Made available in DSpace on 2016-12-06T17:07:30Z (GMT). No. of bitstreams: 1 Luisa.pdf: 853925 bytes, checksum: 7b1f07653d4afbf8c5ab44e3c4c18135 (MD5) Previous issue date: 2011-05-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Chronic venous insufficiency is characterized by an abnormal functioning of the venous system, in which the flow of arterial blood that reaches the lower limbs is greater than the flow of venous blood returning to heart. The blood accumulates in the lower limbs and generates venous hypertension, with consequent edema and skin changes. The objective was to create a simplified protocol of exercises physical to be performed at home, and subsequently evaluate the intervention in patients with chronic venous insufficiency ulcer vein. Method: Initially, we produced a simplified protocol of exercises, which could be easily understood and implemented by patients. In order to facilitate understanding and implementation, was produced a booklet to demonstrate the correct way to perform the exercises. Through a controlled clinical trial, we developed a pilot study evaluated 06 individuals, 03 in Group Experimental (GE) and 03 Control Group (CG). For 15 days, patients were submitted to the GE program of physical exercises performed at home, while the CG patients remained on conventional treatment only. Through the visual analogue scale, tape measure, goniometer, and SF-36 were evaluated, respectively, the pain and swelling in lower limbs, range of motion of the ankles and knees, and quality of life related to health, not being observed significant difference between groups in measured parameters. Conclusion: The protocol for conducting exercises at home was easily understood by all individuals in the GE, allowing the immediate execution of the planeed activity. Probably due to the small number of subjects evaluated and the short intervention period, there was no significant difference between groups. / A insuficiência venosa crônica caracteriza-se por um funcionamento anormal do sistema venoso, no qual o fluxo de sangue arterial que chega aos membros inferiores (MMII) é maior que o fluxo de sangue venoso que retorna ao coração. O sangue acumula-se nos membros inferiores e gera hipertensão venosa, com consequente edema e alterações de pele. O objetivo desta pesquisa foi criar um protocolo simplificado de exercícios físicos para execução domiciliar e, subsequentemente, avaliar a intervenção em pacientes com insuficiência venosa crônica e úlcera venosa. Método: Inicialmente foi produzido um protocolo simplificado de exercícios, que pudesse ser facilmente compreendido e executado pelos pacientes. No intuito de facilitar a compreensão e execução, foi produzida uma cartilha para demonstração da forma correta de executar os exercícios. Por meio de um ensaio clínico controlado, foi desenvolvido um estudo piloto no qual foram avaliados 06 indivíduos, 03 no Grupo Experimental (GE) e 03 no Grupo Controle (GC). Durante 15 dias, os pacientes do GE foram submetidos ao programa de exercícios físicos realizados em domicílio, enquanto os pacientes do GC permaneceram apenas no tratamento convencional. Por meio da escala visual analógica, fita métrica, goniômetro, e questionário SF-36, foram avaliados, respectivamente, a dor e edema em MMII, amplitude de movimento articular dos tornozelos e joelhos, e a qualidade de vida relacionada à saúde, não sendo observada diferença significativa entre os grupos, nos parâmetros avaliados. Conclusão: O protocolo para realização de exercícios em domicílio foi facilmente compreendido por todos os indivíduos do GE, permitindo a imediata execução da atividade prevista. Provavelmente devido ao pequeno número de indivíduos avaliados e ao curto período de intervenção, não foi verificada diferença significativa entre os grupos.

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

Chronic venous disease (CVD) of the lower extremities is a high prevalence disease in general population and is associated with great morbidity. Patients with body overweight are more likely to present themselves with more severally symptoms and are challenging for conventional surgical treatment. The advent of ultrasound guided foam sclerotherapy has broaden the possibility of treatment for these patients. The association of long-term elastic compression after the procedures continues to show conflicting results. Objectives: This study aims to evaluate the changes in the therapeutic response of foam sclerotherapy when using the long-term elastic compression in overweight patients. Method: In this randomized trial the lower limbs were randomly allocated to use or not elastic compression after insufficient venous treatment and submitted to one or two sessions of ultrasound guided sclerotherapy. The evaluations were performed after 3 weeks and 3 months considering as primary outcome the occlusion of the treated venous segment and as secondary outcome the absence of blood reflux in the segment. Results: 131 lower’s limbs were treated: 70 submitted to long-term elastic compression and 62 not. There was no statistic difference between the group’s characteristics. A total of 187 sessions of foam sclerotherapy, being 131 primary interventions and 56 reinterventions, were performed on the entire sample. The number of sessions was greater in the group submitted to long-term elastic compression (p = 0,64). The average foam volume used were slightly higher in the group without long-term elastic compression (p=0,27). The assessment of the primary and secondary outcome showed no difference in the therapeutic response between the groups after 3 weeks and 3 months evaluating the safenofemoral junction (p = 0,47 and p = 0,99) and saphenous magna vein (p = 0,59 and p = 0,26). For the tributaries the success rates were higher after 3 months for the patients submitted to long-term elastic compression (p = 0,0018). Conclusion: The long-term elastic compression did not interfere in the therapeutic response in patients with body overweight in the main venous trunks. The long-term elastic compression had higher success rates in the tributaries. In addition, the elastic compression seems to be associated to a lower foam volume for treatment. / A doença venosa crônica dos membros inferiores (DVC) apresenta alta prevalência na população geral e acompanha-se de elevada morbidade. Pacientes com excesso de peso tendem a apresentar quadros clínicos mais graves e são um desafio ao tratamento cirúrgico convencional. O advento da escleroterapia com espuma guiada por ultrassom (EEE) ampliou a possibilidade de tratamento destes pacientes. A associação da compressão elástica prolongada após intervenções apresenta resultados controversos na literatura. Objetivo: O presente trabalho pretende avaliar as taxas de sucesso terapêutico da EEE quando da utilização da compressão elástica prolongada em pacientes com excesso de peso. Método: Neste ensaio clínico randomizado os membros inferiores foram alocados randomicamente para uso ou não de meia elástica compressiva após tratamento das veias insuficientes. Foram realizadas uma ou duas sessões de escleroterapia guiada por ultrassonografia. As avaliações foram realizadas decorridas 3 semanas e 3 meses do tratamento, considerando para desfecho primário a oclusão do trajeto venoso tratado e para desfecho secundário a ausência de refluxo no segmento. Resultados: Foram tratados 131 membros inferiores: 69 submetidos a compressão elástica prolongada e 62 não. Os grupos foram avaliados quanto à distribuição de suas características de base não havendo diferenças estatisticamente significativas entre eles. Um total de 187 sessões de ecoescleroterapia com espuma, sendo 131 primeiras intervenções e 56 reintervenções, foram realizadas em toda a amostra. O número de sessões foi maior no grupo submetido à compressão elástica prolongada (p= 0,64). O volume médio de espuma aplicada foi discretamente maior no grupo sem compressão elástica prolongada (p=0,27). Na avaliação dos desfechos primário e secundário não houve diferença na resposta terapêutica entre os grupos em 3 semanas e em 3 meses na avaliação da junção safenofemoral (p= 0,47 e p=0,99) e da veia safena magna (p= 0,79 e p=0,87). Para as tributárias as taxas de sucesso foram maiores em 3 meses nos pacientes submetidos a compressão elástica prolongada (p=0,0018). Conclusão: Não houve interferência da compressão elástica prolongada na resposta terapêutica da ecoescleroterapia em pacientes com excesso de peso nos principais troncos venosos. Para as tributárias, a compressão elástica obteve maiores taxas de sucesso. A compressão elástica pode estar associada a um menor volume de espuma necessário para tratamento.

No description available.

yes / To investigate cerebrospinal fluid (CSF) dynamics in the aqueduct of Sylvius (AoS) in chronic cerebrospinal venous insufficiency (CCSVI)-positive and -negative healthy individuals using cine phase contrast imaging. Materials and Methods Fifty-one healthy individuals (32 CCSVI-negative and 19 age-matched CCSVI-positive subjects) were examined using Doppler sonography (DS). Diagnosis of CCSVI was established if subjects fulfilled ≥2 venous hemodynamic criteria on DS. CSF flow and velocity measures were quantified using a semiautomated method and compared with clinical and routine 3T MRI outcomes. Results CCSVI was associated with increased CSF pulsatility in the AoS. Net positive CSF flow was 32% greater in the CCSVI-positive group compared with the CCSVI-negative group (P = 0.008). This was accompanied by a 28% increase in the mean aqueductal characteristic signal (ie, the AoS cross-sectional area over the cardiac cycle) in the CCSVI-positive group compared with the CCSVI-negative group (P = 0.021). Conclusion CSF dynamics are altered in CCSVI-positive healthy individuals, as demonstrated by increased pulsatility. This is accompanied by enlargement of the AoS, suggesting that structural changes may be occurring in the brain parenchyma of CCSVI-positive healthy individuals

Venous disease will affect 1-3% of the western world at some point in their lives, yet there are few effective treatments for the venous system [1]. One such disease is chronic venous insufficiency (CVI), a painful and debilitating illness that affects the superficial and deep vein valves of the legs. When the valves become incompetent they allow reflux and subsequent pooling of blood. Current clinical therapies are only moderately; and therefore, the need for a better solution remains. Prosthetic venous valves were constructed from a novel hydrogel biomaterial patented by Georgia Tech. The valves had flexible cusps similar to normal, anatomic venous valves. The purpose of this work was to evaluate the thrombotic potential of the GT venous valve in an in vitro study and to design a percutaneous delivery system. In vitro thrombosis model provides an appropriate intermediate step between valve development and in vivo analysis, which is necessary to determine the biocompatibility of the prosthetic device. The flow system was modified from a one-pass, flow-through thrombosis assay using whole blood [2] to mimic pulsatile physiologic conditions. Cessation of flow indicated thrombotic obstruction. Histological analysis was performed using H and E staining and Carstairs stain (specific for platelets). A group of valves were lined with Dacron to confirm the thrombotic potential of the system. All Dacron valves were occluded by thrombus connecting the polymer fibers with adherent platelets. Whole blood perfused through the GT prosthetic valves exhibited no thrombosis or platelet adherence. All GT valves were patent and competent after blood perfusion. H and E staining revealed no thrombus deposition on the GT vein valves. A percutaneous delivery system was designed after evaluating the GT valves for their compressibility and plastic deformation over time. Appropriate stents, catheters and sheaths were selected. As designed, this system will be utilized in an ovine trial of the valve. Due to the low in vitro thrombotic potential and strong history of PVA as a medical implant material, positive trial results are expected. With successful animal and human trials this valve can provide a potential intervention for the 7 million people suffering from CVI.

Bakgrund   Allmänsjuksköterskor kommer ofta i kontakt med personer med venösa bensår. Behandling och vård av dessa personer sker ofta inom primärvård, öppenvård eller hemsjukvård, men även på vårdavdelningar och andra sjukvårdsinstanser. Venösa bensår är en följd av underliggande kronisk venös insufficiens. Det är därför stor risk att såren återkommer efter läkning och behandlingen måste därför i många fall bli livslång. Trots detta finns få studier som fokuserar på personers upplevelser av behandling och vård vid venösa bensår.   Syfte  Syftet är att beskriva personers upplevelser av behandling och vård vid venösa bensår. Metod  För att sammanfatta den forskning som i dagsläget finns kring ämnet har en litteraturöversikt gjorts. Sökningar har utförts i de vetenskapliga databaserna Pub Med och CINAHL och 16 artiklar identifierades. Dessa har kvalitetsgranskats genom Sophiahemmet Högskolas bedömningsinstrument. Resultat Litteraturöversiktens tre huvudkategorier, förhoppning och uppgivenhet, att leva ett begränsat liv och att inte bli sedd som person berättar om upplevelser som många personer med venösa bensår har av behandling och vård. Personer upplever att behandling och vård på något sätt begränsar eller påverkar dem. Vårdens kontinuitet, god kommunikation, och relationen till sjuksköterskan är av betydelse för upplevelsen av behandling och vård. Det finns brister i individanpassningen av behandling och vård som påverkar personer med venösa bensårs förtroende för vården. Många personer uppger en ovisshet som gör det svårt att hantera behandlingen psykologiskt. En stark önskan om läkning av de venösa bensåren är gemensamt för många studiedeltagare. Slutsats Det fattas specifik forskning om personers upplevelser. Sjuksköterskor som behandlar personer med venösa bensår saknar kunskaper om deras tillstånd och rekommenderad behandling. I denna litteraturöversikt framkommer ett behov av att skifta fokus från läkning av det venösa bensåret till personens livskvalitet. Sjuksköterskor behöver mer kunskaper om venösa bensår och en större förståelse för den livssituation som många personer med venösa bensår befinner sig i. Ökad nivå av personcentrering i behandling och vård av personer med venösa bensår bör därför eftersträvas, och förutsättningar måste skapas för sjuksköterskor att kunna erbjuda den specialiserade och kvalitativa vård som krävs. / Background Registered nurses frequently come into contact with persons living with venous leg ulcers, as these wounds are primarily treated and cared for by nurses. Persons with venous leg ulcers often experience underlying chronic venous insufficiency, which is the main cause of venous leg ulcers. This means that even once healed venous leg ulcers are likely to reoccur, and treatment is often life-long. In spite of this, very few studies and research projects focus on the person’s experiences of their ailment in relation to the treatment they receive. Aim To highlight persons’ experiences related to the treatment and care of venous ulcers.  Method To summarize the research knowledge of this subject, a review of current literature was undertaken. Searches have been conducted in several online-based databases. Through the databases PubMed and CINAHL 16 articles were identified and then analyzed. Results Many persons with venous leg ulcers feel that treatment and care affects or impedes them in some way. Three core categories were identified as signifying for the result: hopefulness and uncertainty, an impaired life, and not being viewed as a person. Continuity of care, quality of communication, and the nurse-patient relationship are all key contributors to the experiences of treatment and care that persons with venous leg ulcers describe. The result implies that treatment and care of persons with venous leg ulcers is not satisfyingly individualized, which reduces the level of confidence that these persons feel for their healthcare providers. Persons with venous leg ulcers report that experiences of uncertainty make the treatment hard to handle psychologically. A strong desire for permanent healing is shared by persons with venous leg ulcers.  Conclusions There is a shortage of specific research aimed at the experiences of persons with venous leg ulcers of aspects relating to their treatment and care. Many nurses lack vital knowledge regarding the treatment and care of these individuals. In this review a need for a shift of focus is perceived, from simply the healing of the venous leg ulcer, into also considering the quality of life of persons with venous leg ulcers. Nurses are in need of more knowledge of the condition, and more insight into the lives of persons with venous leg ulcers. A person-centred approach should therefore be sought, and conditions must be provided for nurses to expand their knowledge and be able to offer a more specialized and qualitative level of treatment and care.

BACKGROUND: The potential pathogenesis between the presence and severity of chronic cerebrospinal venous insufficiency (CCSVI) and its relation to clinical and imaging outcomes in brain parenchyma of multiple sclerosis (MS) patients has not yet been elucidated. The aim of the study was to investigate the relationship between CCSVI, and altered brain parenchyma venous vasculature visibility (VVV) on susceptibility-weighted imaging (SWI) in patients with MS and in sex- and age-matched healthy controls (HC). METHODS: 59 MS patients, 41 relapsing-remitting and 18 secondary-progressive, and 33 HC were imaged on a 3T GE scanner using pre- and post-contrast SWI venography. The presence and severity of CCSVI was determined using extra-cranial and trans-cranial Doppler criteria. Apparent total venous volume (ATVV), venous intracranial fraction (VIF) and average distance-from-vein (DFV) were calculated for various vein mean diameter categories: < .3 mm, .3-.6 mm, .6-.9 mm and > .9 mm. RESULTS: CCSVI criteria were fulfilled in 79.7% of MS patients and 18.2% of HC (p < .0001). Patients with MS showed decreased overall ATVV, ATVV of veins with a diameter < .3 mm, and increased DFV compared to HC (all p < .0001). Subjects diagnosed with CCSVI had significantly increased DFV (p < .0001), decreased overall ATVV and ATVV of veins with a diameter < .3 mm (p < .003) compared to subjects without CCSVI. The severity of CCSVI was significantly related to decreased VVV in MS (p < .0001) on pre- and post-contrast SWI, but not in HC. CONCLUSIONS: MS patients with higher number of venous stenoses, indicative of CCSVI severity, showed significantly decreased venous vasculature in the brain parenchyma. The pathogenesis of these findings has to be further investigated, but they suggest that reduced metabolism and morphological changes of venous vasculature may be taking place in patients with MS.

No / The purpose of this article is to investigate characteristics of cine phase contrast-calculated cerebrospinal fluid (CSF) flow and velocity measures in patients with relapsing-remitting (RR) multiple sclerosis (MS) receiving standard medical treatment who had been diagnosed with chronic cerebrospinal venous insufficiency (CCSVI) and underwent percutaneous transluminal angioplasty (PTA). This case-controlled, magnetic resonance (MR) imaging-blinded study included 15 patients with RR MS who presented with significant stenoses (>/=50% lumen reduction on catheter venography) in the azygous or internal jugular veins. Eight patients underwent PTA in addition to medical therapy immediately following baseline assessments (case group) and seven had delayed PTA after 6 months of medical therapy alone (control group). CSF flow and velocity measures were quantified over 32 phases of the cardiac cycle by a semiautomated method. Outcomes were compared between groups at baseline and at 6 and 12 months of the study by mixed-effect model analysis. At baseline, no significant differences in CSF flow or velocity measures were detected between groups. At month 6, significant improvement in flow (P<.001) and velocity (P = .013) outcomes were detected in the immediate versus the delayed group, and persisted to month 12 (P = .001 and P = .021, respectively). Within-group flow comparisons from baseline to follow-up showed a significant increase in the immediate group (P = .033) but a decrease in the delayed group (P = .024). Altered CSF flow and velocity measures were associated with worsening of clinical and MR outcomes in the delayed group. PTA in patients with MS with CCSVI increased CSF flow and decreased CSF velocity, which are indicative of improved venous parenchyma drainage.

No / PURPOSE: To investigate cerebrospinal fluid (CSF) dynamics in the aqueduct of Sylvius (AoS) in chronic cerebrospinal venous insufficiency (CCSVI)-positive and -negative healthy individuals using cine phase contrast imaging. MATERIALS AND METHODS: Fifty-one healthy individuals (32 CCSVI-negative and 19 age-matched CCSVI-positive subjects) were examined using Doppler sonography (DS). Diagnosis of CCSVI was established if subjects fulfilled >/=2 venous hemodynamic criteria on DS. CSF flow and velocity measures were quantified using a semiautomated method and compared with clinical and routine 3T MRI outcomes. RESULTS: CCSVI was associated with increased CSF pulsatility in the AoS. Net positive CSF flow was 32% greater in the CCSVI-positive group compared with the CCSVI-negative group (P = 0.008). This was accompanied by a 28% increase in the mean aqueductal characteristic signal (ie, the AoS cross-sectional area over the cardiac cycle) in the CCSVI-positive group compared with the CCSVI-negative group (P = 0.021). CONCLUSION: CSF dynamics are altered in CCSVI-positive healthy individuals, as demonstrated by increased pulsatility. This is accompanied by enlargement of the AoS, suggesting that structural changes may be occurring in the brain parenchyma of CCSVI-positive healthy individuals.