Recomendações para o manejo da úlcera da perna em pessoas com doença falciforme / Recommendations for the management of leg ulcers in people with sickle cell disease / Recomendaciones para el manejo de las úlceras de las piernas en personas con anemia de células falciformes

Objetivo: propor recomendações baseadas em evidências científicas para a prevenção e tratamento da úlcera da perna em pessoas com doença falciforme. Método: estudo de revisão integrativa, realizado a partir de busca nas bases de dados Scopus, Science Direct, Cummulative Index to Nursing and Allied Health Literature, Cochrane Library e Biblioteca Virtual em Saúde, em março de 2020. Resultados: foram publicados dez estudos entre 2010 e 2017. Extraíram-se 20 recomendações com nível de evidência classificado em muito baixo, baixo e moderado, organizadas em cinco temas: avaliação do paciente e da úlcera da perna; manejo da úlcera e do edema; utilização de coberturas no tratamento da úlcera; recomendações para manejo de úlcera recalcitrante; e autocuidado para prevenção de úlcera. Conclusão: o estudo permitiu identificar recomendações para prevenção e tratamento da úlcera da perna em pessoas com doença falciforme, que podem complementar as condutas apresentadas no manual do Ministério da Saúde a respeito do tema.

Objective: to propose scientific evidence-based recommendations for the prevention and treatment of leg ulcers in people with sickle cell disease. Method: this integrative review was performed by searching through the Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and Virtual Health Library databases in March 2020. Results: the ten studies found were published from 2010 to 2017. The 20 recommendations extracted offered evidence at levels rated very low, low and moderate, which was organized into five themes: evaluation of the patient and leg ulcer; management of the ulcer and edema; use of dressings in treating ulcers; recommendations for management of recalcitrant ulcers; and self-care for ulcer prevention. Conclusion: the study identified recommendations for prevention and treatment of leg ulcers in people with sickle cell disease, which can complement the conduct described in the Brazilian Ministry of Health handbook on the subject.

Objetivo: proponer recomendaciones basadas en evidencias científicas para la prevención y el tratamiento de las úlceras de pierna en personas con anemia falciforme. Método: esta revisión integradora se realizó mediante la búsqueda a través de las bases de datos Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library y Virtual Health Library en marzo de 2020. Resultados: los diez estudios encontrados se publicaron de 2010 a 2017. 20 recomendaciones extraídas ofrecieron evidencia en niveles calificados como muy bajo, bajo y moderado, que se organizó en cinco temas: evaluación del paciente y úlcera de pierna; manejo de la úlcera y el edema; uso de apósitos para el tratamiento de úlceras; recomendaciones para el manejo de úlceras recalcitrantes; y autocuidado para la prevención de úlceras. Conclusión: el estudio identificó recomendaciones para la prevención y el tratamiento de las úlceras de pierna en personas con anemia falciforme, que pueden complementar la conducta descrita en el manual del Ministerio de Salud de Brasil sobre el tema.

Terapia de oxigenación hiperbárica en el tratamiento del dolor / Hyperbaric oxygenation therapy in pain treatment

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)

Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)

The effectiveness of the cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta-analysis

Introduction: Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of thirdmolars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective: To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis: An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions: Cryotherapy applied on thefirstday aftermandibular third molar removal can manage edema in the patients.Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication (AU)

A possible role of endoneurial fibroblast-like cells in the resolution of endoneurial oedema following nerve crush injury / El posible rol de los fibroblastos endoneurales en la resolución del edema endoneural después de una lesión por aplastamiento nervioso

SUMMARY: Endoneurial oedema is a salient feature of all types of neuropathy. Its elimination is crucial during the complications of nerve recovery. The objective was to study a possible role of the endoneurial fibroblasts in the resolution of nerve edema. Forty-two albino male rats aged between 30 and 40 days (weight 200 g to 250 g) were used in this study. The left sural nerves of 36 rats were subjected to crush injury at one to three-week intervals with six animals per interval. The right and left sural nerves of the remaining six rats were used as controls. At the end of the second week after crush injury, the endoneurium showed channel-like spaces that were lined by fibroblast-like cells and collagen bundles that contained degenerated myelin, and were connected to the subperineurial spaces. Flattened fibroblast-like cells were arranged in several layers in the subperineurial, forming barrier-like cellular sheets localizing to the endoneurial oedema in the space. Fibroblast-like cells also wrapped around the regenerating nerve fibres with their branching cytoplasmic processes. During the third week, the flattened fibroblast-like cells formed nearly continuous cellular sheets in the subperineurial spaces. Macrophages were frequently observed between these cellular barrier-like sheets and in the subperineurial. The endoneurial fibroblast-like cells form barrier-like cellular sheets that probably localise the endoneurial oedema in the subperineurial space. It also appear to create endoneurial channel-like spaces containing degenerated myelin and endoneurial oedema, which may be helpful in localizing and resolving such oedema.

RESUMEN: El edema endoneural es una característica destacada de todos los tipos de neuropatía. Su eliminación es importante durante las complicaciones de la recuperación nerviosa. El objetivo fue estudiar un posible papel de los fibroblastos endoneurales en la resolución del edema nervioso. En este estudio se utilizaron 42 ratas macho albinas con edades entre los 30 y 40 días (peso 200 a 250 g). Los nervios surales izquierdos de 36 ratas se sometieron a lesiones por aplastamiento en intervalos de una a tres semanas con seis animales por intervalo. Se usaron los nervios surales derecho e izquierdo de las seis ratas restantes como controles. Al final de la segunda semana después de la lesión por aplastamiento, el endoneuro mostró espacios en forma de canal que estaban revestidos por células similares a fibroblastos y haces de colágeno que contenían mielina degenerada y se conectaron a los espacios subperineurales. Las células aplanadas de fibroblastos se dispusieron en varias capas en el subperineuro, formando láminas celulares de tipo barrera que se localizaban en el espacio del edema endoneural. Las células similares a fibroblastos también envolvían las fibras nerviosas regeneradoras con sus procesos citoplásmicos ramificados. Durante la tercera semana, las células aplanadas de fibroblastos formaron láminas celulares casi continuas en los espacios subperineurales. Los macrófagos se observaron con frecuencia entre estas láminas similares a barreras celulares y en el subperineuro. Las células de tipo fibroblasto endoneural formaban láminas celulares de tipo barrera que probablemente localizan el edema endoneural en el espacio subperineural. También parece que crea espacios en forma de canal endoneural que contienen mielina degenerada y edema endoneural, que pueden ser útiles para localizar y resolver este edema.

Remitting seronegative symmetrical synovitis with pitting edema (rs3pe): una inusual causa de edema en el adulto mayor / Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): an unusual cause of edema in the elderly

El RS3PE es una patología infrecuente de la esfera reumatológica que afecta a adultos mayores, manifestándose como poliartritis simétrica más edema con signos de fóvea. Si bien suele tener una excelente respuesta a corticoides, debe tenerse en considera-ción su asociación a neoplasias, lo cual determina el pronóstico de la enfermedad. Se presenta el caso de un varón de 75 años, con artritis y severo edema de extremida-des, el cual revirtió completamente con el uso de prednisona.

RS3PE is a rare rheumatological syndrome that affects older adults, manifesting as symmetrical polyarthritis and limbs edema. Although it usually has an excellent re-sponse to corticosteroids, its association with neoplasms must be taken into con-sideration, which determines the prognosis of the disease. We report the case of a 75-year-old man with arthritis and severe edema of limbs, which completely reversed with the use of prednisone.

Perineal Pain Management with Cryotherapy after Vaginal Delivery: A Randomized Clinical Trial / Manejo da dor perineal com crioterapia no pós-parto vaginal: ensaio clínico randomizado

Abstract Introduction Systematic reviews that evaluate the perineal cryotherapy to reduce pain in the vaginal postpartum are inconclusive. Purpose To evaluate clinical effectiveness of cryotherapy in the management of humanized postpartum perineal pain and vaginal edema. Methods A double-bind randomized controlled clinical trial (UTN number: U1111- 1131-8433) was conducted in a hospital in Northeastern, Brazil.Women were included following humanized childbirth. All had vaginal deliveries of a single, full-term pregnancy with cephalic presentation. Exclusion criteria included previous perineal lesion, episiotomy during the current delivery, instrumental delivery, uterine curettage and postpartum hemorrhage. In the experimental group, an ice pack was applied six times on the perineum for 20 minutes, reducing the temperature between 10 and 15° C, then 60 minutes without exposure to cold. In the non-cryotherapy, a water bag unable to reduce the temperature to this extent was used, compliance with the same application protocol of the first group. Perineal temperature wasmonitored at zero, 10 and 20 minutes for application in both groups. Evaluations were made immediately before and after the applications and 24 hours after delivery spontaneous, to determine the association between variables. Results A total of 80 women were included in the study, 40 in each group. There was no significant difference in scores of perineal pain and edema between the groups with or without cryotherapy until 24 hours after childbirth. There was no difference between groups when accomplished repeated measures analysis over the 24 hours after delivery, considering the median perineal pain (p = 0.3) and edema (p = 0.9). Perineal cryotherapy did not influence the amount of analgesics used (p = 0.07) and no adverse effect was registered. Conclusion The use of cryotherapy following normal vaginal delivery within the concept of humanized minimally interventionist childbirth had no effect on perineal pain and edema, since it was already substantially lower, nor the need for pain medicaments.

Resumo Introdução Revisões sistemáticas que avaliam a crioterapia perineal para redução da dor no pós-parto por via vaginal são inconclusivas. Objetivo Avaliar a efetividade clínica da crioterapia para controlar a dor e o edema perineais após parto vaginal humanizado. Métodos Ensaio clínico (n° UTN: U1111-1131-8433) randomizado controlado duplocego, realizado em uma maternidade no Nordeste do Brasil. Incluíram-se mulheres após parto vaginal humanizado, de gestação única, cefálica, a termo, e foram excluídas aquelas com lesão perineal prévia, episiotomia no parto atual, parto instrumental e hemorragia perineal ativa. O grupo experimental foi submetido a seis aplicações de bolsa de gelo triturado na região do períneo, por 20minutos, reduzindo a temperatura entre 10 e 15°C, com 60 minutos entre as aplicações. O grupo sem crioterapia recebeu uma bolsa de água, que não reduzia a temperatura a esse nível, respeitando o mesmo protocolo de aplicação do primeiro grupo. Amonitorização da temperatura perineal foi realizada nos minutos zero, 10 e 20 de aplicação, emambos os grupos. Para determinar a associação entre as variáveis, foramrealizadas avaliações imediatamente antes e após as aplicações e 24 horas após o parto. Resultados Foram incluídas 80 puérperas no estudo, sendo 40 em cada grupo. Não houve diferença significativa para os escores de dor e edema perineais entre os grupos comou sem crioterapia até 24 horas após o parto. Não houve diferença entre os grupos quando realizada análise de medidas repetidas em todas as avaliações, considerando a mediana dos escores de dor (p = 0,3) e edema (p = 0,9) perineais. A crioterapia perineal não influenciou na quantidade de analgésicos utilizados (p = 0,07) e nenhum efeito adverso foi registrado. Conclusões A utilização da crioterapia após parto vaginal humanizado, minimamente intervencionista, nãomodifica escores de dor e edema perineais, por já serem, substancialmente, baixos, tampouco altera a necessidade de medicamentos analgésicos.

Reacción sistémica tras la ingesta de una oruga procesionaria del pino: ¿Manejo conservador? / Systemic reaction after pine processionary caterpillar ingestion: Conservative management?

La oruga procesionaria del pino, forma larvaria de la mariposa nocturna Thaumetopoea pityocampa, es una de las principales plagas forestales del sur de Europa. Con frecuencia, estas orugas producen reacciones locales en humanos debidas a los pelillos urticantes microscópicos que las recubren. La mayoría de los síntomas ocasionados son cutáneos, como urticaria aguda, y son mucho más infrecuentes las reacciones sistémicas. Se presenta un caso de reacción sistémica, con edema orofacial, babeo y urticaria tras la ingesta de una oruga procesionaria del pino en un lactante de 11 meses, en el cual el tratamiento farmacológico fue suficiente para la resolución de los síntomas. No tuvo, en ningún momento, compromiso de la vía aérea ni otros datos de anafilaxia, por lo que se desestimaron actuaciones más agresivas, como intubación orotraqueal, endoscopía o laringoscopía.

The larval form of the moth Thaumetopoea pityocampa, known as pine processionary caterpillar, is one of the main forest pests in southern Europe. Often, these caterpillars cause local reactions in humans, due to their microscopic stinging hairs. Most symptoms affect skin, in form of acute urticaria. Systemic reactions are rare. An eleven month old infant with a systemic reaction after ingestion of a pine processionary caterpillar is presented. The boy reached the Emergency Room with orofacial edema, drooling and urticaria. Drug treatment was enough to resolve the symptoms. The patient did not present airway commitment, nor anaphylaxis data at any moment, so more aggressive actions, such as endotracheal intubation, endoscopy or laryngoscopy, were rejected.

Effect of high-voltage electrical stimulation on the albumin and histamine serum concentrations, edema, and pain in acute joint inflammation of rats

BACKGROUND: The mechanism by which high-voltage electrical stimulation (HVPC) acts on edema reduction is unknown. OBJECTIVE: To assess the effect of HVPC with negative polarity (-) applied to the ankle of rats with acute joint inflammation. METHOD: Sixty-four rats were divided into four groups (n=16): inflamed+HVPC(-), 0.03 mL application of ι-carrageenan (3%) to the tibiotarsal joint plus HVPC(-); inflamed+HVPC placebo, carrageenan application and HVPC placebo; normal+HVPC(-), HVPC application(-); and normal control, no intervention. The HVPC(-) 100 Hz at a submotor level was applied daily for 45 min on three consecutive days. The variables were pain, hind-foot volume, and serum histamine and albumin assessed before and during the 48 hours following inflammation. The variables were compared using the t test, one-way ANOVA, nested ANOVA for repeated measures, and the post hoc Bonferroni test. Analysis of covariance was applied to adjust the effects of HVPC(-) by measurements of pain, inflammation, albumin, and histamine at 24 h, and the final weight was compared to the other groups. The significance level was set at p<0.05. RESULTS: There were no differences between the inflamed+HVPC(-) and inflamed+HVPC placebo groups in terms of pain or edema (p>0.05). Albumin was reduced in the groups that received the intervention, but there was no differences between them. There was only a 24 hour increase in histamine with the normal+HVPC(-) (p=0.0001) and inflamed+HVPC placebo groups (p=0.01) compared to the normal control group. CONCLUSIONS: The results of the present study suggest that HVPC(-) with the parameters employed did not reduce pain or edema and did not change serum albumin or histamine levels,, which indicates the inability of this resource to have a positive effect when treating treat acute joint inflammation. .

Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound / Correlação de achados clínicos com o risco de trombose venosa profunda de membros inferiores através do ultrassom vascular

BACKGROUND:Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT. .

CONTEXTO:Sintomas e sinais clínicos indicativos de trombose venosa profunda (TVP) são comuns mas podem ter inúmeras causas. OBJETIVOS: 1) Identificar os sintomas mais frequentes e correlacioná-los com achados de dúplex scan (DS); 2) identificar condições clínicas de alto risco para TVP; e 3) avaliar o intervalo de tempo decorrido entre o início dos sintomas e o exame do paciente. MÉTODOS: Um total de 528 pacientes com suspeita clínica de TVP foram examinadosvia DS por ultrassonografistas vasculares experientes. RESULTADOS: TVP esteve presente em 192 (36,4%) dos pacientes analisados. A veia ilíaca externa esteve acometida em 53 pacientes (10,04%), as veias femorais em 110 (20,83%), a veia poplítea em 124 (23,48%), e as veias abaixo do joelho em 157 casos (29,73%). Edema de membro esteve presente em 359 casos (68%), e 303 (57,4%) se queixaram de dor. Sessenta e nove pacientes realizaram DS devido a embolia pulmonar (EP) suspeita ou comprovada; 79 pacientes estavam em período pós-operatório. Na análise multivariada, os fatores de risco independentes para TVP incluíram idade >65 anos [OR=1,49; intervalo de confiança de 95% (IC95%) 1,01-2,18; p=0,042], edema (OR=2,83; IC95% 1,72-4,65; p<0,001), dor (OR=1,99; IC95% 1,3-3,05; p=0,002), câncer (OR=2,32; IC95% 1,45-3,72; p<0,001) e EP (OR=2,62; IC95% 1,29-5,32; p=0,008). O tempo decorrido desde o início dos sintomas foi semelhante nos dois grupos. CONCLUSÕES: No presente estudo, 36,4% dos pacientes encaminhados para DS apresentaram TVP. Idade acima de 65 anos, presença de edema de membro, dor, câncer e EP suspeita ou comprovada devem ser considerados fatores de risco maiores para TVP. .

Using an experimental model for the study of therapeutic touch / Utilização de um modelo experimental para estudo sobre o toque terapêutico / Uso de un modelo experimental para estudio sobre el toque terapéutico

OBJECTIVE: to verify whether the Paw Edema Model can be used in investigations about the effects of Therapeutic Touch on inflammation by measuring the variables pain, edema and neutrophil migration. METHOD: this is a pilot and experimental study, involving ten male mice of the same genetic strain and divided into experimental and control group, submitted to the chemical induction of local inflammation in the right back paw. The experimental group received a daily administration of Therapeutic Touch for 15 minutes during three days. RESULTS: the data showed statistically significant differences in the nociceptive threshold and in the paw circumference of the animals from the experimental group on the second day of the experiment. CONCLUSION: the experiment model involving animals can contribute to study the effects of Therapeutic Touch on inflammation, and adjustments are suggested in the treatment duration, number of sessions and experiment duration.

OBJETIVO: verificar se o modelo de edema de pata pode ser utilizado nas investigações acerca dos efeitos do toque terapêutico sobre a inflamação, mensurando-se as variáveis dor, edema e migração de neutrófilos. MÉTODO: trata-se de estudo piloto, experimental, com 10 camundongos machos da mesma linhagem genética, divididos em grupo experimental e controle, submetidos à indução química de inflamação local na pata direita traseira. O grupo experimental recebeu uma aplicação diária de toque terapêutico com duração de quinze minutos, por três dias. RESULTADOS: os dados evidenciaram diferenças estatisticamente significativas no limiar nociceptivo e na circunferência das patas dos animais do grupo experimental, no segundo dia do experimento. CONCLUSÃO: o modelo de experimento com animal pode contribuir para o estudo dos efeitos do toque terapêutico sobre a inflamação. Sugere-se ajuste no tempo de exposição, número de sessões e tempo de duração do experimento.

OBJETIVO: verificar si el Modelo de Edema de Pata puede ser utilizado en las investigaciones acerca de los efectos del Toque Terapéutico sobre la inflamación, mensurándose las variables dolor, edema y migración de neutrófilos. MÉTODO: se trata de un estudio piloto, experimental, con 10 ratones machos del mismo linaje genético, divididos en grupo experimental y control, sometidos a inducción química de inflamación local en la pata derecha trasera. O grupo experimental recibió una aplicación diaria de Toque Terapéutico con duración de quince minutos, por tres días. RESULTADOS: Los datos evidenciaron diferencias estadísticamente significativas en el umbral de nocicepción y circunferencia de las patas de los animales del grupo experimental durante el segundo día del experimento. CONCLUSIÓN: El modelo de experimento con animal puede contribuir al estudio de los efectos del Toque Terapéutico sobre la inflamación: se sugiere ajuste en el tiempo de exposición, número de sesiones y duración del experimento.

Relación de los niveles plasmáticos de proteína C reactiva con infección y edema en la cirugía de los terceros molares retenidos / Relation between CRP levels as indicator of postoperative infection and edema after third molar impacted surgery

La proteína C reactiva (CRP) por sus siglas en inglés) es una proteína de fase aguda que se utiliza para el seguimiento de enfermedades inflamatorias tales como artritis reumatoidea, lupus eritematoso o vasculitis y procesos infecciosos tales como sepsis y septicemia; así como también, para evaluar la eficacia de las drogas antiinflamatorias y antimicrobianas indicadas en el tratamiento de estas patologías. Igualmente se ha asociado a daño tisular en diversas especialidades quirúrgicas. El objetivo de este estudio fue relacionar los niveles plasmáticos de CRP con la infección y el edema posterior a la cirugía de los terceros molares. A tal efecto se evaluaron 60 pacientes, distribuidos en 3 grupos A, B y C bajo antibioticoterapia profiláctica con Clindamicina (A: dosis única de 600 mg, B: 300 mg c/6h por 5 días y C: Placebo) y terapia analgésica y antiinflamatoria (Ibuprofeno 400mg c/6h por 3 días). A quienes se tomaron muestras de sangre antes y a las 72 horas de la odontectomía de los terceros molares y fotografías digitales para calcular el área de inflamación. No se demostró la relación de los niveles de CRP con infección ya que ningún paciente presentó proceso infeccioso pero si se demostró la relación cualitativa (sensibilidad) de CRP y cuantitativa mediante correlación de Spearman (p<0,05) ya que mientras mayor fue el área de la inflamación, mayores fueron los niveles plasmáticos de CRP

The C reactive protein (CRP) is an unspecific acute phase reaction used for the follow-up of such inflammatory diseases such as rheumatoid arthritis, lupus, or vasculitis and such infectious processes like sepsis; as well as also, to evaluate the efficiency of the anti-inflammatory and antimicrobial drugs indicated in the treatment of this pathologies. Equally it has associated to tissue damage in diverse surgical specialties. The aim of this study was to evaluate the relation between CRP levels as indicator of postoperative infection and edema after third molar surgery. We evaluated 60 patients distributed in three groups A, B and C under antibiotic prophylaxis with Clindamycin (A: single dosis 600 mgs, B: 300 mgs each 6/h by 5 days and C: placebo) and analgesic and anti-inflammatory therapy with Ibuprofen 400 mg. each 6/h by 3 days. Who were taken blood samples to measure the CRP before and 72 hours after surgery and digital photographs to calculate the edema area. We did not demonstrated relation between CRP and infection because no one patient was infected in any group but we demonstrated (By Searman (p<0,05) the value of CRP as indicator of edema in the third molar surgery

Anti-inflammatory and antipyretic activities of the ethanolic extract of Shorea robusta Gaertn. f. resin.

Shorea robusta Gaertn. f. (Sal) is one of the most important traditional Indian medicinal plants. The resin of the plant has been used in the treatment of inflammation in folklore medicine. In the present study, ethanolic extract (70%) of S. robusta resin (SRE) was investigated for its anti-inflammatory and antipyretic activities. Acute inflammation was produced by carrageenan-induced hind paw edema and sub-acute by cotton pellet-induced granuloma in male Wistar rats. The antipyretic activity of SRE was studied using Brewer’s yeast-induced pyrexia in rats. The rats were divided into five groups with five animals in each group. Group I was treated with vehicle i.e. 1% v/v Tween-80 and served as control. Groups II to IV were treated with three different doses of SRE (30, 100 and 300 mg/kg orally). Group V was treated with standard drug etoricoxib (10 mg/kg orally). The anti-inflammatory activity of SRE was assessed by per cent reduction in edema volume of carrageenan-induced hind paw edema and by per cent decrease in granuloma formation in cotton pellet-induced granuloma test. SRE (100 and 300 mg/kg) produced a significant reduction in edema volume and decrease in granulation tissue formation in rats. Significant reduction in pyrexia was observed at all the dose levels of SRE i.e. 30, 100 and 300 mg/kg. The results of the present study demonstrated anti-inflammatory and antipyretic activities of S. robusta resin and supported its traditional therapeutic use in painful inflammatory conditions and fever.

A influência da crioterapia na dor e edema induzidos por sinovite experimental / The cryotherapy influence on pain and edema induced by experimental synovitis

O objetivo deste estudo foi analisar a influência da crioterapia na dor e edema advindos de sinovite induzida em ratos. Foram utilizados 12 ratos, distribuídos em dois grupos: Controle (GC) – submetido à indução de sinovite no joelho direito, e não tratado; e Tratamento (GT) – submetido à sinovite no joelho direito, e tratado com crioterapia. Para induzir a lesão, foi injetado no espaço tíbio-femoral formalina 5%. Para avaliação da dor foi utilizado o teste de incapacidade funcional, que avaliou a dor durante a marcha do animal (tempo de elevação da pata – TEP); e para quantificar o edema foi utilizado um paquímetro metálico, na região da interlinha do joelho. As avaliações ocorreram antes da injeção de formalina (AV1), 1 (AV2) e 2 horas (AV3) após. Após 10 minutos da lesão, o membro posterior direito foi submerso em água com gelo, à 5ºC por 20 minutos. A avaliação do TEP mostrou aumento de 194,03% (AV2) e 169,26% (AV3) para GC; e 134,25% (AV2) e 103,13% (AV3) para GT, com relação à AV1. Na comparação entre os grupos, em AV3, houve diminuição significativa para GT. A avaliação do edema mostrou aumento do diâmetro, para GC de 39,15% (AV2) e 42,39% (AV3); e 27,91% (AV2) e 14,50% (AV3) para GT, tendo como referência AV1; sendo que apenas GT apresentou diminuição significativa entre AV2 e AV3. Conclui-se que os efeitos em curto prazo, da crioterapia, foram significativos para reduzir a dor e edema, em ratos submetidos à indução de sinovite.

The aim of this study was to examine the influence of cryotherapy on pain and swelling in an induced synovitis in rats. A total of 12 rats were allocated into two groups: the control (CG) – underwent the synovitis induction in his right knee, and not treated, and treatment (TG) – synovitis in his right knee, and treated with cryotherapy. To induce injury, was injected into the tibio-femoral joint space 5% formalin. For the pain assessment was used the functional incapacitation test, which assessed pain during gait of the animal (paw elevation time – PET) and to quantify the swelling was used a metal caliper in the region of the interline knee. Assessments occurred prior to injection of formalin (EV1), 1 (EV2) and 2 hours (EV3) after. After 10 minutes of the injury, the right hind limb was immersed in ice water, 5ºC for 20 minutes. The evaluation of PET revealed increased 194.03% (EV2) and 169.26% (EV3) for CG, and 134.25% (EV2) and 103.13% (EV3) to TG, with respect to EV1. Comparing the groups, EV3, a significant decrease in GT. The edema assessment showed increased diameter of 39.15% for CG (EV2) and 43.39% (EV3) and 27.91% (EV2) and 14.5% (EV3) to TG, with reference EV1; and only TG significantly decreased between EV2 and EV3. We conclude that the effects in the short term, cryotherapy, were significant to reduce pain and edema in rats with induced synovitis.

Central Venous Stenosis Caused by Traction of the Innominate Vein due to a Tuberculosis-Destroyed Lung

We report a case of central venous stenosis due to a structural deformity caused by a tuberculosis-destroyed lung in a 65-year-old woman. The patient presented with left facial edema. She had a history of pulmonary tuberculosis, and the chest X-ray revealed a collapsed left lung. Angiography showed leftward deviation of the innominate vein leading to kinking and stenosis of the internal jugular vein. Stent insertion improved her facial edema.

Spontaneous resolution of marked dilatation of cerebral duro-venous system in newborn presenting with fetal hydrops.

A newborn with antenatal diagnosis of fetal hydrops at 36 wk of gestation, presented with congestive heart failure (CHF) and generalized edema. Computed tomographic angiography showed marked dilatation of cerebral duro-venous system including vein of Galen (VOG), straight sinus, torcula and transverse sinus without evidence of arteriovenous fistulae at the vein of Galen. Dilatation of duro-venous system resolved with concomitant improvement in biventricular function and CHF with decongestive therapy. Such entity should be differentiated from more serious conditions like VOG malformation and venous sinus thrombosis.

Drenagem linfática em paciente com dermatofibrose e flebite de membro inferior: relato de caso / Lymph drainage in patients with dermatofibrosis and phlebitis of the lower limb: case report

O presente estudo objetivou avaliar a drenagem linfática como forma coadjuvante de tratamento, em uma paciente idosa com dermatofibrose, flebite de membro inferior e queixa de dores na perna, localizada em região pós-flebítica. Foi realizado tratamento clínico inicial por três meses com drogas venotônicas (diosmin), anti-inflamatórios, analgésicos e repouso, porém com pouca melhora clínica. Foi, então, associada ao tratamento clínico, a drenagem linfática manual e mecânica. Os resultados obtidos incluíram a redução dos sintomas dolorosos e da hiperpigmentação do local acometido. Este trabalho sugere que a drenagem linfática obteve melhora do quadro clínico de paciente portadora de dermatofibrose, sugerindo novas pesquisas para caracterização mais específica dessa abordagem.

This study aimed at evaluating lymphatic drainage as a complementary form of treatment in an elderly patient with dermatofibrosis and phlebitis of the lower limb. The patient complained of pain in the post-phlebitic region. Initially three months of clinical treatment was performed using vasotonic(diosmine), anti-inflammatory and analgesic drugs and the patient was told to rest. However this treatment was not very effective. Manual and mechanical lymph drainage was associated to the clinical treatment. The results gave a significant improvement in the symptoms and the hyperpigmentation of the affected area. This study suggests that lymph drainage obtained improves the clinical of patient with dermatofibrosis, suggesting new research for more specific characterization of this approach.

Uso da ventilação não-invasiva na terapêutica do edema pulmonar cardiogênico / Use of noninvasive mechanical ventilation in the treatment of cardiogenic pulmonary edema

Em pacientes com edema agudo de pulmão, a redução na complacência pulmonar correlaciona-se à congestão pulmonar. Clinicamente importante é o fato de que o desconforto respiratório não está diretamente relacionado à hipoxemia e não pode ser revertido apenas com administração de O2. A terapia médica usual inclui diuréticos, vasodilatadores e inotrópicos. Embora muitos pacientes respondam rapidamente ao tratamento de rotina, um número significante progride para insuficiência respiratória severa, com intubação endotraqueal e suas complicações associadas. O uso de pressão positiva não-invasiva por máscara reduz a necessidade de intubação endotraqueal. A análise da literatura atual comprova que a ventilação não-invasiva é segura e efetiva em reduzir a necessidade de intubação endotraqueal em pacientes com desconforto respiratório de origem cardíaca. Os resultados reforçam o conceito que a pressão positiva não-invasiva deve ser considerada uma forma não farmacológica de tratamento do edema agudo de pulmão cardiogênico e não simplesmente uma medida de suporte.

In patients with cardiogenic pulmonary edema, the reduction in lung compliance correlates with pulmonary congestion. Of clinical relevance is the fact that respiratory distress is not related directly to hypoxemia and cannot be reversed with O2 administration alone. Standard medical therapy includes diuretics, vasodilators and inotropics. Although many patients respond rapidly to standard treatment, a significant number progress to severe respiratory distress leading to endotracheal intubation with its associated complications. Noninvasive use of positive pressure delivered through a mask reduces the need for endotracheal intubation. The analysis of the current literature shows that noninvasive ventilation is safe and is effective in preventing the need for endotracheal intubation in patients with respiratory distress of cardiac origin. The results support the concept that noninvasive positive pressure ventilation must be seen as a non pharmacological form of treatment of acute pulmonary edema, rather than only as a supportive measure.

Avaliação imediata da dor e edema em lesão muscular induzida por formalina e tratada com laser 808 nm / Immediate pain and edema assessment in muscular injury induced by formalin and treated with low-level laser (808nm)

O laser de baixa potência induz a bioestimulação celular, podendo acelerar a cicatrização de feridas, promover a regeneração do músculo esquelético, diminuir a resposta inflamatória, estimular a neoformação de vasos sanguíneos e diminuir a dor. O objetivo deste estudo foi analisar os efeitos de três doses de laser de baixa intensidade (808nm), na dor e edema imediatos, em ratos submetidos a lesão experimental do músculo gastrocnêmio lateral. Foram utilizados 24 ratos Wistar, distribuídos aleatoriamente em quatro grupos, sendo: GC - animais lesionados e tratados com aparelho desligado (simulacro); G20 - animais lesionados e irradiados com dose de 20J/cm²; G50 - animais lesionados e irradiados com 50J/cm; e G100 - animais lesionados e irradiados com 100J/cm². Para a produção da lesão experimental, introduziu-se 0,1mL de formalina a 5 por cento no ventre do músculo gastrocnêmio lateral direito. A avaliação da dor ocorreu através do tempo de elevação da pata (TEP) e o edema foi avaliado com auxílio de paquímetro metálico; ambas as avaliações ocorreram pré-lesão, pós-lesão, pós-tratamento, duas, oito e 24 horas pós-lesão. Os resultados mostraram aumento significativo do TEP e da avaliação com paquímetro, após a indução da lesão. Conclui-se que laser nos parâmetros utilizados não produziu diminuição na dor e edema, em animais submetidos a lesão muscular com injeção de formalina a 5 por cento.

Low-level laser therapy induces to cellular bioestimulation and can accelerate wound healing, promote skeletal muscle regeneration, decrease inflammatory response, stimulate neovascularization and decrease pain. The aim of this study was to analyze the effects of three doses of low-level laser therapy (808 nm), in the immediate pain and edema, in rats submitted to experimental injury of the lateral gastrocnemius muscle. Twenty four Wistar rats, randomly distributed in the following four groups were used: CG - injured and treated with equipment turned off (sham); G20 - injured and treated with 20 J/cm²; G50 - injured and treated with 50 J/cm²; and G100 - injured and treated with 100 J/cm². For the experimental injury production, 0.1 mL of formalin 5 percent was introduced in the right lateral gastrocnemius muscle girth. Pain was assessed through the Paw Elevation Time (PET), and edema was assessed with a metallic caliper. Both evaluations happened before injury, after injury, after treatment, 2, 8 and 24 hours after injury. The results showed significant increase of PET and of the caliper evaluation after injury induction. It has been concluded that the laser irradiation in the used parameters did not produce pain and edema decrease in rats submitted to muscular injury with formalin 5 percent injection.