ABSTRACT
A escleroterapia com microespuma vem sendo utilizada amplamente no tratamento da doença venosa varicosa. No entanto, a despeito da sua pouca invasividade e segurança, complicações potencialmente graves e letais já foram descritas, como o acidente vascular cerebral e parada cardiorrespiratória. Descrevemos um caso de embolia atrial tardia de trombo flutuante da junção safeno-femoral de veia safena magna varicosa, após escleroterapia com microespuma de polidocanol guiada por ultrassom, e o tratamento dessa complicação.
Microfoam sclerotherapy has been widely used in the treatment of varicose vein disease. However, despite its low invasiveness and safety, potentially serious and lethal complications have been described, such as stroke and cardiorespiratory arrest. We describe a case of delayed atrial embolism of floating thrombus in the saphenofemoral junction of a great saphenous varicose vein after microfoam ultrasound-guided sclerotherapy, as well as the treatment of this complication.
Subject(s)
Humans , Male , Embolism/diagnosis , Sclerotherapy/nursing , Venous Thromboembolism , Saphenous Vein/abnormalities , UltrasonographyABSTRACT
CONTEXT: Indications and results of carotid endarterectomy have been defined from clinical multicentric trials like the European Carotid Surgery Trialists, North-American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. The patients included in these trials were highly selected, as were the surgeons performing the operations. Clinical practice is different but the same results should be achieved. OBJECTIVE: To study indications, technique, early and late results, and whether carotid endarterectomy has been performed in accordance with standards defined by multicentric trials. DESIGN: Retrospective case report study. SETTING: A tertiary care private hospital. PARTICIPANTS: 57 patients, on whom 70 carotid endarterectomies were performed over a 10-year period. The median age was 66.4 ± 7.8 years; 43 (75.4 percent) were male, 41 (71.9 percent) hypertensive, 36 (63.1 percent) current smokers and 24 (21.0 percent) had diabetes. Bilateral carotid stenosis was present in 31 (54.3 percent) patients, peripheral arterial occlusions in 32 (56.1 percent) and ischemic cardiopathy in 25 (43.1 percent). All patients had had angiography and 41 (71.9 percent) had also had a duplex-scan of neck arteries. Cerebral imaging via computerized tomography scan or magnetic resonance imaging was obtained for 36 patients. Patients were followed up over a period of one to 122 months. MAIN MEASUREMENTS: early and late post-operative death, early and late post-operative stroke, and recurrence of atheroma plaque and symptoms relative to carotid stenosis. RESULTS: There was one post-operative death (1.4 percent) caused by myocardial infarction and two early strokes (2.8 percent): a total complication rate of 4.2 percent. After 3 and 5 years, 95.4 percent and 81.3 percent of patients respectively were stroke-free and 72.8 percent and 67.3 percent were alive. There were four recurrences and two of them related to stroke. Forty-nine (70 percent) stenoses operated on were symptomatic. Brain infarction was detected in 59.2 percent of patients who underwent computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Carotid endarterectomy was done in accordance with international standards. The most frequent cause of late death was myocardial infarction, and recurrences were related to stroke. Patients should be followed up closely
Subject(s)
Humans , Male , Female , Middle Aged , Endarterectomy, Carotid , Time Factors , Aged, 80 and over , Survival Rate , Retrospective Studies , Treatment Outcome , Endarterectomy, Carotid , Stroke , Myocardial InfarctionABSTRACT
Os autores analisam um grupo de pacientes com abscesso pulmonar, tratados atraves de abordagem cirurgica no Servico de Cirurgia Toracica e Cardiovascular do Hospital das Clinicas da FMUSP. Dezessete pacientes com abscessos pulmonares submetidos a abordagem cirurgica de 1984 a 1995 foram analisados. O grupo era composto de doze pacientes do sexo masculino e cinco do sexo feminino. A idade variou de 25 a 78 anos, com media de 50,1 anos. A principal etiologia foi pos pneumonica. Os criterios para indicacao do tratamento cirurgico foram: insuficiencia do tratamento medicamentoso com piora do estado geral, hemoptise macica e persistencia de cavidade residual...