Venous translumination or translucence
, has been applied in phlebology
since 1996 by the surgeon Pedro Fernandes Neto
, during ambulatory clinical exams (Brazil
). The results were registered in annals of national and international congresses of angiology
. It is a process of reflective image
visualization of veins by the incidence of light
, which reaches up to the superficial venous system. It is an exam of static nature, however it is also a non-invasive method. For being a procedure of easy application and of low cost exam , it can be repeated when it is necessary, what becomes the process useful in the attendance of several pathological situations. Therefore, the use of this process for the obtaining of images with the generation of inconographic files, revealed to be of great importance for the attendance of several stages of venous diseases, beside this facilitating the several treatment conducts, guiding with this, the choice of the best procedure. It is a new diagnostic procedure, still in phase of investigation and a deeper analysis is necessary, in relation to certain technical patterns of this new method. Another aspect is the optical physics. The venous translumination is due to the refraction, absorption
of light, whose principle is the dispersion
and absorption of light colors
. The color that is not absorbed is reflected and is the one that we can see. Therefore, the venous translumination is based on the incidence of a luminous focus on the vein, where part of the light is absorbed and another reflected
, supplying an image of the silhouette
of the studied sanguine vase.
Considerations on technical aspects
Some technical considerations, deserve to be described for better understanding of the process that served as a base for this study. Same questions are following related:
How to avoid artifacts or luminous pollution, during the venous translumination ?
Certain beginnings of the reflection and refraction of the light are importants, for the understanding the distorted images that can appear during a scanning. Many of these can be due to inappropriate sources, that would provoke light loss similar to luminous pollution. We reminded that when a light ray happens on a surface, it leaves across the reflection and part enters as a ray refracted in the second middle, from where can or not to be absorbed.
During the venous translumination, the amount of reflected light depends on the relationship among the indexes of refraction of both means that can be altered as in the venous thrombosis or in the dermatolipoesclerose. Considering this technical parameter, we verified that certain types of lamps process more dispersion than reflection and therefore they favor the formation of artifacts. The luminous pollution in compensation, appears for the use of appropriate components.
Focalizing on this question, another aspect that is observed, it the inability to be obtain translumited images with a fiber optic source due to the irradiation frequency being greater than necessary. It is also known that the reflection in an optic fiber source is initially processed, internally. Certain instruments as the venoscopy are not specific for the obtaining of reflected images. The illumination of the skin for distanced infrared light of the area without there being the impression of the source on the skin, doesn't reveal diagnostic images. The handling of the translumination transductor has to be in direct contact with the skin. The process exam should be similar to the accomplished by the doppler ultrasonography.
Considerations on certain interfaces
The tissue transluminated by a white light has a refraction index in agreement with its texture
. By the impression of the camera on the skin, the red and yellow color is observed. The red color is soon dispersed in the skin and the yellow surrounding it begins to alter its tonality with the change in source direction.
A shade with the change of the direction of the source arises . It is know that the refraction index charge in agreement with the spectrum of transmitted light and when the white light is projected and finds an obstacle, becomes separated in the three elementary colors (RGB). It leaves of this light during the translumination can suffer larger dispersion or reflection depending on the way that the source is put on the examined area. This handling can define the better image or to harm her interpretation. Everything will depend on the examiner's experience.
Interaction of the light with the one of the color's skin.
The skin is opaque to the light. In physics light reception, heat or other type of radiant energy on the part of the molecules, is called absorption. In this case when the tissues are illuminated in the process of translumination, it happens that it leaves of this light is absorbed and the other is reflected. It is known that an object that absorbs the whole radiation that happens on him is known as black body and, therefore the pigments
that give color to the skin and the other tissues, absorb certain wavelengths of the white light and they contemplate as well as they transmit radiant energy
. This is one of the aspects of the color sensation that captured by our vision
. However it is not known the mechanism well by the which certain substances absorb more light than other, presumably that process depends on his molecular
structure. Another observed fact is that the light when reaching more pigmented areas or in patients with dermolipoesclerose, she disperses and it suffers the reflection more easily, being prejudiced absorption tends in view that in that situation the refraction index and smaller, for the difficulty that the white light has to penetrate to the subdermic plans.Several studies about the distribution of the elastin
and of the collagen fibers in the patients bearers of dermal lesions during CIV, they should be analyzed so that she can verify as the same ones come in these situations and the influence of as it is processed those alterations. Considering this aspect is that a study of the tissues consistences using the translumination and the dermatoscopy
could supply important data to complement the diagnosis of some collagen diseases
of the and to study the aging of the tissues. The interaction and the relationship of skin
color during the translumination is important. Individuals of white skin have a better venous visualization during the translumination, than the mulatto or black man
Influence of the viscosity and of the blood flow
The erythrocytes absorb more light because they are oxygenated. Considering that aspect we can deduce that the venous blood has a light absorption different from arterial blood in which sanguine viscosity
is greater due to the higher concentration of CO2 and to the factor of the stasis. In that sense the venous circulation has greater power to reflect the light. When we proceeded the translumination in an arterial-venous fistulae
, we didn’t usually observe reflected images also due to the flow velocity is higher and the fact that the sanguine viscosity in the arterial section is less than in the venous segment. The truth is that it is not possible to visualize arterial vases by translumination, because they don’t supply a reflection due to their accelerated inflow. Another considered aspect is that the iron that participates in the composition of hemosiderin
and others mine existent in the blood
, emit light of several wavelengths when stimulated
Histogram of colors
In the translumination, the spectrum of white light is decomposed of different wavelengths colors, in agreement with the incident area. The histogram represents the graphic visualization of these colors and the luminescence of the obtained images. In a histogram
, the intensity of the luminescence is accompanied by the gray baseline that decreases as the source approaches, where the red scale is more intense and it is represented by a line in ascension. The scales of blue and green colors represent in this situations, the refraction indexes of the light in the occasion that the transluminator is positioned in contact with the studied area. In the histogram, when we disable the selection of a scale, for example the green scale, we can map the intensity of luminescence
of whole captured images. Bollinger and collaborators remind an exam of their experience, denominated fluorescence
videomiscroscopy, based on the video capture of images and study of the luminescence of the same, through the light emission stimulated by the 20% sodium-fluorocein (0.3 ml/l of blood).The principles of spectrographic analysis of this test are similar to that we use to evaluate the intensity of luminescence of captured images by venous translumination, and the histogram that we use also evaluate the scales of red, blue and green (RGB). Finally, we remind that all organic components are composed by several chemical elements that emit light according with its wavelength. This is why the analysis of histogram by the spectrum of colors of transluminated images could be applied, to define a certain organic element in relation to the quality and amount of their components.
- ABURAHMA AF, Sadler D, Robinson PA. Axillary-subclavian veÍn thrombosis: changing patterns of etiology, diagnostic and thera- peutic modalities. Am Surg 1991;57:101.
- ALBRECHTSSON U, Olsson C-G. Thrombotic side-effects of lower - limb phlebography. Lancet 1976; I: 723.
- ACKROYD JS, Thomas ML, Browse NL. Deep vein reflux: an as- sessment by descending phlebography. Br J Surg 1986; 73:31.
- AGUS GB, Castelli P, Sarcina A. Varici recidive degli arti inferiori: patogenesi e indicazioni al trattamento chirúrgico. Min Cardioang 1982;30:25-29.
- ADAMS JT, DeWeese JA, et al. Intermittent subclavian vein ob- struction without THROMBOSIS. SURGERY 1968;63:147.
- BETTMANN MA, Salzman EW, et al. Reduction of venous thrombo- sis complicating phlebography. AJR 1980; 134:1169.
- BETTMANN MA, Robbins A, et al. Contrast venography of the leg: diagnostic efficacy, tolerance, and complication rates with ionic and nonionic contrast media. Radiology 1987;165: 113.
- BETTMANN MA, Paulin S. Leg phlebography: the incidence, nature and modification of undesirable side effects. Radiology 1977; 122:101.
- BAXTER GM, Duffy P, et al. Colour flow imaging of calfvein throm- bosis. Clin Radiol 1992;46: 198.
- BARNES RW, Nix ML, et al. Perioperative asymptomatic venous thrombosis: role of duplex scanning versus venography. J Vasc Surg 1989;9:251.
- BOLLINGER A, Haselbach P, Schnewlin G, Jiinger M (1985) Microangiopathy due to Chronic Venous Incompetence Evaluated by Fluorescence Videomicroscopy. Phlebology. 255: 751- 3.
- BALDRIDGE ED, Martin MA, et al. Clinical significance offree float- ing venous thrombi. J Vasc Surg 1990;11:62.
- BAUM RA, Holland GH, et al. Hypogastric venous thrombosis at MR angiography. Presented at the 79th Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, Nov 28-Dec 3, 1993.
- BALDRIDGE ED, Martin MA, et al. Clinical significance offree float- ing venous thrombi. J Vasc Surg 1990;11:62.
- BRÃUER K, Hahn M (1999) Nonlinear Analysis ofBlood Flux in Human Vessels. Phys. Med. Biol. 44: 1719-33.
- BURNAND KG, Browse NL (1982) The Cause ofVenous Ulceration. Lancet. 31: 243.
- BURNAND KG, Whimester J, Nacidoo A, Browse NL (1982) Pericapillary Fibrin in the Ulcer Bearing Skin of the Leg: The Cause of Lipodermatosderosis and Venous Ulceration. Br. Med. J. 285: 1071-2.
- BENABOU JE, Molnar LJ, Neto FCB, Cerri GC, Puech Leão P. Avaliação por mapeamento duplex da junção safenofemoral em pacientes portadores de varizes recidivantes, submetidos a prévia cirurgia radical de varizes. Cir Vasc Angiol 1996;12:36-39.
- BERNSTEIN EF. Recent advances in noninvasive diagnostic techniques in vascular disease. St. Louis: Mosby; 1990.
- BELOV S. Classification of congenital vascular defects. Int Angiol 1990; 9: 141-146.
Vascular Malformations. Edit. St. Belov DA, Loose J, Weber. Einhorn Presse Verlag. Periodica Angiologica 1989: 16; 25-27.
- BELCARO G, Nicolaides AN, Veller M. in: Assessment of the venous and lymphatic systems. Authors XX, editors. Venous disorders: a manual of diagnosis and treatment. Cidade: Saundres; 1995:41.
- CRANLEY JJ. Diagnostic tests for venous thrombosis. In: Cranley JJ, ed. Vascular surgery. New York: Harper and Row, 1975.
- CHRISTOPOULOS D, Nicolaides AN. Air plethysmography. in: Raju S, Villavicencio JL., Surgical management of venous disease. Cidade: Willians & Wilkins; 1997:93.
- CHILLER KG, Passaro D, Frieden IJ. Hemangiomas of infancy. Clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. Arch Dermatol 2002; 138: 1567-1576.
- CRANLEY JJ, Canos AJ, et al. The diagnosis of deep venous throm - bosis. Arch Surg 1976; III :34.
- COEI MN, Dodge W. Complication rate with supine phlebogra - phy. AJR 1978; 131:821.
- CHRISTOPOULOS D, Nicolaides AN, Szendro G, Irvine AT, Bull ML, Eastcott HHG. Air plethysmography and the effect of elastic compression on the venous haemodynamics of the leg. J Vasc Surg 1987;5:148-159.
- CARDULLO PA. Título. The Journal of Vascular Technology 1991;15 (fascículo)
- CHERIAN SM, Bobryshev YV, Inder SJ, Lord RS, Ashwell KW (1999) Dendritic Cells in Venous Pathologies. 50: 393-402
- CRONAN JJ, Dorfman GS, et al. Deep vein thrombosis: US assess- ment using vein compression. Radiology 1987;162:191.
- COHAN RH. Leder RA, et al. Extravascular extravasation of radio - graphic contrast media: effects of conventional and low-osmolar agents in the rat thigh. Invest RadioI 1990; 25:504.
- CHRISTOPOULOS D, Nicolaides AN, Szendro G. Venous reflux: quantification and correlation with the clinical severity of chronic venous disease. Br J Surg 1988;75:352-356.
- CAMPBELL CB, Chandler JG, et al. Axi!lary, subclavian and bra - chiocephalic vein obstruction. Surgery 1977; 82:816.
- COMEROTA AJ, Katz ML, et al. Venous duplex imaging: should it replace hemodynamic tests for deep vein thrombosis? J Vasc Surg 1990; 11:53.
- CRONAN JJ. Ultrasound evaluation of deep vein thrombosis. Semin Roentgenol 1992;27:39.
- CRONAN JJ. Venous thromboembolic disease: the role of US. Radi- ology 1993;186:619.
- DARKE SG. The morphology of recurrent varicose veins. Eur J Vasc Surg 1992;6:512-517.
- DORFMAN GS, Froehlich JA, et al. Lower-extremity venous throm- bosis in patients with acute hip fractures: determination of ana- tomic location and time of onset with compression sonography. AJR 1990; 154:851.
- DORFMAN GS, Cronan JJ. Venous ultrasonography. Radiol Clin North Am 1992;30:879.
- DONALD’L.Klipstein-Great Internet Light bulb book, part 1, 2005
- DIMMELER S, Assmus B, Hermann C, Haendeler J, Zeiher AM (1998) Fluid Shear Stress Stimulates Phosphorylation of Akt in Human Endothelial Cells: Involvement in Suppression of Apoptosis. Circ. Res. 83: 334-41.
- DAVIDSON BL, E!liott CG, et al. Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. Ann Intern Med 1992; II 7:735.
- DUQUE FLV e Duque AC - Sistema vascular. In: Viera Romero - Semiologia Médica 12° Ed Medsi, 1981.
- DEWEESE JA, Rogoff SM. Phlebographic pattems of acute deep venous thrombosis of the leg. Surgery 1963;53:99. MOSER KM, Brach BB, et al. Clinically suspected deep venous thrombosis of the lower extremities. JAMA 1977; 237: 2195.
- DARKE SG, Vetrivel S, Foy DMA, Smith S, Baker S. The comparison of duplex scanning and continuous wave Doppler in the assessment of primary and uncomplicated varicose veins. Eur J Vasc Endovasc Surg 1997; 14:457-461.
- EVANGELISTA SSM, Fonseca FP. Fotopletismografia no terço superior da perna no estudo de pacientes com varizes tronculares dos MMII: uma nova técnica. Cir Vasc Angiol 1996;12:77-80.
- EVANGELISTA SSM,Angiologia e Cirurgia Vascular Guia Ilustrada-Guilherme Pitta
- ELAM EA, Dorr RT, et al. Cutaneous ulceration due to contrast extravasation; experimental assessment of injury and potential an - tidotes. Invest Radiol 1991; 26:13.
- FONSECA FP, Evangelista SSM. Investigação não invasiva. In: Bonamigo TP, Burihan E, Cinelli JM, Ristow Av. Doenças da aorta e seus ramos diagnóstico e tratamento. São Paulo: Fundo Editorial Byk; 1991:202.
- FRANZECK UK, Bollinger A, Huch R, Huch A (1984) Transcutaneous Oxygen Tension and Capillary Morphologic Characteristics and Density in Patients with Chronic Venous Incompetence. Circulation. 5: 806-11.
- FONSECA FP, Evangelista SSM, Sarquis AL. Surgery for primary troncular varicose veins without stripping the saphenous vein- pre and post-operative evaluationby duplex scan and photoplethysmography. Phlebology (1995) Suppl.1:419-421
- FILHO JL, Sales Cunha S, Paglioli AS, Souza GG.
- GASKELL P, Burton AC (1953) Local Postural Vasomotor Reflexes Arising from the Limb Veins. Circ. Res. 1: 27-39.
- GODART, S. Studies of the physiology lymphatic vessel by microcirculation methods-1968.
- GODART, S Etude de la microcirculation lymphatique dans divers tissus normaux et dans lês brulures.1970.
- GEORGE JE, Berry RE. Noninvasive detection of deep venous thrombosis: a critical evaluation. Am Surg 1990;56:76.
- GARRIDO, MB*- Patologia e Diagnóstico de varizes dos Membros Inferiores - Maffei “Doenças vasculares Periféricas”- 1987 MEDSI
- GLOVICZKI, P Anastomoses lynphatico - veineuses experimentales
- GOMES CS. Estudo do sistema venoso superficial com o duplex scan a cores. Cir Vasc Angiol 1996; 12.
- GLEISER, Marcelo. A dança do universo. Dos mitos de criação ao big-bang. 2. ed. São Paulo: Companhia das Letras (Editora Schwarcz), 1997.
- HANSPOUL S. Makkar, M.D. Transillumination of a Cystic Lymphatic Malformation University of California, San Francisco, CA 94143
- HAMMARSTEN J, , Pederson P. Cerdelund CG, Campanello M. Long saphenous vein saving surgery for varicose veins: a long-term follow-up. Eur J Vasc Surg 1990;4:361-64.
- HOARE M.C, Royle JP. Doppler ultrasound and detection of saphenofemoral and saphenopopliteal incompetence and operative venography to ensure precise saphenopopliteal ligation. Aust N Z J Surg 1984;54:49-52.
- HUGHES ESR. Venous obstruction in upper extremity (Paget- Schroetter’s syndrome). Surg Gynecol Obstet 1949;88:89.
- HAIMOVICI H, Suffness G. Gangrene of the extremities ofvenous origin: case report. Am J Med Sci 1948; 215:278.
- HAIMOVICI H. Gangrene of the extremities of venous origin: re- view of literature with case reports. Circulation 1950; I : 225.
- HAIMOVICI H. Ischemic forms of venous thrombosis: phlegmasia cerulea dolens, venous gangrene. Springfield, IlI: Charles C Tho- mas,1971.
- JUGENHEIMER M, Junginger T. Endoscopic subfascial sectioning of incompetent perforating veins in treatment of primary varicosis. World J Surg 1992; 16:971-5.
- JONES L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg 1996;12:442-445.
- JOHANNES Nendwich, U. Heiter, F. Kupka, N. Nesvacil e Werner W. Weiss Communications in Asteroseismology, 144, 43 (2004)
- KOHOUT MP, Hansen M, Pribaz JJ, Mulliken JB. Arteriovenous malformation of the head and neck: natural history and management. Plast Reconstr Surg 1988; 102: 643-654.
- KILLEWICH LA, Bedford GR, et al. Diagnosis of deep venous throm- bosis: a prospective study comparing duplex scanning to contrast venography. Circulation 1989; 79:810.
- KIM SH, Park JH, et al. Experimental tissue damage after subcu- taneous injection of water - soluble contrast media. Invest Radiol 1990;25:678.
- KOYANO K, Sakaguchi S. Seletive stripping operation based on doppler findings for primary varicose veins of the lower extremities. Surgery 1988;103 (6): 615 - 619.
- KATAYAMA H, Yamaguchi K, et al. Adverse reaction to ionic and nonionic contrast media. Report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990;175:621.
- LUKE JC. Diagnosis of chronic enlargement of the leg, with de- scription of new syndrome. Surg Gynecol Obstet 1941 ;73:472.
- LAUTIN EM, Freeman NJ, et al. Radiocontrast-associated renal dys- function: incidence and risk factors. AJR 1991;157:49.
- LAERUM F, Holm HA. Postphlebographic thrombosis. Radiology 1981; 140:651.
- LENSING A W, Prandoni P, et al. Detection of deep-vein thrombo- sis by real-time B-mode ultrasonography. N Engl J Med 1989; 320:342.
- MAY R, Thumer J. The cause of predominantly sinistral occur- rence ofthrombosis of the pelvic veins. Angiology 1957; 8:419.
- MAFFEI F: Doenças Vasculares Periféricas. 2nd Ed Medsi, S. Paulo, 1995.
- MAYALL RC: Edemas linfáticos e venosos dos membros inferiores. Tese. Rio de Janeiro. Viallini F°. Ltda, 1970.
- MERISA Garrido - Patologia e diagnóstico de varizes dos membros inferiores pg 615
- MAFFEI F: Doenças Vasculares Periféricas. 2nd Ed Medsi, S. Paulo, 1995.
- MERRITT CR. Evaluation of peripheral venous disease. Clin Diagn Ultrasound 1992;27:113.
- MINAR E, Ehringer H, et al. Prevention of postvenographic throm- bosis by heparin flush: fibrinogen uptake measurement. AJR 1984;143:629.
- MUNN SR, Morton JB, Macbeth WAAG, Mcleish AR. To strip or not to strip the long saphenous vein: a varicose veins trial. Br J Surg 1981;68:426-8.
- MICHEL Blay. Luzes e cores: O arco íris cartesiano.
- MÁXIMO, ANTONIO - Curso de física 2 editora harbra
- MOLNAR L. Doença Venosa Obstrutiva. In: Nectoux
- NOVAIS, Vera Lucia - Estrutura da matéria – Atual editora
- NICOLAIDES AN, Zukowski A, Lewis P, Kyprianou P, Malouf M. The value of ambulatory venous pressure measurements. In: Bergan JJ, Yao JST, editors. Surgery of the veins. Orlando: Grune & Stratton; 1985:111-119.
- NICOLAIDES AN, Investigation of Chronic Venous Insufficiency - A Consensus Statement (Circulation. 2000; 102:e 126.) 2000 American Heart Association, Inc.
- NIELSSON GE,Tenland T,Oberg PA(1980)Evaluation of a Doppler laser flowmeter for measurement of tissue blood flow.Molecular Basis for microcirculatory disorders-G.W Schmid-Schonbein,Granger.
- NEEDLEMAN L. Peripheral venous US. In: Rifkin M, ed. Special course: ultrasound 1991. Oak Brood, 1lI: RSNA Publications, 1991.
- NYAMEKYE I, Shepard NA Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins. Eur J Vasc Endovasc Surg 1998; 15:412-415.
- PARFREY PS, Griffiths SM, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. N Engl J Med 1989;320:143.
- PALMER FG. The RACR survey of intravenous contrast media re- actions: final report. Australas Radiol 1988;32:426.
- PEREIRA AH, editores. Ultra-Sonografia Vascular. Rio de Janeiro. Editora Revinter (primeira edição), 2000; 165-172.
- PICARD, J.D. A Veia sua imagenologia, Lemos editora, tradução Merisa Garrido - 2003
- PETER McLaughlin - O coceito de força de Decartes e sua Determinação
- PUIG S, Aref H, Chigot V, Bonin B, Brunelle F. Classification of venous malformations in children and implications for sclerotherapy. Pediatr Radiol 2003; 33: 99-103.
- PERLIN SJ. Pulmonary embolism during compression US of the lowerextremity. Radiology 1992; 184:165.
- POLAK JF, Cutler SS, et al. Deep veins of the calf: assessment with color Doppler flow imaging. Radiology 1989; 171:481.
- POLAK JF. Venous thrombosis. In: Peripheral vascular sonography: a practical guide. Baltimore: Williams and Wilkins, 1992.
- POLAK JF. Chronic venous thrombosis and venous insufficiency. In: Peripheral vascular sonography: a practical guide. Baltimore: Williams and Wilkins, 1992.
- ROSE SC, Zwiebel WJ, et al. Symptomatic lower extremity deep venous thrombosis: accuracy, limitations, and role of color du- plex flow imaging in diagnosis. Radiology 1990;175:639.
- REPORTING standards in venous disease. Prepared by the Subcommittee on Reporting Standards in Venous Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular
- ROSFORS S. Venous photoplethysmography: Relationship between transducer position and regional distribution of venous insufficiency. J Vasc Surg 1990;11:436-40.
- RUTHERFOR RB, Lowenstein DH, Klein MF. Combining segmental systolic pressure and plethysmography to diagnose arterial occlusive disease of the legs. Am J Surg 1979;138:211-17.
- RABINOV K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104:134.
- RETTORI R. Récidives variquenses postopératories au niveau du creux poplité. Données anatomiques guidant l’exploration ultrasonographique et corollaires chirurgicaux. J Mal Vasc 1998; 23:54-60.
- SHOHAT M, ALPERT G Translumination of the abdomen in neonatal necrotizing enterocolitis NCBI Pub Med Harefuah. 1983 Aug;105(3-4):65-7.
- STEPHEN Hawking. O universo numa casca de noz, 5 edição, tradução Ivo Korytowski, Revisão técnica Augusto Damineli.
- STEPHEN gaukroger - Galileu versus Decarrtes - Organizador Saul fuks decartes 400 anos
- SANCHEZ, César e col. Manual de escleroterapia e flebectomia ambulatória
- SARQUIS AL. Avaliação pré e pós-operatório no tratamento cirúrgico conservador de varizes tronculares com o duplex scan a cores. Cir Vasc Angiol 1996;12:9, Phlebology 1995;1 suppl:419-421.
- SARIN S, Shields DA, Scurr JH, Coleridge Smith PD. Photoplethysmography: A valuable noninvasive tool in the assessment of venous dysfunction? J Vasc Surg 1992;16:154-62.
- SURGERY. J Vasc Surg 1988;8 (2): 172-81.
- SHEPPARD M. A procedure for the prevention of recurrent saphenofemoral incompetence. Aust N Z, J Surg 1978; 48:322-326.
- SANTOS dos JC. Phlebographie directe: cónception, technique, pré - miers résultats. J Int Chir 1938;3:625.
- SWINTON NW, Edget JW, et al. Primary subclavian-axillary vein thrombosis. CircuÍation 1968;38:737 .
- SILVA, Cibelle Celestino. A teoria das cores de Newton: um estudo crítico do Livro I do Opticks (dissertação de mestrado). Campinas: Instituto de Física "Gleb Wataghin", 1996.
- Silva, WALDEMY Sindrome de Paget Schrotter-estudo Clinico e flebográfico, Tese para Docência livre da 3 clinica Cirúrgica - Vascular da FMUFPE 1965
- TOPPER, David. Newton on the number of colours in the spectrum. Studies in History and Philosophy of Science 21: 269-79, 1990.
- TALLERCIO CP, Vliestra RE, et al. Risk for renal dysfunction with cardiac angiography. Ann Intem Med 1986; 104:501.
- TROUSSEAU R. Clinique Médicale de I’Hotel Dieu de Paris, vol III. Paris: Balliere, 1868.
- TOPPER, David. Newton on the number of colours in the spectrum. Studies in History and Philosophy of Science 21: 269-79, 1990
- THOMAS ML. Phlebography. Arch Surg 1972; 104:145.
- THOMAS ML, O’Dwyer JA. A phlebographic study of the inci- dence and significance of venous thrombosis in the foot. AJR 1978;130:751.
- THOMAS ML, McAllister V. The radiological progression of deep venous thrombus. Radiology 1971;99:37.
- TALBOT SR. Use of real-time imaging in identifying deep venous obstruction: a preliminary report. Bruit, 1982; 6:41-46.
- VARICOSE Veins: investigation of the pattern and extent of reflux with color flow duplex scanning. Surgery 1996;119:406-409.
- VAN Bemrnelen PS, Bedford G, et al. Visualization of calf veins by color flow imaging. Ultrasound Med Biol 1990; 16:15.
- VACCARO JP, Cronan JJ, et al. Outcome analysis of patients with norrnal compression US examinations. Radiology 1990; 175: 645.
- WALI MA, Sheehan SJ, Colgan MP, Moore DJ, Shanik GD. Recurrent varicose veins. East Afr Méd 1998;75:188-91.
- WARREN R. Behavior ofvenous thrombi. Arch Surg 1980;115:1151. 13. Mayor EE, Galloway JMD, etal. Venography in iliofemoral venous thromboembolism. Surg Gynecol Obstet 1969;129:57.
- WOLF GL, Arenson RL, Cross AP. A prospective trial of ionic vs nonionic contrast agents in routine clinical practice: comparison of adverse effects. AJR 1989; 152:930.
- WHITE RH, McGahan JP, et al. Diagnosis of deep-vein thrombosis using duplex ultrasound. Ann Intern Med 1989; III :297.
- WHITTAKER, Edmund. A history of the theories of aether and electricity. 2 vols. New York: American Institute of Physics, 1987.
- WANER M, Suen JY (eds) Hemangiomas and vascular malformations of the head and week. New York: Wiley-Liss, 1999.
- YANG D, Vavdongen YK, Stacey MC. Variability and reliability of air plethysmographic measurements for the evaluation of chronic venous disease. J Vasc Surg 1997;26:638-642.
- ZWIEBEL WJ, Priest DL. Color duplex sonography of extremity veins. Semin Ultrasound CT MR 1990;11:136.