A ultrassonografia Doppler deixou de ter seu uso apenas como método diagnóstico e vem galgando espaço nos procedimentos terapêuticos. Com maior aplicabilidade e uso de cateteres venosos centrais e procedimentos guiados por ultrassom, há preocupação com a melhora da eficácia e segurança durante o procedimento, assim como com a diminuição das potenciais complicações. Para isso, o treinamento da técnica em modelos (phantoms) é desejável. Os modelos industrializados para treinamento em acesso vascular guiado por ultrassom são caros e não reproduzem adequadamente a ecotextura e a densidade dos tecidos humanos. Na tentativa de treinar e aprimorar os profissionais para o uso do ultrassom em procedimentos de acessos vasculares, desenvolveu-se um modelo animal de baixo custo, fácil confecção e excelente aplicabilidade.
Objective/backgroundThis study is a case report that addresses the key aspects of vascular reconstruction, as well as the intraoperative complications, postoperative morbidity, and possibility of adjunctive therapy.MethodsThis article reports the case of a 46 year old female patient with a leiomyosarcoma located in the middle segment of the inferior vena cava (between the renal and hepatic veins) who underwent surgical resection with vena cava reconstruction and insertion of a tubular graft made of a synthetic material.ResultsThis case report reveals that surgical resection of the tumor with the insertion of a smaller-caliber tubular graft provide better patency of the vena cava reconstruction, which was maintained for a year after surgery. In addition, the patient was asymptomatic for lower limb edema, despite having a local recurrence after one year. Surgical resection is the treatment of choice for leiomyosarcoma of the inferior vena cava (LIVC) and is the only therapy that offers a chance of cure. Several surgical techniques are used for this condition, especially, reconstruction with a vascular graft using natural or synthetic materials.ConclusionDue to the aggressiveness of the disease, this study suggests that surgical intervention used may have no influence on a patient's survival outcome. However, vascular reconstruction with a smaller-caliber tubular graft may yield a better prognosis for patients in terms of postoperative symptoms, such as edema and thrombosis.
Study of the thigh's lateral skin ("saddle bags") in cadavers made it possible to evaluate its regional characteristics. Sex or race were not reported but the age group most appropriate to liposuction was considered. In this way, authors believed that as per standards established at the time, results as to the skin retraction in liposuction, will be able to be analyzed in a comparative way in the future.
Introduction: The use of a venipuncture simulator facilitates technique learning and improves skills, which reduces the risk of venipuncture complications in humans. Objective: To evaluate the efficacy of a non-human experimental model for Ultrasound guided superficial venipuncture. Methods: We randomized 39 nurses in two groups: A and B. The training had three steps: 1 - theoretical class, 2 - practical class, with the ultrasound device and 3 - ultrasound-guided puncture training in the non-human model. The group A participated in steps 1, 2 and 3 and group B in steps 1 and 2. After training, both groups were released for ultrasound guided venipuncture. Results: The success in puncture in group A (n = 20) was 90% and in group B (n = 19) it was 68.42%. In the sum of the identification and the puncture times, the average of group A was 61.5 seconds (95% CI, 33.58; 106.95) and in group B was 148.0 seconds (95% CI, 114.54; 208.44), which was statistically significant (p = 0.007, without overlapping the interval estimates). Conclusion: Nurses who received training with the nonhuman model had better identification and puncture times.
Analysis of the dorsum's skin and sacrum region allowed the authors to evaluate regional characteristics of cutaneous skin integument, taking into consideration the age group most subjected to liposuction. Thus, it was attempted to establish rules to facilitate, in a comparative form, the evaluation of results related to cutaneous retraction in plastic surgery.
Introdução: A vasculite livedoide se manifesta exclusivamente nas extremidades inferiores e principalmente na região maleolar. Pode ser primária ou secundária. Quando secundária, a doença possui comum relação com a trombofilia e outras doenças do tecido conjuntivo. Objetivo: O presente trabalho tem por objetivo investigar por meio de uma revisão integrativa de literatura o tratamento de vasculite livedoide secundária a trombofilias. Métodos: Para o desenvolvimento desta pesquisa, foram utilizadas as bases de dados BVS, Scielo e PubMed. Para se realizar a pesquisas de artigos relevantes usados no desenvolvimento da revisão bibliográfica, utilizou-se os seguintes MESH terms: (livedoid vasculitis) AND (livedoid vasculitis treatment) OR (thrombophilia) AND (livedoid vasculitis secondary to thrombophilia). O período entre os anos de 2010 até 2022 foi um dos limitadores de critério para seleção dos artigos, podendo estes ser em idiomas português, espanhol ou inglês. Foram selecionados 21 artigos para análise desta pesquisa. Resultados: Entre os autores dos 21 artigos analisados, mostrou que o uso da heparina de baixo peso molecular e os anticoagulantes orais diretos foram as terapias mais prevalentes nos casos de vasculite livedoide, todavia isso não indica que as demais terapias sejam ineficazes. Visto que cada quadro clínico tem suas especificidades. Conclusão: As opções de tratamento para vasculite livedoide secundária são variadas, e o médico deve avaliar e individualizar o tratamento para cada paciente. Entre os tratamentos conhecidos e com relevância encontram-se: a terapia heparina de baixo peso molecular, terapia com anticoagulantes orais diretos, imunoglobulinas intravenosas, terapia com uso de fenprocumon e varfarina e oxigenoterapia hiperbárica. Novos estudos comparando os diferentes tratamentos para a vasculite livedoide secundária à trombofilia são necessários principalmente nos casos associados à Síndrome do Anticorpo Antifosfolípide.
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