Median Vein Research Articles

Patterns of superficial veins the cubital fossa among young adults in Tanzania

Background The cubital fossa can be seen superficially as a depression on the anterior side of elbow. It is a common site for removal of blood for analysis, for blood transfusion and intravenous therapy. The superficial veins of upper limbs follow three major veins which are cephalic, basilica and median cubital veins which are variable among individuals. Objectives The aim of the study was to observe and describe patterns of superficial veins in the cubital fossa of MUHAS students, and to assess if there were variations of patterns between left and right cubital fossas, also between male and female participants. Methodology The cross sectional study was designed. Convenient sampling was used to select 170 participants among Muhimbili University students ranging from 21-34 years of age who had visible superficial veins at the cubital fossa. A tourniquet was tied at mid arm level and superficial veins in the cubital fossa were photographed and described into various patterns. Results The commonest pattern was Type A which is N shaped, where median antebrachial vein divides to median cephalic and median basilica which joins cephalic and basilica veins respectively with the percentage of 37.6%. Incidences of type B, C, D, E and F were 17.1%, 26.5 %, 1.8%, 15.3% and 1.8% respectively on the left cubital fossa. There were variations between left and right cubital fossa patterns among same individual in some participants and no variations between male and female superficial venous patterns of cubital fossa. Conclusion Understanding various patterns of superficial veins in the cubital fossa is important in clinical practices since it helps easy locating of common superficial veins in procedures such as venipuncture, blood transfusion, intravenous therapy and arteriovenous fistula. Also there are few studies done in Africa and no studies done in Tanzania about superficial venous patterns in the cubital fossa. Key words: superficial veins, cubital fossa, patterns.

Abdominal drain straying into right atrium: a case report

BackgroundA drain exchange with the use of a guidewire may be accompanied by serious complications.Case presentationThis case involved an 86-year-old man with overlapping cancers of intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma. A left hepatectomy, a left caudal lobectomy (with a medial hepatic vein preservation), an extrahepatic bile duct resection, and a right hepatojejunostomy were performed. The abdominal drain was placed into the hepatectomy side. Bile leakage occurred on the seventh day after the surgery, and the drain was exchanged. Since the bile leakage was still detectable via a computed tomography (CT) scan on the 15th postoperative day, the drain was exchanged again. On the next day, blood had discharged from the drain. A CT scan revealed that the tip of the drain was straying into the right atrium (RA) and the drain was removed from the inferior vena cava (IVC) under general anesthesia. One week later, a fiburin thrombus was observed from the IVC to the RA via the use of transthoracic echocardiography. A right atrial incision, a thrombus removal, and a middle hepatic vein merging section closure surgery were performed. Afterward, the patient’s general condition gradually improved, and he was transferred to the hospital for rehabilitation.ConclusionMore careful guidewire operations are necessary at the time of the exchange of the drain to prevent the drain from being placed too close to blood vessels.

Fruit and seed macro- and micromorphologies of the genus Matthiola (Brassicaceae) in Turkey and their taxonomic value

Macro- and micromorphological features of fruit and seeds belonging to 12 taxa genera of Matthiola W.T.Aiton were studied via stereomicroscope and scanning electron microscope. In macromorphological studies, the following variables were investigated: the shape, size, and color of fruit and seeds; the length of fruiting pedicel; the structure of the median vein; stigma (horns); and trichome properties and density in fruit. In micromorphological studies, the presence or absence of seed wings, seed coat pattern in disc and wing, and epidermal cell shape in disc and wing were determined. According to our findings, all characters of fruit and seeds are extremely variable and can be used as criteria to distinguish species of the genus.

Vein of Galen arteriovenous malformation: Unedited microneurosurgery

Background:Vein of Galen arteriovenous malformations (VGAVMs) are vascular malformations of the pineal region between a persistent embryological median prosencephalic vein of Markowski and the arterial choroidal system by a direct (mural type) or indirect (choroidal type) communication. Angiographic evaluation of VGAVMs usually describes a limbic arch between the anterior and posterior cerebral arteries throughout a pericallosal artery, and the classic “ε” shape configuration of the thalamostriate veins drainage into a subtemporal or a lateral mesencephalic vein due to the underdevelopment of the straight sinus, sigmoid sinus, and jugular bulbs. Moreover, falcine dural channels join the pouch of the malformation with the posterior third of the superior sagittal sinus and less frequently with the cavernous sinus, inferior petrosal sinus, and facial veins. At present, endovascular therapy is the standard management for these lesions. However, under failure of endovascular procedures such in this case, microsurgical management of VGAVMs under an experienced neurosurgical team might be paramount.Case Description:The patient with a choroidal type VGAVM and multiple failed endovascular procedures underwent sitting praying position and midline supracerebellar infratentorial approach. Strong retraction with stitches and proper hemostasis of a highly vascular dura was achieved after transverse sinus-based opening. Accurate microsurgical dissection between the superior cerebellar surface and the tentorium allowed a supracerebellar approach over the vermis and along the midline recognizing the venous pouch of the VGAVM instead of the absent straight sinus. Water dissection allowed us to differentiate the cleavage plane between the VGAVM and surrounding structures maintaining an impeccable surgical field as well. Under high microscopic magnification, arterial feeders of the malformation coming from the posterior cerebral artery were recognized. Intraoperative angiography and reevaluation of the preoperative imaging helped us to confirm a safety approach before coagulation and cut those vascular feeders. Throughout an open-close and short bursts bipolar coagulation techniques preventing attachment of conventional bipolar tips within the vascular structure and without permanent use of water irrigation, the vessels were carefully dissected, coagulated, and sectioned. Along with our experience, we believe that this standard coagulation technique applied in all vascular malformation surgeries is safe and effective. A remaining small plexiform malformation associated with the vein of Galen malformation was coagulated and isolated. A new intraoperative angiography determined complete microsurgical occlusion of the VGAVM. Careful homeostasis based on electrocoagulation and surgical was achieved. Finally, we performed a microsurgical wound closure as a conventional technique in Helsinki neurosurgery.Conclusion:This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe surgery for a VGAVM.Videolink:http://surgicalneurologyint.com/videogallery/vein-of-galen-avm.

Anatomical investigation of four taxa of Scutellaria albida L. (Lamiaceae)

The root, trunk and leaf anatomy of four taxa of Scutellaria albida namely, S. albida subsp. albida, S. albida subsp. velenovskyi, S. albida subsp. colchica and S. albida subsp. condensata were examined. The aim is to determine whether these characters can be used for systematic purposes. The roots displays a typical stele structure in all studied taxa. But their number of pith rays are different in each taxa. The stems of S. albida taxa have square like transection, collateral vascular bundles, parenchymatous pith and show 1-2 layered epidermis coated with thick cuticle. S. albida subsp. condensata has papillate epicuticular wax on its stem cuticle layer. In all taxa angular collenchyma, and cambium forming phloem outward and xylem inward are observed. The leaves are hypostomatic, have single rowed epidermis coated with thick cuticle and show dorsiventral mesophyll in all studied taxa. S. albida subsp. velenovskyi has echinate epicuticular wax on its leaf cuticle layer, but the others have smooth cuticle layer. The midrib shows one collateral bundles in all taxa but the shape of median veins of the leaf blade show variation in each taxa. Some of the anatomical characters viz. the number of pith rays of roots, the number of palisade parenchyma layer, plant cuticles covered by wax, the shape of median veins of the leaf blade and stomata index, provide information of taxonomical significance for these taxa.

Geometric Morphometrics Dismiss the Polymorphic Hydrocotyle quinqueloba (Araliaceae) from the Neotropics

Abstract—Hydrocotyle taxonomy is poorly resolved due the traditional assessment of leaf morphology that has imposed difficulties to species delimitation and prompted the recognition of several infraspecific taxa. Hydrocotyle quinqueloba comprises ten infraspecific taxa that differ mainly by the shape of their leaf blade. The species complex occurs in montane forests of the Andes and eastern Brazil, along the Atlantic Forest and Cerrado domains. However, the geographic distribution of the taxa under H. quinqueloba is poorly known, and their supposedly continuous morphological variation remains unverified. Here we analyze the morphological variation and documented correlated differences in geographic distribution of H. quinqueloba to assess whether they support the delimitation of distinct species or the recognition of infraspecific taxa. For this task, we applied landmark-based geometric morphometrics (GM) to leaves and traditional morphometrics to other structures of specimens of H. quinqueloba. Procrustes analysis of variance (Procrustes ANOVA) indicated that variation of leaf blade shape was weakly associated with geography and was mainly explained by taxa themselves. In contrast, variation of leaf blade size was significantly (p < 0.001) associated with geography, but variation at the specimen level could account for it. Principal component analysis (PCA) of leaf blade shape indicated that taxa differed mainly by the angle and relative size between median and lateral primary veins, by the space between the petiole insertion and middle lobe’s sinuses, and by the width of the middle lobe’s base. Canonical variate analysis (CVA) indicated significant (p < 0.01) differences among seven infraspecific taxa that formed groups defined by leaf blade shape. Linear discriminant analysis (LDA) of 11 morphological characters separated five groups of taxa, which displayed significant (p < 0.001) differences among each other. Based on that, we propose an updated taxonomic treatment that restricts the circumscription of H. quinqueloba to plants from the Andes and accepts four species from eastern Brazil.

PC132. Making the Most of the Median Antebrachial Vein in Hemodialysis Access

There is a continued need for improved strategies to create and to maintain autogenous arteriovenous fistulas (AVFs). The autogenous radial-cephalic AVF is the widely recognized first choice, and brachial-cephalic AVFs are often the second choice. There is variable superficial venous anatomy nearing the antecubital fossa. The median antebrachial vein has dual outflow to both the cephalic and basilic veins. An AVF using the median antebrachial vein (MAV-AVF) is a less commonly performed procedure that affords unique benefits. Between August 2016 and December 2018, there were 14 autogenous MAV-AVFs created at our institution. The proximal radial artery was used as inflow for 12 of these AVFs, and the brachial artery was used for the remaining 2. During the study period, 14 patients underwent AVF creation. One patient experienced a postoperative deatah unrelated to surgery. Of the remaining 13 patients who underwent MAV-AVF creation, 30-day patency was 100%. One patient sustained thrombosis of the fistula 27 months after the index operation, and five patients required subsequent reoperations. Two patients were able to access the fistula using one needle in the cephalic vein and a second needle in the basilic vein immediately after fistula maturation. These patients later underwent basilic vein superficialization because stenosis of the cephalic vein precluded access 12 and 18 months after the index operation. One patient required ligation of the basilic vein for failure of fistula maturation due to competing outflow veins. Two patients underwent ligation of the basilic vein to treat ischemic steal syndrome. All five of these patients were able to continue to access the AVF after reoperation. This series demonstrates that an autogenous AVF using median antebrachial vein as outflow is a viable option for permanent hemodialysis access. The dual outflow of the MAV-AVF has unique benefits and challenges. Both the cephalic and basilic veins can be used for hemodialysis access. If the basilic vein is the dominant outflow, superficialization may be required. Patients with MAV-AVFs can also have complications of high-outflow fistulas, which are easily treated with ligation of one of the outflow veins while maintaining viability of the AVF. Ligation of competing outflow veins is occasionally required to promote fistula maturation. The MAV-AVF is a valuable tool in the vascular surgeon’s armamentarium, with the unique outflow anatomy allowing multiple possible revisions to prolong its life before requiring progression to a more proximal fistula or synthetic graft.

A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report

BackgroundInferior mesenteric arterioportal fistula (APF) is rare as only 35 case reports in the literature. We herein presented a case of simultaneously double cancer in the rectum and stomach with inferior mesenteric APF, which is the first case report by searching using PubMed. Combination of interventional embolization and surgical operation seemed to be optimal treatment for avoiding postoperative complications and the curability.Case presentationA 66-year-old male with epigastric pain was admitted to a practitioner. He underwent a gastroscopy with biopsy, and cancer located in the lesser curvature of the gastric cardia was found. Enhanced CT did not reveal wall thickening of the stomach and distant metastases, but several swollen lymph nodes were observed in the right cardia. In the arterial phase, dilation of inferior mesenteric vein (IMV) and superior rectal artery (SRA) were noted, which raised suspicions of an arterioportal communication. Colonoscopy revealed a type 2 rectal tumor located 12 cm from the anal verge. The histological diagnosis of well-differentiated tubular adenocarcinoma was confirmed by biopsy. At a first step, we planned to perform a radiological embolization of inflow vessels to APFs except for SRA. Additionally, we determined the interval time of 1 month between the first low anterior rectal resection and the sequential gastrectomy for the purpose of decreasing portal pressure. The postoperative course was uneventful without hemorrhagic complications, and S-1 was taken internally 1 year as adjuvant chemotherapy for gastric cancer. The patient still lives without recurrence of this cancer with APF and portal vein thrombosis 2.5 years after the aforementioned surgeries.ConclusionInferior mesenteric APF and/or arteriovenous fistula (AVF) would be consisted of the several inflow arteries as superior rectal, internal iliac, and median sacral arteries, and outflow veins as inferior mesenteric, internal iliac, and median sacral veins. To determine the therapeutic strategy for left-sided colorectal cancers with abnormal vessel communications of the pelvis, it is significant to comprehend distribution and component vessels of APF and/or AVF.

HEMODIALYSIS;

Objective: To evaluate the treatment success rate of percutaneous transluminal angioplasty (balloon angioplasty) for peripheral and central venous stenosis in hemodialysis patients. Study Design: Retrospective/observational study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital Lahore from 1st January 2018 to 30th June 2018. Methods: Thirteen patients of both genders presenting during from two years of hemodialysis failure and ipsilateral arm and neck swelling followed by peripheral and central venous stenosis were included in this study. Patients ages were ranging from 25 to 70 years. Patient’s detailed history including hemodialysis treatment, age, sex, socio-economic status was examined after taking informed consent from the patients. Percutaneous transluminal angioplasty (PTA) was performed at all the patients. Procedural success rate was examined. Results: There were 9 (69.23%) patients were men and rest (13.77%) were women. 5 (38.46%) patients were ages between 25 to 45 years, 6 (46.15%) patients had an ages 46 to 65 years and 2 (15.38%) patients were ages greater than 65 years. 10 (76.92%) had rural residency. 40 % patients had income >30000 PKR. Location and severity of lesions was examined as brachiocephalic vein, subclavian vein, Axillary vein, basilica, cephalic and median cubtal vein in 1,3,2,3,3 and 1 patients respectively. We determine priority patency rate in central lesion PTA was 82.7%, 62% and 38% at 3, 6 and 12 months and priority patency rate in peripheral lesions PTA was 87%, 79.5% and 67.8% at 3, 6 and 12 months. Conclusion: It is concluded that percutaneous transluminal angioplasty (balloon angioplasty) procedure for treatment of central and peripheral venous stenosis in hemodialysis patients was safe and effective with no procedural complications.

Results of transplantation of the hepatic right part from living familial donor

Objective. To estimate the immediate and late results in recipients while transplantation of the hepatic right part with median hepatic vein and without her.
 Маterials and methods. Postoperative data about 86 patients, to whom the hepatic right half was transplanted in 2003 - 2018 yrs., with the objective to estimate the impact of presence of median hepatic vein in the transplant on the morbidity rate development, were analyzed. The patients were divided into two groups: Group I - the patients, to whom the hepatic right half was transplanted without median hepatic vein, while Group II - the patients, to whom the hepatic right half was transplanted with median hepatic vein.
 Results. The investigation have revealed a higher rate of vascular complications in patients, to whom the hepatic right half was transplanted without median hepatic vein, comparing with the patients, to whom the hepatic right half was transplanted with median hepatic vein. The infection-septic complications have developed more frequently in patients, to whom the hepatic right part was transplanted without median hepatic vein. Nonspecific surgical morbidity developed in 10 (23.3%) patients of the Group I and in 8 (18.6%) patients of the Group II. The rate of development of the small hepatic transplant syndrome was higher in the Group I. Оne-year, two-year and five-year survival in the Group I have constituted 79, 72 and 69% accordingly, in the Group II - 83, 74 and 70% accordingly.
 Conclusion. Our experience of performance of the hepatic right half transplantation witnesses, that presence of median hepatic vein in the transplant correlates with lowering of the postoperative morbidity rate, as well as with frequency of development the small hepatic transplant syndrome, postoperative mortality and the stationary stay duration.

Mutation ephb4 responsable de malformation anévrysmale de la veine de Galien

Vein of Galen aneurysmal malformation is a congenital anomaly of the cerebral vasculature representing 30% of all pediatric vascular malformations. We conducted whole exome sequencing in 19 unrelated patients who presented this malformation and subsequently screened candidate genes in a cohort of 32 additional patients using either targeted exome or Sanger sequencing. In a cohort of 51 patients, we found five affected individuals with heterozygous mutations in EPHB4 including de novo frameshift (p.His191Alafs*32) or inherited deleterious splice or missense mutations predicted to be pathogenic by in silico tools. Knockdown of EPHB4 in zebrafish embryos leads to specific anomalies of dorsal cranial vessels including the dorsal longitudinal vein, wich is the orthologue of the median prosencephalic vein and the embryonic precursor of the vein of Galen. This model allowed us to investigate EPHB4 loss-of-function mutations in this disease by the ability to rescue the brain vascular defect in knockdown zebrafish co-injected with wild type but not truncated EPHB4, mimicking the p.His191Alafs mutation. Our data showed that in both species, loss of function mutations of EPHB4result in specific and similar brain vascular development anomalies. Recently, EPHB4 germline mutations have been reported in non-immune hydrops fetalis and in cutaneous capillary malformation–arteriovenous malformation. Here, we show that EPHB4 mutations are also responsible for vein of Galen aneurysmal malformation indicating that heterozygous germline mutations of EPHB4 result in a large clinical spectrum. The identification of EPHB4 pathogenic mutations in patients presenting capillary malformation or vein of Galen aneurysmal malformation should lead to careful follow-up of pregnancy of carriers for early detection of anomaly of the cerebral vasculature in order to propose optimal neonatal care. Endovascular embolization indeed greatly improved the prognosis of patients.

A new species and key to all known species of Confusacris Yin Li, 1987 (Orthoptera: Acrididae) from China.

A new species of the genus Confusacris Yin Li, 1987, namely i.e. Confusacris shanxiensis sp. nov. is described in this paper from Shanxi province of China. The new species is similar to Confusacris brachypterus Yin Li, 1987 but differs from the latter by tegmen of male extending over middle of hind femur distinctly, maximum width of cubital vein area 1.5 times median vein area, furculae large, epiphallus without acute projection on both sides and length of interspace of mesosternum1.6 times minimum width in female. A key to known species of the genus Confusacris Yin Li, 1987 is given in this paper. The type specimens are deposited in the College of Life Sciences, Hebei University, Baoding, China.

Ecological anatomy of Eugenia punicifolia (Kunth) DC. (MYRTACEAE) in the restinga region,state of Ceará

Abstract The species Eugenia punicifolia (Kunth) DC. (myrtle) occurs in the coastal region of the state of Ceará and has ecological and medicinal importance. This study aimed to characterize the leaf anatomy of myrtle (E. punicifolia) in the rainy and dry seasons, as well as in the sun and shade in the restinga region of the state of Ceará and to contribute to the understanding of the morphoanatomic variations in response to the natural conditions of the occurrence of this species. For this, collections of fully expanded leaves were performed at the Botanical Park of Ceará and fixed in FAA70, being replaced by 70% ethanol after 24 hours. The usual anatomical procedures were then performed in order to qualitatively and quantitatively analyze the leaf blade, petiole and epidermis structures. As a result, it was found that myrtle has xeromorphic characteristics such as thick cuticle, hypoestomatic leaf and sclerenchyma fibers in the median vein vascular bundles. It was concluded that E. punicifolia has great plasticity to adjust well under the analyzed conditions.

Laparoscopic ligation of a congenital extrahepatic portosystemic shunt for children with hyperammonemia: a single-institution experience.

A congenital extrahepatic portosystemic shunt (CEPS) associated with hyperammonemia requires occlusion of the shunt vessels. We evaluated the effectiveness and safety of laparoscopic ligation of a CEPS in children with hyperammonemia. The subjects of this retrospective study were seven children with hyperammonemia who underwent laparoscopic ligation of a CEPS. Their median age was 5.2years (range 1-16years). Before the laparoscopic procedure, a catheter was inserted through the femoral vein and placed in the portal vein via the shunt vessel. The shunt vessel was dissected and taped laparoscopically. After measuring the portal vein pressure under temporal occlusion, the shunt vessels were ligated. The types of shunts according to location were patent ductus venosus (n = 2), splenorenal shunt (n = 2), gastrorenal shunt (n = 2), and superior mesenteric vein-inferior vena cava shunt (n = 1). Laparoscopic ligation of the shunt vessel was completed uneventfully in all patients. The median portal vein pressure was 19mmHg after ligation. The median preoperative blood ammonia level was 94µg/dL (range 71-259µg/dL), which decreased after ligation in all patients. There was no incidence of postoperative liver failure. Laparoscopic ligation of a CEPS is safe and effective for children with hyperammonemia.

Gibbocicada brasiliana, new genus and new species from Brazil and a key for the genera of Tibicinini (Hemiptera: Auchenorrhyncha: Cicadidae)

Abstract Four examined specimens from Brazil, Ceará, with morphological characteristics belonging to Tibicinini (Hemiptera: Cicadidae) revealed an undescribed genus and species. Gibbocicada brasiliana gen. et sp. nov., representing the first record of Tibicinini in Brazil, is recognized mainly for the head three times shorter than pronotoum in dorsal view, the lateral ocelli almost reaching the anterior margin of pronotum, the pronotum and mesonotum pronounced dorsally in lateral view, and the fore wings with the median and cubitus anterior veins rising from the same point in the basal cell. A key to the genera of Tibicinini is presented.

New species and records of the genus Caesarodispus (Acari: Prostigmata: Microdispidae) associated with ants (Hymenoptera: Formicidae) from Iran

ABSTRACTIn a survey on heterostigmatic mites (Acari: Prostigmata: Heterostigmata) associated with insects in Lorestan province, western Iran, three species of the genus Caesarodispus (Heterostigmata: Microdispidae) were collected as associates of ants (Hymenoptera: Formicidae). One of them is new to science, Caesarodispus dilatasetus Navabi & Hajiqanbar sp. nov. associated with Pheidole sp., and characterized by dilated setae 1a and 2a with a median vein, and subequal setae 2a and 2b (27–30 long). Two other species are C. minutus (Sevastianov, 1981) associated with an undetermined Myrmicinae (Formicidae) and C brevipes Mahunka, 1981 associated with Tetramorium sp. The latter species is new to mite fauna of Iran. The host range of the genus Caesarodispus is also reviewed and discussed.http://www.zoobank.org/urn:lsid:zoobank.org:pub:108586DF-2DF8-486A-A7DB-14AB9CA7BD0C

Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review

Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.

Malformação Arteriovenosa da Veia de Galeno no Recém-Nascido

A Malformação Arteriovenosa da Veia de Galeno (MAVG) representa cerca de 1% das malformações vasculares intracranianas. É caracterizada por uma dilatação acentuada da Veia de Galeno, contendo múltiplas fístulas arteriovenosas que drenam para uma veia prosencefálica mediana chamada de veia de Markowski, precursora da veia de Galeno. A MAVG tem etiologia ainda desconhecida e sem relação com histórico familiar. Durante o período perinatal, a primeira manifestação clínica geralmente é o quadro de insuficiência cardíaca. O diagnóstico pode ser obtido desde a gestação através da ultrassonografia gestacional e, posteriormente, através de ultrassom transfontanelar, ressonância magnética e angiografia, sendo este o exame padrão. O método mais seguro e mais aceito atualmente para o tratamento é a embolização endovascular. Apresentamos o caso de um recém-nascido com ultrassonografia gestacional sugerindo MAVG, com quadro clássico de insuficiência cardíaca 8 dias após seu nascimento, com hipótese confirmada após investigação com neuroimagem. Após estabilização clínica durante o internamento, o paciente foi submetido à embolização em 3 etapas com boa evolução clínica. A deterioração do prognóstico, quando não tratada, ressalta a importância de se diagnosticar precocemente essa condição que, apesar de rara, deve entrar como diagnóstico diferencial frente a um recém-nascido com insuficiência cardíaca.

Prognostic Factors for Arteriovenous Fistula Maturation

Recent studies have reported successful arteriovenous (AV) fistula maturation rates between 40% and 80%, with older age, distal fistula location, and small vein diameter associated with greater failure rates. Our objective is to determine if these findings are consistent with the outcomes at our institution. A retrospective chart review was performed on patients who underwent upper extremity AV fistula creation at a single institution. Patient demographics and risk factors were analyzed, as well as fistula location and vein diameter based on preoperative ultrasound. Veins less than 2.5mm were not used for fistula creation. Successful fistula maturation was defined as the fistula serving as the primary access for hemodialysis for 3months or greater. Pearson Chi-Square, Fisher's Exact Test, and Mann-Whitney U-tests were used to determine significant associations. Between January 2012 and December 2013, 146 fistulas were created in 136 patients. The median age was 68. Median body mass index (BMI) was 27.8. Ninety-one fistulas were created in men and 55 in women. Ninety-two percent of patients had hypertension, 57% had diabetes, and 33% had coronary artery disease. Sixty percent of fistulas created were brachiocephalic, 24% were basilic vein transpositions, and 16% were radiocephalic. Median vein diameter was 3.7 (range 2.5-8.8). Eighty-four percent of patients were on hemodialysis at the time of fistula creation, and 21% had a prior fistula. One hundred five fistulas were accessed for 3months or more, resulting in a successful overall maturation rate of 72%. BMI greater than 29.5 (P=0.026) negatively impacted successful fistula maturation, whereas age, fistula location, and vein size did not. We noted a successful overall maturation rate of 72% at our institution when veins at least 2.5mm in diameter were used. Our sole negative significant predictor for fistula maturation was BMI greater than 29.5. Therefore, in our experience, age, sex, and fistula location should not be used to preclude patients with a vein diameter of at least 2.5 mm from consideration for AV fistula creation.

A needle in a haystack: the new genus Bernadottea (Diptera: Cecidomyiidae, Winnertziinae) with four new species in the Old World.

A new genus of Winnertziini (Cecidomyiidae: Winnertziinae) named Bernadottea gen. nov. is introduced to absorb four new species from various different parts of the Old World: B. natalensis sp. nov. from South Africa, B. honshuensis sp. nov. from Japan, and B. pahangensis sp. nov. and B. selangorensis sp. nov. from Malaysia. Bernadottea are distinguished from previously known Winnertziini by the unusually complex genitalia of males, and from most members of this tribe by the absence of the fourth medial vein (M4). Another feature of Bernadottea is their rare occurrence in samples of Winnertziini taken by hand or by traps, a circumstance presumably expressing their scarcity in nature, at least at ground level. The new taxa are described based on the morphology of males, while females and larvae remain unknown.