Comparison of reduction of edema after rest and after muscle exercises in treatment of chronic venous insufficiency

<p>Abstract</p> <p>Aim</p> <p>The aim of this work was to compare the reduction in edema obtained in the conservative treatment of phlebopathies after resting and after performing a muscle exercise program in the Trendelenburg position.</p> <p>Methods</p> <p>Twenty-eight limbs of 24 patients with venous edema of distinct etiologies and classified as between C3 and C5 using CEAP classification. Volumetric evaluation by water displacement was carried out before and after resting in the Trendelenburg position and after performing programmed muscle exercises 24 hours later under identical conditions of time, position and temperature. For the statistical analysis the paired t-test was used with an alpha error of 5% being considered acceptable.</p> <p>Results</p> <p>The average total volume of the lower limbs was 3,967.46 mL. The mean reduction in edema obtained after resting was 92.9 mL, and after exercises it was 135.4 mL, giving a statistically significant difference (p-value = 0.0007).</p> <p>Conclusion</p> <p>In conclusion, exercises are more efficient to reduce the edema of lower limbs than resting in the Trendelenburg position.</p

Angioplastia de artéria isquiática persistente: relato de caso

Transluminal balloon angioplasty is a good choice for the treatment of lower limb arterial occlusion. Although there are some guidelines addressing its indications, some situations are so unusual that there is no consensus on their management. The presence of a persistent sciatic artery is a rare congenital anomaly of the circulatory system and may be associated with early atheromatous degeneration and occlusion. The authors describe the case of an 81-year-old woman that presented with a history of rest pain, atrophic lesion and no distal pulses. Angiogram depicted a persistent sciatic artery with segmental occlusion and distal disease. The therapeutic option was balloon angioplasty of the occluded segment, with technical and clinical success at mid-term follow-up.A angioplastia transluminal com balão tem se mostrado uma boa alternativa no tratamento de oclusões arteriais em membros inferiores. Embora já existam algumas diretrizes quanto à sua indicação, algumas situações ainda são inusitadas e carecem de consenso pela sua raridade. A presença de artéria isquiática persistente é uma anomalia congênita rara do sistema circulatório e pode estar associada com doença ateromatosa precoce e oclusão. Os autores apresentam um caso de uma paciente do sexo feminino de 81 anos, com história de dor de repouso, lesão trófica e ausência de pulsos distais. A arteriografia mostrou persistência de artéria isquiática com oclusão segmentar e doença distal. A abordagem terapêutica escolhida foi angioplastia do segmento ocluído, e o seguimento de médio prazo mostrou sucesso técnico e clínico com esta técnica

Lower limb edema after great saphenous vein harvesting to be used as graft in myocardial revascularization

CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5% (a = 0,05). RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p < 0.05) entre os membros operados e os não-operados, sendo 56,8% com volume maior que 50 mL e 31,9% com perímetro maleolar maior que 2 cm. Não se encontrou associação entre a presença do edema e características da amostra ou da cirurgia e de intercorrências clínicas perioperatórias ou tardias. CONCLUSÕES: Pacientes submetidos a ressecções de veia safena magna para sua utilização como ponte coronariana poderão apresentar edema no membro associado.BACKGROUND: Myocardial revascularization using the great saphenous vein is still a very common surgical procedure. The edema that occurs in the operated leg causes much discomfort and requires further studies. OBJECTIVES: To describe lower limb edema secondary to great saphenous vein harvesting using the bridge technique for use as venous graft in myocardial revascularization. METHODS: Forty-four individuals previously submitted to great saphenous vein harvesting for myocardial revascularization more than 3 months before were randomly selected. Patients with factors that might interfere with formation of lower limb edema were excluded. Both operated and non-operated legs were evaluated by volumetry and perimetry of the malleolar region. Differences greater than 50 mL or higher than 2 cm between the operated and the contralateral leg were considered as presence of significant edema. Chi-square, Fisher&#8217;s, McNemar&#8217;s and Student&#8217;s t tests were used for statistical analysis. Significance level was set at 5% (a = 0.05). RESULTS: Statistically significant differences (p < 0.05) were found between operated and contralateral legs, with 56.8% of the individuals having a difference in volume greater than 50 mL and 31.9% having a difference in malleolar region perimeter greater than 2 cm. There was no association between presence of edema and sample characteristics, surgery, perioperative or late clinical complications. CONCLUSIONS: Patients submitted to resection of the great saphenous vein for coronary artery bypass grafting may evolve with edema of the operated leg

Ankle ankylosis and its importance in chronic venous insufficiency

CONTEXTO: O desenvolvimento de anquilose em pacientes com insuficiência venosa crônica (IVC) pode ser evidenciado em diversos estágios da patologia através de medidas da amplitude de movimento da articulação do tornozelo tomadas com a utilização de um goniômetro. OBJETIVO: Relacionar a diminuição da amplitude de movimento da articulação tíbio-társica na IVC dos membros inferiores (MMII) medida por goniometria com a gravidade da IVC, utilizando-se a classificação CEAP. MÉTODOS: No período de março de 2003 a agosto de 2004, 86 pacientes (67 mulheres e 19 homens) com média de idade de 50,6 anos foram submetidos à goniometria do tornozelo. Os indivíduos foram divididos conforme a gravidade da IVC de seus MMII (121 avaliados) de acordo com a classificação CEAP. Quarenta membros foram caracterizados como C0 (grupo-controle), 40 como C3, e 41 como C4. As medidas obtidas nos diferentes grupos foram comparadas entre si. RESULTADOS: A média da amplitude de movimento da articulação tíbio-társica do grupo C0 foi de 42,4º (variação de 26-54); a do grupo C3 foi de 37,9º (variação de 10-61); e a do grupo C4 foi de 24,5º (variação de 8-50). A diferença das médias de C4 e C3 foi de 36%, e a de C3 comparada com o grupo-controle (C0), de 11%, caracterizando a maior diferença entre C3 e C4. CONCLUSÃO: A goniometria do tornozelo auxilia a graduar a hipertensão venosa crônica, pois demonstra a existência de correlação entre a gravidade da anquilose e a severidade da IVC.BACKGROUND: Development of ankylosis in patients with chronic venous insufficiency (CVI) can be observed in different stages of the disease as the ankle range of motion is measured by a goniometer. OBJECTIVE: To relate a reduced ankle range of motion in patients with CVI of the lower limbs measured by goniometry and the severity of CVI according to the CEAP classification. METHODS: From March 2003 to August 2004, 86 patients (67 females and 19 males) with a mean age of 50.6 years had their ankles assessed by a goniometer. Patients were classified into three groups according to the severity of the CVI of the lower limbs (121 were assessed) using the CEAP classification. There were 40 limbs classified as C0 (control group), 40 limbs as C3 and 41 limbs as C4. Measurements of all groups were compared. RESULTS: The average ankle range of motion was 42.4º (from 26º to 54º) in C0 group, 37.9º (from 10º to 61º) in C3 group and 24.5º (from 8º to 50º) in group C4. The difference between C4 and C3 average values was 36% and that between C3 and the control group (C0) was 11%; thus, the contrast between C3 and C4 was more significant. CONCLUSION: Ankle goniometry may be used to assess chronic venous hypertension, as it reveals a correlation between the severity of ankylosis and the severity of CVI

Parotidite aguda pós-cirúgica: prevalência atual no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Postsurgical acute suppurative parotitis is a bacterial gland infection that occurs from a few days up to some weeks after abdominal surgical procedures. In this study, the authors analyze the prevalence of this complication in Hospital das Clínicas/São Paulo University Medical School by prospectively reviewing the charts of patients who underwent surgeries performed by the gastroenterological and general surgery staff from 1980 to 2005. Diagnosis of parotitis or sialoadenitis was analyzed. Sialolithiasis and chronic parotitis previous to hospitalization were exclusion criteria. In a total of 100,679 surgeries, 256 patients were diagnosed with parotitis or sialoadenitis. Nevertheless, only three cases of acute postsurgical suppurative parotitis associated with the surgery were identified giving an incidence of 0.0028%. All patients presented with risk factors such as malnutrition, immunosuppression, prolonged immobilization and dehydration. In the past, acute postsurgical suppurative parotitis was a relatively common complication after major abdominal surgeries. Its incidence decreased as a consequence of the improvement of perioperative antibiotic therapy and postoperative support. In spite of the current low incidence, we believe it is important to identify risks and diagnose as quick as possible, in order to introduce prompt and appropriate therapeutic measures and avoid potentially fatal complications with the evolution of the disease.A parotidite supurativa pós-cirúrgica é infecção bacteriana da glândula que ocorre poucos dias até algumas semanas após procedimento cirúrgico. Os autores analisam a prevalência desta complicação cirúrgica nos últimos 25 anos do Hospital das Clínicas de São Paulo. Foram analisados os prontuários das cirurgias realizadas pelos serviços de Cirurgia do Aparelho Digestivo e Cirurgia Geral da Faculdade de Medicina da Universidade de São Paulo no período de 1980 a 2005, num total de 106790 cirurgias. Todos os prontuários que apresentaram entre os diagnósticos das altas complicações cirúrgicas, parotidite ou sialoadenite foram avaliados. Foram identificados 256 prontuários. Pacientes com outras complicações, ou que já apresentavam sialolitíase ou parotidite crônica anterior à internação foram excluídos do estudo. Foram identificados apenas três casos de parotidite aguda supurativa pós-cirúrgica, revelando incidência de 0,0028%. A parotidite supurativa pós-cirúrgica foi complicação relativamente comum de grandes cirurgias abdominais no passado, com acentuada redução atual da sua incidência decorrente da antibioticoterapia de amplo espectro, além de preparação pré-operatória adequada e suporte pós-operatório dos pacientes. Apesar da baixa incidência atual, consideramos importante identificar seus fatores de risco, assim como realizar diagnóstico precoce, conduta terapêutica apropriada para evitar complicações letais associadas a esta infecção

Aneurisma micótico de tronco tíbio-fibular: a primeira manifestação de uma endocardite infecciosa

Infrapopliteal mycotic aneurysm resulting from endocarditis is rare, with only a few reported cases. We describe the case of a 28-year-old male patient who was suffering with pain and edema in the right leg. The ultrasound revealed an aneurysm of the right tibioperoneal trunk and a deep vein thrombosis (DVT). The patient was admitted and developed acute congestive heart failure, being diagnosed with possible endocarditis. A pseudo-aneurysm was revealed by arteriography. Aggressive antibiotic treatment was initiated, and open surgery confirmed a mycotic pseudo-aneurysm of the tibioperoneal trunk. To our knowledge, this is the 8th case reported of an infected aneurysm in this particular location.Aneurisma micótico infra-poplíteo resultante de endocardite infecciosa é raro, com apenas alguns casos relatados. Descrevemos o caso de um paciente de 28 anos do sexo masculino que apresentou dor e edema na perna direita. A ultrassonografia demonstrou um aneurisma do tronco tíbio-fibular e trombose venosa profunda do membro inferior direito. O paciente foi internado e desenvolveu falência cardíaca aguda, sendo diagnosticado de endocardite bacteriana. Um pseudo-aneurisma foi evidenciado na arteriografia. Antibioticoterapia agressiva foi iniciada e cirurgia aberta confirmou um pseudo-aneurisma micótico do tronco tibio-fibular. Para o nosso conhecimento, este é o oitavo caso relatado de aneurisma infectado localizado especificamente nesta região

Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review

This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked

Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil. A case series

OBJECTIVE: The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years. METHODS: Twenty-eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty-six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma. RESULTS: Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow-up for the overall group was 33.6 months, with 48.7 months (range 8-83 months) for the OR group, and 29.8 months (range 2-91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8-48 h, median 20 h) for the OR group and 30.3 hours (range 2-240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay. CONCLUSION: In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow-up. Nevertheless, long-term follow-up is necessary to confirm the effectiveness of this treatment

Actinic arteritis of subclavian artery: case report and literature review

Diversas são as complicações possíveis da radioterapia na adjuvância do tratamento de neoplasias. Lesões actínicas de artéria subclávia em pacientes submetidos a este tipo de tratamento para neoplasia de mama são complicações conhecidas, porém com poucos relatos de casos publicados. No presente relato, descrevemos um caso de oclusão de artéria subclávia direita em paciente submetida à radioterapia para tratamento de neoplasia de mama, tratada com a revascularização convencional, com interposição de enxerto de politetrafluoretileno (PTFE). Na revisão da literatura realizada, foram encontrados doze casos descritos que evidenciaram diferentes opções terapêuticas. Concluímos que a arterite actínica de artéria subclávia é uma doença incomum, entretanto sua hipótese deve ser aventada em todos os pacientes com isquemia de membro superior já submetidos a tratamento de radioterapia

Ensaio clínico randomizado prospectivo comparando a ablação por radiofrequência e a retirada completa de veia safena em pacientes com doença venosa crônica leve à moderada com seguimento de 3 anos

Objective: To compare the use of the radiofrequency thermoablation of the saphenous vein with the ligation technique, and complete removal of the saphenous vein, from the saphenofemoral junction to the ankle. Methods: A total of 49 patients with chronic venous disease in the Comprehensive Classification System for Chronic Venous Disorders (CEAP) classes 2 to 4 for clinical signs, etiology, anatomic distribution and pathophysiology, were assessed at baseline, after 4 weeks, and after 1 year. The parameters assessed were complications, period of absence from activities, Venous Clinical Severity Score (VCSS) and quality of life scores according to Aberdeen Varicose Veins Questionnaire (AVVQ). They were re-examined 1 and 3 years after treatment to evaluate recurrence rates. Results: The success rate per limb (p=0.540), VCSS (p=0.636), AVVQ (p=0.163), and clinical complications were similar in the two treatment groups. Nevertheless, the radiofrequency thermoablation group had significant shorter length of hospital stay (0.69±0.47) and absence from activities (8.62±4.53), p<000.1. Conclusion: Patients submitted to radiofrequency thermoablation had an occlusion rate, clinical recurrence and improvement in quality of life comparable to removal of the saphenous vein. However, these patients spent less time hospitalized and away from their daily activities during recovering