ABSTRACT
O objetivo é descrever dados clínicos e de imagem em mulher de 24 anos com arterite de Takayasu, que apresentou extensa ulceração de difícil controle no couro cabeludo. Houve acometimento da pele, do tecido subcutâneo, de músculos e ossos parietais subjacentes. A paciente relatou fraqueza nos membros superiores, mais intensa à esquerda, e isquemia intermitente nas quatro extremidades. Ao exame, havia ausência bilateral de pulsos braquiais, radiais e ulnares. Os pulsos tibiais posteriores e pediosos tinham suas amplitudes diminuídas. Constatou-se pressão arterial de 86 por 54 mmHg no braço esquerdo e 100 por 62 mmHg no direito. A associação de arterite de Takayasu com ulceração cutânea é incomum, em especial no couro cabeludo, e deve ser considerada a dermatose pustulosa erosiva como diagnóstico diferencial dessa condição.
The aim is to describe clinical and imaging data of a 24-year-old woman with Takayasu?s arteritis and presenting an extensive ulceration of difficult control in the scalp. There was involvement of the skin and subcutaneouslayer, in addition to the subjacent muscles and parietal bones. The patient claimed of weakness on the upper limbs more intense at the left, and intermitent ischemia in all the extremities. Physical examination showed bilateral absence of brachial, radial, and ulnar pulses, and posterior tibial and dorsalis pedis pulses had reduced amplitudes. Blood pressure levels were 86/54 mmHg on the left arm and 100/62 mmHg on the right arm. Association between Takayasu?s arteritis and skin ulcers is uncommon, in special on the scalp, and erosive pustular dermatosis must be considered as a differential diagnosis of this condition.
ABSTRACT
Objective To discuss the effect of early application of vacuum sealing drainage (VSD) on the small vessels and microthrombus of congested flap.Methods 56 SD rats were randomly divided into 7 groups after operation:one-hour group,four-hour group,one-day group,two-day group,three-day group,four-day group and seven-day group.A flap was designed and put on either side of a rat's back.The flaps were randomly arranged into control group and the flaps on the other side served as the experiment group.The equipment of VSD was fixed to each experiment flap.We observed and measured the flap,survival area,the expression of HIF-1α and vascular endothelial cell and microthrombus on the flap at different time.Results Firstly,the damage of vascular endothelial cell and microthrombus in the experiment flaps was less than the control group of flaps at the same time,so as the expression of HIF-1α.Secondly,the trend of expression of HIF-1α did not rise obviously in first 3 days and rose obviously from the 4th day in the experiment flaps; but in the control flaps,when time-lapse,the expression of HIF-1α increased,reached the plateau level at 6th day.Thirdly,the congestion of experimental flap was mitigated as compared with those under control,and the survival area was bigger,and it reached the top on the third day.Conclusions The application of VSD early to flap can aspirate detained blood initiatively,reduce the ischemic and hypoxic status of the tissue of flaps,and so it can lessen the damage of vascular endothelial cell and the formation of microthrombus of flap,beneficial for the survival of flap.