Superior ophthalmic vein and cavernous sinus thrombosis associated with COVID-19: a case report / Trombose de veia oftálmica superior e seio cavernoso associada à COVID-19: relato de caso

ABSTRACT Cavernous sinus and superior ophthalmic vein thrombosis is a rare clinical condition, and little described in the literature. The clinical presentation is nonspecific and highly variable, and symptoms may include red eye, ophthalmoplegia, coma, and death. The main etiology results from infection of the paranasal sinuses. The final diagnosis must be made through imaging tests such as magnetic resonance imaging. We describe a case of cavernous sinus and superior ophthalmic vein thrombosis after COVID-19 infection in a 64-year-old patient with persistent ocular hyperemia and pain on eye movement. Ophthalmological examination showed preserved visual acuity, conjunctival hyperemia, dilation of episcleral vessels and retinal vascular tortuosity in the right eye. Magnetic resonance imaging confirmed the diagnosis. The association with the COVID-19 was raised, excluding other infectious causes. Enoxaparin and Warfarin were started with significant improvement in the ocular clinical presentation and maintenance of initial visual acuity after 12 months of follow-up.

RESUMO A trombose de seio cavernoso e veia oftálmica superior é uma condição clínica rara e pouco descrita na literatura. A apresentação clínica é inespecífica e altamente variável. Os sintomas podem incluir olho vermelho, oftalmoplegia, coma e morte. A etiologia principal resulta da infecção dos seios paranasais. O diagnóstico final deve ser efetuado por meio de exames de imagem, como ressonância magnética. Descrevemos um caso de trombose de seio cavernoso e veia oftálmica superior após COVID-19 em paciente de 64 anos e com quadro de hiperemia ocular persistente e dor à movimentação ocular. Ao exame oftalmológico, observou-se acuidade visual preservada, hiperemia conjuntival, dilatação de vasos episclerais e tortuosidade vascular retiniana em olho direito. A ressonância confirmou o diagnóstico. A associação com a COVID-19 foi levantada, excluindo-se demais causas infecciosas. Prescrevemos enoxaparina e varfarina, com melhora do quadro clínico ocular e manutenção da acuidade visual inicial após 12 meses de acompanhamento.

Caracterización clínica y epidemiológica de pacientes con trombosis venosa profunda y cáncer / Clinical and epidemiological characterization of patients with deep vein thrombosis and cancer

Introducción: La enfermedad tromboembólica venosa es un trastorno en el que se forma un trombo en el interior de las venas, que bloquea el flujo sanguíneo y produce diferentes sintomatologías en función de su localización. Objetivos: Definir las características clínicas y epidemiológicas de los pacientes con trombosis venosa profunda y cáncer. Métodos: Se realizó un estudio descriptivo y retrospectivo de los pacientes que ingresaron en el Servicio de Flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular, con el diagnóstico de trombosis venosa profunda y cáncer, durante el período entre enero y diciembre de 2018. Se estudiaron las siguientes variables: grupos de edad, sexo, diagnóstico al ingreso, factores de riesgo, tipos de cáncer y localización de la trombosis según Eco-Doppler. Resultados: El grupo de edad predominante fue 60-69 años (30,8 por ciento) y prevaleció el sexo femenino (61,5 por ciento). Sobresalió la localización del cáncer en las mamas y la próstata con tres casos cada uno (23,1 por ciento). El factor de riesgo predominante resultó la edad (38,4 por ciento), seguido por la presencia de metástasis (23,1 por ciento). Como sector predominante, según Eco-Doppler, se halló el femoropoplíteo (58,8 por ciento). Conclusiones: La trombosis venosa profunda afecta en gran medida a los pacientes con cáncer. Los más afectados tienen entre 60 y 69 años. Los factores de riesgo predominantes fueron la edad y la presencia de metástasis; y la localización más frecuente, los miembros inferiores, en específico, a nivel del sector femoropoplíteo(AU)

Introduction: Venous thromboembolic disease is a disorder in which a thrombus forms inside the veins, which blocks blood flow and produces different symptoms depending on its location. Objectives: To define the clinical and epidemiological characteristics of patients with deep vein thrombosis and cancer. Methods: A descriptive and retrospective study of patients admitted in the Phlebolymphology Service of the National Institute of Angiology and Vascular Surgery, with the diagnosis of deep vein thrombosis and cancer, was conducted during the period between January and December 2018. The following variables were studied: age groups, sex, diagnosis upon admission, risk factors, types of cancer and location of thrombosis according to Eco-Doppler. Results: The predominant age group was 60-69 years (30.8 percent) and the female sex prevailed (61.5 percent). The location of cancer in the breasts and prostate stood out with three cases each (23.1 percent). The predominant risk factor was age (38.4 percent), followed by the presence of metastases (23.1 percent). As the predominant sector, according to Eco-Doppler, it was found the femoro-popliteal (58.8 percent). Conclusions: Deep vein thrombosis greatly affects cancer patients. The most affected are between 60 and 69 years old. The predominant risk factors were age and the presence of metastases; and the most frequent location, the lower limbs, specifically, at the level of the femoro-popliteal sector(AU)

Splanchnic vein thrombosis as a manifestation of latent myeloproliferative neoplasm associated with sticky platelet syndrome / Trombosis esplácnica como presentación de neoplasia mieloproliferativa latente asociada con síndrome de plaqueta pegajosa

Abstract Vein thrombosis of unusual sites such as the splanchnic region continues to be not only a diagnostic but also a therapeutic challenge for the clinician due to its manifestation and associated pathologies. Latent JAK2 (Janus kinase 2) positive myeloproliferative neoplasm associated with sticky platelet syndrome is unusual. We present a clinical case of a 38-year-old female patient who presented with sudden onset abdominal pain of a possible vascular origin. Splanchnic thrombosis was diagnosed in latent myeloproliferative neoplasm by identifying the JAK2V617F mutation and sticky platelet syndrome via platelet aggregometry. Off-label anticoagulation with rivaroxaban 20 mg/day was administered. During her outpatient follow-up, she did not suffer any new thrombotic episodes.

Resumen La trombosis venosa de sitios inusuales como la esplácnica continúa siendo un reto no solo diagnóstico sino también terapéutico para el clínico debido a su forma de presentación y las patologías asociadas. La neoplasia mieloproliferativa latente JAK2 (cinasa de Janus 2) positiva asociada con síndrome de plaqueta pegajosa es inusual. Se presenta un caso clínico de una paciente de 38 años de edad que debutó con dolor abdominal de inicio súbito que sugirió un posible origen vascular. Se diagnosticó trombosis esplácnica en relación con neoplasia mieloproliferativa latente por la identificación de la mutación de la JAK2V617F y síndrome de plaqueta pegajosa mediante agregometría plaquetaria. Se administró de manera off-label anticoagulación con rivaroxabán 20 mg/día. Durante su seguimiento ambulatorio no ha presentado nuevos episodios trombóticos.

Venous sinus thrombosis during COVID-19 infection in pregnancy: a case report

ABSTRACT BACKGROUND: Although it is known that the new coronavirus disease (COVID-19), which was first seen in Wuhan, China, in December 2019 and has affected the whole world, mainly targets the respiratory tract, cases of this disease with a wide clinical spectrum are emerging as information is shared. CASE REPORT: We present the case of a pregnant woman who was diagnosed with venous sinus thrombosis after she developed headache and hemiparesis. Polymerase chain reaction (PCR) positivity lasted for two weeks after COVID-19 had been diagnosed. CONCLUSIONS: In patients with suspected COVID-19, especially in the presence of causes of hypercoagu- lability and presence of atypical features, venous sinus thrombosis needs to be kept in mind in making the differential diagnosis.

Massive thrombosis and phlegmasia cerulea dolens while taking rivaroxaban: case report and review / Trombose maciça e flegmasia cerúlea dolens durante o uso de rivaroxabana: relato de caso e revisão

Abstract Our study describes a fatal case of phlegmasia cerulea dolens and massive venous thrombosis in a patient taking rivaroxaban regularly to treat cerebral venous sinus thrombosis. Blood tests samples were positive for lupus anticoagulant. The unique evolution of the case, as well as the positivity for lupus anticoagulant, raises the possibility of an acquired hypercoagulation syndrome. We highlight the fact that the test recommended as the first line for lupus anticoagulant diagnosis (dilute Russell viper venom time) is the most affected by rivaroxaban, leading to a high prevalence of false-positive results. We also discuss potential diagnoses for the current case and review the current state-of-the-art of use of the novel oral anticoagulation agents in this unusual situation. So far, there are no recommendations to use such agents as first options in cerebral venous sinus thrombosis or in hypercoagulation syndromes.

Resumo Nosso estudo descreve um caso fatal de flegmasia cerúlea dolens e trombose venosa maciça em um paciente usando regularmente rivaroxabana para o tratamento de trombose de seio venoso cerebral. A investigação laboratorial foi positiva para o anticoagulante lúpico. A evolução única do caso aumenta a possibilidade de uma síndrome de hipercoagulabilidade adquirida, bem como a positividade para o anticoagulante lúpico. Destacamos o fato de que o teste recomendado como primeira linha para o diagnóstico de anticoagulante lúpico (veneno de víbora de Russel diluído) é o mais afetado pela rivaroxabana, levando a uma alta prevalência de resultados falso-positivos. Também discutimos os potenciais diagnósticos para o presente caso e revisamos o estado da arte atual dos novos agentes de anticoagulação oral usados nessa situação incomum. Até o presente momento, não há recomendações para o uso de tais agentes como primeira opção na trombose de seios venosos cerebrais ou nas síndromes de hipercoagulação.

Embolia pulmonar aguda extensa como complicação de COVID-19 oligossintomática: relato de caso / Extensive pulmonary embolism as complication of oligosymptomatic COVID-19: case report

Resumo Apesar de a fisiopatologia da coagulopatia associada à doença do coronavírus 2019 (COVID‐19) não ser bem conhecida, a ocorrência de embolia pulmonar (EP) é frequentemente observada. No entanto, foram descritos na literatura poucos casos de pacientes que tiveram COVID-19 oligossintomática, sem nenhum fator de risco para tromboembolismo venoso (TEV) e que apresentaram EP aguda extensa. Relatamos um caso de paciente com COVID-19 oligossintomática, complicada por trombose venosa profunda e, posteriormente, EP aguda extensa, sugerindo que esses quadros devem ser considerados de forma sistemática mesmo em pacientes com COVID-19 oligossintomática e sem fatores de risco conhecidos para TEV.

Abstract Although the pathophysiology of coagulopathy associated with the 2019 coronavirus disease (COVID-19) is not well known, occurrence of pulmonary embolism (PE) is frequently observed. However, few cases have been described in the literature in which patients who had asymptomatic COVID-19, with no risk factors for venous thromboembolism (VTE), presented extensive acute PE. We report the case of a patient with asymptomatic COVID-19, complicated by deep vein thrombosis and later by extensive acute PE, suggesting that these conditions should be systematically considered, even in asymptomatic COVID-19 patients with no known risk factors for VTE.

Venous thromboembolism in childhood: where is Brazil after 20 years?

Abstract Due to the longer survival of critically ill children, venous thromboembolism is a problem which is becoming increasingly recognized in pediatric practice. In the last decades, several international studies have been published, shedding a light upon the epidemiology of this disease during childhood. These data show peculiarities in the clinical presentation and the significant morbidity and mortality. The new "epidemic of thrombosis" in pediatric hospitals points toward the urgent need for specific treatment and prevention protocols targeting this population. In Brazil, knowledge regarding this disease remains scarce. The lack of epidemiological data impacts both the clinical care and the design of specific public policies in the field. Thus, a national registry of pediatric venous thromboembolism is relevant to the proposal of an appropriate plan of action to create a qualified net of assistance. The improvement in educational initiatives related to the field of Pediatric Hemostasis is also very important. In this review, we have updated the epidemiological, clinical and therapeutic aspects of the disease, as well as the prevention strategies.

Papel da deambulação na prevenção do tromboembolismo venoso em pacientes clínicos: onde estamos? / Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand?

O tromboembolismo venoso (TEV), que compreende o espectro de manifestações de trombose venosa profunda e/ou embolia pulmonar, é uma complicação comum, grave e evitável em pacientes hospitalizados. Embora a perda da mobilidade recente ou continuada represente um dos principais fatores de risco relacionados ao desenvolvimento de TEV, não existem critérios claros e uniformes para a definição do conceito de imobilidade. A diversidade dessas descrições dificulta a interpretação e a comparação dos resultados de estudos clínicos randomizados no que se refere à influência dos diferentes níveis de imobilidade na magnitude do risco de TEV e ao papel da deambulação precoce, de forma isolada, na prevenção de tais eventos. O entendimento dessas limitações é mandatório para a utilização e interpretação adequadas das ferramentas de avaliação de risco de TEV, e para a indicação da melhor estratégia de prevenção de trombose em pacientes clínicos hospitalizados. O objetivo deste estudo é revisar as principais evidências da literatura quanto ao papel da deambulação na prevenção do TEV

Venous thromboembolism (VTE) encompasses the spectrum of manifestations of deep venous thrombosis and/or pulmonary embolism and is a common, serious, and preventable complication in hospitalized patients. Although immobility plays an important role in determining VTE risk in medical patients, no clear and uniform criteria exist to guide clinicians in assessing immobility. The variation in the descriptions that do exist makes it difficult to interpret and compare the results of randomized clinical trials with respect to the influence of different levels of immobility on the magnitude of VTE risk and the role that early ambulation as an isolated factor plays in prevention of such events. Understanding these limitations is a prerequisite for the proper use and interpretation of VTE risk assessment tools and for indicating the best strategy for preventing venous thrombosis in hospitalized medical patients. The objective of this study was to review the main evidence reported in the literature on the role of ambulation in prevention of VTE

Thrombose veineuse cérébrale au chu de Fann, Dakar : à propos de 30 cas

Introduction:La thrombose veineuse cérébrale représente une pathologie vasculaire veineuse autrefois dite rare. Objectif:L'objectif principal de notre étude était d'étudier les différents aspects cliniques, paracliniques, étiologiques et évolutifs des thromboses veineuses cérébrales. Méthodologie:Il s'agissait d'une étude prospective de 30 cas de thromboses veineuses cérébrales admis au service deneurologie de Fann durant la période allant de janvier 2013 à juillet 2016. L'imagerie cérébrale était le critèreindispensable pour confirmer le diagnostic.Résultats:Notre enquête comportait 21 femmes et 9 hommes avec un âge moyen de 34,4 ans. L'installation des signes était subaigüe dans la majorité des cas. Le motif d'admission était polymorphe, dominé par les céphalées(86,7%), les vomissements (60,0%), l'hémiplégie (56,7%). L'imagerie cérébrale révélait majoritairement 14 cas de thrombose du sinus latéral (46,7 %) et 10 cas de sinus longitudinal supérieur (33,3%). Les causes non infectieuses (50%) notamment gynéco-obstétricales dominaient. L'évolution sous héparinothérapie était le plus souvent favorable ; seules des céphalées séquellaires demeuraient. Conclusion La thrombophlébite cérébrale constitue une urgence pronostique et thérapeutique. La variabilité du diagnostic pourrait expliquer le retard de la prise en charge

Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal / Clinical and radiological features of cerebral venous thrombosis in a children cohort

Resumen: Introducción: La trombosis venosa intracraneal (TVI) es una condición infrecuente y poco estudiada en población pediátrica. Objetivos: Describir y comparar características clínicas/radiológicas de ni ños no neonatos con TVI según edad y analizar la asociación de estas variables con deterioro funcio nal al alta o mortalidad aguda. Metodología: Estudio observacional de una cohorte de niños > 30 días con una primera TVI diagnosticada con imágenes/venografía por resonancia magnética encefálica. Medimos funcionalidad con la escala modificada de Rankin definiendo compromiso funcional mar cado con 3 a 5 puntos. Comparamos los promedios de edades entre grupos con y sin las diferentes variables estudiadas con la prueba U-Mann-Whitney (significancia < 0,05). Realizamos análisis de regresión logística para estimar el riesgo de resultado adverso de cada variable expresado en Odds Ra tios (ORs) e intervalos de confianza (IC) al 95%. Resultados: De 21 pacientes, 42.8% eran niñas, me diana de edad 6,27 años (rango intercuartil: 0,74-10). El promedio de edad fue menor en niños con retardo diagnóstico > 48 h (p = 0,041), puntaje < 12 en la escala coma de Glasgow (p = 0,013), crisis epilépticas (p = 0,041), trombosis de seno recto (p = 0,011) y hemorragia intracraneal (p = 0,049); mientras que fue mayor en niños con síndrome de hipertensión endocraneal (p = 0,008). La presen cia de alguna condición crónica sistémica (OR = 11,2; IC = 1,04-120,4), TVI profunda (OR = 14; IC = 1,3-150,8) e infarto encefálico (OR = 15,8; IC = 1,4-174,2) se asoció a compromiso funcional marcado o mortalidad al alta. Conclusiones: Las características clínicas/radiológicas de la TVI varían según la edad. Las patologías crónicas, compromiso del sistema venoso profundo e infarto encefálico predicen mal pronóstico a corto plazo.

Abstract: Introduction: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. Objectives: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. Methodology: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). Results: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. Conclusions: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Thrombose veineuse profonde d'origine tuberculeuse : à propos d'un cas observé au complexe pédiatrique de Bangui (République Centrafricaine)

La tuberculose est un facteur de risque de maladies thromboemboliques. Nous rapportons le cas d'une fille de dix ans qui a présenté un premier épisode de thrombose veineuse profonde découverte devant une douleur du membre pelvien droit avec œdème et impotence fonctionnelle, confirmée par un échodoppler des vaisseaux de la cuisse. Lors de la recherche de la cause, la tuberculose pulmonaire a été diagnostiquée selon les critères de l'Union Internationale Contre la Tuberculose et les Maladies Respiratoires. La patiente a été mise sous des antituberculeux associés à l'héparine de bas poids moléculaire relayée par l'anti vitamine K. L'évolution a été favorable. Il conviendrait en l'absence de diagnostic microbiologique de la tuberculose dans les pays à ressources limitées, d'évoquer une tuberculose devant toute thrombose veineuse profonde associée à une pneumonie

Trombosis de la vena ovárica: serie de 3 casos en el Hospital Universitario de Cabueñes / Thrombosis of the ovarian vein: series of 3 cases at the Hospital Universitario de Cabueñes

Se presentan 3 casos de trombosis de la vena ovárica, uno en relación a cirugía pélvica y dos durante el postparto. La trombosis de la vena ovárica es una complicación rara, de presentación clínica inespecífica, lo que hace plantearse un diagnóstico diferencial con otras patologías más frecuentes (apendicitis, pielonefritis, etc), siendo la TAC el gold standard para su diagnóstico. El tratamiento más adecuado son los anticoagulantes.

We report 3 cases of varian vein thrombosis, one in relation with pelvic surgery and 2 during the postpartum period. The ovarian vein thrombosis is a rare complication, with inespecific symptoms, that is why it is obligatory to propose a differential diagnosis with more frecuent patologies (appendicitis, pyelonephritis, etc.), the CAT is the gold standard in its diagnosis. Anticoagulants are the most suitable treatment.

Sabemos prescrever profilaxia de tromboembolismo venoso nos pacientes internados? / Do we know how to describe venous thromboembolism prophylaxis to hospitalized patients?

Contexto: Embora preconizada, a profilaxia de tromboembolismo venoso (TEV) deixa de ser realizada sistematicamente em pacientes internados. Objetivo: Verificar se os pacientes hospitalizados recebem a prescrição correta da profilaxia de TEV do médico responsável por sua internação, conforme sua categoria de risco. Métodos: Estudo transversal com análise de prontuários de pacientes internados no Hospital Santa Casa de Misericórdia de Curitiba, PR, entre 20 de março e 25 de maio de 2015. Excluíram-se os pacientes em uso de anticoagulantes ou com sangramento ativo. Analisou-se gênero, idade, tipo de cobertura de saúde, especialidade responsável pelo paciente e fatores de risco dos pacientes para classificá-los em alto, moderado ou baixo risco para TEV. Comparou-se o uso ou não da profilaxia entre as prescrições das especialidades clínicas e cirúrgicas, pacientes internados pelo Sistema Único de Saúde (SUS) e por convênios e de acordo com seu risco para TEV. Resultados: Dos 78 pacientes avaliados, oito preencheram os critérios de exclusão. Dos 70 pacientes elegíveis (média etária 56,9 anos; 41 homens; 62 cobertos pelo SUS), 31 eram tratados por clínicos e 39 por cirurgiões. Apenas 46 (65,71%) pacientes receberam profilaxia para TEV. Dentre os pacientes clínicos, 29 (93,5%) receberam profilaxia, contra 17 (43,6%) do grupo cirúrgico (p < 0,001). Pacientes clínicos de moderado e alto risco receberam mais profilaxia que os cirúrgicos (p < 0,001 e p = 0,002). Não houve diferenças quanto à cobertura de saúde (SUS versus convênios médicos). Conclusões: No Hospital Santa Casa de Misericórdia de Curitiba, pacientes cirúrgicos estão menos protegidos de eventos tromboembólicos em relação aos clínicos

Background: Although prophylaxis to prevent venous thromboembolism is recommended, it is rarely systematically performed in hospitalized patients. Objective: To investigate whether hospitalized patients are given the correct VTE prophylaxis prescription by the physician responsible for them while in hospital, analyzed by risk category. Methods: This was a cross-sectional study based on analysis of medical records for patients admitted to the Hospital Santa Casa de Misericórdia, Curitiba, PR, Brazil, from March 20 to May 25, 2015. Patients on anticoagulants or with active bleeding were excluded. The following variables were analyzed: sex, age, type of healthcare coverage, specialty responsible for the patient, and patients' risk factors to classify them as at high, moderate, or low risk of VTE. Use or not of prophylaxis was compared across prescriptions made by clinical and surgical specialties, between patients treated on the Brazilian National Health Service (SUS - Sistema Único de Saúde) and private health insurance, and according to patients' risk of VTE. Results: Eight of the 78 patients assessed met exclusion criteria. The remaining 70 eligible patients had a mean age of 56.9 years, 41 were male, 62 were treated on the SUS, 31 were treated by clinicians, and 39 were treated by surgeons. Just 46 (65.71%) patients were given prophylaxis for VTE. Among the clinical patients, 29 (93.5%) were given prophylaxis, against 17 (43.6%) in the surgical group (p < 0.001). Moderate and high risk clinical patients were more likely to be given prophylaxis than surgical patients (p < 0.001 and p = 0.002). There were no differences with relation to type of healthcare coverage (SUS vs. private healthcare). Conclusions: At the Hospital Santa Casa de Misericórdia in Curitiba, surgical patients are less well protected from thromboembolic events than clinical patients

Cateteres venosos centrais de inserção periférica: alternativa ou primeira escolha em acesso vascular? / Peripherally inserted central venous catheters: alternative or first choice vascular access?

Contexto: Os cateteres venosos centrais de inserção periférica (PICC) são dispositivos intravenosos, introduzidos através de uma veia superficial ou profunda da extremidade superior ou inferior até o terço distal da veia cava superior ou proximal da veia cava inferior. Apresentam maior segurança para infusão de soluções vesicantes/irritantes e hiperosmolares, antibioticoterapia, nutrição parenteral prolongada (NPT) e uso de quimioterápicos; demonstram reduzido risco de infecção em comparação a outros cateteres vasculares e maior relação custo/benefício se comparados ao cateter venoso de inserção central (CVCIC). Objetivos: Apresentar os resultados de implantes de PICCs ecoguiados e posicionados por fluoroscopia realizados no Hospital e Maternidade São Luiz (HMSL) Itaim, Rede D'or, Brasil. Métodos: Estudo prospectivo, não randomizado, realizado entre fevereiro de 2015 e novembro de 2016. Utilizou-se protocolo pré-estabelecido pela instituição em casos de solicitação de acesso vascular. Foram analisadas indicações, doenças prevalentes, tipo do cateter implantado, sucesso técnico, complicações relacionadas ao cateter, e estabelecidos critérios de inclusão e exclusão. Resultados: Solicitados 256 acessos vasculares, sendo implantados 236 PICCs (92,1%) e 20 CVCICs (7,9%). Principais indicações: antibioticoterapia prolongada (52,0%), NPT (19,3%) e acesso venoso difícil (16,0%). Houve sucesso técnico em 246 cateteres implantados (96,1%). A veia basílica direita foi a principal veia puncionada em 192 pacientes (75,0%), seguida da braquial direita em 28 pacientes (10,9%). Conclusões: O implante dos PICCs ecoguiados e posicionados por fluoroscopia demonstrou baixa incidência de complicações, reduzidos índices de infecção e é seguro e eficaz em casos de acessos vasculares difíceis, sendo esses cateteres considerados dispositivos de escolha em acesso vascular central

Background: Peripherally inserted central catheters (PICC) are intravenous devices inserted through a superficial or deep vein of an upper or lower extremity and advanced to the distal third of the superior vena cava or proximal third of the inferior vena cava. They offer the advantages of greater safety for infusion of vesicant/irritant and hyperosmolar solutions and enable administration of antibiotics, prolonged parenteral nutrition (PPN), and chemotherapy agents. They also involve reduced risk of infection compared to other vascular catheters and are more cost-effective than centrally inserted venous catheters (CICVC). Objectives: To present the results of our team's experience with US-guided and fluoroscopy-positioned PICC placement at the Hospital and Maternidade São Luiz (HMSL) Itaim, Rede D'or, Brazil. Methods: This was a prospective, non-randomized study, conducted from February 2015 to November 2016. The institution's preestablished protocol was followed when vascular access was requested. Indications, prevalent diseases, type of catheter implanted, technical success, and complications related to the catheters were analyzed and inclusion and exclusion criteria are described. Results: A total of 256 vascular accesses were requested, and 236 PICCs (92.1%) and 20 CICVCs (7.9%) were implanted. The main indications were as follows: prolonged antibiotic therapy (52%), PPN (19.3%), and difficult venous access (16%). Technical successes was achieved in 246 catheter placements (96.1%). The right basilic vein was the most common vein punctured for access, in 192 patients (75%), followed by the right brachial vein, in 28 patients (10.9%). Conclusions: Ultrasound-guided and fluoroscopy-positioned PICC placement had a low incidence of complications, reduced infection rates, and proved safe and effective in cases of difficult vascular access. PICCs can be considered the devices of choice for central vascular access

Tratamento endovascular de trombose venosa profunda associada à Síndrome de May-Thurner / Endovascular treatment of deep venous thrombosis related to May-Thurner syndrome

A trombose venosa profunda (TVP) é a causa mais frequente e mais evitável de óbitos intra-hospitalares em todo o mundo. Descreve-se, neste relato, paciente feminina, de 43 anos de idade, que desenvolveu TVP em membro inferior esquerdo sem, aparentemente, fatores de risco associados. O diagnóstico de TVP aguda em mulher adulta ou adulta-jovem, sobretudo à esquerda, inclui a possibilidade de se associar com a variação anatômica da Síndrome de May-Thurner, o que torna menos adequado o seu tratamento isolado e conservador com anticoagulantes, uma vez que não aborda a sua causa base. Nesta situação clinico-cirúrgica, é necessária intervenção cirúrgica para retirar a compressão mecânica extrínseca da veia ilíaca comum esquerda pela artéria ilíaca comum direita, como revelada neste relato, por intermédio da angioplastia transluminal percutânea com colocação de stent auto-expansível. Este relato alerta para a importância da busca de diagnóstico etiopatogênico correto para a decisão terapêutica apropriada, o que permite a abordagem mais efetiva e condizente com a melhor recuperação e retorno à higidez. (AU)

Deep venous thrombosis (DVT) is the most frequent and most preventable cause of in-hospital deaths worldwide. We described in this report a 43-year-old female patient who developed DVT in the lower left limb without apparently associated risk factors. The diagnosis of acute DVT in an adult or young adult woman, especially on the left, includes the possibility of being associated with the anatomical variation of the May-Thurner Syndrome, which makes her isolated and conservative treatment with anticoagulants less suitable, because does not address its underlying cause. In this clinical-surgical situation, surgical intervention is required to remove the extrinsic mechanical compression of the left common iliac vein by the common iliac artery, as revealed in this report, through percutaneous transluminal angioplasty with selfexpanding stent placement. This report alerts to the importance of the correct etiopathogenic diagnostic search for the appropriate therapeutic decision, which allows the most effective approach, consistent with the best recovery and return to health. (AU)

Deep-vein thrombosis in the era of high HIV and tuberculosis prevalence: A prospective review of its diagnosis and treatment in a quaternary centre

Background. Venous thromboembolic disease (VTE) is a leading cause of morbidity and mortality worldwide. HIV and tuberculosis (TB) infections have an aetiological association with VTE. Implementation of national HIV and TB programmes in South Africa (SA) has changed the burden of these two conditions, with resultant effects on VTE prevalence. Furthermore, with the increased use of direct oral anticoagulants (DOACs), baseline thrombosis data are needed to evaluate the effect of these new agents.Objectives. To determine real-life baseline VTE characteristics in a pre-DOAC era, and to document the association of HIV and TB infections with VTE.Methods. This was a single-centre prospective cohort study performed in a quaternary care centre at Charlotte Maxeke Johannesburg Academic Hospital, SA. Key inclusion criteria included signed informed consent by adults (≥18 years) with a new episode of thrombosis. Procedures included physical examination, thrombosis risk factor assessment, duplex Doppler examination, thrombophilia screening, inpatient treatment and outpatient follow-up.Results. Ninety-nine participants with confirmed thrombosis met the inclusion criteria. Participants were predominantly black (79.8%) and female (64.6%), with a median age of 46 (interquartile range (IQR) 38 - 57) years. The prevalences of HIV and TB were 53.0% and 21.2%, respectively. The most common risk factors for thrombosis were TB (17.2%) and malignancies (14.1%). Thrombophilia screening had a low diagnostic yield. The median time to target international normalised ratio during hospitalisation was 5.5 (IQR 4.0 - 7.0) days and the median duration of hospitalisation was 9 (IQR 7 - 11) days. The overall mortality rate in the cohort at 3 months post hospitalisation was 12.1%.Conclusions. This prospective study provides real-life data on thrombosis diagnosis and management at a quaternary public healthcare facility, providing a valuable baseline against which the effect of new DOAC anticoagulants can be assessed. Further research is required to clarify the aetiological association between thrombosis and HIV and TB

Les thromboses veineuses des membres : aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs : étude rétrospective sur une période de 09 ans à propos de 148 cas colliges au service de cardiologie de l'hôpital général de grand Yoff de Dakar

INTRODUCTION:Les thromboses veineuses (TV) constituent une pathologie fréquente et potentiellement grave. Les facteurs de risques ou étiologiques sont multiples. Malgré les nombreuses recommandations internationales sur la prophylaxie, les incidences hospitalières de cette pathologie restent toujours élevées. METHODOLOGIE:Nous avions mené une étude rétrospective et descriptive au service de cardiologie de l'hôpital général de Grand Yoff de Dakar entre janvier 2006 et décembre 2014 soit une période de 9 ans. Tous les dossiers de malades hospitalisés pour thrombose veineuse (TV) confirmée à l'imagerie ont été recensés. Les paramètres étudiés étaient les données épidémiologiques, diagnostiques, thérapeutiques et évolutives. Les données ont été analysées avec le logiciel EPI INFO 6.0. Le seuil de significativité était retenu pour une valeur de p<0,05.RESULTATS:Nous avions colligés 148 cas de thromboses veineuses. La prévalence était de 2,78%. Le sex ratio H/F était de 0,51. L'âge moyen était de 51 ans ± 19,22. La symptomatologie était dominée par le tableau de grosse jambe inflammatoire gauche dans 89 cas (60 %). L'écho-Doppler veineuse objectivait une prédominance des TV au niveau du réseau veineux profond dans 123 cas (83,7%). Les facteurs de risque retrouvés étaient dominés outre l'âge supérieur ou égal à 60 ans (38,5%), la prise de pilules oestro-progestatives (13%) et le tabagisme (9,5%). Les patients avaient bénéficié d'un traitement à base d'héparine de bas poids moléculaire associé dès le 1er jour à un antivitamine K (acénocoumarol) (98%). L'évolution était favorable chez 121 patients (82,4%). La mortalité globale était de 2,7% soit 4 patients.CONCLUSION:Les thromboses veineuses deviennent relativement fréquentes dans nos hôpitaux. Dans notre étude, elle était plus fréquente chez les femmes et les sujets jeunes et plus souvent liée aux facteurs médicaux

Síndrome de Hughes-Stovin / Hughes-Stovin Syndrome, a case report

El síndrome de Hughes-Stovin es una entidad infrecuente caracterizada por trombosis venosa profunda y aneurismas de la arteria pulmonar, siendo su etiología y patogenia desconocida. Algunos autores la consideran una variante de la enfermedad de Behcet. Su curso natural es generalmente fatal. Se presenta con tos, disnea, hemoptisis, dolor torácico y fiebre. El tratamiento es con esteroides y agentes citotóxicos hasta la cirugía. Presentamos el caso de un hombre de 41 años que consultó por disnea, hemoptisis y dolor torácico, llegándose al diagnóstico de trombosis venosa profunda de miembro inferior derecho, trombo-embolismo de pulmón y aneurismas de arterias pulmonares. Recibió tratamiento con corticoides en altas dosis y 6 pulsos de ciclofosfamida de 1 gramo durante 6 meses, con regresión completa de los aneurismas y de la sintomatología.

The Hughes-Stovin syndrome is a rare entity characterized by deep vein thrombosis and pulmonary artery aneurysms of unknown etiology and pathogenesis. Some authors considered a variant of Behcet's disease. Its natural course is usually fatal. The symptoms are cough, dyspnea, hemoptysis, chest pain and fever. The treatment goes from steroids and cytotoxic agents to surgery. We present the case of a 41 year old man who shows dyspnea, hemoptysis, and chest pain leading to the diagnosis of deep venous thrombosis of the right leg, lung thromboembolism and pulmonary artery aneurysms. He was treated with high-dose corticosteroids and 6 cyclophosphamide pulses of 1 gram each per 6 months with complete regression of aneurysms and symptomatology.