Nilon Erling

Microcirculatory effects of local and remote ischemic preconditioning in supraceliac aortic clamping.

INTRODUCTION Supraceliac aortic clamping in major vascular procedures promotes splanchnic ischemia and reperfusion (I/R) injury that may induce endothelial dysfunction, widespread inflammation, multiorgan dysfunction, and death. We tested the hypothesis that local or remote ischemic preconditioning (IPC) may be protective against injury after supraceliac aortic clamping through the modulation of mesenteric leukocyte-endothelial interactions, as evaluated with intravital microscopy and expression of adhesion molecules. METHODS Fifty-six male Wistar rats (weight, 190 to 250 g), were divided into four groups of 14 rats each: control-sham surgery without aortic occlusion; I/R through supraceliac aortic occlusion for 20 minutes, followed by 120 minutes of reperfusion; local IPC through supraceliac aortic occlusion for two cycles of 5 minutes of ischemia and 5 minutes of reperfusion, followed by the same protocol of the IR group; remote IPC through infrarenal aortic occlusion for two cycles of 10 minutes of ischemia and 10 minutes of reperfusion, followed by the same protocol of the IR group. Seven animals per group were used to evaluate in vivo leukocyte-endothelial interactions in postcapillary venules with intravital microscopy and another seven animals per group were used to collect mesentery samples for immunohistochemistry demonstration of adhesion molecules expression. RESULTS Supraceliac aortic occlusion increased the number of rolling leukocytes with slower velocities and increased the number of adherent leukocytes to the venular surface and leukocyte migration to the interstitium. The expression of P-selectin, E-selectin, and intercellular adhesion molecule-1 was also increased significantly after I/R. Local or remote IPC reduced the leukocyte recruitment in vivo and normalized the expression of adhesion molecules. CONCLUSIONS Local or remote IPC reduces endothelial dysfunction on mesenteric microcirculation caused by I/R injury after supraceliac aortic clamping.

Tratamento cirúrgico dos aneurismas da aorta abdominal: existe diferença dos resultados entre homens e mulheres?

OBJECTIVE: To evaluate perioperative results in patients submitted to elective conventional open repair of abdominal aortic aneurysm, comparing the results between women and men in relation to perioperative mortality and morbidity, as well as long term outcomes. PATIENTES AND METHODS: Between December 1983 and December 2003, 675 patients were submitted to infrarenal abdominal aortic aneurysm repair. We divided these patients into two groups: men (n = 575) and women (n = 100). Demographic and operative data, as well as perioperative outcomes were obtained from chart review. Discharged patients formed a retrospective cohort, in which the late causes of death and survival were evaluated. RESULTS: The mean age was similar, but no statistical difference was observed between men and women (68.9 ± 9.1 versus. 67.4 ± 7.1 years; P = 0.089). The presence of hypertension was significantly higher in women (73 versus 62.4%; P = 0.042), and coronary artery disease and history of smoking were more prevalent in men (P <0.05). The overall mortality rate was 2.8%, without any significant difference between women and men (4 versus 2.6%, respectively; P = 0.43). Perioperative morbidity was similar in both groups (14% for women; 18.4% for men; P 0.05). The survival rates in 1, 3, 5, and 10 years were similar in the groups, with a 5-year survival of 71% for women and 72% for men (P 0.05). Cardiovascular disease was the main late death cause in both groups, followed by renal complications in women and neoplasia in men. CONCLUSION: Perioperative mortality and morbidity rates did not significantly increase in women after conventional infrarenal abdominal aortic aneurysm repair. Furthermore, long term results were similar in both genders.

Tratamento endovascular da síndrome da veia cava superior: relato de caso e revisão da literatura

We report a case of a patient with symptomatic benign superior vena cava syndrome treated by the endovascular technique. The angiographic resonance before angioplasty showed extensive thrombosis of the left brachiocephalic trunk, left subclavian vein and superior vena cava obstruction close to the right brachiocephalic trunk. The patient underwent radical mastectomy 2 years ago with adjuvant chemotherapy and chest radiotherapy. Venous angioplasty and balloon-expandable stenting were performed. Satisfactory result was obtained with immediate relief of symptoms due to recanalization of the right brachiocephalic trunk and superior vena cava. Oral anticoagulation was initiated. The patient is still asymptomatic after 8 months of follow-up. The endovascular treatment is a therapeutic alternative with low morbidity and satisfactory mid-term results that can be offered to patients with superior vena cava syndrome.

Seat Belt Syndrome and Aortoiliac Lesion: Case Report and Review of the Literature.

Blunt vascular trauma represents 7–9% of the vascular lesions in civilians. There are few reports associating blunt trauma with aortoiliac lesion to the trauma associated with the use of seat belts. We report a case of aortic bifurcation disruption and bilateral iliac artery thrombosis directly related to seat belt use and not associated with pelvic fractures. Arterial revascularization was accomplished through an aortoiliac bypass with spiraled saphenous vein interposition graft and perfusion was restored to both limbs. However, the patient died 5 days after due to respiratory distress syndrome. A high index of suspicion and early diagnosis are essential for patient survival and limb salvage.

Derivação carótido-carotídea por via retrofaríngea: seguimento tardio

Existem diversas opcoes para o tratamento da doenca oclusiva dos troncos supra-aorticos, de acordo com a apresentacao clinica e a localizacao das lesoes arteriais. As abordagens cervicais sao aceitas como alternativas de baixa morbimortalidade, com elevada perviedade em longo prazo. Os autores relatam um caso tratado com sucesso atraves de derivacao carotido-carotidea cruzada por via retrofaringea associada a endarterectomia da bifurcacao carotidea. Sao discutidos tambem os aspectos clinicos e as opcoes cirurgicas ou endovasculares para o melhor tratamento desses pacientes.

Hipertensão arterial sistêmica severa em paciente jovem

1. Professor adjunto, Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre (FFFCMPA). Chefe do Servico de Cirurgia Vascular, Santa Casa de Misericordia de Porto Alegre, RS. 2. Residente de Cirurgia Vascular, FFFCMPA, Porto Alegre, RS. 3. Mestrando da FFFCMPA. Cirurgiao vascular, Santa Casa de Misericordia de Porto Alegre, RS. 4. Mestre. Cirurgia vascular, Santa Casa de Misericordia de P. Alegre, RS. 5. Cirurgia vascular, Hospital de Caridade de Ijui, RS.