RESUMO - RACIONAL: A adequada fixação da tela cirúrgica determina o sucesso de uma herniorrafia. Entender a resposta inflamatória e as propriedades mecânicas da tela contribui para definir se há superioridade de um método de fixação. OBJETIVO: Avaliar a cicatrização de defeitos em parede abdominal de ratos, comparando-se o reparo das telas de polipropileno macroporosas fixadas com cola cirúrgica e fio de polipropileno. MÉTODOS: Foi produzido defeito na parede abdominal de 20 ratos Wistar com integridade do peritônio parietal. Na correção, as telas foram fixadas com cola cirúrgica 2-octil cianoacrilato (C1) ou sutura (C2). Os dois subgrupos de 10 animais foram eutanasiados no 90º dia de pós-operatório e os fragmentos da parede abdominal foram submetidos a análise macroscópica, histológica e tensiométrica. RESULTADOS: A análise macroscópica não mostrou qualquer anormalidade. A tensiometria no 90º dia de pós-operatório no subgrupo C1 demonstrou tensão média de ruptura de 28,47N e no subgrupo C2 de 32,06N (p=0,773). O escore de processo inflamatório revelou que ambos os grupos se encontram na fase subaguda (p=0,380). CONCLUSÃO: A fixação de tela macroporosa de polipropileno para reparo de defeito em parede abdominal pode ser realizada com cola cirúrgica (2-octil cianoacrilato) ou sutura de polipropileno, sendo ambos os métodos igualmente eficazes.

ABSTRACT - BACKGROUND: Proper fixation of the surgical mesh determines the success of a herniorrhaphy. Understanding the inflammatory response and the mechanical properties of the mesh helps to define whether a fixation method is superior. AIM: This study aimed to evaluate the healing of defects in the abdominal wall of rats, comparing the repair of macroporous polypropylene meshes fixed with surgical glue and polypropylene thread. METHODS: In 20 Wistar rats, a defect was produced in the abdominal wall, with the integrity of the parietal peritoneum. For correction, the meshes were fixed with surgical glue (2-octyl cyanoacrylate) (subgroup C1), or polypropylene suture (subgroup C2). The two subgroups of 10 animals were euthanized on the 90th postoperative day, and the fragments of the abdominal wall were submitted to macroscopic, histological, and tensiometric analysis. RESULTS: Macroscopic analysis did not show any abnormalities. Tensiometry on the 90th postoperative day in subgroup C1 showed mean rupture tension of 28.47N and in subgroup C2 32.06N (p=0.773). The inflammatory process score revealed that both groups are in the subacute phase (p=0.380). CONCLUSION: The fixation of a polypropylene macroporous mesh to repair an abdominal wall defect can be performed with surgical glue (2-octyl cyanoacrylate) or polypropylene suture, both methods being equally effective.

RESUMO Racional: Na definição da tela a ser utilizada na correção das hérnias deve-se considerar a porosidade, quantidade de material absorvível e polipropileno ou inabsorvível nas diversas fases da cicatrização. Objetivo: Avaliar a reação inflamatória das telas macro e microporosas de alta e baixa gramatura no reparo de defeito da parede abdominal de ratos. Método: Foram utilizados 90 ratos da raça Wistar (Rattus norvegicus albinus). Os animais foram submetidos a procedimentos cirúrgicos semelhantes, com lesão da parede abdominal ventral, mantendo a integridade do peritônio parietal e correção utilizando as telas Prolene®, Ultrapro® e Bard Soft®. Realizou-se a eutanásia aos 30, 60 e 120 dias de pós-operatório. Os segmentos da parede abdominal foram submetidos à análise histológica com H&E, tricômio de Masson, imunoistoquímica, picrosirius red e análise tensiométrica. Resultado: No 120º dia a análise tensiométrica mostrou superioridade da tela macroporosa Ultrapro®. O escore do processo inflamatório demonstrou prevalência significativa de processo subagudo no início e no final do estudo. As telas microporosas mostraram encapsulamento em bloco e as macroporosas encapsulamento predominantemente filamentar. Conclusão: A tela Ultrapro® mostrou melhor desempenho em relação às demais na cicatrização da parede abdominal.

ABSTRACT Background: In the definition of the mesh to be used to correct hernias, porosity, amount of absorbable material and polypropylene should be considered in the different stages of healing process. Aim: To evaluate the inflammatory reaction in the use of macro and microporous meshes of high and low weight in the repair of defects in the abdominal wall of rats. Methods: Ninety Wistar rats (Rattus norvegicus albinus) were used. The animals were submitted to similar surgical procedures, with lesion of the ventral abdominal wall, maintaining the integrity of the parietal peritoneum and correction using the studied meshes (Prolene®, Ultrapro® and Bard Soft®). Euthanasia was performed at 30, 60 and 120 days after surgery. The abdominal wall segments were submitted to histological analysis using H&E, Masson’s trichrome, immunohistochemistry, picrosirius red and tensiometric evaluation. Results: On the 120th day, the tensiometric analysis was superior with Ultrapro® macroporous mesh. The inflammatory process score showed a significant prevalence of subacute process at the beginning and at the end of the study. Microporous meshes showed block encapsulation and in macroporous predominance of filamentous encapsulation. Conclusion: The Ultrapro® mesh showed better performance than the others in healing process of the abdominal wall.

Abstract Cilostazol (CLZ) is a phosphodiesterase III inhibitor with antiplatelet and vasodilator properties. It has been recently verified that CLZ plays a significant role in the arteries by inhibiting the proliferation and growth of muscle cells, increasing the release of nitric oxide by the endothelium and promoting angiogenesis. Considering these promising effects, the use of nanocapsules may be an interesting strategy to optimize its pharmacokinetics and pharmacodynamics at the vascular level for preventing atherosclerosis. The aim of this study was to evaluate the effect of cilostazol-loaded nanocapsules in the abdominal aortic tunics and on the lipid profile of Wistar rats in order to investigate its potential role in the prevention of atherosclerosis. Thirty-two animals were divided into four groups of eight animals, with 30-day treatment. Group 1 received nanoencapsulated CLZ; Group 2, control nanocapsules with no drug; Group 3, propylene glycol and water; and Group 4, a solution of CLZ in propylene glycol and water. After 30 days, there was no statistically significant difference between the groups regarding the cellularity and thickness of the arterial tunics of the abdominal aorta. However, the group that received nanoencapsulated CLZ (Group 1) had an improvement in HDL-c and triglyceride values compared to unloaded nanocapsules (Group 2).

Resumo A isquemia crítica de membro inferior sem leito distal tem opções restritas para tratamento. Desviar o fluxo sanguíneo de maneira retrógrada através da circulação venosa é uma alternativa amparada em evidências de inúmeros trabalhos publicados. Comparou-se através de mapeamento dúplex a distribuição do fluxo sanguíneo arterial em membros posteriores de suínos mantidos em circulação fisiológica com o contralateral submetido à isquemia e reperfusão por circulação retrógrada. O fluxo nos membros em circulação fisiológica e retrógrada foi avaliado por mapeamento dúplex através da determinação da velocidade de pico sistólico (VPS), da velocidade diastólica final (VDF) e do índice de resistividade (IR) em artérias selecionadas. A análise comparativa das extremidades mantidas em circulação fisiológica em relação às mantidas em isquemia e reperfusão, por circulação retrógrada, mostrou nestas, ao mapeamento dúplex, que as alterações nos padrões de onda espectral e nas variáveis hemodinâmicas são indicadores satisfatórios e sugerem boa distribuição do fluxo sanguíneo vascular distal.

Abstract Treatment options for critical lower limb ischemia in the absence of the distal bed are limited. Diverting blood flow in a retrograde direction through the venous circulation is one alternative option that is supported by evidence from several published articles. Duplex scanning was used to compare the distribution of arterial flow in hind limbs of pigs maintained in physiological circulation to contralateral limbs subjected to ischemia and reperfusion by retrograde circulation. Flow in limbs with physiological and retrograde circulation was evaluated by duplex scanning with analysis of Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), and the Resistivity Index (RI) for selected arteries. This comparative analysis of extremities maintained in physiological circulation in relation to those subjected to ischemia and reperfusion by retrograde circulation showed, via duplex scanning, that changes in spectral wave patterns and hemodynamic variables are satisfactory indicators and suggest good distribution of distal blood flow.

RESUMO Racional: Dentre as várias estratégias para evitar exagerada reação de corpo estranho no tratamento das hérnias está a limitação da quantidade de polipropileno na tela ou utilização de material absorvível. Objetivo: Avaliar a cicatrização de defeito em parede abdominal de ratos, comparando-se as telas de polipropileno microporosa, polipropileno macroporosa e polipropileno/poliglecaprone. Métodos: Em 90 ratos Wistar foi produzido defeito na parede abdominal ventral, com integridade do peritônio parietal. Na correção foram utilizadas as telas Prolene®, Ultrapro® e Bard Soft®. Nove subgrupos de 10 animais foram submetidos à eutanásia no 30º, 60º e 120º dia do pós-operatório. Fragmentos da parede abdominal dos animais foram submetidos à análise tensiométrica. Resultados: A tensiometria aos 30dias mostrou maior resistência do tecido com tela Bard Soft® em relação à de Prolene®; no 60º dia a Bard Soft® manteve a resistência superior ao Prolene®; no 120º dia a reparação com tela macroporosa Ultrapro® mostrou-se mais resistentes que a de Prolene® e Bard Soft®. Conclusão: Os tecidos reparados com telas macroporosas demonstraram maior resistência do que as microporosas em todas as fases, sendo que aos 120 dias de pós-operatório a Ultrapro® teve melhor desempenho que as demais.

ABSTRACT Background: Among the various strategies to avoid exaggerated foreign body reaction in the treatment of hernias is the limitation of the amount of polypropylene or the use of absorbable material. Aim: To evaluate the healing of defects in the abdominal wall of rats, comparing microporous polypropylene, macroporous polypropylene and polypropylene/polyglecaprone at the 30º, 60º and 120º postoperative day. Methods: Wistar rats were submitted to defect production in the ventral abdominal wall, with integrity of the parietal peritoneum. Prolene®, Ultrapro® and Bard Soft® meshes were used in the correction of the defect. Nine subgroups of 10 animals were submitted to euthanasia at 30th, 60th and 120th postoperative day. Fragments of the abdominal wall of the animals were submitted to tensiometric analysis. Results: The tensiometry at the 30th postoperative day showed greater resistance of the tissues with Bard Soft® (macroporous mesh) in relation to the tissues with Prolene® (microporous mesh). On the 60th postoperative day Bard Soft® maintained the superior resistance to the tissues comparing to Prolene Mesh®. On the 120th postoperative day the tissues repaired with Ultrapro® (macroporous mesh) proved to be more resistant than the ones by Prolene® (microporous mesh) and Bard Soft® (macroporous mesh). Conclusion: The tissues repaired with macroporous meshes showed greater resistance than with microporous meshes at all stages, and at 120 days postoperative Ultrapro® performed better than the others.

Resumo Contexto Isquemia crítica de membro inferior sem leito distal tem opções restritas para tratamento. Desviar o fluxo de maneira retrógrada através da circulação venosa é alternativa amparada em evidências de inúmeros trabalhos publicados. Objetivos Comparar o comportamento de variáveis clínicas e laboratoriais em extremidades de suínos submetidas a isquemia e a isquemia com reperfusão por circulação retrógrada entre si e em relação e a um grupo controle. Métodos Dez suínos foram separados em dois grupos. No grupo 1 (n=5), controle, avaliaram-se padrões fisiológicos de variáveis como fluxo ao Doppler, temperatura, gasometria, lactato, creatinoquinase (CK) e pressão arterial. No grupo 2 (n=5), após um período médio de isquemia de 27 minutos e 30 segundos, consequente à interrupção do fluxo nas artérias femorais, os animais foram submetidos a arterialização venosa no membro posterior esquerdo e a manutenção da isquemia no direito. As variáveis foram analisadas separadamente durante momentos 0, 2, 3, 4 e 6 horas após a reperfusão para efeito de comparação entre si e com o grupo controle. Resultados A análise das variáveis mostrou, em ambos os procedimentos, queda de BE e pO2, com elevação significativa de lactato e CK em relação ao grupo controle. Nos membros isquêmicos arterializados, encontramos fluxo ao Doppler e maiores pressões arteriais e temperaturas quando comparadas ao membro em isquemia. Conclusões A análise comparativa das extremidades em isquemia e isquemia arterializada mostrou, em relação ao grupo controle, um quadro de acidose metabólica, com significativo aumento de lactato e CK, que sugerem dano celular e sinais de reperfusão retrógrada nas extremidades arterializadas.

Abstract Background There are few options for treating critical ischemia in limbs with no distal patency. Diverting flow through the venous circulation is an option supported by evidence from numerous published studies. Objectives To compare the behavior of clinical and laboratory variables between the hind limbs of pigs subjected to ischemia and to ischemia with reperfusion by retrograde circulation and between these intervention groups and a control group. Methods Ten pigs were divided into 2 groups. In group 1 (n=5), controls, patterns of physiological variables such as flow according to Doppler ultrasound, temperature, blood gas analysis results, lactate, creatine kinase, and blood pressure were evaluated. In group 2 (n=5), after an initial ischemia period with mean duration of 27 minutes and 30 seconds, provoked by interrupting flow through the femoral arteries, the animals were subjected to venous arterialization of the left hind limb while the right hind limb was maintained in ischemia. Variables were analyzed separately for each hind leg at 0, 2, 3, 4, and 6 hours after reperfusion and compared against each other and the control group. Results Analysis of variables from both procedures showed decreases in BE and PO2 and significant increases in lactate and creatine kinase, in relation to the control group. In arterialized ischemic limbs, we observed flow on Doppler ultrasound, and arterial pressures and temperatures were higher than in the ischemic limbs. Conclusions Comparative analysis of the extremities in ischemia and arterialized ischemia showed, in relation to the control group, metabolic acidosis with significant increases in lactate and creatine kinase, suggesting cellular damage, and there were signs of retrograde reperfusion in arterialized extremities.

Resumo Contexto A arterialização venosa tem sido adotada com bons resultados como estratégia para salvar membros em isquemia crítica sem leito arterial distal. No entanto, os mecanismos pelos quais a irrigação das extremidades ocorre permanecem desconhecidos. Objetivos Desenvolver um modelo experimental para testar hipóteses que podem explicar os mecanismos de nutrição em arterialização venosa. Métodos Onze porcos foram submetidos a um período de isquemia seguida de reperfusão do membro posterior, realizada por arterialização venosa, com interposição de condutos preenchidos com 10 mL (cinco animais - grupo 1) e 1 mL (seis animais - grupo 2) de tinta da China. Após a eutanásia, os membros foram amputados e submetidos a análise histológica. Resultados Na microscopia óptica, o pigmento foi encontrado no lúmen de arteríolas de seis (55%) dos 11 porcos utilizados no experimento; quatro (80%) de cinco animais eram do grupo 1 e dois (33%) de seis animais eram do grupo 2. Conclusões O modelo experimental utilizado foi capaz de testar a hipótese. A presença de tinta da China no lúmen arteriolar mostra que é possível alcançar o vaso arterial por meio de arterialização venosa.

Abstract Background Venous arterialization has been adopted as a strategy for salvage of limbs in critical ischemia without the distal arterial bed, with successful outcomes, but the mechanisms by which irrigation of the extremities takes place are still unknown. Objectives To develop an experimental model to test hypotheses that could explain the mechanisms of blood supply in venous arterialization. Methods Eleven pigs underwent a period of hind limb ischemia followed by reperfusion achieved by venous arterialization, after interposition of conduits filled with 10 ml (5 animals – group 1) or 1 ml (6 animals – group 2) of China Ink. After euthanasia, the limbs were amputated and underwent histological analysis. Results Under optical microscopy, ink staining was observed in the arteriolar lumen of six (55%) of the eleven pigs used in the experiment; four (80%) out of five from group 1 and two (33%) out of six from group 2. Conclusions The experimental model was capable of testing the hypothesis. The presence of China Ink in the arteriolar lumen shows that it is possible to supply the arterial vessels by means of venous arterialization.

INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality.OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis.METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients).RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group.CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group.

CONTEXTO: A trombose venosa profunda (TVP) é uma doença frequente e grave, tendo como complicações o tromboembolismo pulmonar (TEP) e a síndrome pós-trombótica. A importância e os benefícios de uma correta e efetiva profilaxia medicamentosa em relação à TVP estão bem documentados.OBJETIVOS: Este trabalho tem por objetivos avaliar a adequação das profilaxias de TVP e TEP na Santa Casa de Misericórdia de Ponta Grossa (SCMPG), Paraná, e estratificar o perfil de risco.MÉTODOS: Realizou-se um estudo de coorte, com a finalidade de avaliar a profilaxia da TVP nos pacientes internados no dia 15 de maio de 2009. Uma amostra de 104 pacientes foi dividida em grupos clínico e cirúrgico, e estratificada em diferentes especialidades. A correta utilização da profilaxia para TVP foi avaliada segundo recomendações da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV), considerando-se métodos profiláticos presentes nas informações explícitas encontradas na prescrição médica de cada paciente.RESULTADOS: Dos 104 pacientes entrevistados, 51 (49,04%) eram pacientes clínicos e 53 (50,96%) eram cirúrgicos. De acordo com a estratificação do risco, 17 (16,35%) foram classificados como baixo risco, 37 (35,58%) como risco moderado, 46 (44,23%) como alto risco e 4 (3,85%) como altíssimo risco para TVP e TEP. Do total de pacientes, 68 (65,38%) receberam profilaxia, sendo que, deste número, apenas 56 (53,85%) receberam uma profilaxia correta e 36 (34,62%) não receberam nenhuma profilaxia.CONCLUSÕES: As profilaxias de TVP e TEP neste serviço apresentam uma aderência superior aos índices encontrados em trabalhos publicados na literatura.

CONTEXT: Deep vein thrombosis (DVT) is a serious, common disease whose complications include pulmonary thromboembolism (PTE) and postthrombotic syndrome. The importance and benefits of correct and effective pharmacological prophylaxis for DVT are well documented.OBJECTIVES: The aims of this study were to evaluate adequacy of prophylaxis for DVT and PTE at the Santa Casa de Misericórdia de Ponta Grossa (SCMPG), Paraná, Brazil, and determine risk stratification for patients hospitalized in this institution.METHODS: A cohort study was conducted to assess DVT prophylaxis of patients hospitalized on May 15th, 2009. The study population consisted of a sample of 104 patients, subdivided into clinical and surgical groups and stratified into different specialties. Correct use of DVT prophylaxis was evaluated according to recommendations published by The Brazilian Society for Angiology and Vascular Surgery and took into account prophylactic methods specified explicitly in information found in each patient's medical chart.RESULTS: Of the 104 patients interviewed, 51 (49.04%) were clinical patients and 53 (50.96%) surgical. Based on risk stratification, 17 (16.35%) were classified as low risk, 37 (35.58%) as moderate risk, 46 (44.23%) as high risk and 4 (3.85%) as extremely high risk for DVT/PTE. A total of 68 patients (65.38%) received prophylaxis, but of these only 56 (53.85%) received the correct prophylaxis, and 36 (34.62%) did not receive any prophylaxis.CONCLUSION: The rates of prophylaxis use for DVT and PTE in this service are higher than rates published in the literature.

OBJETIVO: Avaliar a cicatrização de um defeito, na parede abdominal ventral de ratos, comparando-se as telas de polipropileno e polipropileno/poliglecaprone no 30º e 60º dia do pós-operatório. MÉTODOS: Trinta e dois ratos Wistar foram submetidos à produção de defeito na parede abdominal ventral, com integridade do peritônio parietal. Na correção foram utilizadas as telas de polipropileno (grupo A) e polipropileno/poliglecaprone (grupo B). Houve subdivisão em quatro subgrupos (A30, A60, B30 e B60) de oito animais que foram submetidos à eutanásia no 30º e 60º dia do pós-operatório. Fragmentos da parede abdominal foram submetidos à análise macroscópica, tensiométrica e histológica. RESULTADOS: A tensiometria no subgrupo A30 mostrou tensão média de ruptura de 0,78 Mpa e no subgrupo A60 de 0,66 MPa. No subgrupo B30 foi de 0,84 MPa e no B60 de 1,27 MPa. O escore do processo inflamatório mostrou fase subaguda nos subgrupos A30 e B30 e processo inflamatório crônico no subgrupo A60 e B60. CONCLUSÕES: A resistência à tensão foi maior na parede reparada pela tela de polipropileno/poliglecaprone no 60º dia pós-operatório. Na análise histológica houve maior concentração da fibrose na superfície da tela de polipropileno com tendência ao encapsulamento. Nos subgrupos polipropileno/poliglecaprone a análise histológica mostrou maior fibrose entre os filamentos da tela.

PURPOSE: To evaluate the healing process of a defect in the ventral abdominal wall of rats, comparing the polypropylene and polypropylene/poliglecaprone meshes on the 30th and 60th postoperative day. METHODS: Thirty two Wistar rats were submitted to a ventral abdominal wall defect, with integrity of the parietal peritoneum. In the repair, were used polypropylene (group A) and polypropylene/poliglecaprone (group B) meshes. The groups were subdivided into four subgroups of eight animals euthanized on the 30th (A30 and B30) and 60th postoperative day (A60 and B60). Fragments of the abdominal wall of the animals were submitted to macroscopic, tensiometric and histological evaluations. RESULTS: The tensiometry on subgroup A30 showed a mean average break point of 0.78 MPa and in A60, 0.66 Mpa. In subgroup B30 it was 0.84 MPa and in B60, 1.27 Mpa. The score of the inflammatory process showed subacute phase on A30 and B30 sub-groups and chronic inflammatory process in subgroups A30 and 60B. CONCLUSIONS: The tensile strength was higher on the wall repaired by polypropylene/poliglecaprone mesh in the 60th post-operative day. Histology showed higher concentration of fibrosis on the surface of the polypropylene mesh with a tendency to encapsulation. In polypropylene/poliglecaprone subgroups the histology showed higher concentration of fibrosis on the surface of mesh filaments.

CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO), 6 com tromboangeíte obliterante (TO) e 1 com trombose de aneurisma de artéria poplítea (TA) foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6%) mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9%) foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5%). CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.

BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO), 6 with thromboangiitis obliterans (TO) and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point onward. RESULTS: Limb salvage was achieved in 10 (55.6%) patients, 5 with AO and 5 with TO. Seven (38.9%) patients were amputated, 5 with AO, 1 with TO and 1 with Ta. One (5.5%) patient died. CONCLUSION: Arterialization of the venous system of the foot should be considered for the salvage of limbs with critical ischemia in the absence of a distal arterial bed.

Em isquemia crítica sem leito arterial distal, um dos modos de irrigar o membro isquêmico é derivar o fluxo de maneira retrógrada através do sistema venoso. As primeiras tentativas de fístulas arteriovenosas terapêuticas datam do início do século passado. Realizadas na parte proximal dos membros inferiores, não obtiveram resultados favoráveis. A partir da década de 70, com os trabalhos pioneiros de Lengua, as fístulas passaram a ser estendidas até o pé, e os bons resultados apareceram em várias publicações. Os autores relatam a evolução de um caso de tromboangeíte obliterante submetida ao procedimento. Essa é uma cirurgia de indicação precisa, que requer estudo pré-operatório arterial e venoso e observância a detalhes de técnica operatória.

In critical ischemia without arterial run-off, it is possible to irrigate the ischemic limb by turning the course of the flow reversely through the venous system. The first experiments with therapeutic arteriovenous fistulas date from the beginning of the last century. They were performed in the proximal area of the lower limbs, but showed unfavorable results. Since the 1970's, with the pioneer studies of Lengua, fistulas started being extended to the foot and several publications have reported good outcomes. The authors report the evolution of a case of thromboangiitis obliterans which was submitted to the procedure. This is an accurate surgical procedure which requires arterial and venous preoperative study and the observance of technical operative details.

OBJECTIVE: Correlate the evolution of the resistance of Staphylococcus aureus collected from healthcare workers with the local consumption of antibiotics. MATERIAN AND METHODS: Open prospective research.Study Site. General Reference Hospital with 200 beds in a 700,000 inhabitant region, in Ponta Grossa, Paraná, Brazil. RESULTS: Two collections (samples) of Staphylococcus aureus isolates were obtained from healthcare-workers during an approximate four-year interval. Samples 1 (n= 200) and 2 (n= 270) had this bacterium in 63 (32%) and 90 (33%) of the patients, respectively. At the same time, the annual consumption of antibiotics in DDD/1,000 patient-days was determined. The variation of resistance was significantly smaller (m.s.d.=12.11) for gentamycin (p<0.01) and (m.s.d.=9.22) for Tobramycin (p<0.05). The correlation between variation in resistance and antibiotic consumption was not significant. Workers studied in the two samples showed a significant (p<0.01) frequency (c²=10.44) for persistent nasal carriage and for non carriage. Methicillin resistant Staphylococcus aureus was found in 12 (6%) patients of sample 1 and 11 patients (4%) of sample 2. CONCLUSION: Stability of resistance allows us to maintain therapeutic outlines. The variation in bacterial resistance in the twice-sampled population (n=105) indicated the selection pressure of the hospital environment. The resistance that was found is representative of the hospital microbiota; this relationship represents a biological model, based on the healthcare-workers' interaction with colonizing bacteria and nosocomial infections. New studies could improve this model for other bacteria, to determine the tendency for resistance and help guide the antibiotic use.