¿Podemos prevenir la dehiscencia anastomótica en cirugía oncológica colorrectal mediante el empleo de la angiografía de fluorescencia con verde de indocianina? / Could we pevent anastomotic leak in colorectal oncological surgery by using indocyanine green fluorescence angiography?

Resumen Objetivo La dehiscencia anastomótica (DA) en cirugía colorrectal es una de las complicaciones más devastadoras. El empleo de la angiografía de fluorescencia con verde de indocianina, se ha introducido en este campo como una herramienta prometedora para reducir la incidencia de DA. El objetivo de este estudio es valorar en nuestro medio, los resultados de la introducción de esta técnica en cuanto a prevención de DA. Materiales y Método: Se llevó a cabo un estudio prospectivo, incluyendo 59 pacientes sometidos a cirugía colorrectal resectiva a los que se les realizó una evaluación mediante angiografía con verde de indocianina intraoperatoria de la vascularización anastomótica. Resultados: Tras la aplicación de la técnica, se modificó el punto de sección en 9 pacientes (15,25%); en los cuales no se registró ninguna DA. La tasa de complicaciones global fue de 35,59% (n = 21) objetivando 3 dehiscencias anastomóticas en la serie. Conclusión: Esta técnica se perfila como una estrategia adicional en la prevención de la aparición de DA. Serán necesarios estudios randomizados con inclusión de mayor número de pacientes para obtener resultados concluyentes.

Aim: Anastomotic leakage (AL) following colorectal surgery is one of the most devastating complication. The use of indocyanine green fluorescence angiography has been developed as a promising tool to reduce the incidence of AL. The aim of this study is to evaluate the impact of this technique on the prevention of AL. Materials and Method: A prospective study was carried out, including 59 patients undergoing resective colorectal surgery. It was performed intraoperatively indocyanine green angiography evaluation of the anastomotic perfusión in all of then. Results: The section point was modified in 9 patients (15.25%); in which no AL was registered. The overall complication rate was 35.59% (n = 21), founding 3 anastomotic dehiscences in the serie. Conclusion: In conclusion, in our experience this technique is an additional strategy in the prevention of the AL. Randomized control trial including more patients will be necessary to obtain conclusive results.

Anafilaxia com convulsões após angiografia com fluoresceína em paciente ambulatorial / Anaphylaxis with convulsions following intravenous fluorescein angiography at an outpatient clinic

A fluoresceína endovenosa é associada a pequenos efeitos adversos durante a angiografia da retina, a maioria deles sem gravidade e não relacionada a mecanismos imunológicos. Entretanto, em raras ocasiões, pode ocorrer reação anafilactoide; fatalidades envolvendo o uso de fluoresceína têm sido descritas. Complicações graves após injeção endovenosa de fluoresceína requerem ação imediata da equipe envolvida, assim como treinamento regular para padronizar o tratamento.

Fluorescein is associated with minor adverse effects during retinal angiography, and most of these effects are not severe and not related to immunological mechanism. However, on rare occasions, anaphylatoid reaction can occur, and fatalities involving fluorescein have been described. Life threatening complications after intravenous injection of sodium fluorescein require immediate intervention. Trainings for professionals are needed to standardize treatment for this event.

Anaphylaxis with convulsions following intravenous fluorescein angiography at an outpatient clinic.

Fluorescein is associated with minor adverse effects during retinal angiography, and most of these effects are not severe and not related to immunological mechanism. However, on rare occasions, anaphylatoid reaction can occur, and fatalities involving fluorescein have been described. Life threatening complications after intravenous injection of sodium fluorescein require immediate intervention. Trainings for professionals are needed to standardize treatment for this event.

Adverse reactions of fluorescein angiography: a prospective study.

PURPOSES: To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS: Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS: Out of 1,500 enrolled patients, 1,039 (69.3%) underwent the test for the first time. The mean age was 58 +/- 16 years and the median age was 60 years. Of these, 628 (60.4%) were women. Nausea occurred in 71 (6.83%) patients, vomiting in 14 (1.35%), urticaria in 11 (1.06%), bronchospasm in 4 (0.38%) and laryngeal edema in 1 (0.01%). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A cumulative incidence of 9.72% adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.

Adverse reactions of fluorescein angiography: a prospective study

PURPOSES: To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS:Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS: Out of 1,500 enrolled patients, 1,039 (69.3 percent) underwent the test for the first time. The mean age was 58 ± 16 years and the median age was 60 years. Of these, 628 (60.4 percent) were women. Nausea occurred in 71 (6.83 percent) patients, vomiting in 14 (1.35 percent), urticaria in 11 (1.06 percent), bronchospasm in 4 (0.38 percent) and laryngeal edema in 1 (0.01 percent). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A cumulative incidence of 9.72 percent adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.

OBJETIVO: Determinar a incidência de reações adversas em pacientes submetidos à angiofluoresceinografia pela primeira vez e determinar se hipertensão arterial sistêmica, diabetes ou história de alergia aumentam a chance de reações à fluoresceína intravenosa. MÉTODOS: Os dados foram coletados entre janeiro de 2001 e outubro de 2002 em Recife, Brasil. Pacientes com angiofluoresceinografia prévia, gestantes ou pacientes em uso de medicamentos corticosteróides, imunossupressores ou anti-histamínicos foram excluídos. RESULTADOS: Dos 1.500 pacientes iniciais, 1.039 (69,3 por cento) realizavam o exame pela primeira vez. A idade média foi de 58 ± 16 anos e a mediana de 60 anos. Dentre esses, 628 (60,4 por cento) pessoas eram do sexo feminino. Náusea ocorreu em 71 (6,83 por cento) pacientes, vômito em 14 (1,35 por cento), urticária em 11 (1,06 por cento), broncoespasmo em 4 (0,38 por cento) e edema de laringe em 1 (0,01 por cento). Cinco pacientes apresentaram mais de uma reação adversa. Maiores incidências de reações adversas foram observadas em diabéticos [p<0,002, RR=1,80 (IC=1,24-2,60)], hipertensos [p<0,002, RR=1,84 (IC=1,26-2,71)] e pacientes com história de alergia [p<0,001, RR=3,90 (IC=2,70-5,63)]. CONCLUSÕES: Uma incidência cumulativa de 9,72 por cento de reações adversas foi observada em pacientes submetidos à angiofluoresceinografia pela primeira vez. Presença de história de alergia, diabetes ou hipertensão arterial aumentou a incidência de reações adversas ao contraste.

Influence of bromopride in the prophylaxis of nausea associated with fluorescein angiography.

PURPOSES: To determine the efficacy of bromopride in the prophylaxis of nausea during fluorescein angiography, when compared with a placebo. METHODS: The study was a double-masked random clinical trial, between December of 2004 and April of 2005. Examinations were performed with 20% intravenous fluorescein sodium in a single dose of 2.5 ml. The patients were divided into two groups: group 1, patients who received a 2 ml intravenous dose of 5 mg/ml bromopride and group 2, patients who received a 2 ml intravenous dose of 0.9% sodium chloride (placebo), both 20 minutes before the dye injection. Cases of nausea were observed during and after the examination. RESULTS: 352 patients were enrolled, 176 in each group. Cases of nausea were observed in 12 (6.8%) patients of the bromopride group and in 11 (6.3%) patients of the placebo group (p<0.829 - relative risk=1.05). CONCLUSION: Bromopride did not prevent the occurrence of nausea in fluorescein angiography, when compared with a placebo.

Influence of bromopride in the prophylaxis of nausea associated with fluorescein angiography

PURPOSES: To determine the efficacy of bromopride in the prophylaxis of nausea during fluorescein angiography, when compared with a placebo. METHODS: The study was a double-masked random clinical trial, between December of 2004 and April of 2005. Examinations were performed with 20 percent intravenous fluorescein sodium in a single dose of 2.5 ml. The patients were divided into two groups: group 1, patients who received a 2 ml intravenous dose of 5 mg/ml bromopride and group 2, patients who received a 2 ml intravenous dose of 0.9 percent sodium chloride (placebo), both 20 minutes before the dye injection. Cases of nausea were observed during and after the examination. RESULTS: 352 patients were enrolled, 176 in each group. Cases of nausea were observed in 12 (6.8 percent) patients of the bromopride group and in 11 (6.3 percent) patients of the placebo group (p<0.829 - relative risk=1.05). CONCLUSION: Bromopride did not prevent the occurrence of nausea in fluorescein angiography, when compared with a placebo.

OBJETIVOS: Determinar a eficiência da bromoprida na profilaxia de náuseas na angiofluoresceinografia, quando comparada a um placebo. MÉTODOS: O estudo foi um ensaio clínico aleatório duplo-mascarado, entre dezembro de 2004 e abril de 2005. Os exames foram realizados com fluoresceína sódica a 20 por cento intravenosa em dose única de 2,5 ml. Os pacientes foram divididos em dois grupos: grupo 1, pacientes que receberam 10 mg/ 2 ml de bromoprida via intravenosa e o grupo 2, pacientes que receberam uma dose 2 ml de cloreto de sódio a 0,9 por cento (placebo), ambos 20 minutos antes da injeção do contraste. Foram registrados os casos de náusea durante e após o exame. RESULTADOS: Foram selecionados 352 pacientes, 176 em cada grupo. Foram registrados casos de náusea em 12 (6,8 por cento) pacientes do grupo da bromoprida e 11 (6,3 por cento) pacientes do grupo placebo (p<0,829 - risco relativo=1,09). CONCLUSÃO: Neste estudo a bromoprida não preveniu a ocorrência de náuseas na angiofluoresceinografia, quando comparada a um placebo.

[Angiography: safety x economy]. / Angiografia: segurança x economia.

PURPOSE: To evaluate the safety, effectiveness, and cost of angiofluoresceinographic examination by using both the least amount of dye as well as digital equipment along with a laser photocopier. METHODS: Prospective and comparative study carried out in a group of 70 patients, who underwent an angiographic evaluation with a conventional retinographer injecting 5 ml sodium fluorescein at 10% (control group) as well as a group of 70 patients who underwent an angiographic evaluation with a digital retinographer injecting 2 ml fluorescein at 10% (study group). Arterial pressure, heart rate and oximetry were assessed prior to and after the dye injection. Organic reactions related to the examination were reported. Photograph quality as well as cost between the two techniques were compared. RESULTS: Control group patients showed a greater increase in systolic and diastolic arterial pressure. Heart rate, oximetry measurement and adverse reactions did not show any significant statistical differences between both groups. As for the quality of photographs, a better performance was noticed in the control group. As for the cost, the examination carried out in the study group required lower cost and thus saved around 54.8% per examination in relation to the control group. CONCLUSION: The examination carried out with a lower dose of fluorescein using digital equipment along with a laser photocopier provided greater stability in the systolic and diastolic arterial pressure. However, it did not have any influence on heart rate, oximetry or adverse reactions such as nausea, vomiting, syncope and rashes. The quality of photographs was poor although they enabled diagnosis as well as therapy follow-up for those who carried out the examination. Moreover, economically the above procedure represented a gain of 66.26%, against 25.81% in relation to the conventional equipment.

[Knowledge of ophthalmologists regarding the treatment of adverse reactions in fluorescein angiography]. / Preparo do oftalmologista para o tratamento das reações adversas na retinografia fluoresceínica.

PURPOSES: To evaluate the emergency resources of the clinics that perform fluorescein angiography in Pernambuco and, through a short multiple-choice questionnaire, to evaluate the ophthalmologists' performance to treat adverse reactions to contrast injection and to determine if the time after completing the specialization course in Ophthalmology influences in the results. METHODS: An interview with the eighteen ophthalmologists of the ten clinics where this examination is performed was made. The multiple-choice questionnaire had ten questions with five options each and only one correct answer. This questionnaire was about adverse reactions to fluorescein injection. RESULTS: One physician refused to participate and was excluded from the analysis. Among the others, fifteen physicians (88.2%) were certified specialists by the Brazilian Council of Ophthalmologists. All clinics had the basic structure for the initial care of adverse reactions to contrast injection. Half of these clinics (five) performed this examination with the presence of an anesthesiologist directly monitoring the patient and the other half had one on duty, if necessary. The number of correct answers varied between 3 and 8, with a mean of 5.2 +/- 1.6. Only four (23.6%) physicians gave more than seven correct answers. Specialists with five or less years of postgraduation in Ophthalmology had better results regarding the questionnaire (p<0.001). CONCLUSIONS: Despite appropriate material resources and support by anesthesiologist, the results of this study suggest that ophthalmologists who perform fluorescein angiography are not well-prepared to manage the possible adverse reactions, mainly doctors with more than five years after postgraduation in Ophthalmology.

Preparo do oftalmologista para o tratamento das reações adversas na retinografia fluoresceínica / Evaluation of knowledge of the ophthalmologists regarding for the treatment of adverse reactions in fluorescein angiography

OBJETIVOS: Avaliar a estrutura das clínicas que realizam retinografia fluoresceínica em Pernambuco e, por meio de questionário, avaliar o preparo do oftalmologista para contornar reações adversas relativas ao exame e determinar se o tempo de conclusão do curso de especialização influencia nos resultados. MÉTODOS: Foi realizada entrevista com os 18 médicos nas dez clínicas que realizam este exame. O questionário era de múltipla escolha com dez questões. Versava sobre aspectos das reações adversas. RESULTADOS: Um médico recusou-se a participar e foi excluído. Entre os demais, quinze (88,2 por cento) possuíam o título de especialista. Todas as clínicas estavam bem aparelhadas em relação à estrutura básica de equipamentos e medicações para o atendimento inicial de reações adversas. Metade das clínicas (cinco) realizava o exame com a presença de um anestesista na sala e a outra metade dispunha de um anestesista de sobreaviso dentro da instituição. O número de acertos obtidos pelos médicos variou de 3 a 8, com média de 5,2±1,6 acertos. Apenas quatro (23,6 por cento) médicos obtiveram nota igual ou superior a sete acertos. Médicos com até cinco anos de conclusão do curso de especialização obtiveram melhor desempenho no questionário (p<0,001). CONCLUSÕES: Apesar das clínicas avaliadas contarem com boa estrutura física e disponibilidade de assistência por anestesista, os resultados deste estudo sugerem que a formação dos médicos oftalmologistas que realizam o exame de retinografia fluoresceínica apresenta deficiências em relação à condução de reações adversas deste contraste injetável, principalmente em médicos com mais de cinco anos de conclusão do curso de especialização.

[Secondary ionizing radiation generated by digital and analog coronary cineangiographic equipment: influence of external systems of radiologic protection]. / Radiación ionizante secundaria generada en equipos de cineangiografía coronaria digital y analógica: influencia de los sistemas externos de protección radiológica.

BACKGROUND: Exposure to ionizing radiation is a known hazard of radiological procedures. AIM: To compare the emission of secondary ionizing radiation from two coronary angiographic equipment, one with digital and the other with analog image generation. To evaluate the effectiveness of external radiological protection devices. MATERIAL AND METHODS: Environmental and fluoroscopy generated radiation in the cephalic region of the patient was measured during diagnostic coronary angiographies. Ionizing radiation generated in anterior left oblique projection (ALO) and in anterior right oblique projection (ARO) were measured with and without leaded protections. In 19 patients (group 1), a digital equipment was used and in 21 (group 2), an analog equipment. RESULTS: Header radiation for groups 1 and 2 was 1194 +/- 337 and 364 +/- 222 microGray/h respectively (p < 0.001). During fluoroscopy and with leaded protection generated radiation for groups 1 and 2 was 612 +/- 947 and 70 +/- 61 microGray/h respectively (p < 0.001). For ALO projection, generated radiation for groups 1 and 2 was 105 +/- 47 and 71 +/- 192 microGray/h respectively (p < 0.001). During filming the radiation for ALO projection for groups 1 and 2 was 7252 +/- 9569 and 1671 +/- 2038 microGray/h respectively (p = 0.03). Out of the protection zone, registered radiation during fluoroscopy for groups 1 and 2 was 2800 +/- 1741 and 1318 +/- 954 microGray/h respectively (p < 0.001); during filming, the figures were 15,500 +/- 5840 and 18,961 +/- 10,599 microGray/h respectively (NS). CONCLUSIONS: Digital radiological equipment has a lower level of ionizing radiation emission than the analog equipment.

Angiografia fluoresceínica e suas complicaçöes: relato de um caso de óbito / Fluorescein angiography complication survey

Relato das complicaçöes mais frequentemente encontradas durante a realizaçäo da angiofluoresceinografia. Num período de 3 anos foram realizadas 5626 angiografias. Säo citadas todas complicaçöes ocorridas. Conclue-se que angiografia fluoresceínica é um exame extremamente confiável apesar de näo ser totalmente inócuo

Retinopatia serosa central / Central serous retinopathy

O autor faz uma versao semiotica de angiofluoresceinografia, sua tecnica, suas reacoes, suas idicacoes e contra indicacoes. Fala da importancia de sua realizacao no diagnostico de retinopatia serosa central e, por fim, mostra casos dessa patologia com suas alteracoes anngiofluoresceinografica.