ResumoObjetivo: Determinar os fatores predisponentes para a amputação de membros inferiores nos doentes internados com diabetes melito e úlceras nos pés.Métodos: Foram acompanhados os pacientes diabéticos com úl-ceras nos pés internados no período de 6 meses e analisadas as amputações nesses doentes em relação à idade, sexo, amputação prévia, número de ulcerações, tempo de diagnóstico do diabete, tempo de ulceração, tempo médio de internação, gravidade das lesões, presença de pulso.Resultado: Verificou-se que 55% (44/80) dos doentes evoluíram para algum tipo de amputação de membros inferiores; a mediana das idades foi de 61 anos, porém a ocorrência de amputação foi significativamente maior na faixa etária dos 60 aos 90 anos (P = 0,03). Não se observou uma variação significativa da mediana do tempo de diagnóstico do diabetes, do tempo de ulceração e do tempo médio de internação em relação ao grupo de pacientes que foram amputados. Entretanto, as lesões mais graves, quando avaliadas pela classificação de Wagner (P < 0,001) e pela ausência de detecção dos dois pulsos distais (P < 0,001) dos membros inferiores, revelaram-se bastante significativas com relação ao desfecho de amputação.Conclusão: Foram considerados fatores predisponentes para a ocorrência de amputação nesses doentes a gravidade das lesões, a ausência de pulsos e as idades acima de 60 anos. Palavras-chave:Amputação, diabetes melito, pé diabético, úlcera. AbstractObjective: To determine the predisposing factors for amputation of lower limbs in diabetic patients with foot ulceration.Methods: The research was carried out in hospitals, and all diabetic patients with foot ulceration were included. Amputation was studied in relation to age, sex, previous amputation, number of ulcers, time of diagnosis of diabetes mellitus, time of ulceration, average number of days in hospital, Wagner's classification, and presence of foot pulse.Result: We verified that 55% (44/80) of the patients progressed to some type of amputation of the lower limbs; mean age was 61 years, but the occurrence of amputation was significantly higher in the age group between 60 and 90 years (P = 0.03). We did not observe a significant variation in the following variables: time of diagnosis of diabetes, time of ulceration, and hospitalization time in relation to the group of patients who were amputated. Nevertheless, the most severe lesions, when evaluated by Wagner's classification (P < 0.001) and by the absence of both distal pulses (P < 0.001) of lower limbs, turned out to be very significant in relation to the amputation outcome.Conclusion: The severity of lesions, the absence of pulse and age over 60 years were considered predisposing factors for amputation in these patients.

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The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. In this review, we provide a simplified imaging approach to the evaluation of the bronchial arteries. We highlight the anatomy and function of the bronchial arteries, typical imaging findings, how to recognize bronchial artery dilatation, and its underlying causes. Contrast-enhanced computer tomography plays a major role in diagnosing bronchial artery enlargement and also improves treatment planning. Bronchial artery embolization has proven to be effective in controlling the potential hazardous hemoptysis.

Objectives. To present a detailed description of the gastrocnemius venous network. Design. Anatomical study in cadavers. Material and methods. Forty lower limbs from 20 adult male cadavers were studied. All gastrocnemius veins were dissected from the gastrocnemius muscle heads proximally toward their drainage site. Results. Eighty heads of 40 gastrocnemius muscles showed 438 gastrocnemius veins. The number of veins per muscle head varied between 2 and 12. There were 221 gastrocnemius trunks distributed as 95 main gastrocnemius trunks, 81 axial and 45 collateral ones. From the 95 main gastrocnemius trunks, 83 (87%) drained into the popliteal vein. Direct observation of the gastrocnemius venous network allowed us to classify the anatomical distribution as four distinct types. Conclusions. The majority of main gastrocnemius venous trunks drain into the popliteal vein. There is wide variability in the number of gastrocnemius veins. We propose a classification of four distinct types of anatomical pattern.

Soleus veins have been implicated as the site for deep venous thrombosis initiation. Detailed anatomic knowledge is required for the early diagnosis using non-invasive ultrasound techniques. In the present work, we describe the anatomy of the veins that emerge from the ventral face of the soleus muscle. Twenty-eight soleus muscles were dissected and 543 veins were found. The number of veins per leg ranged from 7 to 38. The distribution of these veins per quadrant ranged from 0 to 12. The greatest number of veins occurred at the superior lateral quadrant. Most soleus veins mainly drained into the posterior tibial and fibular veins. The mean length of the soleus veins ranged from 0.907 to 2.804 cm. We conclude that there is a wide variability in the distribution of soleus veins through the soleus muscle and their quadrants. The majority of the soleus veins drain into the tibial and fibular veins.

2DTTE and 3DTEE underestimate LVOT area when compared to MDCT with significant impact on AVA estimation. Assessment through MDCT fusion AVA may be of incremental value in patients with discrepant severity criteria for AS.

OBJETIVE:This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.METHODS:Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer’s for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes.RESULTS:Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer’s and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer’s (group II).CONCLUSIONS:Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer’s solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

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