Protocol for prophylaxis of venous thromboembolism in varicose vein surgery of the lower limbs.

Pulmonary embolism is the most feared complication of venous thromboembolism (VTE) and the third leading cause of cardiovascular mortality in the world, after acute myocardial infarction and stroke. The risk of VTE is virtually universal in hospitalized patients, especially those with reduced mobility. Although variable in incidence between clinical and surgical patients, up to 66.6% of events related to hospitalizations can occur after discharge, with this risk remaining for up to 90 days. Despite all the investment made in VTE prophylaxis in recent decades, there is still no consensus or specific guidelines for its prevention in patients undergoing conventional surgery for varicose veins of lower limbs. The adoption of a validated risk assessment model for VTE prophylaxis, based on the current literature, may help in the implementation and standardization of VTE prophylaxis in conventional lower limb varicose vein surgery, in addition to this benefit, it may lead to a reduction in the length of hospital stay and the number of readmissions.

Thromboprophylaxis in lower limb varicose vein surgery in Brazil.

Background: Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. Objectives: To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Methods: Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Results: Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Conclusions: Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.

Tromboprofilaxia na cirurgia de varizes dos membros inferiores no Brasil / Thromboprophylaxis in lower limb varicose vein surgery in Brazil

Resumo Contexto Apesar de todo o investimento na profilaxia primária do tromboembolismo venoso (TEV) em pacientes cirúrgicos nos últimos anos, ainda não existem diretrizes específicas para aqueles que serão submetidos a procedimentos para tratamento de varizes de membros inferiores. Objetivos Avaliar o perfil de conduta de profilaxia do TEV pelos cirurgiões vasculares brasileiros para procedimentos de tratamento de varizes de membros inferiores. Métodos Pesquisa de levantamento por envio de questionário eletrônico a cirurgiões vasculares brasileiros. Os respondentes foram divididos entre os que realizam tratamento de veias safenas por cirurgia convencional e os que realizam termoablação para fim de comparação entre os grupos. Resultados Entre os 765 respondentes, o tratamento de escolha das veias safenas foi a cirurgia convencional para 405 (53%), espuma ecoguiada para 44 (6%) e termoablação (endolaser ou radiofrequência) para 199 (26%). Os cirurgiões que realizam termoablação prescrevem mais farmacoprofilaxia após o procedimento que aqueles que preferem cirurgia convencional (67/199, 34% vs. 112/405, 28%; p = 0,002). O grupo termoablação estratifica o paciente quanto ao risco de TEV com mais frequência que o grupo cirurgia convencional (102/199, 51% vs. 179/405, 44%; p =0,004). Ambos os grupos usam mais frequentemente enoxaparina como medicação para profilaxia, porém o grupo termoablação usa mais anticoagulantes orais diretos proporcionalmente que o grupo cirurgia convencional (26% vs. 10%, p < 0,001). Conclusões Cirurgiões vasculares brasileiros que fizeram o tratamento de veias safenas por termoablação prescrevem farmacoprofilaxia com maior frequência e por um período mais prolongado do que os que realizaram o tratamento por cirurgia convencional.

Abstract Background Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. Objectives To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Methods Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Results Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Conclusions Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.

Protocol for prophylaxis of venous thromboembolism in varicose vein surgery of the lower limbs / Protocolo para a profilaxia do tromboembolismo venoso em cirurgia de varizes dos membros inferiores

ABSTRACT Pulmonary embolism is the most feared complication of venous thromboembolism (VTE) and the third leading cause of cardiovascular mortality in the world, after acute myocardial infarction and stroke. The risk of VTE is virtually universal in hospitalized patients, especially those with reduced mobility. Although variable in incidence between clinical and surgical patients, up to 66.6% of events related to hospitalizations can occur after discharge, with this risk remaining for up to 90 days. Despite all the investment made in VTE prophylaxis in recent decades, there is still no consensus or specific guidelines for its prevention in patients undergoing conventional surgery for varicose veins of lower limbs. The adoption of a validated risk assessment model for VTE prophylaxis, based on the current literature, may help in the implementation and standardization of VTE prophylaxis in conventional lower limb varicose vein surgery, in addition to this benefit, it may lead to a reduction in the length of hospital stay and the number of readmissions.

RESUMO O tromboembolismo pulmonar é a complicação mais temida do tromboembolismo venoso (TEV) e a terceira causa de mortalidade cardiovascular no mundo, atrás apenas do infarto agudo do miocárdio e do acidente vascular cerebral. O risco de TEV é praticamente universal nos pacientes hospitalizados, especialmente naqueles com redução da mobilidade. Embora variável em incidência entre os pacientes clínicos e cirúrgicos, até 66,6% dos eventos relacionados às internações, podem ocorrer após a alta, permanecendo este risco por até 90 dias. Apesar de todo investimento feito na profilaxia do TEV nas últimas décadas, ainda não existem consensos ou diretrizes específicos para a sua prevenção em pacientes submetidos à cirurgia convencional de varizes dos membros inferiores. A adoção de um modelo de avaliação de risco validado para a profilaxia do TEV, embasado na literatura vigente, poderá ajudar na implementação e padronização da profilaxia do TEV na cirurgia convencional de varizes de membros inferiores, além deste benefício, poderá levar a diminuição do tempo de internação hospitalar e do número de reinternações.

Avaliação da mortalidade no pós-operatório de fraturas de fêmur em idosos com comorbidades prévias / Evaluation of postoperative mortality of femoral fractures in elderly with previous comorbidities

Introdução: Queda é o acidente que ocorre com maior frequência no idoso, sendo a principal causa de morte naqueles com mais de 65 anos. As fraturas do quadril ocupam um papel de grande importância, gerando grande problema de ordem clínica envolvendo pacientes e familiares e de ordem econômica para a sociedade. Objetivo: Coletar dados de questionário da admissão e correlacionar a presença de comorbidades prévias a mortalidade em 30 dias do pós-cirurgia. Métodos: Estudo retrospectivo observacional não randomizado com 216 pacientes com fraturas cirúrgicas do quadril com 61 anos ou mais de idade atendidos no setor de emergência do Centro Hospitalar São Lucas na cidade de Niterói, RJ, no período de 30/03/2016 a 20/03/2018. Resultados: A incidência de óbito após a cirurgia do quadril é igual a 6,9% no primeiro mês. O paciente com fratura no quadril tem comorbidades cardiovasculares (75,9%). O óbito está associado à comorbidade hepática em 13,3% e ao baixo peso em 33,3%. O fato de ter duas ou mais comorbidades não está significativamente associado ao óbito. Conclusão: As comorbidades hepáticas, o baixo peso e a presença de disfunções cardiovasculares são importantes preditores prognósticos na mortalidade do paciente com mais de 61 anos após cirurgia de fratura do fêmur no primeiro mês. (AU)

Introduction: Falls are the leading cause of accidents and death in those aged 65 and above. The high incidence of these injuries impact patients, their families and it represents an economic problem for society. Objective: Collect data from the admission survey and correlate previous comorbidities to mortality in 30 days after surgery. Methods: Retrospective observational non-randomized study. 216 patients were included, aged 61 years or older, who were admitted at the emergency department of the Centro Hospitalar São Lucas in Niterói city, Rio de Janeiro. All the participants were candidates of hip fracture surgery between 03/30/2016 and 03/20/2018. Results: The mortality after hip surgery was 6.9% in the first month. Patients who underwent hip surgery had, previously, cardiovascular diseases (75.9%). Death was associated with liver comorbidity in 13.3% and low weight in 33.3%. The fact of having two or more comorbidities was not associated with death. Conclusion: Liver and cardiovascular diseases and low weight are important prognostic predictors in mortality of patients over 61 years of age after femoral fracture surgery in the first month. (AU)

Reabilitação do polegar reimplantado: avaliação dos resultados funcionais em uma unidade de saúde no Rio de Janeiro / Rehabilitation of the replanted thumb: evaluation of functional results in a health unit in Rio de Janeiro

Introdução: O polegar é o dedo de maior importância funcional da mão, por isso a justificativa de reimplantação e reabilitação do mesmo. Objetivo: Realizar uma análise retrospectiva dos resultados, via revisão de prontuários de pacientes submetidos à reimplante de polegar, realizados pelo Serviço SOS-Reimplante do Hospital Estadual Adão Pereira Nunes. Metodologia: Trata-se de um estudo retrospectivo com amostra de conveniência, abrangendo o período entre janeiro de 2010 a dezembro de 2015, realizado através de prontuários de pacientes submetidos a processo de reimplante de polegar, atendidos no Serviço de Terapia Ocupacional/TO-Mão no Hospital estadual Adão Pereira Nunes, em Duque de Caxias, Rio de Janeiro. Foram coletadas informações sociodemográficas, além de força muscular, sensibilidade e tempo de reabilitação. Resultados: Foram revisados 63 prontuários de pacientes submetidos a procedimento de reimplante de polegar, na faixa etária de 18 a 65 anos. Quanto ao local do acidente, 76,1% dos casos foi decorrente de acidente de trabalho e 23,2% acidentes domésticos. Ao observamos à lateralidade da lesão, 92% dos pacientes eram destros, enquanto o polegar com maior número de lesões foi o esquerdo, com um total de 82,5% pacientes. Quanto ao nível da lesão, 25,3% pacientes sofreram lesão na falange proximal, 20,8% pacientes sofreram lesão na região da interfalangeana, e 53,9% dos pacientes apresentaram lesão na falange distal. Dentre os reencaminhados para nova avaliação, 28,5% pacientes, foram submetidos a outros procedimentos cirúrgicos. Houve ganho de força em global em 88,2% dos pacientes em de sensibilidade. Conclusão: A maioria dos pacientes que sofreram reimplante do polegar conseguiram obter ganho de força muscular e sensibilidade, conseguirem retornar as suas atividades laborais, com um tempo de reabilitação que variou de 4 a 14 meses. (AU)

Introduction: The thumb is the greatest functional finger of the hand, which is justifies its replantation and rehabilitation. Objective: To carry out a retrospective analysis of the medical records of patients undergoing thumb reimplantation, performed by the SOS-Reimplantation Service of the State Hospital Adão Pereira Nunes. Methodology: This is a retrospective study with a convenience sample, covering the period between January 2010 and December 2015, conducted thorough medical records of patients undergoing the process of thumb replantation, attended at the Occupational Therapy Service / TO - Hand at the Adão Pereira Nunes State Hospital, in Duque de Caxias, Rio de Janeiro. Sociodemographic information was collected, in addition to muscle strength, sensitivity, and rehabilitation time. Results: 63 medical records of patients who underwent thumb reimplantation procedure, aged 18 to 65 years, were reviewed. As for the accident site, 76.1% of the cases were due to occupational accidents and 23.2% to domestic accidents. When observing the laterality of the lesion, 92% of the patients were righthanded, while the thumb with the largest number of lesions was left, with a total of 82.5% patients. As for the level of the lesion, 25.3% of patients suffered an injury to the proximal phalanx, 20.8% of patients suffered an injury to the interphalangeal region, and 53.9% of the patients had lesions to the distal phalanx. Among those referred for further evaluation, 28.5% of patients underwent other surgical procedures. There was overall strength gain in 88.2% of patients in sensitivity. Conclusion: Most patients who underwent thumb reimplantation were able to obtain gains in muscle strength and sensitivity, being able to return to their work activities, with a rehabilitation time that varied from 4 to 14 months. (AU)

The role of Angiology and Vascular Surgery in the COVID-19 pandemic.

The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".

A atuação da Angiologia e da Cirurgia Vascular na pandemia de COVID-19

A epidemia pelo novo Coronavirus (2019-nCoV), surgido na cidade de Wuhan, na China, em dezembro de 2019, quando sintomática, apresenta-se majoritariamente por um quadro de pneumonia pulmonar que é precedida por febre, tosse seca e mialgia. No entanto, conforme a doença se espalhou globalmente e o número de hospitalizações aumentaram de forma exponencial, notou-se que a maior parte dos pacientes graves internados por COVID-19 possuem alterações laboratoriais dignas de atenção, como linfopenia, neutrofilia, aumento do tempo de protrombina e elevação dos níveis de D-dímero. Devido tais mudanças se mostrarem cruciais para a taxa de mortalidade e morbidade nesse subgrupo de infectados, diversos trabalhos com enfoque na fisiopatologia, principalmente hematológica, da doença surgem a cada dia. Aprofundando em tais estudos, variados trabalhos publicados evidenciaram a infecção pelo Sars-CoV-2 à instalação de um estado pró-trombótico em pacientes hospitalizados graves, o que acarreta em potencial ocorrência de eventos trombóticos venosos ou arteriais nessa coorte. Assim, para entender como os Departamentos de Angiologia e Cirurgia Vascular estão atuando no contexto da pandemia de COVID-19, este estudo tem por objetivo reunir estudos que revelam desde protocolos aplicados nos serviços vasculares na atual conjuntura, até a atuação dos cirurgiões vasculares e angiologistas no manejo clínico e cirúrgico de pacientes infectados ou não, como forma de ajudar e esclarecer essa especialidade durante o contexto de pandemia pelo novo coronavírus. Para a seleção dos trabalhos foram utilizados os seguintes critérios de busca: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" e "COVID-19 Coronavirus and thrombosis".

The role of Angiology and Vascular Surgery in the COVID-19 pandemic

The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".

The role of Angiology and Vascular Surgery in the COVID-19 pandemic / A atuação da Angiologia e da Cirurgia Vascular na pandemia de COVID-19

ABSTRACT The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".

RESUMO A epidemia pelo novo Coronavirus (2019-nCoV), surgido na cidade de Wuhan, na China, em dezembro de 2019, quando sintomática, apresenta-se majoritariamente por um quadro de pneumonia pulmonar que é precedida por febre, tosse seca e mialgia. No entanto, conforme a doença se espalhou globalmente e o número de hospitalizações aumentaram de forma exponencial, notou-se que a maior parte dos pacientes graves internados por COVID-19 possuem alterações laboratoriais dignas de atenção, como linfopenia, neutrofilia, aumento do tempo de protrombina e elevação dos níveis de D-dímero. Devido tais mudanças se mostrarem cruciais para a taxa de mortalidade e morbidade nesse subgrupo de infectados, diversos trabalhos com enfoque na fisiopatologia, principalmente hematológica, da doença surgem a cada dia. Aprofundando em tais estudos, variados trabalhos publicados evidenciaram a infecção pelo Sars-CoV-2 à instalação de um estado pró-trombótico em pacientes hospitalizados graves, o que acarreta em potencial ocorrência de eventos trombóticos venosos ou arteriais nessa coorte. Assim, para entender como os Departamentos de Angiologia e Cirurgia Vascular estão atuando no contexto da pandemia de COVID-19, este estudo tem por objetivo reunir estudos que revelam desde protocolos aplicados nos serviços vasculares na atual conjuntura, até a atuação dos cirurgiões vasculares e angiologistas no manejo clínico e cirúrgico de pacientes infectados ou não, como forma de ajudar e esclarecer essa especialidade durante o contexto de pandemia pelo novo coronavírus. Para a seleção dos trabalhos foram utilizados os seguintes critérios de busca: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" e "COVID-19 Coronavirus and thrombosis".

Doença cística adventicial da artéria poplítea: relato de caso / Adventitial cystic disease of the popliteal artery: case report

A doença cística adventicial da artéria poplítea é uma doença pouco frequente, que deve ser considerada no diagnóstico diferencial de pacientes jovens com claudicação intermitente e sem fatores de risco para doença arterial periférica aterosclerótica. Apresentamos um caso de claudicação intermitente de membros inferiores em paciente masculino de 51 anos no qual essa doença foi diagnosticada. Foi submetido a ressecção do segmento de artéria comprometido e interposição de safena autóloga ipsilateral. Discutimos alternativas diagnósticas e terapêuticas

Adventitial cystic disease of the popliteal artery is an uncommon pathology that should be considered in differential diagnostic of younger patients with intermittent claudication and without risk factors for peripheral atherosclerotic arterial disease. We report the case of a 51 year-old male patient presenting with lower-limb intermittent claudication in whom this pathology was diagnosed and who was treated with segmental arterial resection and autologous saphenous vein interposition. We also discuss diagnostic and therapeutic alternatives

A pilot study comparing bovine mesenteric artery and expanded polytetrafluoroethylene grafts as non-autogenous hemodialysis options.

BACKGROUND: Many dialysis patients do not have the necessary conditions for construction of a native arteriovenous fistula (AVF). Expanded Polytetrafluoroethylene (ePTFE) vascular prostheses are the most widely-used option, but it is known that they are inferior to native vein AVFs. OBJECTIVES: To identify a graft with superior performance to ePTFE, comparing their results with those of AVFs made from bovine mesenteric arteries treated with L-Hydro technology (Labcor Laboratories ®). METHODS: A prospective and controlled study of 10 patients with AVFs constructed with ePTFE and 10 patients with L-Hydro bioprostheses, matched for comorbidities. The variables studied were: primary patency, assisted primary patency, and secondary patency, surgical manipulability, and prevalence of infections. The performance of prostheses was assessed by duplex-scan and repeated consultations with health professionals at hemodialysis clinics. The chi-square test was used for statistical analysis. RESULTS: After 1 year of postoperative follow-up, secondary and primary patency rates were higher for L-Hydro than ePTFE AVFs. Fewer interventions were needed to maintain AVF patency in the L-Hydro AVF group. The most common complication was graft thrombosis, which was more frequent in the ePTFE group. While the figures indicate more favorable outcomes in the L-Hydro AVFs, this could not be confirmed with the statistical treatment employed. CONCLUSIONS: The L-Hydro graft appears to be a valuable alternative option for AVFs, since it seems to require fewer interventions to maintain patency when compared to ePTFE grafts.

Early gastrostomy associated with speech therapy in patients with amyotrophic lateral sclerosis / Benefícios da gastrostomia precoce associada a terapêutica fonoaudiológica em pacientes com esclerose lateral amiotrófica

Esclerose Lateral Amiotrófica (ELA) é uma doença degenerativa que cursa com a deterioração dos neurônios motores. O início do comprometimento clínico pode ser bulbar com o tempo médio de vida após os primeiros sintomas de 2 à 5 anos, apresentando sérios distúrbios de deglutição, fala e respiração. Os transtornos de deglutição podem ocasionar desnutrição, desidratação, aspiração, desprazer, além de complicações mais graves como a pneumonia aspirativa e o óbito. Com a evolução da doença o paciente necessita de procedimentos que geram dúvidas nos profissionais e nos familiares como o momento correto de indicação do uso de vias alternativas de alimentação de longa duração denominada gastrostomia (GTT). O objetivo desse artigo é analisar o impacto da disfagia e o momento mais favorável para a colocação da gastrostomia. A colocação precoce da GTT pode auxiliar a evitar que o paciente se debilite clinicamente mais rapidamente, responda melhor as terapêuticas da equipe multidisciplinar e tenha mais conforto. (AU)

Amyotrophic Lateral Sclerosis (ALS) is a degenerative disease that occurs with the deterioration of motor neurons. The beginning of clinical impairment may be bulbar with the average life time, after the first symptoms, between 2 to 5 years, presenting serious swallowing, speech and breathing disorders. Deglutition disorders can lead to malnutrition, dehydration, aspiration, displeasure, and more serious complications such as aspiration pneumonia and death. With the evolution of the disease, the patient needs procedures that generate doubts in the professionals and family, as the correct moment of indication of the use of alternative long-term feeding routes called gastrostomies (GTT). The objective of this article is to analyze the impact of dysphagias and the most favorable moment for the placement of gastrostomies. Early GTT placement may help prevent the patient from clinically debilitating more quickly, respond better to multidisciplinary team therapeutics, and feel more comfortable. (AU)

O uso do balão com paclitaxel no tratamento da reestenose intra-stent no segmento fêmoro-poplíteo / Use of paclitaxel-coated balloon to treat in-stent restenosis in femoropopliteal segments

Resumo Contexto A reestenose intra-stent por hiperplasia miointimal pós-angioplastia é uma intercorrência frequente e que limita a perviedade do procedimento a longo prazo. A terapia com balões revestidos de droga com ação antiproliferativa pode ser uma alternativa no tratamento dessa complicação. Objetivos Demonstrar eficácia e as complicações (óbito, grandes amputações, etc.) do balão farmacológico no tratamento da reestenose intra-stent de segmento femoropoplíteo. Métodos Estudo de coorte retrospectivo de 32 pacientes consecutivos tratados entre os anos de 2012 e 2016, submetidos a terapia de reestenose intra-stent de segmento femoropoplíteo com angioplastia com balão farmacológico revestido com paclitaxel. A taxa de sucesso foi mensurada pela ocorrência de sucesso do procedimento e reestenose inferior a 50% em avaliação por eco-Doppler colorido 30, 90 e 180 dias após o procedimento. Resultados Quatro pacientes (12,5%) apresentaram reestenose superior a 50%, sendo um (3,1%) após 90 dias e três (9,4%) após 180 dias, conferindo uma taxa de sucesso de 87,5% ao procedimento. Após 180 dias, todos os pacientes referiam melhora ou cessação dos sinais e/ou sintomas apresentados antes do procedimento. Não houve óbitos, e complicações ocorreram apenas em dois casos, no pós-operatório imediato. Conclusões Os resultados a curto prazo da terapia com balão farmacológico são promissores, com redução na taxa de reestenose e baixo índice de complicações. Ainda precisam ser apresentados estudos demonstrando os efeitos a longo prazo dessa terapia, assim como seu impacto econômico quando comparada a outros procedimentos.

Abstract Background In-stent restenosis due to myointimal hyperplasia after angioplasty is common and limits long-term patency. Treatments using balloons coated with antiproliferative drugs may offer an alternative option for this pathology. Objectives To demonstrate the efficacy and complications (death, major amputations, etc.) of drug-coated balloons for treatment of in-stent restenosis in femoropopliteal segments. Methods This was a retrospective cohort study of 32 consecutive patients treated between 2012 and 2016 who underwent treatment to correct in-stent restenosis in the femoropopliteal segment using paclitaxel-coated balloons. The success rate was measured in terms of technical success and restenosis of less than 50% on Doppler ultrasonography at 30, 90, and 180 days after the procedure. Results Four patients (12.5%) exhibited restenosis greater than 50%, one (3.1%) after 90 days and three (9.4%) after 180 days, equating to a success rate of 87.5% of procedures, and by 180 days all patients experienced improvement or cessation of the signs and/or symptoms they had presented prior to the procedure. There were no deaths and complications occurred in just 2 cases in the immediate postoperative period. Conclusions Short-term results are promising, with reductions in the magnitude of restenosis and a low rate of complications. Further studies are needed that can demonstrate the long-term effects and the economic impacts in comparison to other procedures.

Cervical Spondylotic Myelopathy: What the Neurologist Should Know.

Cervical spondylotic myelopathy is a well-known cause of disability among older people. A significant amount of these patients is asymptomatic. Once the symptoms start, the worsening may follow a progressive manner. We should suspect of spondylotic myelopathy in any individual over 55 years presenting progressive changes in gait or losing fine motor control of the upper limbs. Despite its frequent prevalence, this condition is still neglected and many times confused with other supratentorial lesions regarding diagnostic. Here we address some of most important aspects of this disease, calling attention to pathophysiology, the natural history, presentation, differential diagnosis, clinical assessment, and treatment.

Currents issues in cardiorespiratory care of patients with post-polio syndrome.

METHOD: A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. RESULTS AND DISCUSSION: Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. CONCLUSION: Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.