Análise comparativa do aneurisma da aorta abdominal aterosclerótico (AAA) com o tipo inflamatório (AAAI) / Comparative analysis of atherosclerotic abdominal aortic aneurism non inflmatory (AAA) with inflamatory aneurism (AAAI)

O aneurisma da aorta abdominal do tipo inflamatório, descrito por Waker e Goldbone, é considerado uma variante do aterosclerótico. Apresenta algumas características, como a fibrose da parede e do retro peritoneo e aderências em estruturas vizinhas que dificultam o ato opertório, exigindo maiores cuidados da equipe cirúrgica. O trabalho faz a análise comparativa entre o AAA e o AAAI, nos aspectos clínicos no pré, intra e pós-operatório, observando algumas variáveis como: quadro clínico, doenças associadas, técnica cirúrgica/duração do ato cirúrgico, as complicaçöes, volume de transfusão e a morbi-mortalidade. Os resultados obtidos demosntram diferenças importantes entre o AAA e o AAAI, e que o cirurgião vascular deverá ficar atento na avaliação dos aneurismas da aorta abdomina, buscando diagnosticar o AAAI na fase pré-opertória, e com isto preparar-se para melhores resultados e redução da taxa de morbi-mortalidade.

[Percutaneous transluminal angioplasty. An efficient alternative in the treatment of peripheral obstructive arteriopathy]. / Angioplastia transluminal percutânea. Uma alternativa eficaz no tratamento da arteriopatia periférica obstrutiva.

At the present, patients with obstructive vascular disease in the lower extremities can be treated with percutaneous procedures without surgery. By what is called Interventional Radiology. Three patients with iliac or femoral arterial obstructions were treated with Percutaneous Transluminal Angioplasty (PTA). For all of them, claudication was the principal symptom and was treated with PTA due the failure of regular treatment. The dilatation was performed with high pressure balloon. Both technical and clinical results showed success and there were no complications.

[Embolomycotic pseudoaneurysm of the common femoral artery in infective endocarditis]. / Pseudoaneurisma embolomicótico da artéria femoral comum na endocardite infecciosa.

A male patient, six years old, with mitral valve endocarditis presented with pseudoaneurysm of the right femoral artery. He was submitted to surgical treatment with reconstruction of the artery with good outcome.

Impact of cigarette smoking on papaverine-induced erection.

Owing to the vasoconstrictive effect of nicotine, smoking may potentially interfere in the results of the drug-induced erection test for papaverine hydrochloride. To investigate the effect of smoking on this test, 12 patients between 22 and 65 years old underwent the following protocol: phase 1--intracavernous injection of 100 mg. papaverine hydrochloride with measurement of intracavernous pressure by puncture with a 19 caliber butterfly needle attached to an aneroid manometer and phase 2--1 week after the initial test the procedure was repeated after the patient smoked 2 cigarettes. In phase 1 all men obtained a full erection, compared to only 4 in phase 2. The average intracavernous pressures were 85.83 and 53.50 mm. Hg, respectively, in phases 1 and 2 (p less than 0.01). We conclude that cigarette smoking, probably through nicotine, interferes with the drug-induced erection test, which might explain some false negative results.

Extracranial mycotic aneurysms in infective endocarditis.

Nine of 217 (4.15%) patients with infective endocarditis who were followed from October 1978 to February 1984 had extracranial mycotic aneurysms (MA). Age range of patients was 6-43 years (mean of 24.8 years) and 7 were male. Etiologic agents were Streptococcus viridans (3 cases), Staphylococcus aureus (2 cases), Staphylococcus epidermidis (1 case), and Pseudomonas aeruginosa (1 case). Two patients had negative blood cultures. The MA involved the arteries of the limbs (5 cases), thoracic (3 cases), and abdominal (1 case) arteries. The diagnosis was made by means of physical examination (5 cases), chest roentgenogram (2 cases), ultrasound examination (1 case), and aortography (1 case), at hospital admission (2 cases), early or before antibiotic therapy (2 cases), and from two days to six months after finishing antibiotic therapy (5 cases). All but one patient were operated upon due to MA; bleeding occurred in three cases; surgery was an emergency procedure in one case and performed from 8 to 58 days after the diagnosis of the MA in the others. Signs of infection at surgery were found in one case. In the others, further antibiotic therapy was not administered. There were no limb losses in the peripheral MA. Four patients received surgical treatment for endocarditis. There was one in-hospital death and another one 6 months later due to heart failure.