Maria del Carmen Janeiro Perez

Avaliação da postura e dos movimentos articulares dos membros superiores de pacientes pós-mastectomia e linfadenectomia

ABSTRACT Objective: To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment. Methods: Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests. Results: Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion. Conclusion: Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.

Gestação e varizes de membros inferiores: prevalência e fatores de risco

Background: During and after pregnancy, lower limb varicose disease presents specific features that have influenced the conduction of studies designed to provide a better understanding of the condition. Such features include the appearance of lower limb varicose veins, their early development and intensity, and their rapid regression after delivery. Objective: To assess the prevalence of lower limb varicose disease during pregnancy and to identify the main associated risk factors. Prevalence of varicose disease during pregnancy is high, affecting almost 70% of pregnant women considering all types of varicose disease. This high prevalence is mainly caused by the increase in the estrogen and progesterone levels during pregnancy. Material and method: We analyzed 352 pregnant women during prenatal follow-up. The subjects were randomly selected during a 14-month period. Varicose disease was clinically identified and classified according to Widmers criteria: trunk varicose veins, reticular varicose veins, and telangiectasias; being reclassified according to the criteria of the CEAP clinical classification. The results of prevalence and risk factors were statistically analyzed using univariate and multivariate analyses. Results: Considering all types of varicose veins, prevalence of varicose disease was 72.7% (256 pregnant women). Only 27.3% (96) of pregnant women did not have varicose disease (C0), and this group was considered the control group. After multivariate analysis, the main risk factors were: family history and pregnant womens age. Conclusion: The high prevalence of varicose disease and the associated risk factors suggest the need of providing the health professionals involved in womens health care, especially during the fertile period, with information on this disease.

Doença veno-linfática: alterações linfocintilográficas nas úlceras venosas

Contexto: O sistema linfatico tem papel relevante em qualquer tipo de edema periferico. Atualmente, a linfocintilografia e considerada o principal exame para diagnostico da doenca linfatica das extremidades. Embora haja associacao entre edema linfatico e ulcera de estase venosa cronica, a fisiopatologia dessas alteracoes permanece indefinida. Objetivo: Verificar as alteracoes linfocintilograficas qualitativas que ocorrem em pacientes portadores de ulceras de estase dos membros inferiores. Metodos: Quarenta pacientes portadores de ulcera de estase venosa cronica ou cicatriz unilateral foram submetidos a linfocintilografia de ambos os membros inferiores. Foram estudados 25 mulheres e 15 homens, com media de idade de 53,7 anos (28 a 79 anos) e tempo medio de ulcera de 71,5 meses (3 a 240 meses). Foram comparados qualitativamente os parâmetros linfocintilograficos dos membros inferiores, previamente classificados em tres grupos de acordo com a classificacao clinica, etiologica, anatomica e patologica (CEAP): I, membros sem sinais clinicos de doenca venosa ou com telangiectasias e veias reticulares (classes 0 e 1); II, membros inferiores com veias varicosas, edema e/ou alteracoes de pele e subcutâneo (classes 2, 3 e 4); III, membros inferiores com ulcera e/ou cicatriz (classes 5 e 6). Resultados: Quando foi comparada a presenca de alteracoes linfocintilograficas dos membros com ulcera ou cicatriz (grupo III - classes 5 e 6) com as dos membros sem ulcera (grupos I e II - classes 0, 1, 2, 3 e 4), houve diferenca significativa (p < 0,001). Estratificando os membros inferiores de acordo com a classificacao CEAP, tambem foi observada diferenca estatisticamente significante (p < 0,001), sendo as alteracoes linfocintilograficas presentes em 72,5% no grupo III (classes 5 e 6), 30,8% no grupo II (classes 2, 3 e 4) e 7,1% no grupo III (classes 0 e 1). Em relacao aos parâmetros analisados na linfocintilografia, ocorreu diferenca significativa entre o grupo III e os outros grupos quanto a retencao de radiofarmaco, adenomegalia inguinal e refluxo dermico. Nao houve significância nos parâmetros linfonodo popliteo e circulacao colateral. Conclusao: Considerando os resultados, conclui-se que quanto mais grave a estase venosa cronica, maiores serao as alteracoes linfocintilograficas observadas, corroborando a associacao entre doenca venosa e linfatica e entre linfedema secundario e estase venosa cronica.

Percutaneous transluminal angioplasty in the treatment of renovascular hypertension: sequential prospective study

OBJECTIVE To evaluate the use of percutaneous transluminal renal angioplasty (PTRA) in the treatment of renal vascular hypertension. DESIGN Sequential prospective PTRA treatment of severe arterial hypertension, screening by the captopril test, confirmed by renal arteriography, and the result evaluated by post-PTRA arteriography, blood pressure measurement and renal function. SITE: Vascular Surgery, angioradiology sector, and Nephrology outpatients department of the Federal University of São Paulo-Paulista School of Medicine, São Paulo, Brazil, a tertiary health-care institution. PARTICIPANTS PTRA was employed on 32 patients screened by clinical examination, captopril test and renal arteriography. EVALUATION PTRA results were evaluated by the criteria of the Cooperative Study of Renovascular Hypertension. RESULTS After PTRA the completion arteriography showed no renal stenosis in 24 patients (75%), residual stenosis (20-50%) in 3 (9.4%) and no change in 5 (15.6%). The blood pressure results were: 3 patients (9.4%) were cured, 24 (75%) improved and 5 (15.6%) were unchanged. We observed normal renal function before and after PTRA in 25 patients (78%); altered pre- and improved post-PTRA in 2 (6.3%); post-PTRA remained unaltered in 2 (6.3%); and altered pre- and worsened post-PTRA in 3 (9.4%). Recurrence of stenosis occurred in one patient after 8 months. CONCLUSIONS PTRA is a convenient procedure, relatively safe and an effective complementary method of medical therapy for controlling renovascular hypertension.