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1.
Rev. bras. ortop ; 57(3): 455-461, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1388017

ABSTRACT

Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.


Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.


Subject(s)
Humans , Ulnar Artery/injuries , Ultrasonography, Doppler , Forearm Injuries
2.
Prensa méd. argent ; 108(3): 132-135, 20220000. fig, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1373064

ABSTRACT

Introducción: Los tumores de las glándulas salivales son infrecuentes en la población en general y comprenden menos del 3% de los tumores de cabeza y cuello1 . En pediatría el 90% corresponden a tumores de la glándula parótida,2 siendo en su mayoría tumores benignos. Objetivo: Describir la incidencia de tumores parotídeos en un centro de referencia, haciendo hincapié en la variabilidad etiológica y la presentación por grupos etarios. Materiales y métodos: Se trata de un estudio de cohorte retrospectivo de pacientes menores de 18 años con tumores de parótida en un periodo de 10 años: de 2011 a 2021, seguidos en el Servicio de Cirugía General Pediátrica del Hospital Italiano de Buenos Aires. Se incluyeron todos los pacientes pediátricos que presentaron tumor en la región parotídea seguidos o tratados en este centro, se excluyeron aquellos que no se pudieron recabar los datos de forma completa. Las variables analizadas fueron edad, sexo, forma de presentación, estudios complementarios, tipo de tratamiento, histología, complicaciones. Resultados: Se analizaron un total de 33 pacientes, de estos un 64% (N = 21) fueron mujeres, con una relación mujer/hombre de 1,7. La media de edad al diagnóstico fue de 8.5 años, siendo 2 de diagnóstico prenatal y hasta los 18 años. La localización fue en un 57% (N = 19) izquierda, el 43% restante derecha. La forma de presentación más frecuente fue la masa palpable en región parotídea 75% (N=25), en dos pacientes fue un hallazgo en estudios por imágenes: resonancia prenatal y otro por resonancia de cerebro. Conclusiones: en pediatría, a diferencia de la población adulta, se presentan una gran variedad de diagnósticos, que incluye desde lesiones vasculares hasta tumores malignos. Debido a que las lesiones parotídeas malignas son clínicamente indistinguibles de las benignas, es importante establecer un diagnóstico preciso. Esta serie representa esta diversidad etiológica en pediatría, así como la distribución etaria comparada con la descrita por la literatura


Introduction: Salivary gland tumors are rare in the general population and comprise less than 3% of head and neck tumors1. In pediatrics, 90% correspond to tumors of the parotid gland,2 being mostly benign tumors. Objective: To describe the incidence of parotid tumors in a reference center, emphasizing the etiological variability and the presentation by age groups. Materials and methods: Tis is a retrospective cohort study of patients under 18 years of age with parotid tumors over a period of 10 years: from 2011 to 2021, followed up at the Pediatric General Surgery Service of the Italian Hospital of Buenos Aires. All pediatric patients who presented tumor in the parotid region followed up or treated in this center were included, those who could not collect the data completely were excluded. Te variables analyzed were age, sex, form of presentation, complementary studies, type of treatment, histology, and complications. Results: A total of 33 patients were analyzed, of which 64% (N = 21) were women, with a female/male ratio of 1.7. Te mean age at diagnosis was 8.5 years, with 2 prenatal diagnoses and up to 18 years. Te location was 57% (N = 19) left, the remaining 43% right. Te most frequent form of presentation was a palpable mass in the parotid region 75% (N=25), in two patients it was a finding in imaging studies: prenatal MRI and another by brain MRI. Conclusions: in pediatrics, unlike the adult population, a wide variety of diagnoses are presented, ranging from vascular lesions to malignant tumors. Because malignant parotid lesions are clinically indistinguishable from benign ones, it is important to establish an accurate diagnosis. Tis series represents this etiological diversity in pediatrics, as well as the age distribution compared to that described in the literature


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Parotid Neoplasms/surgery , Parotid Neoplasms/etiology , Parotid Neoplasms/therapy , Retrospective Studies , Cohort Studies , Ultrasonography, Doppler , Early Diagnosis
3.
J. vasc. bras ; 21: e20190001, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1365069

ABSTRACT

Resumo A artéria femoral profunda, devido às suas características anatômicas, se encontra protegida da maioria dos traumatismos vasculares. Relatamos um caso de pseudoaneurisma de ramo perfurante da artéria femoral profunda, associado à fístula arteriovenosa, secundário a rotura completa do músculo vasto medial em paciente jogador de futebol. A ressonância magnética demonstrou lesão muscular associada a pseudoaneurisma, e a angiotomografia confirmou a presença de pseudoaneurisma associado a fístula arteriovenosa de ramo da artéria femoral profunda. Foi realizado tratamento endovascular da fístula através da embolização com micromolas fibradas e drenagem cirúrgica do hematoma muscular. O paciente evoluiu bem, sem queixas clínicas no 30º dia de pós-operatório e também após 1 ano.


Abstract Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.


Subject(s)
Humans , Male , Adult , Arteriovenous Fistula/therapy , Aneurysm, False , Quadriceps Muscle/injuries , Femoral Artery/injuries , Rupture , Angiography , Magnetic Resonance Spectroscopy , Ultrasonography, Doppler , Embolization, Therapeutic , Femoral Artery/diagnostic imaging , Endovascular Procedures
4.
Ann. Health Res. (Onabanjo Univ. Teach. Hosp.) ; 8(1): 49-62, 2022. figures, tables
Article in English | AIM | ID: biblio-1362843

ABSTRACT

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.


Subject(s)
Humans , Male , Female , Middle Aged , Blood Flow Velocity , Carotid Artery Diseases , Ultrasonography, Doppler , Diabetes Mellitus, Type 2 , Hypertension
5.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.728-736, tab, ilus.
Monography in Portuguese | LILACS | ID: biblio-1353103
6.
Medisan ; 25(5)2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1346545

ABSTRACT

Se presenta el caso clínico de un paciente de 21 años de edad, con antecedente de herniorrafia inguinal derecha, quien asistió a consulta de control y refirió presentar una induración y dolor en la región dorsal del pene con 4 días de evolución, que había comenzado después de una relación sexual en la cual consumió marihuana. En el examen físico se encontró la vena dorsal del pene engrosada, dura y dolorosa a la palpación. Se le diagnosticó una enfermedad de Mondor del pene. La ecografía Doppler confirmó la tromboflebitis de esta vena. El paciente recibió tratamiento médico y evolucionó satisfactoriamente.


The case report of a 21 years patient with history of right inguinal herniorrhaphy is presented, who attended control visit and he made reference to an induration and pain in the dorsal region of the penis with 4 days of evolution that had begun after a sexual relationship in which he consumed marihuana. In the physical exam the penis dorsal vein was found thicken, hard and painful to the palpation. He was diagnosed a Mondor disease of the penis. The Doppler scanning confirmed the thrombophlebitis of this vein. The patient received medical treatment and had a favorable clinical course.


Subject(s)
Penis/injuries , Thrombophlebitis/diagnostic imaging , Ultrasonography, Doppler , Herniorrhaphy
7.
Rev. cuba. oftalmol ; 34(3): e1025, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1352025

ABSTRACT

Objetivo: Determinar los hallazgos por eco-Doppler orbitario en pacientes con glaucoma primario de ángulo abierto según factores de riesgo aterosclerótico. Métodos: Se realizó un estudio observacional descriptivo y transversal en 300 órbitas de 150 pacientes con diagnóstico de glaucoma primario de ángulo abierto. A todos los casos se les realizó tonometría de contorno dinámico y tomografía de coherencia óptica. Se identificaron mediante interrogatorio y por el laboratorio clínico los factores de riesgo aterosclerótico: hipertensión arterial, tabaquismo, diabetes mellitus tipo 2, dislipidemia, obesidad y consumo excesivo de alcohol. Se les realizó ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales se procedió a evaluar mediante eco-Doppler las arterias oftálmica, central de la retina y ciliares posteriores temporales. Resultados: La edad media de los sujetos estudiados fue de 62,3 años. El 55,3 por ciento correspondió al sexo femenino y el 47,3 por ciento al color blanco de la piel. El número de factores de riesgo mostró una correlación lineal moderada, positiva y significativa con el índice de resistencia, mientras que con las velocidades dicha correlación resultó ser negativa. Todos los factores de riesgo expresaron efectos dañinos sobre la hemodinámica del flujo ocular, la presión intraocular y el grosor de las capas de fibras neurorretinianas temporales. Tras ajustar para la edad, esta negativa influencia continuó siendo relevante en la mayoría de los casos. Conclusiones: Los aspectos vasculares del glaucoma deben integrarse a la práctica clínica de esta afección, lo que ayudará a que el enfoque sea más completo, y redundará en un mejor pronóstico de la enfermedad(AU)


Objective: Determine the orbital echo-Doppler findings in patients with primary open angle glaucoma according to atherosclerotic risk factors. Methods: A cross-sectional observational descriptive study was conducted of 300 orbits of 150 patients diagnosed with primary open angle glaucoma. All the cases underwent dynamic contour tonometry and optical coherence tomography. Interrogation and clinical laboratory testing led to identification of the following atherosclerotic risk factors: arterial hypertension, smoking, diabetes mellitus type 2, dyslipidemia, obesity and excessive alcohol consumption. Orbital and carotid Doppler ultrasounds were performed, and only if they were normal they would be followed by echo-Doppler evaluation of the ophthalmic, central retinal and posterior temporal ciliary arteries. Results: Mean age of the study subjects was 62.3 years. 55.3 percent were female and 47.3 percent had white skin. The number of risk factors showed a moderate, positive and significant linear correlation with the resistive index, and a negative correlation with the velocities. All the risk factors expressed harmful effects on ocular flow hemodynamics, intraocular pressure and the thickness of temporal neuroretinal fibers. After adjusting for age, this negative influence continued to be relevant in most cases. Conclusions: The vascular aspects of glaucoma should be incorporated into the clinical management of this condition. This will make the approach more thorough and help achieve a better diagnosis(AU)


Subject(s)
Humans , Female , Middle Aged , Glaucoma, Open-Angle/diagnosis , Risk Factors , Ultrasonography, Doppler/methods , Tomography, Optical Coherence/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic , Intraocular Pressure
8.
J. coloproctol. (Rio J., Impr.) ; 41(3): 234-241, July-Sept. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1346425

ABSTRACT

The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective: To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method: A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with highmucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence. Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion: Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Hemorrhoids/therapy , Treatment Outcome , Ultrasonography, Doppler , Hemorrhoidectomy/methods
9.
Arq. bras. neurocir ; 40(1): 107-112, 29/06/2021.
Article in English | LILACS | ID: biblio-1362261

ABSTRACT

Neurofibromatosis type 1 (NF1) is a genetic syndrome which typically presents with neurological manifestations. Some of the patients may also present with vasculopathies, among which arterial aneurysms and stenosis are the most common. Deep vein thrombosis (DVT) has rarely been described, and, to the best of our knowledge, the present is the first report of DVT due to venous compression by a neurofibroma in the setting of NF1. This is the case of a 23-year-old male with NF1 who experienced DVT due to compression of the left posterior tibial veins by a large tumor arising from the tibial nerve. The DVT was acutely treated with enoxaparin and then with rivaroxaban. Two months after the diagnosis, Doppler ultrasonography showed partial recanalization and persistence of the DVT. The patient was then referred to neurosurgery for surgical resection of the tumor. There were no complications during the procedure, and the patient did not present postoperative neurological deficits. The final histopathological diagnosis was of a benign neurofibroma. After one year of follow-up with vascular surgery, the patient presented no more episodes of DVT. In case there is a tumor compressing the deep vessels of the leg and promoting DVT, surgical resection with microsurgical techniques may be curative.


Subject(s)
Humans , Male , Young Adult , Neurofibromatosis 1/surgery , Neurofibromatosis 1/complications , Venous Thrombosis/etiology , Venous Thrombosis/drug therapy , Neurofibromatosis 1/diagnostic imaging , Enoxaparin/therapeutic use , Ultrasonography, Doppler/methods , Venous Thrombosis/diagnostic imaging , Rivaroxaban/therapeutic use , Neurofibroma/surgery
10.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 383-394, Mar.-Apr. 2021. graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1248923

ABSTRACT

This study used B-mode and Doppler ultrasonography to characterize the abdominal structures of healthy peccaries raised in captivity. Fifteen peccaries were used for this study. The urinary vesicle appeared as an ovoid structure, located in the abdominal and pelvic transition, with a hyperechogenic, thin, smooth, and regular wall. The kidneys presented retroperitoneal topography and had similar sizes. The kidney/aorta ratio had an average value of 10.53±15cm (right) and 10.23±0.12 (left). The right adrenal gland had a length of 1.93±0.34cm and diameter of 0.56±0.16cm. The left adrenal gland had a length of 1.85±0.42cm and diameter of 0.52±0.11cm. The spleen had a diameter of 1.13±0.18cm. The hepatic vein demonstrated polyphasic flow in pulsed Doppler, with two retrograde peaks and an anterograde peak with a flow velocity of 25.7±0.83cm/s. The abdominal aorta had a diameter of 0.58±0.05cm and a flow velocity of 115.17±5.32cm/s. The morphological and hemodynamic study of the abdominal structures of the peccary, observed through B-mode and Doppler ultrasonography, aided in identifying the size, shape, position, echogenicity, and echotexture of the abdominal organs and in making inferences about the normal parameters for these structures in this species.(AU)


Este estudo teve como objetivo utilizar as ultrassonografias de modo-B e Doppler para caracterizar as estruturas abdominais de um cateto sadio criado em cativeiro. Quinze catetos foram utilizados para este estudo. A vesícula urinária apareceu como uma estrutura ovoide, localizada na transição entre as partes abdominal e pélvica, com uma parede hiperecogênica, fina, lisa e regular. Os rins apresentaram topografia retroperitoneal e tamanhos semelhantes. A relação rim/aorta teve um valor médio de 10,53 ± 15cm (direita) e 10,23 ± 0,12cm (esquerda). A glândula adrenal direita tinha um comprimento de 1,93 ± 0,34cm e um diâmetro de 0,56 ± 0,16cm. A glândula suprarrenal esquerda tinha um comprimento de 1,85 ± 0,42cm e um diâmetro de 0,52 ± 0,11cm. O baço tinha um diâmetro de 1,13 ± 0,18cm. A veia hepática demonstrou fluxo polifásico no Doppler pulsátil, com dois picos retrógrados e um pico anterógrado com velocidade de fluxo de 25,7±0,83cm/s. A aorta abdominal tinha um diâmetro de 0,58 ± 0,05cm e uma velocidade de fluxo de 115,17±5,32cm/s. Os estudos morfológico e hemodinâmico das estruturas abdominais do queixada, observadas por meio das ultrassonografias modo-B e Doppler, auxiliaram na identificação do tamanho, da forma, da posição, da ecogenicidade e da ecotextura dos órgãos abdominais e na realização de inferências sobre os parâmetros de normalidade para as estruturas nas espécies.(AU)


Subject(s)
Animals , Artiodactyla/anatomy & histology , Abdomen/diagnostic imaging , Hemodynamics , Echocardiography, Doppler/veterinary , Ultrasonography, Doppler/veterinary
11.
Rev. bras. med. fam. comunidade ; 16(43): 2572, 20210126. tab, graf
Article in Portuguese | LILACS, ColecionaSUS | ID: biblio-1292041

ABSTRACT

Introdução: A iatrogenia é uma causa importante de morbimortalidade, logo, a prevenção quaternária (P4), ação que ceifa a cascata diagnóstica supérflua, foi incluída como exercício de boa prática. A medicina de família e comunidade (MFC) introjeta a P4 na vivência, sendo capaz de usar ciência aliada a habilidades de comunicação para conhecer as pessoas, resolvendo assim cerca de 85% das queixas, o que inclui as de origem vascular. Existe uma alta demanda no Sistema Único de Saúde (SUS) tanto na marcação de exames quanto no encaminhamento para especialistas focais no que tange às queixas circulatórias, mas nem sempre encaminhar é oportuno. Nesse cenário, a MFC funciona como um caminho para a P4. Objetivos: O objetivo do presente estudo foi avaliar as referências para cirurgia vascular e angiologia e as solicitações de ultrassonografia (USG) Doppler de vasos de unidades de saúde da família (USFs) de João Pessoa/PB, analisando as taxas de solicitações por população adulta (>18 anos) adscrita, nas unidades conveniadas ao programa de residência em medicina de família e comunidade (PRMFC) há mais de 1 ano, há menos de 1 ano e naquelas sem convênio com PRMFC, sob o olhar crítico da P4. Métodos: Trata-se de um estudo transversal a partir de dados fornecidos pela Central de Regulação da Secretaria Municipal de Saúde de João Pessoa (SMS/JP), entre janeiro de 2017 e agosto de 2018. Para realização dos cálculos de correlação entre as variáveis estudadas, utilizou-se o teste de Kruskall-Wallis através do software SPSS 21.0. Resultados: O número total de pedidos de exames em análise foi de 3.918, oriundos de 90 USF, que somam uma população adscrita maior de 18 anos de 332.819 pessoas. Solicitou-se 1 Doppler a cada 85 habitantes adultos. Os resultados do estudo sugerem que os médicos residentes solicitam mais exames que os médicos não residentes, mas por outro lado apresentam menor taxa de encaminhamento aos especialistas. Conclusões: Estes achados podem sugerir que os médicos residentes encaminham menos, o que pode estar relacionado ao aumento da resolubilidade da atenção primária à saúde (APS) e ao ensino da P4 sob orientação de um médico de família e comunidade preceptor. Entretanto, novos delineamentos de pesquisa são necessários para melhor elucidar esta hipótese.


Introduction: Iatrogenesis is an important cause of morbimortality and quaternary prevention (P4), an action that reduces the superfluous diagnostic cascade, was included as an exercise of good practice. Family practice projects P4 into practice, being able to use science combined with communication skills to know people, solving about 85% of complaints, including vascular discomforts. There is a high demand at Sistema Único de Saúde (SUS) both in scheduling exams and referrals to focal specialists with regard to circulatory complaints, but referring is not always appropriate. In this scenario, family practice works as a pathway to P4. Objectives: The aim of the present study was to evaluate the referrals for vascular surgery/angiologist and requests for Doppler ultrasonography (USG) of vessels from family health units (USF) in João Pessoa, PB, analyzing the rates of requests per registered adult population (>18-years-old) in the units affiliated to the family practice medical residency program (FPMRP) for more than a year, less than a year and in the non-affiliated ones, under P4's critical view. Methods: This is a cross-sectional study of data provided by the Regulation Center of the Municipal Health Department of João Pessoa, between January 2017 and August 2018. To perform the correlation calculations between the studied variables, Kruskall-Wallis' correlation test was used through the SPSS 21.0 software. Results: The total number of exam requests under analysis was 3,918, from 90 USF, which add up to an enrolled population over 18-years-old of 332,819 people. For every 85 adult inhabitants, one Doppler exam was requested. Data suggest that the resident doctors request more exams than the non-residents, but on the other hand they have lower rates of referrals to focal experts. Conclusions: These findings may suggest that resident physicians refer less, which may be related to the increase in the resolution of primary care and the teaching of P4 under the guidance of a family practice preceptor. However, new research designs are considered to better elucidate this hypothesis.


Introducción: La iatrogenia es una causa importante de morbilidad y mortalidad, por lo que se incluyó como ejercicio de buena práctica la prevención cuaternaria (P4), una acción que corta la cascada diagnóstica superflua. La medicina familiar y comunitaria (MFC) introduce la P4 en la práctica, siendo capaz de utilizar la ciencia aliada a las habilidades de comunicación para conocer a las personas, resolviendo así alrededor del 85% de las quejas, lo que incluye las quejas vasculares. En el Sistema Único de Salud (SUS) brasileño hay una gran demanda, tanto para programar exámenes como para derivar a los especialistas focales las dolencias circulatorias, pero la derivación no siempre es oportuna. En este escenario, la CBM funciona como una vía hacia la P4. Objetivo: El objetivo del presente estudio fue evaluar las referencias de cirugía vascular y angiología y las solicitudes de ultrasonografía Doppler (USG) de vasos de las unidades de salud de la familia (USF) de João Pessoa/PB, analizando las tasas de solicitudes por población adulta (>18 años) asignada, en las unidades asociadas al programa de residencia en medicina de la familia y de la comunidad (CFMRP) por más de 1 año, por menos de 1 año y en las que no tienen convenio con el CFMRP, bajo la visión crítica del P4. Métodos: Se trata de un estudio transversal de datos proporcionados por la Central de Regulación de la Secretaría Municipal de Salud de João Pessoa (SMS/JP), entre enero de 2017 y agosto de 2018. Se utilizó la prueba de Kruskall-Wallis para realizar los cálculos de correlación entre las variables estudiadas mediante el programa informático SPSS 21.0. Resultados: El número total de solicitudes de pruebas analizadas fue de 3.918, procedentes de 90 USF, que suman una población asignada mayor de 18 años de 332.819 personas. Se solicitó un Doppler por cada 85 habitantes adultos. Los resultados sugieren que los médicos residentes solicitan más pruebas que los no residentes, pero por otro lado tienen una tasa de derivación a especialistas más baja. Conclusiones: Estos resultados pueden sugerir que los médicos residentes derivan menos, lo que puede estar relacionado con la mayor resolutividad de la Atención Primaria de Salud (APS) y la enseñanza de la P4 bajo la dirección de un médico de familia y un preceptor comunitario. Sin embargo, se necesitan nuevos diseños de investigación para dilucidar mejor esta hipótesis.


Subject(s)
Humans , Adolescent , Adult , Primary Health Care , Referral and Consultation/statistics & numerical data , Vascular Surgical Procedures/statistics & numerical data , Ultrasonography, Doppler/statistics & numerical data , Quaternary Prevention , Internship and Residency , Cross-Sectional Studies
14.
Article in French | AIM | ID: biblio-1353568

ABSTRACT

Introduction. L'index de pression systolique (IPS) est considéré comme un outil indispensable, pour la prise en charge de l'artériopathie oblitérante des membres inférieurs (AOMI), cependant un complément d'exploration par les autres testes physiologiques, IPS au gros orteil et IPS effort s'impose afin de réduire le nombre des faux négatifs. Objectif. Démontrer le faible apport de l'IPS cheville de repos par rapport à l'échodoppler artériel des membres inférieurs dans le diagnostic de l'AOMI. Matériels et méthodes. Sur une série de 300 malades coronariens consécutifs durant l'année 2016 hospitalisés dans le service de cardiologie de l'hôpital universitaire de Constantine, un dépistage de l'AOMI a été réalisé par les investigations suivantes : Mesure de l'IPS à la cheville, compléter par la mesure de l'IPS a l'orteil si incompressibilité artérielle et par la mesure de l'IPS d'effort si l'IPS de repos est limite. Un échodoppler artériel des membres inférieurs a été réalisée par un échographe vividE9 General Electric pour l'ensemble de nos malades, en utilisant une sonde à balayage linéaire 12L, destinée à l'exploration vasculaire périphérique permettant d'obtenir un dépistage ciblé, Le traitement et l'exploitation des données ont fait appel au logiciel SPSS22. Résultats. Une sensibilité modérée de l'ordre de 50%, face à une spécificité élevée avoisinant 100% de l'IPS cheville de repos par rapport à l'échodoppler artériel des membres inférieurs. Sensibilité nettement améliorer après complément par les autres testes physiologiques qui sont la prise de l'IPS cheville effort et la mesure de l'index de pression systolique au gros orteil. Conclusion. L'examen vasculaire des membres inférieurs associe à la mesure de l'IPS cheville couplée aux autres testes physiologique (IPS au gros orteil et IPS effort) assurent une bonne sensibilité et spécificité diagnostiques de l'AOMI


Subject(s)
Ultrasonography, Doppler , Lower Extremity , Ankle Brachial Index , Peripheral Arterial Disease
15.
Acta sci. vet. (Impr.) ; 49: Pub. 1846, 2021. tab, graf
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1363567

ABSTRACT

The oscillometric monitor is a noninvasive method used for measuring blood pressure in dogs and cats. Despite widely used, there is a large variability in the accuracy of oscillometric monitors, which may also be influenced by the location of the blood pressure cuff. The Doppler ultrasound is another non-invasive method that was shown to measure blood pressure with good accuracy and precision in small animals. The present study aimed to determine the agreement between systolic arterial pressure (SAP) measured by the Prolife P12 oscillometric monitor with 2 cuff locations and the Doppler ultrasound in anesthetized dogs. Dogs scheduled for routine anesthetic procedures were included in the study, which was carried out in 2 phases. In Phase 1, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor with the cuff placed at the thoracic limb for both methods. In Phase 2, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor, with the cuff placed at the thoracic limb for the Doppler and at the base of the tail for the P12. The cuff width corresponded to approximately 40% of limb or tail circumference. On all occasions, 3 consecutive measurements of SAP were recorded, followed by a single measurement of SAP by the P12, and then other 3 measurements were performed with the Doppler. The arithmetic mean of the 6 SAP measurements with the Doppler was compared with the SAP value measured by the P12 monitor (paired measurements). Agreement between SAP values measured by the Doppler and the P12 monitor was analyzed by the Bland Altman method for calculation of the bias (Doppler - P12) and standard deviation (SD) of the bias. The percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg and Pearson's correlation coefficients were also calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods. A total of 33 dogs were included in Phase 1 and 15 were included in Phase 2. During Phases 1 and 2, 179 and 87 paired measurements were recorded, respectively. Most of the measurements were recorded during normotension (SAP = 90-130 mmHg): 113/179 in Phase 1 and 52/87 in Phase 2. The bias (± SD) for Phases 1 and 2 were -2.7 ± 14.1 mmHg and 7.2 ± 25.8 mmHg. The percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: Phase 1, 61% and 83%; Phase 2, 41% and 70%. Correlation coefficients were 0.81 and 0.67 for Phases 1 and 2, respectively. According to the ACVIM criteria, maximum values accepted for bias are 10 ± 15 mmHg, the percentages of differences ≤ 10 mmHg and ≤ 20 mmHg should be ≥ 50% and ≥ 80%, respectively, and the correlation coefficient should be ≥ 0.9. When the blood pressure cuff was placed at the thoracic limb, SAP values measured by the P12 monitor met most of the ACVIM criteria, demonstrating good agreement with SAP values measured by the Doppler. The only requirement not met was the correlation coefficient which was 0.81 whereas the recommended is ≥ 0.9. Conversely, when the cuff was placed at the base of the tail, SAP values measured by the P12 monitor did not meet most of the ACVIM criteria indicating that, in anesthetized dogs, SAP measurements with the P12 monitor should be performed with the cuff placed at the thoracic limb. One limitation of this study was that most measurements fell in the normotensive range and the results should not be extrapolated for hypotensive and hypertensive conditions. In conclusion, the Prolife P12 oscillometric monitor demonstrated good agreement with SAP values measured by the Doppler and provides acceptable values in normotensive anesthetized dogs.(AU)


Subject(s)
Animals , Dogs , Blood Pressure Determination/instrumentation , Blood Pressure Determination/veterinary , Ultrasonography, Doppler/instrumentation , Arterial Pressure
16.
J. vasc. bras ; 20: e20210098, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1356453

ABSTRACT

Resumo Contexto A insuficiência renal crônica é um problema de saúde pública mundial. A hemodiálise é a principal terapia renal substitutiva. As fístulas arteriovenosas (FAV) são uma possível escolha, mas apresentam altas taxas de falência. Objetivos Este estudo tem como objetivo avaliar a relação entre as variáveis hemodinâmicas ao ultrassom vascular com Doppler no intraoperatório e a perviedade precoce da FAV para hemodiálise. Métodos Tratou-se de um estudo prospectivo observacional. Os pacientes consecutivos foram submetidos a FAV com ultrassonografia vascular com Doppler em intraoperatório nos dias 1, 7, 30 e 60. Eles foram divididos em grupos quanto à presença ou não de perviedade primária e secundária, e o volume de fluxo (VF) e a velocidade de pico sistólico (VPS) foram comparados. Foram realizadas curvas receiver operating characteristic (ROC), com definição de valores de VPS e VF com sensibilidade (S) e especificidade (E). Resultados Foram analisados 47 pacientes, os quais preencheram os critérios de inclusão. Os valores de VPS e VF intraoperatório foram maiores nos pacientes com perviedade primária e secundária comparados àqueles com falência. Os seguintes valores apresentaram maiores sensibilidade e especificidade para predizer perviedade primária aos 30 dias: 106 cm/s para VPS venoso, S: 75%, E: 71,4%; e 290,5 mL/min para VF arterial, S: 80,6%, E: 85,7%. Para perviedade secundária aos 30 dias, foram observados: 106 cm/s para VPS arterial, S: 72,7%, E: 100%; e 230 mL/min para VF venoso, com S: 86,4%, E: 100%. Para a perviedade primária no 60º dia, foram observados: 106 cm/s para VPS venoso, S: 74,4%, E: 62,5%; e 290,5 mL/min para VF arterial, S: 80%, E: 75%. Conclusões A velocidade de pico sistólico e o VF ao ultrassom vascular com Doppler intraoperatório são preditores de perviedade precoce na FAV para hemodiálise.


Abstract Background Chronic kidney disease is a major public health problem. Hemodialysis is the most common renal replacement therapy. Arteriovenous fistulas (AVF) are a possible access option, but early failure rates remain high. Objectives to investigate the value of intraoperative vascular Doppler ultrasound for predicting early AVF patency. Methods Prospective observational study. Consecutive patients undergoing AVF were assessed with vascular Doppler ultrasonography intraoperatively and on days 1, 7, 30, and 60. Patients were divided into groups according to presence or absence of primary and secondary patency. Blood flow (BF) and peak systolic velocity (PSV) were compared. ROC curves were plotted and used to define the PSV and BF values that yielded greatest sensitivity (Sens) and specificity (Spec). Results 47 patients met the inclusion criteria and were analyzed. Higher intraoperative PSV and BF values were observed in patients who had primary and secondary patency than in patients with access failure. The values with greatest sensitivity and specificity for predicting 30-day primary patency were 106 cm/s for venous PSV (Sens: 75% and Spec: 71.4%) and 290.5 ml/min for arterial blood flow (Sens: 80.6% and Spec 85.7%). Values for 30-day secondary patency were 106 cm/s for arterial PSV (Sens: 72.7%, Spec: 100%) and 230 ml/min for venous blood flow (Sens: 86.4%, Spec100%). Values for 60-day primary patency were 106 cm/s for venous PSV (Sens: 74.4%, Spec: 62.5%) and 290.5 ml/min for arterial blood flow (Sens: 80%, Spec: 75%). Conclusions Peak systolic velocity and blood flow measured using intraoperative vascular Doppler ultrasound can predict early patency of hemodialysis arteriovenous fistulas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vascular Patency , Arteriovenous Fistula/diagnostic imaging , Ultrasonography, Doppler/methods , Arteriovenous Shunt, Surgical/adverse effects , Prospective Studies , Renal Dialysis , Hemodynamic Monitoring/methods , Intraoperative Care/methods
17.
J. vasc. bras ; 20: e20200093, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1346433

ABSTRACT

Resumo Contexto O ultrassom contrastado por microbolhas (CMUS) é uma modalidade diagnóstica de acurácia bem demonstrada por estudos internacionais para seguimento de reparo endovascular do aneurisma de aorta abdominal (EVAR). Não existem, no entanto, estudos nacionais focados nesse método de seguimento. Objetivos O objetivo deste estudo foi relatar a experiência inicial com CMUS em um hospital terciário, traçando uma comparação dos achados do CMUS com o ultrassom Doppler convencional (USGD), com o intuito de verificar se a adição de contraste ao protocolo padrão de controle ultrassonográfico incorreu alteração nos achados. Métodos Entre 2015 e 2017, 21 pacientes em seguimento de EVAR foram submetidos ao USGD seguido de CMUS. Foram avaliados os achados de exame referentes à identificação de complicações, bem como à capacidade de identificação da origem da endofuga. Resultados Entre os 21 casos avaliados, 10 complicações foram evidenciadas no total: sete pacientes apresentaram endofuga (33,3%); dois pacientes apresentaram estenose em ramo de endoprótese (9,52%); e um paciente apresentou dissecção em artéria ilíaca externa (4,76%). Em 21 pacientes avaliados, o uso combinado dos métodos identificou 10 casos de complicações pós-EVAR. Em seis dos sete casos de endofugas (85,71%), o uso dos métodos combinados foi capaz de identificar a origem. O USGD isolado falhou na identificação da endofuga em dois casos (28,5%), identificando achados duvidosos em outros dois casos (28,5%), que obtiveram definição diagnóstica após associação do CMUS. Conclusões O CMUS é uma técnica de fácil execução, a qual adiciona subsídios ao seguimento de EVAR infrarrenal.


Abstract Background Microbubble contrast enhanced ultrasound (CEUS) is an accurate diagnostic method for follow-up after endovascular abdominal aortic aneurysm repair (EVAR) that has been well-established in international studies. However, there are no Brazilian studies that focus on this follow-up method. Objectives The objective of this study was to report initial experience with CEUS at a tertiary hospital, comparing the findings of CEUS with those of conventional Doppler ultrasound (DUS), with the aim of determining whether addition of contrast to the standard ultrasonographic control protocol resulted in different findings. Methods From 2015 to 2017, 21 patients in follow-up after EVAR underwent DUS followed by CEUS. The findings of these examinations were analyzed in terms of identification of complications and their capacity to identify the origin of endoleaks. Results There was evidence of complications in 10 of the 21 cases examined: seven patients exhibited endoleaks (33.3%); two patients exhibited stenosis of a branch of the endograft (9.52%); and one patient exhibited a dissection involving the external iliac artery (4.76%). In the 21 patients assessed, combined use of both methods identified 10 cases of post-EVAR complications. In six of the seven cases of endoleaks (85.71%), use of the methods in combination was capable of identifying the origin of endoleakage. DUS alone failed to identify endoleaks in two cases (28.5%) and identified doubtful findings in another two cases (28.5%), in which diagnostic definition was achieved after employing CEUS. Conclusions CEUS is a technique that is easy to perform and provides additional support for follow-up of infrarenal EVAR.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Ultrasonography, Doppler/instrumentation , Contrast Media , Microbubbles , Endovascular Procedures , Follow-Up Studies , Aortic Aneurysm, Abdominal/rehabilitation , Aortic Aneurysm, Abdominal/diagnostic imaging , Ultrasonography, Doppler/methods
18.
J. vasc. bras ; 20: e20200216, 2021. tab, graf
Article in English | LILACS | ID: biblio-1279379

ABSTRACT

Abstract Moyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.


Resumo A doença de moyamoya é um distúrbio raro que envolve o sistema cerebrovascular. Normalmente, leva à oclusão das artérias do sistema cerebral e causa problemas circulatórios no cérebro. Uma mulher de 48 anos foi admitida em nossa clínica com claudicação intermitente em ambas as pernas. Na ultrassonografia com Doppler, foram detectados padrões de formato de onda bifásico e monofásico nas extremidades inferiores distais (artérias da trifurcação) de forma bilateral. Portanto, realizou-se o exame vascular sistêmico na paciente. A angiografia por tomografia computadorizada revelou oclusão carotídea bilateral no nível dos segmentos supraclinoides, e opacificações foram detectadas nos segmentos distais das artérias cerebelares anteriores e médias de forma bilateral. A paciente foi diagnosticada com doença de moyamoya, e o tratamento anticoagulante foi iniciado. Em conclusão, a maioria dos relatos anteriores apresentou o envolvimento cerebrovascular da doença de moyamoya. No entanto, essa doença pode envolver diferentes sistemas vasculares periféricos, e um exame vascular sistêmico minucioso é necessário para um diagnóstico exato.


Subject(s)
Humans , Female , Middle Aged , Ultrasonography, Doppler , Computed Tomography Angiography , Moyamoya Disease/diagnostic imaging , Popliteal Artery , Intermittent Claudication/complications , Leg , Moyamoya Disease/complications
19.
J. vasc. bras ; 20: e20200070, 2021. graf
Article in Portuguese | LILACS | ID: biblio-1279370

ABSTRACT

Resumo A regurgitação tricúspide severa é citada como fator associado ao desenvolvimento ou à recidiva de varizes em membros inferiores as quais podem, retrogradamente, apresentar um fluxo pulsátil. O diagnóstico etiológico diferencial desse achado ultrassonográfico deve ser feito com a pesquisa de fístulas arteriovenosas, tendo em vista as diferentes formas de tratamento. Dada a complexidade do estado geral dos pacientes com regurgitação tricúspide, a escolha do tratamento das varizes pulsáteis deve ser individualizada, fruto de uma avaliação multidisciplinar. Fazem parte do arsenal terapêutico todas as técnicas habitualmente empregadas no tratamento de varizes, bem como a associações entre elas a serem escolhidas levando-se em conta a gravidade das manifestações clínicas e o risco cardiovascular envolvido. Relatamos um caso de varizes pulsáteis secundárias a regurgitação tricúspide, diagnosticado durante a suspeita primária de aneurisma de artéria femoral em paciente de 73 anos, com a classificação clínica da doença venosa (CEAP) 4a, oligossintomática, tratada com medidas posturais e elastocompressão.


Abstract Severe tricuspid regurgitation is mentioned as a factor associated with development or recurrence of varicose veins in the lower limbs and may present with retrograde pulsatile flow. Differential etiological diagnosis of this ultrasound finding must include investigation of arteriovenous fistulas, since the treatment methods are different. Given the complexity of the general condition of patients with tricuspid regurgitation, treatment for pulsatile varices should be chosen on a case-by-case basis after multidisciplinary evaluation. All of the techniques commonly used to treat varicose veins are part of the therapeutic arsenal, as well as combinations of them, taking into account the severity of clinical manifestations and the cardiovascular risk involved. We report a case of pulsatile varices secondary to tricuspid regurgitation diagnosed when investigating a primary suspicion of femoral artery aneurysm in a 73-year-old patient, CEAP 4a, oligosymptomatic, who was treated with postural measures and elastic compression.


Subject(s)
Humans , Female , Aged , Tricuspid Valve Insufficiency/complications , Varicose Veins/complications , Varicose Veins/therapy , Varicose Veins/diagnostic imaging , Pulsatile Flow , Ultrasonography, Doppler , Diagnosis, Differential
20.
ABCD arq. bras. cir. dig ; 34(1): e1560, 2021. tab, graf
Article in English | LILACS | ID: biblio-1248509

ABSTRACT

ABSTRACT Background: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.


RESUMO Racional: O tratamento da doença hemorroidária pela técnica de THD (Transanal Hemorrhoidal Dearterialization) é minimamente invasivo e tem se mostrado seguro e eficiente. No entanto, dados sobre a recorrência e complicações (dor e tenesmo) no pós-operatório são muito variáveis. Objetivo: Avaliar se a desarterialização e mucopexia seletiva, sem o uso de Doppler, é suficiente para o controle de sintomas e se a morbidade pós-operatória é menor com esta técnica. Métodos: Vinte pacientes foram tratados com essa técnica e avaliados sobre controle de sintomas, morbidade pós-operatória e recorrência. Resultados: Controle do prolapso e sangramento foi observado em todos pacientes (n=20). Complicações pós-operatórias foram: tenesmo (n=2), trombose hemorroidária externa (n=2), retenção urinária (n=2). Após um seguimento médio de 13 meses, nenhuma recorrência foi detectada. Conclusões: O procedimento de desarterialização e mucopexias seletivas é seguro e eficiente em termos de controle do prolapso e sangramento. Esta técnica resulta em menor morbidade cirúrgica, uma vez que diminui o número de suturas no canal anal, resultando em menos dor e tenesmo pós-operatório. Para este procedimento o uso de ultrassom Doppler é desnecessário, o que diminui custos e o torna mais atrativo do ponto de vista econômico.


Subject(s)
Humans , Hemorrhoidectomy , Hemorrhoids/surgery , Anal Canal , Arteries/surgery , Rectum , Treatment Outcome , Ultrasonography, Doppler , Ligation
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