Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura / Endothermal heat-induced thrombosis (EHIT): reports on two case treated with rivaroxaban and literature review

Define-se trombose induzida pelo calor endovenoso como a propagação do trombo a partir de uma veia superficial em direção a uma veia mais profunda. Em geral, é considerada clinicamente insignificante quando não há propagação do trombo para o sistema venoso profundo. Essa condição pode ser tratada com terapia anticoagulante, embora a observação pareça ser suficiente, principalmente para graus menores. Neste estudo, relatamos dois casos de trombose induzida pelo calor endovenoso que teriam indicação de heparina de baixo peso molecular até a resolução do quadro. Porém, optou-se pelo uso da rivaroxabana (15 mg de 12 em 12h), com resolução completa do trombo em 4 semanas (caso 1) e em 7 dias (caso 2). A rivaroxabana pode ser uma alternativa promissora no tratamento da trombose induzida pelo calor endovenoso avançada, pela simplicidade da posologia, sem comprometimento da eficácia ou da segurança. São necessários estudos prospectivos, randomizados e controlados que possibilitem melhor entendimento da condição e o desenvolvimento de recomendações mais definitivas sobre opções de prevenção e tratamento.

Endothermal heat-induced thrombosis (EHIT) is defined as propagation of a thrombus from a superficial vein into a deeper vein and is generally considered clinically insignificant if the thrombus does not propagate to the deep venous system. The condition can be treated with anticoagulation therapy, although monitoring may be sufficient, especially in less severe cases. In this paper we report on two cases of EHIT that met the criteria for indication of low molecular weight heparin until resolution of symptoms. However, the treatment actually chosen was 15 mg of rivaroxaban every 12 h and the outcomes were complete thrombus resolution in 4 weeks in Case 1 and 7 days in Case 2. Rivaroxaban may be a promising alternative for treatment of severe EHIT because the dosage regimen is simplified without compromising efficacy or safety. Prospective, randomized, controlled studies are needed to better understand EHIT and to develop more definitive recommendations on prevention and treatment options for this condition.

Discussion on the strategy of standardized resident training model of vascular ultrasonogra-phy / 中华医学教育探索杂志

Resident doctor is the beginning period of a doctor career. Resident standardization training is the basement period for the clinical ability training and is the important part for medical students after graduation education. Vascular ultrasonography belongs to ultrasound medicine and has its own discipline characteristics. The diagnosis accuracy of vascular ultrasonography largely depends on the accumulation of basic knowledge of multiple clinical sciences , standardization of operation techniques and especially the accurate application of hemodynamic theory. According to the discipline characteristics of vascular ultrasonography, we train the residents from the following five aspects: basic theory knowledge, operation techniques, clinic thinking ability, sciences research ability, communica-tion and team work ability. On the basis of practice, we explore the establishment of standardized training mode for medical professionals of vascular ultrasnography in China, training practical, innova-tive and independent talents, to provide reference for improving the professional level of vascular ultra-sound in our country.

Role of modified Seldinger technique combined with vascular ultrasonography in the placement of peripherally inserted central catheters in patients with breast cancer undergoing postoperative chemotherapy / 中华临床营养杂志

Objective To investigate the role of modified Seldinger technique combined with vascular ultrasonography in the placement of peripherally inserted central catheters (PICC) in patients with breast cancer undergoing postoperative chemotherapy.Methods Totally 120 patients with breast cancer undergoing postoperative chemotherapy were equally divided into the observation group and the control group using the table of random number.In the observation group,PICC were placed using the modified Seldinger technique combined with vascular ultrasonography; in the control group,the PICC were placed using the traditional blind puncture technique.The success rate of first puncture,success rate of first placement,and the incidences of mechanical phlebitis and thrombosis were compared between two groups.Results The success rate of first puncture,success rate of first placement,and the incidences of mechanical phlebitis were 91.67％,100％,and 3.33％,respectively,in the observation group and 76.67％,86.67％,and 45％,respectively,in the control group (P =0.0061,P =0.0434,and P ＜ 0.0001).However,no significant difference was found on the incidence of thrombosis between the two groups (P =0.1187).Conclusion Modified Seldinger technique combined with vascular ultrasonography is efficient and safe for PICC placement for patients with breast cancer undergoing postoperative chemotherapy.