Guilherme Benjamin Brandão Pitta

A diferença na qualidade de vida de pacientes com doença venosa crônica leve e grave

BACKGROUND: Chronic venous disease afflicts individuals in their most productive years, resulting in pain and loss of mobility and independence in performing routine daily activities, which may directly interfere with the patients quality of life. Clinical symptoms result from venous hypertension caused by reflux and/or venous blockage. OBJECTIVE: To determine differences in the quality of life of patients with mild and severe chronic venous disease. METHODS: A cross-sectional comparative study was conducted in a health care facility during an 8-month period. The sample was composed of 88 patients divided into two groups: group A (clinical CEAP class 1, 2 and 3) and group B (clinical CEAP class 4, 5 and 6). The Medical Outcomes Study - 36-Item Short-Form Health Survey (SF-36) questionnaire was used. Statistical analysis was conducted using the Student t test, with a 95% confidence interval and a level of significance set at p < 0.05. RESULTS: We analyzed 88 subjects, 47 in group A and 41 in group B. Of the total, 87.5% (77) were women and 34% (30) were aged 30 to 40 years. Subcutaneous changes (CEAP class 4) were the most common symptoms, observed in 28.4% of the individuals. Except for the general health perceptions domain, group B showed lower scores than group A in all other domains. CONCLUSIONS: The quality of life of patients with mild and severe chronic venous disease proved to be different according to disease severity.

Fatores predisponentes para amputação de membro inferior em pacientes diabéticos internados com pés ulcerados no estado de Sergipe

OBJETIVO: Determinar os fatores predisponentes para a amputacao de membros inferiores nos doentes internados com diabetes melito e ulceras nos pes. METODOS: Foram acompanhados os pacientes diabeticos com ulceras nos pes internados no periodo de 6 meses e analisadas as amputacoes nesses doentes em relacao a idade, sexo, amputacao previa, numero de ulceracoes, tempo de diagnostico do diabete, tempo de ulceracao, tempo medio de internacao, gravidade das lesoes, presenca de pulso. RESULTADOS: Verificou-se que 55% (44/80) dos doentes evoluiram para algum tipo de amputacao de membros inferiores; a mediana das idades foi de 61 anos, porem a ocorrencia de amputacao foi significativamente maior na faixa etaria dos 60 aos 90 anos (P = 0,03). Nao se observou uma variacao significativa da mediana do tempo de diagnostico do diabetes, do tempo de ulceracao e do tempo medio de internacao em relacao ao grupo de pacientes que foram amputados. Entretanto, as lesoes mais graves, quando avaliadas pela classificacao de Wagner (P <0,001) e pela ausencia de deteccao dos dois pulsos distais (P <0,001) dos membros inferiores, revelaram-se bastante significativas com relacao ao desfecho de amputacao. CONCLUSAO: Foram considerados fatores predisponentes para a ocorrencia de amputacao nesses doentes a gravidade das lesoes, a ausencia de pulsos e as idades acima de 60 anos.

Histological and biochemical serum effects of alpha-tocopherol on ischemia/reperfusion-related injuries induced in the pelvic limb of rats.

PURPOSE To evaluate the protective action of alpha-tocopherol in ischemia/reperfusion injuries of pelvic member of rats. METHODS Thirty adult male rats of the Wistar strain were randomized into three experimental groups of 10: Group I--control group with no ischemia or reperfusion. Groups II and III--four hours of ischemia and of hours of reperfusion by means of clamping of the infrarenal aorta. The animals of Group II were treated with saline and those of Group III were treated with i.v. alpha-tocopherol (50 mg/kg). Parameters studied were biopsies of the soleus muscle, dosing of creatine phosphokinase, lactate dehydrogenase, potassium, calcium and arterial blood gasometry. RESULTS The results of biopsies of the soleus muscles studied by optical microscopy, were not significant in terms of presence of edema among the three groups studied. Variables inflammation and necrosis were not observed, therefore cannot be statistically analyzed. As to dosing of calcium and lactate dehydrogenase, the pH, pO2 and pCO2 values were not significant for all groups studied. We observed that the levels of potassium (Group II > Group I, Fcalculated = 5.84; Fcritical = 3.33), creatine phosphokinase (Group II > Groups I and III, Hcalculated = 13.92; Hcritical = 5.99) and bicarbonate (Groups I and III > Group II, Hcalculated = 11.98; Hcritical = 5.99) presented significant results among groups. CONCLUSION From the serum biochemical perspective, the treatment with alpha-tocopherol has attenuated the metabolic injuries in the ischemia/reperfusion syndrome in this experimental model.

Comparação dos fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família

CONTEXTO: Dentre as maiores causas de internamento hospitalar em pacientes com diabetes melito tipos 1 e 2 estao as complicacoes do pe diabetico, principalmente pelas sequelas, muitas vezes incapacitantes, destacando-se as amputacoes de membros inferiores. A insuficiencia vascular periferica ocorre mais precocemente nesses pacientes. A coexistencia de neuropatia, isquemia e imunodeficiencia favorece o desenvolvimento de infeccoes nos membros inferiores, que, se nao tratadas adequadamente, podem levar a amputacoes e ate a morte. OBJETIVOS: Comparar os fatores de risco para amputacoes maiores e menores em pacientes diabeticos de um Programa de Saude da Familia do CAIC Virgem dos Pobres III, em Maceio, AL. METODOS: Foram examinados 93 pacientes com o diagnostico de diabetes melito, sendo avaliada a realizacao ou nao de amputacoes de membros inferiores. As variaveis analisadas foram: sexo, idade, tipo do diabetes, pressao arterial, amputacao previa (se maior ou menor), alteracoes dermatologicas, alteracoes de pulsos arteriais pedioso e tibial posterior, deformidades e neuropatia, e foram classificadas de acordo com a classificacao de Wagner e de Texas. RESULTADOS: Todos os pacientes eram diabeticos tipo 2. Verificou-se que 4,30% dos pacientes evoluiram para amputacao de membros inferiores. Nao se observou variacao significativa da hipertensao, deformidades e neuropatia em relacao ao grupo de pacientes que foram amputados. Entretanto, a ausencia de deteccao dos pulsos distais dos membros inferiores revelou-se bastante significativa com relacao ao desfecho de amputacao. CONCLUSAO: Deve-se proporcionar aos diabeticos um atendimento ambulatorial adequado para que seja possivel prevenir ou minimizar tais complicacoes.

Tradução e adaptação cultural do Charing Cross Venous Ulcer Questionnaire - Brasil

BACKGROUND: The translation and cultural adaptation are steps that will allow an instrument created in a particular language and culture might be used in another cultural context. The Charing Cross Venous Ulcer Questionnaire (CCVUQ) is a quality of life questionnaire in English for patients with venous ulcers that need to be translated and culturally adapted to be used in Brazil. OBJECTIVE: To translate and culturally adapt to the Brazilian the CCVUQ. METHODS: The process consisted of two translations and two back translations performed by freelance translators, evaluation of versions, followed by the development of consensus version and pre-test commented. RESULTS: In the process of translating some words and expressions were changed in its literal aspect. Pre-test evaluation indicated changes were needed for better understanding of the respondent. The average time to respond to the questionnaire was 5 minutes and 23 seconds. CONCLUSION: The Portuguese version of the Charing Cross Venous Ulcer Questionnaire was translated and adapted for use in Brazilian population.

Válvulas da veia braquial comum: estudo anatômico

CONTEXTO: Boa parte das insuficiencias venosas e devida a incompetencia de suas valvulas. Como uma das alternativas cirurgicas, temos os enxertos venosos valvulados no segmento insuficiente. OBJETIVO: Descrever a anatomia das valvulas da veia braquial comum. METODOS: Foram selecionados 30 cadaveres do sexo masculino, independentemente de raca, que tinham seus membros superiores articulados ao tronco. Os mesmos estavam formolizados e foram mantidos em conservacao com solucao de formol a 10%. Utilizamos como criterio de exclusao a existencia de desarticulacao de um dos membros ou de alteracoes deformantes em topografia das estruturas estudadas. RESULTADOS: O numero total de valvulas identificadas foi de 28 em membro superior direito e de 33 em membro superior esquerdo, sendo 15 no segmento proximal direito e 21 no segmento proximal esquerdo. Mais de 91% das valvulas foram do tipo bicuspide e parietal. CONCLUSAO: Conclui-se que a veia braquial comum apresenta frequentemente valvulas do tipo bicuspide e parietal.

Freqüência da profilaxia mecânica para trombose venosa profunda em pacientes internados em uma unidade de emergência de Maceió

BACKGROUND: Deep venous thrombosis (DVT) is a multidisciplinary and frequent disease, also including complications such as pulmonary thromboembolism. Mechanical prophylaxis is one of the best (due to its low cost and proven effectiveness) and simplest means to reduce its incidence; therefore, investigating its use as an attempt to enhance benefits to the patient and hospital service is of great importance. OBJECTIVE: To determine the frequency of mechanical prophylaxis for DVT at the Emergency Room Dr. Armando Lages in Maceio, Brazil. METHODS: A descriptive cross-sectional study at the emergency room was carried out for an 8-month period. The sample was composed of 282 patients admitted to the nursing wards of various specialties. Data were collected from medical records and by patient interview. Each patients medical record was searched for use of mechanical prophylaxis for DVT, in addition to several factors for risk stratification, according to the Brazilian Society of Angiology and Vascular Surgery. Statistical analysis was performed using SPSS software and chi-square test, considering p < 0.05. RESULTS: A total of 282 patients were analyzed, 181 (64%) men and 101 (36%) women, mean age of 54.1 years. Classification of risk was as follows: 210 (74.5%) were classified as high risk, 56 (19.8%) as moderate risk, and 16 (5.7%) as low risk. Of all patients, 234 (83%) did not received prophylaxis and 48 (17%) did. There was no statistical difference between the data obtained in the research and those found in the literature (p = 0.065). CONCLUSIONs: Despite having its efficacy confirmed, mechanical prophylaxis for DVT has not reached satisfactory levels of use.

Avaliação da bomba muscular da panturrilha em pacientes portadores de varizes primárias dos membros inferiores através da pletismografia a ar

OBJECTIVE: This article aims at assessing the influence of calf muscle vein reflux (suraland genicular veins) on calf muscle pump function in patients with primary varicose veins of the lower limbs. METHODS: Cross-sectional and prospective study assessing 120 patients divided into two groups (60 subjects each) by physical examination, duplex scan and air plethysmography. The first group showed calf muscle venous reflux, whereas the second group presented absence of reflux. Both groups were examined by air plethysmography to verify calf pump function through measurement of ejection fraction, residual volume fraction, ejected volume and venous filling index in both limbs. RESULTS: In the group of patients with reflux, ejection fraction indexes lower than 60% (p < 0.001) were found in 82.3% (left leg) and 74.6% (right leg) of cases. Levels of residual volume fraction greater than 60% were identified in 62.5% (left leg, p= 0.015) and in 86.7% (right leg, p = 0.014) of assessed cases. There was no statistically significant variation concerning the venous filling index between groups with or without reflux, with p= 0.140 in both legs. Of all patients, 63.6% had calf vein reflux (left leg) and 61.8% (right leg) had ejection volume greater than 150 mL (p = 0.001). CONCLUSIONS: The calf pump function decreased in both lower limbs, due to presence of calf muscle vein reflux (genicular and sural veins).

Implementação financeira e o impacto do mutirão de cirurgias de varizes, após a criação do Fundo de Ações Estratégias e Compensação (FAEC)

BACKGROUND: In spite of the fact that the number of surgeries presented by the elective surgery task force did not entirely reflect the reality, it is possible to declare that the financial implementation of the Brazilian Ministry of Health has been significative, as well as the increasing number of varicose vein surgeries, especially after the creation of the Strategic Actions and Compensation Fund (FAEC). OBJECTIVE: To evaluate the application of financial investment in the Ministry of Health campaign for varicose vein surgery. METHODS: A transversal study of retrospective nature has been conducted, using information available at the Data Processing Department of the National Healthcare System database (DATASUS). All the authorization of hospital internment from the inferior member varicose vein surgeries, financed by the Brazilian Ministry of Health from January 1998 to December 2004, have been included in the research. RESULTS: In 1998, before the implementation of the elective surgery task force, 23,531 varicose vein surgeries have been performed, and R

Validação no Brasil de Questionário de Qualidade de Vida na Doença Venosa Crônica (Questionário Aberdeen para Veias Varicosas no Brasil/AVVQ-Brasil)

5,819,033.27 invested. After the creation of the FAEC, 457,026 inferior member varicose vein surgeries have been performed from 1999 to 2004, and R