Pressure Ulcer Scale for Healing no acompanhamento da cicatrização em pacientes idosos com úlcera de perna / Pressure Ulcer Scale for Healing in monitoring of wound healing in elderly patients with leg ulcer

Introdução: Este trabalho objetiva descrever a evolução da cicatrização e o tratamento realizado em pacientes com úlceras de perna no ambulatório de feridas, utilizando o instrumento Pressure Ulcer Scale for Healing - PUSH. Métodos: Trata-se de pesquisa na modalidade estudo de caso, realizada com quatro pacientes. Os dados foram colhidos em um Hospital Estadual do interior de São Paulo, nos anos 2009 e 2010, por meio de fotografias digitais e da escala de evolução de feridas Pressure Ulcer Scale for Healing. Os itens avaliados são: área da ferida, quantidade de exsudato e aparência do leito da ferida. Resultados: Na primeira avaliação, o primeiro caso apresentava escore total 16; o segundo e o terceiro casos, escore total 13; e o quarto caso, escore total 15. Na segunda avaliação, o primeiro caso apresentava escore total 13; o segundo, escore total 7; o terceiro, escore total 6; e o quarto, escore total 11. Na última avaliação, o primeiro caso apresentava escore total 4 e no segundo, terceiro e quarto casos, o escore total foi zero. A aplicação da Escala Pressure Ulcer Scale for Healing na avaliação dos 4 pacientes deste estudo possibilitou aos enfermeiros realizar a prescrição da cobertura ideal para o processo cicatricial da lesão. Conclusão: Concluiu-se que o referido instrumento facilita sobremaneira a atuação da enfermagem na avaliação e na escolha da cobertura ideal para a promoção da epitelização da lesão, uma vez que tem por base a avaliação de parâmetros importantes durante o processo dinâmico do cuidar de feridas.

Introduction: This work describes the evolution of wound healing and outpatient treatment of patients with leg ulcers using the Pressure Ulcer Scale for Healing (PUSH) tool. Method: This research was performed as a case study with four patients. The data were gathered at a State Hospital in the countryside of the State of São Paulo from 2009 to 2010 through digital photographs and the PUSH wound evolution scale. The wound area, amount of exudate and appearance of the wound bed were assessed. Results: In the first assessment, the first case presented with a total score of 16; the second and third cases, 13; and the fourth case, 15. In the second assessment, the first case presented with a total score of 13; the second, 7; the third, 6; and the fourth, 11. In the last assessment, the first case presented a total score of 4, and the second, third and fourth cases, 0. The application of the PUSH to assess the four patients in this study allowed nurses to perform the optimal wound dressing prescribed for the healing process. Conclusion: It was concluded that the aforementioned tool greatly facilitates nursing performance in assessing and choosing the optimal dressing to promote the epithelialization of the wound, which is based on the assessment of important parameters during the dynamic process of wound care.

Cavernous body reduction in four patients with erectile dysfunction due to insufficient venous occlusion and a deficit of elastic fibers in the tunica albugínea

INTRODUCTION: The corpora cavernosa are cylindrical vessels containing fluid under pressure. Thus, if cavernous wall resistance decreases, the radius increases and internal pressure decreases (LaPlace's law). We reasoned that if we decrease the corpus cavernosum radius, by excising a strip from each tunica albuginea, intracavernous pressure would increase during erection. MATERIALS AND METHODS: We treated with this procedure, four patients (mean age 41.5) with long-standing erectile dysfunction due to veno-occlusive dysfunction, non-responders to phosphodiesterase-5 inhibitors and intracavernous PGE1 injection. RESULTS: Two months post-surgery, intracavernous PGE1 (40 mcg) induced a satisfactory erection in two patients and a 45 percent and 58 percent tumescence in the other two. PGE1 responders also responded to 100 mg sildenafil. After 100 mg sildenafil and 20 mg tadalafil, the two non-responders had erections that enabled penetration but were short lasting. CONCLUSION: The procedure described could be more effective than cavernous revascularization operations. The results seem to confirm the mathematical assumptions.

Preoperative corporal biopsy as a predictor of postoperative results in venoocclusive erectile dysfunction

Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction [ED] and whether preoperative corporeal biopsy can help predict postoperative results. Thirty-six patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction [IIEF] scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months postoperatively, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls. The mean age of the patients with ED was 32.1 +/- 8.6 years. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity, however, decreased from 11.0 cm/s to 5.1 cm/s [P=.023]. Only 2 patients had satisfactory penile rigidity after venous ligation. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had normal histologies, and 2 had a slight decrease of smooth muscle cell mass. Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy

Venous surgery in erectile dysfunction Therapeutic strategy and results

Fifty seven [57] patients with venogenic impotence -were treated from period of 1989 to 1993. Their corporal veno-occlusive functions was evaluated by dynamic infusion cavernosography and cavernosometery [DICC]. Patients were divided into two groups on the basis of the type of venous operation performed. Thirty [30] patients were subjected to dorsal vein ligation with resection of 1.5 cm of deep dorsal vein. While 27 patients were subjected to deep dorsal vein ligation plus ligation of the proximal parts of both corporae The overall success rate in both groups was [38.7%] [22 patients out of 57]. Success rate was more in patients with dorsal vein ligation plus spongiolysis than in patients with dorsal vein ligation plus ligation of crorae. Data obtained in our series suggest that venous surgery should only be offered to a selected group of patients comprising young impotent males with venous leakage