Impacto da escleroterapia com espuma de polidocanol guiada por ultrassom em pacientes com úlcera venosa / Impact of ultrasound-guided polidocanol foam sclerotherapy in patients with venous ulcers

Contexto: A escleroterapia com espuma de polidocanol guiada por ultrassom tem sido utilizada no tratamento de pacientes com úlceras venosas. É um procedimento minimamente invasivo e de fácil execução, porém apresenta taxas de recidiva elevadas. Objetivos: Relatar a evolução a curto e médio prazo de pacientes com úlcera venosa tratados com escleroterapia com espuma de polidocanol guiada por ultrassom. Métodos: Foram reavaliados 19 pacientes submetidos ao tratamento de escleroterapia com espuma de polidocanol guiada por ultrassom no período de janeiro de 2013 a dezembro de 2014. Foram analisados tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização das veias tratadas, recidiva dos sintomas e da úlcera venosa. Resultados: Foram analisados 15 pacientes do sexo feminino (78,9%) e quatro do sexo masculino (21,1%). A média geral de idade foi de 53 anos. O tempo de seguimento dos pacientes variou de 448 dias a 1.276 dias (média de 791 dias). O tempo médio de presença das úlceras foi de 53 meses. Na avaliação pós-procedimento, foram observadas recanalização total em 15,7%, recanalização parcial em 21% e oclusão em 47,3% das veias tratadas. Apenas em um caso foi observada recidiva da úlcera. Pela avaliação das médias do Venous Clinical Severity Score (VCSS), houve diferença significativa antes e após o procedimento, com variação entre os grupos de 11,2 (p < 0,01). Conclusões: A escleroterapia por espuma guiada por ultrassom apresenta altas taxas de sucesso terapêutico, com índices de cicatrização de úlceras venosas elevados

Background: Ultrasound-guided polidocanol foam sclerotherapy is used to treat patients with venous ulcers. It is a minimally invasive procedure and is simple to perform, but it has high relapse rates. Objectives: To report short to medium term results in patients with venous ulcers treated using ultrasound-guided polidocanol foam sclerotherapy. Methods: A sample of 19 patients who had been treated with ultrasound-guided polidocanol foam sclerotherapy between January 2013 and December 2014 were followed-up. Time taken for ulcers to heal, improvement of clinical symptoms, recanalization of treated veins, and relapse of symptoms and of venous ulcers were analyzed. Results: Fifteen of the patients analyzed were female (78.9%) and four were male (21.1%). Overall mean age was 53 years. Follow-up times ranged from 448 days to 1,276 days (mean of 791 days). The mean duration of active ulcers was 53 months. At postoperative follow-up assessments, total recanalization was observed in 15.7%, partial recanalization in 21%, and occlusion in 47.3% of the veins that had been treated. There was only one case of ulcer relapse. Analysis of mean Venous Clinical Severity Scores (VCSS) revealed a significant difference from before to after the procedure, with a variation of 11.2 (p < 0.01). Conclusions: Ultrasound-guided foam sclerotherapy has high rates of therapeutic success and achieves high rates of venous ulcer healing

Associação entre sintomas, veias varicosas e refluxo na veia safena magna ao eco-Doppler / Associations between symptoms and varicose veins and great saphenous vein reflux seen on Doppler ultrasonography

Resumo Contexto A doença venosa crônica requer avaliação clínica, quantificação dos efeitos hemodinâmicos e definição da distribuição anatômica para decisão diagnóstica e tratamento. Métodos Estudo prospectivo realizado em 2015 com amostra de 1.384 pacientes (2.669 membros) com idade entre 17 e 85 anos, sendo 1.227 do sexo feminino. Nas respostas do questionário aplicado, os sintomas pesquisados eram dor, cansaço, sensação de peso, queimação, câimbras e formigamento. Para a formação dos grupos, foi considerado o número de membros, distribuídos em relação ao gênero, ao índice de massa corporal e à idade. Após a definição grupos e a realização do eco-Doppler para estudo da veia safena magna (VSM), os pacientes foram distribuídos em três grupos (I: sintomas presentes e varizes ausentes, II: sintomas ausentes e varizes presentes e III: sintomas presentes e varizes presentes). A análise estatística utilizou o teste qui-quadrado ou exato de Fisher para verificar a homogeneidade entre os grupos. Em caso de associação com significância de 5%, foi calculada a razão de chances. Resultados Para ambos os gêneros, foi observada chance de insuficiência da VSM 11,2 vezes maior no grupo III. Por sua vez, os casos de obesidade mórbida ocorreram 9,1 vezes mais no mesmo grupo. Além disso, pacientes na faixa etária entre 30 e 50 anos desse grupo apresentaram chance de insuficiência da VSM 43,1 vezes maior. Conclusões A insuficiência da VSM foi significantemente mais frequente no grupo III, tanto globalmente como considerando apenas os casos de obesidade mórbida e a faixa etária mais elevada.

Abstract Background Chronic venous disease demands clinical assessment, quantification of hemodynamic effects, and definition of anatomic distribution before diagnostic and treatment decisions can be made. Methods This is a prospective study conducted in 2015 with a sample of 1,384 patients (2,669 limbs) aged from 17 to 85 years, 1,227 of whom were female. The most common symptoms reported in response to the questionnaire were pain, tiredness, feelings of heaviness, burning, cramps, and tingling. Subsets were formed on the basis of number of limbs distributed by sex, body mass index, and age. After definition of subsets, Doppler ultrasonography was used to conduct examinations of the great saphenous vein (GSV) and patients were distributed into three clinical groups (I: symptoms present and varicose veins absent, II: symptoms absent and varicose veins present and III: symptoms present and varicose veins present). Statistical analysis employed the chi-square test or Fisher’s exact test to test for homogeneity between groups. When associations significant to 5% were detected, odds ratios were calculated. Results For both sexes, the chance of GSV insufficiency was 11.2 times greater in group III. Among cases with morbid obesity, the chance was 9.1 times greater in the same group. Additionally, patients in this group with ages ranging from 30 to 50 years exhibited a 43.1 times greater chance of GSV insufficiency. Conclusions Insufficiency of the GSV was significantly more frequent in group III, both overall and when considering only cases with morbid obesity, or cases in older age groups.

Avaliação linfocintilográfica qualitativa de pacientes com linfedema de membros inferiores tratados com compressão pneumática intermitente por quatro semanas / Qualitative lymphoscintigraphic evaluation of patients with lower limb lymphedema, treated with sequential intermittent pneumatic compression for four weeks

Introdução: O tratamento conservador do linfedema periférico consta de drenagem linfática manual, exercícios terapêuticos, contenção elástica e inelástica e também a compressão pneumática intermitente sequencial. Objetivo: Avaliar o efeito da compressão pneumática intermitente sequencial associada ao uso de contenção inelástica e elástica e exercícios miolinfocinéticos, durante quatro semanas, em pacientes com linfedema das extremidades inferiores, utilizando a análise qualitativa da linfocintilografia e a perimetria. Material e métodos: Dez pacientes portadores de linfedema das extremidades inferiores selecionados por conveniência, totalizando 14 membros acometidos, foram submetidos a quatro semanas de tratamento com compressão pneumática intermitente sequencial, contenção inelástica e elástica e exercícios miolinfocinéticos. Para a avaliação dos membros realizou-se a análise qualitativa da linfocintilografia e também a perimetria dos membros antes e após o tratamento proposto. Resultados: Não foi encontrada diferença estatisticamente significativa nos achados linfocintilográficos pré e pós-tratamento. Contudo, encontrou-se redução significativa da perimetria dos membros (p < 0,01) cuja redução máxima encontrada foi de 5,9% na perimetria do tornozelo e a mínima de 1,8% na perimetria da coxa. Conclusão: O tratamento realizado foi eficaz na redução da perimetria do membro tratado, porém não foi observada alteração significativa nos padrões linfocintilográficos qualitativos para estes pacientes. (AU)

Introduction: Conservative treatment of peripheral lymphedema consists of manual lymphatic drainage, therapeutic exercises, elastic and inelastic compression and sequential intermittent pneumatic compression. Objective: The objective of this study was to evaluate the effect of four weeks of sequential intermittent pneumatic compression combined with elastic and inelastic compression and lymphokinetic exercises on patients with lymphedema of the lower extremities by means of qualitative analysis with lymphoscintigraphy and circumference measurements. Methods: Ten people with lymphedema of the lower limbs, totaling 14 limbs treated, selected by convenience, underwent lymphoscintigraphy before and after four weeks of treatment with sequential intermittent pneumatic compression, elastic and inelastic sleeves and lymphokinetic exercises. For evaluating limbs, were carried out qualitative analysis of lymphoscintigraphy and also circumference measurements before and after the proposed treatment. Results: No statistically significant differences were detected in lymphoscintigraphic findings before and after treatment. However, there was a significant reduction in the circumference measurements (p <0.01) of the limbs. The maximum reduction was found 5.9% in the ankle circumference and the minimum was 1.8% thigh circumference. Conclusion: The treatment was effective at reducing limb circumference, however, no significant changes were observed on the qualitative lymphoscintigraphic analysis for these patients. (AU)

Associação entre aplasia segmentar de veia safena magna e varizes em membros inferiores avaliada pelo ecocolor Doppler / Association between segmental aplasia of great saphenous vein and varicose veins of lower limbs, evaluated using color Doppler ultrasonography

Há diferenças individuais no diâmetro da veia safena magna (VSM) em membros normais e doentes; sendo possível a identificação dessas alterações pelo ecocolor Doppler.ObjetivoAvaliar a associação da aplasia segmentar da VSM com a presença de varizes e/ou insuficiência da mesma em membros inferiores, usando o ecocolor Doppler em pacientes com clínica de doença venosa crônica (DVC).Métodos1.408 pacientes com queixas compatíveis de DVC de membros inferiores, sendo 1.286 do sexo feminino, com idade entre 17 e 85 anos, examinados com ecocolor Doppler. Foram incluídos aqueles com classificação CEAP clínica C0 a C4. Pela avaliação clínica, a amostra foi distribuída em grupo A, pacientes com varizes, e grupo B, aqueles sem varizes. O ecocolor Doppler determinou se havia aplasia da VSM pela análise do seu trajeto no compartimento safeno e presença de veias varicosas nos diferentes sítios. Para estatística, foram considerados os testes Qui-quadrado ou Exato de Fisher e uma análise de resíduos em tabelas, com nível de significância de 5%.ResultadosNo grupo A houve 479 (83,9%) de VSM insuficientes, 169 (38,2%) com aplasia e 71 (80,7%) com insuficiência e aplasia associadas. No grupo B, houve 92 (16,1%) de VSM insuficientes, 273 (61,8%) com aplasia e 17 (19,3%) com insuficiência e aplasia associadas.ConclusãoA aplasia segmentar da VSM ocorre mais em membros inferiores que não apresentam varizes e/ou insuficiência da mesma, mas considerando-se a presença da associação de aplasia e insuficiência, houve maior incidência no grupo de membros que apresentavam varizes.

There are individual differences in the diameter of the great saphenous vein (GSV) in both normal and non-functional limbs and it is possible to identify these differences using color Doppler ultrasonography.ObjectivesTo assess the association between segmental GSV aplasia and the presence of varicose veins and/or GSV insufficiency in lower limbs using color Doppler ultrasonography, in patients with chronic venous disease (CVD).MethodsA total of 1,408 patients with complaints compatible with CVD of lower limbs were examined using color Doppler ultrasonography. The age range of the sample was from 17 to 85 and 1,286 of the patients were female. People with clinical classifications (CEAP) ranging from C0 to C4 were included. On the basis of clinical examination, the sample was subdivided as follows: group A patients had varicose veins and group B patients were free from varicose veins. Color Doppler ultrasonography was used to determine whether there was GSV aplasia, by analysis of its route into the saphenous compartment, and the presence of varicose veins in different sites. Statistical analysis was conducted using the chi-square test or Fisher’s exact tests followed by an analysis of residuals in tables, with a 5% significance level.ResultsIn group A, there were 479 (83.9%) patients with GSV insufficiency, 169 (38.2%) with aplasia and 71 (80.7%) with both insufficiency and aplasia. In group B, there were 92 (16.1%) patients with GSV insufficiency, 273 (61.8%) with aplasia and 17 (19.3%) with both insufficiency and aplasia.ConclusionSegmental GSV aplasia was more common in lower limbs with no varicose veins and/or insufficiency, but there was a higher incidence of patients with both aplasia and insufficiency in the group with varicose veins.

Accuracy of doppler ultrasonography in the evaluation of hemodialysis arteriovenous fistula maturity.

OBJECTIVE: to determine the accuracy of Doppler ultrasonography (USD) for hemodialysis arteriovenous fistula (AVF) maturity. METHODS: we included patients with no prior AVF. Each patient underwent two USD examinations. After initiation of hemodialysis, we followed the patients during the first month of the access use and verified its adequacy to hemodialysis sessions. At statistical analysis we measured specificity, sensitivity, accuracy, ROC curve (Receiver operator characteristic) curve, TG-ROC (Two graph - receiver operator characteristic) and logistic regression. RESULTS: we included 76 patients, of which 51 completed the study. They formed two groups, those who have had good adequacy for hemodialysis (45) and those who had not (6). The average flow volume (FV) and the average draining vein diameter (DVD) of each group were, respectively: 940mL/min (95% CI: 829-1052) and 325mL/min (95% CI: 140-510); and 0.48cm (95% CI: 0.45-0.52) and 0.33cm (95% CI: 0.27-0.40). The area under the ROC curve of FV and DVD were 0.926 and 0.766, respectively. CONCLUSION: the accuracy of the measured volume flow measured at the draining vein to evaluate maturation of hemodialysis arteriovenous fistula was 85%.

Ultrasonografic changes in the axillary vein of patients with lymphedema after mastectomy.

OBJECTIVE: To determine the prevalence of sonographic abnormalities (SA) in the axillary vein of patients with and without post-mastectomy lymphedema. METHODS: We studied a sample of 80 women, divided into two equal groups, with and without lymphedema, with B mode ultrasound, color and pulsed Doppler. The primary variable, SA, is defined as change in the venous diameter, parietal thickening, intraluminal images, compressibility, parietal collapse at inspiration and feature of the axillary venous flow on the operated side. Secondary variables were: stage of lymphedema, surgical technique, number of radio and chemotherapy sessions, limb volume, weight and age. The differences between the proportions in the groups were determined using the Chi-square test and / or Fisher's test. For continuous variables, we used the Mann-Whitney Test. To estimate the magnitude of the associations, we used the prevalence rate of SA in both groups as a measure of frequency, and as a measure of association, the prevalence ratio (PR) obtained as a function of relative risk (RR) and estimated by the test Mantel-Haenszel homogeneity test. We adopted the statistical significance level of 5% (p < 0.05). RESULTS: only the criterion "parietal thickening" was strongly associated with the lymphedema group (p = 0.001). The prevalence of SA was 55% in patients with lymphedema and 17.5% in the group without it, with difference in prevalence of 37.5%. CONCLUSION: the prevalence of SA was higher in patients undergoing mastectomy with lymphedema than in those without lymphedema.

Accuracy of doppler ultrasonography in the evaluation of hemodialysis arteriovenous fistula maturity / A acurácia da ultrassonografia com doppler na avaliação da maturação da fístula arteriovenosa para hemodiálise

OBJECTIVE:To determine the accuracy of Doppler ultrasonography (USD) for hemodialysis arteriovenous fistula (AVF) maturity. METHODS:we included patients with no prior AVF. Each patient underwent two USD examinations. After initiation of hemodialysis, we followed the patients during the first month of the access use and verified its adequacy to hemodialysis sessions. At statistical analysis we measured specificity, sensitivity, accuracy, ROC curve (Receiver operator characteristic) curve, TG-ROC (Two graph - receiver operator characteristic) and logistic regression. RESULTS:We included 76 patients, of which 51 completed the study. They formed two groups, those who have had good adequacy for hemodialysis (45) and those who had not (6). The average flow volume (FV) and the average draining vein diameter (DVD) of each group were, respectively: 940mL/min (95% CI: 829-1052) and 325mL/min (95% CI: 140-510); and 0.48cm (95% CI: 0.45-0.52) and 0.33cm (95% CI: 0.27-0.40). The area under the ROC curve of FV and DVD were 0.926 and 0.766, respectively. CONCLUSION:The accuracy of the measured volume flow measured at the draining vein to evaluate maturation of hemodialysis arteriovenous fistula was 85%.

OBJETIVO: Testar a acurácia da ultrassonografia com Doppler (USD) na avaliação da maturação do acesso vascular para hemodiálise. MÉTODOS:Foram incluídos pacientes que não haviam feito uma fistula arteriovenosa (FAV) anteriormente. Cada paciente foi submetido a dois exames de USD. Após o início da hemodiálise, foram acompanhados durante o primeiro mês utilizando o acesso e verificando sua adequação às sessões de hemodiálise. Foram aferidas: especificidade, sensibilidade, acurácia, curva ROC (Receiver operator characteristic), curva TG-ROC (Two graph - receiver operator characteristic) e regressão logística. RESULTADOS:Foram incluídos na pesquisa 76 pacientes, 51 concluíram o estudo. O volume de fluxo (VF) médio e o diâmetro médio da veia de drenagem (DVD) foram, respectivamente, para cada grupo: 940 ml/min (IC95%: 829-1052 ml/min); 325 ml/min (IC95%: 140-510 ml/min); e 0,48cm (IC95%: 0,45-0,52 cm); 0,33cm (IC95%: 0,27-0,40 cm). A área sob a curva ROC do VF e do DVD foram, respectivamente, 0,926 e 0,766. CONCLUSÃO:A acurácia da medida de volume de fluxo aferido na veia de drenagem para avaliar a maturação da fistula de hemodiálise foi 85%, o melhor parâmetro disponível isoladamente.

Ultrasonografic changes in the axillary vein of patients with lymphedema after mastectomy / As alterações ultrassonográficas na veia axilar de portadoras de linfedema pós-mastectomia

OBJECTIVE: To determine the prevalence of sonographic abnormalities (SA) in the axillary vein of patients with and without post-mastectomy lymphedema. METHODS: We studied a sample of 80 women, divided into two equal groups, with and without lymphedema, with B mode ultrasound, color and pulsed Doppler. The primary variable, SA, is defined as change in the venous diameter, parietal thickening, intraluminal images, compressibility, parietal collapse at inspiration and feature of the axillary venous flow on the operated side. Secondary variables were: stage of lymphedema, surgical technique, number of radio and chemotherapy sessions, limb volume, weight and age. The differences between the proportions in the groups were determined using the Chi-square test and / or Fisher's test. For continuous variables, we used the Mann-Whitney Test. To estimate the magnitude of the associations, we used the prevalence rate of SA in both groups as a measure of frequency, and as a measure of association, the prevalence ratio (PR) obtained as a function of relative risk (RR) and estimated by the test Mantel-Haenszel homogeneity test. We adopted the statistical significance level of 5% (p < 0.05). RESULTS: only the criterion "parietal thickening" was strongly associated with the lymphedema group (p = 0.001). The prevalence of SA was 55% in patients with lymphedema and 17.5% in the group without it, with difference in prevalence of 37.5%. CONCLUSION: the prevalence of SA was higher in patients undergoing mastectomy with lymphedema than in those without lymphedema.

OBJETIVO: Verificar se existe prevalência de alterações ultrassonográficas (AUS) na veia axilar de pacientes portadoras e não portadoras de linfedema do membro superior pós-mastectomia. MÉTODOS:uma amostra de 80 mulheres, alocadas em dois grupos iguais, com e sem linfedema foi estudada com ultrassonografia modo B, Doppler colorido e pulsado. A variável primária AUS foi definida como: alteração do diâmetro venoso, espessamento parietal, imagens intraluminares, compressibilidade, colapso parietal à inspiração e característica do fluxo venoso axilar no lado operado. Como variáveis secundárias: estádio do linfedema, técnica operatória, número de sessões de radio e quimioterapia, volume do membro, peso e idade. As diferenças entre as proporções nos grupos foram verificadas com o teste qui-quadrado de Pearson e/ou exato de Fisher. Para variáveis contínuas usamos o teste de Mann-Whitney. Para estimar a magnitude das associações utilizou-se como medida de frequência a prevalência de AUS em ambos os grupos e como medida de associação, a razão de prevalência (RP) obtida em função do risco relativo (RR) e estimada por meio do teste de homogeneidade de Mantel-Haenszel. Adotou-se o nível de significância estatístico de 5% (pd"0,05). RESULTADOS:somente o critério "espessamento parietal" se relacionou fortemente com o grupo com linfedema (p=0,001). A prevalência de AUS foi 55% no grupo com linfedema e 17,5% no grupo sem linfedema, com diferença de prevalências de 37,5%. CONCLUSÃO:a prevalência de AUS foi maior nas pacientes submetidas à mastectomia e com linfedema do que naquelas sem linfedema.

Biomarkers of inflammation may be of use for identification of more severe peripheral arterial occlusive disease / Biomarcadores inflamatórios circulantes podem ser úteis para identificar doença arterial obstrutiva periférica mais grave

Background: Atherosclerosis is a multifactorial disease with an inflammatory pathophysiological basis. Cytokines released during the atherosclerotic process induce production of C-reactive protein (CRP) in the liver, which is an important marker of inflammation. Objective: We tested whether inflammatory biomarkers were associated with deterioration of peripheral arterial occlusive disease (PAOD) in a population at high cardiovascular risk. Methods: 1,330 subjects ≥30 years of age underwent clinical and laboratory examinations as part of a population-based study of the prevalence of diabetes. PAOD was defined as an ankle-brachial index (ABI) ≤0.90. After application of exclusion criteria, the sample comprised 1,038 subjects. Traditional risk factors, CRP and interleukin 6 (IL-6) were also compared across three ABI categories (≤0.70; 0.71-0.90; ≥0.90). Mean values for these variables were compared by presence/absence of DAOP (Student's t test) and by ABI categories (ANOVA). Poisson regression and logistic regression models were used to test for associations between risk factors and DAOP and between risk factors and the ABI categories. Pearson's linear correlation coefficients were calculated for the relationship between CRP and IL-6 levels. Results: Mean age was 56.8±12.9 years, 54% of the sample were women and the prevalence of DAOP was 21.0% (95%CI 18.4-24.1). Individuals with ABI ≤0.70 had higher concentrations of CRP-us (2.1 vs. 1.8) and of IL-6 (1.25 vs. 1.17). Concentrations of CRP and IL-6 were only correlated in patients with DAOP, (p=0.004). Conclusions: The finding that CRP and IL-6 levels were only elevated among people with advanced DAOP may suggest that these biomarkers have a role to play as indicators of more severe disease. Prospective studies are needed to test this hypothesis...

Contexto: Aterosclerose é doença multifatorial, cuja base fisiopatológica é um processo inflamatório. Estudos são controversos quanto ao papel dos biomarcadores como fatores de risco. A liberação de citoquinas durante aterogênese promove síntese hepática de proteína C-reativa (PCR), importante marcador inflamatório. Objetivo: Avaliamos se biomarcadores inflamatórios estavam associados à deterioração da doença arterial obstrutiva periférica (DAOP), em população de risco cardiovascular. Métodos: Estudo populacional sobre prevalência de diabetes, em que 1.330 indivíduos com ≥30 anos foram submetidos a exames clínico-laboratoriais. Diagnóstico de DAOP foi feito pelo índice tornozelo-braço (ITB) ≤0,90. Após exclusões, 1.038 indivíduos foram analisados. Fatores de risco tradicionais, PCR e interleucina 6 (IL-6) foram comparados também segundo três categorias de ITB (≤0,70; 0,71-0,90; ≥0,90). Valores médios das variáveis foram comparados segundo presença de DAOP (teste t Student) e categorias do ITB (ANOVA). Utilizou-se modelo de Poisson e regressão logística para avaliar associações da DAOP e categorias do ITB com fatores de risco. Estimou-se coeficiente de correlação linear de Pearson para relação entre os valores de PCR e IL-6. Resultados: A idade média foi 56,8±12,9 anos, 54% mulheres e prevalência de DAOP 21,0% (IC95% 18,4-24,1). Indivíduos com ITB ≤0,70 apresentaram maiores valores de PCR-us (2,1 vs. 1,8) e IL-6 (1,25 vs. 1,17. Apenas em portadores de DAOP, valores de PCR e IL-6 mostraram-se correlacionados (p=0,004). Conclusão: O achado de concentrações mais elevadas de PCR e IL-6 apenas em indivíduos com DAOP avançada pode sugerir um...

Association between peripheral arterial disease and C-reactive protein in the Japanese-Brazilian population.

OBJECTIVE: To evaluate the relationship between peripheral arterial disease and elevated levels of C-reactive protein in the Japanese-Brazilian population of high cardiovascular risk. METHODS: We conducted a cross-sectional study derived from a population-based study on the prevalence of diabetes and associated diseases in the Japanese-Brazilian population. One thousand, three hundred and thirty individuals aged e" 30 underwent clinical and laboratory examination, including measurement of ultrasensitive C-reactive protein. The diagnosis of peripheral arterial disease was performed by calculating the ankle-brachial index. We considered with peripheral arterial disease patients who had ankle-brachial index d" 0.9. After applying the exclusion criteria, 1,038 subjects completed the study. RESULTS: The mean age of the population was 56.8 years; 46% were male. The prevalence of peripheral arterial disease was 21%, with no difference between genders. Data analysis showed no association between peripheral arterial disease and ultrasensitive C-reactive protein. Patients with ankle-brachial index d" 0.70 showed higher values of ultrasensitive C-reactive protein and worse cardiometabolic profile. We found a positive independent association of peripheral arterial disease with hypertension and smoking. CONCLUSION: The association between low levels of ankle-brachial index and elevated levels of ultrasensitive C-reactive protein may suggest a relationship of gravity, aiding in the mapping of high-risk patients.

Association between peripheral arterial disease and creactive protein in the japanese-brazilian population / Avaliação da associação entre doença arterial obstrutiva periférica e níveis aumentados de proteína C-reativa em população nipo-brasileira

OBJECTIVE: To evaluate the relationship between peripheral arterial disease and elevated levels of C-reactive protein in the Japanese-Brazilian population of high cardiovascular risk. METHODS: We conducted a cross-sectional study derived from a population-based study on the prevalence of diabetes and associated diseases in the Japanese-Brazilian population. One thousand, three hundred and thirty individuals aged e" 30 underwent clinical and laboratory examination, including measurement of ultrasensitive C-reactive protein. The diagnosis of peripheral arterial disease was performed by calculating the ankle-brachial index. We considered with peripheral arterial disease patients who had ankle-brachial index d" 0.9. After applying the exclusion criteria, 1,038 subjects completed the study. RESULTS: The mean age of the population was 56.8 years; 46% were male. The prevalence of peripheral arterial disease was 21%, with no difference between genders. Data analysis showed no association between peripheral arterial disease and ultrasensitive C-reactive protein. Patients with ankle-brachial index d" 0.70 showed higher values of ultrasensitive C-reactive protein and worse cardiometabolic profile. We found a positive independent association of peripheral arterial disease with hypertension and smoking. CONCLUSION: The association between low levels of ankle-brachial index and elevated levels of ultrasensitive C-reactive protein may suggest a relationship of gravity, aiding in the mapping of high-risk patients. .

OBJETIVO: avaliar a relação entre a doença arterial obstrutiva periférica e níveis elevados de proteína C-reativa em população nipo-brasileira de alto risco cardiovascular. MÉTODOS: estudo transversal derivado de estudo de base populacional sobre a prevalência de diabetes e doenças associadas em população nipo-brasileira. Mil trezentos e trinta indivíduos com idade >30 foram submetidos a exame clínico e laboratorial, incluindo a dosagem da proteína C-reativa ultrassensível. O diagnóstico da doença arterial obstrutiva periférica foi realizado através do cálculo do índice tornozelo-braço. Foram considerados portadores de doença arterial obstrutiva periférica os pacientes que apresentaram índice tornozelo-braço <0,9. Após aplicação dos critérios de exclusão, 1038 indivíduos completaram o estudo. RESULTADOS: a média de idade da população foi 56,8 anos, 46% pertencentes ao sexo masculino. A prevalência da doença arterial obstrutiva periférica foi 21%, sem diferença entre os sexos. A análise dos dados não mostrou associação entre doença arterial obstrutiva periférica e proteína C-reativa ultrassensível. Os pacientes com índice tornozelo-braço <0,70 apresentaram valores mais elevados de proteína C-reativa ultrassensível e o pior perfil cardiometabólico. Encontramos associação positiva e independente da doença arterial obstrutiva periférica com hipertensão arterial e tabagismo. . CONCLUSÃO: a associação encontrada entre valores baixos de índice tornozelo-braço e níveis elevados de proteína C-reativa ultrassensível pode sugerir uma relação de gravidade auxiliando mapeamento dos pacientes ...

A case study involving a blunt abdominal trauma leading to disruption of the aortic bifurcation in an infant / Estudo de caso de trauma abdominal contuso levando à ruptura da bifurcação aórtica em criança

The incidence of aortic disruption secondary to blunt abdominal trauma is rarely reported in the pediatric population. In general, most of the cases described are the result of motor vehicle accidents. We report on the treatment and outcomes of a 5-year-old child with aortic bifurcation disruption secondary to an unusual case of blunt abdominal trauma who was admitted to the emergency room in hypovolemic shock and subjected to immediate exploratory laparotomy and vascular repair. The mechanical forces involved in aortic disruption and the management options for repair and treatment of this injury will be discussed...

A incidência de ruptura aórtica secundária a um trauma abdominal contuso é uma condição extremamente rara e pouco relatada na população pediátrica. Em geral, a maioria dos casos descritos é devida a acidentes automobilísticos. Descrevemos o caso de uma criança de cinco anos de idade, vítima de trauma abdominal contuso de etiologia incomum, a qual foi admitida em sala de emergência em choque hipovolêmico e submetida a laparotomia exploradora, com o reparo de uma laceração da bifurcação aórtica. Serão discutidas as forças mecânicas envolvidas e as opções de tratamento para esse tipo de lesão...

Study of risk factors associated with peripheral arteriopathy in Japanese-Brazilians from Bauru (SP).

BACKGROUND: Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. OBJECTIVE: This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. METHODS: This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged≥30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI≤0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. RESULTS: The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). CONCLUSION: The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population.

Estudo dos Fatores de Risco Associados a Arteriopatia Periferica em Nipo-brasileiros de Bauru (SP) / Study of Risk Factors Associated with Peripheral Arteriopathy in Japanese-Brazilians from Bauru (SP)

Fundamento: As patologias cardiovasculares são a maior causa de morbimortalidade nos países desenvolvidos e emergentes. Sua principal etiologia, a aterosclerose, é doença disseminada acometendo os territórios coronariano, cerebral e periférico. A doença arterial obstrutiva periférica (DAOP), além de suas consequências per se, sinaliza o acometimento do território coronariano. Portanto, seu melhor conhecimento permite tratamento adequado, retardando complicações locais e à distância, diminuindo o custo para o sistema de saúde. Objetivo: Este estudo estima a porcentagem de DAOP em nipo-brasileiros de Bauru (SP), reconhecidos pela alta prevalência de distúrbios metabólicos, como hipertensão arterial (43%), diabetes melito (33%) e hipercolesterolemia (60 %), e analisa a associação com biomarcadores de risco. Métodos: Este estudo transversal populacional avaliou 1.330 nipo-brasileiros de ambos os sexos com idade ≥ 30 anos que foram submetidos a exame físico completo, medidas antropométricas, exames laboratoriais e índice tornozelo-braço (ITB). Participantes com ITB ≤ 0,90 foram diagnosticados como portadores de DAOP. Após aplicação dos critérios de exclusão, 1.038 indivíduos integraram a análise. Empregou-se regressão de Poisson para análise das associações com DAOP. Resultados: A idade média foi 56,8 anos e a porcentagem de DAOP foi 21,1%, igual entre os sexos. DAOP associou-se com tabagismo (RP 2,16 [1,33-3,48]) e hipertensão arterial (RP 1,56 [1,12-2,22]). Conclusão: A porcentagem de DAOP nos nipo-brasileiros foi semelhante à de outras populações de perfil cardiometabólico desfavorável (US PARTNERS e POPADAD). A associação independente de DAOP com tabagismo e hipertensão, ...

Background: Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. Objective: This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. Methods: This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. Results: The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). Conclusion: The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population. .

Alprostadil attenuates inflammatory aspects and leucocytes adhesion on renal ischemia and reperfusion injury in rats

PURPOSE: To evaluate the effects of alprostadil in an experimental model of ischemia and reperfusion injury (IRI) in rat renal tissue. METHODS: Adult male Wistar rats were randomized into three groups Vehicle-treated group(Veh), Alprostadil-treated(Al), and sham(Sh) group. Veh and Al groups had suprarenal aorta occluded for 30 minutes and reperfused for 60 minutes. Saline or 20 µg/kg of Alprostadil was intravenously infused immediately before declamping. Sh group animals underwent similar procedure without aortic occlusion. Left nephrectomy and blood sampling were performed after 60 minutes of reperfusion. Renal ICAM-1 expression and histological analysis were performed to estimate inflammatory response and tissue disarrangement. Serum biochemical markers for IRI were also measured. Kruskal-Wallis test was used to assess differences between the groups. RESULTS: There was lower expression of ICAM-1 in groups Veh and Sh. On histologically evaluation, inflammation and necrosis in the Veh group was significantly higher (grades III/IV) than Al group (Veh>Al=Sh; p = 0.025), as well as CPK levels (Veh>Al=Sh; p = 0.03). CONCLUSION: Alprostadil attenuates the immunohistochemical and histological repercussions in the renal tissue of rats submitted to a post-ischemic reperfusion with supra-renal aortic clamping. .

Neovascularization after surgical exposure of rat external jugular vein endothelium.

PURPOSE: To investigate the neovascularization after exposure of the external jugular venous endothelium in an experimental model. METHODS: The sample was composed of 60 male rats of Wistar OUT B breed provided by animal colony of the Medicine College of Juazeiro do Norte, weighing 250 to 350 g, aged 90-120 days. Randomized study in OUT B Wistar rats, open, with 60 days duration. The animals were distributed into three groups of 20 specimens and were subjected to the following: Group 1: neck incision with dissection, ligation and section of the external jugular vein. Group 2: neck incision with dissection and ligation of the external jugular vein. Group 3: cervicotomy without dissection of the external jugular vein without ligation or section. The animals were sacrificed, half of them in 30 days and the other half within 60 days. The material in block harvested from the operated site were sectioned and stained for immunohistochemistry with CD34 marker. RESULTS: Neovascularization occurred with level of significance when compared group 1 to group 3 at 30 days (p=0.0076) and the same occurred at 60 days (p=0.0001) (Newman-Keuls test). CONCLUSION: The group with exposure of the venous endothelium showed a significant increase of neovascularization when compared with other groups.

Avaliação da postura e dos movimentos articulares dos membros superiores de pacientes pós-mastectomia e linfadenectomia / Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy

OBJETIVO: Avaliar as alterações posturais e de amplitudes de movimento de membro superior nas mulheres pós-mastectomia e linfadenectomia que se submeteram à radioterapia como tratamento adjuvante. MÉTODOS: Foram avaliados dois grupos: 16 mulheres pós-mastectomia com linfedema de membro superior e 14 mulheres pós-mastectomia sem linfedema. As pacientes foram submetidas à avaliação feita por programas computadorizados, um para postura e outro para medir as amplitudes de movimento de ombro, cotovelo e punho. Os resultados obtidos foram comparados entre lado direito e esquerdo, e operado e não operado, sendo submetidos a testes estatísticos. RESULTADOS: Ambos os grupos apresentaram anteriorização de tronco. As mulheres com linfedema mostraram rotação de cabeça à direita, protusão de ombro do lado esquerdo e medidas do ângulo de talhe menores do lado operado, além de elevação da escápula bilateralmente, quando comparadas ao grupo sem linfedema. As alterações de amplitude de movimento também foram menores do lado operado na flexão, abdução e rotação externa de ombro para todas as mulheres e, para aquelas que tinham linfedema, a extensão de cotovelo e a flexão de punho tiveram menor amplitude de movimento. CONCLUSÃO: Mulheres que foram submetidas à mastectomia apresentaram assimetrias e alterações de postura, e o linfedema parece agravar essa condição. Além disso, apresentaram déficits de amplitude de movimento em ombros, do lado operado. Mulheres com linfedema exibiram também déficits em cotovelo e punho.

OBJECTIVE: To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment. METHODS: Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests. RESULTS: Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion. CONCLUSION: Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.

Neovascularization after surgical exposure of rat external jugular vein endothelium

PURPOSE: To investigate the neovascularization after exposure of the external jugular venous endothelium in an experimental model. METHODS: The sample was composed of 60 male rats of Wistar OUT B breed provided by animal colony of the Medicine College of Juazeiro do Norte, weighing 250 to 350g, aged 90-120 days. Randomized study in OUT B Wistar rats, open, with 60 days duration. The animals were distributed into three groups of 20 specimens and were subjected to the following: Group 1: neck incision with dissection, ligation and section of the external jugular vein. Group 2: neck incision with dissection and ligation of the external jugular vein. Group 3: cervicotomy without dissection of the external jugular vein without ligation or section. The animals were sacrificed, half of them in 30 days and the other half within 60 days. The material in block harvested from the operated site were sectioned and stained for immunohistochemistry with CD34 marker. RESULTS: Neovascularization occurred with level of significance when compared group 1 to group 3 at 30 days (p=0.0076) and the same occurred at 60 days (p=0.0001) (Newman-Keuls test). CONCLUSION: The group with exposure of the venous endothelium showed a significant increase of neovascularization when compared with other groups.

Avaliação da ocorrência do refluxo venoso da safena magna pela ultrassonografia com doppler colorido após tratamento cirúrgico da insuficiência da junção safeno-femoral / Evaluation of the venous reflux of the great saphenous vein by duplex scan after surgical treatment of the saphenofemoral junction insufficiency

OBJETIVO: avaliar a ocorrência do refluxo da safena magna através da ultrassonografia com Doppler colorido em sujeitos submetidos ao tratamento da insuficiência da junção safeno-femoral por ligadura simples ou por ligadura com secção da crossa. MÉTODOS: foram realizadas 60 operações (45 sujeitos) de varizes com insuficiência da junção safeno-femoral (JSF), pertencentes à classificação clínica do CEAP 2 a 5, que foram distribuídos aleatoriamente em dois grupos. Um grupo denominado C, com ligadura e secção da crossa, e um grupo denominado L, com ligadura simples sem secção da crossa da veia safena magna. Foi então pesquisada a ocorrência do refluxo da safena magna nos grupos C e L através da ultrassonografia doppler colorida após o tratamento cirúrgico com intervalos de seis meses a um ano. RESULTADOS: dos 60 membros submetidos à abordagem da crossa da safena magna, 57 foram avaliados pela ultrassonografia doppler pós-operatório, pois dois sujeitos (três membros) não retornaram e foram excluídos do estudo. A média de idade foi 54 anos, 93% do sexo feminino e predominância da classificação (CEAP) C2 de 60,5%. Das 57 operações para o tratamento do refluxo da crossa da safena, 43,9% apresentaram refluxo no pós-operatório, sendo 14,1% do grupo C e 29,8% no grupo L (p<0,05). O risco relativo de apresentar refluxo da crossa da safena no grupo L foi 2,03 vezes maior em comparação com o grupo C. CONCLUSÃO: a secção da crossa da safena magna apresenta menos refluxo pós-operatório do que a ligadura simples no tratamento da insuficiência da crossa da veia safena magna.

OBJECTIVE: To evaluate the occurrence of reflux from the great saphenous vein by color Doppler ultrasonography in subjects undergoing treatment of insufficiency of the saphenofemoral junction by simple ligation or ligation with section of the saphenous arch. METHODS: We performed 60 operations (in 45 subjects) of varicose insufficiency of the saphenofemoral junction (SFJ), belonging to the CEAP clinical classification of 2-5, who were randomly divided into two groups. A group called C, with ligature and section of the saphenous arch, and a group called L, with simple ligation of the saphenous vein and no sectioning of its arch. We then investigated the occurrence of reflux from the great saphenous vein in groups C and L through postoperative color Doppler ultrasonography at intervals of six months to one year. RESULTS: Of the 60 members submitted to the approach of the saphenous arch, 57 were evaluated by postoperative doppler ultrasound, since two subjects (three limbs) did not return and were excluded from the study. The mean age was 54 years, with 93% females and predominance of CEAP classification 2 in 60.5%. Of the 57 operations for the treatment of reflux of the saphenous arch, 43.9% had reflux postoperatively,14.1% in group C and 29.8% in group L (p < 0,05). The relative risk of reflux of the saphenous arch in group L was 2.03 times higher compared with group C. CONCLUSION: the section of the arch of the great saphenous vein causes less postoperative reflux than simple ligation in treatment of insufficiency of the great saphenous vein.