Objetivo: Comparar o tratamento cirúrgico convencional das varizes de membros inferiores com a escleroterapia com espuma ecoguiada nos pacientes com úlcera venosa. Como objetivo secundário, foi comparada a incidência de complicações com os métodos empregados e a melhora na qualidade de vida após a realização dos procedimentos. Casuística e Métodos: Foi realizado um estudo randomizado e prospectivo de 49 pacientes com úlceras ativas (C6), que foram submetidos ao tratamento cirúrgico (28 membros) ou escleroterapia espuma (23 membros), tendo como desfechos a cicatrização de úlceras de origem venosa, complicações do tratamento e qualidade de vida,. Os pacientes completaram o Questionário Aberdeen Veias Varicosas (QAVV), o escore de severidade clínica venoso (ESCV) e o Escore de Incapacidade Venosa (EIV). Resultados: A média e desvio padrão de acompanhamento foi de 502 ± 220 dias. A úlcera cicatrizou em 100% e 91,3% dos doentes tratados com cirurgia ou escleroterapia espuma, respectivamente (P > 0,05). QAVV, ESCV e EIV melhoraram em ambos os grupos após o tratamento. Não houve diferenças significativas no resultado final do QAVV, ESCV e EIV entre os dois grupos, vários meses após os procedimentos (p = 0,45, 0,58 e 0,66, respectivamente; Mann- Whitney U). As complicações ocorreram em 14,2% e 13,0% nos grupos cirúrgico e escleroterapia com espuma, respectivamente. Conclusão: A escleroterapia com espuma não foi inferior ao tratamento cirúrgico de úlceras venosas. Portanto a escleroterapia é uma alternativa ao tratamento cirúrgico, particularmente adequada para pacientes de alto risco cirúrgico que apresentam insuficiência venosa avançada e úlcera ativa / Objective: To compare the results of varicose vein treatment using ultrasoundguided foam sclerotherapy versus conventional surgery in patients with venous ulcers. As a secondary outcome, we compared the incidence of complications related to the employed technique and improvements in quality of life after the procedures. Methods: A randomized and prospective study was conducted in 49 patients with active venous ulcers (C6), submitted to surgical treatment (28 limbs) or foam sclerotherapy (23 limbs). The primary outcomes analysed included healing of venous ulcer, treatment complications and improvements in quality of life. All patients completed the Aberdeen Varicose Veins Questionnaire (AVVQ), the Venous Clinical Severity score (VCSS) and Venous Disability Score (VDS). Results: The mean and standard deviation follow-up was 502 ± 220 days. Ulceration healing was observed in 100% and 91.3% of patients treated with surgery or foam sclerotherapy, respectively (P > 0.05). AVVQ, VCSS and VDS improved in both groups following treatment. There were no significant differences in AVVQ, VCSS and VDS between the two groups several months after the procedures (p = 0,45, 0.58 and 0.66, respectively; Mann-Whitney U test). Complications occurred in 14.2% and 13.0% in the surgical and foam sclerotherapy groups, respectively. Conclusion: Sclerotherapy was non-inferior to surgical treatment in the management of venous ulcers. Therefore sclerotherapy can be considered an alternative to surgical treatment, especially in high surgical risk patients presenting with advanced venous insufficiency and an active ulcer

Objetivo: Comparar o tratamento cirúrgico convencional das varizes de membros inferiores com a escleroterapia com espuma ecoguiada nos pacientes com úlcera venosa. Como objetivo secundário, foi comparada a incidência de complicações com os métodos empregados e a melhora na qualidade de vida após a realização dos procedimentos. Casuística e Métodos: Foi realizado um estudo randomizado e prospectivo de 49 pacientes com úlceras ativas (C6), que foram submetidos ao tratamento cirúrgico (28 membros) ou escleroterapia espuma (23 membros), tendo como desfechos a cicatrização de úlceras de origem venosa, complicações do tratamento e qualidade de vida,. Os pacientes completaram o Questionário Aberdeen Veias Varicosas (QAVV), o escore de severidade clínica venoso (ESCV) e o Escore de Incapacidade Venosa (EIV). Resultados: A média e desvio padrão de acompanhamento foi de 502 ± 220 dias. A úlcera cicatrizou em 100% e 91,3% dos doentes tratados com cirurgia ou escleroterapia espuma, respectivamente (P > 0,05). QAVV, ESCV e EIV melhoraram em ambos os grupos após o tratamento. Não houve diferenças significativas no resultado final do QAVV, ESCV e EIV entre os dois grupos, vários meses após os procedimentos (p = 0,45, 0,58 e 0,66, respectivamente; Mann- Whitney U). As complicações ocorreram em 14,2% e 13,0% nos grupos cirúrgico e escleroterapia com espuma, respectivamente. Conclusão: A escleroterapia com espuma não foi inferior ao tratamento cirúrgico de úlceras venosas. Portanto a escleroterapia é uma alternativa ao tratamento cirúrgico, particularmente adequada para pacientes de alto risco cirúrgico que apresentam insuficiência venosa avançada e úlcera ativa / Objective: To compare the results of varicose vein treatment using ultrasoundguided foam sclerotherapy versus conventional surgery in patients with venous ulcers. As a secondary outcome, we compared the incidence of complications related to the employed technique and improvements in quality of life after the procedures. Methods: A randomized and prospective study was conducted in 49 patients with active venous ulcers (C6), submitted to surgical treatment (28 limbs) or foam sclerotherapy (23 limbs). The primary outcomes analysed included healing of venous ulcer, treatment complications and improvements in quality of life. All patients completed the Aberdeen Varicose Veins Questionnaire (AVVQ), the Venous Clinical Severity score (VCSS) and Venous Disability Score (VDS). Results: The mean and standard deviation follow-up was 502 ± 220 days. Ulceration healing was observed in 100% and 91.3% of patients treated with surgery or foam sclerotherapy, respectively (P > 0.05). AVVQ, VCSS and VDS improved in both groups following treatment. There were no significant differences in AVVQ, VCSS and VDS between the two groups several months after the procedures (p = 0,45, 0.58 and 0.66, respectively; Mann-Whitney U test). Complications occurred in 14.2% and 13.0% in the surgical and foam sclerotherapy groups, respectively. Conclusion: Sclerotherapy was non-inferior to surgical treatment in the management of venous ulcers. Therefore sclerotherapy can be considered an alternative to surgical treatment, especially in high surgical risk patients presenting with advanced venous insufficiency and an active ulcer

Background: Venous thromboembolism (VTE), comprising the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common acute cardiovascular event associated with increased long-term morbidity, functional disability, all-cause mortality, and high rates of recurrence. Major advances in identification, prophylaxis, and treatment over the past 3-decades have likely changed its clinical epidemiology. However, there are little published data describing contemporary, population-based, trends in VTE prevention and management. Objectives: To examine recent trends in the epidemiology of clinically recognized VTE and assess the risk of recurrence after a first acute episode of VTE. Methods: We used population-based surveillance to monitor trends in acute VTE among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) from 1985 through 2009, including in-hospital and ambulatory settings. Results: Among 5,025 WMSA residents diagnosed with acute PE and/or lower-extremity DVT between 1985 and 2009 (mean age = 65 years), 46% were men and 95% were white. Age- and sex-adjusted annual event rates (per 100, 000) of clinically recognized acute first-time and recurrent VTE was 142 overall, increasing from 112 in 1985/86 to 168 in 2009, due primarily to increases in PE occurrence. During this period, non-invasive diagnostic VTE testing increased, vi while treatment shifted from the in-hospital (chiefly with warfarin and unfractionated heparin) to out-patient setting (chiefly with low-molecular-weight heparins and newer anticoagulants). Among those with community-presenting first-time VTE, subsequent 3-year cumulative event rates of key outcomes decreased from 1999 to 2009, including all-cause mortality (41% to 26%), major bleeding episodes (12% to 6%), and recurrent VTE (17% to 9%). Active-cancer (with or without chemotherapy), a hypercoagulable state, varicose vein stripping, and Inferior vena cava filter placement were independent predictors of recurrence during short- (3-month) and long-term (3-year) follow-up after a first acute episode of VTE. We developed risk score calculators for VTE recurrence based on a 3-month prognostic model for all patients and separately for patients without active cancer. Conclusions: Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the disease burden from VTE in residents of central Massachusetts remains high, with increasing annual events. Declines in the frequency of major adverse outcomes between 1999 and 2009 were reassuring. Still, mortality, major bleeding, and recurrence rates remained high, suggesting opportunities for improved prevention and treatment. Clinicians may be able to use the identified predictors of recurrence and risk score calculators to estimate the risk of VTE recurrence and tailor outpatient treatments to individual patients.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-04-12T13:04:38Z No. of bitstreams: 1 GUILHERME CAMARGO GON?ALVES DE ABREU.pdf: 3685278 bytes, checksum: b38c6f9cbee974306c1235fc31b386a3 (MD5) / Made available in DSpace on 2017-04-12T13:04:38Z (GMT). No. of bitstreams: 1 GUILHERME CAMARGO GON?ALVES DE ABREU.pdf: 3685278 bytes, checksum: b38c6f9cbee974306c1235fc31b386a3 (MD5) Previous issue date: 2017-02-22 / Chronic Venous Insufficiency (CVI) is the leading cause of venous leg ulcers (VLU). Primary varicose veins are the most frequent cause of CVI. The requirements for each treatment method limits its applicability. Foam sclerotherapy has been shown to be effective, safe and great applicability. OBJECTIVE: Analize patient?s evolution after ultrasound-guided foam sclerotherapy (USGFS). METHOD. Clinical trial without control group. Patients with primary CVI venous ulcer (VU) and great saphenous vein (GSV) reflux were treated with USGFS from June 2015 to June 2016. We evaluate diseases severity, quality of life (QoL), ulcer?s healing and elimination of venous reflux. Patients were followed for 180 days and evaluated by Doppler ultrasound (USD), Aberdeen varicose veins questionnaire (AVVQ) and venous clinical severity score (VCSS). Anatomical and clinical data were collected. AVVQ, VCSS and ulcers diameters were tested by ANOVA method. Patients were grouped according to outcome (VU healing, venous occlusion and reflux elimination) and variables were compared by the Mann-Whitney test or the Fisher exact test. RESULTS: 22 patients were treated (15 men and 7 women) aged 35 to 70 years (56 +/-10.5). There was improvement in quality of life, ulcers diameters antics were reduced (p < 0.001; ANOVA). 77% of VLU were completely healed, 14% remained open with reduced dimensions. Venous reflux was eliminated in 64% of the treated great saphenous vein. Worse QoL patients needed more treatment sessions (? = 0.5449; p = 0.0087; Spearman). Men had better QOL after 180 days and had a higher gain on QOL than women (p = 0.0074). Older patients, patients with larger ulcers, away from work and women had more severe disease (p 0.05 <; ANOVA). No variable related to evolution of clinical severity. Women had more complications (p = 0.017; Fisher) and there was no severe complications. Completely healed VLU and completely occluded GSV were at beginning smaller than not completely healed UV and not completely occluded GSV (p < 0.05; Mann-Whitney). CONCLUSION: The absence of severe adverse effects and improvement of evaluated parameters observed in most patients indicates that USGFS is an applicable alternative to patients with severe CVI. / A insufici?ncia venosa cr?nica (IVC) ? a principal causa de ?lceras nos membros inferiores (UV). Varizes prim?rias s?o a causa mais frequente de IVC. Os diversos tratamentos propostos para varizes com IVC apresentam requisitos que limitam sua aplicabilidade. Escleroterapia com espuma tem se mostrado eficaz segura barata e de grande aplicabilidade. OBJETIVO: Analisar a evolu??o dos portadores de IVC com refluxo da veia safena magna e ?lcera venosa submetidos a escleroterapia ecoguiada com espuma de polidocanol (EEE). M?TODO. Ensaio cl?nico sem grupo controle. Portadores de IVC prim?ria com ?lcera varicosa e refluxo na veia safena magna foram tratados com EEE de forma consecutiva. Os pacientes foram observados por 180 dias entre junho de 2015 e junho de 2016. A evolu??o dos pacientes foi estudada em termos de qualidade de vida (QV) avaliado pelo question?rio Aberdeen para veias varicosas (QA); gravidade da doen?a avaliada por escore de gravidade cl?nica (ECV), elimina??o do refluxo venoso pelo ultrassom Doppler (USD) e cicatriza??o de ?lceras. Foram coletados dados cl?nicos, anat?micos e sociais. QA, ECV, di?metro das ?lceras e a influ?ncia das vari?veis foram comparados pelo m?todo de ANOVA. Os pacientes foram agrupados de segundo desfecho (cicatriza??o de UV, oclus?o e elimina??o do refluxo venoso) e as vari?veis foram comparadas pelo teste de Mann-Whitney ou pelo teste exato de Fisher. RESULTADOS: Foram tratados 22 pacientes (7 homens e 15 mulheres) com idade entre 35 a 70 anos (56 +/- 10,5). Houve melhora na qualidade de vida, redu??o da gravidade da doen?a e redu??o dos di?metros das ?lceras (p<0.001; ANOVA). Houve cicatriza??o completa de 77% das UV, 14% permaneceram abertas com redu??o das dimens?es. Houve elimina??o do refluxo em 64% das VSM tratadas. Pacientes com pior QV necessitaram maior n?mero de sess?es para tratamento da doen?a (?=0.5449; p-valor = 0.0087; Spearman). Homens apresentaram melhor QV ap?s 180 dias e tiveram maior ganho na QV que as mulheres (p = 0.0074; Mann-Whitney). Pacientes mais idosos, portadores de ?lceras maiores, afastados do trabalho e mulheres (p<0,05; ANOVA) apresentaram doen?a mais grave. Nenhuma vari?vel se relacionou a evolu??o da gravidade cl?nica. Mulheres apresentaram mais complica??es (p = 0.017; Fisher) e n?o houve complica??es graves. As UV completamente cicatrizadas e as VSM que apresentaram oclus?o completa apresentavam dimens?es inicialmente menores quando comparadas as UV n?o completamente cicatrizadas e as VSM n?o completamente oclu?das (p<0,05; Mann-Whitney). CONCLUS?O: A aus?ncia de complica??es graves e a melhora observada dos par?metros avaliados na maioria dos pacientes indica que EEE ? alternativa aplic?vel aos portadores de IVC grave.

Abstaract(thesis) In my thesis, I decided to take the issue of treatment of vascular input in surgical department and surgical intensive care units. This nursing problem can be found practically on every inpatient department and each nurse meets with vascular access dutiny her career. The work is divided into theoretical part and empirical part. The first theoretical part deals with the history of vascular input, a list of basic vascular entries and the educational process. Of the vascular inputs, the work focuses especially on central venous catheter and peripheral venous catheter. The second empirical part focuses on the evaluation of collected data and their statistical analysis. Before the research 4 hypotheses were provided. These hypothesis were confirmed by statistical evaluation of questionnaires. The questionnaires were filled in by sisters from the surgical department and intensive care units. At the end of the thesis is work evaluation. Keywords Vascular access, peripheral venous cannula, central venous cannula, nursing, dressing, asepsis, infections, nurse, patient

The venous ulcer is defined as a chronic injury present in the lower third of the legs. It affects the individuals of different age ranges and it is associated to chronic venous insufficiency. It has importance from social and clinic point of view because it compromises their productivity and life quality. So, it becomes a challenge for the health team caring people who have venous ulcer due to its complexity and socio-economical repercussion. Therefore it is essential to create a link with the individual and his/her family promoting the knowledge exchange and approximating the learnings. Thus, through this survey one seeks for contributing with the professionals of health, especially those of Nursing both in the knowledge construction and in the care qualification to the patients with venous ulcers, aiming at the approaching of the professional wisdom to the popular wisdom. The research has as guiding question: What are popular care practices adopted by venous ulcer persons assisted at the angiology outpatient clinic of the Universitary Hospital of Santa Maria, Rio Grande do Sul, Brazil? And as goal: to know the popular care practices adopted by outpatients suffering from venous ulcer attended at the angiology ambulatory of the Universitary Hospital of Santa Maria, RS. This is a field research, which is qualitative, exploratory and descriptive, being developed at the clinic of the referring hospital and at venous ulcer people s household, in the period between December 2012 and March 2013. The research participants are adults and elderly with venous injury. These persons are being accompanied in this ambulatory. The data collection was carried out by a semi-structured interview. Afterwards, the data were transcribed and submitted to the content analysis. Ethical aspects were respected in accordance to the Resolution 196/96 of the National Health Council. The results are presented in an article format: Article 1: People are going to teach me the things and I do them! : popular practices in venous ulcer care; Article 2: Health care in outpatient people with venous ulcer. It can be evidenced that people resort to multiple alternatives in care, seeking for solving their health condition. Among the popular care practices referred by respondents, are: bless, pray, the use of plants and several types of tea, and pluralisms of practices. Besides these, there is the care with the nourishment, with injury and with the rest. Therefore, it is necessary that the health professionals, especially the nurses, know the population socio-cultural reality, which they attend, aiming at a congruent care. / A úlcera venosa é definida como uma lesão crônica presente no terço inferior das pernas. Acomete indivíduos de diferentes faixas etárias e está associada à insuficiência venosa crônica, tendo importância do ponto de vista social e clínico, uma vez que compromete a produtividade e qualidade de vida desses. Assim, torna-se um desafio para a equipe de saúde cuidar das pessoas com úlcera venosa, devido a sua complexidade e repercussão socioeconômica. Considera-se imprescindível a construção de um vínculo com o indivíduo e sua família favorecendo a troca de conhecimentos e aproximando os saberes. Esta investigação, busca contribuir com os profissionais de saúde, especialmente com a enfermagem, tanto na construção do conhecimento como na qualificação do cuidado aos pacientes com úlceras venosas, visando a aproximação do saber profissional ao popular. A pesquisa tem como questão norteadora: Quais as práticas de cuidado popular adotadas pelas pessoas com úlcera venosa atendidas no ambulatório de angiologia do Hospital Universitário de Santa Maria, no Rio Grande do Sul, Brasil? E, como objetivo: conhecer as práticas de cuidado popular adotadas pelas pessoas com úlcera venosa atendidas no ambulatório de angiologia do Hospital Universitário de Santa Maria/RS. Trata-se de uma pesquisa de campo, qualitativa, exploratória e descritiva, desenvolvida no ambulatório do referido hospital e no domicílio das pessoas com úlcera venosa, no período entre dezembro de 2012 e março de 2013. Os participantes da pesquisa são adultos e idosos, com lesão venosa, em acompanhamento neste ambulatório. A coleta de dados foi realizada por meio de entrevista semiestruturada. Após, os dados foram transcritos, e submetidos à análise de conteúdo. Foram respeitados os aspectos éticos em consonância à Resolução nº 196/96 do Conselho Nacional de Saúde. Os resultados são apresentados no formato de artigos: Artigo 1: As pessoas vão me ensinando as coisas e eu faço! : práticas populares no cuidado com a úlcera venosa; Artigo 2: Cuidados em saúde das pessoas com úlcera venosa em assistência ambulatorial.Pode-se constatar que as pessoas recorrem a múltiplas alternativas de cuidados em busca de solução para sua condição de saúde. Entre as práticas de cuidado popular referidas pelos entrevistados estão benzer, rezar/orar, uso de plantas e chás e pluralismos de práticas. Além dessas, encontraram-se os cuidados com a alimentação, com a lesão e o repouso. Portanto, há necessidade de os profissionais de saúde, em especial os enfermeiros, conhecerem a realidade sociocultural da população que assistem, com vistas a um cuidado congruente.

Made available in DSpace on 2014-12-17T15:16:20Z (GMT). No. of bitstreams: 1 CibeleTDR_DISSERT.pdf: 1600601 bytes, checksum: 17a20c970bdc4a9e7d51aa44c7922b20 (MD5) Previous issue date: 2014-02-04 / Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (? 26,2%) with alginate e 19,4% (? 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing. / A doen?a venosa cr?nica (DVC) evidencia-se entre as doen?as cr?nicas por acometer a popula??o idosa e ser a principal respons?vel pelas ?lceras de membros inferiores nesta popula??o. O uso de adesivos no cuidado de uma ?lcera venosa ? parte fundamental no tratamento para a cicatriza??o, no entanto, as evid?ncias para auxiliar na escolha do melhor adesivo s?o escassas. O objetivo principal do estudo foi avaliar a efic?cia do tratamento com o hidrogel na cicatriza??o de ?lceras venosas mediante m?todos de busca, s?ntese de informa??o e an?lise estat?stica atrav?s de uma revis?o sistem?tica com meta-an?lise. Foram selecionados estudos controlados randomizados nas seguintes bases de dados: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Al?m dessas bases foram consultados tr?s websites para identificar estudos em andamento: ClinicalTrials.gov, OMS ICTRP e ISRCTN. Os desfechos prim?rios analisados foram: cicatriza??o completa das ?lceras e incid?ncia de infec??o das ?lceras e os secund?rios foram: altera??es no tamanho da ?lcera, tempo de cicatriza??o das ?lceras, recorr?ncia das ?lceras, qualidade de vida dos participantes, dor e custos do tratamento. Quatro estudos est?o atualmente inclu?dos na revis?o com um total de 250 pacientes. O uso do hidrogel parece ser superior ao curativo convencional, gaze embebida em salina, para a cicatriza??o de ?lceras venosas de membros inferiores; 16/30 pacientes apresentaram cicatriza??o completa das ?lceras (RR 5,33, 95%CI [1,73,16,42]). O gel de alginato demonstrou ser mais efetivo quando comparado ao hidrogel quanto ? redu??o da ?rea da ?lcera; 61,2% (? 26,2%) com o alginato e 19,4% (? 24,3%) com o hidrogel ao final das quatro semanas de tratamento. O mel de Manuka demonstrou ser similar ao hidrogel em rela??o ? porcentagem de redu??o da ?rea. Esta revis?o mostrou que n?o existem evid?ncias dispon?veis a respeito da efic?cia do hidrogel em rela??o aos outros tipos de curativo na cicatriza??o de ?lceras venosas de membros inferiores, demonstrando assim a necessidade de futuras pesquisas para auxiliar os profissionais da sa?de na escolha do adesivo correto

Portal hypertension (PHT) is a condition with serious complications, such as variceal bleeding, refractory ascites and bowel ischemia. The cause of PHT may be pre-, intra- or post-hepatic. Initial treatment is pressure-reducing drugs and the treatment of acute symptoms. Ten patients presented with severe abdominal pain and acute portomesenteric venous thrombosis. Their response to systemic anticoagulation was insufficient. Treatment with primary continuous thrombolysis by a transhepatic or transjugular approach in four patients resulted in major complications, incomplete recanalization and a 75% survival rate. Treatment with repeated transjugular thrombectomy (TT) combined with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) achieved near complete recanalization, prompt symptom relief and 100% survival in five patients treated with this method as the primary intervention. In one patient, treated with TT and TIPS secondary to surgical thrombectomy and bowel resection, the outcome was fatal. Nineteen patients with portal vein thrombosis presented with acute or threatening variceal bleeding or refractory ascites. TIPS was feasible in 16 of the 18 patients in whom it was attempted and symptom relief was achieved in the majority of them. In 14 patients with Budd-Chiari syndrome, 13 patients were treated with TIPS, four of them after previous liver vein angioplasty. The 5-year transplantation-free survival rate was 100% in patients treated with primary TIPS. In 131 patients with variceal bleeding treated with TIPS, the survival at 12 months in patients with and without cirrhosis was 70% and 100% respectively and in accordance with previous studies. A high Child-Pugh score prior to TIPS and severe HE within 12 months after TIPS was related to an increased mortality. The occurrence of HE after TIPS did not correlate with the PSG after TIPS. Re-bleeding within 12 months after TIPS occurred in 10 patients and was associated with TIPS dysfunction. In conclusion, endovascular intervention, mainly TIPS, seems to be safe and effective for treating patients with complications of PHT, regardless of the underlying cause of disease and site of venous blood flow obstruction. HE may occur more frequently after TIPS than medical and endoscopic treatment, but is often mild and easily treated. In selected patients with PHT, TIPS may improve survival.

Orientador: Joyce Maria Annichinno-Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T02:29:39Z (GMT). No. of bitstreams: 1 Mello_TayanaBezerraTeixeira_D.pdf: 2343820 bytes, checksum: be3d8e4b057cd84ec6771c67b8b1407d (MD5) Previous issue date: 2006 / Resumo: Nos últimos anos tem sido demonstrada uma associação entre níveis elevados de certos fatores da coagulação e risco de tromboembolismo venoso (TEV). Entretanto, o número de estudos é pequeno e a maioria estão restritos a populações caucasóides. Neste estudo caso-controle emparelhado por idade, sexo e etnia investigamos os níveis plasmáticos do fibrinogênio, FVII, FVIII, FIX, FX, FXI, FvW e grupo sanguíneo (GS) ABO no risco trombótico. Foram analisados 175 pacientes com TEV (122 mulheres e 53 homens), com idade mediana de 36 anos (13-63), acompanhados no Ambulatório de Hemostasia da Unicamp no período de julho de 2002 a julho de 2005. Na análise univariada, níveis elevados de FVIII (OR: 5,3 IC95% 2,9-9,6), FvW (OR: 4,9 IC95% 2,7-8,9), FIX (OR: 2,4 IC95% 1,3-4,4), FXI (OR: 2,1 IC95% 1,1-4,0) e GS não O (OR: 3,0 IC95% 1,9-4,6) foram fatores de risco para TEV. O FVIII, FvW e GS não O foram associados ao risco tanto em membro inferior como em sítio incomum da doença. A análise de todas estas variáveis, segundo critério de seleção ¿stepwise¿, mostrou o FVIII (OR: 3,1 IC95% 1,6-6,0), FvW (OR:2,8 IC95% 1,4-5,4) e o GS não-O (OR:2,2 IC95% 1,3-3,5) como fatores de risco independentes para TEV e que o FIX e FXI agiram sinergicamente a estas variáveis no acréscimo do risco trombótico. Risco de recorrência foi conferido por elevações do FIX (OR: 4,7 IC95% 1,8-11,9) e FXI (OR: 3,4 IC95% 1,8-8,7). Os determinantes dos níveis plasmáticos do FVIII não estão totalmente esclarecidos. Como a LRP (Low density lipoprotein receptor related protein) tem um papel no catabolismo do FVIII, foram pesquisados os polimorfimos C200T, o A775P e o D2080N no gene codificador dessa proteína, como fator de risco para TEV e a influência dos mesmos sobre os níveis do FVIII e FvW. Não houve diferença nas prevalências destes polimorfismos entre pacientes e controles. No entanto, no grupo-controle, o genótipo DN, do polimorfismo D2080N, foi associado a menores concentrações do FVIII (77,4 UI/dl) e FvW (70,2 UI/dl), quando comparado ao genótipo DD (127 UI/dl e 108,4 UI/dl, respectivamente p<0,05). Em conclusão, nesta população brasileira miscigenada, o FVIII, FvW , FIX, FXI e GS não O foram associados ao risco de TEV e o polimorfismo D2080N, no gene da LRP, interferiu com os níveis plasmáticos de FVIII e FvW / Abstract: During the last years an association between high levels of certain coagulation factors and the risk for venous thromboembolism (VTE) has been demonstrated. The number of studies, however, is small, and most of them are restricted to Caucasian populations. In this case control study, matched for age, sex and ethnicity, we investigated the plasma levels of fibrinogen, FVII, FVIII, FIX, FX, FXI, vWF and the ABO blood group (BG) in the thrombotic risk. It was analyzed 175 patients with VTE (122 women and 53 men), median age 36 years (13-63), followed at the hemostasis outpatient clinic at the State University of Campinas ¿ UNICAMP, between July 2002 and July 2005. In univariate analysis, elevated levels of FVIII (OR: 5.3 95%CI 2.9-9.6), FvW (OR: 4.9 95%CI 2.7-8.9), FIX (OR: 2.4 95%CI 1.3-4.4), FXI (OR: 2.1 95%CI 1.1-4.0) and non O BG (OR: 3.0 95%CI 1.9-4.6) were risk factors for VTE. FVIII, FvW and non O BG were associated with the risk both in lower limbs and unusual sites of disease. Analysis of all these variables by stepwise selection criteria showed FVIII (OR:3.1 95%CI 1.6-6.0), FvW (OR:2.8 95%CI 1.4-5.4) and non O BG (OR:2.2 95%CI 1.3-3.5) as independent risk factors for VTE, and FIX and FXI increased synergistically the risk of thrombosis of these variables. Risk of recurrence was conferred by FIX (OR:4.7 IC95% 1.8-11.9) and FXI (OR:3.4 IC95% 1.8-8.7). The FVIII plasma levels determinants are not well established. Since LRP (Low density lipoprotein receptor related protein) has a role in the catabolism of FVIII, we evaluated the C200T, A775P and, D2080N polymorphisms in the gene coding of this protein, as risk factor for VTE and their influence upon the levels of FVIII and vWF. There was no difference regarding the prevalence of these polymorphisms between patients and controls. However, in the control group, the DN genotype, of the D2080N polymorphism, was associated with lower concentrations of FVIII (77.4 UI/dl) and vWF (70.2 UI/dl), when compared to DD genotype (127 UI/dl e 108.4 UI/dl, respectively p<0.05). In conclusion, in these Brazilian miscigenous population, increased levels of FVIII, FvW, FIX, FXI and non O BG were associated with VTE risk and the D2080N polymorphism, in the LRP gene, influenced plasma levels of FVIII and vWF / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica

Orientador: Carmen Maria Casquel Monti Juliani / Resumo: Objetivos: caracterizar o risco de tromboembolismo venoso e o uso de profilaxia em pacientes clínicos e cirúrgicos, avaliando a conformidade ou não-conformidade da prescrição de profilaxia medicamentosa e desvelar a percepção dos enfermeiros frente ao uso do protocolo de profilaxia de tromboembolismo venoso. Métodos: Estudo descritivo, com abordagem multimétodos ou método misto, utilizando técnicas quantitativas (estudo transversal) e qualitativas (fenomenologia), com a finalidade de realizar a interação entre os métodos, fornecendo melhores possibilidades analíticas. Resultados: A taxa global de profilaxia de tromboembolismo venoso foi 70% e os pacientes clínicos apresentaram maior conformidade de prescrição de profilaxia em relação ao protocolo e a quantidade de fatores de risco/pacientes foi maior em pacientes clínicos em relação aos cirúrgicos. Os enfermeiros costumam preencher o protocolo no momento da admissão do paciente e, quando não conseguem, informam a necessidade durante passagem do plantão. Há um consenso entre os enfermeiros que médicos fixos nos setores prescrevem mais adequadamente a medicação profilática em relação aos rotativos. Conclusão: Para que todos os usuários se beneficiem da profilaxia, é necessária educação permanente/continuada associada a estratégias para envolvimento da equipe multiprofissional, além de divulgação maciça do protocolo de profilaxia de tromboembolismo venoso, a fim de diminuir as lacunas do conhecimento e instrumentalizar as equipe... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objectives: To characterize the risk of venous thromboembolism and the use of prophylaxis in clinical and surgical patients, to evaluate a measure or non-compliance of prescribing medication prophylaxis and to develop nurses' perceptions regarding the use of venous prophylaxis protocol. Methods: Descriptive study with a multimedia approach or method, using quantitative (cross-sectional) and qualitative (phenomenology) techniques, using an interaction between methods, providing better analytical alternatives. Results: An overall rate of venous thromboembolism prophylaxis was 70% and clinical patients with a higher prevalence of prophylaxis prescription compared to the protocol and a number of risk factors / patients were the highest in clinical patients compared to physicians. Nurses usually complete the protocol at the time of patient admission and, when unable to do so, provide the necessary information during the passage of planting. There is a consensus among nurses that doctors fix in the prescribed sectors more that use prophylactic medication in relation to rotary ones. Conclusion: For all users who benefit from prophylaxis, it is mandatory / continued associated with multiprofessional team participation strategies, in addition to the massive dissemination of venous thromboembolism prophylaxis protocol, an end of loss as knowledge gaps and to instrumentalize as teams with the specific practice in using. / Doutor