Túlio Pinho Navarro

Correlação entre classificação clínica ceap e qualidade de vida na doença venosa crônica

OBJECTIVES To evaluate the quality of life (QOL) of patients with chronic venous disease (CVD) and to analyze the relationship between QOL and disease severity. METHODS This was a cross-sectional study with a convenience sample of 50 participants with a diagnosis of CVD. The participants were classified according to disease severity using the CEAP clinical classification (Clinical manifestations, Etiological factors, Anatomical distribution of disease, Pathophysiological findings). They were then divided into two groups: CEAP 1, 2 and 3 (less clinically compromised) and CEAP 4, 5 and 6 (more clinically compromised). QOL was evaluated using the SF-36 questionnaire. The Mann-Whitney U test was used to compare the SF-36 scores between the groups. The Spearman correlation was used to evaluate the association between QOL and the CEAP. Differences were considered statistically significant with p < 0.05. The SPSS statistical software version 16.0 was used for the analyses. RESULTS Seventy-four percent of the sample was female. The mean age was significantly higher (p<0.001) among participants classified as CEAP 4, 5 and 6 (56.6+/-10.3) than among those classified as CEAP 1, 2 and 3 (40.6+/-10.7). All the domains of the physical component of the SF-36 presented significantly lower scores in the CEAP 4, 5 and 6 group (p<0.05), thus showing greater physical and functional impairment. Only the domains of the physical component presented statistically significant negative correlations with the CEAP. CONCLUSIONS The physical and functional characteristics were more impaired, especially in the more severe forms of CVD. These findings may contribute to a better understanding of the effects of CVD on QOL and better management of therapeutic interventions in this population.

Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting.

To determine the frequency of carotid plaque and intima-media thickness (IMT) in patients with systemic lupus erythematosus (SLE) and their association with risk factors in a Brazilian university setting. Carotid plaque and IMT were identified and measured by ultrasonography. Traditional risk factors and lupus-related factors were analysed. One hundred and seventy-two patients (women = 96%, age = 38 ± 11 years) were evaluated. The frequency of carotid plaque was 9.3%. The median (IR) IMT was 0.60 mm (0.54—0.71 mm). Age, family history (FH) of premature coronary disease, low-density cholesterol (LDL-c) >100 mg/dL, hypertriglyceridemia, diabetes, hypertension, smoking, postmenopause, number of risk factors, Framingham risk score, age at diagnosis, duration of lupus, mucocutaneous manifestations and duration of prednisone use were associated with plaque (P < 0.05), univariate analysis. Nephritis, immunosuppressive therapy, intravenous methylprednisolone and a higher average daily dose of prednisone were associated with the absence of plaque. Independent predictors of plaque were smoking (P = 0.004), LDL-c >100 mg/dL (P = 0.044), Framingham score (P = 0.006) and absence of immunosuppressive therapy (P = 0.032). There was an independent correlation between IMT and age (P < 0.001) and duration of prednisone use (P = 0.020). Subclinical atherosclerosis was associated with traditional risk and SLE-related factors, especially the absence of immunosuppressive therapy. The present study suggests that the levels of LDL-c should be kept under 100mg/dL in lupus. Lupus (2008) 17, 105—113.

Adaptação transcultural do questionário VEINES/QOL-SYM: avaliação da qualidade de vida e sintomas na doença venosa crônica

OBJECTIVE: To adapt cross-culturally and to analyze the clinimetric properties of the VEINES-QOL⁄Sym, which is a specific questionnaire to evaluate the quality of life and symptoms in patients with chronic venous disease. METHODS: The VEINES-QOL⁄Sym was adapted according to the recommended methodology and administered to 74 subjects (53,7±12,3 years-old) with chronic venous disease, who were assisted at the outpatient clinic. RESULTS: The results showed a good internal consistency for VEINES-QOL (Cronbachs alpha (α) = 0,88) and VEINES/Sym (α=0,84). The inter and intra-rater reliability evaluated by the Intraclass Correlation Coefficient ranged from 0,95-0,98 for VEINES-QOL and 0,76-0,79 for the VEINES/Sym. The intraclass correlation coefficient was calculated for each item and some of them showed values lower than the expected, deserving a revision. The correlations with SF-36 were significant (p<0.001); however, of moderate magnitude. Only the VEINES-QOL was capable to distinguish the subjects in two groups, according to the severity of chronic venous disease (p=0.02). CONCLUSION: The VEINES-QOL/Sym, Brazil-Portuguese version has presented good clinimetric properties and has shown to be applicable to the population

Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study

OBJECTIVE This study was designed to evaluate analgesia (pain intensity and analgesic consumption) and the time of discharge of patients who underwent ilioinguinal (II) and iliohypogastric (IH) nerve block associated with wound infiltration with 0.75% ropivacaine, or not, after inguinal hernia repair surgery under spinal anesthesia. METHODS This was a prospective, randomized, double-blind study with 34 patients undergoing inguinal hernia repair. Patients were divided into two groups: control (C) and II and IH nerve block (B). Group C (n = 17) received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine and Group B (n = 17) received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine associated with II and IH nerve block (10 mL of 0.75% ropivacaine) and surgical wound infiltration (10 mL of 0.75% ropivacaine). The following data were analyzed: demographic data, pain intensity according to the visual analog scale (VAS), and number of doses of analgesics (dipyrone, ketorolac and nalbuphine) in the immediate postoperative period, as well as at the time of hospital discharge. RESULTS The VAS at rest was significantly lower in Group B compared with Group C (p < 0.05), three hours after the procedure, with no differences on VAS during movement in all postoperative periods. The number of doses of analgesics during the postoperative period was similar in both groups, but patients in Group B were discharged earlier than in Group C. CONCLUSION II and IH nerve block associated with surgical wound infiltration with 0.75% ropivacaine provides better postoperative analgesia and early hospital discharge in patients undergoing inguinal hernia repair under spinal anesthesia.

Carotid intimal-medial thickening and endothelial function in coronary artery disease

OBJECTIVE To investigate the correlation between the endothelial function and the carotid intimal-medial thickening (IMT) in a population of patients with coronary artery disease, as well as that between the endothelial function and carotid IMT with the severity of the coronary lesions. METHODS Forty-three patients aged 60.5+/-9.2 years, (67.4% males) with coronary artery disease at the coronariography were studied. Endothelial function was assessed using the brachial artery reactivity test (BART), which measured the percentage of flow-mediated dilatation (%FMD). The carotid IMT was evaluated through vascular ultrasound. RESULTS The mean %FDM was 4.7 +/- 3.6 and the mean carotid IMT was 1.08 +/- 0.23 mm. The carotid MIT and %FMD measurements showed a statistically significant correlation, with Spearmans coefficient of 0.315, p= 0.042, demonstrating that lower %FMD values corresponded to an increased carotid IMT (r = -0.315, p = 0.042). There was no correlation between %FMD or IMT and the severity of coronary lesions. CONCLUSIONS The presence of a correlation between carotid IMT and %FMD demonstrates a concomitance of anatomical and functional vascular alterations in coronary artery disease, regardless of the severity of the atherosclerotic lesions.

Relação entre força muscular e capacidade funcional em pacientes com doença arterial obstrutiva periférica: um estudo piloto

CONTEXTO: As informacoes sobre o grau de correlacao entre forca muscular e capacidade funcional em pacientes com doenca arterial obstrutiva periferica (DAOP) sao inconsistentes, alem de nem sempre apresentarem protocolos que relacionem apropriadamente medidas de forca muscular com desempenho. OBJETIVO: Estabelecer o nivel de correlacao entre forca muscular e capacidade funcional em pacientes fisicamente ativos com DAOP. METODOS: Doze pacientes com diagnostico da doenca e presenca de claudicacao intermitente participaram do estudo. Todos realizaram testes de forca muscular e de caminhada. Grau de correlacao entre forca muscular e capacidade funcional foi avaliado pela correlacao de Pearson. RESULTADOS: Dos 12 voluntarios incluidos, 10 eram do sexo masculino e 2 do sexo feminino. Os participantes tinham media de idade de 63 ± 11 anos. Houve alta correlacao (r = 0,872; p = 0,0001) entre distância percorrida no teste de deslocamento bidirecional progressivo (TDBP) e carga alcancada no teste de resistencia maxima. Nao se observou correlacao entre distância percorrida no TDBP e tempo gasto para realizacao das cinco flexoes plantares no teste de ponta de pe. CONCLUSAO: O desempenho funcional em um grupo de pacientes com DAOP, em sua maioria fisicamente ativos, foi fortemente correlacionado com forca muscular de extensores de joelho, mas nao com desempenho observado funcionalmente pelo teste de ponta de pe. Futuros estudos sao necessarios para avaliar se forca muscular de flexores plantares, mensurada de forma especifica e isolada, correlaciona-se com funcao em pacientes com a doenca.

Avaliação da dor pós-operatória e alta hospitalar com bloqueio dos nervos ilioinguinal e ílio-hipogástrico durante herniorrafia inguinal realizada com raquianestesia: estudo prospectivo

OBJECTIVE: This study was designed to evaluate analgesia (pain intensity and analgesic consumption) and the time of discharge of patients who underwent ilioinguinal (II) and iliohypogastric (IH) nerve block associated with wound infiltration with 0.75% ropivacaine, or not, after inguinal hernia repair surgery under spinal anesthesia. METHODS: This was a prospective, randomized, double-blind study with 34 patients undergoing inguinal hernia repair. Patients were divided into two groups: control (C) and II and IH nerve block (B). Group C (n = 17) received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine and Group B (n = 17) received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine associated with II and IH nerve block (10 mL of 0.75% ropivacaine) and surgical wound infiltration (10 mL of 0.75% ropivacaine). The following data were analyzed: demographic data, pain intensity according to the visual analog scale (VAS), and number of doses of analgesics (dipyrone, ketorolac and nalbuphine) in the immediate postoperative period, as well as at the time of hospital discharge. RESULTS: The VAS at rest was significantly lower in Group B compared with Group C (p < 0.05), three hours after the procedure, with no differences on VAS during movement in all postoperative periods. The number of doses of analgesics during the postoperative period was similar in both groups, but patients in Group B were discharged earlier than in Group C. CONCLUSION: II and IH nerve block associated with surgical wound infiltration with 0.75% ropivacaine provides better postoperative analgesia and early hospital discharge in patients undergoing inguinal hernia repair under spinal anesthesia.

Embolia balística venosa retrógrada transtorácica: relato de caso e revisão da literatura

Bullet embolism is a rare event when providing care to traumatized patients. These cases usually present with few symptoms or are asymptomatic, and treatment is controversial, in spite of the evolution observed. The endovascular approach has stood out as a treatment modality for this type of embolism with low morbidity and mortality rates. This article reports the case of a 30-year-old male patient victim of gunshot thorax injury with multiple entrance signs who was successfully submitted to bullet removal by endovascular technique after failed attempt by thoracotomy.

Treatment of Hostile Proximal Necks During Endovascular Aneurysm Repair.

Endovascular aneurysm repair (EVAR) is a therapy that continues to evolve rapidly as advances in technology are incorporated into new generations of devices and surgical practice. Although EVAR has emerged as a safe and effective treatment for patients with favorable anatomy, treatment of patients with unfavorable anatomy remains controversial and is still an off-label indication for endovascular treatment with some current stent-grafts. The proximal neck of the aneurysm remains the most hostile anatomic barrier to successful endovascular repair with long-term durability. Open surgery for unfavorable necks is still considered the gold standard treatment in contemporary practice, despite the increased mortality and morbidity attributed to suprarenal cross-clamping, particularly in high-risk patients. Evolving technology may overcome the obstacles preventing endovascular treatment of unfavorable proximal neck anatomy; current approaches include purely endovascular as well as hybrid approaches, and generally include strategies that either extend the length of the short neck, move the proximal neck more proximally, or keep the short neck intact. These approaches include the use of debranching techniques, banding, chimneys, fenestrated and branched devices, filling the sac with endobags, endoanchors, and other novel devices. These newer-generation devices appear to have promising short- and midterm results. However, lack of good evidence of efficacy with long-term results for these newer approaches still precludes wide dissemination of endovascular solutions for the hostile proximal neck.

Chronic Venous Disease and Varicose Veins

The lower limb venous system is responsible for the return of the blood from the leg toward the heart. Chronic venous disease occurs by a deficiency in the blood return due to structural or functional abnormalities of the veins of the lower limbs. Insufficient venous return leads to the accumulation of blood in the lower limbs and to varying degrees of venous hypertension, presenting a wide spectrum of clinical manifestations, ranging from simple telangiectasies and varicose veins to advanced forms. Chronic venous disease has a large prevalence in the world population and has significant impact on health services for high demand due to disease symptoms, activity limitation and aesthetic concern. Common symptoms are pain, cramps, heaviness, edema, and lower limb ulcer. The presence of tortuous and dilated veins must be noted, as well as telangiectasies, angiomatous formation, edema, and trophic skin alterations. CEAP classification has been proposed in order to standardize the scientific publications about varicose veins and therapeutic indications. Chronic venous disease treatment involves no interventionist actions to control symptoms and improve the quality of life with physical activity, compression therapy, phlebotropic agents, and interventional treatment such as sclerotherapy, transdermal laser, or surgery. Today, we have the minimally invasive methods as an alternative of surgery: endovenous ablation with laser or radiofrequency and foam sclerotherapy.