During ischemia, the cell structures are progressively damaged, but restoration of the blood flow, paradoxically, intensifies the lesions caused by the ischemia. The mechanisms of ischemia injury and reperfusion (I/R) have not been completely defined and many studies have been realized in an attempt to find an ideal therapy for mesenteric I/R. The occlusion and reperfusion of the splanchnic arteries provokes local and systemic alterations principally derived from the release of cytotoxic substances and the interaction between neutrophils and endothelial cells. Substances involved in the process are discussed in the present review, like oxygen-derived free radicals, nitric oxide, transcription factors, complement system, serotonin and pancreatic proteases. The mechanisms of apoptosis, alterations in other organs, therapeutic and evaluation methods are also discussed.

The prevalence of varicose veins (VV) and of chronic venous insufficiency (CVI) was studied among 1755 adults over 15 years of age (443 men and 1312 women). These people attended the University Health Center in Botucatu, a country town in the State of Sao Paulo, Brazil, for routine examination or for any disease complaints. The prevalence of all grades of VV not including telangiectasis and reticular varices grade I was 47.6% (37.9% in men and 50.9% in non-pregnant women). The prevalence of VV recorded as moderate or severe was 21.2%. The more severe form of CVI with active or healed ulcer was present in 3.6% of the subjects (2.3% of men and 4% of women). For only 5.5% of the patients was VV or CVI the reason for medical consultation. The prevalence of VV increased with age and number of pregnancies and was greater among white than non-white people. Working posture or posture adopted for defaecation did not influence the prevalence of VV. Our data show the prevalence of VV and CVI to be higher or as high as the prevalence found in developed western countries. We therefore propose that studies of these conditions should be included in epidemiological surveys of other developing areas or countries, so that if data similar to ours are verified prophylaxis and early treatment could be included in health planning for these areas with the aim of reducing future morbidity and the related social onus.

Summary. Objectives: Although effective strategies for the prevention of venous thromboembolism (VTE) are widely available, a significant number of patients still develop VTE because appropriate thromboprophylaxis is not correctly prescribed. We conducted this study to estimate the risk profile for VTE and the employment of adequate thromboprophylaxis procedures in patients admitted to hospitals in the state of Sa˜o Paulo, Brazil. Methods: Four hospitals were included in this study. Data on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis were collected from 1454 randomly chosen patients (589 surgical and 865 clinical). Case report forms were filled according to medical and nursing records. Physicians were unaware of the survey. Three risk assessment models were used: American College of Chest Physicians (ACCP) Guidelines, Caprini score, and the International Union of Angiololy Consensus Statement (IUAS). The ACCP score classifies VTE risk in surgical patients and the others classify VTE risk in surgical and clinical patients. Contingency tables were built presenting the joined distribution of the risk score and the prescription of any pharmacological and non-pharmacological thromboprophylaxis (yes or no). Results: According to the Caprini score, 29% of the patients with the highest risk for VTE were not prescribed any thromboprophylaxis. Considering the patients under moderate, high or highest risk who should be receiving prophylaxis, 37% and 29% were not prescribed thromboprophylaxis according to ACCP (surgical patients) and IUAS risk scores, respectively. In contrast, 27% and 42% of the patients at low risk of VTE, according to Caprini and IUAS scores, respectively, had thromboprophylaxis prescribed. Conclusion: Despite the existence of several guidelines, this study demonstrates that adequate thromboprophylaxis is not correctly prescribed: high-risk patients are under-treated and low-risk patients are over-treated. This condition must be changed to insure that patients receive adequate treatment for the prevention of thromboembolism.

ObjectiveTo provide a brief review of the development of cardiopulmonary bypass.MethodsA review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation.ResultsThe advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies.ConclusionSteady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient's physiological function.

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IMPORTANCE Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant.OBJECTIVE To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. INTERVENTIONSThe patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. MAIN OUTCOMES AND MEASURESThe primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas).RESULTS Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09).CONCLUSIONS AND RELEVANCE Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02054325

Bariatric surgery was defined as high risk for development of venous thromboembolism (VTE) in the 2012 ninth edition of the American College of Chest Physicians' (ACCP) Consensus, along with surgery for gynecological cancer, pneumonectomy, craniotomy and traumas involving the brain or spinal cord, or other major traumas.1 Without prophylaxis, the incidence of deep venous thrombosis (DVT) in this risk category ranges from 40 to 80% distally in the leg and from 10 to 20% proximally in the thigh, with a 0.2-5.0% incidence of fatal pulmonary embolism (PE).2 Data for bariatric surgery patients corroborate these findings, with DVT frequencies of 0.2-2.4% and PE rates of 1-2%, 3-6 the latter being responsible for 30-50% of mortality related to the operation. [7][8][9][10] In view of this, prophylaxis for VTE is mandatory.A meta-analysis conducted by Becattini et al. 11 found that the regimens most often used for bariatric surgery patients were as follows:1. Unfractionated heparin (UFH) -at a dosage of 5,000 international units (IU) subcutaneously (SC) 3 times a day for 15 days.2. Low molecular weight heparin (LMWH) -enoxaparin at a dosage of 30 mg SC twice a day or 40 mg twice a day for 15 days.Adjusting doses for Anti-Xa provoked an increase in the frequency of bleeding without reducing VTE.11 Irrespectively, pharmacological prophylaxis must always be managed on a case-by-case basis, considering the risk of bleeding in each case (active peptic ulcer, uncontrolled systemic arterial hypertension, coagulopathy, thrombocytopenia, renal failure, etc.). 12Enoxaparin can be administered at a dosage of 60 mg twice a day for 14 days.12 A study that compared this with a dosage of 40 mg twice a day for 14 days found that the risk of bleeding was similar in both groups. This study did not assess VTE frequency during the postoperative period.Stroh et al. 13 analyzed registry data compiled in Germany on 31,668 surgeries (13,772 Roux-en-Y-gastric bypasses, 11,840 sleeve gastrectomies and 3,999 gastric bandings) reporting DVT in 0.07% of cases and PE in 0.10% and concluding that LMWH was preferable to unfractionated heparins. These data were recently corroborated by an analysis conducted by different authors.14 In these data, around 94.4% of procedures were Roux-en-Y open surgeries and 5.6% were laparoscopies.Some authors prefer to combine HNF with mechanical prophylaxis, such as early mobilization, intermittent pneumatic compression (IPC), and graduated elastic compression stockings (GECS). 12,15In a randomized study comparing fondaparinux (5 mg/day) with enoxaparin (40 mg twice a day), 16 the results for complications (VTE) during the postoperative period were similar in two groups with body mass index (BMI) > 40 kg/m 2 . However, fondaparinux was associated with better control of anti-Xa levels. Apparently, therefore, either enoxaparin at a dosage of 40 mg twice a day or fondaparinux (5mg/day) can be recommended for patients with BMI > 40 kg/m . [18][19][20] According to the same review mentioned above, 17 the 0.5 mg/kg eno...

Resumo Contexto O tromboembolismo venoso (TEV) é uma doença silenciosa e potencialmente letal que acomete parcela importante dos pacientes hospitalizados. Com alta morbimortalidade e elevado custo financeiro para o sistema de saúde, o TEV pode ser prevenido com uso da profilaxia, já estabelecida pela literatura. No mundo real, a profilaxia para TEV possui média de adequação inferior a 50%. Objetivos Definir o perfil epidemiológico do doente com TEV em um hospital universitário e a taxa de adequação da profilaxia para TEV no referido serviço, além de determinar meios para melhorá-la. Métodos Estudo transversal observacional realizado pela coleta de dados no prontuário médico dos pacientes que preencheram critérios de inclusão. Comparou-se a taxa de adequação da profilaxia para TEV prescrita para pacientes clínicos e cirúrgicos, segundo diretrizes da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV), de acordo com sua classificação de risco para TEV. Resultados A taxa global de adequação das prescrições de profilaxia para TEV foi de 42,1% versus 57,9% de inadequação. Pacientes clínicos obtiveram taxa de adequação de 52,9%, enquanto pacientes cirúrgicos obtiveram taxa de adequação de 37,5%. Conclusões As taxas de prescrição adequada para profilaxia para TEV ainda se encontram aquém do esperado. Educação continuada, estímulo à aplicação da estratificação de risco à beira do leito e adequações no sistema de prescrição eletrônica podem aumentar as taxas de prescrição adequada para profilaxia de TEV.