OBJETIVO: As estenoses benignas da via biliar (EBVB) decorrem de lesões iatrogênicas em 95% casos. Embora pouco freqüentes seu prognóstico é sombrio, e a prevenção é o melhor tratamento. O objetivo deste trabalho é estudar a conduta cirúrgica nas EBVB e seus resultados. MÉTODO: Foram analisados retrospectivamente, 11 pacientes submetidos à correção de EBVB no Hospital Universitário Regional do Norte do Paraná (HURNP) no período de Julho/1992 a Dezembro/2001. RESULTADOS: Nove pacientes eram do sexo feminino e dois do masculino,com média de idade de 43,71 (± 17,05) anos. A cirurgia que originou a lesão foi colecistectomia aberta em 81,8% dos pacientes e por laparoscopia em 18,2%. Os sinais e sintomas mais freqüentes foram icterícia (64,3%), dor (64,3%), e febre (21,4%). O diagnóstico foi confirmado por colangiopancreatografia retrógrada endoscópica (CPRE) em 90,9% dos casos e por colangiografia transparieto- hepática (CTPH) em 9,1%. Segundo os critérios de Bismuth lesões do tipo I ocorreram em 18,2% dos casos, tipo II em 45,4%, tipo III em 18,2% e tipo IV em 18,2%. O tratamento cirúrgico para as EBVB foi anastomose colédoco-duodenal, anastomose hepático-jejunal em Y de Roux , anastomose hepático-jejunal à Hepp- Couinaud e anastomose hepático-jejunal com enxertia de mucosa (Smith), para as lesões tipo I,II,III e IV, respectivamente. Seis (54,55%) pacientes apresentaram complicações pós-operatórias , e dois (18,2%) evoluíram para óbito CONCLUSÕES: As correções cirúrgicas das EBVB apresentam altos índices de complicações e devem ser realizadas em centros especializados. Em geral estas estenoses decorrem de lesões iatrogênicas durante colecistectomias.
ObjectiveTo assess changes in the great saphenous vein (GSV) after foam sclerotherapy for varicose veins.Materials and MethodsThis was a prospective study of 33 patients who were treated with polidocanol foam sclerotherapy after having had varicose veins with a clinical severity-etiology-anatomy-pathophysiology classification of C4-C6 for three months. The patients were evaluated by ultrasound before, during, and after the procedure (on post-procedure days 7, 15, 30, 60, and 90). The GSV diameter, the rate of venous occlusion, and the rate of reflux elimination were determined. Two patients were excluded for having a history of deep vein thrombosis history, and one was excluded for having bronchial asthma.ResultsThirty patients (26 females and 4 males, with mean age of 62 years) completed the protocol. The mean pre-procedure GSV diameter was 6.0 ± 0.32 mm (range, 3.6-11.2 mm). During the sclerotherapy, the mean GSV diameter was reduced to 1.9 ± 0.15 mm (range, 0.6-3.8 mm). On post-procedure day 7, the mean GSV diameter increased to 6.3 ± 0.28 mm (range, 3.9-9.7 mm). On post-procedure day 90, the mean GSV diameter was 4.0 ± 0.22 mm (range, 1.9-8.2 mm). The rate of GSV reflux was significantly lower in the assessment performed on post-procedure day 90 than in the pre-procedure assessment (p < 0.0028).ConclusionOn the basis of our ultrasound analysis, we can conclude that foam sclerotherapy for varicose veins results in a significant reduction in GSV diameter, as well as in the elimination of GSV reflux.
Objectives To describe saphenous reflux patterns in patients classified as CEAP C2 by analysis of 2027 vascular ultrasound examination reports. Methods A total of 2027 venous mapping studies were reviewed and 1196 patients classified as CEAP C2 were selected. Patients were classified according to patterns of reflux for the great saphenous vein and for the small saphenous vein, and rates of great saphenous vein and small saphenous vein reflux were analyzed for both sexes. Results The overall prevalence of saphenous vein reflux was 45%. Males had significantly higher great saphenous vein reflux prevalence than females ( p < 0.001). The most common great saphenous vein reflux pattern in females was segmental reflux and the most common pattern in males was proximal reflux. Conclusions Saphenous vein reflux is common in C2 patients and is more frequent in males. Standardization of classifications of reflux patterns is very important for correct management of the disease.
Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.
BACKGROUND Ultrasound-guided foam sclerotherapy (UGFS) for treatment of chronic venous insufficiency (CVI) has been attracting significant interest over the past 20 years. It is a minimally invasive technique that comprises a safe treatment option and has yielded good results, especially in cases of advanced disease, with high rates of wound healing. OBJECTIVE To examine clinical, ultrasound, and photoplethysmography outcomes after a 1-year follow-up of UGFS for CVI. MATERIALS AND METHODS Twenty-nine legs classified as C4, C5, or C6 of the CEAP classification were included. Patients answered the VEINES questionnaire on quality of life and symptoms. and their venous filling time (VFT) was measured using photoplethysmography before and 45, 180, and 360 days after treatment of CVI with UGFS. RESULTS The results showed statistically significant improvements in VEINES quality-of-life and symptom scores and in VFT measured by photoplethysmography and a reduction in great saphenous vein diameter (p < .0001) at 45, 180, and 360 days after treatment with UGFS. CONCLUSION Ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels, confirmed by improvement in questionnaire scores, venous refilling time, and ultrasound findings.
Introduction Approximately 40 cases of spontaneous rupture of the aorta have been described in the literature. Diagnosis can be challenging, and a high index of clinical suspicion enabling prompt treatment can be lifesaving. Report This report presents the case of a 73 year old man who had three multilevel ruptures of the aorta at different times, all treated endovascularly. The patient had a good post-operative course, with no complaints during regular follow up. Discussion Clinical presentation was non-specific because the ruptures were contained, but spontaneous rupture of the aorta can manifest with a catastrophic presentation and hypovolaemic shock, requiring immediate treatment. The endovascular technique used was safe and resolved the patient's symptoms.
This paper discusses the importance of computing relative properties and not just retrieving absolute properties when generating geographic referring expressions such as "northern France". We describe an algorithm that computes spatial properties at run-time by means of spatial operations such as intersecting and analyzing parts of wholes. The evaluation of the algorithm suggests that part-whole relations are key in geographic expressions.
Organic or organomineral fertilization favours aeration; the distribution, storage and drainage of water through the structure of the soil favouring, in this way, the reduction in sudden variations in temperature that interrupts the of absorption of nutrients by plants. In addition, it is an important source of macro- and micronutrients essential for plant growth and development. The present study was carried out at the Olericulture Sector of the Federal University of the Valleys of Jequitinhonha and Mucuri with the aim of determining the behaviour and growth pattern of lettuce plants (Lactuca sativa L.) cv. Regina, at different levels of fertilization and variable temperature. Temperatures were 12 °C, 20 °C, 23°C and 28°C. A granulated organic fertilizer modified with conventional minerals, proposed by Geofert (a pelletized organic-mineral ((4N-17P2O5-7K2O at 5.30 g/pot) was applied, and cattle manure plus a control treatment without fertilizer. Parameters as plant height, 'head' point diameter, and leaves number/plant were measured. In addition, chlorophyll A and B contents were estimated, leaf area ratio (LAR), the specific leaf area (SLA) and leaf weight ratio (LWR). Fertilization with bovine manure and Geofert fertilizer favoured plant growth, especially at lower or higher temperatures than the recommended for this vegetable (15 - 24 ° C). Organic fertilizers were more efficient than conventional fertilization in the moderating effects of the high temperatures evaluated.
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