OBJETIVO: O presente estudo, realizado em gestantes de alto risco com diagnóstico de insuficiência placentária, tem como objetivo avaliar o fluxo sanguíneo fetal na veia portal esquerda (VPE), veia umbilical (VU) e ducto venoso (DV), e estabelecer quais parâmetros associam-se com a acidemia fetal no nascimento. MÉTODO: Pesquisa prospectiva envolvendo 58 gestantes, classificadas segundo a presença ou ausência do diagnóstico de acidemia no nascimento, de acordo com o pH no sangue da artéria umbilical, constituindo-se de: Grupo I: 26 casos (acidemia pH<7,20) e Grupo II: 32 casos (pH normal pH7,20). Foram excluídos da pesquisa os casos com diagnóstico pós-natal de anomalia do RN e aqueles em que não se obteve a mensuração do pH no nascimento. As seguintes variáveis dopplervelocimétricas da VPE e VU foram comparadas entre os grupos: escore-zeta da TAMxV (time averaged maximum velocity) (cm/s), Q/Kg (fluxo sanguíneo por Kg de peso fetal) (ml/min/kg) e presença de pulsatilidade; e o escore-zeta do índice de pulsatilidade para veias (IPV) do DV. RESULTADOS: O escore-zeta da TAMxV (rho=0,392, P=0,002) e o Q/Kg da VPE (rho=0,274, P=0,037), o escore-zeta do IPV do DV (rho=-0,377, P=0,004) e o Q/Kg da VU (rho=0,261, P=0,048) apresentaram correlação significativa com o pH no nascimento. Realizando-se a análise de regressão logística multivariada, as variáveis independentes que restaram no modelo final para a ocorrência de acidemia no nascimento (pH<7,20) foram: escore-zeta da TAMxV da VPE (OR=0,41; IC95% 0,25 a 0,71; P=0,001) e fluxo reverso na VPE (OR=0,004; IC95% 0,00 a 0,15; P=0,003), ambas demonstrando efeito protetor para acidemia. Com o presente modelo, constatou-se que 74,1% dos casos são corretamente classificados para acidemia no nascimento. CONCLUSÕES: pela análise do Doppler venoso fetal na insuficiência placentária constatou-se que a acidemia no nascimento (pH<7,20) está associada de forma independente com o fluxo reverso na VPE e com o escore-zeta da TAMxV da VPE, ambos demonstrando efeito protetor com redução do risco para a acidemia / OBJECTIVE: This study, conducted in high-risk pregnancies with placental insufficiency, aims to avaliate blood flow in the fetal left portal vein (LPV), umbilical vein (UV) and ductus venosus (DV), and establish which parameters are associated with acidemia at birth. METHOD: A prospective research involving 58 pregnant women, classified according to the presence or absence of the diagnosis of fetal acidosis at birth, according to pH in the blood of the umbilical artery, consisting of: Group I: 26 cases (acidemia, pH <7,20) and Group II: 32 cases (normal pH, pH 7,20). Exclusion criteria were patients who had postnatal diagnosis of abnormality of the newborn and those in which the pH measurement was not obtained at birth. The following Doppler variables of LPV and UV were compared between the groups: TAMxV (Time Averaged Maximum Velocity) (cm/s) zeta-score, Q/kg (blood flow per kg of fetal weight) (ml/min/kg) and presence of pulsatility; and DV pulsality index for veins (PIV) zetascore. RESULTS: LPV TAMxV zeta-score (rho=0.392, P=0.002) and Q/kg (rho=0.274, P=0.037), DV PIV zeta-score (rho=-0.377, P=0.004) and UV Q/kg (rho=0.261, P=0.048) showed significant correlation with pH at birth. Performing the multivariate logistic regression analysis, the independent variables that remained in the final model were: TAMxV of LPV zeta-score (OR=0.41; IC95% 0.25 a 0.71; P=0.001) and reverse flow in LPV (OR=0.004; IC95% 0.00 a 0.15; P=0.003), both showing a protective effect to reduce the risk of acidemia. With this model, it was found that 74,1% of cases are correctly classified to birth acidemia. CONCLUSION: by analysis of fetal venous Doppler in placental insufficiency we found that acidemia at birth (pH <7.20) is independently associated with reverse flow in the LPV and LPV TAMxV z-score, both showing a protective effect with reduced risk for the event

Varicose veins is a condition, which affects numerous people. The condition is mostly not harmful but aesthetically unappreciated. Therefore many people choose to have them surgically removed. After the surgery is completed, the leg is bandaged, this for creating an ideal healing environment, without any complications occurring. It is important that a uniform pressure is distributed evenly along the bandaged leg, because high or low pressure can cause complications which prolongs healing. During the bandaging it is difficult to achieve an even pressure since the pressure varies due to the shape of the leg and who is bandaging the leg. PressCise has developed a compression bandage with a guide along the bandage, so that each bandaging will give the same pressure upon the leg. The bandage is designed after a specific mathematical formula that is derived from the law of Laplace. This means that no matter how thick or thin the leg is at different points, the pressure will distribute itself evenly over the entire bandaged leg. PressCise aims to obtain a CE-mark for the product before a launch. An analysis of demands and a wide test study therefor needs to be carried out. Demands and requirements for the product from different laws and regulations have been observed in order to determine which tests are necessary to execute. At this stage PressCise also needs to evaluate different parameters. To begin with, they need to see how the bandage behaves in different types of treatments, and secondly they need to evaluate the properties in order to give the correct information concerning usage and durability advices. In this report, a survey of the competitors was conducted in order to estimate which standards and tests the competitors are marketing their products with. An examination of the requirements of the product from the PressCise, CE marking and laws will be study, to see which demands and regulations lies upon the bandage. In this report a minor test study will be executed, where the product will go through a washing test, an abrasion test and a hysteresis test. The report will conclude with a requirement specification for the current product and its launching. / Program: Textilingenjörsutbildningen

Introdução – O tratamento da hipertensão portal continua sendo um desafio e muitos desses pacientes necessitam até transplante de fígado, como tratamento definitivo. Nesse contexto a derivação porto-sistêmica intra-hepática transjugular (Transjugular Intrahepatic Portosystemic Shunt – TIPS) surgiu como uma alternativa atraente para esta complicação da doença hepática crônica, sobretudo por não requerer laparotomia e efetivamente reduzir a pressão portal. O conhecimento da distância entre as veias hepáticas e os ramos portais e outros dados anatômicos, no fígado cirrótico, são requisitos importantes no planejamento e execução desse procedimento. Objetivos - Determinar as distâncias e diâmetros das veias hepáticas direita e média para os ramos portais e para a bifurcação da veia porta, no fígado cirrótico humano, com vistas à construção do TIPS. Tipo de estudo – Estudo anatômico descritivo e macroscópico em moldes vasculares de resina obtidos por corrosão de fígados humanos isolados e cirróticos. Material e método – O estudo foi autorizado pelo Comitê de Ética em Pesquisa do HUOC/Procape-UPE e todos os pacientes, ou seus representantes legais, assinaram Termo de Consentimento Livre e Esclarecido. Foram obtidos 21 moldes de resina acrílica dos ramos portais e veias hepáticas de fígados cirróticos, de pacientes transplantados, dos hospitais Jayme da Fonte e Universitário Oswaldo Cruz, do Recife/PE. Após a completa corrosão do parênquima, foram medidas as distâncias e diâmetros das veias hepáticas e ramos da veia porta. Para testar a hipótese de diferença da média estimada em relação a um valor de referência, foi aplicado o teste t-Student para uma amostra. Resultados - A distância média da veia hepática direita para o ramo direito da veia porta e para a sua bifurcação foram, respectivamente, de 33 (±6,4) e 36 (±7,4) mm, ambos significativamente menores (p<0,0001 e p<0,0002) que os resultados encontrados na literatura, em fígados normais. A distância média da veia hepática média para o ramo direito e para o ramo esquerdo da veia porta foi, respectivamente, de 36 (±6,8) e 26 (±8,8) mm . Conclusão – As distâncias entre a veia hepática direita e o ramo direito da veia porta ou a bifurcação da mesma, em fígados cirróticos, foram significativamente menores que as anteriormente relatadas em fígados normais. A veia hepática média é confirmada como uma via alternativa adequada. / Introduction - The treatment of portal hypertension remains a challenge and many of these patients need liver transplantation as definitive treatment. In this context the Transjugular Intrahepatic Portosystemic Shunt (TIPS) has emerged as an attractive alternative to this complication of chronic liver disease, especially for not requiring laparotomy and effectively reducing the portal pressure. Knowing the distance between the hepatic veins and portal branches and other anatomical data in the cirrhotic liver, they are important requirements in the planning and execution of this procedure. Purpose: To determine spatial arrangements and diameters of right and middle hepatic veins relative to portal vein branches in cirrhotic human livers, gaining strategic insight to percutaneous procedures as transjugular intrahepatic portosystemic shunt. (TIPS). Materials and Methods: This study was authorized by an area Research Ethics Committee, and each study subject or legal representative granted signed informed consent. Acrylic corrosion casts of 21 resected cirrhotic livers were generated. Diameters of hepatic veins and portal branches and pertinent intervening distances were measured. To assess differences in estimated average (relative to reference values), Student's t-test for one sample was applied. Results: Mean distances from right hepatic vein to right portal branch and to portal vein bifurcation were 33±6.4 mm and 36±7.4 mm, respectively, both significantly shorter than published reference values in healthy human livers (p<0.0001 and p<0.0002, respectively). Mean distances from middle hepatic vein to right and left branches of portal vein were 36±6.8 mm and 26±8.8 mm, respectively. Conclusion: Distances separating right hepatic vein and portal vein (right branch and bifurcation) are diminished in cirrhotic livers compared to healthy ones. The middle hepatic vein is confirmed as a suitable alternative route.

La compression élastique est la thérapeutique conservatrice la plus efficace pour la prise en charge de l'insuffisance veineuse et pour le traitement de la maladie veineuse chronique et de ses complications. Malheureusement, en pratique, les objectifs thérapeutiques ne sont pas toujours atteints ce qui souligne le manque de connaissance actuel concernant les mécanismes qui permettent aux Bas Médicaux de Compression (BMC) d'apporter les bienfaits thérapeutiques. Pour apporter des éléments de réponse, une étude numérique de l’action des BMC sur les veines a été réalisée. Dans un premier temps, une nouvelle méthodologie a été développée pour prévoir les pressions transmises aux parois des veines superficielles et pour quantifier la diminution de la pression transmurale et du calibre que la compression engendre. Une étude de sensibilité réalisée à partir du modèle Eléments Finis développé a permis de mettre en évidence les principaux paramètres qui conditionnent l’action des BMC. Il a ensuite été utilisé pour simuler différents scénarios d’application en lien avec la compression en post-sclérothérapie pour répondre à des problématiques industrielles. Dans une deuxième phase de l’étude, une méthode de modélisation numérique de la réponse des veines profondes à la contraction musculaire lors du port d’un BMC a été développée. Une étude de sensibilité a permis d’apporter des éléments de réponse quant à l’influence relative des aponévroses musculaires, de la contraction musculaire et du port d’un BMC. Ces travaux ouvrent des perspectives d’études nouvelles sur le développement d’outils pour permettre aux fabricants de BMC d’adapter le niveau de compression à chaque patient. / Compression therapy is a highly effective modality for treating venous disorders of the lower leg and is considered as the “gold standard” for non-operative therapy. However the mechanisms by which Medical Compression Stockings (MCS) benefit the control and treatment of venous insufficiency are neither clearly understood nor have they been conclusively demonstrated. In the present study, the biomechanical response of the lower leg veins to elastic compression is modelled in order to address some of the issues relating to the mechanisms by which it achieves its medical function. First, a new methodology has been developed in order to predict the pressure transmitted to the superficial vein wall during external compression and to quantify the resulting variations of transmural pressure and of the vein cross sectional area. A parametric study was performed to study the influence of the model parameters on the response of the vein. The developed model was also used to simulate different scenarii related to the use of elastic compression after sclerotherapy. In a second step, a numerical approach was developed to model the biomechanical response of deep veins to elastic compression. A parametric study was performed to evaluate the relative influence of the muscular aponeurosis, muscular contraction and external compression applied by MCS. The obtained results bring a new insight on MCS mechanical action and its possible benefits. They also open up new perspectives, especially, regarding the development of new tools to assist MCS manufacturers in adapting the level of compression to the location of the deep vein, the morphology of the patient and the severity of the disease.

A doença venosa crônica (DVC) é uma desordem complexa que compreende sinais e sintomas que variam das telangiectasias às úlceras ativas. A DVC é classificada de acordo com aspectos clínicos, etiológicos, anatômicos e fisiopatológicos (CEAP) em sete classes variando de C0 à C6. A principal causa da DVC é a hipertensão venosa que altera o fluxo venoso e, consequentemente, a força de cisalhamento que induz alterações fenotípicas nas células endoteliais que passam a expressar mediadores pró-inflamatórios e pró-trombóticos, que levam à adesão de leucócitos, ao aumento do estresse oxidativo, da permeabilidade vascular e do dano endotelial e ao remodelamento tecidual e vascular.Em virtude dos inúmeros mecanismos e da diversidade de moléculas envolvidas na patogênese e progressão da DVC, é essencial conhecer a interação entre elas e também saber quais são as moléculas (biomarcadores) que se correlacionam positivamente ou negativamente com a gravidade da doença. Foram avaliados os níveis de Interleucina-6 (IL-6), sL-selectina, sE-selectina, sP-selectina, molécula de adesão intercelular-1solúvel (sICAM-1), molécula de adesão das células vasculares-1 solúvel (sVCAM-1), ativador tecidual do plasminogênio (tPA), atividade do inibidor do ativador do plasminogênio-1 (PAI-1), trombomodulina solúvel (sTM), fator de von Willebrand (vWF), metaloproteinase de matriz (MMP)-2, MMP-3, MMP-9, inibidor tecidual das MMPs -1 (TIMP-1), angiopoietina-1 e -2, sTie-2 e s-Endoglina e fator de crescimento do endotélio vascular (VEGF) no sangue coletado da veia braquial de 173 mulheres com DVC primária divididas em grupos C2, C3, C4 e C4 menopausadas (C4m) e de 18 voluntárias saudáveis (grupo C0a). Foram também analisados os níveis urinários de ent-prostaglandina F2&#945; nesses grupos. Não foram encontradas diferenças estatisticamente significativas com relação às concentrações sanguíneas e urinárias de sE-selectina, sP-selectina, sICAM-1, atividade de PAI-1, MMP-3, razão TIMP-1/MMP-3, angiopoietin-2, razão angiopoietina-1/angiopoietina-2, s-Endoglina e ent-prostaglandina F2&#945; entre os grupos estudados, possivelmente devido à alta variabilidade na concentração desses biomarcadores entre as participantes do mesmo grupo. Entretanto, as concentrações sanguíneas de IL-6 sL-selectina, sVCAM-1, tPA, vWF, sTM, MMP2, MMP-9, TIMP-1, razão TIMP-1/MMP-2, razão TIMP-1/MMP-9, angiopoietina-1 e VEGF foram estatisticamente diferentes entre os grupos. Não foi identificado nenhum biomarcador que se correlacionasse diretamente ou inversamente com a progressão da DVC, provavelmente devido à diversidade de fatores envolvidos e à complexa interação entre eles durante o curso da doença. / Chronic Venous Disease (CVD) is a complex disorder, which encompasses signs and symptoms that vary from telangiectasias to active ulcers. The CVD is classified according Clinical, Etiologic, Anatomical and Pathophysiological (CEAP) aspects into seven classes varying from C0 to C6. The main cause of CVD is venous hypertension, which alters venous flow and consequently, shear stress. Abnormal shear stress induces phenotypic changes in endothelial cells that start to express pro-inflammatory and pro-thrombotic mediators that lead to leukocyte adhesion, oxidative stress, increased vascular permeability and endothelial cell damage and tissue and vascular remodeling. Due to several mechanisms and the diversity of molecules involved in the pathogenesis and progression of CVD, is essential to know the interplay between them and which are the molecules (biomarkers) that correlate positively and negatively with the severity of the disease. We investigated the levels of interleukin-6 (IL-6), sL-selectin, sE-selectin, sP-selectin, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) activity, soluble thrombomodulin (sTM), von Willebrand factor (vWf), matrix metalloproteinase (MMP)-2, MMP-3, MMP-9, tissue inhibitor of metaloproteinases-1 (TIMP-1), angiopoietin-1 and -2, sTie-2, s-Endoglin, vascular endothelial growth factor (VEGF) in the blood taken from the brachial vein of 173 patients with primary CVD divided into C2, C3, C4 and menopaused C4 (C4m) groups and 18 healthy volunteers (C0a group).We also investigated the urinary levels of ent-prostaglandin F2&#945; in these groups. There was no statistically significant difference between groups with respect to blood or urinary levels of sE-selectin, sP-selectin, sICAM-1, PAI-1 activity, MMP-3, TIMP-1/MMP-3 ratio, angiopoietin-2, angiopoietin-1/angiopoietin-2 ratio, s-Endoglin and ent-prostaglandin F2&#945;, likely due to the high variability of these biomarkers concentration among participants within the same group. However, blood levels of IL-6, sL-selectin, sVCAM-1, tPA, vWF, sTM, MMP-2, MMP-9, TIMP-1, TIMP-1/MMP-2 ratio, TIMP-1/MMP-9 ratio, angiopoietin-1 and VEGF were statistically different between groups. It was not identified any biomarker that correlated directly or inversely with the progression of CVD, probably due to the diversity of factors involved and the complex interplay between them in the course of the disease.

Orientador: Marcone Lima Sobreira / Resumo: Introdução: O tratamento mais comum para a insuficiência venosa na gravidez são as meias de compressão, entretanto ainda não há evidência científica sobre sua eficácia. Objetivo: avaliar a eficácia do uso de meias de compressão no refluxo venoso e na prevenção de varizes nos membros inferiores de gestantes, bem como analisar a percepção sobre as vantagens e desvantagens quanto ao seu uso. Método: Foi realizado um ensaio clínico controlado, randomizado, cego. Foram incluídas 60 gestantes saudáveis, com 10 a 13 semanas de gravidez, de idade entre 18 e 40 anos, com pulsos distais normais, distribuídas em 2 grupos: grupo 1 (n=30) usou de meia de compressão por 8 horas diárias e grupo 2 controle (n=30), que não utilizou a meia. Foram analisados o refluxo venoso, diâmetro da Veia Safena Magna-VSM e Veia Safena Parva- VSP, por meio do eco Doppler, bem como sintomatologia e classificação CEAP, no início e no final da gestação, por um pesquisador, no laboratório vascular da Faculdade de Medicina de Botucatu, Unesp. Os testes estatísticos paramétricos e não paramétricos foram realizados ao nível de significância de 5%. Resultado: Os valores do refluxo na VSM proximal, no início e no final da pesquisa, foram respectivamente 0,13s e 0,04s (p<0,0001) na perna direita e 0,17s e 0,03s (p<0,0001) na perna esquerda do grupo 1. No grupo 2, essa mesma variável apresentou 0,02s e 0,34s (p<0,0001) na perna direita e 0,03s e 0,29s (p<0,0001) na perna esquerda. Os diâmetros da VSM proximal na perna... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The most common treatments for venous insufficiency in pregnancy are compression stockings, though there is still no scientific evidence for its efficacy. Objective: To evaluate the efficacy of compression stockings use on venous reflux and prevention of varicose veins in the lower limbs of pregnant women, as well as to analyze the perception of the advantages and disadvantages with its use. Methods: A randomized controlled clinical trial, blinded, was conducted. Sixty healthy pregnant women, 10 to 13 weeks pregnant, aged 18 to 40 years, with normal distal pulses, were divided into 2 groups: group 1 (n = 30) used compression stockings for 8 hours daily and group 2 control (n = 30), who did not use the stockings. The venous reflux, the diameter of the Great Saphenous Vein – GSV and of he Small Saphenous Vein - SSV were analyzed by DOPPLER US, as well as symptomatology and CEAP classification, at the beginning and at the end of pregnancy, by a researcher in the vascular laboratory of the Botucatu Medical School, Unesp. Parametric and non-parametric statistical tests were performed at a significance level of 5%. Results: The values of reflux in the proximal GSV, at the beginning and at the end of the study, were respectively 0.13s and 0.04s (p<0.0001) in the right leg and 0.17s and 0.03s (p<0,0001) in the left leg of group 1. In the group 2, this same variable presented 0.02s and 0.34s (p<0.0001) in the right leg and 0.03s and 0.29s (p <0.0001) in the left leg. Th... (Complete abstract click electronic access below) / Doutor

Ainda existe controvérsia se a terapia hormonal estrogênica confere benefício ou dano cardiovascular. O dano potencial causado por doses padrão de estrogênio incluindo doença cardíaca coronariana e trombose venosa pode ser atenuada por uso de doses mais baixas. O objetivo deste estudo foi avaliar o efeito do tratamento com conjugado estrogênio equino, no leito mesentérico venular (LVM) de SHR ovariectomizadas (OVX), com dose padrão (SD) vs dose mínima (LD). Angiotensina II (AngII) foi perfundida de forma concentração-dependente. Hiperreatividade à Ang II, aumento na geração de EROS, redução da atividade da SOD e catalase e da biodisponibilidade do NO foram encontrados em OVX e SD vs controle e LD. Por outro lado, a resposta reduzida à AngII no LVM de ratas LD foi relacionado ao aumento da atividade da eNOS, redução na geração de EROS e aumento da expressão dos receptores AT2,ER<font face=\"Symbol\">&#945; e GPR30. Sugerimos que a dose mínima tem efeito protetor sobre o LVM das OVX e que a dose SD pode aumentar o risco para a doença venular induzindo alterações na reatividade venular. / Controversy still exists whether estrogen hormonal therapy confers cardiovascular benefit or harm. The potential harm caused by standard dosages of estrogen including coronary heart disease and venous thrombosis may be mitigated by use of lower doses. The aim of this study was evaluated the effect of conjugated equine estrogen (CEE) treatment, in isolated mesenteric venular bed (MVB) of ovariectomized SHR (OVX), at standard therapeutic (SD) vs low dose (LD). Angiotensin II (Ang II) was perfused in a concentration-dependent manner. Hyperreactivity to Ang II,augmented ROS generation, reduced SOD, catalase activity and NO availability were found in OVX and SD vs. control and LD. However, the reduced MVB response to Ang II in LD rats was related to increased endothelial NO synthase activity, reduced ROS generation and increased Ang II AT2, ER<font face=\"Symbol\">&#945; and GPR30 receptor expression. We suggest that CEE at a low dose has a protective effect in OVX mesenteric venular bed. The standard dose might increase the risk for venular disease by inducing alterations in venular reactivity.

Introdução: A termoablação vem substituindo a cirurgia convencional no tratamento cirúrgico do refluxo da veia safena magna em pacientes portadores de varizes dos membros inferiores. Contudo, a termoablação apresenta elevados custos. A Eletrocoagulação endovenosa pode, seletivamente e de forma segura, causar necrose da parede da veia safena magna, mas seus resultados clínicos nunca foram estudados previamente. O objetivo deste estudo é comparar a Eletrocoagulação e a Radiofrequência no tratamento da insuficiência da veia safena magna, considerando eficácia, complicações e impacto na qualidade de vida. Métodos: Trata-se de um ensaio clinico prospectivo, randomizado e duplo-cego. Os pacientes portadores de varizes de membros inferiores e refluxo de veia safena magna ao Eco Doppler colorido foram randomizados em dois grupos de tratamento: Eletrocoagulação ou Radiofrequência. O seguimento dos pacientes ocorreu após uma semana, três meses e seis meses do procedimento. O desfecho primário foi considerado como oclusão da veia safena magna ao Eco Doppler colorido e o desfecho secundário, como a taxa de complicações e a melhora na qualidade de vida, mediante pontuação do Escore de Gravidade Clínica Venosa e Questionário Aberdeen para Veias Varicosas. Resultados: Foram incluídos no estudo 57 pacientes, totalizando 85 veias safenas magnas tratadas, sendo que 43 foram submetidas à Radiofrequência e 42, à Eletrocoagulação. Não houve diferença estatisticamente significante entre os grupos, no pré-operatório, em relação à idade (P = 0,264), gênero (P = 0,612), Escore de Gravidade Clínica Venosa (P = 0,125), Questionário Aberdeen para Veias Varicosas (P = 0,054), diâmetro (P = 0,880) e profundidade (P = 0,763) da veia safena magna tratada. No intraoperatório, imediatamente após a realização da termoablação, todas as veias safenas magnas submetidas à eletrocoagulação apresentaram ausência de fluxo no segmento tratado e incompressibilidade, enquanto 12 membros ainda exibiam fluxo em sua veia safena magna tratada (P < 0,001) e 9 veias apresentavam-se compressíveis (P < 0,001), quando submetidas à Radiofrequência. A principal complicação pós-operatória encontrada foi a parestesia, não havendo significância estatística quanto à sua presença entre os grupos (P = 0,320). O tempo de retorno às atividades rotineiras foi menor no grupo da Eletrocoagulação em relação ao grupo da Radiofrequência (P = 0,026). Não houve diferença entre os grupos em relação à taxa de oclusão da veia safena magna no seguimento de 3 meses (P = 0,157) e 6 meses (P = 0,157), bem como na melhora da pontuação do Questionário Aberdeen para veias varicosas após 3 meses (P = 0,786) e 6 meses (P = 0,401) e na melhora da pontuação do Escore de Gravidade Clínica Venosa após 3 meses (P = 0,324) e 6 meses (P = 0,367). Conclusões: A Eletrocoagulação revelou-se um método eficaz para ablação da veia safena magna, com taxa de oclusão venosa, ocorrência de complicações e impacto na qualidade de vida semelhantes àqueles encontrados na Radiofrequência. / Background: Thermoablation has been replacing conventional surgery in the surgical treatment of great saphenous vein reflux in patients with lower limb varicose veins; however, thermoablation is expensive. Intravenous Electrocoagulation may, selectively and safely, cause necrosis of the great saphenous vein wall, but the clinical results have never been studied. The objective of this study was to compare Electrocoagulation and Radiofrequency in the treatment of great saphenous vein insufficiency, considering efficacy, complications and effect on quality of life. Methods: This is a prospective, double-blind, randomized clinical trial. Patients with lower limb varicose veins and great saphenous vein reflux confirmed by duplex ultrasonography were randomized into two treatment groups: Electrocoagulation or Radiofrequency. Patients were followed-up 1 week, 3 months and 6 months after the procedure. Occlusion of the great saphenous vein confirmed by duplex ultrasonography was considered the primary outcome and the rate of complications and improvement in quality of life, using the Aberdeen Varicose Veins Questionnaire and Venous Clinical Severity Score, were the secondary outcome. Results: Fifty-seven patients were included, with a total of 85 treated great saphenous veins; 43 were treated with Radiofrequency and 42 with Electrocoagulation. There was no statistically significant difference between the groups regarding age (P = 0,264), sex (P = 0,612), Venous Clinical Severity Score (P = 0,125), Aberdeen Varicose Veins Questionnaire score (P = 0,054), diameter (P = 0,880) and depth (P = 0,763) of the treated great saphenous vein. In the intraoperative period, immediately after thermoablation, all great saphenous veins treated with Electrocoagulation presented no flow in the treated segment and incompressibility, while 12 limbs still had flow in treated great saphenous vein (P < 0,001), and 9 veins showed compressibility (P < 0,001) when treated with Radiofrequency. The main postoperative complication was paresthesia; however there was no statistical significance between the groups (P = 0,320) regarding its presence. Time to return to routine activities was lower in the Electrocoagulation group than in the Radiofrequency group (P = 0,026). There was no difference between the groups at the 3-month (P = 0,157) and 6-month (P = 0,157) follow-ups regarding occlusion of the great saphenous vein and in improvement of Aberdeen Varicose Veins Questionnaire score after 3 months (P = 0,786) and 6 months (P = 0,401) and Venous Clinical Severity Score after 3 months (P = 0,324) and 6 months (P = 0,367). Conclusions: Electrocoagulation has been shown to be an effective method for ablation of the great saphenous vein, with venous occlusion rate, occurrence of complications, and effect on the quality of life similar to that with Radiofrequency.

Ainda existe controvérsia se a terapia hormonal estrogênica confere benefício ou dano cardiovascular. O dano potencial causado por doses padrão de estrogênio incluindo doença cardíaca coronariana e trombose venosa pode ser atenuada por uso de doses mais baixas. O objetivo deste estudo foi avaliar o efeito do tratamento com conjugado estrogênio equino, no leito mesentérico venular (LVM) de SHR ovariectomizadas (OVX), com dose padrão (SD) vs dose mínima (LD). Angiotensina II (AngII) foi perfundida de forma concentração-dependente. Hiperreatividade à Ang II, aumento na geração de EROS, redução da atividade da SOD e catalase e da biodisponibilidade do NO foram encontrados em OVX e SD vs controle e LD. Por outro lado, a resposta reduzida à AngII no LVM de ratas LD foi relacionado ao aumento da atividade da eNOS, redução na geração de EROS e aumento da expressão dos receptores AT2,ER<font face=\"Symbol\">&#945; e GPR30. Sugerimos que a dose mínima tem efeito protetor sobre o LVM das OVX e que a dose SD pode aumentar o risco para a doença venular induzindo alterações na reatividade venular. / Controversy still exists whether estrogen hormonal therapy confers cardiovascular benefit or harm. The potential harm caused by standard dosages of estrogen including coronary heart disease and venous thrombosis may be mitigated by use of lower doses. The aim of this study was evaluated the effect of conjugated equine estrogen (CEE) treatment, in isolated mesenteric venular bed (MVB) of ovariectomized SHR (OVX), at standard therapeutic (SD) vs low dose (LD). Angiotensin II (Ang II) was perfused in a concentration-dependent manner. Hyperreactivity to Ang II,augmented ROS generation, reduced SOD, catalase activity and NO availability were found in OVX and SD vs. control and LD. However, the reduced MVB response to Ang II in LD rats was related to increased endothelial NO synthase activity, reduced ROS generation and increased Ang II AT2, ER<font face=\"Symbol\">&#945; and GPR30 receptor expression. We suggest that CEE at a low dose has a protective effect in OVX mesenteric venular bed. The standard dose might increase the risk for venular disease by inducing alterations in venular reactivity.

Iatrogenic vascular injuries (IVIs) and injuries associated with vascular surgery can cause severe morbidity and death. The aims of this thesis were to study those injuries in the Swedish vascular registry (Swedvasc), the Swedish medical injury insurance where insurance claims are registered, the Population and Cause of death registries, and in patient records, in order to explore preventive strategies. Among 87 IVIs during varicose vein surgery 43 were venous, mostly causing bleeding in the groin. Among 44 arterial injuries, only 1/3 were detected intraoperatively. Accidental arterial stripping predominated, with poor outcome. Four patients died, all after venous injuries. IVIs increased over time, and constitute more than half of the vascular injuries registered in the Swedvasc. Lethal outcome was more common (4.9%) among patients suffering IVIs than among non-iatrogenic vascular injuries (2.5%). Risk factors for death were age, diabetes, renal insufficiency and obstructive lung-disease. Fifty-two patients died within 30 days after IVI. The most common lethal IVIs were puncture during endovascular procedures (n=24, 46%), penetrating trauma during open surgery (11) and occlusion after compression (6). Symptoms were peripheral ischemia (n=19), external bleeding (14), and hypovolemic chock without external bleeding (10). Most died within two weeks (n=36, 69%). After &gt;2 weeks the IVI as a cause of death was uncertain. Among 193 insurance claims after vascular surgery during 2002-2007, nerve injuries (91) and wound infections (22) dominated. Most patients suffered permanent injuries, three died. Patients with insurance claims were correctly registered in the Swedvasc in 82%. In 32 cases of popliteal artery injury during knee arthroplasty symptoms were bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Only twelve injuries (38%) were detected intraoperatively. Patency at 30 days was 97%, but only seven (22%) patients had complete recovery. Six of those had intraoperative diagnosis of popliteal injury and immediate vascular repair. In conclusion, registration of IVIs is increasing and outcome is often negatively affected by diagnostic and therapeutic delay. Not all fatalities after IVIs are attributable to the injury itself. The most common causes of insurance claims after vascular surgery were nerve injuries, and 82% were correctly registered in Swedvasc.