ABSTRACT
BACKGROUND:The anatomy of small saphenous vein (SSV) is very variable because of its complex embryological origin. SSV incompetence often causes reflux that goes to the perforating veins, sometimes not respecting the anatomical course. OBJECTIVE: To analyze differences in reflux direction and reentry in the SSV. METHODS:In this prospective, observational study, 60 lower limbs with SSV incompetence of 43 patients were assessed using a color Doppler ultrasound protocol. RESULTS: Reentry variations were grouped into four types and subtypes. Percentage results were: Type A, perforating veins on the medial side = 25/60 cases (41.66%); subtypes: Cockett, Sherman, paratibial and vertex; Type B, lateral malleolus and perforating veins on the lateral side (fibular 17-26 cm) = 15/60 cases (25%); subtypes: fibular and malleolus; Type C, two branches = 19/60 cases (31.66%); subtypes: gastrocnemius and Cockett, gastrocnemius and malleolus, and/or fibular, Cockett and malleolus, Cockett-vertex and fibular; Type D, reflux in the superficial system = 1/60 cases (1.66%. CONCLUSION:On most of the lower limbs assessed, reflux did not follow the classical anatomic course. Our findings demonstrated a high degree of variation in reflux/reentry, but no SSV anatomical variations. Reflux seems to, either look for the most accessible anatomical connection for reentry or be originated in the distal area and then reach the SSV.
CONTEXTO:A veia safena parva (VSP) apresenta grande variabilidade anatômica graças à sua complexa origem embriológica. Na VSP insuficiente, o refluxo que se dirige para a perfurante de reentrada nem sempre obedece ao mesmo trajeto anatômico. OBJETIVO: Estudar a variabilidade da direção do refluxo da VSP e sua reentrada. MÉTODOS:Neste estudo prospectivo e observacional, 60 membros inferiores com insuficiência de VSP em 43 pacientes foram avaliados por protocolo de eco-color Doppler. RESULTADOS: As variações de reentrada foram agrupadas em quatro tipos, com seus respectivos subtipos. A porcentagem dos achados foi: Tipo A, perfurantes de face medial = 25/60 casos (41,66%), subtipos Cockett, Sherman, paratibiais e do vértice; Tipo B, maléolo externo e perfurantes da face lateral (externa) (fibulares 17-26 cm) = 15/60 casos (25%), subtipos fibulares e maléolo; Tipo C, em dois ramos = 19/60 casos (31,66%), subtipos gastrocnêmias e Cockett, gastrocnêmias e maléolo e/ou fibulares, Cockett e maléolo, Cockett-vértice e fibular; Tipo D, terminação no sistema superficial = 1/60 casos (1,66%). CONCLUSÃO: Na maior parte desta casuística, o refluxo não obedeceu ao percurso anatômico clássico. Demonstrou-se a variabilidade do trajeto do refluxo ou sua reentrada, e não a variabilidade anatômica da veia safena parva. Pode-se interpretar que o refluxo buscaria, como reentrada, a conexão anatômica mais acessível, ou então se originaria no setor distal, alcançando depois a veia safena parva.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Venous Insufficiency/diagnosis , Venous Insufficiency , Saphenous Vein/anatomy & histology , Lower Extremity , Prospective Studies , Time FactorsABSTRACT
An estimated 1% to 10% of all colorectal tumors (CRC) are related to high-penetrance genes. Families with Lynch Syndrome, caused by mutations in MMR repair genes, present a high frequency, not only of CRC, but also extracolonic tumors. Objective:To verify the frequency of CRC and extracolonic cancers in families that meet Amsterdam I and II criteria. Methods: Families had been included that meet Amsterdam I and II criteria, in the Registry of Colorectal Cancer of A. C. Camargo Hospital from 1992 to 2007. Family history was taken and stored in the Cyrillic® 2.1 software. Data collection forms were filled. Results:1578 individuals were identified, and 337 of them presented tumors. CRC was the most frequent, with 221 individuals,with a mean age of 46 years at diagnosis. The most frequent extracolonic tumors were breast (17 cases), endometrium (15), stomach (14), urinary (12), leukemia (9), and prostate (6). Discussion: As expected, the age at diagnosis of colorectalcancer was younger than the general population; breast tumor was the most frequent; molecular studies must differentiate patients with Lynch Syndrome (LS) from those with familial colorectal cancer.
Subject(s)
Humans , Colorectal Neoplasms , Colorectal Neoplasms, Hereditary NonpolyposisABSTRACT
A estenose idiopática de traquéia é incomum. Relatam-se quatro casos com quadro clínico semelhante: história de tratamento de broncoespasmo sem resultado e diagnóstico por broncoscopia. O tratamento em três pacientes foi dilatação e corticóide sistêmico; em um realizou-se traqueoplastia. No quarto, a estenose era mais extensa (2 cm) com redução da luz de 70 por cento, sem possibilidade de dilatação. Realizou-se ressecção laringo-traqueal. Todos apresentaram boa evolução. A estenose idiopática de traquéia deve ser cogitada em casos de "bronquite" mal resolvida com tratamentos convencionais. A broncoscopia e a dilatação têm apresentado bons resultados. Eventualmente, torna-se necessária ressecção laringo-traqueal.
Idiopathic tracheal stenosis is uncommon. Herein, we report four cases, all presenting a similar clinical profile: diagnosed through bronchoscopy and having a history of being treated unsuccessfully for bronchospasm. Three of the patients were treated with dilatation and an oral corticosteroid. One of those three underwent tracheoplasty. In the remaining patient, the stenosis was more extensive (2 cm, with a 70 percent reduction in the size of the lumen), and dilatation was not an option. Therefore, that patient underwent laryngotracheal resection. In all four patients, the evolution was favorable. Idiopathic tracheal stenosis should be contemplated in cases of æbronchitisÆ that are not resolved using conventional treatments. Bronchoscopy and dilatation have provided satisfactory results. Occasionally, laryngotracheal reconstruction is necessary.