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1.
Rev. baiana saúde pública ; 45(3,supl.n.esp): 39-47, 28 dec. 2021.
Article in English | LILACS | ID: biblio-1352323

ABSTRACT

Hyperbaric Oxygen Therapy (HBOT) assumes that high pressure hyperoxygenation causes faster tissue recovery and wound healing. Lower extremity flow rates are affected by leg ulcers that change vasodilation, microcirculation resistance, and local tissue demands; how blood hyper oxygenation influences these factors is still unclear. Peripheral arterial occlusive disease (PAOD) has been mostly associated with HBOT results in the femoral artery than in other arteries. Common femoral artery (CFA) peak systolic velocities (PSV), measured pre and post HBOT, were analyzed to research HBOT hemodynamics. Sixteen patients with leg ulcers who were 65 ± 11 (SD) (38-87) years-old, had HBOT of 90 minutes at 2.6 ATA. Bilateral CFA Doppler velocity waveforms were recorded immediately pre and post HBOT. Ulcerated vs non-ulcerated peak systolic velocity (PSV) data were compared using paired t-test. CFA PSV were significantly equal in the ulcerated and non-ulcerated extremities before HBOT: 114 ± 35 (SD) cm/s vs 116 ± 41 cm/s (p = 0.87 by paired t-test). CFA PSV in the ulcerated extremity increased to 122 ± 35 cm/s after HBOT but were statistically insignificant (p =.19 by one-tailed paired t-test). On the other hand, CFA PSV decreased to 103 ± 28 cm/s (p =.049 by one-tailed paired t-test) in the non-ulcerated extremity and were significantly lower after HBOT, with 103 ± 28 cm/s vs 122 ± 35 cm/s for the ulcerated limb (p =.02 by paired t-test). Blood velocity responses post HBOT showed differences between ulcerated vs non-ulcerated extremities. The non-ulcerated extremity apparently responded to oxygenation more than the ulcerated extremity. Such observation suggests further research on hemodynamic reactions caused by HBOT.


A oxigenoterapia hiperbárica (HbOT) assume que a oxigenação de alta pressão resulta em mais celeridade na recuperação do tecido e na cicatrização de feridas. As taxas de fluxo nas extremidades inferiores são afetadas por úlceras nas pernas que alteram a vasodilatação, a resistência da microcirculação e as demandas locais de tecido; esses fatores podem ser influenciados pela hiperoxigenação sanguínea de maneiras ainda não claramente compreendidas. A doença arterial oclusiva periférica femoral (DAOP) tem sido associada a melhores resultados de HBOT quando comparada a outras artérias. As velocidades sistólicas de pico (PSV) da artéria femoral comum (CFA) medidas antes e depois da HBOT foram analisadas como parte de um projeto de pesquisa da hemodinâmica da HBOT. Dezesseis pacientes com úlceras de perna, com idade 65 ± 11 (DP), 38-87 anos, realizaram HBOT com duração de 90 minutos a 2,6 ATA. As formas de onda de velocidade do Doppler CFA bilateral foram registradas imediatamente antes e depois da HBOT. Os dados de PSV ulcerado vs. não ulcerado foram comparados usando o teste t pareado. Pre HBOT CFA PSV não foi significativamente diferente nas extremidades ulceradas e não ulceradas: 114 ± 35 (DP) cm/s vs 116 ± 41 cm/s (p = 0,87 pelo teste t pareado). O PSV pós HbOT CFA na extremidade ulcerada aumentou para 122 ± 35 cm/s, mas não atingiu significância estatística (p = 0,19 pelo teste t pareado unicaudal). Em contraste, CFA PSV na extremidade não ulcerada diminuiu para 103 ± 28 cm/s (p = 0,049 pelo teste t pareado unicaudal). O pós-HbOT CFA PSV foi significativamente menor no membro não ulcerado, 103 ± 28 cm/s vs 122 ± 35 cm/s para o membro ulcerado (p = 0,02 pelo teste t pareado). As respostas da velocidade do sangue após HbOT mostraram diferenças entre as extremidades ulceradas e não ulceradas. Aparentemente, a extremidade não ulcerada respondeu mais significativamente à oxigenação do que a extremidade ulcerada. Tal observação sugere pesquisas adicionais sobre as reações hemodinâmicas decorrentes da HbOT.


La terapia de oxígeno hiperbárico (HbOT) asume que la hiperoxigenación a alta presión da como resultado una recuperación más rápida de los tejidos y una cicatrización de heridas. Las tasas de flujo de las extremidades inferiores se ven afectadas por úlceras en las piernas que alteran la vasodilatación, la resistencia de la microcirculación y las demandas de los tejidos locales; estos factores pueden verse influenciados por la hiperoxigenación de la sangre, de formas que aún no se han entendido con claridad. La enfermedad oclusiva arterial periférica femoral (PAOD) se ha relacionado con los mejores resultados de HbOT que otras arterias. Las velocidades sistólicas máximas (PSV) de la arteria femoral común (CFA) medidas antes y después de la HbOT se analizaron como parte de un proyecto para investigar la hemodinámica de la HbOT. Dieciséis pacientes con úlceras en pierna, 65 ± 11 (DE) (38-87) años, 12 hombres, 11 diabéticos, tenían HbOT de 90 minutos a 2,6 ATA. Se registraron formas de onda de velocidad de CFA Doppler bilaterales inmediatamente antes y después de la HbOT. Se compararon los datos de la velocidad sistólica máxima (PSV) ulcerada frente a la no ulcerada mediante la prueba t pareada. Pre HbOT CFA PSV no fue significativamente diferente en las extremidades ulceradas y no ulceradas: 114 ± 35 (DE) cm/s vs 116 ± 41 cm/s (p = 0,87 por prueba t pareada). Post HbOT CFA PSV en la extremidad ulcerada aumentó a 122 ± 35 cm/s pero no alcanzó significación estadística (p =.19 por prueba t unilateral pareada). En contraste, CFA PSV en la extremidad no ulcerada disminuyó a 103 ± 28 cm/s (p =.049 por prueba t unilateral pareada). El PSV después de la HbOT CFA fue significativamente menor en la extremidad no ulcerada, 103 ± 28 cm/s frente a 122 ± 35 cm/s para la extremidad ulcerada (p = 0,02 según la prueba t pareada). Las respuestas de velocidad sanguínea post HbOT mostraron diferencias entre las extremidades ulceradas y no ulceradas. Aparentemente, la extremidad no ulcerada respondió más significativamente a la oxigenación que la extremidad ulcerada. Tal observación sugiere una mayor investigación sobre las reacciones hemodinámicas debidas a la HbOT.


Subject(s)
Femoral Artery , Hyperbaric Oxygenation , Leg , Leg Ulcer
2.
Säo Paulo med. j ; 139(5): 424-434, May 2021. tab, graf
Article in English | LILACS | ID: biblio-1290254

ABSTRACT

ABSTRACT BACKGROUND: Leg length discrepancy (LLD) may play a key role in exercise biomechanics. Although the Podoprint platform has been used in dynamic pressure studies, there are no data regarding the reliability and repeatability of dynamic measurements under simulated LLD conditions. OBJECTIVES: To determine the intra and intersession repeatability and reliability of dynamic parameters of the Podoprint pressure platform under simulated LLD conditions. DESIGN AND SETTING: Observational cross-sectional study at a public university. METHODS: Thirty-seven healthy volunteers participated in this study. LLD was simulated using ethyl vinyl acetate plantar lifts with heights of 5 mm, 10 mm, 15 mm and 20 mm located under the right shoe of each volunteer. The procedure was performed to capture the dynamic parameters of each participant under five different simulated LLD conditions. Stance time, mean pressure and peak pressure measurements were registered in three trials for each foot and each LLD level. Data were collected during two separate testing sessions, in order to establish intrasession and intersession reliability. RESULTS: The intraclass correlation coefficients (ICCs) for intrasession reliability ranged from 0.775 to 0.983 in the first session and from 0.860 to 0.985 in the second session. The ICCs for intersession reliability ranged from 0.909 to 0.990. Bland-Altman plots showed absence of systematic measurement errors. CONCLUSIONS: The results from this study indicate that the Podoprint platform is a reliable system for assessing dynamic parameters under simulated LLD conditions. Future studies should evaluate plantar pressures under LLD conditions, in association with exercise, biomechanics and musculoskeletal disorders.


Subject(s)
Humans , Foot , Leg , Exercise , Cross-Sectional Studies , Reproducibility of Results
4.
Article in Chinese | WPRIM | ID: wpr-888330

ABSTRACT

OBJECTIVE@#To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA).@*METHODS@#Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, 0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant (@*CONCLUSION@#High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Female , Femur/surgery , Humans , Leg , Leg Length Inequality/etiology , Male , Middle Aged , Retrospective Studies
5.
Article in Chinese | WPRIM | ID: wpr-921544

ABSTRACT

With the wide application of vascular Doppler ultrasound as well as the improvement of instrument precision and personnel operation practice,calf muscular venous thrombosis(CMVT)has been more and more frequently diagnosed among patients,becoming a common clinical disease.However,it is controversial about the anticoagulant therapy for CMVT patients.In this article,we summarize the current research progress of anticoagulation therapy,aiming to provide reference for the treatment of CMVT.


Subject(s)
Anticoagulants/therapeutic use , Humans , Leg , Muscle, Skeletal , Pulmonary Embolism , Venous Thrombosis/drug therapy
6.
Article in English | WPRIM | ID: wpr-921341

ABSTRACT

Objective@#To evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults.@*Methods@#Totally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment.@*Results@#The prevalence of cognitive impairment was 34.36%. The adjusted odds ratio ( @*Conclusion@#Sarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.


Subject(s)
Aged , Aged, 80 and over , China/epidemiology , Cognitive Dysfunction/etiology , Female , Hand Strength , Humans , Leg/anatomy & histology , Logistic Models , Male , Sarcopenia/pathology
7.
J. vasc. bras ; 20: e20200197, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1287088

ABSTRACT

Resumo Contexto A insuficiência venosa crônica (IVC) é uma doença comum, uma disfunção da bomba muscular da panturrilha que repercute na hemodinâmica das estruturas. Objetivos Analisar os efeitos dos exercícios de fortalecimento muscular da panturrilha na hemodinâmica venosa em pacientes com IVC. Métodos O estudo contou com a participação de 13 pacientes e 25 membros inferiores com IVC, classificados entre C1 e C5 da classificação Clínica, Etiologia, Anatomia e Fisiopatologia (CEAP), oriundos do ambulatório de cirurgia vascular do Hospital Universitário Regional dos Campos Gerais. As variáveis analisadas foram dinamometria isométrica, goniometria, perimetria, adipometria no início, primeiro mês, segundo mês e final da aplicação do protocolo de exercícios. Resultados Os valores da dorsiflexão e da plantiflexão aumentaram 5º (p < 0,001). Na adipometria notou-se uma redução de 5 mm (p < 0,001). Quando separados em grupos pela CEAP, na C2 houve aumento de 5º na dorsiflexão (p = 0,02) e na plantiflexão (p < 0,001); na C3 houve aumento de 5º na dorsiflexão (p = 0,003) e redução de 1 mm na adipometria (p < 0,004); na C1 houve aumento da perimetria de 1,2 cm (p = 0,04). Conclusões A aplicação de protocolos de exercícios deveria ser considerada como uma forma de tratamento para IVC, pois impacta positivamente em fatores de risco e nas funções que estão deterioradas pela patologia.


Abstract Background Chronic venous insufficiency (CVI) is a common disease that causes calf muscle pump dysfunction and has repercussions for the hemodynamics of the structures involved. Objectives To analyze the effects on venous hemodynamics of exercises to strengthen the calf muscles in patients with CVI. Methods The study analyzed 25 lower limbs with CVI, classified from C1 to C5 according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, in 13 patients recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital Universitário Regional dos Campos Gerais (Brazil). The variables analyzed were collected by isometric dynamometry, goniometry, leg circumference measurement, and adipometry at baseline, after 1 month and 2 months and at the end of the exercise protocol. Results Dorsiflexion and plantar flexion measurements increased by 5º (p < 0.001). Adipometry detected a reduction in 5 mm (p < 0.001). When grouped by CEAP class, C2 exhibited 5º increases in dorsiflexion (p = 0.02) and plantar flexion (p < 0.001); C3 exhibited a 5ºincrease in dorsiflexion (p = 0.003) and a 1mm reduction in adipometry (p < 0.004); and C1 exhibited a 1.2cm increase in leg circumference (p = 0.04). Conclusions Administration of exercise protocols should be considered as a treatment option for CVI, since it has a positive impact on risk factors and on the functions that are impaired by this pathology.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Venous Insufficiency/therapy , Exercise , Resistance Training , Chronic Disease , Intervention Studies , Risk Factors , Adiposity , Manual Dynamometry , Leg
8.
J. vasc. bras ; 20: e20200216, 2021. tab, graf
Article in English | LILACS | ID: biblio-1279379

ABSTRACT

Abstract Moyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.


Resumo A doença de moyamoya é um distúrbio raro que envolve o sistema cerebrovascular. Normalmente, leva à oclusão das artérias do sistema cerebral e causa problemas circulatórios no cérebro. Uma mulher de 48 anos foi admitida em nossa clínica com claudicação intermitente em ambas as pernas. Na ultrassonografia com Doppler, foram detectados padrões de formato de onda bifásico e monofásico nas extremidades inferiores distais (artérias da trifurcação) de forma bilateral. Portanto, realizou-se o exame vascular sistêmico na paciente. A angiografia por tomografia computadorizada revelou oclusão carotídea bilateral no nível dos segmentos supraclinoides, e opacificações foram detectadas nos segmentos distais das artérias cerebelares anteriores e médias de forma bilateral. A paciente foi diagnosticada com doença de moyamoya, e o tratamento anticoagulante foi iniciado. Em conclusão, a maioria dos relatos anteriores apresentou o envolvimento cerebrovascular da doença de moyamoya. No entanto, essa doença pode envolver diferentes sistemas vasculares periféricos, e um exame vascular sistêmico minucioso é necessário para um diagnóstico exato.


Subject(s)
Humans , Female , Middle Aged , Ultrasonography, Doppler , Computed Tomography Angiography , Moyamoya Disease/diagnostic imaging , Popliteal Artery , Intermittent Claudication/complications , Leg , Moyamoya Disease/complications
9.
J. vasc. bras ; 20: e20210003, 2021. graf
Article in English | LILACS | ID: biblio-1279378

ABSTRACT

Abstract Chronic ulcerations of the lower extremities are quite a common condition amongst adults, most often caused by chronic venous insufficiency. Irrespective of the main underlying cause, chronic limb ulcerations are usually associated with significant symptoms, impairing daily functioning. Improper or delayed diagnosis and inadequate treatment increase the risk of serious complications, including limb amputations. Malignancies can develop secondary to chronic leg ulcers. About 2.4% of ulcers arising from chronic venous stasis undergo malignant transformation. Squamous cell carcinoma is the most common type of malignancy found in chronic leg ulceration biopsies. Basal cell carcinoma, sarcoma, and melanoma have all been documented infrequently. In the case described here, we found lymphoma of the marginal zone of mucosa-associated lymphoid tissue (MALT), which is an extremely rare cutaneous neoplasm of the lower extremities, but one that may have an association with autoimmune diseases.


Resumo Úlceras crônicas dos membros inferiores são uma condição bastante comum entre adultos, na maioria das vezes causadas por insuficiência venosa crônica. Independente da sua causa principal, úlceras crônicas dos membros estão geralmente associadas a sintomas significativos, prejudicando o funcionamento diário. O diagnóstico inadequado ou tardio e o tratamento inadequado aumentam o risco de complicações graves, inclusive o risco de amputação do membro. Malignidades podem se desenvolver secundariamente em úlceras crônicas da perna. Em torno de 2,4% das úlceras decorrentes de estase venosa crônica sofrem transformação maligna. O carcinoma de células escomosas é o tipo de malignidade mais comum que pode ser encontrada em biópsias de úlceras crônicas da perna. Carcinoma basocelular, sarcoma e melanoma foram raramente documentados. No caso aqui descrito, encontramos linfoma da zona marginal do tecido linfoide associado à mucosa (mucosa-associated lymphoid tissue, MALT), o qual é uma neoplasia cutânea dos membros inferiores extremamente rara mas que pode estar associada a doenças autoimunes.


Subject(s)
Humans , Female , Aged , Venous Insufficiency/complications , Sjogren's Syndrome/complications , Lymphoma, B-Cell, Marginal Zone/complications , Skin Neoplasms , Ulcer , Chronic Disease , Lymphoma, B-Cell, Marginal Zone/diagnosis , Leg
10.
J. vasc. bras ; 20: e20200034, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1250249

ABSTRACT

Resumo Contexto A insuficiência venosa crônica é uma doença de alta prevalência mundial, podendo chegar a até 80% da população. Sua incidência aumenta com a idade e é mais frequente no sexo feminino. Das opções terapêuticas, destaca-se a terapia compressiva, sendo a principal o uso de meia elástica de compressão graduada, considerado o tratamento básico para a insuficiência venosa crônica independentemente da classificação clínica do paciente. Na prática clínica, o resultado da terapia é prejudicado pela não adesão ao uso da meia. Objetivos Avaliar a taxa de adesão ao uso da meia elástica de compressão graduada, assim como compreender a problemática da não aderência ao tratamento. Métodos Estudo observacional transversal, realizado entre junho de 2017 até janeiro de 2019, mediante aplicação de questionário aos pacientes em ambulatório de cirurgia vascular do Sistema Único de Saúde (SUS), em um hospital-escola, em Curitiba, no estado do Paraná (PR). Os dados foram analisados com o programa computacional IBM SPSS Statistics v.20.0. Resultados Foram analisados 240 pacientes. A média de idade foi de 57,5±12,9 (22-86); 84,2% eram do sexo feminino. Do total de pacientes analisados, 106 (44,2%) não aderiram ao uso das meias. As justificativas para o não uso foram: questão financeira, dor, desconhecimento da necessidade, calor e outras. Conclusões A taxa de adesão encontrada no presente estudo foi de 55,8%, e o principal motivo para o não uso foi a questão financeira.


Abstract Background Chronic venous insufficiency (CVI) is a pathology of great importance due to its high worldwide prevalence, affecting up to 80% of the population. Its incidence increases with age and is more frequent in females. One of the most important treatment options is compression therapy and the main method employed is wearing graduated compression stockings, which is considered the basic treatment for CVI regardless of the patient's clinical classification. In clinical practice, treatment outcomes are impaired by patients not wearing the stockings properly. Objectives To analyze the rate of adherence to wearing graduated compression stockings and to understand the problem of treatment non-adherence. Methods Cross-sectional observational study conducted from June 2017 to January 2019, based on administration of questionnaires to patients at a SUS vascular surgery clinic at a teaching hospital, in Curitiba, PR, Brazil. Data were analyzed using the IBM SPSS Statistics v.20.0 computer program. Results 240 patients were analyzed. Mean age was 57.5 ± 12.9 (22 - 86) and 84.2% of the sample were female. 106 of the 240 patients analyzed (44.2%) were non-adherent with wearing compression stockings. Reasons for not wearing the stockings were: financial; pain; ignorance of the need to wear them; heat; and others. Conclusions The adherence rate observed in the present study was 55.8% and the most prevalent reason for not wearing stockings was financial.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Venous Insufficiency/therapy , Unified Health System , Stockings, Compression , Venous Insufficiency/prevention & control , Cross-Sectional Studies , Treatment Adherence and Compliance , Leg/blood supply
11.
J. vasc. bras ; 20: e20200125, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250246

ABSTRACT

Abstract Exercise training (ET) is an important tool in the management of patients with chronic venous insufficiency (CVI). The objective of this article was to discuss the effects of ET on the calf pump, functional parameters, and quality of life of patients with mild and advanced CVI. A systematic review was conducted and eleven studies were included. In patients with mild CVI, ET was effective for improving venous reflux, muscle strength, ankle range of motion, and quality of life. In advanced CVI patients, ET increased ejection fraction, reduced residual volume fraction, and improved muscle strength and ankle range of motion, but did not change venous reflux indices or quality of life. It is concluded that ET is effective for improving calf pump function, muscle strength, and ankle range of motion in CVI. In patients with mild CVI, additional benefits were observed in quality of life.


Resumo O treinamento físico é uma importante ferramenta no tratamento de pacientes com insuficiência venosa crônica. O objetivo foi discutir os efeitos do tratamento físico na bomba da panturrilha, os parâmetros funcionais e a qualidade de vida de pacientes com insuficiência venosa crônica leve e avançada. Uma revisão sistemática foi realizada, e 11 estudos foram incluídos. Na insuficiência venosa crônica leve, o treinamento físico foi eficaz na melhora do refluxo venoso, da força muscular, da amplitude de movimento do tornozelo e da qualidade de vida. Na insuficiência venosa crônica avançada, o treinamento físico aumentou a fração de ejeção, reduziu a fração de volume residual e melhorou a força muscular e amplitude de movimento do tornozelo, sem alterações nos índices de refluxo venoso e na qualidade de vida. Conclui-se que o treinamento físico é eficaz na melhoria da bomba da panturrilha, da força muscular e da amplitude de movimento do tornozelo na insuficiência venosa crônica. Em pacientes com insuficiência venosa crônica leve, foram encontrados benefícios adicionais na qualidade de vida.


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Venous Insufficiency/therapy , Exercise , Muscle Strength , Quality of Life , Venous Insufficiency/prevention & control , Range of Motion, Articular , Leg , Ankle
12.
Clinics ; 76: e2805, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249586

ABSTRACT

OBJECTIVES: Demonstrate that continuous peripheral nerve block (CPNB) may be an alternative with adequate analgesia and a lower incidence of side effects for ischemic pain due peripheral obstructive arterial disease (POAD). METHODS: Retrospective cohort study with 21 patients with POAD, Fontaine IV graded, with foot pain. Patients were submitted to continuous sciatic nerve block (CSNB), through a perineural catheter. Primary outcomes were pain intensity (by numerical rating scale) and opioid consumption (in oral morphine equivalents). RESULTS: During CSNB, pain scores markedly decreased in comparison to the pre-block period. CONCLUSIONS: CPNB may be a good option for ischemic pain treatment in in-patients, as it provides effective pain control with fewer adverse effects.


Subject(s)
Humans , Nerve Block , Pain, Postoperative/drug therapy , Peripheral Nerves , Retrospective Studies , Analgesics, Opioid/therapeutic use , Anesthetics, Local/therapeutic use , Leg
13.
Rev. bras. ortop ; 55(6): 736-741, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156197

ABSTRACT

Abstract Objective To describe and demonstrate the outcomes of the modified Monteiro (1991) technique for lower limb reconstruction with a fasciocutaneous flap of the distal pedicle in a series of 15 cases. Method We present the technique and outcomes from a series of 15 cases of the modified technique using a fasciocutaneous flap of the distal pedicle to repair the lower third of the leg and the foot. Results Outcomes were satisfactory since these flaps provided good cutaneous and subcutaneous tissue coverage in cases with bone exposure and skin loss. The donor area was closed 3 days after surgery with a partial skin graft to provide better graft viability. Conclusion The fasciocutaneous flap of the distal pedicle proved to be a good option for reconstruction of the middle and lower thirds of the leg, offering good bone coverage.


Resumo Objetivo Descrever e demonstrar o desfecho da técnica modificada de Monteiro (1991) para a reconstrução do membro inferior com retalho fasciocutâneo de pedículo distal numa série de 15 casos. Método Com uma série de 15 casos, apresentamos a técnica e o desfecho da técnica modificada do retalho fasciocutâneo de pedículo distal com para a reparação do terço inferior da perna e do pé. Resultados Os resultados foram satisfatórios porque os retalhos proporcionaram boa cobertura de pele e tecido celular subcutâneo nos casos de exposição óssea e perda cutânea. A área doadora foi fechada 3 dias após a cirurgia, com enxerto de pele de espessura parcial, proporcionando uma melhor viabilidade do enxerto. Conclusão O retalho fasciocutâneo de pedículo distal mostrou-se como uma boa opção para a reconstrução do terço médio e inferior da perna, oferecendo boa cobertura óssea.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Surgical Flaps , Tissue Donors , Bereavement , Skin Transplantation , Lower Extremity , Fascia , Foot , Leg
15.
Rev. habanera cienc. méd ; 19(4): e3129, ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1139177

ABSTRACT

Introducción: La insuficiencia venosa crónica es el conjunto de síntomas y signos derivados de una hipertensión venosa en los miembros inferiores debido a un mal funcionamiento valvular de los sistemas venosos. Se han asociado varias complicaciones a esta entidad, una de ellas es el pseudosarcoma de Kaposi, enfermedad rara y caracterizada por una proliferación reactiva vascular, con lesiones cutáneas similares a las del sarcoma de Kaposi. Objetivo: Describir el proceso diagnóstico de una paciente con pseudosarcoma de Kaposi tipo Mali unilateral como complicación de la insuficiencia venosa crónica. Presentación del caso: Se presenta una paciente femenina, piel blanca, de 51 años de edad, con lesiones cutáneas de aproximadamente 9 años de evolución, tipo placas eritematomarronáceas y papuloescamocostrosas, en el miembro inferior derecho, que progresivamente fueron extendiéndose; la paciente presentaba además insuficiencia venosa crónica. Se diagnosticó pseudosarcoma de Kaposi tipo Mali unilateral, teniendo en cuenta, fundamentalmente, los antecedentes patológicos personales, el examen clínico realizado, la biopsia de la lesión, la inmunohistoquímica para anticuerpos CD 34 y el dúplex venoso de miembro inferior derecho. Se indicó terapia compresiva de la extremidad y ungüento esteroideo en lesiones, con mejoría de estas. Conclusiones: Una de las complicaciones asociadas a la insuficiencia venosa crónica es el pseudosarcoma de Kaposi. En esta rara entidad cutánea el estudio histopatológico y la inmunohistoquímica desempeñan un papel muy importante para su correcto diagnóstico y diferenciación del sarcoma de Kaposi, principal diagnóstico diferencial a tener en cuenta(AU)


Introduction: Chronic venous insufficiency is the set of symptoms and signs derived from venous hypertension in the lower limbs due to a valvular malfunction of the venous system. Several complications have been associated with this entity; one of them is Pseudo-Kaposi's sarcoma, a rare disease characterized by reactive vascular proliferation with skin lesions similar to those of Kaposi's sarcoma. Objective: To describe the diagnostic process of a patient with unilateral Mali-type Pseudo-Kaposi's sarcoma as a complication of chronic venous insufficiency. Case presentation: Fifty-one-year-old white female patient with about 9-year history of brownish erythematosus-type and squamous, crusty plaque-like skin lesions in the right lower limb that were progressively extending. The patient also presented chronic venous insufficiency. Unilateral Mali-type Pseudo-Kaposi's sarcoma was diagnosed, mainly considering the personal pathological antecedents, the clinical examination performed, the biopsy of the lesion, the immunohistochemistry for CD34 antibodies and the venous duplex imaging of the right lower limb. Compressive therapy of the limb and steroid ointment was indicated for the lesions, with improvement of the condition. Conclusions: Pseudo-Kaposi's sarcoma is one of the complications associated with chronic venous insufficiency. In this rare skin entity, the histopathological study and immunohistochemistry play a very important role in the correct diagnosis and differentiation of Kaposi's sarcoma, being this the main differential diagnosis to take into account(AU)


Subject(s)
Humans , Female , Middle Aged , Sarcoma, Kaposi/etiology , Skin Neoplasms/etiology , Venous Insufficiency/complications , Leg
16.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(2): 147-150, jun. 2020. []
Article in Spanish | LILACS, BINACIS | ID: biblio-1125552

ABSTRACT

La flegmasia cerúlea dolens es una presentación poco habitual y grave de una trombosis venosa profunda producida por una obstrucción al flujo venoso de salida de la extremidad inferior, que conlleva un alto grado de morbilidad. Este cuadro no ha sido comunicado como complicación del tratamiento definitivo de una fractura de pelvis. Consideramos que una breve descripción del tema y la presentación de un caso pueden ser útiles para el cirujano ortopédico ante una situación similar. Nivel de Evidencia: IV


Phlegmasia cerulea dolens (PCD) is an unusual and serious presentation of deep venous thrombosis (DVT) caused by an obstruction to the venous outflow of the lower limb, which is associated with significant morbidity. To our knowledge, this complication has not yet been reported as a complication of the definitive treatment of a pelvic fracture. We believe that a brief description of the subject matter and the description of the case may be useful to Orthopedic surgeons in similar situations. Level of Evidence: IV


Subject(s)
Middle Aged , Pelvis/injuries , Postoperative Complications , Acute Disease , Venous Thrombosis , Fractures, Bone , Leg/pathology , Anticoagulants/therapeutic use
18.
Arq. neuropsiquiatr ; 78(3): 139-142, Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1098076

ABSTRACT

Abstract Many people have a habit of moving their legs and believe that this behavior is due to the restless legs syndrome (RLS), a highly prevalent neurological condition that greatly impairs the quality of life of affected individuals. This behavioral pattern, characterized by the habit of moving one's legs and feet, may be an important confounding factor in the diagnosis of RLS. Objective: To describe the main movements associated with this benign behavioral state to characterize a possible clinical condition that can contribute to the differential diagnosis of RLS. Methods: Experienced sleep specialists, who primarily see RLS patients listed the most frequent movements people without RLS report while describing their suspected RLS. We first compiled a list of the lower-limb movements described by the specialists. Then, one of the authors (KC) carried out all movements of the list on camera to obtain a video footage. This footage was sent to one of the authors, EPC, who, alongside a group of students, drew graphic representations (cartoons) of the recorded movements. Results: The panel of sleep experts described 13 leg movements commonly reported by their patients. The experts reported 11 simple movements and two combined movements. Conclusion: In this study we developed an instrument that allows us to oppose and distinguish a pathological condition (RLS) from a behavioral phenomenon. This state of behavioral leg fidgeting needs to be better characterized and may eventually be recognized as a clinical entity per se.


Resumo Muitas pessoas têm o hábito de movimentar as pernas e acreditam que esse comportamento decorre da Síndrome das Pernas Inquietas (SPI), uma condição neurológica altamente prevalente com grande impacto na qualidade de vida dos indivíduos acometidos. Esse padrão de comportamento, caracterizado pelo costume de mover as pernas e os pés, pode ser um importante fator confundidor no diagnóstico da SPI. Objetivo: Descrever os principais movimentos associados a esse estado comportamental benigno, com a finalidade de caracterizar uma eventual condição clínica que possa contribuir para o diagnóstico diferencial da SPI. Métodos: Especialistas em distúrbios do sono, que atendem principalmente pacientes com SPI, listaram os movimentos que as pessoas sem SPI reportam com maior frequência enquanto descrevem a sua suspeita de síndrome. Elaboramos uma lista de movimentos dos membros inferiores descritos pelos especialistas e um dos autores (KC) realizou esses movimentos para que fossem gravados em vídeo. Essa filmagem foi enviada ao autor EPC, que, em conjunto com um grupo de alunos, realizou a representação gráfica (cartoon) dos movimentos gravados. Resultados: Os especialistas reportaram 13 movimentos de pernas, sendo 11 movimentos simples e dois movimentos combinados. Conclusão: Neste estudo, elaboramos um instrumento que permite opor, com a finalidade de diferenciá-las, uma condição patológica (SPI) de um fenômeno comportamental. Esse estado de inquietude comportamental das pernas necessita ser mais bem caracterizado, podendo eventualmente vir a ser reconhecido como uma entidade clínica per se.


Subject(s)
Humans , Quality of Life , Restless Legs Syndrome/psychology , Cartoons as Topic , Leg , Movement
19.
J. Phys. Educ. (Maringá) ; 31: e3164, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134712

ABSTRACT

ABSTRACT This experiment investigted transfer of skills from dominant leg limb to non-dominant leg limb and vice versa in dribbling with the ball, juggling and passing/shooting technics of soccer for inexperienced male children. 24 male student age of 10 years from 3th grade who have not involved in a football club as a player. In football basic technical practices, dominant leg (DL) group just used their dominand leg/foot, and non-dominant leg (NDL) group just used their non-dominant leg/foot. Practice phase applied one time a week between February and May on the football field with synthetic grass. The results showed there were not exist no significant difference between the transfers from dominant leg group to non-dominant group or vice versa. On the other hands, performance of all technics improved on dominant and non-dominant groups for the comparison of pre- and post-tests. The findings suggest that the transfer of learning skills could be more effective from non-dominant leg limb to dominant leg limb significantly for technics of juggling, dribbling and kicking.


RESUMO Este experimento investigou a transferência de habilidades do membro dominante da perna para o membro não dominante e vice-versa no drible com a bola, controle de bola e nas técnicas de passe/chute do futebol para meninos iniciantes. Participaram do estudo 24 estudantes de 10 anos de idade da terceira série que não tinham participado de nenhum clube de futebol como jogador. Nas práticas das técnicas básicas do futebol o grupo de perna dominante (PD) apenas usou a perna/pé dominante e o grupo de pernan não dominante (PND) apenas usou a perna não dominante. A fase de prática foi aplicada uma vez por semana entre fevereiro e maio no campo de futebol com grama sintética. Os resultados mostraram que não houve diferença significativa entre as transferências do grupo dominante das pernas para o grupo de pernas não dominantes e vice-versa. Por outro lado, o desempenho de todas as técnicas melhorou no grupo de pernas dominantes e não dominantes na comparação de pré-teste para o pós-teste. As descobertas sugerem que a transferência de habilidades de aprendizado poderia ser mais eficaz do membro não dominante para o membro dominante nas técnicas de controle de bola, drible e chute.


Subject(s)
Humans , Male , Child , Soccer , Sports , Child , Methods , Aptitude , Physical Education and Training/methods , Play and Playthings , Students , Teaching , Athletic Performance/education , Team Sports , Leg
20.
Article in Korean | WPRIM | ID: wpr-811247

ABSTRACT

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.


Subject(s)
Analgesics, Opioid , Anticonvulsants , Arm , Benzodiazepines , Diagnosis , Dopamine Agonists , Extremities , Hand , Humans , Immobilization , Iron , Leg , Paresthesia , Polysomnography , Pregabalin , Pregnancy , Restless Legs Syndrome , Sleep Wake Disorders , Uremia
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