Age-related white matter hyperintensities and overactive bladder: A systematic review.

INTRODUCTION: Age-related white matter hyperintensities (ARWMHs) on brain magnetic resonance imaging have been associated with lower urinary tract symptoms/dysfunction (LUTS/LUTD), namely overactive bladder (OAB) and detrusor overactivity. We aimed to systematically review existing data on the association between ARWMH and LUTS and which clinical tools have been used for this assessment. MATERIALS AND METHODS: We searched PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov (from 1980 to November 2021) and considered original studies reporting data on ARWMH and LUTS/LUTD in patients of both sexes aged 50 or above. The primary outcome was OAB. We calculated the unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the outcomes of interest using random-effects models. RESULTS: Fourteen studies were included. LUTS assessment was heterogeneous and mainly based on the use of nonvalidated questionnaires. Urodynamics assessment was reported in five studies. ARWMHs were graded using visual scales in eight studies. Patients with moderate-to-severe ARWMHs were more likely to present with OAB and urgency urinary incontinence (UUI; OR = 1.61; 95% CI: 1.05-2.49, p = 0.03), I2 = 21.3%) when compared to patients with similar age and absent or mild ARWMH. DISCUSSION AND CONCLUSIONS: High-quality data on the association between ARWMH and OAB is scarce. Patients with moderate to severe ARWMH showed higher levels of OAB symptoms, including UUI, when compared to patients with absent or mild ARWMH. The use of standardized tools to assess both ARWMH and OAB in these patients should be encouraged in future research.

Association between endothelial biomarkers and lipid and glycemic levels: a cross-sectional study with diabetic patients.

Background: Biomarkers can help understand the impact of achieving therapeutic goals in developing vascular diseases in diabetics. Aim: To assess the association between lipid and glycemic profiles and endothelial biomarkers in diabetics. Methods: Cross-sectional study that evaluated lipid and glycemic levels and biomarkers (VCAM-1, Sdc-1, FGF-23 and KIM-1 in diabetics. Results: Higher VCAM-1 levels were associated with higher low-density lipoprotein cholesterol and non-high-density lipoprotein (HDL) cholesterol levels (in the group with inadequate glycohemoglobin A1c [HbA1c] levels), with higher glycemic levels (in the group with inadequate HDL cholesterol levels) and with lower HDL cholesterol levels (both groups). VCAM-1 was independently associated with not achieving adequate HbA1c levels. Conclusion: In uncontrolled diabetics, VCAM-1 was independently associated with having inadequate HbA1c levels, suggesting they may already have endothelial damage.

New Diagnostic Criteria for Overmedication in Systemic Arterial Hypertension.

BACKGROUND: Guidelines on managing arterial blood pressure have begun to include lower targets, despite the risk for overmedication-induced hypotension. Because there is no consensus as to what constitutes overmedication in the treatment of hypertension, we conducted a study to develop relevant diagnostic criteria. METHODS: We used ambulatory monitoring during a 24-hour period to measure blood pressure in 567 patients with medication-controlled hypertension. We then divided this cohort into 3 groups. Group A (n = 413 [72.8%]) comprised patients in whom less than 10% of systolic blood pressure measurements were less than 100 mm Hg (no or mild hypotension). Group B (n = 154 [27.2%]) comprised patients in whom 10% or more of the measurements were less than 100 mm Hg, signifying overmedication. Group C comprised those patients in Group B in whom 20% or more of the measurements were less than 100 mm Hg (n = 74 [48.1%]; attributed to "accentuated" overmedication). Group C patients were prescribed significantly more antihypertensive drugs than were group A patients. RESULTS: Our findings support a 2-part definition of overmedication in hypertension treatment: (1) mild overmedication, in which 10% or more but less than 20% of systolic blood pressure measurements are less than 100 mm Hg in the awake state and less than 90 mm Hg during sleep; and (2) accentuated overmedication, characterized by 20% or more of valid systolic blood pressure measurements less than 100 mm Hg in the awake state and less than 90 mm Hg during sleep, during a 24-hour period. CONCLUSION: We think this guidance will help to avoid overmedicating and consequences such as fainting and falls when systolic blood pressure is too low.

Heart Disease and the Kidneys.

Clinical Background: The heart can cause kidney disease, and the kidney can cause heart disease. As an example of the first situation, we can mention dilated cardiomyopathies, which can lead to renal failure of the pre-renal type due to the state of renal hypoflow. As an example of the second situation, we can remember that renal failure is a risk factor for cardiovascular diseases, such as coronary heart disease, due to the acceleration in the process of atherosclerosis that it promotes. Epidemiology: In this chapter, we will address what we consider to be the two main aspects of the interrelationships between heart and kidney disease that are "cardiorenal syndrome (CRS)" and "chronic kidney disease (CKD) and coronary heart disease (CHD)." Challenges: For CRS, we discuss its epidemiology, types, pathophysiological mechanisms common to CRS types 1, 2, 3 and 4 and pathogenesis of CSR type 5. Treatment: For "CKD and CHD" we discuss the association of CKD and CHD in community-based populations, traditional risk factor in CKD, non-traditional risk factor in CKD, reduced risk of CHD in patients with CKD, statin treatment, hypertension treatment, anti-platelet aggregation therapy, treatment of CHD in patients with CKD and prognosis of CHDF in CKD patients.

What happened after birth to pregnant women undergoing ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension?

The latest Brazilian Guidelines on ambulatory blood pressure monitoring (ABPM) consider an exam as a useful tool during pregnancy, especially during the first half of pregnancy. They also indicate that white coat hypertension as well as masked hypertension may occur in up to one-third of pregnancies. As white coat hypertension has a more favorable diagnosis than gestational hypertension, it remains associated with 50% of pregnancies and is not associated with complications. Elsewhere, 40% of pregnant women develop gestational hypertension. As per the guidelines, the guidance values should be the same for the general population. The aim of this study was to verify the blood pressure behavior after birth in pregnant women who underwent ABPM and whether ABPM in pregnant women may serve as a predictor of preeclampsia and abnormalities in newborns. Between 01 January 2017 and 31 December 2019, 117 ABPM routines in pregnant women were performed at Unicordis. Among them, 40 were requested for the diagnosis of hypertension, and 77 were requested for antihypertensive therapeutic assessment. The study population comprised pregnant women who underwent ABPM for the diagnosis of hypertension. We assessed a population that comprised 31 subjects who underwent ABPM, 17 of whom had normal results and 14 of whom had abnormal results. Of the 14 pregnant women with abnormal blood pressure behavior, only three (21%) had a physiological drop in blood pressure, seven had attenuated descent, and four did not have blood arterial descent. The age of the pregnant women ranged from 21 to 42 years. The gestational age at the beginning of ABPM ranged from 6 to 37 weeks. In the group with normal ABPM, two pregnant women (11.7%) developed preeclampsia during pregnancy. Additionally, in the group with abnormal ABPM, seven pregnant women (50%) developed preeclampsia during pregnancy. In the group with normal ABPM, three newborns had abnormalities (17.6%); in the group with abnormal ABPM, four newborns had abnormalities (28.5%). In the group with normal ABPM, two subjects developed hypertension after birth (11.7%). In the group with abnormal ABPM, ten subjects (71%) remained hypertensive following birth (Table 1). Conclusions: (1) the results show that the proportion of patients who presented with preeclampsia was higher among individuals with abnormal ABPM than that among individuals with normal ABPM. (2) The proportion of subjects with hypertension following birth was higher among individuals with abnormal ABPM than that among individuals with normal ABPM.

The Impact of Sacral Neuromodulation on Sexual Dysfunction.

BACKGROUND/AIMS: Sacral neuromodulation (SNM) is a well-established treatment in several urinary and bowel dysfunctions, nevertheless its role on sexual dysfunction remains unclear. We evaluate the impact of SNM on sexual function and its association with age at SNM, functional diagnosis and post-void residual urine (PVR) before SNM. METHODS: Patients who had SNM were retrospectively analyzed. Sexual function was assessed before and after treatment with the International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI) for women. IIEF-5 and FSFI were also associated with age at SNM, functional diagnosis, and PVR. RESULTS: Fifteen females and 9 males, with a median age of 41 years (26-72 years), median follow-up 20.7 months (2-53 months) were enrolled. IIEF-5 improved in 4 patients (p = 0.06), and FSFI total score in 5 (p = 0.2). There was significant association between functional diagnosis and FSFI total score (p = 0.05), and FSFI specific domains of arousal (p = 0.03), lubrication (p = 0.04), and satisfaction (p = 0.03), with significant improvement showed in patients with detrusor overactivity with impaired contractility. CONCLUSION: Although gains observed in IIEF-5 and FSFI were modest, our preliminary results show that SNM may have favorable impact on sexual function.

Effectiveness of low-dose diuretics for blood pressure reduction to optimal values in prehypertension: a randomized clinical trial.

BACKGROUND: To determine the effectiveness of low-dose diuretic therapy to achieve an optimal level of blood pressure (BP) in adults with prehypertension. METHODS: The PREVER-prevention trial was a randomized, parallel, double-blinded, placebo-controlled trial, with 18 months of follow-up, conducted at 21 academic medical centers in Brazil. Of 1772 individuals evaluated for eligibility, 730 volunteers with prehypertension who were aged 30-70 years, and who did not reach optimal blood pressure after 3 months of lifestyle intervention, were randomized to a fixed association of chlorthalidone 12.5 mg and amiloride 2.5 mg or placebo once a day. The main outcomes were the percentage of participants who achieved an optimal level of BP. RESULTS: A total of 372 participants were randomly allocated to diuretics and 358 to placebo. After 18 months of treatment, optimal BP was noted in 25.6% of the diuretic group and 19.3% in the placebo group (P < 0.05). The mean net reduction in SBP and DBP for the diuretic group compared with placebo was 2.8 mmHg (95% CI 1.1 to 4.5) and 1.1 mmHg (95% CI -0.09 to 2.4), respectively. Most participants in the active treatment group (74.5%) and in the placebo group (80.7%) continued to have BP in the prehypertension range or progressed to hypertension. CONCLUSION: Low-dose diuretic therapy increased the probability of individuals with prehypertension to achieve optimal BP but most of those treated continued to have a BP in the prehypertension range or progressed to having overt hypertension.

Resection osteotomy for calcaneus flattening after micro-surgical flap: technical note.

An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance.

A fratura exposta do calcâneo com perda de substância é uma lesão desafiadora, demanda cuidados especializados, envolve elevados custos e exige atenção, apesar de sua menor incidência. As principais complicações são osteomielite, úlceras de pressão, fistulas, além de quadros álgicos nas regiões lateral, medial e plantar. Essa relação se deve à grande perda de tecido e à mudança da conformação anatômica do calcâneo em alguns casos. Porém, quando ocorre uma modelação do formato ósseo do calcâneo com seu aplainamento, essas complicações podem ser prevenidas ou tratadas com sucesso. O objetivo desta nota técnica é descrever a técnica de osteotomia de ressecção para aplainamento do calcâneo na prevenção e no tratamento de complicações após retalho microcirúrgico em casos de fratura exposta ou perda de substância.

Resection osteotomy for calcaneus flattening after micro-surgical flap: technical note / Osteotomia de ressecção para aplainamento do calcâneo após retalho microcirúrgico: nota técnica

ABSTRACT An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance.

RESUMO A fratura exposta do calcâneo com perda de substância é uma lesão desafiadora, demanda cuidados especializados, envolve elevados custos e exige atenção, apesar de sua menor incidência. As principais complicações são osteomielite, úlceras de pressão, fistulas, além de quadros álgicos nas regiões lateral, medial e plantar. Essa relação se deve à grande perda de tecido e à mudança da conformação anatômica do calcâneo em alguns casos. Porém, quando ocorre uma modelação do formato ósseo do calcâneo com seu aplainamento, essas complicações podem ser prevenidas ou tratadas com sucesso. O objetivo desta nota técnica é descrever a técnica de osteotomia de ressecção para aplainamento do calcâneo na prevenção e no tratamento de complicações após retalho microcirúrgico em casos de fratura exposta ou perda de substância.

Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER-Prevention Randomized Clinical Trial.

BACKGROUND: Prehypertension is associated with higher cardiovascular risk, target organ damage, and incidence of hypertension. The Prevention of Hypertension in Patients with PreHypertension (PREVER-Prevention) trial aimed to evaluate the efficacy and safety of a low-dose diuretic for the prevention of hypertension and end-organ damage. METHODS AND RESULTS: This randomized, parallel, double-blind, placebo-controlled trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. The primary outcome was incidence of hypertension. Development or worsening of microalbuminuria, new-onset diabetes mellitus, and reduction of left ventricular mass were secondary outcomes. Participant characteristics were evenly distributed by trial arms. The incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38-0.82), resulting in a cumulative incidence of 11.7% in the diuretic arm versus 19.5% in the placebo arm (P=0.004). Adverse events; levels of blood glucose, glycosylated hemoglobin, creatinine, and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. Left ventricular mass assessed through Sokolow-Lyon voltage and voltage-duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (P=0.02). CONCLUSIONS: A combination of low-dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR-74rr6s.

Transtriquetral perihamate fracture-dislocation: case report.

The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

O punho é uma região muito vulnerável a traumas de extremidade. Entre tais lesões, as fraturas do piramidal (ou triquetrum), associadas à luxação do hamato e à instabilidade carpal, são pouco frequentes. Geralmente relacionadas a traumatismos de alta energia, podem estar associadas a déficit neurovascular, miotendíneo, lesões de pele ou em outros ossos do carpo. Assim, neste relato, apresenta-se um desses casos raros de fratura-luxação transtriquetral peri-hamato com instabilidade carpal, diagnosticadas por radiografias do punho direito de um paciente que apresentava dor, edema e limitação da flexoextensão do carpo após trauma na região. As etapas do atendimento foram descritas desde a consulta inicial até o tratamento cirúrgico e a fisioterapia, que culminaram com a restauração da força e da amplitude de movimento do punho.

Transtriquetral perihamate fracture-dislocation: case report / Fratura-luxação transtriquetral peri-hamato: relato de caso

ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

RESUMO O punho é uma região muito vulnerável a traumas de extremidade. Entre tais lesões, as fraturas do piramidal (ou triquetrum), associadas à luxação do hamato e à instabilidade carpal, são pouco frequentes. Geralmente relacionadas a traumatismos de alta energia, podem estar associadas a déficit neurovascular, miotendíneo, lesões de pele ou em outros ossos do carpo. Assim, neste relato, apresenta-se um desses casos raros de fratura-luxação transtriquetral peri-hamato com instabilidade carpal, diagnosticadas por radiografias do punho direito de um paciente que apresentava dor, edema e limitação da flexoextensão do carpo após trauma na região. As etapas do atendimento foram descritas desde a consulta inicial até o tratamento cirúrgico e a fisioterapia, que culminaram com a restauração da força e da amplitude de movimento do punho.

Laparoscopic Psoas Hitch Double Ureteral Re-implantation in the Duplex Urinary System for Treatment of Ureterovaginal Fistula.

INTRODUCTION: Although laparoscopy is widely established for ablative urologic procedures, pelvic reconstructive procedures are still mostly performed by open-surgery. As urologists continue to introduce advanced laparoscopic skills to reconstructive urologic procedures, we present our experience with a laparoscopic psoas hitch double ureteral re-implantation in a patient with an ureterovaginal fistula and an ipsilateral duplex urinary system. MATERIALS AND METHODS: A 42-year-old patient presented with continuous involuntary urine loss from the vagina after an abdominal hysterectomy. A double modified Lich-Gregoir ureteral re-implantation with a psoas hitch was performed, using a 4-port laparoscopic approach. RESULTS: There were no post-operative complications and the cystography at post-operative day 14 revealed good positioning of the psoas hitch, with no leak or reflux. At three-months follow-up, the patient is completely dry and asymptomatic. CONCLUSION: Laparoscopic ureteroneocystostomy with psoas hitch for the treatment of lesions of the distal ureter is a possible, safe, and effective way to resolve a complex urologic situation with minimally invasive surgery. Laparoscopy is becoming the standard approach to urologic pelvic reconstructive procedures, even in the most complex cases.

Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension: results from the PREVER-treatment randomized trial.

OBJECTIVES: To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of stage I hypertension. METHODS: In a randomized, double-blind, controlled trial, 655 participants were followed for 18 months in 21 Brazilian academic centers. Trial participants were adult volunteers aged 30-70 years with stage I hypertension (BP 140-159 or 90-99 mmHg) following 3 months of a lifestyle intervention. Participants were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 333) or 50 mg of losartan (N = 322). If BP remained uncontrolled after 3 months, study medication dose was doubled, and if uncontrolled after 6 months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg twice daily) were added as open-label drugs in a progressive fashion. At the end of follow-up, 609 (93%) participants were evaluated. RESULTS: The difference in SBP during 18 months of follow-up was 2.3 (95% confidence interval: 1.2 to 3.3) mmHg favoring chlorthalidone/amiloride. Compared with those randomized to diuretic, more participants allocated to losartan had their initial dose doubled and more of them used add-on antihypertensive medication. Levels of blood glucose, glycosilated hemoglobin, and incidence of diabetes were no different between the two treatment groups. Serum potassium was lower and serum cholesterol was higher in the diuretic arm. Microalbuminuria tended to be higher in patients with diabetes allocated to losartan (28.5 ±â€Š40.4 versus 16.2 ±â€Š26.7 mg, P = 0.09). CONCLUSION: Treatment with a combination of chlorthalidone and amiloride compared with losartan yielded a greater reduction in BP. CLINICAL TRIALS REGISTRATION NUMBER: NCT00971165.

Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus / Avaliação da flexão do cotovelo após transferência muscular livre do gastrocnêmio medial ou transferência do latíssimo do dorso na lesão traumática do plexo braquial

To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05). RESULTS: The patients' mean age was 32 years (range: 17-56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 ( p = 0.1). CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used.

Comparar o ganho de flexão do cotovelo em pacientes com lesão traumática do plexo braquial após transferência muscular do latíssimo dorsal (TMLD) com a transferência muscular livre do ventre medial do gastrocnêmio (TMLGM). METÓDOS: Estudo retrospectivo, revisão de prontuários, amostra de conveniência, com 13 pacientes operados, entre 2000 e 2010. Grupo 1 (TMLGM) com sete pacientes e grupo 2 ou controle (TMLD) com seis. Função avaliada: 1) amplitude de movimento (ADM) em graus da flexão do cotovelo, goniometria manual; 2) grau de força de flexão do cotovelo, por escala de força muscular. Satisfatórios: 1) ADM: flexão do cotovelo ≥ 80°; 2) Força: flexão do cotovelo ≥ M3. Testes exato de Fisher e Kruskal-Wallis (p < 0,05). RESULTADOS: Média de idade foi de 32 anos (17 a 56). Acidente de moto em 72%. Força de flexão do cotovelo ≥ M3 no grupo 1 em sete pacientes (100%) e o grupo 2 em cinco (83,3%) (p = 0,462). Não tivemos M5 e o grupo 2 apresentou um paciente (16,7%) com resultado ruim M2. ADM na flexão do cotovelo com ganho ≥ 80° (funções diárias) foram encontrados no grupo 1 em seis pacientes (86%) e no grupo 2 em três (50%) (p = 0,1). CONCLUSÃO: Pacientes do grupo 1 tiveram um ganho maior de força e ADM, quando comparados com os do grupo 2, sem significado estatístico. Assim, TMLGM se torna uma nova opção cirúrgica, caso não possam ser aplicadas outras técnicas.

Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment.

OBJECTIVE: To evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus. METHOD: This was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: (1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; (2) grade of strength of the shoulder, elbow and wrist/hand; (3) sensitivity; and (4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi-square, Friedman, Wilcoxon and Kruskal-Wallis tests were used (p < 0.05). RESULTS: The patients' mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2-48). Thirty-one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery in 39 cases (81.3%). The ROM achieved was ≥30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p = 0.001). Thirteen (27.1%) already had shoulder strength ≥M3 (p = 0.001). Twenty-seven patients (56.2%) had elbow flexion ≥80°, with a range from 30° to 160° and mean of 80.6° (p < 0.001). Twenty-two had strength ≥M3 (p < 0.001). Twenty-two patients (45.8%) had wrist extension ≥30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p = 0.003). Twenty-seven (56.3%) presented wrist/hand extension strength ≥M3 (p = 0.002). Forty-five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p = 0.006). The initial VAS was 4.5 (range: 1.0-9.0) and the final VAS was 3.0 (range: 1.0-7.0) (p < 0.001). CONCLUSION: Traumatic lesions of the brachial plexus were more prevalent among young adults (21-40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle-tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pain.

OBJETIVO: Avaliar aspectos sociodemográficos e clínicos de pacientes operados de lesão traumática do plexo braquial (LTPB). MÉTODO: Estudo retrospectivo, revisão de prontuários, amostra de conveniência, 48 pacientes operados entre 2000 e 2010. Avaliados: 1) ADM ­ em graus, do ombro, cotovelo e punho/mão; 2) grau de força do ombro, cotovelo e punho/mão; 3) sensibilidade; 4) EVA (0 a 10). Testes de t de Student, qui-quadrado, Friedman, Wilcoxon e Kruskal­Wallis (p < 0,05). RESULTADOS: Idade de 30,6 anos, 60,4% acidentes motociclísticos. Politraumatismo 52,1%. Tempo até a cirurgia de 8,7 meses (2 a 48). Trinta e um (64,6%) com lesão total do plexo. Cirurgias mais frequentes: neurais em 39 (81,3%). ADM ≥ 30° do ombro 20 pacientes (41,6%) de 30° a 90°, média 73° (p = 0,001); 13 (27,1%) já tinham força no ombro ≥ M3 (p = 0,001). Cotovelo ≥ 80° de flexão, 27 pacientes (56,2%) de 30° a 160°, com média de 80,6° (p < 0,001); 22 com força ≥ M3 (p < 0,001). Extensão do punho ≥ 30° partindo de 45° de flexão em 22 pacientes (45,8%), de 30° a 90°, média 70° (p = 0,003); 27 (56,3%) tinham força de extensão do punho/mão ≥ M3 (p = 0,002); 45 (93,8%) hipoestesia e três (6,2%) anestesia (p = 0,006). EVA inicial 4,5 (1 a 9) e EVA final 3 (1 a 7) (p < 0,001). CONCLUSÃO: As LTPB tem maior prevalência em jovens (21­40 anos), homens, urbanos, trabalhadores braçais, acidentes motociclísticos, com politrauma, lesão total do plexo. Cirurgias neurais, seguidas em segundo tempo, pelas transferências miotendíneas. A cirurgia para LTPB mostrou melhoria significativa de ADM e força em ombro, cotovelo e punho/mão, da sensibilidade do membro afetado e diminuição da dor final.

O papel do índice tornozelo-braço no prognóstico cardiovascular e na predição de lesões de órgãos-alvo em pacientes hipertensos / The role of the ankle brachial index in cardiovascular prognosis and in predicting target organ damage in hypertensive patients

O número de casos de doença arterial periférica (DAOP) vem aumentando globalmente. Nesse cenário destaca-se o índice tornozelo-braço (ITB), exame de baixo custo e boa acurácia para a detecção de DAOP, e forte preditor para a ocorrência de eventos cardiovasculares. Poucos estudos, entretanto, correlacionam valores anormais do ITB à ocorrência de lesões em órgãos-alvo em pacientes hipertensos. Nesta revisão, abordamos os principais estudos que mostram o valor do ITB na estratificação de risco cardiovascular do paciente hipertenso e destacamos as investigações que demonstram que valores do ITB alterados estão relacionados às alterações cardíacas (disfunção sistólica, hipertrofia, anormalidades da cinética regional do ventrículo esquerdo), em outros sítios arteriais (maior número de placas ateroscleróticas em carótidas) e também nos rins (maior prevalência de queda da taxa de filtração glomerular)

The number of cases of peripheral arterial disease (PAD) is globally increasing. In this scenario, the ankle arm index (AAI) is highlighted; an inexpensive test, with good accuracy for the detection of PAD and a strong predictor for the occurrence of cardiovascular events. Few studies, however, correlate abnormal values of ABI with the occurrence of lesions in target organs. In this review, we address the main studies that demonstrate the value of ABI in cardiovascular risk stratification of hypertensive patients, and highlight the reports that showed that ABI values are related to cardiac abnormalities (systolic dysfunction, hypertrophy and abnormalities of regional left ventricular kinetics), in other arterial sites (higher number of atherosclerotic plaques in carotid arteries) and also in kidney (higher prevalence of decline in glomerular filtration rate)