Mobilization of fluids in large volumetric reductions during intensive treatment of leg lymphedema.

AIM: The aim of the current study was to evaluate fluid mobilization during the intensive treatment of leg lymphedema. METHODS: The mobilization of intracellular and extracellular fluids in the lower and upper extremities and trunk was evaluated with the intensive treatment of leg lymphedema in a prospective study. Mobilization of fluids was assessed by bioelectrical impedance using the InBody S10 device in ten patients with leg lymphedema, regardless of the cause. Treatment consisted of six to eight hours per day of Manual Lymphatic Therapy (Godoy & Godoy technique), Mechanical Lymphatic Therapy (RAGodoy device®) and a non-elastic cotton-polyester stocking. RESULTS AND CONCLUSION: A significant reduction in total water was observed for the lymphedematous limb, but with an increase in intracellular water of from 59% to 61%. Additionally, total water increases were observed in the limbs without lymphedema and in the trunk. There was an increase in total intracellular water of the extremities and trunk, but without any change in the extracellular water. In high-volume reductions during lymphedema treatment, fluids are displaced from the lymphedematous limb to extremities without lymphedema and to the trunk.

Assessment of venous thrombus time of progression by gray-scale median analysis.

AIM: To determine if gray-scale median (GSM) analysis could differentiate acute and recent deep venous thrombosis (DVT). METHODS: Patients submitted to vascular ultrasound examination of lower extremities due to suspected DVT were evaluated. Patients with acute or recent femoropopliteal DVT were included, whereas those without DVT, with chronic or isolated calf DVT were excluded. Time of onset of DVT symptoms was recorded. A transverse image of the thrombosed vein and adjacent artery was obtained. Two sonographers determined a subjective impression of thrombus time of progression and classified it as acute or recent. Thrombus GSM was calculated with a software. ROC curve was used to determine GSM cut-off points. Fischer's exact and Student´s t tests were also used. P<0.05 indicated statistical significance. RESULTS: 128 veins of 63 extremities were studied. Thrombus GSM correlated with time of onset of DVT symptoms (P=0.005) and with subjective evaluation of thrombus time of progression (P<0.001). When DVT symptoms had begun up to two weeks before and thrombus was classified as acute, GSM was lower. Area under ROC curve for thrombus GSM was 0.76 (P<0.001). GSM 17.90, 23.03, and 40.02 cut-off points differentiated between acute and recent thrombi with 35.59% sensitivity and 91.30% specificity, 59.32% sensitivity and 84.06% specificity, 91.53% sensitivity and 31.88% specificity, respectively. CONCLUSION: GSM was a reliable tool for objectively differentiating acute and recent DVT in most thrombus images. GSM 17.90 and 40.02 cut-off points showed high specificity and high sensitivity, respectively, for acute and recent DVT differentiation. In 17.90 to 40.02 interval, GSM cut-off point that best distinguished acute from recent DVT was 23.03.

Does the number of pregnancies affect patterns of great saphenous vein reflux in women with varicose veins?

OBJECTIVES: Impact of pregnancies on great saphenous vein (GSV) reflux patterns deserves clarification. Which GSV segment is most affected? Is the saphenofemoral junction (SFJ) involved? METHODS: Colour-flow duplex ultrasonography was performed in 583 women extremities with primary varicose veins (clinical, aetiological, anatomical and pathological elements [CEAP C2]), without oedema, skin changes or ulcer. Women with previous thrombosis or varicose surgery were excluded. GSV reflux sources and drainage points were located at SFJ, thigh, knee and calf. Prevalence of most proximal reflux source was noted as a function of 0, 1, 2, 3 and 4 or more pregnancies. chi(2) statistics was employed. RESULTS: Prevalence of GSV reflux was not dependent on 0, 1, 2, 3 or >or=4 pregnancies: 75%, 69%, 79%, 70% and 76% for right leg (P = 0.79) and 78%, 81%, 82%, 79% and 73% for left leg (P = 0.87), respectively. Prevalence of SFJ reflux and GSV reflux, starting at the thigh, knee or calf, was similar and showed no tendencies to increase with number of pregnancies. CONCLUSIONS: Number of pregnancies did not influence GSV reflux patterns in women with primary varicose veins.

Diameter-reflux relationship in perforating veins of patients with varicose veins.

PURPOSE: Treatment of chronic venous valvular insufficiency requires understanding of the hemodynamics of perforating veins. To preserve normal veins or veins that can function normally once primary sources of valvular insufficiency are removed, a better understanding of the diameter-reflux relationship is desirable. We measured reflux and diameters in 500 perforating veins of patients with varicose veins (C(2)E(P)A(SP)P(R)). METHODS: Color flow duplex ultrasonography scanning was performed with the patient standing. Perforating veins were mapped medially in the thigh and medially, laterally, and posteriorly in the calf. Reflux was defined as reverse flow that lasted longer than 0.5 seconds. Diameters were measured on B-mode transverse projections at the crossing of the fascia. Competent versus incompetent vein diameters were compared by means of Student t test, one-way analysis of variance, and Bonferroni t test. RESULTS: Diameters of competent and incompetent perforators averaged 2.5 +/- 0.9 mm (n = 17) and 4.7 +/- 1.9 mm (n = 17) at the medial thigh (P <.0002), 2.2 +/- 0.8 mm (n = 179) and 3.7 +/- 1.0 mm (n = 210) at the medial calf (P <.0001), 2.2 +/- 0.6 mm (n = 13) and 3.5 +/- 0.8 mm (n = 37) at the posterior calf (P <. 0001), and 2.1 +/- 0.8 mm (n = 9) and 3.3 +/- 0.7 mm (n = 18) at the lateral calf (P <.003), respectively. Perforating vein diameters of 3.5 mm or larger in the calf and thigh were associated with reflux in more than 90% of the cases. CONCLUSION: An enlargement in the diameter of the perforating veins of 1 to 1.5 mm in the calf or 2 mm in the thigh of patients with varicose veins could be the difference between normal flow and reflux. Further studies are needed to confirm if elimination of reflux in patients with primary varicosity will transform incompetent perforators to competent ones.

Monitorizaçäo pós-operatória pelo duplex scan nos transplantes renais / Post-operative noninvasive monitoring of renal allografts

Em um período de 12 mese foram realizadas 79 avaliaçöes näo invasivas com Eco-doppler colorido em 30 pacientes transplantados renais para detecçäo de complicaçöes e comparaçäo com achados de biópsia renal percutânea. Nos casos de rejeiçäo foram comparados estatisticamente os resultados do Eco-Doppler (índices de resistência e pulsatilidade) e da biópsia renal. Dos pacientes avaliados foram detectados dois casos de complicaçöes vasculares e 10 casos de rejeiçäo confirmada pela biópsia renal. quando mparados os casos de rejeiçào aos achados do Eco-Doppler, utilizando-se índice de resitência > 0,57 nas artérias interlobares e segmentares, foi encontrada sensibilidade de 94 por cento e valor preditivo positivo de 100 por cento, e com índice de resitência < 0,68, especificidade de 100 por cento, com valor preditivo negativo de 93 por cento. Os índices de pulsatilidade mostraram-se menos efetivos na avaliaçäo desses casos. A acurácia foi de 97 por cento. Os autores concluem que Eco-Doppler colorido conttui-se um método de vigilância pós-operatório útil na avaliaçäo e identificaçäo precoce de complicaçöes dos pacientes submetidos a transplante renal.