Diagnosis and management of patients with acute limb ischemia after Covid-19 infection: a case series.

The Covid-19 pandemic caused by the Sars-Cov-2 virus created challenges and stimulated development of new forms of treatment in many different areas of medicine. Studies have described the clinical characteristics of patients and their outcomes, including disorders affecting the coagulation system, in which patients infected by the virus enter a hypercoagulable and proinflammatory state that mimics vasculitis. The objective of this study was to describe the clinical status and the treatment administered to three patients who developed acute arterial occlusion after Covid-19 infection. The management adopted in these cases enabled the patients to recover without sequelae. The low incidence and scarcity of published reports make it difficult to establish universally accepted treatment criteria and options for cases of ischemia in patients infected with the novel coronavirus, whether presenting early or late.

Use of ultrasound imaging software to differentiate venous and lymphatic edema in lower limbs.

BACKGROUND: Lower limb edema has both systemic and local causes. Using software to differentiate the origin of edema in ultrasound images is an innovation. OBJECTIVE: To determine the parameters for using software to differentiate edema of venous and/or lymphatic origin in ultrasound images of the lower limbs. METHOD: This is a cross-sectional, quantitative, analytical study with non-probabilistic sampling by convenience. Data were collected by patient interview, physical examination, ultrasound examination, and analysis of software for tissue characterization in ultrasound image by means of quantification of echogenicity and Gray Scale Median (GSM). RESULTS: The sample comprised 42 lower limbs with venous edema, 35 with lymphatic edema, 14 with mixed edema, and 11 control limbs. The distributions of pixels in echogenicity intervals by group was as follows. In the venous edema group, 88.31% were distributed from hypoechogenic interval IV to echogenic interval III; in the lymphatic edema group 71.73% were from hypoechogenic interval II to echogenic interval I; in the mixed edema group 76.17% were from hypoechogenic interval III to echogenic interval II; and in the control group 84.87% were distributed from echogenic interval II to hyperechogenic interval I. Mean and standard deviation of GSM values showed statistical differences between groups. CONCLUSION: The CATUS software enabled differentiation of the type of lower limb edema, facilitating diagnosis of edema type and, consequently, choice of the best therapeutic option.

Responsiveness of the CCVUQ-Br quality of life questionnaire in chronic venous ulcer patients.

BACKGROUND: Responsiveness is a measure of an instrument's ability to reflect in its score the variability that has occurred in a patient's life as a result of an intervention. The CCVUQ-Br has been validated in Portuguese, but its responsiveness still needs to be tested. When this study has been completed, the CCVUQ-Br will be available for use as an instrument capable of detecting and reflecting in its score the changes that take place in the quality of life of people with venous ulcers. OBJECTIVES: To evaluate the responsiveness of the CCVUQ-Br. METHODS: A longitudinal intervention study was conducted at public and private centers for patients with venous ulcers. The sample comprised people with chronic venous ulcers due to start treatment and the variables analyzed were CCVUQ-Br score and its domain scores, a pain visual analog scale (pain VAS), and the Global Assessment of Change Scale, in addition to CEAP classification, and size of ulcer. The CCVUQ-Br was administered to 51 people about to start treatment who were recruited at random. The CCVUQ-Br was then re-administered 4 weeks after treatment had started. RESULTS: Mean CCVUQ-Br scores reduced from the first to the second administration. The highest mean score at baseline was for the Emotional Status domain, at 63.45, which dropped to 52.00 after 4 weeks. There were also correlations between changes in CCVUQ-Br scores and pain VAS ratings and CEAP class. With regard to the effect size, total CCVUQ-Br score and ulcer size exhibited high sensitivity, while pain VAS and the majority of the CCVUQ-Br domains had moderate sensitivity. CONCLUSIONS: The CCVUQ-Br questionnaire is sensitive in the Brazilian population and exhibited response to change in the sample tested.

Determination of the longitudinal sensitivity of the AVVQ-Brazil Quality of Life Questionnaire to non-surgical treatment of chronic venous disease.

BACKGROUND: Sensitivity determines the efficiency and quality of construction of an assessment measure, but studies of the subject are scarce in the literature. OBJECTIVE: To evaluate the longitudinal sensitivity of the AVVQ-Brazil to clinical changes after treatment for chronic venous disease (CVD). METHODS: A longitudinal intervention study, with 112 chronic venous patients receiving elective treatment, assessed with CEAP, VAPS, AVVQ-Brazil, and VEINES-QOL/Sym at pre-treatment (baseline) and post-treatment (4 weeks). Differences in the scores for the scales at different times were evaluated using Student's t test for paired samples and Wilcoxon's z, which were also used to asses individuals by CEAP grade and assessment time. Effect size, confidence intervals, and partial η2 were used to determine the sensitivity of changes in scale scores over time. Correlations between changes in the scores of the same scales and between different scales were measured using Pearson coefficients, Spearman coefficients, and Kendall's tau-b coefficient. RESULTS: The mean age of the patients was 59.51 years. The majority were female (82.1%), with standing for prolonged periods (49.1%), had completed secondary (22.3%) or higher (25%) education, and had CEAP C2 (28.6%) or C6 (32.1%) clinical severity. The following results were observed: mean scale scores reduced from baseline to post-treatment, except for the Extent of Varicosities domain of the AVVQ-Brazil and the VEINES-QOL/Sym scales; sensitivity was low for the AVVQ-Brazil and its domains and for the VAPS, and was from low to high for the other scales; there were improvements or maintenance of CEAP grade after treatment; and moderate to excellent correlations between changes in scale scores over time. CONCLUSIONS: The AVVQ-Brazil is sensitive to longitudinal clinical changes after treatment for CVD and is an important measure for assessment of QoL and of disease severity in Brazil.

Treatment topical with silver nanoparticles and Stryphnodendron Adstringens (Mart.) Coville in cervical lesions: randomized clinical trial.

OBJECTIVE: To assess the feasibility of incorporating technology as a new alternative for treating topics on cervical lesions. METHOD: This is a randomized, double-blind, controlled clinical trial with a prospective design. During the realization of this study, 43 women were included and divided between groups A (ointment without silver nanoparticles n = 23) and B (ointment with silver nanoparticles n = 20) clinically healthy and who used the unified health system. RESULTS: There were no significant differences when comparing before and after the use of ointment for IVA test (p = 0.15), Schiller test (p = 0.15), cellular changes (p = 0.47) and microbiological analysis (p = 0.89) through cytology. After use, no adverse reaction was observed in the sample studied. CONCLUSION: Based on the results identified in this study, identified that the product is safe and does not promote adverse events. Regarding the effectiveness of the product in uterine cervical lesions, it is necessary to continue the study in phase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

Treatment topical with silver nanoparticles and Stryphnodendron Adstringens (Mart. ) Coville in cervical lesions: randomized clinical trial / Tratamento tópico com nanopartículas de prata e Stryphnodendron Adstringens (Mart. ) Coville em lesões cervicais: ensaio clínico randomizado / Tratamiento tópico con nanopartículas de plata y Stryphnodendron Adstringens (Mart. ) Coville en lesiones cervicales: ensayo clínico aleatorizado

ABSTRACT Objective: To assess the feasibility of incorporating technology as a new alternative for treating topics on cervical lesions. Method: This is a randomized, double-blind, controlled clinical trial with a prospective design. During the realization of this study, 43 women were included and divided between groups A (ointment without silver nanoparticles n = 23) and B (ointment with silver nanoparticles n = 20) clinically healthy and who used the unified health system. Results: There were no significant differences when comparing before and after the use of ointment for IVA test (p = 0.15), Schiller test (p = 0.15), cellular changes (p = 0.47) and microbiological analysis (p = 0.89) through cytology. After use, no adverse reaction was observed in the sample studied. Conclusion: Based on the results identified in this study, identified that the product is safe and does not promote adverse events. Regarding the effectiveness of the product in uterine cervical lesions, it is necessary to continue the study in phase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

RESUMO Objetivo: Avaliar a viabilidade da incorporação da tecnologia como uma nova alternativa para o tratamento de lesões cervicais. Método: Trata-se de um ensaio clínico randomizado, duplo-cego e controlado com um desenho prospectivo. Durante a realização deste estudo, foram incluídas 43 mulheres, divididas entre os grupos A (pomada sem nanopartículas de prata n = 23) e B (pomada com nanopartículas de prata n = 20), clinicamente saudáveis e usuárias do sistema único de saúde. Resultados: Não houve diferenças significativas na comparação entre antes e depois do uso da pomada para o teste IVA (p = 0,15), teste de Schiller (p = 0,15), alterações celulares (p = 0,47) e análise microbiológica (p = 0,89) por meio de citologia. Após o uso, não foi observada nenhuma reação adversa na amostra estudada. Conclusões: Com base nos resultados identificados neste estudo, identificou-se que o produto é seguro e não promove eventos adversos. Com relação à eficácia do produto em lesões cervicais uterinas, é necessária a continuidade do estudo na fase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

RESUMEN Objetivo: evaluar la viabilidad de la incorporación de la tecnología como una nueva alternativa para el tratamiento de temas sobre lesiones cervicales. Método: Se trata de un ensayo clínico aleatorizado, doble ciego, controlado y con un diseño prospectivo. Durante la realización de este estudio se incluyeron 43 mujeres divididas entre los grupos A (pomada sin nanopartículas de plata n = 23) y B (pomada con nanopartículas de plata n = 20) clínicamente sanas y usuarias del sistema unificado de salud. Resultados: No hubo diferencias significativas al comparar antes y después del uso de la pomada para la prueba de IVA (p = 0,15), la prueba de Schiller (p = 0,15), los cambios celulares (p = 0,47) y el análisis microbiológico (p = 0,89) mediante citología. Tras el uso, no se observó ninguna reacción adversa en la muestra estudiada. Conclusiones: Con base en los resultados identificados en este estudio, se identificó que el producto es seguro y no promueve eventos adversos. Con relación a la eficacia del producto en lesiones cervicales uterinas, es necesario continuar el estudio en fase II. Registro de Estudios Clínicos Brasileños: UTN: U1111-1218-2820.

Diagnóstico e manejo de isquemia aguda de membro em paciente pós infecção viral por covid-19: série de casos / Diagnosis and management of patients with acute limb ischemia after Covid-19 infection: a case series

Resumo A pandemia causada pela doença do coronavírus 2019 (covid-19) estabeleceu desafios e estimulou o desenvolvimento de diferentes formas terapêuticas em várias áreas médicas. Estudos descreveram características clínicas e desfechos de pacientes, incluindo desordens do sistema de coagulação, em que os pacientes infectados pelo vírus apresentam um estado de hipercoagulabilidade e pró-inflamatório que mimetiza uma vasculite. O objetivo deste trabalho foi descrever o quadro clínico e a terapia empregada em uma série de três pacientes que evoluíram com quadro de oclusão arterial aguda no período pós-infecção por covid-19. O manejo aplicado nesses casos permitiu que os pacientes evoluíssem sem sequelas. A baixa incidência e a pobreza em relatos descritos tornam difícil o estabelecimento de critérios e opções terapêuticas universalmente aceitos nos casos de isquemia, seja precoce ou tardia, dos pacientes infectados pelo novo coronavírus.

Abstract The Covid-19 pandemic caused by the Sars-Cov-2 virus created challenges and stimulated development of new forms of treatment in many different areas of medicine. Studies have described the clinical characteristics of patients and their outcomes, including disorders affecting the coagulation system, in which patients infected by the virus enter a hypercoagulable and proinflammatory state that mimics vasculitis. The objective of this study was to describe the clinical status and the treatment administered to three patients who developed acute arterial occlusion after Covid-19 infection. The management adopted in these cases enabled the patients to recover without sequelae. The low incidence and scarcity of published reports make it difficult to establish universally accepted treatment criteria and options for cases of ischemia in patients infected with the novel coronavirus, whether presenting early or late.

Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model.

OBJECTIVE: to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. METHODS: we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. RESULTS: there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. CONCLUSION: there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent. OBJETIVO: determinar as alterações do padrão do fluxo sanguíneo após tratamento endovascular do aneurisma sacular de aorta abdominal com triplo stent. MÉTODOS: estudo hemodinâmico de sete suínos das raças Landrace e Large White portadores de aneurismas saculares de aorta abdominal infrarrenal artificialmente produzidos segundo técnica descrita. Os animais foram submetidos a implante de triplo stent para correção endovascular do aneurisma e reavaliados por duplex scan quanto ao padrão do fluxo sanguíneo antes e após o implante dos stents. A análise estatística foi realizada com o teste Mann-Whitney não pareado. RESULTADOS: verificou-se uma queda significativa da velocidade sistólica média de 127,4cm/s na fase pré-stent para 69,81cm/s na fase pós-stent. Houve ainda mudança no padrão do fluxo de turbilhonar no saco aneurismático para laminar intrastent. CONCLUSÃO: o estudo demonstrou alterações do padrão do fluxo sanguíneo do aneurisma sacular de aorta abdominal após tratamento endovascular com triplo stent.

Modified technique for preparation of venous circulation resin casts in the cirrhotic liver.

This study describes two major adaptations for the preparation of resin casts in human cirrhotic liver, harvested at the time of transplantation. The first is the way of fixing the catheter in the ostia of the hepatic and portal veins through a cerclage, so as to prevent displacement of the catheter and / or leakage of the resin during its injection. The second is the extension of corrosion time in the NaOH solution, averaging 6.8 days, with daily replacement the solution until complete removal of parenchymal tissue. We applied the method in 14 cirrhotic livers, with good filling and coloring of the portal and hepatic vein territories, using different colors. This allows an anatomical study of these vessels, able to complement the knowledge of the histopathology in research work, and the planning of therapeutic procedures, such as the Trans-Jugular Intrahepatic Port-Systemic Shunt (TIPS). RESUMO Este estudo descreve duas importantes adaptações para o preparo de moldes de resina em fígado humano cirrótico, captado no momento do transplante: a primeira, é a maneira de fixação dos cateteres nos "óstios" das veias hepáticas e porta, através de uma "cerclagem" dos mesmos, de modo a evitar o deslocamento do cateter e/ou extravasamento da resina durante sua injeção, e a segunda, é o prolongamento do tempo de corrosão na solução de NaOH, atingindo a média de 6,8 dias, com a substituição diária da solução, até a remoção completa do tecido parenquimatoso. O método foi empregado em 14 fígados cirróticos com bom preenchimento e coloração dos territórios das veias porta e hepáticas, utilizando cores distintas. Isto permite um estudo anatômico desses vasos, capaz de complementar os conhecimentos da histopatologia em trabalhos de pesquisa, e planejar procedimentos terapêuticos como a derivação porto-sistêmica intra-hepática transjugular (TIPS - Transjugular Intrahepatic Postosystemic Shunt).

Experimental Model of Saccular Abdominal Aortic Aneurysm in Swines with Pericardium Sac.

OBJECTIVE: To consider modifications in an experimental model of saccular aortic aneurysm, aiming at better reproducibility, to be used in the development of vascular prostheses. METHODS: Experimental study in two phases, developed in the Center of Experimental Surgery and Bioterium (CCEB) of the University of Health Sciences of Alagoas (UNCISAL), with 11 hybrid swine, female, mean weight of 20 ± 5 kg, according to modifications in the Perini technique was performed. In the first phase, the aneurysm was confectioned with bovine pericardial patch. In the second phase, fifteen days later, the patency of the aneurysms was confirmed by Doppler ultrasonography. The described variables were aortic and aneurysm sac patency, incidence of rupture, morbidity and mortality. The statistical analysis program used was STATA v.8. RESULTS: All animals survived to the procedures. Surgical mean time was 73 minutes. Aneurysm rupture, proximal or distal aortic thrombosis, visceral or legs ischemia weren't observed. Parietal thrombus formation was observed in all of the aneurysms, two of which (18%; IC 95% = 3.98 - 48.84) were occluded and nine (82%; IC 95% = 51.15 - 96.01) were patent. CONCLUSION: In this series, the modifications carried out in the technique related to the surgical approach, race, anesthesia, and imaging exams reproduced the experimental model, reducing its costs, without hindering the analysis of the variables. The satisfactory patency ratio allows the method to be used in experimental models for the development of vascular prostheses.

Allium sativum Compared to Cilostazol as an Inhibitor of Myointimal Hyperplasia.

Objective: Intimal hyperplasia is associated with graft failure and vascular sutures in the first year after surgery and in postangioplasty restenosis. Allium sativum (common garlic) lowers cholesterol and has antioxidant effects; it also has antiplatelet and antitumor properties and, therefore, has great potential to reduce or inhibit intimal hyperplasia of the arteries. Our objective is to determine if the garlic has an efficacy to inhibit myointimal hyperplasia compared to cilostazol. Methods: Female New Zealand rabbits were divided into the following groups (n=10 each) according to treatment: group A, garlic, 800 µg×kg-1×day-1, orally; group C, cilostazol, 50 mg.day-1, orally; group PS, 10 ml of 0.9% physiological saline solution, orally. Our primary is the difference of the mean of myointimal hyperplasia. Statistical analysis was performed by using ANOVA and Tukey tests, as well as the Chi-square test. We calculated the 95% confidence interval for each point estimate, and the P value was set as < 0.05. Results: Group PS had a mean hyperplasia rate of 35.74% (95% CI, 31.76-39.71%); group C, 16.21% (95% CI, 13.36-19.05%); and group A, 21.12% (95% CI, 17.26-25.01%); P < 0.0001. Conclusion: We conclude that Allium sativum had the same efficacy in inhibiting myointimal hyperplasia when compared to the positive control, cilostazol.

Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera.

OBJECTIVE: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. METHODS: we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. RESULTS: there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. CONCLUSION: there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

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%.

Uso de software na imagem ultrassonográfica para diferenciação de edema de origem venosa e de origem linfática em membros inferiores / Use of ultrasound imaging software to differentiate venous and lymphatic edema in lower limbs

Resumo Contexto O edema de membros inferiores (MMII) possui causas de origem sistêmicas e locais. Uma inovação é a utilização de um software de caracterização tecidual para diferenciação da origem do edema em imagens de ultrassom. Objetivos Determinar os parâmetros do uso de software na imagem ultrassonográfica para diferenciação de edema de origem venosa e/ou linfática em MMII. Métodos Trata-se de um estudo transversal do tipo quantitativo analítico com amostragem não probabilística por conveniência. Os instrumentos de coleta foram: anamnese, exame físico, exame de ultrassom e análise do software de caracterização tecidual por imagem ultrassonográfica por meio da quantificação da ecogenicidade e da mediana da escala de cinza (GSM). Resultados A amostra foi composta por 42 MMII de edema venoso, 35 de edema linfático, 14 de edema misto e 11 controle. Quanto à distribuição dos pixels nos intervalos de ecogenicidade, o grupo com edema venoso apresentou 88,31% entre o intervalo hipoecogênico IV ao ecogênico III; o grupo com edema linfático, 71,73% entre o intervalo hipoecogênico II ao ecogênico I; grupo com edema misto, 76,17% entre o intervalo hipoecogênico III ao ecogênico II; e o grupo controle, 84,87% entre o intervalo ecogênico II ao hiperecogênico I. A média e o desvio-padrão da GSM apresentaram diferença estatística entre os grupos. Conclusão O software CATUS permitiu a diferenciação do tipo de edema de MMII, facilitando o diagnóstico do tipo de edema e, consequentemente, a escolha da melhor opção terapêutica.

Abstract Background Lower limb edema has both systemic and local causes. Using software to differentiate the origin of edema in ultrasound images is an innovation. Objective To determine the parameters for using software to differentiate edema of venous and/or lymphatic origin in ultrasound images of the lower limbs. Method This is a cross-sectional, quantitative, analytical study with non-probabilistic sampling by convenience. Data were collected by patient interview, physical examination, ultrasound examination, and analysis of software for tissue characterization in ultrasound image by means of quantification of echogenicity and Gray Scale Median (GSM). Results The sample comprised 42 lower limbs with venous edema, 35 with lymphatic edema, 14 with mixed edema, and 11 control limbs. The distributions of pixels in echogenicity intervals by group was as follows. In the venous edema group, 88.31% were distributed from hypoechogenic interval IV to echogenic interval III; in the lymphatic edema group 71.73% were from hypoechogenic interval II to echogenic interval I; in the mixed edema group 76.17% were from hypoechogenic interval III to echogenic interval II; and in the control group 84.87% were distributed from echogenic interval II to hyperechogenic interval I. Mean and standard deviation of GSM values showed statistical differences between groups. Conclusion The CATUS software enabled differentiation of the type of lower limb edema, facilitating diagnosis of edema type and, consequently, choice of the best therapeutic option.

Responsividade do questionário de qualidade de vida CCVUQ-Br em portadores de úlcera venosa crônica / Responsiveness of the CCVUQ-Br quality of life questionnaire in chronic venous ulcer patients

Resumo Contexto A responsividade consiste na capacidade de um instrumento em verificar se a pontuação reflete a variabilidade ocorrida na vida do paciente decorrente de uma intervenção. O CCVUQ-Br foi validado na língua portuguesa e necessita ter sua responsividade verificada. Quando finalizado este estudo, o CCVUQ-Br será utilizado como um instrumento capaz de perceber e refletir, na sua pontuação, as mudanças ocorridas na qualidade de vida do portador de úlcera venosa. Objetivos Avaliar a responsividade do CCVUQ-Br. Métodos Estudo de intervenção longitudinal, realizado em centros públicos e privados para pacientes com úlcera venosa. A amostra foi composta por portadores de úlcera venosa crônica submetidos à conduta terapêutica, tendo como variáveis as pontuações do CCVUQ-Br e de seus domínios, da escala visual analógica da dor (EVA dor) e da Escala de Avaliação Global de Mudança, além da classificação CEAP e o tamanho da úlcera. O CCVUQ-Br foi aplicado em 51 indivíduos submetidos a conduta terapêutica, recrutados de forma aleatória. Após 4 semanas, o CCVUQ-Br foi reaplicado. Resultados Houve diminuição das pontuações médias do CCVUQ-Br entre os dois momentos de aplicação, sendo que, no momento basal, a maior média de pontuação foi a do domínio Estado Emocional, com 63,45, diminuindo, após 4 semanas, para 52,00. Ainda apresentou correlações das mudanças com EVA dor e CEAP. Em relação ao tamanho do efeito, pode-se considerar que pontuação total do CCVUQ-Br e tamanho da úlcera apresentaram sensibilidade elevada, enquanto EVA dor e a maioria dos domínios do CCVUQ-Br apresentaram sensibilidade moderada . Conclusões O questionário CCVUQ-Br é sensível na população brasileira, apresentando garantia de resposta à amostra testada.

Abstract Background Responsiveness is a measure of an instrument's ability to reflect in its score the variability that has occurred in a patient's life as a result of an intervention. The CCVUQ-Br has been validated in Portuguese, but its responsiveness still needs to be tested. When this study has been completed, the CCVUQ-Br will be available for use as an instrument capable of detecting and reflecting in its score the changes that take place in the quality of life of people with venous ulcers. Objectives To evaluate the responsiveness of the CCVUQ-Br. Methods A longitudinal intervention study was conducted at public and private centers for patients with venous ulcers. The sample comprised people with chronic venous ulcers due to start treatment and the variables analyzed were CCVUQ-Br score and its domain scores, a pain visual analog scale (pain VAS), and the Global Assessment of Change Scale, in addition to CEAP classification, and size of ulcer. The CCVUQ-Br was administered to 51 people about to start treatment who were recruited at random. The CCVUQ-Br was then re-administered 4 weeks after treatment had started. Results Mean CCVUQ-Br scores reduced from the first to the second administration. The highest mean score at baseline was for the Emotional Status domain, at 63.45, which dropped to 52.00 after 4 weeks. There were also correlations between changes in CCVUQ-Br scores and pain VAS ratings and CEAP class. With regard to the effect size, total CCVUQ-Br score and ulcer size exhibited high sensitivity, while pain VAS and the majority of the CCVUQ-Br domains had moderate sensitivity. Conclusions The CCVUQ-Br questionnaire is sensitive in the Brazilian population and exhibited response to change in the sample tested.

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.

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.

Compartment syndrome after tibial plateau fracture.

Fractures of the tibial plateau are relatively rare, representing around 1.2% of all fractures. The tibia, due to its subcutaneous location and poor muscle coverage, is exposed and suffers large numbers of traumas, not only fractures, but also crush injuries and severe bruising, among others, which at any given moment, could lead compartment syndrome in the patient. The case is reported of a 58-year-old patient who, following a tibial plateau fracture, presented compartment syndrome of the leg and was submitted to decompressive fasciotomy of the four right compartments. After osteosynthesis with internal fixation of the tibial plateau using an L-plate, the patient again developed compartment syndrome.

As fraturas de platô tibial são relativamente raras e representam, aproximadamente, 1,2% de todas as fraturas. A tíbia, por sua localização subcutânea e pobre cobertura muscular, está exposta a sofrer grandes quantidades de traumatismos, que não são somente fraturas, mas também lesões por achatamento, contusões severas, entre outras que, em um determinado momento, podem causar no enfermo a síndrome compartimental. É relatado o caso de um paciente de 58 anos que, após fratura de platô tibial, apresentou síndrome compartimental de perna e foi submetido à fasciotomia descompressiva dos quatro compartimentos direitos. Após osteossíntese com fixação interna de platô tibial com placa em L, evoluiu com nova síndrome compartimental.

Evaluation of the venous reflux of the great saphenous vein by duplex scan after surgical treatment of the saphenofemoral junction insufficiency.

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.

Stable experimental model of carotid artery saccular aneurysm in swine using the internal jugular vein.

OBJECTIVE: To develop an experimental model of stable saccular aneurysm in carotid of pigs using the internal jugular vein. METHODS: In 12 healthy pigs, weighing between 25 and 5 0kg, five males and seven females, we made a right common carotid artery aneurysm. After elliptical arteriotomy, we carried out a terminolateral anastomosis with the distal stump of the internal jugular vein. Aneurysm volume was calculated so that the value did not exceed 27 times the area of the arteriotomy. After six days angiography and microscopic examination were performed to assess patency of the aneurysm and the presence of total or partial thrombosis. RESULTS: There was a significant weight gain of pigs in the time interval between the manufacture of the aneurysm and angiography (p = 0.04). Aneurysmal patency was observed in ten pigs (83%). Operative wound infections occurred in two animals (16.6%), both with early onset, three days after the making of the aneurysm. Histological analysis showed aneurysm thrombus partially occluding the light in nine pigs (75%). In these animals, it was observed that on average 9% of the aneurysmal diameter was filled with thrombi. CONCLUSION: It was possible to develop a stable experimental model of saccular aneurysms in pig carotid artery by use of the internal jugular vein.