAS 36 & IAS 38 affect the financial statements of companies listed on the Stockholm Stock Exchange and if the new rules have an impact on these firms acquisition...

219

COLLABORATIVE RESEARCH: IN SITU MITIGATION OF MERCURY CONTAMINATED GROUNDWATER IN KAZAKHSTAN  

Abstract for EPA Science Forum. The EPA Office of International Affairs is managing a U.S. State Department -funded project to redirect former Soviet Union biological weapons scientists. Scientists in countries of the former Soviet Union receive funding through the Interna...

220

ESTRUCTURA INTERNA DE LA GUADUA Y SU INCIDENCIA EN LAS PROPIEDADES MECÁNICAS/ INTERNAL STRUCTURE OF THE GUADUA AND ITS INCIDENCE IN THE MECHANICAL PROPERTIES  

Abstract in spanish La Guadua angustifolia kunth GAK, fue caracterizada en su estructura interna, y se encontró la incidencia que presenta esta en la resistencia a flexión y a tensión. La resistencia a la flexión disminuye de la capa externa a la interna, debido a la reducción de la cantidad de células de fibras en ese sentido. Los valores de resistencia a flexión en la GAK disminuyen con la presencia de nudos debido a la discontinuidad de las fibras en esa parte del material. La resi (more) stencia a la tensión al igual que la de flexión disminuye de la capa externa a la interna, aspecto que se relaciona con que la cantidad de las células de fibra disminuyen hacia la capa interna. Abstract in english The Guadua angustifolia kunth GAK, was characterized in its microestructure, and founded the effect that this one presents in the resistance to flexion and to stress. The resistance to the flexion diminishes from the external to the internal layer, due to the reduction of the quantity of cells of fibers in this direction. The resistance to flexion values in the GAK diminishes with the presence of nodes due to the discontinuity of the fibers in this part of the material. T (more) he resistance to the stress as that of flexion diminishes of the external to the internal layer, aspect that relates that the quantity of the cells of fiber diminishes towards the internal layer.

 
 
 
 
221

Impact of Air Distribution on Heat Transfer during Night-Time Ventilation  

Passive cooling by night-time ventilation is seen as a promising approach for energy efficient cooling of buildings. However, uncertainties in prediction of cooling potential and consequenses for thermal comfort restrain architects and engineers from applying this technique. Heat transfer at interna...

222

Deficient Proliferation and Apoptosis in the Granulosa and Theca Interna Cells of the Bovine Cystic Follicle  

The aim of the present study was to examine the frequencies of cell proliferation and death of granulosa and theca interna layers during development of cystic follicles in order to understand the mechanisms of cystic follicle formation. Paraffin sections of cystic follicles were immunostained with antibodies against proliferating cell nuclear antigen (PCNA) and cleaved caspase-3 in order to observe proliferating and apoptotic cells, respectively. The concentrations of estradiol-17? and progesterone in the follicular fluid of these follicles were measured by ELISA. The granulosa and theca interna layers contained both PCNA- and caspase-3-positive cells, although their numbers were limited. There was significant negative correlation between the estradiol-17? and progesterone concentrations in the follicular fluid. Regression analysis revealed no significant correlation, except for that between the PCNA-positive cells in the theca interna and the caspase-3-positive cells in the granulosa layer. These results indicate that the granulosa and theca interna cells of the cystic follicle show weak proliferative activity and low apoptotic frequency; this implies that the cystic follicle grows slowly and then maintains a static condition without degeneration, which leads to long-term persistence of the follicle.   

223

Space Operations Mission Directorate (PDF-3.9 MB)  

exploration activities in low-Earth orbit are the Space Shuttle and Interna- tional Space Station programs. .... we re-create wind tunnel test databases, as well. As Constel- ..... enhancements for lower-speed flows with high-speed jets. The increased ..... Computational Fluid Dynamics, Seoul, Korea, July 2008. [2] Kiris, C .

224

Comparison of Methods of Extracting Salmonella enterica Serovar Enteritidis DNA from Environmental Substrates and Quantification of Organisms by Using a General Internal Procedural Control  

This paper compares five commercially available DNA extraction methods with respect to DNA extraction efficiency of Salmonella enterica serovar Enteritidis from soil, manure, and compost and uses an Escherichia coli strain harboring a plasmid expressing green fluorescent protein as a general interna...

225

A climatology of infrasound detections in northern Norway at the experimental ARCI array  

Abstract The study of infrasound is experiencing a renaissance in recent years since it was chosen as a verification technique for the Comprehensive Nuclear-Test-Ban Treaty. Currently, 60 infrasound arrays are being installed to monitor the atmosphere for nuclear tests as part of the Interna...

226

Optimal MRI methods for direct stereotactic targeting of the subthalamic nucleus and globus pallidus.  

Reliable identification of the subthalamic nucleus (STN) and globus pallidus interna (GPi) is critical for deep brain stimulation (DBS) of these structures. The purpose of this study was to compare the visibility of the STN and GPi with various MRI techniques and to assess the suitability of each te...

227

Measurement of VOC emissions from curative treated wood: a new emission test chamber method  

In order to precisely measure emissions from building products and estimate the potential heath impact of emitted pollutants, standardised analytical methods are needed. The aim of this paper is to present the new standards prepared by the European Committee for Standardization (CEN) and the Interna...

228

Distribution of Within-Ring Internal Checking in Pinus radiata Grown in Southern Chile/ Distribución de Grietas Internas Inter-Anulares en Pinus radiata Crecido en El Sur de Chile  

Abstract in spanish El incremento de las plantaciones de Pinus radiata en Chile ha entregado importantes volúmenes a la industria y por lo tanto la oportunidad de transformarlos en productos de alto valor. Las grietas internas constituyen un problema que puede afectar la calidad de la madera, en particular en aquellos productos que se clasifican por su apariencia. Este problema se puede apreciar en la zona de madera temprana de la albura en madera seca y sólo cuando la madera es trozada. E (more) l propósito de este estudio fue el de analizar, la frecuencia de aparición de grietas internas inter-anulares en madera seca de Pinus radiata. Como resultados, se encontró en las tablas centrales, compuestas por madera juvenil, una alta frecuencia de grietas internas entre los anillos 4 y 6. Abstract in english The increase of Pinus radiata plantations in Chile has brought larger annual volumes to the industry and the opportunity to process them into value-added products. Within-ring checks constitute an important problem that may affect the appearance quality of lumber. This problem occurs in the early wood portion of sapwood growth rings in dry lumber and can only be seen when the board is cross cut. The purpose of this study was to analyze the frequency of within-ring interna (more) l checking in kiln-dried Pinus radiata lumber from different logs grown in southern Chile. Centre boards were more affected by the internal checking. Checks were located more frequently between rings 4 to 6.

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Facial Action Recognition Combining Heterogeneous Features via Multi-Kernel Learning  

This paper presents our response to the first interna- tional challenge on Facial Emotion Recognition and Analysis. We propose to combine different types of features to automatically detect Action Units in facial images. We use one multi-kernel SVM for each Action Unit we want to detect. The first k...

230

General Dynamic Surface Reconstruction: Application to the 3D Segmentation of the Left Ventricle  

Aquesta tesi descriu la nostra contribució a la reconstrucció tridimensional de les superfícies interna i externa del ventricle esquerre humà. La reconstrucció és un primer procés dins d'una aplicació global de Realitat Virtual dissenyada com una important eina de diagnòstic per a hospitals. L'aplic...

231

Indian Academy of Sciences - Prof. C. N. R. Rao  

rao, chintamani nagesa ramachandra hon. prof., iisc and linus pauling research professor,- jncasr, s. h nagesa rao and nagamma m. indumati, one s, one d of purdue, bordeaux novosibirk (ussr.), wroclaw (poland), serbian academy of sc. and slovenian academy of sc.; member, of japan and korea, and interna-tional academy of ceramics. fara ...

232

Utility of Pars Plana Vitrectomy with Internal Limiting Membrane Dissection, in the Surgical Treatment of Macular Hole and Diabetic Macular Edema. Clinic-Pathological Correlation  

ObjetivosEstudiar el papel de la extracción de la membrana limitante interna (MLI) durante la vitrectomía posterior por vía pars plana (VPP), en el tratamiento quirúrgico de lo agujero macular (AM) y de lo edema macular crónico diabético (EMCD). Hemos estudiado las tasas de éxito clínico de la extra...

233

Estudio preliminar de las grietas internas en anillos de madera inicial y su relación con características de la estructura anatómica y densidad en Eucalyptus nitens/ Preliminary study of internal checks within growth-rings and their relationship with anatomical features and density in Eucalyptus nitens/ preliminar das fissuras internas em anéis de madeira inicial e sua relação com características da estrutura anatômica e densidade em Eucalyptus nitens  

Abstract in portuguese A presença de fissuras internas dentro dos anéis de crescimento foi relacionada com a densidade e as características anatômicas de uma árvore de Eucaliptus nitens. O desenho experimental incluiu como variáveis a posição radial e apical. As fissuras internas foram avaliadas depois da secagem ao ar e a 60ºC. As características anatômicas e a densidade foram determinadas mediante métodos normalizados e apoio de raios X. A intensidade das fissuras internas foi con (more) dicionada pela posição radial e apical na árvore. As fissuras internas foram mais intensas entre os anéis 4 a 9, e se relacionaram inversamente com a densidade da madeira e diretamente com a proporção e diâmetro de vasos. Abstract in spanish La presencia de grietas internas dentro de los anillos de crecimiento fue relacionada con la densidad y las características anatómicas de un árbol de Eucalyptus nitens. El diseño experimental incluyó como variables la posición radial y apical. Las grietas internas fueron evaluadas después del secado al aire y a 60ºC. Las características anatómicas y la densidad fueron determinadas mediante métodos normalizados y apoyo de rayos X. La intensidad de las grietas in (more) ternas fue condicionada por la posición radial y apical en el árbol. Las grietas internas fueron más intensas entre los anillos 4 a 9, y se relacionaron inversamente con la densidad de la madera y directamente con la proporción y diámetro de vasos. Abstract in english Internal checks within growth rings were correlated with density and anatomical characteristics of Eucalyptus nitens. The radial and longitudinal positions in the tree were the experimental variables. Internal checks were characterized after air drying and after conventional drying at 60°C. The anatomical characteristics and density were determined using standardized methods and the X-ray technique. The size of internal checks was influenced by their radial and longitudi (more) nal positions in the tree. Internal checks were larger in growth rings 4 to 9, and were inversely related to wood density and directly related to the proportion and diameter of the vessels.

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Anatomia do sistema porta renal e suas implicações no emprego de agentes anestésicos na contenção de avestruzes (Struthio camelus)/ Anatomy of the renal portal system and its implications for the use of anesthetic agents in the restraint of ostriches (Struthio camelus)  

Abstract in portuguese Objetivou-se com este estudo caracterizar a anatomia do sistema porta renal e verificar sua influência sobre o protocolo anestésico xilazina, tiletamina e zolazepam na contenção de avestruzes, por comparação da administração dos fármacos nos músculos da perna ou da asa. Em cinco animais foi injetado látex nas veias femorais no sentido de drenagem e, posteriormente, as aves foram fixadas em formol a 10%, por 72 horas. Em uma ave, procedeu-se à localização, co (more) lheita e fixação das valvas portais renais em formol a 10%. O sistema porta renal apresentou-se constituído por duas veias portais renais craniais, duas veias portais renais caudais e seis valvas portais renais. Na contenção química, seis avestruzes foram pré-tratados com xilazina (1mg kg-1) e, decorridos 10 minutos, receberam tiletamina/zolazepam (6mg kg-1). Os animais foram manipulados em duas ocasiões diferentes, sendo que na primeira anestesia o protocolo foi administrado nos músculos da base das asas (GI) e, após 15 dias, os mesmos animais receberam o protocolo nos músculos das pernas (GII). Os períodos de latência, hábil e de recuperação não foram diferentes entre os grupos (P>0,05). A freqüência cardíaca permaneceu abaixo dos valores basais durante a anestesia (P Abstract in english This study was aimed at characterizing the anatomy of the renal portal system, and determining its influence on the anesthetic protocol xylazine, tiletamine and zolazepam, in the restraint of ostriches, compared with the administration of drugs into the leg or wing muscles. Latex was injected into the femoral veins of five animals, for drainage purposes, and the birds were then fixed in 10% formaldehyde, for 72 hours. In one bird, the renal portal valves were located, col (more) lected and fixed in 10% formaldehyde. The renal portal system consisted of two cranial renal portal veins, two caudal renal portal veins, and six renal portal valves. In the chemical restraint, six ostriches were anesthetized with xylazine (1mg kg-1) and after 10 minutes, tiletamine/zolazepam (6mg kg-1). The animals were handled on two different occasions: in the first anesthesia, the protocol was administered into the muscles at the base of the wings (GI) and after 15 days, the same animals received the protocol in the leg muscles (GII). The periods for the onset and duration of the anesthesia, and recovery, showed no difference between the groups (P>0.05). The heart rate remained below the basal values during the anesthesia (P

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Critérios prognósticos de sucesso e recorrência na ablação circunferencial para tratamento da fibrilação atrial/ Prognostic criteria of success and recurrence in circumferential ablation for the treatment of atrial fibrillation  

Abstract in portuguese OBJETIVOS: Analisar o sucesso da ablação circunferencial da fibrilação atrial e investigar possíveis preditores, clínicos e eletroanatômicos, de recorrência da arritmia. MÉTODOS: Foram analisados 104 pacientes consecutivos, submetidos à ablação circunferencial para tratamento de fibrilação atrial paroxística/persistente, sem cardiopatia estrutural e refratários a pelo menos duas drogas antiarrítmicas. Eram do sexo masculino 72 pacientes e a idade média d (more) o grupo foi de 58,6 + 10,9 anos. O procedimento consistiu em punção transeptal única e mapeamento tridimensional, com o sistema CARTO® para a aquisição de pontos no átrio esquerdo e veias pulmonares. As aplicações de radiofreqüência foram realizadas ao redor dos óstios das veias pulmonares, até a redução > 80% da amplitude dos potenciais atriais. Uma linha adicional foi criada no istmo mitral e outra no istmo cavotricuspídeo. Foram analisadas: volume total do átrio esquerdo, área ablacionada ao redor das veias pulmonares e a presença ou não de falhas na linha de ablação (linha completa ou incompleta). Foi considerada linha completa quando a distância entre dois pontos contíguos de aplicação de radiofreqüência foi inferior a 10 mm. RESULTADOS: Em acompanhamento médio de 18 meses, 87 pacientes estavam em ritmo sinusal (84%) e 17 pacientes apresentaram recidiva (16%). Na análise multivariada, somente o volume atrial esquerdo (p Abstract in english OBJECTIVES: To analyze the success of circumferential ablation on atrial fibrillation and investigate possible clinical and electro-anatomical predictors of the recurrence of cardiac arrhythmia. METHODS: Analysis was done of 104 consecutive patients, free of structural heart disease and refractory to at least 2 antiarrhythmic drugs, submitted to circumferential ablation for treatment of paroxysmal/persistent atrial fibrillation. Were males 72 of the patients and the avera (more) ge age of the group was 58.6 + 10.9. The procedure consisted in a single transeptal puncture and three-dimensional mapping using the CARTO® system. Images of the left atrium and pulmonary veins were reconstructed. Radiofrequency applications were performed around the pulmonary vein ostia, up to a > 80% reduction in atrial potential amplitude. An additional mitral isthmus line was created, as well as one in the cavo-tricuspid isthmus. Total left-atrial volume, area ablated around the pulmonary veins, and the presence or absence of flaws in the ablation line (complete or incomplete line) were analyzed. A line was considered complete when the distance between two contiguous radiofrequency application points was less than 10 mm. RESULTS: After an average follow-up period of 18 months, 87 patients were in sinus rhythm (84%), while 17 patients presented recidivism (16%). In the multivariate analysis only left-atrial volume (p

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Variations in white blood count, thromboxane B2 levels and hematocrit in chronic venous hypertension  

Abstract in portuguese OBJETIVOS: Analisar a variação do número de leucócitos e produção de tromboxane B2 em coleta na veia femoral de pacientes com hipertensão venosa crônica. TIPO DE ESTUDO: Estudo clínico, prospectivo, controlado, não randomizado e aberto LOCAL: Disciplina de Cirurgia Vascular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. PARTICIPANTES: Quinze doentes, com história pregressa de úlcera de estase venosa recidivada, selecionados ale (more) atoriamente no Ambulatório de Doenças Venosas. Quatro pacientes sem alterações venosas dos membros inferiores. INTERVENÇÃO: Amostras de sangue colhidas na veia femoral e veia braquial após decúbito horizontal e proclive a 45º. VARIÁVEIS: Contagem dos leucócitos com câmara de contagem, e dosagem de tromboxane B2 com teste ELISA (Enzyme Linked Immunosorbent Assay). RESULTADOS: Após 30 minutos de proclive, houve redução na contagem de leucócitos de ±27% (p=0,02) e elevação na dosagem de tromboxane B2 de ±158% (p=0,02). CONCLUSÕES: Sugerimos que futuros estudos com medicações para tratamento de úlceras de estase avaliem a ação destes no seqüestro leucocitário e produção de tromboxane B2 e a correlação desta ação com o índice de cicatrização, no intuito de elucidar alguns aspectos importantes na etiologia das úlceras de estase. Abstract in english OBJECTIVE: To analyze variations in leukocyte count and thromboxane B2 production in the femoral vein of patients with chronic venous hypertension (CVH). DESIGN: Prospective clinical study, controlled, non randomized and open. LOCATION: Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, referral center, university hospital. PARTICIPANTS: 15 patients with recurring stasis ulcer were analyzed, selected randomly from the venous diseases outpatient c (more) enter, and 4 without lower limb venous alterations were also analyzed. INTERVENTION: Blood samples from the femoral and brachial veins were drawn following supine and 45º reverse Trendelenburg. MAIN OUTCOMES MEASURES: Direct leukocyte count and analysis of the thomboxane B2 with enzyme linked immunosorbent assay test. RESULTS: After 30 minutes in reverse Trendelenburg, patients with CVH showed a leukocyte count reduced by ±27% (p=0.02) and thromboxane B2 levels increased by ±158% (p=0.02). CONCLUSIONS: We suggest that future studies of medications for stasis ulcers include their effects on leukocyte entrapment and thromboxane B2 production in the lower limb venous system.

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Fontes de proteína, ingestão de alimentos e fluxo esplâncnico de nutrientes em ovinos/ Protein sources, feed intake and splanchnic flux of nutrients in sheep  

Abstract in portuguese O objetivo deste trabalho foi avaliar a ingestão de nutrientes e o fluxo esplâncnico de glicose, nitrogênio alfa-amino, amônia e uréia em ovinos alimentados com diferentes fontes de proteína. Foram utilizados três ovinos pesando, em média, 50 kg, implantados com quatro catéteres, sendo um na veia mesentérica, um na artéria mesentérica, um na veia porta e um na veia hepática. O delineamento utilizado foi o quadrado latino 3x3. Os tratamentos consistiram na uti (more) lização de três diferentes fontes de proteína: o farelo de soja, a farinha de penas e o farelo de glúten de milho. Não houve efeito dos tratamentos na ingestão de matéria seca (MS), matéria orgânica (MO), proteína bruta (PB) e fibra em detergente neutro (FDN). As concentrações portal, hepática e arterial de glicose, N alfa-amino, amônia e uréia não diferiram com a utilização de diferentes fontes de proteína. Somente o fluxo portal de glicose aumentou e o esplâncnico de N alfa-amino diminuiu com a utilização do farelo de glúten de milho como fonte de proteína. As taxas de extração hepática dos nutrientes foram de -10,51; 4,07; 47,69 e -4,81%, para a glicose, N alfa-amino, amônia e uréia, respectivamente, e não diferiram entre os tratamentos. Abstract in english Three wethers averaging 50 kg LW, fitted with four catheters, in the mesenteric vein, mesenteric artery, portal vein and hepatic vein, were used to evaluate nutrient intake and glucose, alpha-amino nitrogen, ammonia and urea splanchnic fluxes in sheep fed with different protein sources. Statistical design was a 3x3 Latin square. Treatments consisted of three different protein sources utilization: soybean meal, hydrolyzed feather meal and corn gluten meal. There were no tr (more) eatment effects over intake of dry matter (DM), organic matter (OM), crude protein (CP) and neutral detergent fiber (NDF). Portal, hepatic and arterial concentrations for glucose, alpha-amino nitrogen, ammonia and urea were not affected by different protein sources. Only glucose portal flux increased and alpha-amino nitrogen flux decreased when corn gluten meal as protein source was used. Nutrient hepatic extraction rate were -10.51, 4.07, 47.69 and -4.81% for glucose, alpha-amino nitrogen, ammonia and urea, respectively, and there was no difference among treatments.

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Adequação do teste de raios X para avaliação da qualidade de sementes de Embaúba (Cecropia pachystachya Trec.)/ Using X-ray test to evaluate the quality of Embaúba seeds (Cecropia pachystachya Trec.)  

Abstract in portuguese O trabalho foi realizado com o objetivo de adequar o teste de raios X para a avaliação da qualidade de sementes de embaúba e verificar a influência da formação da sua estrutura interna na germinação. As sementes foram expostas à radiação por tempos e intensidades variados, com utilização do equipamento Faxitron X-Ray, modelo MX-20 para definição da melhor combinação para visualização da morfologia interna . Definidas as condições para melhor visualiza (more) ção interna, as sementes foram radiografadas e classificadas em três classes, de acordo com a estrutura interna visualizada nas radiografias, em sementes totalmente formadas, parcialmente formadas e sementes não formadas. Individualmente, as sementes foram devidamente identificadas de acordo com a classe de formação e submetidas ao teste de germinação.. O teste de raios X é eficiente para avaliar as estruturas internas da semente de embaúba e a exposição por 360 segundos na intensidade de 10kV é adequada para a visualização. Há relação entre o nível de formação das sementes e os resultados do teste de germinação. Abstract in english The x-ray test was studied to evaluate the quality of embaúba seeds and verify the influence of the internal morphology on the seed germination. Seeds of a lot harvested in 2005 were used from the Bio Flora company. The seeds were exposed to radiation for various amounts of time and intensity, using Faxitron X-Ray equipment, model MX-20. The seeds were divided into three categories according to their internal structure visualized by radiographs in totally formed, partial (more) ly formed and not formed seeds. Soon after, seeds were submitted to the germination test. The results showed that the time of 360 seconds and 10kV intensity are recommendable for visualizing internal seed structures. The x-ray test is efficient to evaluate development level of embaúba seed structure. There is correlation between seed formation and the germination test results.

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CONDICIONANTES DE LAS GRIETAS INTERNAS DENTRO DE LOS ANILLOS DURANTE EL SECADO DE PINO RADIATA/ SOME FACTORS AFFECTING THE WHITING-RING INTERNAL CHECKING DURING DRYING OF RADIATA PINE  

Abstract in spanish Se estudian las grietas internas dentro de los anillos de madera inicial durante el secado industrial del pino radiata. Se determina el porcentaje de las grietas internas y se analizan algunos factores condicionantes de las grietas internas durante el secado industrial a temperaturas convencionales. Los ensayos de secado a temperaturas convencionales son realizados en un horno convectivo de 150 m³ de capacidad, operando en una planta industrial de la Octava Región (Chil (more) e). El diseño experimental incluye como factores variables, el sitio de procedencia de la madera (arcilla, arena), el tipo de madera (central, lateral y transición) y el tipo de corte (radial, tangencial y mixto). Los resultados indican que el porcentaje de grietas internas varía entre 1 y 18 % y que el sitio de procedencia de la madera y el tipo de madera condicionan significativamente el porcentaje de grietas internas durante el secado industrial a temperaturas convencionales del pino radiata Abstract in english The internal checking during the industrial drying of radiata pine is studied. The percentage of internal checking is determined and some factors influencing the internal checking are analyzed during the industrial drying at conventional temperatures. The runs are made in a 150 m³ capacity dry kiln in an industrial plant of the Eighth Region (Chile). The experimental design includes as variables, the origin site of the wood (clay, sand), the wood localization (central-wo (more) od, lateral-wood and transition-wood) and the type of cut (radial, tangential and mixed). The results indicate that the percentage of internal checking varies between 1 and 18% and that the origin site of the wood and the wood localization significantly condition the percentage of internal checking during the radiata pine industrial drying at conventional temperatures

240

An Anomalous Left External Jugular Vein Draining into Right Subclavian Vein: A Case Report/ Vena Yugular Externa Izquierda Anómala Drenando en la Vena Subclavia Derecha: Reporte de un Caso  

Abstract in spanish El conocimiento de los diferentes patrones de drenaje de las venas superficiales de la cabeza y cuello, en particular, las venas yugulares no sólo son importantes para anatomistas, sino también para los cirujanos que operan a este nivel y para los médicos en general. Las variaciones son importantes también para los radiólogos intervencionistas, quienes realizan procedimientos transyugulares, así como implantaciones portales y portosistémicas transyugulares intrahep (more) áticas o derivación venosa selectiva. Resultados de estudios recientes informan que la venas superficiales, especialmente la vena yugular externa, es cada vez más utilizada para la canulación en diagnósticos y procedimientos terapéuticos. Se reporta una muy inusual variación anatómica de la vena yugular externa del lado izquierdo, presente en un cadáver embalsamado de sexo masculino. Fueron realizadas evaluaciones embriológicas de la anomalía y se compararon con la literatura mostrando que se trata de una variación rara. Abstract in english Knowledge of the varying drainage patterns of superficial veins of head & neck, in particular, jugular veins are not only important for anatomists but also for the surgeons operating at this level and to clinicians in general. The variations are important for interventional radiologists too who perform transjugular procedures, such as port implantations and the transjugular intrahepatic portosystemic shunt or selective venous samplings. Results of recent studies report th (more) at the superficial veins, especially the external jugular vein (EJV), is been increasingly utilized for cannulation to conduct diagnostic and therapeutic procedures. We report a very unusual presentation of external jugular vein on left side of an embalmed male cadáver. Embryological evaluations of the anomaly was done and compared with available literature which showed that the observed variation is rare.

 
 
 
 
241

Neuroradiological examinations of extracranial extension of brain tumors  

Before the application of CT scan, the exact identification of extracranial extension of brain tumors was difficult. In the present paper, neuroradiological findings of eight brain tumors with extracranial extension were reviewed. These eight cases were composed of two sphenoidal meningiomas, one CP angle meningioma, one CP angle neurofibroma, two pituitary adenomas, and two jugular foramen chemodectomas. After the first application of CT scan on May, 1976, 841 cases of primary intracranial tumors have been experienced in our clinic. So the incidence of brain tumors with extracranial extension was about 1%. The mean age of the patients was 51 years and all of the patients were females. In the neuroradiological examinations, plain skull films, tomograms, angiograms and CT scans were reviewed. Plain skull films and tomograms showed indirect signs of extracranial extension, such as destruction or hyperostosis of the skull and enlargement of the foramina. Direct signs of extracranial extension in the plain films were not obtained except in the pituitary adenomas, which extended into the paranasal sinuses and pharynx. Angiograms showed direct signs of extracranial extension, when remarkable tumor stain existed. Occlusion of the internal jugular vein suggested the extension of the tumor through the jugular foramen. In the cases without tumor stains, angiograms were useless to identify the extracranial portion of the tumor. CT scans were useful in all cases to detect extracranial extension. From the findings of CT scan, extracranial extensions of brain tumors were classified into four types. 1. Extracranial extension with destruction of the skull. 2. Extracranial extension with hyperostosis of the skull. 3. Extracranial extension with both hyperostosis and destruction of the skull. 4. Extracranial extension with enlargement of the skull foramina. To detect extracranial extension of brain tumors, enhanced coronal CT scan seemed most useful.

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US-guided placement of temporary internal jugular vein catheters: immediate technical success and complications in normal and high-risk patients  

Objective: : To evaluate the technical success and immediate complication rates of temporary internal jugular vein (IJV) haemodialysis catheter placement in normal and high-risk patients. Methods and materials: Two-hundred and twenty temporary internal jugular vein catheters inserted under ultrasound guidance in 172 patients were prospectively analyzed. Of 172 patients, 93 (54%) were males and 79 (46%) were females (age range, 18-83; mean, 56.0 years). Of 220 catheters, 171 (78%) were placed in patients who had a risk factor for catheter placement like patients with disorder of haemostasis, poor compliance, and previous multiple catheter insertion in the same IJV. Forty-seven (21.3%) procedures were performed on bed-side. A catheter was inserted in the right IJV in 178 procedures (80.9%) and left IJV in 42 procedures. Of 172 patients, 112 (65%) had only one catheter placement and the rest had had more than one catheter placement (range, 1-5). Results: Technical success was achieved in all patients (100%). Average number of puncture was 1.24 (range, 1-3). One hundred and eighty-three insertions (83.1%) were single-wall punctures, whereas 37 punctures were double wall punctures. Nine (4%) minor complications were encountered. Inadvertent carotid artery puncture without a sequel in four procedures (1.8%), oozing of blood around the catheter in three procedures (1.4%), a small hematoma in one procedure (0.4%), and puncture through the pleura in one procedure (0.4%) without development of pneumothorax. Oozing of blood was seen only in patients with disorder of haemostasis. Conclusion: Ultrasound-guided placement of internal jugular vein catheters is very safe with very high success rate and few complications. It can safely be performed in high-risk patients, like patients with disorders of haemostasis and patients with previous multiple catheter insertion in the same vein.

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Assessment of injection bolus in first-pass radionuclide angiography. Evaluation of injection site and needle size  

First-pass radionuclide angiography (FPRNA) using a multi-crystal gamma camera can correctly provide many quantitative and qualitative indices of left ventricular function as well as anatomic information. A compact injection bolus of radiotracer is, however, essential to the first-pass study since the temporal separation of cardiac chambers is required for the first-pass acquisition. To examine which factors affect the quality of an injection bolus, 327 patients who had FPRNA in the anterior projection were randomized for injection site of radiotracer (right or left external jugular veins, and right antecubital vein) and needle size (19- or 21-gauge). The injected bolus was assessed from the full width at half maximum (FWHM) of the bolus time-activity curve in the superior vena cava. As to injection site using a 19-gauge needle, an attemption through right external jugular vein (EJV) revealed the shortest FWHM of an injection bolus, followed by left EJV and right antecubital vein (AV). In right EJV 91% of injected bolus FWHM was less than 1.5 sec, which was significantly higher (p<0.001) than those of the other sites (left EJV: 70%. right AV: 65%). Approximately 7% of injection from left EJV and right AV, showed a split bolus of radiotracer. However, no split bolus was observed from right EJV. There was no significant difference in FWHM of an injection bolus between 19- and 21-gauge needle from EJV. Our present study demonstrated that the quality of an injection bolus from left EJV and AV was affected by RVEF in a case of low right ventricular function. In conclusion, right EJV is the first choice of injection site to obtain a compact bolus of radiotracer for the first-pass cardiac study. A 21-gauge needle can also be inserted from the external jugular vein to perform a good bolus injection. (author)

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Neck duplex Doppler ultrasound evaluation for assessing chronic cerebrospinal venous insufficiency in multiple sclerosis patients.  

INTRODUCTION: Recent clinical studies have suggested a relationship between multiple sclerosis (MS) and the occurrence of pathological changes in the jugular, vertebral and azygous veins that result in abnormal blood outflow from the brain and the spinal cord. Together, these pathological changes have been designated chronic cerebrospinal venous insufficiency (CCSVI). The aim of the present study was to evaluate the usefulness of duplex Doppler ultrasound in the evaluation of central nervous system venous outflow disturbances in patients suffering from MS. METHODS: We examined 181 patients with MS, diagnosed on the basis of the McDonald criteria, and 50 healthy volunteer controls. All patients underwent Doppler ultrasound examination of the internal jugular veins (IJV) and vertebral veins (VVs). The presence of outflow disturbances and morphological abnormalities were evaluated. RESULTS: Pathological changes in the extracranial jugular veins were diagnosed in 148/181 MS patients (82%) and 7/50 control group volunteers (14%). The following abnormalities in the MS group were revealed: the presence of a reflux in the IJVs and/or VVs (54%), narrowing (54%), a complete block in the flow through the IJV (10%) and an abnormal postural control of the cerebral outflow route (25%). These particular pathologies were of statistical significance in the MS group compared with the control group. This study also revealed a correlation between the occurrence of inverted flow in patients in a sitting position and chronic progressive MS (P = 0.0033). CONCLUSIONS: The examinations undertaken indicate a possible connection between MS and CCSVI. The widely accessible and highly sensitive and specific Doppler ultrasound test may be useful for revealing, and preliminary analysis of, CCSVI pathologies. PMID:22357458

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Late-onset congestive heart failure in a patient with a 58-year-old huge traumatic carotid-jugular fistula and pseudoaneurysm: endovascular treatment with a stent-graft.  

We report a case of successful stent-graft endovascular treatment of a huge traumatic carotid-jugular fistula with a pseudoaneurysm that had resulted from a bullet injury. A 77-year-old man with a pulsatile neck mass came to our hospital complaining of dyspnea and chest pain at rest; about 58 years ago, a gunshot accident had inflicted a penetrating bullet wound on the right side of his neck. Computerized tomography angiogram had demonstrated a huge vascular mass protruding into the right anterior neck with a pseudoaneurysm. The calcified pseudoaneurysm had an oval-shaped opening in the right common carotid artery, with a large base into the right internal jugular vein. Echocardiography showed deteriorating congestive heart failure, wherein left ventricular (LV) enlargement with a LV end-diastolic diameter of 6.1 cm, severe tricuspid valve regurgitation, and LV ejection fraction of 60% was seen. The surgical approach was considered risky because of the severe deformity of the native vasculature, the severe calcified pseudoaneurysm, and the context of advanced age with congestive heart failure. Thus, we decided to treat this patient with endovascular devices. Fortunately, a stent-graft was delivered successfully across the carotid-jugular fistula and immediate follow-up angiogram demonstrated a small filling defect at the base of stent-graft representing thrombus. The follow-up computerized tomography angiograms obtained 2 weeks and 4 months later further demonstrated a patent stent-graft, no evidence of thrombus progression, and no abnormal shunt flow. The patient did not experience any neurologic complications nor did he show any evidence of pulmonary embolism for 8 months. PMID:20832001

246

Thermoregulation in pronghorn antelope (Antilocapra americana, Ord) in winter.  

Conservation of energy is a prerequisite thermoregulatory strategy for survival in northern hemisphere winters. We have used thermistor/data logger assemblies to measure temperatures in the brain, carotid artery, jugular vein and abdominal cavity, in pronghorn antelope to determine their winter body temperature and to investigate whether the carotid rete has a survival role. Over the study period mean black globe and air temperature were -0.5+/-3.2 degrees C and -2.0+/-3.4 degrees C, respectively, and mean daytime solar radiation was approximately 186 W m(-2). Brain temperature (T(brain), 39.3+/-0.3 degrees C) was higher than carotid blood temperature (T(carotid), 38.5+/-0.4 degrees C), and higher than jugular temperature (T(jugular), 37.9+/-0.7 degrees C). Minimum T(brain) (38.5+/-0.4 degrees C) and T(carotid) (37.8+/-0.2 degrees C) in winter were higher than the minimum T(brain) (37.7+/-0.5 degrees C) and T(carotid) (36.4+/-0.8 degrees C) in summer that we have reported previously. Compared with summer, winter body temperature patterns were characterized by an absence of selective brain cooling (SBC), a higher range of T(brain), a range of T(carotid) that was significantly narrower (1.8 degrees C) than in summer (3.1 degrees C), and changes in T(carotid) and T(brain) that were more highly correlated (r=0.99 in winter vs r=0.83 in summer). These findings suggest that in winter the effects of the carotid rete are reduced, which eliminates SBC and prevents independent regulation of T(brain), thus coupling T(brain) to T(carotid). The net effect is that T(carotid) varies little. A possible consequence is depression of metabolism, with the survival advantage of conservation of energy. These findings also suggest that the carotid rete has wider thermoregulatory effects than its traditional SBC function. PMID:18281337

247

Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound.  

OBJECTIVES: Chronic cerebrospinal venous insufficiency (CCSVI) is a malformative condition characterized by several anomalies of the azygos and/or internal jugular veins (IJVs). Recommended diagnosis of CCSVI is performed with colour-Doppler (CD) sonography. Though catheter venography (CV) is considered as the gold standard for determining vascular anatomy, its uniplanar point of view does not allow an overall evaluation of endoluminal structures. This limit could be addressed by intravascular ultrasound (IVUS). The aim of this report is to evaluate, in patients with multiple sclerosis (MS), the accuracy of CD sonography and CV versus IVUS in estimating the diameter and the cross-sectional area (CSA) of the IJVs and in detecting jugular endoluminal malformations (JEM). METHOD: Forty-five MS patients with CCSVI, diagnosed by CD sonography, were submitted to CV during IJVs angioplasty. Twenty-five subjects were also examined with IVUS. The IJVs maximum diameter (MAXD) and CSA were estimated. CD and CV data were compared with IVUS data with the Bland-Altman method. RESULTS: The mean difference in IJV MAXD recorded by CD and IVUS was -0.5 mm. The mean difference in IJV MAXD recorded by CV and IVUS was 3.36 mm. The mean difference in IJV CSA recorded by CD and IVUS was -11.2 mm(2). JEM recorded by IVUS were detected by CD sonography and CV with 88% and 32% accuracy, respectively. CONCLUSIONS: CV was significantly inferior to CD sonography and IVUS in detecting JEM. Differences between IVUS and CD sonography in detecting JEM and in quantifying jugular diameters were not significant. The IJV CSA was underestimated by CD sonography compared with IVUS. CD sonography was proven to be important in the anatomical characterization of CCSVI, providing useful information for correct intravascular treatment. PMID:23155132

248

Intradural jugular foramen tumors/ Tumores intradurais do forame jugular  

Abstract in portuguese Onze pacientes com lesões expansivas do forame jugular associadas ou não a componente extradural foram submetidos a ressecção cirúrgica no Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP) entre 1998 e 2001. Foi utilizada cirurgia combinada com dissecção do pescoço, mastoidectomia sem transposição do nervo facial e técnica de reconstrução miofascial da base do crânio desenvolvida por um dos autores. Quatro pacientes foram operados via cra (more) niectomia retrosigmoidea. Ressecção total foi feita em 9 pacientes, subtotal em um e parcial em outro. Nenhum dos 11 pacientes teve progressão da doença em 2 anos de acompanhamento. Não houve mortalidade. Cinco pacientes tiveram déficits adicionais de nervos cranianos baixos. Nove pacientes mantiveram ou melhoraram suas pontuações de acordo com a escala de Karnofsky. Para adequada abordagem do paciente com tumor de forame jugular, são necessários bom conhecimento anatômico da região, exposição cirúrgica ampla, e técnica de reconstrução eficiente para obter cura com baixas taxas de complicações pós-operatórias. Abstract in english Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and 2001. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished (more) in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.

249

Comparative utility of centrally versus peripherally transduced venous pressure monitoring in the perioperative period in spine surgery patients  

Study Objective: To compare central venous pressure (CVP) with peripheral venous pressure (PVP) monitoring during the intraoperative and postoperative periods in patients undergoing spine surgery. Design: Prospective observational study. Setting: University-affiliated teaching hospital. Patients: 35 ASA physical status 1, 2, and 3 patients. Interventions: A peripheral catheter in the forearm or hand and a central catheter into the internal jugular vein were placed for PVP and CVP monitoring, respectively. Measurements: CVP and PVP values were collected simultaneously and recorded electronically at 5-minute intervals throughout surgery and in the recovery room. The number of attempts for catheter placement, ease of use, maintenance, and interpretation were recorded. Patient comfort, frequen...

250

Changes in mean plasma ACTH reflect changes in amplitude and frequency of secretory pulses  

ACTH is secreted in an episodic manner from the anterior pituitary. Unanesthetized rats with indwelling jugular and femoral venous cannulae were continuously bled and simultaneously infused with isotonic fluid by peristaltic pump. Two-minute blood samples were collected for up to five hours in 8 male rats. ACTH was measured by radioimmunoassay. The resulting time series were analyzed for significant secretory pulses with the PULSAR program. Elevations or declines in mean plasma ACTH levels were associated with significant changes in amplitude and frequency of secretory pulses.

251

Pelvic limb lameness due to malignant melanoma in a horse.  

Malignant melanoma in a 21-year-old, gray, Arabian gelding was manifested by rapidly deteriorating lameness of the right pelvic limb. A melanotic, cutaneous mass of small dimensions was identified in the left jugular furrow. Exploratory laparoscopy revealed widespread infiltration of melanotic masses into the structures of the abdominal cavity. Necropsy indicated the lameness to have resulted from infiltration of neoplastic cells into the sacral nerves, dorsal root ganglia, proximal ischiatic nerve, and gluteal muscle fibers. The primary tumor could not be identified. PMID:4008306

252

Post-TIPS Hepatic Encephalopathy Treated by Occlusion Balloon-Assisted Retrograde Embolization of a Coexisting Spontaneous Splenorenal Shunt  

A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS.

253

Modified use of the Hemodialysis Reliable Outflow (HeRO) graft for salvage of threatened dialysis access  

The Hemodialysis Reliable Outflow (HeRO) graft (Hemosphere Inc, Eden Prairie, Minn) offers a new option to provide upper extremity arteriovenous (AV) dialysis access in patients with central venous occlusive disease. Creative use of this device can allow for salvage of failing or threatened AV fistulas and grafts. We present two patients who underwent a modified implantation of the HeRO device for immediate salvage of a malfunctioning AV access. Ipsilateral central venous occlusions were successfully overcome by anastomosing a HeRO device to the existing AV access and tunneled across the chest to the contralateral internal jugular vein.

254

Internal jugular vein thrombosis as paraneoplastic syndrome of primary ovarian non-Hodgkin's lymphoma.  

Primary malignant lymphoma involving the ovaries is extremely rare. We present a unique case of a primary Non-Hodgkin's lymphoma (NHL) of both ovaries, preceded by an internal jugular vein trombosis (IJVT) as paraneoplastic syndrome. Currently, 36 months after surgical treatment of this FIGO Stage Ib, Ann Arbor Stage 2E NHL, the patient is clinically free of disease. Based on this case and a review of the literature it is concluded that paraneoplastic syndromes like spontaneous IJVT should prompt the clinician to make a thorough diagnostic work-up in search of an underlying malignancy, including the female genital tract. PMID:21319515

255

Subclavian Insertion of the Bicaval Dual Lumen Cannula for Venovenous Extracorporeal Membrane Oxygenation  

Extracorporeal membrane oxygenation (ECMO) has demonstrated utility in the management of adult respiratory failure refractory to mechanical ventilation. The recent introduction of a bicaval dual-lumen ECMO cannula has improved the efficiency of venovenous ECMO and has enabled the concept of full extracorporeal respiratory support in place of mechanical ventilation. Standard placement of this cannula through the right internal jugular vein is particularly troublesome in individuals of short stature, because of excess cannula length. We describe a method for cannula placement through the left subclavian vein that is well suited for smaller patients and convenient for patient mobility.

256

New Insights into Pacemaker Lead-Induced Venous Occlusion: Simulation-Based Investigation of Alterations in Venous Biomechanics  

Venous obstruction is a major complication of transvenous pacemaker placement. Despite the increasing use of pacemakers and implantable cardiac defibrillators, a lack of understanding remains with regard to risk factors for the development of device-associated venous obstruction. We hypothesize that computational fluid dynamics simulations can reveal prothrombogenic locations and define thrombosis risk based on patient-specific anatomies. Using anatomic data derived from computed tomography, computer models of the superior vena cava, subclavian, innominate, and internal jugular veins were constructed for three adult patients with transvenous pacemakers. These models were used to perform patient-specific simulations examining blood flow velocity, wall shear stress, and blood pressure, both ...

257

Spontaneous Resolution of Delayed Onset Large Subclavian Artery Pseudoaneurysm  

A 70-year-old woman with a history of end-stage renal disease secondary to anti-neutrophil cytoplasmic autoantibody-associated vasculitis had been receiving hemodialysis for 5 years. The patient underwent attempted right internal jugular vein cannulation for temporary hemodialysis catheter placement. Pulsating mass developed in the neck and angiography revealed a subclavian artery pseudoaneurysm 4 days later. The pseudoaneurysm disappeared spontaneously during the interval between the diagnosis and the planned surgical procedure. Such delayed onset and spontaneous resolution of subclavian artery pseudoaneurysm is uncommon. Close observation may be optimal if delayed onset of pseudoaneurysm occurs after small needle puncture with cessation of antiplatelet/anticoagulant administration.   

258

Comparison of radiolabelled agents for thrombus imaging using a rabbit model  

The quantitative uptakes of five potential thrombus-localizing radiopharmaceuticals in experimental thrombi of the rabbit jugular vein have been compared to assist with the selection of a thrombus imaging agent for clinical use. Three hours after injection, /sup 111/In-platelets were clearly the agent of choice but at 18 h sup(99m)Tc-fibrinogen had more favourable characteristics. Both agents were superior to sup(99m)Tc-plasmin or its acyl derivatives, including sup(99m)Tc-streptokinase-activated anisoylplasminogen. The ease of preparation coupled with favourable biological properties suggest that sup(99m)Tc-fibrinogen should be of value in the clinical situation.

259

The Influence of Exercise on the Daily Rhythm of Serum Homocysteine in Horses  

The aim of this study was to determine the daily rhythms in the blood serum of homocysteine in horses. Ten thoroughbred horses, five athletic (trained for 1 h, 6 days a week) and five sedentary, were used. Blood samples were collected on each subject every 4 h for two days by means of the jugular vein. On each individual sample, the serum concentration of homocysteine was assessed. The results obtained during the experimental period indicated the existence of a daily rhythm of serum homocysteine in sedentary and athletic horses. They also demonstrated that in horses, physical exercise influences the daily rhythm of serum homocysteine.   

260

Up-regulation of arginase II contributes to pulmonary vascular endothelial cell dysfunction during experimental pulmonary embolism  

Pulmonary embolism (PE) causes pulmonary hypertension by mechanical obstruction and constriction of non-obstructed vasculature. We tested if experimental PE impairs pulmonary vascular endothelium-dependent dilation via activation of arginase II. Experimental PE was induced in male Sprague-Dawley rats by infusing 25 Mu m microspheres in the right jugular vein, producing moderate pulmonary hypertension. Shams received vehicle injection. Pulmonary arterial rings were isolated after 18 h and isometric tensions were determined. Dilations were induced with acetylcholine, calcium ionophore A23187 or nitroglycerin (NTG) in pre-contracted rings (phenylephrine). Protein expression was assessed by Western blot and immunohistochemistry. Arginase activity was inhibited by intravenous infusion of Nw-hyd...

 
 
 
 
261

Computer tomographic anatomy of the neck  

The structures in the neck which can be recognised by computer tomography, and their course, is described. The cartilagenous larynx and trachea, the oesophagus, thyroid, sternocleidomastoid muscle, common carotid arteries and internal jugular veins can be recognised regularly. In addition, one can identify smaller muscles, vessels and nerves, such as the sterno-hyoid, omo-hyoid, anterior and medial scalenus muscles, the superior and inferior thyroid arteries and the suprascapular, internal thoracic and vertebral arteries, the thyro-cervical trunk and the vagus and phrenic nerves. An accurate knowledge of the anatomy is essential for the recognition of enlarged parathyroid glands.

262

CONTRAST-ENHANCED CONVENTIONAL CT IN PATIENTS AFTER SURGERY FOR MALIGNANT TUMORS: EVALUATION OF THE OPTIMAL METHOD OF THE ADMINISTRATION OF THE CONTRAST MEDIUM  

Patients after ablative surgery for malignant tumors require computed tomography (CT) examination of a wide area on the head and neck to follow-up for recurrence and lymph metastasis. The aim of this study was to determine a more effective method for the infusion of the contrast medium into post-operative patients undergoing conventional CT, based on the relationship between the method of administering the contrast medium and the contrast-enhancing effect in the internal jugular vein. First eleven images were selected from the existing contrast-enhanced and plain CT images in a manner such that the CT values of the internal jugular vein were distributed evenly in a range of 50-180. Seven experienced observers evaluated the contrast-enhancing effect of each image set at a window value of 40 and window widths of 120, 200, and 280. Secondly, the CT values of the right internal jugular vein were measured in a total of 10 CT images from the thyroid to maxillary sinus level from each of 60 post-operative patients. The injection needles and contrast-enhancing techniques used in the 60 patients were drip infusion using an 18G injection needle in 20, drip infusion using a 21G injection needle with bolus intravenous injection immediately before scanning in 20, and drip infusion using a 23G injection needle with bolus intravenous injection immediately before scanning in 20. A CT value of 100 or above, preferably 120 or above, in the internal jugular vein was needed for the contrast-enhancing effect of a CT image to be judged as clinically significant. Our results found that, when a conventional CT was used in patients after surgery for malignant tumors, drip infusion using a 21G or 23G injection needle should be combined with bolus injections immediately before the beginning of scanning, and at the glottis or submandibular gland level during the scanning. A sufficient contrast-enhancing effect can also be obtained by drip infusion using an 18G injection needle without bolus injection.   

263

Damage control sternotomy for penetrating mediastinal vascular injury  

Damage control laparotomy with temporary abdominal closure is a common practice for abdominal trauma patients who develop hypothermia, acidosis and coagulopathy. Utilization of these management principles for patients with thoracic injuries is less well defined due to concerns over cardiopulmonary compromise. The following case report describes the use of temporary vacuum-assisted closure and packing of a median sternotomy following exploration and repair of an adolescent with multiple stab wound injuries to the internal jugular and innominate veins. Damage control principles can be used in select thoracic trauma patients with minimal cardiac and respiratory compromise, allowing for continued resuscitation.

264

[Budd-Chiari syndrome: current medical-surgical management].  

The Budd-Chiari syndrome or obstruction of the hepatic veins and/or suprahepatic inferior vena cava is a rare process, frequently associated with hypercoagulable states. There exist several clinical presentations, being most common the acute and subacute forms and rarely seen the fulminant and chronic forms (cirrhosis or fibrosis associated). We present here a female patient with Budd-Chiari syndrome produced by polycythemia, resolved by mesentericocaval interposition "H" shunt using internal jugular vein, after analyzing the current different modalities of medical-surgical treatment, specially portal system shunts and liver transplantation, related to presentation form. PMID:9866414

265

Lemierre syndrome complicating multiple brain abscesses caused by extended-spectrum b-lactamase-producing Klebsiella pneumoniae cured by fosfomycin and meropenem combination therapy  

A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum b-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice.

266

Microvascular porcine model for the optimization of vascularized composite tissue transplantation  

BackgroundDevastating extremity injuries are prevalent but most often survivable on the modern battlefield. The complexity of these injuries requires advanced methods of reconstruction. This study is designed to validate the feasibility of gracilis myocutaneous flap transplantation via microvascular free tissue transfer in a porcine model. This model will facilitate study of autotransplant physiology as well as vascularized composite allotransplantation as an evolving method for reconstructing previously nonreconstructable injuries. Material and methodsA donor gracilis myocutaneous flap is procured from Yorkshire swine. The right external carotid artery and internal jugular vein are prepared as the recipient axis for microvascular anastomoses. Group 1 undergoes immediate microvascular anas...

267

A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency  

Objective Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by combined stenoses of the principal pathways of extracranial venous drainage, including the internal jugular veins (IJVs) and the azygous (AZY) vein, with development of collateral circles and insufficient drainage shown by increased mean transit time in cerebral magnetic resonance (MR) perfusion studies. CCSVI is strongly associated with multiple sclerosis (MS). This study evaluated the safety of CCSVI endovascular treatment and its influence on the clinical outcome of the associated MS. Methods Sixty-five consecutive patients with CCSVI, subdivided by MS clinical course into 35 with relapsing remitting (RR), 20 with secondary progressive (SP), and 10 with primary progressive (PP) MS, underwent percutaneous tr...

268

Endolymphatic sac tumor and angiomatous lesions of the nasal and pharyngeal mucosa as a first manifestation of von Hippel-Lindau disease  

Abstract In the present article we report an endolymphatic sac tumor in a 15-year-old male who had additional angiomatous lesions in the nasal and pharyngeal mucosa and was diagnosed with von Hippel-Lindau disease postoperatively. Preoperative imaging excluded cholesteatoma, but did not provide sufficient information to distinguish between jugular paraganglioma and endolymphatic sac tumor. To the authors' knowledge this is the first description of angiomatous lesions in the mucosa of the upper respiratory tract in a von Hippel-Lindau disease patient, a potentially useful finding for future radiological differential diagnosis in cases presenting with endolymphatic sac tumor. Laryngoscope, 2012

269

Endolymphatic sac tumor and angiomatous lesions of the nasal and pharyngeal mucosa as a first manifestation of von Hippel-Lindau disease.  

In the present article we report an endolymphatic sac tumor in a 15-year-old male who had additional angiomatous lesions in the nasal and pharyngeal mucosa and was diagnosed with von Hippel-Lindau disease postoperatively. Preoperative imaging excluded cholesteatoma, but did not provide sufficient information to distinguish between jugular paraganglioma and endolymphatic sac tumor. To the authors' knowledge this is the first description of angiomatous lesions in the mucosa of the upper respiratory tract in a von Hippel-Lindau disease patient, a potentially useful finding for future radiological differential diagnosis in cases presenting with endolymphatic sac tumor. Laryngoscope, 2012. PMID:22777797

270

Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery  

A 50-year-old man presented with an abdominal bulge 2 years after receiving a ventriculoperitoneal (VP) shunt for hydrocephalus. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. Exploration through a small neck incision revealed that the shunt catheter had entered the internal jugular vein. The catheter was extracted and positioned in the subcutaneous space in preparation for reimplantation. This type of shunt migration is quite unusual, but it could cause lethal pulmonary infarction or arrhythmia. Follow-up radiography should be scheduled to detect such complications.   

271

Endovascular Stenting for Left Subclavian Venous Stenosis for a Hemodialysis Patient with a Persistent Left Superior Vena Cava  

A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly, and we should be aware of its existence. We encountered a case of significant left arm swelling due to recurrent left subclavian venous stenosis in a hemodialysis patient with a PLSVC. Endovascular stent placement was performed safely and effectively for the stenosis employing the pull-through technique, in which a guidewire was passed from the left internal jugular vein to the access vein. On the following day, left arm swelling had improved. 3 months after stent placement the left arm swelling has not recurred.   

272

Cerebrospinal fluid flow. Pt. 2; Physiology of respiration-related pulsations  

Cerebrospinal fluid (CSF) flow in the cerebral aqueduct and spinal canal was analysed using real-time magnetic resonance imaging measurement techniques. Respiration-induced rhythmic modulation of the cardiac-related oscillating CSF pulsation in the cerebal aqueduct and spinal canal was found. Deep inspiration was immediately followed by marked increase in downward CSF flow in the cervical spinal canal, whereas a delay of about two heart beats was seen before downward flow from the third to the fourth ventricle increased. This pattern was also detected during yawning and was followed by a marked increase of blood flow in the internal jugular vein. (orig.)

273

Peritoneoatrial shunting for intractable chylous ascites complicating thoracic duct ligation.  

Thoracic duct ligation for chylothorax is considered a safe and efficient procedure. However, we observed two cases that were complicated by intractable chylous ascites. Refractory chylous ascites are usually cured by surgical peritoneovenous shunting, but in both patients successful treatment required peritoneoatrial shunting. Actually, a peritoneovenous shunt was impossible because of extensive venous thrombosis in jugular and superior vena cava in one patient and failed because of constrictive pericarditis requiring pericardectomy in the other, both underlying diseases also accounting for the thoracic duct ligation complications. PMID:19379920

274

Peritoneoatrial Shunting for Intractable Chylous Ascites Complicating Thoracic Duct Ligation  

Thoracic duct ligation for chylothorax is considered a safe and efficient procedure. However, we observed two cases that were complicated by intractable chylous ascites. Refractory chylous ascites are usually cured by surgical peritoneovenous shunting, but in both patients successful treatment required peritoneoatrial shunting. Actually, a peritoneovenous shunt was impossible because of extensive venous thrombosis in jugular and superior vena cava in one patient and failed because of constrictive pericarditis requiring pericardectomy in the other, both underlying diseases also accounting for the thoracic duct ligation complications.

275

Follicular carcinoma of the thyroid with massive invasion into the cervical and mediastinum great veins: Our own experience and literature review.  

Thyroid carcinomas with massive intralumen invasion of the great veins are extremely rare and reported to have poor prognosis. We report a case of a poorly differentiated follicular carcinoma of the thyroid with extensive invasion into the bilateral internal jugular veins, brachiocephalic vein, and superior vena cava. All of the seven major drainage veins from the thyroid were involved by tumor thrombus. The patient was successfully treated by surgical resection including removal of the tumor thrombus and repair of the great veins. The importance of preoperative radiological findings, treatment, and outcome are discussed along with a literature review. PMID:22951943

276

Glycopyrrolate abolishes the exercise-induced increase in cerebral perfusion in humans  

Brain blood vessels contain muscarinic receptors that are important for cerebral blood flow (CBF) regulation, but whether a cholinergic receptor mechanism is involved in the exercise-induced increase in cerebral perfusion or affects cerebral metabolism remains unknown. We evaluated CBF and cerebral metabolism (from arterial and internal jugular venous O2, glucose and lactate differences), as well as the middle cerebral artery mean blood velocity (MCA Vmean; transcranial Doppler ultrasound) during a sustained static handgrip contraction at 40% of maximal voluntary contraction (n= 9) and the MCA Vmean during ergometer cycling (n= 8). Separate, randomized and counterbalanced trials were performed in control (no drug) conditions and following muscarinic cholinergic receptor blockade by glycopy...

277

The Use of Inferior Vena Cava Filters in Young Children  

The present report describes the authors' experience with the placement and retrieval of inferior vena cava (IVC) filters in children with a maximum IVC diameter of 1 cm. Over a 14-month period, three filters were placed in three children. Two filters were placed via the right internal jugular vein, with one placed via the right femoral vein. The filters were deployed successfully in all three children and retrieved in two. In one case, the child was receiving palliative care and removal was not attempted. No complications were encountered during placement, the period of implantation, or retrieval.

278

Prolactin Levels and Maternal Behavior Induced by Ultrasonic Vocalizations of the Rat Pup  

The relationship among ultrasonic vocalization (USV), prolactin and maternal behavior was investigated in lactating rat mothers and their pups. The lactating mother had a cannula inserted into the external jugular vein, and was exposed to USVs emitted from a pup immediately. Changes of prolactin and maternal behavior were determined. Prolactin increased dramatically during exposure to USVs, when maternal search, retrieving and nest building behavior appeared significantly. These results suggested that the relationship among USV, prolactin and maternal behavior was included in communication between lactating mother and pup.   

279

Combined lung injury, meningitis and cerebral edema: how permissive can hypercapnia be?  

We describe a patient with combined meningococcal septicemia and meningitis, cerebral edema and acute respiratory distress syndrome, in whom we balanced the conflicting carbon dioxide strategies for optimal pulmonary and neurological management using jugular oxygen saturation (SjvO2) monitoring to identify the upper limit of "tolerable" hypercapnia. Our observations suggest that significant acidosis was not well tolerated; however, cautious induction of pH down to 7.32 and an arterial carbon dioxide tension (PaCO2) SjvO2 could be undertaken so that patient-specific criteria for permissive hypercapnia can be determined. PMID:9681785

280

Oxygen saturation monitoring.  

Pulse-oximeter is described as the most important technological proceeding for monitoring the patients' safety during anesthesia, after surgery and in emergency. This opinion was widely confirmed in the 1990s when pulse-oximeter has been definitively introduced in the standard for base monitoring in the OR and has been proposed for routinary use also in the ICU. In this paper we consider the importance, in the cardiovascular, respiratory and brain parameters monitoring, of continuous oximetry of mixed venous blood (SVO2) and blood venous saturation in the internal jugular vein (SjvO2). PMID:12029270

 
 
 
 
281

Accuracy of continuous jugular bulb venous oximetry during intracranial surgery.  

We compared readings obtained from the Baxter-Edwards continuous jugular bulb venous oximetry catheter with those obtained from blood gas analysis of simultaneously drawn samples from the catheter in 12 patients undergoing neurosurgical procedures. Within the range studied (SjvO2, 42-95%), the 111 (median, nine samples per patient; range five to 17) oximetric catheter readings correlated well with hemoglobin oxygen saturation values obtained from in vitro analysis of simultaneously drawn blood samples from the catheter (y = 0.93x + 3.4, r = 0.94, p SjvO2 during neurosurgical procedures. PMID:7549368

282

The effect of different ventilation regimes on jugular venous oxygen saturation in elective neurosurgical patients.  

Since the concept of hyperventilation on neurosurgical and neurotraumatological patients has been contested, our analysis was aimed at its scrutiny on the basis of easily accessible parameters of perisurgical monitoring. Furthermore, the influence of an improved oxygen supply was tested on hyperventilationally induced cerebral changes and to what extent recommendations could be derived for clinical application. In 50 patients (normoventilation FiO2 = 0.4, 0.6; moderate hyperventilation up to a value of paCO2 = 31 mmHg and FiO2 = 0.4, 0.6 and 0.8), who underwent an elective neurosurgical operation at the central nervous system, a fiberoptical catheter was inserted into the bulb of the jugular vein for the continuous monitoring of the jugular venous oxygen saturation (sjvO2), additionally to the regular measures of perioperative monitoring. Approval for this study was given by the Ethics Committee of the University of Leipzig. At five defined times an analysis of arterial and jugular venous blood gas samples was made and their lactate and glucose concentration determined: 1. Immediately after inducing anesthesia; 2. After dura opening; 3. Sixty minutes after dura opening; 4. At dura closing; 5. Sixty minutes after the end of the operation. The lactate oxygen index (LOI) as well as the cerebral oxygen extraction (CEO2) were calculated from primary data. Hyperventilation with a value of FiO2 = 0.4 leads to a significant decrease of the jugular venous oxygen saturation below 55%. It can be positively influenced by increasing the inspiratory oxygen concentration from 40% to 60%. The CEO2 increases, above values of 42% under a hyperventilation of FiO2 = 0.4. This effect can be reversed by increasing the FiO2 value up to 0.6. Under hyperventilation the LOI reaches 'pre-ischemic' values (LOI > 0.03) prior to dura opening. Further decrease of FiO2 to 0.8 has no positive additional effect. Normoventilation with FiO2 = 0.6 induces a decrease of sjvO2 but also a decrease of LOI. Hyperventilation as a routine procedure during elective neurosurgery shall be applied critically and be combined with an increased inspiratory oxygen concentration if necessary. A longterm normoventilation with increased FiO2 should be avoided. PMID:9584928

283

Vasopressor Use and Effect on Blood Pressure After Severe Adult Traumatic Brain Injury  

Background We describe institutional vasopressor usage, and examine the effect of vasopressors on hemodynamics: heart rate (HR), mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PbtO2), and jugular venous oximetry (SjVO2) in adults with severe traumatic brain injury (TBI). Methods We performed a retrospective analysis of 114 severely head injured patients who were admitted to the neurocritical care unit of Level 1 trauma center and who received vasopressors (phenylephrine, norepinephrine, dopamine, vasopressin or epinephrine) to increase blood pressure Results Phenylephrine was the most commonly used vasopressor (43%), followed by norepinephrine (30%), dopamine (22%), and vasopressin (5%). Adjusted for age, gender...

284

Relashionship between Plasma Testosterone Concentrations and Age, Breeding Season and Harem Size in Misaki Feral Horses  

Jugular vein blood samples were collected from 23 young and sexual mature feral stallions to examine the relationship between plasma testosterone concentration and age, breeding season or harem size. Testosterone concentration increased with the age of the stallions until they formed their own harems, at about 4 to 6 years old. Seasonal variations in testosterone concentrations were observed, and found to be significantly higher (P<0.001) throughout the breeding season than non-breeding season, from 3 years of age. Testosterone levels were correlated with harem size for individual stallions. It can be inferred from these results that there is a relationship between plasma testosterone concentration and age, breeding season and harem size.   

285

Experience of Vein Grafting in G?tingen Minipigs  

We experimented with vein grafting surgery on Götingen minipigs. Using the internal jugular vein for the tissue graft, we performed side-to-side anastomosis to the carotid artery, to which it runs parallel. One key point in this surgery was to prevent vasospasm of the carotid artery so as to keep the lumen sufficiently patent during anastomosis. The histopathological findings in the grafts which remained patent resembled those of vein grafts in humans. We therefore considered that this technique in minipigs can be applied for the study of coronary artery bypass surgery in humans.   

286

Surgical removal of a thymoma in a burrowing owl (Athene cunicularia).  

A 12-year-old male burrowing owl (Athene cunicularia) was presented for evaluation of a mass in the right cervical region. A thymoma was diagnosed after surgical resection and histopathologic evaluation. Extensive adherence of the thymoma to the esophagus and suspected invasion into the right jugular vein contributed to a poor postsurgical outcome. Diagnosis and treatment of thymomas in avian species is similar to that in mammals. Surgical removal of noninvasive thymomas is usually curative. Thymomas are rarely reported in avian species and this is the first report in a strigiform bird. PMID:22872980

287

Transoral endoscopic anatomy of the parapharyngeal space: A step-by-step logical approach with surgical considerations  

AbstractBackground Surgical approaches to the parapharyngeal spaces are challenging. Little is known about the transoral perspective of the anatomy of the parapharyngeal space. Thus, transoral approaches are seldom performed, and only for small-sized tumors. Methods Six freshly injected cadaver heads were dissected to illustrate the transoral surgical anatomy of the parapharyngeal space. Results The transoral window dominates the parapharyngeal space from the medial pterygoid muscle laterally to the superior constrictor muscle medially. The stylopharyngeus and styloglossus muscles seem to be critical landmarks in this approach. Posterior to these muscles and laterally to the superior constrictor muscle, the internal carotid artery, internal jugular vein, and lower cranial nerves are identi...

288

Case of aneurysm of the jugular and mediastinal veins radioisotopic blood pool study of venous aneurysm  

Venous aneurysm not associated with other cardiovascular disease or trauma is a rare condition. A case is present of bilateral jugular and mediastinal venous aneurysm, which was detected and depicted to a full extent by means of a blood-pool study with sup(99m)Tc-fibrinogen, undertaken because of concurrent thrombocytopenia. The aneurysm was confirmed by subsequent X-ray angiography and surgery. In radioisotopic blood pool study venous aneurysm, unlike arterial or aortic aneurysm, may be filled to the equilibrium state later than the appearance of the cardiac pool.

289

Posterior transjugular and transcervical approach for glomus tumours within the head and neck.  

Glomus tumours within the head and neck are highly vascular in nature and are surrounded by vital neurovascular structures. The aim of this study is to review the step-by-step surgical techniques for a posterior transjugular approach and transcervical approach and to clarify the advantages of these approaches in the treatment of glomus tumours within the head and neck. The advantage of these approaches is that a wide operative field from the jugular bulb to the cervical portion can be obtained. In addition, the bloodless operative field that is achieved by the preoperative embolisation appeared to contribute to reducing the risk of cranial nerve injury. PMID:22978486

290

Intracranial catecholamine secreting paragangliomas  

Three intracranial catecholamine-secreting paragangliomas are described. They involved a glomus jugulare, a sphenopalatine ganglion and the clivus and upper cervical spine respectively. The extent of the tumours was shown by CT and MRI. They are all highly vascular with a substantial blood supply from systemic arteries which was subjected to particulate embolisation, followed in two cases by surgery. The importance of studying any tumour which could possibly be a paraganglioma for hormonal and, especially, for catecholamine secretion prior to any invasive procedure, including angiography and embolisation, is emphasised: all such procedures should be covered with catecholamine blocking agents and, in addition, carefully monitored with resuscitation facilities immediately available.

291

Effects of anesthesia and blood sampling techniques on plasma metabolites and corticosterone in the rat  

Blood is routinely sampled from laboratory animals in biomedical research, and many of the commonly applied sampling techniques require anesthesia. Acute effects of many sampling and anesthesia procedures may confound the results, but those effects are incompletely characterized. We here compare the effects of four common anesthesia procedures (inhalation anesthesia with ether (EA) or isoflurane (IA) and intraperitoneal injection anesthesia with xylazin/ketamine (XKA) or medetomidine/midazolam/fentanyl (MMFA)) on plasma concentrations of glucose, lactate, non-esterified fatty acids (NEFAs), and corticosterone in blood obtained from a previously implanted jugular vein (JV) catheter with the effect of JV blood sampling from non-anesthetized, freely-moving rats (JV-NA). Also, we included in t...

292

CONTINUOUS INFUSION OF SIVELESTAT SODIUM HYDRATE PREVENTS LIPOPOLYSACCHARIDE-INDUCED INTESTINAL PARALYSIS AND HYPOTENSION IN CONSCIOUS GUINEA-PIGS  

SUMMARY Sivelestat sodium hydrate (sivelestat), a neutrophil elastase inhibitor, is used to treat acute lung injury associated with systemic inflammatory response syndrome, but its effects have not been described for endotoxaemia. In the present study, we examined the effects of a continuous infusion of sivelestat on intestinal mechanical activity and blood pressure using an endotoxaemic model in conscious, unrestrained guinea-pigs. Guinea-pigs underwent laparotomy while anaesthetized and were implanted with a force transducer sutured onto the taenia caecum. With this transducer, changes in tension in the intestinal longitudinal muscle were measured continuously via telemetry. Catheters were inserted into the carotid artery and jugular vein, were tunnelled subcutaneously and were accessed ...

293

Interventional Radiology in the Treatment of Chronic Cerebrospinal Venous Insufficiency  

Chronic cerebrospinal venous insufficiency (CCSVI) is a theory that implicated venous reflux in the cerebral veins as a cause of multiple sclerosis (MS). Originally diagnosed by indirect duplex findings of abnormal flow in the cervical veins, all patients were found to have large vein (internal jugular or azygous) stenoses on venography. Although 100% prevalence of positive duplex findings in the MS population has not been confirmed, multiple investigators have reported the frequent relief of symptoms after percutaneous recanalization. There is a strong patient demand for the intervention, despite the absence of prospective randomized studies. This report reviews the evidence for CCSVI, the anatomy and percutaneous interventions, and the reported safety and outcomes data.

294

Contiguous bilateral head and neck paragangliomas in a carrier of the SDHB germline mutation  

Paragangliomas are extremely rare neoplasms with multicentric presentation usually linked to familial tumor syndromes. This patient presented with the uncommon combination of concurrent bilateral carotid body tumors and a unilateral glomus jugulare mass that demonstrated vascular continuity. During treatment, the patient was found to be heterozygous for the SDHB germline mutation, an autosomal dominant genotype of the familial paraganglioma syndromes associated with increased malignancy. The unique profile of the SDHB patient as regards primary evaluation, surgical considerations, and extended surveillance was explored and has led to a proposed treatment algorithm for these patients.

295

Contiguous bilateral head and neck paragangliomas in a carrier of the SDHB germline mutation.  

Paragangliomas are extremely rare neoplasms with multicentric presentation usually linked to familial tumor syndromes. This patient presented with the uncommon combination of concurrent bilateral carotid body tumors and a unilateral glomus jugulare mass that demonstrated vascular continuity. During treatment, the patient was found to be heterozygous for the SDHB germline mutation, an autosomal dominant genotype of the familial paraganglioma syndromes associated with increased malignancy. The unique profile of the SDHB patient as regards primary evaluation, surgical considerations, and extended surveillance was explored and has led to a proposed treatment algorithm for these patients. PMID:21820839

296

Lower island trapezius myocutaneous flap reconstruction of a large neck defect in an infant  

Free tissues transfer has been well-described in infants but there is limited data on techniques for reconstruction of large neck defects with regional myocutaneous flaps in this population. We report on the use of a lower island trapezius myocutaneous flap to reconstruct a large posterior neck and occiput wound in an 18-month-old child. The use of a regional myocutaneous flap allowed for reliable transfer of a relatively large volume of skin and soft tissue, providing coverage of the internal jugular vein and spinal accessory nerve as well as limiting the likelihood of debilitating scar contracture.

297

Bile pigment pharmacokinetics and absorption in the rat: therapeutic potential for enteral administration  

BACKGROUND AND PURPOSE Bilirubin and biliverdin possess antioxidant and anti-inflammatory properties and their exogenous administration protects against the effects of inflammation and trauma in experimental models. Despite the therapeutic potential of bile pigments, little is known about their in vivo parenteral or enteral absorption after exogenous administration. This study investigated the absorption and pharmacokinetics of bile pigments after i.v., i.p. and intraduodenal (i.d.) administration in addition to their metabolism and routes of excretion. EXPERIMENTAL APPROACH Anaesthetized Wistar rats had their bile duct, jugular and portal veins cannulated. Bile pigments were infused and their circulating concentrations/biliary excretion were measured over 180-min. KEY RESULTS After i.v. a...

298

Effect of the period of extrinsic mechanical compression following sclerotherapy in veins in rabbit ears/ Efeito do tempo da compressão mecânica extrínseca após escleroterapia em veias de orelhas de coelhos  

Abstract in portuguese OBJETIVO: Pesquisar se o tempo de compressão venosa de até 120 horas pós-escleroterapia é suficiente para evitar reperfusão nas veias tratadas; se há relação entre a intensidade inflamatória na parede venosa e tecidos adjacentes e o tamanho do trombo venoso; se a intensidade da inflamação pós-escleroterapia varia com o tempo de compressão; se há relação entre a presença de hemossiderina nos tecidos adjacentes ao vaso esclerosado e coágulo venoso. MÉTODO (more) S: Utilizaram-se 28 coelhos, machos, distribuídos em quatro grupos (0, 24, 72 e 120). Em todos os animais foram administrados 0,25 ml de solução de polidocanol 1% e, como controle, 0,25 ml de solução de cloreto de sódio 0,9% na veia marginal dorsal das orelhas direita e esquerda, respectivamente. Realizou-se compressão mecânica em trecho da veia perfundida, exceto nos animais do grupo 0. O tempo de compressão variou de 0 a 120 horas nos grupos. Realizou-se exame anatomopatológico de trecho das veias marginais dorsais direita e esquerda de todos os animais. RESULTADOS: Não houve diferenças significativas nos diversos tempos de compressão, tanto no grau de trombose venosa como na intensidade inflamatória, em ambas as orelhas, nos diversos grupos. Observou-se correlação positiva e significativa entre intensidade inflamatória e tamanho do trombo e na ocorrência de trombos e hemossiderina. CONCLUSÕES: O tempo de até 120 horas de compressão não é suficiente para evitar reperfusão nos vasos esclerosados. A intensidade da inflamação nos tecidos tem relação com o tamanho do trombo, mas não com o tempo de compressão. A presença de hemossiderina nos tecidos adjacentes ao vaso submetido à esclerose está relacionada com a presença de coágulo venoso. Abstract in english PURPOSE: Research whether a post-sclerotherapy venous compression period of up to 120 hours is sufficient to avoid reperfusion in treated veins; whether there is a relationship between the inflammatory intensity in venous walls and adjacent tissue and the size of venous thrombosis; whether the intensity of the post-sclerotherapy inflammation varies with the period of compression; whether there is a relationship between the presence of hemosiderin in the tissues adjacent t (more) o the sclerosing blood vessels and venous blood clots. METHODS: Twenty eight rabbits, all male, were utilized, distributed into four groups (0, 24, 72 and 120). All the animals were administered with 0.25 ml of 1% polidoconal solution and, as a control, 0.25 ml of 0.9% sodium chloride solution in the marginal dorsal vein of the right and left ears, respectively. Mechanical compression was applied to the perfused stretch of the vein, except for the animals in group 0. The period of compression varied from 0 to 120 hours in the groups. An anatomopathological examination of the section of the right and left marginal dorsal veins of all the animals was conducted. RESULTS: There was no significant difference among the various compression periods, both in terms of the degree of vein thrombosis and in the inflammatory intensity in both ears of the various groups. A positive and significant correlation was observed between the inflammatory intensity and the size of the thrombus and in the occurrence of thrombi and hemosiderin. CONCLUSIONS: A compression period of up to 120 hours is not sufficient to prevent reperfusion in sclerosing blood vessels. The intensity of tissue inflammation is related to the size of the thrombus, but not to the compression period. The presence of hemosiderin in the tissues adjacent to the vessels subjected to sclerosis is related to the presence of venous coagulation.

299

Intervenção percutânea em enxerto venoso aortocoronário em "Y" com anastomoses sequenciais/ Percutaneous intervention in aortocoronary venous "Y" graft with sequential anastomosis  

Abstract in portuguese É relatado o caso de um paciente de 58 anos, submetido a cirurgia de revascularização há 4 meses, com história de aortite, evoluindo com angina instável e apresentando lesão significativa na bifurcação de ponte de veia safena em "Y" com anastomoses sequenciais. O paciente foi submetido com sucesso a implante de stent eluidor de paclitaxel no óstio da derivação da ponte para o ramo descendente posterior e ramo marginal da circunflexa. Abstract in english This report describes the case of a 58-year-old male patient with a previous history of aortitis, who had undergone coronary artery bypass graft surgery 4 months before, evolving with unstable angina and presenting severe lesion at the bifurcation of a "Y" saphenous sequential graft. Patient successfully underwent coronary angioplasty with a paclitaxel eluting stent implanted at the ostium of one of the limbs of the "Y" graft, anastomosed to the posterior descending artery and marginal branch of the left circumflex artery.

300

Recognition characters and new records of two species of Phylloscyrtini (Orthoptera, Gryllidae, Trigonidiinae) from southern Brazil/ Reconhecimento de caracteres e novos registros de duas espécies de Phylloscyrtini (Orthoptera, Gryllidae, Trigonidiinae) do sul do Brasil  

Abstract in portuguese A tribo Phylloscyrtini ocorre do sul dos Estados Unidos a Argentina e inclui 21 espécies válidas. Trata-se de um grupo de grilos negligenciado e pouca informação a respeito de sua biologia e distribuição está disponível. Neste trabalho registramos Cranistus colliurides Stål, 1861 e Phylloscyrtus amoenus (Burmeister, 1880) no estado do Rio Grande do Sul e fornecemos informações a respeito de seu som de chamado, local de estridulação, veia estridulatória e outros caracteres importantes para o reconhecimento dos táxons. Abstract in english The Phylloscyrtini occurs from eastern United States to Argentina and includes 21 valid species. It is a highly neglected group of crickets and little is known about its biology and distribution. Cranistus colliurides Stål, 1861 and Phylloscyrtus amoenus (Burmeister, 1880) were recorded for the state of Rio Grande do Sul, southern Brazil, and information on calling song, stridulatory file and recognition characters were provided.

 
 
 
 
301

Drenagem anômala total das veias pulmonares, em sua forma infracardíaca: desafio diagnóstico/ Infracardiac total anomalous pulmonary venous drainage: a diagnostic challenge  

Abstract in portuguese No período neonatal, a drenagem anômala total das veias pulmonares, em sua forma infracardíaca, pode ser erroneamente diagnosticada como desconforto respiratório decorrente de diferentes etiologias. No pré-operatório, a ecocardiografia bidimensional com Doppler orientado pelo mapeamento de fluxo em cores pode definir o local exato da drenagem e o padrão de retorno venoso pulmonar, permitindo, dessa forma, que a cirurgia cardíaca seja realizada imediatamente antes que ocorra qualquer dano clínico. Abstract in english Infracardiac total anomalous pulmonary venous drainage can be erroneously diagnosed as respiratory distress of several different etiologies during the neonatal period. A cross-sectional echocardiography study with Doppler color flow mapping can preoperatively determine the precise drainage site and pulmonary venous return pattern, thereby allowing cardiac surgery to be performed promptly, prior to any clinical deterioration.

302

Dopplervelocimetria dos Compartimentos Arterial e Venoso da Circulação Fetal e Umbilical em Gestação de Alto-Risco: Análise dos Resultados Perinatais/ Dopplervelocimetry of the Arterial and Venous Compartments of the Fetal and Umbilical Circulation in High-Risk Pregnancy: Perinatal Results  

Abstract in portuguese Objetivos: estudar o perfil hemodinâmico fetal em gestantes de alto risco e avaliar a relação das suas alterações com os resultados perinatais. Métodos: realizou-se estudo prospectivo transversal em 108 gestantes atendidas no ambulatório de pré-natal da Clínica Obstétrica do HCFMUSP. Tais gestantes foram encaminhadas ao Setor de Avaliação de Vitalidade Fetal, onde foram submetidas à dopplervelocimetria das artérias umbilicais, cerebral média, aorta, ducto v (more) enoso e veia cava inferior. Os critérios de inclusão foram gestantes que apresentavam qualquer doença ou intercorrência na gravidez encaminhadas para avaliação da vitalidade fetal, nas quais a resolução da gestação ocorreu nas próximas 24 horas após os exames. Foram excluídas as pacientes com gestação gemelar ou com malformação fetal. Resultados: as repercussões hemodinâmicas na circulação fetal foram demonstradas pela observação de alterações na dopplervelocimetria das artérias umbilicais, aorta, artéria cerebral média, ducto venoso e veia cava inferior. Valores alterados do índice de pulsatilidade (IP) da artéria umbilical foram observados em 25,9% dos casos, da aorta em 24,0% e da artéria cerebral média em 34,2%. O IPV do ducto venoso estava alterado em 18,2% dos casos e o da veia cava inferior em 46,6%. Os segmentos da circulação fetal que melhor se correlacionaram com os resultados perinatais foram a artéria umbilical e o ducto venoso. O IP alterado da artéria umbilical correlacionou-se significativamente com índices de Apgar de 1º minuto inferior a 7 em 42,8% e com necessidade de UTI neonatal em 50,0% dos casos. O IPV (indice de pulsatilidade para veias) do ducto venoso alterado apresentou associação significativa com o índice de Apgar de 1º minuto inferior a 7 (52,6%), Apgar de 5º minuto inferior a 7 (15,7%), acidemia no nascimento (60,0%), necessidade de UTI neonatal (52,6%) e óbito neonatal (21,1%). Os valores de predição da alteração do IPV do ducto venoso para o diagnóstico de acidemia foram: sensibilidade de 39,1; especificidade de 90,4; valor preditivo positivo de 60,0 e valor preditivo negativo de 80,2. Conclusão: a dopplervelocimetria permite avaliar a hemodinâmica fetal nas mais variadas situações e o estudo do ducto venoso constitui exame importante na avaliação das alterações hemodinâmicas decorrentes da hipoxia fetal. Abstract in english Purpose: to study the fetal hemodynamic profile in high-risk pregnancy and correlate it with perinatal results. Methods: transverse prospective study of 108 patients of the Obstetric Clinic of the Hospital das Clínicas, São Paulo University School of Medicine. The patients were evaluated at the Fetal Surveillance Unit, and Doppler examinations of umbilical, aorta, middle cerebral artery, inferior vena cava and ductus venosus were performed. The criteria for inclusion we (more) re patients whose delivery was in the next 24 hours after evaluation. Twin pregnancies and fetal malformations were excluded. Results: the hemodynamic implications in the fetal circulation were demonstrated by changes in the Doppler ultrasonographic results in the umbilical artery, aorta, middle cerebral artery, ductus venosus and in the inferior vena cava. The Doppler examinations were abnormal in the umbilical artery (25.9%), fetal aorta (24%), middle cerebral artery (34.2%), ductus venosus (18.2%) and inferior vena cava (46,6%). Segments of the fetal circulation which best correlated with the perinatal results were the umbilical artery and the ductus venosus. The abnormal results in the umbilical artery were significantly associated with 1st minute Apgar score

303

Resposta cronotrópica ao exercício após isolamento das veias pulmonares ou cirurgia de Cox-maze/ Chronotropic response to exercise after pulmonary veins isolation or Cox-maze operation  

Abstract in portuguese OBJETIVO: Avaliar a resposta cronotrópica ao exercício nos períodos pós-operatório imediato e tardio, após tratamento cirúrgico de fibrilação atrial e valva mitral por técnicas distintas. MÉTODOS: Estudo clínico prospectivo controlado, com amostra de 42 pacientes, portadores de fibrilação atrial crônica associada à valvulopatia mitral, submetidos a cirurgia pela técnica de isolamento de veias pulmonares (n=16), pela técnica do labirinto (Cox-maze modific (more) ado, sem uso de crioblação) (n=13), ambas com correção de valvulopatia mitral, ou para correção de valvulopatia isolada (n=13). As características clínicas pré-operatórias, indicações para cirurgia tipo e etiologia da lesão valvar foram semelhantes entre os três grupos. Os pacientes foram acompanhados em ambulatório e submetidos a testes ergométricos seriados. RESULTADOS: A resposta cronotrópica no pós-operatório imediato foi semelhante nos grupos analisados, em média 73,6% ± 12,3% da freqüência cardíaca máxima prevista. No grupo de isolamento das veias pulmonares, houve aumento de 64,4% ± 12,4% da freqüência cardíaca máxima, no pós-operatório imediato, para 78,9% ± 10,5% no 12º mês de pós-operatório (P=0,012). No grupo Cox-maze, a freqüência cardíaca máxima variou de 73,9% ± 11,14% para 78.8% ± 15,2% (P=1,000) e no grupo controle (apenas correção da valva mitral), de 67,2% ± 14,3% para 71,9% ± 12,9% (P=0,889). CONCLUSÃO: A atenuação pós-operatória imediata da resposta cronotrópica ao exercício foi semelhante no pós-operatório das três diferentes técnicas cirúrgicas. Houve melhora significativa da mesma, na evolução pós-operatória, no grupo de isolamento das veias pulmonares. Estes resultados sugerem que o procedimento de simples isolamento cirúrgico das veias pulmonares pode estar relacionado à melhor preservação do cronotropismo atrial. Abstract in english OBJECTIVE: To evaluate the chronotropic response to exercise during immediate and late postoperative period after atrial fibrillation and mitral valve surgical treatment by different techniques. METHODS: Prospective controlled clinical study of 42 patients presenting chronic AF associated mitral valve disease, who underwent surgery by the techniques of pulmonary veins isolation (n=16), Modified Cox-maze procedure, without crioablation (n=13), both with isolated mitral val (more) ve repair (n=13). The preoperative clinical characteristics, surgical indications, kind and aetiology of valve lesion were similar between groups. The patients were outpatient followed-up and underwent series of ergometric tests. RESULTS: In the immediate postoperative period, chronotropic response was similar in the 3 groups with mean of 73.6 ± 12.3% of maximal calculated heart rate. In the surgical pulmonary veins isolation group, there was an increment of heart rate, from 64.4 ± 12.4% of maximal heart rate in the immediate postoperative period to 78.9 ± 10.5% in the 12th month (P=0.012) of postoperative. In the Cox-maze group, heart rate varied, respectively, from 73.9 ± 11.14% to 78.8 ± 15.2% (P=1.000) and in the control group (only mitral valve surgery), from 67.2 ± 14.3% to 71.9 ± 12.9% (P=0.889). CONCLUSION: An attenuation of immediate postoperative chronotropic response to exercise was similar in the postoperative in the three different surgical techniques. There was a significant improvement in this response concerning to postoperative outcome in the pulmonary veins isolation group. These results suggest that simple surgical pulmonary veins isolation may be related to a better preservation of atrial chronotropism.

304

Embolia atrial de trombo flutuante da veia safena magna após escleroterapia com microespuma ecoguiada/ Atrial embolism of floating thrombus of the great saphenous vein after microfoam ultrasound-guided sclerotherapy  

Abstract in portuguese A escleroterapia com microespuma vem sendo utilizada amplamente no tratamento da doença venosa varicosa. No entanto, a despeito da sua pouca invasividade e segurança, complicações potencialmente graves e letais já foram descritas, como o acidente vascular cerebral e parada cardiorrespiratória. Descrevemos um caso de embolia atrial tardia de trombo flutuante da junção safeno-femoral de veia safena magna varicosa, após escleroterapia com microespuma de polidocanol guiada por ultrassom, e o tratamento dessa complicação. Abstract in english Microfoam sclerotherapy has been widely used in the treatment of varicose vein disease. However, despite its low invasiveness and safety, potentially serious and lethal complications have been described, such as stroke and cardiorespiratory arrest. We describe a case of delayed atrial embolism of floating thrombus in the saphenofemoral junction of a great saphenous varicose vein after microfoam ultrasound-guided sclerotherapy, as well as the treatment of this complication.

305

Vena cava thrombosis associated with nephrotic syndrome in the puerperal gestational cycle  

Abstract in portuguese CONTEXTO: A gestação é acompanhada de um estado fisiológico de hipercoagulabilidade. Fenômenos de Trombose podem ocorrer. OBJETIVO: Relatar um caso clínico envolvendo uma paciente que apresentava história importante de trombifilia familiar, e que desenvolveu trombose venosa profunda no membro inferior e trombose da veia cava durante o ciclo gravídico-puerperal, apresentando síndrome nefrótica como principal complicação. TIPO DE ESTUDO: Relato de caso. Abstract in english CONTEXT: The puerperal gestational cycle is accompanied by a state of physiological hypercoagulability. Thromboembolic phenomena may occur at this time. OBJECTIVE: To report on a clinic case involving a patient that presented a family history of thromboembolism and developed deep vein thrombosis in a lower limb and vena cava thrombosis during the puerperal gestational cycle, displaying nephrotic syndrome as the main complication. DESIGN: Case report.

306

Correlação das características do ecodoppler do sistema porta com presença de alterações endoscópicas secundárias à hipertensão porta em pacientes com cirrose hepática/ Correlation of Doppler ultrasound of the portal system with endoscopic changes caused by portal hypertension in cirrhotic patients  

Abstract in portuguese RACIONAL: A hipertensão portal é a causa principal das complicações da cirrose hepática, traduzidas clinicamente por circulação colateral visível na parede abdominal, ascite e varizes esofágicas. OBJETIVO: Avaliar a capacidade do ecodoppler do sistema porta no diagnóstico de alterações esôfago-gástricas endoscópicas secundárias à hipertensão porta em pacientes com cirrose hepática. PACIENTES E MÉTODOS: Cento e oitenta e seis pacientes dos ambulatórios (more) de gastroenterologia e hepatologia do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, foram selecionados para avaliação. Destes, 145 completaram todas as etapas e 133 puderam ser incluídos na análise final dos dados. Todos foram submetidos a endoscopia digestiva alta, visando determinar presença e grau de varizes esofágicas e gástricas e de gastropatia congestiva e ao ecodoppler do sistema porta para medir/aferir pico de velocidade sistólica da veia porta, diâmetro das veias porta e esplênica, tamanho do baço, presença de recanalização da veia umbilical e de fluxo hepatofugal. RESULTADOS: Os pacientes com varizes esofágicas e gástricas tiveram diferença significativa do tamanho do baço quando comparados com os pacientes sem essas alterações. No entanto, a exatidão e a especificidade deste parâmetro não foi adequada. O diagnóstico de gastropatia congestiva pode ser predito de maneira significativa, tanto pelo diâmetro da veia porta, quanto pelo da esplênica e também pelo tamanho do baço. Da mesma forma, todavia, a exatidão e especificidade destes parâmetros foram ruins. As medidas foram validadas pela construção de curvas ROC ("Receiver Operating Characteristic"), cujas áreas sob as curvas foram sempre menores que 0,8. CONCLUSÃO: Nesta série de pacientes não houve boa correlação dos parâmetros do ecodoppler do sistema porta com a presença das principais alterações endoscópicas (varizes esofágicas, varizes gástricas, gastropatia congestiva) em pacientes com cirrose hepática. Abstract in english BACKGROUND: The portal hypertension in cirrhotic patients is the main cause of this illness complication, that are clinically translated to visible collateral circulation in the abdominal wall, ascites and esophageal varices. AIM: To evaluate if the portal system echodoppler is able to estimate the presence of esophageal varices, gastric varices and congestive gastropathy in patients with hepatic cirrhosis. PATIENTS AND METHODS: One hundred and eighty six patients of the (more) gastroenterology and hepatology ambulatory of the Clinical Hospital of the Federal University of Paraná, Curitiba, PR, Brazil, had been selected for evaluation. Of those, 145 had completed all the stages of the evaluation and 133 had been enclosed in the final analysis. All had been submitted to high digestive endoscopy for evaluation of esophagogastric varices and congestive gastropathy and then to Doppler ultrasound of the portal system with study of the systolic peak speed of the portal vein, diameter of the portal and splenic vein and spleen size, presence of the umbilical vein recanalization and hepatofugal flow. RESULTS: The patients with esophagogastric varices had significant difference of the spleen size when compared to patients without these change. However, none of the Doppler ultrasound parameters showed good accuracy and specificity in this group of cirrhotic patients. Congestive gastropathy patients had their diagnosis predict with significant manner not only by the portal and splenic vein diameter but also by the spleen size. Similarly to that described above, they do not have a good accuracy and specificity. These evaluations were validated by the construction of ROC (Receiver Operating Characteristic) curves, whose areas below the curves had always been less than 0,8. CONCLUSION: There was not a good correlation of the Doppler ultrasound parameters of the portal system to the presence of the main endoscopic alterations (esophagogastric varices and congestive gastropathy) in patients with hepatic cirrhosis.

307

Oclusão percutânea da veia cava superior esquerda persistente conectada anomalamente no teto do átrio esquerdo/ Percutaneous occlusion of the left superior vena cava with an anomalous connection to the left atrium roof  

Abstract in portuguese Relatamos um caso raro de veia cava superior esquerda persistente conectada anomalamente no teto do átrio esquerdo associada a pequena comunicação interatrial do tipo seio venoso, em criança cianótica de 9 anos, com história pregressa de abscesso cerebral. O vaso anômalo foi ocluído com sucesso no laboratório de cateterismo, utilizando-se uma prótese Amplatzer. Abstract in english A rare case of persistent left superior vena cava anomalously connected to the roof of the left atrium associated with a small coronary sinus type atrial septal defect in a cyanotic 9-year-old child with a previous history of cerebral abscess is reported. The anomalous vessel was successfully occluded in the catheterization laboratory using an Amplatzer device.

308

Incidência e preditores de eventos cardiovasculares adversos maiores no tratamento percutâneo contemporâneo de enxertos de veia safena/ Incidence and predictors of major adverse cardiac events in contemporary percutaneous treatment of saphenous vein grafts  

Abstract in portuguese INTRODUÇÃO: Pacientes submetidos a intervenção coronária percutânea (ICP) em enxertos de veia safena caracteristicamente exibem maior risco de eventos cardiovasculares adversos maiores (ECAM). Foram avaliados a incidência e os preditores de ECAM no cenário atual, em que dispositivos de proteção distal e de aspiração de trombos e o uso de stents farmacológicos fazem parte da prática diária. MÉTODOS: Neste estudo foram avaliados 69 casos consecutivos de paci (more) entes com enxertos de veia safena, tratados com stents, entre janeiro de 2005 e dezembro de 2008. Foram avaliadas as características clínicas, angiográficas e relacionadas ao procedimento, bem como a incidência e preditores de ECAM na evolução tardia. RESULTADOS: A média de idade dos pacientes foi de 72 ± 10,2 anos, 79,7% eram do sexo masculino, 31,9% eram diabéticos, e 56,5% foram tratados na vigência de síndrome coronária aguda. Foram abordados 71 enxertos de veia safena, com lesões predominantemente localizadas no corpo (35,3%), tratadas mais frequentemente com stents farmacológicos (82,8%). Dispositivos de proteção distal foram utilizados em 31,9% e de aspiração de trombo em 1,4% dos pacientes, e em 30,4% foram utilizados inibidores da glicoproteína IIb/IIIa. No-reflow ocorreu em 8,7% e o sucesso do procedimento foi constatado em 89,9% dos casos. Na evolução tardia, ECAM, óbito, infarto agudo do miocárdio e revascularização do vasoalvo ocorreram em 15,9%, 7,2%, 4,3% e 14,5%, respectivamente, e trombose de stent foi observada em 2,9% dos pacientes. Na regressão de Cox apenas o uso de stents nãofarmacológicos foi associado a ECAM [hazard ratio (HR) 4,1, intervalo de confiança de 95% (IC 95%) 1,2-13,3; P = 0,02]. CONCLUSÕES: Pacientes com lesões em enxertos de veia safena, tratados percutaneamente, exibiram elevada taxa de eventos adversos a médio prazo e o uso de stents nãofarmacológicos esteve associado a pior evolução. Abstract in english BACKGROUND: Patients undergoing percutaneous coronary interventions (PCI) in saphenous vein grafts tipically have a higher risk of major adverse cardiac events (MACE). MACE incidence and predictors were evaluated in the current scenario, where distal protection and thrombus aspiration devices and the use of drug-eluting stents are part of the daily practice. METHODS: Sixty-nine consecutive patients undergoing coronary stenting in saphenous vein grafts from January 2005 to (more) December 2008 were evaluated. Clinical, angiographic and procedure-related variables were evaluated as well as the incidence and predictors of MACE in the late follow-up. RESULTS: Mean age was 72 ± 10.2 years, 79.7% were male, 31.9% were diabetic, and 56.5% presented with acute coronary syndromes. Seventy-one saphenous vein grafts were treated, with lesions located mainly in the body of the graft (35.3%) and more frequently treated with drug-eluting stents (82.8%). Distal protection devices were used in 31.9% and thrombus aspiration in 1.4% of the patients, and 30.4% received glycoprotein IIb/IIIa inhibitors. No-reflow was observed in 8.7% and procedure success was observed in 89.9% of the cases. In the late follow-up, MACE, death, acute myocardial infarction and target vessel revascularization were observed in 15.9%, 7.2%, 4.3%, and 14.5%, respectively and stent thrombosis was observed in 2.9% of the patients. In the Cox regression analysis only the use of bare metal stents was associated with MACE [hazard ratio (HR) 4.1, 95% confidence interval (95% CI) 1.2-13.3; P = 0.02] CONCLUSIONS: Patients with lesions in saphenous vein grafts treated by percutaneous interventions had a high rate of mid-term adverse events and the use of bare metal stents was associated to a worse clinical outcome.

309

Avaliação da bomba muscular da panturrilha em pacientes portadores de varizes primárias dos membros inferiores através da pletismografia a ar/ Assessment of calf muscle pump in patients with primary varicose veins of the lower limbs by air plethysmography  

Abstract in portuguese OBJETIVO:Avaliar a influência do refluxo das veias musculares da panturrilha (surais e geniculares) na função da bomba muscular da panturrilha em pacientes com varizes primárias nos membros inferiores. MÉTODOS: Estudo transversal prospectivo, no qual os pacientes foram avaliados por meio de exame físico, mapeamento dúplexe pletismografia a ar. Foram selecionados 120 pacientes divididos em dois grupos (60 indivíduos em cada). O primeiro grupo apresentava refluxo da (more) s veias musculares da panturrilha e o segundo grupo apresentava ausência de refluxo. Cada grupo foi analisado com pletismografia a ar para estudo da função da bomba da panturrilha. As variáveis estudadas foram fração de ejeção, fração do volume residual, volume ejetado e índice de enchimento venoso para membro inferior direito e esquerdo. RESULTADOS: No grupo com refluxo, índices de fração de ejeção abaixo de 60% (com p Abstract in english OBJECTIVE: This article aims at assessing the influence of calf muscle vein reflux (suraland genicular veins) on calf muscle pump function in patients with primary varicose veins of the lower limbs. METHODS: Cross-sectional and prospective study assessing 120 patients divided into two groups (60 subjects each) by physical examination, duplex scan and air plethysmography. The first group showed calf muscle venous reflux, whereas the second group presented absence of reflux (more) . Both groups were examined by air plethysmography to verify calf pump function through measurement of ejection fraction, residual volume fraction, ejected volume and venous filling index in both limbs. RESULTS: In the group of patients with reflux, ejection fraction indexes lower than 60% (p

310

Are femorodistal bypass grafts for acute limb ischemia worthwhile?/ Vantagem associada ao uso de enxertos femorodistais para isquemia aguda de membros  

Abstract in portuguese Contexto: Já foi mostrado que veias autógenas estão associadas às melhores taxas de salvamento de membros para a cirurgia de bypass femorodistal. No entanto, em cenários de emergência, quando não há uma veia autógena disponível, é crítica a decisão entre o uso de material de enxerto sintético ou a amputação. Objetivo: Avaliar a adequação de enxertos femorodistais para isquemia aguda de membros em cenários de emergência. Métodos: Pacientes submetidos a (more) cirurgia de bypass de urgência e cirurgia de bypass femorodistal eletiva entre 1996 e 2006 foram retrospectivamente revisados em um único centro. Resultados: Havia 147 pacientes, dentre os quais 84 haviam sido submetidos à cirurgia de bypass eletiva e 63 à cirurgia de bypass de urgência. As taxas de patência dos enxertos para internações eletivas foram 44 e 25% versus 25 e 23% para internações para cirurgia aguda de enxerto femorodistal a dois e quatro anos, respectivamente (p Abstract in english Background: It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. However, in emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make. Objective: To assess the appropriateness of femorodistal bypass grafts for acute limb ischemia in emergency settings. Methods: Patients who underwent emergent bypass and elective femorodistal b (more) ypass surgery between 1996 and 2006 were reviewed retrospectively in a single center. Results: There were 147 patients of which 84 had elective and 63 had emergent bypass. The graft patency rates for elective admissions were 44 and 25% vs. 25 and 23% for admissions for acute femorodistal graft surgery at 2 and 4 years, respectively (p

311

Hepatectomia direita ampliada com ressecção parcial da veia cava para metástase colorretal: relato de caso/ Extended right hepatectomy with partial resection of the vena cava from colorectal metastases: case report  

Abstract in portuguese Introdução: A hepatectomia tem sido o tratamento padrão para metástase de origem colorretal (CR). Metástase com invasão da veia cava inferior (VCI) pode requerer ressecção combinada do fígado e VCI. Esta abordagem pode apresentar alto risco cirúrgico. Sangramento profuso e embolia gasosa são complicações intra-operatorias letais. Relato de Caso: Os autores relatam um caso de metástase colorretal única tratada com hepatectomia direita ampliada e ressecção (more) parcial da veia cava com reconstrução primaria. Paciente apresentou boa evolução pós-operatória sem recidiva (um ano de seguimento). Conclusão: Ressecção da VCI e reconstrução combinada com hepatectomia pode ser satisfatoriamente realizada em casos selecionados. A falta de tratamentos alternativos e o prognostico reservado nos casos não operados justificam esta conduta agressiva. No entanto, esta abordagem deve ser realizada por equipe especializada em cirurgia hepática. Abstract in english Introduction: Hepatectomy has been standard treatment for metastases from colorectal origin (CR). Metastases with inferior vena cava (IVC) involvement may require combined resection of the liver and IVC. This approach may present high surgical risk, Both profuse bleeding and gas embolism are letal intraoperative complications. Case: The authors present a case of single hepatic CR metastasis that was treated by means extended right hepatectomy with partial inferior vena ca (more) va resection and primary reconstruction. Patient present good postoperative course without neoplasm recurrence (one year follow-up period). Conclusion: Resection of VCI and combined reconstruction with hepatectomy may be satisfactorily done in selected cases. Lack of alternative treatments associated poor prognosis of untreated cases has justified this aggressive conduct. Therefore, this approach should be realized by hepatic surgery expertise team.

312

The main indications and techniques for vascular exclusion of the liver/ Principais indicações e técnicas para exclusão vascular do fígado  

Abstract in portuguese RACIONAL: O clampeamento vascular hepático durante as hepatectomias tem como meta reduzir o sangramento e suas complicações. OBJETIVO: Mostrar passo a passo as principais técnicas cirúrgicas para exclusão vascular do fígado e suas indicações. MÉTODO: São descritas as seguintes técnicas: clampeamento do hilo hepático, manobra de ''Pringle''; clampeamento intermitente do pedículo hepático; exclusão vascular intermitente do fígado, sem clampeamento da veia c (more) ava inferior e a exclusão vascular hepática com clampeamento da veia cava inferior. Discutem-se, também, as conseqüências hemodinâmicas e metabólicas, bem como as falhas técnicas de cada uma destas manobras. CONCLUSÃO: A escolha da técnica de exclusão vascular durante a hepatectomia depende da avaliação do cirurgião. Atitudes dogmáticas e sistemáticas são prejudiciais para o paciente e os cirurgiões de fígado devem estar habituados a usar qualquer uma das manobras. Abstract in english BACKGROUND: The purpose of vascular clamping during the course of liver resection is to reduce bleeding and subsequent complications. AIM: To show both step-by-step surgical techniques for vascular exclusion of the liver and their indications. METHODS: It is described the following techniques: clamping of the hepatic pedicle, ''Pringle'' maneuver; intermittent clamping of the hepatic pedicle; intermittent vascular exclusion of the liver, without vena cava clamping, and he (more) patic vascular exclusion with vena cava clamping. Also metabolic and homodynamic consequences as well as the technical failure of the application of each of them are discussed. CONCLUSIONS: The choice of technique to use for clamping during hepatectomy depends on the surgeon's judgment. Dogmatic or systematic attitude, is prejudiciable for the patient and liver surgeon must be able to use all kinds of clamping.

313

Estudo histopatológico do efeito do tenoxicam com água bidestilada ou com cloreto de sódio a 0,9% no endotélio venoso de coelhos/ Histopathologic study on the effects of tenoxicam with bidistilled water or with 0.9% sodium chloride in rabbits venous endothelium/ Estudio histopatológico del efecto del tenoxican con agua bidestilada o con cloreto de sodio a 0,9% en el endotélio venoso de conejos  

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: Em estudo com células endoteliais de veias umbilicais humanas expostas à indometacina, foi observado aumento da atividade pró-coagulante. Estudo em coelhos comprovou a presença de trombose nas veias auriculares após administração de tenoxicam com seu diluente ou de seu diluente isolado. Não foram encontrados estudos na literatura consultada que tenham avaliado o endotélio venoso após a administração do tenoxicam, em seres humanos. O (more) objetivo desta pesquisa foi avaliar se o tenoxicam com cloreto de sódio a 0,9% (NaCl a 0,9%) provoca alterações no endotélio venoso de coelhos, como as observadas quando associado ao seu diluente (água bidestilada). MÉTODO: Noventa coelhos (2.000 - 3.500 g) foram distribuídos aleatoriamente em dois grupos: Controle, com administração de NaCl a 0,9%; Experimento, com tenoxicam (20 mg) associado à água bidestilada ou ao NaCl a 0,9%. O volume injetado nos dois grupos foi constante de 2 ml. A anestesia foi induzida com maleato de acepromazina, cloridrato de cetamina e cloridrato de xilazina, sendo a punção das veias auriculares caudais direita e esquerda realizada com agulha tipo borboleta 27G. Os animais foram mantidos no biotério por 6 h, 12 h e 24 h, novamente anestesiados e submetidos à eutanásia, sendo então realizada exérese das aurículas em sua base e posterior avaliação microscópica das veias. RESULTADOS: Observou-se trombose no grupo Experimento, numa porcentagem de 19,4% após administração do tenoxicam com água bidestilada e 22,2% após administração do tenoxicam com NaCl a 0,9%. No grupo Controle, em que foi injetado somente NaCl a 0,9%, nenhuma das veias apresentou trombose. CONCLUSÕES: Os resultados encontrados permitem concluir que o tenoxicam, com água bidestilada ou com solução de cloreto de sódio a 0,9%, produziu trombose nas veias em que foi injetado. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: En estudio con células endoteliales de venas umbilicales humanas expuestas a la indometacina, fue observado aumento de la actividad pró-coagulante. Estudio en conejos comprobó la presencia de trombosis en las venas auriculares después de la administración de tenoxicam con su diluyente o de su diluyente aislado. No fueron encontrados estudios en la literatura consultada que hayan evaluado el endotélio venoso después de la administración d (more) e tenoxicam, en seres humanos. El objetivo de esta pesquisa fue evaluar se el tenoxicam con cloreto de sodio a 0,9% (NaCl a 0,9%) provoca alteraciones en el endotélio venoso de conejos, como las observadas cuando asociado a su diluyente (agua bidestilada). MÉTODO: Noventa conejos (2.000 - 3.500 g) fueron distribuidos aleatoriamente en dos grupos: Control, con administración de NaCl a 0,9%; Experimento, con tenoxicam (20 mg) asociado a agua bidestilada o al NaCl a 0,9%. El volumen inyectado en los dos grupos fue constante de 2 ml. La anestesia fue inducida con maleato de acepromazina, clorhidrato de cetamina y clorhidrato de xilazina, siendo la punción de las venas auriculares caudales derecha e izquierda realizada con aguja tipo mariposa 27G. Los animales fueron mantenidos en el biotério por 6 h, 12 h e 24 h, nuevamente anestesiados y sometidos a eutanasia, siendo entonces realizada exéresis de las aurículas en su base y posterior evaluación microscópica de las venas. RESULTADOS: Se observó trombosis en el grupo Experimento, en una porcentaje de 19,4% después de administración del tenoxicam con agua bidestilada y 22,2% después administración del tenoxicam con NaCl a 0,9%. En el grupo Control, en que fue inyectado, solamente NaCl a 0,9%, ninguna de las venas presento trombosis. CONCLUSIONES: Los resultados encontrados permiten concluir que el tenoxicam, con agua bidestilada o con solución de cloreto de sodio a 0,9%, produjo trombosis en las venas en que fue inyectado. Abstract in english BACKGROUND AND OBJECTIVES: After exposure to indomethacin, human umbilical vein endothelial cells have shown increased procoagulant activity. Thrombosis in rabbit auricular veins has been observed after injection of tenoxicam with its diluent or of the diluent alone ². Human studies evaluating venous endothelium after tenoxican injection were not found in the literature. This study aimed at evaluating whether tenoxicam with 0.9% sodium chloride changes the venous endothe (more) lium of rabbits as it is observed when associated to its diluent (bidistilled water). METHODS: The study involved 90 rabbits (2000 and 3500 grams) divided in two groups: Control group, which received 0.9% NaCl; Experimental group, which received tenoxicam (20 mg) with bidistilled water or with 0.9% NaCl. A constant volume of 2 ml was administered to both groups. Anesthesia was induced with acepromazine maleate, ketamine hydrochloride and xylazine hydrochloride, and the puncture of right and left caudal auricular veins was performed with a 27G butterfly needle. Animals were confined for 6 hrs, 12 hrs, and 24 hrs, when they were once more anesthetized and sacrificed, with extraction of the auriculae at their base, followed by microscopic venous study. RESULTS: Thrombosis was observed in 19.4% of the Experimental Group after the administration of tenoxicam with bidistilled water and in 22.2% after the administration of tenoxicam with 0.9% sodium chloride. In the Control group, which has only received 0.9% sodium chloride, no thrombosis was observed. CONCLUSIONS: It was possible to conclude that tenoxicam, either with bidistilled water or 0.9% sodium chloride, has induced thrombosis in the veins it was injected.

314

Anatomia endoscópica do seio esfenoidal/ Endoscopic anatomy of the sphenoid sinus  

Abstract in portuguese Introdução: A importância da compreensão da anatomia interna do seio esfenoidal deve-se à sua peculiar localização no centro do crânio, com estruturas vizinhas de nobreza indiscutível, e por transparecer estas relações anatômicas em suas delgadas paredes internas. Forma de estudo: Anatômico. Material e método: No presente estudo foram dissecados endoscopicamente 52 seios esfenoidais, sendo suas saliências e depressões internas analisadas, correspondentes a (more) os relevos internos produzidos pela artéria carótida interna, nervo óptico, nervo maxilar, e nervo vidiano. Resultado: Em 88,5% dos casos a artéria carótida interna apresentou-se saliente, e o nervo óptico o fez em 55,8%. O nervo vidiano e o nervo maxilar mostraram-se visíveis em 25% e 30,8% dos casos, respectivamente. Conclusão: Tais dados nos chamam a atenção para a rica e frágil anatomia interna do seio esfenoidal que, devido ao avanço dos métodos de cirurgia endoscópica, está progressivamente mais próxima e vulnerável a manobras e procedimentos cirúrgicos. Assim, sua compreensão torna-se essencial quando se trata de cirurgia endoscópica endonasal e seu horizonte de recursos técnicos. Abstract in english Introduction: The internal anatomy of the sphenoid sinus plays a role of great importance due to its peculiar placement in the center of the head, surrounded by important adjacent structures, which make themselves transparent in its internal walls. Study design: Anatomic. Material and method: In this study, 52 sphenoid sinus were endoscopically dissected, and the elevations and depressions presented on its internal walls, produced by the internal carotid artery and the op (more) tic, maxillary and vidian nerves, were analyzed. Results: In 88,5% of the cases, the internal carotid artery were projected into the sinus, while the optic nerve were in 55,8%. The vidian and maxillary nerves were salient in 25% and 30% respectively. Conclusion: These data point us to the rich end delicate internal anatomy of the sphenoid sinus, which is progressively closer and more vulnerable to surgical maneuvers, due to the advance of surgical skills, techniques and knowledge. Thus, the study and comprehension of the sphenoid sinus internal anatomy became essential, concerning the endoscopic sinus surgery and its huge field of technical resources.

315

Stent placement in arteriovenous fistula : an experimental study  

To determine the efficacy of metallic stents in the treatment of experimentally created carotid-jugular fistulas. Materials and Methods : Carotid-jugular fistulas were constructed surgically in four mongrel swines. Three Wallstents (Schneider, Bulbanch, Switzerland), 6mm in diameter and 23mm in length, and one Nir stent (Boston Scientific Corporation, Boston, U.S.A.), 3-5mm in diameter and 16mm in length, were placedendovascularly across the fistula holes within the carotid artery. Carotid angiography was performed before,immediately after, and 1-3 months after stent placement. Fistula specimens were obtained after final angiography and gross and microscopic examination was performed. Results : Angiography demonstrated decreased flow through the fistula immediately after stent placement. During follow-up, flow through the fistula decreased progressively but complete closure did not occur. Carotid arteries p in which Wallstents were placed were patent throughout the follow-up period. A carotid artery in which a Nir stent was used showed no decreased flow during follow-up angiography lasting two months. Pathologically, a thin layer of endothelium covered the stent wires; there was a transitional zone between the fibrous connective tissue of organizing thrombus, and endothelial proliferation occurred in the overlying fistula hole. Conclusions : Stent placement effectively reduced flow through the fistulas but during the ensuing three months closure did not occur. Occlusion was then progressive.Pathologically, intimal proliferation arose from the organizing thrombus on the surface of the stent mesh.

316

Three-field dissection for squamous cell carcinoma in the thoracic esophagus.  

An esophageal cancer has frequent metastasis in the cervical and upper mediastinal lymph nodes, in particular along the recurrent nerves. Cervicothoracoabdominal three-field dissection is the most radical and rational lymphadenectomy procedure based on this evidence. During three-field dissection, the nodes along the recurrent nerves from the neck to the mediastinum are more meticulously resected than during any other procedure of radical lymphadenectomy. A consensus has been obtained that complete resection of the recurrent nerve nodes improves the survival rates of patients with cancer in each of the various locations of the thoracic esophagus, and that resection of the supraclavicular and internal jugular nodes improves the survival rates of patients with cancer in the upper thoracic esophagus. There is, however, still some controversies over whether or not resection of the supraclavicular and internal jugular nodes improves the survival rates of patients with cancer in the middle or lower thoracic esophagus. Moreover, there remains many controversies over the indication for three-field dissection regarding metastasis-positivity in the lymph nodes, the numbers of the metastasis-positive nodes, the stage, surgical risks and other aspects. Large randomized prospective studies are needed to accumulate conclusive evidence for the benefits of three-field dissection. PMID:12517291

317

Ultrasound-guided vascular catheterization in loggerhead sea turtles (Caretta caretta).  

In this study, the authors describe a simple, nontraumatic procedure for ultrasound-guided placement and maintenance ofjugular and cephalic vein catheterization. The ultrasound scans were performed with a GE Logiq 400 machine connected to a multifrequency (7-11 MHz) linear-array transducer. To find the cephalic vein, longitudinal and transverse color-Doppler ultrasonographic scans were made of the dorsal surface of the flipper. To find the jugular vein, scans of the midline of the lateral surface of the neck were performed. Once the vein had been located, a 16- to 22-gauge 51-mm needle catheter was inserted into the skin beneath the ultrasound probe, inclined at 15-25 degrees to the skin surface. The successful insertion of the catheter inside the vein was monitored by ultrasound. The authors believe that the procedure described offers a good option for fashioning a simple, nontraumatic, and durable vascular access in sea turtles compared with previously described techniques. Caretta caretta, cephalic vein, jugular vein, ultrasonography, vascular catheterization. PMID:20945652

318

Imaging of human thrombi in the rabbit jugular vein. I. Comparison of two fibrin-specific monoclonal antibodies  

The development of monoclonal antibodies with a specificity for cross-linked fibrin may have a potential role in the detection and of thrombi and thrombolytic therapy. In this study, two monoclonal antibodies with a specificity for fibrin have been examined. In vitro studies have shown NIBn 123 (which has a high affinity for X-oligomer) and DD-3B6 to bind to immobilized fibrin on PVC plates as well as plasma clots which were incubated in the presence of plasma. The Km values for NIBn 123 and DD-3B6 wre 1.0 x 10(10)/7.7 x 10(8) M and 2.6 x 10(8) M respectively. No significant binding to fibrinogen either immobilized or in solution was found. The binding of these antibodies to a human thrombus in the jugular vein of the rabbit was monitored over a 24 hour period. Preferential binding of each antibody reached a ratio of approximately 1.0 (jugular/heart) at 24 hours and an image was detected.

319

The Use of Inferior Vena Cava Filters in Pediatric Patients for Pulmonary Embolus Prophylaxis  

Purpose: To report our experience with inferior vena cava (IVC) filters in pediatric patients. Methods: Over a 19-month period, eight low-profile percutaneously introducible IVC filters were placed in four male and four female patients aged 6-16 years (mean 11 years). Indications were contraindication to heparin in six patients, anticoagulation failure in one, and idiopathic infrarenal IVC thrombosis in one. Six of the eight devices placed were titanium Greenfield filters. One LGM and one Bird's Nest filter were also placed. Two of the filters were introduced via the right internal jugular vein by cutdown, and the remainder were placed percutaneously via the right internal jugular vein or the right common femoral vein. Patients received follow-up abdominal radiographs from 2 to 13 months after IVC filter placement. Results: All filters were inserted successfully without complication. Three of the patients died during the follow-up period: two due to underlying brain tumors at 2 and 12 months and a third at 6 weeks due to progressive idiopathic renal vein and IVC thrombosis. The remaining five patients were all alive and well at follow-up without evidence of IVC thrombosis, pulmonary emboli, or filter migration. Conclusion: IVC filter placement using available devices for percutaneous delivery is technically feasible, safe, and effective in children.

320

Three-dimensional reconstruction of paracentesis approach in transjugular intrahepatic portosystemic shunt.  

To establish a digital transjugular intrahepatic portosystemic shunt (TIPS) model and provide morphological data for radiological diagnosis and interventional radiology to reduce portal vein pressure, 400 serial sectional images from the internal jugular vein superior margin to the lower edge of the liver were chosen from the Chinese Visible Human dataset. Surface and volume reconstructions were performed using 3D-DOCTOR 3.5 software on an ordinary personal computer. Volume and surface renderings were employed to perform data segmentation and image edge detection for reconstruction of the internal jugular vein, brachiocephalic vein, superior vena cava, heart, inferior vena cava, hepatic vein, and portal vein for computerized 3D reconstruction of the TIPS pathway and construction of a 3D visible model of different structures along it. The model can also display pathway and distribution characteristics and interactively show the spatial structural relationships between intrahepatic venous lines from any position and angle, plus complete data acquisition for any range and angle for 3D reconstruction with stereopsis and measurements using any visualization platform. The digital reconstruction of the TIPS pathway correctly reflected the complicated anatomic structural characteristics and spatial adjacency relationships between intrahepatic venous lines, providing a reference 3D morphology for image diagnostics and interventional TIPS therapy. PMID:22252432

 
 
 
 
321

System and method for improving ultrasound image acquisition and replication for repeatable measurements of vascular structures  

High resolution B-mode ultrasound images of the common carotid artery are obtained with an ultrasound transducer using a standardized methodology. Subjects are supine with the head counter-rotated 45 degrees using a head pillow. The jugular vein and carotid artery are located and positioned in a vertical stacked orientation. The transducer is rotated 90 degrees around the centerline of the transverse image of the stacked structure to obtain a longitudinal image while maintaining the vessels in a stacked position. A computerized methodology assists operators to accurately replicate images obtained over several spaced-apart examinations. The methodology utilizes a split-screen display in which the arterial ultrasound image from an earlier examination is displayed on one side of the screen while a real-time live ultrasound image from a current examination is displayed next to the earlier image on the opposite side of the screen. By viewing both images, whether simultaneously or alternately, while manually adjusting the ultrasound transducer, an operator is able to bring into view the real-time image that best matches a selected image from the earlier ultrasound examination. Utilizing this methodology, measurement of vascular dimensions such as carotid arterial IMT and diameter, the coefficient of variation is substantially reduced to values approximating from about 1.0% to about 1.25%. All images contain anatomical landmarks for reproducing probe angulation, including visualization of the carotid bulb, stacking of the jugular vein above the carotid artery, and initial instrumentation settings, used at a baseline measurement are maintained during all follow-up examinations.

322

Does thoracic pump influence the cerebral venous return?  

We assessed the hemodynamic effects induced by the thoracic pump in the intra- and extracranial veins of the cerebral venous system on healthy volunteers. Activation of the thoracic pump was standardized among subjects by setting the deep inspiration at 70% of individual vital capacity. Peak velocity (PV), time average velocity (TAV), vein area (VA), and flow quantification (Q) were assessed by means of echo color Doppler in supine posture. Deep respiration significantly increases PV, TAV, and Q, but it is limited to the extracranial veins. To the contrary, no significant hemodynamic changes were recorded at the level of the intracranial venous network. Moreover, at rest TAV in the jugular veins was significantly correlated with Q of the intracranial veins. We conclude that the modulation of the atmospheric pressure operated by the thoracic pump significantly modifies the hemodynamics of the jugular veins and of the reservoir of the neck and facial veins, with no effect on the vein network of the intracranial compartment. PMID:22174396

323

[Sequential pacing following cardiopulmonary bypass].  

Twenty patients with combined mitral valve disease were studied to evaluate whether the mode of cardiac pacing can influence myocardial performance after cardiopulmonary bypass. All patients underwent the same surgical procedure (mitral-valve-replacement) under standardized anaesthetic procedure. After weaning from extracorporeal circulation the following haemodynamic measurements were performed either under ventricular pacing or under sequential ("physiological") pacing: blood-pressure (radial artery), central venous pressure (CVP, jugular vein), cardiac output (as cardiac index, C. I.), pulmonary artery pressure (PAP) using Swan-Ganz-thermodilution catheter (jugular vein) and left atrial pressure (LAP). All patients were investigated as well under ventricular pacing as under sequential pacing (heart rate: 90 X min-1; AV-delay: 200 msec; stimulation with a pacemaker Medtronics 5330). Compared with the situation under ventricular pacing the haemodynamic parameters changed, when sequential pacing was applied: arterial pressure and cardiac output increased, whereas CVP as well as PAP and LAP decreased. The data indicate that there is some influence on cardiac work by the mode of pacing. Physiological pacing compared to ventricular pacing seems to lead to a marked improvement in cardiac performance. Particularly patients with severe dysrhythmia following cardiopulmonary bypass should be treated by physiological (sequential) pacing. PMID:6476301

324

Equilíbrio ácido-base e hidroeletrolítico em eqüinos com cólica/ Acid-base and hidroelectrolytic balance in colic horses  

Abstract in portuguese Foram utilizados setenta eqüinos distribuídos em três grupos experimentais, G1 (vinte eqüinos hígidos), G2 (vinte e cinco eqüinos com cólica, os quais passaram por tratamento clínico ou cirúrgico e sobreviveram) e G3 (vinte e cinco eqüinos com cólica, os quais passaram por tratamento clínico ou cirúrgico e foram a óbito ou foram sacrificados). Amostras de sangue foram obtidas em dez diferentes momentos, mediante punção da jugular, para estudo do equilíbri (more) o ácido-base e hidroeletrolítico. Os eqüinos com cólica apresentaram diminuição (P Abstract in english Seventy horses were distributed into three experimental groups ad follows: G1, twenty healthy animals; G2, twenty-five colic horses that survived after clinical or surgical treatment; and G3, twenty-five colic horses that were sacrificed or died after clinical or surgical treatment. Blood samples were taken from the jugular vein to assess acid-base balance and water-electrolyte balance. Colic horses had lower pH(v) (P(more) e lower pH(v) associated with decreased pCO2(v), cBase(v) and cHCO-3(vP), which was probably due to an increased production of lactate during anaerobic glycolysis as a result from hypovolemia. Furthermore, hyponatremia, hypokalemia and hyperchloremia were detected. The presence and the extent of the imbalances contributed substantially to the prognosis of colic horses.

325

Capillary-oxygenation-level-dependent near-infrared spectrometry in frontal lobe of humans.  

Brain function requires oxygen and maintenance of brain capillary oxygenation is important. We evaluated how faithfully frontal lobe near-infrared spectroscopy (NIRS) follows haemoglobin saturation (SCap) and how calculated mitochondrial oxygen tension (PMitoO2) influences motor performance. Twelve healthy subjects (20 to 29 years), supine and seated, inhaled O2 air-mixtures (10% to 100%) with and without added 5% carbon dioxide and during hyperventilation. Two measures of frontal lobe oxygenation by NIRS (NIRO-200 and INVOS) were compared with capillary oxygen saturation (SCap) as calculated from the O2 content of brachial arterial and right internal jugular venous blood. At control SCap (78%+/-4%; mean+/-s.d.) was halfway between the arterial (98%+/-1%) and jugular venous oxygenation (SvO2; 61%+/-6%). Both NIRS devices monitored SCap (P0.74; P<0.05). These results show that NIRS is an adequate cerebral capillary-oxygenation-level-dependent (COLD) measure during manipulation of cerebral blood flow or inspired oxygen tension, or both, and suggest that motor performance correlates with the frontal lobe COLD signal. PMID:17077816

326

Septic Thrombophlebitis: Percutaneous Mechanical Thrombectomy and Thrombolytic Therapies.  

Suppurative thrombophlebitis (Lemierre's syndrome) of the internal jugular vein is a rare and sometimes fatal complication. It commonly occurs from oropharyngeal infections, peripheral lines, complications from dental procedures, gingivitis, or central venous catheterizations. Empiric antibiotics are the initial treatment of choice followed by thrombolytics or surgical thrombectomy in refractory cases. We present a case of septic thrombophlebitis of the right internal jugular vein from a peripherally inserted central venous catheter. We also review the current percutaneous mechanical thrombectomy and thrombolytics therapies for such a rare disorder. Mechanical thrombectomy includes rotational thrombectomy or rheolytic therapies. Devices include the Amplatz thrombectomy device (Microvena), the Arrow-Trerotola Percutaneous thrombolytic device (Arrow), and the Cragg-Casteneda thrombolytic brush (Microtherapeutics). Rheolytic therapies include Angiojet, the Hydrolyzer, and the Oasis Thrombectomy System. Percutaneous mechanical thrombectomy techniques include rotational fragmentation, aspiration or suction thrombectomy, and hydrodynamic thrombectomy. AngioJet catheters may be used for percutaneous embolectomy in conjunction with pulse spray techniques, which instill thrombolytics locally. Thrombolytics include streptokinase, urokinase, and recombinant-tissue plasminogen activator. Mechanical thrombectomy combined with thrombolytics provide optimal treatment results secondary to their complementary effects. Therefore, patients who are refractory to standard medical therapy and considered poor surgical candidates may benefit from combined percutaneous mechanical thrombectomy with thrombolytics to achieve superior results if no contraindications exist for thrombolytics. PMID:22198069

327

Experimental model for creation of carotid artery aneurysms in dogs  

To describe the detailed technique for producing experimental carotid aneurysms in dogs and the success rate, cause of failure and remedy, based on our experience. Fourteen male dogs weighing 12-15kg were anesthetized with inhalation of 1-2% halothane and 50% nitrous oxide. Each surgical procedure was performed under sterile condition with the aid of an operating microscope. A paramidline incision 7-8cm in length was made parallel to and medial to the external jugular vein in the dog's neck. The external jugular vein was harvested as a 1cm vein pouch by ligation and division of the proximal and distal ends. The ipsilateral common carotid artery was exposed and clamped at both ends by a vascular clamp. A 5-mm long elliptical arteriotomy was made at the mid portion of the artery, and then end to side anastomosis between the artery and vein sac was performed by using interrupted 7-0 monofilament prolene sutures. Carotid arteriography or Doppler sonography was performed 1-6 weeks after aneurysm construction. Twenty experimental aneurysms were constructed, and 17 aneurysms were patent on follow up study, but one dog with two aneurysms died from hemorrhagic pneumonia 17 days after surgery. The overall patency rate was 75%. We demonstrated the feasibility of creating experimental aneurysm models in the dog and expect that the technique presented will help to avoid failure in the construction of aneurysms.

328

Routine Chest Radiographs After Central Line Insertion: Mandatory Postprocedural Evaluation or Unnecessary Waste of Resources?  

Purpose: To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided central venous catheter insertion. Methods: Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclavian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients. Results: Postprocedural chest fluoroscopy showed no evidence of pneumothorax, hemothorax, or mediastinal hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters. These problems were all corrected while the patient was on the interventional table. Postprocedural chest radiographs showed no complications but proximal catheter tip migration was noted in six of 621 catheters (1%). These latter six catheters required further manipulation. The total technical and related charges for the postprocedural chest radiographs in this series were estimated at Pounds 15,525. Conclusion: Postprocedural chest radiographs after image-guided central venous catheter insertion are not routinely required. A postprocedural chest radiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.

329

Creation of large elastase-induced aneurysms: Pre-surgical arterial remodeling using arteriovenous fistulae  

Purpose To determine whether creation of a carotid-jugular arteriovenous fistula, (AVF) to induce remodeling of the right common carotid artery (RCCA) results in larger elastase-induced aneurysms in rabbits. Materials and Methods RCCA-right jugular AVFs were created in 6 New Zealand white rabbits (Group 1), followed by elastase-induced aneurysm creation 4 weeks later. Follow up Digital subtractive angiography (DSA) was performed to assess AVF patency and aneurysm sizes. Six other elastase-induced aneurysms created in regular way were used as control (Group 2). Diameters of right common carotid artery (RCCA) and left common carotid artery (LCCA) in Group 1, and aneurysm sizes in both groups were measured from DSA images and compared using the Student’s t test. Results The patency of AVFs in Group 1 was confirmed in all the six (100%) cases. Mean RCCA diameter in Group 1 was larger than contralateral LCCA (3.6 ± .7 mm versus 2.0 ± .1 mm, from 1.8 to 2.2 mm, p RCCA remodeling that yields relatively larger elastase-induced aneurysms.

330

Axonal tracing of autonomic nerve fibers to the superficial temporal artery in the rat.  

The origin of nerve fibers to the superficial temporal artery of the rat was studied by retrograde tracing with the fluorescent dye True Blue (TB). Application of TB to the rat superficial temporal artery labeled perikarya in the superior cervical ganglion, the otic ganglion, the sphenopalatine ganglion, the jugular-nodose ganglionic complex, and the trigeminal ganglion. The labeled perikarya were located in ipsilateral ganglia; a few neuronal somata were, in addition, seen in contralateral ganglia. Judging from the number of labeled nerve cell bodies the majority of fibers contributing to the perivascular innervation originate from the superior cervical, sphenopalatine and trigeminal ganglia. A moderate labeling was seen in the otic ganglion, whereas only few perikarya were labeled in the jugular-nodose ganglionic complex. Furthermore, TB-labeled perikarya were examined for the presence of neuropeptides. In the superior cervical ganglion, all TB-labeled nerve cell bodies contained neuropeptide Y. In the sphenopalatine and otic ganglia, the majority of the labeled perikarya were endowed with vasoactive intestinal polypeptide. In the trigeminal ganglion, the majority of the TB-labeled nerve cell bodies displayed calcitonin gene-related peptide, while a small population of the TB-labeled neuronal elements contained, in addition, substance P. In conclusion, these findings indicate that the majority of peptide-containing nerve fibers to the superficial temporal artery originate in ipsilateral cranial ganglia; a few fibers, however, may originate in contralateral ganglia. PMID:2472893

331

Collateral Lymphatic Congifuration of the Internal Jugular Chain and Jugulo-Omohyoid Nodes  

Minute dissection was performed bilaterally on 178 human adult cadavers (356 sides) in order to investigate the collateral lymphatic configurations of the internal jugular node chain. The superior and inferior collateral pathways identified based on the topographical anatomy of the large collecting vessels in the neck region. The superior collateral pathway (in 99 of 208 sides,47.6%) consisted of a node chain, lying on the common carotid artery or along the medial edge of the internal jugular vein, connecting the submandibular lymphatics to the jugulo-omohyoid node (JO). In contrast, the inferior collateral pathway (in 63 of 356 sides,17.7%) consisted of a single large collecting vessel, lying immediately superficial to the inferior deep cervical nodes, and which directly connected the JO to the venous angle region. A short cervical lymphatic trunk arising from the inferior deep cervical nodes, was also observed in the inferior collateral pathway. The JO seemed to be located at a critical position, where it connected the two collateral pathways. These results are discussed in relation to the fascial arrangement and development of the lymphatics in the cervical region.   

332

Diabetes Mellitus Does Not Affect Jugular Bulb Oxygen Saturation in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery  

Background Diabetes mellitus (DM) is associated with the impairment of cerebral oxygenation during cardiac surgery. The aim of the present study was to investigate the effects of DM on cerebral oxygenation assessed by jugular bulb oxygen saturation (SjvO2) in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) in a prospective controlled trial. Methods and Results Twenty-three diabetic patients with glycosylated hemoglobin above 7.0% (DM group) and 23 non-diabetic patients (control group) undergoing OPCAB with no-touch aortic technique were included. A fiberoptic oximetry catheter was inserted into the jugular bulb. The lowest SjvO2 and the number of patients with cerebral desaturation, defined as SjvO2 less than 50% over 5 min, were recorded during coronary grafting. Three neurocognitive tests were done before surgery and at postoperative day 2 and 7. There were no differences in SjvO2 between the groups. Furthermore, the number of patients with cerebral desaturation and all neurocognitive test scores were similar between the 2 groups. None of the patients developed neurocognitive dysfunction. Conclusions Cerebral oxygenation in diabetic patients was similar to that of non-diabetic patients and well maintained above the critical level without resulting in clinically significant postoperative neurocognitive dysfunction during OPCAB with no-touch aortic technique. (Circ J 2008; 72: 1259 - 1264)   

333

Comparison of TRPA1-versus TRPV1-mediated cough in guinea pigs.  

TRPA1 receptor is activated by endogenous inflammatory mediators and exogenous pollutant molecules relevant to respiratory diseases. Previous studies have implicated TRPA1 as a drug target for antitussive therapy. Here we evaluated the relative efficacy of TRPA1 activation to evoke cough. In conscious guinea pigs the TRPA1 agonist allyl-isothiocyanate (AITC) evoked cough with a maximally effective concentration of 10mM that was abolished by the selective TRPA1 antagonist AP-18. AITC (10mM) was approximately 3-times less effective in inducing cough than capsaicin (50 ?M). Ex vivo single fiber extracellular recordings revealed that, similarly to capsaicin, AITC evoked activation in airway jugular C-fibers, but not in airway nodose A?-fibers. Consistent with the cough studies, AITC was approximately 3-times less effective than capsaicin in evoking sustained activation of the jugular C-fibers. Another TRPA1 agonist, cinnamaldehyde, was approximately twofold more effective than AITC in inducing cough. However, the cinnamaldehyde (10mM)-induced cough was only partially inhibited by the TRPA1 antagonist AP-18, and was abolished by combination of AP-18 and the TRPV1 antagonist I-RTX. We conclude that in naïve guinea pigs, TRPA1 activation initiates cough that is relatively modest compared to the cough initiated by TRPV1, likely due to lower efficacy of TRPA1 stimulation to induce sustained activation of airway C-fibers. PMID:22683866

334

Evaluation of a new fiberoptic catheter for monitoring jugular venous oxygen saturation  

OBJECTIVE: The purpose of this study was to evaluate three modified, fiberoptic, oxygen saturation catheters as monitors of jugular venous oxygen saturation (SjvO2). METHODS: Three modified fiberoptic catheters, designated Catheters 1, 2, and 3, were evaluated. After preinsertion calibration, the catheters were inserted in the dominant jugular vein of patients with severe head injuries. The catheter reading for SjvO2 was compared with the SjvO2 value measured in a blood sample drawn through the catheter, at intervals up to 72 hours. RESULTS: Catheter 3 (a modified version of the pediatric Swan-Ganz catheter) showed significantly better performance than the other two catheters. Both the initial calibration of the catheter and the calibration with time were significantly better for Catheter 3 than for the other two catheters tested. The Catheter 3 value for SjvO2 was more than 4% different from the co-oximeter value in only 6% of the 4-hour calibration checks, compared with 26% and 29% for Catheters 1 and 2, respectively. CONCLUSION: Catheter 3, which is now being marketed as the Opticath P540-H catheter, represents a significant improvement in performance and may make SjvO2 monitoring in the intensive care unit more practical. PMID:10371628

335

Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy.  

The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.2 ml) made into a double lumen intraventricular balloon catheter. The objective of this study was thus to determine the effectiveness of the decompressive craniectomy done on the worst brain site with regard to compliance (Cl), pressure volume index (PVI), jugular oximetry (SjVo2), autoregulation abnormalties, brain tissue oxygen (TiO2) and cerebral blood flow (CBF). This is a prospective cohort study of 17 patients who were enrolled after consent and approval of the ethics committee between the beginning of the year 2001 and end of the year 2002. For pre and post assessment on compliance and PVI, all 12 patients who survived were reported to become normal after decompressive craniectomy. There is no significant association between pre and post craniectomy assessment in jugular oxymetry (p > 0.05), autoregulation (p > 0.05), intracranial brain oxymetry (p = 0.125) and cerebral blood flow (p = 0.375). Compliance and PVI improved dramatically in all alive patients who received decompressive craniectomy. Compliance and PVI monitoring may be crucial in improving the outcome of severe head injured patients after decompressive craniectomy. PMID:16463872

336

Cerebral energy failure after subarachnoid hemorrhage: the role of relative hyperglycolysis.  

After subarachnoid hemorrhage (SAH) cerebral metabolism is significantly impaired. Hyperglycolysis describes the reduction of oxidative metabolism followed by a relative increase of anaerobic glycolysis to maintain energy supply. This phenomenon is known in head injury but has not as yet been shown after SAH. This study was conducted to test the hypothesis that hyperglycolysis is present in SAH patients and is associated with vasospasm. A total of 105 measurements were conducted on 21 SAH patients (age 49+/-15 years, median World Federation of Neurosurgical Societies Grade 4) over the first 5 days following admission. Arteriovenous differences were calculated for oxygen (avDO2) and glucose (avDGlc). Relative hyperglycolysis was defined as metabolic ratio (MR=avDO2[mmol/L]/avDGlc[mmol/L])SjvO2), mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP) were monitored. Relative hyperglycolyis was recorded in 34% of studies after SAH. In hyperglycolytic studies both jugular-venous lactate and SjvO2 were significantly elevated (jugular-venous lactate 14.9+/-9.9 vs. 11.8+/-5.5 mg/dL, p=0.04; SjvO2: 70.0+/-18% vs. 81.7+/-9%, p=0.002). Relative hyperglycolysis is associated with outcome after SAH. In patients who died after SAH almost 50% of studies showed hyperglycolysis, whereas patients who survived without neurological deficit had no hyperglycolytic events. Relative hyperglycolysis is a common event after SAH. It may be associated with relative hyperemia but most importantly with outcome. PMID:17669657

337

Re-defining the ischemic threshold for jugular venous oxygen saturation--a microdialysis study in patients with severe head injury.  

Neurological change is more likely to occur when jugular venous oxygen saturation (SjvO2) is less than 50%. However, the value indicating cellular damage has not been clearly defined. We determined the critical SjvO2 value below which intracerebral extracellular metabolic abnormalities occurred in 25 patients with severe head injury. All patients received standard treatment with normoventilation and maintenance of intracranial pressure SjvO2 was measured from the dominant jugular bulb using a calibrated fibreoptic catheter. Intracerebral metabolic monitoring was performed by collecting perfusate from a microdialysis probe placed in the frontal lobe anterior to the intracranial catheter. Excitotoxin (glutamate) and other extracellular metabolites (lactate, glucose and glycerol) were measured frequently using enzymatic and colorimetric methods. We observed biphasic relationships between SjvO2 and all intracerebral metabolites. Analysis of variance showed that there were rapid increases in glutamate, glycerol and lactate when SjvO2 dropped below 40, 43 and 45% respectively. Extracellular glucose decreased when SjvO2 dropped below 42%. Our findings suggested that the ischemic threshold for SjvO2 in patients with severe head injury is 45%, below which secondary brain damage occurred. PMID:16463822

338

Predicting clinical ischaemia during awake carotid endarterectomy: use of the SJVO2 probe as a guide to selective shunting.  

Stroke is a major cause of disability within the western world. About 20% of strokes are a consequence of atheromatous narrowing of the origin of the internal carotid artery. Carotid endarterectomy has been shown to be an effective treatment for those with symptomatic and severe stenosis, provided the risk of death and peri-operative stroke is less than 7%. The aim of this study was to investigate the clinical value of jugular venous oxygen saturation (SJVO2) monitoring in identifying patients who develop cerebral ischaemia whilst undergoing an awake carotid endarterectomy by comparison with a simple neurological assessment. Each patient underwent a standard awake carotid endarterectomy. Peri-operatively a SJVO2 catheter was inserted, and the jugular oxygen saturation was correlated with the presence or absence of cerebral ischaemia. Data from 34 patients were analysed using time-series plots and by calculating a receiver operator characteristic (ROC) curve. The optimal sensitivity and specificity for this technique were found to be 1.0 and 0.8, respectively, when a 25% change in SJVO2 was used as a threshold. Although a small observational study, we have shown that percentage change in SJVO2 correlates well with the development of clinically apparent cerebral ischaemia. This technique may improve the safety of carotid endarterectomy under general anaesthesia when used with other more established monitoring methods. PMID:12812420

339

Brain tissue pO2 related to SjvO2, ICP, and CPP in severe brain injury.  

The aim of this report is to present first experience in comparing the course of brain tissue oxygen pressure values (PtiO2) to changes in jugular vein oxygen saturation (SjvO2), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) after severe brain injury. PtiO2 monitoring was done using a polarographic Clark type microcatheter (LICOX pO2 probe) (GMS, Kiel, Germany) with a diameter of 0.5 mm and a sensitive area 7.9 mm long inserted in a right frontal position. The microcatheter was connected to a LICOX pO2 device. A fiber-optic catheter was used to measure SjvO2 and placed into the right internal jugular vein. The ICP monitoring was performed with a fiber-optic intraparenchymal device (Camino Laboratories, San Diego, Calif.) inserted in a left frontal position. Consistent correlations could be noticed between reduced PtiO2 and higher ICP and lower CPP levels. However, the absolute value of a single SjvO2 data point seemed to be less relevant diagnostically than its trend over a period of time. Owing to their experience, the authors suppose that PtiO2 monitoring will be a very important and reliable tool in the treatment of brain injury in the future, especially in its correlation to ICP and CPP. PMID:10926102

340

[Clinical assessment of brain oxygen metabolism and function during cardiopulmonary bypass with induced hypothermia].  

This study was designed to demonstrate the changes in brain metabolism/function, and to clarify the reason for assessing brain dysfunction during cardiopulmonary bypass (CPB) with systemic hypothermia. Fifteen patients, who received high-dose fentanyl anesthesia, for cardiac surgery under CPB were analysed concerning systemic hemodynamics, brain oxygen extraction, internal jugular venous oxygen saturation (SjVO2), glucose uptake, and compressed spectral array EEG for brain function. Internal jugular venous temperature decreased from 35.4 +/- 1.0 degrees C (mean +/- SD) at pre-CPB, to 22.3 +/- 1.6 degrees C during CPB. Systemic oxygen delivery decreased by 43% (P SjVO2 rose from 64.5 +/- 6.3% of pre-CPB level to 78.7 +/- 2.2% during CPB (P SjVO2, inhibition of metabolism and low EEG activity. During CPB, EEG activity exhibited identical trend as during ischemia/hypoxia, while the changes in brain oxygen extraction and SjVO2 did not. In conclusion, detection of brain dysfunction by monitoring brain oxygen metabolism or EEG is controversial during CPB using hypothermia. PMID:7745782

 
 
 
 
341

Intraoperative jugular desaturation during surgery for traumatic intracranial hematomas.  

Traumatic intracranial hematomas which are present on hospital admission or which develop during the hospital course are associated with a worse neurological outcome than diffuse injuries. The purpose of this study was to monitor jugular venous oxygen saturation (Sjvo2) during surgery for evacuation of traumatic intracranial mass lesions, to determine the incidence and the causes of jugular venous desaturation, and to assess the usefulness of Sjvo2 monitoring in this setting. Twenty-five severely head injured patients were monitored during 27 surgical procedures. At the start of the surgical procedure, the median Sjvo2 was 47% (range 25%-89%). Seventeen (63%) of the patients had a Sjvo2 less than 50%. Five patients had extremely low Sjvo2 values (Sjvo2 to 65% (range 50%-88%). Intracranial hypertension was the primary cause of the low Sjvo2, as confirmed by the response to surgical evacuation. Hypotension (mean arterial pressure Sjvo2 might provide useful information about the adequacy of cerebral perfusion. PMID:8895278

342

Metabolic suppressive therapy as a treatment for intracranial hypertension--why it works and when it fails.  

Thirty years after its first description metabolic suppressive therapy is still controversial in patients with intractable intracranial hypertension. In this study high dose propofol was used to induce metabolic suppression. The effects on intracranial pressure (ICP) and the cerebral metabolic rates for oxygen and glucose (CMRO2 and CMRGlc) are reported. A total of 28 studies were performed on 14 head injured patients. A Xenon133 cerebral blood flow (CBF) and a CO2-reactivity (CO2R) test were performed prior to induction of metabolic suppression. The following parameters were continuously monitored: EEG, etCO2, SjvO2, ICP, MAP and bilateral MCA flow velocity (VMCA). PCO2 was obtained before and during propofol-induced EEG burst-suppression in arterial and jugular-venous blood. CMRO2, CMRGlc and Metabolic Ratio (MR = CMRO2/CMRGlc) were calculated. MR < 0.6 was defined as relative hyperglycolysis. ICP decreased by 24.1 +/- 29.0% during burst-suppression. Arterial, jugular-venous and etCO2 also decreased. Multiple regression analysis revealed that CO2 was the strongest predictor for ICP. Lower baseline ICP and normal CO2 reactivity were predictors for normal metabolic suppression reactivity. In studies with normal metabolic ratio, ICP reduction was associated with a reduction in CMRO2. In studies with hyperglycolysis, ICP reduction was poor but CMRGlc decreased significantly. In conclusion, intact CO2R, normal or only moderately elevated ICP and normal MR are predictive of ICP reduction with high dose propofol after head injury. PMID:12168359

343

Cerebral physiologic effects of burst suppression doses of propofol during nonpulsatile cardiopulmonary bypass. CNS Subgroup of McSPI.  

Central nervous system (CNS) complications are common after cardiac surgery. Death due to cardiac causes has decreased, but the number of deaths due to CNS injury has increased. As a first stage in the evaluation of its cerebral protection potential, we evaluated the cerebral physiologic effects of burst suppression doses of propofol during nonpulsatile cardiopulmonary bypass. Thirty patients without history of cerebral vascular disease were randomized to two study groups: control group (n = 15) who received sufentanil and vecuronium, or propofol group (n = 15) who received the control anesthetic and propofol infused to maintain electroencephalogram (EEG) burst suppression. Catheters were placed in the radial artery and right jugular bulb for sampling of systemic arterial and jugular bulb venous blood. 133Xe clearance was used to determine cerebral blood flow (CBF) at the start of normothermic bypass, during stable hypothermia, and when rewarmed to 35-37 degrees C nasopharyngeal temperature. Pharmacologic burst suppression with propofol produced a statistically significant reduction in CBF, cerebral oxygen delivery (DO2), and cerebral metabolic rate (CMRO2) at each measurement interval (P SJvO2) were not statistically different between groups, indicating maintenance of cerebral metabolic autoregulation (coupling). The reduction in CBF and CMRO2, prominent during the normothermic phases of cardiopulmonary bypass (CPB), indicates a potential for propofol to reduce cerebral exposure to the embolic load during CPB. PMID:7653803

344

Continuous monitoring of jugular bulb oxygen saturation in comatose patients--therapeutic implications.  

Comatose patients run a high risk of developing cerebral ischaemia which may considerably influence final outcome. It would therefore be extremely useful if one could monitor cerebral blood flow in these patients. Since there is a close correlation between the arteriovenous difference of oxygen and cerebral blood flow, it was a logical step to place a fiberoptic catheter in the jugular bulb for continuous measurement of cerebrovenous oxygen saturation. We have monitored cerebral oxygenation in 54 patients, comatose because of severe head injury, intracerebral haemorrhage or subarachnoid haemorrhage. Normal jugular venous oxygen saturation (SJVO2) ranges between 60 and 90%. A decline to below 50% is considered indicative of cerebral ischaemia. Spontaneous episodes of desaturation (SJVO2 < 50% for at least 15 min) were frequent during the acute phase of these insults. Many of these desaturation episodes could be attributed to hyperventilation, even though considered moderate. Likewise, insufficient cerebral perfusion pressure and severe vasospasm were found to be important causes of desaturation episodes. In many instances, tailoring of ventilation or induced hypervolaemia and hypertension were capable of reversing these low flow states. The new method of continuous cerebrovenous oximetry is expected to contribute to a better outcome by enabling timely detection and treatment of insufficient cerebral perfusion. PMID:7668132

345

Effects of glucose and volatile fatty acids on blood ghrelin concentrations in calves before and after weaning.  

The effect of feeding and intravenous injections of glucose and VFA on blood ghrelin concentrations were investigated in calves before and after weaning. Eight Holstein bull calves were fed whole milk, allowed free access to solid feeds, and weaned at 7 wk. Measurements were carried out at 2, 4, 6, 9, 11, and 13 wk, at which time jugular blood samples were taken from four calves through a catheter from 10 min before to 120 min after their morning feed at 10 min intervals (Exp. 1). An additional 4 calves of the same age were intravenously injected with glucose (1.0 mmol·kg BW(-1)) and a solution of VFA (2.4 mmol·kg BW(-1), acetate:propionate:butyrate in a 6:3:1 ratio) using a catheter, and jugular blood samples were taken temporally relative to the injection time (Exp. 2). In Exp. 1, blood ghrelin concentrations decreased after feeding at all ages. However, preprandial ghrelin concentrations were lower (P = 0.025) and the degree of postprandial depression of ghrelin tended to be greater during the post-weaning period (P = 0.084) than during the pre-weaning period. Blood glucose concentrations increased after feeding during the pre-weaning period (P depress blood ghrelin concentrations than glucose. PMID:22871932

346

Giant Dumbbell-Shaped Intra- and Extracranial Nerve Schwannoma in a Child Presenting with Glossopharyngeal Neuralgia Syncope Syndrome: A Case Report and Review of the Literature.  

Lower cranial nerve schwannomas are benign tumors of the neurolemmocytes of the cranial nerves. Among children, cranial nerve schwannomas are extremely rare and are predominantly associated with neurofibromatosis (NF) type 2. The purpose of the current case report is to describe a unique giant extra- and intracranial foramen jugular schwannoma in a young boy with lower cranial nerve deficits and glossopharyngeal neuralgia syncope syndrome and to review the pertinent literature. In the current case report, we illustrate the course of disease in a 14-year-old boy with a 4-month history of recurrent syncope and a big bulge on the left side of his neck. Audiometry showed deafness of the left ear. Magnetic resonance imaging (MRI) demonstrated a giant unilateral dumbbell-shaped intra- and extracranial foramen jugular schwannoma with a volume of 156 cm3 causing severe brain stem compression and obstructive hydrocephalus. The tumor was removed completely in a two-step surgery. The tumor was confirmed during surgery to originate from the glossopharyngeal nerve. The histological examination revealed the characteristic features of a schwannoma. The MRI 3 months after the second surgery confirmed complete tumor removal. The genetic examination for NF was negative. Review of literature showed that dumbbell-shaped lower cranial nerve schwannomas in the childhood population are rare. PMID:23104590

347

Aneurismas experimentales en cerdos con la técnica de Varsos  

Abstract in english Objective. To achieve an aneurysm model in swine with a low rate of sponatneous thrombosis. Material and method. Five swines were operated using a two stages technique (Varsos technique). In the first step ten carotidjugular fistulas in the neck (4 internal and 6 external jugular vein) were performed. The two vessels formed a 45° angle after the anastomosis. After a week the venous component of the fistula was occluded in order to create an aneurysm. The aneurysms patenc (more) y was angiographically studied fifteen days later. At this time several types of stents and coils could be released. Results . The fistula and the aneuysms could be performed without complications. Seven of 10 aneurysm were angiogaphically patent. Three were thrombosed, all of them were created with the internal jugular vein. A carotid stenosis was observed at the anastomosis site in a thrombosed aneurysm. Conclusions. The Varsos technique in swines, specially when performed with the external yugular vein has a low rate of spontaneous aneurysm thrombosis.

348

Staphylococcus-associated abortions in ewes with long-term central venous catheterization.  

Forty-two ewes had an intravenous catheter sewn in place in a prepared area over the jugular vein and beginning at 60 days of gestation received an infusion 3 times daily. The infusion consisted of sterile saline or sterile saline containing arginine. Twenty-six ewes in both control and treatment groups aborted between 81 days of gestation and term. Fetuses from 16 ewes that aborted were examined. Most were autolyzed or had early mummification. Macroscopic placentitis and noncollapsing lungs were noted. Large numbers of coagulase-positive Staphylococcus were isolated from fetal abomasal content, lungs, brains, or placentas. Histologically, suppurative placentitis with necrosis and pulmonary aspiration of meconium and amniotic debris often with suppurative bronchopneumonia were observed in abortuses. Four ewes euthanized and examined after abortion had suppurative endometritis. Three ewes had severe, chronic, jugular thrombophlebitis from which coagulase-positive Staphylococcus was isolated. The fourth ewe had mild phlebitis, and Staphylococcus aureus was isolated from both the catheter and the blood. Catheter-associated staphylococcal abortion was diagnosed. PMID:18984790

349

A Lemierre syndrome variant caused by Klebsiella pneumoniae.  

Lemierre syndrome is an extremely rare disease characterized by oropharyngeal infection, septicemia, internal jugular vein thrombosis, and skip lesions. The most common causative pathogen is Fusobacterium necrophorum. We reported a 45-year-old woman who presented with left neck painful swelling and septicemia. Magnetic resonance imaging of the head and neck demonstrated venous thrombosis extending from the left internal jugular vein to the sigmoid sinus. During admission we discovered that the patient had uncontrolled diabetes mellitus. We also found a metastatic lesion through chest radiography. Klebsiella pneumoniae was cultivated from both blood samples and pus from deep neck spaces. Surgical drainage, early and adequate antibiotic treatment, anticoagulation, and strict control of blood glucose led to the patient's complete recovery. Because Lemierre syndrome is a forgotten disease in the era of antibiotics, awareness of the signs and symptoms of this disease is important because of its associated high mortality rate. This case illustrated that the presence of K pneumoniae can lead to Lemierre syndrome. PMID:22817819

350

Hypoplasia of the internal carotid artery: collateral circulation and ultrasonographic findings. A case report  

SommarioIntroduzione L'ipoplasia della carotide interna e una rara anomalia congenita che si verifica per un incompleto sviluppo dell'organo. Soltanto pochi casi sono stati riportati in letteratura. La prevalenza dell'ipoplasia se calcolata insieme alla agenesia e alla aplasia e stimata essere dello 0.01%. Caso clinico Descriviamo il caso di un uomo di 66 anni affetto da ipoacusia all'orecchio sinistro e nessun segno di problemi vascolari. L'ipoplasia della carotide interna fu scoperta accidentalmente durante un ecocolordoppler dei tronchi sovraortici e venne confermata da angio risonanza magnetica e tomografia assiale computerizzata del cranio. Discussione I flussi di compenso permettono a questi pazienti di rimanere asintomatici per molti anni ma possono essere causa nel tempo di complic...

351

Involvement of cell proliferation in the process of follicular atresia in the guinea pig  

Cell morphology and proliferation was investigated in the atretic follicles during estrous cycles in the guinea pig. Ovarian samples on days 1, 4, 8, 12 and 16 of the estrous cycle in the guinea pig were taken in the morning for histologic staining with hematoxylin and eosin (HE), and immunohistochemical staining of the protein proliferating cell nuclear antigen (PCNA). The results indicated that the granulosa cells degenerated and eliminated first in atretic follicles, while the fibroblast-like cells appeared in the innermost layer of theca interna cells. When the fibroblast-like cells migrated to the antrum, they proliferated and formed a new tissue in peripheral to the zona pellucida of the oocyte. Our results also revealed that the orientation of the theca interna cell arrangement chan...

352

Adaptação e validação do Cardiac Patients Learnings Needs Inventory para pacientes brasileiros/ Adaptation and validation of Cardiac Patients' Learning Needs Inventory for Brazilian patients/ Adaptación y validación del Cardiac Patients Learnings Needs Inventory para pacientes brasileños  

Abstract in portuguese OBJETIVOS: Adaptar culturalmente o Cardiac Patients'Leaning Needs Inventory para uso no Brasil e testar sua confiabilidade (consistência interna e estabilidade) em pacientes brasileiros com doença arterial coronariana. MÉTODOS: Participaram do estudo 65 pacientes com infarto agudo do miocárdio, internados em um hospital público do interior do Estado de São Paulo. Para a coleta dos dados, foram utilizados um instrumento para caracterização sociodemográfica e a ver (more) são em português do Cardiac Patients Leaning Needs Inventory. A consistência interna foi estimada com base no alfa de Cronbach. A estabilidade foi medida apoiada no teste-reteste e calculada pelo teste t de Student. O nível de significância adotado foi 0,05. RESULTADOS: Identificou-se consistência interna alta (0,96 na primeira medida e 0,78 na segunda). O domínio que apresentou melhor consistência interna foi Fatores de Risco (?= 0,91). CONCLUSÃO: A versão adaptada manteve as equivalências conceituais, semânticas e idiomáticas da versão original e apresentou confiabilidade e estabilidade adequadas. Abstract in spanish OBJETIVOS: Adaptar culturalmente el Cardiac Patients Leaning Needs Inventory para su uso en Brasil y probar su confiabilidad (consistencia interna y estabilidad) en pacientes brasileños con enfermedad arterial coronaria. MÉTODOS: Participaron del estudio 65 pacientes con infarto agudo del miocardio, internados en un hospital público del interior del Estado de Sao Paulo. Para la recolección de los datos, se utilizó un instrumento para la caracterización sociodemográ (more) fica y la version en portugués do Cardiac Patients Leaning Needs Inventory. La consistencia interna fue estimada con base en el alfa de Cronbach. La estabilidad fue medida con apoyo en el teste-reteste y calculada por el test t de Student. El nivel de significancia adoptado fue de 0,05. RESULTADOS: Se identificó consistencia interna alta (0,96 en la primera medida y 0,78 en la segunda). El dominio que presentó mejor consistencia interna fue Factores de Riesgo (?= 0,91). CONCLUSIÓN: La versión adaptada mantuvo las equivalencias conceptuales, semánticas Abstract in english OBJECTIVES: To culturally adapt the Cardiac Patients' Learning Needs Inventory for use in Brazil and to test its reliability (internal consistency and stability) in Brazilian patients with coronary artery disease. METHODS: The study included 65 patients with acute myocardial infarction, hospitalized in a public hospital in the state of São Paulo. For data collection, we used an instrument for sociodemographics characteristics and the Portuguese version of the Cardiac Pat (more) ients' Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. The stability was established using the test-retest method and calculated using the Student's t-test. The level of significance was 0.05. RESULTS: We identified high internal consistency (0.96 in the first step, and 0.78 in the second). The domain that presented better internal consistency was Risk Factors (? = 0.91). CONCLUSION: The adapted version maintained conceptual equivalence, semantics and language of the original version, and presented adequate reliability and stability.

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Potential interest to combine an intensity modulated conformal radiotherapy (I.M.C.R.T.) with a daily repositioning on intra-prostate implants to reduce sexual toxicity induced by exclusive irradiation of prostate cancers; Interets potentiels de combiner une radiotherapie de conformation avec modulation d'intensite (RCMI) avec un repositionnement journalier sur implants intraprostatiques pour reduire la toxicite sexuelle induite par l'irradiation exclusive des cancers de prostate  

A reduction in margins defining the forecast target volume thanks to a daily repositioning on intra prostate implants would reduce the doses delivered to the penis bulb, corpora cavernosa penis and a. pudendae internae left and right. An optimization of the I.M.C.R.T. on the same anatomical structures amplifies this earnings. The combination of the two could improve the sexual preservation and be proposed for patients with favourable stage prostate cancer. A study of Phase 2 begins soon. (N.C.)

354

Outbreak of Tinea capitis by Trichophyton tonsurans and Microsporum canis in Niterói, RJ, Brazil/ Microepidemia de tinha do couro cabeludo por Trichophyton tonsurans e Microsporum canis em Niterói, RJ, Brasil  

Abstract in portuguese 18 meninas internas do Orfanato Santo Antônio em Niterói apresentaram tinha do couro cabeludo causada por Trichophyton tonsurans (15 casos - 83,3%) e Microsporum canis (3 casos - 26,7%). São discutidos aspectos clínicos e terapêuticos desta microepidemia Abstract in english 18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases - 83.3%) and Microsporum canis (3 cases - 26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidemy

355

Monitoramento da carga interna no basquetebol/ Monitoring internal load in basketball  

Abstract in portuguese O objetivo do presente estudo foi quantificar a magnitude da carga interna referente a uma partida oficial de Basquetebol feminino e avaliar se a carga interna apresenta relação com o número de ações técnicas realizadas no jogo. A amostra foi constituída de 10 atletas (25 ± 4 anos) que participaram do XI Campeonato Brasileiro de Basquetebol Feminino. Foram avaliados o comportamento da frequência cardíaca (FC) e a percepção subjetiva de esforço (PSE) em respos (more) ta à partida. A carga interna foi calculada pelo método de Edwards e pelo método de Foster. Além disso, foram analisados os parâmetros de desempenho técnico na partida. A carga interna estimada pelo método de Edwards e Foster foram 255±62 e 321±127 unidades arbitrárias, respectivamente. Foi detectada correlação moderada entre os dois métodos utilizados (Edwards e Foster; r = 0,64; - p Abstract in english The aim of this study was to quantify the magnitude of the internal load induced by an official women's basketball match and to determine whether the magnitude of the internal load is correlated with the number of basketball maneuvers perfomed. The sample consisted of 10 athletes (25 ± 4 years), who participated in the XI Brazilian Women's Basketball Championship. Heart rate and rating of perceived exertion in response to the match were evaluated. The internal load was c (more) alculated by the methods of Edwards and Foster. In addition, the basketball maneuvers perfomed in the match were analyzed. The internal load estimated by the methods of Edwards and Foster was 255 ± 62 and 321 ± 127 arbitrary units, respectively. A moderate correlation was observed between the two methods used (r = 0.64, p

356

Influencia del proceso de cocción y temperatura de almacenamiento sobre las características fisicoquímicas, microbiológicas y sensoriales del jamón de cerdo/ Influence of the cooking process and storage temperature on physicochemical, microbiological and sensorial characteristics of sliced ham/ Influencia do processo de cocção e temperatura de armazenamento sobre as características físico-químicas, microbiológicas e sensoriais do presunto de suíno  

Abstract in portuguese A presente pesquisa teve como objetivo identificar a influência do processo de cocção e temperatura de armazenamento sobre a vida de prateleira do presunto de suíno, fatiado e embalado. Foram feitos seis tratamentos, com três temperaturas internas de cocção (72, 75, 78 °C) e dois temperatura de armazenamento (4 e 8 °C). foi elaborado um padrão absoluto cozinhado ate atingir uma temperatura interna de 72 °C, sem tempo de retenção, com uma vida útil p (more) revista previamente de 26 dias e um padrão relativo, elaborado nas mesmas condições do padrão absoluto, armazenado a 0 °C. Os resultados mostram que os valores de mesófilos, bactérias ácido lácticas e cor, apresentaram diferencias significativas (p Abstract in spanish El presente trabajo de investigación tiene como objetivo identificar la influencia del proceso de cocción y la temperatura de almacenamiento sobre la vida útil del jamón de cerdo, tajado y empacado. Se realizaron seis tratamientos, con tres temperaturas internas de cocción (72, 75, 78 °C) y dos temperaturas de almacenamiento (4 y 8 °C). Se elaboró un patrón absoluto cocido hasta una temperatura interna de 72 °C, sin tiempo de retención, con una vida ú (more) til establecida previamente de 26 días y un patrón relativo, elaborado bajo las mismas condiciones del patrón absoluto, almacenado a 0 °C. El estudio mostró que los recuentos de mesófilos, bacterias ácido lácticas y color, presentaron diferencia significativa (p Abstract in english Both, cooking and storage, can affect processed meat traits. In this study, six treatments were evaluated: three internal cooking temperatures (72, 75, 78 °C) and two storage temperatures (4 and 8 °C). Mesophilic counts, lactic acid bacteria and color differed (p(more) eatments reached degradation levels above the established by technical regulations. As the storage time increased, hardness and instrumental adhesiveness also tended to increase, with the 75 °C - 5 min - 4 °C treatment resulting in the highest hardness value. For all the treatments, pH diminished and syneresis increased as the storage time increased.

357

Consistencia interna y análisis de factores de la escala APGAR para evaluar el funcionamiento familiar en estudiantes de básica secundaria/ Internal Consistency and Factorial Analysis of Family Functioning APGAR Scale in Middle School Students  

Abstract in spanish Antecedentes: existen varias escalas para valorar el funcionamiento familiar; no obstante, en Colombia desconocemos algunas propiedades psicométricas básicas de estos instrumentos en adolescentes estudiantes. Objetivo: evaluar la consistencia interna y conocer los factores de la escala APGAR para evaluar el funcionamiento familiar (APGAR familiar) en estudiantes de un colegio de Bucaramanga, Colombia . Método: se tomó una muestra no probabilística de 91 estudiantes d (more) e un colegio que diligenció el APGAR familiar. Esta es una escala tipo Likert que consta de cinco ítems. Se determinó la consistencia interna y se establecieron los factores que componen el instrumento. Resultados: la consistencia interna medida con la prueba de alfa de Cronbach fue 0,793. El análisis factorial mostró que la escala estaba compuesta por un único factor que explicaba el 55,6% de la varianza. Conclusión: la escala de APGAR familiar tiene una buena consistencia interna y está compuesta por un solo factor. Abstract in english Background: There are several scales available to evaluate family functioning. However, in Colombia, the basic psychometric properties of these tools among adolescent students are unknown. Objective: To evaluate of the internal consistency and the factors of the family APGAR scale in adolescent students attending a school in Bucaramanga, Colombia. Method: The study was conducted in a non-probabilistic sample of 91 students who filled out the family APGAR scale. This is a (more) five-item Likert type scale. Internal consistency and the number of factors were established. Results: Internal consistency measured with Cronbach’ s alpha test was 0.793. The factorial analysis isolated only one factor that it explained 55.6% of the variance. Conclusion: The family APGAR scale has a good internal consistency and it is composed of a unique factor.

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Avaliação de burnout em uma amostra de policiais civis/ Assessment of burnout levels in a sample of police officers/ Evaluación de burnout en una muestra de policiales civiles  

Abstract in portuguese OBJETIVO: Comparar os níveis de burnout em dois grupos de policiais civis, considerando a área de atuação dos mesmos (atividade laboral interna ou externa). MÉTODO: Utilizando a versão em português do Maslach Burnout Inventory (MBI), um grupo de 35 policiais envolvidos em atividades externas foi comparado com um grupo de 25 policiais envolvidos em atividades internas. Utilizou-se o teste t de Student para comparar o escore total da escala, bem como os fatores const (more) ituintes da mesma. RESULTADOS: Considerando-se um nível de significância de 95%, não houve diferenças entre os dois grupos para o escore total da escala (p Abstract in spanish OBJETIVO: Comparar los niveles de burnout en dos grupos de policiales, considerándose sus áreas de actuación - actividad de trabajo interna o externa. MÉTODO: Utilizándose la versión en portugués del Maslach Burnout Inventary (MBI), un grupo de 35 policiales que realizan actividades externas fue comparado a un grupo de 25 policiales que hacen actividades internas. Se ha utilizado el test t de Student para comparar el escore total de la escala, así como los factore (more) s que la constituyen. RESULTADOS: Considerándose un nivel de significación del 95% no hubo diferencia entre los dos grupos para el escore total de la escala (p Abstract in english OBJECTIVE: To compare burnout levels in two groups of police officers, considering their working activities (administrative vs. operational). METHODS: Using a Brazilian Portuguese version of the Maslach Burnout Inventory (MBI), a group of 35 police officers involved in operational activities was compared to a group of 25 officers involved in administrative activities. The Student t test was used to compare the t