Quelle prise en charge pour une suspicion de thrombose veineuse profonde des membres inférieurs [Suspicion of lower limb deep vein thrombosis: update on diagnosis and treatment].

Si l'examen clinique revêt une importance essentielle en lymphologie et exige des praticiens expérimentés, la lymphoscintigraphie et plus récemment la lympho-fluoroscopie au vert d'indocyanine constituent des moyens d'investigation précieux dans la prévention, le diagnostic et le traitement des pathologies vasculaires lymphatiques. L'intérêt de la lymphoscintigraphie réside dans l'analyse qualitative et quantitative de la migration des macromolécules par les vaisseaux lymphatiques et l'évaluation du secteur lymphatique profond. La lympho-fluoroscopie se distingue de la lymphoscintigraphie par l'obtention d'une cartographie détaillée des vaisseaux lymphatiques superficiels et d'images dynamiques en temps réel. Elle apporte à l'angiologue et au physiothérapeute des informations irremplaçables sur leur contractilité et la présence de dérivations compensatoires à privilégier lors du drainage lymphatique manuel. Venous thromboembolism is a frequent disease with an annual incidence of 0.75-2.69/1000 reaching 2-7/1000 > 70 years. Deep vein thrombosis (DVT) and pulmonary embolism are two manifestations of the same underlying disease. Most frequent localization of DVT is at lower limbs. The diagnostic workup begins with an estimation of DVT risk, a judicious use of D-Dimers, and compression venous ultrasound depending on DVT probability. The development of direct oral anticoagulants and recent data on interventional DVT treatment, in selected cases, have widened the therapeutic spectrum of DVT. The present article aims at informing the primary care physician of the optimized workup of patients with lower limb suspicion of DVT.

A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity.

BACKGROUND: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. METHODS: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. RESULTS: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. CONCLUSIONS: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.

Bilateral breast swelling secondary to superior vena cava obstruction and subclavian vein thrombosis

Superior vena cava syndrome is defined by a set of signs and symptoms secondary to superior vena cava obstruction caused principally by malignant diseases. The present report describes the case of an unusual clinical manifestation of this syndrome with bilateral breast swelling, and emphasizes the relevance of knowledge on mammographic signs of systemic diseases.

Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography

Complications from central venous catheterization include infectious conditions, pneumothorax, hemothorax and venous thrombosis. Pericardial effusion with cardiac tamponade hardly occurs, and in infants is generally caused by umbilical catheterization. The authors describe the case of cardiac tamponade occurred in an infant during chest computed tomography with contrast infusion through a central venous catheter inserted into the right internal jugular vein.

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Determinação de bifenilos policlorados em soro de cordão umbilical através de extração por hidrólise ácida seguida de cromatografia a gás acoplada a um microdetector de captura de elétrons

The present work describes the determination of polychlorinated biphenyls in 123 umbilical cord serum samples by liquid-liquid extraction method with acid hydrolyze step and analysis by GC-mECD. The analytical method was evaluated with following figures of merit for all PCBs: linearity (>0.997); precision (<12.55%); recoveries (73-119%); limit of detection (0.1 ng mL-1); limit of quantification (0.25-0.5 ng mL-1). The results showed high contamination in the analyzed samples. PCB more frequent was 138 (66.7%), followed by 180 (55.3%) and 52 (51.3%).

Detection of Varicosavirus and Ophiovirus in lettuce associated with lettuce big-vein symptoms in Brazil

During surveys undertaken from 1998 to 2003 in the major vegetable growing areas of the city of São Paulo green belt, lettuce (Lactuca sativa) and endive (Cichorium endivia) plants were observed, which showed chlorotic thickening of foliar veins, defective growth and, in some cases, failure to form complete heads. Biological and serological [DAS-Enzyme linked immunosorbent assay (Elisa)] tests together with electron microscope observations, revealed the presence of Lettuce big-vein virus and Mirafiori lettuce virus, in these plants both responsible for the lettuce big-vein syndrome.

Frequência de Lettuce big-vein associated virus e Mirafiori lettuce big-vein virus em Plantas de alface no Estado de São Paulo e transmissão através de extrato vegetal e solo

A presença de sintomas de 'big vein' ou engrossamento das nervuras em alface e a associação do Lettuce big-vein associated virus (LBVaV) e Mirafiori lettuce big-vein virus (MLBVV) foram verificadas por RT-PCR utilizando-se oligonucleotídeos específicos para ambos os vírus. Foram coletadas 366 plantas sintomáticas nas regiões de Bauru, Campinas e Mogi das Cruzes no estado de São Paulo nos meses de junho e setembro de 2004 e abril e julho de 2005, e 18 plantas assintomáticas na região de Mogi das Cruzes no mês de dezembro de 2004. Infecção mista do LBVaV e MLBVV foi detectada em 76,2% das plantas sintomáticas, em 11,5% somente o MLBVV foi detectado e em 6,6% somente o LBVaV. Nas plantas assintomáticas coletadas em dezembro na região de Mogi das Cruzes, em áreas de alta incidência da doença durante o inverno, foi detectada a presença de MLBVV em 9 amostras e LBVaV em 7 amostras. Quatro dessas amostras apresentaram infecção mista, indicando que o desenvolvimento de sintomas depende de fatores abióticos, como temperatura. A inoculação via extrato vegetal a partir de plantas de alface com infecção mista pelo MLBVV e LBVaV foi realizada a 16°C/ 10°C (dia/noite) e fotoperíodo de 11 horas, verificando-se que o MLBVV foi transmitido para Nicotiana tabacum TNN, N. rustica, N. occidentalis, Chenopodium quinoa e para as cultivares de alface Trocadero e White Boston, enquanto o LBVaV foi transmitido apenas para a alface White Boston. Entretanto, nenhuma destas plantas apresentou sintomas da doença, com exceção de C. quinoa que apresentou sintomas de lesões locais. Plantio em solo proveniente de áreas com histórico da doença de Mogi das Cruzes permitiu a transmissão do LBVaV para alface cv. White Boston e do MLBVV para alface cv. Trocadero e White Boston, embora apenas a cv. White Boston tenha apresentado sintomas da doença. Em conjunto, estes resultados demonstram a dificuldade de transmissão de ambos os vírus, mesmo em condições de laboratório.

Dinâmica temporal e espacial da begomovirose causada por Tomato yellow vein streak virus em tomateiro na região de Campinas-SP

O objetivo desse trabalho foi caracterizar os padrões temporal e espacial do Tomato yellow vein streak virus (ToYVSV) em tomatais cultivados em condições de campo, no município de Sumaré, e de estufa plástica, na região de Elias Fausto, Estado de São Paulo. No ensaio de campo, plantado com a variedade Alambra, foram avaliadas 4.032 plantas, distribuídas em oito blocos. Em oito estufas plásticas, com plantios escalonados da variedade Ikram, foram avaliadas 6.016 plantas. As avaliações foram feitas com base nos sintomas característicos induzidos por esse vírus. A confirmação da identidade do vírus foi feita por meio da análise da seqüência de nucleotídeos de parte do DNA-A viral (genes AV1 e AC3). No ensaio em condições de campo, a incidência da doença evoluiu lentamente, desde um mínimo de 0,002 (proporção de plantas sintomáticas) até um máximo de 0,0497. Mesmo assim, foi possível constatar um efeito de borda, pois a incidência média de plantas doentes nos blocos situados nos bordos da área foi 2,1 vezes maior do que naqueles internos. O progresso da incidência da doença foi linear, o que indica que novas infecções foram devidas principalmente a um influxo constante de vetores virulíferos de fora para dentro da área avaliada. Nos plantios em estufas plásticas, os níveis finais de doença foram fortemente dependentes da época de plantio, com médias variando de 4,8% a 69,3%. A distribuição espacial de plantas sintomáticas nesses plantios foi fortemente agregada. Essa agregação provavelmente não se deve a infecções secundárias dentro das estufas plásticas, mas sim à concentração de plantas sintomáticas nos bordos das estufas, conseqüência da migração de vetores virulíferos a partir de áreas externas à estufa. Com base nesses resultados, sugere-se a eliminação de fontes de inóculo representadas por plantios mais velhos de tomateiro e por hospedeiras do vírus na vegetação espontânea como uma das principais medidas para o manejo da doença.

Sequence diversity in the coat protein gene of Lettuce big-vein associated virus and Mirafiori lettuce big-vein virus infecting lettuce in Brazil

Lettuce big vein associated virus (LBVaV) and Mirafiori lettuce big vein virus (MLBVV) have been found in mixed infection in Brazil causing the lettuce big vein disease. Analysis of part of the coat protein (CP) gene of Brazilian isolates of LBVaV collected from lettuce, showed at least 93% amino acid sequence identity with other LBVaV isolates. Genetic diversity among MLBVV CP sequences was higher when compared to LBVaV CP sequences, with amino acid sequence identity ranging between 91% to 100%. Brazilian isolates of MLBVV belong to subgroup A, with one RsaI restriction site on the coat protein gene. There is no indication for a possible geografical origin for the Brazilian isolates of LBVaV and MLBVV.

Incidence of deep vein thrombosis and quality of venous thromboembolism prophylaxis

OBJECTIVE: to determine the incidence of deep vein thrombosis and prophylaxis quality in hospitalized patients undergoing vascular and orthopedic surgical procedures. METHODS: we evaluated 296 patients, whose incidence of deep venous thrombosis was studied by vascular ultrasonography. Risk factors for venous thrombosis were stratified according the Caprini model. To assess the quality of prophylaxis we compared the adopted measures with the prophylaxis guidelines of the American College of Chest Physicians. RESULTS: the overall incidence of deep venous thrombosis was 7.5%. As for the risk groups, 10.8% were considered low risk, 14.9%moderate risk, 24.3% high risk and 50.5% very high risk. Prophylaxis of deep venous thrombosis was correct in 57.7%. In groups of high and very high risk, adequate prophylaxis rates were 72.2% and 71.6%, respectively. Excessive use of chemoprophylaxis was seen in 68.7% and 61.4% in the low and moderate-risk groups, respectively. CONCLUSION: although most patients are deemed to be at high and very high risk for deep vein thrombosis, deficiency in the application of prophylaxis persists in medical practice.

Splenic vein graft for the reconstruction of the mesenteric-portal trunk after gastroduodenopancreatectomy

Resection of the confluence of the superior mesenteric and portal veins has been performed most frequently in the treatment of adenocarcinoma of the pancreas, in view of the reported positive results, but it can also be used in cases of benign pancreatic neolpasias when they are strongly adhered to the mesenteric-portal trunk. Nevertheless, there is no study on the best type of venous grafts for reconstruction of the mesenteric-portal trunk when required. The choice of graft depends on the preference of the surgeon or the institution. This technical note critically discusses the use of the splenic vein as an option for mesenteric-portal trunk reconstruction after gastroduodenopancreatectomy.