Epidemiological data on lower limb lymphedema

Objective: The aim of the present study was to evaluate epidemiological data of patients seen at a clinic specialized in the treatment of lymphedema. Methods: A retrospective, cross-sectional study was conducted involving data from 150 consecutive patients with lower limb lymphedema in clinical stages II and III treated at the Godoy Clinic in São Jose do Rio Preto. The follow data were collected: sex, age, type of lymphedema (primary or secondary), cause of secondary lymphedema (cancer, trauma, venous disease) and limb dominance. The diagnosis of lymphedema was based on the clinical history and physical examination; in cases of doubt, lymphoscintigraphy of the lower limbs was requested. Descriptive statistics were performed and results were expressed as percentages. Results: Twenty-five (16.66%) of the patients were male and 125 (83.33%) were female. Mean age was 42.52 years (41.8 years among the men and 42.67 years among the women). One hundred nine cases (72.66%) were primary lymphedema and 41 (27.33%) were secondary. Among the secondary cases, 27 (18%) were related to cancer treatment, 10 (6.6%) were linked to trauma and four (2.6%) were cases of phlebolymphedema. Mean age was 51.4 years among the patients with cancer treatment-related lymphedema, 41 years among those with trauma-related lymphedema and 64.25 years among those with phlebolymphedema. The left leg was affected in 61 cases (40.66%), the right leg was affected in 37 cases (24.66%) and lymphedema was bilateral in 52 cases (34.66%). Conclusion: Primary lymphedema was predominant and affected women more than men. Primary lymphedema occurred at an earlier age compared to cancer treatment-related lymphedema and phlebolymphedema. The left leg was affected more often, followed by bilateral lymphedema and, finally, the right leg alone

Exercícios passivos na reabilitação de pacientes com dor, edema e limitação articular: estudo piloto / Passive exercises in the rehabilitation of patients with pain, edema and joint limitation: pilot study

A Imobilização parcial ou completa leva a diferentes processos de ajuste como perda de força muscular, diminuição do desempenho geral e edema. Objetivo: Avaliar a melhora da dor utilizando de um dispositivo eletromecânico que realiza movimentos passivo nos pacientes com dor, limitação da mobilidade e uso de dispositivos auxiliadores da marcha. Método: Foram avaliados em ensaio clinico prospectivo 20 pacientes, a melhora da dor, fazendo uso de dispositivos auxiliares de locomoção, em pacientes que faziam tratamento convencional por quatro a 12 meses, mas que passaram a fazer diariamente por uma hora e, comparando com exercício passivo realizado com o dispositivo, por duas horas/dia, por cinco dias, e avaliados pela escala analógica de dor antes e depois no Hospital de Base da Fundação Faculdade de Medicina de São Jose do Rio Preto - FUNFARME de março de 2019 a janeiro de 2020. Resultados: Quando compara a diferença de redução do grupo realizou dispositivo eletromecânico passivo com o grupo convencional houve uma redução de 6,6 na escala analógica de dor e em relação ao grupo convencional de 2, sendo diferente estatisticamente teste t pareado valor p= 0,0001. Conclusão: Exercícios passivos mecânicos, que realizam a drenagem linfática é uma nova opção de tratamento aos pacientes que tem dor e limitação crônica da marcha.

Partial or complete immobilization leads to different adjustment processes such as loss of muscle strength, decreased overall performance and edema. Objective: Was to assess pain improvement using an electromechanical passive device in patients with pain, limited mobility and use of gait assistive devices. Method: 20 patients were evaluated in a prospective clinical trial, pain improvement, using auxiliary locomotion devices, in patients who underwent conventional treatment for four to 12 months, but who started doing it daily for an hour and, compared with exercise passive performed with electromechanical passive device, for two hours/day, for five days, and evaluated by the pain scale before and after in Hospital de Base - Fundação Faculdade de Medicina de Sao Jose do Rio Preto - FUNFARME from march 2019 to january 2020. Results: When comparing the difference in reduction of the electromechanical passive device group with the conventional group, there was a reduction of 6.6 in the analogue pain scale and in relation to the conventional group of 2, with a statistically different paired t-test p= 0.0001. Conclusion: Passive mechanical exercises that perform lymphatic drainage are a new treatment option for patients who have pain and chronic gait limitation.

Automedicação entre acadêmicos de medicina de Fernandópolis ­ São Paulo / Self medication among medical students: analysis of variable related

Objetivo: buscou-se investigar a automedicação por acadêmicos de curso de graduação em Medicina de instituição privada e analisar possíveis variáveis relacionadas. Métodos: trata-se de um estudo transversal realizado com 320 discentes dos quatro primeiros anos do curso de Medicina da Universidade Brasil, campus Fernandópolis-SP. Foi aplicado questionário validado com variáveis sociais e de consumo de medicamentos, seguido de análise estatística por regressão linear simples. Resultado: como resultado, a automedicação foi considerada uma opção em 309 dos participantes, a maioria deles do sexo feminino, idade entre 21 a 23 anos, solteiros, sem curso superior prévio, com convênio médico e conscientes de eventuais riscos à Saúde, mesmo após acesso a bulas ou a pesquisas on-line. O quadro clínico precedente à automedicação incluiu, principalmente, cefaleia e mialgia. Houve preferência por fármacos anteriormente utilizados com consumo médio (por 1 a 2 dias), principalmente de analgésicos e anti-inflamatórios. Estar mais próximo ao término do curso (p = 0,006) e possuir convênio médico (p = 0,046) se relacionaram com automedicação. Conclusão: o hábito da automedicação aumenta, gradativamente, ao decorrer

Objective: we sought to investigate self-medication by Medicine undergraduated students in a private institution of Medicine and to examine possible related variables. Methods: it is a cross-sectional study conducted with 320 students of the first four years of medical school at Universidade Brasil, Fernandópolis-SP campus. Validated questionnaire was applied taking into account social variables and medicine consumption, being followed by statistical analysis with simple linear regression. Results: as a result, self-medication was considered an option to 309 of the participants, the majority of women, aged 21-23 years old, single, without higher education, with health insurance and aware of possible risks to health even after access to bulls or online research. Clinical symptoms prior to self-medication included headache and myalgia. There was a preference for drugs previously used with an average consumption (from 1 to 2 days), especially analgesics and anti-inflammatories. It was verified that being related to self-medication was more likely to happen among those students closer to the end of the course (p = 0.006) and to those who have health insurance (p = 0.046). Conclusion: the habit of self-medication gradually increases over the undergradution, therefore, it is suggested to implement an educational pedagogical proposal on this subject in medical school curriculum.

Compression therapy: Unna boot applied to venous injuries: an integrative review of the literature. / Terapia compressiva: bota de Unna aplicada a lesões venosas: uma revisão integrativa da literatura.

OBJECTIVE: To analyze the literature related to the types of therapies for venous injuries with emphasis on use of the Unna boot, and to investigate and discuss the main aspects related to its use compared to other techniques. METHOD: Integrative review of the literature of the last five years through searches in the following databases: VHL, LILACS, BDENF, SciELO, MEDLINE/PubMed. RESULTS: Twenty-two publications were identified, with 15,931 cases among adult or elderly individuals, whose mean age was 60 (35-78) years or greater with no sex differences. The Unna boot presented a shorter healing time than the single and two-layer elastic bandage. CONCLUSION: Although other compression techniques may prove to be more efficient than the Unna boot by adding more technology, the boot stands out as a traditional low-cost dressing. Multilayer bandage is a gold standard technique. This review demonstrated the best option may not be the Unna boot, because it requires a higher healing time compared to the multilayer bandage, but it meets the expectation with a high rate of treatment efficiency, also when compared to simple dressing, single or two-layer bandage.

Evidências do efeito da terapia fotodinâmica sobre a Propionibacterium acnes / Evidence of the effect of photodynamic therapy on Propionibacterium acnes

Introdução: A Propionibacterium acnes é uma bactéria causadora da acne. Devido aos efeitos colaterais ou à falta de resposta ao tratamento da acne, foi proposta a terapia fotodinâmica como um tratamento alternativo para a acne. Objetivo: O objetivo foi evidenciar a ação fotodinâmica do LED vermelho 660 nm e do fotossensibilizador azul de metileno sobre Propionibacterium acnes in vitro. Métodos: Os ensaios foram constituídos por quatro grupos: 1. controle (sem aplicação de luz e sem fotossensibilizador); 2. com aplicação de luz; 3. com fotossensibilizador e sem aplicação de luz; 4. com fotossensibilizador e com aplicação de luz. Os ensaios foram submetidos a aplicação de luz por 4 ciclos de 5 minutos com intervalos de 3 minutos. Resultados: Houve redução estatisticamente significante (p<0,05) nas médias dos grupos 1, 2 e 4, ainda que o grupo 3 não tenha apresentado significância estatística, mas houve redução detectada nas médias. Conclusão: A ação fotodinâmica é eficiente para a destruição do material biológico por irradiação a 660nm atribuída ao processo de fotossensibilização pela presença do fotossensibilizador.(AU)

Introduction: Propionibacterium acnes is a bacterium that causes acne. Due to the side effects or the lack of response to acne treatment, photodynamic therapy was proposed as an alternative treatment for acne. Objective: To demonstrate the photodynamic action of the 660 nm red LED and the methylene blue photosensitizer on Propionibacterium acnes in vitro. Methods: Four groups were studied: 1. control (without light application and without photosensitizer); 2. with light application; 3. with photosensitizer and without light application; 4. with photosensitizer and light application. The assays were subjected to light application for 4 cycles of 5 minutes at 3 minute intervals. Results: There was a statistically significant reduction (p <0.05) in the means of groups 1, 2 and 4, although group 3 did not present statistical significance, but there was a reduction detected in the means. Conclusion: The photodynamic action is efficient for the destruction of the biological material by irradiation at 660nm attributed to the process of photosensitization by the presence of the photosensitizer.(AU)

Terapia compressiva: bota de Unna aplicada a lesões venosas: uma revisão integrativa da literatura / Terapia compresiva: bota de Unna aplicada a lesiones venosas: una revisión integrativa de la literatura / Compression therapy: Unna boot applied to venous injuries: an integrative review of the literature

RESUMO Objetivo: Analisar a bibliografia relacionada aos tipos de terapias para lesões venosas, enfatizando o uso da bota de Unna, e investigar e discutir os principais aspectos relacionados ao seu uso, comparados aos de outras técnicas. Método: Revisão integrativa da literatura dos últimos 5 anos, por meio de buscas na BVS, LILACS, BDENF, SciELO, MEDLINE/PubMed. Resultados: Foram identificadas 22 publicações, com 15.931 casos entre adultos ou idosos, cuja média de idade foi igual ou superior a 60 (35-78) anos, sem discrepância na porcentagem de gênero. A bota de Unna apresentou um tempo inferior de cicatrização que a bandagem elástica simples e de duas camadas. Conclusão: Embora outras técnicas compressivas possam mostrar-se mais eficientes do que a bota de Unna, por agregar mais tecnologia, a bota se destaca por ser um curativo tradicional de baixo custo. A bandagem multicamada é uma técnica padrão-ouro. Esta revisão mostrou que a bota de Unna pode não ser a melhor opção, por demandar um tempo superior de cicatrização em comparação à bandagem multicamada, mas atende à expectativa com um alto índice de eficiência no tratamento, ainda se comparada ao curativo simples, bandagem simples ou de duas camadas.

RESUMEN Objetivo: Analizar la bibliografía relacionada con los tipos de terapias para lesiones venosas, subrayando el empleo de la bota de Unna, e investigar y discutir los principales aspectos relacionados con el uso, comparados con los de otras técnicas. Método: Revisión integrativa de la literatura de los últimos cinco años, mediante búsquedas en la BVS, LILACS, SciELO, MEDLINE/PubMed. Resultados: Fueron identificadas 22 publicaciones, con 15.931 casos entre adultos o añosos, cuyo promedio de edad fue igual o superior a 60 (35-78) años, sin discrepancia en el porcentaje de género. La bota de Unna presentó un tiempo inferior de cicatrización que el vendaje elástico simple y de dos capas. Conclusión: Aunque otras técnicas compresivas puedan mostrarse más eficientes que la bota de Unna, por agregar más tecnología, la bota se destaca por ser un apósito tradicional de bajo costo. El vendaje multicapa es una técnica regla de oro. Esta revisión mostró que la bota de Unna puede no ser la mejor opción, al demandar un tiempo superior de cicatrización en comparación con el vendaje multicapa, pero atiende a la expectación con un alto índice de eficiencia en el tratamiento, incluso si comparada con el apósito simple, vendaje simple o de dos capas.

ABSTRACT Objective: To analyze the literature related to the types of therapies for venous injuries with emphasis on use of the Unna boot, and to investigate and discuss the main aspects related to its use compared to other techniques. Method: Integrative review of the literature of the last five years through searches in the following databases: VHL, LILACS, BDENF, SciELO, MEDLINE/PubMed. Results: Twenty-two publications were identified, with 15,931 cases among adult or elderly individuals, whose mean age was 60 (35-78) years or greater with no sex differences. The Unna boot presented a shorter healing time than the single and two-layer elastic bandage. Conclusion: Although other compression techniques may prove to be more efficient than the Unna boot by adding more technology, the boot stands out as a traditional low-cost dressing. Multilayer bandage is a gold standard technique. This review demonstrated the best option may not be the Unna boot, because it requires a higher healing time compared to the multilayer bandage, but it meets the expectation with a high rate of treatment efficiency, also when compared to simple dressing, single or two-layer bandage.

Photodynamic action of the red laser on Propionibacterium acnes.

BACKGROUND: Photodynamic therapy is a therapeutic modality that has consolidated its activity in the photooxidation of organic matter, which arises from the activity of reactive oxygen species. OBJECTIVE: To evaluate the effect of red laser 660nm with the photosensitizer methylene blue on Propionibacterium acnes in vitro. METHOD: The experimental design was distributed into four groups (1 - control group without the application of light and without photosensitizer, 2 - application of light, 3 - methylene blue without light, and 4 - methylene blue with light). Tests were subjected to red laser irradiation 660nm by four cycles of 5 minutes at 3-minute intervals. RESULTS: It was evidenced the prominence of the fourth cycle (20 minutes) groups 2, 3 and 4. STUDY LIMITATIONS: Despite the favorable results, the laser irradiation time photosensitizer associated with methylene blue were not sufficient to to completely inhibit the proliferation of bacteria. CONCLUSION: Further studies in vitro are recommended to enable the clinical application of this photosensitizer in photodynamic therapy.

Photodynamic action of the red laser on Propionibacterium acnes

Abstract: Background: Photodynamic therapy is a therapeutic modality that has consolidated its activity in the photooxidation of organic matter, which arises from the activity of reactive oxygen species. Objective: To evaluate the effect of red laser 660nm with the photosensitizer methylene blue on Propionibacterium acnes in vitro. Method: The experimental design was distributed into four groups (1 - control group without the application of light and without photosensitizer, 2 - application of light, 3 - methylene blue without light, and 4 - methylene blue with light). Tests were subjected to red laser irradiation 660nm by four cycles of 5 minutes at 3-minute intervals. Results: It was evidenced the prominence of the fourth cycle (20 minutes) groups 2, 3 and 4. Study limitations: Despite the favorable results, the laser irradiation time photosensitizer associated with methylene blue were not sufficient to to completely inhibit the proliferation of bacteria. Conclusion: Further studies in vitro are recommended to enable the clinical application of this photosensitizer in photodynamic therapy.

Godoy & Godoy Compression Sleeve in the Treatment of Arm Lymphedema: New Concepts for Materials

ABSTRACT The aim of this work was to study on a new low-elastic textile that fulfilled the criteria of fabrics for the manufacture of compression garments to treat lymphedema. The evolution of Godoy & Godoy compression sleeves was performed by following the patients treated for arm lymphedema. Sixty-six patients with ages ranging from 35 to 83 years and a mean of 58.8 years were included in this study. Diagnosis, by the clinical evaluation confirmed by the volumetry, was defined as a volume difference of more than 200 mL between the arms. All the participants were submitted to treatment sessions once, or two times weekly in an outpatient setting. The material used for the compression sleeve in this study was commercialized in Brazil under the name of Gorgurão(r). When high alterations in the pattern of sleeves were made, the patients were monitored by weekly volumetric assessments. The criterion to maintain the modifications in the design was that the hand did not present with edema. By the end of the study, the design of the sleeve was changed so as not to use compression therapy of the hands in 81.8% of the cases; 12.2% continued with compression of the hand, 3.0% stopped using compression completely and 3.0% used only a glove. Thus, Godoy & Godoy compression sleeves could be an efficient option for compression in the treatment of arm lymphedema as they provided better independence in day-to-day activities.

Estudo-piloto no tratamento do linfedema de membros inferiores com meia de gorgurão / Pilot study on the treatment of lower limb lymphedema using grosgrain socks

Objetivo: o objetivo do presente estudo foi avaliar a redução do linfedema em membros inferiores utilizando meia de gorgurão (não elástica) como forma isolada de tratamento. Método: foram avaliados em ensaios clínicos prospectivos 13 pacientes consecutivos com linfedema em membros inferiores tratados com meia de gorgurão e avaliados pela volumetria na Clínica Godoy em 2012. Foram cinco do sexo masculino e oito do sexo feminino, com idades variando entre 26 e 72 anos, com média de 49,0anos. O critério de inclusão foi ter linfedema grau II em membros inferiores, independentemente da causa; houve também a exclusão de pacientes com histórico de alergias e intolerância a mecanismos de contenção, processos infecciosos ativos, imobilidade articular e outras causas que pudessem interferir nos edemas em geral. O tratamento realizado foi a meia de gorgurão, que é inelástica, confeccionada sob medida, em queo fechamento é feito com ilhós e permite ajustamento pelo próprio paciente. Foi feita volumetria - técnica de mensura por deslocamento de água - no início e em todos os retornos. Para análise estatística foi utilizado o teste-t pareado, sendo considerado erro alfa de 5%. Resultado: o estudo foi aprovado pelo Comitê de Ética em Pesquisa. Detectou-se redução significativa nos pacientes tratados, teste t pareado bicaudal com p.

Objective: the objective of this study was to evaluate lymphedema reduction in lower limbs using grosgrain socks (inelastic) as an isolated form of treatment. Method: 13 consecutive patients with lymphedema in the lower limbs treated with grosgrain socks were evaluated in prospective clinical assays for volumetry in the Godoy Clinic in 2012. There were five male and eight female patients, with ages ranging between 26 and 72 years and average of 49.0 years. The inclusion criterion was presenting grade II lymphedema in the lower limbs regardless of the cause; patients with a history of allergies and intolerance to containment mechanisms, infectious processes, joint immobility, and other causes that could interfere with the edema were excluded. The treatment used grosgrain socks, which are inelastic, custom made and closed through eyelets that allow adjustment by the patient. The volumetric technique was used to measure water-offset at the start and all follow-ups. The paired t-test was used for the statistical analysis considering a 5% alpha error. Results: the study was approved by the Research Ethics Committee. A significant reduction was detected in treated patients, two-tailed paired t-test with p.

Lymphoscintigraphic changes after harvesting of the saphenous vein for coronary artery bypass graft.

Bridged incisions do not eliminate lesions to the lymphatic vessels and so the identification of risk factors associated to lymphatic lesions is important.

Mortality within the endovascular treatment in Stanford type B aortic dissections.

BACKGROUND: Endovascular stent-graft repair of aortic dissections is a relatively new procedure, and although apparently less invasive, the efficacy and safety of this technique have not been fully established. OBJECTIVE: To evaluate mortality in patients with complicated Stanford type B aortic dissections submitted to endovascular treatment. METHODS: Clinical, anatomical, imaging and autopsy data of 23 patients with complicated type B aortic dissections were reviewed from November 2004 to October 2007. The main indications for transluminal thoracic stent-grafting included: persistent pain in spite of medical therapy, signs of distal limb ischemia, signs of aortic rupture, progression of aneurismal dilation of the descending aorta during follow-up (defined as a diameter > 50 mm) and the diameter of descending thoracic aorta of 40 mm or larger at the onset of aortic dissection. Data were analyzed statistically; all p-values were two-tailed and differences < 0.05 were considered to indicate statistical significance. Continuous variables were expressed as mean (± SD), and medians were compared by the Student's t test. Differences in categorical variables between the groups were analyzed by the Chi-square or Fisher's exact test. RESULTS: The procedure presented primary technical success in 82.6% of patients. Four patients (17.4%) had an incomplete proximal entry seal. Three patients (13%) died within 30 days of the procedure and eight patients (34.8%) died after 30 days. CONCLUSION: Endovascular correction of complicated Stanford type B aortic dissections is a feasible and effective treatment option.

Mortality within the endovascular treatment in Stanford type B aortic dissections / Mortalidade no tratamento endovascular nas dissecções aórticas tipo B

BACKGROUND: Endovascular stent-graft repair of aortic dissections is a relatively new procedure, and although apparently less invasive, the efficacy and safety of this technique have not been fully established. OBJECTIVE: To evaluate mortality in patients with complicated Stanford type B aortic dissections submitted to endovascular treatment. METHODS: Clinical, anatomical, imaging and autopsy data of 23 patients with complicated type B aortic dissections were reviewed from November 2004 to October 2007. The main indications for transluminal thoracic stent-grafting included: persistent pain in spite of medical therapy, signs of distal limb ischemia, signs of aortic rupture, progression of aneurismal dilation of the descending aorta during follow-up (defined as a diameter > 50 mm) and the diameter of descending thoracic aorta of 40mm or larger at the onset of aortic dissection. Data were analyzed statistically; all p-values were two-tailed and differences < 0.05 were considered to indicate statistical significance. Continuous variables were expressed as mean (± SD), and medians were compared by the Student's t test. Differences in categorical variables between the groups were analyzed by the Chi-square or Fisher's exact test. RESULTS: The procedure presented primary technical success in 82.6 percent of patients. Four patients (17.4 percent) had an incomplete proximal entry seal. Three patients (13 percent) died within 30 days of the procedure and eight patients (34.8 percent) died after 30 days. CONCLUSION: Endovascular correction of complicated Stanford type B aortic dissections is a feasible and effective treatment option.

INTRODUÇÃO: O tratamento endovascular na dissecção de aorta é um procedimento relativamente novo e, embora aparentemente menos invasivo, a eficácia e a segurança dessa técnica não estão totalmente estabelecidas. OBJETIVO: Avaliar a mortalidade e complicações nos pacientes submetidos a tratamento endovascular na dissecção de aorta tipo B de Stanford. MÉTODOS: Foram revisados, a partir de novembro de 2004 a outubro de 2007, em estudo clínico, anatômico, de imagens e dados da autopsia de 23 pacientes com dissecção aórtica tipo B. As principais indicações para o procedimento foram: dor persistente apesar da terapia médica, sinais de isquemia distal do membro, sinais de ruptura da aorta, progressão da dilatação do aneurisma da aorta descendente, durante o seguimento (definida como um diâmetro > 5 cm) e descendente da aorta torácica de 40 mm ou mais de diâmetro no início da dissecção aórtica. Os dados foram analisados estatisticamente considerados erro alfa de 5 por cento. As variáveis contínuas foram expressas como média (± dp) e medianas e comparadas pelo teste t Student. As diferenças entre os grupos em variáveis categóricas e analisadas pelo chi-quadrado ou teste exato de Fisher. RESULTADOS: O procedimento apresentou sucesso técnico primário em 82,6 por cento dos pacientes. Quatro (17,4 por cento) pacientes tinham um selo de entrada incompleto proximal. Três (13 por cento) pacientes morreram antes de 30 dias e oito (34,8 por cento), após 30 dias do procedimento. CONCLUSÃO: Os procedimentos endovasculares são factíveis na dissecção da aorta torácica tipo B, na qual as complicações das causas de mortalidades alertam sobre a gravidade da doença e de intercorrências das próteses como no caso das fistulas.

Estudo piloto no tratamento intensivo da celulite / Pilot study of the intensive treatment of cellulitis

Introdução: a celulite afeta em torno de 90% das mulheres, contudo não há uma forma eficaz de tratamento estabelecida. Objetivo: o objetivo do presente estudo é relatar uma nova forma de tratamento intensivo da celulite e nova hipótese da fisiopatologia desta doença. Método: foi avaliado o tratamento intensivo em quatro mulheres com celulite do grau IV, cujas idades foram de 22, 32, 25 e 26 anos. Os critérios de inclusão foram celulite do grau IV, estar dentro do peso corporal e sem edema. Os critérios de exclusão foram obesidade, história de edema e de qualquer doença clínica evidente. O tratamento foi drenagem linfática técnica Godoy & Godoy adaptada para celulite, drenagem linfática com RAGodoy® e mecanismos de contenção de baixa elástica durante quatro horas diárias por dez dias em duas semanas. A avaliação foi por fotografia e perimetria antes e após dez dias de tratamento. Resultados: todas as mulheres tiveram redução de medidas que variou entre 8 e 10 cm nas maiores variações, alterações fotográficas e clínicas. Conclusão: conclui-se que a forma intensiva preconizada permite a redução da celulite em curto período de tempo.

Clinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique.

OBJECTIVE: The aim of this study was to assess clinical complications of limbs undergone harvesting of the great saphenous vein for venous coronary artery bypass graft surgery using bridge technique. METHODS: Fourty-four patients who had undergone CABG using the great saphenous vein harvested by the bridge technique over more than 3 months ago were randomly selected. The exclusion criteria were the harvesting of both saphenous veins, prior saphenectomy of the contralateral limb, edema caused by a systemic etiology, such as heart, renal, thyroid or hepatic diseases and venous insufficiency of the lower limbs as characterized by swollen varicose veins both with and without trophic changes. The age, gender, diabetes, time of surgery and occurrence of complications, such as edema, paresthesia, infection, lymphorrhea, erysipelas and deep venous thrombosis, were assessed. The assessment was clinic and diagnosis of the diabetes was performed by the preoperative exams. The chi-square, Fisher and Student's t tests were used for statistical analysis with an alpha error of 5%. RESULTS: The time between surgery and assessment ranged between 3 and 187 months with a mean of 47.3+/-42.5 months. Infections of the saphenous harvest site were detected in 25% of the cases, edema in 52.3%, paresthesia in 29.5%, erysipelas in 9.1%, lymphorrhea in 4.5% and deep venous thrombosis in 2.3%. There was no association between diabetes and complications. CONCLUSION: The saphenous vein harvesting using bridge technique for coronary artery bypass grafting does not eliminate clinical complications, such as paresthesia, infection and edema of the saphenous vein harvesting site.

Drenagem linfática em paciente com dermatofibrose e flebite de membro inferior: relato de caso / Lymph drainage in patients with dermatofibrosis and phlebitis of the lower limb: case report

O presente estudo objetivou avaliar a drenagem linfática como forma coadjuvante de tratamento, em uma paciente idosa com dermatofibrose, flebite de membro inferior e queixa de dores na perna, localizada em região pós-flebítica. Foi realizado tratamento clínico inicial por três meses com drogas venotônicas (diosmin), anti-inflamatórios, analgésicos e repouso, porém com pouca melhora clínica. Foi, então, associada ao tratamento clínico, a drenagem linfática manual e mecânica. Os resultados obtidos incluíram a redução dos sintomas dolorosos e da hiperpigmentação do local acometido. Este trabalho sugere que a drenagem linfática obteve melhora do quadro clínico de paciente portadora de dermatofibrose, sugerindo novas pesquisas para caracterização mais específica dessa abordagem.

This study aimed at evaluating lymphatic drainage as a complementary form of treatment in an elderly patient with dermatofibrosis and phlebitis of the lower limb. The patient complained of pain in the post-phlebitic region. Initially three months of clinical treatment was performed using vasotonic(diosmine), anti-inflammatory and analgesic drugs and the patient was told to rest. However this treatment was not very effective. Manual and mechanical lymph drainage was associated to the clinical treatment. The results gave a significant improvement in the symptoms and the hyperpigmentation of the affected area. This study suggests that lymph drainage obtained improves the clinical of patient with dermatofibrosis, suggesting new research for more specific characterization of this approach.

Edema de membro inferior secundário a exérese de veia safena magna para utilização como enxerto na revascularização do miocárdio / Lower limb edema after great saphenous vein harvesting to be used as graft in myocardial revascularization

CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5 por cento (a = 0,05). RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p < 0.05) entre os membros operados e os não-operados, sendo 56,8 por cento com volume maior que 50 mL e 31,9 por cento com perímetro maleolar maior que 2 cm. Não se encontrou associação entre a presença do edema e características da amostra ou da cirurgia e de intercorrências clínicas perioperatórias ou tardias. CONCLUSÕES: Pacientes submetidos a ressecções de veia safena magna para sua utilização como ponte coronariana poderão apresentar edema no membro associado.

BACKGROUND: Myocardial revascularization using the great saphenous vein is still a very common surgical procedure. The edema that occurs in the operated leg causes much discomfort and requires further studies. OBJECTIVES: To describe lower limb edema secondary to great saphenous vein harvesting using the bridge technique for use as venous graft in myocardial revascularization. METHODS: Forty-four individuals previously submitted to great saphenous vein harvesting for myocardial revascularization more than 3 months before were randomly selected. Patients with factors that might interfere with formation of lower limb edema were excluded. Both operated and non-operated legs were evaluated by volumetry and perimetry of the malleolar region. Differences greater than 50 mL or higher than 2 cm between the operated and the contralateral leg were considered as presence of significant edema. Chi-square, Fisher's, McNemar's and Student's t tests were used for statistical analysis. Significance level was set at 5 percent (a = 0.05). RESULTS: Statistically significant differences (p < 0.05) were found between operated and contralateral legs, with 56.8 percent of the individuals having a difference in volume greater than 50 mL and 31.9 percent having a difference in malleolar region perimeter greater than 2 cm. There was no association between presence of edema and sample characteristics, surgery, perioperative or late clinical complications. CONCLUSIONS: Patients submitted to resection of the great saphenous vein for coronary artery bypass grafting may evolve with edema of the operated leg.

Bandagem úmida empregada com baixa elasticidade no tratamento de úlcera em paciente com lipolinfedema / Damp low-stretch bandage employed in the treatment of an ulcer in patient with lipolymphedema

O lipedema é caracterizado pelo aumento bilateral e simétrico dosmembros inferiores, sem o acometimento dos pés, sinal de Stemmernegativo, podendo ocorrer hipotermia cutânea, alteração no suporteplantar e hiperalgesia. O objetivo do presente estudo é relatar umaforma incomum de lesão ulcerada em paciente com lipolinfedematratado com bandagem úmida empregada com baixa elasticidade.Paciente, do sexo feminino, de 50 anos, com história familiar delipedema refere vários episódios de erisipela em membro inferioresquerdo há cerca de 20 anos e com surgimento de úlceras de difícilcicatrização há mais de cinco anos. Foi tratada com bandagemúmida de baixa elasticidade e teve boa evolução com cicatrização da ferida. Lesões ulceradas são raras no lipolinfedema, porém a sua ocorrência esta associada com dificuldade na cicatrização.

Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio / Clinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique

OBJETIVO: Avaliar as intercorrências clínicas nos membros submetidos a retirada da veia safena magna por técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Selecionou-se aleatoriamente 44 pacientes submetidos a revascularização do miocárdio utilizando a veia safena magna retirada por incisões escalonadas há mais de 3 meses. Critérios de exclusão: retirada da veia safena de ambos os lados; safenectomia prévia do membro contralateral; etiologias de edema de causas sistêmicas, tais como cardíacas, renais, tireoideanas, hepáticas e insuficiência venosa nos membros inferiores (MMII), representada por varizes exuberantes com ou sem alterações tróficas. Foram avaliados as seguintes variáveis: idade, sexo, diabetes, tempo de cirurgia, presença de intercorrências, como edema, parestesias, infecção, linforréia, erisipela e trombose venosa profunda. A avaliação foi clínica e o diagnóstico do diabete foi feito pelos exames do pré-operatório para cirurgia. Para análise estatística foram empregados o teste qui-quadrado, teste exato de Fisher e teste t de Student, considerando erro alfa de 5 por cento. RESULTADOS: O tempo entre avaliação e cirurgia foi de 3 a 187 meses, com média 47,3 + 42,5 meses. Detectou-se 25 por cento de infecção no leito da safena, edema em 52,3 por cento dos casos, parestesia em 29,5 por cento, erisipela em 9,1 por cento, linforréia em 4,5 por cento e trombose venosa profunda em 2,3 por cento. Não houve associação entre diabetes com as intercorrências. CONCLUSÃO: A exérese escalonada da veia safena magna para revascularização do miocárdio não elimina as intercorrências clínicas no leito da safena, como parestesias, infecção e edema

OBJECTIVE: The aim of this study was to assess clinical complications of limbs undergone harvesting of the great saphenous vein for venous coronary artery bypass graft surgery using bridge technique. METHODS: Fourty-four patients who had undergone CABG using the great saphenous vein harvested by the bridge technique over more than 3 months ago were randomly selected. The exclusion criteria were the harvesting of both saphenous veins, prior saphenectomy of the contralateral limb, edema caused by a systemic etiology, such as heart, renal, thyroid or hepatic diseases and venous insufficiency of the lower limbs as characterized by swollen varicose veins both with and without trophic changes. The age, gender, diabetes, time of surgery and occurrence of complications, such as edema, paresthesia, infection, lymphorrhea, erysipelas and deep venous thrombosis, were assessed. The assessment was clinic and diagnosis of the diabetes was performed by the preoperative exams. The chi-square, Fisher and Student's t tests were used for statistical analysis with an alpha error of 5 percent. RESULTS: The time between surgery and assessment ranged between 3 and 187 months with a mean of 47.3±42.5 months. Infections of the saphenous harvest site were detected in 25 percent of the cases, edema in 52.3 percent, paresthesia in 29.5 percent, erysipelas in 9.1 percent, lymphorrhea in 4.5 percent and deep venous thrombosis in 2.3 percent. There was no association between diabetes and complications. CONCLUSION: The saphenous vein harvesting using bridge technique for coronary artery bypass grafting does not eliminate clinical complications, such as paresthesia, infection and edema of the saphenous vein harvesting site.