Anomalous sub aortic left brachiocephalic vein: a case report

The left brachiocephalic vein occasionally follows an aberrant course. It is usually associated with congenital cardiac anomaly. We present a case of anomalous left brachiocephalic vein which followed a sub aortic course, with no cardiac abnormality. Multi detector computed tomography is very useful in accurate diagnosis of this condition and prevents any further investigation in cases of isolated abnormalities.

Posterior Sub-Tenon Triamcinolone Injection for Chronic Macular Oedema Associated With Non-Ischemic Branch or Central Retinal Vein Occlusion

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized eye. Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and 12 (if required) months after injections and re-injection considered. Results: In the BRVO group, mean foveal thickness was 548.2±49.50 μm preoperatively, and 452.8±56.2 μm and 280.8±62.5 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test) 3 months after injections. Improvement of visual acuity by at least 0.2 LogMAR was seen in 3(50%) of the 6 eyes. No re-injection was needed. In the CRVO group, mean foveal thickness was 543.7±34.4 μm preoperatively, and 283.0±29.0 μm and 234.8±23.6 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test). Improvement of visual acuity by at least 0.2 LogMAR was seen in 7 eyes (88%). Mean number of re-injection was of 2.1±0.3. Intraocular pressure elevation of 22 mm Hg or higher was found in 2/14 eyes (14%). Cataract progression was noted in 5/14 eyes (36%). Conclusions: PST injection of TA appears to be as safe and effective treatment for chronic macular oedema associated due to both non-ischemic BRVO or CRVO, with a better efficacy in BRVO.

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.

Single Heartstring aortotomy for multiple off-pump venous bypass grafts.

Off-pump coronary bypass grafting may decrease the rate of stroke, due to minimal aortic manipulation. For venous grafts, clampless hemostasis when performing the proximal anastomosis can be achieved using the Heartstring device. We describe a technique using a single device to suture two veins to one aortotomy. This technique requires less space and could be advantageous in very short, small, and calcified aortas. In to our experience, this technique is rapid, simple, easy to reproduce, and cost-saving.

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.

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.

Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

AbstractObjective:Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes.Materials and Methods:Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum.Results:Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients.Conclusion:Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.

Venous thromboembolism and obstruction after pacemaker implantation. - A Prospective Study of 150 Consecutive Cardiac Pacing Device Implantations

Background: Pacemaker implantation (PMI) may predispose to venous thromboembolism (VTE) and obstruction (VO). This prospective study aimed at quantifying changes in venous calibers, and at determining the incidence of symptomatic and asymptomatic VTE/VO after PMI. Further goals included an assessment of the role of transesophageal echocardiography (TEE) in the diagnosis of lead-related central venous thrombi (CVT), and determination of predictors for VTE/VO. Methods: 150 (mean age 67; 61% male) consecutive patients with first PMI were enrolled and followed for 6 months. Contrast venography was performed at baseline and 6 months after PMI to measure venous diameters, and to detect stenosis, total occlusions and thrombi. TEE was conducted in 66 patients. Based on clinical suspicion, work-up for pulmonary embolism (PE) or acute deep vein thrombosis (DVT) were performed as needed. A total of 50 cases underwent longer-term (mean 2.4 years) follow-up venography. All cases with VTE/VO during the initial 6 months, and their matched controls, were selected for a case-control study focused on possible predictive role of laboratory and patient-related factors for the development of VTE/VO. Results: 10 (7 %) patients were found to have baseline venous abnormalities (e.g. 8 obstructions). Mean venous diameters diminished significantly during the first 6 months, but no further reduction occurred in late follow-up. New VO was discovered in 19 patients (14 %; 14 stenosis, 5 total occlusions; all asymptomatic). Small non-obstructive thrombi were found in 20/140 (14 %) 6-month venograms. TEE at 6 months disclosed CVT in 6 (9 %) patients. One (0.7 %) patient had acute symptomatic upper-extremity DVT, and PE was discovered in 5/150 (3.3 %) patients during the first 6 months with no further cases thereafter. At 6 months, the total number of cases with VTE/VO amounted to 47 (31.3 %). Additionally, the later 2-year venograms (n=50) disclosed 4 (8 %) total occlusions and 1 (2 %) stenosis. In the case-control study, no parameter was predictive of venous end-points as a single variable, but there appeared to be significant clustering of traditional VTE risk-factors among the cases. Laboratory parameters showed a definite acute hypercoagulative state induced by PMI, but its degree did not predict subsequent development of VTE/VO. Conclusions: This study shows that VTE/VO is relatively common after PMI with an overall incidence of at least 30 %. Although the majority of the lesions are asymptomatic and clinically benign, cases of PE were also encountered, and totally occluded veins may hamper future upgrading or replacement of pacing system. Venous complications seem difficult to prognosticate as firm predictors were not identified from a wide range of parameters analyzed in this study, although clustering of classic VTE risk factors may be a predisposing factor. Parameters related to implantation procedure or pacing systems and the severity of implantation-induced trauma did not emerge as predictors.

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.