ABSTRACT
A rotura da camada íntima que marca o início da dissecção aórtica se origina na maioria dos casos na aorta torácica, sendo rara a dissecção espontânea da aorta abdominal infra-renal. As três principais causas são: iatrogênica, traumática ou espontânea. A dor abdominal e a isquemia de membros são os sintomas mais comuns e um número significativo de pacientes e´ assintomatico. O diagnóstico tem sido feito através de métodos de imagem como ultrassonografia, tomografia computadorizada, ressonância nuclear magnética e angiografia aliados ao alto índice de suspeição. Relatamos os casos de duas pacientes que apresentaram dissecção de aorta abdominal infrarrenal com quadro de dor abdominal súbita, sem sinais de irritação peritoneal com pulsos presentes e simétricos ao exame físico que deram entrada no pronto socorro do Hospital e Maternidade Celso Pierro da PUC Campinas e que foram tratadas pela equipe de Cirurgia Vascular. As duas pacientes no momento do exame apresentavam-se hipertensas e ao ultrassom apresentavam alteração da conformidade da aorta abdominal que foram tratada s cirurgicamente. Uma paciente foi tratada cirurgicamente submetida a endarterectomia da placa dissecada da aorta abdominal infrarrenal de 2,2 cm de diâmetro e 2,0 cm de extensão. A outra paciente foi submetida a revascularização da aorta abdominal bi-iliaca com prótese de Dacron 16 × 8 mm por apresentar disseccao da aorta abdominal distal. As duas pacientes apresentaram boa evolução pos-operatoria tendo alta hospitalar em bom estado geral.
The rupture of the intimal layer marks the beginning of the aortic dissection, which usually happens in the thoracic aorta. The spontaneous dissection of the infrarenal aorta is rare. The main causes are: iatrogenic, traumatic and spontaneous. Abdominal pain and limb ischemia are the commonest symptoms, and some patients are asymptomatics. The diagnosis is made by ultrasound, computed tomography, nuclear magnetic resonance and angiography, with a high suspicious index. We describe two cases of spontaneous rupture of the infrarenal aorta that were treated surgically. We report two cases of patients who were admitted to the emergency room of Celso Pierro Hospital with infrarenal abdominal aortic dissection and were treated by the vascular surgery group. They have presented sudden abdominal pain, no signs of peritoneal irritation and pulses were presents and simmetrics in physical examination The two patients during the examination were hypertensive and the ultrasound showed abnormal compliance of the abdominal aorta who were treated surgically. One patient was treated surgically with dissected plaque endarterectomy of infrarenal abdominal aorta of 2.2 cm in diameter and 2.0 cm in length. The other patient underwent revascularization of the abdominal aorta with bi-iliac Dacron graft 16 × 8 mm due to distal abdominal aortic dissection. Both patients had good postoperative evolution and they were discharged in good general condition.
Subject(s)
Humans , Female , Aged , Aorta, Abdominal , Endarterectomy/rehabilitation , Rupture, Spontaneous/diagnosis , Dissection , Magnetic Resonance Spectroscopy , Tomography, Emission-Computed/nursingABSTRACT
The objective of this study was to determine whether sending an information pamphlet to patients scheduled for a PET test two weeks prior to the appointment date significantly reduced patient anxiety and increased patient knowledge about the test. This study was conducted as a randomized controlled trial in which patients were randomly allocated to receive a mailed information pamphlet (intervention) or no mailed pamphlet two weeks prior to the appointment (usual care). The results of this study suggested that sending information pamphlets to patients scheduled for PET scans did not decrease pre-test levels of patient anxiety or result in increased patient knowledge about test preparation and procedures.
Subject(s)
Anxiety/prevention & control , Attitude to Health , Patient Education as Topic/methods , Teaching Materials/standards , Tomography, Emission-Computed , Aged , Anxiety/diagnosis , Anxiety/etiology , Educational Measurement , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Nursing Evaluation Research , Pamphlets , Psychiatric Status Rating Scales , Tomography, Emission-Computed/adverse effects , Tomography, Emission-Computed/nursing , Tomography, Emission-Computed/psychologyABSTRACT
Positron emission tomography (PET), the newest of the nuclear medicine imaging instruments, is now being used for diagnosis in 20 clinical sites in the United States. Recent approval of third-party reimbursement for PET scans for selected illnesses has set the precedence for wider clinical applications of this advanced diagnostic tool. Most practical of the newest applications of PET in the US is in early detection of recurrent brain tumors. Early detection not only saves lives, but also may save thousands of dollars in unnecessary tests, treatments, and surgeries. PET has two basic advantages over computerized tomography (CT) scans and magnetic resonance imaging (MRI). First, PET creates vastly superior images of metabolic activity, making possible more accurate and detailed diagnoses. Secondly, PET causes very low radiation absorption due to the volatile nature of the radioisotopes used. The rapidly increasing use of PET in clinical situations requires the nurse to become aware of its basic principles and applications, as well as the nursing care involved when a client is scheduled for a PET scan. This study serves to explain basic physical principles employed by PET. The historical development of PET and the comparison of PET with x-ray, CT, and MRI are reviewed. The article concludes with a discussion of future oncologic applications and the latest research developments in clinical use of PET scans.
