Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

OBJECTIVES: The aim of this study was to analyze silicone tubes with an internal diameter of 4 mm as a possible material for vascular prostheses. METHODS: Grafts were implanted into the infrarenal aortas of 33 rabbits. Fluoroscopic examinations were performed within 150 days after surgical implantation. Sample grafts were analyzed via electron microscopy to evaluate the eventual endothelialization of the prostheses. RESULTS: The patency rates of the prostheses were 87% (±6.7%) after 30 days, 73% (±9.3%) after 60 days and 48% (±12%) after 120 days. The material presented characteristics that support surgical implantation: good tolerance promoted by polyester tear reinforcement, ease of postoperative removal and a lack of pseudoaneurysms. However, intimal hyperplasia was a limiting factor for the patency rate. CONCLUSIONS: We concluded that polydimethylsiloxane has limited potential as an alternative material for small vascular prostheses.

CONTEXTO: A doença arterial obstrutiva periférica (DAOP) afeta os membros inferiores (MMII) e tem como principal causa a aterosclerose. Por se tratar de uma doença sistêmica, é frequente que a aterosclerose cause o envolvimento simultâneo de outros sítios arteriais, especialmente das artérias coronárias. Desta forma, os pacientes submetidos a cirurgia de reconstrução arterial periférica, devido a isquemia crítica dos MMII, apresentam maior chance de infarto agudo do miocárdico (IAM). Apesar disso, há na literatura poucos relatos que avaliem a prevalência do IAM adequadamente neste grupo de pacientes. OBJETIVO: Avaliar incidência do infarto agudo do miocárdio no pós-operatório imediato de pacientes submetidos à revascularização de MMII devido a DAOP. MATERIAL E MÉTODOS: Foram avaliados 64 pacientes portadores de DAOP submetidos a 82 cirurgias de revascularização arterial dos MMII, no período de fevereiro de 2011 a julho de 2012. Os pacientes foram submetidos no pós-operatório imediato (até 72 horas) a eletrocardiograma (ECG) e dosagem sanguínea de troponina I cardíaca. RESULTADOS: Considerando as 82 cirurgias realizadas, em cinco (6%) casos, foram encontradas alterações no ECG e elevação sanguínea da troponina I cardíaca compatíveis com infarto agudo do miocárdio. Considerando apenas as 52 cirurgias feitas por técnica convencional, a incidência de IAM foi de 9,6%. Dois pacientes evoluíram ao óbito. CONCLUSÃO: No presente estudo, a incidência do infarto agudo do miocárdio nos pacientes submetidos à revascularização arterial de membros inferiores por DAOP foi de 6%. Considerando apenas as cirurgias feitas por técnica convencional, a incidência de IAM foi de 9,6%.

BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

OBJETIVOS: Identificar por imunoistoquímica eventuais micrometástases nos linfonodos regionais previamente considerados livres pelo exame histopatológico convencional e avaliar a influência do comprometimento destes linfonodos na sobrevivência dos doentes com carcinoma colorretal extirpado com intenção curativa. MÉTODO: Foram estudados 51 doentes portadores de carcinoma colorretal nos estádios A (13 casos) e B (38 casos), segundo a classificação de Dukes. Um total de 501 linfonodos previamente considerados livres pelo exame histopatológico convencional foi investigado por meio de técnica imunoistoquímica com anticorpos monoclonais anticitoqueratina AE1/AE3 para identificar células epiteliais. Cada bloco previamente fixado em formalina e embebido em parafina foi seccionado em três partes, obtendo-se de cada uma delas três cortes com espessura de 4 milimícron cada. RESULTADOS: Em seis doentes (11,7%) no estádio B de Dukes, células neoplásicas foram identificadas em sete linfonodos do mesocolo (1,4%) previamente considerados livres de neoplasia pelo exame histopatológico convencional. Em um enfermo, a micrometástase era representada por aglomerado celular, enquanto que nos outros cinco doentes as micrometástases eram constituídas por células isoladas. A sobrevivência dos enfermos com micrometástases linfonodais foi menor do que a dos doentes com linfonodos não comprometidos, porém sem atingir diferença significativa. CONCLUSÕES: O método imunoistoquímico pode ser empregado com sucesso na detecção de células neoplásicas em linfonodos previamente considerados livres pelo exame histopatológico convencional. O acometimento dos linfonodos regionais por micrometástases não influenciou a sobrevivência dos doentes com carcinoma colorretal extirpado.

BACKGROUND: To identify possible micrometastases by immunohistochemistry, to verify their morphological characteristics in regional lymph nodes and to evaluate their influence on the survival of patients with colorectal carcinoma that had been extirpated in a curative intent. METHOD: A study was made of 51 patients with colorectal carcinoma in stages A (13 patients) and B (38 patients), according to Dukes classification. A total of 501 lymph nodes previously considered free by conventional histopathological examination were submitted to immunohistochemical study using the technique of AE1/AE3 anticytokeratin monoclonal antibodies for the detection of neoplastic epithelial cells in their interior. Three serial sections, with three slices per section, with 4 millimicron were prepared from each slice. RESULTS: Neoplastic cells were identified in six patients (11.7%) at stage B in the Dukes classification, in seven lymph nodes of the mesocolon (1.4%) previously considered free of neoplasia by conventional histopathological examination. In one case, micrometastasis was represented by a cell agglomeration, while in the other five cases, it was made up of isolated cells. Survival of patients with extirpated colorectal cancer with lymph node metastases was less than for the group of patients with involved lymph nodes, although without presenting a significant difference. CONCLUSIONS: The immunohistochemical method may be employed for the detection of neoplastic cells in lymph nodes previously considered free by conventional histopathological examination. The presence of a micrometastasis in regional lymph nodes did not significantly influenced survival of patients who had colorectal carcinoma extirpated with curative intent.