Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro / Superficial venous arterialization with the great saphenous vein in situ: a single-center experience

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Abstract Background Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment. Objectives The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique. Methods This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021. Results Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures. Conclusions We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

O arquétipo da anima, a sexualidade, o amor e a ferida de Amfortas: uma interpretação da psicologia simbólica junguiana da lenda do Graal / Anima archetype, sexuality and king Amfortas' wound: an interpretation of the Grail legend by Jungian symbolic psychology

Baseado no referencial teórico da psicologia simbólica junguiana, o autor analisa o símbolo da ferida do rei Amfortas na lenda do Graal. Nesta teoria, os arquétipos matriarcal, patriarcal, da anima, do animus e da alteridade não se restringem ao individual, ao masculino ou ao feminino, pois todos esses arquétipos incluem os dois gêneros e a dimensão cultural. Na transição para a maturidade (40-60 anos), segunda adolescência ou metanoia, ativam-se conteúdos dos arquétipos da anima, do animus e da alteridade na posição ativa (Byington, 2013). Essa transição é a missão redentora do herói inocente e tolo Parsifal, na lenda do Graal, pois foi nela que o rei Amfortas caiu na lascívia e numa depressão defensiva patriarcal, pela sedução de Kundry, dominada pelo feiticeiro Klingsor. Parsifal é o herói inocente-tolo do arquétipo da alteridade, que resiste à tentação de Kundry, resgata a lança, anula a feitiçaria de Klingsor e destrói seu castelo. Ao curar a ferida de Amfortas com a lança que o feriu e a Jesus, Parsifal salva o reino, resgata a fixação matriarcal e patriarcal do Self individual e do Self cultural e se torna rei do Graal. No nível mitológico o herói Parsifal pode ser associado a Cristo e a Buda.

Based on Jungian symbolic psychology, the author analyses the symbol of king Amfortas' incurable wound in the Grail legend. In this theory, the matriarchal, patriarchal, anima, animus and alterity (otherness) archetypes are not restricted exclusively either to the feminine or the masculine, as all these archetypes include both genders. They can be activated to lead individuation in any existential dimension. In the maturity stage (40-60 years), the second adolescence or metanoia, contents of the anima, animus and alterity (otherness) archetypes are activated in the active position (Byington, 2013). This transition is the goal of the Grail legend when king Amfortas tempted by Kundry fell into matriarchal lasciviousness and patriarchal defensive depression, dominated by the magic of the sorcerer Klingsor. Parsifal is the innocent fool hero guided by the alterity (otherness) archetype. He resists Kundry's temptation, rescues the spear, exorcises Klingsor's magic and his castle is destroyed. Curing Amfortas's wound and the matriarchal and patriarchal fixations, Parsifal saves Kundry, king Amfortas and the kingdom and is crowned king of the Grail. In this sense, two great symbols of anima and animus archetypes in the archetypal theory of history are the mythological figures of Buddha and Christ.

Investigation on current status of advanced schistosomiasis in Shanggao County / 中国血吸虫病防治杂志

Objective To understand the current status of advanced schistosomiasis patients, so as to provide the reference for improving the medical care of them in Shanggao County. Methods The data of advanced patients in Shanggao County were collected from the Information Management System for the Advanced Schistosomiasis Chemotherapy and Assistance in Jiangxi Province and a field survey including the epidemiological investigation physical examinations and B ultrasound examinations was performed in 2014. All the data were analyzed statistically and compared with those in 2010. Results Among the 128 ad?vanced schistosomiasis patients the male female ratio was 2.46 1 the average age was 68.02±6.19 years and the patients old?er than 65 years contributed to 64.84%for the all. The proportions of clinically types of ascites splenomegaly multiple granulo?ma in the colon dwarf general and haemorrhage were 57.81% 12.50% 2.34% 0 26.57% and 0.78% respectively. The ultrasound examinations revealed the average diameter of the main trunk of portal vein was 12.70 ± 1.91mm in 2014 which was significantly broader than that of 12.05 ± 0.34mm in 2010 P < 0.01 . Conclusions The advanced schistosomiasis patents in Shanggao County decreases with years and shows an aging trend. Some advanced schistosomiasis patients are worse therefore the chemotherapy and salvation work still should be strengthened.

Techniques in Lower Extremity Reconstruction with Supermicrosurgery

PURPOSE: The concept and development of perforator free flaps have led to significant advances in microsurgery. Ongoing developments in perforator free flap surgery are aimed at reducing complications and improving surgical outcomes. The aim of this study was to evaluate the effectiveness and application of supermicrosurgery in free flap surgery. MATERIALS AND METHODS: A total of 267 patients with soft tissue defects of the lower extremity due to various etiologies from January, 2007 to January, 2013. The patients received either an anterolateral thigh free flap (n=83), a superficial circumflex iliac artery free flap (n=152), an upper medial thigh free flap (n=19), or a superior gluteal artery perforator free flap (n=13). Microanastomosis was performed using a perforator-to-perforator technique, either end-to-end or end-to-side. RESULTS: The mean postoperative follow up period was eight months (range: one to 16 months) and flap loss occurred in 11 cases out of 267. All cases of flap loss occurred within two weeks of surgery due to either arterial insufficiency (n=5) or venous congestion (n=6). CONCLUSION: Supermicrosurgery enables the selection of the most efficient perforator for microanastomosis at the defect site. It also reduces the time required for dissection of recipient vessels, and reduces the possibility of injury to major vessels. Microsurgery using a vessel of less than 1 mm has been reported to increase the risk of flap failure; however, using the most advanced surgical tools and developing experience in the technique can produce success rates similar to those found in the literature.

Utilização da safena magna in situ para arterialização do arco venoso do pé / The great saphenous vein in situ for the arterialization of the venous arch of the foot

CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO), 6 com tromboangeíte obliterante (TO) e 1 com trombose de aneurisma de artéria poplítea (TA) foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6 por cento) mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9 por cento) foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5 por cento). CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.

BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO), 6 with thromboangiitis obliterans (TO) and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point onward. RESULTS: Limb salvage was achieved in 10 (55.6 percent) patients, 5 with AO and 5 with TO. Seven (38.9 percent) patients were amputated, 5 with AO, 1 with TO and 1 with Ta. One (5.5 percent) patient died. CONCLUSION: Arterialization of the venous system of the foot should be considered for the salvage of limbs with critical ischemia in the absence of a distal arterial bed.

Arterialización venosa temporal del pie diabético / Temporal venous arterialization of the diabetic foot

La primera idea que tuvieron los cirujanos (1902) para evitar amputaciones por isquemia fue la de desviar el flujo arterial al sistema venoso por intermedio de una fístula arteriovenosa entre vasos adyacentes, pero con resultados inciertos. Desde entonces se han inventado las simpatecomias, las endarteriectomias y los injertos puentes o bypass y, últimamente, otros avances médicos, quirúrgicos y endovasculares. Sin embargo, en el mundo se siguen haciendo amputaciones, sobre todo en diabéticos. La arterialización de las venas del pie, basada en la vieja idea de la circulación invertida, constituye una esperanza más para estos pacientes ya condenados a la pérdida del miembro. Objetivo: Demostrar que la arterialización de las venas del pie en diabéticos con lesiones neuroisquémicas, generalmente infectadas (pie diabético), es un método eficaz y durable, aunque el puente solo funcione temporalmente. Pacientes y método: De enero de 2000 a febrero de 2009, 59 pacientes con pie diabético fueron tratados por arterialización de las venas del pie...

The first idea of surgeons (1902) to avoid amputations due to ischemia was to deviate the arterial flow to the venous system using an arteriovenous fistula between adjacent vessels; however, the results were unreliable. Since then, sympathectomies, endarterectomies and bypasses have been created, and more recently, other medical, surgical, and endovascular advances have been used. However, amputations continue to be performed worldwide mainly in diabetic patients. The arterialization of the foot veins, based on the old idea of inverted blood flow, is a new possibility for these patients who, otherwise, could lose their limbs. Objective: To demonstrate that arterialization of the foot veins in diabetic patients with neuroischemic lesions, usually infected (diabetic foot), is an effective and long-lasting method, even though the bypass only works temporally. Patients and method: From January 2000 to February 2009, 59 patients with diabetic foot were threated by means of arterialization of the foot veins. An early death was not included in the analysis. Of the 58 remaining patients, 44 were male and 14 were female. Their mean age was 71 years old: (53-91 years). Fifty-four of them were classified as being Fontaine IV and four were IIIB...

La saga eugenesia social / Social Eugenics: a saga

El fundamento biopolítico de estos tiempos no es la libertad sino la nuda vida. La idea de eugenesia nopuede desligarse de la vida comprometida con la mera zoe, en tanto puro espacio biológico limitado agarantizar la resolución de necesidades de la vida y supervivencia individual y colectiva. La zoé es parteconstituyente de las políticas públicas por cuanto la vida biológica se ha convertido en el objeto y elobjetivo de la política. En el espacio público, como espacio soberano, se define la esencialidad de lavida colectiva y las condiciones de esclavitud de estos tiempos al dictaminar las reglas que rigen la luchapor la supervivencia: selección excepcional y permanente de la cadena de la desigualdad, destino desacrificio y muerte en vida de las mayorías sometidos a la indignidad y a vivir refugiados en la resoluciónde su propia subsistencia. Como dimensión moral el poder extrema la potencialidad del mal: trivializala dominación, se otorga inmunidad - viola derechos, inhibe el castigo, juzgamiento o rebelión ante loscrímenes que genera – naturaliza la ficción de la representatividad, manipula, aniquila toda consideraciónque legitime igualdad o bienestar, transgrede las autonomías y todo principio de dignidad. La ficcióndel bien común socava la promesa de bienestar, salvación y vida digna para todos al definir las cadenasde la esclavitud mayoritaria - encierro del afuera, vida de la necesidad, expropiación de sí- a cambio delsacrificio en vida y promesas de protección y salvación futura.

The biopolitical fundamental of our times is not freedom: it is the “nude life”. Eugenics as an idea cannot be separated from life committed to the mere zoe – seen as a pure, biological space the limitof which lies in guaranteeing the solution of the needs life demands, and the individual and collective survival as well. “Zoe” is a constitutive part of public policies inasmuch as biological life is nowboth the object, and objective of politics. Within the public space, as a sovereign space, the essential aspect of collective life is defined, as well as the slavery conditions of our times, when rules governing the struggle for survival are defined, namely: an exceptional and permanent selection of the inequalitychain, a destiny of sacrifice and a “living death” imposed to majorities subject to indignity, subject to searching a solution for their own subsistence. As a moral dimension, power maximizes thepotential of evil: by trivializing domination, immunity is granted: rights are violated, either punishment, trial, or rebellion against crimes evil generates are inhibited. In other words, powernaturalizes the fiction of being a representative government, manipulates, annihilates every possibleconsideration aimed at legitimizing either equality or well-being, transgressing autonomies and every possible dignity principle as well. The “common good” fiction undermines the promise ofwell-being, salvation, and a decent life for all, by defining what are the chains for the majority slavery condition: being locked outside, living in need, being expropriated from oneself – in exchangefor a life-long sacrifice, protection and a future salvation are promised.

Investigation on medicine taking in rural schizophrenia patients / 中国康复理论与实践

@#ObjectiveTo investigate the status medicine taking in rural schizophrenic patients.MethodsThe families of 217 schizophrenic patients in a town of Shaoxing rural area were investigated with self-made questionnaire.Results and Conclusion125 cases routinely took medicine(57.6%). The main reason caused patients to resist taking medicine was absence of family or family's care. The medicine were obtained from hospital, drugstore, free drugs from mental preventing organization, mail-order, half or more of them were free. Only 53.46% of the objects would like to receive free drugs. The most of the others want to give up. The objects suggested mental preventing organization to provide more kinds and costly free drugs, simplify procedures of obtaining drugs, permit to receive more drugs at a time and be more kindly.