Amélia Cristina Seidel

Prevalência de insuficiência venosa superficial dos membros inferiores em pacientes obesos e não obesos

BACKGROUND: Chronic venous insufficiency of the lower limbs is the most prevalent venous disease. There is an ongoing debate about its etiology and pathophysiology. Several risk factors have been associated with its development, such as age, sex and diet. Obesity is a public health problem and its prevalence has been increasing. Color Doppler ultrasonography is a useful method to evaluate the presence of reflux and/or obstruction of the venous system. OBJECTIVE: To compare the prevalence of superficial venous insufficiency and associated symptoms in obese and non-obese patients. METHODS: After weighing, height measurement and physical examination, patients with body mass index (BMI) 35 kg/m2 and complaints compatible with venous insufficiency were divided into groups I and II, respectively. They underwent color Doppler ultrasonography of the lower limbs, in order to assess the presence or absence of reflux. RESULTS: A total of 311 limbs of 168 patients 25 to 72 years old were examined. For statistical analysis, complaints of varicose veins, pain, swelling, dermatitis, eczema and ulcers, associated or not, were considered. A total of 109 and 104 limbs with varicose veins were obtained in groups I and II, respectively. The prevalence of visible varicose veins (p<0.001) and visible varicose veins with pain (p=0.0118) was higher in group I. Complaints of varicose veins with edema (p<0.001), only edema (p<0.001) and edema with pain (p<0.001) were more prevalent in group II. Data did not present significant statistical difference in the prevalence of varicose veins between groups I and II. CONCLUSION: The prevalence of varicose veins in obese and non-obese individuals is similar ; clinical complaints differ between groups and are consistent and dependent on the presence of venous insufficiency.

Effect of lung resection and sham surgery on the frequency of infection in alloxan-diabetic rats

The present study was carried out in order to determine the effect of lung resection on the frequency of infections in alloxan-diabetic rats. Adult female Wistar rats were injected with alloxan (40 mg/kg, iv) to induce diabetes mellitus (group D; N = 45) or with vehicle (1.0 ml/kg, iv) to be used as controls (group C; N = 45). Thirty-six days after receiving alloxan both groups were randomly divided into three subgroups: no operation (NO; N = 15), sham operation (SO; N = 15), and left pneumonectomy (PE; N = 15). The rats were sacrificed 36 days after surgery and their lungs were examined microscopically and macroscopically. The occurrence of thoracic wall infection, thoracic wall abscess, lung abscess and pleural empyema was similar in groups D and C. In contrast, the overall infection rate was higher (P<0.05) in the diabetic rats (SO-D and PE-D subgroups, but not in the NO-D subgroup). Considering that the overall infection rate was similar in the SO-D and PE-D subgroups, we suggest that surgery but not pneumonectomy was related to the higher prevalence of infection in diabetic rats.

Relationship between the diameter of great saphenous vein and body mass index

OBJETIVO: Este estudo teve o objetivo de comparar o diâmetro da veia safena magna em diferentes niveis dos membros inferiores e o indice de massa corporal dos sujeitos para determinar uma possivel relacao entre esses fatores. METODOS: Cinquenta e dois membros inferiores de 26 voluntarios (seis homens e 20 mulheres) sem registro de doenca venosa cronica, com idades entre 21 e 68 anos, foram avaliados. O indice de massa corporal foi definido antes do eco-Doppler colorido. Os sistemas venosos superficial e profundo e as veias perfurantes foram avaliados de acordo com a literatura. O diâmetro da veia safena magna foi medido atraves de imagem ultra-sonografica longitudinal em sete niveis diferentes. Para a analise estatistica, foram utilizados o teste t de Student para dados pareados e o teste de Spearman. RESULTADOS: A diferenca observada na veia safena no segundo e terceiro niveis, quando comparada aos membros inferiores direito e esquerdo, nao foi considerada significativa, e somente um grupo foi formado para a comparacao com o indice de massa corporal. A correlacao foi considerada estatisticamente irrelevante. CONCLUSAO: Atraves da comparacao dos diâmetros da veia safena magna com o indice de massa corporal dos sujeitos, percebeu-se que a relacao entre esses dois fatores nao e significativa e, portanto, pode-se concluir que individuos altos e magros podem ter veias safenas magnas com diâmetros similares aos de individuos baixos e gordos.

Epistemologia sobre amputações e desbridamentos de membros inferiores realizados no Hospital Universitário de Maringá

BACKGROUND: There are no precise data on the number of amputations performed every year. However, the decrease in quality of life of patients submitted to amputation is well-known, as is the need to involve a multidisciplinary team in the rehabilitation of these individuals. OBJECTIVE: To analyze all lower limb amputations performed by the Angiology and Vascular Surgery at Hospital Universitario Regional de Maringa, from 2000 to 2006. METHODS: A descriptive and retrospective study was performed to review medical records of patients submitted to amputation or surgical debridement of lower limbs to treat vascular diseases or trauma. RESULTS: A total of 116 procedures were carried out (84.5% amputations and 15% debridements) in 111 patients; 78 were males and 33 were females, with a mean age of 63.4 years (4-100 years). The main etiological factors were vascular diseases (92.8%) and trauma (7.2%). The most prevalent comorbidities and risk factors were hypertension (66%), diabetes mellitus (60%), tobacco (28%) and cardiac arrhythmia (0.9%). As to schooling, 52.2% of the patients had complete elementary school, 6.5% had complete or incomplete high school, and 41.3% were illiterate. Primary amputation was performed in 94.9% of patients, and secondary amputation in 5.1%. However, there was a progressive reduction in amputation rate at each year. CONCLUSIONS: Incidence of lower limb amputation was greater in males, had atherosclerotic disease as its main cause, but had progressive reduction.

Animal model of chronic abdominal hernia in rabbit

PURPOSE To create a feasible animal model of hernia that should be reliable to test the different types of mesh and/or surgical technique. METHODS Thirty six male New Zealand albino rabbits were submitted to surgical procedure to provoke a standard hole in the abdominal wall. A metallic frame measuring 3 cm length and 1 cm width was allocated longitudinally on the umbilicus scar and the comprehensive three squared centimeters area was resected. A continuous 4.0 polyamide was performed to closure the subcutaneous and skin. RESULTS During three weeks a score of signals/symptoms was performed to evaluate the wound and clinical conditions. No death or severe complications occurred. In the 3rd week the hernia ring and visceral adhesions were evaluated. Soft omental adherences were present in the hernial sac in all animals. The area of hernia ring ranged from 32.1+/-5.5 to 35.6+/-3.1 squared centimeter and the maximum was 39 cm(2) and the minimum was 30 cm(2). The model results in protrusion which was similar to a human incisional hernia with hernia sac, visceral adhesions and fibrous healing ring. CONCLUSION The model was more reliable to test further techniques or mesh on hernia repair.

Anastomose colônica com adesivo de fibrina em ratos diabéticos

OBJETIVO: Estudar aspectos da cicatrizacao na anastomose colonica com adesivo de fibrina em ratos normais e diabeticos. METODO: Foram utilizados 160 ratos Wistar (Rattus novergicus albinus), machos, com peso variando de 250 a 300g, sendo que oitenta destes animais eram nao diabeticos e os outros oitenta animais apresentavam diabetes mellitus induzido pela aloxana, Os animais foram submetidos a procedimento operatorio padronizado que consistiu em colectomia parcial esquerda e anastomose primaria por sutura manual ou com adesivo de fibrina. Foram reavaliados no quarto ou setimo dia de pos-operatorio quando se observou a presenca de colecao liquida ou purulenta na tela subcutânea; integridade da sutura; presenca de aderencias; presenca de deiscencia; resistencia da anastomose (pressao maxima de insuflacao) em mmHg, e a concentracao tecidual de hidroxiprolina. RESULTADOS: Em relacao a presenca de deiscencia de anastomose e mortalidade ocorreram piores resultados nos animais diabeticos no quarto e setimo dias de observacao em comparacao ao controle. Nos grupos e subgrupos estudados os resultados com o uso do adesivo de fibrina nao foram melhores que os da sutura manual. Em relacao a concentracao tecidual de hidroxiprolina nao houve diferenca significativa entre os grupos. CONCLUSAO: O diabetes mellitus induzido pela aloxana impede a reparacao normal da anastomose colonica em ratos e o uso adesivo de fibrina na anastomose colonica em ratos normais e diabeticos nao trouxe beneficios na evolucao pos-operatoria.

Response of the lung after pneumonectomy in alloxan diabetic rats

In order to determine the response of remaining lung after pneumonectomy during diabetes, female Wistar rats that received an intraperitoneal injection of alloxan (D Group) or saline (C Group) were submitted to lung resection. Six days after alloxan injection (45 mg/kg), diabetes was confirmed. The rats were randomized divided in 3 subgroups: non-operated (NO), sham operation (SO) and left pneumonectomy (PE). Thirty days after the surgery all rats were killed and the weight and volume of the lungs were measured. PE-diabetic rats showed smaller lung weight and volume than PE-non-diabetic animals. The results demonstrated that the compensatory lung growth postpneumonectomy were not observed in diabetic rats.

Taracotomia sem intubação orotraqueal: modelo experimental em ratos

O objetivo deste trabalho e descrever uma tecnica para realizacao de toracotomias, com ou sem resseccoes pulmonares sem intubacao orotraqueal. Foram utilizados 36 Rattus novergucus albinus, Wistar, adultos, femeas, submetidos a resseccao pulmonar sob vetilzacao espontânea e carater de oxigenio com fluxo de 1 litro / minuto em um capacete que envolvia toda cabeca do animal. Nao houve obito no per ou po-operatorio devido complicacoes inerentes ao procedimento. Os resultados mostraram que esta operacao, sem intubacao orotraqueal pode ser realizada, apresentando como vantagens, a simplicidade na execucao e ausencia de trauma traqueal.

Influence of prevalent occupational position during working day on occupational lower limb edema

Background: The lower limb edema observed in normal people at the end of their working days can vary in intensity and frequency depending on the predominant working positions required to perform different jobs. Objectives: To compare lower limb volumes of volunteers allocated to three study groups, depending on the predominant positions in which they work. Methods: Volumetric assessments were conducted of both lower limbs of 51 people free from vascular disease, allocated to three groups of 17 individuals each by predominant working position: sitting, static standing or alternating between the two. Volumes were measured at the start and at the end of the working day and the differences in volumes were calculated for each group. Means and frequencies were compared using appropriate inferential statistics and correlation coefficients were calculated. Results: The groups were homogenous in terms of sex distribution, age, skin color and BMI. The volumetric data from measurements taken before starting work revealed significant differences between all three groups. Volunteers who predominantly worked sitting down had largest volumes, followed by those who remained standing for long periods and then those who varied between these positions. The frequency of lower limb volume increase > 100 mL was significantly higher in the group of people who worked sitting down and maintained this position for long periods. Conclusions: Postural edema is more common among people who work sitting down for long periods, among whom it appears that there is a cumulative effect from the position, since they exhibit larger lower limb volumes at the start of the day.

Síndrome da veia cava superior em criança

The authors describe a case of benign superior vena cava syndrome post phlebotomy in childhood, including exams for diagnosis and possible treatment.