317 resultados para venous thromboembolism


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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%, 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%).

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Em 30 pares de rins estudaram-se as artérias e veias, no hilo de cão da raça Pequinês. Os ramos arteriais são contados à direita e à esquerda, entre 6 e 16, e 5 e 13, e as raízes venosas, 1 e 7, e 1 e 10; os vasos arteriais são exclusivamente periféricos 100% e 93,3%, e as raízes venosas centrais; os vasos arteriais são iguais em número, 13,3%, e as raízes venosas, 46,6%; os quadrantes craniais são mais densamente povoados. O teste t de Student não é significante, ao nível de 5%, quanto ao sexo e aos rins (direito e esquerdo). O coeficiente de correlação linear de Pearson é positivo entre o número de artérias e veias, nas fêmeas, para ambos os rins, mas inexistente nas mesmas condições entre os machos.

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O estudo da veia porta quanto aos vasos confluentes para sua formação e suas tributárias foi efetuado em 10 cutias (Dasyprocta aguti), adultas (3 fêmeas e 7 machos), nas quais o sistema desta veia foi injetado com látex corado, sendo a seguir fixadas em formol a 10% e dissecadas. Verificou-se que o tronco da veia porta origina-se sempre pela confluência de duas raízes, sendo representadas em 90% dos casos, pela veia lienal e pelo tronco mesentérico comum, constituído pelas veias mesentéricas cranial e caudal e, em 10%, pela veia lienal e pela veia mesentérica cranial. O tronco da veia porta recebe como tributárias a veia pancreaticoduodenal cranial (100%), a veia gástrica direita (90%) e, ainda, a veia gastroepiplóica direita (40%).

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CONTEXTO: Embora cerca de 30% a 50% dos pacientes hospitalizados em unidades de terapia intensiva (UTI) recebam algum tipo de sedativo, existe escassez de informações sobre efeitos adversos desta prática, especialmente no Brasil. Estes efeitos podem ser significantes e o uso de sedativos é associado a elevação de infecção e mortalidade, mesmo sendo difícil avaliar o impacto clínico deste procedimento. OBJETIVO: Avaliar o impacto da sedação sobre incidência de complicações e mortalidade em doentes graves durante internação em unidade de terapia intensiva. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade de Terapia Intensiva Cirúrgica da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. PARTICIPANTES: Após excluídos pacientes que permaneceram menos de 24 horas ou sem exames indispensáveis para o cálculo do índice de gravidade (APACHE II), restaram 307 pacientes. Estes foram divididos em dois grupos: Grupo Sedado e Grupo Não Sedado. Constatada heterogeneidade com relação ao APACHE II, foram pareados 97 sedados e 97 não sedados com idênticos índices de gravidade. VARIÁVEIS ESTUDADAS: Impacto da sedação e das técnicas sobre a mortalidade, tempo de internação, além da incidência de escara de decúbito ou pressão, trombose venosa profunda e infecção. RESULTADOS: Não houve diferença na incidência de trombose venosa profunda, entre os grupos Sedado e Não Sedado, enquanto que escara de decúbito foi significativamente maior nos sedados (p = 0,03). Infecção foi detectada em 45,4% dos pacientes com sedação e em 21,6% dos pacientes sem sedação (p = 0,006). A mortalidade para os pacientes que não receberam qualquer tipo de sedativo foi de 20,6% e, para aqueles que foram sedados durante a internação, foi de 52,6% (p < 0,0001). CONCLUSÕES: Conclui-se que a sedação está associada a maior duração da internação, morbidade e mortalidade significativas. Apesar da intensidade das associações encontradas, não é possível estabelecer relação causal entre sedação e mortalidade.

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Aim. The authors assess a modified Greenfield filter (GF) for the long-term patency, filter tilting and histopathologic alterations of the inferior vena cava (IVC).Methods. Adult sheep (n=7) underwent modified GF placement in the IVC. Cavograms were obtained every 3 months and pulmonary angiography at 12 months. Histopathologic and scanning electron microscopy (SEM) analyses were performed on the IVC explanted at 12 months.Results. Cavograms showed that all IVC were patent at the end of the study. Filter tilting occurred in 2/7 animals and extrusion of struts was not observed. Macroscopic examination at explantation showed minimal venous wall thickening. Microscopic examination showed minimal IVC fibrosis and intimal hyperplasia. SEM showed endothelium on the IVC surface at the filter implantation site and a presumed endothelial layer covering partially or totally the struts. The interface filter-IVC was covered by deposits of leucocytes and platelets. No signs of pulmonary embolism were found in all pulmonary angiograms of both groups.Conclusion. The modified filter presented good biocompatibility, stability and absence of thrombogenicity at 12 months. It presented low tendency to tilting and extrusion of struts. The long-term histopathologic alterations in vena caval wall were minimal and the appearance of the studied filters in the IVC was similar to stents placed in the arterial system.

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1. A method for obtaining the end-systolic left ventricular (LV) pressure-diameter and stress-diameter relationships in man was critically analyzed.2. Pressure-diameter and stress-diameter relationships were determined throughout the cardiac cycle by combining standard LV manometry with M-mode echocardiography. Nine adult patients with heart disease and without heart failure were studied during intracardiac catheterization under three different conditions of arterial pressure, i.e., basal (B) condition (mean +/- SD systolic pressure, 102 +/- 10 mmHg) and two stable states of arterial hypertension (H(I), 121 +/- 12 mmHg; H(II), 147 +/- 17 mmHg) induced by venous infusion of phenylephrine after parasympathetic autonomic blockade with 0.04 mg/kg atropine.3. Significant reflex heart rate variation with arterial hypertension was observed (B, 115 +/- 20 bpm; H(I), 103 +/- 14 bpm; H(II), 101 +/- 13 bpm) in spite of the parasympathetic blockade with atropine. The linear end-systolic pressure-diameter and stress-diameter relationships ranged from 53.0 to 160.0 mmHg/cm and from 97.0 to 195.0 g/cm3, respectively.4. The end-systolic LV pressure-diameter and stress-diameter relationship lines presented high and variable slopes. The slopes, which are indicators of myocardial contractility, are susceptible to modifications by small deviations in the measurement of the ventricular diameter or by delay in the pressure curve recording.

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Rock cavies are rodents found in the semi-arid caatinga of Brazil. We studied the structure of the rock cavy placenta by light and transmission electron microscopy. The exchange area of the labyrinth was organized in lobes separated by interlobular areas. The interhaemal barrier was syncytial haemomonochorial. The syncytiotrophoblast had recesses in the basal membrane and some invaginations of the apical membrane, but transtrophoblastic channels could not be found. The interlobular regions comprised syncytiotrophoblast, enclosing maternal venous blood channels, and cytotrophoblast. There was a prominent subplacenta composed of cytotrophoblast and syncytiotrophoblast. Microvilli projected into spaces between the cytotrophoblasts and into lacunae within the syncytiotrophoblast. The yolk sac epithelium exhibited coated pits, endocytotic vesicles and larger vacuoles, consistent with a role in protein uptake from the uterine lumen. Tight junctions between these cells provided a barrier to diffusion by the intercellular route. The reproductive biology of the rock cavy differs from other members of the family, including the guinea pig, but the architecture of the placenta remains remarkably constant. (c) 2004 Elsevier Ltd. All rights reserved.

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Aim. To investigate the effects of physical training associated to dexamethasone administration in carbohydrate metabolism and adrenocorticotrophic hormone (ACTH) release. Materials and methods. Young Wistar rats were divided into four groups: sedentary control (CS), sedentary dexanzethasone (DxS), trained control (CT) and trained dexamethasone (DxT). The rats were submitted to swimming training associate to administration of dexamethasone for ten weekends. Before sacrifice the rats received Subcutaneous insulin to calculate the maximum decreased in blood glucose. Venous blood was sampled obtained at the end experiment period to determine glucose, insulin, free fatty acids (FFA) and ACTH. Gastrocnemius and liver tissue samples were used to determination glycogen, and adipose epididimal tissue was used to measured the weight. Results. Dexamethasone administration provoke insulin resistance and the physical training reverted this aspect. Training promoted increase in muscle and liver glycogen store and a high utilization of FFA. Moreover the dexamethasone provoke decreased of ACTH release in response to acute exercise, showing marked differences in the functioning of the hypothalamy pituitary-adrenal (HPA) axis between groups of rats. Conclusions. a) Low-dose of dexamethasone promote several side effects in metabolism intermediary and chronic exposure to steroid was associated with insulin resistance; b) the regular swimming exercise promoted increased insulin sensitiviry Therefore. exercise can override the dexametasone negative feedback of the HPA axis activation in rats.

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The present study was conducted to evaluate the zootechnical parameters and age related changes in physiological responses of broiler chickens exposed to hot environment from early age onwards. The broiler chickens were exposed to high temperature (30 degreesC) at 15 d of age and maintained to Day 38 or maintained under thermoneutral environment (control).No significant decrease in feed consumption (FC) and body weight (BW) gain was observed in high temperature group after 7 d of exposure, but in the subsequent period, heat exposure lowered BW and FC, compared to control group. However, the weight gain was not significantly changed after 24 d of exposure, and the feed efficiency was not affected throughout the experimental period.The venous pCO(2) pressure was only significantly decreased by temperature after 24 d of heat exposure. The glucose, non-esterified fatty acid (NEFA), triglyceride (TG), glucose, lipid peroxidation (LPO), creatine kinase (CK), and corticosterone were not influenced by the temperature treatment. The significant decrease in uric acid and increase in lactate concentration due to high temperature were observed respectively at 28 and 35 d of age. The concentrations of triiodothyronine (T-3) and thyroxine (T-4) were changed oppositely at 28 d of age, as T-3 was decreased and T-4 was elevated by high temperature. However, the concentration of T-4 in plasma was decreased whereas T-3 was not changed at 38 d of age. The relationships between the blood parameters were changed due to the temperature treatment, suggesting that not only absolute values but also their interrelationships have to be considered when studying the effects of a particular treatment on physiological functioning.These results suggest the growth and physiological responses of broiler chickens, exposed to high temperature from early age onwards, differed at different stages of acclimation. The process of heat acclimation is related to the mode of heat exposure imposed and is not only reflected in the changes in the absolute concentrations, but also in the correlations among the blood indices.

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The gross anatomy of the portal vein (V. portae) and its tributaries was studied through anatomical methods, i.e. dissection, corrosion and diaphanization, in 45 opossums (Didelphis albiventris). In all animals the portal vein was formed by the junction of the cranial mesenteric, caudal mesenteric and lienal veins (V. mesenterica cranialis, V. mesenterica caudalis and V. lienalis, respectively). Many collateral tributaries were observed running into the portal venous trunk.

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The placental vasculature of five hystricomorph rodents was examined by latex injection of the blood vessels, immunohistochemistry and scanning electron microscopy of vessel casts. The pattern of branching of the vessels is described at the level of fine structure. The placenta is divided into lobes separated by interlobular trophoblast. Fetal arteries course through the interlobular areas and give rise to capillaries from which blood drains into veins at the centre of the lobes. Maternal blood reaches the placenta through spiral arteries that pass around the perimeter of the subplacenta. They supply large maternal blood sinuses, lined by trophoblast, which run through the interlobular areas and into the centre of the lobes. Here they supply fine channels that run parallel to the fetal capillaries, so that maternal blood flows from the centre of the lobe to the periphery. This arrangement provides the morphological basis for countercurrent exchange. The maternal channels of the labyrinth drain into spaces formed by the latticework of the interlobular trophoblast and thence through venous lacunae to a basal venous lacunar ring. The subplacenta is supplied by a single fetal artery. The vessels within the subplacenta pursue a tortuous course with dilatations and constrictions as in an endocrine gland. (C) 2003 Elsevier Ltd. All rights reserved.

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Peritoneal dialysis (PD), although classically described and utilized in the treatment of patients with end-stage renal disease, can also be utilized in the acute setting in different clinical situations. Recent studies showed that, in patients with acute renal failure, it is possible to obtain reasonable dialysis doses with adequate metabolic and etectrolytic control and tow incidence of complications by utilizing continuous PD through a cycler at high volume. In patients with congestive heart failure without end-stage renal disease, PD is capable of promoting clinical improvement with slow removal of liquids, becoming an attractive alternative for situations of rapidly or slowly worsening cardiac function. In patients submitted to chronic hemodialysis but who have vascular access difficulties, PD can also be utilized as a bridge, thereby avoiding the use of central venous catheters, which can be associated with infectious complications such as bacterial endocarditis. New studies must be realized showing other indications for PD.

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The coronary sinus was investigated in 34 normal adult dogs, in order to verify its formation, tributaries, length and the valves, as well as the relationship of the venous walls to the epicardium and to the myocardium. The valve of the coronary sinus was observed in only 4 cases (1.7 %). In 30 cases (98.3 %) the ostium of the coronary sinus was lacking a valve. The valve of Vieussens double, was found at the level of the transition between the great cardiac vein and the coronary sinus, as well as others parietal venous valves. A comparison with the human pattern was made, particularly regarding the action of the valve of the coronary sinus and the formation of the sinus.

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The objective of this study was to determine intraocular pressure (IOP) and cardiac changes in normocapnic dogs maintained under controlled ventilation and anesthetized using sevoflurane or desflurane. Sixteen healthy adult mixed-breed dogs, seven males and nine females, weighing 10-15 kg were used. The dogs were randomly assigned to one of two groups composed of eight animals anesthetized with sevoflurane (SEVO) or desflurane (DESF). In both groups, anesthesia was induced with propofol (10 mg/kg), and neuromuscular blockade was achieved with rocuronium (0.6 mg/kg/h IV). No premedication was given. Ventilation was adjusted to maintain end-tidal carbon dioxide partial pressure at 35 mmHg. Anesthesia was maintained with 1.5 minimum alveolar concentration (MAC) of sevoflurane or desflurane. In both groups IOP was measured by applanation tonometry (Tono-Pen) before induction of anesthesia. IOP, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI) and central venous pressure (CVP) were also measured 45 min after the beginning of inhalant anesthesia and then every 20 min for 60 min. A one-way repeated measures ANOVA was used to compare data within the same group and Student's t-test was used to assess differences between groups. P < 0.05 was considered statistically significant. Measurements showed normal IOP values in both groups, even though IOP increased significantly from baseline during the use of desflurane. IOP did not differ between groups. CI in the desflurane group was significantly greater than in the sevoflurane group. Sevoflurane and desflurane have no clinically significant effects on IOP, MAP, HR, CI or VCP in the dog.

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Objective: To determine the effects of storage of arterial and venous blood samples in ice water on blood gas and acid-base measurements.Design: Prospective, in vitro, laboratory study.Setting: School of veterinary medicine.Subjects: Six healthy dogs.Measurements and main results: Baseline measurements of partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), pH, hemoglobin concentration (tHb), oxyhemoglobin saturation, and oxygen content (ContO(2)) were made. Bicarbonate (HCO3) and standard base excess (SBE) were calculated. Arterial and venous blood samples were separated into 1 and 3 mL samples, anaerobically transferred into 3 mL plastic syringes, and stored in ice water for 6 hours. Measurements were repeated at 15, 30 minutes, and 1, 2, 4, and 6 hours after baseline measurements. Arterial (a) PO2 increased significantly from baseline after 30 minutes of storage in the 1 mL samples and after 2 hours in the 3 mL samples. Venous (v) PO2 was significantly increased from baseline after 4 hours in the 1 mL samples and after 6 hours in the 3 mL samples. The pHa significantly decreased after 2 hours of storage in the 1 mL samples and after 4 hours in the 3 mL samples. In both the 1 and 3 mL samples, pHv decreased significantly only after 6 hours. Neither the arterial nor the venous PCO2 values changed significantly in the 1 mL samples and increased only after 6 hours in the 3 mL samples. No significant changes in tHb, ContO(2), SBE, or HCO3 were detected.Conclusions: the PO2 of arterial and venous blood increased significantly when samples were stored in plastic syringes in ice water. These increases are attributable to the diffusion of oxygen from and through the plastic of the syringe into the blood, which occurred at a rate that exceeded metabolic consumption of oxygen by the nucleated cells.