Resultados de longo prazo do tratamento fibrinolítico da trombose venosa iliacofemoral por infusão seletiva do ativador de plasminogênio tissular recombinante em baixas doses

PURPOSE: To evaluate the efficacy of catheter-directed low-dose recombinant tissue-type plasminogen activator infusion in the treatment of iliofemoral deep venous thrombosis and prevention of post-thrombotic syndrome. METHOD: Eighteen patients (out of 260 evaluated) with acute iliofemoral deep venous thrombosis and no previous evidence of venous insufficiency were prospectively selected for thrombolytic therapy. Catheter-directed low-dose recombinant tissue-type plasminogen activator (1 mg/h) was infused into the thrombotic segments. RESULTS: Effective fibrinolysis was achieved in 14 of 18 cases, with correlation between effective fibrinolysis and major/complete resolution of acute signs and symptoms (POBJETIVOS: Avaliar a eficácia da infusão seletiva por cateter do ativador de plasminogênio tecidual recombinante em baixas doses no tratamento da trombose venosa iliacofemoral e na prevenção da síndrome pós-trombótica. MÉTODO: Dezoito pacientes (de 260 avaliados) portadores de trombose venosa profunda iliacofemoral sem evidência prévia de insuficiência venosa foram selecionados para terapia fibrinolítica e submetidos a infusão seletiva por cateter do ativador de plasminogênio tecidual recombinante na dose de 1mg/dl nos segmentos venosos trombóticos. RESULTADOS: Quatorze pacientes apresentaram fibrinólise efetiva; observamos correlação entre o grau de melhora clínica observado e a redução percentual do volume trombótico (

Late results of catheter-directed recombinant tissue plasminogen activator fibrinolytic therapy of iliofemoral deep venous thrombosis

PURPOSE: To evaluate the efficacy of catheter-directed low-dose recombinant tissue-type plasminogen activator infusion in the treatment of iliofemoral deep venous thrombosis and prevention of post-thrombotic syndrome. METHOD: Eighteen patients (out of 260 evaluated) with acute iliofemoral deep venous thrombosis and no previous evidence of venous insufficiency were prospectively selected for thrombolytic therapy. Catheter-directed low-dose recombinant tissue-type plasminogen activator (1 mg/h) was infused into the thrombotic segments. RESULTS: Effective fibrinolysis was achieved in 14 of 18 cases, with correlation between effective fibrinolysis and major/complete resolution of acute signs and symptoms (P <.01). There were no episodes of major complications. Four patients presented with early rethrombosis (1 to 8 weeks). Individuals were followed for a period up to 131 weeks (average, 85.2). The incidence of clinical signs and symptoms of venous insufficiency and duplex-scan findings of valvular reflux was significantly lower in the patients in which lytic therapy succeeded and patency was kept, compared with patients experiencing acute therapeutic failure or rethrombosis (P <.01). CONCLUSIONS: Low-dose recombinant tissue-type plasminogen activator fibrinolytic therapy is safe and effective in the treatment of acute iliofemoral venous thrombosis. The late evolution as revealed clinically and by ultrasound was superior in patients for whom lytic therapy was effective

Cobertura do terço distal da perna com retalhos de perfurantes pediculados Covering the distal third of the leg with pedicled perforating vessels patches

Os retalhos de vasos perfurantes representam um avanço no tratamento das perdas cutâneas. No terço distal da perna as opções para a cobertura cutânea são poucas e muitas vezes devemos recorrer a microcirurgia. Neste trabalho realizou-se uma avaliação prospectiva de 20 pacientes submetidos ao tratamento de áreas cruentas no terço distal da perna através de retalhos pediculados em artéria perfurante. A localização das artéria perfurantes foi feita , no pré-operatório , através do exame de eco-doppler. Os retalhos foram planejados de forma a permitir sua rotação junto à área cruenta em até 180 graus. Em 6 casos os vasos perfurantes tinham como origem a artéria fibular, em 10 a artéria tibial posterior e 4 a artéria tibial anterior. O índice de acerto do eco-doppler foi de 88,2%. Em pacientes jovens com lesões traumáticas houve 15,4% de falha do procedimento e 33,3% em pacientes com morbidades associadas. Baseado em nossos resultados concluímos ser o retalho de perfurante uma boa opção de tratamento das perdas cutâneas no segmento distal da perna.<br>Perforating vessels patches represent an advancement in terms of skin failures treatment. On the distal third of the leg, the alternatives for skin covering are scarce, often requiring microsurgery. In this study, we aimed to make a prospective assessment of 20 patients submitted to treatment of bloody areas of leg's distal third by means of pedicled patches in perforating arteries. The location of the perforating arteries was preoperatively found using the ecodoppler test. The patches were planned to allow up to 180-degree rotation in the bloody area. In 6 cases, perforating vessels had the fibular artery as source; in 10, the posterior tibial artery, and; in 4, the anterior tibial artery. The accuracy rate of the ecodoppler was 88.2%. For young patients presenting injuries caused by trauma, procedure failures were found in 15.4%, and for those with associated comorbidities, 33.3%. Based on our studies, we conclude that perforating vessels patches are a good alternative for skin failures on the distal segment of the leg

Gap junctions and hemichannels: communicating cell death in neurodevelopment and disease

Gap junctions are unique membrane channels that play a significant role in intercellular communication in the developing and mature central nervous system (CNS). These channels are composed of connexin proteins that oligomerize into hexamers to form connexons or hemichannels. Many different connexins are expressed in the CNS, with some specificity with regard to the cell types in which distinct connexins are found, as well as the timepoints when they are expressed in the developing and mature CNS. Both the main neuronal Cx36 and glial Cx43 play critical roles in neurodevelopment. These connexins also mediate distinct aspects of the CNS response to pathological conditions. An imbalance in the expression, translation, trafficking and turnover of connexins, as well as mutations of connexins, can impact their function in the context of cell death in neurodevelopment and disease. With the ever-increasing understanding of connexins in the brain, therapeutic strategies could be developed to target these membrane channels in various neurological disorders