Atrogenic pseudoaneurysm of axillary artery

Universidade Federal de São Paulo (UNIFESP) Universidade Estadual de MaringáUNIFESP, Universidade Estadual de MaringáSciEL

Ruptured thoracoabdominal aortic aneurysm in the right pleural space

The case of a thoracoabdominal aortic aneurysm rupture in the right pleural space of a 76-year-old patient with chronic renal insufficiency is reported. Possible therapeutic measures are discussed.É relatado um caso de ruptura de aneurisma aórtico toracoabdominal em cavidade pleural direita, em paciente de 76 anos, com insuficiência renal crônica. Serão discutidas as possibilidades terapêuticas, salientando a importância do diagnóstico e tratamento precoces.UNIFESPSBACVCBRUniversidade Estadual de Maringá curso de MedicinaUNIFESP-EPM Departamento de Cirurgia da Universidade Federal de São Paulo (UNIFESP)Hospital Universitário Regional de MaringáUNIFESP, EPM Depto. de Cirurgia da UNIFESPSciEL

Superior vena cava syndrome in childhood

The authors describe a case of benign superior vena cava syndrome post phlebotomy in childhood, including exams for diagnosis and possible treatment.Universidade Estadual de Maringá Curso de MedicinaUNIFESP-EPMHURM Hospital Universitário Regional de MaringáUNIFESP, EPMSciEL

Prevalence of lower limbs superficial venous insufficiency in obese and non-obese patients

BACKGROUND: Chronic venous insufficiency of the lower limbs is the most prevalent venous disease. There is an ongoing debate about its etiology and pathophysiology. Several risk factors have been associated with its development, such as age, sex and diet. Obesity is a public health problem and its prevalence has been increasing. Color Doppler ultrasonography is a useful method to evaluate the presence of reflux and/or obstruction of the venous system. OBJECTIVE: To compare the prevalence of superficial venous insufficiency and associated symptoms in obese and non-obese patients. METHODS: After weighing, height measurement and physical examination, patients with body mass index (BMI) 35 kg/m² and complaints compatible with venous insufficiency were divided into groups I and II, respectively. They underwent color Doppler ultrasonography of the lower limbs, in order to assess the presence or absence of reflux. RESULTS: A total of 311 limbs of 168 patients 25 to 72 years old were examined. For statistical analysis, complaints of varicose veins, pain, swelling, dermatitis, eczema and ulcers, associated or not, were considered. A total of 109 and 104 limbs with varicose veins were obtained in groups I and II, respectively. The prevalence of visible varicose veins (p35 kg/m² e queixas compatíveis com insuficiência venosa foram distribuídos nos grupos I e II, respectivamente. Foram submetidos à realização do ecocolor Doppler dos membros inferiores para avaliação da presença ou não de refluxo. RESULTADOS: Foram examinados 311 membros de 168 pacientes com 25-72 anos. Para análise estatística, foram consideradas queixas de varizes, dor, edema, dermatite, eczema e úlcera, associados ou não. Foi obtido um total de 109 e 104 membros com varizes nos grupos I e II, respectivamente. Queixas de varizes visíveis (p<0,001) e varizes visíveis com dor (p = 0,0118) foram mais prevalentes no grupo I. Queixas de varizes com edema (p<0,001), somente edema (p<0,001) e edema associado a dor (p<0,001) foram mais prevalentes no grupo II. Os dados não mostraram diferença estatisticamente significante na prevalência de varizes entre os grupos I e II. CONCLUSÃO: A prevalência de varizes é semelhante entre os obesos e não obesos; as queixas clínicas diferem entre os grupos e são compatíveis e dependentes da presença de insuficiência venosa.Universidade Estadual de MaringáUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Evaluation of the greater saphenous vein with classification C2 e C3 (CEAP) by air plethysmography and color Doppler ultrasonography

BACKGROUND: With the presence of venous reflux, there is need evaluate the clinical severity by quantifying the hemodynamic effect of venous incompetence and definition of their anatomical distribution. OBJECTIVE: To determine and correlate the degree of reflux of the greater saphenous vein (insufficiency) in a clinical CEAP C2/C3 by air plethysmography and color Doppler ultrasonography. METHODS: We prospectively investigated 87 limbs with reflux of the greater saphenous vein as ascertained by Doppler ultrasound and 32 limbs without signs or symptoms of the venous disease. All patients underwent clinical examinations using air plethysmography and Doppler ultrasound of the lower limbs. The parameters used with the Doppler ultrasound were: the diameter of the saphenous vein (seven levels) and the speed and time of reflux. In the plethysmography, the venous filling index, ejection fraction and residual volume fraction were also considered. RESULTS: Of the 119 limbs, 61 were class C2. In comparing the diameters of the vein of the control group with the study group there were statistically significant differences. There was an exception at the malleolus level. Using the Spearman correlation to analyze the indices for the plethysmography and Doppler ultrasound it showed some difference, but the coefficient of determination (r²) showed that they were weak. CONCLUSIONS: The parameters of the plethysmography did not correlate with the degree of reflux in the greater saphenous vein. There was a very weak correlation between their values, time and speed of reflux. Only the venous filling index correlated with venous reflux. The ejection fraction and residual volume fraction were not important for discrimination of clinical severity.CONTEXTO: Com a presença de refluxo venoso, há necessidade de avaliar a gravidade clínica da doença pela quantificação do efeito hemodinâmico da incompetência venosa e definição de sua distribuição anatômica. OBJETIVO: Determinar a correlação da pletismografia a ar com o grau de refluxo pelo eco-Doppler na insuficiência da veia safena magna no quadro clínico C2 e C3 da CEAP. MÉTODOS: Foram examinados, prospectivamente, 87 membros com refluxo da veia safena magna determinado pelo eco-Doppler e 32 membros sem sinais ou sintomas de doença venosa. Todos foram submetidos ao exame clínico, pletismografia e eco-Doppler de membros inferiores. Do eco-Doppler foram utilizados os parâmetros: diâmetro da veia safena em sete níveis, velocidade e tempo de refluxo. Da pletismografia foram considerados o índice de enchimento venoso, a fração de ejeção e a fração de volume residual. RESULTADOS: Dos 119 membros, 61 pertenciam à classe C2. Na comparação do diâmetro da veia nos grupos controle e estudo houve diferença estatisticamente significante, exceto ao nível do maléolo. Utilizando-se a Correlação de Spearman para análise dos índices da pletismografia e eco-Doppler foram observadas algumas significâncias, porém o coeficiente de explicação (r²) mostrou que foram fracas. CONCLUSÕES: Os parâmetros da pletismografia não se correlacionam com o grau de refluxo na veia safena magna, pois houve uma correlação muito fraca entre seus valores e o tempo e a velocidade do refluxo. Somente o índice de enchimento venoso tem correlação com refluxo venoso. A fração de ejeção e de volume residual não se mostraram importantes na discriminação da gravidade clínica.UEM Curso de MedicinaUEM curso de MedicinaUNIFESP-EPM Departamento de Medicina PreventivaUniversidade de Santo Amaro Departamento de Saúde PúblicaUNIFESP-EPM Departamento de CirurgiaUNIFESP, EPM, Depto. de Medicina PreventivaUNIFESP, EPM Depto. de CirurgiaSciEL

Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux

Objectives. To determine the prevalence and distribution of primary venous re truncal saphenous reflux.Design. Prospective cohort study.Patients and methods. One thousand and seven hundred and twelve patients with suspected venous disease were examined by duplex ultrasonography. Seven hundred and thirty-five patients had primary varicose veins with competent saphenous trunks. Limbs With truncal saphenous reflux, deep vein reflux or obstruction, previous injection sclerotherapy or vein surgery, arterial disease and inflammation of non-venous origin were excluded from further consideration. the CEAP classification system was used for clinical staging. Systematic duplex ultrasound examination was undertaken to assess the distribution a incompetent saphenous tributaries.Results. the prevalence of primary reflux with competent saphenous trunks was 43%. Reflux of GSV calf tributaries was the most common. the majority of the limbs (96%) belonged to chronic venous disease classes C1 and C2 of the CEAP classification.Conclusions. Superficial venous reflux causing varicose veins in the presence competent saphenous trunks is very prevalent in this series in contrast to other studies, presumably reflecting differing patient populations. Our data clearly show that varicose veins may occur in any vein and do not depend on truncal saphenous incompetence. Careful duplex ultrasound evaluation allows the pattern of venous reflux to be established in this group of patient ensuring appropriate management of varices.Maringa State Univ, BR-87050610 Maringa, Parana, BrazilUniversidade Federal de São Paulo, Vasc Div, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biostat, São Paulo, BrazilSanto Amaro Univ, São Paulo, BrazilMaringa Reg Hosp, Maringa, Parana, BrazilUniversidade Federal de São Paulo, Vasc Div, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biostat, São Paulo, BrazilWeb of Scienc

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements