Cirurgia de varizes em regime de mutirão / A task force for varicose vein surgery / A task force for varicose vein surgery

CONTEXTO: A cirurgia de varizes de membros inferiores é um dos procedimentos mais realizados dentro do Sistema Único de Saúde, através dos Mutirões de Cirurgias Eletivas. No entanto, não há informações detalhadas sobre os resultados dessa iniciativa, especialmente com relação à população que se beneficia dos mutirões. OBJETIVO: Apresentar e discutir o perfil dos pacientes operados durante o mutirão de varizes realizado em instituição pública de saúde. MÉTODOS: Os pacientes foram selecionados a partir de um cadastro organizado pelo Ministério da Saúde para o programa de cirurgias eletivas, e não havia vínculo prévio com a instituição hospitalar. Foi aplicado um protocolo de avaliação objetiva com os dados clínicos e perfil demográfico dos pacientes. Os pacientes foram estagiados de acordo com a classificação CEAP (clínica, etiológica, anatômica e fisiopatológica). RESULTADOS: No período entre setembro de 2005 e janeiro de 2006, 100 pacientes foram submetidos a cirurgia (106 procedimentos), com predominância do sexo feminino (85 por cento dos casos). A média de idade foi 35±9,8 anos. O grau de escolaridade predominante entre os pacientes foi o ensino fundamental, em 53 por cento dos casos. As classes C2 (49,5 por cento) e C3 (39 por cento) foram as mais freqüentes na avaliação clínica dos membros inferiores (classificação CEAP). Foram realizadas 106 cirurgias (100 pacientes). A anestesia mais utilizada foi o bloqueio (93 por cento dos procedimentos). Seis pacientes foram submetidos a procedimentos escalonados pelo grande volume de varizes de membros inferiores; 33 pacientes foram submetidos à safenectomia interna, sendo quatro safenectomias segmentares; e oito pacientes foram submetidos à safenectomia total bilateral. CONCLUSÃO: O perfil da população que se beneficiou dos mutirões sugerido neste trabalho é de pacientes jovens, do sexo feminino, com baixa escolaridade, sintomáticas do ponto de vista da doença venosa de membros...

BACKGROUND: Varicose vein surgery of the lower limbs is one of the most frequent procedures carried out in the Brazilian public health system (Sistema Único de Saúde), especially during task forces focused on elective surgeries. However, detailed information on the results of such initiatives are absent in the literature, particularly with regard to the population that benefits from the task forces. OBJECTIVES: To present and discuss the profile of patients operated on during a task force for varicose vein surgery carried out in a public health institution. METHODS: The patients were selected from a database organized by the Brazilian Health Ministry for the program of elective surgeries, and they had no previous link with the hospital institution. A protocol for objective evaluation with the clinical data and demographic profile of the patients was applied. The patients were staged according to CEAP classification. RESULTS: From September 2005 to January 2006, 100 patients (106 procedures) underwent surgery, females being predominant (85 percent of the cases). Mean age was 35±9.8 years. Predominant schooling level among patients was primary school (53 percent). C2 (49.5 percent) and C3 (39 percent) were the most frequent CEAP classes in the clinical evaluation of lower limbs. A total of 106 surgeries was performed (100 patients). The preferred anesthetic technique was block anesthesia (93 percent of the procedures). Six patients were submitted to two different procedures due to great volume of lower limb varicose veins; 33 patients were submitted to internal saphenous vein stripping (four cases of segmental saphenous vein stripping); and eight patients were submitted to bilateral total saphenous vein stripping. CONCLUSION: Profile of the population that benefited from the task force for varicose vein surgeries was: young symptomatic female patients, with low schooling level, moderate stages of disease, especially in CEAP clinical...

Abordagem videolaparoscópica de cisto esplênico não parasitário / Laparoscopic approach of a nonparasitic splenic cyst

A rare case of primary splenic cyst is shown in a young woman who had a left subcostal abdominal pain. Abdominal echography and CT scan revealed a cyst of the anterior aspect of the spleen. A sorologic test for hidatic disease was negative. On the basis of a presumed diagnostic of nonparasitic cyst, the patient was referred to a laparoscopic decapsulation with excision of the cyst wall not covered by splenic tissue. The patient was discharged 24 hours later. Histological report revelead epidermoid cyst. The laparoscopic approach has being recently considered an effective and less invasive alternative in the treatment of splenic diseases. We demonstrated that it should be considered for the treatment of splenic cysts present in a superficial location, with the advantage of organ preservation.