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1.
Autops. Case Rep ; 11: e2021330, 2021. graf
Article in English | LILACS | ID: biblio-1339242

ABSTRACT

Varix of the lower extremities is a common entity that eventually presents fatal outcome. Fatal massive bleeding due to rupture of a peripheral varicose vein is rare. The estimated incidence of these cases is 1/1000 autopsies. The case we present is unique among 26,054 autopsies performed in Milan from 1993 to 2020. It describes the investigations carried out in the suspicion of a non-natural event in an elderly woman. She was found dead at home with a large volume of blood near her feet that drained from the right leg. Pathological examination disclosed that the hemorrhage occurred by the rupture of a venous varix of the lower limb. Cases of fatal hemorrhage from peripheral variceal rupture are insidious and require proper characterization. The bloodstain pattern analysis, careful autopsy dissection by layers to demonstrate the rupture, and histologic examination of the lesion are the essential elements to find out the actual cause of death.


Subject(s)
Humans , Female , Aged, 80 and over , Varicose Veins/blood , Cause of Death , Hemorrhage/pathology , Rupture , Autopsy , Varicose Veins , Varicose Veins/pathology , Fatal Outcome , Dissection/methods
2.
Arq. ciências saúde UNIPAR ; 24(2): 113-116, maio-ago. 2020.
Article in Portuguese | LILACS | ID: biblio-1116374

ABSTRACT

O estudo da Anatomia Humana (AH) é parte integrante e de relevância inquestionável na graduação dos cursos da saúde. Com a constante redução na carga horária destinada à AH e diante dos debates sobre os novos métodos de ensino, o uso do código de quick response (código QR) se mostrou promissor. Nesse sentido, foi desenvolvido no Departamento de Anatomia da Universidade Estadual de Londrina (UEL) o processo de catalogação das estruturas anatômicas com o uso do código QR, sendo nosso objetivo relatar esta experiência. Neste processo, as estruturas dissecadas no Laboratório de Anatomia da UEL foram catalogadas com base em uma planilha contendo a correlação entre estruturas e números e, as informações de cada estrutura transcritas em um código QR através de um gerador eletrônico, sendo então impresso, plastificado e anexado à peça anatômica. As marcações foram realizadas por meio da sutura de etiquetas enumeradas. Dentro da discussão dos métodos alternativos de ensino há como exemplos a plastinação, a projeção em três dimensões e a prospecção. Em destaque neste relato, o uso do código QR mostrou-se como uma alternativa válida na agregação de conhecimento nos currículos acadêmicos. Por meio das atividades empreendidas no processo de catalogação, foi possível, além da aquisição de mais tempo dedicado ao conhecimento teórico-prático em AH, ampliar a independência no estudo e no desenvolvimento de pesquisas. Dessa forma, tem-se a oportunidade de se expandir as análises voltadas ao ensino da AH e aos novos métodos de aprendizado.


The study of human anatomy is a relevant part of the curriculum of health course graduation students. Given the constant reduction of hours destinated to the study of Anatomy and the debates regarding new teaching methods, the use of the Quick Response Code (QR code) has shown to be promising. Therefore, the Anatomy Department at the State University of Londrina (UEL) has developed a cataloging process concerning anatomical structures with the application of QR code, and this paper has the purpose of reporting on such experience. In the process, the structures dissected in UEL's Anatomy Laboratory were cataloged based on a spreadsheet which contained the correlation between these structures and numbers; the information regarding each structure was then transcribed into a QR code using a digital generator, with posterior printing, lamination and attachment to the body part. The labels were made by sewing the numbered tags onto the structures. Within the discussion regarding alternative teaching methods, examples can be given regarding lamination, three-dimension projection and prospection. The use of the QR code has proven to be a valid alternative in aggregating knowledge to academic curriculum. Through the activities performed in the process of cataloging, it was possible not only to dedicate more time to the theorical and practical learning of human anatomy, but also to increase the independence in studying and developing research. Furthermore, there is an opportunity to expand the analysis directed toward human anatomy teaching and toward new learning methods.


Subject(s)
Humans , Educational Technology/methods , Education, Medical, Undergraduate/methods , Anatomy/education , Locomotion , Musculoskeletal System/anatomy & histology , Teaching Materials , Educational Technology/instrumentation , Dissection/methods
3.
Arq. bras. oftalmol ; 83(2): 87-91, Mar.-Apr. 2020. tab
Article in English | LILACS | ID: biblio-1088975

ABSTRACT

ABSTRACT Purpose: The present study's aim was to compare the biomechanical properties of corneal tissue in patients who underwent deep anterior lamellar keratoplasty (DALK) surgery, with successful big bubble formation and manual lamellar dissection, during failed big bubble formation. Methods: This retrospective comparative study included 60 eyes from 60 keratoconus patients who previously underwent DALK surgery. These patients were categorized as big bubble (+) or big bubble (−) based on the success or failure of big bubble formation during the surgery. The big bubble (+) group included 42 eyes, while the big bubble (−) group had 18 eyes. Moreover, the patients were regrouped as 0.25 mm and 0.50 mm to evaluate the effects of the disparity between donor and trephine punches on the biomechanical properties of the cornea. These biomechanical properties, characterized by corneal hysteresis and the corneal resistance factor, were measured using the Ocular Response Analyzer 12 months after the surgery. Results: There was no statistically significant difference between the big bubble (+) and big bubble (−) groups in the biomechanical properties of the cornea (corneal hysteresis: 10.06, 10.25; p=0.716/corneal resistance factor: 10.15, 10.07; p=0.805, respectively). In addition, pachymetry results were not statistically different between the two groups. Multivariate regression analysis revealed that corneal hysteresis and corneal resistance factor were positively associated with central corneal thickness (p<0.001/r2=0.506; p<0.001/r2=0.561, respectively). However, the study did not demonstrate a relationship between any of the punch sizes and corneal hysteresis or between the punch sizes (p=0.673) and the corneal resistance factor (p=0.643). Conclusions: The corneal hysteresis and corneal resistance factor values were similar in big bubble and manual lamellar dissection after DALK. Thus, manual lamellar dissection was not a disadvantage considering the cornea's biomechanical properties.


RESUMO Objetivo: O objetivo do estudo foi comparar pa râmetros biomecânicos corneanos de pacientes com cirurgia de ceratoplastia lamelar anterior profunda com formação bem-sucedida de bolha e dissecção lamelar manual, frente à falha de formação da grande bolha. Métodos: Este estudo comparativo retrospectivo incluiu 60 olhos de 60 pacientes com ceratocone submetidos à cirurgia de ceratoplastia lamelar anterior profunda. Os pacientes foram agrupados como grande bolha (+) e grande bolha (-) de acordo com o sucesso da formação da grande bolha durante a cirurgia. O grupo grande bolha (+) incluiu 42 olhos, enquanto o grupo grande bolha (-) tinha 18 olhos. Além disso, para a avaliação dos efeitos da disparidade entre alterações individuais nas propriedades biomecânicas da córnea, reagrupamos os pacientes em 0,25 mm e 0,50 mm. Parâmetros biomecânicos da córnea, caracterizados por histerese corneana e fator de resistência corneana foram medidos com o ORA 12 meses após a cirurgia. Resultados: Não houve diferença estatisticamente significativa entre os grupos grande bolha (+) e grande bolha (-) em relação aos parâmetros biomecânicos da córnea (histerese corneana: 10,06, 10,25, p=0,716/fator de resistência da córnea: 10,15, 10,07, p=0,805, respectivamente). Além disso, os resultados de paquimetria não diferiram estatisticamente entre os dois grupos. A análise de regressão multivariada demonstrou que a histerese da córnea e o fator de resistência corneana estavam associados positivamente com a espessura corneana central (p<0,001/r2=0,506, p<0,001/r2=0,561 respectivamente). No entanto, o estudo não revelou associação entre qualquer um dos tamanhos de punção e histerese corneana, bem como entre os tamanhos de punção e o fator de resistência corneano (p=0,673, p=0,643). Conclusões: A histerese da córnea e os valores do fator de resistência da córnea foram comparáveis com formação de grande bolha e dissecção manual lamelar na ceratoplastia lamelar anterior profunda. Assim, a dissecção manual lamelar não foi uma desvantagem, considerando os fatores biomecânicos da córnea.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Corneal Transplantation/methods , Cornea/surgery , Keratoconus/surgery , Reference Values , Biomechanical Phenomena , Multivariate Analysis , Regression Analysis , Retrospective Studies , Treatment Outcome , Cornea/physiopathology , Dissection/methods , Keratoconus/physiopathology
5.
Rev. bras. cir. cardiovasc ; 34(6): 667-673, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057505

ABSTRACT

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Radial Artery/surgery , Tissue and Organ Harvesting/methods , Dissection/methods , Electrocoagulation/methods , Ultrasonic Surgical Procedures/methods , Postoperative Period , Coronary Artery Bypass/methods , Radial Artery/pathology , Intercellular Adhesion Molecule-1 , Postoperative Hemorrhage
7.
Rev. bras. oftalmol ; 78(4): 239-241, July-Aug. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1013682

ABSTRACT

Resumo Objetivo: O objetivo do presente estudo foi desenvolver uma metodologia que aproxime o discente do conteúdo abordado nas aulas de anatomia do globo ocular. Métodos: Foi realizada uma incisão circular na lâmina orbital do osso frontal de um cadáver humano de uma instituição em saúde e, para acessar as estruturas orbitárias, foram dissecadas as estruturas da área criando uma via para a injeção de uma solução de borracha de silicone branca entre o cristalino e a retina com posterior enucleação e dissecação final. Resultados: O emprego da técnica permitiu que os discentes do curso construíssem o conhecimento tátil do órgão em questão e transformando o saber teórico em prático, reconhecendo músculos, funcionalidade, vasos sanguíneos e estruturas oculares durante o procedimento de dissecação. Conclusão: A metodologia empregada no presente estudo é uma opção viável para o ensino da anatomia do olho.


Abstract Objective: The objective of the present study was to develop a methodology that approximates the student of the content addressed in the classes of anatomy of the eyeball. Methods: A circular incision was made in the orbital blade of the frontal bone of a human cadaver of a health institution and, to access the orbital structures, the area structures were dissected creating a pathway for the injection of a solution of white silicone rubber between the lens and the retina with subsequent enucleation and final dissection. Results: The use of the technique allowed the students of the course to construct the tactile knowledge of the organ in question and transform the theoretical knowledge into practice, recognizing muscles, functionality, blood vessels and ocular structures during the dissection procedure. Conclusion: The methodology used in the present study is a viable option for teaching the anatomy of the eye.


Subject(s)
Humans , Education, Medical, Undergraduate/methods , Eye/anatomy & histology , Anatomy/education , Ophthalmology/education , Silicone Elastomers , Students, Medical , Teaching , Cadaver , Dissection/education , Dissection/instrumentation , Dissection/methods
8.
Int. j. morphol ; 37(2): 533-540, June 2019. tab
Article in Spanish | LILACS | ID: biblio-1002255

ABSTRACT

Desde la antigüedad se han desarrollado técnicas para el estudio del cerebro con fines didácticos o neuroquirúrgicos. Hacia 1934 Josef Klingler desarrolla una técnica de preparación de hemisferios cerebrales que basada en la fijación con formalina y el congelamiento para aislar los tractos cerebrales. El objetivo de la presente artículo ha sido analizar los métodos de preparación utilizados para la disección de tractos en cerebros humanos y de animales. Se realizó una revisión de la literatura en las bases de datos Web of Science, Scopus, Pubmed, Medline y Scielo, utilizando como descriptores: Disección, Cerebro, Tracto, con el operador booleano "AND" entre ellos, en los idiomas inglés y español, hasta junio de 2018. Fueron seleccionados 26 documentos, para el análisis se determinaron las variables: espécimen, número de hemisferios cerebrales, concentración de formalina, tiempo de fijación, temperatura, tiempo de congelamiento y tractos identificados. En la literatura seleccionada, un total de 410 hemisferios cerebrales fueron analizados, 372 de humanos y 38 de animales; 330 fueron conservados en formalina al 10 %, 20 en formalina al 5 % y el resto en otras concentraciones. El tiempo de fijación fue variable entre 10 y 180 días, así como la temperatura y tiempo de congelación (-10 ºC y -20 ºC, entre 8 y 30 días). En todos los casos se reportó que, en su totalidad o parcialmente, los fascículos cerebrales de asociación fueron aislados. En la preparación de hemisferios cerebrales para disección de tractos, Ludwig & Klingler (1956) recomiendan que en la fijación de los especímenes se utilice formalina al 5 %, sin embargo, el 80 % de los hemisferios utilizados fueron fijados en formalina al 10%, y en esta concentración, el tiempo de fijación, temperatura y tiempo de congelación fue variable, lográndose, en todos los casos analizados, la disección parcial o total de los tractos.


Since ancient times, techniques for the study of the brain have been developed for didactic or neurosurgical purposes. By 1934, Josef Klingler developed a cerebral hemisphere preparation technique based on formalin fixation and freezing to isolate the cerebral tracts. The aim of this article was to analyze the preparation methods used for tracts dissection in human and animal brains. A review of the literature using Web of Science, Scopus, Pubmed, Medline and Scielo databases, with the following descriptors: Dissection, Brain, Tract, with the boolean operator "AND" among them, also in spanish, until June 2018. Twenty-six documents were selected, and we analized the following variables: specimen, number of cerebral hemispheres, formalin concentration, fixing time, temperature, freezing time and tracts. In the selected literature, a total of 410 cerebral hemispheres were analyzed, 372 from humans and 38 from animals; 330 were preserved in 10 % formalin, 20 in 5 % formalin and the rest in other concentrations. The fixation time was variable between 10 and 180 days, as well as the temperature and freezing time (-10 ºC and -20 ºC, between 8 and 30 days). In all cases it was reported that, in whole or in part, the cerebral fascicles of association were isolated. In the preparation of cerebral hemispheres for dissection of tracts, Klingler recommend that 5 % formalin for the fixation of specimens; however, 80 % of the hemispheres used were fixed in 10 % formalin, and in this concentration, the time of fixation, temperature and time of freezing was variable, achieving, in all the cases analyzed, the partial or total dissection of the tracts.


Subject(s)
Humans , Animals , Histocytological Preparation Techniques/methods , Dissection/methods , Cerebrum/anatomy & histology , Time Factors , Tissue Preservation/methods , Fixatives , Formaldehyde/chemistry , Freezing
9.
J. vasc. bras ; 17(4): 358-361, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-969252

ABSTRACT

This study reports on a rare variation of the right internal jugular vein (IJV) identified during routine anatomic dissection of a male cadaver. The right IJV had a tributary located parallel and medially to the IJV itself. This branch of the IJV emerged between the transverse processes of the 3rd and 4th cervical vertebrae and drained into the junction between the right internal jugular and brachiocephalic veins. The present study described a rare branch of the right IJV, which is important knowledge for surgeons, in order to prevent accidental injury and bleeding during surgical procedures


O presente estudo demonstrou uma variação rara da veia jugular interna direita (VJI), identificada durante uma dissecção de rotina de um cadáver masculino. A VJI direita apresentou uma tributária localizada paralelamente e medialmente à referida veia. Essa tributária da VJI emergiu entre os processos transversos das 3ª e 4ª vértebras cervicais e drenou para a junção entre as veias jugular interna e braquiocefálica direita. O conhecimento da variação anatômica demonstrado no presente estudo é importante para os cirurgiões, a fim de prevenir lesões acidentais e sangramento durante procedimentos cirúrgicos


Subject(s)
Humans , Male , Aged , Anatomy , Jugular Veins/anatomy & histology , Surgical Procedures, Operative/methods , Blood Vessels , Cervical Vertebrae/anatomy & histology , Dissection/methods
10.
Int. j. morphol ; 36(3): 821-828, Sept. 2018. graf
Article in Spanish | LILACS | ID: biblio-954192

ABSTRACT

El uso de recursos tecnológicos como material de apoyo en la docencia de anatomía humana tiene antecedentes históricos en Chile desde el siglo 19, con la llegada del primer modelo anatómico artificial. En conjunto con las tradicionales clases magistrales y lectura de los textos clásicos sobre la materia, durante los trabajos prácticos se presentaba al estudiante una serie de contenidos estrictamente anatómicos que posteriormente serían evaluados. Esta metodología de enseñanza se mantuvo hasta muy avanzado el siglo 20. Posteriormente con los avances en tecnología médica de las últimas décadas incorporados a la práctica clínica habitual, también debieron integrarse conocimientos sobre las estructuras anatómicas, en cuanto a su representación en los exámenes obtenidos mediante técnicas de imágenes médicas. Por esta razón para la formación de las nuevas generaciones de médicos, se han debido actualizar paulatinamente; la literatura básica integrando a ella contenidos clínicos, la metodología docente haciéndola participativa hacia el estudiante y en el último tiempo los materiales para trabajos prácticos, de manera que se logre un aprendizaje duradero, cuyos contenidos sean utilizados posteriormente en otras asignaturas básicas y clínicas. Previo a iniciar las actividades docentes en el laboratorio de anatomía de la nueva Escuela de Medicina de la Universidad de Tarapacá, Chile, la institución adquirió material de apoyo docente de última generación para complementar la enseñanza en los trabajos prácticos de anatomía. En este artículo se describirá la implementación de los nuevos recursos tecnológicos de apoyo docente en anatomía para nuestra escuela de medicina, entre los cuales se encuentran: modelos anatómicos impresos en tres dimensiones (3D) Erler-Zimmer®, cadáver humano sintético Syndaver®, mesa de disección digital 3D SECTRA® y su estación de trabajo complementaria. Todos estos materiales se unieron al uso de otros recursos tradicionales en la enseñanza de esta disciplina, para entregar los contenidos de la anatomía con un enfoque combinado.


The use of technological resources as assisting material in the teaching of human anatomy has been referenced in Chile since the 19th century with the first artificial anatomical model. In conjunction with traditional lectures and classical texts on the subject during practical work, the student was presented with a series of strictly anatomical contents that would later be evaluated. This teaching methodology was maintained until well into the 20th century. Subsequently, medical technology progress and innovation was integrated in clinical practice over the last decades. Further, knowledge of anatomical structures, in terms of their representation in exams obtained through medical imaging techniques was also consolidated. For this reason for the education of the new generations of medical doctors, a gradual update was required. These included basic clinical content literature, a teaching methodology with student participation, and use of materials for practical work to achieve learning techniques that would be useful in later courses. Prior to the beginning of the school year, the School of Medicine of the Universidad de Tarapacá acquired state of the art material to complement teaching in practical anatomy work for its anatomy laboratory. This article describes implementation of the new technological resources for educational support in anatomy for our school of medicine, among these are: anatomical models printed in three dimensions (3D) Erler-Zimmer®, synthetic human cadaver Syndaver®, SECTRA® 3D digital dissection table and complementary workstation. All of this material will be used in conjunction with other traditional resources when teaching anatomy, so as to provide an overall view of the contents in this subject area.


Subject(s)
Humans , Students, Medical/psychology , Imaging, Three-Dimensional , Anatomy/education , Models, Anatomic , Teaching , Surveys and Questionnaires , Dissection/methods , Printing, Three-Dimensional
11.
Int. j. cardiovasc. sci. (Impr.) ; 31(5)set.-out. 2018. graf
Article in English | LILACS | ID: biblio-914706

ABSTRACT

Background: The aortic arch diseases exhibit high morbidity and mortality rates. Some surgical strategies recommend partial preservation of the aortic arch and the supra-aortic vessels, but the immediate and mediumterm mortality rates of patients undergoing this surgical strategy is uncertain. Objectives: To compare overall mortality and mid- term survival curve of patients undergoing surgical strategy of partial preservation of the aortic arch and supra-aortic vessels (group A) compared to conventional strategies of the aortic arch approach (group B); to assess cardiovascular mortality over time. Methods: Descriptive and retrospective study of the medical records of patients undergoing aortic arch repair surgery between February 2000 and July 2013. We analyzed 111 patients, 29 in group A and 82 in group B. The overall survival and survival from cardiovascular events were assessed by Kaplan-Meier test. Results: In- hospital mortality from any cause was 31% in group A and 29.3% in group B. At 1 year, 2 year, and 5 year general survival was similar between the groups. In-hospital, 2 years and 5 years mortality from cardiovascular causes was 13.8%, 14.8%, e 22.7% in group A and 26.8%, 34.6% e 50.9% in group B. The difference between the groups in 5 years showed statistical significance (p = 0.0234). Survival from cardiovascular causes in 2 years and 5 years was 85.2% and 77,3% in group A and 65.4% and 49,1% in group B. Occurrence of urgent and emergency procedures were greater in group A, but without statistical significance. Conclusions: There was no difference in all-cause mortality over time between the groups. Group A showed lower cardiovascular mortality at 5 years than group B


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aorta, Thoracic/physiopathology , Aorta, Thoracic/surgery , Aortic Aneurysm/surgery , Mortality , Survivorship , Cardiovascular Diseases/mortality , Continuity of Patient Care , Data Collection/methods , Dissection/methods , Hemorrhage/complications , Prostheses and Implants , Retrospective Studies , Risk Factors , Statistical Analysis , Surgical Procedures, Operative , Surveys and Questionnaires
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 254-259, jul.-ago. 2018. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-916417

ABSTRACT

As situações clínicas de aumento súbito da pressão arterial (PA) que caracterizam as crises hipertensivas são comuns na prática clínica, principalmente nas consultas realiza-das no pronto atendimento, portanto, o diagnóstico adequado é essencial para o melhor tratamento e desfecho clínico. A crise hipertensiva é definida pelo aumento súbito na PA (≥180 /120 mmHg) e a necessidade da redução agressiva da PA depende da gravidade da situação clinica associada. A presença de lesões novas ou progressivas em órgãos-alvo e risco iminente de morte definem as emergências hipertensivas que requerem tratamento imediato visando a rápida redução da pressão arterial, porém, não, necessariamente, a níveis normais. Na maioria dos casos, a velocidade do aumento da PA é mais importante que o nível real da PA, portanto, é fundamental que haja avaliação clínica para o diagnóstico preciso dessas condições clínicas, as quais incluem encefalopatia hipertensiva, síndromes coronarianas agudas, edema agudo dos pulmões, acidente vascular cerebral, dissecção de aorta e eclampsia. As metas para diminuição da PA para as emergências hipertensivas, de acordo com o órgão-alvo envolvido, são revisadas pelas atuais diretrizes brasileiras e ame-ricanas de hipertensão. O tratamento das emergências hipertensivas inclui vasodilatadores de ação direta e bloqueadores adrenérgicos já consagrados, entretanto, evidências recentes mostram o benefício do uso de novos fármacos ainda não disponíveis em nosso meio


The clinical conditions of an acute rise in blood pressure (BP) that characterize hyperten-sive crises are common in clinical practice, particularly in consultations that take place in the emergency room. Therefore the correct diagnosis is important for the best treatment and clinical outcome. Hypertensive crisis is defined as a sudden rise in BP (≥ 180/120 mmHg), and the need for aggressive reduction of BP depends on the severity of the associated clinical situation. The presence of new or progressive target organ injury and imminent risk of death define hypertensive emergencies requiring immediate treatment aimed at rapid reduction of blood pressure, not ne-cessarily to normal levels. In most cases, the speed of the rise in BP is more important than the actual level of BP, and clinical evaluation is essential for the accurate diagnosis of these clinical conditions, which include hypertensive encephalopathy, acute coronary syndromes, pulmonary edema, stroke, aortic dissection, and eclampsia. The goals of BP reduction for hypertensive emergencies, according to the target organ involved, have been reviewed by the current Brazi-lian and American guidelines on hypertension. Treatment of hypertensive emergencies includes direct action vasodilators and adrenergic blockers, which are already well established, but recent evidence shows the benefit of the use of new drugs, not yet available in Brazil


Subject(s)
Humans , Male , Female , Risk Factors , Hypertension/diagnosis , Hypertension/therapy , Aorta , Vasodilator Agents/therapeutic use , Nitroprusside/therapeutic use , Echocardiography/methods , Cardiovascular Diseases/physiopathology , Clonidine/therapeutic use , Guidelines as Topic/standards , Stroke , Target Organs , Dissection/methods , Electrocardiography/methods , Acute Coronary Syndrome/complications , Antihypertensive Agents/therapeutic use
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 260-266, jul.-ago. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-916420

ABSTRACT

A dissecção da aorta é uma condição grave cujo diagnóstico preciso precoce é fun-damental para a sobrevida dos pacientes. Dentro do contexto da dor torácica aguda no setor de emergência, seu diagnóstico pode passar despercebido, o que exige um alto índice de suspeição para ser realizado em tempo hábil. A disponibilidade dos métodos de imagem têm contribuído para a prontidão desse diagnóstico. Os objetivos iniciais do tratamento consistem no controle da dor e da pressão arterial através, principalmente, do uso de betabloqueadores endovenosos. Tais medidas diminuem o stress na parede da aorta, minimizando a propagação da delaminação. A identificação da localização do segmento de aorta dissecado é crucial, pois impacta no tratamento e no prognóstico. Pacientes com dissecção tipo B de Stanford e sem complicações podem receber trata-mento medicamentoso exclusivo, enquanto que a dissecção aguda tipo A de Stanford é uma emergência cirúrgica. Em relação à cirurgia, têm-se discutido o benefício da técnica do Frozen Elephant Trunk, a qual corrige uma maior extensão de aorta comprometida, po-dendo beneficiar pacientes com isquemia distal, apesar de apresentar maior complexidade e aumentar o risco de complicações neurológicas. Para as dissecções tipo B, o reparo endovascular tem sido amplamente utilizado e vários especialistas têm sugerido essa abordagem também para os casos não complicados, pois estudos recentes descrevem a influência do tratamento no remodelamento aórtico e, consequentemente, na sobrevida


Aortic dissection is a dramatic condition whose early accurate diagnosis is fundamen-tal for patient survival. Within the context of acute chest pain in the emergency room, its diagnosis can be overlooked, requiring a high level of suspicion to be performed in a timely manner. The availability of imaging methods has contributed to a faster diagnosis. The initial management goal is to control pain and blood pressure, mainly through the use of intra-venous beta-blockers. This strategy decreases shear stress on the aortic wall, minimizing the progression of delamination. Identifying the location of the dissected aortic segment is crucial, as this will impact on the treatment and prognosis. Patients with uncomplicated Stanford type B dissection may receive pharmaceutical treatment alone, while acute type A dissection is a surgical emergency. In relation to surgery, the benefit of the "Frozen Ele-phant Trunk" technique has been discussed, which corrects a greater area of compromised aorta and may benefit patients with distal ischemia, despite adding greater complexity and increasing the risk of neurological complications. For type B dissections, endovascular repair has been widely used, and several experts have also suggested this approach for uncomplicated cases, as recent studies have described the influence of the treatment on aortic remodeling and consequently, on survival


Subject(s)
Humans , Male , Female , Aorta , Dissection/methods , Aneurysm, Dissecting/diagnosis , Aneurysm, Dissecting/physiopathology , Aortic Diseases , Prognosis , Chest Pain/complications , Diagnostic Imaging/methods , Tomography/methods , Risk Factors , Echocardiography, Transesophageal/methods , Endovascular Procedures/methods , Hypertension/therapy , Obesity
14.
J. vasc. bras ; 17(3)jul.-set. 2018.
Article in Portuguese | LILACS | ID: biblio-915848

ABSTRACT

A fístula arteriovenosa (FAV) é uma comunicação anormal e permanente entre uma artéria e uma veia devido a traumas penetrantes e lesões iatrogênicas. O trauma penetrante na parede arterial pode levar à formação de pseudoaneurismas (PSA) e, se houver lesão venosa concomitante, à formação de uma FAV. Os autores apresentam o caso de um paciente portador de FAV complexa de vasos poplíteos associada a pseudoaneurisma de artéria poplítea, sugeridos a partir de exames clínicos e exames de imagem, e tratados por cirurgia convencional devido à indisponibilidade de um stent graft com diâmetro apropriado, além de a cirurgia endovascular não estar disponível no serviço em que o paciente foi operado


An arteriovenous fistula (AVF) is an abnormal and permanent communication between an artery and a vein caused by penetrating traumas or iatrogenic injuries. A penetrating trauma to the endothelial wall can lead to formation of pseudoaneurysms (PSA) and to formation of an AVF. Here, the authors present the case of a patient with a complex AVF of popliteal vessels, associated with popliteal artery pseudoaneurysm, suggested by clinical features and imaging exams, and treated with conventional surgery due to unavailability of a stent graft with appropriate diameter and because endovascular surgery isn't provided at the service where this patient was operated


Subject(s)
Humans , Male , Middle Aged , Aneurysm, False/surgery , Aneurysm, False/therapy , Arteriovenous Fistula/surgery , Arteriovenous Fistula/therapy , Popliteal Artery , Angiography/methods , Dissection/methods , Endovascular Procedures/methods , Lower Extremity , Popliteal Vein , Risk Factors , Surgical Procedures, Operative/methods , Tomography/methods , Wounds and Injuries/complications , Wounds and Injuries/diagnosis
15.
J. vasc. bras ; 17(2): 152-155, abr.jun.2018.
Article in Portuguese | LILACS | ID: biblio-910804

ABSTRACT

O aneurisma verdadeiro da artéria dorsal do pé é um achado médico raro, e suas principais causas e manifestações clinicas são pouco conhecidas. Paciente do sexo feminino, 49 anos de idade, apresentou-se com uma massa pulsátil no dorso do pé direito. O exame clínico e a imagem ultrassonográfica confirmaram o diagnóstico de um aneurisma. O aneurisma foi ressecado após dissecação, exposição e isolamento dos cotos proximal e distal da artéria dorsal do pé. A ligadura simples e a ressecção do aneurisma vêm se mostrando um tratamento seguro quando o arco plantar se mantém pérvio.


A true aneurysm of the dorsal artery of the foot is a rare medical finding and its principal causes and clinical manifestations are not well known. A 49-year-old female patient presented with a pulsatile mass on the dorsal part of her right foot. Clinical and ultrasound examinations confirmed a diagnosis of aneurysm. The aneurysm was resected after dissection, exposure and isolation of the proximal and distal stumps of the dorsalis pedis artery. Simple ligature and resection of the aneurysm is proving to be a safe treatment option in patients with a patent plantar arch.


Subject(s)
Humans , Female , Middle Aged , Aneurysm/diagnostic imaging , Aneurysm/surgery , Tibial Arteries/surgery , Vascular Surgical Procedures/rehabilitation , Dissection/methods
16.
J. coloproctol. (Rio J., Impr.) ; 37(4): 332-335, Oct.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-894000

ABSTRACT

ABSTRACT Background: Combined abdominal and transvaginal anterior perineal approaches have been used as an alternative surgical method for the surgical treatment of the lower rectal cancer. The main aim of this paper is to describe the surgical stages of the combined abdominal and transvaginal approaches performed for lower rectal cancer, especially in transvaginal anterior perineal stage. Method: We have performed sphincter-saving surgical operations by using transvaginal anterior perineal access by combining with the abdominal access in four female patients who had lower rectal cancer. Results: Sphincter-saving extrasphincteric dissection and proximal segmental sphincteric excision techniques were performed in four female patients operated with combined abdominal and transvaginal anterior perineal approach. All patients were found to have continence. Postoperatively, one patient was converted to abdominoperineal rectal amputation due to the detected distal resection margin positivity. Conclusion: Transvaginal anterior perineal access provides the extrasphincteric rectal dissection possibility in the ischioanal fossa. Therefore, the combined abdominal and transvaginal anterior perineal approaches have been based on the different anatomical and surgical features when compared to intersphincteric dissection technique which is the most common used surgical procedure in lower rectal cancer surgery.


RESUMO Introdução: Uma combinação de abordagens abdominal e perineal anterior transvaginal tem sido empregada como método cirúrgico alternativo para o tratamento cirúrgico do câncer de reto baixo. O principal objetivo do presente artigo é a descrição dos estágios cirúrgicos das abordagens abdominal e transvaginal combinadas realizadas para câncer de reto baixo, especialmente no estágio perineal anterior transvaginal. Método: Realizamos operações cirúrgicas com preservação de esfíncter com o uso do acesso perineal anterior transvaginal, em combinação com o acesso abdominal, em quatro pacientes mulheres portadoras de câncer de reto baixo. Resultados: Realizamos técnicas de dissecção extra-esfincteriana e de excisão esfincteriana segmental proximal com preservação de esfíncter em quatro pacientes operadas com uma combinação de abordagens abdominal e perineal anterior transvaginal. Todas as pacientes estavam continentes. Em uma paciente, houve necessidade de conversão para amputação retal abdominoperineal, por ter sido detectada, no pós-operatório, positividade na margem de ressecção distal. Conclusão: O acesso perineal anterior transvaginal torna possível a dissecção retal extra-esfincteriana na fossa isquioanal. Portanto, as abordagens combinadas abdominal e perineal anterior transvaginal se baseiam em diferentes características anatômicas e cirúrgicas, em comparação com a técnica de dissecção interesfincteriana, que é o procedimento cirúrgico de uso mais comum na cirurgia para câncer de reto baixo.


Subject(s)
Humans , Female , Anal Canal/surgery , Rectal Neoplasms/complications , Colorectal Surgery/methods , Dissection/methods
17.
J. vasc. bras ; 16(4): f:270-l:275, out.-dez. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-880665

ABSTRACT

Contexto: Úlceras são a resultante final de varizes associadas a refluxo de veias safenas. Objetivo: Demonstrar a possibilidade de associar dois procedimentos, a escleroterapia com espuma de veias safenas e o enxerto de pele parcial, para o tratamento de pacientes com úlceras venosas relacionadas a refluxo de veias safenas. Métodos: Foram tratados 20 membros em 20 pacientes, todos com ulcerações relacionadas a refluxo de veias safenas. Realizamos o enxerto de pele expandida, seguido da escleroterapia ecoguiada com espuma de polidocanol nas veias associadas às úlceras, através de punção ou dissecção da veia. Resultados: Em todos os casos, houve melhora dos sintomas relacionados à úlcera e cicatrização da lesão. Em 11 casos, obtivemos a viabilidade do enxerto de pele por completo; em quatro casos, houve cicatrização de cerca de 50% da lesão; e nos cinco casos restantes, houve cicatrização de aproximadamente 75% da lesão. A primeira ultrassonografia de controle revelou esclerose completa dos vasos tratados em 19 dos 20 casos e esclerose parcial sem refluxo detectável em um caso. Na segunda ultrassonografia, realizada após 45 dias, observamos esclerose completa de 15 casos; em cinco casos, houve esclerose parcial, dos quais três sem refluxo detectável e dois com refluxo em segmentos isolados associados a varizes. A complicação mais frequente foi a pigmentação nos trajetos venosos, observada em 13 pacientes. Um caso apresentou trombose assintomática de veias musculares da perna. Conclusão: Essa associação de procedimentos consiste em uma opção válida com potencial para promover um tratamento mais breve e de menor custo


Background: Ulcers are the end result of varicose veins associated with reflux in saphenous veins. Objective: To demonstrate the possibility of combining two procedures, foam sclerotherapy of saphenous veins and skin grafting, to treat patients with venous ulcers related to reflux in saphenous vein. Methods: 20 limbs were treated in 20 patients. All patients had ulcers related to saphenous vein reflux. We performed the grafting with expanded skin, followed by administration of ultrasound guided polidocanol foam sclerotherapy in veins associated with ulcers, accessed by puncture or dissection of the vein. Results: In all cases there was improvement of ulcer-related symptoms and healing of the lesion. In 11 cases we achieved full skin grafting viability. In four cases there was healing of about 50% of the lesion and in the other five cases approximately 75% of the lesion healed. The first control ultrasonographic examination revealed complete sclerosis of the vessels treated in 19 of 20 cases, with partial sclerosis in one case, but no detectable reflux. The second ultrasonographic examination performed at 45 days showed complete sclerosis in 15 cases. In five cases there was partial sclerosis, without detectable reflux in three and with reflux in isolated segments associated with varicose veins in two. The most common complication was pigmentation along vein paths, observed in 13 patients. In one case there was asymptomatic thrombosis of muscle veins of the leg. Conclusion: This combination of procedures is a valid option, with the potential to provide quicker and less expensive treatment


Subject(s)
Humans , Male , Female , Saphenous Vein/surgery , Sclerotherapy/methods , Skin Transplantation/methods , Varicose Ulcer/therapy , Dissection/methods , Leg Ulcer/therapy , Lower Extremity/surgery , Treatment Outcome , Varicose Veins/therapy
18.
J. vasc. bras ; 16(3): f:248-l:251, jul.-set. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-877046

ABSTRACT

The subscapular, anterior circumflex, and posterior circumflex arteries arise from the third part of the axillary artery. During dissection of the right upper limb of the cadaver of a 70-year-old male, a common trunk was observed arising from the third part of the axillary artery which, after traveling for 0.5 cm, bifurcated into subscapular and posterior circumflex humeral arteries. The common trunk was crossed anteriorly by the radial nerve. The medial nerve was formed by medial and lateral roots on the medial side of the third part of the axillary artery, remaining medial to the brachial artery up to the cubital fossa and then following its usual course thereafter. Awareness of the vascular variations observed in the present case is important when conducting surgical procedures in the axilla, for radiologists interpreting angiographs, and for anatomy-pathologists studying rare findings


As artérias subescapular, circunflexa anterior e circunflexa posterior se originam da terceira parte da artéria axilar. Durante a dissecção de membro superior direito de um cadáver humano com 70 anos de idade, do sexo masculino, um tronco comum foi observado originando-se da terceira parte da artéria axilar, após um percurso de 0,5 cm, bifurcando-se em artéria subescapular e artéria circunflexa posterior do húmero. O tronco comum era cruzado anteriormente pelo nervo radial. O nervo medial era formado por raízes medial e lateral, no lado medial da terceira parte da artéria axilar, permanecendo em posição medial à artéria braquial até a fossa cubital e seguindo seu curso usual a partir de então. Conhecimento das variações vasculares observadas neste caso é importante ao executar procedimentos cirúrgicos na axila, para radiologistas que interpretam radiografias, e também para anatomo-patologistas que estudam achados raros


Subject(s)
Humans , Male , Aged , Axillary Artery/physiology , Humerus/physiology , Rotator Cuff , Arteries/physiology , Dissection/methods , Pectoralis Muscles/physiology , Radial Nerve
19.
J. vasc. bras ; 16(3): f:252-l:257, jul.-set. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-877049

ABSTRACT

O complexo tratamento de dissecção da aorta ainda apresenta controvérsias devido à gravidade do caso e à necessidade de individualização da terapêutica. A gravidade relaciona-se ao difícil diagnóstico pelas queixas inespecíficas e pelas graves complicações inerentes à evolução da doença (ruptura aórtica, síndrome de má perfusão, dissecção retrógrada, dor ou hipertensão refratária). Este relato apresenta um homem de 61 anos, tabagista e hipertenso mal controlado, que evoluiu para dissecção aórtica de tipo B de Stanford. Foi abordado através de técnica endovascular com uso de endoprótese com stent para tratamento do caso após falha do tratamento medicamentoso. O tratamento endovascular mostrou-se uma ferramenta eficaz para o tratamento definitivo, com boa taxa de sobrevida ao final do primeiro ano após o procedimento


Complex treatment of aortic dissection is still a controversial subject because of the severity of these cases and the need to treat on a case-by-case basis. Severity is related to the difficulty of diagnosis caused by nonspecific complaints and by the serious complications inherent to disease progression (aortic rupture, hypoperfusion syndrome, retrograde dissection, refractory hypertension or pain). This article reports the case of a 61-year-old male smoker with poorly controlled hypertension who suffered a Stanford type B aortic dissection. After drug-based treatment failed, the patient was treated using endovascular techniques to place an endoprosthesis with stenting. Endovascular treatment is proving to be an effective tool for definitive treatment, with a good survival rate at the end of the first year after the procedure


Subject(s)
Humans , Male , Middle Aged , Aortic Valve/surgery , Dissection/methods , Chest Pain/complications , Computed Tomography Angiography/methods , Femoral Artery/surgery , Risk Factors
20.
J. vasc. bras ; 16(3): f:258-l:261, jul.-set. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-877057

ABSTRACT

The testicular artery is frequently subjected to radiographic imaging techniques such as angiography for diagnosis and treatment of conditions like epididymitis, testicular torsion, tumor, hematoma, and hydrocele and in cases of undescended testis. Radiologists and surgeons should therefore be aware of testicular artery variants. Although there are numerous studies and case reports that mention testicular artery variants, this is probably the first case, reporting a bilateral low origin of the testicular artery and discussing its probable embryological etiology


A artéria testicular é frequentemente examinada por técnicas de imagem como angiografia, para o diagnóstico e tratamento de condições como epididimite, torsão testicular, tumor, hematoma e hidrocele, e também em casos de criptorquidia. Sendo assim, radiologistas e cirurgiões devem estar cientes de variantes anatômicas da artéria testicular. Embora numerosos estudos e relatos de caso mencionem variantes da artéria testicular, este provavelmente é o primeiro caso a descrever origem bilateral baixa da artéria testicular e a discutir sua provável etiologia embriológica


Subject(s)
Humans , Male , Middle Aged , Diagnostic Imaging , Testis/diagnostic imaging , Abdominal Wall/physiology , Arteries , Dissection/methods
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