Camila Pereira Leguisamo

A efetividade de uma proposta fisioterapêutica pré-operatória para cirurgia de revascularização do miocárdio

Introduction: Postoperative pulmonary complications are a major source of mortality and morbility. Respiratory physiotherapy, which is often used to prevent and treat these complications, can be started preoperatively, in order to assess and guide the patients. Objective: To establish the effectiveness of a preoperative Effetiveness of a preoperative physiotherapeutic approach in myocardial revascularization

Ventilatory profile of patients undergoing CABG surgery.

OBJECTIVE To assess the ventilatory, radiological and clinical profile of patients undergoing elective CABG in a cardiology reference hospital in South Brazil. METHODS This study included 108 patients undergoing elective CABG surgery, in the period between April 2006 and February 2007 at the Cardiology Institute of Rio Grande do Sul (IC-FUC). The surgical procedure involved median sternotomy, and the saphenous vein and/or internal mammary artery were used for grafting. Lung volume and capacity, as well as the possible existence of ventilatory changes, were assessed by spirometry, and the ventilatory muscle strength was assessed using a vaccum manometer. All evaluations were performed on the preoperative period and on the sixth postoperative day. RESULTS Preoperative levels of FEV1 and FVC were significantly reduced on the 6th postoperative day (P<0.001) when compared to the preoperative levels. A significant decrease of ventilatory muscle strength, expressed as maximum inspiratory and expiratory pressures (MIP and MEP), was also observed from the pre- to the sixth postoperative day (P<0.001). Pulmonary events were more frequent on the 6th postoperative day (78%) than on the 1st postoperative day (40%). CONCLUSION Patients undergone CABG surgery present important reduction in pulmonary volume and capacity, as well as on the ventilatory muscle strength during the postoperative period.

Effects of physiotherapeutic instructions on anxiety of CABG patients

INTRODUCTION The coronary artery bypass graft surgery is an option of treatment for cardiovascular diseases, and the patients who underwent such procedure can suffer from preoperative anxiety. OBJECTIVE The aim of this study is to verify the effects of physiotherapeutic instructions at the anxiety level on patients undergone coronary artery bypass graft surgery. METHODS Randomized clinical trial, with the sample composed by 51 individuals, 27 on the control group and 24 on the intervention; on which it was assessed the anxiety (Beck Scale for Anxiety) and pain (Visual Analog Scale) levels on the pre- and postoperative period and only the second group received instructions about the surgery procedures and ventilatory exercises. For statistical analysis the Wilcoxon, Mann-Whitney and Spearman tests were used. RESULTS The lower anxiety levels were observed in patients that received the intervention on the period before surgery (9.6 +/- 7.2 versus 13.4 +/- 5.9, P=0.02). On the control group, the difference among the anxiety levels before and after the surgery was statistically significant (P= 0.003). The female individuals presented more anxious before the surgery compared to the male ones (P=0.058). It was also verified a relationship between length of stay at hospital and postoperative anxiety (P=0.05), where the more anxious individuals remained more time at the hospital. CONCLUSION Patients oriented and instructed about physiotherapeutic ventilatory exercises and hospital routine, presented their levels of anxiety reduced on the preoperative compared to the control group. However, at the postoperative, both groups presented their anxiety levels reduced without significant difference between them.

Exercícios físicos na doença arterial obstrutiva periférica

Most patients with intermittent claudication, a clinical aspect of peripheral arterial disease, have important limitations on physical activity and a reduced quality of life. The purpose of this study was to review literature on exercise intervention for patients with peripheral occlusive arterial disease and intermittent claudication. BIREME, PubMed (MEDLINE), SciELO and LILACS databases were searched for the terms intermittent claudication, peripheral vascular diseases, rehabilitation, exercise, exercise therapy, all of which were taken from the list of Health Science Descriptors (BIREME). It was concluded that, despite the variability of walking regimens identified in the literature, the aerobic training is of general benefit to patients with peripheral arterial disease and intermittent claudication, mainly improving their walking performance, which can have a significant impact on the quality of life of these patients.

Estimativa do custo de tratar o pé diabético, como prevenir e economizar recursos

In this work the cost of hospital treatment for diabetic foot wounds was estimated and the literature regarding prophylaxis for these lesions was examined. For this purpose, the records of all patients with diabetic foot symptoms submitted to surgical treatment over a period of 16 months in a public hospital were reviewed. There were 44 admissions with an average hospitalization period of 11.93 days, (± 6.34), 61 surgical procedures, with amputations in 65% of the cases. An average cost of R

Incidência de complicações pulmonares na cirurgia de revascularização do miocárdio

4,367.05 (± 9249.01) and a total cost of R

Dor lombar crônica e dor nos membros inferiores em idosas: etiologia em revisão

192,150.40 was calculated for the hospital treatment involved. Treatment of diabetic foot symptoms had a high cost and required amputation in the majority of cases. A review of the literature revealed many possible models to be adopted for action in the prophylaxis of wounds associated with the diabetic foot, which can avoid amputations and save funds.

Incidence of pulmonary complications in myocardial revascularization

BACKGROUND despite the increasingly careful attempts to reduce perioperative risks, pulmonary complications following surgery are still very common, leading to longer length of hospital stays or death. OBJECTIVE to describe the incidence of pulmonary complications and identify their association with duration of extracorporeal circulation (ECC), surgery and ischemia, number of bypass grafts performed, location of drains and length of drainage following myocardial revascularization (MRV). METHODS this contemporaneous cohort consisted of 202 patients undergoing elective myocardial revascularization (MRV) with saphenous vein graft and internal mammary artery graft and ECC, at a referral university cardiology hospital in Southern Brazil, from April 2006 to November 2007. The following outcomes were analyzed: duration of mechanical ventilation; pneumonia onset; atelectasis; pleural effusion; location of drains and time of removal; and length of hospital stay. RESULTS of the 202 patients, 90 developed some sort of pulmonary complication. The incidence of pleural effusion was 84%, whereas atelectasis was 65%. The following variables were associated with pulmonary complications: duration of ECC (p = 0.003), surgery (p = 0.040) and ischemia (p = 0.001); length of drainage (p = 0.050) and location of pleural drains (p = 0.033); age (p = 0.001); ejection fraction (p = 0.010); diagnosis of asthma (p = 0.047) and preoperative abnormal chest X-ray findings (p = 0.029). CONCLUSION variables related to the complexity of the surgery and preexisting comorbidities are associated with a high incidence of postoperative pulmonary complications. These data reinforce the importance of having patients undergo perioperative clinical assessment to detect early respiratory complications after MRV.FUNDAMENTO: No periodo do peri-operatorio, os cuidados tem sido cada vez mais criteriosos, entretanto, as complicacoes pulmonares apos a abordagem cirurgica ainda sao frequentes, predispondo o paciente a um maior tempo de internacao ou ao obito. OBJETIVO: Descrever a incidencia de complicacoes pulmonares e identificar a sua associacao com tempos de circulacao extracorporea (CEC); cirurgia e isquemia; numero de enxertos; localizacao e tempo de drenos apos cirurgia de revascularizacao do miocardio (CRM). METODOS: Nesta coorte contemporânea, foram estudados 202 pacientes em hospital universitario de referencia para cardiologia no sul do Brasil, submetidos a CRM eletiva com ponte safena e arteria mamaria interna com CEC, no periodo de abril/2006 a novembro/2007. Os desfechos considerados foram: tempo de ventilacao mecânica; surgimento de pneumonia; atelectasia; derrame pleural; hora da retirada e localizacao dos drenos; e tempo de internacao. RESULTADOS: Observou-se algum tipo de complicacao pulmonar em 90 dos 202 pacientes. A frequencia de derrame pleural foi de 84% e a de atelectasia foi de 65%. Apresentaram associacao com complicacoes pulmonares os tempos de CEC (p = 0,003), cirurgico (p = 0,040) e isquemia (p = 0,001); o tempo de permanencia de drenos (p = 0,050) e a localizacao pleural dos drenos (p = 0,033), alem de idade (p = 0,001), fracao de ejecao (p = 0,010), diagnostico de asma (p = 0,047) e exame radiologico de torax pre-operatorio anormal (p = 0,029). CONCLUSAO: Variaveis relacionadas a complexidade do ato cirurgico e comorbidades pre-existentes estao associadas a uma alta incidencia de complicacoes pulmonares no pos-operatorio. Esses dados reforcam a importância da avaliacao clinica peri-operatoria para deteccao precoce de complicacao respiratoria apos CRM.

Functional capacity, pulmonary and respiratory muscle strength in individuals undergoing hemodialysis

INTRODUCTION: Relation between low back pain, pain in lower extremity and functional dependence in aged is proven for the behavior of pain during the execution of activities of daily life. To remain in foot, to pull or to push great objects and to walk can unchain pain and cause great suffering for the aged ones. OBJECTIVE: Ahead of this, the present study had as objective to identify causes in literature relative to chronic lumbar pain and pain in lower extremity in aged. METHOD: Search in the databases Medline and Pubmed of literature in English published between 1992 and 2008 was fullfilled. RESULTS: Of 48 found articles, 33 had been analyzed. Not-mechanical causes of pain had been mentioned as vertebral compression fractures related to osteoporosis, lumbar spinal stenosis, metastatic cancer, malignancy, cauda equina syndrome, bacteremia, genitourinary infections, tuberculosis, polymyalgia rheumatica, aortic aneurysm, Paget disease and Parkinson disease. Between the mechanical causes, prevalent in aged and related to the musculoskeletal system, had been found doubts about relation of cause and effect established between osteoartritis and pain. In women, relation between menopause, estrogen use and occurrence of osteoporosis-fracture-pain still seems little clarified. Association between lumbar pain and pain in lower extremity can suggest mechanical causes or other causes, because circulatory disease and osteoartritis, common in aged, not even are pain sources. CONCLUSION: For the analysis of literature we concluded that beyond the mentioned etiology, other possibilities of causes, not yet completely identified and understood, can be in the origin of lumbar pain and pain in lower extremity of aged.

Physical exercise in patients with diabetic neuropathy: systematic review and meta-analysis of randomized clinical trials

BACKGROUND despite the increasingly careful attempts to reduce perioperative risks, pulmonary complications following surgery are still very common, leading to longer length of hospital stays or death. OBJECTIVE to describe the incidence of pulmonary complications and identify their association with duration of extracorporeal circulation (ECC), surgery and ischemia, number of bypass grafts performed, location of drains and length of drainage following myocardial revascularization (MRV). METHODS this contemporaneous cohort consisted of 202 patients undergoing elective myocardial revascularization (MRV) with saphenous vein graft and internal mammary artery graft and ECC, at a referral university cardiology hospital in Southern Brazil, from April 2006 to November 2007. The following outcomes were analyzed: duration of mechanical ventilation; pneumonia onset; atelectasis; pleural effusion; location of drains and time of removal; and length of hospital stay. RESULTS of the 202 patients, 90 developed some sort of pulmonary complication. The incidence of pleural effusion was 84%, whereas atelectasis was 65%. The following variables were associated with pulmonary complications: duration of ECC (p = 0.003), surgery (p = 0.040) and ischemia (p = 0.001); length of drainage (p = 0.050) and location of pleural drains (p = 0.033); age (p = 0.001); ejection fraction (p = 0.010); diagnosis of asthma (p = 0.047) and preoperative abnormal chest X-ray findings (p = 0.029). CONCLUSION variables related to the complexity of the surgery and preexisting comorbidities are associated with a high incidence of postoperative pulmonary complications. These data reinforce the importance of having patients undergo perioperative clinical assessment to detect early respiratory complications after MRV.FUNDAMENTO: No periodo do peri-operatorio, os cuidados tem sido cada vez mais criteriosos, entretanto, as complicacoes pulmonares apos a abordagem cirurgica ainda sao frequentes, predispondo o paciente a um maior tempo de internacao ou ao obito. OBJETIVO: Descrever a incidencia de complicacoes pulmonares e identificar a sua associacao com tempos de circulacao extracorporea (CEC); cirurgia e isquemia; numero de enxertos; localizacao e tempo de drenos apos cirurgia de revascularizacao do miocardio (CRM). METODOS: Nesta coorte contemporânea, foram estudados 202 pacientes em hospital universitario de referencia para cardiologia no sul do Brasil, submetidos a CRM eletiva com ponte safena e arteria mamaria interna com CEC, no periodo de abril/2006 a novembro/2007. Os desfechos considerados foram: tempo de ventilacao mecânica; surgimento de pneumonia; atelectasia; derrame pleural; hora da retirada e localizacao dos drenos; e tempo de internacao. RESULTADOS: Observou-se algum tipo de complicacao pulmonar em 90 dos 202 pacientes. A frequencia de derrame pleural foi de 84% e a de atelectasia foi de 65%. Apresentaram associacao com complicacoes pulmonares os tempos de CEC (p = 0,003), cirurgico (p = 0,040) e isquemia (p = 0,001); o tempo de permanencia de drenos (p = 0,050) e a localizacao pleural dos drenos (p = 0,033), alem de idade (p = 0,001), fracao de ejecao (p = 0,010), diagnostico de asma (p = 0,047) e exame radiologico de torax pre-operatorio anormal (p = 0,029). CONCLUSAO: Variaveis relacionadas a complexidade do ato cirurgico e comorbidades pre-existentes estao associadas a uma alta incidencia de complicacoes pulmonares no pos-operatorio. Esses dados reforcam a importância da avaliacao clinica peri-operatoria para deteccao precoce de complicacao respiratoria apos CRM.