Intestinal lymphangiectasia in an adult: case report.

Intestinal lymphangiectasia is a group of rare diseases characterized by dilation of lymphatic channels. Its pathophysiology comprises obstruction of small bowel lymphatic drainage with secondary dilation of mucosal, submucosal, or subserous lymphatic vessels, distorting villous architecture and causing loss of lymph into the intestinal lumen, leading to malabsorption. The affected lymphatic vessels are primarily located in the small intestine, which is affected to a varying extent. Its etiology is still unknown. The following report presents a rare case of intestinal lymphangiectasia in an adult patient.

Linfangiectasia intestinal em adulto: relato de caso / Intestinal lymphangiectasia in an adult: case report

Resumo A linfangiectasia intestinal consiste em um grupo de doenças raras caracterizadas pela dilatação dos canais linfáticos. A fisiopatologia compreende a obstrução da drenagem linfática do intestino delgado com dilatação secundária dos vasos linfáticos mucosos, submucosos ou subserosos, que distorcem a arquitetura das vilosidades e conduzem à perda de linfa para a luz intestinal, levando à má absorção. Os vasos linfáticos afetados localizam-se primariamente no intestino delgado, que é atingido em extensão variável. A sua etiologia é ainda desconhecida. O relato a seguir apresenta um raro caso de linfangiectasia intestinal em paciente adulto.

Abstract Intestinal lymphangiectasia is a group of rare diseases characterized by dilation of lymphatic channels. Its pathophysiology comprises obstruction of small bowel lymphatic drainage with secondary dilation of mucosal, submucosal, or subserous lymphatic vessels, distorting villous architecture and causing loss of lymph into the intestinal lumen, leading to malabsorption. The affected lymphatic vessels are primarily located in the small intestine, which is affected to a varying extent. Its etiology is still unknown. The following report presents a rare case of intestinal lymphangiectasia in an adult patient.

Use of brimonidine tartrate to resolve telangiectatic matting: case report.

Sclerotherapy is currently the treatment of choice for telangiectasias and reticular veins, with grade 1A recommendation in the European Guideline for sclerotherapy. The most common side effects of this procedure are hyperpigmentation and telangiectatic matting, the second of which provokes great concern because of the esthetic damage and the difficulty of treatment. Matting refers to vessels with a diameter of less than 0.2 mm, which may emerge irregularly or in well-defined areas, especially on the lower limbs. This report presents a case of matting treated with topical Brimonidine Tartrate.

Uso de tartarato de brimonidina para resolução de matting telangiectásico: relato de caso / Use of brimonidine tartrate to resolve telangiectatic matting: case report

Resumo A escleroterapia é, atualmente, o tratamento de escolha para telangiectasias e veias reticulares, apresentando nível de recomendação 1ª pela diretriz europeia para escleroterapia. Os efeitos colaterais mais comuns desse procedimento são a hiperpigmentação e o matting telangiectásico, sendo este último um dos mais temidos em virtude do dano estético e da dificuldade de tratamento. O matting se refere a vasos com diâmetro inferior a 0,2 mm que podem surgir esporadicamente ou em áreas bem definidas, principalmente nos membros inferiores. Este relato apresenta um caso de matting tratado com o uso de tartarato de brimonidina tópico.

Abstract Sclerotherapy is currently the treatment of choice for telangiectasias and reticular veins, with grade 1A recommendation in the European Guideline for sclerotherapy. The most common side effects of this procedure are hyperpigmentation and telangiectatic matting, the second of which provokes great concern because of the esthetic damage and the difficulty of treatment. Matting refers to vessels with a diameter of less than 0.2 mm, which may emerge irregularly or in well-defined areas, especially on the lower limbs. This report presents a case of matting treated with topical Brimonidine Tartrate.

Resultados da herniorrafia inguinal bilateral simultânea pela técnica de Lichtenstein / Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique

OBJETIVO: analisar os resultados da herniorrafia inguinal bilateral pela técnica de Lichtenstein. MÉTODOS: estudo dos prontuários de 59 pacientes submetidos à herniorrafia inguinal bilateral simultânea, eletiva, no período entre 2003 e 2007. Foram analisados: sexo, idade, peso, tempo operatório, tempo total de internação, classificação de Nyhus, intercorrências no pós-operatório imediato e tardio, e recidiva. Esses dados foram submetidos à análise estatística descritiva. RESULTADOS: dos 59 pacientes, 95% eram homens; e 5%, mulheres. A idade variou de 40 a 60 anos, o peso de 50 a 103 kg, o tempo operatório de 60 a 180 minutos, o tempo de internação de um a seis dias. Trinta pacientes apresentavam hérnias do tipo IIIB; nove, do tipo II; dez, do tipo IIIA; sete, do tipo IV; um, do tipo II à esquerda e tipo IIIB à direita; um, tipo IIIA à direita e IIIB à esquerda; e um, do tipo IIIA à direita e do tipo II à esquerda. No pós-operatório imediato, a dor foi a manifestação mais importante em 30,5% dos casos. Em 94,92% dos casos, não houve complicações tardias. Ocorreram dois casos de inguinodinia e um de dor em queimação local. Observou-se uma recidiva, no 29º mês de pós-operatório. CONCLUSÕES: a herniorrafia inguinal bilateral simultânea pela técnica de Lichtenstein foi segura e eficaz, pois houve baixo índice de complicações, curta permanência hospitalar e, em um período médio de 48 meses de acompanhamento, houve apenas um caso de recidiva.

OBJECTIVE: To analyze the results of bilateral inguinal hernia repairs by the Lichtenstein technique. METHODS: We studied the charts of 59 patients who underwent elective simultaneous bilateral inguinal hernia repair between 2003 and 2007. We analyzed: gender, age, weight, operative time, length of hospital stay, Nyhus classification, complications in the immediate and late postoperative periods, and recurrence. These data were submitted to descriptive statistical analysis. RESULTS: Of the 59 patients, 95% were men. Age ranged from 40 to 60 years; weight, from 50 to 103 kg; operative time, from 60 to 80 minutes; and the length of stay, from one to six days. Thirty patients had type IIIB hernias; nine, type II; ten, type IIIA; seven, type IV; one, type II on the left and type IIIB on the right; one, type IIIA on the right and IIIB on the left; and one, type IIIA on the right and type II on the left. In the immediate postoperative period, pain was the most important manifestation, in 30.5% of subjects. In 94.92% of cases there were no complications. There were two cases of inguinodinia and one of burning pain in the surgical site. There was one recurrence 29 months after the procedure. CONCLUSIONS: Simultaneous bilateral inguinal hernia repair by Lichtenstein technique was safe and effective, with a low rate of complications, short hospital stay, and only one case of recurrence at an average of 48 months follow-up.

Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique.

OBJECTIVE: To analyze the results of bilateral inguinal hernia repairs by the Lichtenstein technique. METHODS: We studied the charts of 59 patients who underwent elective simultaneous bilateral inguinal hernia repair between 2003 and 2007. We analyzed: gender, age, weight, operative time, length of hospital stay, Nyhus classification, complications in the immediate and late postoperative periods, and recurrence. These data were submitted to descriptive statistical analysis. RESULTS: Of the 59 patients, 95% were men. Age ranged from 40 to 60 years; weight, from 50 to 103 kg; operative time, from 60 to 80 minutes; and the length of stay, from one to six days. Thirty patients had type IIIB hernias; nine, type II; ten, type IIIA; seven, type IV; one, type II on the left and type IIIB on the right; one, type IIIA on the right and IIIB on the left; and one, type IIIA on the right and type II on the left. In the immediate postoperative period, pain was the most important manifestation, in 30.5% of subjects. In 94.92% of cases there were no complications. There were two cases of inguinodinia and one of burning pain in the surgical site. There was one recurrence 29 months after the procedure. CONCLUSIONS: Simultaneous bilateral inguinal hernia repair by Lichtenstein technique was safe and effective, with a low rate of complications, short hospital stay, and only one case of recurrence at an average of 48 months follow-up.

[Prehospital care to multiple victims with simulated trauma]. / Atendimento pré-hospitalar à múltiplas vítimas com trauma simulado.

OBJECTIVE: To assess the quality of prehospital care agencies conducted in Vitória, capital of Espírito Santo State, Brazil. METHODS: We conducted a retrospective study in the archives of the League of Academic Surgery and Trauma Care of Espírito Santo (Lacates) regarding 40 victims of a simulated crash between a bus and two cars. The patients were treated by four teams: Military Fire Department of Espírito Santo, Samu 192, County Guard and Civil Defense. The performance of these teams was evaluated by Lacates, through analysis of a check-list with pre-established guidelines for each victim. RESULT: The Fire Department of Espírito Santo (CBMES), which extricated victims, outlined the danger zones and carried out the screening by the method START, acted correctly in 92.5% of cases. The Samu 192 victims, which attended victims by the mnemonic method (ABCDE) in medical outposts, acted correctly in 92.5% of cases in the category Airway; 97.5% in breathing, 92.5% in circulation, 90% in Neurological Assessment, and 50% in the Exhibition and Environmental Control. The analysis showed that the ABCDE care was correct in 42.5% of cases. The transport of patients was performed correctly in 95% of cases. The County Guard secured the patency of the avenues for transportation of patients and Civil Defense successfully coordinated the work of teams involved in the command post. CONCLUSION: The triage and transport of victims have been performed satisfactorily. However, more attention should be given to exposure and hypothermia protection of victims, since this item compromised treatment.

Atendimento pré-hospitalar à múltiplas vítimas com trauma simulado / Prehospital care to trauma victmis with multiple simulated

OBJETIVO: Analisar a qualidade do atendimento pré-hospitalar realizado pelas agências em Vitória-ES. MÉTODOS: Estudo retrospectivo realizado nos arquivos da Liga Acadêmica de Cirurgia e Atendimento ao Trauma do Espírito Santo (Lacates) dos dados de 40 vítimas de um acidente simulado entre um ônibus e dois automóveis. Os pacientes foram assistidos por quatro equipes: Corpo de Bombeiro Militar do Espírito Santo, Samu 192, Guarda Municipal e Defesa Civil. A atuação dessas equipes foi avaliada pela Lacates, através da análise do check-list com orientações pré-estabelecidas para cada vítima. RESULTADO: O Corpo de Bombeiros Militar do Espírito Santo (CBMES), que desencarcerou as vítimas, delimitou as zonas de perigo e realizou a triagem pelo método START atuou corretamente em 92,5% dos casos. O Samu 192 que atendeu as vítimas pelo método mnemônico (ABCDE) no posto médico avançado agiu corretamente em 92,5% dos casos, no quesito Via Aérea; 97,5%, no Respiração; 92,5%, no Circulação; 90%, no Avaliação Neurológica; e 50%, no Exposição e Controle do Ambiente. A análise conjunta do ABCDE mostrou que o atendimento foi correto em 42,5% dos casos. O transporte dos pacientes foi realizado corretamente em 95% dos casos. A Guarda Municipal garantiu a perviedade das avenidas para transporte dos pacientes, e a Defesa Civil coordenou eficazmente o trabalho das equipes envolvidas no posto de comando. CONCLUSÃO: A triagem e o transporte foram executados satisfatoriamente, entretanto, maior atenção deve ser dada à exposição e proteção contra hipotermia das vítimas, já que esse item comprometeu o tratamento.

OBJECTIVE: To assess the quality of prehospital care agencies conducted in Vitória, capital of Espírito Santo State, Brazil. METHODS: We conducted a retrospective study in the archives of the League of Academic Surgery and Trauma Care of Espírito Santo (Lacates) regarding 40 victims of a simulated crash between a bus and two cars. The patients were treated by four teams: Military Fire Department of Espírito Santo, Samu 192, County Guard and Civil Defense. The performance of these teams was evaluated by Lacates, through analysis of a check-list with pre-established guidelines for each victim. RESULT: The Fire Department of Espírito Santo (CBMES), which extricated victims, outlined the danger zones and carried out the screening by the method START, acted correctly in 92.5% of cases. The Samu 192 victims, which attended victims by the mnemonic method (ABCDE) in medical outposts, acted correctly in 92.5% of cases in the category Airway; 97.5% in breathing, 92.5% in circulation, 90% in Neurological Assessment, and 50% in the Exhibition and Environmental Control. The analysis showed that the ABCDE care was correct in 42.5% of cases. The transport of patients was performed correctly in 95% of cases. The County Guard secured the patency of the avenues for transportation of patients and Civil Defense successfully coordinated the work of teams involved in the command post. CONCLUSION: The triage and transport of victims have been performed satisfactorily. However, more attention should be given to exposure and hypothermia protection of victims, since this item compromised treatment.