Objective:To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment.Methods:Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests.Results:Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion.Conclusion:Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.
RESUMO: Objetivo:Demonstrar os acessos vasculares para hemodiálise mais utilizados em 23 unidades de hemodiálise, distribuídas em sete estados brasileiros. Método : Entre outubro de 1999 a agosto de 2000, foram avaliados 2559 pacientes em 23 unidades de hemodiálise distribuídas em 23 estados brasileiros onde foi observado: A -A freqüência da utilização do acesso vascular, se externo através de cateteres ou se interno através de fístula arteriovenosa (FAV). B -Os tipos de cateteres, se de curta permanência ou de longa permanência, assim como os locais anatômicos utilizados para sua inserção. C -Os tipos de FAV, se direta ou com interposição de algum tipo de prótese e os locais anatômicos onde foram construídas, se distais ou proximais. D -O custo financeiro com os acessos vasculares. Resultados : Constatou-se que 93,4% dos pacientes tinham um acesso vascular através de FAV e 6,6% através de cateter. As FAV diretas distais foram as mais utilizadas em 74,8% dos pacientes; as FAV diretas proximais foram construídas em 21,7% das vezes; as FAV com politetrafluoretileno expandido (PTFE) 3,2% da totalidade; a veia safena foi utilizada em 0,1% e as FAV consideradas como outras em 0,2%. Os cateteres de longa permanência foram utilizados em 8,7% da totalidade dos cateteres e os de curta permanência em 91,3%. Como via de acesso a veia jugular foi utilizada em 42,4%, a veia subclávia em 42,4% e a veia femoral em 6,5%. O custo financeiro com acesso para hemodiálise foi de 1% do custo total das unidades. Conclusões : O acesso vascular no Brasil tem características próprias. O acesso mais utilizado é a FAV distal e o uso do PTFE é baixo.
. Tutor. Responsible for conception and critical revision of the study. ABSTRACT PURPOSE:To evaluate the effects of alprostadil in an experimental model of ischemia and reperfusion injury (IRI) in rat renal tissue. METHODS:Adult male Wistar rats were randomized into three groups Vehicle-treated group(Veh), Alprostadil-treated(Al), and sham(Sh) group. Veh and Al groups had suprarenal aorta occluded for 30 minutes and reperfused for 60 minutes. Saline or 20 µg/ kg of Alprostadil was intravenously infused immediately before declamping. Sh group animals underwent similar procedure without aortic occlusion. Left nephrectomy and blood sampling were performed after 60 minutes of reperfusion. Renal ICAM-1 expression and histological analysis were performed to estimate inflammatory response and tissue disarrangement. Serum biochemical markers for IRI were also measured. Kruskal-Wallis test was used to assess differences between the groups. RESULTS:There was lower expression of ICAM-1 in groups Veh and Sh. On histologically evaluation, inflammation and necrosis in the Veh group was significantly higher (grades III/IV) than Al group (Veh>Al=Sh; p = 0.025), as well as CPK levels (Veh>Al=Sh; p = 0.03). CONCLUSION:Alprostadil attenuates the immunohistochemical and histological repercussions in the renal tissue of rats submitted to a post-ischemic reperfusion with supra-renal aortic clamping.
Background: Ultrasound-guided polidocanol foam sclerotherapy is used to treat patients with venous ulcers. It is a minimally invasive procedure and is simple to perform, but it has high relapse rates. Objectives: To report short to medium term results in patients with venous ulcers treated using ultrasound-guided polidocanol foam sclerotherapy. Methods: A sample of 19 patients who had been treated with ultrasound-guided polidocanol foam sclerotherapy between January 2013 and December 2014 were followed-up. Time taken for ulcers to heal, improvement of clinical symptoms, recanalization of treated veins, and relapse of symptoms and of venous ulcers were analyzed. Results: Fifteen of the patients analyzed were female (78.9%) and four were male (21.1%). Overall mean age was 53 years. Follow-up times ranged from 448 days to 1,276 days (mean of 791 days). The mean duration of active ulcers was 53 months. At postoperative follow-up assessments, total recanalization was observed in 15.7%, partial recanalization in 21%, and occlusion in 47.3% of the veins that had been treated. There was only one case of ulcer relapse. Analysis of mean Venous Clinical Severity Scores (VCSS) revealed a significant difference from before to after the procedure, with a variation of 11.2 (p < 0.01). Conclusions: Ultrasound-guided foam sclerotherapy has high rates of therapeutic success and achieves high rates of venous ulcer healing.
Background: In spite of the fact that the number of surgeries presented by the elective surgery task force did not entirely reflect the reality, it is possible to declare that the financial implementation of the Brazilian Ministry of Health has been significative, as well as the increasing number of varicose vein surgeries, especially after the creation of the Strategic Actions and Compensation Fund (FAEC). Objective: To evaluate the application of financial investment in the Ministry of Health campaign for varicose vein surgery. Methods: A transversal study of retrospective nature has been conducted, using information available at the Data Processing Department of the National Healthcare System database (DATASUS). All the authorization of hospital internment from the inferior member varicose vein surgeries, financed by the Brazilian Ministry of Health from January 1998 to December 2004, have been included in the research. Results: In 1998, before the implementation of the elective surgery task force, 23,531 varicose vein surgeries have been performed, and R$ 5,819,033.27 invested. After the creation of the FAEC, 457,026 inferior member varicose vein surgeries have been performed from 1999 to 2004, and R$ 187,760,196.81 were invested with an average of R$ 31,293,336.13 per year. Conclusion: Thus, it is possible to conclude that the bigger investment from the Brazilian Ministry of Health, represented by the implementation of the elective surgery task forces by the FAEC, has been responsible for increasing the number of varicose vein surgeries all around Brazil.
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