Clinical significance of ostial great saphenous vein reflux.

PURPOSE: To evaluate anatomical and haemodynamic differences in patients with great saphenous vein (GSV) insufficiency by duplex scanning and air plethysmography. MATERIAL AND METHODS: Duplex scanning and air plethysmography examination were undertaken. One hundred and twenty-one limbs in 91 patients were selected prospectively and divided into three groups: group A consisted of 27 controls; group B consisted of 25 limbs with GSV reflux and normal saphenous femoral junction (SFJ) and group C consisted of 69 limbs of patients with GSV and SFJ reflux. The presence of reflux and GSV diameter (SFJ, proximal and medial thirds of the thigh, the knee and medial and distal thirds of the calf) were assessed by duplex scanning. Air plethysmography was used to evaluate haemodynamic parameters: total venous volume (VV), venous filling index (VFI), residual volume fraction (RVF) and ejection fraction (EF). RESULTS: There was a significant difference in GSV diameter among the three groups in almost all segments evaluated (e.g. medial thigh group A = 2.4 SD 0.3 mm; B = 3.2 SD 0.7 mm; C = 5.9 SD 2.2mm p<0.001, Anova). A significant difference in VFI was found among the groups (group A = 1.2 SD 0.5; B = 2.0 SD 1.4; C = 4.0 SD 2.5 p<0.05, Anova). VV was statistical different between groups A and C (p = 0.004) and B and C(p = 0.03). EF and RVF were comparable in all groups. The VFI was normal in 68% in group B comparing with only 14.5% in group C patients, finding a reflux more than 5ml/s (determined by VFI) in 26.1% of the group C patients, comparing with only 4% of group B patients (p<0.05). CONCLUSION: We have shown that in patients with GSV reflux those with incompetence of the ostial valve of the GSV show greater venous reflux and dilatation of the saphenous trunk than those in whom the ostial valve is competent.

[Effect of methylprednisolone on jejunal anastomotic tension]. / Efeito da metilprednisolona sobre a tensão anastomótica jejunal.

Steroid therapy has been related to an healing impairment. The aim of the present paper was to assess the role of steroids on jejunal anastomoses. Forty rats submitted to jejunal anastomoses were divided into four groups (n = 10). Two groups received intraperitoneal methyl-prednisolone (10 mg/kg) and the others (control group) received 0.9% saline fluid. The animals submitted to steroids decreased their weight and reduced the anastomotic tensile strength. Three fistulas occurred in the group with steroids. Histological studies showed more delicate fibrosis in the group submitted to methyl-prednisolone. Our results indicate that rats treated with steroids presented a delayed healing of jejunal anastomoses, decreased anastomotic tensile strength and postoperative complications not observed in the control animals.