Silvio Romero de Barros Marques

Envolvimento macrovascular e esclerose sistêmica

Este artigo tem como objetivo revisar os aspectos descritos na literatura sobre o acometimento da macrovasculatura na esclerose sistemica e avaliar a ocorrencia e distribuicao das alteracoes macrovasculares nos pacientes com esclerose sistemica atraves do eco-Doppler e do indice tornozelo-braco, alem da associacao desses achados com as caracteristicas demograficas, forma clinica, tempo de evolucao da doenca, fenomeno de Raynaud (FR), alteracoes digitais, ulceracoes de membros, reabsorcao de falange, amputacao, bem como fatores de risco e antecedentes da doenca ateromatosa. O estudo foi prospectivo, do tipo serie de casos, constituido de 20 pacientes, sendo 19 do sexo feminino, com idade media de 46,30 anos. Todos os pacientes tinham fenomeno de Raynaud objetivo, 85% a forma clinica difusa, 55% alteracao de polpa digital, 15% ulcera atual de membros, 25% reabsorcao de falange, nenhuma amputacao e 70% de um a quatro fatores de risco. Foram estudadas pelo eco-Doppler as arterias aorta e carotida, dos membros inferiores e superiores, para a avaliacao de espessamento do complexo intimo-medial e presenca de placas e aneurismas. Nas arterias dos membros inferiores, foi tambem realizado o indice tornozelo-braco. O indice tornozelo-braco foi normal em todos os pacientes; entretanto, 12 (60%) destes apresentaram doenca macrovascular pelo eco-Doppler, sendo nove (45%) na aorta, seis (30%) nas carotidas, uma (5%) nas arterias dos membros superiores e sete (35%) nas dos membros inferiores. Observou-se associacao entre doenca macrovascular e alteracoes de polpas digitais (p = 0,0045). A doenca macrovascular foi identificada em 60% dos pacientes atraves do eco-Doppler, mas nao pelo indice tornozelo-braco, que foi normal em todos. Verificou-se associacao significante da doenca macrovascular com as alteracoes atuais de polpas digitais, o que nao ocorreu com as demais variaveis estudadas.

Um novo substituto vascular: arterioplastia femoral em cães com remendo de membrana de biopolímero de cana-de-açúcar - avaliação hemodinâmica e histopatológica

Background: Achievement of an ideal arterial substitute to be used in the reconstruction of small- and medium-caliber arteries is still the main objective of most scientific research studies developed in the area of vascular substitutes. Sugarcane biopolymer membrane could be extremely useful to perform vascular reconstruction in arteries with diameter smaller than 4 mm, allowing treatment of diseases that affect millions of people in Brazil and worldwide.BACKGROUND: Achievement of an ideal arterial substitute to be used in the reconstruction of small- and medium-caliber arteries is still the main objective of most scientific research studies developed in the area of vascular substitutes. Sugarcane biopolymer membrane could be extremely useful to perform vascular reconstruction in arteries with diameter smaller than 4 mm, allowing treatment of diseases that affect millions of people in Brazil and worldwide. OBJECTIVE: To evaluate the hemodynamic and histopathologic behavior of sugarcane biopolymer membrane when used as a patch in femoral artery angioplasty in dogs. METHOD: Eight adult mongrel dogs, under general anesthesia, underwent percutaneous Doppler velocimetry of the left and right femoral arteries for preoperative control at the Health Sciences Center Experimental Research Laboratory of Universidade Federal de Pernambuco. After being disinfected, the dogs underwent femoral artery patch angioplasty using a sugarcane membrane biopolymer patch on the left side and an expanded PTFE (e-PTFE) patch on the right side. The dogs underwent daily clinical evaluation for the first week and weekly thereafter. Clinical evaluation consisted of an examination of femoral artery pulses, gait assessment and verification as to whether there was any pulsatile tumor, bruising, hemorrhage or surgical wound infection. One hundred and eighty days after the angioplasties, percutaneous Doppler velocimetry of the femoral arteries was performed under general anesthesia. Next, the dogs underwent dissection of the femoral arteries, measurement of the arterial diameter and perioperative Doppler velocimetry proximally and distally to the artery angioplasty. Laparotomy was then performed to expose the abdominal aorta for angiographic access. The femoral artery segments with patches were harvested for histopathologic analysis, and the animals were sacrificed under a toxic dosage of anesthetic. RESULTS: At 180 days, no cases of surgical wound infection, aneurysm, rupture, pseudoaneurysm or thrombosis were observed in either group. A chronic inflammatory reaction with lymphocytes and neutrophils was seen in both groups on the outer surface of patches. Fibrosis was seen on the inner and outer surfaces of the patches. Invasion by fibroblasts of all e-PTFE patches occurred in the control group. CONCLUSIONS: Based on the results obtained with the experimental model employed, for a 180-day period, it may be concluded that the sugarcane biopolymer membrane is an adequate arterial substitute when used as a patch in femoral artery angioplasty in dogs.

Visualização linfocintigráfica da desembocadura do ducto torácico

OBJETIVO: Avaliar a sensibilidade da linfocintigrafia intersticial na visualizacao da desembocadura do ducto toracico. METODO: Foram analisados 535 exames linfocintigraficos realizados no Servico de Medicina Nuclear do Hospital das Clinicas, Universidade Federal de Pernambuco (UFPE), no periodo de 1993 a 1999. Todas as linfocintigrafias foram realizadas atraves da injecao subcutânea, no primeiro espaco interdigital de cada pe, de 1 ml da solucao de Dextran 500 marcado com Tecnecio-99 metaestavel. RESULTADOS: A desembocadura do ducto toracico foi visualizada em 424 pacientes, que representam 79,3% das linfocintigrafias realizadas. Na avaliacao por sexo, a desembocadura do ducto toracico foi visualizada em 191 pacientes do sexo feminino, representando 77% dos casos. Nos pacientes do sexo masculino, a desembocadura foi visualizada em 233 casos (80,9%). CONCLUSAO: O presente estudo confirma a importância da linfocintigrafia como metodo de escolha na avaliacao da circulacao linfatica e demonstra que esse exame apresenta uma alta sensibilidade para a visualizacao da desembocadura do ducto toracico.

Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema

OBJECTIVE The contralateral limbs of patients with unilateral lymphedema in the lower limbs (LLs) can exhibit abnormal lymphatic circulation, even in the absence of lymphedema. This idea is based on a number of reports that have studied isolated cases using lymphoscintigraphy. It is likely that these patients previously had some form of lymphopathy, and the lymphedema arose after the action of some external factor. However, there are no studies in the literature that adequately assess the asymptomatic contralateral limbs of these patients or address the prevalence and characteristics of the abnormal lymphatic circulation in these limbs. The aim of this study was to assess the prevalence of abnormal lymphatic circulation in the asymptomatic contralateral limbs of patients with unilateral lymphedema of the LL. METHODS Forty-three patients from the angiology and vascular surgery ward of the Hospital das Clínicas da Universidade Federal de Pernambuco with unilateral lymphedema of the LL underwent lymphoscintigraphy. All patients received a subcutaneous injection of 0.2 mL (74 MBq) of a solution of dextran 70 labeled with technetium Tc 99m in the first interdigital space of each foot. Images were obtained on two occasions: 10 minutes and 1 hour after the injection. The study design was transversal prospective. RESULTS Among the 43 asymptomatic LLs, 30 (70%) showed abnormal lymphatic circulation. The lymphoscintigraphic abnormalities found were the following: reduced visualization of the lymphatic vessels and lymph nodes during 1 hour (83%), collateral circulation (30%), visualization of the inguinal and pelvic lymph nodes after at least 1 hour (30%), visualization of the popliteal lymph nodes (20%), dilation and lymphatic tortuosity (20%), and dermal backflow (10%). CONCLUSIONS In this study,70% of the patients with unilateral lymphedema of the LL had some form of lymphopathy in the contralateral limb during the lymphoscintigraphic examination. These findings could favor the early treatment of these patients to prevent the disease from progressing to its most severe stage.

Aneurisma verdadeiro bilateral de artéria tibial posterior

This article reports a case of true bilateral aneurysm of the tibial posterior artery in a 57 year-old patient. The aneurysms occurred at different times. The clinical, diagnostic and therapeutic aspects of this case are discussed. This report is important because the authors did not find a similar description in the literature.

Estudo experimental de reconstrução da veia femoral com enxerto tubular do bipolímero de cana-de-açúcar.

OBJECTIVE to evaluate, through Doppler flowmetry, venography, histology and clinical evolution, the use of sugarcane biopolymer (BP) tubular grafts in the reconstruction of femoral veins in dogs. METHODS we submitted eight adult dogs to femoral vein reconstruction, on the left with BP tubular graft and on the right with autologous vein. In the postoperative period, the animals underwent clinical evaluation and femoral vein Doppler flowmetry. After 360 days, we reoperated the dogs and submitted them to femoral vein phlebography with iodinated contrast. We removed the segments of the femoral veins containing the grafts and sent them for histopathological evaluation. RESULTS the dogs did not present hemorrhage, hematoma, surgical wound infection or operated limb edema. One animal had superficial venous dilatation in the left inguinal region. Phlebography performed 360 days after the first surgery showed that three (37.5%) BP grafts and seven (87.5%) grafts from the control group (C) were patent. In the histopathological evaluation, we found an inflammatory reaction, with neutrophils and lymphocytes on the external surface of both groups. In the intimal layer of the grafts and in the outer layer in the two groups, we observed fibrosis. CONCLUSION based on the results obtained with the experimental model used, BP presents potential to be used as a tubular graft for venous revascularization. However, new research must be performed to confirm its efficacy in the revascularization of medium and large diameter veins, which could allow its use in clinical practice.

Inversão circulatória vértebro-subclávia - "steal syndrome" - secundária a trauma torácico fechado

The authors report a case of thrombosis of the right subclavian artery in its pre-vertebral segment causing subclavian steal syndrome as a result of a blunt thoracic trauma in a 43-year-old woman. Aspects of the diagnosis and surgical treatment of this rare injury are reported and discussed.