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1.
Eur J Vasc Endovasc Surg ; 58(4): 583-591, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31474494

RESUMO

OBJECTIVES: Telangiectasia is a common venous formation that mainly affects women and causes discomfort, including psychological distress. This study compared photodynamic therapy (PDT) with glucose for vessel sclerosis in a rabbit ear model. METHODS: Thirty-six ears of 18 rabbits were randomly divided into four groups: Group 1: only injection of Photogem (4 mg/mL); Group 2: only light (635 nm, 100 mW/cm2, 8 min, 48 J/cm2); Group 3: glucose 75% injection; Group 4: PDT procedure with injection of Photogem and illumination immediately after. Injections were made into the central ear artery. After injection or sham procedures, manual compression of the marginal vein was maintained for 8 min in all ears. Follow up was immediately after the procedures, and one and six days later. The percentage of length reduction of spider veins, the target vessels, was analysed in digital photographs with Image J software. Ear thermographs were made with a thermocamera device and average temperatures were collected for analysis. Ear biopsies were obtained after six days. Endothelium average, inflammation, fibrosis, necrosis, skin burn, and vascular thrombosis were assessed using a specific score. RESULTS: The mean vessel length reduction was 26% for Group 4, 2.4% for Group 3, .4% for Group 1, and 0 for Group 2, highlighting that in Group 4, the vessel lengths were significantly reduced compared with the other groups (p < .001). In the thermal analysis, in Group 3, the temperature was unchanged from the initial temperature and the central diameter vessel increased after six days, while, in Group 4, the temperature decreased and the vessels were not clearly detected, suggesting a reduction of the vessels and smaller infusion. Histology showed no difference among groups and one case of necrosis was found in Group 4. CONCLUSIONS: PDT was associated with significantly more target vessel sclerosis than glucose injection and controls.

2.
J Vasc Bras ; 18: e20180040, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236100

RESUMO

Background: Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. However, VTE can be prevented using prophylaxis measures that have been established in the literature. Nonetheless, in the real world, mean rates of appropriately administered VTE prophylaxis are lower than 50%. Objectives: To define the epidemiological profile of patients with VTE in a University Hospital and the rate of appropriately administered VTE prophylaxis at that service and to identify measures to improve the rate. Methods: A cross-sectional, observational study was conducted with data collected from the medical records of patients who met the inclusion criteria. The rates of correct VTE prophylaxis prescribed to clinical and surgical patients were compared, assessed according to guidelines published by the Brazilian Society of Angiology and Vascular Surgery (SBACV), based on VTE risk classification. Results: The overall rate of correctly-prescribed VTE prophylaxis was 42.1%, while 57.9% of patients were not managed correctly in this respect. Clinical patients had a 52.9% rate of appropriate prophylaxis, while the equivalent rate for surgical patients was 37.5%. Conclusions: Rates of correctly-prescribed VTE prophylaxis are still lower than they should be. Ongoing education, measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates.

3.
J. vasc. bras ; 18: e20180040, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-990123

RESUMO

O tromboembolismo venoso (TEV) é uma doença silenciosa e potencialmente letal que acomete parcela importante dos pacientes hospitalizados. Com alta morbimortalidade e elevado custo financeiro para o sistema de saúde, o TEV pode ser prevenido com uso da profilaxia, já estabelecida pela literatura. No mundo real, a profilaxia para TEV possui média de adequação inferior a 50%. Objetivos Definir o perfil epidemiológico do doente com TEV em um hospital universitário e a taxa de adequação da profilaxia para TEV no referido serviço, além de determinar meios para melhorá-la. Métodos Estudo transversal observacional realizado pela coleta de dados no prontuário médico dos pacientes que preencheram critérios de inclusão. Comparou-se a taxa de adequação da profilaxia para TEV prescrita para pacientes clínicos e cirúrgicos, segundo diretrizes da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV), de acordo com sua classificação de risco para TEV. Resultados A taxa global de adequação das prescrições de profilaxia para TEV foi de 42,1% versus 57,9% de inadequação. Pacientes clínicos obtiveram taxa de adequação de 52,9%, enquanto pacientes cirúrgicos obtiveram taxa de adequação de 37,5%. Conclusões As taxas de prescrição adequada para profilaxia para TEV ainda se encontram aquém do esperado. Educação continuada, estímulo à aplicação da estratificação de risco à beira do leito e adequações no sistema de prescrição eletrônica podem aumentar as taxas de prescrição adequada para profilaxia de TEV


Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. However, VTE can be prevented using prophylaxis measures that have been established in the literature. Nonetheless, in the real world, mean rates of appropriately administered VTE prophylaxis are lower than 50%. Objectives To define the epidemiological profile of patients with VTE in a University Hospital and the rate of appropriately administered VTE prophylaxis at that service and to identify measures to improve the rate. Methods A cross-sectional, observational study was conducted with data collected from the medical records of patients who met the inclusion criteria. The rates of correct VTE prophylaxis prescribed to clinical and surgical patients were compared, assessed according to guidelines published by the Brazilian Society of Angiology and Vascular Surgery (SBACV), based on VTE risk classification. Results The overall rate of correctly-prescribed VTE prophylaxis was 42.1%, while 57.9% of patients were not managed correctly in this respect. Clinical patients had a 52.9% rate of appropriate prophylaxis, while the equivalent rate for surgical patients was 37.5%. Conclusions Rates of correctly-prescribed VTE prophylaxis are still lower than they should be. Ongoing education, measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates


Assuntos
Humanos , Masculino , Feminino , Adulto , Prevenção de Doenças , Tromboembolia Venosa/diagnóstico , Hospitais Universitários , Trombose , Perfil de Saúde , Doença Crônica , Estudos Transversais , Fatores de Risco , Trombose Venosa , Embolia , Infarto do Miocárdio
4.
J. vasc. bras ; 17(4): 353-357, out.-dez. 2018. ilus
Artigo em Português | LILACS | ID: biblio-969248

RESUMO

Pseudoaneurysms of gluteal arteries are rare, especially involving the inferior gluteal artery. They are mainly associated with penetrating trauma, infections, or pelvic fractures. A minority of cases are caused by blunt traumas, with only six cases reported in English. We present a case of pseudoaneurysm of the right inferior gluteal artery after a bicycle fall, presenting with a large hematoma in the gluteal region, observed during clinical examination, and significantly reduced hemoglobin. CT angiography revealed a large hematoma, with contrast extravasation and pseudoaneurysm formation. Angiography revealed that the origin of the lesion was in the right inferior gluteal artery. This artery was embolized with coils. After the procedure, the patient was referred to an intensive care unit, from where he was later transferred to a different hospital, with bleeding controlled. Endovascular treatment of these cases is a safe, fast and an effective option


Pseudoaneurismas de artérias glúteas são raros, especialmente os que envolvem a artéria glútea inferior. Eles estão associados principalmente a traumas penetrantes, infecções ou fraturas de pelve. Em uma minoria de casos, são causados por traumas fechados, havendo somente seis casos relatados na literatura. Apresenta-se aqui um caso de pseudoaneurisma da artéria glútea inferior direita após queda de bicicleta, evoluindo com grande hematoma na região glútea ao exame clínico e queda hematimétrica significativa. A angiotomografia revelou um grande hematoma na região glútea, com extravasamento de contraste e formação de pseudoaneurisma no local. A angiografia revelou que a origem da lesão era na artéria glútea inferior direita. Foi realizada embolização dessa artéria com molas. Após esse procedimento, o paciente foi encaminhado para a unidade de terapia intensiva, de onde foi posteriormente transferido para outro hospital, com o sangramento controlado. Para esses casos, o tratamento endovascular é uma opção segura, rápida e efetiva


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Nádegas/irrigação sanguínea , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico , Angiografia/métodos , Acidentes de Trânsito , Ultrassonografia Doppler/métodos , Diagnóstico Diferencial , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Hematoma
6.
Monoclon Antib Immunodiagn Immunother ; 37(2): 100-104, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29708868

RESUMO

We report an immunization technique that can update the production of monoclonal antibodies (mAbs): the multiple tolerization subtractive immunization (MTSI). A total of 10 BALB/C mice were used. Animals in group 1 received one inoculation of RWPE-1 cells (nontumoral), followed by cyclophosphamide, and then received serial inoculations of nonirradiated PC3 cells (tumoral). Animals in group 2 received our MTSI protocol, as follows: one inoculation of RWPE-1 cells, followed by cyclophosphamide (Cy). This whole tolerization step was repeated three other times, with 14-day intervals between the last Cy exposure and the next RWPE-1 cell inoculation. Finally, the animals received the same nonirradiated PC3 cell exposure as group 1. Blood was taken from each animal, and their polyclonal sera individually tested against the nontumoral RWPE-1 cells in flow cytometry. We found out that, after the MTSI was employed, the serum of the immunized animals, in group 2, contained considerably less antibodies that reacted against the tolerogenic cells, compared with the serum of the animals that underwent regular subtractive immunization. We showed that, by repeating the tolerization cycles, the polyclonal antibodies produced by mice have a reduced specificity toward common/immunodominant epitopes present at nontumoral cells, and thus this technique can be readily used by others in studies involving murine mAb protocols.


Assuntos
Anticorpos Monoclonais/biossíntese , Células Epiteliais/transplante , Tolerância Imunológica/efeitos dos fármacos , Imunização/métodos , Vacinação/métodos , Animais , Anticorpos Monoclonais/isolamento & purificação , Linhagem Celular Transformada , Linhagem Celular Tumoral , Ciclofosfamida/administração & dosagem , Humanos , Hibridomas/química , Hibridomas/imunologia , Imunossupressores/administração & dosagem , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Próstata/imunologia , Próstata/patologia
7.
J. vasc. bras ; 17(1): f:81-l:88, jan.-mar. 2018. ilus
Artigo em Português | LILACS | ID: biblio-905078

RESUMO

Nos últimos anos, balões farmacológicos surgiram como promissora alternativa terapêutica em intervenções endovasculares. Com essa tecnologia, transferem-se drogas antiproliferativas à parede arterial, sem a necessidade de implante metálico para liberação. Descreve-se o caso de um paciente com uma segunda recidiva de reestenose intra-stent renal tratada por angioplastia com balão coberto por droga, com boa evolução clínica caracterizada por adequado controle pressórico e redução de classes e dosagem dos anti-hipertensivos. Os resultados obtidos com balões farmacológicos em outros territórios e esta experiência isolada podem contribuir como sugestão para o uso desses dispositivos na reestenose intra-stent renal, com resultados iniciais satisfatórios


During recent years, drug-coated balloons (DCBs) have emerged as a promising therapeutic option. DCBs directly transfer antiproliferative drugs to the arterial wall in order to decrease myointimal hyperplasia. We describe a case of de novo renal artery in-stent restenosis (ISR) treated with drug-coated balloon angioplasty with acceptable short-term results, achieving blood pressure control using fewer antihypertensive agents. The experience and results obtained with DCBs in other territories could suggest and justify use of this technology in renal artery ISR


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Angioplastia com Balão/métodos , Artéria Renal/diagnóstico por imagem , Stents , Angiografia/métodos , Aorta Abdominal , Vasos Sanguíneos/diagnóstico por imagem , Cateterismo/métodos , Procedimentos Endovasculares/métodos
8.
Ann Vasc Surg ; 46: 218-225, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28689936

RESUMO

BACKGROUND: Amputations of lower limbs can be conducted as one-stage amputation (OSA) or staged amputation (SA) procedures. The objective of this study was to analyze technical success and mortality rates of both techniques, as well as factors that might influence outcomes in patients with critical limb ischemia (CLI). METHODS: A retrospective study of 185 consecutive patients with CLI who underwent amputations in the period 2004-2011. Primary end points were rates of technical success (healing without dehiscence or reintervention) and mortality. The influence on outcomes of demographic data, clinical status, and comorbidities was also analyzed by logistic regression. RESULTS: A total of 101 SA (91 patients) and 106 OSA (94 patients) were analyzed. SA had proportionally higher success rate (SA 77.2% vs. OSA 66.0%, P = 0.0253), lower perioperative mortality rate (SA, 10.9% vs. OSA, 20.7%, P = 0.0247), and lower 30-day mortality rate (SA, 12.2% vs. OSA, 23.8%, P = 0.0220) in spite of more cases with Rutherford classes 5 and 6 (SA, 87.1% vs. OSA, 72.6%, P = 0.0047), diabetes (71.2% vs. 55.6%, P = 0.0076), and infection (44.5% vs. 28.3%, P = 0.0061). Logistic regression demonstrated that in SA, success was more frequent in patients with diabetes who did not use insulin (P = 0.0072), in those with transfemoral amputations (P = 0.0392), with no coronary artery disease (P = 0.0053), and in foot infection (P = 0.0446), while for OSA success was more frequent in nondiabetic patients (P = 0.0077), limbs without infection (P = 0.0298), amputations at foot level (P = 0.0155), or transfemoral amputations (P = 0.0030). CONCLUSIONS: SA had a higher rate of technical success and lower mortality rates than OSA, even with greater number of patients with diabetes and more severe cases of ischemia and infection. However, prospective studies comparing both techniques are needed for further evidence.


Assuntos
Amputação/métodos , Pé Diabético/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Infecção dos Ferimentos/cirurgia , Idoso , Amputação/efeitos adversos , Amputação/mortalidade , Comorbidade , Estado Terminal , Pé Diabético/diagnóstico , Pé Diabético/mortalidade , Pé Diabético/fisiopatologia , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Cicatrização , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/mortalidade , Infecção dos Ferimentos/fisiopatologia
9.
J Vasc Bras ; 17(4): 353-357, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30787957

RESUMO

Pseudoaneurysms of gluteal arteries are rare, especially involving the inferior gluteal artery. They are mainly associated with penetrating trauma, infections, or pelvic fractures. A minority of cases are caused by blunt traumas, with only six cases reported in English. We present a case of pseudoaneurysm of the right inferior gluteal artery after a bicycle fall, presenting with a large hematoma in the gluteal region, observed during clinical examination, and significantly reduced hemoglobin. CT angiography revealed a large hematoma, with contrast extravasation and pseudoaneurysm formation. Angiography revealed that the origin of the lesion was in the right inferior gluteal artery. This artery was embolized with coils. After the procedure, the patient was referred to an intensive care unit, from where he was later transferred to a different hospital, with bleeding controlled. Endovascular treatment of these cases is a safe, fast and an effective option.

10.
Acta Cir Bras ; 32(9): 706-711, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29019588

RESUMO

PURPOSE: To investigate the ultrastructural characteristics and analysis of residual DNA in scaffold models, produced with decellularized vena cava in an experimental model with rabbits. METHODS: Three groups were created for ultrastructural and residual DNA analysis: group 1 - control, consisting of samples of vena cava in natura; group 2 - SD, consisting of vein fragments submitted to 2% sodium deoxycholate decellularization by shaking (160rpm - Shaker News Brunswick Scientific®) for 1 hour at controlled temperature shaker at 37°C; group 3 - SDS, consisting of vein fragments submitted to 1% sodium dodecyl sulfate decellularization under the same previous condition, for 2 hours. RESULTS: The ultrastructural matrix of the blood vessel maintained its vintegrity after either decellularization models. The results of the two quantification methods demonstrated a significant decrease in the DNA content of the decellularized vena cava samples as compared to the control samples and, differed statistically from each other, p <0.05. CONCLUSION: The 2% DS protocol for vein decellularization, in this experimental model, was considered the best protocol because it presented less amount of residual DNA without causing substantial destruction of the extracellular matrix.


Assuntos
DNA/ultraestrutura , Engenharia Tecidual , Tecidos Suporte , Veias Cavas/ultraestrutura , Animais , Feminino , Microscopia Eletrônica de Transmissão , Coelhos
11.
JAMA Dermatol ; 153(12): 1249-1255, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-28973414

RESUMO

Importance: Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant. Objective: To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). Design, Setting, and Participants: Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. Interventions: The patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. Main Outcomes and Measures: The primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas). Results: Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09). Conclusions and Relevance: Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. Trial Registration: clinicaltrials.gov Identifier: NCT02054325.


Assuntos
Solução Hipertônica de Glucose/administração & dosagem , Polietilenoglicóis/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Doenças Vasculares/terapia , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Extremidade Inferior , Pessoa de Meia-Idade , Polidocanol , Estudos Prospectivos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/patologia , Veias/patologia , Adulto Jovem
12.
J. vasc. bras ; 16(4): f:314-l:319, out.-dez. 2017. ilus
Artigo em Português | LILACS | ID: biblio-880798

RESUMO

O trombo venoso flutuante em veia femoral é um tipo de trombo com alto potencial de embolização pulmonar. Entretanto, ainda é controversa a conduta mais apropriada nesses casos. Tratamentos clínicos com anticoagulantes ou fibrinolíticos e trombectomias abertas ou por meio de dispositivos endovasculares vêm sendo empregados ainda sem um critério de indicação bem definido. Apresentamos três casos clínicos de trombos flutuantes em veia femoral, de etiologias distintas, cujos tratamentos e respectivas evoluções serão discutidos


A floating venous thrombus in the femoral vein is a type of thrombus with a high potential for pulmonary embolization. However, the most appropriate management for these cases is still controversial. Clinical treatments, using anticoagulants or fibrinolytics, open thrombectomies, or thrombectomies by means of endovascular devices have all been used, although the criteria for indication of each are not yet defined. We present 3 clinical cases of floating thrombi in femoral veins with different etiologies and discuss their respective treatments and outcomes


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Veia Femoral/cirurgia , Trombose Venosa/cirurgia , Anticoagulantes/uso terapêutico , Enoxaparina/administração & dosagem , Extremidade Inferior , Embolia Pulmonar , Terapêutica/métodos , Trombectomia/métodos , Trombose/cirurgia , Ultrassom/métodos , Varfarina/administração & dosagem
13.
Acta cir. bras ; 32(9): 706-711, Sept. 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-886236

RESUMO

Abstract Purpose: To investigate the ultrastructural characteristics and analysis of residual DNA in scaffold models, produced with decellularized vena cava in an experimental model with rabbits. Methods: Three groups were created for ultrastructural and residual DNA analysis: group 1 - control, consisting of samples of vena cava in natura; group 2 - SD, consisting of vein fragments submitted to 2% sodium deoxycholate decellularization by shaking (160rpm - Shaker News Brunswick Scientific®) for 1 hour at controlled temperature shaker at 37°C; group 3 - SDS, consisting of vein fragments submitted to 1% sodium dodecyl sulfate decellularization under the same previous condition, for 2 hours. Results: The ultrastructural matrix of the blood vessel maintained its vintegrity after either decellularization models. The results of the two quantification methods demonstrated a significant decrease in the DNA content of the decellularized vena cava samples as compared to the control samples and, differed statistically from each other, p <0.05. Conclusion: The 2% DS protocol for vein decellularization, in this experimental model, was considered the best protocol because it presented less amount of residual DNA without causing substantial destruction of the extracellular matrix.

14.
Rev Col Bras Cir ; 44(3): 308-313, 2017.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28767808

RESUMO

The endovenous laser ablation (EVLA) of the insufficient saphenous vein has similar results to open conventional surgery, but less morbidity. The echo-guided polidocanol foam sclerotherapy technique has been used for the same purpose. The combined techniques may play a role for more severe diseases, such as those with varicose ulcers. An EVLA device (called VELAS) has been developed in the Optics and Photonics Research Center of USP-São Carlos in agreement with FMB-UNESP. In this study, we present the preliminary results of the VELAS device (MMO 980nm diode) in patients with chronic venous ulcer, associated with echo-guided polidocanol foam sclerotherapy for the treatment of varicosities. Primary outcomes were healing time of the venous ulcer, occlusion of the treated veins and treatment-related adverse events. We included 12 patients with insufficient saphenous vein and chronic venous ulcer. Initially, we treated all of them with thermoablation of the insufficient saphenous vein (VELAS), on an outpatient basis, with local anesthesia. After one week of the procedure, we sclerosed the varicosities with polidocanol foam (Tessari technique). The national VELAS device was easily handled. Total venous occlusion occurred in 83.3% of the patients (in seven days) and the association of the techniques was responsible for a wound healing rate of 83.3%, with no adverse events.


Assuntos
Procedimentos Endovasculares/métodos , Terapia a Laser , Lasers Semicondutores/uso terapêutico , Polietilenoglicóis/uso terapêutico , Veia Safena , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Insuficiência Venosa/terapia , Adulto , Idoso , Brasil , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Rev. Col. Bras. Cir ; 44(3): 308-313, mai.-jun. 2017. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-896583

RESUMO

RESUMO A termoablação endovascular das veias safenas insuficientes com laser é descrita como uma técnica menos invasiva, com resultados semelhantes à cirurgia convencional, porém, com efeitos adversos menos frequentes. A técnica de escleroterapia com espuma de polidocanol ecoguiada vem sendo empregada com a mesma finalidade. A combinação de técnicas pode representar uma alternativa para pacientes mais graves, como os portadores de úlcera varicosa. Um equipamento de laser (denominado VELAS) foi desenvolvido no Centro de Pesquisas em Ótica e Fotônica da USP-São Carlos em convênio com a FMB-UNESP para termoablação endoluminal da veia safena insuficiente. Neste estudo apresentamos os resultados preliminares do uso do aparelho de laser VELAS (diodo MMO 980nm) na termoablação endovascular de veias safenas insuficientes, em portadores de úlcera venosa crônica, associado à complementação com espuma de polidocanol para o tratamento de varicosidades, após uma semana. Os desfechos analisados foram o tempo de cicatrização da úlcera venosa, oclusão das veias tratadas e eventos adversos relacionados aos tratamentos. Foram incluídos 12 pacientes portadores de insuficiência de veia safena e úlcera venosa crônica que aceitaram participar do projeto. Todos foram tratados em regime ambulatorial, com anestesia local e termoablação da veia safena insuficiente (VELAS). Após uma semana da cirurgia, as varicosidades foram esclerosadas com polidocanol espuma (técnica de Tessari). O equipamento laser VELAS nacional apresentou fácil manuseio, oclusão venosa total em 83,3% dos pacientes (em sete dias) e a associação das técnicas foi responsável por uma taxa de cicatrização de feridas de 83,3%, sem ocorrência de eventos adversos.


ABSTRACT The endovenous laser ablation (EVLA) of the insufficient saphenous vein has similar results to open conventional surgery, but less morbidity. The echo-guided polidocanol foam sclerotherapy technique has been used for the same purpose. The combined techniques may play a role for more severe diseases, such as those with varicose ulcers. An EVLA device (called VELAS) has been developed in the Optics and Photonics Research Center of USP-São Carlos in agreement with FMB-UNESP. In this study, we present the preliminary results of the VELAS device (MMO 980nm diode) in patients with chronic venous ulcer, associated with echo-guided polidocanol foam sclerotherapy for the treatment of varicosities. Primary outcomes were healing time of the venous ulcer, occlusion of the treated veins and treatment-related adverse events. We included 12 patients with insufficient saphenous vein and chronic venous ulcer. Initially, we treated all of them with thermoablation of the insufficient saphenous vein (VELAS), on an outpatient basis, with local anesthesia. After one week of the procedure, we sclerosed the varicosities with polidocanol foam (Tessari technique). The national VELAS device was easily handled. Total venous occlusion occurred in 83.3% of the patients (in seven days) and the association of the techniques was responsible for a wound healing rate of 83.3%, with no adverse events.

16.
Int J Stem Cells ; 10(1): 83-92, 2017 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-28446003

RESUMO

Background and Objectives: Maintaining a permissive microenvironment is essential for adequate nerve regeneration. Cell-based therapy has the potential based cell replacement and promotion of axonal growth. The adipose tissue derived mesenchymal stromal cells (Ad-MSC) attract interest because neuroregenerative and anti-inflammatory properties. The aim of this study was to evaluate the effects of canine and murine Ad-MSC transplantation on the sciatic nerve regeneration. Methods: Forty Wistar rats were divided randomly into: control group - CG (n=8); denervated group - DG (n=8); decellularized vein group - VG (n=8); decellularized vein+canine MSC-cMSC (n=8); descellularized vein+murine MSC-mMSC (n=8). After 10-mm nerve gap, the tubulation technique was performed with decellularized vein filled with 106 MSC labeled with quantum dots (Qtracker 665®). The sciatic nerve functional index (SFI) and electroneuromyography (ENMG) measurements were carried and morphometric and immunohistochemistry analysis of the tissue. Results: The SFI values were higher in the cMSC and mMSC groups at day 27 (p<0.020) and day 35 (p<0.011). The ENMG analysis also revealed better results in the mMSC group. Density, number, and total area of the fibers were increased in the mMSC and cMSC groups. Brain-derived neurotrophic factor BDNF and S-100 protein positive immunoreactivity showed a higher expression for both in the nerve of the mMSC and cMSC groups. The MSC labeled with quantum dots were detected at day 35, indicating neuronal survival long after the nerve damage. Conclusions: Murine and canine Ad-MSC associated with decellularized vein scaffold had positive effects on sciatic nerve regeneration in rats.

18.
Phlebology ; 32(7): 488-495, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27703067

RESUMO

Objectives Compare the efficacy and safety of fibrin gel to 8% papain gel for wound dressing of venous ulcers. Method Patients with chronic venous ulcers were randomly assigned to one in three groups: Group 1-fibrin gel; Group 2-8% papain gel; Group 3-carbopol gel (control). Patients were seen every 15 days during 2 months, verifying reduction of the ulcer area, local infection, exudation, and epithelization. All serious or nonserious adverse events were recorded. Results Fifty-five patients (total of 63 ulcers) were randomly distributed in three groups (G1 = 21; G2 = 19; G3 = 23). No patient was excluded or discontinued treatment throughout the study. The areas of the ulcers were similarly reduced in all groups (14.3%, 21.1%, and 30.4% in groups 1, 2, and 3, respectively), and all had significant reduction in exudation and contamination. Conclusion The data demonstrate that neither fibrin gel nor papain gel were able to improve the process of ulcer-healing, as compared to control.


Assuntos
Fibrina/uso terapêutico , Géis , Papaína/uso terapêutico , Úlcera Varicosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens , Doença Crônica , Método Duplo-Cego , Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Cicatrização
19.
J. vasc. bras ; 15(4): 312-316, Oct.-Dec. 2016. graf
Artigo em Português | LILACS | ID: biblio-841395

RESUMO

Resumo Infecções de sítios cirúrgicos com envolvimento de próteses sintéticas constituem grande desafio para tratamento. Apresentamos o caso de uma paciente com múltiplas comorbidades, histórico de enxerto aortobifemoral há 6 anos e reabordagem das anastomoses femorais por reestenoses há 5 anos. Apresentou dor inguinal esquerda e abaulamento súbitos com diagnóstico de pseudoaneurisma femoral roto e instabilidade hemodinâmica. Foi submetida a correção emergencial com interposição de prótese de dácron recoberta por prata e correção de grande hérnia incisional abdominal com tela sintética ao mesmo tempo. No pós-operatório, manteve-se por longo período sob terapia intensiva com dificuldade de extubação. Nesse ínterim, apresentou deiscência das suturas e fístula purulenta inguinal esquerda em contato com a prótese vascular. Optou-se pelo tratamento conservador, com desbridamento das feridas e aplicação de curativo a vácuo. A paciente evoluiu com melhora e cicatrização das feridas. Essa pode se constituir em ferramenta importante em casos similares.


Abstract Infections at the sites of surgery involving synthetic prostheses are challenging to treat. We present a case of a patient with multiple comorbidities who had undergone an aortobifemoral bypass 6 years previously and then re-intervention at the femoral anastomoses for restenosis 5 years previously. The patient presented with acute left inguinal pain and swelling and was diagnosed with a ruptured femoral pseudoaneurysm and hemodynamic instability. A repair was conducted by interposition of a silver-coated Dacron graft in the emergency room, and a large abdominal incisional hernia was repaired with synthetic mesh during the same intervention. After surgery, the patient remained intubated in intensive care for a long period. Meanwhile, she presented dehiscence of sutures and a left inguinal purulent fistula that was in contact with the vascular prosthesis. Conservative treatment was chosen, with debridement of wounds and vacuum therapy. The patient improved and the wounds healed. This could be an important tool in similar cases.


Assuntos
Humanos , Feminino , Idoso , Falso Aneurisma/diagnóstico por imagem , Artéria Femoral/diagnóstico por imagem , Controle de Infecções , Curativos Oclusivos/efeitos adversos , Comorbidade , Extremidade Inferior
20.
Medicine (Baltimore) ; 95(39): e4812, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27684809

RESUMO

BACKGROUND: Telangiectasias are defined as small venules abnormally dilated, located in the intradermal portion of the skin, of reddish or bluish tinge, their diameter not exceeding 1 mm; they are classified by the American Venous Forum as mild venous disease CEAP C1. Conventional treatment consists of chemical sclerotherapy, considered a minimally invasive technique with rapid clinical recovery. A wide variety of sclerosing solutions can be used for this purpose. METHODS/DESIGN: This project intends to include 96 patients that will be randomized to a triple-blind study. Inclusion criteria are women between 18 and 65 years, with telangiectasia on the lateral thigh. Male patients, female patients with chronic venous disease CEAP 2 to 6, women with allergies, pregnant, breastfeeding, with any type of skin problems or any decompensated clinical disease will be excluded. All patients included will be submitted to venous ultrasound mapping in order to rule out venous disease not clinically visible, deep venous system insufficiency, and insufficiency of the ostial valve of the great saphenous vein. One group will be treated with glucose 75% solution and the other will receive polidocanol 0.2% diluted in glucose 70%. Each patient will receive only 1 treatment session in 1 single member. The volume of sclerosing solution will not exceed 5 mL and the treatment area will be limited to a region of 150 cm on the lateral thigh. Clinical follow-up will be: 1 initial visit, when the clinical report will be filled; photographic record and treatment with sclerotherapy (D0); follow-up visits after 7 and 60 days (D7 and D60, respectively), always with clinical and photographic documentation. DISCUSSION: The project intends to evaluate the efficacy and safety of sclerotherapy in eliminating telangiectasia in a predetermined area in order to establish efficacy and safety parameters for the treatments presented. CONCLUSION: This protocol for clinical trial will provide date to determine the efficacy and safety of sclerotherapy with the solutions presented. TRIAL REGISTRATION IDENTIFIER: ClinicalTrial.gov NCT02657252 Date: 01/12/2016 (retrospectively registered).


Assuntos
Glucose/uso terapêutico , Polietilenoglicóis/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Telangiectasia/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol , Projetos de Pesquisa , Coxa da Perna , Adulto Jovem
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